Biomedical subjects

A Fingerhut

Publications and source records attributed to A Fingerhut.

At least 109 records · Page 6Linked to original sources

PubMed1993

Single-dose ceftriaxone, ornidazole, and povidone-iodine enema in elective left colectomy. A randomized multicenter controlled trial. The French Association for Surgical Research.

Patients undergoing elective left colectomy for colonic carcinoma or diverticulosis (n = 341) were randomly assigned to three groups. Patients in groups 1 (102 patients) and 2 (122 patients) had two 5% povidone-iodine enemas whereas those in group 3 (117 patients) had saline enemas. Groups 1 and 3 received 24-hour intravenous cefotaxime sodium and metronidazole hydrochloride. Group 2 received single injections of ceftriaxone sodium (1 g) and ornidazole (1 g). Senna concentrate was administered the evening before surgery. There was no statistically significant difference found between groups 1 and 2 concerning the number of infected patients (eight vs 11), anastomotic leakages (four vs four), extra-abdominal complications (32 vs 29), or infection-related deaths (one vs zero). Despite poorer tolerance, povidone-iodine enema was more effective than saline enemas, as there were less infected patients in group 1 (8%) or groups 1 + 2 (8.5%) than in group 3 (13%). Single-dose ceftriaxone-ornidazole combined with povidone-iodine enemas is effective against infective complications in elective left colonic surgery for carcinoma or diverticular disease. Single-dose antibiotic prophylaxis reduces costs and work for the nursing staff.

Adult↗

PubMed1993

Factors associated with early discharge after inguinal hernia repair in 500 consecutive unselected patients. French Associations for Surgical Research.

The feasibility of discharge within 48 h of surgery was evaluated in 500 consecutive men with unilateral uncomplicated non-recurrent inguinal hernia. Eighty-nine [corrected] patients were unsuitable for short-stay surgery on medical or social grounds. Of 411 patients suitable for early discharge, 107 stayed longer than 48 h. Early discharge was declined by 84 otherwise suitable patients and contraindicated because of local or general complications in 42. A total of 304 patients were discharged within 48 h; 1-day surgery was performed in 51 patients. Employment, low physical requirements, a lower age and fewer than two medical risk factors were associated with feasible and successful short-stay surgery. These factors may not be independent variables.

Adolescent↗

PubMed1993

Ileocolonic anastomosis after right hemicolectomy for carcinoma: stapled or hand-sewn? A prospective, multicenter, randomized trial.

440 patients were prospectively enrolled in a randomized, multicenter trial to compare 4 types of manual (84 interrupted end-to-end, 77 continuous end-to-end, 82 interrupted end-to-side, and 91 continuous end-to-side) (polyglycolic derived suture) and 1 type of stapled (106 side-to-side with GIA+TA devices) ileocolonic anastomosis after right hemicolectomy for carcinoma. The trial was designed according to Schwartz' pragmatic formulation. All 5 groups were well-matched, except for a lower rate of intraoperative sepsis in the stapled group (P < 0.02). The main end point was anastomotic leakage detected clinically or by routine sodium diatrizoate enema on the 8-10th postoperative day. Results showed that stapled ileocolonic anastomosis was associated with less anastomotic leakages (2.8%) than all the other techniques combined (8.3%). In spite of the fact that staples are approximately ten times more expensive, our results suggest performing side-to-side (GIA+TA) mechanical anastomosis after right resection for carcinoma.

Adult↗

PubMed1993

[Traumatic rupture of the pericardium with left intrapleural luxation of the heart in a patient with multiple trauma].

Traumatic rupture of the pericardium is a rare lesion usually associated with violent thoracic trauma and sudden deceleration. The case described herein is one of left intra-pleural luxation of the heart secondary to trauma which was asymptomatic for nine hours and was revealed by acute symptoms due to mobilisation of the patient. Diagnosis of this entity is difficult and is usually made in the acute multiple trauma setting. Although usually negative, lung films may be contributive; sonocardiogram, which should be obtained routinely in this setting, is often non-specific but usually provides the indication for thoracotomy. The most severe complication is extra-pericardic luxation of the heart with strangulation or volvulus, depending on the site and size of the pericardial tear. While all proven cases of pericardial rupture should be explored surgically, treatment varies for different teams according to the site and the size of the rupture.

Adult↗

PubMed1993

Indications for right hemicolectomy in carcinoid tumors of the appendix. The French Associations for Surgical Research.

