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E Pélissier

Publications and source records attributed to E Pélissier.

At least 19 recordsLinked to original sources
PubMed2005

[Pre-peritoneal continuous infusion of local anesthetics for pain relief after laparotomy. A preliminary report].

INTRODUCTION: Continuous administration of local anesthetic through a catheter placed in the scar of a laparotomy is a postoperative analgesic technique, which seems effective but remains little developed and poorly codified. METHODS: In this prospective evaluation, we present a series of 25 observations of adult patients scheduled for abdominal laparotomy, to which a multiperforate catheter was placed at the end of the intervention by the surgeon in pre-peritoneal position, allowing the continuous perfusion of ropivacaïne over the first 48 postoperative hours. Patients received intravenous paracetamol associated with ketoprophene or nefopam. Opiates were given as rescue analgesics, in case of failure in pain relief, defined on objective criteria measured on visual analogic scale (VAS). RESULTS: The feasibility of the technique was excellent, except in one case of catheter obstruction. Pain was adequately relieved, with a majority of patients having VAS scores lower than 3/10 cm with the VAS, as well as rest as during mobilization. Only 9 patients needed morphine rescue analgesics. There was no sign of clinical overdose nor parietal complication related to the technique. Blood dosages of ropivacaine, carried out among 5 patients having received 600 mg daily, showed serum concentrations below the thresholds of toxicity. CONCLUSIONS: These results reveal a good effectiveness of the method, with moderate pain intensity and a low analgesic consumption. The local and general tolerance was excellent.

Adult↗
PubMed2005

[Reducing the hospital stay after colorectal resection].

INTRODUCTION: The postoperative hospital stay after colorectal resection is about 15 days in France, when some authors have published a postoperative stay of 2 to 5 days. The aim of this work was to obtain a postoperative hospital stay less than 7 days. PATIENTS AND METHODS: Sixty-one patients who underwent a colorectal resection performed by laparotomy were included in the study: 16 right hemicolectomies, 9 left hemicolectomies, 15 sigmoidectomies and 21 anterior resections were performed. The operation was performed through a midline incision extended over the umbilicus in 13 cases, limited below the umbilicus in 22 cases and elective in 26 cases (right transverse in 16 and left iliac fossa in 10 cases). The protocol comprised epidural analgesia or wound infusion with ropivacaine, restricted intravenous fluids, early oral feeding and active mobilisation. RESULTS: The median and mean times of discharge were 6 and 7.3 days respectively; 36 patients (59%) were discharged on postoperative days 3 to 6, 8 patients (13%) on days 7 and 17 (28%) after day 7. A nasogastric tube was necessary in 2 cases (3.3%). Ten (16%) postoperative complications and 3 (5%) readmissions occurred. There were no deaths. CONCLUSION: Although the postoperative stay cannot be reduced in all the cases, a median hospital stay inferior to which is currently observed can easily be obtained by applying some simple and inexpensive means. This is advantageous for the patient, whose recovery is faster, and contributes to reduce the cost, which is of crucial importance today.

Adult↗
PubMed2000

[Labile blood product traceability: definition, regulation, evaluation, and perspectives].

The traceability of blood products is an essential part of hemovigilance and transfusion safety. Law no 94-68 of 24 January 1994 is the legal foundation of the system of traceability. In this article, the structures of the system and the main actors are discussed. An evaluation of the system of traceability showed that it is both feasible and adaptable. An evaluation process is needed to assess the proper functioning of the system and to detect and prevent possible deficiencies.

Antibodies↗
PubMed1999

Is prophylactic pelvic drainage useful after elective rectal or anal anastomosis? A multicenter controlled randomized trial. French Association for Surgical Research.

