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Biomedical subjects

A Sauvanet

Publications and source records attributed to A Sauvanet.

At least 145 records · Page 8Linked to original sources
PubMed1992

[Role of resection of the celiac plexus in the analgesic treatment of pancreatic cancers].

The aim of this study was to evaluate the pain relief related to resection of the celiac plexus in pancreatic carcinoma. This technique was attempted in 26 consecutive patients and performed in 23 (feasibility: 88%), whose mean age was 64 years. Before surgery, patients were divided into two groups: patients not treated by narcotic analgesics (group 1, n = 10) and patients treated by narcotic analgesics (group II, n = 13). Surgery was indicated in 22 patients for pancreatic resection or by-pass, and in 1 patient for pain relief after an unsuccessful per-cutaneous celiac plexus block. Resection of the celiac plexus was always performed via a trans-peritoneal approach, after mobilization of the head of the pancreas and the duodenum. Only the right half of the celiac plexus was resected in 4 patients (17%) due to technical difficulties. Pathologic examination was performed in 16 patients (8 patients from each group) and neoplastic involvement was observed only in 3 patients of group II. There was no operative death. Two complications related to this method occurred (9%). One patient developed a chylous ascites and was treated conservatively. In a second patient, an occlusion of the celiac trunk was complicated by infarction of the spleen and of the left lobe of the liver; this patient was reoperated and his subsequent post-operative course was uneventful. In group I, eight patients (80%) did not require narcotic analgesics after resection of the celiac plexus. Two failures occurred, one immediately after surgery and one delayed. In group II, seven patients (53%) did not require narcotic analgesics; 6 of these 7 patients died. Six failures occurred, 4 early after surgery and 2 delayed. Three of the 4 early failures occurred in patients who underwent resection of the right half of the celiac plexus. The authors concluded that resection of the celiac plexus seems to be an effective pain treatment in pancreatic carcinoma. However, resection must be bilateral to provide analgesia. Specific morbidity of this technique may lead to the use of non-surgical methods if surgery is not indicated for pancreatic resection or by-pass.

Adenocarcinoma↗
PubMed1992

[Liver transplantation without clamping the vena cava inferior].

An original technique of orthotopic liver transplantation with preservation of the recipient's entire inferior vena cava and side-to-side caval anastomosis is described. The procedure was used in 21 consecutive patients. It has permitted to avoid vena cava occlusion and the need for venous bypass. No consequences on caval flow were observed during the anhepatic phase. Such technique avoids retrocaval dissection and requires only one caval anastomosis, reducing the duration of the anhepatic phase.

Acute Disease↗
PubMed1992

A new technique of side to side caval anastomosis during orthotopic hepatic transplantation without inferior vena caval occlusion.

An original technique of OLT with preservation of the entire IVC of the recipient and side to side caval anastomosis is described. The procedure has permitted the avoidance of retrocaval dissection and temporary vena caval occlusion. The caval outflow was respected during the anhepatic phase. The technique, requiring only one caval anastomosis, has reduced the duration of the anhepatic phase and the need for venous bypass.

Anastomosis, Surgical↗
PubMed1992

[Adrenal gland pheochromocytomas. Apropos of 35 operated patients].

Thirty-five patients (20 female and 15 male, mean age = 47 years) operated on for an adrenal pheochromocytoma were reviewed. Catecholamine excessive production was symptomatic in 33 patients (94%). Urinary excretion of vanyl-mandelic acid, catecholamines and metanephrine was abnormal in 84%, 75% and 90% of cases, respectively. Tumor was presumed benign (no metastasis) in 31 cases. Sensitivity of CT scan (n = 35) and magnetic resonance imaging (n = 13) was 100%. Meta-iodo-benzylguanidine scan (n = 19) always recognized the main tumor, but did not visualize 1 second tumor in 1 patient and 1 metastasis in 1 other patient. An anterior intraperitoneal approach was performed in all cases. Operative mortality rate was 5.7%. In the last 15 patients, systematic preoperative treatment by prazosine did not lead to fall in rates of peroperative arrythmia and hemodynamic disorders. Twenty-two of 25 (88%) hypertensive patients remained normotensive without medication postoperatively. The risk of undiagnosed pheochromocytoma and problems in resection of large right-sided tumors are discussed.

Adolescent↗
PubMed1991

[Preliminary results with "ex situ" surgery for hepatic tumors: an alternative between palliative treatment and liver transplantation?].

We report 3 cases of liver tumors which were unsuitable for conventional resection and which were removed using a technique combining hypothermic portal perfusion with an anhepatic period of more than 2 hours. The liver was mobilized after section of the infra- and supra-hepatic inferior vena cava in 2 cases. The tumor was a cholangiocarcinoma in 2 cases and colonic metastasis in 1 case. Non-tumoral liver parenchyma was normal in all cases. The inferior vena cava was involved by the tumor in 2 cases. Complete tumor resection was achieved in all cases, but required reconstruction of the hepatic veins in 1 case. Two patients in whom portal venous bypass was not used developed hemodynamic failure after liver revascularization. One of them died. In patients without underlying chronic liver disease and with unresectable tumor by conventional technique, "ex situ" resection can be a worthwhile therapeutic alternative.

