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Camus M, Heyries L, Metivier-Cesbron E, Le Balleur Y, Koch S, Lesur G. [Commentary on the work of Ojima T et al., pp. 645]. Endoscopy 2014; 46:823. [PMID: 25202792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Camus M, Heyries L, Metivier-Cesbron E, Le Balleur Y, Koch S, Lesur G. [Commentary on the work of Mohamadnejad M et al., pp. 650]. Endoscopy 2014; 46:823-4. [PMID: 25202793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Camus M, Heyries L, Metivier-Cesbron E, Le Balleur Y, Koch S, Lesur G. [Commentary on the work of Choi J-H et al., pp. 656]. Endoscopy 2014; 46:824. [PMID: 25202794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Camus M, Heyries L, Metivier-Cesbron E, Le Balleur Y, Koch S, Lesur G. [Commentary on the work of Rahmi H et al., pp. 670]. Endoscopy 2014; 46:824. [PMID: 25202796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Heresbach D, Lesur G. [Comment on PMID 24473907]. Endoscopy 2014; 46:262. [PMID: 24712038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Heresbach D, Lesur G. [Comment on PMID 24500977]. Endoscopy 2014; 46:261. [PMID: 24712039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Heresbach D, Lesur G. [Comment on PMID 24500976]. Endoscopy 2014; 46:261. [PMID: 24712040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Heresbach D, Lesur G. [Comment on PMID 24254386]. Endoscopy 2014; 46:262. [PMID: 24712036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Heresbach D, Lesur G. [Comment on PMID 24218307]. Endoscopy 2014; 46:262. [PMID: 24712037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Chabrun E, Heyries L, Lesur G, Palazzo L, Rahmi G. [Not Available]. Endoscopy 2014; 46:260. [PMID: 24624427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Chabrun E, Heyries L, Lesur G, Palazzo L, Rahmi G. [Not Available]. Endoscopy 2014; 46:260. [PMID: 24624428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Chabrun E, Heyries L, Lesur G, Palazzo L, Rahmi G. [Not Available]. Endoscopy 2014; 46:260. [PMID: 24624431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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63
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Chabrun E, Heyries L, Lesur G, Palazzo L, Rahmi G. [Not Available]. Endoscopy 2014; 46:261. [PMID: 24624433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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64
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Chabrun E, Heyries L, Lesur G, Palazzo L, Rahmi G. [Not Available]. Endoscopy 2014; 46:260. [PMID: 24624430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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65
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Chabrun E, Heyries L, Lesur G, Palazzo L, Rahmi G. [Not Available]. Endoscopy 2014; 46:261. [PMID: 24624432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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66
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Barret M, Boustiere C, Canard JM, Arpurt JP, Bernardini D, Bulois P, Chaussade S, Heresbach D, Joly I, Lapuelle J, Laugier R, Lesur G, Pienkowski P, Ponchon T, Pujol B, Richard-Molard B, Robaszkiewicz M, Systchenko R, Abbas F, Schott-Pethelaz AM, Cellier C. Factors associated with adenoma detection rate and diagnosis of polyps and colorectal cancer during colonoscopy in France: results of a prospective, nationwide survey. PLoS One 2013; 8:e68947. [PMID: 23874822 PMCID: PMC3715530 DOI: 10.1371/journal.pone.0068947] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 06/04/2013] [Indexed: 02/06/2023] Open
Abstract
Introduction Colonoscopy can prevent deaths due to colorectal cancer (CRC) through early diagnosis or resection of colonic adenomas. We conducted a prospective, nationwide study on colonoscopy practice in France. Methods An online questionnaire was administered to 2,600 French gastroenterologists. Data from all consecutive colonoscopies performed during one week were collected. A statistical extrapolation of the results to a whole year was performed, and factors potentially associated with the adenoma detection rate (ADR) or the diagnosis of polyps or cancer were assessed. Results A total of 342 gastroenterologists, representative of the overall population of French gastroenterologists, provided data on 3,266 colonoscopies, corresponding to 1,200,529 (95% CI: 1,125,936-1,275,122) procedures for the year 2011. The indication for colonoscopy was CRC screening and digestive symptoms in 49.6% and 38.9% of cases, respectively. Polypectomy was performed in 35.5% of cases. The ADR and prevalence of CRC were 17.7% and 2.9%, respectively. The main factors associated with a high ADR were male gender (p=0.0001), age over 50 (p=0.0001), personal or family history of CRC or colorectal polyps (p<0.0001 and p<0.0001, respectively), and positive fecal occult blood test (p=0.0005). The prevalence of CRC was three times higher in patients with their first colonoscopy (4.2% vs. 1.4%; p<0.0001). Conclusions For the first time in France, we report nationwide prospective data on colonoscopy practice, including histological results. We found an average ADR of 17.7%, and observed reduced CRC incidence in patients with previous colonoscopy.
