Jean-louis Frossard - Academia.edu (original) (raw)
Papers by Jean-louis Frossard
American Journal of Physiology-Gastrointestinal and Liver Physiology, 1999
The mechanisms responsible for intrapancreatic digestive enzyme activation as well as the relatio... more The mechanisms responsible for intrapancreatic digestive enzyme activation as well as the relationship between that activation and cell injury during pancreatitis are not understood. We have employed an in vitro system in which freshly prepared pancreatic acini are exposed to a supramaximally stimulating concentration of the CCK analog caerulein to explore these issues. We find that in vitro trypsinogen activation depends on the continued presence of Ca2+in the suspending medium and that it is half-maximal in the presence of 0.3 mM Ca2+. Caerulein-induced trypsinogen activation can be halted by removal of Ca2+from the suspending medium or by chelation of intracellular Ca2+. Increasing intracellular Ca2+with either ionomycin or thapsigargin does not induce trypsinogen activation. We have monitored cell injury by measuring the leakage of lactate dehydrogenase (LDH) from acini and by quantitating intercalation of propidium iodide (PI) into DNA. Leakage of LDH and intercalation of PI in...
Scientific Reports
Our objective was to describe the etiologies of acute colitis and to identify patients who requir... more Our objective was to describe the etiologies of acute colitis and to identify patients who require diagnostic endoscopy. Patients with symptoms of gastrointestinal infection and colonic inflammation on CT were prospectively included. Those immunosuppressed, with history of colorectal cancer or inflammatory bowel disease (IBD), were excluded. Microbiological analysis of the feces was performed using PCR assays BD-Max and FilmArray (GI panel,) and fecal cultures. Fecal calprotectin was determined. Patients with negative BD-Max underwent colonoscopy. One hundred and seventy-nine patients were included. BD-Max was positive in 93 patients (52%) and FilmArray in 108 patients (60.3%). Patients with infectious colitis (n = 103, 57.5%) were positive for Campylobacter spp. (n = 57, 55.3%), Escherichia coli spp. (n = 8, 7.8%), Clostridioides difficile (n = 23, 22.3%), Salmonella spp. (n = 9, 8.7%), viruses (n = 7, 6.8%), Shigella spp. (n = 6, 5.8%), Entamoeba histolytica (n = 2, 1.9%) and othe...
BackgroundReshaping the tumor microenvironment by novel immunotherapies represents a key strategy... more BackgroundReshaping the tumor microenvironment by novel immunotherapies represents a key strategy to improve the treatment of cancers. Nevertheless, responsiveness to these treatments is often correlated with the extent of the T cell infiltration at the tumor site. Remarkably, microsatellite stable rectal cancer is characterized by poor infiltration and, therefore, do not respond to immune checkpoint blockade. To date, the only available curative option for these patients relies on extensive surgery. With the aim to broaden the application of promising immunotherapies, it is necessary to develop alternative approaches to promote T cell infiltration into the tumor microenvironment of these tumors. In this regard, recent evidence shows that radiotherapy may have profound immunostimulatory effects, hinting at the possibility of combining it with immunotherapy. The combination of long-course chemoradiotherapy and immunotherapy was recently shown to be safe and yielded promising results ...
Hepatology Communications, 2021
Acute alcoholic microvesicular steatosis (MIC) may complicate heavy alcohol intake and present as... more Acute alcoholic microvesicular steatosis (MIC) may complicate heavy alcohol intake and present as alcoholic hepatitis (AH) syndrome. However, detailed clinical, biological, and histologic data associated with MIC are scarce. We compared the clinical presentation, histologic features, and hepatic transcriptomic of patients presenting with AH due to either MIC or severe alcoholic steatohepatitis (ASH). In this case‐control study, patients who drank heavily (>100 g/day) with the AH syndrome were included either in the MIC group (>50% severe microvesicular steatosis, no inflammation) or in the severe ASH group (polynuclear neutrophil infiltration, macrosteatosis, ballooned hepatocytes). All patients received standard supportive care plus steroids for those with severe ASH and were followed up for 3 months. Whole‐liver transcriptome profiling was performed on liver snap‐frozen biopsies. Compared to ASH (n = 24, mean age 49.3 years), patients in the MIC group (n = 12, mean age 49.1 ...
Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver, 2017
Perioperative chemotherapy improves the prognosis of patients with locoregionally advanced resect... more Perioperative chemotherapy improves the prognosis of patients with locoregionally advanced resectable gastric and gastro-esophageal junction adenocarcinoma. Nevertheless, only 50% of operated patients could receive the postoperative component chemotherapy. An exclusive preoperative chemotherapy is therefore an interesting strategy. We report the clinical course of patients with operable gastric and gastroesophageal junction adenocarcinoma treated with an intention of exclusive preoperative chemotherapy. The medical records of all consecutive patients with an operable gastric or gastroesophageal junction adenocarcinoma and treated with an intention of exclusive preoperative chemotherapy were analysed. Between 1999 and 2014, 90 eligible patients were identified. Fifty-eight patients (64%) presented with clinical T3-T4 tumour and 63 (70%) had a lymph node involvement. Eighty (90%) patients were treated with 4 cycles of preoperative chemotherapy containing docetaxel, 5-fluorouracil (5FU...
Annales de Chirurgie, 2006
Disponible sur internet le 27 juin 2006 Résumé La maladie de Crohn peut toucher l'ensemble du tra... more Disponible sur internet le 27 juin 2006 Résumé La maladie de Crohn peut toucher l'ensemble du tractus digestif, mais il est rare qu'elle se révèle par une atteinte duodénale. Nous décrivons ici le cas d'un homme de 22 ans qui débutait sa maladie de Crohn par une sténose duodénale symptomatique, entraînant une dénutrition sévère. Le traitement médical ayant échoué, et le bilan endoscopique ayant confirmé le diagnostic, le patient était opéré et bénéficiait d'une gastroentéroanastomose sur anse en Y selon Roux. Les suites opératoires étaient favorables permettant au patient de s'alimenter à nouveau normalement. Cette présentation clinique rare, permet de discuter la stratégie chirurgicale en cas d'atteinte isolée du cadre duodénal par une maladie inflammatoire chronique de l'intestin.
Annals of Surgery, 2010
The aim of this study was to compare open and laparoscopic sigmoid resection for diverticulitis w... more The aim of this study was to compare open and laparoscopic sigmoid resection for diverticulitis with the patient and the nursing staff blinded to the surgical approach. Méthode: 113 patients scheduled for an elective sigmoidectomy were randomised to receive either a traditional open (54 patients) or a laparoscopic (59 patients) approach. Postoperatively, an opaque wound dressing was applied and left in place for 4 days, and patients from both groups were managed similarly. The primary endpoints for analysis were; 1) postoperative pain; 2) duration of postoperative ileus; and 3) duration of hospital stay (ClinicalTrials.gov, number NCT 00453830). Résultats: The median duration of procedure was 165 minutes (range 90-285) in the laparoscopy group and 110 minutes (range 70-210) in the open group (p<0.0001). The median delay between surgery and first bowel movement was 76 (range 31-163) hours in the laparoscopy group versus 105 (range 53-175) hours in the open group (p<0.0001). The median score for maximal pain (assessed by a Visual Analog Scale) was 4 (range 1-10) the laparoscopy group and 5 (range 1-10) in the open group (p=0.05). Finally, the median duration of hospital stay was 5 days [range 4-69] in the laparoscopy group versus 7 days (range 5-17) in the open group (p<0.0001). Conclusion: Laparoscopic sigmoid resection is associated with a 30% reduction in duration of postoperative ileus and hospital stay; by comparison, benefits in terms of postoperative pain appear less impressive, when the patient is blinded to the surgical technique.
