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Biomedical subjects

M Lecomte-Houcke

Publications and source records attributed to M Lecomte-Houcke.

At least 109 records · Page 6Linked to original sources
PubMed1993

Perioperative endoscopy of the whole small bowel in Crohn's disease.

The aim of this study was to search for small bowel lesions by means of a perioperative endoscopy in 20 patients operated on for Crohn's disease. Seven women and 13 men (mean age 29 years) had a total retrograde exploration to the angle of Treitz during an ileocolectomy (16 of 20 patients) or a colonic or ileal resection (four of 20 patients). Endoscopic exploration was completed, through an enterotomy, from the surgical area to the angle of Treitz. Periendoscopic biopsy samples were taken on macroscopic lesions and every 20 cm systematically. In 13 of 20 cases, various lesions scattered over the whole small intestine were found. These were aphthoid ulcerations (10 patients), superficial ulcerations (seven patients), mucosal oedema (three patients), non-ulcerative stenosis (three patients), erythema (two patients), pseudopolyps (two patients), deep ulcerations (two patients), and ulcerative stenosis (one patient). In seven patients none of the lesions detected at perioperative endoscopy had been recognised by preoperative evaluation or surgical inspection of the serosal surface. A typical granuloma was found at biopsy of lesions identified by endoscopy in three cases and at biopsy of an apparently healthy area in one case. Thus 65% of patients operated on for Crohn's disease had lesions of the small intestine detected by endoscopy, which were unrecognised before surgery in more than half of the cases.

Adolescent↗
PubMed1993

Patellar metastasis from a large bowel adenocarcinoma.

Although bone tumors are often located in the knee area, primary tumors of the patella are rare (6, 8), and patellar metastases even rarer. A few cases were reported in the literature, originating from the breast, lung, kidney, uterine cervix and oesophagus. We report a case, for the first time to our knowledge, of a patellar metastasis from a large bowel carcinoma.

Adenocarcinoma↗
PubMed1993

[Sphenoidal aspergillosis in a seed-shop keeper].

Human infections due to Aspergillosis Fungi are unusual and occur preferentially in defenseless patients. Nonetheless, our patient, a seed-shop owner, was not immuno-depressed and became infected by inhaling or chewing the seeds. Moreover, the aspergillosis was situated in the sphenoidal sinus, which is extremely unusual. In fact, the initial pseudo tumoral and misleading appearance justified a surgical biopsy which revealed a black "truffle" suggestive of aspergillosis and was confirmed by anatomo-pathology.

Aged↗
PubMed1992

High incidence of malignant pheochromocytoma in a surgical unit. 26 cases out of 100 patients operated from 1971 to 1991.

In this surgical series of 100 pheochromocytomas (PH), where 91 cases were studied and followed up, the frequency of malignancy appears high (29%) on macroscopic criteria observed at the first operation (25 out 26 cases of malignant PH) or thanks to the occurrence of metastases (1 case out of 26 malignant PH). While some clinical signs are suggestive, there is no excretory profile predictive of malignancy. Isolated or predominant secretion of dopamine is not specific of malignancy event if it occurs more frequently and severely in malignant PH. Bilateral involvement, occurring in the setting of phacomatosis or of multiple endocrine neoplasia (MEN II), or in a sporadic case, is not a predictor for malignancy. Contrarily, extraadrenal involvement is a major feature indicative of malignancy. A CT scan which demonstrates possible locoregional invasion, and a MIGB scan revealing distant localizations raise the suspicion of malignancy. The preferred surgical approach is via a laparotomy, thus allowing the exploration of all possible abdominal chromaffin site and the search for intraabdominal metastases. Intraoperative MIBG scanning checks the completeness of the excision. Flow cytometric DNA ploidy studies have been performed in 25 of our patients. The follow up of benign or malignant PH, after excision "for cure" must be life-long: clinically, biologically and by MIGB scan. Persistence of the disease after surgery or recurrence with unresectable metastases can benefit from MIGB and chemotherapy.

3-Iodobenzylguanidine↗
PubMed1992

Multiglandular disease in seemingly sporadic primary hyperparathyroidism revisited: where are we in the early 1990s? A plea against unilateral parathyroid exploration.

