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Biomedical subjects

R Chiche

Publications and source records attributed to R Chiche.

At least 19 recordsLinked to original sources
PubMed1999

Prediction of common bile duct stones by noninvasive tests.

OBJECTIVE: To define accurate and useful predictors of common bile duct stones (CBDS). SUMMARY BACKGROUND DATA: The ability to predict CBDS with noninvasive tests can avoid unnecessary, costly, or risky procedures. METHODS: All patients referred for examination for CBDS by endoscopic ultrasonography (EUS) from 1993-1996 were prospectively entered in a database. In a first sample selected randomly from the whole population, predictors of CBDS were determined by univariate analysis and logistic regression. Predictors were subsequently tested in that sample and in the rest of the population. A separate analysis was done for patients planned for cholecystectomy. RESULTS: Eight hundred and eighty patients (328 men, 552 women), aged 57.8 +/- 17 years (range 16-94), were included. The prevalence of CBDS was 18.8%. Age, serum levels of bilirubin, aspartate aminotransferase, alanine aminotransferase, gamma-glutamyl transferase (GGT), and alkaline phosphatase, and the existence of jaundice and fever, a dilated bile duct, and a pathologic gallbladder were found to be associated with CBDS. Logistic regression was undertaken separately for patients younger than 70 years (predictors: GGT >7 x normal; pathologic gallbladder; dilated bile duct) and older than 70 years (predictors: GGT >7 x normal; fever > 38 degrees C; dilated bile duct). Odds ratios were 3 to 6.7. The model was satisfactorily applicable to the second sample; age <70 years: chi2 = 3.3 (NS); age >70 years: chi2 = 3.8 (NS). In patients younger than age 70 and planned for cholecystectomy, the combination of the level of GGT and dilated bile duct predicted CBDS accurately. CONCLUSIONS: A simple screening of patients at risk for CBDS can be achieved with three predictive criteria adapted for the patient's age.

Adolescent↗
PubMed1999

[Granular cell tumor of the common bile duct. Contribution of endoscopic ultrasonography in 2 cases].

We report two cases of granular cell tumors involving the common bile duct in patients presenting with obstructive jaundice. Pre-operative endoscopic ultrasonography showed short asymmetric stricture with small well delimited hypoechoic mass in the distal common bile duct wall and proximal dilatation. These tumors were misdiagnosed as a bile duct carcinoma in one case and biliary metastasis of a melanoma in the other. Histological examination of the resected specimen showed granular cell tumors. A review of the previously reported cases shows that preoperative diagnosis is uncommon. It should be considered when endoscopic ultrasonography performed for biliary obstruction in a young woman shows a small and well limited hypoechoic mass.

Adult↗
PubMed1998

[W enterocystoplasty with resorbable staples: technic and functional results. Preliminary study].

INTRODUCTION: The use of absorbable staples for enterocystoplasty allows a marked reduction of the operating time. The long-term results on continence need to be evaluated at result term before adopting this technique. METHODS: Eight patients underwent "W" enterocystoplasty performed with absorbable staples according to the so-called "Detroit" technique, with direct uretero-ileal anastomosis. The continence of these patients was evaluated by clinical follow-up and urodynamic assessment (3 patients). Quality of life was studied by a questionnaire sent to the patient. RESULTS: The mean operating time was 5 hours 20 minutes, the plasty was performed in 25 to 35 minutes. The mean follow-up was 18.7 months, during which two uretero-ileal strictures were diagnosed. 7 of the 8 patients have a good diurnal continence (no leaks) and 1 patient has moderate continence (1 protection). Nocturnal continence was considered to be good in 3 cases, moderate in 2 cases and poor in 3 cases (> 1 protection). Four of the patients evaluated by questionnaire reported urinary disorders. CONCLUSION: The use of absorbable staples allows a definite reduction of the operating time, for a modes excess cost and satisfactory functional results.

Absorption↗
PubMed1998

[Laparoscopic cholecystectomy and lithiasis of the common bile duct: prospective study on the importance of preoperative endoscopic ultrasonography and endoscopic retrograde cholangiography].

