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Biomedical subjects

D Gossot

Publications and source records attributed to D Gossot.

At least 73 records · Page 4Linked to original sources
PubMed1994

Decreased mesenteric blood flow supplying retrosternal esophageal ileocoloplastic grafts during positive-pressure breathing.

Esophageal replacement after esophagogastric injury caused by ingestion of lye may require the interposition of a retrosternal ileocolic graft. In this new anatomic situation, the mesenteric circulation supplying the graft is subjected to the intrathoracic pressure surrounding the graft. Thus, mesenteric blood flow supplying the graft may be impaired when intrathoracic pressure is increased during mechanical ventilation. This study was designed to evaluate the effect of increasing intrathoracic pressure by application of a positive end-expiratory pressure on mesenteric blood flow supplying esophageal ileocolic grafts. Eight cases were studied in the immediate postoperative period. Miniaturized implantable Doppler microprobes were sutured to the single artery supplying the graft and connected to an 8 MHz pulsed Doppler flowmeter. Two sets of measurements were successively performed with zero end-expiratory pressure ventilation and after application of a 15 cm water positive end-expiratory pressure. Positive end-expiratory pressure induces mean arterial pressure (-12%); p < 0.05) and cardiac output (-17%; p < 0.05) decrease. Mesenteric blood flow also decreases (-38%; p < 0.05) as did the mesenteric blood flow/cardiac output ratio, suggesting a potential mesenteric vasoconstriction assessed by mesenteric vascular resistance increase and mesenteric diastolic blood flow velocity decrease. These results suggest that, in the particular anatomic situation of the graft, increased intrathoracic pressure induces mesenteric blood flow decrease in relation to systemic hemodynamic alterations associated with perivisceral pressure increase. This change may be deleterious to graft perfusion.

Adult↗
PubMed1993

Splenectomy in human immunodeficiency virus-related thrombocytopenia.

To evaluate the efficacy and safety of splenectomy in patients with human immunodeficiency virus (HIV)-related thrombocytopenia, 30 HIV-infected patients with thrombocytopenia (platelet count < 50 x 10(9)/l) who underwent splenectomy were followed prospectively for a mean period of 42 months. There were no perioperative deaths and morbidity was minimal. Twenty-one patients had a persistent complete response, six had a partial response and were asymptomatic after splenectomy, and only three showed no response. Three patients developed acquired immune deficiency syndrome during follow-up, an incidence that was no different from that expected. Splenectomy is a safe and effective treatment in HIV-infected patients with severe symptomatic thrombocytopenic purpura resistant to medical therapy.

Adolescent↗
PubMed1993

Thoracoscopic esophagectomy: technique and initial results.

To reduce the high morbidity rate associated with esophageal surgery, we have developed a technique of thoracoscopic esophagectomy. A feasibility study was first carried out in an animal model and a specific instrument was developed for this purpose. Esophagectomy using a right thoracoscopic approach was attempted in 15 patients, 13 males and 2 females whose average age was 48 years. Indications consisted of squamous cell carcinoma in 10 patients, adenocarcinoma in 1, and caustic stenosis in 4. We used a technique that consisted of double-lumen tracheal intubation and the creation of five ports. The whole esophagus was mobilized thoracoscopically and the esophagectomy was completed through the abdomen. The reconstruction was achieved using a gastric pull-through, and the anastomosis was made in the neck. There were three failures: in 1 patient there was a large tumor, making the exposure unsafe, and, in 2 patients, incomplete lung collapse made exposure of the posterior mediastinum difficult. These 3 cases were converted into a thoracotomy. The thoracoscopic dissection was successful in the remaining 12 patients. The average time of the thoracoscopic stage was 125 minutes. The postoperative course was uneventful in 10 patients. Two patients had a left atelectasis. Although our series is limited, these initial results indicate that thoracoscopic esophagectomy is feasible. However, further evaluation of the technique is needed to assess its benefit in terms of respiratory morbidity.

Burns, Chemical↗
PubMed1993

Laparoscopic splenectomy: initial laboratory experience.

