Search PubMed⌕ Search

Biomedical subjects

E Sarfati

Publications and source records attributed to E Sarfati.

At least 91 records · Page 5Linked to original sources
PubMed1987

Management of caustic ingestion in adults.

The treatment of 484 adults with caustic ingestion injury is discussed. Signs and symptoms are an unreliable guide to injury and a chest X-ray and fibreoptic endoscopy should be performed as soon as possible. All of the 250 patients who developed superficial lesions of the oesophagus, stomach or duodenum experienced healing without sequelae. Forty-four patients required emergency surgery of whom twenty-four died and oesophagectomy without thoracotomy is now advocated for this group, followed by interval surgery to restore continuity. The remaining 190 patients suffered gastric or oesophageal ulceration without necrosis: 92 recovered without complication, 3 succumbed to aorto-oesophageal fistula, 12 survived following delayed surgery for complications and 83 developed oesophageal and/or gastric stenosis which subsequently required endoscopic or surgical treatment.

Adolescent↗
PubMed1987

[Parathyroid microadenomas].

Ten out of 329 cases of hyperparathyroidism operated over a 4 year period had lesions which conformed to the diagnostic criteria of microadenoma. Although small and light weight these lesions all gave rise to complete laboratory work ups and 7 out of the 10 patients had clinical signs. The microadenomas were not easily identified at surgery and the diagnosis could only be confirmed after a thorough histological examination. After resection, all patients seemed to be permanently cured.

Adenoma↗
PubMed1987

[Parathyroid adenoma at an atypical site, ectopic or not].

Of 800 patients undergoing operation for primary hyperparathyroidism between 1960 and 1985, 163 presented parathyroid adenomas located in other than typical sites in normal parathyroid glands. A retrospective study of case-reports is used to demonstrate the value of complementary investigations in the localization of these lesions, and to emphasize certain operative factors indispensable for their detection.

Adenoma↗
PubMed1987

[Is the palliative treatment of cancer of the esophagus by retrosternal bypass justified?].

We report a retrospective study of 52 patients with unresectable carcinomas of the esophagus treated with substernal bypass without resection. There were 49 squamous-cell carcinomas and 3 adenocarcinomas. The site of the tumor was the middle third of the esophagus in 32 patients, the upper third in 9, and the lower third in 11. The diagnosis of inextirpability was made preoperatively in 34 patients and at laparotomy in 18. Thoracotomy was never performed. The bypass procedure was ileocolic in 22 cases and gastric in 30 cases. No patient had postoperative chemotherapy or radiation therapy. The operative mortality rate was 9.6 p. 100 (5 cases) and the hospital mortality was 19.2 p. 100 (10 cases). Morbidity was 46 p. 100. Twenty-two cervical fistulas occurred; 19 closed spontaneously. Eighteen endoscopic dilatations and four reoperations were performed for 22 secondary stenoses of the cervical anastomosis. Median survival rate was 6.2 months. We conclude that substernal bypass is a valuable alternative for palliation of esophageal cancer but that its indications should be limited.

Adenocarcinoma↗
PubMed1987

Early blunt esophagectomy in severe caustic burns of the upper digestive tract. Report of 29 cases.

Caustic ingestion may cause severe necrosis of the upper digestive tract. Of 520 patients admitted in our department for caustic ingestion, 29 (5.5%) underwent emergency esophagogastrectomy because of transmural necrosis. We used a stripping procedure, which was performed through a cervicotomy and a laparotomy. This method allowed 18 patients (62%) to survive. Thus it appears to be a safer technique than open thoracic esophagectomy, which we used in our earlier experience.

Adolescent↗
PubMed1986

[Perforations of the thoracic esophagus. Apropos of 14 surgical cases].

The authors report the datas of 14 patients with perforation of the esophagus who underwent surgical treatments. Three patients died (21%). Various technics have been used, but a new personal one consisting in stappling the cervical esophagus--and sometimes the lower end in the chest-is brought forward. The last six patients who underwent this technic healed. Five out five have got a spontaneous repermeation of the esophagus. The sixth healed after fiberendoscopic dilatation.

