PubMed Health⌕ Search

Biomedical subjects

L de Calan

Publications and source records attributed to L de Calan.

At least 19 recordsLinked to original sources
PubMed1999

Cystadenomas and cystadenocarcinomas of the pancreas: a multiinstitutional retrospective study of 398 cases. French Surgical Association.

OBJECTIVE: To review the features of patients with benign and malignant cystadenomas of the pancreas, focusing on preoperative diagnostic accuracy and long-term outcome, especially for nonoperated serous cystadenomas and resected cystadenocarcinomas. SUMMARY BACKGROUND DATA: Serous cystadenomas (SCAs) are benign tumors. Mucinous cystic neoplasms should be resected because of the risk of malignant progression. A correct preoperative diagnosis of tumor type is based on morphologic criteria. Despite the high quality of recent imaging procedures, the diagnosis frequently remains uncertain. Invasive investigations such as endosonography and diagnostic aspiration of cystic fluid may be helpful, but their assessment is limited to small series. The management of typical SCA may require resection or observation. Survival after pancreatic resection seems better for cystadenocarcinomas (MCACs) than for ductal adenocarcinomas of the pancreas. METHODS: Three hundred ninety-eight cases of cystadenomas of the pancreas were collected between 1984 and 1996 in 73 institutions of the French Surgical Association. Clinical presentation, radiologic evaluation, and surgical procedures were analyzed for 144 operated SCAs, 150 mucinous cystadenomas (MCAs), and 78 MCACs. The outcome of 372 operated patients and 26 nonoperated patients with SCA was analyzed. RESULTS: Cystadenomas represented 76% of all primary pancreatic cystic tumors (398/522). An asymptomatic tumor was discovered in 32% of patients with SCA, 26% of those with MCA, and 13% of those with MCAC. The tumor was located in the head or uncinate process of the pancreas in 38% of those with SCA, 27% of those with MCA, and 49% of those with MCAC. A communication between the cyst and pancreatic duct was discovered in 0.6% of those with SCA, 6% of those with MCA, and 10% of those with MCAC. The main investigations were ultrasonography and computed tomography (94% for SCA, MCA, and MCAC), endosonography (34%, 28%, and 22% for SCA, MCA, and MCAC respectively), endoscopic retrograde cholangiopancreatography (16%, 14%, 22%), and cyst fluid analysis (22%, 31%, 35%). An accurate preoperative diagnosis of tumor type was proposed for 20% of those with SCA (144 cases), 30% of those with MCA, and 29% of those with MCAC. An atypical unilocular macrocyst was observed in 10% of SCA cases. The most common misdiagnosis for mucinous cystic tumors was pseudocyst (9% of MCAs, 15% of MCACs). Intraoperative frozen sections (126 cases) allowed a diagnosis according to definitive histologic examination in 50% of those with SCA and MCA and 62% of those with MCAC. For management, 93% of patients underwent surgery. Nonoperated patients (7%) had exclusively typical SCA. A complete cyst excision was performed in 94% of benign cystadenomas, with an operative mortality rate of 2% for SCA and 1.4% for MCA. Resection was possible in 74% of cases of MCAC. Mean follow-up of 26 patients with nonresected SCAs was 38 months, and no patients required surgery. For resected MCACs, the actuarial 5-year survival rate was 63%. CONCLUSIONS: Spiral computed tomography is the examination of choice for a correct prediction of tumor type. Endosonography may be useful to detect the morphologic criteria of small tumors. Diagnostic aspiration of the cyst allows differentiation of the macrocystic form of SCA (10% of cases) and the unilocular type of mucinous cystic neoplasm from a pseudocyst. Surgical resection should be performed for symptomatic SCAs, all mucinous cystic neoplasms, and cystic tumors that are not clearly defined. Conservative management is wholly justified for a well-documented SCA with no symptoms. An extensive resection is warranted for MCAC because the 5-year survival rate may exceed 60%.

Adolescent↗
PubMed1999

[Right adrenal recurrence of pheochromocytoma discovered 24 years after ablation of two ectopic pheochromocytomas].

