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Biomedical subjects

A Wurtz

Publications and source records attributed to A Wurtz.

At least 19 recordsLinked to original sources
PubMed1992

Malignant pericardial effusions: usefulness of pericardioscopy.

In cases of malignant pericardial effusion, surgical subxiphoid biopsy sometimes fails to prove malignancy. To assess the usefulness of pericardioscopy, which allows an endoscopic investigation of the pericardial cavity, this technique was systematically performed during surgical drainage procedures that were performed on 40 patients who had pericardial effusions of suspected malignant origin. Twenty-six patients had a history of neoplasm, 10 had a history of hematologic malignancy, and four had recent tumors or lymphadenopathies that were suspected to be of malignant origin. Classical tests that are usually performed during a conventional surgical drainage procedure (fluid studies and subxiphoid biopsy) were combined with direct visualization of the pericardial surfaces and guided biopsies of suspicious areas. The follow-up period after pericardioscopy was at least 12 months. Two early deaths occurred after pericardioscopy, but no death was directly related to the endoscopy. According to all of the tests that were performed, diagnoses were malignant pericardial effusion in 15 of 40 patients (group I, 37%) and nonmalignant pericardial effusion in 25 of 40 patients (group II, 73%). In 3 of 13 patients (23%) in group I, the diagnosis was obtained only by pericardioscopy (results of cytologic studies and subxiphoid biopsy were negative). In two patients in group I, pericardioscopy could not be completed, but the diagnosis of malignant pericardial effusion was obtained by pericardiocentesis. In group II, effusion was considered to be postradiation pericarditis in five cases, infectious pericarditis in three cases (bacterial in one and tuberculous in two), hemopericardium induced by coagulation disturbances in three cases, and idiopathic pericarditis in 14 cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Biopsy↗
PubMed1992

Extraperitoneal pelvioscopy in lymph node staging of bladder and prostatic cancer.

In view of the inadequate accuracy of radiological investigations, surgical lymphadenectomy is generally the last resort to assess lymph node involvement in bladder and prostatic cancers. Extraperitoneal pelvioscopy is a simple and effective method to avoid such invasive surgery, which is always slightly regrettable to perform purely for staging purposes. The investigation is performed with the patient under low spinal anesthesia via a short iliac incision using an instrument derived from the mediastinoscope. It allows biopsies from the external iliac, internal iliac, common iliac and obturator lymph node chains. We analyzed our results of pelvioscopy in 101 patients (36 prostatic and 65 bladder cancers). Extraperitoneal pelvioscopy, unilateral in 78 and bilateral in 23 cases, corrected the conclusions of the radiological assessment in 39% of the prostatic cancer cases and in 28% of the bladder cancer cases. The specificity and positive predictive value is 100%, sensitivity 84%, negative predictive value 93% and over-all reliability 95%. On the basis of the quality of the results and the low morbidity (5 cases of rapidly resolving lymphorrhea, 1 injury to the external iliac vein and 1 obturator nerve lesion), extraperitoneal pelvioscopy can be considered as a useful complement to the preoperative staging of bladder and prostatic cancer.

Endoscopes↗
PubMed1992

[Cardiac herniation and sub-herniation. Complication of intrapericardial pneumonectomy].

Two cases are reported of cardiac herniation complicating intrapericardial pneumonectomy in the early postoperative period. Both patients had a radical pneumonectomy for right-sided bronchial carcinoma invading, in one patient, the carina and the superior vena cava. The pericardial defect, made necessary by the surgical procedure, had not been closed in either patient. About two hours after the end of surgery, both patients, lying supine, developed a state of shock, with tachycardia and arterial hypotension. The diagnosis of cardiac herniation was made in both cases on the chest film. Placing the patient on his left side was only partly efficient in one patient, slowing the heart rate from 160 b.min-1 to 120 b.min-1 and increasing the systolic blood pressure (from 60 mmHg to 80 mmHg). Both patients therefore required to be operated on again. In one patient, the heart had completely herniated through the pericardial defect, and had turned to the right side about the vena caval axis; in the other patient, partly improved by being turned to his left, the heart had returned to its normal position. The pericardial defects were closed in both cases with a strip of dura mater previously treated with 2 (ethyl-mercurithiol-5-benzoxazol) carboxylic acid. The immediate postoperative course was uneventful. Unexpected symptoms and sign occurring in the early postoperative period after intrapericardial pneumonectomy must imperatively lead to carrying out a chest X-ray.