Annals of Internal Medicine, 1997
ABSTRACT Current methods for detecting mediastinal lymph node involvement with non-small-cell lun... more ABSTRACT Current methods for detecting mediastinal lymph node involvement with non-small-cell lung cancer can be inaccurate and are often invasive and expensive. To assess the utility of endoscopic ultrasonography, fine-needle aspiration biopsy guided by endoscopic ultrasonography, and computed tomography for the detection of metastases to the posterior mediastinal lymph nodes in non-small-cell lung cancer. Prospective preoperative evaluation of the diagnostic operating characteristics of these procedures. Referral-based academic medical center. 130 consecutive patients with non-small-cell lung cancer who were otherwise good surgical candidates. All patients had initial computed tomography of the chest; those with enlarged nodes were referred for endoscopic ultrasonography. Endoscopic ultrasonography-guided fine-needle aspiration biopsy was done on suspicious contralateral posterior mediastinal or subcarinal lymph nodes identified by ultrasonography. At surgery, lymph nodes were dissected and categorized by location and underwent histopathologic evaluation. 52 patients were ultimately enrolled in the study: Thirty-one had thoracotomy with mediastinal dissection, and 21 had tumors considered unresectable on the basis of preoperative evaluation. Ultrasonography without aspiration biopsy had an overall accuracy of 84% for predicting metastasis to lymph nodes; computed tomography had an accuracy of 49% (P < 0.025). Twenty-four patients had ultrasonography-guided aspiration biopsy; 14 of 24 were ineligible for surgery because cytology showed malignancy. Results of surgical pathology correlated with negative aspiration cytology results in 9 of 10 patients, the one node with false-negative results contained a 2-mm focus of cancer. The accuracy of ultrasonography-guided aspiration biopsy in diagnosing metastasis to lymph nodes was 96%; the results of this test prompted a change in management in 95% of the patients who had the procedure. Endoscopic ultrasonography alone or with fine-needle aspiration biopsy adds useful diagnostic information in determining metastasis to posterior mediastinal or subcarinal lymph nodes in patients with non-small-cell lung-cancer. These procedures are especially helpful in the preoperative evaluation of patients with suspicious contralateral mediastinal or "bulky" subcarinal nodes.
Surgical Endoscopy
Background Duodenal defects are complex clinical situations, and their management is challenging ... more Background Duodenal defects are complex clinical situations, and their management is challenging and associated with high mortality. Besides surgery, endoscopic treatment options exist, but the size and location of the perforation can limit their application. We present a retrospective study, demonstrating a successful application of endoscopic vacuum therapy (EVT) for duodenal leaks. Methods We performed a retrospective study of all patients who underwent EVT for duodenal perforations between 2016 and 2021 at two tertiary centers. We analyzed demographic and clinical patient characteristics, surgical outcomes, leak characteristics, sponge-related complications, and success rate. Results Indications for treatment with EVT in the duodenum consisted of leak after duodenal suture of a perforated ulcer (n = 4), iatrogenic perforation after endoscopic resection (n = 2), iatrogenic perforation during surgery (n = 2), and anastomotic leak after upper gastrointestinal surgery (n = 2). EVT w...
Vous trouverez les questions à choix multiple concernant cet article à la page 71 ou sur internet... more Vous trouverez les questions à choix multiple concernant cet article à la page 71 ou sur internet sous www.smf-cme.ch.
International Journal of Molecular Sciences, 2020
Identification of disease-associated autoantibodies is of high importance. Their assessment could... more Identification of disease-associated autoantibodies is of high importance. Their assessment could complement current diagnostic modalities and assist the clinical management of patients. We aimed at developing and validating high-throughput protein microarrays able to screen patients’ sera to determine disease-specific autoantibody-signatures for pancreatic cancer (PDAC), chronic pancreatitis (CP), autoimmune pancreatitis and their subtypes (AIP-1 and AIP-2). In-house manufactured microarrays were used for autoantibody-profiling of IgG-enriched preoperative sera from PDAC-, CP-, AIP-1-, AIP-2-, other gastrointestinal disease (GID) patients and healthy controls. As a top-down strategy, three different fluorescence detection-based protein-microarrays were used: large with 6400, intermediate with 345, and small with 36 full-length human recombinant proteins. Large-scale analysis revealed 89 PDAC, 98 CP and 104 AIP immunogenic antigens. Narrowing the selection to 29 autoantigens using p...
Swiss Medical Forum ‒ Schweizerisches Medizin-Forum, 2007
CME zu diesem Artikel finden Sie auf S. 71 oder im Internet unter www.smf-cme.ch. Einleitung Von ... more CME zu diesem Artikel finden Sie auf S. 71 oder im Internet unter www.smf-cme.ch. Einleitung Von einer exokrinen Pankreasinsuffizienz spricht man bei ungenügender Produktion von Pankreasenzymen mit entsprechend mangelhafter Verdauung der Nahrung, was sich klinisch in einer Steatorrhoe äussert. Eine solche Organinsuffizienz entsteht meist aufgrund einer chronischen Pankreatitis, einer histologisch durch eine progressive Fibrose, eine irreversible Zerstörung
American Journal of Physiology-Gastrointestinal and Liver Physiology, 2001
Although the pancreatic heat shock response has already been reported to confer protective effect... more Although the pancreatic heat shock response has already been reported to confer protective effects during experimental pancreatitis, the mechanism of action remains unknown. We investigated the effects of hyperthermia in cerulein-induced pancreatitis. Heat shock protein 70 (HSP70) expression in rats was induced by a 20-min period of water immersion (42°C). The severity of pancreatitis as well as the pancreatic expression of cytokines, nuclear factor-κB (NF-κB), and inhibitory factor κB-α (IκB-α) were evaluated in the presence and absence of hyperthermia. We found that hyperthermia resulted in time-dependent expression of HSP70 within the pancreas associated with a reduction in the severity of acute pancreatitis. Tumor necrosis factor-α and intercellular adhesion molecule-1 expression was significantly reduced in the presence of hyperthermia. Moreover, NF-κB activity was delayed in the presence of hyperthermia whereas IκB-α was stabilized in the cytoplasm. These results suggest that ...
