Biomedical subjects

Y Francois

Publications and source records attributed to Y Francois.

17 recordsLinked to original sources

PubMed2003

Small bowel length in Crohn's disease.

BACKGROUND AND AIMS: This prospective study compared jejunoileal length in patients with Crohn's disease (CD) and the general population to determine whether this parameter can be related to outcome and management of CD complications. PATIENTS AND METHODS: Small bowel (SB) length was measured during abdominal surgery prior to bowel resection in 93 patients with CD and 92 patients without inflammatory or small bowel disease. RESULTS: SB length was shown to be shorter in patients with CD (462 vs. 567 cm) and was correlated to sex and height. There was no correlation of SB length to clinical expression (perforating or nonperforating), site, or outcome. SB length is not a prognosis factor of postoperative relapse. The presence of perineal disease and systemic abnormalities seem to be the only prognostic factors of surgical recurrence. Sex, age at onset, time of first surgery, site of disease, and mode of onset are not predictive of surgical recurrence. CONCLUSION: We recommend minimal intestinal resection when surgical treating CD complications in patients at high risk of surgical relapse and initial short SB. We advise using stricturoplasty or leaving asymptomatic intestinal lesions to reduce short bowel syndrome occurrence when performing iterative surgery.

Adult↗

PubMed2003

Surgery combined with peritonectomy procedures and intraperitoneal chemohyperthermia in abdominal cancers with peritoneal carcinomatosis: a phase II study.

PURPOSE: To evaluate the tolerance of peritonectomy procedures (PP) combined with intraperitoneal chemohyperthermia (IPCH) in patients with peritoneal carcinomatosis (PC), a phase II study was carried out from January 1998 to September 2001. PATIENTS AND METHODS: Fifty-six patients (35 females, mean age 49.3) were included for PC from colorectal cancer (26 patients), ovarian cancer (seven patients), gastric cancer (six patients), peritoneal mesothelioma (five patients), pseudomyxoma peritonei (seven patients), and miscellaneous reasons (five patients). Surgeries were performed mainly on advanced patients (40 patients stages 3 and 4 and 16 patients stages 2 and 1) and were synchronous in 36 patients. All patients underwent surgical resection of their primary tumor with PP and IPCH (with mitomycin C, cisplatinum, or both) with a closed sterile circuit and inflow temperatures ranging from 46 degrees to 48 degrees C. Three patients were included twice. RESULTS: A macroscopic complete resection was performed in 27 cases. The mortality and morbidity rates were one of 56 and 16 of 56, respectively. The 2-year survival rate was 79.0% for patients with macroscopic complete resection and 44.7% for patients without macroscopic complete resection (P =.001). For the patients included twice, two are alive without evidence of disease, 54 and 47 months after the first procedure. CONCLUSION: IPCH and PP are able to achieve unexpected long-term survival in patients with bulky PC. However, one must be careful when selecting the patients for such an aggressive treatment, as morbidity rate remains high even for an experienced team.

Adenocarcinoma↗

PubMed2003

Pattern of failures in gastric cancer patients with lymph node involvement treated by surgery, intraoperative and external beam radiotherapy.

AIMS: High local failure rates in gastric cancer have been reported, up to 67%. To achieve a better local control, we evaluated intraoperative radiotherapy (IORT) and external beam radiotherapy (EBRT) in association with surgery for gastric cancer patients with lymph node involvement. We report here the analysis of the patterns of failure for patients involved in this IORT protocol. MATERIAL AND METHODS: Forty-two positive lymph node (N+) gastric cancer patients were operated on (31 total, three subtotal and eight extended gastrectomies) with IORT procedure between 1985 and 1997 (33 males, nine females, mean age 61.3 years). IORT was focused on coeliac area (mean dose 15 Gy), followed by EBRT (46 Gy) in 36 patients. Ten patients were pN1 and 32 were pN2. A concurrent systemic chemotherapy (five Fluoro-Uracil and Cisplatinum) was performed in 14 patients. RESULTS: One patient died postoperatively. Actuarial pN+ 10 year survival rate was 44.8%. The 5 year actuarial local control and disease-free survival rates were 78.8 and 47.5%, respectively. As far as patterns of failure were explored, 5 patients have a local coeliac recurrence (12%) and 12 have distant metastases with no evidence of coeliac recurrence. CONCLUSION: This retrospective analysis suggests a potential effect of IORT and/or EBRT in promoting local control and long-term survival in gastric cancer patients with lymph node involvement.