An experimental study was conducted in an animal model to test the feasibility of laparoscopic splenectomy. Twelve pigs were operated on. The splenectomy was feasible in 10 cases. However, a splenic injury occurred in five cases and the average blood loss was 80 ccm. We concluded that laparoscopy is feasible in an experimental model but is not a safe and easy procedure. Clinical applications should probably be limited to selected cases.

Animals↗
PubMed1993

[Problems related to thoracoscopic resection of pulmonary nodules].

We present the initial results fo thoracoscopic resection of pulmonary nodules, based on a report of 23 patients. The resection was performed through a sole thoracoscopy in 12 cases, but was associated with a mini-incision in 11 cases. In 4 cases, the procedure had to be converted to thoractomy. We discuss the problems encountered and the indications of the technique.

Adult↗
PubMed1992

[Surgery of the esophagus under thoracoscopy. Study of feasibility].

An experimental study of thoracoscopic surgery on the esophagus was conducted in 11 animals. Complete dissection of the esophagus was carried out in the ten last cases. Other procedures performed included mode picking, truncal vagotomies, and myotomies. The thoracoscopic esophageal surgery might allow to decrease the morbidity of thoracotomy. Its interest, compared with other methods of dissection without thoracotomy, has to be evaluated.

Animals↗
PubMed1992

Usefulness of perioperative pulsed Doppler flowmetry in predicting postoperative local ischemic complications after ileocolic esophagoplasty.

Regional ischemia may induce cervical anastomosis leakage or stenosis or graft necrosis after esophageal reconstruction by retrosternal interposition of an ileocolic graft. These complications may be related to systemic or local hemodynamic alterations. This study was designed to evaluate the relationship between immediate postoperative arterial blood supply to the graft, arterial patency monitored by angiography, and clinical outcome. Eight patients (mean age 30 +/- 4 years; standard deviation) were studied. Miniaturized Doppler implantable microprobes were sutured to the single artery supplying the graft and connected to an 8 MHz pulsed Doppler flowmeter. Systemic hemodynamic parameters and mesenteric hemodynamic data were collected 3 hours after the end of the surgical procedure. These data were compared with the angiogram of the right superior colic artery supplying the graft, systematically performed on the fifteenth postoperative day, and with the clinical course of follow-up for 3 months. Five patients (group 1) had excellent clinical and angiographic results. Mean mesenteric blood flow in these patients was 51 +/- 49 ml.min-1 (+/- standard deviation, ranging from 9 to 122). Three patients (group 2) had a poor clinical outcome. One had early complete graft necrosis and the two others had leakage of the cervical anastomosis with poor distal arterial vascularization of the graft on the angiogram. Mean mesenteric blood flow was nul in the first patient and, respectively, 24 and 28 ml.min-1 in the two others. Cardiac output and mean arterial pressure were in the same range for all patients. Phasic velocity shape analysis revealed that the three group 2 patients had an end-systolic or end-diastolic reverse flow pattern that was not observed in the five group 1 patients, which suggested a submaximal increase in downstream vascular resistance. This reverse flow pattern seems to be a good predictor of ischemia-related complications. We conclude that perioperative pulsed Doppler blood flow monitoring in an ileocolic graft may be useful for the diagnosis and prevention of ischemic complications.

Adult↗
PubMed1991

Isoflurane, and not halothane, increases mesenteric blood flow supplying esophageal ileocoloplasty.

