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M Ziol

Publications and source records attributed to M Ziol.

28 records · Page 2Linked to original sources

Cells are present in the smoke created during laparoscopic surgery.

BACKGROUND: The application of laparoscopy for malignancy has been halted in many centres because of a growing number of reports of metastases arising in port sites. The smoke created by coagulation during laparoscopic surgery appears to contain particles visible to the naked eye. This study tested the hypothesis that whole cells can be carried as an aerosol in the pneumoperitoneum during laparoscopy. METHODS: Nine patients undergoing laparoscopic surgery for benign and metastatic disease were studied. Throughout the procedure the gas of the pneumoperitoneum was allowed to escape through a filter. The filters and tubing were washed, and washing solution was centrifuged and stained immunohistochemically to identify the cells. Three of the filters were also examined with an electron microscope. RESULTS: Six of the nine samples contained cells. Clumps of whole cells were identified as mesothelial in origin; the electron micrographs showed many other cells stuck to the filter, which appeared to be blood and mesothelial cells but were not analysed further. CONCLUSION: The presence of whole identifiable cells carried in the pneumoperitoneum raises concerns for operating staff and could be a mechanism for tumour implantation. No malignant cells were found, but ethical considerations prevented intentional coagulation of malignant tissue.

Aerosols↗

[Laparoscopic surgery. Does smoke transport cells?].

The study was designed to test the hypothesis that whole cells can be carried as an aerosol in the pneumoperitoneum during laparoscopy. Twelve patients undergoing laparoscopic surgery for benign and metastatic disease were included in the study. Throughout the 12 procedures, the smoke and the gas of the pneumoperitoneum was evacuated through 17 filters. Twelve filters and the tubing were washed. The liquid was centrifuged and stained immunocytochemically to identify the cells. Five other filters were also photographed with an electron microscope. On immunocytochemistry, nine of the twelve samples were identified as mesothelial in origin and the electron micrograph show many other cells stuck to the filter which appeared to be blood cells and mesothelial cells. Malignant cells were not conclusively identified, but ethical considerations prevented any intentional coagulation of malignant tissue. The presence of whole identifiable cells in the pneumoperitoneum could partly explain, port site metastasis after laparoscopic surgery for cancer.

Carbon Dioxide↗

[Laparoscopic resection of gastric conjunctive tumor. Apropos of 2 cases].

We report two cases of benign gastric tumours which were resected laparoscopically. The lesions were diagnosed pre-operatively by upper endoscopy and endoscopic ultrasound. Excisions were complete with satisfactory resection margins. The post-operative courses were uncomplicated: the length of hospital stay for both patients was 6 days. This technique would appear to be a promising alternative to laparotomy for selected cases.

Endosonography↗

A histopathological study of the effects of 6-month versus 12-month interferon alpha-2b therapy in chronic hepatitis C.

BACKGROUND/AIMS: Interferon therapy has been shown to have beneficial effects in chronic hepatitis C, but the optimal duration of treatment has not been clearly defined. The aims of this study were: (a) to perform a detailed histological comparison of the effects of a 6-month and a 12-month treatment using the Knodell score as well as a recently proposed grid of analysis, (b) to determine possible histological predictive factors of response to therapy, and (c) to attempt to relate histological and biochemical modifications. METHODS: Liver biopsies obtained before and 18 months after beginning of treatment were therefore compared in 26 patients treated for 6 months, and in 34 patients treated for 12 months. RESULTS: Six months of treatment induced a significant decrease in periportal (p = 0.02) and intralobular (p = 0.004) hepatocyte necrosis. The same items were improved in the 12-month-treated patients but, in addition, portal inflammation (p = 0.01), bile duct lesions (p = 0.03), lymphoid aggregates (p = 0.002) and fibrosis (p = 0.008) were also improved, according to the Knodell score. Low scores for fibrosis, steatosis and cholangiolar proliferation on the pretreatment liver biopsy could be considered predictive factors for alanine aminotransferase normalization at 6 months. There was no relationship between biochemical response and modification of fibrosis. CONCLUSION: Our results suggest that: (a) a decrease in fibrosis might be detected only after a 12-month interferon treatment, and (b) initial fibrosis, cholangiolar proliferation and steatosis are predictive of a lack of biochemical response. The absence of a relation between biochemical response and evolution of fibrosis implies that the evaluation of treatments in chronic hepatitis C should always include a detailed histopathological study.

Alanine Transaminase↗

[Can we recognize the pathological character of the appendix during laparoscopy? Prospective study: 81 cases].

In a prospective study of 81 patients, the appendix was photographed during a laparoscopy performed for pain in the right iliac fossa. An appendicectomy was performed in 65 patients, for the remaining 16, another cause for the pain was found and the appendix was left in place. The evaluation of the photographed appendix was formed afterwards by a group of 10 surgeons and compared with the histopathological results. In 20 cases (30%) the appendix was normal. In 7 (10%) minimal mucosal inflammation was found and in 38 (60%) acute appendicitis. All the surgeons correctly recognised acute appendicitis. The accuracy of recognition of a normal appendix was 70% overall, and the maximum risk of leaving an early form of appendicitis to evolve was 14%. We propose not removing an appendix judged to be normal during laparoscopy if no other cause for the pain is found. A short course of antibiotics would cover the low risk of allowing a very early appendicitis to develop.

Acute Disease↗

Reduction of intimal hyperplasia by naroparcil, a 4-methylumbelliferyl beta-D-xyloside analogue, after arterial injury in the hypercholesterolemic rabbit.

4-Methylumbelliferyl beta-D-xylosides (beta-D-xylosides) inhibit proteoglycan synthesis, and this is associated with reduced proliferation and extracellular matrix production by vascular smooth muscle cells. This study evaluated whether treatment with naroparcil, a beta-D-xyloside analogue, reduced intimal hyperplasia after arterial injury in the hypercholesterolemic rabbit. Forty-two rabbits were assigned to three groups that received either a 1% cholesterol-enriched diet (group 1, n = 15) or the same diet with added 100 mg.kg-1 naroparcil (group 2, n = 15) or 300 mg.kg-1 naroparcil (group 3, n = 12). All animals underwent iliac artery endothelial abrasion at day 14 and were killed at day 56. At the time of death, the angiographic minimal luminal diameter was significantly larger in both treated groups. Morphometric analysis showed a larger luminal area in treated rabbits (groups 2 and 3) compared with control rabbits (group 1) (0.75 +/- 0.54 and 0.85 +/- 0.61 mm2 versus 0.32 +/- 0.25 mm2, respectively; P < .05), with a decreased intimal thickness in groups 2 and 3 (average reduction of 37% and 39%, respectively, compared with group 1; P < .05) but without changes in medial area. Total vessel area was comparable among all groups. In the media, immunohistochemistry suggested reduced infiltration by macrophages and a larger fractional area of smooth muscle cells. There were no differences in plasma or arterial wall cholesterol content between groups. Plasma levels of glycosaminoglycans and dermatan sulfate content were increased only in group 3. In this model, oral treatment with naroparcil appears to preserve the arterial lumen and reduce intimal thickness after arterial injury.

Administration, Oral↗

Aortic dissection and cardiovascular syphilis: report of an observation with transesophageal echocardiography and anatomopathologic findings.

We report the case of a man who had thoracic pain and stroke. Transesophageal echocardiography enabled us to diagnose an intramural hematoma and a saccular aneurysm of the thoracic aorta before he died. Autopsy showed lesions compatible with syphilitic aortitis in the aortic wall. Transesophageal echocardiography and anatomopathologic findings are correlated, and the role of syphilis as a causal factor is discussed.

Aortic Dissection↗