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R Delcenserie

Publications and source records attributed to R Delcenserie.

At least 19 recordsLinked to original sources
PubMed2005

[Pancreas divisum and the dominant dorsal duct syndrome].

Pancreas divisum, the most frequent congenital malformation of the pancreas, results from the absence of embryologic fusion of the dorsal and ventral pancreatic ducts which keep an autonomy of drainage. The dorsal pancreatic duct is dominant and drains the major part of the pancreatic fluid through a non adapted accessory papilla. The high prevalence of pancreas divisum in patients presenting recurrent acute pancreatitis, the presence of obstructive pancreatitis electively located on the dorsal pancreatic duct and the results of the treatments targeted on the accessory papilla are the arguments pleading for the pathogenic character of the pancreas divisum. Currently, the diagnosis of pancreas divisum is based on magnetic resonance imaging. For symptomatic patients (after exclusion of patients with intestinal functional disorders), results of endoscopic sphincterotomy or surgical sphincteroplasty are favourable in 75% of patients with recurrent acute pancreatitis. They are worse in patients with chronic pain. Surgical sphincteroplasty must be discussed in the same manner as the endoscopic treatment for sometimes avoiding multiplication of the procedures.

Acute Disease↗
PubMed2004

[Self expanding metallic stent in the management of malignant colonic obstruction].

INTRODUCTION: Fifteen to thirty percent of colonic cancers are diagnosed at acute colic obstruction stage. In this situation surgery is associated with a high morbi-mortality. The self-expandable metallic stents (SEM) have two objectives: (a) resolution of the obstructive to allow secondary planified radical surgical procedure; (b) palliative in the event of advanced disease. PATIENTS AND METHODS: From May 2001 to December 2002, 11 patients, mean age 75 +/- 8 years, presenting with acute colic obstruction were initially treated by SEM placed by endoscopy. Four patients were classified score ASA 4. Ten patients had a colonic cancer, and a patient presented a peritoneal carcinomatosis from an ovarian carcinoma. Overall five patients had a carcinomatosis. Stenosis, mean length 4 +/- 3 cm, were located on the left colon. In five patients the SEM was proposed as a palliative treatment. RESULTS: Successfully placement of SEM was obtained in 10 (91%) patient without perforation. Three complications (bleeding, reobstruction, migration) were observed. Clinical success (colonic decompression within 96 h without endoscopic or surgical reintervention) was observed in nine out of ten (90%) patients. Six patients had a SEM with curative attempt allowing (i) colonic resection (9 +/- 2 days) without stomy (one postoperative death) in five patients; (ii) a colo-colic derivation for diffuse carcinomatosis discovered peroperatively. A diverting colostomy was carried out in two of the four patients (j6, j30) (reobstruction, migration) for whom the SEM had been proposed as palliative treatment. CONCLUSIONS: This study confirms that SEM and surgery are not competitive but complementary techniques. When the SEM is placed with curative attempt, it allows resolution of the obstructive syndrome and secondary planified radical surgical procedure under better conditions. The results observed in the palliative SEM group suggested to reconsider this indication.

Aged↗
PubMed2004

[The treatment of biliary stenosis with metallic stents: the need for multidisciplinary decision making].

A patient presented with a cholangiocarcinoma of the common bile duct; it was initially considered unresectable leading to the placement of the metallic stent whose upper end extended beyond the convergence of the hepatic ducts. The metallic biliary stent became obstructed and so encrusted as to be unremovable; the patient required a left hepatectomy with resection of the stent and the biliary convergence in addition to a pancreatoduodenectomy in order to resect his primary lesion This difficult situation emphasizes that, whenever there is doubt as to the resectability of a biliary lesion, the decision to place a metallic stent should be the fruit of a thorough medico-surgical discussion; where there is any doubt, a plastic stent which is more easily removable should be placed.

Aged↗
PubMed2001

[Physiology of intestinal absorption].

Hydrolysis of dietary constituents is necessary to allow nutrients absorption by the small intestinal enterocytes. The digestion process takes place in the intestinal lumen, in the brush border membrane, in the enterocyte, and is mediated by a large number of hydrolases secreted in the gastrointestinal tract or produced by the epithelial cells and localized in the brush border. Nutrients are essentially absorbed via a transcellular route across enterocyte cell membranes to enter bloodstream or lymphatic circulation. Transport of nutrients across apical or basolateral membranes occur by active or facilitated mechanisms involving specific transporters. Water, electrolytes and small molecules can be partly absorbed via paracellular pathway. Tight junction permeability is regulated by osmolarity of intercellular space, definite nutrient concentrations in lumen, and activity of brush border membrane transporters.

Biological Transport↗
PubMed2001

Pancreatic concentrations of cefepime.

The concentrations of cefepime in pancreatic pseudocyst fluid (n = 4), pancreatic tissue (n = 4) and pancreatic fistula fluid (n = 1), and simultaneous plasma concentrations, were measured after intravenous administration of a single 2 g dose to nine patients. Mean plasma concentration was 27.4 mg/L between 120 and 200 min after the end of infusion. Mean pancreatic cefepime concentration was 6.3 mg/L in pseudocyst and 10.7 mg/L in pancreatic tissue. Cefepime was detected by 30 min after the end of the perfusion in pancreatic fistulae fluid, and persisted at 8 h. We conclude that cefepime is a potentially useful antibiotic in prevention and treatment of pancreatic infection.

