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Biomedical subjects

Y François

Publications and source records attributed to Y François.

At least 19 recordsLinked to original sources
PubMed2006

[Rectal amputation by pure perineal approach with laparoscopic colostomy: a palliative therapeutic option for low rectal or anal cancers for elderly patients with multiple comorbidities].

Rectal syndrome caused by locoregional evolution of low rectal cancers and anal cancers is prevented and treated by surgical resection. But, for old patients with multiple tares, carcinologic surgical resection as abdominoperineal amputation can not be considered. Management of rectal syndrome becomes a therapeutic challenge. We reported a prospective serie of 5 patients more than 80 years old with multiple tares, treated by rectal amputation by pure perineal approach with laparoscopic colostomy. This surgery avoided for all patients trying rectal symptoms and maintained acceptable quality of life with fast coming back at home. The palliative treatment of low rectal cancers or anal cancers combining rectal amputation by pure perineal approach with laparoscopic colostomy may be an interesting therapeutic option for patients who cannot undergoing aggressive carcinologic surgical treatment.

Aged↗
PubMed2004

Cytoreductive surgery and intraperitoneal chemohyperthermia for peritoneal carcinomatosis arising from gastric cancer.

HYPOTHESIS: The most common cause of palliative resection and recurrence in gastric cancer is peritoneal seeding. This study evaluates the efficacy of intraperitoneal chemohyperthermia after cytoreductive surgery in patients with peritoneal carcinomatosis arising from gastric cancer. DESIGN: Prospective clinical trial. SETTING: Surgical department at a university academic hospital. PATIENTS: Forty-nine consecutive patients with peritoneal carcinomatosis treated between January 1, 1989, and February 29, 2000. INTERVENTIONS: All patients underwent intraperitoneal chemohyperthermia with mitomycin C (40-60 mg); 21 patients had previously undergone extensive cytoreductive surgery. MAIN OUTCOME MEASURES: Clinicopathologic factors that affect overall survival rates. RESULTS: With median follow-up of 99 months, overall median survival was 10.3 months. Two factors were significant independent predictors of survival by multivariate analysis: preoperative ascites (P =.04) and completeness of cancer resection (CCR) by cytoreductive surgery (P<.001). Median survival was 21.3 months for patients with CCR-0 (macroscopic complete resection) or CCR-1 (diameter of residual nodules <5 mm) and 6.1 months for patients with CCR-2 (diameter of residual nodules >5 mm) (P<.001). Four patients survived longer than 5 years. CONCLUSIONS: An aggressive management strategy combining intraperitoneal chemohyperthermia with cytoreductive surgery is effective for patients with peritoneal carcinomatosis arising from gastric cancer. In highly selected patients (good general status, resectable primary tumor, resectable peritoneal carcinomatosis), this therapy may result in long-term survival.

Adult↗
PubMed2003

Intraperitoneal chemohyperthermia using a closed abdominal procedure and cytoreductive surgery for the treatment of peritoneal carcinomatosis: morbidity and mortality analysis of 216 consecutive procedures.

BACKGROUND: Peritoneal carcinomatosis has been regarded as a lethal clinical entity. Recently, aggressive treatments combining intraperitoneal chemohyperthermia (IPCH) with cytoreductive surgery have resulted in long-term survival in selected patients. The aim of this trial was to analyze the mortality and morbidity of 216 consecutive treatments of peritoneal carcinomatosis by IPCH by using a closed abdominal procedure combined with cytoreductive surgery. METHODS: Between February 1989 and August 2001, 207 patients who underwent 216 IPCH procedures using a closed abdominal procedure with mitomycin C, cisplatin, or both were prospectively studied. RESULTS: The postoperative mortality and morbidity rates were 3.2% and 24.5%, respectively. The most frequent complications were digestive fistula (6.5%) and hematological toxicity (4.6%). Morbidity was statistically linked with the carcinomatosis stage (P =.016), the duration of surgery (P =.005), and the number of resections and peritonectomy procedures (P =.042). Duration of surgery and carcinomatosis stage were the most common predictors of morbidity. CONCLUSIONS: The frequency of complications after IPCH and cytoreductive surgery was mainly associated with the carcinomatosis stage and the extent of the surgical procedure. The IPCH closed abdominal procedure has shown an acceptable frequency of adverse events.

Adult↗
PubMed2001

[A case of recto-urethral fistula in Crohn's disease].