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Lacombe P, Lacout A, Marcy PY, Binsse S, Sellier J, Bensalah M, Chinet T, Bourgault-Villada I, Blivet S, Roume J, Lesur G, Blondel JH, Fagnou C, Ozanne A, Chagnon S, El Hajjam M. Diagnosis and treatment of pulmonary arteriovenous malformations in hereditary hemorrhagic telangiectasia: An overview. Diagn Interv Imaging 2013; 94:835-48. [PMID: 23763987 DOI: 10.1016/j.diii.2013.03.014] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Hereditary hemorrhagic telangiectasia (HHT) or Rendu-Osler-Weber disease is an autosomic dominant disorder, which is characterized by the development of multiple arteriovenous malformations in either the skin, mucous membranes, and/or visceral organs. Pulmonary arteriovenous malformations (PAVMs) may either rupture, and lead to life-threatening hemoptysis/hemothorax or be responsible for a right-to-left shunting leading to paradoxical embolism, causing stroke or cerebral abscess. PAVMs patients should systematically be screened as the spontaneous complication rate is high, by reaching almost 50%. Neurological complications rate is considerably higher in patients presenting with diffuse pulmonary involvement. PAVM diagnosis is mainly based upon transthoracic contrast echocardiography and CT scanner examination. The latter also allows the planification of treatments to adopt, which consists of percutaneous embolization, having replaced surgery in most of the cases. The anchor technique consists of percutaneous coil embolization of the afferent pulmonary arteries of the PAVM, by firstly placing a coil into a small afferent arterial branch closely upstream the PAVM. Enhanced contrast CT scanner is the key follow-up examination that depicts the PAVM enlargement, indicating the various mechanisms of PAVM reperfusion. When performed by experienced operators as the prime treatment, percutaneous embolization of PAVMs, is a safe, efficient and sustained therapy in the great majority of HHT patients.
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Herault J, Rincon F, Cossu C, Lesur G, Ogilvie GI, Longaretti PY. Periodic magnetorotational dynamo action as a prototype of nonlinear magnetic-field generation in shear flows. PHYSICAL REVIEW. E, STATISTICAL, NONLINEAR, AND SOFT MATTER PHYSICS 2011; 84:036321. [PMID: 22060506 DOI: 10.1103/physreve.84.036321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2010] [Revised: 07/15/2011] [Indexed: 05/31/2023]
Abstract
The nature of dynamo action in shear flows prone to magnetohydrodynamc instabilities is investigated using the magnetorotational dynamo in Keplerian shear flow as a prototype problem. Using direct numerical simulations and Newton's method, we compute an exact time-periodic magnetorotational dynamo solution to three-dimensional dissipative incompressible magnetohydrodynamic equations with rotation and shear. We discuss the physical mechanism behind the cycle and show that it results from a combination of linear and nonlinear interactions between a large-scale axisymmetric toroidal magnetic field and nonaxisymmetric perturbations amplified by the magnetorotational instability. We demonstrate that this large-scale dynamo mechanism is overall intrinsically nonlinear and not reducible to the standard mean-field dynamo formalism. Our results therefore provide clear evidence for a generic nonlinear generation mechanism of time-dependent coherent large-scale magnetic fields in shear flows and call for new theoretical dynamo models. These findings may offer important clues to understanding the transitional and statistical properties of subcritical magnetorotational turbulence.
