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M Pocard

Publications and source records attributed to M Pocard.

At least 37 records · Page 2Linked to original sources
PubMed2002

[Massive rectal bleeding after appendectomy: report of 2 further cases and review of the literature].

Massive rectal bleeding complicating appendectomy is extremely rare. This study describes two cases of severe gastrointestinal haemorrhage from an appendiceal stump, occurring one and seven days after appendectomy respectively. The two cases were successfully treated by emergency cecal resection. We reviewed the other previously reported etiologies of massive rectal bleeding after appendectomy for appendicitis.

Adult↗
PubMed2001

Single alteration of p53 or E-cadherin genes can alter the surgical resection benefit in an experimental model of colon cancer.

PURPOSE: p53 and E-cadherin mutations are associated with a high risk of metastatic potential and local recurrence after colorectal surgery. LoVo, a human colon cancer cell line expressing a wild-type p53 and a normal E-cadherin, was studied. Clone LoVo-XC17 was obtained from LoVo cells transfected with a vector bearing a p53 273his mutation. Clone LoVo-92R4 was obtained from LoVo by culture cells with an E-cadherin down-regulation. LoVo, LoVo-XC17, and LoVo-92R4 were studied for in vivo behavior in a surgical intracolonic graft model. METHODS: Ten nude mice were used per cell line. A colonic tumor was obtained by tumor implantation into the cecal wall. The cecal tumor was resected at Day 15; at this time the volumes of the different tumors were similar. RESULTS: Surgical resection of the LoVo tumor led to 100 percent disease-free animals at one month. Surgical resection of mice grafted with the LoVo-XC17 line did not cure any mice (0/10; P = 0.001). Mice had local recurrences (10/10), mesenteric lymph node metastases (9/10), liver metastases (2/10), and peritoneal carcinomatosis (8/10). Surgical resection of LoVo-92R4 tumors led to cures in 30 percent (3/10), whereas 70 percent had isolated mesenteric lymph node metastases (7/10; P = 0.003). CONCLUSION: In this model surgical tumor resection was consistently effective for colonic tumors with functional p53 and E-cadherin, it was consistently ineffective with tumors displaying a mutated p53, and it was partially effective with E-cadherin-deficient tumors. This study shows that the alteration of a single gene can be associated with a profound alteration of surgical resection benefit.

Adenocarcinoma↗
PubMed2001

Long-term results of ileal pouch-anal anastomosis for colorectal Crohn's disease.

INTRODUCTION: The aim of this study is to report ten-year results of ileal pouch-anal anastomosis in selected patients with colorectal Crohn's disease for whom coloproctectomy and definitive end ileostomy was the only alternative. METHODS: 41 patients (22 females/19 males) with a mean age of 36 +/- 13 (range, 16-72) years underwent ileal pouch-anal anastomosis for colorectal Crohn's disease between 1985 to 1998. None had past or present history of anal manifestations or evidence of small-bowel involvement. Diagnosis of Crohn's disease was established preoperatively in 26 patients, on the resected specimen after ileal pouch-anal anastomosis, or after occurrence of Crohn's disease-related complication in 15 patients. RESULTS: Follow-up was 113 +/- 37 months, (18-174) 20 patients having been followed for more than 10 years. There was no postoperative death. Eleven (27 percent) patients experienced Crohn's disease-related complications, 47 +/- 34 months (8-101) after ileal pouch-anal anastomosis: 2 had persistent anal ulcerations with pouchitis and granulomas on pouch biopsy and were treated medically; 2 experienced extrasphincteric abscesses and 7 presented pouch-perineal fistulas which were treated surgically. Among them, 3 patients with persistent perineal fistula despite surgery required definitive end-ileostomy. Of the 20 patients followed for more than 10 years, 7 (35 percent) experienced Crohn's disease-related complications which required pouch excision in 2 (10 percent). CONCLUSIONS: Ten years after ileal pouch-anal anastomosis for colorectal Crohn's disease, rates of Crohn's disease-related complications and pouch excision were 35 and 10 percent, respectively. These good long-term results justify for us to propose ileal pouch-anal anastomosis in selected patients with colorectal Crohn's disease (i.e., no past or present history of anal manifestations and no evidence of small-bowel involvement) for whom the only alternative is definitive end ileostomy.

