Biomedical subjects
Publications and source records attributed to B Gattegno.
A new absorbable hemostatic clip was investigated by a study in the rat. The reliability and innocuity of the clip were similar to that of the metallic clips from the clinical point of view. Its absorbability and radiotransparency qualities make it the method of choice for ensuring hemostasis and lymphostasis when long-term follow-up investigations involve modern radiological techniques such as computed tomography.
Over 7 years, 592 patients infected by Schistosoma haematobium were detected. Among these, 102 had a cystoscopy which found carcinoma in 3 patients, polypi in 1 and vesical "bilharzioma" (so-called pseudo-polyps) in 14. From the results of the biopsies and data from the medical literature the relationship between schistosomiasis and carcinoma in the schistosomial bladder is discussed, as well as the meaning of various lesions, such as malpighian metaplasia, papillomatous hyperplasia and glandular cystitis, seen in biopsy specimens from "bilharziomas". The cystoscopic diagnosis of one (or several) tumours resembling "bilharzioma" requires biopsy, resection and close monitoring.
Placing female patients in prone position with widely spread legs provides very good exposure of the anterior vaginal wall and makes it possible to use the vaginal route alone for the surgical treatment of lower urinary tract lesions, such as vesico-vaginal fistulas.
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The authors investigated the effect of giving a single injection of the antibiotic gentamycin one hour before endoscopic resection of the prostate, by random case selection in a group of 47 cases. The untreated and the treated cases were considered quite comparable. The presence of bacteriurea greater than 10(5) per ml during the first 15 postoperative days was significantly greater in the untreated group than in the preoperatively treated group. The results showed 44% for the untreated group and 14% for the treated group. After 15 days the results were identical for the two groups.
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The authors report their experience of 58 patients undergoing endoscopic internal urethrotomy for urethral stenosis. In 47 with a follow up of 6 months or more, the following information has been obtained : - deep longitudinal section of the urethral stenosis, at 12 o'clock, passing widely beyond the diseased area, usually suffices; - the essential aetiology of the stenoses treated was represented by iatrogenic urethral trauma in 17 cases out of 47 (36%). The particularly harmful role of urethral catheterisation should be noted. Stenosis of undetermined origin was more common than stenosis of an infectious or non-iatrogenic traumatic origin; - the stenosis was bulbar in almost half the cases and was double in 1/4 of cases. In most instances the length was less than 1.5 cm; - morbidity was slight and mortality nil; - results were considered to be good in 57.5% of cases and no recurrent stenosis occurred beyond the 18th month. Good results were seen essentially in cases of stenosis of infectious origin situated in the penile or bulbar urethra, less than 1.5 cm in length and having undergone calibration by a urethral catheter after endoscopic section for a period of more than three days. Amongst the 12 patients undergoing a second urethrotomy, 5 obtained a lasting successful result. Endoscopic internal urethrotomy is thus a procedure which may recommended, insofar as it offers a high percentage of good results and that in the cases of failure there is no interference with any other urethroplasty procedure.
The authors report a quite exceptional case of isolated angiomyolipoma of one kidney in the absence of any manifestation of phakomatosis. Discovery of the tumour led to special investigations which confirmed the solid and hypervascularised nature of the tumour. A doubt remained with regard to its precise nature, and hence an extended nephrectomy, though without damage to the vessels at the time of section. The kidney was cooled and preserved by perfusion which allowed time for adequate histological study. The diagnosis of angiomyolipoma being confirmed, without the slightest risk of dissemination if by chance it had not been a benign tumour, the kidney was transplanted into the lumbar fossa via its own vessels with an excellent result. The authors discuss two problems on the basis of this case: 1) That of preoperative diagnostic difficulties: the scanner provides valuable information when it reveals the presence of intra-tumoral fatty tissue. 2) Difficulties in management when the benign nature of the lesion cannot be confirmed before histological examination. The solution adopted: routine extended nephrectomy with ex-vivo perfusion of the kidney making it possible to obey the basic rules of oncology. Frozen section biopsy confirms the diagnosis of angiomyolipoma. It is then possible to auto-transplant the kidney after tumorectomy.
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90 case records of renal cysts in adults submitted to surgery are studied. A simple pathological classification is proposed. The accompanying signs were, hematuria in 30 p. 100 of cases, but one should always seek another cause; renal colic is present in 22 p. 100 of cases, a palpable tumour in 50 p. 100, on the other hand, infection of the cyst is rare. 35 p. 100 of the cysts were associated with another disease, usually obstructive uropathy, and there were 3 cases of association with carcinoma of the kidney in this series. Pre-operative diagnosis, eliminating carcinoma of the kidney, was ensured by intravenous urography and echotomography which permitted us to restrict the indications for arteriography and aspiration of the cyst. Surgical treatment permits resection of the salient dome of the cyst in the absence of general contra-indications, in order to suppress symptoms due to the cyst and above all, eliminate carcinoma of the kidney. The post-operative period was uneventful and the mortality nil.
Retroperitoneal laparoscopic nephrectomy (RLN) is a relatively recent technique whose performance needs to be firmly established. The aim of this study was to compare the results of RLNs in 19 patients with retrospective results for 10 cases of open surgery. Ten of the RLN patients had transplanted kidneys. We used a slightly modified, already published technique with only three trocars that did not require balloon dilatation of the retroperitoneal space. It was successful in patients with and without transplants. The average operative times of RLN and open surgery were 115 and 110 minutes, respectively. In no instance did the laparoscopic procedure need to be converted to open surgery. There were no peri- or postoperative complications that could be related to the RLN technique. The average length of hospitalization after RLN was considerably shorter (3.8 days) than after open surgery (7.9 days). In conclusion, our experience shows that RLN is a safe, reproducible technique that reduces recovery time. It has become our first-line approach for simple nephrectomy, nephroureterectomy for ureteral tumors, and removal of the native kidney in transplant recipients.
PURPOSE: The purpose of our study was to evaluate the accuracy of 3D helical CT and its value in surgical planning for the treatment of ureteropelvic junction obstruction (UPJO). METHOD: CT scans and 3D reconstruction of renal vessels and the renal pelvis were performed in 20 cases of UPJO treated by open surgery. We analyzed scans in search of a vessel at the junction and its position relative to the UPJ. Helical CT scans and 3D reconstructions were correlated with macroscopic surgical findings. RESULTS: CT scans demonstrated the presence of a UPJO in all cases. Crossing vessels were present at the junction in 13 of 20 cases. The vessel crossed the junction posteriorly in six cases and anteriorly in seven cases. Macroscopic surgical findings were in agreement with helical CT reconstructions in 100% of the cases. CONCLUSION: Axial scans together with 3D reconstruction are an accurate way of detecting crossing vessels when UPJO occurs, and the choice of the most adequate surgical technique is facilitated.
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Surgical correction without parenchymal injury of a high flow renal arteriovenous fistula diagnosed 5 years after a percutaneous renal biopsy is reported. An arteriovenous fistula is elicited in 16% of all percutaneous renal biopsies. Spontaneous occlusion occurs in 50 to 70% of these cases. Persistent gross hematuria in the early stage or heart failure later may require correction of the fistula.