Adenoma, Bile Duct↗
PubMed1991

[Pancreatico-gastric anastomosis after cephalic duodenopancreatectomy].

Between January 1988 and February 1991, 27 patients underwent pancreaticogastrostomy after pancreaticoduodenectomy. The mean age of the patient was 57 years and 18 of them were male. Pancreatic disease was malignant in 21 patients (78%) and benign in 6 patients. The pancreatic remnant was normal in 15 patients (56%) and fibrotic in 12 patients. There was one operative death (3.7%) unrelated to the pancreaticogastrostomy. Only two complications (7.5%) were related to pancreaticogastrostomy: one patient had intra-gastric bleeding and was reoperated, one patient developed a pancreatic leak (3.7%) which healed without reoperation. The authors conclude that pancreaticogastrostomy in the preferred method of management of the pancreatic remnant after pancreaticoduodenectomy.

Adenocarcinoma↗
PubMed1991

[Pulmonary sequestration. Surgical aspects based on 61 cases].

Between 1955 and 1989, 61 patients (33 men, 28 women; mean age: 20 years) were operated upon for lung sequestration. Sequestration was intralobar in 49 cases and extralobar in 10 cases; both types were present in 2 cases. The abnormality was discovered by chance in 15 patients (24%). The most frequent clinical manifestations were those of recurrent bronchopneumonia (54%). X-ray films of the chest showed an apparently benign, posterobasal image in 88% of the cases. Arteriography was performed in 40 patients and revealed an abnormal systemic artery in 28. An abnormal artery was found by the surgeons and the pathologists in all cases. The intralobar type of sequestration was treated, by preference, by lobectomy, and the extralobar type by sequestrectomy. Problems were encountered in 5 cases: 2 wounds of an unrecognized artery and 3 difficult bleeding controls which required aortic clamping. The operative mortality was nil, and the morbidity rate was 5%. Computerized tomography and magnetic resonance imaging can confirm the diagnosis of pulmonary sequestration, but arteriography seems to be the best method to ascertain the diagnosis and guide the surgical procedure. Surgery is the rule in case of doubtful diagnosis or to treat symptomatic sequestration.

Adolescent↗
PubMed1990

[Non-functioning tumors of the endocrine pancreas. Concept, diagnosis, treatment].

Five cases of nonfunctioning islet cell tumors of the pancreas are reported. There were 3 males and 2 females aged from 34 to 83 years (Average: 55.8 years). Two tumors were malignant since already metastatic, one tumor was probably malignant and two tumors were judged as benign. One patient died post-operatively. The four remaining patients are alive without recurrence after from 1.4 to 7.3 years. The concepts of nonfunctioning tumors of the pancreas and APUD system are discussed in view of these 5 cases and the relevant literature. The value of tumor markers as well as the radiographic appearances of these tumors are reported. Having a better prognosis than the adenocarcinoma of the exocrine pancreas, the nonfunctioning tumors of the endocrine pancreas are best managed by surgery. The indications and the results of surgery and chemotherapy are discussed.

Adenoma, Islet Cell↗
PubMed1981

[Thymoma associated with myasthenia, erythroblastopenia, myositis and giant cell myocarditis. One case (author's transl)].

The authors report on a 76-year-old woman presenting with malignant thymoma associated with myasthenia, erythroblastopenia, myositis and giant cell myocarditis. Blood examination showed antinuclear antibodies, anti-platelet antibodies and LE cells. Only one similar case and 22 cases of thymoma associated with giant cell myocarditis have been published. It seems probable that thymomas plays a part in the pathogenesis of giant cell myocarditis.

Aged↗
PubMedDate not supplied

Pseudotumor developing in heterotopic pancreas.

Cystic dystrophy in heterotopic pancreas (CDHP) is characterized by the presence of cystic formations surrounded by inflammation and scarring. It usually involves the duodenal wall and can be responsible for strictures and pain. The diagnosis of this disorder was previously based on pancreatoduodenectomy specimens removed for a suspected pancreatic tumor. Six cases were observed in young men (mean age 40 years) between 1989 and 1993. Computed tomography (CT) and endoscopic ultrasonography (EUS) features allowed definitive preoperative diagnosis of CDHP. After surgical resection of the tissue-bearing segments that included five pancreatoduodenectomies and one antrectomy, symptoms disappeared in all patients. Patients were followed 2 to 45 months; one patient experienced recurrence of pain and hyperamylasemia 17 months after surgery. The preoperative diagnosis of CDHP is presently possible because of modern imaging procedures and improved knowledge of specific signs. Resection is the most appropriate treatment.

Adult↗
PubMedDate not supplied

[Technique of surgical ampullectomy].

