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Biomedical subjects

B Launois

Publications and source records attributed to B Launois.

At least 127 records · Page 7Linked to original sources
PubMed1986

[Spontaneous rupture of the esophagus].

Eighteen patients (16 men and two women), aged 20 to 77 years, were admitted to the University hospital between 1973 and 1984 for a Boerhaave's syndrome. Fourteen over eighteen were more than forty years old. Other particular features were the frequency of alcoholism (11 patients) and the lack of preexisting gastrointestinal symptomatology. The cardinal symptom, pain, occurred in 17 cases. It was preceded in 10 subjects by vomiting. Subcutaneous emphysema was only found in five patients, but standard chest X-ray showed seven times a pneumomediastinum. Pleural effusion was present in 14 subjects. Thirteen patients underwent thoracotomy: five within 48 h (1 death) and eight after 48 h (4 deaths); two further deaths were due to withholding surgery, and a third by performing bipolar oesophageal exclusion at a late stage (8th day); six of these deaths were related to local infection. The clinical and radiological features of Boerhaave's syndrome are presented in a review of the literature; particular attention is paid to the various methods of treatment.

Adult↗
PubMed1985

[Detection of intra-abdominal suppuration. Value of scintigraphy with indium-111-labeled autologous polynuclears].

Between February, 1982 and August, 1983, 53 patients with symptoms suggestive of post-operative intra-abdominal abscess were explored by scintigraphy with indium-111 labeled autologous polymorphonuclears. The sensitivity and specificity of this method were both 96%. Scintigraphy of course must be preceded by ultrasonic exploration which is of more delicate interpretation as well as less sensitive (60%) and less specific (84%). The results of scintigraphy avoided an unnecessary laparotomy in more than one-half of the patients.

Abdomen↗
PubMed1985

[Terminalized lateral colostomy].

Complete diversion of the digestive transit requires intestinal section and terminal rather than lateral colostomy. This can now be achieved by using a mechanical stapler to obturate temporarily the distal end of the colonic segment bearing a conventional lateral colostomy, then performing an extra-mucosal anastomosis to re-establish continuity. This technique can be applied to protect low colonic anastomoses or to treat a minor anastomotic disruption. It can also be extended to ileostomy.

Colostomy↗
PubMed1984

[Gastric bypass in the treatment of major obesity. 15 cases].

Gastro-jejunal bypass, as derived from Mason's technique, consists of excluding most of the stomach, leaving only a 60 ml fundic pouch anastomosed with a Y-shaped jejunal loop. Fifteen patients (11 women and 4 men), aged from 21 to 51 years, were operated upon by this technique. In 3 of them, a jejuno-ileal bypass was transformed into a gastric bypass. The amount of weight lost by each individual patient was unpredictable and varied, in fact, from 1 to 50 kg (mean :30 kg). This was obtained within the 6 months following surgery, after which weight remained stable. All but one of the patients failed to attain their ideal weight. The only post-operative complication observed was abscess of the abdominal wall in 3 cases. Digestive disorders were constant during the first 3 months, but rapidly subsided thereafter. In view of the overall satisfactory loss of weight and low incidence of complications, this treatment can be considered useful. However, it should only be applied after strict selection and provided the patient's nutritional status can be regularly supervised.

Adult↗
PubMed1984

Circular anastomosis stapler. An alternative to pursestring suture.

When used with the circular anastomosis stapler, the pursestring suture (PSS) is not always secure, primarily due to esophageal fragility and secondarily due to poor operative exposure. This problem prompted us to develop a simple, rapid technique to replace the PSS. It consists of a total circular ligature of the esophageal wall, which is tightened around the axis of the stapler between the anvil and cartridge. Exposure of the esophagus and introduction of the device are easily done. Anastomosis reliability was shown by the absence of postoperative complications caused by anastomotic leakage in more than 200 consecutive patients.

Esophagus↗
PubMed1984

[Hepatic insufficiency and nutritional problems after major hepatobiliary surgery].

