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Biomedical subjects

D Gallot

Publications and source records attributed to D Gallot.

At least 73 records · Page 4Linked to original sources
PubMed1989

[Treatment of acute obstruction due to left colonic cancer].

Retrospective study on 47 patients (23 men, 24 women); mean age was 70.2 years. The mean delay of complete obstruction was 6.95 days. There were associated pathology and clinical factors of gravity in 53.2%, and local factors of gravity in 43.9% of all cases. Three steps surgery in 22 cases (46.8%), two steps in 14 cases (29.7%): 6 "ideal" colectomies (12.7%), 5 colostomies alone (10.6%). Mortality: 3 patients died (6.8%), post operative complications occurred in 22 patients (46.8%); morbidity due to colostomies itself was 37.4%. All first step-colostomies, except one, has been closed after colectomy. The mean duration of total stays in hospital was 31.5 days, according with the surgical procedure in one (14.3 days), two (37.9 days) or three (43.2 days) steps. Duration of complete obstruction, bioclinical status of patients, staging and complications of the cancer and surgeon's experience are determining therapeutic choices. The choice for colostomy as first step is the best policy. In this series the mortality of the colostomy as first step was none. It must be performed with elective incision, on free colic segment (transverse or sigmoid), with the simplest technical procedure (loop colostomy). Others surgical procedures have only peculiar indications.

Acute Disease↗
PubMed1989

[Prognosis in ovarian cancer as a function of the results of the second-look laparatomy].

Second-look laparotomy (SLL) was performed after chemotherapy in 106 patients with epithelial ovarian cancer. Thirteen were stage I and II and 93 stage III and IV. Seventy-eight patients received cisplatin-based regimens. Median follow-up was 60 months. Negative SLL was found in 32 patients who had a 5-year survival rate of 43.4% after SLO. Microscopy residual disease was present in 9 patients whose 5-year survival rate was 25%. Maximum residual tumor of 2 cm or less was found in 13 patients with 5-year survival rate of 30%. Residual tumor larger than 2 cm after secondary cytoreduction was present in 21 patients, their 3-year survival rate was 18.3%. Eighteen patients with bulky residual disease who did not have cytoreduction were all dead within 17 months. Patients with initial residual tumor at first laparotomy less than 2 cm had a near significant advantage in survival rate over patients with residual disease greater than 2 cm and stage IV (p = 0.07). Non-responders to initial chemotherapy had a survival rate similar to that of partial-responders. These findings justify discontinuation of conventional systemic chemotherapy for patients showing residual disease after SLL and secondary tumor removal in case of residual tumor at SLL. Therapeutic trials are needed in advanced ovarian cancer testing initial aggressive surgery or early debulking to avoid bulky residual disease and consolidation therapy in patients who achieved complete pathological response or minimal residual intraperitoneal disease.

Adult↗
PubMed1978

Hemodynamic monitoring during complete vascular exclusion for extensive hepatectomy.

Hemodynamic monitoring during normothermic vascular exclusion of the liver, with or without clamping of the upper part of the abdominal aorta appears mandatory, based upon an experience with ten patients. Nine patients underwent extensive liver resection for major tumors unsuitable for conventional surgical procedures. No operative accidents were observed. Permanent monitoring during the procedure included pulmonary artery pressures, radial artery pressures, heart rate and cardiac output, measured by the thermodilution method. Hemodynamic changes after short isolated venous or aortic and combined clampings were also studied. With this procedure, the most critical period occurred immediately after the release of the clamps, with a major rise in the pulmonary artery pressures, which led to hemodynamic pulmonary edema level. The acute modifications of circulating blood volume actually carried a high risk of vascular overloading, and the most reliable method to avoid this was the permanent control of the pulmonary artery pressures. Blood volume replacement was, at its best, adjusted with the use of such a parameter, especially when hemorrhage was important. Combined aortic clamping reduced blood losses and minimized pooling in the splanchnic area and the lower extremities.

Adult↗
PubMed1978

Normothermic hepatic vascular exclusion for extensive hepatectomy.

