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Biomedical subjects

A Jayet

Publications and source records attributed to A Jayet.

At least 19 recordsLinked to original sources
PubMed2000

A 3-year experience with laparoscopic gastric banding for obesity.

BACKGROUND: The introduction of laparoscopic techniques-especially that of gastric banding-and the fact that conservative management does not provide satisfactory long-term results in patients with morbid obesity has resulted in a marked increase in the demand for bariatric surgery in our department since 1995. In this paper, we present our experience during the first 3 years with this approach. METHODS: Data for all patients who had bariatric surgery at our institution were collected prospectively. They were analyzed for the purpose of this study. RESULTS: A total of 150 patients were operated on between December 1995 and December 1998 (37 months). There were 130 women and 20 men, with a mean age of 37.5 years (range, 19-62). The mean initial excess body weight was 102.9% (range, 58-191%), and the mean initial body mass index (BMI) was 44. 6 kg/m(2) (range, 35.1-64.1). A Lapband was used in 101 cases and a SAGB in 47 cases. In two patients in whom conversion was necessary, we performed a vertical banded gastroplasty. Duration of surgery decreased over time from 210 min (first 20 cases) to 73 min (last 20 cases). Six patients (4%) developed major complications, one of whom died. The median duration of postoperative hospital stay was 3 days. The mean follow-up was 17 months. In all, 24 patients (16%) developed late complications, and 22 (14.6%) required reoperation, mainly for band slippage and/or pouch dilatation (14 cases). An incorrect surgical technique used for the first 30 patients (Lapband within the lesser sac) was responsible for more than half of these complications. The mean excess weight loss was 34% at 6 months, 55% at 1 year, and 56% at 2 years. Compared to vertical banded gastroplasty (197 cases between 1981 and 1995), postoperative morbidity was greatly decreased, late morbidity was similar, and weight loss was equivalent. CONCLUSIONS: Laparoscopic gastric banding is followed by a weight reduction that is similar to that observed after vertical banded gastroplasty, with a much lower postoperative morbidity, a shorter hospital stay, and an earlier resumption of normal activities. If these results can be confirmed by long-term follow-up, laparoscopic gastric banding will be confirmed as the restrictive procedure of choice for morbid obesity.

Adult↗
PubMed2000

Vertical banded gastroplasty: long-term results comparing three different techniques.

BACKGROUND: Vertical banded gastroplasty (VBG) has been our procedure of choice for the treatment of morbid obesity from 1981-1995, at which time it was replaced by laparoscopic gastric banding. Three different techniques have been used for banding: silastic band, marlex mesh, adjustable sphincter. The purpose of this paper is to present the long-term results. METHODS: The charts from all patients operated on during the aforementioned period were reviewed and the data analysed retrospectively. RESULTS: This series comprises 197 patients, 172 females and 25 males, with a mean initial excess weight of 94.8% (6-300%) and a mean initial Body Mass Index (BMI) of 42.9 kg/m2 (23-88 kg/m2). 73 patients had a silastic band, 40 Marlex mesh, and 84 an adjustable sphincter. Overall excess weight loss was 66% after 12-24 months, and remained between 50 and 60% up to 9 years postoperatively. There was no difference between the 3 groups. 82 patients (41%) developed a total of 117 complications during follow-up. Among them were stenosis 20%, staple-line disruption 11%, incisional hernia 13%, severe esophagitis 7% and band migration 1.5%. Stenosis developed more often with a silastic band or an adjustable sphincter, and severe esophagitis was more prevalent after the adjustable sphincter. 58 patients required one or more procedures for correction, including dilatation in 21, band removal in 17, band replacement in 15, restapling in 19 and incisional hernia repair in 11 patients. Overall, 29.4% of patients had to be reoperated. There were more reoperations in the silastic and adjustable sphincter groups compared with the Marlex mesh group. CONCLUSIONS: VBG is associated with a rapid weight loss that is relatively well-maintained over time, although there is a tendency to slight weight regain after 2 years. The price for these results is high if complications and further necessary procedures are considered, especially after banding with a silastic band or an adjustable sphincter. Marlex mesh represents the banding material of choice if VBG is chosen.

Adult↗
PubMed1999

Early results of laparoscopic gastric banding compared with open vertical banded gastroplasty.