Regional ischemia may induce anastomotic leakage or stenosis after esophageal reconstruction using retrosternal interposition of an ileocolic graft. These complications may be related to systemic or local hemodynamic alterations. This study was designed to evaluate the influence of inhalational anesthetic agents on the intestinal circulation supplying these ileocolic grafts. Seven patients (age 30 +/- 5 yr, mean +/- standard deviation [SD]) were studied in the immediate postlaparotomy period. Miniaturized Doppler implantable microprobes were sutured to the single artery supplying the graft and connected to an 8-MHz pulsed Doppler flowmeter. Continuous fentanyl infusion (300 micrograms.h-1) was maintained throughout the study. Measurements were performed at the end of four 30-min periods, which were, successively: first control; isoflurane or halothane anesthesia; second control; and isoflurane or halothane anesthesia. Isoflurane and halothane were administered in cross sequence with end-tidal concentration of 0.8% and 0.5%, respectively, to induce equipotent anesthesia. Both anesthetics induced similar decreases in mean systemic arterial pressure (MAP), cardiac output (CO), and systemic vascular resistance. During isoflurane, mean mesenteric blood flow (MBFm) supplying the graft was increased (+38%; P less than 0.05), and the mesenteric vascular resistance index (MVRI; -44%; P less than 0.05) was decreased, leading to an increase in the MBFm/CO ratio (P less than 0.05). Halothane changed neither the MBFm nor the MBFm/CO ratio, despite a mild decrease in MVRI (-14%; P less than 0.05). Diastolic blood flow velocity increased significantly (2.3 +/- 0.9 vs. 0.8 +/- 0.3 cm.s-1, P less than 0.05) only with isoflurane, suggesting a local vasodilation not observed with halothane.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

[Use of the colon for esophageal substitution. Mortality and morbidity. Report of 105 cases].

One hundred and five colonic interpositions were performed in 102 patients. The indications for operation were caustic stenosis in 57 cases (Group A) and esophageal cancer in 45 patients (Group B). The right colon was used in 97 cases and isoperistaltic transverse colon in 8 cases. Eighty-nine transplants were anastomosed to the cervical esophagus and 16 to the pharynx. The distal anastomosis was to the antrum in 67 cases, to the second duodenum in 37 cases, and to the jejunum in 1 case. The overall mortality rate was 8.6 percent (9 cases), 5.3 percent (3 cases) in group A and 13.6 percent (6 cases) in group B (p less than 0.05). The morbidity rate was significantly higher in group B than in group A (77.3 percent vs 53.7 percent, p less than 0.05). Ischemic necrosis (3 cases) and chronic ischemia of the transplant (7 cases) were the major complications. Strictures occurred at the proximal anastomosis significantly more often in group B (63 percent) than in group A (40 percent) (p less than 0.05). Seven failures occurred in 93 survivors, i.e. oral feeding was impossible. In conclusion, mortality and morbidity rates of coloplasty are high. The use of colon as an esophageal substitute is justified only in case of caustic stenosis with unavailable stomach.

Adolescent↗
PubMed1989

Acute primary hyperparathyroidism: experience of 59 cases.

Acute primary hyperparathyroidism is a rare disease with a high mortality rate in some series. Between 1960 and 1986, 1000 patients were treated for primary hyperparathyroidism, among them 59 patients with acute hyperparathyroidism. All these patients were successfully operated on; none of them died before surgery. This study reveals the importance of resuscitation and urgent surgery. It is necessary to rehydrate, to correct electrolyte disorders and to lower serum calcium levels, but it is not necessary to obtain normal serum calcium levels before surgery.

Acute Disease↗
PubMed1989

[Clear cell carcinoma of the thyroid; diagnostic difficulties].

Thyroid carcinomas with clear cell change are rare neoplasms, and always bring up the possibility of a metastasis from another primary clear cell carcinoma. We report the case of a 33-year-old woman operated on for a solitary cold thyroid nodule. Histologic and ultrastructural studies showed a clear cell carcinoma with a trabecular and follicular pattern. Neoplastic cells included lipid droplets, glycogen granules and intranuclear cytoplasmic inclusions, and were stained with one of the two antithyroglobulin polyclonal antibodies used. Radiologic investigations then showed a tumor mass of the right kidney. Surgical management proved it to be a benign cyst, and assessed the absence of kidney neoplasm. Thus, this case exemplifies the pitfalls in the diagnosis of clear cell thyroid neoplasms, and points out the fact that immunohistochemical staining for thyroglobulin should be systematically performed.

Adenocarcinoma↗