OBJECTIVES: Laparoscopic cholecystectomy is the standard treatment of symptomatic gallstones. At present, no consensus has been reached on the diagnostic and therapeutic methods of concomitant common bile duct stones. Systematic preoperative endoscopic ultrasonography followed, if necessary, by endoscopic retrograde cholangiography and sphincterotomy during the same anesthetic procedure could be a diagnostic and therapeutic alternative for common bile duct stones making possible a laparoscopic cholecystectomy without intraoperative investigation of the common bile duct. METHODS: One hundred and twenty-five patients underwent a prospective endoscopic ultrasonographic evaluation prior to laparoscopic cholecystectomy for symptomatic gallstones. Fourty-four patients (35%) had at least one predictive factor for common bile duct stones. Endoscopic ultrasonography and cholecystectomy were performed on the same day. Endoscopic ultrasonography was followed by endoscopic retrograde cholangiography and sphincterotomy by the same endoscopist in case of common bile duct stones on endoscopic ultrasonography. Patients were routinely followed up between 3 and 6 months and one year after cholecystectomy. RESULTS: Endoscopic ultrasonography suggested common bile duct stones in 21 patients (17%). Endoscopic ultrasonography identified a stone in 17 of 44 patients (38.6%) with predictor of common bile duct stones and only in 4 of 81 patients (4.9%) without predictor of common bile duct stone. Among these 21 patients, one patient was not investigated with endoscopic retrograde cholangiography because of the high risk of sphincterotomy, 19 patients had a stone removed after sphincterotomy, one patient had no visible stone neither on endoscopic retrograde cholangiography, nor on exploration of the common bile duct after sphincterotomy. Endoscopic ultrasonography was normal in 104 patients (83%). However, two patients in this group were investigated with endoscopic retrograde cholangiography because endoscopic ultrasonography was incomplete in one case and because endoscopic ultrasonography was normal in the second case but a stone in the left hepatic duct was detected by ultrasonography. A stone was removed after endoscopic sphincterotomy in these two patients. In the group of 102 patients without stone, 91 out of 92, continued to be asymptomatic during a median follow-up of 8.5 months. One patient with symptoms one month after cholecystectomy underwent endoscopic sphincterotomy but no stone was found. CONCLUSIONS: Systematic preoperative endoscopic ultrasonography followed, if necessary with endoscopic retrograde cholangiography and sphincterotomy is a diagnostic and therapeutic alternative for common bile duct stones making possible a laparoscopic cholecystectomy without intraoperative investigation of the common bile duct for all patients. This alternative is only justifiable in patients with predictor of common bile duct stones.

Adult↗
PubMed1994

Electroconductive lithotripsy: principles, experimental data, and first clinical results of the Sonolith 4000.

The electroconductive lithotripter (ECL) is a new concept for shockwave generation in which a highly conductive solution channels the discharge between the anode and cathode. In vitro experiments showed a linear relation between the voltage setting and the pressure at F2. In vitro stone disintegration studies showed a considerable reduction in shockwave pressure variability, improved energy transfer to the stone, and a unique linear relation between fragmentation and electrode voltage without a saturation effect. This new concept has been used clinically in the Sonolith 4000 lithotripter. In 142 evaluable treatments with a 3-month follow-up, the overall stone-free rate was 82%, and the retreatment rate in stone-free patients was 10%. For stones equal or less than 10 mm, the 3-month stone-free rate, retreatment rate, and secondary procedure rate were 85%, 5%, and 0%, respectively. For stones between 11 and 20 mm, these figures were 83%, 4%, and 2%, respectively. The efficiency quotient was found to be 81% for stones equal or less than 10 mm and 78% for stones between 11 and 20 mm. These clinical results confirm the improvements in efficacy observed in vitro with very satisfactory tolerance.

Follow-Up Studies↗
PubMed1994

[Electroconductive lithotripsy: experimental and clinical results with the Sonolith 4000].