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Heresbach D, Vedrenne B, Laugier R, Saurin JC, Burtin P, Bories E, Guillet M, Ponchon T, Richard-Molard B, Arpurt JP, Boustière C, Bulois P, Burtin P, Calazel A, Canard JM, Heresbach D, Lesur G, Lapuelle J, Laugier R, Prat F, Pujol B, Richard-Molard B, Saurin JC, Systchenko R, Pienkowski P, Ponchon T. Consensus en endoscopie digestive : Conduite à tenir après polypectomie ou mucosectomie rectocolique selon le résultat de l’analyse d’anatomie pathologique. ACTA ACUST UNITED AC 2011. [DOI: 10.1007/s10190-011-0179-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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70
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Boustière C, Veitch A, Vanbiervliet G, Bulois P, Deprez P, Laquiere A, Laugier R, Lesur G, Mosler P, Nalet B, Napoleon B, Rembacken B, Ajzenberg N, Collet JP, Baron T, Dumonceau JM. Endoscopy and antiplatelet agents. European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2011; 43:445-61. [PMID: 21547880 DOI: 10.1055/s-0030-1256317] [Citation(s) in RCA: 148] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
With the increasing use of antiplatelet agents (APA), their management during the periendoscopic period has become a more common and more difficult problem. The increase in use is due to the availability of new drugs and the widespread use of drug-eluting coronary stents. Acute coronary syndromes can occur when APA therapy is withheld for noncardiovascular interventions. Guidelines about APA management during the periendoscopic period are traditionally based on assessments of the procedure-related risk of bleeding and the risk of thrombosis if APA are stopped. New data allow better assessment of these risks, of the necessary duration of APA discontinuation before endoscopy, of the use of alternative procedures (mostly for endoscopic retrograde cholangiopancreatography [ERCP]), and of endoscopic methods that can be used to prevent bleeding (following colonic polypectomy). This guideline makes graded, evidence-based, recommendations for the management of APA for all currently performed endoscopic procedures. A short summary and two tables are included for quick reference.
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Arpurt J, Lesur G, Heresbach D, Soudan D, Barrioz T, Richard-Molard B. Consensus en endoscopie digestive: hémorragie digestive basse aiguë. ACTA ACUST UNITED AC 2010. [DOI: 10.1007/s10190-010-0110-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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72
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Lacout A, Pelage JP, Lesur G, Chinet T, Beauchet A, Roume J, Lacombe P. Pancreatic involvement in hereditary hemorrhagic telangiectasia: assessment with multidetector helical CT. Radiology 2010; 254:479-84. [PMID: 20093519 DOI: 10.1148/radiol.09090096] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE To evaluate and describe pancreatic involvement by using multidetector computed tomography (CT) in patients with a diagnosis of hereditary hemorrhagic telangiectasia (HHT). MATERIALS AND METHODS Institutional review board approval was obtained, and all patients provided informed consent. Across 12 months, all consecutive adult patients with a confirmed diagnosis of HHT referred to our pluridisciplinary HHT center for evaluation were enrolled prospectively in the study and underwent contrast material-enhanced multidetector CT of the abdomen. Pancreatic telangiectases and arteriovenous fistulas were noted, and their characteristics were described. Genetic mutation was also investigated. RESULTS Thirty-five patients (19 women, 16 men; mean age, 48.4 years) were included. All patients were asymptomatic. A genetic mutation was identified in 28 (80%) patients, including endoglin in 16 (57%), activin type-II-like receptor kinase 1 (ALK1) in 11 (39%), and SMAD4 in one (4%). Eleven (31%) patients exhibited pancreatic involvement. Fifty-four percent of patients with ALK1 mutation had pancreatic involvement. Twenty-three pancreatic telangiectases were identified during the arterial phase in nine patients. Seven pancreatic arteriovenous malformations (AVMs) were identified in four patients. CONCLUSION Pancreatic involvement commonly is found in patients with HHT (31% in our study), mainly in patients with ALK1 mutation; pancreatic telangiectases or AVMs are only diagnosed duringthe arterial phase at multidetector CT.