Adult↗
PubMed1992

Acquired type II von Willebrand's disease associated with adrenal cortical carcinoma.

A case of acquired von Willebrand's disease (AvWD) associated with an adrenal cortical carcinoma is reported. The circulating highest molecular weight multimers (HMWM) of von Willebrand factor (vWF) were decreased when assessed by SDS-agarose plasma electrophoresis, leading to the diagnosis of type II AvWD. No forms of inhibitor could be detected in the plasma of the patient. In contrast, indirect immunoperoxidase studies with a monoclonal antibody to vWF demonstrated an absorption of vWF into malignant cells. Infusion of a vWF-FVIII concentrate, containing significant amounts of HMWM of vWF, allowed surgical resection of the tumour. After the first infusion of the concentrate, the vWF-RCo recovery was found to be low (38%) compared to the vWF:Ag (75%) and FVIII:C (163%) recoveries. The resolution of all biological signs of vWD, including the abnormal multimeric pattern, in the post-operative period was prompt and permanent. Therefore, the absorption of the HMWM of vWF by carcinomatous cells appears to represent a likely pathophysiological mechanism responsible for the AvWD syndrome in this patient.

Adrenal Gland Neoplasms↗
PubMed1992

[Bacterial translocation in Crohn disease].

Bacterial translocation is the passage of viable endogenous bacteria from the gastrointestinal tract to mesenteric lymph nodes and other internal organs. The aim of this work was to study bacterial translocation in patients operated on for Crohn's disease. Twenty-eight patients, mean age 29 years, not having received any antibiotics since at least 8 days, presenting with ileal (n = 12), ileo-colonic (n = 14) or colonic (n = 2) Crohn's disease were studied. In 25 out of 28 cases (89%) indication for surgery was strictures inducing an upper small bowel distension in 9 out of 25 patients. Mesenteric lymph nodes and liver biopsies, portal blood samples and peritoneum swabs were harvested after laparotomy and before gut opening. Bacterial translocation, defined as the presence of intestinal bacteria in at least one of the specimens, was present in 8 out of 28 patients. This was found in lymph nodes draining surgical territories in 7 out of 8 cases. Bacterial strains involved in translocation included E. coli (n = 5), Enterococcus (n = 3), Clostridium perfringens (n = 2), Proteus (n = 2), and Bacteroides fragilis (n = 1). The rate of translocation differed neither according to Crohn's disease site nor with perforating or non perforating type of the disease. Five out of 9 patients operated on for strictures with proximal distension had a translocation. In conclusion, bacterial translocation was identified in 29% of patients operated on for Crohn's disease in this series. Distension of the intestine proximal to a digestive stricture could favor the occurrence of bacterial translocation in Crohn's disease.

Adolescent↗
PubMed1992

[Pericardioscopy: techniques, indications and results. Apropos of an experience with 70 cases].

Pericardoscopy (PCS) is an original method of examination of the pericardial cavity. Its principle is derived from pleuroscopy and the apparatus is derived from mediastinoscopy. The main indication for this technique is the diagnosis of pericardial effusions. Sixty-five PCS were performed for this purpose, allowing an accurate etiological diagnosis in 35 cases. The etiological diagnosis was based on the clinical and paraclinical context in 4 other effusions, considered to be idiopathic after PCS. In 23 cases, the etiology remained uncertain, but a tuberculous or neoplastic etiology was ruled out after PCS. Three false negative results were obtained. Complete cleaning of the pericardial cavity allowed favorable immediate and mid a term outcome, avoiding possible constriction. Finally, PCS established the operability of two bronchial cancers, located in the hilar area and suspected of intrapericardial extension (PCS was performed in these cases in absence of pericardial effusion).

Acute Disease↗
PubMed1992

[Conservative treatment for trauma of the spleen in adults. Comparative study of thirty-four cases of conservative treatment and sixty-one cases of splenectomy].