Adolescent↗
PubMed1986

[Multiple hypersecreting lesions of the parathyroid glands during treatment with lithium].

A 64 year old woman had been on lithium carbonate for 12 years for manico-depressive psychosis. Mild asthenia leads to the diagnosis of primary hyperparathyroidism based on the findings of hypercalcemia up to 2.85 mmol/l inappropriate levels of parathormone and a non-suppressive rise of nephrogenic cyclic AMP. These symptoms were not relieved by removal of a chief cell adenoma of the left inferior parathyroid; surgical reexploration leads to the removal of an adenoma in a high, ectopic situation. Further venous samplings were collected during cervico mediastinal phlebography because of persistent hypercalcemia: parathormone levels were high in a thymic vein and a new cervicotomy revealed a fifth gland with an adenoma in the high mediastinum. After removal of the third adenoma, the patient became hypocalcemic. Lithium was not discontinued according to the patient's wishes. Eighteen months later she was well and normocalcemic on alfacalcidol therapy. Multiple adenomas of the parathyroids are rare (1.7 p. 100 to 5 p. 100) and the recurrence of an adenoma on a supernumerary gland is exceptional. Eighteen clinical cases of primary hyperparathyroidism under lithium therapy have been reported, but mild asymptomatic hypercalcemia with inappropriate increased parathormone levels seems to be more common. Duration of treatment is very variable: 1 day to 12 years, and serum calcium levels or up to 3.9 mmol have been observed. Ten patients underwent cervicotomy with removal of an adenoma 6 of them remaining under treatment, with 2 recurrences in our case. Five of the 8 non-operated patients remained on lithium therapy and showed mild hypercalcemia.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenoma↗
PubMed1986

[Gastropericardial fistula. Late complication of the treatment of hiatal hernia].

An exceptional case of gastropericardial fistula is reported, the lesion developing from a gastric ulcer on an antireflux valve instituted ten years previously. A literature review showed 31 similar cases: 14 gastropericardial fistulae, 16 esophagopericardial fistulae and one jejunopericardial fistula. Three features common to all these fistulae were determined: the frequency of hiatus hernia in the genesis of these lesions, either from an ulcer on esophagitis or herniated stomach or from surgical complication; the extremely high mortality of these fistulae (68% mortality); the need for aggressive treatment.

Aged↗
PubMed1986

[Evaluation of 16 severe pharyngo-esophageal caustic stenoses. Value of the anterior approach in an ileo-colic transplant].

Results of treatment of 16 cases of severe pharyngo-esophageal stenosis of caustic origin are reviewed. Emergency treatment is described, the place of otorhinolaryngology in investigation of lesions of upper respiratory and digestive tract discussed, and a description given of a technique of esophagopharyngoplasty by right ileocolic transplant with a suprahyoidal or supraglottic anterior cervical approach with epiglottectomy. Strict selection of patients is essential, taking into account their psychiatric profile. The functional result of this operation, with its long and difficult postoperative course, was inconstant (11 of the 16 cases could be fed liquids and solids by mouth exclusively, ensuring maintenance of body weight, although endoscopic dilatation might be necessary in one or two cases), and appears to depend on the outcome of corrosive lesions and psychologic behavior of patients.

Adolescent↗
PubMed1986

[Diagnostic and therapeutic problems in a severe case of hyperparathyroidism with renal insufficiency].

It may sometimes be difficult to distinguish primary from secondary hyperparathyroidism when advanced renal failure coexists. We report here the case of a patient with end-stage renal failure who had severe hyperparathyroidism. Cervical exploration revealed only the presence of four parathyroid glands normal in size and histological appearance which were removed. Because the existence of severe hyperparathyroidism had been firmly established based on biochemical and radiological evidence, the diagnosis of primary hyperparathyroidism due to an ectopic adenoma became obvious. Digital angiography and computerized tomography were then carried out. The results of angiography were inconclusive but computerized tomography revealed and precisely localized a mediastinal adenoma which was subsequently removed via sternotomy. The existence of a hypoparathyroid state was confirmed over the following two months. Reimplantation of parathyroid fragments which had been cryopreserved during the first operation, was then performed with success.

Adenoma↗