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Biomedical subjects

B Launois

Publications and source records attributed to B Launois.

211 records · Page 12Linked to original sources
PubMedDate not supplied

[Salvage esophagoplasty using free jejunal transplant after repeated failure of other esophagoplasties. 25 cases].

Salvage oesophagoplasty using a free jejunal transplant is the ultimate reconstruction possible after repeated failures using the classic procedures of oesophagoplasty. The free jejunal transplant appears to be the best choice. Twenty-five free jejunal transplants were performed by the same surgeon for such reconstructions including 13 cases involving benign lesions and 12 cases of cancer. There were no post-operative death and none of the transplantations was a complete failure although three cases of stenosis and fistulization occurred. Several recommendations can be made: save the existing digestive tract, redissect the residual digestive plasty and pull it up. The residual digestive flap can be examined by opacification or endoscopically in order to evaluate its length. An arteriography of the pediculated plasty gives information on its vascularization. A free jejunal graft can safely cover 25 to 30 cm. When possible, residual plasties should be positioned subcutaneously. The reconstruction of the cervico-thoracic oesophagus usually requires a vascular bypass with a saphene graft. In difficult cases, it may be necessary to remove a part of the sternal manubrium and the head of the clavicular bone in order to avoid compressing the jejunal graft. When the length of the reconstruction is greater than 30 cm, a long jejunal transplant with two pedicules (1 pedicule revascularized from the cervical vessels and the other pedicule from the internal thoracic vessels) is needed. An alternative technique would be a free antebrachial flap (six cases operated with two post-operative deaths at 6 weeks and two fistulas).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

["Piggyback" method in hepatic transplantation].

Using the traditional technique for liver transplantation, there are two supra and subhepatic anastomoses to the vena cava. With the piggy-back method, the donor's inferior vena cava is implanted terminolaterally into the recipient's inferior vena cava. The aim of this work was to evaluate results in two matched groups. PATIENTS AND METHODS. From June 1992 to May 1993, 13 patients underwent piggy-back liver transplantation (group 1) and 14 others underwent traditional liver transplantation (group 2). There were 17 men and 10 women, mean age 48 years (range 25-65 years). There was no significant difference between the groups for age, sex, indications, number of rejections and retransplantations. RESULTS. There were no deaths in group 1 and 2 deaths in group 2 within the first 30 days postoperatively. There was no significant difference between groups 1 and 2 for duration of cold ischaemia (552 +/- 323 vs 463 +/- 345 min respectively), the number of packed cell transfusions (9.8 +/- 11 vs 11.1 +/- 5.5), duration of the operation (474 +/- 151 vs 500 +/- 95 min), duration of anastomosis (56 +/- 17 vs 66 +/- 20 min), creatinine levels at day 30 (140 +/- 79 vs 200 +/- 145 min). But there was a significant difference in the anhepatic phase (56 +/- 17 vs 66 +/- 20 min). CONCLUSION. Unexpectedly, there was no significant difference between the two types of transplantation with the exception of the anhepatic phase.

Adult↗
PubMedDate not supplied

[Esophagectomy without thoracotomy. Comparison between a retrospective study and a prospective randomized trial].

From 1983 to 1989, 96 oesophagectomies (30% of all oesophagectomies performed during this period) were performed without thoracotomy and then analyzed retrospectively. Most were performed due to contraindications including age (17%), respiratory disease (47%), heart disease (37%) or for superficial oesophageal lesions (35% were stage T1). Operative mortality was 3.1%. Fistulization of the anastomosis occurred in 7.5% of the cases. Actuarial survival rate at 5 years was 29% and was independent of age but dependent on localization, the size of the tumour, presence of parietal invasion and TNM classification. However, patient selection introduced bias and a prospective randomized study comparing oesophagectomy without thoracotomy and oesophagectomy via right thoracotomy and midline incision demonstrated that mortality and complications were similar with the two techniques. Long term survival was not dependent on access route, but on the stage of the disease.

Adult↗
PubMedDate not supplied

Surgical management of hepatocellular carcinoma in genetic haemochromatosis.

From 1975 to 1989, 51 patients presenting with hepatocellular carcinoma complicating genetic haemochromatosis were managed in our institution. Twenty-one patients underwent a laparotomy. Laparotomy was limited to surgical exploration or palliation in 8 patients in whom the tumour was deemed unresectable. Thirteen patients underwent either a partial hepatectomy (11 patients) or a total hepatectomy and liver transplantation (2 patients). Actuarial survival at 1 and 3 years following partial hepatectomy was 56% and 40% respectively. There was one hospital death in the resection group and in the transplant group. Only 3 patients have remained free of tumour recurrence after a mean follow-up of 18 months. Common clinical and histological features for patients with this condition included masculine gender, age 50 years or above, 10 or more years of history of diagnosed genetic haemochromatosis, high alcohol intake, and grade III or IV hepatic fibrosis.