American Journal of Physiology-Gastrointestinal and Liver Physiology, 2001
Complement factor C5a acting via C5a receptors (C5aR) is recognized as an anaphylotoxin and chemo... more Complement factor C5a acting via C5a receptors (C5aR) is recognized as an anaphylotoxin and chemoattractant that exerts proinflammatory effects in many pathological states. The effects of C5a and C5aR in acute pancreatitis and in pancreatitis-associated lung injury were evaluated using genetically altered mice that either lack C5aR or do not express C5. Pancreatitis was induced by administration of 12 hourly injections of cerulein (50 μg/kg ip). The severity of pancreatitis was determined by measuring serum amylase, neutrophil sequestration in the pancreas, and acinar cell necrosis. The severity of lung injury was evaluated by measuring neutrophil sequestration in the lung and pulmonary microvascular permeability. In both strains of genetically altered mice, the severity of pancreatitis and pancreatitis-associated lung injury was greater than that noted in the comparison wild-type strains of C5aR- and C5-sufficient animals. This exacerbation of injury in the absence of C5a function ...
PloS one, 2018
The role of intraoperative cholangiogram (IOC) during cholecystectomy is debated. The aim of the ... more The role of intraoperative cholangiogram (IOC) during cholecystectomy is debated. The aim of the present study was to evaluate the feasibility, benefit and risk of performing systematic IOC in patients undergoing cholecystectomy for acute gallstone-related disease. Between July 2013 and January 2015, all patients admitted for an acute gallstone-related condition and undergoing same-hospital-stay cholecystectomy were prospectively followed. IOC was systematically attempted and predictors of IOC failure were analyzed. Among the 581 enrolled patients, IOC was deliberately not performed in 3 cases. IOC was successful in 509/578 patients (88.1%). The main predictors of IOC failure were age, body mass index, male gender and associated acute cholecystitis. Thirty-two patients with suspected common bile duct stone on IOC underwent 38 unnecessary negative postoperative common bile duct investigations (32/509, 6.3%). There was one IOC-related adverse outcome (mild pancreatitis, 1/578, 0.2%). ...
Case reports in gastroenterology
The SPINK1 protein is a potent antiprotease that can inactivate any intrapancreatic trypsin activ... more The SPINK1 protein is a potent antiprotease that can inactivate any intrapancreatic trypsin activity that would otherwise induce autodigestion of the pancreas. SPINK1 mutations have been recognized to be associated with chronic pancreatitis in patients without a family history of pancreatitis. We here describe the case of a 24-year-old woman referred to our service for recurrent abdominal pain and search for the cause of chronic calcifying pancreatitis, who was found to carry 2 SPINK1 mutations.
Journal of translational medicine, Jun 2, 2017
Discriminating between autoimmune pancreatitis (AIP), chronic pancreatitis (CP), and pancreatic d... more Discriminating between autoimmune pancreatitis (AIP), chronic pancreatitis (CP), and pancreatic ductal adenocarcinoma (PDAC) can be challenging. In this retrospective study, levels of serum and tissue cytokines were analyzed as part of the clinical strategy for the preoperative differentiation between AIP and PDAC. The identification of differential cytokine profiles may help to prevent unnecessary surgical resection and allow optimal treatment of these pathologies. To compare the cytokine profiles of AIP, CP, and PDAC patients, serum and pancreatic tissue homogenates were subjected to multiplex analysis of 17 inflammatory mediators. In total, serum from 73 patients, composed of 29 AIP (14 AIP-1 and 15 AIP-2), 17 CP, and 27 PDAC, and pancreatic tissue from 36 patients, including 12 AIP (six AIP-1 and six AIP-2), 12 CP, and 12 PDAC, were analyzed. Comparing AIP and PDAC patients' serum, significantly higher concentrations were found in AIP for interleukins IL-1β, IL-7, IL-13, and...
