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Biomedical subjects

B Gayet

Publications and source records attributed to B Gayet.

At least 73 records · Page 4Linked to original sources
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

[Reoperations for failure of gastroesophageal reflux surgery. Apropos of fifty reoperations].

Fifty patients were reoperated for failed antireflux procedures or post-fundoplication symptoms. Cases of severe esophagitis, that is stenosis or Barrett's esophagus, were excluded. The usual cause of failure was a technical error. All of the operations, a new fundoplication in 35 cases and a total duodenal diversion in 15 cases, were performed via an abdominal incision. Operative mortality was nil. After a 42 months follow-up, according to the patient, the clinical results were good or excellent in 93% of the cases. The objective results-fibroscopy, pHmanometry, X-Ray were normal in 86%.

Adult↗
PubMed1991

Hypertrophic gastropathy with gastric adenocarcinoma: Menetrier's disease and lymphocytic gastritis?

Lymphocytic gastritis is a form of gastric inflammation characterised by a pronounced increase in lymphocytes in gastric surface and foveolar epithelium. Lymphocytic gastritis is often associated with endoscopic evidence of 'varioliform gastritis'. Lymphocytic gastritis has recently been reported to be associated with other forms of hypertrophic gastropathies. We present a case of hypertrophic gastropathy with gastric adenocarcinoma, with both Menetrier's disease and lymphocyte gastritis. Immunohistochemical studies showed that the intraepithelial lymphocytes were predominantly alpha/beta T cells as in the normal stomach and not gamma/delta T cells as in coeliac sprue. This case together with the six recently published cases suggests that Menetrier's disease and lymphocytic gastritis may be part of the same disease spectrum.

Adenocarcinoma↗
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

Surgical management of failed esophagomyotomy (Heller's operation).

An analysis of the causes of failure of Heller's operation is necessary in order to arrive at appropriate treatment. We retrospectively studied 100 reoperations for failed esophagomyotomy. Usually, a repeat myotomy was performed via an abdominal approach if the initial Heller's operation proved a failure, or via a thoracic approach if extensive motor disorders were discovered at manometry. Until 1978, esophagogastric resections were performed for severe esophageal injuries due to reflux after Heller's operation, but since then, duodenal diversion has obviated the need for resection. Antrectomy with Roux-en-Y gastrojejunostomy and vagotomy might be performed via an abdominal approach because the latter, always mandatory, is feasible through a transdiaphragmatic approach. Esophageal resection was reserved for major esophageal asystole, some cases of sclerosis, and carcinomas occurring or discovered after Heller's operation.

Esophageal Achalasia↗
PubMed1991

Total duodenal diversion in patients with previous gastric surgery.

Total duodenal diversion (TDD) was performed in 19 patients with severe post-gastric surgery symptoms. Previous operations were truncal vagotomy associated with pyloroplasty or antrectomy (n = 6), proximal esophagogastrectomy (n = 8) or total gastrectomy (n = 5). Technical adjustments to the standard procedure (truncal vagotomy, antrectomy and gastrojejunal anastomosis using a 70 cm Roux-en-Y loop) were required. There were no postoperative deaths, no anastomotic leakage or anastomotic ulceration. The main symptoms were eliminated, and endoscopic gastritis and esophagitis healed in all patients. Heartburn and bilious vomiting ceased in all patients, but in five out of 14 patients with a residual stomach some symptoms persisted. TDD proved a safe and effective treatment of disabling symptoms following gastric surgery.

Adult↗
PubMed1991

Mechanical sutures in perforation of the thoracic esophagus as a safe procedure in patients seen late.

Between 1976 and 1988, we treated 13 perforations of the thoracic esophagus, excluding ruptured carcinoma and intraoperative wounds, by mechanical sutures without exclusion. The delay between perforation and treatment ranged from eight to 168 hours, more than 24 hours in 11. The length of perforation was 0.5 to 15.0 centimeters. Suture was covered with a flap in ten instances; an antireflux procedure was associated with five instances. No digestive ostomies were performed. There was one death; a patient who was comatose upon arrival. The results of this small series suggest that myotomy exposing the mucosa and a flap are two essential elements of the technique; perforations of less than 6 centimeters, even when seen late, may be treated by primary surgical closure.

Adult↗
PubMed1991

[Evolution of indications and results of the treatment of alcoholic chronic pancreatitis in men. Study of 222 cases].

The aim of this study was to analyze the evolution of surgical indications in alcoholic chronic pancreatitis (ACP) and to compare long term results after medical (n = 72) and surgical (n = 150) treatment with or without pancreatic resection. Since 1968, a retrospective study was carried out on 222 consecutive male patient. 68% of them, were operated on for unrelieved pain or complications at a mean of 5 years after the onset of the symptom. The mean follow-up was 10 years. The study of evolution of the indications and results of surgical treatment was made on two consecutive ten-year periods and showed that 68% of pancreaticoduodenectomies and 55% of distal pancreatectomies (DP) were performed during the first period. Indications for primary pancreaticoduodenectomy did not decrease since 1980, while those of distal pancreatectomy (DP) changed (no DP for acute pancreatic effusion with fistula before 1980, no DP for unrelieved pain after 1980). Ten patients underwent operative drainage of pseudocysts before 1980 versus 21 after 1980 (13% vs 29%) with no operative death. Twenty patients underwent biliary and/or intestinal and/or ductal drainage during the first period versus 22 during the second (25% vs 30%). The overall 12-year actuarial survival between operated and non operated patients was no significantly different (respectively 72% +/- 10% and 64% +/- 12%). The actuarial 10-year survival rate was significantly better after DP (73% versus 53% after drainage and 28% after pancreaticoduodenectomy). No patients underwent specific pancreatic reoperation after pancreaticoduodenectomy versus 25% after DP.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed1991

[Value of computed tomography and celiomesenteric angiography in assessing vascular involvement in cancer of the exocrine pancreas. Apropos of 31 cases].