BACKGROUND: The introduction of laparoscopy and the increasing awareness that surgery is the only efficient long-term treatment for morbid obesity have been followed by an enormous increase in the demand for bariatric surgery. We introduced laparoscopic gastric banding (GB) in 1995, after a 15-year experience with vertical banded gastroplasty (VBG). The aim of this article is to compare the early results of this new technique with those of VBG. METHODS: The charts of all the patients who underwent VBG (group A) between 1981 and 1995 were reviewed. The data for the patients who underwent laparoscopic GB (group B) between December 1995 and March 1998 were collected prospectively. Weight loss was compared between groups. All the complications arising during follow-up in the laparoscopy group were considered for analysis. In the VBG group, the complications during the first 18 postoperative months were taken into consideration. RESULTS: There were 197 patients in group A and 76 patients in group B. The ages and risk factors were similar in both groups, but the mean body weight (116 kg vs. 121 kg, P < 0.01) and the mean body mass index (BMI) (42.7 versus 45.5, P < 0.001) were significantly higher in the laparoscopy group. If the first 30 patients of group B are excluded, duration of surgery was not different between groups. Mortality was similar, but the postoperative morbidity was higher in the VBG group (23.8% vs. 8.0%, P < 0.005). The hospital stay was much shorter in group B. Weight loss was less after 6 and 12 months in group B but was similar after 18-24 months in both groups. During early follow-up as defined in the Methods section, overall morbidity and the need for reoperation were not different between groups. Most complications were noted among the first 30 patients operated on. CONCLUSIONS: Laparoscopic GB takes no longer to perform than VBG once the learning curve is over. It is associated with less postoperative morbidity and a much shorter hospital stay. Weight loss is slower after laparoscopic GB but is similar to that achieved after 18-24 months by VBG. With proper surgical technique, laparoscopic GB can be performed adequately with a very low rate of postoperative and long-term complications. Considering the high incidence of long-term complications after VBG, it is probable that laparoscopic GB will eventually replace VBG as the restrictive procedure of choice for morbid obesity.

Adolescent↗
PubMed1995

Long-term Results on Quality of Life of Surgical Treatment of Obesity with Vertical Banded Gastroplasty.

BACKGROUND: Few papers assess quality of life after vertical banded gastroplasty (VBG). METHODS: 100 patients with severe obesity (preoperatively mean BMI 41.7 kg m(2)) answered an interview 60 (+/- 2.5) months after VBG. RESULTS: There was no fatal outcome. Nine patients had pulmonary embolus; ten patients required reoperation because of stomal stenosis. Of the 89 patients that still bore a gastroplasty at the moment of the interview, 65 had lost more than 40% of their excess weight (= "success'). Improvement in quality of life of these 89 patients was reflected by significant diminution of depression and back pains. Significant diminution of arterial hypertension and improvement of professional satisfaction, and of social, physical, and sexual activity was significantly related to weight loss. CONCLUSION: VBG resulted generally in a favorable long-term effect on quality of life. However, patients should be informed preoperatively about potential side-effects such as possible persistent vomiting after several years, esophagitis and gastritis, restriction in the choice of foods and prolongation of meals.

Journal Article↗
PubMed1995

[Value of duplex ultrasound in diagnosis of ergotism of the legs].

Ergot's derivatives are widely used in the treatment of migraine and in the prophylaxy of deep venous thrombosis in association with heparin. Clinical ergotism is rarely observed and can affect all the arteries, especially of the inferior limbs. Vasospasm of the peripheral arteries and collateral formation are specific findings on angiography. We report the illustrative case of a 38 years old woman hospitalized for a small bowel occlusion. She suffers from chronic migraine treated by ergotamine tartrate. During her hospitalization, she develops an acute ischemia of the lower limbs. An ergotism was clinically suspected and confirmed by Duplex sonography which demonstrate multiple vasospasm. Under iv sodium nitroprusside and peridural analgesia the spasm resolved in 24 hours. The control Duplex sonography confirm the normality of the lower limb arteries. This examination modality allow a non-invasive diagnosis and evolution control of arteriospasm.

Adult↗
PubMed1989

[Surgical treatment of exogenous morbid obesity: results of Mason's vertical gastroplasty].