American Journal of Physiology-Gastrointestinal and Liver Physiology, 1999
The mechanisms responsible for intrapancreatic digestive enzyme activation as well as the relatio... more The mechanisms responsible for intrapancreatic digestive enzyme activation as well as the relationship between that activation and cell injury during pancreatitis are not understood. We have employed an in vitro system in which freshly prepared pancreatic acini are exposed to a supramaximally stimulating concentration of the CCK analog caerulein to explore these issues. We find that in vitro trypsinogen activation depends on the continued presence of Ca2+in the suspending medium and that it is half-maximal in the presence of 0.3 mM Ca2+. Caerulein-induced trypsinogen activation can be halted by removal of Ca2+from the suspending medium or by chelation of intracellular Ca2+. Increasing intracellular Ca2+with either ionomycin or thapsigargin does not induce trypsinogen activation. We have monitored cell injury by measuring the leakage of lactate dehydrogenase (LDH) from acini and by quantitating intercalation of propidium iodide (PI) into DNA. Leakage of LDH and intercalation of PI in...
Scientific Reports
Our objective was to describe the etiologies of acute colitis and to identify patients who requir... more Our objective was to describe the etiologies of acute colitis and to identify patients who require diagnostic endoscopy. Patients with symptoms of gastrointestinal infection and colonic inflammation on CT were prospectively included. Those immunosuppressed, with history of colorectal cancer or inflammatory bowel disease (IBD), were excluded. Microbiological analysis of the feces was performed using PCR assays BD-Max and FilmArray (GI panel,) and fecal cultures. Fecal calprotectin was determined. Patients with negative BD-Max underwent colonoscopy. One hundred and seventy-nine patients were included. BD-Max was positive in 93 patients (52%) and FilmArray in 108 patients (60.3%). Patients with infectious colitis (n = 103, 57.5%) were positive for Campylobacter spp. (n = 57, 55.3%), Escherichia coli spp. (n = 8, 7.8%), Clostridioides difficile (n = 23, 22.3%), Salmonella spp. (n = 9, 8.7%), viruses (n = 7, 6.8%), Shigella spp. (n = 6, 5.8%), Entamoeba histolytica (n = 2, 1.9%) and othe...
BackgroundReshaping the tumor microenvironment by novel immunotherapies represents a key strategy... more BackgroundReshaping the tumor microenvironment by novel immunotherapies represents a key strategy to improve the treatment of cancers. Nevertheless, responsiveness to these treatments is often correlated with the extent of the T cell infiltration at the tumor site. Remarkably, microsatellite stable rectal cancer is characterized by poor infiltration and, therefore, do not respond to immune checkpoint blockade. To date, the only available curative option for these patients relies on extensive surgery. With the aim to broaden the application of promising immunotherapies, it is necessary to develop alternative approaches to promote T cell infiltration into the tumor microenvironment of these tumors. In this regard, recent evidence shows that radiotherapy may have profound immunostimulatory effects, hinting at the possibility of combining it with immunotherapy. The combination of long-course chemoradiotherapy and immunotherapy was recently shown to be safe and yielded promising results ...
Hepatology Communications, 2021
Acute alcoholic microvesicular steatosis (MIC) may complicate heavy alcohol intake and present as... more Acute alcoholic microvesicular steatosis (MIC) may complicate heavy alcohol intake and present as alcoholic hepatitis (AH) syndrome. However, detailed clinical, biological, and histologic data associated with MIC are scarce. We compared the clinical presentation, histologic features, and hepatic transcriptomic of patients presenting with AH due to either MIC or severe alcoholic steatohepatitis (ASH). In this case‐control study, patients who drank heavily (>100 g/day) with the AH syndrome were included either in the MIC group (>50% severe microvesicular steatosis, no inflammation) or in the severe ASH group (polynuclear neutrophil infiltration, macrosteatosis, ballooned hepatocytes). All patients received standard supportive care plus steroids for those with severe ASH and were followed up for 3 months. Whole‐liver transcriptome profiling was performed on liver snap‐frozen biopsies. Compared to ASH (n = 24, mean age 49.3 years), patients in the MIC group (n = 12, mean age 49.1 ...
Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver, 2017
Perioperative chemotherapy improves the prognosis of patients with locoregionally advanced resect... more Perioperative chemotherapy improves the prognosis of patients with locoregionally advanced resectable gastric and gastro-esophageal junction adenocarcinoma. Nevertheless, only 50% of operated patients could receive the postoperative component chemotherapy. An exclusive preoperative chemotherapy is therefore an interesting strategy. We report the clinical course of patients with operable gastric and gastroesophageal junction adenocarcinoma treated with an intention of exclusive preoperative chemotherapy. The medical records of all consecutive patients with an operable gastric or gastroesophageal junction adenocarcinoma and treated with an intention of exclusive preoperative chemotherapy were analysed. Between 1999 and 2014, 90 eligible patients were identified. Fifty-eight patients (64%) presented with clinical T3-T4 tumour and 63 (70%) had a lymph node involvement. Eighty (90%) patients were treated with 4 cycles of preoperative chemotherapy containing docetaxel, 5-fluorouracil (5FU...
Annales de Chirurgie, 2006
Disponible sur internet le 27 juin 2006 Résumé La maladie de Crohn peut toucher l'ensemble du tra... more Disponible sur internet le 27 juin 2006 Résumé La maladie de Crohn peut toucher l'ensemble du tractus digestif, mais il est rare qu'elle se révèle par une atteinte duodénale. Nous décrivons ici le cas d'un homme de 22 ans qui débutait sa maladie de Crohn par une sténose duodénale symptomatique, entraînant une dénutrition sévère. Le traitement médical ayant échoué, et le bilan endoscopique ayant confirmé le diagnostic, le patient était opéré et bénéficiait d'une gastroentéroanastomose sur anse en Y selon Roux. Les suites opératoires étaient favorables permettant au patient de s'alimenter à nouveau normalement. Cette présentation clinique rare, permet de discuter la stratégie chirurgicale en cas d'atteinte isolée du cadre duodénal par une maladie inflammatoire chronique de l'intestin.
Annals of Surgery, 2010
The aim of this study was to compare open and laparoscopic sigmoid resection for diverticulitis w... more The aim of this study was to compare open and laparoscopic sigmoid resection for diverticulitis with the patient and the nursing staff blinded to the surgical approach. Méthode: 113 patients scheduled for an elective sigmoidectomy were randomised to receive either a traditional open (54 patients) or a laparoscopic (59 patients) approach. Postoperatively, an opaque wound dressing was applied and left in place for 4 days, and patients from both groups were managed similarly. The primary endpoints for analysis were; 1) postoperative pain; 2) duration of postoperative ileus; and 3) duration of hospital stay (ClinicalTrials.gov, number NCT 00453830). Résultats: The median duration of procedure was 165 minutes (range 90-285) in the laparoscopy group and 110 minutes (range 70-210) in the open group (p<0.0001). The median delay between surgery and first bowel movement was 76 (range 31-163) hours in the laparoscopy group versus 105 (range 53-175) hours in the open group (p<0.0001). The median score for maximal pain (assessed by a Visual Analog Scale) was 4 (range 1-10) the laparoscopy group and 5 (range 1-10) in the open group (p=0.05). Finally, the median duration of hospital stay was 5 days [range 4-69] in the laparoscopy group versus 7 days (range 5-17) in the open group (p<0.0001). Conclusion: Laparoscopic sigmoid resection is associated with a 30% reduction in duration of postoperative ileus and hospital stay; by comparison, benefits in terms of postoperative pain appear less impressive, when the patient is blinded to the surgical technique.
Annals of Internal Medicine, 1997
ABSTRACT Current methods for detecting mediastinal lymph node involvement with non-small-cell lun... more ABSTRACT Current methods for detecting mediastinal lymph node involvement with non-small-cell lung cancer can be inaccurate and are often invasive and expensive. To assess the utility of endoscopic ultrasonography, fine-needle aspiration biopsy guided by endoscopic ultrasonography, and computed tomography for the detection of metastases to the posterior mediastinal lymph nodes in non-small-cell lung cancer. Prospective preoperative evaluation of the diagnostic operating characteristics of these procedures. Referral-based academic medical center. 130 consecutive patients with non-small-cell lung cancer who were otherwise good surgical candidates. All patients had initial computed tomography of the chest; those with enlarged nodes were referred for endoscopic ultrasonography. Endoscopic ultrasonography-guided fine-needle aspiration biopsy was done on suspicious contralateral posterior mediastinal or subcarinal lymph nodes identified by ultrasonography. At surgery, lymph nodes were dissected and categorized by location and underwent histopathologic evaluation. 52 patients were ultimately enrolled in the study: Thirty-one had thoracotomy with mediastinal dissection, and 21 had tumors considered unresectable on the basis of preoperative evaluation. Ultrasonography without aspiration biopsy had an overall accuracy of 84% for predicting metastasis to lymph nodes; computed tomography had an accuracy of 49% (P < 0.025). Twenty-four patients had ultrasonography-guided aspiration biopsy; 14 of 24 were ineligible for surgery because cytology showed malignancy. Results of surgical pathology correlated with negative aspiration cytology results in 9 of 10 patients, the one node with false-negative results contained a 2-mm focus of cancer. The accuracy of ultrasonography-guided aspiration biopsy in diagnosing metastasis to lymph nodes was 96%; the results of this test prompted a change in management in 95% of the patients who had the procedure. Endoscopic ultrasonography alone or with fine-needle aspiration biopsy adds useful diagnostic information in determining metastasis to posterior mediastinal or subcarinal lymph nodes in patients with non-small-cell lung-cancer. These procedures are especially helpful in the preoperative evaluation of patients with suspicious contralateral mediastinal or "bulky" subcarinal nodes.