Adult↗
PubMed2001

[Hepatic disorders related to Lyme disease. Study of two cases and a review of the literature].

We report two cases of Lyme disease, revealed by hepatic damage in a 71- and a 59-year old man. In the first case, the disease was revealed by febrile jaundice whereas, in the second case, results of liver tests showed cytolytic and cholestatic abnormalities with fever. Lyme disease is a zoonosis due to infection by Borrelia burdorferi transmitted by ticks. The multiple phases of the disease explain the polymorphism of the clinical manifestations. Usually, extrahepatic symptoms are first observed, including neurological tropisms of Borrelia burdorferi. On the contrary, hepatic impairment due to Lyme disease is rare, often asymptomatic and with biological manifestations only.

Adult↗
PubMed1998

[Percutaneous cholecystostomy. A study of 30 patients].

OBJECTIVE AND METHODS: The treatment of acute cholecystitis or angiocholitis is often difficult in elderly or very ill patients. The aim of this retrospective study was to assess the efficacy and the results of ultrasound guided percutaneous cholecystostomy in patients with acute cholecystitis or biliary tract obstruction and anesthetic or surgical contraindications. RESULTS: Thirty patients (25-93 years, 16 men and 14 women) were included in this study. Ultrasound guided percutaneous cholecystostomy was successful on the septic syndrome in 27 patients; endoscopic sphincterotomy was performed in 6 patients after clinical improvement. A failure of the procedure on sepsis was observed in 3 patients: cholecystectomy was performed after cardiac improvement in one patient, and 2 patients died. Two other patients died of extradigestive diseases. No serious complication related to cholecystostomy was observed. CONCLUSION: Ultrasound guided percutaneous cholecystostomy is a safe and simple procedure. It can be done at bedside and has low morbidity and mortality. It can be considered as a definitive treatment, or a temporary one with secondary surgical or endoscopic management.

Adult↗
PubMed1997

Cirrhosis: a new, but expected cause of biliary sludge.

BACKGROUND/AIMS: Biliary sludge is increasingly recognized as a natural stage in gallstone formation. Logically, cirrhosis, a well-documented cause of black pigment cholelithiasis, should be another condition predisposing to the development of sludge. The aim of this study was to assess the prevalence of biliary sludge in an unselected population and to test the hypothesis that cirrhosis could be one of the causes of sludge. METHODS: We reviewed the clinical findings and ultrasonograms of 2138 patients, hospitalized or not, consecutively seen in our department between January 1993 and December 1994. Sonograms showing biliary sludge mixed with stones were excluded. Three hundred and eighty-eight of the 2138 were cirrhotic patients. RESULTS: The overall prevalence of biliary sludge was 4%. Sludge was found in 44 of 388 (11%) of the cirrhotic patients (alcoholism, n = 39; chronic viral B hepatitis, n = 3; hemochromatosis, n = 1; and cryptogenic, n = 1), compared with 42 of 1750 (2%) noncirrhotic patients (p < 0.000001). Thirteen cirrhotic patients received intravenous alimentation for 2 to 17 days, 8 were given somatostatin for variceal bleeding, and 7 have previously had 1 to 5 sessions of endoscopic sclerotherapy of esophageal varices with polidocanol. CONCLUSIONS: This study convincingly demonstrates that cirrhosis must be added to the growing list of conditions associated with biliary sludge.

Adult↗
PubMed1997

Frequency and risk factors of recurrent pain during refeeding in patients with acute pancreatitis: a multivariate multicentre prospective study of 116 patients.

BACKGROUND/AIMS: The period of refeeding in patients with acute pancreatitis is critical because they may have pain relapse. A multicentre, multidimensional, prospective study was performed to assess the frequency and the risk factors of pain relapse in these patients. METHODS: Patients were included if they had acute pancreatitis severe enough to stop oral feeding for more than 48 hours. Clinical, biochemical, radiological, and therapeutic data were prospectively recorded and analysed by unidimensional and multidimensional analysis. The moment to refeed patients was chosen by the clinician but the diet was the same in all centres. RESULTS: A total of 116 patients were included with a Ranson's bioclinical score > or = 3 in 35% and a Balthazar's CT score > or = D in 42%. The cause of acute pancreatitis was biliary in 47% and alcohol misuse in 31%. During the oral refeeding period, 21% of the patients had pain relapse. This occurred on days 1 and 2 in 50% of patients. The duration of the painful period was longer in patients who relapsed than in others (p < 0.002). Pain relapse occurred in 39% of patients with a serum lipase concentration > 3x the upper limit of the normal range the day before refeeding and in 16% of other patients (p < 0.03). Patients with higher Balthazar's CT scores had pain relapse more often than the others (p < 0.002). None of the therapeutic procedures significantly modified the frequency of pain relapse. Using multidimensional analysis, Balathazar's CT score, period of pain, and serum lipase concentration the day before refeeding were independently associated with an increased risk of pain relapse. At a threshold of 0.5, a logistic score had a 37% sensitivity, 95% specificity, and 83% accuracy to predict pain relapse. Pain relapse nearly doubled total hospital stay and hospital stay after the first attempt at oral refeeding. CONCLUSION: Pain relapse occurred in one fifth of the patients with acute pancreatitis during oral refeeding and was more common in patients with necrotic pancreatitis and with longer periods of pain. The results of this study can be used to predict high risk patients and are a first step in the prevention of pain relapse.

Acute Disease↗