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Lesur G, Vedrenne B, Heresbach D, Arpurt JP, Laugier R. Consensus en endoscopie digestive (CED). ACTA ACUST UNITED AC 2010. [DOI: 10.1007/s10190-009-0111-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Bachet JB, Lesur G, Rougier P. [Colon and rectal tumours]. LA REVUE DU PRATICIEN 2009; 59:383-391. [PMID: 19408886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Lesur G, Bassot PH, Dubreuil O, El Hajjam M, Penna C, Rougier P, Emile JF. [Case report: a voluminous colonic lipoma]. ACTA ACUST UNITED AC 2008; 32:870-2. [PMID: 18703298 DOI: 10.1016/j.gcb.2008.04.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2008] [Revised: 04/15/2008] [Accepted: 04/22/2008] [Indexed: 11/15/2022]
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Lesur G, Bourgault I, Longvert C, El Hajjam M, Dubreuil O, Julié C, Saiag P, Clerici T. [Rectosigmoid junction metastasis from melanoma: a case report]. ACTA ACUST UNITED AC 2008; 33:93-6. [PMID: 18678451 DOI: 10.1016/j.gcb.2008.05.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2008] [Accepted: 05/23/2008] [Indexed: 11/25/2022]
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Lesur G, Rouprêt M. [Place of laparoscopic radical cystectomy in the treatment of invasive bladder urothelial carcinoma]. Prog Urol 2008; 18:145-51. [PMID: 18472066 DOI: 10.1016/j.purol.2007.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2007] [Accepted: 08/01/2007] [Indexed: 11/16/2022]
Abstract
Radical cystectomy is the reference treatment for recurrent superficial or invasive bladder tumours. The most standardized incision is midline infra-umbilical laparotomy. The first laparoscopic cystectomy was performed in 1992 in a patient with neurogenic bladder and several teams have subsequently described this incision for the treatment of bladder tumours. The advantages of laparoscopy have been reported in terms of morbidity and earlier return to daily activities. The current oncological results of this incision are difficult to compare with those of conventional open surgery due to the insufficient follow-up. However, published series have not reported any significant difference in the intermediate term. Until convincing results become available, it therefore appears legitimate to allow teams skilled in laparoscopy to demonstrate the oncological efficacy of this approach. At the present time, the reference treatment for invasive bladder cancer remains open cystectomy.
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Lesur G, Fontaine E, Page B. [Severe lower gastrointestinal bleeding related to prostate biopsy]. ACTA ACUST UNITED AC 2008; 32:848-9. [PMID: 18394838 DOI: 10.1016/j.gcb.2008.01.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2007] [Accepted: 01/08/2008] [Indexed: 10/22/2022]
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Mitry E, Taleb-Fayad R, Deschamps A, Mansencal N, Lepère C, Declety G, Lièvre A, Vaillant JN, Lesur G, Cramer É, Dubourg O, Rougier P. Risk of venous thrombosis in patients with pancreatic adenocarcinoma. ACTA ACUST UNITED AC 2007; 31:1139-42. [DOI: 10.1016/s0399-8320(07)78352-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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82
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Barrioz T, Lesur G. [Endoscopic hemostatic methods]. GASTROENTEROLOGIE CLINIQUE ET BIOLOGIQUE 2007; 31:698-707. [PMID: 17925770 DOI: 10.1016/s0399-8320(07)91920-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
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83
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Cosconea S, Lesur G. [Upper gastrointestinal hemorrhage in a cardiac patient with chronic renal insufficiency]. GASTROENTEROLOGIE CLINIQUE ET BIOLOGIQUE 2007; 31:708-711. [PMID: 17925771 DOI: 10.1016/s0399-8320(07)91921-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
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84