Adenocarcinoma↗

PubMed2001

[Segmental resection of tumoral invasion of the inferior vena cava without reconstruction].

STUDY AIM: Oncological complete surgery of retroperitoneal tumours may require segmental resection of part of the invaded inferior vena cava. The aim of this retrospective study was to assess whether reconstruction of the inferior vena cava is necessary and presents any advantage. PATIENTS AND METHODS: This study included four patients who underwent partial resection of the inferior vena cava invaded by a retroperitoneal tumour, without reconstruction. Tumours were one renal cancer, one malignant phaeochromocytoma, one malignant retroperitoneal histiofibroma and one undifferentiated retroperitoneal carcinoma. The resection was located at the level of the renal confluence, associated with right nephrectomy, in 3 patients, and above this confluence, at the level of the retrohepatic inferior vena cava in 1 patient. RESULTS: Only one case of transient acute renal failure was observed during the postoperative course. One patient developed right deep vein thrombosis after three months and another one after 30 months. One patient died from cancer recurrence after 19 months. The other 3 patients were alive with anticoagulant therapy and without sequelae after 3, 6 and 15 years.

Acute Kidney Injury↗

PubMed2000

Intraperitoneal chemohyperthermia with mitomycin C for digestive tract cancer patients with peritoneal carcinomatosis.

BACKGROUND: Most patients with peritoneal carcinomatosis of digestive tract origin die within 6 months. Intraperitoneal chemohyperthermia (IPCH) associated with surgery has been reported as a possible new therapeutic approach. METHODS: A prospective Phase II trial was carried out with 83 patients who had digestive tract cancer and peritoneal carcinomatosis to evaluate the tolerance and efficacy of IPCH with mitomycin C (MMC) associated with surgery. Eighty-six IPCH treatments with MMC were given as complementary therapy after surgery (peritoneal perfusate with a 10 mg/L dose of MMC; inflow temperature, 46-49 degrees C; use of a closed circuit; duration, 90 minutes). Primary tumors were mainly gastric (in 42 cases) or colorectal (in 27 cases). RESULTS: Mortality and morbidity occurred in 3 of 83 cases and 8 of 83 cases, respectively. For patients with resectable tumors, the median survival time was 16 months when carcinomatosis was Stage I and II (malignant granulations less than 5 mm in greatest dimension), whereas it was 6 months when carcinomatosis was Stage III and IV (malignant granulations more than 5 mm in greatest dimension). For patients with resectable gastric cancer and Stage I and II carcinomatosis, 1-, 2-, and 3-year actuarial survival rates were 80%, 61%, and 41%, respectively, whereas the rate was 10% at 1 year for patients with bulky disease (Stage III and IV). CONCLUSIONS: IPCH appears to be a promising new approach to treating patients with digestive tract cancers and peritoneal carcinomatosis with small, malignant granulations (Stage I and II).

Adult↗

PubMed2000

Outcome of ileal pouch after secondary diagnosis of Crohn's disease.

Ileal-pouch anal anastomosis is sometimes performed inappropriately in Crohn's disease patients. The aim of this study was to evaluate long-term results in this subset. In 54 ileal-pouch anal anastomoses performed between 1985 and 1997 for CUD the patient was eventually diagnosed as having Crohn's disease in seven cases. A retrospective review was performed. Definitive diagnosis was established on histopathology, endoscopy, and clinical presentation. The principal outcome factors were pouch failure, reason for failure, and functional results in cases of retained pouch. Patients ranked their quality of life between 1 and 10. We found three failures due to pelvic abscess, anoperineal disease, and anovulvar fistula. The pouch was excised in the latter patient; four patients retained their pouch. Functional results were good in the four (7 year follow-up): 7.25 bowel movements per day, ability to discriminate flatus from feces in three, soiling in one, urgency in one, perianal pad in one, ability to differ bowel movement for 66 min, diet, and antidiarrheal medication all four, pouchitis in one, sexual troubles in one woman, no urinary or obstetric trouble. Quality of life was judged satisfactory by six of the seven patients. Our 13% rate of inadvertent ileal-pouch anal anastomosis is higher than results usually reported. This difference is explained by the diagnostic criteria, whose validity is controversial. Three-stage surgery to decrease inadvertent restorative coloproctectomy is worth considering. Even if results are good when the pouch is functioning, Crohn's disease remains a contraindication to ileal-pouch anal anastomosis because of its high rate of failure and excision.