OBJECTIVE: We investigated the role of drainage in the prevention of complications after elective rectal or anal anastomosis in the pelvis. Anastomotic leakage after colorectal resection is more prevalent when the anastomosis is in the distal or infraperitoneal pelvis than in the abdomen. The benefit of pelvic drains versus their potential harm has been questioned. Drain-related complications include (1) those possibly benefiting from drainage (leakage, intra-abdominal infection, bleeding) and (2) those possibly caused by drainage (wound infection or hernia, intestinal obstruction, fistula). METHODS: Between September 1990 and June 1995, 494 patients (249 men and 245 women), mean age 66 +/- 15 (range 15 to 101) years, with either carcinoma, benign tumor, colonic Crohn's disease, diverticular disease of the sigmoid colon, or another disorder located anywhere from the right colon to the midrectum undergoing resection followed by rectal or anal anastomosis were randomized to undergo either drainage (n = 248) with 2 multiperforated 14F suction drains or no drainage (n = 246). The primary end point was the number of patients with one or more postoperative drain-related complications. Secondary end points included severity of these complications as assessed by the rate of related repeat operations and associated deaths as well as extra-abdominally related morbidity and mortality. RESULTS: After withdrawal of 2 patients (1 in each group) both groups were comparable with regard to preoperative characteristics and intraoperative findings. The overall leakage rate was 6.3% with no significant difference between those with or without drainage. There were 18 deaths (3.6%), 8 (3.2%) in those with drainage and 10 (4%) in those without drainage. Five patients with anastomotic leakage died (1%), 3 of whom had drainage. There were 32 repeat operations (6.5%) for anastomotic leakage 11 in the group with drainage and 4 in the group with no drainage. The rate of these and the other intra-abdominal and extra-abdominal complications did not differ significantly between the 2 groups. CONCLUSION: Prophylactic drainage of the pelvic space does not improve outcome or influence the severity of complications.

Adult↗
PubMed1994

[Value of blood assay of tumor markers for detecting recurrence of colorectal cancer].

Clinicians have at least 12 serial tumoral markers for the follow-up of colorectal cancer patients. The literature analysis indicates that serial carcinoembryonic antigen determination (CEA), is the most effective. The determination of other markers together with CEA does not add any benefit. CEA determination seems to be associated with a high rate of recurrence resection. However, the influence on overall survival of a planned follow-up including CEA determination is missing.

Biomarkers, Tumor↗
PubMed1991

[Validation of an ultrasonographic method of gastric emptying measurement in men].

Our purpose was to validate an ultrasonographic technique based on the assessment of the gastric antrum. Sixteen patients presenting with various functional disorders were studied by ultrasound on two occasions. Ten healthy volunteers were simultaneously studied by scinti- and ultrasonic scans. After an overnight fast, the healthy subjects ingested a 2,000 kJ test meal containing 150 microCi of 111In DTPA in 250 ml orange juice and 3 mCi of 99m Tc sulfur colloid in chicken liver. Using an ultrasound scanner fitted with a 3.5 MHz transducer, the area of the gastric antrum section was always measured in the same plane. Ultrasonographic measurement of gastric emptying rate was feasible in all of the 10 healthy subjects and in 14 of 16 selected patients. The ultrasonographic method was reproducible, and repeated t 1/2 measurements in 14 patients correlated well (95.3 +/- 27.9 vs 99.2 +/- 20.6 min; r = 0.70, P less than 0.001). The t 1/2 measurement was 39.4 +/- 7.7 min with the ultrasonographic method, and correlated well with 36.4 +/- 4.3 min for the t 1/2 measurement of the liquid phase with the scintigraphic method. We conclude that the ultrasonic method was reproducible and could be used for assessment of gastric emptying rate when repeated measurements are necessary, especially in pharmacologic studies.

Adult↗
PubMed1989

[Leiomyosarcoma of the esophagus. Apropos of a case with a review of the literature].

The authors report a new case of leiomyosarcoma of the oesophagus, and a review of the literature since 1960 (during this period almost every case has been resected). Four macroscopic aspects are observed: polypoid, mediastinal, intra-mural and infiltrating. The accurate diagnosis is difficult and was established before the operation only in half cases. It is based on barium swallow examination and esophagoscopy, that reveal different appearances depending on the anatomical type, and on the biopsy. The interpretation of the biopsy may be difficult because of the superficial nature of the sampling, frequently taking only mucosa or necrotic tissue. It is necessary to remove the necrotic tissue to discover the tumoral tissue, or to perform a wide diathermic snare biopsy. The diagnosis of malignancy is mainly based on the mitosis count, and interpretation of the peroperative pathologic examination is difficult. The surgeon may have to decide on an esophageal resection, according to the gross appearance. Esophagectomy is the most logical treatment; adjuvant radiation therapy could have some efficiency.

Adult↗
PubMed1987

[Results of the surgical treatment of common bile duct calculi in aged patients].

One hundred and two patients (median age: 76 years old; range: 70-91) underwent choledocotomy for biliary lithiasis. Seventy patients had at least one risk factor, 31 had at least 2 factors and 12 had 3 or 4 factors. The indication for surgical treatment was based on evolutive complications in 64 cases; an elective operation was performed in 38 cases. Common bile duct lithiasis was present in only 87 cases but associated lesions made a choledocotomy necessary in every case. A choledocoduodenostomy was performed in 40 cases and a choledocojejunostomy in 3 cases. No postoperative complications occurred in 86 patients. Of 16 patients with complications, 2 were fatal being due to hemiplegia and respiratory failure respectively. Two patients had residual lithiasis. Ninety-four patients were followed on a long-term basis (median follow-up time: 6 years): 34 died from underlying diseases, while 60 are still alive. Treatment failures were, in one case, recurrent lithiasis treated by choledocoduodenostomy and, in the other case, biliary anastomosis stenosis. These results show that the surgical treatment of choledocolithiasis does not necessarily increase the mortality rate in the elderly.