The authors report the fourteenth case of rectourethral fistula associated with Crohn's disease, in a 53-year-old man with a 20-year history of ileocolonic Crohn's disease. The patient developed a rectourethral fistula following an episode of complex anoperineal suppuration surgically exposed on several occasions. Repeated surgical exposure and urine drainage were not sufficient to close the fistula and cure the perineal suppuration. After 10 months, the patient was treated by the rectal mucosal transposition flap technique to close the rectal aspect of the fistula, which ensured cure of the patient's fistula and anoperineal lesions. This technique has been used successfully on 4 occasions and appears to be an effective treatment for rectourethral fistula in Crohn's disease with healthy rectal mucosa.

Crohn Disease↗
PubMed2000

Peritoneal carcinomatosis from non-gynecologic malignancies: results of the EVOCAPE 1 multicentric prospective study.

BACKGROUND: Peritoneal carcinomatosis (PC) is a common evolution of digestive cancer, associated with a poor prognosis. Yet it is poorly documented in the literature. METHODS: Three hundred seventy patients with PC from non-gynecologic malignancies were followed prospectively: the PC was of gastric origin in 125 cases, of colorectal origin in 118 cases, of pancreatic origin in 58 cases, of unknown origin in 43 cases, and of miscellaneous origins in 26 cases. A previously reported PC staging system was used to classify these 370 patients. RESULTS: Mean and median overall survival periods were 6.0 and 3.1 months, respectively. Survival rates were mainly affected by the initial PC stage (9.8 months for Stage I with malignant peritoneal granulations less than 5 mm in greatest dimension, versus 3.7 months for Stage IV with large, malignant peritoneal masses more than 2 cm in greatest dimension). The presence of ascites was associated with poor survival of patients with gastric or pancreatic carcinoma. Differentiation of the primary tumor did not influence the prognoses of patients with PC. CONCLUSIONS: A better knowledge of the natural history of PC is needed, in view of the many Phase I, II, and III trials currently being conducted to evaluate aggressive multimodal therapeutic approaches to treating patients with PC from non-gynecologic malignancies.

Adult↗
PubMed2000

[Stomach adenocarcinoma. Evolution of surgical treatment in a series of 350 cases].

STUDY AIM: The aim of this prospective study was to evaluate, in a series of 350 gastric adenocarcinomas, the evolution of their clinical and histological features and the evolution of their surgical management. PATIENTS AND METHODS: From 1970 to 1996, 350 patients with gastric carcinoma (cardiac cancer excluded) were operated on in the same center. Mean age was 68.8 years and the sex ratio 1:4. These patients were divided into three groups which were analysed and compared (group 1 operated on between 1970 and 1988, group 2 between 1979 and 1987, group 3 between 1988 and 1996). RESULTS: Antropyloric cancer was the most common (56% in group 3). Tumor size decreased but there were in group 3 more undifferentiated tumors (54.2%) and more tumors with lymph node involvement (72%). Stage III and IV tumors were still common (70% in group 3) and early gastric cancer incidence very low (9.9%). After 1980, surgical management was more radical, with more total gastrectomies and larger lymph node dissections. Adjuvant intraoperative and postoperative radiotherapy has been associated since 1985. Postoperative mortality rate decreased (13.8% in group 1 vs 6.1% in group 3) (P = 0.04) as did the postoperative morbidity rate (31.8% in group 1 vs 17.5% in group 3). The five-year actuarial survival rate was respectively 18.9% and 39.2% for groups 1 and 2 (P = 0.003); it was respectively 59.8% and 43.6% for all patients treated by adjuvant radiotherapy and for those with lymph node involvement. CONCLUSION: Prognosis of gastric adenocarcinoma is still poor. A more radical surgical treatment did not increase the postoperative morbidity rate, but increased the survival rate. New adjuvant treatments including radiotherapy have to be evaluated in order to improve the prognosis.

Actuarial Analysis↗
PubMed2000

[Lipid pneumonia and pleural-pulmonary atypical mycobacteriosis].

We report a case of fat deposit pneumonia extending to the parietal pleura with a granulomatous reaction centered on the fat vaculoles. This case was complicated by an atypical and fatal mycobacterial infection caused by Mycobacterium chelonae. The severity of Mycobacterium chelonae infection in fat deposit pneumonia warrants early empirical antibiotic therapy.

Anti-Bacterial Agents↗
PubMed2000

Intraoperative radiotherapy and external beam radiation therapy in gastric adenocarcinoma with R0-R1 surgical resection.