Adolescent↗

PubMed2000

[Gallbladder cancers discovered fortuitously].

STUDY AIM: The aim of this retrospective study was to report a series of 12 carcinomas of the gallbladder diagnosed on the histological examination of specimens after cholecystectomy. PATIENTS AND METHODS: From 1986 to 1996, 784 cholecystectomies were performed in the same center and 12 unexpected carcinomas of the gallbladder were histologically diagnosed (11 adenocarcinomas and one epidermoid carcinoma; one pT1, five pT2 and six pT3). There were nine women and three men (mean age: 72 years) with symptoms in relation with lithiasis. Complementary treatments were: intraoperative radiation therapy (IRT) plus external beam radiation therapy (ERT) in two cases (one pT1 and one pT2), surgery for a 2 cm deep excision of the liver bed plus lymph node dissection plus IRT and ERT in three cases (three pT3), ERT plus chemotherapy in one case (one pT3), no complementary treatment in six cases (four pT2 and two pT3). RESULTS: One patient died on day 30 from acute respiratory failure. There was no morbidity. One patient died at 7 months from intercurrent disease. The mean survival rate for patients with pT1 and pT2 tumors was 45 months (with two recurrences at 1 year and 3 years) and for patients with pT3 tumors, 6.7 months. CONCLUSION: Unexpected carcinomas of the gallbladder were recognized in 1.5% of specimens after cholecystectomy for lithiasis. In pT1 tumors, a simple cholecystectomy is sufficient. In pT2 and pT3, a liver resection with lymph node dissection is required, eventually associated with radiation therapy. Laparoscopic cholecystectomy is contraindicated in case of pre- or peroperative suspicion of a gallbladder carcinoma because of the risk of port site recurrences.

Adenocarcinoma↗

PubMed1999

Influence of the interval between preoperative radiation therapy and surgery on downstaging and on the rate of sphincter-sparing surgery for rectal cancer: the Lyon R90-01 randomized trial.

PURPOSE: The optimal timing of surgery after preoperative radiotherapy in rectal cancer is unknown. The aim of this trial was to evaluate the role of the interval between preoperative radiotherapy and surgery. PATIENTS AND METHODS: Patients with rectal carcinoma accessible to rectal digital examination, staged T2 to T3, NX, M0, were randomized before radiotherapy (39 Gy in 13 fractions) into two groups: in the short interval (SI) group, surgery had to be performed within 2 weeks after completion of radiation therapy, compared with 6 to 8 weeks in the long interval (LI) group. Between 1991 and 1995, 201 patients were enrolled onto the study. RESULTS: A long interval between preoperative radiotherapy and surgery was associated with a significantly better clinical tumor response (53. 1% in the SI group v 71.7% in the LI group, P =.007) and pathologic downstaging (10.3% in the SI group v 26% in the LI group, P =.005). At a median follow-up of 33 months, there were no differences in morbidity, local relapse, and short-term survival between the two groups. Sphincter-preserving surgery was performed in 76% of cases in the LI group versus 68% in the SI group (P = 0.27). CONCLUSION: A long interval between preoperative irradiation and surgery provides increased tumor downstaging with no detrimental effect on toxicity and early clinical results. When sphincter preservation is questionable, a long interval may increase the chance of a successful sphincter-saving surgery.

Adenocarcinoma↗

PubMed1998

The role of radiotherapy in the conservative treatment of rectal carcinoma--the Lyon experience.

The purpose of this study was to present the Lyon experience using radiotherapy alone or with surgery, with intent to cure rectal cancer and to avoid rectal amputation. Two groups of patients were treated between 1980 and 1996: Group I with radiotherapy alone with contact x-ray for T1 N0 (101 patients) or with a combination of external beam radiation therapy (EBRT), contact x-ray and 192 iridium implant in inoperable T2-3 N0-1 patients (43 patients); Group II with preoperative EBRT either as a pilot study (158 patients) or in a randomized trial (210 patients). With contact x-ray alone it was possible to control T1 N0 in 90% of cases, and with the combined approach 70% of the inoperable patients were controlled. In Group II, anterior resection was performed in 60% to 70% of the patients. Local recurrence was seen in 11% of cases. Surgery is the basic treatment used for rectal cancer but radiotherapy is playing an increasing role in the conservative treatment of this cancer.

Adenocarcinoma↗

PubMed1997

Intraoperative radiation therapy combined with limited lymph node resection in gastric cancer: an alternative to extended dissection?