The classical localisation of chromaffin cell tumours is intra-adrenal. Ectopic or multiple tumours are not rare and are commonly observed in children. The authors report a case of ectopic pheochromocytoma with a double localisation in a 14 year old child (renal pedicle and right retropleural space), in which surgical ablation resulted in an immediate and sustained correction of the hypertension. Hypertension recurred 24 years later and a classical right adrenal pheochromocytoma was demonstrated by methyl-iodo-benzylguanidine (M.I.B.G.) scintigraphy and abdominal CT scan. Right adrenalectomy resulted in normalisation of the hypertension once again without antihypertensive therapy with a follow-up of three years. Regular follow-up is necessary after ablation of a pheochromocytoma, especially in children, even in the absence of a phacomatosis or multiple endocrine neoplastic syndromes.

Adolescent↗
PubMed1998

[Are pancreatic cystadenocarcinomas degenerated mucinous cystadenomas? French Association of Surgery].

OBJECTIVES OF THE STUDY: To define arguments in agreement or disagreement with the generally accepted theory of transformation from benign mucinous cystadenoma (MC) to malignant cystadenocarcinoma (CC) of the pancreas. METHODS: A review of the literature since 1978 was conducted together with a comparative analysis of a multicentre retrospective study of the different mucinous cystic tumours of the pancreas: 150 MC, 79 CC and 55 intraductal papillary mucinous tumours of the pancrease (TIPMP). Multiple epidemiological and clinicopathological data were compared between MC and CC: mean age at diagnosis, sex distribution, association with diabetes or concurrent cancer, tumour location and size, type of pancreatic main duct communication, pancreatic fibrosis and serum CA 19-9 levels. The analysis concerned also histopathological features of resected cystadenocarcinomas (n = 58). RESULTS: Two features suggested malignant transformation of mucinous cystadenomas: older mean age at diagnosis of CC and histological characteristics revealing areas of benign-appearing epithelium associated with areas of invasive carcinoma in 55% of cases. Conversely, two statistically significant discordant features were observed: a higher proportion of men (40% for CC vs 13% for MC) and a more frequent location in the head of the pancreas (49% vs 27%). The other differences were not in contradiction with the malignant transformation of MC: associated diabetes mellitus, increasing serum CA 19-9 levels and chromosomal aberrations were more frequent in CC. TIPMP were predominant in men (67%), and more common in the head of the pancreas (67%). CONCLUSION: The risk of malignant transformation of MC should not be questioned despite sex distribution and location differences between MC and CC. These differences may be due to inaccurate designation of intraductal mucinous carcinomas as communicating CC or of CC as pancreatic mucinous adenocarcinomas.

Aged↗
PubMed1998

[Myotomy for esophageal muscular hypertrophy with eosinophil infiltration of the esophagus associated with toxocariasis revealed by esophageal motor disorder].

We report the case of a 61-year-old-man with an eosinophilic esophagitis with esophageal motor disorder associated with toxocariasis. He complained of non cardiac chest pain and had eosinophilia leading to the detection of Toxocara canis infection. Pain persisted despite treatment of toxocariasis. Basal manometry was normal but ambulatory 24-hour manometry-pHmetry showed diffuse esophageal spasm. Ultrasonography showed a thickening of the esophageal musculature in the two inferior thirds of the esophagus. After failure of treatment with sodium cromoglycate steroids and esophageal dilatation, calcium antagonists were partially effective. A long esophageal myotomy was performed permiting the disappearance of symptoms. The histological examination of a side myotomy biopsy showed an eosinophilic infiltration of the esophageal muscle layer. This observation leads to discuss the possible relation between toxocariasis, the esophageal motor disorder and the eosinophilic infiltration of the esophageal muscle layer.

Eosinophilia↗
PubMed1998

[Therapeutic choices for cancer of the rectum: discussion and update of the consensus conference].

Three years after the consensus conference on the therapeutic options for rectal cancer, a recent literature review gave us some decision elements. Quality of the surgical resection appears to be the most important therapeutic factor in the prognosis of rectal cancer. Total mesorectal excision was followed by a significant decrease of locoregional recurrence rate for the tumor of the two lower thirds of rectum. In this way, it has been shown that pelvic nerves can be easily preserved. Which nerves are important for a good postoperative sexual activity remains however debated. Furthermore, whether the nerve sparing techniques influence the prognosis is also a matter of controversy. On the other hand, abdominoperineal resection is still indicated in most lower tumors to prevent local recurrences. Preoperative radiation therapy appears more effective than the postoperative one to decrease postoperative local recurrence rate after B2 (Astler-Coller) or T3 (TNM) tumors. At present, only one study showed that preoperative radiation therapy improved five-year survival. Combination of radiotherapy and chemotherapy improves also five-year survival, but this option leads to high toxicity. Thus the best adjuvent treatment remains to be defined. Awaiting for this, the good quality of surgical resection is mandatory.

