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Biomedical subjects

B Launois

Publications and source records attributed to B Launois.

At least 109 records · Page 6Linked to original sources
PubMed1989

[Uncommon arterial and venous reconstruction in liver transplantation].

The aim of this work was to define the best technical options of reconstruction that we can proposed in front of an anatomical or parietal anomalies of venous or arterial system in hepatic transplantation. Through a retrospective study of 10 reconstructions performed between 1978 and 1989, we observed 5 cases of right hepatic artery from superior mesenteric artery of the donor. The two basic methods of reconstruction were either the "fold over" technic of Gordon or the realization of an end to end anastomosis between donor's right hepatic artery and donor's splenic artery. In 3 cases, the insufficiency of the hepatic arterial blood flow after classic anastomosis, led us to employ an arterial iliac graft between the recipient's aorta and the donor's coeliac patch. 2 patients with portocaval shunt or portal parietal defect underwent reconstruction by venous iliac graft. In conclusion, we emphasize the importance of a perfect reconstructed reconstruction as much on the anatomical level than functional.

Arteriovenous Malformations↗
PubMed1989

[Total gastrectomy versus partial gastrectomy of adenocarcinoma of the antrum. A French prospective controlled study].

In a prospective multicentric trial we compared the post-operative mortality and the 5-year survival of elective total gastrectomy (TG) versus subtotal gastrectomy (SG) for adenocarcinoma of the antrum operated on with intent of cure. Two hundred and one patients were included in the study: thirty two were excluded after pathological examination (linitis plastica, superficial cancer, lymphoma). One hundred and sixty nine patients remained for analysis with 93 TG and 76 SG. Elective TG did not increase post-operative mortality (1.3%) in comparison 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 operations TG and SG can be performed safely in patients with adenocarcinoma of the antrum; however TG did not increase the survival rate.

Adenocarcinoma↗
PubMed1989

[Results of surgical treatment of cancer of the common bile duct as a function of age].

The aim of this study was to determine whether an age greater than 70 years constitutes a risk factor in subjects who undergo surgery for cancer of the common bile duct. From a total population of 758 cases, 216 patients belonged to this age group. Tumour lesions did not appear to be more progressive in patients over 70 years, however there was a significantly higher incidence of visceral involvement in the latter group. The rate of palliative procedures was comparable in the under 70 and over 70 years groups. However, hepatectomy and hepatic transplantation were only carried out in patients under 70 years. Mortality increased with age both for palliative and curative surgery. The mortality rates were respectively 10% and 10.1% under 70 years and 41% and 49.1% over 70 years. These results should therefore lead to the choice of endoscopic drainage procedures in more elderly patients. However, in the absence of a contraindication to anaesthesia, surgery remains indicated when curative resection is envisaged, in cases of distal stenosis of the bile duct or for failure of other methods.

Adult↗
PubMed1989

Cervical or thoracic anastomosis for esophagectomy for carcinoma.

A prospective trial was conducted to compare intrathoracic and cervical anastomoses after esophagectomy for squamous cell carcinoma of the middle or lower one-third of the esophagus. One hundred and twenty-three patients were randomized to have either a cervical or thoracic anastomosis. Thirty-one patients were subsequently excluded either because esophagectomy was performed without thoracotomy or the tumor was unresectable or because the randomization protocol was not complied with. Transfusion requirements and operating time were similar for the 49 patients having esophagectomy by way of the laparotomy and right thoracotomy (TA) and the 43 patients who underwent laparotomy, right thoracotomy and cervicotomy (CA). Forty-three per cent of the CA and 49 per cent of the TA patients had involved lymph nodes. An esophagectomy incorporating a cervical anastomosis resulted in a significantly greater margin of macroscopically normal esophagus above the tumor (median of 4.0 versus 1.5 centimeters for TA). A leak was significantly more frequent after cervical anastomosis (26 per cent) than thoracic (4 per cent) (p less than 0.002). Respiratory complications were more frequent with a thoracic anastomosis, but this was not statistically significant. Thirty day mortality rates were similar for the two groups: 14.3 per cent, TA, and 9.3 per cent, CA (p = N.S.). Postoperative strictures occurred in 14 per cent of TA and 23 per cent of CA patients and were most common after an anastomotic leak. The survival patterns of the two groups were similar. The median survival time for CA patients was 23 months and for TA, 20 months. Excluding hospital mortality, 47 per cent of patients were alive at two years and 30 per cent at 40 months. Survival was related to extent of disease. The greater length of tumor-free esophagus removed with a cervical anastomosis did not result in an improved long term survival period, but was associated with a significantly higher incidence of anastomotic fistula.

Aged↗
PubMed1989

[Surgical treatment of chronic pancreatitis. Indications and results. An experience of 246 cases].