BACKGROUND: Most of the available data on multiglandular disease (MGD) originate from long-term series. The spectrum of the disease has changed now because of earlier diagnosis. We decided to assess the current frequency of MGD in seemingly sporadic primary hyperparathyroidism. METHODS: MGD was defined as the finding that more than one grossly enlarged gland weighed more than 50 mg and the rim of normal parathyroid tissue was diagnostic of adenoma. Nine hundred eight consecutive neck explorations for hyperparathyroidism were performed, 624 before 1989 and 284 between 1989 and 1991, and studied retrospectively. Since 1989, oil Red O staining has been done to assess hyperfunction. RESULTS: When multiple endocrine neoplasia and non-multiple endocrine neoplasia familial cases of hyperparathyroidism are excluded, the frequency of MGD in seemingly sporadic primary hyperparathyroidism, 17.7% before 1989, is still 14% since then, including a 3% frequency of true multiple adenomas. With more restrictive criteria, which exclude the second enlarged gland if it weighed less than 100 mg, if it had no rim, and if oil Red O staining was negative, the frequency of MGD in sporadic hyperparathyroidism has remained 11% since 1989. Unilateral exploration had missed 78% of second enlarged glands, and preoperative imaging studies, when performed, showed more than one gland in only two of 22 cases. CONCLUSIONS: Routine bilateral neck exploration is recommended in primary hyperparathyroidism because of a current frequency of MGD of at least 11%.

Adenoma↗
PubMed1992

[Esophagectomy for advanced malpighian cancer of the thoracic esophagus. Esogastric anastomosis in the neck or in the thorax? Late results of a "randomized" prospective study].

During a 2 1/2 year period, 60 consecutive patients with cancer of the thoracic esophagus were randomized to undergo cervical (CA) or thoracic (TA) esophago-gastrostomy. The tumors were staged post-operatively and were almost equally distributed between the two groups. The esophageal specimens were macroscopically studied on the fresh specimens with vital staining, then microscopically. The prevalence of peri-tumoral mucosal and sub-mucosal lesions was confirmed. Microscopic malignant invasions of esophageal sections were more frequent in TA (10) than in CA (3). Resected positive lymph nodes were more numerous in CA (17) than in TA (7). The mortality was identical in the two groups. Respiratory complications and recurrent laryngeal nerve trauma were more frequent in CA. Long-term survivors had N0 disease with a healthy esophageal section. Even though subtotal esophagectomy reduces the prevalence of microscopic esophageal wall invasion at the upper section level and allows more complete unilateral exploration and resection of invaded lymph nodes, it offers no significant benefit concerning survival of patients with advanced cancer and malignant lymphadenopathy, after resection with post-operative radiotherapy.

Adult↗
PubMed1992

[Can pheochromocytoma be considered a benign unilateral intra-adrenal sporadic hypertensive tumor ? Reflections on a series of 105 surgically treated subdiaphragmatic chromaffin tumors].

In a 20 year period, from 1971 through 1991, 105 chromaffin tumours--excluding cervical ones--were operated by the same surgeon: 50 during the first 15 years and 55 during the last 5 years. Pheochromocytomas are defined as intra-adrenal chromaffin tumours, and paragangliomas--or ectopic pheochromocytomas--as of extra-adrenal location. Among those tumours, 30 were malignant (i.e. metastatic) and 75 benign. Among the 30 malignant tumours, 14 were ectopic, 2 occurred in a MEN II A setting and were bilateral, 2 were associated with liver adenoma and liver hemangioma respectively suggesting Von Hippel-Lindau syndrome, and one case was associated with a seemingly sporadic primary hyperparathyroidism. 9 out of those 30 malignancies were not associated with hypertension. Among 75 benign pheochromocytomas or paragangliomas, 10 were ectopic, 7 occurred in a MEN setting (6 type II, 1 type I). 3 patients without evidence of MEN or other neuroectodermal abnormalities presented bilateral pheochromocytoma, either synchronous (2) or metachronous (1). 7 cases occurred in a Von Hippel-Lindau syndrome (3 bilateral) and 4 in a neurofibromatosis setting (1 bilateral). 3 other cases were familial without evidence of MEN (including a case of triple tumour: bilateral and ectopic and another ectopic case). 2 other cases were associated with seemingly sporadic hyperparathyroidism. As a whole, in 34 of 75 benign pheochromocytomas or paragangliomas, the tumour was not intra-adrenal, unilateral and sporadic. Among those 75 tumours, 22 were not overtly hypertensive, including 10 out of the 41 seemingly intra-adrenal, solitary and sporadic. The pheochromocytoma, benign, intra-adrenal sporadic, hypertensive accounts for no more than 30% of the subphrenic catecholamine-secretin chromaffin tumours.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenal Gland Neoplasms↗
PubMed1992

