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M Zins

Publications and source records attributed to M Zins.

At least 37 records · Page 2Linked to original sources
PubMed2000

Preoperative nonresectability criteria used for pancreatic head adenocarcinoma: a practical survey among gastroenterologists and surgeons. Société Française de Chirurgie Digestive.

Preoperative nonresectability criteria for carcinoma of the pancreatic head remain controversial. We sought to assess prospectively the preoperative criteria used currently in clinical practice and to determine the different therapeutic strategies used between gastroenterologists (GEs) and digestive surgeons (Ss). The evaluation comprised all of the registered GEs (n = 3,466) and Ss (n = 687) who were sent a questionnaire surveying nonresectability criteria. The hypothesis in question concerned adenocarcinoma of the pancreatic head in a patient in the absence of general operative contraindication. Six hundred fifteen complete responses to the questionnaire were received (GEs, 426; Ss, 189). The mean estimated percentage of resected tumor was 22% (GEs, 19%; Ss, 31%; p < 0.0001). Preoperative nonresectability criteria differed between the two groups and included weight loss >25% (percentage of GEs using this criterion, 57%; Ss, 48%; p < 0.04), duodenal wall invasion (GEs, 30%; Ss, 4%; p < 0.001), gastric extension (GEs, 55%; Ss, 23%; p < 0.001), invasion of gastroduodenal artery (GEs, 58%; Ss, 19%; p < 0.001), invasion of superior mesenteric artery (GEs, 85%; Ss, 92%; p < 0.02), invasion of portal vein (GEs, 78%; Ss, 52%; p < 0.001), tumor diameter >6 cm (GEs, 52%; Ss, 38%; p < 0.001), peripancreatic lymph nodes (GEs, 33-69% depending on the node area; Ss, 5-52%; p < 0.02-0.001). Consensual criterion used by >85% of GEs and Ss was celiac trunk invasion. Criteria rejected by >85% both of GEs and Ss were back pain, weight loss <25%, and tumor diameter < or = 5 cm. Criteria without consensus (used or rejected by <85% of GEs and Ss) were superior mesenteric vein and hepatic artery invasion. The preoperative nonresectability criteria used in determining operative resectability differs significantly between medical and surgical gastroenterologists. This study is the first to quantify this difference. These results underline the need for consensus agreement in the criteria of resectability.

Adenocarcinoma↗
PubMed1999

Predictors of change in alcohol consumption among Frenchmen of the GAZEL study cohort.

AIMS: To identify the predictors of changes in alcohol intake among French men. DESIGN: Longitudinal study over a 2-year period. SETTING: The GAZEL volunteer cohort comprising workers employed by Electricité de France-Gaz de France. PARTICIPANTS: The study included 11,613 men aged 40-50 years who had answered a self-administered questionnaire in 1989 and 1991. MEASUREMENTS: Subjects were defined according to initial levels of alcohol intake and changes in that intake (cessation, decrease and increase) and compared with subjects with corresponding levels but unchanged intake by logistic regression. The effects of individual characteristics and of occupational and health conditions were investigated. FINDINGS: Different variables measured in 1989 were predictive of changes in alcohol consumption in 1991, depending on the change. Self-perception of bad health, consumption of sleeping pills and unmarried status were predictive of the cessation of alcohol consumption. Working under favourable conditions (with no specific occupational risks) and being a non-smoker tended to be associated with reduced consumption. Increased consumption was associated with the number of reported disease and the smoking status. Among abstainers or light daily drinkers, being exposed to more than one constraint enlarged the risk of increased consumption. For moderate drinkers, the risk of increased consumption was higher, irrespective of the number of physical constraints. CONCLUSIONS: These results highlight the fact that many inter-related factors help to determine changes in drinking habits.

Adult↗
PubMed1999

[Mediastinal and cervical diffusion of necrosis infiltration in acute pancreatitis].

Thoracic complications of acute pancreatitis are mainly caused by the rupture of the main pancreatic duct leading to the diffusion of pancreatic juice into the mediastinum. Occasionally, esophagus or respiratory tract may also be involved. We report here the case of a 51-year-old man with acute alcohol-related pancreatitis who developed mediastinal and cervical infiltration through a wirsungo-mediastinal fistula caused by the leak of the main pancreatic duct which was successfully treated by splenopancreatectomy.