Aged↗
PubMed1986

[Low molecular weight heparin in extracorporeal circulation. 1st clinical applications].

The haemorrhagic complications inherent to the use of heparin during cardiac surgery led us, after a pilot experimental study, to try out a low molecular weight heparin (LMWH), PK 10169, which has weaker haemorrhagic effects in vitro. Our initial experience was confined to 23 patients with differing pathologies, undergoing cardiopulmonary bypass lasting 30 to 165 minutes. The modes of injection of YK 10169 varied according to the results, especially with respect to the limitation of peaks of anti-Xa activity; 8 patients were given one bolus intravenous injection, 9 were given a bolus injection and a continuous infusion, and 6 were only given the continuous infusion. Biological monitoring of anticoagulation was based on anti-Xa activity. Analysis of the biological results showed that the principal feature was the partial correction, and occasionally the non-correction of anti-Xa activity by protamine sulphate, with no correlation between this anti-Xa activity and postoperative bleeding. The authors report cases of severe postoperative bleeding despite the supposed theoretical and experimental weakly haemorrhagic properties of LMWH, and also discuss the inefficacy of protamine sulphate. The indications for LMWH for cardiopulmonary bypass which were retained, were the rare cases of heparin-induced thrombocytopaenia. In conclusion, it is possible to use LMWH during cardiac surgery but we do not advise using it routinely as its theoretical advantages are not confirmed in practice.

Adolescent↗
PubMed1984

[Magnesium deficiencies in cardiovascular diseases].

Plasma (pl), red blood cell (ery) and urinary magnesium (Mg) concentrations were measured by spectrophotometry in over 300 patients at the Cardiology Department of Broussais Hospital. Other biological parameters, including pl and ery potassium, calcium and phosphate concentrations were measured simultaneously. In a control group (54 subjects) the mean pl Mg was 0,851 mmol/l in men and 0,819 mmol/l in women; mean ery Mg was 2,12 mmol/l and 2,09 mmol/l respectively. Magnesium depletion was observed in several pathological cardiovascular conditions: -- mitral valve prolapse: the Mg levels were significantly lower in women (19 cases) (pl Mg 0,740 mmol/l; ery Mg 1,83 mmol/l: p less than 0,001); the deficit was less pronounced in men: pl Mg 0,829 mmol/l, p less than 0,01, and ery Mg 2,01 mmol/l (NS); -- recurrent junctional tachycardia (21 cases): the Mg levels were significantly lower than normal: pl Mg = 0,796 mmol/l in men and 0,763 mmol/l in women; ery Mg = 1,93 and 1,88 mmol/l, respectively; -- coronary insufficiency (86 cases): pl Mg = 0,821 mmol/l in men and 0,768 mmol/l in women (p less than 0,001). In a subgroup with coronary spasm (22 cases), the mean ery Mg was decreased (2,01 mmol/l, p less than 0,05); -- unstable or labile hypertension (24 cases): the decrease was significant, especially in women (pl Mg = 0,796 mmol/l, ery Mg = 1,88 mmol/l). These magnesium deficits were sometimes associated with a low pl Ca, and often associated with a low ery K although pl K was usually raised. In some privileged cases of cardiac arrhythmia and coronary spasm, intravenous Mg repletion was beneficial but did not affect plasma concentrations. The role of magnesium depletion in cardiovascular disease remains obscure and requires further study.

Adolescent↗
PubMed1978

[Medullary carcinomas of the thyroid. General review apropos of 3 further cases].

The authors report of three cases of medullary carcinoma of the thyroid and, from a review of the literature, study the definition, frequency, embryological and etiological characteristics of this disease. The physiology of thyrocalcitonin, the concept of the APUD system the secretion of active substances by the tumour cells are considered. The macroscopic and microscopic characteristics and its mode of spread are described. The two main clinical forms, the sporadic form and the familial form are described together with the other endocrine involvements. Among the factors in positive diagnosis, accent is placed on per-operative histological examination and on biological tests of familial detection. Among the forms of treatment the essential place of surgery explains partly the relatively favourable course and prognosis of the malignant disease.

Adult↗