Adolescent↗
PubMed2001

Handsewn ileal pouch-anal anastomosis on the dentate line after total proctectomy: technique to avoid incomplete mucosectomy and the need for long-term follow-up of the anal transition zone.

PURPOSE: During ileal pouch-anal anastomosis, both conservation of the anal transitional zone during the stapled technique and incomplete mucosectomy in the standard Park's procedure may expose the patient to disease recurrence. We propose here an technique whose aim is to solve both problems by performing handsewn ileal pouch-anal anastomosis on the dentate line after rectal eversion and total proctectomy. METHODS: We reviewed the records of 172 consecutive patients who had undergone ileal pouch-anal anastomosis since 1984 for chronic ulcerative colitis (n = 80), familial adenomatous polyposis (n = 48), selected cases of Crohn's disease (n = 42), or other causes (n = 2). RESULTS: One patient (0.5 percent) died postoperatively. Operative morbidity was similar to that reported after the Park's and stapled procedures. Of our 128 patients with a five-year follow-up, anastomotic stricture occurred in 15 (12 percent), and 4 patients (3 percent) had to have pouch removal. Stool frequency per 24 hours was 4.8 +/- 1.6 (range, 1-11), continence was perfect in 104 patients (81 percent), and sexual activity was estimated to be unchanged in 120 (94 percent). No evidence of disease recurrence was noted in the patients with familial adenomatous polyposis or ulcerative colitis. CONCLUSIONS: During ileal pouch-anal anastomosis, Park's procedure carries the risk of incomplete mucosectomy and disease recurrence, and the stapled procedure requires a long-term follow-up of the anal transitional zone. Our alternative technique with total proctectomy avoids both problems and gives similar long-term functional results.

Adenomatous Polyposis Coli↗
PubMed2001

[Intensive care after digestive surgery: the outcome in elderly patients].

STUDY AIM: In surgical intensive care, the results must be analyzed both in terms of mortality and quality of life; this is particularly important in elderly patients for whom recovery remains uncertain. The aim of this prospective study was to assess the early and late prognosis in elderly patients (aged over 75 years) admitted to a digestive surgical intensive care unit (DSICU) for mortality, quality of life, patient autonomy, and also the predictive factors involved. PATIENTS AND METHODS: Over a one-year period, 182 patients were admitted to a tertiary referral DSICU; 30 of these subjects were over 75 years old, and formed the basis of this study. The following data were analyzed: hospital mortality rate; mortality rate at six months, and quality of life at six months (Kamofsky scale). These factors were correlated with the severity of the patient's state at admission and also with the causal disease, circumstances connected with admission, and duration of stay in the DSICU. RESULTS: The hospital mortality rate of patients was 23% (7/30 patients), and the overall mortality rate at six months was 40% (12/30 patients). Of the 12 patients who stayed in the DSICU for more than ten days with a simplified acute physiology score (APS) = 10, not one was alive at six months post-DSICU admission. The 18 remaining patients were still alive at six months, and 72% of them (13/18 patients) had regained their previous post-operative autonomy. CONCLUSION: These results provide reference data for this patient category. The results concerning long-term survival and the good functional outcome are encouraging. If the prognostic criteria defined in this investigation are confirmed by further studies, they may help in making the sometimes difficult decisions regarding elderly patients hospitalized in a DSICU.

Age Factors↗
PubMed2001

[Hepatic resection for breast cancer metastases: results and prognosis (65 cases)].

