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Biomedical subjects

A Elhadad

Publications and source records attributed to A Elhadad.

At least 37 records · Page 2Linked to original sources
PubMed1995

Supraperitoneal colorectal anastomosis: hand-sewn versus circular staples--a controlled clinical trial. French Associations for Surgical Research.

BACKGROUND: Although used widely for supraperitoneal anastomoses, circular stapled anastomoses have never been proved better than hand-sewn anastomoses. In the one prospective controlled trial that studied these anastomoses specifically, the only significant difference found was that there were more clinically obvious leakages with the circular stapled variety, but not in the overall clinical and roentgenologic leakage rates. METHODS: One hundred fifty-nine consecutive patients (88 men and 71 women, mean age 65.8 +/- 12.1 years) were randomized to undergo hand-sewn (n = 74) or circular stapled (n = 85) supraperitoneal colorectal anastomosis after left colectomy. RESULTS: Patient demographics were similar in both groups. Overall mortality was 1.3% (2 of 159; one in each group). No statistically significant difference (NS) was found in the rate of early complications, including anastomotic leakage (4 of 74 versus 6 of 85) in the hand-sewn and stapled anastomoses, respectively). Mishaps (n = 10) and hemorrhage (n = 5) occurred in the stapled group only. Stapled anastomoses took an average of 8 minutes less to perform (p < 0.001), but this time gain did not significantly influence the overall duration of operation (identical median times). The median duration of hospitalization was 13 and 14 days, respectively (NS). At 8 months there were 2 of 74 strictures in the hand-sewn group and 4 of 85 strictures in the stapled group (NS). CONCLUSIONS: According to these results, there seems to be no advantage of routine or regular use of stapling instruments for supraperitoneal colorectal anastomosis.

Adult↗
PubMed1994

Curative resection for left colonic carcinoma: hemicolectomy vs. segmental colectomy. A prospective, controlled, multicenter trial. French Association for Surgical Research.

PURPOSE: This study was developed to compare median and actuarial survival after left hemicolectomy vs. left segmental colectomy. METHODS: Between January 1980 and January 1985, 270 consecutive patients (133 males and 137 females; mean age, 64 +/- 12 (range, 18-91) years with left colonic carcinoma located between the left third of the transverse colon and (but not, including) the colorectal juncture were randomly allotted to undergo either left hemicolectomy or left segmental colectomy. Left hemicolectomy removed the entire left colon along with the origin of the inferior mesenteric artery and the dependent lymphatic territory. Left segmental colectomy removed a more restricted segment of the colon and left the origin of the inferior mesenteric artery unmolested. RESULTS: After elimination of 10 patients for protocol violation, 131 patients with left hemicolectomy and 129 with left segmental colectomy were analyzed. Both groups were similar with regard to preoperative risk factors (age, sex, obesity, weight loss, anemia, diabetes, cirrhosis, kidney failure, steroid therapy or radiation therapy performed for any cause other than cancer), pathology findings (size, degree of differentiation, Dukes stage, invasion of lymph nodes at the origin of the inferior mesenteric artery), and associated lesions. Only the length of tumor-free margins of colon removed was significantly longer in left hemicolectomy. The number of early postoperative abdominal and extra-abdominal complications was similar in both groups. Overall, early postoperative mortality was 4 percent higher, but not significantly in left hemicolectomy (eight deaths, 6 percent) than in left segmental colectomy (three deaths, 2 percent). Median survival was 10 years and nearly equivalent in both groups. The two actuarial survival curves were similar. Bowel movement frequency was significantly increased after left hemicolectomy during the first postoperative year. Our results suggest that survival after left segmental colectomy is equivalent to that of left hemicolectomy. Notwithstanding the observation of other carcinologic rules, left segmental colectomy rather than left hemicolectomy may theoretically be performed under laparoscopy without compromising the carcinologic outcome.

Adenocarcinoma↗
PubMed1994

[Celioscopic treatment of inguinal hernias by intraperitoneal patch of ePTFE according to Spaw. Preliminary results of a prospective study of 162 hernioplasties in 135 patients. Groupe CHIC (Cure des hernies inquinocrurales sous coelioscopie)].