Problems raised by major hepatobiliary surgery affect the total economy of the human body. The liver is implicated in all body metabolism processes and possible problems during partial or total hepatectomy can only be solved by a knowledge of liver physiology. The liver plays a major role in the metabolism of products of digestion, whether these are carbohydrates or amino acids arriving in the portal blood. The most important activity of the liver is the preservation of a constant level of glucose by ensuring a fixed and predictable concentration to extrahepatic tissues. It ensures a very precise control of plasma and tissue flow of amino acids and thus protein synthesis and neoglycogenesis. Synthesis and degradation of non-esterified fatty acids, ketogenesis, cholesterol synthesis and triglyceride production result from the action of the liver on lipid metabolism. Free cholesterol is the precursor of bile acids and steroid hormones, but esterified cholesterol is not synthetized in the liver. Apart from its role in bilirubin metabolism, it has a key role to play in correct functioning of most endocrine systems: many are catabolized in the liver. But one of the most interesting properties of the hepatic tissue, as far as the surgeon is concerned, is liver regeneration, which combines hypertrophy with hyperplasia. This is dependent on age, hepatotrophic factors of portal blood, and extraportal factors. A study of hepatic metabolic processes allows assessment of the consequences of partial hepatectomy. Postoperative hypoglycemia, in the absence of a continuous infusion of glucose, is easily explained by the weakness of hepatic reserves in glycogen. Albumin levels fall during the first 7-10 days after liver resection, but this hypo-albuminemia is often marked by the need to infuse large quantities of frozen fresh plasma to try to avoid lesions of the other specific proteins, which are coagulation factors. Lipid metabolism disorders are of little clinical consequence. Hepatic resection is being alarming when it involves 80 to 90% of the hepatic mass and menaces the life of the patient. The existence of a previous liver alteration worsens the consequences of major hepatobiliary surgery. Indications for hepatic resection must be weighed carefully in patients with cirrhosis, liver regeneration being totally absent after resection. Metabolic consequences of total hepatectomy followed by transplantation are identical in kind to those of partial hepatectomy but are increased in frequency and start during operation. Postoperative surveillance must be strict to avoid marked variations in glycemia with the risk of hypoglycemia, and variations in kaliemia.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMed1983

Surgical treatment of malignant esophagotracheal fistulas.

Malignant esophagotracheal fistulas represent the fatal evolution of esophageal cancer. Since October 1974, 18 patients were seen who had confirmed esophagotracheal fistula, and in half of these patients, the fistula was the revealing symptom. Upper gastrointestinal studies (using hydrosoluble dye) and bronchoscopic examination confirmed the diagnosis, which was already strongly suspected in 16 of the patients due to the specific nature of the cough triggered by swallowing. The average age of the patients was 57 years, (range, 32 to 78 years). In 12 patients, the nutritional repercussions were moderate, and in only 6 patients, were the bronchopulmonary consequences serious. Therapeutically, we adopted a palliative surgical attitude since the physical and psychological condition of these patients was considered fatal the month after discovery of the fistula. In addition, the results of intubation were uncertain and transitory. Our surgical methods evolved in three stages: first, we performed bipolar exclusion of the esophagus coupled with gastrostomy (four patients), second, we performed retrosternal coloplasty (five patients), and third retrosternal gastroplasty with drainage of the inferior portion of the esophagus by Roux-Y jejunal anastomosis (six patients). The latter technique was inspired from that described by Kirschner in 1920. It is moderately aggressive and has the advantage of dealing with several objectives: exclusion of the fistula, reestablishment of normal alimentation, drainage of the inferior portion of the esophagus, and permitting postoperative radiotherapy. In our series, when only the patients who underwent coloplasty or gastroplasty were considered, 3 of 11 died, and the longest postoperative survival times were 16 and 23 months. Regarding gastroplasty alone, our results were in agreement with those in the literature. In the 19 patients who underwent gastroplasty, the operative mortality was 31.5 percent and the average length of survival was 9 months. Six patients survived from 8 to 26 months. Therefore, this "last resort" surgery seems legitimate in light of the fact that the results are sometimes superior to those of radical curative surgery for extirpative esophageal cancer.

Adult↗
PubMed1983

Results of the surgical treatment of carcinoma of the esophagus.

Between 1972 and 1980, 360 patients were operated upon for the treatment of carcinoma of the esophagus at this university hospital. By adopting a policy of routine endoscopy in all patients with minor esophageal symptoms, early diagnosis was possible. Nutritional and respiratory support preoperatively and postoperatively diminished anastomotic leakages and pulmonary complications. We were able to lower our mortality from 17.6 to 2.6 per cent and to increase our resectablity rate from 60.2 to 85.0 per cent. It is still too early to determine if the Akiyama technique, while permitting an improvement of the results, will increase the five year survival rate.

Adult↗