Among the various surgical methods of treating exogenous morbid obesity, Mason's vertical gastroplasty has gradually become the method of choice throughout the world. The method is relatively simple and the operating time short, so that if offers the great advantage of maintaining normal digestive activity free of metabolic disturbances. Between December 1981 and December 1988 we treated 160 patients in this way, the mortality in the series being nil. The results obtained are encouraging, since among 75 patients followed up for at least 2 year, 50 (66%) had a weight index between 20 and 25, 15 (20%) a weight index between 25 and 30, while 10 patients (14%) failed to respond to the treatment.

Adolescent↗
PubMed1989

[The intragastric balloon: a logical and attractive idea, but probably ineffective].

Loss of post prandial satiety is often of limiting value in the success of a slimming training. Thus, the idea to introduce a balloon filled partially with air to occupy the stomach seems to be logic. A technic easy to handle had contributed to a large diffusion of this method before people asked about its real efficacy. Several short term (10 days) or medium term (6-10 months) studies show a significant weight loss, but there have been no controlled trials to determine the relative contribution to weight loss of the gastric balloon vs dietary and behaviour modifications. Furthermore, a great variability in the weight loss, some subjects even gaining weight, suggest that the compliance of the patients may be the most relevant factor. Adverse effects are effectively low and principally concern local gastric irritation (2-5%) and intestinal occlusion in some rare cases requiring surgical removal of the partially deflected balloon. Thus, if the implantation of a gastric balloon is relatively safe, it is difficult to recommend its use to the treatment of obesity in regard of the actual published results, even if most of the treated patients suffered of refractory obesity, difficult to modify with non surgical treatment.

Adult↗
PubMed1980

[Pulmonary granuloma, pseudolymphoma and lymphoma].

We are presenting 10 patients with tumors of the lungs - granulomas or lymphomas - among more than one thousand patients suffering from lung cancer. Apart from the granulomas with its obvious inflammation characteristics, it seems that the distinction between pseudolymphomas and malignant lymphomas is possible through histological examinations but contrary to their clinical evolution. Two patients with s-called pseudolymphomas have shown recurrent bilateral recidivism. As shown in all medical literature, the good prognosis of pulmonary lymphomas makes the distinction between pseudolymphomas and lymphomas futile. Nonetheless, it should be noted that clinical symptoms in markedly malignant cases can appear after several symptom free years. None of our patient has died from their pulmonary condition. Only thoracic exploration and surgical ablation of the lesion permit a correct diagnosis and a satisfactory therapeutic approach. The surgical ablation of the lesion must be economical, because of frequent recurrence, sometimes bilateral. Both patients with so-called pseudolymphomas and the one with malignant lymphoma showed bilateral recurrences successfully treated by radiotherapy, with 10--15 years survival rate.

Diagnosis, Differential↗
PubMed1978

[Bronchial and subpleural lipoma (author's transl)].

Three cases of bronchopulmonary lipomas are reported, two sub pleural and one endobronchial. They represent 2,8% of all so-called benign bronchopulmonary tumours in our statistic. The two subpleural and asymptomatic lipomas were treated by thoracotomy and enucleation, the third, the endobronchial lipoma required lobectomy because of irreversible pulmonary damage.

Adult↗
PubMed1977

[Pneumoblastomas. Apropos of 2 cases].

Pulmonary blastomas, also referred to as embryonal carcinosarcomas or, in the past, embryomas, are rare tumors of which thirty cases have been described in English, German, and Italian publications. We present two typical pulmonary blastomas one in a 43-year-old man and the other in an infant of six months, the youngest case yet reported. Several arguments exist in favor of the embryonic origin of these neoplams: their histogenesis, their resemblance to nephroblastomas, their bifocal or multifocal presence in certain cases, and in about one third of all cases their discovery in patients under 20 years of age. Histologically the tumoral tissue contains two components: an epithelial component in which tubes resembiling fetal bronchi are found, and a loose mesenchymal component of an embryonic type containing various areas of differentiation. Although some tumors evolve slowly or have been known for years, most of the time the appearance of symptoms is soon followed by hematogenous dissemination and rapid demise. Our two patients died quickly: the infant from mediastinal compression with cardiorespiratory insufficiency, and the adult form metastatic dissemination.

Adult↗