Spaw's (original and modified) was technique evaluated in a prospective, multicentre study: from november 1992 to september 1993, 162 intraperitoneal laparoscopic herniorraphies were carried out in 135 patients for recurrent hernias or for hernias associated with a high risk of recurrence. Three needed an open procedure. Three early complications (2 periprosthetic hematomas, 1 microscopic bladder injury) were treated by another laparoscopy; a bowel loop retained in a trocar orifice was reintegrated under local anesthesia; dysesthesias of the lateral cutaneous nerve of the thigh in 1 patient and nonspecific parietal pain in 2 patients resolved within three weeks. Three seromas resolved after only one percutaneous aspiration. The mean post operative pain, evaluated by a visual analogic scale graduated from 1 to 10 was 1.8 (0 to 6) at D1, 05 (0 to 2) at D2 and the mean duration of analgesic requirments was 1.7 (0 to 15) days. The mean hospital stay was 2 (1 to 17) days for unilateral herniorraphies and the mean time to return to work or normal activity was 10 (2 to 44) days, even in heavy workers (35 patients). All patients were reviewed. The mean follow-up was 4 (1 to 10) months. Two complications needed further laparoscopic treatment: 1 recurrence at the internal edge of the patch, easily restapled with a stronger stapler, 1 bowel adhesion between patch and bladder revealed by pain without obstruction. The recurrence rate was 0.6% (1/162). The conversion rate was 2% (3/162) and the overall morbidity was 7.5% (12/162), decreasing respectively to 0 and 4% after the learning curve. This study confirms that Spaw's technique and its variant are feasible, and allows us to continue this study, and suggest these techniques would be useful in the treatment of some recurrent inguinal hernias.

Adolescent↗
PubMed1994

Infraperitoneal colorectal anastomosis: hand-sewn versus circular staples. A controlled clinical trial. French Associations for Surgical Research.

BACKGROUND: Disagreement continues among several studies as to the relative advantages and disadvantages of stapled versus sutured colorectal anastomoses. METHODS: One hundred and thirteen consecutive patients (48 men and 65 women, mean age: 67 +/- 12 years) were randomized to either hand-sewn (n = 59) or stapled (n = 54) infraperitoneal colorectal anastomosis. Both groups had similar patient demographics except that fewer patients (4 versus 15) had chronic disease (p < 0.02) and were undergoing side-to-end (11 versus 39) and more patients were undergoing end-to-end (37 versus 20) anastomosis in the stapled group (p < 0.001). RESULTS: Overall mortality was 6% (7 of 113 patients), with no difference found between the two types of anastomosis. Fewer anastomotic leaks occurred in the stapled group (11 versus 7), with an a posteriori gamma error of 11%, whereas the other early postoperative complications occurred with similar frequency in the two groups. Nine mishaps occurred in the stapled group. Stapled anastomoses took less time (median, 42 versus 30 minutes) to perform (p < 0.02). At 8 months, two strictures occurred in the hand-sewn group (n = 52) compared with eight strictures in the stapled group (n = 50) (p < 0.001). CONCLUSIONS: It was not possible to prove that lower anastomosis can be achieved with the stapling device. Routine or regular use of stapling instruments for infraperitoneal colorectal anastomosis cannot be advocated because of higher incidence of mishaps and strictures, even though the operation takes less time to perform and anastomotic leakage occurs less often.

Adult↗
PubMed1992

[Upper parietal pleurectomy with resection of bullae by thoracoscopy in spontaneous pneumothorax. New perspectives from preliminary results in 20 cases].

In view of the increasing development of laparoscopic surgery and hoping to minimize thoracotomy's risks, we had the idea to perform pleurectomy as a treatment of Spontaneous Pneumothorax (S.P.) through video thoracoscopy. The operation was performed under general endobronchial anesthesia, the patient placed in the posterolateral thoracotomy position. Three trocars inserted through the 5th, 7th and 9th intercostal space, allowed the introduction of non specific thoracoscopic instruments similar to those used in laparoscopic surgery. The apical pleurectomy was delimited by the 6th rib, the internal thoracic vessels, the costovertebral sulcus and the first rib. Blebs and small bullae are now transected with application of the "EndoGIA 30". Pleural cavity was drained by F28 ans F32 tubes through the lower orifices. This procedure was performed in 18 patients presenting 20.S.P.. Operative indications were: persistent air link (7 cases), recurrence (9 cases), bullae with bridle and or anterior thoracotomy for S.P. (4 cases). One bleeding of 200 ml from a wounded intercostal vessel ligated with a clip was the sole operative hitch. Operative duration decreased from two to one hour. Average drainage duration was 3.5 dys and hospital stay 4.5 days. There was no death nor immediate complications. Post-operative pain was judged in all cases less intensive than that experienced after pleurectomy with thoracotomy. This original procedure is the first described as entirely performed through thoracoscopy with non specific instruments and hence economic impact.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

[Colorectal anastomosis: manual or mechanical? A controlled multicenter study].

