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Biomedical subjects

V Maunoury

Publications and source records attributed to V Maunoury.

At least 55 records · Page 3Linked to original sources
PubMed1992

Endoscopic palliation for inoperable malignant dysphagia: long term follow up.

This prospective non-randomised trial of 128 selected patients with unresectable oesophageal or gastrooesophageal junction cancers aims to evaluate the initial relief of malignant obstruction by means of bipolar electrocoagulation for both circumferential and submucosal strictures of Nd:YAG laser for the other patients. A limited dilatation was performed initially if a small calibre endoscope was unable to pass through the stricture. Prompt and significant relief of dysphagia without complications was achieved in 83% of patients. Improved patients were retreated monthly during the follow up period. Radiotherapy was recommended when possible. Symptomatic relief of obstruction lasted 4.2 months on average and 76% of patients remained palliated until death. Monthly retreatment using the most appropriate endoscopic procedure for the tumour configuration and radiotherapy after endoscopic relief of obstruction seems to give the best palliation for patients with unresectable cancers of the oesophagus or gastrooesophageal junction.

Adenocarcinoma↗
PubMed1990

[Laser treatment of rectosigmoid villous tumors. Study of a series of 313 patients].

Endoscopic laser treatment is reported in 313 patients with benign rectosigmoid villous adenomas. Total tumor destruction was achieved in 92% of them, without any major complications. The circumferential extension of the tumor base was the only factor affecting this result. During the average 37-month follow-up period of the patients with total tumor destruction, 14% had a tumor recurrence. The recurrence rate after initial treatment was higher a) in patients treated for a recurrence after a previous non laser treatment, b) when the initial histology was low-grade dysplasia and c) when the tumor was located in the lower or middle rectum. Because treatment is long and difficult with a high cancer rate, laser treatment for patients with a circumferential villous adenoma should be limited to nonsurgical candidates. In the other cases, laser is well adapted to old and fragile patients, when transanal resection seems difficult or in case of recurrence after a previous non-laser treatment.

Actuarial Analysis↗
PubMed1990

[Blue rubber bleb nevus syndrome. 3 cases treated with a Nd:YAG laser and bipolar electrocoagulation].

This report concerns three patients with "blue rubber bleb nevus syndrome" presenting with recurrent digestive tract hemorrhage. Tuberous angiomas of the digestive tract associated with typical skin lesions as described by Bean led to diagnosis. Endoscopic coagulation with Nd:YAG laser and bipolar electrocoagulation "Bicap" of gastric and colonic angiomas was performed successfully without complication but did not avoid hemorrhagic recurrence originating from lesions located in the small bowel, as demonstrated during laparotomy in one case.

Adult↗
PubMed1989

Parameters affecting laser palliation in patients with advanced digestive cancers.

Ninety-nine nonsurgical patients (group I) with esophagogastric cancer were referred to the laser center for palliation of dysphagia, and another 142 nonsurgical patients (group II) with a rectosigmoid cancer were referred for palliation of abnormal rectal discharge (125 patients) or occlusion (17 patients). The immediate success rate was 83% in group I and 90% in group II. Patients were retreated monthly. The average duration of palliation was 4.3 months +/- 0.5 (+/- standard error) in group I and 9.3 months +/- 0.95 in group II. Complication rate was 4% in group I and 3.4% in group II. Parameters affecting results were found only in group I. Factors that could negatively affect the immediate success rate included annular size of the tumor basis more than two thirds of the circumference, tumor localization at the upper third of the esophagus, and recurrence after a nonlaser treatment. The average duration of improvement after initial success was affected only by the circumferential extension.

Aged↗
PubMed1989

Laser palliation for rectosigmoid cancers.

Lasers are now used in the rectum an colon for treatment of vascular telangiectasia [1], and benign and malignant sessile tumours [2,3]. This paper will describe the results of a 7 years experience with treatment of sessile rectosigmoid cancers.

Adult↗
PubMed1989

Endoscopic laser treatment for rectosigmoid villous adenoma: factors affecting the results.