The records of 181 patients with carcinoid tumor of the appendix, seen during a ten year period (1977 to 1987), were analyzed retrospectively to determine the indications for right colectomy and the signification of intermediate histopathologic forms. Appendectomy was the only treatment in 146 patients; while right hemicolectomy was performed upon 35 patients--in seven patients with one postoperative death initially and in 28 patients without any death or morbidity, secondarily. Colectomy was indicated initially in seven patients for bulky tumors of the base of the appendix invading the cecum or for associated carcinoma of the right colon. The 28 secondary colectomies were indicated for tumors that were statistically larger and more invasive than those treated by simple appendectomy or for intermediate forms, or both, in five instances. There were five instances of residual tumor on secondary hemicolectomy specimens. In 11 of the 181 carcinoid tumors (6 percent), the intermediate type tumor was associated with mucinous production--seven adenocarcinoids and four carcinoids with mucocele. Of the seven instances of adenocarcinoid, there was one death at two years and one patient is alive with metastases. Other than size greater than 2 centimeters and base localization, the results of the current study suggest that the presence of mucinous production cells is a further indication for secondary right hemicolectomy.

Adolescent↗

PubMed1992

Conservation therapy for invasive lobular carcinoma of the breast.

Earlier literature suggests a high incidence of multicentricity and bilaterality, with an overall poor prognosis, in patients with invasive lobular carcinoma of the breast. Consequently, there is considerable disagreement regarding appropriate local management of this disease. To determine the influence of invasive lobular histologic findings on local tumor control, disease-free survival, and overall survival, the authors reviewed 60 patients with Stage I and II invasive lobular breast carcinoma treated with local tumor excision and radiation therapy between 1981 and 1987 (mean follow-up, 5.5 years; range, 2.5 to 10 years). The 5-year actuarial risk of locoregional recurrence was 5%, with two of three failures occurring in the regional lymphatics. The mean time to locoregional failure was 28 months. The 5-year actuarial disease-free survival (84%) and overall survival (91%) were comparable to those seen in several large series of similarly treated patients with invasive ductal carcinoma. Contralateral breast cancer occurred at a rate of approximately 0.6% per year. This study and a review of the literature suggest that breast conservation, with local resection and radiation therapy, is appropriate therapy for invasive lobular breast cancer.

Adult↗

PubMed1992

Splenic salvage using an absorbable mesh: feasibility, reliability and safety.

Forty-nine adults underwent surgery for splenic injury: 17 (group 1) had salvage with a splenic mesh, seven (group 2) underwent other preservation techniques, and 25 (group 3) underwent splenectomy. There were six, zero and 11 hilar lesions in groups 1, 2 and 3, respectively. Seven of 15 associated lesions involved the digestive tract. There was no significant difference in transfusion requirements, length of operation or postoperative complications. One patient died in each of groups 1 and 2, and eight in group 3. Secondary splenectomy was performed once in groups 1 and 2. The duration of hospital stay was shorter in the preservation groups (1 and 2) than in group 3. Splenic preservation was feasible in 24 of 49 adults with splenic injury requiring surgery. The splenic mesh wrap is safe and reliable, and allows splenic salvage even with hilar injury.

Adolescent↗

PubMed1992

Predictability of clinicobiochemical scoring systems for early identification of severe gallstone-associated pancreatitis.

Early identification of severe gallstone-associated acute pancreatitis (GAAP) is a prerequisite for treatment with urgent endoscopic sphincterotomy. This study assesses the value of two clinicobiochemical scoring systems to this end. Over the 7-year period from 1983 to 1989, 100 consecutive patients with acute pancreatitis (45 related to gallstones, 36 to alcohol, and 19 of undetermined etiologies) had clinicobiochemical analysis within 48 hours of admission. The final diagnosis and outcome were retrospectively compared with the prediction achieved by the scoring systems. With regard to Blamey's criteria for early identification of gallstones, significant differences were found between the biliary and nonbiliary groups with respect to female sex, serum amylase concentration greater than or equal to 4,000 IU/L, alkaline phosphatase level greater than or equal to 300 IU/L, and alanine aminotransferase level greater than or equal to 100 IU/L (all p values less than 0.001). Age greater than or equal to 50 years was found to be significant (p less than 0.02) only in differentiating gallstone- versus alcohol-associated acute pancreatitis. When three or more positive factors were present, the sensitivity and specificity for predicting gallstones were 60% and 87%, respectively; the predictive value of a positive result was 79%, of a negative result 74%, and the overall accuracy was 75%. At a cutoff level of five, rather than three or more prognostic factors, the modified Ranson's criteria for patients known as having GAAP allowed a suitable discrimination of patients with an expected high risk of complications and mortality. When the two scoring systems (Blamey greater than or equal to 3 and Ranson greater than or equal to 3) were combined, 17 patients were predicted as having severe GAAP: 6 of these 17 patients were misdiagnosed as having biliary pancreatitis, whereas 9 patients with definite severe GAAP were not selected because of a Blamey score less than 3. More specific diagnostic tools are needed, and higher cutoff levels for prognostic scores are required for the prediction of severe GAAP, particularly in view of selecting patients for potentially dangerous approaches such as urgent endoscopic sphincterotomy.