Humans↗
PubMed1999

[Preoperative staging of pancreatic adenocarcinoma: a practice survey of French gastroenterologists and digestive surgeons. Ordering of supplemental examinations and preoperative criteria of loco-regional spread].

BACKGROUND: Means used by physicians to perform preoperative staging of pancreatic adenocarcinoma are not well known. Therapeutic strategy used relies on knowledge of loco-regional spread criteria. AIMS: To assess the frequency of prescription of imaging procedures in patients with suspected pancreatic head adenocarcinoma; the use by French gastroenterologists (GE) and digestive surgeons (S) of criteria which lead to suspect lymph node invasion or vascular involvement; the frequency of histological determination in patients with unresectable tumor; if there is a difference between GE and S. METHODS: All the French GE (n = 3466) and S (n = 687) were sent a survey asking them about their habits. RESULTS: 615 answers were received (GE = 426, S = 189). There was no significant difference between GE and S for the prescription of ultrasonography and CT scan. Endosonography and upper digestive endoscopy were more systematically performed by GE than S (44 vs 35% and 50 vs 35%, respectively). Celio-mesenteric angiography was less often used by GE (6 vs 13%). Laparoscopy was electively used by 35% GE and 52% S. None of vascular involvement criteria was used by more than 75% of GE and S. Tumor-vessel interface loss was used by 46% GE and 16% S (P < 0.001). Intravascular thrombosis and truncular portal hypertension signs were used more often by S than GE (84 vs. 71%: P < 0.001; 65 vs. 51%: P < 0.001). None of nodal involvement criteria was used by more than 50% of physicians. All these nodal criteria were used more often by GE than S (P < 0.001). Percentage of physicians requiring histological confirmation in case of unresectable tumor was 41%. CONCLUSION: Preoperative staging of suspected pancreatic head adenocarcinoma is performed with grossly the same manner by GE and S. Histological proof is searched for in a low percentage of cases. Imaging criteria of loco-regional spread of pancreatic adenocarcinoma are heterogeneously used by GE and S, the former using them more frequently than the latter. A better use of imaging criteria is necessary to optimise the treatment of patients with pancreatic adenocarcinoma.

Adenocarcinoma↗
PubMed1999

[Spontaneous gas gangrene of the pancreas caused by Clostridium perfringens].

The case of a 60-year-old patient with acute biliary pancreatitis spontaneously infected by Clostridium perfringens is reported. On CT scan, all the pancreatic bed was filled by gas. The patient survived. Four cases have previously been published. Three were fatal and 2 occurred after a pancreatic biopsy. Complete gas gangrene of the pancreas is a severity criterion and suggests an infection by Clostridium perfringens.

Gas Gangrene↗
PubMed1998

[Staging of exocrine pancreatic cancer].

The aim of this review is to report results of investigations used in the staging of pancreatic cancer and draw a practical approach in the treatment of this cancer. For the diagnosis of pancreatic mass and the diagnosis of malignancy, ultrasonography and helical-CT seem to be the best methods. In cases of non evident malignancy, diagnosis of pancreatic cancer can be done by endoscopic retrograde cholangiopancreatography and confirmed by transcutaneous biopsy, under CT locating. The diagnosis of vascular involvement is usually done by helical-CT, while endoscopic ultrasonography gives best results in the diagnosis of lymph node involvement. The diagnosis of hepatic and peritoneal metastasis can be difficult, specially in case of small peritoneal deposits, but accuracy of helical-CT remains high. Grading of these investigations depends on the situation after performing ultrasonography and CT scan. When a pancreatic resection seems to be possible, a surgical treatment can be directly proposed or preceding by endoscopic ultrasonography for lymph node diagnosis, and/or laparoscopy for detection of small peritoneal deposits.

Biopsy↗
PubMed1997

Risk factors for Raynaud's phenomenon among workers in poultry slaughterhouses and canning factories.

