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Biomedical subjects

C Gouillat

Publications and source records attributed to C Gouillat.

52 records · Page 3Linked to original sources
PubMed1983

[Surgical treatment of primary hyperparathyroidism. Evaluation of 263 cases].

A retrospective study of the case-reports of 263 patients explored surgically for primary hyperparathyroidism demonstrated the cause to be: an adenoma (206 cases), a primary hyperplasia (29 cases), or a cancer (3 cases), exploration was negative in 25 cases. Presenting symptoms were mainly urinary, but 15 p. 100 of patients seen during the last two years had been asymptomatic. Nine patients required emergency surgery and 29 had a primary normocalcemic hyperparathyroidism. The two most useful laboratory examinations, apart from measurement of blood calcium and phosphorus levels, were parathormone assay (elevated levels were present in 80 p. 100 of cases) and quantitative bone biopsy (positive in over 80 p. 100 of patients). The surgical approach was mainly cervical, except for repeat operations when ten sternotomies were performed with successful results in 4 cases. Immediate postoperative mortality was quite high (3 p. 100), particularly in the acute forms or those with multiple adenomas, and in patients over 70. Morbidity (hypocalcemia, recurrent nerve palsy) was increased after repeat surgery. Analysis of long-term results, particularly with respect to urinary symptoms, showed marked differences between lesions of single glands (adenoma) and hyperplasia. The most difficult problem to resolve with this surgery is the importance to attach to excision of the parathyroids when lesions are present in several glands.

Acute Disease↗
PubMed1982

[Superficial gastric cancer. Results of surgery in 30 cases (author's transl)].

Gastrectomy was performed in 30 patients with superficial gastric cancer, equivalent to 12 p. cent of cases operated upon for gastric neoplasms since 1970. Presenting signs were epigastralgia in 19 cases (in 12 cases of the ulcer type), external bleeding from the digestive tract in 4 cases, dyspeptic disorders in 2 cases, and anaemia in one patient. The lesion was asymptomatic in 4 cases, while in 3 patients it was detected by endoscopy after polypectomy or for achlorhydria. In one case the lesion was discovered completely fortuitously. Cancer was suspected by the endoscopist from gross pathological findings in 7 of the 30 cases. An adenocarcinoma was diagnosed after biopsy in 26 cases, and suspected in the remaining 4 patients. Sub-total gastrectomy was employed in 27 cases, total gastrectomy in 2 cases, and extension to a total gastrectomy in one patient. Gross pathology showed cancer of type I : 8 cases, type II (IIa : 1, IIb : 0, IIc : 10) : 11 cases, type III : 6 cases, and mixed types IIc + III : 5 cases. The submucosa was invaded 17 times, the other 13 lesions involving the mucosa only. There were no immediate postoperative deaths. Three patients were not seen again, while 7 died from secondary causes : 5 for reasons unrelated to their cancer and 2 from unknown causes. By applying strict attention to surgical procedures and precise examination of histological data it should be possible to obtain postoperative survivals comparable to those of Japanese series (80 to 90 p. cent at 5 years, 70 p. cent at 10 years).

Adenocarcinoma↗
PubMed1980

[Warren's operation for portal hypertension. Evaluation of results by early angiography in 23 cases (author's transl)].

After distal splenorenal anastomosis, as described by Warren, in 23 patients, early assessment of results (after 2 weeks and 2 months) by endoscopic examination and celiomesenteric angiography was used to evaluate the effectiveness of the procedure and its effects on hepatic portal perfusion. The distal splenorenal shunt remained open in almost all cases (22 out of 23), the varices diminished, and postoperative hemorrhage rarely occurred (3/23 cases). The portogastric disconnection was incomplete in 8 patients, preservation of hepatoportal flow not being constant, as 6 cases with partial and 2 cases with complete portal thrombosis were observed.

Adult↗
PubMed1978

[Non-recurrent inferior laryngeal nerve (15 operative cases)].