In humans, there is still considerable controversy concerning the tolerance of the liver to warm ischemia. To avoid anoxic hepatocellular damage, chilled intraportal and intra-arterial infusion has been advised as an adjunct to hepatic vascular isolation. Fourteen patients with hepatic tumors underwent extensive hepatic resection, complete hepatic vascular exclusion being used but without the use of refrigeration. This procedure may considerably reduce blood loss during resection of large and hypervascular hepatic tumors and increase the safety of hazardous lobectomies. Careful hemodynamic monitoring including pulmonary artery pressure is necessary. Hepatic tolerance to prolonged warm ischemia up to 65 minutes is surprisingly good, in the absence of preoperative, extensive hepatic dysfunction. The use of this procedure is advised for resection of large hepatic tumors when the technical risks appear to be high. It is suggested that the classical delay of 15 to 20 minutes of normothermic hepatic ischemia may be safely extended to about one hour when necessary.

Adult↗
PubMed1977

[Peri-ano-rectal cysts and tumours of vestigial origin in the adult (author's transl)].

Four cases of cysts or tumours developing from embryological remnants in the peri-ano-rectal space are reported. The authors propose for these rare lesions a coherent and simplified classification in two main groups: teratomas on the one hand, developmental cysts on the other hand. The various methods of diagnosis are studied. The precise diagnosis of a congenital cyst can only be made by pathological examination of the specimen after surgical removable. Any rapid local change implied malignant degeneration. Such a risk suggests immediate removal of any known ano-rectal cyst or tumour. The route of approach is usually perineal. Kraske's position gives good access to the retro-ano-rectal space. Possible pelvic spread of these lesions sometimes requires the use of the abdominal approach, either straight away or secondarily when total removal is impossible by the perineal route alone.

Adenocarcinoma↗
PubMed1976

[Total vascular exclusion of the liver in extensive hepatic exeresis. Value and limits].

Three cases of right hepatic lobectomy performed under complete hepatic vascular exclusion with aortic clamping in normothermia are reported. Hemostasis of the row surface of the liver is obtained with application of a biological glue. Hepatic vascular exclusion (from 24 to 30mn) was harmless to the remnant liver and the kidneys. Blood loss was minimal. The hemodynamic tolerance was good all along the procedure, but there is a high risk of overloading and acute congestive heart failure immediately after removal of the clamps. The continuous monitoring of pulmonary artery pressures must be emphasized. This procedure may be advised for massive and hypervascular tumors of the right lobe of the liver.

Adolescent↗
PubMed1976

A simplified bloodless procedure for extensive hepatectomy. Experimental study in the pig.

An original procedure of extensive bloodless hepatectomy is described in the pig. Complete vascular liver isolation with aorta clamping up to 25 min allows 60-75% bloodless hepatectomy without any portal triad dissection. Perfect hemostasis and shortening of liver ischemia is obtained with the use of a gelatin-resorcin-formaldehyde adhesive. Hemodynamic tolerance is good, and liver regeneration appears to be as fast as in minor species.

Alanine Transaminase↗
PubMed1976

Hemodialysis versus cross hemodialysis in experimental hepatic coma.

In this study, the effects of conventional hemodialysis on experimental hepatic coma have been compared with those of hemodialysis against blood from a normal donor which allows exchanges without mixing of blood. cuprophan and polyacrylonitrile membranes were compared. Cross hemodialysis with a donor resulted in rpompt but transient recovery of consciousness, whichever membrane was used. Cuprophan hemodialysis without donor had no effect. Polacrylonitrile hemodialysis without donor allowed progressive and prolonged improvement in the consciusness level and the electroencephalograms. Therefore, clearance of middle molecular weight substances was more effective than exchange with a donor. Preliminary results in man showed total recovery of consciousness in six of ten patients with acute liver failure and coma and partial recovery from complete grade IV coma to grade II encephalopathy in two patients. These two patients reacted when called by their name by opening their eyes and obeying simple orders.

Acrylic Resins↗
PubMed1975

[Pulmonary embolism, an unrecognized risk of post-traumatic arterio-venous fistulae of the hepatic veins (1 case)].

A stab wound of the right lobe of the liver, initially treated by suture, led to the development of a large arterio-venous fistula with hemobilia. Re-operation on the 23rd day in order to carry out right hepatectomy, was rapidly followed by a massive and recurrent pulmonary embolism. A Trendelenburg operation associated with right hepatectomy did not prevent the patient's death. This risk of pulmonary embolism during post-traumatic hematoma of the liver is not fully recognised and the authors suggest, in cases of arterio-venous fistula of the hepatic veins, primary vascular exclusion of the supra-hepatic vena cava.

Adult↗