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Lesur G, Julié C, Romdhane N, Bruneval P. [Vascular malformation of the colon and lower gastrointestinal tract]. GASTROENTEROLOGIE CLINIQUE ET BIOLOGIQUE 2006; 30:483-4. [PMID: 16633320 DOI: 10.1016/s0399-8320(06)73209-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
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87
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Lesur G, Bour B, Aegerter P. Management of bleeding peptic ulcer in France: a national inquiry. ACTA ACUST UNITED AC 2005; 29:140-4. [PMID: 15795661 DOI: 10.1016/s0399-8320(05)80717-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS OF THE STUDY To evaluate and compare management practices in France for bleeding peptic ulcers using a national inquiry of university and non-university hospitals. METHOD Responses to questionnaires sent to 812 gastroenterologists, 496 practicing in non-university hospitals and 316 in university hospitals, were compared. RESULTS An analysis was possible in 279 (34% response rate) of the questionnaires. Forrest classification was used more frequently in university hospitals (83% vs 60%, P<0.01). Endoscopic hemostatic therapy was used more frequently in university hospitals for Forrest Ib (92% vs 81%, P=0.02), IIa (93% vs 73%, P<0.001), and IIb (58% vs 29%, P<0.001) ulcers. Injection therapy, mainly epinephrine, was the first-intention treatment for 99% of the responding gastroenterologists. Proportions of clinicians employing hemoclips (27%) or argon plasma coagulation (21%) were similar in both types of practice. Anti-secretory treatment included mainly omeprazole (82%), given intravenously (76%), sometimes as bolus i.v. doses followed by i.v. high-dose continuous infusion (15%) with some variations according to the type of hospital. In the event of recurrent or persistent bleeding, surgery was more frequent in non-university hospitals. When rebleeding occurred, a second endoscopic treatment was performed in about one quarter of patients. CONCLUSION In France, management practices for bleeding peptic ulcer vary between university and non-university hospitals.
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Moussa A, Mitry E, Hammel P, Sauvanet A, Nassif T, Palazzo L, Malka D, Delchier JC, Buffet C, Chaussade S, Aparicio T, Lasser P, Rougier P, Lesur G. Pancreatic metastases: a multicentric study of 22 patients. ACTA ACUST UNITED AC 2004; 28:872-6. [PMID: 15523224 DOI: 10.1016/s0399-8320(04)95151-2] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
AIMS OF THE STUDY To evaluate the diagnosis, treatment and outcome of patients with pancreatic metastases. PATIENTS AND METHODS We retrospectively reviewed the records of patients with pancreatic metastasis managed in the Paris area between 1990 and 2000. RESULTS The series analyzed included 22 patients, 10 men and 12 women, mean age 61 years (range: 35-76). The primary tumors were renal-cell carcinoma (N=10), colorectal cancer (N=4), lung cancer (N=4), breast cancer (N=2), cutaneous melanoma (N=1) and ileal carcinoid (N=1). The mean interval between primary treatment and presentation was 73.5 months (range: 2-151). Diagnosis was established because of clinical symptoms (N=15) or during surveillance (N=7). Computed tomography (N=19) and endoscopic ultrasound (EUS) (N=18) mainly showed solitary and hypodense/or hypoechoic masses. Histological diagnosis was obtained before surgery by EUS-guided fine needle aspiration (N=6), ultrasound-guided biopsy (N=3) or duodenoscopy (N=3). Among 10 patients with primary renal-cell carcinoma, 7 were treated by surgery. Median global survival was 33 months. Median survival was 61 months in the event of surgical treatment and 20 months in the other patients (ns). Mean survival depended on the type of primary tumor, 61 months for renal-cell carcinoma and 33 for colorectal cancer (P=0.06). CONCLUSIONS Most pancreatic metastases develop from renal-cell carcinoma and can occur several years after nephrectomy. Histological diagnosis is often obtained before surgery. Surgical resection must be discussed as it can allow long-term survival.