Endoscopic laser treatment is reported in 264 patients with benign rectosigmoid villous adenomas revealed by biopsy. Patients include 100 who had contraindications to surgery, 60 who had a tumor recurrence after a nonlaser treatment, 101 for whom surgical resection appeared to be too drastic for a tumor found benign on biopsy, and 3 who refused surgery. Two types of lasers were used: the Nd:YAG and the argon laser. In some patients, both lasers were used. Treatment was completed in 226 patients. Total tumor destruction was attained in 92% of them, a carcinoma was detected in 7% on biopsy specimens obtained during laser treatment, and benign villous tissue persisted in 1%. During the average 25.9-mo follow-up period of the patients with total tumor destruction, 13% had a tumor recurrence. Treatment was well-tolerated with no major complications. The circumferential extension of the tumor base was the only factor affecting the duration of treatment, and the rate of complications. The recurrence rate after initial treatment was higher in patients treated for a recurrence after a previous nonlaser treatment than in patients treated only by laser (p = 0.04). It was also higher when the initial histology was low-grade dysplasia than if it was high-grade dysplasia (p = 0.017) and when the tumor was located in the lower or middle rectum as opposed to the upper rectum or sigmoid (p = 0.04). We estimated that the direct cost of laser treatments was 28%-40% of the surgery charges for lesions of identical size in our hospital and 31%-69% at UCLA Center for the Health Sciences. Because treatment is long and difficult and the cancer rate is high, endoscopic laser for patients with a circumferential villous adenoma should be limited to nonsurgical candidates. The risk of a fatal complication after surgery has to be balanced against the risk of undetected carcinoma in the other patients and the indication for endoscopic laser treatment should be discussed case by case.

Adenoma↗
PubMed1987

Palliative treatment of rectosigmoid carcinoma by laser endoscopic photoablation.

Ninety-five patients underwent endoscopic outpatient neodymium:yttrium aluminum garnet or argon laser treatments for palliation (relief of obstruction, control of bleeding or discharge) of rectosigmoid carcinoma at the Lille Multidisciplinary Laser Center. All patients were classified as inoperable because of coincident medical conditions or extent of tumor. Two groups were identified as follows: 10 group 1 patients had exophytic tumors less than 3 cm in diameter, and 85 group 2 patients had more advanced tumors. Local control of the tumor was obtained in all patients in group 1 without complication. Eighty-five percent of group 2 patients were symptomatically improved by the treatment. The survival rate (by life table analysis method) at 24 mo was only 19%, but the percentage of surviving patients who remained symptomatically improved was high [90% (3 mo) to 68% (24 mo)]. Factors influencing improvement or survival rates include the main symptom at the beginning of treatment, reason for choosing laser treatment, and circumferential extent of tumor base. There was one fatal perforation and one perirectal abscess. Laser photoablation was able to locally control small rectosigmoid carcinomas in patients unable to undergo incisional surgery. Laser treatment provided relief of symptoms in inoperable patients with advanced rectosigmoid carcinomas.

Aged↗
PubMed1987

[Palliative treatment of cancer of the esophagus and cardia by laser photo-ablation].

The results of the palliative treatment by laser photo-ablation for esophageal and gastric cancers in 79 nonsurgical patients are reported. The aim of treatment was to relieve dysphagia in 60 patients with an obstructive tumor, to maintain esophageal lumen patency in 8 patients with a nonobstructive tumor, and to completely destroy 11 small tumors. The success rate in the patients with dysphagia was 78 p. 100. Functional improvement lasted as long as patients survived with further treatment required once or twice a month. The best results were obtained in exophytic, non circumferential lesions, and in adenocarcinomas of the esophagogastric junction. The localization at the upper third of the esophagus was associated with poor prognosis. The complication rate was 6.6 p. 100. Eight of the 11 small lesions were completely destroyed, but radiation therapy had been associated in four cases with invasive cancer, one of which recurred after 6 months. No complications occurred in this last group of patients.

Aged↗