STUDY AIM: To report results of liver resections for breast cancer liver metastasis (BCLM) and to evaluate the rate of survival and the prognostic factors. PATIENTS AND METHOD: Between 1988 and 1999, 69 patients were operated on for BCLM and 65 who had liver resection were analyzed. The selection criteria for surgery were: normal performance status and liver function test; radiological objective response to chemotherapy (and/or hormonotherapy); in cases of non-isolated BCLM, complete response of associated metastatic site (usually bone) and no brain metastases. The mean age of the 65 patients was 47 (30-70) years. BCLM was diagnosed an average of 60 (0-205) months after the initial cancer. The BCLM was more frequently solitary (n = 44). The mean diameter was 3.8 (0-12) cm. The mean number of cycles of chemotherapy before surgery was 7.5 (3-24). Liver resections included major hepatectomy (n = 31): right n = 19, extended left n = 4, left n = 8, minor hepatectomy (n = 25) and limited resection (n = 9). RESULTS: There was no postoperative mortality. The 18% morbidity rate included a majority of pleural effusions with two reoperations. The median follow-up was 41 months (6-100 months). The survival rate after surgery was 90% at 1 year, 71% at 3 and 46% at 4 years. Thirteen patients are alive at 4 years. The 36-month survival rate differed according to the time to onset of BCLM: 55% before versus 86% after 48 months (p = 0.01). The other studied factors were not statistically associated with survival. The recurrence rate in the remaining liver at 36 months differed according to the lymph node status of the initial breast cancer: 40% for N0-N1 versus 81% for N1b-N2 (p = 0.01) and according to the type of liver resection: 45% for minor liver resection versus 73% for major (p = 0.02). CONCLUSION: Adjuvant liver surgery should be included in multicenter treatment protocols for medically-controlled breast cancer liver metastasis.

Adult↗
PubMed2001

Long-term results of faecal diversion for refractory perianal Crohn's disease.

BACKGROUND AND AIMS: Faecal diversion (FD) for refractory anoperineal Crohn's disease (APCD) is thought to be unsatisfactory with a low overall rate of defunctioning stoma closure. However, only a few patients have so far been reported in the literature. The aim of this study was to reassess the long-term efficiency of FD for APCD. METHODS: Among 136 patients who were operated for APCD over a 18-year period, 17 underwent FD. The factors assessed were the mortality and morbidity of stoma formation, the evolution of anoperineal Crohn's disease after FD, and predictive factors of FD effectiveness. RESULTS: Mean follow-up after FD was 135 +/- 79 months (range 20-328). Initial healing of APCD was observed in 11 patients (65%), allowing stoma closure after 14 +/- 9 months (range 3-52). The 6 other patients underwent abdominoperineal resection (APR) for persistent APCD. Three of the 11 patients with normal bowel continuity underwent secondary APR for APCD recurrence. Thus, at the end of follow up 9 (53%) patients had definitive end ileostomy and 8 (47%) continued to have normal bowel continuity with a mean follow up of 124 +/- 90 months (range 12-292) after stoma closure. The presence of rectal lesions at the time of FD was the only predictive factor of poor outcome: 8/9 (89%) patients with rectal lesions underwent APR vs 1/8 (13%) patients without rectal lesion (P < 0.01). CONCLUSIONS: Faecal diversion for anoperineal Crohn's disease produced a high initial rate of anoperineal lesion healing. After long-term follow-up, results of faecal diversion are good (normal bowel continuity was restored in 89%) in patients without associated rectal lesions. However, in patients with associated rectal lesions, the prospects for restoring continuity were limited, thus making faecal diversion a questionable procedure.

Journal Article↗
PubMed2001

Synergistic efficacy of 3n-butyrate and 5-fluorouracil in human colorectal cancer xenografts via modulation of DNA synthesis.

