Search PubMed⌕ Search

Biomedical subjects

B Launois

Publications and source records attributed to B Launois.

At least 91 records · Page 5Linked to original sources
PubMed1991

Malignant melanoma of the hepatic and common bile ducts. A case report and review of the literature.

We report a case of malignant melanotic melanoma involving the extrahepatic biliary tract in a 34-year-old white woman. The diagnosis was established using conventional light microscopic examination and immunohistochemical stains. The clinical absence of any primary cutaneous or visceral melanoma suggests that the tumor arose primarily from the biliary tract. To our knowledge, only two previous cases of malignant melanoma of the common bile duct have been reported in the literature.

Adult↗
PubMed1991

[Indications and results of hepatic transplantation for cancer].

From April 1978 to 1st October 1990, 19 patients underwent liver transplantation for primary or secondary cancer of the liver. Eleven patients were transplanted for hepatocellular carcinoma secondary to cirrhosis, generally alcoholic (9 cases), hepatitis B (1 case) or secondary to haemochromatosis (1 cas). Three patients developed hepatocellular carcinoma in a normal liver, including one fibrolamellar cancer and three a proximal bile duct cancer. Lastly, two patients received a graft for secondary cancer from a colonic adenocarcinoma and a carcinoid tumour of the right colon. The operative mortality was nil for the transplantations for cancer in a normal liver, but there were 4 deaths out of the 11 cases of cancer secondary to cirrhosis. The actuarial survival of the overall series was 55% at 1 year and 31% at 2 years. The poorest survival was observed for cancers in a normal liver, with the exception of the fibrolamellar cancer in which recurrence was delayed. The longest survival was observed for cancers secondary to cirrhosis. At three years, the results of liver transplantation were equal to those of hepatic resections with a survival of 37%, despite the fact that the transplantation was generally performed for very large tumours.

Adult↗
PubMed1990

[Technics of arterial and venous reconstruction in liver transplantation].

In liver transplantation, the quality of the immediate postoperative period depends on a perfect surgical technique and, notably, on the quality of the hepatic arterial blood flow. In case of arterial abnormality, the reconstruction resulting from a donor's right hepatic artery is performed either by Gordon's technique or by reimplantation of the patch on splenic artery. An insufficient hepatic arterial blood flow requires the installation of an iliac artery graft between the recipient's aorta and the donor's coeliac patch. The presence of portal thrombosis, parietal defect or portocaval anastomosis requires the use of an interposed iliac vein graft. Direct implantation on the superior mesenteric vein suppresses the need for dissection of a portocaval shunt or resection of the thrombotic vein.

Anastomosis, Surgical↗
PubMed1990

[Liver transplantation in metastases of carcinoid tumor].

A 30-year-old woman underwent a liver transplantation for metastasis of a carcinoid tumor of the midgut previously resected. Operative manipulation of the liver resulted in arterial hypotension, tachycardia, high pulmonary arterial pressure, oedema of the face and peripheral cyanosis, although the patient was given somatostatin (Modustatine, Clin-Midy) (300 micrograms a hour) prior to the procedure. The improvement of the symptoms was obtained by the increase of somatostatin infusion rate to 750 micrograms a hour associated with dopamine (6 micrograms.kg-1.min-1) and fluid replacement. The diagnosis of carcinoid syndrome is discussed. This unusual observation stresses the difficulty in preventing and/or treating a carcinoid shock. If somatostatin seems to be the treatment of choice of such a syndrome, its role in that case was limited.

Adult↗
PubMed1990

[Auto-transplantation of small intestine, an emergency salvage procedure after failure of esophagoplasty].

The colon or stomach is generally used for extended oesophagoplasty. These pediculated plasties may be complicated by necrosis or stenosis and require total or partial resection at a later stage. We report such an outcome in this case report: failure of left coloplasty, partial failure of right coloplasty and stomach then rendered unusable. The cervico-thoracic oesophagus was reconstructed using a free revascularised small bowel transplant, re-establishing the continuity between the cervical oesophagus and the retrosternal right colon. This case presents several particularities: semi-emergency salvage procedure, use of a saphenous vein graft to revascularise the intestinal artery using the lingual artery as nutrient artery, venous drainage of the transplant via the intrathoracic left brachiocephalic vein, necessity for resection of the left half of the manubrium sterni and the head of the left clavicle.

Colon↗
PubMed1990

[Severe and late complications after Nissen's procedure].

Eleven severe complications have been observed in 8 patients operated on with Nissen's procedure. The average time of occurrence of these lesions is of 4 years and 7 months +/- 3 years and 10 months (extreme values 9 months-11 years and 3 months). These patients were 3 women and 5 men of a mean age of 42 +/- 11 years (extreme ages 25-61 years). The complications are of two different types. In 5 cases they consist in the perforation of a gastric ulcer into the pericardium, the mediastinum, the pleura or one of the crura of the diaphragm. The diagnosis is established by Christ Ray and esogastroduodenal gastrograffin follow-through. A quite different picture is that of hemorrhagic ulcer occurring abruptly without any warning signs in 6 cases, causing cataclysmal bleeding in three. The etiological diagnosis is based on fibroscopy. Two patients had multiple complications. In three cases there were in addition obvious signs of disorders of gastric emptying and in one case alkaline reflux. The perforated ulcers were all treated by suture, but for the bleeding ulcers total or upper partial gastrectomy was required in 2 of 6 cases. No hospital mortality or morbidity was noted. The pathogenesis of these complications is controversial, but they seem to be caused by disorders of gastric emptying or alkaline reflux. The occurrence of these complications leads to call into question the indications of Nissen's procedure in the treatment of gastroesophageal reflux. The treatment must be medical at first.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

[Urologic complications after 333 kidney transplantations].