Between 1972 and 1986, 246 patients, mainly alcoholic, with a mean age of 44 years, underwent a total of 270 laparotomies. Parenchymal resections were carried out in 99 patients and drainage and diversion procedures were carried out in 159. Pain was the principal symptom and led to surgery in 60% of cases; biliary or duodenal obstruction was present in 40 and 23.5% of cases respectively. Operative mortality was 9% for resections and 5.8% for other forms of surgery. In the long term, the best results were obtained in patients in whom a Whipple procedure was performed.

Adult↗
PubMed1988

Duodenal closure and esophagojejunostomy experience with mechanical stapling devices in total gastrectomy for cancer.

Two hundred fifty patients with cancer underwent gastrectomy over a ten-year period. In 225 the duodenum was closed by stapler and only one disruption occurred (0.45%). The first 89 esophagojejunostomies were hand sewn, and thereafter 161 were stapled with an end-to-end anastomosis device. Overall mortality was 27% and 10%, respectively. Death due to surgical causes occurred in 19% of the cases in the first group and 6.8% in the second. No statistical difference was observed in the esophageal anastomosis leakage rate, but the mortality due to such fistula was significantly higher in the group of hand-sewn anastomoses. Surprisingly, esophageal end invasion (at the anastomotic site) was 14% in the manual group vs 3.9% in the stapled one. The operator's experience had no effect on the incidence of esophageal fistula when the stapler was used. Thus, staplers are safe and useful when total gastrectomy is undertaken, provided that sound experience has been acquired.

Adolescent↗
PubMed1988

[Spontaneous rupture of an adenoma of the liver during pregnancy].

Must often reporting to an hepatic subcapsular hemorrhage with pre or true eclampsia, Spontaneous rupture of adenoma of the liver during pregnancy is unusual entity. Very exceptionally cases of rupture of anatomic hepatic lesion underlying had been reported. About a new case, diagnosis, physiopathologic and management problems are approached.

Adenoma↗
PubMed1987

[Cavo-suprahepatic lesions in severe hepatic injuries. Repair under extracorporeal circulation].

Liver injuries always have a sombre prognosis. Triple or quadruple clamping has been suggested to control haemorrhages, but the risk of the heart running dry has warranted internal shunts which have only been successful in odd cases. The severity of these lesions justifies a temporary packing pending admission in specialized unit for subsequent treatment. A final treatment may be undertaken under extracorporeal circulation. In the case reported here, the superior right hepatic vein was sutured and the holes of the infrahepatic vena cava related to the tearing of middle and inferior right hepatic veins or the dorsal veins of segment I could be repaired. Rupture of the renal pelvis was also repaired.

Constriction↗
PubMed1987

[Neoplastic jaundice. Percutaneous transhepatic approach to biliary endoprosthesis. 39 cases].

Over a 5-year period attempts at transhepatic introduction of a biliary endoprosthesis were made in 39 inoperable patients. The procedure was in 3 stages: transhepatic cholangiography, passage through the stenosis and positioning of the prosthesis. Stenosis was intrapancreatic in 20 cases, pedicular in 9 cases and hilar in 10 cases. The endoprosthesis was successfully set in 20 cases (51%), the success rate being related to the level of the obstacle: intrahepatic 60%, hilar 30%. Failure was more frequent in patients with right liver metastasis, cholangitis or prior unsuccessful palliative surgery. The prosthesis was effective for 1 month in 17 patients and for 6 months or more in 7 patients, two of whom were followed up for 14 and 18 months respectively. Provided patients are better selected and the procedure is used mainly for cholangiocarcinomas, we see no reason why the transhepatic route (combined, if necessary, with endoscopy) should no longer be used to introduce biliary endoprostheses.

Aged↗
PubMed1987

Surgical possibilities of oesophageal cancer.

The number of options now open to surgeons in the treatment of carcinoma of the oesophagus is considerable. One, two or three different approaches can be used to remove tumours at any level between the hypopharynx and the cardia. The Sweet procedure involves a left thoracotomy followed by anastomosis. The Lewis Tanner operation begins with the stomach being mobilized through an abdominal approach followed by resection and anastomosis by a right thoracotomy. A triple approach--cervical, thoracic and abdominal--is selected when anastomoses are extrathoracic. In McKeown's operation, the whole stomach is used and the posterior mediastinal route selected. Akiyama tubulizes the stomach and has chosen the retrosternal route. Orringer has recently developed oesophagectomy without thoracotomy. When tumour removal is impossible or there is a local or general reason for refusing excision, the surgeon can turn to palliative surgery to give the patient the means of enjoying a normal life during the time that is left to him. The whole stomach can be used or it can be made into a tube by resecting the lesser curvature. Postlethwait made use of Lortat-Jacob's technique. Reversing the stomach has also been suggested. Colonic oesophagoplasty is possible if previous gastrectomy has been carried out. The surgical management of malignant oesophagotracheal fistulae can be limited to bipolar exclusion of the oesophagus. Ideally, a retrosternal gastric plasty should also be performed with drainage of the lower oesophagus into a Roux-en-Y loop. The choice of treatment is made on the basis of the preoperative assessment of the patient. The extent of disease spread is evaluated. The most important diagnostic tools are fibreoptic bronchoscopy and ultrasound. The type of surgery selected is contingent on the tumour site and the patient's physical condition. Oesophagectomy without thoracotomy has meant that surgery is available to patients for whom thoracotomy would have been inadvisable. Malignant oesophagotracheal fistulation must be treated by the Kirschner operation. Palliative bypass is carried out only in patients under 50 years of age. It is our opinion that surgery is too often overlooked in the treatment of oesophageal carcinoma. The survival rate at 5 years is 23% for potentially curable resection and the operative mortality 2.6%. In other cases, palliative resection (or bypass for patients under 50) allows the patient to feed himself and lead a normal life until the inevitable fatal outcome.