INTRODUCTION: The aims of this study were to evaluate the results of intraoperative radiotherapy (IORT) and external beam therapy (EBRT) in the treatment of gastric adenocarcinoma. METHODS: From 1986 to 1999, 87 patients who underwent surgical resection for gastric adenocarcinoma combined with IORT were reviewed. A R0 surgical resection was performed in 82 patients and five underwent R1 resection. The stage was: pT1 in 12, pT2 in 19, pT3 in 44 and pT4 in seven. Thirteen patients were pN1 and 43 were pN2, The IORT dose ranged from 12 to 23 Gy. Patients with pT3 and/or pN tumours underwent EBRT with a standard dose of 44-46 Gy. RESULTS: The post-operative mortality and morbidity rates were 2.3 and 6.8%, respectively. The 5-year survival rate for R0 patients was 60%, for R0-pN0 was 90% and for R0-pN+ patients was 55%. The local failure rate in the 19 pN+ patients was 21%. CONCLUSION: IORT and EBRT combined with surgical resection may provide overall survival, improving the local control after gastrectomy.

Adenocarcinoma↗
PubMed1999

Alcoholic beverage preferences and self-reported problems in Switzerland.

The study examined sex-specific changes in beverage preference by age group in three Swiss linguistic regions, the relationship between preference and self-reporting of alcohol-related problems, and sociocultural and linguistic influences. A sample of 953, interviewed in 1987, was reinterviewed in 1995. Preference differed by region and remained relatively stable. Only young adults changed, adopting typical regional patterns. Self-reporting, and remission and incidence of problem-reporting, were related to total intake and to changes in total intake, but only at younger ages to changes in preference. Beverage preference has little value as a predictor of self-reporting of problems.

Adolescent↗
PubMed1998

Prophylactic pancreaticoduodenectomy for premalignant duodenal polyposis in familial adenomatous polyposis.

The frequency of duodenal adenomas in patients with, familial adenomatous polyposis is high. Duodenal adenoma has malignant potential, and duodenal adenocarcinoma is one of the main causes of death in patients who have had previous proctocolectomy. A conservative approach to the treatment of duodenal adenomas (nonsteroidal anti-inflammatory drugs, endoscopy, polypectomy through duodenotomy) is inefficient and unsafe. When invasive cancer occurs in duodenal adenomas, the result of surgery is poor. We have performed prophylactic pancreaticoduodenal resection (PDR) for nonmalignant severe duodenal polyposis in five patients since 1991. No operative mortality was observed. One patient developed a pancreatic fistula which was successfully managed by medical treatment. The mean follow-up was 35 months. All five patients are still alive and have a good functional outcome. Prophylactic PDR may be indicated in familial adenomatous polyposis when duodenal polyposis is severe. Stages III and IV of Spigelman's classification, periampullary adenoma, age above 40, and family history of duodenal cancer are factors that may lead to the decision to perform prophylactic PDR.

Adenoma↗
PubMed1998

Respiratory mechanics during laparoscopic cholecystectomy: the effects of the abdominal wall lift.

UNLABELLED: The abdominal wall lift (AWL) has been proposed for laparoscopic cholecystectomy to reduce hemodynamic effects caused by carbon dioxide (CO2) and high intraabdominal pressures (IAP). Data concerning effects of AWL on respiratory mechanics are scant. We therefore used a noninvasive method to evaluate whether the AWL could offset these effects. The PETCO2, airflow, and airway pressure were continuously measured in nine patients undergoing laparoscopic cholecystectomy using an AWL with minimal CO2 insufflation. We used a least-squares method to calculate maximal airway pressure (Pmax), elastance (Ers), and resistances (Rrs) of the respiratory system. After CO2 insufflation, the initiation of AWL resulted in a significantly decreased IAP (from 13 to 6 mm Hg; P < 0.001) and Rrs (from 20.6 to 17.8 cm H2O.L(-1).s(-1); P = 0.029), whereas Ers was partly modified (34.0 to 33.3 cm H2O/L; not significantly different). With AWL, we hypothesized that the diaphragm remained flat and stiff, outweighing the beneficial effect of the decrease of IAP on Ers. PETCO2 significantly increased after AWL and at the end of the procedure. We conclude that AWL partly reverses the impairment of the respiratory mechanics induced by CO2 insufflation during laparoscopic surgery. IMPLICATIONS: The abdominal wall lift (AWL), acting on the abdominal chest wall, had some benefits during laparoscopic surgery by limiting CO2 peritoneal insufflation and several side effects, such as hemodynamics. We examined the consequences of this technique on respiratory mechanics in nine patients undergoing laparoscopic cholecystectomy. Our findings suggest that the AWL decreases intraabdominal pressure and respiratory resistances without a significant effect on respiratory elastance.

