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D Melliere

Publications and source records attributed to D Melliere.

At least 19 recordsLinked to original sources
PubMed1991

Thoracic outlet syndrome caused by tumor of the first rib.

We report a new case of thoracic outlet syndrome caused by a tumor of the first rib and review 11 other reports found in the literature. A 25-year-old man was admitted with thoracic outlet syndrome in the C8-T1 nerve roots. The first rib was removed through a supraclavicular approach with excision of the medial clavicle. All symptoms disappeared. On histologic examination fibrous dysplasia was found in the rib. Tumors of the first rib are uncommon and are rarely responsible for thoracic outlet syndrome. When the tumor is very large, as in our case, we recommend a supraclavicular approach associated with excision of the medial clavicle. During the liberation of the brachial plexus, great care should be exercised to avoid nerve injuries. Because malignancy of the tumor cannot be eliminated with certainty before or during the operation, wide excision of the entire rib is recommended.

Adult↗
PubMed1991

[Sub-crural bypasses via saphenous vein in situ. Predictive factors of early occlusion].

Twenty-six early occlusions were encountered in a series of 155 infrainguinal saphenous vein bypasses for arterial disease. By univariate and logistic regression analysis, two predictive factors were found to be strongly associated with early occlusion: vein fibrosis (F) and uncorrected intraoperative arteriographic anomaly (A). Regression coefficients were 0.775 +/- 0.343 for F and 1.125 +/- 0.352 for A. The probability (p) of early occlusion of bypass is: [formula; see text] (Exp = Exponent) The vein diameter, the quality of run-off, the site of anastomosis and the length of the bypass were not predictive of early occlusion. We conclude that 1) the presence of fibrous ipsilateral saphenous vein should prompt using the contralateral vein, and 2) routine intraoperative arteriograms of the entire length of the bypass should be obtained: any anomaly visible on the intraoperative films should be corrected immediately, even if it seems minute or if bypass flow seems otherwise adequate.

Adult↗
PubMed1990

Arterial occlusive disease after radiotherapy: a report of fourteen cases.

Fourteen cases of arterial occlusion or severe narrowing following radiotherapy are studied in order to assess the possible etiological role of such therapy in arterial lesion. Surgical results are also discussed in terms of long-term efficacy. The average time of occurrence after radiotherapy was 8 years post-radiotherapy. This series includes 7 supra-aortic trunk stenoses and 7 abdominal aorta trunk stenoses. The doses received in the volumes irradiated ranged from 47 to 70 Gy with standard fractionation. Association of atherosclerotic risk factors (smoking, hyperlipidemia, diabetes, high blood pressure) was present in 12 patients, but stenoses were usually confined to irradiated areas, and at times occurred in uncommon sites. Surgical management included 11 by-passes, 2 endarterectomies and one percutaneous transluminal angioplasty. All patients experienced immediate and satisfactory functional improvements. Three patients were re-operated on because of the re-occlusion of the by-pass (2 cases) and graft infection (1 case). On the whole, stenoses in previously irradiated areas showed no particular difficulties for surgical treatment. It was concluded that radiotherapy seems to be a definite risk factor for arterial occlusion or narrowing, especially in association with atherosclerotic risk factors.

Adult↗
PubMed1990

[Postoperative vascular infections. A pathognomonic x-ray computed tomographic sign].

The potential gravity of post-operative vascular infection makes early diagnosis essential. We report a case where this diagnosis was made on CT findings alone, in the absence of any other signs of infection. Rapid intervention led to complete cure. Beyond the immediate post-operative period, the presence of gas on the CT scan is rare but pathognomonic in the absence of a cutaneous fistula. The presence of this sign is therefore sufficient to indicate that reintervention is mandatory.

Aged↗
PubMed1990

Acute and chronic dissections of the abdominal aorta: clinical features and treatment.

We report seven cases of dissection of the abdominal aorta. Three patients had acute back pain, whereas four patients had more chronic courses. In six cases, as a result of the palpation of a pulsatile abdominal mass, clinical diagnosis was an atheromatous aneurysm. Angiography and CT scanning demonstrated a dissected abdominal aorta and a normal thoracic aorta. Six patients with an infrarenal dissection were treated by replacement of the aorta with a Dacron prothesis, and one patient with an suprarenal dissection was treated conservatively. With a mean follow-up of 3 years, all patients were alive and free of symptoms. These results favor graft replacement in case of infrarenal aortic dissection and more selective surgical indications in suprarenal aortic dissection.

Aortic Dissection↗
PubMed1989

Training of vascular surgeons in France: ten years of the French College of Vascular Surgery.

The French College of Vascular Surgeons serves several functions including the organization of vascular surgery training nationwide, overseeing the practical aspects of institutional training, providing motivation for trainees by creating final exams, and bringing surgeons together to update their knowledge. This article details the results of their programs, the demographic changes in vascular surgical practice over the last ten years, and the problems to be solved in the near future. These challenges include: maintenance of autonomy in the surgical world, enlargement of the fields of action, clarification of indications for vascular procedures, demographic control, and recognition of training programs on the wider, European level.

Certification↗
PubMed1988

Operation for hyperthyroidism. Methods and rationale.