Combined Modality Therapy↗
PubMed1997

Preoperative radiotherapy (RT) for rectal cancer: predictive factors of tumor downstaging and residual tumor cell density (RTCD): prognostic implications.

PURPOSE: To determine predictive factors and prognostic value of tumor downstaging and tumor sterilization after preoperative RT for rectal cancer. METHODS AND MATERIALS: Between 1977 and 1994, 167 patients with a histologically proven adenocarcinoma (70 T2, 65 T3, 29 T4, and 3 local recurrences) underwent preoperative RT. Median dose was 44 Gy (5-73 Gy). Surgery was performed in a mean time of 5 weeks after RT. Pathologic specimens have been reviewed by the same pathologist in order to specify the modified Astler Coller classification (MAC), and to quantify the residual tumor cell density (RTCD). RESULTS: According to the MAC, there was 9 stage 0 (5%), 10 stage A (6%), 103 stage B1-B3 (62%), and 45 stage C1-C3 (27%) tumors. Seventeen percent and 56% of the patients who received a dose > or = 44 Gy had respectively a 0-A and a B tumor, compared to 4 and 69% in those who received a dose < 44 Gy (p = 0.04). Tumor differentiation and a longer interval before surgery were significantly associated with a more frequent downstaging, and preoperative staging correlated well to the postoperative pathological findings. According to the RTCD, 62 tumors (37%) showed no or only rare foci of residual tumor cells (Group 1); 62 (37%) showed an intermediate RTCD (Group 2); and 43 (26%) a high RTCD (Group 3). No predictive factor of RTCD was statistically significant. In univariate analysis, postoperative staging was a significant prognostic factor, with corresponding 5-year overall survival rates in 0-A, B, and C stages of 92, 67, and 26% (p < 0.01). RTCD was not a prognostic factor. However, overall and disease-free survival rates for patients with complete pathologic response of 83% at 2 and 5 years suggested a better outcome in this subgroup of patients. CONCLUSION: The favorable influence of higher doses of preoperative RT on pathologic stage has been observed. Tumor differentiation, preoperative classification and time before surgery were the other predictive factors of tumor downstaging. However, there was no predictive factor of complete pathologic response. Even after preoperative RT, postoperative staging remained a prognostic factor.

Adenocarcinoma↗
PubMed1997

[Effect radiotherapy on postoperative staging and residual tumor cell density in rectal cancers].

PURPOSE: To determine predictive factors and prognostic value of tumor downstaging and sterilization after preoperative radiotherapy for rectal cancer. PATIENTS AND METHODS: Between 1977 and 1994, 167 patients with a histologically proven adenocarcinoma underwent preoperative radiotherapy (median dose, 44 Gy; mean time before surgery, 5 weeks). Pathologic specimens were reviewed by the same pathologist in order to specify the modified Astler Coller classification (MAC) and to quantify residual tumor cell density (RTCD). RESULTS: According to the MAC, there were nine stage 0 (5%), 10 stage A (6%), 103 stage B1-B3 (62%) and 45 stage C1-C3 (27%) tumors. Seventeen per cent and 56% of the patients who received a dose > or = 44 Gy presented with stage 0-A and stage B1-B3 tumors, respectively, compared to 4 and 69% of those who received a dose < 44 Gy (P = 0.04). Tumor differentiation and a longer interval before surgery were significantly associated with more frequent downstaging. According to the RTCD, 62 tumors (37%) showed no or only rare foci of residual tumor cells; 62 (37%) showed an intermediate RTCD and 43 (26%) a high RTCD. No predictive factor of RTCD was statistically significant. Only post-operative staging was a significant prognostic factor (P < 0.01). CONCLUSION: The favourable influence of higher doses of preoperative radiotherapy on pathologic stage has been observed. Tumor differentiation and time before surgery were the other significant predictive factors of tumor downstaging. Even after preoperative radiotherapy, post-operative staging retained its prognostic value.

Adenocarcinoma↗
PubMed1997

Frequency and risk factors of recurrent pain during refeeding in patients with acute pancreatitis: a multivariate multicentre prospective study of 116 patients.