Acute Disease↗

PubMed1992

Treatment of adenocarcinoma of the pancreas with somatostatin and gonadoliberin (luteinizing hormone-releasing hormone). The French Associations for Surgical Research.

Experimental studies have shown a significant inhibition of adenocarcinoma of the pancreas by gonadoliberin (luteinizing hormone-releasing hormone [LH-RH]) and somatostatin. The aim of this prospective randomized study was to compare the potential value of somatostatin (250 micrograms every 8 hours), LH-RH (3.75 mg monthly), or combined, to a control group. One hundred sixty-three patients with adenocarcinoma of the pancreas who did not undergo resection for cure were divided into 4 groups that did not differ in terms of clinical, biologic, or pathologic data. The mean survival times were 6 months in the LH-RH plus somatostatin group, 5.5 months in the LH-RH group, 4.3 months in the control group, and 3.8 months in the somatostatin group. However, the life-table analyses for all randomized patients, and separately according to sex, the lymph node extension, and metastatic spread were not different between groups. Improvement of patient status was observed in 20% of the patients receiving hormone therapy without any difference noted between the treatment regimens. These disappointing results may be explained by the degree of extension of pancreatic carcinoma in the patients studied. The results suggest that different hormone therapy regimens might be considered according to the age and the sex of patients, as well as to the presence or absence of hormone receptors.

Adenocarcinoma↗

PubMed1992

Prospective evaluation of ultrasonic surgical dissectors in hepatic resection: a cooperative multicenter study.

Blood loss is the major cause of postoperative mortality and morbidity associated with hepatic resection. A prospective multicenter study was conducted to determine if ultrasonic dissectors (USD) were useful in hepatic resection and could reduce this hemorrhagic risk. Forty-seven hepatic resections were performed in 42 consecutive patients during a two month period in 11 public, surgical centers. Twenty-one patients had primary or secondary malignancies, six had benign tumors, two had biliary cysts, one had cholangiocarcinoma, one had Caroli's disease, and 11 had hydatid cysts of the liver. Two different USD devices were evaluated (CUSA System-Lasersonics and NIIC-DX 101 T). The hepatic resections tested included a wide range of procedures. Each surgeon had the possibility of choosing between the USD and his own usual technique for each operative step and according to local conditions. The average volume of blood infused, irrespective of the underlying pathology or the procedure performed, was 1.0 L (range 0-4.8 L). Fourteen patients required no transfusions. No operative or immediate postoperative deaths were recorded. Five major complications, all unrelated to the use of the USD, developed in three patients. Access to intra and extraparenchymal arterial and venous tributaries and particularly the control of the hepatic veins were facilitated by USD. While transection of hepatic parenchyma was neither easier nor faster than with conventional techniques, it was found to be less hemorrhagic. Overall appraisal was expressed on an analog scale; the USD was found to be helpful or very helpful in 75 percent of all resections. With regard to the pathology being treated, total or partial excision of hydatid cysts was greatly enhanced by the use of the USD while this benefit was not found for wedge resections of other hepatic lesions. With regard to user friendliness and maintenance, the NIIC-DX 101 T device was preferred. We conclude that the USD facilitates formal hepatic resections. Converging opinions emerging from various surgical centers reinforce this conclusion.

Adult↗

PubMed1992

[Treatment of tumors of the small intestine in Peutz-Jeghers' syndrome. Value of a combined endoscopic and surgical approach. Apropos of 2 familial cases, one of which with a 15-year follow-up].