26 urological complications were observed in 25 patients following 333 kidney transplantations. The low incidence of these complications (7.8%) is largely due to the systematic resort to the Leadbetter-Politano ureterovesical anastomosis, except in one case (uretero-ureterostomy due to the shortness of the graft). We recorded 9 urinary fistulae and 17 cases of ureteral obstruction. Urinary lithiasis was excluded from this work. Urinary fistulae occur almost only between the second week and the end of the first month. Ureteral obstructions occur relatively early (within 30 days in 14 cases and within the first 48 hours in 9 cases). Two grafts were lost (8% of complications, but 0.6% of the entire series), and one patient died following transplantectomy. In 10 of 26 cases (38.5%), the etiology of the urological complication was related to the harvesting technique (2 short ureters, 8 ischemic ureters).

Adolescent↗
PubMed1989

[Curative surgery treatment of cancer of the biliary tract and exocrine pancreas].

Curative surgery for cancers of the biliary tract and pancreas varies according to their location. Cancer of the upper third of the extrahepatic bile duct is remarkable for the technical problems it raises, with the possible combination of partial or total liver resection followed by transplantation. Cancer of the lower third of this duct is similar to cancer of the pancreas as regards both diagnosis and treatment which consists of cephalic duodeno-pancreatic cancers. Cancer of the middle third should be treated, depending on its extension, as upper third or lower third cancer. The survival obtained by curative surgery is longer than that obtained by surgical or non-surgical palliative treatment, with an equal or higher operative risk, frequent cholangitis and an often mediocre quality of life.

Biliary Tract Neoplasms↗
PubMed1989

Total versus subtotal gastrectomy for adenocarcinoma of the gastric antrum. A French prospective controlled study.

In a multicentric trial the postoperative mortality and the 5-year survival of elective total gastrectomy (TG) was compared with subtotal gastrectomy (SG) for adenocarcinoma of the antrum operated on with intent of cure. Two hundred and one patients were included in the study; 32 were excluded after pathologic examination (linitis plastica, superficial cancer, lymphoma). One hundred sixty-nine patients remained for analysis, with 93 undergoing TG and 76 undergoing SG. Elective TG did not increase postoperative mortality (1.3%) compared with SG (3.2%). There was no difference in the 5-year survival rate (48%). Analysis of survival showed no difference in the two techniques when related to nodal involvement and serosal extension. It is concluded that both TG and SG can be performed safely in patients with adenocarcinoma of the antrum; however TG did not increase the survival rate.

Adenocarcinoma↗
PubMed1989

[Cost efficacy analysis of thrombolytic strategies].

Price disparities of thrombolytic agents and variability in complementary reperfusion therapies have a big impact on hospital costs of thrombolysis. Nine strategies combining 3 thrombolytic preparations (SK alone, SK + aspirin and rt-PA) and 3 strategies for the management of reocclusion are compared. Unit costs of cardiac catheterisation and surgery and direct cost of a hospital day were estimated from hospital accounts. The hypotheses concerning the frequency of interventions and length of stay were based on results in the literature and analysis of a series of 420 patients from 3 hospital centres. The average direct cost of hospitalisation per patient treated with streptokinase plus aspirin with a conservative approach was 22,500 FF. It increased by 15 p. 100 with delayed elective angioplasty and by 45 p. 100 with an aggressive reperfusion strategy. In a conservative protocol, hospital costs were 37 p. 100 higher when rt-PA was used instead of streptokinase. An rt-PA conservative management strategy was associated with a twenty times higher cost per additional survivor than that of streptokinase with aspirin.

Cost-Benefit Analysis↗
PubMed1989

[Effect of age on the results of surgical treatment of cancer of the gallbladder].

The aim of the study was to define the influence of age on the surgical treatment of cancer of the gall bladder. From a population of 731 patients: 104 were over 80 years (14%) and 230 were between 70 ant 80 years (32%). The histological stages T1, T2, T3, T4 were also distributed throughout the various age groups. There were however significantly more in situ lesions before the age of 70 years than after. The incidence of resection was similar in the various age groups but extended right hepatectomy was only carried out in patients under 70 years. The mortality rate was low for patients who underwent surgery for lesions graded Tis, T1 and T2. High survival rates were only obtained in the Tis and T1 patient groups. T2 grade cancers had a significantly improved prognosis when resection was carried out. Duration of survival after bilio-intestinal anastomosis was very short regardless of the age of the patient. In summary, age did not appear to constitute a contraindication to resection for early lesions, but it did have an effect for the lesions graded T1, T2, on the degree of hepatic resection around the gall bladder. Lesions graded Tis were all treated by simple cholecystectomy regardless of age. Patients with T3 or T4 lesions did not benefit from resection, regardless of age, and in these cases the value of bilio-intestinal anastomosis is debatable.

Actuarial Analysis↗