Surgical Endoscopy
Background Duodenal defects are complex clinical situations, and their management is challenging ... more Background Duodenal defects are complex clinical situations, and their management is challenging and associated with high mortality. Besides surgery, endoscopic treatment options exist, but the size and location of the perforation can limit their application. We present a retrospective study, demonstrating a successful application of endoscopic vacuum therapy (EVT) for duodenal leaks. Methods We performed a retrospective study of all patients who underwent EVT for duodenal perforations between 2016 and 2021 at two tertiary centers. We analyzed demographic and clinical patient characteristics, surgical outcomes, leak characteristics, sponge-related complications, and success rate. Results Indications for treatment with EVT in the duodenum consisted of leak after duodenal suture of a perforated ulcer (n = 4), iatrogenic perforation after endoscopic resection (n = 2), iatrogenic perforation during surgery (n = 2), and anastomotic leak after upper gastrointestinal surgery (n = 2). EVT w...
Vous trouverez les questions à choix multiple concernant cet article à la page 71 ou sur internet... more Vous trouverez les questions à choix multiple concernant cet article à la page 71 ou sur internet sous www.smf-cme.ch.
International Journal of Molecular Sciences, 2020
Identification of disease-associated autoantibodies is of high importance. Their assessment could... more Identification of disease-associated autoantibodies is of high importance. Their assessment could complement current diagnostic modalities and assist the clinical management of patients. We aimed at developing and validating high-throughput protein microarrays able to screen patients’ sera to determine disease-specific autoantibody-signatures for pancreatic cancer (PDAC), chronic pancreatitis (CP), autoimmune pancreatitis and their subtypes (AIP-1 and AIP-2). In-house manufactured microarrays were used for autoantibody-profiling of IgG-enriched preoperative sera from PDAC-, CP-, AIP-1-, AIP-2-, other gastrointestinal disease (GID) patients and healthy controls. As a top-down strategy, three different fluorescence detection-based protein-microarrays were used: large with 6400, intermediate with 345, and small with 36 full-length human recombinant proteins. Large-scale analysis revealed 89 PDAC, 98 CP and 104 AIP immunogenic antigens. Narrowing the selection to 29 autoantigens using p...
Swiss Medical Forum ‒ Schweizerisches Medizin-Forum, 2007
CME zu diesem Artikel finden Sie auf S. 71 oder im Internet unter www.smf-cme.ch. Einleitung Von ... more CME zu diesem Artikel finden Sie auf S. 71 oder im Internet unter www.smf-cme.ch. Einleitung Von einer exokrinen Pankreasinsuffizienz spricht man bei ungenügender Produktion von Pankreasenzymen mit entsprechend mangelhafter Verdauung der Nahrung, was sich klinisch in einer Steatorrhoe äussert. Eine solche Organinsuffizienz entsteht meist aufgrund einer chronischen Pankreatitis, einer histologisch durch eine progressive Fibrose, eine irreversible Zerstörung
American Journal of Physiology-Gastrointestinal and Liver Physiology, 2001
Although the pancreatic heat shock response has already been reported to confer protective effect... more Although the pancreatic heat shock response has already been reported to confer protective effects during experimental pancreatitis, the mechanism of action remains unknown. We investigated the effects of hyperthermia in cerulein-induced pancreatitis. Heat shock protein 70 (HSP70) expression in rats was induced by a 20-min period of water immersion (42°C). The severity of pancreatitis as well as the pancreatic expression of cytokines, nuclear factor-κB (NF-κB), and inhibitory factor κB-α (IκB-α) were evaluated in the presence and absence of hyperthermia. We found that hyperthermia resulted in time-dependent expression of HSP70 within the pancreas associated with a reduction in the severity of acute pancreatitis. Tumor necrosis factor-α and intercellular adhesion molecule-1 expression was significantly reduced in the presence of hyperthermia. Moreover, NF-κB activity was delayed in the presence of hyperthermia whereas IκB-α was stabilized in the cytoplasm. These results suggest that ...