272 patients underwent randomly 133 hand sewn anastomosis and 139 stapled anastomosis (159 proximal and 119 distal) after elective colorectal resection for 194 carcinomas, and 78 sigmoid diverticulosis and benign tumors. Both groups were comparable with regard to mortality (3.3 p. cent), wound abcesses (3 p. cent) extra abdominal post operative complications (20 p. cent). There were however more reoperations in the stapled group (10 versus 6), and also more low intestinal anastomotic bleeding (9 versus 5). Stapled anastomosis were associated with less clinical fistulas (8 p. cent versus 12 p. cent) and only after low colorectal anastomosis (9 p. cent versus 20 p. cent). Stapling devices decrease the duration of the anastomosis by 8 mn, but this gained time does not influence the total duration of the operation. These advantages must be weighed against the risks inherent to their uses, mishaps (14 p. cent), hemorrhages (6.5 p. cent), strictures (8 p. cent), and their higher cost (15 times as much).

Adult↗
PubMed1989

[Development of antibiotherapy at the General Hospital Center R Ballanger of Aulnay-sous-Bois between 1978 and 1986: comparison of 2 prevalence surveys].

Two investigations of the prevalence of antibiotherapy and pathology due to infections have been conducted in 1978 and 1986 in a General Hospital (650 beds). In the first investigation, 29%, and, in the second one, 20% of hospitalized patients received a curative antibiotherapy. Among these patients, microbiology tests scored positive in 44% of cases in the first investigation and in 36% of cases in the second one. In the last inquiry, it was found that: the prescription was adapted to the infection in 95% of cases; the choice of antibiotic was adequate in 78% of curative treatments. Preventive antibiotherapy accounts for 30% of treatments in both investigations. In the second investigation, the prescription was adequate in 97% of cases and the length of treatment was less than 72 hours in 53% of cases. The frequency of Gram-positive cocci infections was increased while Gram-negative bacilli infections were reduced. Between the two investigations, antibiotic treatments have changed. Most noticeably, there is an increase in the number of prescriptions of macrolides, cephalosporins, nitro-imidazole derivatives and a reduction of tetracyclines, urinary antiseptics, quinolones of the 1st generation, sulfamides and penicillins. However, penicillins remain the most commonly used antibiotics family.

Anti-Bacterial Agents↗
PubMed1986

[Absence of the appendix. Apropos of a case].

A case of congenital absence of the appendix is reported by the authors. It is a very rare anatomic finding, the frequency of which is about 1 p. 100 000. The awareness of this malformation must not authorize young surgeon to forsake a difficult search of the appendix. The diagnosis should not be made unless the entire right colon and the ileo-cecal area are mobilized and thoroughly explored.

Adult↗
PubMed1977

[Pleural and intraspinal tumor with hypercalcitoninemia].

The authors report a case of probably ectopic secretion of calcitonin in a 35 year old woman suffering from a malignant tumour in a double intra- and extra-spinal form. Hormone levels returned to normal after complete excision of the tumour, in which it was impossible to demonstrate the presence of calcitonin despite a very marked secretory appearance by electron microscopy. Study of the literature concerning the secretion of calcitonin by malignant tumours indicates the high degree of contradiction concerning the origin and the significance of increased radio-immunological levels of this hormone, which it is not possible to use without criticism as a "marker" of carcinomas.

Adult↗
PubMed1976

[Digestive lesions after abdominopelvic irradiation, in the treatment of cancers of the genital tract].

The authors report 15 cases collected over a few years on a gastroenterology unit, and emphasize the digestive complications occurring after pelvic or abdomino-pelvic irradiation for genital carcinoma. The rectum and pelvic colon are generally affected. The delays of onset after radiotherapy may reach or exceed several months. The vascular lesions, caused by ionising radiation, explain the tissue ischemia and, consequently the failure of local medical treatment. When severe hemorrhage or visceral perforation occur, surgery is necessary. However, sutures often break down on these insufficiently vascularised tissues and re-operation is always associated with a poor prognosis.

Aged↗
PubMed1976

[Non-parasitic cysts of the spleen. 2 cases].

Although splenic cysts are benign, a gradual increase in volume of the liquid mass often leads to diagnosis owing to the large volume. The two cases reported are an example of this. A cure was obtained by splenectomy. It is usually easy to carry out and the prognosis is benign.

Adult↗