BACKGROUND: Apart from the use of vibrating tools, little is known about risk factors for Raynaud's phenomenon. However, it has been hypothesized that this disorder may have a multifactorial aetiology, involving potential causal or triggering factors which can be found in the workplace. The objective of the study is to identify individual and occupational risk factors of Raynaud's phenomenon in a population of workers not exposed to vibration, but exposed to cold. METHODS: The survey was carried out in 1987-1988 in 17 poultry slaughterhouses and six canning factories and included 1474 employees. Data were collected at the annual visit to the occupational health physician. Finger sensitivity to cold and Raynaud's phenomenon were identified from a list of symptoms occurring from exposure to cold. The role of potential risk factors was assessed using multiple logistic regression. RESULTS: A high prevalence of symptoms of finger sensitivity to cold was observed. Raynaud's phenomenon was more common in women than in men, was related to family history of the disease but not to smoking or alcohol consumption. After controlling for non-occupational factors, the following working conditions appeared as risk factors for Raynaud's phenomenon: use of plastic gloves, less than four rest breaks, breaks in an unheated place, continual repetition of the same series of operations, exertion of the arm or hand and being able to think of something else while working. CONCLUSION: The study showed that a number of working conditions were associated with an increased risk of Raynaud's phenomenon and finger sensitivity to cold. Changes in working conditions might reduce the risk of this disorder in the food processing industry.

Adult↗
PubMed1997

Predictive factors in the outcome of pseudocysts complicating alcoholic chronic pancreatitis.

AIMS: To determine the clinical, biochemical, and/or morphological features which could predict the need for treatment of pseudocysts at diagnosis in a homogeneous population of patients with alcoholic chronic pancreatitis. METHODS: Between January 1983 and December 1993, all patients followed for alcoholic chronic pancreatitis complicated by pseudocysts and confirmed by computed tomography (CT) scan at diagnosis were studied retrospectively. Two groups of pseudocysts were considered according to their pattern of evolution and the therapeutic requirements. Group I included 45 pseudocysts that regressed spontaneously (25 patients) or that persisted without symptoms (20 patients). Group II included 45 pseudocysts with persisting symptoms or complications, requiring surgical or non-surgical treatment. The evolution of pseudocysts was monitored by CT scanning or abdominal ultrasound. Initial CT scans of all patients were reviewed by an experienced radiologist. For each patient with pseudocysts, the following morphological parameters were recorded: number of pseudocysts, maximal diameter, location, intrapancreatic or extrapancreatic development, complications related to the pseudocyst, pancreatic calcifications, enlargement of the main pancreatic duct, and signs of recent acute pancreatitis. Univariate analysis, and then multivariate analysis with all significant variables on univariate analysis were performed. RESULTS: On univariate analysis, location of pseudocysts in the pancreatic head and intrapancreatic development of pseudocysts were significantly more frequent in group I than in group II (78% versus 55%, p < 0.02 and 89% versus 60%, p < 0.001, respectively). The median diameter of pseudocysts was significantly smaller in group I than in group II (25 (10-110) mm and 40 (10-120) mm respectively, p < 0.001). No differences between groups I and II were found for the clinical or biochemical parameters. Multivariate analysis showed that the intrapancreatic development of pseudocysts and a diameter less than 4 cm were the only independent factors associated with a spontaneous and favourable outcome. These factors accounted for 20% of the total variance. CONCLUSIONS: Pseudocysts larger than 4 cm and extrapancreatic development can be considered independent predictive factors of persisting symptoms and/or complications in patients with pseudocysts and alcoholic chronic pancreatitis.

Adult↗
PubMed1997

[Ultrasonographic anomalies of intrahepatic biliary ducts: contribution of the comet-tail image].