American Journal of Physiology-Gastrointestinal and Liver Physiology, 2001
Complement factor C5a acting via C5a receptors (C5aR) is recognized as an anaphylotoxin and chemo... more Complement factor C5a acting via C5a receptors (C5aR) is recognized as an anaphylotoxin and chemoattractant that exerts proinflammatory effects in many pathological states. The effects of C5a and C5aR in acute pancreatitis and in pancreatitis-associated lung injury were evaluated using genetically altered mice that either lack C5aR or do not express C5. Pancreatitis was induced by administration of 12 hourly injections of cerulein (50 μg/kg ip). The severity of pancreatitis was determined by measuring serum amylase, neutrophil sequestration in the pancreas, and acinar cell necrosis. The severity of lung injury was evaluated by measuring neutrophil sequestration in the lung and pulmonary microvascular permeability. In both strains of genetically altered mice, the severity of pancreatitis and pancreatitis-associated lung injury was greater than that noted in the comparison wild-type strains of C5aR- and C5-sufficient animals. This exacerbation of injury in the absence of C5a function ...
PloS one, 2018
The role of intraoperative cholangiogram (IOC) during cholecystectomy is debated. The aim of the ... more The role of intraoperative cholangiogram (IOC) during cholecystectomy is debated. The aim of the present study was to evaluate the feasibility, benefit and risk of performing systematic IOC in patients undergoing cholecystectomy for acute gallstone-related disease. Between July 2013 and January 2015, all patients admitted for an acute gallstone-related condition and undergoing same-hospital-stay cholecystectomy were prospectively followed. IOC was systematically attempted and predictors of IOC failure were analyzed. Among the 581 enrolled patients, IOC was deliberately not performed in 3 cases. IOC was successful in 509/578 patients (88.1%). The main predictors of IOC failure were age, body mass index, male gender and associated acute cholecystitis. Thirty-two patients with suspected common bile duct stone on IOC underwent 38 unnecessary negative postoperative common bile duct investigations (32/509, 6.3%). There was one IOC-related adverse outcome (mild pancreatitis, 1/578, 0.2%). ...
Case reports in gastroenterology
The SPINK1 protein is a potent antiprotease that can inactivate any intrapancreatic trypsin activ... more The SPINK1 protein is a potent antiprotease that can inactivate any intrapancreatic trypsin activity that would otherwise induce autodigestion of the pancreas. SPINK1 mutations have been recognized to be associated with chronic pancreatitis in patients without a family history of pancreatitis. We here describe the case of a 24-year-old woman referred to our service for recurrent abdominal pain and search for the cause of chronic calcifying pancreatitis, who was found to carry 2 SPINK1 mutations.
Journal of translational medicine, Jun 2, 2017
Discriminating between autoimmune pancreatitis (AIP), chronic pancreatitis (CP), and pancreatic d... more Discriminating between autoimmune pancreatitis (AIP), chronic pancreatitis (CP), and pancreatic ductal adenocarcinoma (PDAC) can be challenging. In this retrospective study, levels of serum and tissue cytokines were analyzed as part of the clinical strategy for the preoperative differentiation between AIP and PDAC. The identification of differential cytokine profiles may help to prevent unnecessary surgical resection and allow optimal treatment of these pathologies. To compare the cytokine profiles of AIP, CP, and PDAC patients, serum and pancreatic tissue homogenates were subjected to multiplex analysis of 17 inflammatory mediators. In total, serum from 73 patients, composed of 29 AIP (14 AIP-1 and 15 AIP-2), 17 CP, and 27 PDAC, and pancreatic tissue from 36 patients, including 12 AIP (six AIP-1 and six AIP-2), 12 CP, and 12 PDAC, were analyzed. Comparing AIP and PDAC patients' serum, significantly higher concentrations were found in AIP for interleukins IL-1β, IL-7, IL-13, and...