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Biomedical subjects

A Hamy

Publications and source records attributed to A Hamy.

81 records · Page 5Linked to original sources
PubMedDate not supplied

Feasibility of radioimmunoguided surgery of colorectal carcinoma using indium 111 CEA specific antibody and simulation with a phantom using 2 steps targetting with bispecific antibody.

The study was undertaken to define the potential use of radiolabelled (Indium 111 or Technetium 99 m) carcinoembryonic antigen specific antibody (CEA f(ab')2) for the radioimmunodetection of colorectal cancer using an intraoperative hand-held gamma probe. A clinical study performed with ten patients showed that tumor with good uptake of CEA specific antibody could be detected with sufficient contrast only in two patients. Results of a biodistribution study performed with tumor fragment and normal tissue countings in a gamma counter showed high tumor uptake in five patients. There was no correlation between tumor uptake and the count rates measured intraoperatively. To increase the signal/background of the gamma probe, a simulation study with a peritoneal cavity phantom was performed. We determined the efficiency of a two steps targetting method compared to the direct method. We simulated different tumor sizes with plexiglas balls (0.5, 1, 2, 5 ml) and tested two scintillators (NaI, BgO). Experiments were performed with 111 In and 99 m Tc. The two steps targetting method was better than direct method. The results of simulation with direct method radiolabelled with 111 in confirmed our clinical study: no efficiency of a gamma probe for the surgeon to detect a tumor. However the two steps targetting method (indirect labelling method) was very encouraging to detect tumors (size 1 and 2 ml) and definitively convincing with 99 m Tc.

Antibody Specificity↗
PubMedDate not supplied

[Evaluation of quality of care in a general surgery department].

A permanent evaluation of a department's activity and the quality of health care it provides is needed to avoid inappropriate use resulting from a wide range of causes. The activity of a general surgery department treating and average of 1,500 patients per year and performing 1,200 operations was analyzed over the period 1986 to 1992. Post-operative hospital follow-up was noted for each patient and any complications were analyzed on discharge day by the surgeons, the anaesthesiologists and the nursing staff. A year-end sum up was conducted each year by homogeneous groups. Examples are presented: surgery for cancer of the oesophagus (122 cases), surgery for gastro-oesophageal reflux (120 cases), thyroid surgery (1,314 cases from 1988 to 1992). Complications, hospital stay and former pathologies were evaluated in order to determine the indications, prevent complications and evaluate more rapidly the advantages of modifications in techniques. The results were compared between surgeons. This daily evaluation allowed a better analysis than a retrospective study compared with data in the literature. Permanent personal reevaluation was one of the practical consequences of the study considered to be and enriching experience.

France↗
PubMedDate not supplied

[Retroperitoneal perforations of the colon. Apropos of 2 cases].

The retroperitoneal perforation of the colon is rare and our observations illustrate its two modes of revelation: a retroperitoneal suppuration; it must be traited quickly in order to decrease the mortality. Note that the abscess of the thigh is exceptional. Retroperitoneal perforations during colonoscopy whose treatment (initially medical) become surgical if there is no clinical improvement.

Aged↗
PubMedDate not supplied

[Surgical treatment of secondary hyperparathyroidism in chronic kidney failure. Results of total parathyroidectomy with parathyroid autotransplantation].

Between 1978 and 1990, 68 patients, operated on for secondary hyperparathyroidism (HPT), received a forearm intramuscular free autologous parathyroid graft (37 women and 31 men--mean age: 43 +/- 16 years). The transplantation (Wells technique) was performed in the same time as the total parathyroidectomy and the remaining parathyroid material after surgical resection was cryopreserved. The results were evaluated in term of clinical and/or radiological and/or biological response respectively 3 or 5.5 years later, depending of the realisation of a renal transplantation (n = 27) or not. Four patients were lost to follow-up and 4 died post-operatively, including a wrong diagnosis (60 patients evaluated). Mortality rate was 12% (5 cases out of 7 related to chronic renal insufficiency). In 3 patients (5%) the transplanted gland had to be removed because of recurrent HPT (1 graft hyperplasia; 2 wrong diagnosis: 1 cervical gland left over and 1 aluminium intoxication). Second cervicotomy was performed in 3 cases (5%) for remaining cervical parathyroid gland (2 cases) and false-positive Tallium-Technetium scan (1 case). Overall results were good or very good in 51 cases (85%). A review of the literature indicate that subtotal parathyroidectomy in not superior to the Wells technique and the latter remain the landmark technique in the authors' hands in order to treat secondary HPT.