OBJECTIVES: The aim of this study was to evaluate the sensitivity and specificity of the ultrasound intrahepatic bile duct wall comet-tail artifact for the diagnosis of biliary disease. METHODS: All subjects who underwent upper abdominal ultrasound examination were included in the study over an 18-month period. The presence or absence of the comet-tail artifact (that is hyperechoic pattern with several parallels lines, constant, lining on the intrahepatic biliary ducts) was noted. RESULTS: Fourteen thousand four hundred and ninety-eight patients were included. The comet-tail artifact was only found in 10 of the 14 211 patients without biliary tract disease (99.9% specificity), but in 35 of the 287 patients with biliary disease (12.2% sensitivity). The positive predictive value for the diagnosis of biliary tract disease was 77.7%. The artifact was associated with an angiocholitis in 83% of the patients. CONCLUSION: Despite its low sensitivity, the sonographic comet-tail artifact of the intrahepatic bile duct wall was strongly correlated with the presence of biliary disease. This artifact may be related to an enlargement of the bile duct wall.

Bile Duct Diseases↗
PubMed1997

[Comparison between spiral x-ray computed tomography and endosonography in the diagnosis and staging of adenocarcinoma of the pancreas. Clinical preliminary study].

OBJECTIVE: To determinate in a retrospective clinical study the benefit of helical-CT for the diagnosis and staging of pancreatic carcinoma compared with endoscopic ultrasonography. METHOD: Results of helical-CT and endoscopic ultrasonographic investigations relative to 24 cases of histologically proved adenocarcinoma were reviewed. The criteria studied were: a) existence of a pancreatic mass, b) diagnosis of malignancy, c) existence of vascular involvement, d) lymph node involvement. Statistical analysis (binomial test) was performed in 24 patients for the assessment of mass and malignancy and in 10 patients for the assessment of vascular involvement (9 patients who underwent surgery and one patient with a positive arteriography). RESULTS: For diagnosis of pancreatic mass both methods were equivalent: 91.5% (22 cases out of 24) for helical-CT and 87.5% (21 cases out of 24) for endoscopic ultrasonography. Two pancreatic masses were seen only with endoscopic ultrasonography. Their size was under 3 cm. Two of the 3 masses not seen with endoscopic ultrasonography were infiltrative lesions measuring more than 3 cm. Helical-CT was significantly superior to endoscopic ultrasonography for the diagnosis of malignancy (96% vs 71%) (P = 0.035). The accuracy of helical-CT for vascular involvement was significantly superior to endoscopic ultrasonography (90% vs 40%) (P = 0.031). Endoscopic ultrasonography underestimated vascular involvement in 5 cases: mesenterico-portal confluence (3 cases), superior mesenteric artery (2 cases). In the 6 cases with histologically proved lymph node involvement, endoscopic ultrasonography (6 correct assessments) was superior to helical-CT (3 correct assessments). CONCLUSION: This study confirms the complementarity of helical-CT and endoscopic ultrasonography for the diagnosis of pancreatic carcinoma. It suggests that helical-CT is superior to endoscopic ultrasonography for diagnosis of malignancy and assessment of vascular involvement and endoscopic ultrasonography is superior to helical-CT for diagnosis of lymph node involvement. These preliminary results have to be confirmed by a prospective study including a large number of patients with surgical correlation.

Adenocarcinoma↗
PubMed1997

[Congenital cystic dilatation of the common bile duct. Radio-anatomical correlations in 14 patients].

OBJECTIVES: The aim of this study was to compare imaging and pathological results of congenital cystic enlargement of the biliary tract to determine the best preoperative management strategy. PATIENTS AND METHODS: Radiological findings of 14 cases treated by surgery were reviewed. Radiological examinations were reviewed: ultrasound (n = 20), computed tomography (n = 13), endoscopic ultrasound (n = 8), endoscopic retrograde cholangiopancreatography (n = 10), percutaneous transhepatic cholangiography (n = 3), peroperative cholangiography (n = 11). Imaging and surgical or pathological correlations were obtained with regard to topographical type using Todani's classification, pancreatobiliary junction, and associated diseases, especially biliary malignancies (cystic wall and gallbladder). RESULTS: Cystic enlargement of the biliary tract was type Ia in 2 patients, type Ib in 1, type Ic in 4, type IVa in 5, and type IVb in 2. The radio-pathological correlation was excellent for the topographical type, and quite good for intrahepatic extension. An abnormal pancreatobiliary junction was identified in 5 cases, and visualized before surgery in I case. This junction was not opacified pre- or pre-operatively in 7 cases. Gallbladder stones were present in 2 cases, choledocal stones, in 2 cases, and intrahepatic stones in one cases, always seen on ultrasound. Malignant degeneration was present in the cyst in one case in the pathological specimen, but was not visualized by imaging procedures or peroperatively; one intrahepatic degeneration was visualized on CT and histologically proven in the surgical specimen. CONCLUSION: Ultrasound and CT allow positive diagnosis of cystic enlargement of the biliary tract, and diagnosis of intrahepatic cyst and associated diseases. The bifurcation extension and the study of pancreatobiliary junction require peroperative or retrograde cholangiography.