The prediction of vascular involvement by computed tomography (CT) with intravenous bolus contrast medium enhancement was compared to that of angiography in 31 patients with pancreatic carcinoma. CT was performed in 29 patients, angiography in 18 patients, while 16 had both investigations. Results of both radiological investigations were reviewed and compared with surgical findings. Sensitivity and specificity of CT was 88 and 100 percent respectively. Sensitivity and specificity of angiography was 57 and 100 percent respectively. The four false-negative results of CT concerned the superior mesenteric and portal veins. The ten false-negative results of angiography concerned the superior mesenteric and portal veins in four cases, and the celiac and superior mesenteric arteries in six cases. Comparison of results of CT and angiography revealed that the two methods concurred in 12 patients, five without and seven with vascular involvement. In three other cases, CT detected more abnormal vessels than angiography. In another case, only CT demonstrated nonresectability. In conclusion, CT with enhancement seems to be more accurate than angiography in the prediction of vascular involvement of pancreatic carcinoma.

Adenocarcinoma↗
PubMed1990

[Endoscopic ultrasonography in the preoperative evaluation of rectal cancer. A prospective study in 31 patients].

Endoscopic transrectal ultrasonography (EUS) is performed with an ultrasonic transducer (7.5 mHz or 12 mHz) situated in the tip of a side viewing endoscope. Its accuracy to assess the depth of rectal cancer invasion was studied prospectively in 31 patients. The ultrasonic examination was complete in 26 cases; in 5, the stricturing tumour could not be passed by the probe. The depth of invasion was correctly evaluated in 27 of the 31 patients (accuracy: 90 per cent). The 7 superficial lesions were all correctly detected with EUS. EUS appears to be a very promising method for the pretherapeutic staging of rectal cancer.

Aged↗
PubMed1990

Staging of esophageal carcinoma: comparison of results with endoscopic sonography and CT.

We compared the results of endoscopic sonography and CT in the preoperative staging of 46 patients with esophageal carcinoma studied prospectively. All patients had surgery and 44 had pathologic examination of the mediastinal and celiac lymph nodes. The results of CT and endoscopic sonography were compared with surgical and pathologic findings. A total of 51 tumors were found in 46 patients. Sonographic estimation of tumor extension through the different layers of the esophagus was correct in 37 (73%) of all 51 tumors and in 22 (85%) of the 26 tumors in which the examination was complete. The echoendoscope (13-mm diameter) could not pass through the tumor in 23 cases (50%). Infiltration to adjacent organs was found in 15 cases at surgery. In four of these 15, the extension was detected by CT; in seven of the 15 cases, it was detected by sonography. False-negative determination of tumor extension occurred with endoscopic sonography in patients with stenotic tumor. There were no false-positive results with either CT or endoscopic sonography. For detection of mediastinal lymph-node involvement, the sensitivity of CT was 48%. The sensitivity of sonography was 50% if metastatic nodes unexplored by sonography were included, or 84% if only cases in which stenosis was passed were considered. Statistical comparison revealed that sonography was superior to CT for the detection of metastases to lymph nodes. CT and endoscopic sonography provide complementary information. When the echoendoscope can be maneuvered past the tumor, sonography can be used accurately to define extension through the layers of the esophagus, extension to the adjacent organs, and involvement of the lymph nodes. When the tumor cannot be passed by the echoendoscope, CT is superior to sonography for detection of mediastinal extension.

Adult↗
PubMed1990

[Echoendoscopy: a new technic for studying esophago-gastric subepithelial tumors and extrinsic compression].

The value of endoscopic ultrasonography in the diagnosis of subepithelial tumors and extrinsic compression of the esophagus and the stomach was evaluated in 34 patients with 21 subepithelial tumors and 13 extrinsic compressions. Endoscopic ultrasonography was always performed after axial-vision fiberscopy anal routine biopsy specimens were obtained. Computed tomography was also done in all cases of extrinsic compression. Distinction between subepithelial tumor and extrinsic compression was made in all patients by endoscopic ultrasonography and in 5 cases by fiberscopic examination with biopsy specimens. Localization and intramural spread of subepithelial tumors were correctly determined in 12 of 13 cases by endoscopic ultrasonography (diagnostic accuracy: 92 percent). The echoendoscopic semiology of 21 subepithelial tumors was retrospectively established. The histologic nature of some of these tumors can be suggested by these signs. Endoscopic ultrasonography is superior to computed tomography in the evaluation of esogastric extrinsic compressions, particularly in the diagnosis of posterior mediastinal carcinomatosis and of tumoral invasion of the deep parietal layers. We conclude that endoscopic ultrasonography is currently the best procedure in the assessment of subepithelial tumors and extrinsic compressions of the esophagus and the stomach.

Carcinoma↗