Carcinoma↗
PubMed1987

[What has become of preliminary transfusion protocols in kidney transplantation?].

Many studies have demonstrated that pretransplant blood transfusions improved cadaver kidney graft outcome. The nature and the frequency of transfusions-induced lymphocytotoxic antibodies depends of sex, previous pregnancies and kidney grafts, and transfusional patterns. This provoked immunisation is not a hindrance to beneficial effects of transfusions. Numerous reports have investigated the responsible mechanism for this effect. Controversial data concern the optimum number of blood units. In a previous prospective study in patients who received anti-lymphocyte globulins as part of immunosuppressive therapy, we have shown that a multiple transfusions policy does not give better results than only one. Recently, the beneficial effect of transfusions has been questioned, either entirely, or for particular patients according to age, sex, immunosuppressive treatment including cyclosporin or not. This leaded us to reassess benefits of transfusions.

Blood Transfusion↗
PubMed1986

[Surgical treatment of hepatoma on a cirrhotic liver].

From January 1, 1975 to July 1, 1984, 37 patients with a tentative diagnosis of hepatocarcinoma on cirrhosis were operated upon. There were 34 men and 3 women, aged from 32 to 82 years (mean: 60 years). The diagnosis of cirrhosis rested either on a history of liver failure associated with clinical and biochemical signs of hepatocellular dysfunction (4 cases), or on a positive liver biopsy (5 cases). In 20 cases the diagnosis was suspected on account of abnormal liver function tests, but in 8 patients it was revealed by macroscopic examination of the liver during surgery. Cirrhosis was attributed to chronic alcoholism in 25 cases, haemochromatosis in 11 cases and positive HBs antigen in 7 cases. The diagnosis of hepatocarcinoma, suggested by altered general condition or recent pain, rested on the finding of a tumoral image at scintigraphy (16 cases), ultrasonography (19 cases), computed tomography (7 cases), arteriography (17 cases) or laparoscopy (7 cases). In only 7/32 patients was the alpha-foetoprotein level higher than 500 ng/l. Surgery confirmed the diagnosis of hepatocarcinoma in every case but that of cirrhosis in only 14/37 cases; 10 patients had lesion of hepatic fibrosis and 1 had regenerative nodular hyperplasia. In 10 cases no accurate histological diagnosis could be made since the liver tissue sample had been taken too close to the tumour. The finding of normal liver tissue shows that one should not refrain from operating merely because the diagnosis of cirrhosis rests on clinical grounds. Since 1979, surgical treatment consists in an attempt to excise the tumour. Per-operative mortality is the same with excision surgery (21%) as with exploratory or palliative surgery (17%). Fourteen excisions were performed (i.e. aresectability rate of 38% for the series): 2 liver transplantations, 2 right hepatectomies, 2 left hepatectomies, 2 left lobectomies, 2 bisegmentectomies and 3 tumorectomies. The survival rate of 2 years was 27%, as opposed to 5% with exploratory or palliative surgery. Systematic monitoring of cirrhosis with ultrasonography should result in early diagnosis of hepatocarcinoma at a stage where limited hepatic excision is possible and the chances of surviving are highest.

Adult↗
PubMed1986

[Repair of a suprahepaticocaval injury under extracorporeal circulation].

The case of a 29-year old man who presented with haemorrhage from hepatic veins and the retrohepatic vena cava is reported. On the belief that a conventional technique would be dangerous, total extracorporeal circulation was used as a supportive procedure. The method facilitated anatomic definition of the venous injuries. The repair could then be calmly and precisely carried out because of a practically bloodless operative field. The procedure was well tolerated and the postoperative course was uneventful; the patient was discharged 15 days later. Many surgical techniques have been described for the repair of traumatic injuries of the inferior vena cava and hepatic veins, but all with a high level of peroperative mortality. So, cardiopulmonary bypass and hypothermia seemed to be a useful procedure. However, some points need further consideration: heparin administration may promote bleeding from other lesions and, in the case of associated gastrointestinal injuries, the risk of major septic dissemination is great.

Adult↗