BACKGROUND/AIMS: The period of refeeding in patients with acute pancreatitis is critical because they may have pain relapse. A multicentre, multidimensional, prospective study was performed to assess the frequency and the risk factors of pain relapse in these patients. METHODS: Patients were included if they had acute pancreatitis severe enough to stop oral feeding for more than 48 hours. Clinical, biochemical, radiological, and therapeutic data were prospectively recorded and analysed by unidimensional and multidimensional analysis. The moment to refeed patients was chosen by the clinician but the diet was the same in all centres. RESULTS: A total of 116 patients were included with a Ranson's bioclinical score > or = 3 in 35% and a Balthazar's CT score > or = D in 42%. The cause of acute pancreatitis was biliary in 47% and alcohol misuse in 31%. During the oral refeeding period, 21% of the patients had pain relapse. This occurred on days 1 and 2 in 50% of patients. The duration of the painful period was longer in patients who relapsed than in others (p < 0.002). Pain relapse occurred in 39% of patients with a serum lipase concentration > 3x the upper limit of the normal range the day before refeeding and in 16% of other patients (p < 0.03). Patients with higher Balthazar's CT scores had pain relapse more often than the others (p < 0.002). None of the therapeutic procedures significantly modified the frequency of pain relapse. Using multidimensional analysis, Balathazar's CT score, period of pain, and serum lipase concentration the day before refeeding were independently associated with an increased risk of pain relapse. At a threshold of 0.5, a logistic score had a 37% sensitivity, 95% specificity, and 83% accuracy to predict pain relapse. Pain relapse nearly doubled total hospital stay and hospital stay after the first attempt at oral refeeding. CONCLUSION: Pain relapse occurred in one fifth of the patients with acute pancreatitis during oral refeeding and was more common in patients with necrotic pancreatitis and with longer periods of pain. The results of this study can be used to predict high risk patients and are a first step in the prevention of pain relapse.

Acute Disease↗
PubMed1995

Pancreatic cystadenoma and cystadenocarcinoma: diagnostic value of preoperative morphological investigations.

OBJECTIVE: To find out whether preoperative morphological investigations differentiated between serous cystadenoma, mucinous cystadenoma, and cystadenocarcinoma of the pancreas. DESIGN: Multicentre retrospective study of casenotes. SETTING: 24 Adult gastroenterology units (1 private, 8 non-university teaching hospitals, and 15 university teaching hospitals) in France. SUBJECTS: 71 Patients with 74 tumours diagnosed between January 1978 and January 1988. MAIN OUTCOME MEASURES: Correlation between histological diagnosis and results of ultrasonography, computed tomography, angiography, and magnetic resonance imaging. RESULTS: 6 of 59 ultrasound scans (10%), 7 of 52 computed tomograms (13%), 0 of 18 angiograms, 1 of 12 pancreatograms (8%), and the single magnetic resonance scan correctly diagnosed the type of pancreatic tumour. Ultrasonography or computed tomography, or both, diagnosed cystadenoma (but not the type) in 26 cases (37%). "Pseudocyst" was diagnosed in 14 cases (20%). CONCLUSIONS: In contrast to other studies, our results indicate that preoperative morphological investigations are of limited value in diagnosing cystadenomas of the pancreas. In particular, their ability to differentiate between different types of cystadenoma is poor.

Adult↗
PubMed1992

[Scintigraphic detection of gastrointestinal hemorrhage. Value and limitations].

A technetium-99m labelled red blood cell scintigraphy was performed in 51 patients with an unexplained gastro intestinal bleeding. Static images were acquired on the injection day then at 24 hours. Forty one patients had a positive scintigraphy. In 13 patients with a positive scintigraphy, on the injection day (5 cases) and later (8 cases), no intestinal bleeding was identified in spite of further investigations guided by scintigraphy. In 24 patients, with a positive scintigraphy on the injection day (20 cases) and later (4 cases), an intestinal lesion was identified and treated; data were confirmed in 19 cases: there were 15 colon lesions, localized on caecum in 10 cases and 4 small bowel lesions. Clinical value and limitations of the investigation are discussed. The scintigraphic localization is usually accurate if the abnormal focus activity is noticed on the injection day. It helps to guide further investigations of the bleeding site. This non invasive method should be performed more quickly to help to localize intestinal bleeding which poses a diagnostic problem.