Adolescent↗
PubMed1997

[Imaging of atypical cysts of the liver. Study of 26 surgically treated cases].

OBJECTIVES: Differential diagnosis between a benign cystic hepatic lesion, biliary cyst, and a potentially malignant lesion or biliary cystadenoma, is difficult. The aim of this study was to evaluate imaging features of atypical cystic liver lesions and the role of imaging techniques in determining a specific diagnosis. METHODS: Twenty-six patients with atypical cystic hepatic lesions were included in this study. All patients underwent surgery and pathological diagnosis was atypical hepatic cyst (n = 18), biliary cystadenoma (n = 4), hydatic cyst (n = 3), and ciliated hepatic foregut cyst (n = 1). We systematically reviewed US (n = 24), CT (n = 24), and MRI (n = 8) examinations. RESULTS: Septum were seen in both cystadenomas (US: n = 4, CT: n = 1) and hepatic cysts (US: n = 11, CT: n = 6). No mural nodules were seen. A thin wall was noted in both hepatic cysts (n = 2) and cystadenomas (n = 3). The intrahepatic biliary tract was dilated in 3 patients with hepatic cysts, 1 patient with cystadenoma, and 2 patients with hydatic cysts. Calcifications were noted in 1 patient with hepatic cyst, 3 patients with hydatic cysts, and in the case of ciliated hepatic foregut cyst. We found an associated typical hepatic cyst in 77% of cases (14/18) with atypical hepatic cysts; this was never found in other atypical cystic lesions (P < 0.01). CONCLUSION: In this series, no imaging features provided a differential diagnosis of atypical hepatic cysts and cystadenomas. The presence of associated typical hepatic cysts is helpful in suggesting the diagnosis of hepatic cyst.

Adult↗
PubMed1996

Peritoneal carcinomatosis in patients with digestive endocrine tumors.

BACKGROUND: Peritoneal carcinomatosis (PC) in patients with digestive endocrine tumors (DET) is considered rare but its prevalence is unknown. The objectives of this study were to assess the prevalence and prognostic implications of PC in patients with various types of DET. METHODS: One hundred and sixteen consecutive patients with DET seen over a 3-year period were studied. Fifty-nine had gastrinomas, 30 had carcinoid tumors, and 27 had other types of endocrine tumors, mainly nonfunctioning ones. Diagnosis of PC was based on clinical symptoms (ascites and König's syndrome), findings of computed tomography scans that were performed at least yearly, and pathologic confirmation of tumor nodules or positive cytology in the peritoneal fluid. Factors associated with PC were investigated and the influence of PC on patients' survival was assessed. RESULTS: PC was found in 11 patients (overall PC prevalence: 10%; with 27% in patients with carcinoid tumors, 11% in those with nongastrinoma pancreatic endocrine tumors, and 0% in patients with gastrinomas). Nine of 11 patients with PC also had liver metastases. PC was metachronous to detection of the primary tumor in 7 of 11 patients, occurring 54 months (range, 23-273 months) after the diagnosis. In addition to the nature of the primary tumor, a greatest dimension of more than 5 cm was associated with the presence of PC in two of three patients with pancreatic endocrine tumors. In patients with carcinoid tumors, an ileal primary tumor occurred more frequently in patients with PC (87.5%) than in those without PC (50%). Prevalence of liver and other metastases was not significantly increased in patients with PC. Although five patients died of their disease, no deaths were related to PC. Actuarial survival rates at 5 years were 64% and 84% in patients with and without PC, respectively (P = not significant), whereas they were 73% and 93% in patients with and without liver metastases, respectively (P < 0.02). CONCLUSIONS: PC is not a rare event in the course of DET, especially in patients with carcinoid tumors. It did not occur in the patient population with gastrinomas, which are less often malignant but may also differ from the other types of DET by several cell characteristics. In contrast to liver metastases, PC is not associated with a significant decrease in life expectancy.