PURPOSE: To describe the results of a series of 63 Western patients presenting with gastric adenocarcinoma and treated with surgery and intraoperative radiation therapy (IORT) over a 8-year period and to discuss the role of IORT when combined with limited lymph node dissection. METHODS AND MATERIALS: From 1986 to 1993, 63 patients with gastric adenocarcinoma have been operated in the department of radiation oncology of the Hospices Civils de Lyon. The stage was: I in 17, II in 11, IIIA in 9, IIIB in 20, and IV in 6. The lymph node dissection was considered to be limited in 56 patients and extended in 7. The IORT dose ranged from 12 to 23 Gy (median: 15). Thirty patients also underwent a postoperative external beam irradiation with a standard dose of 44-46 Gy. RESULTS: The postoperative mortality rate was 4.8%. The 5-year overall survival in the entire series was 47% and was 82, 55, 78, 20, and 0% in Stages I, II, IIIA, IIIB, and IV, respectively. Loco-regional relapse occurred in 15 of 63 patients and metastases in 15 of 63. CONCLUSION: In Western patients treated by gastrectomy for adenocarcinoma of the stomach, IORT combined with limited lymph node dissection may provide overall survival similar to that observed after gastrectomy with extended lymph node dissection but with less postoperative mortality.

Adenocarcinoma↗

PubMed1994

Postoperative adhesive peritoneal disease. Laparoscopic treatment.

The aim of this prospective study was to judge the efficiency of laparoscopic adhesiolysis: 52 patients have been treated laparoscopically either for obstruction (group 1: 17 patients) or for chronical abdominal pain (group 2: 35 patients). Two out of five peroperative complications required a laparoconversion whereas two postoperative complications required a laparotomy for intestinal obstruction. Six patients of group 1 developed a recurrence of obstruction treated by laparoscopy in four and by laparotomy in two cases. At the time of the study (among 50 patients with a mean follow-up of 24 months), 32 patients were asymptomatic, 13 found that their symptoms had lessened, and finally, five patients were not improved. We concluded that laparoscopic adhesiolysis is an attractive surgical procedure, allowing a clinical improvement in 45 out of 50 patients in our study.

Abdominal Pain↗

PubMed1990

Conservative treatment of low rectovaginal fistula in Crohn's disease.

A conservative operative treatment of anovaginal fistula in Crohn's disease is described. This consists of simply laying open the fistula with section of the rectovaginal septum and the portion of external sphincter superficial to the fistula. The operation may be performed in the presence of rectal involvement even during an acute exacerbation of the disease; a temporary defunctioning stoma is not required. The fistula was of the high transsphincteric type in three patients and low transsphincteric in six. All wounds healed in less than 3 months without any further surgery. At a mean follow-up of 29 months, 6 had perfect continence and 3 could control solid but not liquid stools nor flatus.

Adult↗

PubMed1989

Small intestinal obstruction complicating ileal pouch-anal anastomosis.

Small bowel obstruction remains the most common complication after proctocolectomy with ileal pouch-anal anastomosis. Of 626 patients who underwent this operation between January 1981 and October 1986 for ulcerative colitis (544 patients), familial adenomatous polyposis (72 patients), or indeterminate colitis (ten patients), 17% developed small bowel obstruction, 7.5% of whom required surgical intervention. The obstruction occurred either before or after closure of the temporary ileostomy. Patients who had a temporary Brooke ileostomy were more likely to develop obstruction (four of 32 patients, 12.5%) than those who had a loop ileostomy (25 of 564 patients, 4.6%) (p = 0.07). Also, patients who had had previous operations were at greater risk of obstruction (8.5%) than those who had not (2.2%) (p less than 0.04).

Adenomatous Polyposis Coli↗

PubMed1984

[Hydatid cyst of the psoas muscle. Diagnosis using the CT scanner].

A 30-year-old Maroccan man was admitted with a swelling in the right iliac fossa and right flank. Serology gave negative results but ultrasonography and CT scan images were suggestive of a hydatid cyst of the psoas muscle. A cystectomy was followed by total recovery. Hydatid cysts are rarely detected in France and their clinical and diagnostic characteristics are discussed. Ultrasonography and particularly CT scaner imaging are effective diagnostic procedures, avoiding unnecessary needle punctures and enabling adequate therapeutic measures to be instituted.

Adult↗

PubMedDate not supplied

Intraperitoneal chemo-hyperthermia with mitomycin C for gastric cancer patients with peritoneal carcinomatosis.