Electroconductive lithotripsy uses a highly conductive liquid to bathe the electrodes rather than water. The effect is to channel energy between the electrodes and force it to pass directly from the anode to the cathode, exactly at F1. The Sonolith 4000 (Technomed Medical Systems) uses this new generation of "electroconductive" shock waves. Experimental and clinical results are presented. The typical electroconductive technique creates a linear relationship between energy level, in kilovolts, and the amplitude of the acoustic shock at F2 over a wide range of power. There is also a linear relationship between power and effectiveness of desintegration. More than 800 patients have been treated to date. Follow-up has reached 3 months in the 166 treatments reported here. Overall success rate without residual stone was 82%. The percentage of patients with residual stones smaller than 5mm was 5%. The rate of clinical success was 87%. The rate of retreatment in patients without residual stone was 10%. For 11 to 20 mm stones, the success rate (0 fragments), the rate of retreatment and the rate of auxiliary procedures were 83%, 4% and 2% respectively for stones < or = 10 mm and 78% for 11 to 20 mm stones. The electroconductive generator used in this study provided very satisfactory results, better than those generally obtained with classical generators. Tolerance was excellent.

Humans↗
PubMed1993

[TULIP: transurethral ultrasound-guided laser-induced prostatectomy. One-year clinical results].

The TULIP (transurethral ultrasound-guided laser-induced prostatectomy) system combines a real-time ultrasound transducer and a Nd:YAG laser delivery system with a 1.064 microns wavelength within a 22 F urethral probe. The goal is to produce a coagulation necrosis of the prostatic parenchyma, with a subsequent elimination of tissue in the urine. 29 patients have been included in this study, and 13 have a minimal one year follow-up. No complication occurred. 2 patients underwent a transurethral resection of the prostate secondary to the TULIP treatment. All patients complained of irritative urinary symptoms (frequency, burning on urination...) in the days or weeks following the treatment, and suprapubic catheterization tube had to be left in place for a mean duration of 13.8 days. Inclusion/exclusion criteria and evaluation modalities have been the same as in the American national study published elsewhere. At one year, our success rate for at least one criteria has been 84.6%, but only 2 (15%) out of 13 patients have been successful both in symptom score and flow rate.

Aged↗
PubMed1993

[TULIP: transurethral ultrasound-guided laser-induced prostatectomy. Clinical results after on year].

The TULIP (Transurethral Ultrasound-guided Laser-Induced Prostatectomy) system combines a real-time ultrasound transducer and a Nd:YAG laser delivery system with a 1.064 micron wavelength within a 22 F urethral probe. The goal is to produce a coagulation necrosis of the prostatic parenchyma, with a subsequent elimination of tissue in the urine. 29 patients have been included in this study, and 13 have a minimal one year follow-up. No complication occurred. 2 patients underwent a transurethral resection of the prostate secondary to the TULIP treatment. All patients complained of irritative urinary symptoms (frequency, burning on urination...) in the days or weeks following the treatment, and suprapubic catheterization tube had to be left in place for a mean duration of 13.8 days. Inclusion/exclusion criteria and evaluation modalities have been the same as in the American national study published elsewhere. At one year, our success rate for at least one criteria has been 84.6%, but only 2 (15%) out of 13 patients have been successful both in symptom score and flow rate.

Follow-Up Studies↗
PubMed1992

[Primary carcinoid tumor of the kidney. Apropos of a case with immunohistochemical study].

The authors report a case of primary renal carcinoid in a 57-year-old woman in whom the diagnosis, established by histological findings, was confirmed by argyrophilia and immunohistochemical studies using anti-neuron-specific enolase, chromogranin A, serotonin and somatostatin antibodies. The clinical and pathological features of this rare renal tumor are discussed.

Carcinoid Tumor↗
PubMed1992

Polymorphonuclear count in ascitic fluid after laparotomy in cirrhotic patients.

In order to establish whether an ascitic polymorphonuclear count greater than 250/mm3 remains a diagnostic criterion for postoperative bacterial peritonitis, a prospective study of 16 patients with cirrhosis and ascites undergoing hepatectomy (n = 4), portocaval shunt (n = 5) and biliary and digestive surgery (n = 7) was carried out. Sixty-four consecutive specimens of ascitic fluid were obtained through abdominal one-way suction tubes left in situ. In 17 (26%) specimens, ascitic fluid was blood stained and the polymorphonuclear count was unreliable; none of these specimens demonstrated positive ascitic fluid culture. In the remaining 47 specimens the polymorphonuclear count ranged from 5 to 5,920/mm3. Positive ascitic fluid culture was significantly higher in polymorphonuclear > or = 250/mm3 group (5/13: 38%) than in polymorphonuclear < 250/mm3 group (2/34: 6%) (p < 0.02). These results suggest that, as in non-operated cirrhotic patients: (a) polymorphonuclear count should be taken in account in the diagnosis of postoperative bacterial peritonitis; (b) polymorphonuclear count greater than 250/mm3 is a good criterion for the diagnosis of bacterial postoperative peritonitis.