Actuarial Analysis↗
PubMed1996

Prospective evaluation of endoscopic ultrasonography and microscopic examination of duodenal bile in the diagnosis of cholecystolithiasis in 45 patients with normal conventional ultrasonography.

The aim of this study was to prospectively evaluate endoscopic ultrasonography and microscopic examination of duodenal bile in the diagnosis of cholecystolithiasis not detected by conventional ultrasonography. Forty five consecutive patients (26 females, 19 males, mean age: 50 years) with suspected cholecystolithiasis and at least two normal transcutaneous ultrasonography examinations were included. Endoscopic ultrasonographic criteria for the diagnosis of cholecystolithiasis were the presence of stones with or without acoustic shadowing or sludge. Criteria of microscopic examination of bile were cholesterol or bilirubinate crystals or spheroliths. Thirty three patients underwent cholecystectomy and lithiasis was found in gall bladder bile in 24. Twelve patients who were not operated on and were followed up (median: 17 months), had no evidence of cholecystolithiasis. Endoscopic ultrasonography and duodenal bile examination were 96% and 67% sensitive, respectively (p < 0.03). The specificity was not different (86 and 91%, respectively). None of the 16 patients with negative results in both procedures had evidence of cholecystolithiasis. It was found that for the diagnosis of cholecystolithiasis in patients with normal conventional ultrasonography, the sensitivity of endoscopic ultrasonography is higher than that of microscopic examination of duodenal bile. If endoscopic ultrasonography and microscopic examination of duodenal bile are negative, the risk of underdiagnosing cholecystolithiasis is negligible.

Adult↗
PubMed1996

Calcification in focal nodular hyperplasia: a new problem for differentiation from fibrolamellar hepatocellular carcinoma.

PURPOSE: To describe calcification in focal nodular hyperplasia (FNH) of the liver, which poses a new problem for the differentiation of FNH from fibrolamellar hepatocellular carcinoma (HCC). MATERIALS AND METHODS: Ultrasound, computed tomography, and magnetic resonance imaging findings of 357 FNH lesions diagnosed in the past 5 years in 295 patients (274 female, 21 male; aged 14-72 years) were retrospectively reviewed with emphasis on intralesional calcification. RESULTS: Calcifications were seen in five FNH lesions (1.4%) as small, solitary spots located centrally or peripherally within the lesions. Morphologic features of these calcifications were similar to those of calcifications in two of six fibrolamellar HCCs in the same period. CONCLUSION: Calcification in FNH is a rare and atypical finding that poses further difficulty for differentiation from fibrolamellar HCC.

Adult↗
PubMed1996

[Imaging of ciliated hepatic or biliary cysts. 4 cases].

Four patients with ciliated hepatic cysts, a rare and benign lesion, were examined between 1990 and 1994. Imaging features were compared to 12 previous cases. All lesions were revealed by US, and were hypoechoic in 3 cases, and anechoic in 1 case. All lesions were less than to 4 cm in diameter, and were well-defined, unilocular, isolated, and located in subcapsular areas, usually in the medial segment of the left lobe of the liver (3 cases). In one case, the cyst was found in the gallbladder wall. The lesions were low density on pre- and post-contrast CT scan (performed in 2 cases), strongly hyperintense on T2-weighted MR images (2 cases), and had a variable signal intensity on T1-weighted MR images. One patient underwent percutaneous guided biopsy but no diagnosis was obtained. None of the patients had preoperative diagnosis and all underwent surgery. Diagnosis was confirmed by histopathologic examination of the resected specimen. Ciliated hepatic cysts may be suspected in this study and in the literature. Diagnostic criteria are as follows: hypoechogenic mass less than 4 cm in diameter, located in the subcapsular area of the medial segment of the left lobe of the liver.

Adult↗