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Lesur G, Bour B. Individualized management of bleeding peptic ulcer. Gastrointest Endosc 2004; 59:329-30; author reply 330-1. [PMID: 14989233 DOI: 10.1016/s0016-5107(03)02552-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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91
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Lesur G, Taleb-Fayad R. [Lower gastrointestinal bleeding]. GASTROENTEROLOGIE CLINIQUE ET BIOLOGIQUE 2003; 27:1129-42. [PMID: 14770116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
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92
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Lesur G, Bour B. [Towards individualized management of bleeding peptic ulcer? ]. GASTROENTEROLOGIE CLINIQUE ET BIOLOGIQUE 2003; 27:394-7. [PMID: 12759679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
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Lesur G. [The place of endoscopic treatment in other causes of upper gastrointestinal haemorrhage]. Presse Med 2003; 32:233-4. [PMID: 12610468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
IN MALLORY-WEISS SYNDROME: With fissuring of the cardial area, probably subsequent to a rapid increase in intra-gastric pressure, hemorrhagic Mallory-Weiss syndrome may justify haemostatic endoscopic treatment. However, one should not forget that the majority of these syndromes usually regress spontaneously. IN DIEULAFOY'S ULCERS: Loss of substance destroying the muscle mucosa, Dieulafoy's ulcer would be at the origin of around 2% of upper gastrointestinal haemorrhages. Initial haemostasis can be obtained using endoscopic treatment in 85% of cases. The mechanical methods (clips, elastic ligature) are probably more effective than injections, but they are still under assessment.
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Lesur G. [The place of endoscopic treatment in hemorrhagic ulcers]. Presse Med 2003; 32:227-9. [PMID: 12610466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
INJECTIONS OF ADRENALINE: More than one third of upper gastrointestinal haemorrhages are still of ulcerous origin. In the case of active bleeding ulcers or ulcers with non-haemorrhagic visible vessels, endoscopy should be performed to stop bleeding. Injections of adrenaline, which combine efficacy, simplicity and absence of morbidity represent the treatment of choice for many. THE USE OF THERMAL METHODS: Spurting haemorrhages are probably the only haemorrhages that would benefit from injections of adrenaline combined with another haemostatic method, notably thermal. THE NEED FOR ASSOCIATED MEDICAL TREATMENT: Whatever the haemostatic method used, a powerful anti-secretory treatment administered intravenously must be associated since it will enhance the effects of endoscopic treatment.
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Lesur G. [The aims of endoscopy in upper gastrointestinal hemorrhage]. Presse Med 2003; 32:224-6. [PMID: 12610465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
FOR DIAGNOSIS AND FOR TREATMENT: Endoscopy for upper gastrointestinal haemorrhage has a double objective. It is difficult and to be optimal, it must be conducted at the right time and in the best technical conditions as possible. Depending on the etiology, identification of the cause of bleeding precedes the choice of the haemostatic method to be used, preferentially injections of adrenaline in the case of bleeding ulcers and elastic ligature in the case of ruptured oesophageal varicose veins. In general the aim of endoscopic treatment is to stop the haemorrhage and to reduce as far as possible the risk of recurrent haemorrhage, which represents a factor of high deathrate.
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Lesur G. [The place of endoscopic treatment in portal hypertension]. Presse Med 2003; 32:230-2. [PMID: 12610467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
A POTENTIALLY SEVERE EVENT: Upper gastrointestinal haemorrhage in a cirrhotic patient is always extremely serious, particularly in the case of rupture of the oesophageal varices, which is the most frequent cause. THE TWO POLES OF TREATMENT: Early vasoactive treatment permits elastic ligature in optimal conditions using an endoscope. The prevention of other complications of cirrhosis is an essential element in the management of these patients.
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Lesur G. [Medical treatment of hemorrhaging ulcer]. Presse Med 2001; 30:1907-9. [PMID: 11819918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
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98
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Lesur G. [Helicobacter pylori, non-steroidal anti-inflammatory drugs and aspirin: a new piece of the puzzle]. GASTROENTEROLOGIE CLINIQUE ET BIOLOGIQUE 2001; 25:725-6. [PMID: 11688500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
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99
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Lesur G. [Is endoscopic hemostatic retreatment of peptic ulcer justified, after or even before recurrent hemorrhage?]. GASTROENTEROLOGIE CLINIQUE ET BIOLOGIQUE 2001; 25:657-8. [PMID: 11673731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
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100
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Lesur G, Artru P, Mitry E. [Bleeding peptic ulcer: natural history and place of endoscopic hemostasis]. GASTROENTEROLOGIE CLINIQUE ET BIOLOGIQUE 2000; 24:656-66. [PMID: 10962390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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