Adolescent↗
PubMedDate not supplied

[Echo-guided percutaneous cholecystostomy in the treatment of acute cholecystitis. Apropos of 41 cases].

Differents studies note many complications of the traditional cholecystectomy for acute cholecystitis in critically ill and very old patients. We report a retrospective study of ultrasound-guided cholecystostomy as an alternative treatment avoiding surgery in 41 patients between April 1988 and January 1994. Mean-age was 77.8 years (42-95). Hospital mortality concerned five (12.2%) patients. Four (9.8%) required surgical procedure, all of them with simple post-operative course. Six (14.6%) had a recurrence between 1 and 67 months after the end of the drainage. Twenty-six patients are considered as healed, without recurrence, after a mean-follow-up of 33 months. The percutaneous echoguided cholecystostomy seems to be a treatment of choice for patients with a contraindication for a surgical procedure. This technic allows an efficient treatment in patients with post-operative cholecystitis.

Acute Disease↗
PubMedDate not supplied

[Gastric adenocarcinomas (excluding linites). Prognostic factors apropos of a series of 101 cases].

The incidence of some factors on prognosis of adenocarcinoma of the stomach was evaluated in 101 cases. Linites as well as cancers of the cardia were excluded from the analysis. There were 47 total gastrectomies with more or less extensive node dissection and 54 partial gastrectomies. Overall actuarial survival was 34.5% despite the large number of advanced stage cancers (70% positive lymph nodes, 35 with invasion of neighbouring organs, 13 cases of carcinosis and 13 with liver metastasis). Univariate analysis showed that the following factors were associated with poor prognosis: invasion of the serous layer, nodal involvement, emboli, degree of differentiation. Peritumoural reactional lymphoid infiltration, the presence of a chronic gastritis and intestinal metaplasia were found to be favourable factors. Gastric resection appeared to have less impact than the quality of the nodal dissection. These findings emphasize the importance of extensive dissection of the lymph nodes (survival ranging from 31 to 78% depending on the node score). Extensive dissection, allowing better locoregional control of the disease, improved prognosis whatever the size of the tumour (14.8% survival in case extending to neighbouring organs). The only exceptions were palliative exereses and N4+ cases.

Adenocarcinoma↗
PubMedDate not supplied

Sigmoid perforation, an exceptional late complication of peritoneal prosthesis for treatment of inguinal hernia.

Two cases of sigmoid perforation and fistula occurred as late complications after insertion of a nonresorbable prosthesis by the open preperitoneal inguinal route. These infrequent complications are favoured by peritoneal defects and use of materials which can cause extensive sclerous reactions. Indications for this type of mesh are increasingly common with the intraperitoneal laparoscopic approach, so that careful peritoneal dissection and closure are required.

Aged↗
PubMedDate not supplied

Laparoscopic hepatic surgery. Report of a clinical series of 11 patients.

BACKGROUND: Hepatic laparoscopic surgery is now possible, though its feasibility has not been demonstrated. METHODS: Eleven patients with benign hepatic lesions underwent laparoscopic surgery for different reasons (deroofing or excision of cysts, non-anatomical and anatomical resections of benign tumours). RESULTS: No deaths occurred, and morbidity was low. Conversion to laparotomy was not required, and none of the patients needed homologous blood transfusion. CONCLUSIONS: Hepatic laparoscopic surgery appears to be a safe and valid procedure for benign lesions but may not be suitable for all types of malignancy.

Adult↗