Ascitic Fluid↗
PubMed1991

[Pelvic pain in women. Evaluation of a celioscopic intraperitoneal appendectomy technique].

The diagnostic and therapeutic value of laparoscopic surgery has been established for ovarian cysts and ectopic pregnancies. The diagnosis of appendicitis is difficult and laparoscopy is useful. The aim of this study is to assess feasibility, efficacy and advantages of a new technique of laparoscopic appendectomy. From 1st August to 15th December 1989, the women seen for pelvic pain were divided into three groups: appendicitis, pelvic inflammatory disease (PID) and doubtful. Intra-peritoneal appendectomy was performed when the laparoscopic diagnosis was not PID. Via three supra symphyseal trochars, the appendix was exposed and its mesentery was coagulated. The appendix stump was closed with a clip applicator. Twelve women were included in this study. In two thirds of cases, laparoscopy confirmed the clinical diagnosis. Mean operation time was 39 minutes. Laparotomy was never necessary. There were no post-operative complications and intestinal transit was always complete on the second post-operative day. The patient's and nurse's appreciation was excellent. This operation was possible on every occasion. This technique is sure, quick and easily reproducible. A comfortable post-operative period and esthetic advantages were reported by the women.

Appendectomy↗
PubMed1990

[Idiopathic calcinosis of the scrotum. Apropos of 2 cases].

The authors report two cases of idiopathic calcinosis of the scrotum studied between the years 1986-1987 at the Central Histology Laboratory of Hopital St-Louis. These patients had subcutaneous calcinosis strictly limited to the scrotum and not accompanied by any clinical signs or abnormal laboratory parameters. The macroscopic and histological appearance of the lesions is typical and should suggest the diagnosis. Numerous authors have tried to attribute a pathogenic interpretation to this lesion, but the various etiologies proposed are still purely hypothetical.

Adult↗
PubMed1989

[Idiopathic calcinosis of the scrotum. Apropos of 2 cases].

The authors report two cases of idiopathic calcinosis of the scrotum studied between the years 1986-1987 at the Central Histology Laboratory of Hopital St-Louis. These cases presented subcutaneous calcinosis strictly limited to the scrotum and not accompanied by any clinical signs and no abnormal laboratory parameters. The macroscopic and histological appearance of the lesions is typical and should suggest the diagnosis. Numerous authors have tried to attribute a pathogenic interpretation to this lesion, but the various etiologies proposed are still purely hypothetical.

Adult↗
PubMed1988

[Treatment in a ventral position of vesicovaginal fistula by ordinary suture or autoplasty of the labia majora].

The authors describe a modification of technique which improves the exposure of vesico-vaginal fistulas treated surgically by a low approach. The patient is placed in a ventral horizontal position with the thighs in abduction, and the buttocks spread apart. With the patient installed in this way, care is facilitated by more anatomical technique. Using this installation it is possible to close the fistula by simple suture (Chassar-Moir) or with interposition of the labium majus (Martius autoplasty).

Female↗
PubMed1985

[Treatment of advanced prostatic cancer with a gonadorelin agonist, dTrp6 LHRH. 41 cases].

Forty-one patients with prostatic cancer were treated with DTrp6 LH-RH, a luteinizing hormone releasing hormone agonist. Thirty-eight of them had advanced cancer with either metastases or major local spread. In all cases with plasma testosterone levels were normal before treatment, the LH-RH agonist brought them down to values observed after surgical castration. An objective response ("improvement" or "stabilization") was obtained in 68% of the patients, but virtually all "improved" patients were those without previous hormonal treatment. As with all LH-RH agonists, the pharmacological castration produced by DTrp6 LH-RH is of considerable value in the treatment of prostatic cancer, especially since this compound, unlike estrogens, does not seem to cause cardiovascular accidents. However, transient hyperandrogenism may occur during the first days of treatment (as it did in 9 of our patients) and may be responsable for an acute flare-up of the tumoral process, as suggested by 2 of our cases. The concomitant administration of an anti-androgenic drug should perhaps be considered.

Aged↗