Abdomen↗
PubMed1998

Discordant public perception of doping in elite versus recreational sport in Switzerland.

OBJECTIVE: To assess public awareness of performance-enhancing drug use, that is, doping in sport in Switzerland. DESIGN: Representative telephone survey in September 1995. SETTING: Two of the three Swiss linguistic areas (French and German), representing 96% of the entire Swiss population. SUBJECTS: A total of 1201 respondents between 18 to 74 years old, selected by stratified random sampling. MAIN OUTCOME MEASURES: Perception of the doping problem in elite versus recreational sport, estimated prevalence of doping in different sports, parents' decisions to keep children out of sport because of doping. RESULTS: The use of doping in sport was perceived as a "somewhat serious problem" or "very serious problem" by 84% of the respondents for elite sport and by 44% for recreational sport (p < 0.01 for difference). Doping was mostly perceived to represent a physical health problem or an ethical problem. Track and field (79%) and cycling (27%) were most often cited as sports having doping problems, and 35% of the respondents believed that > 60% of bodybuilders use doping. The black market (91%), athletes and trainers (80%), and fitness centers (74%) were the most frequently mentioned sources of doping substances. Thirteen of 14 parents would not dissuade their children from participating in sport because of a concern about the problems of doping. CONCLUSIONS: The Swiss population perceives a high prevalence of doping in sports. There is a clear distinction, however, made by the respondents between the estimated prevalence of doping in elite sport, seen overwhelmingly as a "very serious problem" or "somewhat serious problem," and recreational sport, in which doping is less often seen as a problem. Doping is considered a serious threat to health and ethics in sport, but despite this judgment, only a few parents would hold back their children from sport because of the risks of doping.

Adolescent↗
PubMed1998

Prevention of lymphorrhea by means of fibrin glue after axillary lymphadenectomy in breast cancer: prospective randomized trial.

A prospective randomized trial was carried out to evaluate the efficacy of fibrin glue in preventing lymphorrhea after axillary lymphadenectomy in breast cancer. One hundred and eight breast cancer patients, operated on by two senior surgeons, were randomized into two groups: group 1 (n = 58) without fibrin glue and group 2 (n = 50) with 2 ml of fibrin glue applied to the axillary dissection area at the end of the lymphadenectomy procedure. Early postoperative morbidity was 2/58 and 0/50 in groups 1 and 2, respectively. Mean daily postoperative drainage was significantly greater in group 1. The mean cumulative drainage quantity 6 days after the operation was 407.8 ml and 214.4 ml in groups 1 and 2, respectively (p = 0.001). The mean postoperative hospital stay was 10.1 days and 8.0 days in groups 1 and 2, respectively (p = 0.006). One delayed seroma was observed in each group. Fibrin glue seems to reduce daily postoperative drainage and hospital stay, but did not affect delayed seroma formation after axillary lymphadenectomy for breast cancer.

Aged↗
PubMed1997

[Screening for problem alcohol drinking in the Swiss population: comparison between an ISPA-developed instrument and the CAGE questionnaire. The Swiss Institute for the Prevention of Alcoholism].

In 1987, the Swiss Institute for the Prevention of Alcohol and Drug Problems (SIPA) developed a set of questions on alcohol-related problems in the general population. The aim of this article is to study the results of the questionnaire used as a screening instrument to detect problem drinking in the Swiss population, and to compare it with the CAGE test. The sample consisted of 953 people aged 20 or over. Among the drinkers (89% of the sample), 91 males (21.7%) and 34 females (8.7%) had a positive SIPA test and 53 males (12.7%) and 17 females (4.3%) a positive CAGE test. The SIPA test was more sensitive than the CAGE in detecting persons who drink regularly and quite heavily but without binge drinking. The item "Eye-opener" of the CAGE is too blunt for application to the Swiss general population and could with advantage be removed from the questionnaire. Females tend to deny alcohol problems much more than males. Binge drinking increases the risk of a positive test (SIPA: OR: 1.9; i.c. 95%: 1.2-3.0; CAGE: OR: 3.3; i.c. 95%: 1.8-6.0). In short, the SIPA test is more suitable in estimating the number of problem drinkers in the Swiss population than the CAGE, which was initially developed for the American medical population. Furthermore, the results suggest the necessity of using a different cut-off for each gender.

Adult↗