Five hundred patients with hyperthyroidism underwent operation between 1970 and 1984. Sixty-nine percent had Graves' disease, 19 percent had toxic thyroid adenoma, and 12 percent had multinodular toxic goiter. Good results were achieved in the 275 patients most recently treated. These results may be attributed to the following: good personal contact between the surgeon and the patient at the first meeting, 1 month of preoperative management with carbimazole and propranolol without interruption of work, operation adapted to the type of goiter, and treatment of postoperative tachycardia by propranolol. The mean duration of hospital stay was 5 days. Sequelae were rare. In the patients with Graves' disease, results at 2 years were as follows: 74 percent of operated patients were euthyroid, 23 percent required substitutive treatment, and surgical treatment failed or early relapse occurred in 3 percent. There were no recurrences after operation in patients with solitary or multinodular toxic goiter, but 30 percent of the former and 98 percent of the latter had to be treated with L-thyroxine. Seventy-two percent of the patients who presented with atrial fibrillation had return of normal cardiac rhythm after operation.

Adenoma↗
PubMed1986

[Which antibiotics should one choose for prophylaxis in vascular surgery?].

Although the principle and duration of prophylactic antibiotic therapy in prosthetic vascular surgery are fairly widely accepted, the choice of antibiotic is still open to discussion. During two successive periods, identical groups of patients received peri-operative prophylaxis with, during period I (455 cases) oxacillin alone and during period II (537 cases) combined treatment with oxacillin and amikacin. The aim of the study was to evaluate efficacy of the association and to draw general conclusions on choice of antibiotic. The addition of amikacin reduced frequency of infection in elective operations, particularly aorto-ilio-femoral prostheses (0.5% as against 1.24%), but not in operations conducted as emergencies. In addition, frequency of infection due to BGN fell only slightly. Finally, combined therapy with oxacillin-amikacin had 2 disadvantages: impossibility of using these antibiotics for prophylaxis alone as provided for in the protocol, and its high cost. Factors of choice of antibiotic should be: efficacy against germs encountered, which can vary from year to year, rarity of toxic or side effects, good tissue diffusion, the rare need for therapeutic use and a low cost.

Amikacin↗
PubMed1985

[Endocrine pancreatic tumor secreting somatostatin and somatocrinin].

A case of endocrine pancreatic tumour secreting the 2 antagonistic peptides that regulate growth hormone, somatostatin and somatocrinin, is reported. Such tumours are extremely rare and only one other case has been published so far, although pancreatic malignant tumours frequently secrete several hormones. In our patient, the association of diabetes with steatorrhoea, hypochlorhydria, anaemia and biliary lithiasis suggested hypersecretion of somatostatin. Acromegaly, suggested by clinical signs, was confirmed by an excess of growth hormone and somatomedin, and pre-operative somatrocrinin assay confirmed its extra-pituitary origin. Finally, the presence of hyperparathyroidism due to parathyroid gland hyperplasia and of a Recklinghausen disease constituted a multiple endocrine neoplasia syndrome. The significance and implications of this double secretion in vivo are discussed.

Adenoma, Islet Cell↗
PubMed1985

Pulmonary function after transverse or midline incision in patients with obstructive pulmonary disease.

Atelectasis and bronchopneumonia occur frequently in patients undergoing aorto-iliac reconstructive surgery. Transverse (T) incisions in upper abdominal surgery are thought to be followed by fewer pulmonary complications than midline incisions (M) but reports remain controversial. We studied the incidence of postoperative pulmonary complications and lung dysfunction after T and M incisions for aorto-iliac surgery in 13 patients with chronic obstructive pulmonary disease (COPD) and 13 control patients with normal lungs (C). For all subjects, we evaluated (1) postoperative clinical or radiological pulmonary events; (2) preoperatively and on postoperative days 2 (D2), 5 (D5), 9 (D9) and 12 (D12) - the forced expiratory volume in 1 s (FEV1), vital capacity (VC), alveolar-arterial oxygen difference (AaPO2), and (3) convenience for the surgeon. Operatively, aortic exposure was excellent with both incisions. Bronchopneumonia occurred only after M in five patients (1 C, 4 COPD). In contrast with the control patients in whom no difference was found between T and M incisions, the FEV1 of COPD patients was significantly less impaired with T than with M incisions (p less than 0.005 on D2 and p less than 0.05 on D5). VC decreased similarly with both incisions on D2 but on D5 the improvement was less with M (p less than 0.005). Changes in AaPO2 were more marked on D2 and D5 for the COPD patients with M incisions. We conclude that (1) in patients with chronic obstructive pulmonary disease, laparotomy with a transverse incision was associated with better postoperative lung function and fewer pulmonary complications; (2) in patients without pulmonary disease, midline and transverse incisions were equivalent.

Abdominal Muscles↗
PubMed1979

[Cold nodules of the thyroid. Reevaluation of surgical excision on the basis of a new group of 607 patients(author's transl)].

In a serie of 607 cold nodules developing in normal or apparently normal (on preoperative clinical examination) thyroids, the results of histopathological examination were compared with those in an identical series studied 10 years before. Carcinoma was frequent: 9.7% in the current series and 19% in the first series. Insofar as neither clinical examination nor special investigations at the present time make it possible to affirm that a cold nodule is not malignant, surgical complete lobectomy with frozen section examination remains the required procedure in view of its harmless nature and the good prognosis in differentiated tumours operated upon before any visceral extension has taken place, contrasting with the poor prognosis of others. Recurrences may be prevented by special operative techniques (routine excision of Lalouette's pyramid, division of the contralateral ligament of Grubert) and routine postoperative thyroid extracts in patients with a morphological, familial or biological risk of recurrence.

Adenoma↗