Aged↗
PubMedDate not supplied

Lacing technique using dermal autografts for the management of large incisional hernias.

Between 1980 and 1990, 25 patients were treated for large incisional hernias using the skin lacing technique. Twenty-four hernias were midline and one was at the site of a McBurney incision. Hernia defects were greater than 10 cm in diameter for 24 patients. A 1 cm-wide uninterrupted segment of skin was harvested from excess skin overlying the hernia and was then alternatively passed through the left and right fascial margins of the hernia. The operative mortality was nil. Two wound abscesses were drained locally and did not mandate removal of the skin lace. After a mean follow-up of 4.9 years, 3 recurrences were observed. Among 22 patients who had a successful repair of their incisional hernia, 20 returned to their previous occupations and two others reported improvement in performing their daily tasks. The skin lacing technique is an interesting alternative to other more sophisticated techniques in the management of large incisional hernias.

Adult↗
PubMedDate not supplied

Caroli's disease: a surgical dilemma.

We report the case of a 31-year-old male patient with a diffuse form of Caroli's disease presenting as recurring bouts of biliary pancreatitis. Following sphincterotomy, the patient remained asymptomatic for 5 years. He then developed acute cholangitis and, at laparotomy, all superficial liver cysts were fenestrated in order to remove intrahepatic bile duct calculi. A right hepatectomy, removing the most severely affected liver parenchyma was not considered feasible because of the small size of the left lobe and the existence of an associated congenital hepatic fibrosis. In diffuse forms of Caroli's disease biliary drainage techniques have often proved ineffective in preventing recurring bouts of cholangitis. Moreover, liver resection is seldom feasible because of associated congenital hepatic fibrosis. In this setting, liver transplantation may represent the only effective and durable form of treatment.

Adult↗
PubMedDate not supplied

Focal nodular hyperplasia of the liver. A retrospective review of 20 patients managed surgically.

Focal nodular hyperplasia remains a difficult diagnostic and clinical dilemma. Over a 10-year period, 20 patients with this diagnosis underwent surgery in our service. Eight of the patients had focal nodular hyperplasia discovered incidentally as part of investigation or surgery for other unrelated conditions. Seventeen of the patients were female, with 64% receiving oral contraceptives. In the 12 patients without concomitant disease all but one had upper abdominal pain. Despite the use of CT scan, isotope studies, NMR, angiography, ultrasound and biopsy, a firm preoperative diagnosis of focal nodular hyperplasia was made in only one patient. Resective surgery was performed without complication in all cases. During a mean follow-up of 42 months (range 6-128 months) one patient died from lymphoma and two patients had recurrent abdominal pain. This study highlights the difficulty in preoperative diagnosis of focal nodular hyperplasia. Conservative treatment can be considered or resective surgery safely performed for symptomatic or suspect lesions.

Adult↗
PubMedDate not supplied

[Surgical treatment of hepatocarcinoma in cirrhosis].

In 1986, our institution published the first results of surgical résection of hepatocarcinoma in cirrhotic patients. The aim of this paper is to present long term results of this surgical management. From April 1978 to February 1992, 74 patients were operated on at the surgical clinic of University Medical Center of Rennes (35000) France. There were 60 hepatectomies and 14 transplantations. The mean age was 60.2 years-9 years and the sex ratio: 70 males and 4 females. The etiology was alcoholic in 43 patients (58%), post hepatitis (B and C) in 22 patients (30%) and due to hemochromatosis in 9 patients (12%). According to the Child Pugh classification, 48 patients were Child A, 11 Child B and one Child C in the hepatectomy group and 9 patients Child A and 5 Child B in transplantation group. The operative mortality was 10% in hepatectomy group and 35.7% in liver transplantation group. Overall survival was 61.8% at 1 year, 47.1% at 2 years, 38.2% at 3 years and 20% at 5 years. 5 year survival is 21.4% after transplantation and 18.5% after resection. This difference is not significant. In conclusion, according to 5 years survival and to operative mortality the treatment of choice is hepatectomy in HCC in cirrhotic patients. However the best treatment is the prevention of cirrhosis.

Actuarial Analysis↗
PubMedDate not supplied

Experimental colonic carcinogenesis: a new animal model.

The aim of this work was to develop an animal model of accessible colonic tumours simulating human carcinogenesis. A segment of the colon was exteriorized to the skin in 60 rats and swabbed with N-methyl-N-nitrosourea. All the animals developed tumoral abnormalities or frank dysplasic tissue 7 months after the beginning of the experiment. This animal model which closely mimics human colonic carcinogenesis is particularly interesting because tumour development can be monitored in live animals without interrupting normal intestinal functions.

Animals↗