We describe the technique of surgical ampullectomy, which consists of complete resection of the papilla of Vater, including the sphincter, the distal part of common bile duct and Wirsung duct, and the duodenal wall around the papilla. Limits of resection are assessed by frozen section, particularly on both biliary and pancreatic ducts which are sutured together and reinserted on the duodenal wall. Surgical ampullectomy, combined with frozen section, is associated with a low morbidity, and represents a valid alternative to pancreaticoduodenectomy and endoscopic ampullectomy for presumed-benign ampullomas.

Ampulla of Vater↗
PubMedDate not supplied

[Surgical treatment of gastric, enteric, and pancreatic endocrine tumors Part 1. Treatment of primary endocrine tumors].

Endocrine tumors (ET) of the digestive tract (formerly called neuroendocrine tumors) are rare. They are classified into two principal types: gastrointestinal ET's (formerly called carcinoid tumors) which are the most common, and pancreaticoduodenal ET's. Functioning ET's secrete polypeptide hormones which cause characteristic hormonal syndromes. The management of ET is multidisciplinary. Poorly-differentiated ET's have a poor prognosis and are treated by chemotherapy. Surgical excision is the only curative treatment of well-differentiated ET's. The surgical goals are to: 1. prolong survival by resecting the primary tumor and any nodal or hepatic metastases, 2. control the symptoms related to hormonal secretion, 3. prevent or treat local complications. The most common sites of gastrointestinal ET's ( carcinoids) are the appendix and the rectum; these are often small (<1 cm), benign, and discovered fortuitously at the time of appendectomy or colonoscopic removal. Ileal ET's, even if small, are malignant, frequently multiple, and complicated in 30-50% of cases by bowel obstruction, mesenteric invasion, or bleeding. The carcinoid syndrome (consisting of abdominal pain, flushing, diarrhea, hypertension, bronchospasm, and right sided cardiac vegetations) is caused by the hypersecretion of serotonin into the systemic circulation; it occurs in 10% of cases and is usually associated with hepatic metastases. More than half of the cases of pancreatic ET are non-functional. They are usually malignant and of advanced stage at diagnosis presenting as a palpable or obstructing mass or as liver metastases. Insulinoma and gastrinoma (cause of the Zollinger-Ellison syndrome) are the most common functional ET's. 80% are sporadic; in these cases, tumor size, location, and malignant potential determine the type of resection which may vary from a simple enucleation to a formal pancreatectomy. In 10-20% of cases, pancreaticoduodenal ET presents in the setting of multiple endocrine neoplasia (NEM type I), an autosomal-dominant genetic disease with multifocal endocrine involvement of the pituitary, parathyroid, pancreas, and adrenal glands. For insulinoma with NEM-I, enucleation of lesions in the pancreatic head plus a caudal pancreatectomy is the most appropriate procedure. For gastrinoma with NEM-I, the benefit of surgical resection for tumors less than 2-3 cm in size is not clear. The lesions are frequently small, multiple, and widespread and recurrence is frequent after excision. The long-term prognosis is nevertheless fairly good. But the eventual development of liver metastases which are the most common cause of mortality still argues for an aggressive surgical approach in the early stages of the disease.

Adult↗
PubMedDate not supplied

[Surgical treatment of gastric, enteric pancreatic endocrine tumors. Part 2. treatment of hepatic metastases].

The development of hepatic metastases (HM) marks a turning point in the evolutionand prognosis of well-differentiated endocrine tumors (ET). Management is usually multicisciplinary (chemotherapy, arterial chemo-embolization, percutaneous ablation, somatostatin analogs, biotherapy, and surgery). A thorough pre-operative work-up is neecessary to exclude extrahepatic disease and to detect tiny HM's. Complete resection (RO) is the only curative treatment for well-differentiated ET with HM. The type of resection is specific to each case and may range from wedge resection of a metastasis to complex hepatectomy with simultaneous resection of the primary ET. Cytoreductive surgery may be indicated for palliation when medical therapy fails to control endocrine symptoms. Operative mortality is low (0-6%) and global survival is 60-70% afterafter R) resection of HM of well-differentiated ET's. After resection of HM involving only one hepatic lobe, 5 year survival is better than 90%. When HM are multiple, bilobar and synchronous, the prognosis is very poor--only 10% of such patients can have a complete resection and this often requires a long prologue of ancillary procedures (chemotherapy, chemoembolization, portal vein ligation, percutaneous ablation). Hepatic transplantation (HT) has only a limited rôle in the treatment of HM for ET; mortality is high when HT is associated with large and complex resections, i.e. pancreaticoduodenectomy. Although there is no consensus in the literature, HT should be limited to the most optimal cases (young, good general health, well-differentiated tumor, slow evolution, complete resection of the primary rumor, and unresectable liver metastases). Global survival for HT in patients with ET is 60% at 2 years, 47% at 5 years; tumor-free survival at 5 years is 24%. HT for HM has better survival results for ET's of intestinal origin (carcinoids) than for duodenopancreatic ET's.

Embolization, Therapeutic↗