We report two cases of Peutz-Jeghers syndrome who underwent intraoperative enteroscopy. In the first case, the fiberscope was sterilized with ethylene oxide, while in the second, an electronic colonoscope was decontaminated with glutaraldehyde plus phenate. The endoscope was introduced through an enterotomy. This led to the discovery of several hamartoma greater than 10 mm which had gone undetected by the surgeon and guided the surgical procedure. In a case with approximately 30 hamartoma, associated endoscopic polypectomy and surgical removal of polyps by eversing the mucosa through enterotomies allowed the medicosurgical team to obtain a "clean small bowel" without resection.

Adult↗

PubMed1991

[Benign mucus-secreting tumors of the appendix. Six cases].

The authors report six cases of mucus-secreting tumor of the vermicular appendix, in four women and two men (mean age 59 years). All were benign. Pain in the right lower quadrant was the initial sign in 4 cases, while the mucus-secreting tumor was an incidental finding in the other two cases. A mass was palpated in the right lower quadrant in one case. A barium enema was performed in four cases and showed an extrinsic compression of the caecal base in one case, and of the right colon in another case. Four appendectomies, one associated with removal of the adjacent caecal tissues and two right colectomies were performed. Analysis of these six cases and a review of the literature allow us to recall the histologic classification of these tumors, which determines the prognosis and to emphasize the sonographic and CT scan findings which might lead to earlier preoperative diagnosis in the future. Management depends upon the circumstances under which the tumor is discovered, the local anatomy, and the type of tumor. Appendectomy is the treatment most often performed. Faced with a tumor of the appendix, without histologic proof or when the local anatomic conditions increase the risk of opening an abscess, right colectomy is recommended.

Aged↗

PubMed1991

Postoperative radiation therapy does not increase survival after curative resection for squamous cell carcinoma of the middle and lower esophagus as shown by a multicenter controlled trial. French University Association for Surgical Research.

In 1978, postoperative radiation therapy was suggested to be an additive treatment of carcinoma of the esophagus. In 1987, we began a multicenter trial of patients with epidermoid carcinoma of the middle third or the lower third of the esophagus. Isolated surgical treatment (119 patients) was compared with surgical treatment followed by radiation therapy (102 patients). Randomization was performed according to the results of pathologic examination of all resected lymph nodes. Patients were divided into three groups: N0, no lymph node invasion; N+1, invasion of paraesophageal lymph nodes, and N+2, invasion of distal lymph nodes (recurrent, tracheal and celiac). All patients included in this trial had a curative esophageal resection. In the group receiving radiation therapy (102 patients), a total dose of 45 to 55 Grays was delivered in the mediastinal, right and left supraclavicular areas and also to the celiac area when celiac lymph node invasion was present. Two hundred and twenty-one patients were randomized and observed from three to nine years; life table method (log rank method) was used to compare survival and local recurrence. In all patients studied, the survival rate was significantly higher (p less than 0.01) in patients without lymph node invasion (group N0) than in patients with lymph node invasion (groups N+1 and N+2). Postoperative radiation therapy did not improve survival in any group. This lack of improvement in survival was present regardless of lymph node status. However, there were significantly fewer recurrences in patients receiving radiation therapy as compared with those not receiving radiation therapy.

Carcinoma, Squamous Cell↗

PubMed1990

Intraductal carcinoma of the breast (208 cases). Clinical factors influencing treatment choice.

Two hundred eight cases of intraductal breast carcinoma (DCIS) were selectively treated; 97 with mastectomy, 96 with radiation therapy, and 15 using excisional biopsy only. Mastectomy patients tended to have larger tumors, involved biopsy margins, palpable and often multifocal tumors. Breast preservation patients tended to have smaller, often occult, tumors with clear surgical margins. Before 1983, mastectomy was more common; during and after 1983, breast preservation was more common. Comedocarcinomas were the most frequent tumors. They were the largest, had the highest percentage of microinvasion (20%), and had the highest recurrence rate (8%). Noncomedo DCIS had a recurrence rate of 1%, one of 103 tumors. The recurrence rate for comedocarcinomas treated with radiation therapy was nearly three times higher than for those treated with mastectomy (11% versus 4%). One of 164 (0.6%) axillary lymph node dissections yielded positive nodes. Nine patients have recurred: two in the mastectomy group and seven in the breast conservation group (P less than 0.1). Eight of nine recurrences were the comedo subtype (P less than 0.05). Three patients developed metastatic disease, two of whom have died. Axillary dissection for intraductal carcinoma of the breast is unlikely to yield involved nodes and is not indicated for most cases. It should be reserved for lesions revealing microinvasion. Conservative therapy for comedocarcinoma must be viewed with caution.