OBJECTIVE: This study evaluates the tolerance and efficacy of Intraperitoneal Chemo-hyperthermia (IPCH) with Mitomycin C (MMC) associated with surgery, in peritoneal carcinomatosis of gastric origin. BACKGROUND: Most patients with peritoneal carcinomatosis of gastric origin die within 6 months, and IPCH associated with surgery has been reported as a possible new therapeutic approach. METHODS: A prospective non randomized trial was carried out on 42 patients with gastric cancers and peritoneal carcinomatosis. Fourty-three IPCH with MMC were used as complementary treatment after surgery (peritoneal perfusate with a 10 mg/l dose of MMC, inflow temperature 46 to 49 degrees C, use of a closed circuit, duration 90 minutes). Fourteen primary tumors were unresectable ones and 12 patients had large malignant preoperative ascites. RESULTS: Mortality and morbidity rates were 2/42 and 4/42 respectively. For resectable gastric cancers with stage 1 and 2 carcinomatosis (malignant granulations less than 5 mm in diameter), one, two and three year survival rates were 80, 61 and 41% respectively. For unresectable primary tumors and for stage 3 and 4 carcinomatosis (granulations larger than 5 mm in diameter), six and twelve month survival rates were 50% and 10% respectively. CONCLUSIONS: IPCH appears as a safe new therapeutic approach in gastric cancers with peritoneal carcinomatosis with small malignant granulations (stage 1 and 2) and randomized trials are now needed to clearly evaluate its efficacy.

Aged↗

PubMedDate not supplied

Peritonectomy combined with intraperitoneal chemohyperthermia in abdominal cancer with peritoneal carcinomatosis: phase I-II study.

OBJECTIVE: To evaluate the feasibility and the tolerance of Peritonectomy Procedure (PP) combined with Intraperitoneal Chemohyperthermia (IPCH) in patients with peritoneal carcinomatosis, a phase I-II study has been realised from January 1997 to September 1998. METHODS: Eighteen patients were included for peritoneal carcinomatosis from colorectal cancer (13), ovarian cancer (2), gallbladder cancer (1), gastric cancer (1) and peritoneal mesothelioma (1). Peritoneal carcinomatosis were mainly advanced disease (16 stage 3 and 4, 2 stage 2). All the patients underwent surgical resection of their primary tumor with PP as described by Sugarbaker and IPCH (with Mitomycin C, Cisplatinum or both). IPCH used in this study was a "closed sterile circuit" device with inflow temperatures ranging from 46 to 48 degrees C. IPCH was performed on the same day as PP (8118) or delayed (10/18). RESULTS: Significant down-staging of peritoneal carcinomatosis was achieved for 16 patients. One patient died postoperatively, while the morbidity rate was 6/18 (long postoperative ileus, grade 3 leucopenia and anastomotic leakage). CONCLUSIONS: Combination of PP and IPCH could achieve significant tumoral volume reduction in peritoneal carcinomatosis. This aggressive treatment must be employed selectively because of its morbidity. Larger phase III studies are now needed.

Abdominal Neoplasms↗

PubMedDate not supplied

Effects of oral and subarachnoid clonidine on spinal anesthesia with bupivacaine.

This study was designed to determine whether clonidine has analgesic properties, decreases the minimum alveolar concentration of inhalational anesthetics, or affects the quality and the duration of spinal anesthesia with bupivacaine. The comparative effects of oral and subarachnoid clonidine on spinal anesthesia with bupivacaine were studied in 36 patients scheduled for orthopedic surgery. Patients were allocated randomly into four groups to receive either oral diazepam (10 mg in Groups I and II) or oral clonidine (150 micrograms and 300 micrograms in Groups III and IV, respectively), as premedication. Spinal anesthesia was performed with 15 mg hyperbaric bupivacaine 0.5% plus either 1 ml isotonic saline in Groups I, III, and IV, or 150 micrograms clonidine in Group II. Subarachnoid but not oral clonidine significantly prolonged the duration of sensory block (time for regression to L2 was 157 +/- 21 minutes in Group I and 267 +/- 75 minutes in Group II) and the duration of motor block (duration of Grade 3 motor block--Bromage scale--was 103 +/- 20 minutes in Group I and 175 +/- 68 minutes in Group II). Only the subarachnoid administration of clonidine achieves adequate concentrations to significantly increase the duration of spinal anesthesia.

Administration, Oral↗