Adolescent↗
PubMed1990

Surgery for carcinoma of the colon in people aged 75 years and older.

From January 1976 to June 1986, 154 patients (75 men and 79 women) who were 75 years of age or older were admitted for the surgical treatment of a colonic cancer. The mean age was 80.7 years. Patients were divided into two groups: 66 patients, between 75 and 80 years of age, were in Group I; 88 patients, 80 years of age and older, were in Group II. One hundred and forty-three patients (93%) were operated on and a resection was carried out in 125 patients (87%). The overall post-operative mortality rate was 12% (Group I: 5%; Group II: 17%; p less than 0.02). The actuarial survival rate of patients operated on was 32 +/- 8% at 3 years and 26 +/- 8% at 5 years (Group I: 37%; Group II: 17%). In both groups the survival rate was closely related to the extent of the disease according to Dukes classification. These results suggest that in the 75-80 year group age alone should no longer be considered a major risk factor for immediate surgical outcome. In patients aged 80 and older, the results are worse but it is not advanced age per se which influences mortality, rather the physiologic status of the patient.

Aged↗
PubMed1988

Surgical treatment of Graves' disease.

Seven men and 81 women were operated on for Graves' disease. Their median age was 33 years. Eleven patients underwent a bilateral subtotal lobectomy; 77 patients underwent a complete lobectomy with contralateral partial lobectomy. Forty-seven patients were treated before 1981. In these patients, the weight of the thyroid remnant was estimated empirically between 5 and 12 g. In the 41 patients treated since 1981, the remnant weight was estimated at 5 g by comparative weighing. There were no postoperative deaths. Functional results were established in 83 patients with an average follow-up of 50 months (range 12 to 156 months), with control of vocal cord mobility demonstrated by indirect laryngoscopy in 66 patients. Hormonal determinations were carried out in 74 patients. There were no cases of permanent hypoparathyroidism. Three patients (4.5 percent) had unilateral vocal cord dysfunction. Twelve patients (14.5 percent) had clinical and biologic hypothyroidism, which occurred within 1 year postoperatively in 11 cases. Seven patients (8.3 percent) had latent hypothyroidism only discovered by hormonal determinations. Fifteen patients (17.8 percent) had recurrent hyperthyroidism, 6 of whom were diagnosed by hormonal determinations. The actuarial recurrence rate increased progressively up to the sixth postoperative year. The only predictive factor for recurrence was the type of operation. Patients who underwent a bilateral subtotal lobectomy had more recurrences than patients who underwent a complete lobectomy with partial contralateral lobectomy (p less than 0.01). These results suggest that patients should be followed closely for many years and should undergo hormonal determinations regularly, as some recurrences can occur 5 years or more after operation with very few symptoms.

Adolescent↗
PubMed1988

Carcinoma of the cardia and proximal third of the stomach. Results of surgical treatment in 91 consecutive patients.

In the present retrospective study, 79 percent of the patients were men with a median age of 65.5 years. Of 91 patients, 84 were surgically explored. Excision of the tumor was carried out in 57 patients (63 percent) and was curative in 28 cases and palliative in 29 cases. Curative resection included proximal gastrectomy in 5 patients and total gastrectomy in 23 patients, which was extended to the spleen and distal pancreas in 18 patients. Lymph node metastases were found in 67 percent of the patients treated by resection. According to the TNM classification, 18 percent of the patients undergoing resection had stage I tumor, 28 percent had stage II tumor, 40 percent had stage III tumor, and 14 percent had stage IV tumor. The postoperative mortality rate was 16 percent for the entire series, 21 percent for patients undergoing palliative resection, and only 4 percent for patients undergoing curative resection. Three patients had an obvious anastomotic leak, one of whom died. Median survival time was 5 months for patients who had exploration only, 6 months for patients who had palliative resection, and 36 months for patients who had potentially curative resection. The 5 year actuarial survival rate was 20 percent for patients having resection and 40 percent for patients having curative resection. Survival was closely related to tumor stage. These results indicate that total gastrectomy with complete abdominal lymph node dissection can give comparatively good long-term results when performed for cure. Nevertheless, only one of three patients in this series could have a potentially curative resection. The only way to increase the curative resection rate and to improve survival is to detect the cancer at an early stage.

Adult↗