BACKGROUND & AIMS: Butyrate, produced in the colon lumen, maintains mucosal cell homeostasis. Poorly diffusible, its access is compromised in growing colon cancers and absent in distant metastases. Butyrate regulates DNA synthesis. We postulated that systemic administration of butyrate should reduce colon cancer growth and enhance 5-fluorouracil (5-FU) efficacy. METHODS: A stable derivative of butyrate (3n-But) was used. The antitumoral efficacy of 5-FU and 3n-But, alone or combined, was evaluated in human colorectal cancers (hCRCs) subcutaneously, orthotopically, or intrasplenically grafted into nude mice. Thymidylate synthase (TS) and thymidine kinase (TK) mRNA expression, proliferation, apoptosis, and cell cycle alterations were studied. RESULTS: In vivo, 5-FU alone inhibited growth of only 3 of the 12 hCRCs tested and 3n-But alone had no effect; the 5-FU/3n-But combination inhibited growth of all 16 hCRCs tested. The hCRCs differed in their p53 and microsatellite instability status. 5-FU/3n-But decreased TK and TS mRNA expression by 20- and 40-fold, respectively, and TS activity by 75%, stopped cell proliferation without affecting cell differentiation, and significantly enhanced apoptosis. 3n-But potentiated the efficacy of Tomudex and methotrexate, 2 TS inhibitors, but not that of oxaliplatin. In vitro, 5-FU/3n-But inhibited [3H]thymidine but not bromodeoxyuridine incorporation and induced apoptosis in hCRC cell lines. Cells treated with 5-FU/3n-But did not accumulate in G1 nor in S phase of the cell cycle, while 5-FU and 3n-But arrested the cycle in S and in G1 phase, respectively. 3n-But prevented the cell rescue from 5-FU-induced cytotoxicity by uridine or thymidine. CONCLUSIONS: 3n-But and TS inhibitors acted synergistically against colorectal cancers, independently of the genetic alterations of the hCRCs. The mechanism of action of 5-FU/3n-But could be enhanced reduction of TS and prevention of thymidine salvage in DNA synthesis.

Animals↗
PubMed2000

Induction of invasion in vivo of alpha-catenin-positive HCT-8 human colon-cancer cells.

Variants from the HCT-8 colon-cancer cell line were implanted s.c. and orthotopically into nude mice. Well-differentiated HCT-8/E11 and HCT-8/E41 cells have a functional E-cadherin-catenin complex and are non-invasive into pre-cultured chick heart fragments in vitro, whereas poorly differentiated HCT-8/E11R1 cells are deficient in alpha-catenin protein and invasive in heart fragments. We investigated whether these differences were maintained in vivo. In contrast with in vitro observations, in vivo the 3 HCT-8 variants behaved very similarly and all formed undifferentiated tumors. The in vivo invasive behavior of HCT-8 cells was site-dependently modulated: HCT-8 cells invaded when injected into the cecum but not when injected s.c. Metastases to the liver or lungs were not observed. The composition and expression of the E-cadherin-catenin complex in nude mouse HCT-8 tumors was the same as in HCT-8 cells in culture on solid substrate. We conclude that the in vivo invasive behavior of HCT-8 cells is not determined by whether alpha-catenin is expressed or not but by as yet unidentified host factors.

Animals↗
PubMed2000

Hepatic resection in metastatic breast cancer: results and prognostic factors.

AIMS: Breast cancer liver metastases (BCLM) usually indicate the presence of disseminated cancer with a very poor prognosis. However, systemic treatments now allow control of tumour progression in certain cases. We evaluated, in a group of highly selected patients with stabilization or complete response to systemic therapy, a particular management protocol for medically controlled BCLM: < > liver surgery. METHODS: Fifty-two patients underwent surgery between May 1988 and September 1997. Results of this strategy are reported, together with analysis of prognostic factors for survival and recurrence in the remaining liver (RRL). RESULTS: The mean number of cycles of chemotherapy, before surgery, was seven (3-24). Resection was considered to be curative in 86% of cases. The median follow-up was 23 months (1-72 months). The survival after surgery, was 86% at 12 months, 79% at 24 months and 49% at 36 months. The 36-month survival rate differed according to the time to onset of BCLM: 45% before versus 82% after 48 months (P=0.023). The RRL rate at 36 months differed according to the lymph node status of the initial breast cancer: 41% for N0-N1 versus 83% for N1b-N2 (P=0.021). CONCLUSIONS: Adjuvant liver surgery allowed discontinuation of chemotherapy in 46% of cases and, in this highly selected patient group, allowed good quality prolonged survival. It could be included in multicentre treatment protocols for controlled BCLM, one arm with prolonged chemotherapy, one with adjuvant liver surgery.