During surgery on the right thyroid lobe, 15 cases of non-recurrence of the inferior laryngeal nerve were observed, among which two types of equal frequency. Embryologic data explain why this abnormality is always associated with an abnormal origin of the right subclavian artery, directly from the aortic arch. The right subclavian artery generally passes behind the oesophagus in these cases. These 15 cases represent 0,79% of the 1889 cases studied during a short period (1971-1978).

Adult↗
PubMedDate not supplied

[Treatment of low rectal cancer by conservative rectal resection after preoperative irradiation. Long term results and prospective study].

AIMS: A prospective study was undertaken to assess the feasibility and long term results of sphincter-preserving rectal excision after preoperative radiation (35 Gy). PATIENTS AND METHODS: From 1986 to 1990, 42 patients were included in the study. Thirty four (81%) could be managed by rectal excision and stapled coloanal anastomosis. They had an adenocarcinoma located at a mean distance of 55 +/- 13 mm (range: 20-80) from the anal verge. RESULTS: Eight specimens were free of tumor. The 26 others were tabulated as follows according to the Astler-Coller staging: A = 2, B1 = 15, B2 = 5, C1 = 1, C2 = 3. The mean distal free margin was 16 +/- 11 mm (range: 1-40). The follow-up period ranged from 5 to 9 years. Six patients (18%) experienced postoperative complications including minor anastomotic leakage (n = 3), bowel obstruction (n = 2), major diarrhea requiring fecal diversion (n = 1). The functional result was good in all but 3 patients (9%) who experienced a supra anastomotic stenosis and underwent a permanent colostomy. A pelvic recurrence was observed in 5 patients (15%) after a postoperative delay ranging from 11 to 50 months. At 5 years, 17 patients (50%) were alive free of cancer, 14 (41%) of them having a good functional result without colostomy. CONCLUSION: This work demonstrates that in most cases low rectal carcinoma can be safely managed by sphincter-preserving rectal excision after preoperative radiation. It strongly suggests that the long-term pelvic recurrence rate is similar to the one observed after abdomino-perineal excision. However both procedures and patients selection must be carefully performed.

Adenocarcinoma↗
PubMedDate not supplied

[The parathyroid risk in thyroid surgery (author's transl)].

A parathyroid insufficiency, defined like a functional deficit sufficient to pull down calcemia underneath 75 mg/l and/or give clinical obvious disturbances of neuromuscular hyperexcitability, have been observed on 57 patients (2,7%). The risk as interested bilateral gestures (5,5%) with a maximum for total thyroïdectomies (17,7%), surgery for carcinoma (8,5%) and Basedow's illness (8,3%). Less than half the patients can stop their vitaminocalcical treatment, and before the sixth month. First prevention is respect of the frail glandules and their vascularisation, obliging a particular, precise and bloodness surgery. Finally the autotransplantation of parathyroid gland accidentally pulled off or deteriored seems to constitute an interesting contribution.

Adolescent↗
PubMedDate not supplied

Results of the Warren operation for portal hypertension.

The results are reported of 40 distal spleno-renal shunts as described by Warren, carried out from 1975 to 1980. Angiographically, the shunt appeared functional in 37 cases and thrombosed in 3; flow towards the liver was preserved in 28 of the operated patients, but in 12 cases there was portal thrombosis, partial (10 cases) or total (2 cases). Five of the operated cases (12.5%) died soon afterwards, 3 of these from recurrent haemorrhage associated twice with thrombosis of the shunt and once with a massive portal thrombosis. Two patients died subsequently at 4 months ans 3 1/2 years from liver failure. The 33 other patients, at a follow-up of 1 to 6 years, are leading a normal life without encephalopathy or recurrent haemorrhage.

Celiac Artery↗
PubMedDate not supplied

Surgical management of pelvic recurrence from resected rectal cancer: technical aspects.

Management of local-regional recurrences of primary rectal cancer (LRR) by a multi-disciplinary surgical team (GI, urological and plastic surgeons) is presented. Aggressive treatment involving surgical debulking and intra operative radiation can result in local control and long term survival in 10 to 20% of the patients with a low mortality and morbidity. Sequelae caused by the extended surgical resection are limited thanks to the fast healing following omentoplasty associated with musculo cutaneous flaps and to the fashioning of a continent stoma.

Combined Modality Therapy↗