Adult↗

PubMed1990

[Homeopathy for the restoration of transit after abdominal surgery].

Six hundred patients were alloted to one of 4 groups and given: 1) no treatment, 2) a homeopathic treatment (Opium and Raphanus), 3) Opium + a placebo, 4) two placebos. This work does not confirm the role of either Opium or Raphanus in the restoration of transit following abdominal surgery.

Abdomen↗

PubMed1990

[Colorectal preparation for excision surgery. Development after 4 randomized multicenter studies].

1,265 patients having elective surgery with colectomy for cancer or sigmoiditis have been included in four successive randomized multidepartmental studies in order to define the most effective preparation, reducing the rate of postoperative infections, and the shortest one. The first study included 202 patients divided up into 2 groups, and compared a three-day conventional preparation (CP) (low-residue diet, laxatives and enemas) with a total digestive irrigation (TDI) (9 liters in 6 h) with Mannitol. Both preparations were associated with a three-day preoperative antibiotic therapy with Neomycin and Tetracyclin. Intolerance to TDI (50% of cases) and the greater number of fistulae with this method lead to preferring CP. The second study (326 patients in 4 groups) compared on one hand, a CP with the single absorption of a sachet of Sennosides or 2 liters of 10% Mannitol, and on the other hand, the preoperative antibiotic treatment utilizing Neomycin or Tetracyclin over three days with a 24-hour treatment with Metronidazole. Its conclusions are that the absorption of Sennosides is better tolerated than Mannitol and significantly more effective than the CP. There is no significant difference between the antibiotic therapy over three days and that over 24 h. The third study (335 patients in 4 groups) compared on one hand, lukewarm water enemas to enemas with iodinated polyvidone diluted to 5%, and on the other hand an antibiotic therapy utilizing Metronidazole on the day before, the same day and the three following surgery with a 24-hour antibiotic therapy utilizing Metronidazole (1.5 g) and/or Cefotaxime (4 g) on the same day as the operation.(ABSTRACT TRUNCATED AT 250 WORDS)

Anti-Bacterial Agents↗

PubMed1990

[Epidemiology of traffic accidents in France].

The prevalence of deaths due to traffic accidents in France is approximately 20/100,000 inhabitants (1988). This places France 9th in Europe. Sixty-five percent of the accident population are between 16 and 65 years old. Sixty-three percent of deaths occur in people who are in passenger cars, while 11% are pedestrians. There were six deaths for every 100 accidents in 1988. The number of corporal accidents and deaths were 22.6% and 37.2%, respectively, on turnpikes, 31.3% and 47.2%, on rural roads, and 46.1% and 15.6% on urban networks. The two most commonly incriminated factors were speeding and drunken driving. Speeding was responsible for one out of six deaths on turnpikes and national roads, one out of two on urban and rural roads. Costs were 53,000,000 FF in 1988, 47,000,000 FF going in work compensations and lost working days. Prevention measures include improvement of supervision of road networks, especially in rural areas, more severe fines with reinforced fool-proof paying conditions, mandatory seat-belts for passengers in the front and back of cars, as well as continuous education for drivers.

Accident Prevention↗

PubMed1990

[Invalidating polyarthritis in chronic pancreatitis. Recovery by pancreaticojejunostomy].

A 38 year-old man presented with migratory joint arthropathy. He complained of abdominal pain, diarrhea and weight loss for 2 years. Periarticular needle aspiration yielded cytosteatonecrosis. The diagnosis of chronic pancreatitis was based on the results of ultrasound, CT scan, and endoscopic retrograde pancreatography. The latter showed a dilated and moniliform main pancreatic duct. Failure of symptomatic medical treatment of arthritis led to perform pancreaticojejunostomy which was followed immediately by complete relief of arthritic symptoms. During pancreatic disease, whether malignant or benign, joint involvement is often associated with bone, cutaneous, serosal, and multiorgan involvement. The pathogenesis and therapy of joint lesions in pancreatic disease are controversed. Surgical treatment of the causative disease, and especially pancreaticojejunostomy should undoubtedly be considered more often.

Adult↗