Between 1983 and 1990, 95 patients with abdominal injury and splenic damage underwent surgery. Conservative treatment was performed in 34 cases (group I) and splenectomy was performed in 61 cases (group II). In group I, one patient died and post-operative complications occurred in 18 patients (53%). In group II, 3 patients died (of a 0hrenic abscess for one of them), and postoperative complications occurred in 38 patients (62%). There was no significant difference between group I and group II in terms of length of hospital stay and operation time; but a greater number of red cell concentrates was required during the operation in group II. No patient of group I developed post-operative infection during the mean interval of 18 months. This experience confirms that the conservative treatment of splenic contusions does not worsen the prognosis of abdominal injuries. Medium and long term infectious complications might be prevented by the conservative treatment but it is still too early to assess the real benefit of this option.

Abdominal Injuries↗
PubMed1991

[Use of a biological glue in partial pulmonary excision surgery. Results of a controlled trial in 50 patients].

A controlled study concerning the surgical use of a fibrin glue was conducted in 50 patients undergoing partial pulmonary excision. In 25 of these patients, chosen at random, hemostasis and aerostasis of the fissural, and/or intersegmentary dissection planes were achieved by electrocoagulation, in the other 25 by the application of fibrin glue. The statistical study did not show any significant difference between the two groups in terms of the surgical indication, the type of excision and the associated surgical procedures (pleurectomy and parietectomy). No significant statistical difference was observed concerning the quality of aerostasis, the post-operative drainage, the persistance of residual collection or faulty reexpansion after removal of the latter, and the necessity for repeated drainage. The same applied to the length of post-operative hospital stay. This study seems to demonstrate that the surgical application of fibrin glue on the fissural and/or intersegmentary dissection planes is feasible but, as compared to electrocoagulation, does not significantly improve the quality of the surgical results for partial pulmonary excision; however its use could reduce the duration of post-operative drainage.

Adolescent↗
PubMed1990

[Computed tomography of the abdomen in 8 cases of pancreatic trauma].

Computed tomography (CT) is an accurate method for detecting pancreatic trauma. There are two pitfalls to its use: the indication of CT and the risk of misinterpretation. The purpose of this study was to evaluate these 2 difficulties. We report our experience and results obtained in 8 patients with pancreatic trauma (7 closed, 1 open). Peritoneal lavage demonstrated an increased amylase level in the fluid in 2 of our patients. Computed tomography was performed as an emergency diagnostic test for 2 patients and secondarily in 6 patients. In 5 patients, the pancreatic injury was considered to be deep with suspicion of a major pancreatic duct lesion and in 3 patients, the lesion was superficial. Six patients had operative confirmation of the CT results. Pancreatic injuries were classified according to Hervé and Arrighis. Four were grade III, 1 grade II, 1 grade I, while CT showed 5 deep injuries and 1 superficial injury in these patients. Two patients with CT signs of superficial injury were not operated. When there is a clinical suspicion and/or a high amylase level in serum, urine or fluid collected from peritoneal lavage, CT must be carried out as part of in the overall strategy of management of isolated pancreatic trauma. We believe that CT is a valuable tool to evaluate the extent of the injury to the pancreatic parenchyma.

Adolescent↗
PubMed1990

[A superior vena cava syndrome of unusual etiology: compression syndrome of the innominate veins].

A 65-year-old hypertensive and atheromatous presented with "unilateral superior vena cava syndrome". Venography and computed tomography scan with hemodynamic studies demonstrated an intermittent compression of the left innominate vein by the supra-aortic trunks, mainly due to the left subclavian artery, during expiration. The late development of symptoms might be due to arterial atheroma coupled with a narrow superior mediastinum. The case described here is a thoracic equivalent of Cockett's syndrome and so can be called "innominate vein compression syndrome".

Aged↗
PubMed1990

Bacterial translocation in colorectal cancers.

Bacterial translocation, the passage of viable indigenous bacteria from the gastrointestinal tract to the mesenteric lymph nodes and other internal organs, has been poorly studied in man to date. Pericolonic lymph nodes, liver, portal blood, and peritoneum specimens were harvested before antibiotics were administered during 20 operations for colorectal cancer and compared with those obtained in 20 operations for non colorectal conditions. Bacterial translocation, defined as the presence of intestinal bacteria in at least one of the specimens, was found in 13 patients (65 percent) in the colorectal cancer group as compared to 6 (30 percent) in the control group (p less than 0.05). The increased incidence of bacterial translocation in colorectal cancers was mainly due to the presence of bacteria in the pericolonic lymph nodes adjacent to the cancer. These findings suggest that intestinal bacteria translocate from the bowel lumen in a high proportion of patients with colorectal cancer and further stress the need for prophylactic antibiotics in colorectal cancer surgery.