Adult↗
PubMed1999

Management of anastomotic leakage after nondiverted large bowel resection.

BACKGROUND: The purpose of this study was to determine the natural history of anastomotic leakage after elective colorectal resection and supraperitoneal anastomosis without temporary stoma. STUDY DESIGN: Medical records from 1990 to 1997 were studied; 655 consecutive patients underwent colonic or rectal resection (without stoma). Patients were divided into two groups: those with clinical anastomotic leakage confirmed by laparotomy (group 1) and those without anastomotic leakage (group 2). Postoperative clinical and biologic findings were compared between the two groups. RESULTS: Anastomotic leakage occurred in 39 of 655 patients (6%). Clinically suspected anastomotic leakage was only confirmed by contrast radiography in 13 of 24 patients (54%), and by CT in 8 of 9 patients (89%). Significantly more patients in group 1 than group 2 had the following: fever (> 38 degrees C) on day 2 (p < 0.001); absence of bowel action on day 4 (p < 0.001); diarrhea before day 7 (p < 0.001); collection of more than 400 mL of fluid through abdominal drains from day 0 to day 3 (p < 0.01); renal failure on day 3 (p < 0.02); and leukocytosis after day 7 (p < 0.02). Among the 39 patients in group 1, 28 (71%) had at least one of these clinical or biologic manifestations before day 5, but the mean delay for reoperation was only 8 days. The combination of signs observed before day 5 was associated with an increased risk of anastomotic leakage, from 18% with two signs to 67% with three signs. Overall mortality rate was 2% (13 of 655) and was significantly higher in group 1 than group 2: 5 of 39 (13%) versus 8 of 616 (1%, p < 0.001). In patients with anastomotic leakage, death occurred in 5 of 23 patients (22%) reoperated on after day 5, versus 0 of 11 patients (0%) reoperated on before day 5 (NS). Univariate analysis showed that three clinical characteristics were associated with a significantly high risk of mortality after reoperation for anastomotic leakage: age greater than 65 years (p < 0.01), American Anesthesiologist Association score greater than 3 (p < 0.05), and blood transfusions during the first operation (p < 0.02). CONCLUSIONS: In our study, some postoperative clinical and biologic signs were associated with a higher risk of anastomotic leakage. The knowledge of these findings might help in the early diagnosis and management of patients with anastomotic leakage after large bowel resection.

Anastomosis, Surgical↗
PubMed1999

Possible first report of distant peritoneal metastases from a nodal mesenteric lymphoma after laparoscopic inguinal hernia repair.

Laparoscopic surgery has gained wide acceptance. However, there is still debate as to its role in assessment and staging of gastrointestinal malignancies(1)since it may promote dissemination of cancer cells.(2)We report the first case of a low-grade mesenteric nodal lymphoma for laparoscopic hernia repair, complicated by distant implants both on the peritoneum and wall mesh.

Aged↗
PubMed1999

[Value of human colonic cancer models by surgical cecal implantation in nude mice].

A better understanding of the nature and treatment of colon cancer, and of by metastatic dissemination should be achieved by the use and study of appropriate animal models. Such models can be created by grafting human cancer cells or tumour fragments orthotopically into the colon or caecum of nude mice. This review examines the rationale behind these models and the principal results of orthotopic transplantation. Despite the fact that they require surgical expertise and are time-consuming, they provide valuable information on the mechanism of metastasis and the efficacy of novel treatments.

Animals↗
PubMed1999

[Total excision of the mesorectum and preservation of the genitourinary innervation in surgery of rectal cancer].

Locoregional recurrence is one of the most important problems after surgery for rectal cancer. Four to five per cent local recurrence rates have been reported after total mesorectal excision with autonomic nerve preservation. After an anatomic description, the authors describe the surgical technique of total mesorectal excision with nerve preservation. Carcinologic and functional results are reported, before concluding that this technique should be performed for mid or low rectal tumours with a distance to anorectal junction less than 5 cm.

Autonomic Nervous System↗