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Biomedical subjects

A Wurtz

Publications and source records attributed to A Wurtz.

At least 73 records · Page 4Linked to original sources
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↗
PubMed1989

[Diagnosis and surgical treatment of abdominal angina caused by atheromatous stenosis of the digestive arteries].

The diagnosis and technical aspects of revascularization are discussed in a series of 14 consecutive cases of intestinal arterial insufficiency. The typical clinical presentation of post-prandial pain and weight loss was found in 12 out of 14 cases. Gastroenterological investigations demonstrated associated lesions in 8 cases, including 5 cases of gastroduodenal ulcer disease where this was initially considered responsible for the symptomatology. No case of malabsorption was noted. Angiography demonstrated involvement of the three splanchnic vessels in 7 cases, two vessels in 6 cases and one vessel only in the remaining case. The revascularization techniques were as follows: reimplantation of the superior mesenteric (n = 1), bypass from the sub-renal aorta (n = 5), or a sub-renal aortic graft (n = 2) or supra-coeliac aorta (n = 6). Control angiography demonstrated permeability in 9 out of 10 cases where this examination was carried out. The early results included one post operative mortality. From a nutritional and functional point of view they were three failures and ten good results. Overall, follow up and survival ranged from 6 months to 9 years. In five cases death was due to secondary causes. Abdominal angina occurs in a population at high vascular risk. In view of this etiology the diagnosis should be considered at an early stage and this also explains the secondary mortality. Gastroduodenal ulcerative lesions may occur as part of the clinical presentation. The angiographic data confirmed the Mikkelsen rule, however the functional effects of stenosis could be better evaluated by pulsed echo-doppler.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdominal Pain↗
PubMed1989

[Large B cell lymphoma of the mediastinum. 6 cases].

Mediastinal large cell lymphoma with sclerosis (MLCLS) is a recently described entity characterized by its locoregional extension, within the anterior mediastinum, and its B cell origin, although the proliferation arises from the thymus. It has been, in the past, often mistaken for other tumors of the anterior mediastinum: invasive thymoma, Hodgkin's disease, poorly differentiated clear cell carcinoma and seminoma, thus leading to inappropriate therapeutic approaches. We diagnosed 6 cases of MLCLS in 1986 and 1987, in 4 males and 2 females, aged 16 to 44 (mean 27). Five of the 6 patients presented with a compressive anterior mediastinal mass, dyspnea, dysphonia, superior vena cava syndrome and parietal protrusion (3 cases). The CT scan confirmed the invasive and compressive characters of the tumor. Two patients initially had disseminated disease. Microscopically, the proliferation was composed of large clear cells, and segmented by bands of sclerosis. Immunologic studies demonstrated the B origin of the tumor cells. All 6 patients received combination therapy with an intensive CHOP protocol (L N H 84 Lyon). The first patient was initially operated, after a false frozen section diagnostic of thymoma. Resistance to chemotherapy (and rapid death within 2 months) was seen in 2 cases. On patient had a partial remission and 3 entered complete remission, of 5+, 10+ and 11 months duration, respectively, with central nervous system relapse in the latter case. Excavation of the tumor on CT scan imaging seemed to be a poor prognostic factor.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

[Aneurysm of the deep veins of the legs. Apropos of a case involving a vein in the calf].

A fusiform venous aneurysm of a deep calf vein was discovered following pulmonary embolism occurring during laparotomy in a 59 year old woman. This lesion has especially been described at popliteal vein level and 25 cases were found in the literature. Analysis shows that the principal clinical manifestation is pulmonary embolism due to clot migration from the thrombosed aneurysmal pocket. Local signs are much rarer. Diagnosis depends on venography. Subsequent management of a venous aneurysm, discovered incidentally, remains unclear since the incidence of complications is unknown. Anticoagulant therapy is required in the presence of thrombotic complications. The general tendency is to combine a caval filter with resection of the aneurysm. The necessity for venous reconstruction following the latter remains debatable.

Aneurysm↗
PubMed1988

[Invasive thymoma with pulmonary metastasis. Complete remission 5 years after surgery and chemotherapy using the CHOP-BLEO protocol].

We report a case of invasive lympho-epithelial thymoma with pulmonary metastases, treated by complete macroscopic excision of primary tumour and then by chemotherapy using CHOP-BLEO. The epithelial nature of the tumour was confirmed by immunohistochemical studies. Chemotherapy enabled a complete and prolonged remission (greater than 63 months). Therapeutic trials of CHOP-BLEO merit further assessment and the results should be compared to the baseline treatment using platinum and prednisolone.

Adolescent↗
PubMed1988

[Value of pericardioscopy in pericardial effusion. Apropos of 20 patients].

The value of pericardioscopy in pericardial effusion of uncertain origin was evaluated in 20 patients, aged from 18 to 77 years, whose pericardial effusion had been diagnosed by ultrasonography; 2 patients presented with clinical signs of tamponade. The cause of the pericarditis was unknown, but the clinical context suggested a malignant disease in 13 patients, tuberculosis in 5 patients and another cause in 2 patients. The pericardium was explored by means of a direct vision, cold-light endoscope, usually a mediastinoscope, introduced by the retroxiphoidal route under general of local anaesthesia. This method made it possible to study the pericardial fluid, examine the pericardial serous membrane, perform biopsies at a distance from the orifice of entry and cleanse the pericardium thoroughly in cases with blood or pus collection. Apart from 2 cases where the examination could not be completed because of an anterior mediastinal mass and a pericardial symphysis, valuable information could be obtained in purulent pericarditis (n = 1), chronic radiation induced lesions (n = 2), metastases (n = 2), haemopericardium (n = 2), and biopsies could be performed in tumoral or suspicious areas. These guided biopsies revealed a metastasis in 3 cases where the pericardial window was negative. No sign of tuberculosis was found in the 5 cases where the disease was suspected. The final diagnoses were: neoplastic pericarditis in 4 cases, radiation-induced pericarditis in 2 cases, purulent pericarditis in 2 cases, haemopericardium in 3 cases and idiopathic or reactive pericarditis in 9 cases. The post-operative period was uneventful, with no major complication ascribable to the procedure.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

[Lipoblastic liposarcoma of the lung. Ultrastructural study of a case].

A case of fatal lipoblastic pulmonary liposarcoma in a 20 year-old female is reported. A thoracotomy was performed but failed to yield the pathological diagnosis. This diagnosis was obtained by ultrastructural study of a cerebral metastasis. To our knowledge, only seven cases of pulmonary liposarcoma have been previously described in the literature and the lipoblastic aspect was never mentioned.

Adult↗