Adenocarcinoma↗
PubMed1990

[Correlation of diameters measured by x-ray computed tomography and intraparietal extension of squamous cell carcinoma of the thoracic esophagus. Apropos of 101 anatomoradiologic comparisons].

In order to assess the value of tomodensitometric classification of squamous cell carcinomas of the upper esophagus, which has been recently advocated, we compared the CT-measured diameters and the extent of intraparietal invasion in 101 tumors. According to selected criteria (superficial -T1- tumors: not apparent or less than 10 mm; tumors infiltrating incompletely the muscularis -T2- ; mass less than 10 to less than 20 mm in diameter; tumors extending beyond the muscularis -T3, T4- : diameter greater than or equal to 30 mm), 84/101 tumors were correctly assessed. The positive predictive value for T2 tumors was 73% in the 10 to less than 20 mm diameter range, and 71% for T3 and T4 tumors in the 20 to less than 30 diameter range. Starting from 30 mm, this value was 96% for T3 and T4 tumors. At the close of this study, it appeared that the classification criteria proposed did not have to be modified. CT-scanning is worth using jointly with ultrasonographic endoscopy (more performing when analysing small tumors) for pre-treatment classification of carcinomas of the upper esophagus, owing to the fact that the extent of wall infiltration is one of the elements which need be taken into account when planning therapy: direct surgery or, possibly, combined preoperative radio- and chemotherapy.

Carcinoma, Squamous Cell↗
PubMed1989

[Endoscopy of the retroperitoneal space. Technics, results and current indications].

Retroperitoneoscopy (RPS), a form of direct vision endoscopy derived from mediastinoscopy, allows exploration of the majority of the lumbar and pelvic retroperitoneal space. Over a period of three years since May 1985, we have performed 135 RPS for 107 indications in 106 patients. Twenty-two examinations were performed for the diagnosis of retroperitoneal masses or adenopathy and a precise histological result was obtained in 20 cases. In 2 cases, the hypothesis of malignant lymphadenopathy was formally excluded. Lymph node extension from 78 pelvic cancers (bladder : 52, prostate : 22, cervix : 3, endometrium : 1) were studied by unilateral or bilateral pelviscopy; RPS corrected the imaging in 24 cases and there were 4 false negatives. Seven patients with suspected lymph node recurrence from malignant diseases (3 lymphomas, 4 miscellaneous tumours) were examined : 3 recurrences were confirmed and 2 were excluded. There were 2 failures responsible for 2 false negatives. The diagnostic accuracy of RPS (94%) is superior to that of other diagnostic investigations for retroperitoneal masses and evaluation of retroperitoneal lymph nodes. In many cases, it eliminates the need for exploratory laparotomy.

Adolescent↗
PubMed1989

[Resection and reconstruction of the carina with separate two-lung high-frequency jet ventilation].

Carinal resection and reconstruction via a right transpleural approach in an hypoxemic patient provides difficult maintenance of satisfactory gas exchange when one lung ventilation is inadequate. The present case report concerns a 62-year-old patient with chronic obstructive airways disease and a carinal squamous cell carcinoma. He underwent tracheobronchial reconstruction surgery by Barclay's procedure through a right postero-lateral thoracotomy. During resection and reconstruction phases, the gas exchange was maintained by a new technic: high-frequency-jet-ventilation (HFJV) with two small-bore catheters through the endotracheal tube and JVHF ventilators adjusted to the compliance of each lung (high for the right lung, low for the left one). No circulatory changes were observed during the sutures lines phase (90'). The oximeter and the arterial blood gas values show an adequate procedure. The immediate post operative period was unremarkable and uncomplicated. The histological diagnosis was squamous cell carcinoma involving the carina with one metastatic pretracheal lymph node and microscopic infiltration of the left main bronchus resection margin. Sixteen grays postoperative radiotherapy was required. Ten months after the patient is alive, without tumor recurrence. HFJV greatly facilitates surgery by avoiding endobronchial intubation with large cuffed tubes into the surgical field. In patients with low pulmonary reserve, bilateral lung HFJV is required: two JVHF ventilators with different ranges delivering separate ventilation to the right and left lungs avoid left hypoventilation and right surgical emphysema and insure good surgical conditions.

Anastomosis, Surgical↗