Resection for advanced cancer of the thoracic esophagus: cervical or thoracic anastomosis? Late results of a prospective randomized study.

During a 2 1/2-year period, 60 consecutive patients with cancer of the thoracic esophagus were randomized to undergo a cervical or thoracic anastomosis. The tumors were staged postoperatively (stage I, n = 2; stage II, n = 19; stage III, n = 9; and stage IV, n = 30) and were almost equally distributed between the two groups. The upper limit of three tumors was above the convexity of the aortic arch. The esophageal specimens were studied with regard to measurements of the tumor and of the resected esophagus. The microscopic aspects were evaluated by serial sections after vital staining. The prevalence of ignored plurifocal cancers, of submucosal infiltrations, and of distant areas of dysplasia in both groups was confirmed. Malignant invasions of esophageal sections were more frequent in patients undergoing thoracic anastomosis (10 versus 3), and diseased upper mediastinal lymph nodes were more frequent in those undergoing cervical anastomosis (17 versus 7). Mortality was equally divided between the two groups. Respiratory complications and recurrent laryngeal trauma were more frequent in patients having cervical anastomosis. Long-term survivors had stage N0 disease, with a healthy esophageal section. Even though subtotal esophagectomy reduces the prevalence of microscopic esophageal wall invasion above the tumor and allows more complete unilateral exploration and resection of invaded lymph nodes, it offers no significant benefit concerning survival of patients with advanced cancer and malignant lymphadenopathy.

Adult↗
PubMed1992

[Primary malignant teratoma of the thyroid. Two cases involving immunohistochemical and ultrastructural studies].

Two cases of primary malignant teratoma of the thyroid are reported. The first case, which occurred in a 21-year-old female, was mostly composed of tumoral neural tissue and foci of foetal cartilage. The patient died with lung metastases within 5 months after the first symptoms. The second case, which occurred is a 8-year-old infant female, had epithelial and mesenchymal components without neural tissue. This case had a better prognosis with survival of four years after initial diagnosis. The different tumoral components were identified by a thorough histopathological examination of the thyroidectomy with immunological and ultrastructural studies. As for other teratomas, presence of immature neural tissue bore a poor prognosis. The clinical, histopathological features and the histogenesis of this rare tumour are described and literature is reviewed.

Adult↗
PubMed1991

[Liposarcoma of the infratemporal fossa. Apropos of a case].

The authors report about one female patient with a liposarcoma of the right infratemporal fossa. Such tumors are rare, making up 10 to 12% of all soft-tissue sarcomas. Their occurrence in a cervical site is rare, unlike that in the inguinal region, the retroperitoneum or the lower limbs. Their diagnosis is mainly established by the histopathological study. Computed tomography and magnetic resonance imaging are particularly useful to choose the surgical approach. The technique chosen for this infratemporal tumor was a transmandibular cervical approach. Evolution was favorable, and the patient has currently had no reoccurrence after two years.

Adult↗
PubMed1991

[Papillary--cystic tumor of the pancreas. Apropos of 1 case with histological, immunohistochemistry and ultrastructural study].

The authors report the clinical and histological features of a case of papillary and cystic tumour of the pancreas in a 34 year old man. The solid and papillary tumour architecture associated with pseudocystic areas and a richly vascular stroma gave this tumour an original histological appearance. The study of the immunochemical and ultrastructural features of the tumour cells suggested an acinar differentiation.

Adult↗