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Biomedical subjects

E Tiret

Publications and source records attributed to E Tiret.

At least 91 records · Page 5Linked to original sources
PubMed1992

[Total pharyngolaryngoesophagectomy. Indications and results apropos of 17 cases].

Pharyngolaryngoesophagectomy (PLO) allows one-stage treatment of synchronous tumors involving both esophagus and hypopharynx and may also be advocated when the pharyngo-esophageal junction (PEJ) is involved. Less radical surgery may be advocated in the case of hypopharyngeal malignancy sparing the pharyngoesophageal junction. The authors report the results of 17 PLO carried out in 11 cases for a tumor involving the PEJ, and in 4 cases for synchronous tumors involving esophagus and hypopharynx. In 2 instances, PLO was performed for primary hypopharyngeal malignancy requiring total circular excision (i.e. which did not involve the PEJ). Five patients had previously received chemotherapy and 6 had had an association of chemotherapy and radiation therapy as initial treatment before surgery. Reconstructive procedure used the stomach and colon in 12 and 5 cases respectively. Hospital mortality was 4 cases out of 17. There was 1 cervical fistula secondary to pharyngogastric anastomosis necrosis. One and 2 year actuarial survival rates were 73% and 37%. Tumor recurrence and a remote new tumor were noted in 6 and 4 cases respectively, despite extensive surgical procedures and the use of chemotherapy and/or radiotherapy. When esophagectomy was added to total circular excision in case of hypopharyngeal tumor sparing the PEJ, no significant benefit was noted. Good functional results obtained by means of PLO shall lead to therapeutic trials including surgery, chemotherapy and radiotherapy with the aim of improving long-term results.

Adult↗
PubMed1989

[Acute necroticohemorrhagic pancreatitis. Why, when and how to drain? Apropos of 106 cases].

The heavy toll of necrotizing acute pancreatitis led the authors to start developing a new method of treatment in experimental and clinical conditions in 1979. This was aimed on one hand at creating a large channel for the centrifugal drainage of pancreatic or peri-pancreatic foci, and on the other hand at maintaining this draining channel during the first 5 weeks of acute evolution of the acute necrotizing pancreatitis in order to allow the permanent evacuation of purulent or necrotic fragments. From 1979 to 1989, 106 patients were treated with this method, ie. 71 men and 35 women with an average age of 47.9 years. 73 (74%) of these patients had been referred by other hospitals, and 64 only had been initially operated at Saint-Antoine hospital. All patients presented with extensive peripancreatic necrosis. The average Ranson score was 4.8 (not taking the fluid sequestration during the first few hours into account). Visceral failure was observed in 76% of the patients before surgery. The necrosis of the pancreatic gland was focal in 6 cases, extensive in 47 cases and total or subtotal in 25 cases. Out of the 70 CT studies, 64 showed a Ranson grade of E. All patients received enteral feeding on a jejunal site postoperatively. The mortality rate was 16%. The stay of the surviving patients in the intensive care unit averaged 50 days. 29 patients (27%) were reoperated on for complications or insufficient drainage.

Adult↗
PubMed1989

[Adjuvant radiochemotherapy in operable cancers of the thoracic esophagus. Preliminary results of a multicenter study. A study of 119 cases].

119 operable patients with an oesophageal squamous cell carcinoma were treated preoperatively by a combination of radiotherapy (37 Gy in two courses) and chemotherapy by cisplatin (delivered before each course of radiation). The response was evaluated on the resected specimen. 111 patients underwent operation and 101 tumours were resected. The toxicity was acceptable by reducing the Cisplatin dosage from 100 mg/m2 to 80 mg/m2 for the last 67 patients. A complete response was observed in 24 patients and a partial response in 46. The preliminary results show a 57% eighteen-month survival in the group of resected patients. A controlled study is needed to compare this combined regimen versus surgery alone in curatively resectable patients.

Adult↗
PubMed1989

Comparative clinical results of ileal-pouch anal anastomosis and ileorectal anastomosis in ulcerative colitis.

The aim of the study was to compare the results of ileal-pouch anal anastomosis (IAA) and total abdominal colectomy with ileorectal anastomosis (IRA) in the treatment of ulcerative colitis. The number of patients included in the comparative trial was 104 (IAA) and 197 (IRA), respectively. No clear advantage of IRA over IAA was seen: postoperative mortality and morbidity were about the same; functional results as shown by the frequency of stools and daytime continence were virtually equal. A factor favoring IAA was, among others, recurrence of proctitis after IRA which is more difficult to treat than the pouchitis occurring after IAA and is associated with a higher rate of secondary permanent end ileostomy; besides, IRA entails the risk of cancer developing in the rectal stump, while at the same time it is difficult to follow up these patients closely enough. IRA is indicated only if the diagnosis of ulcerative colitis is in doubt; if the patient is more than 60 years of age; and if IAA proves technically too difficult, IAA is usually preferable, however, if there is any doubt as to whether the patient is suffering from ulcerative colitis or Crohn's disease, ileorectostomy is preferred which does not preclude IAA at a later date in case of need.

Anal Canal↗
PubMed1989

[Ileo-anal anastomosis: various types of ileal reservoir].

The creation of an ileal reservoir ensures an improvement in the functional result obtained after ileo-anal anastomosis. As a result of its storage function, the reservoir allows a reduction in the number of stools per day. Several types of reservoir have been described. The S-shaped reservoir consists of three aniso-peristaltic limbs and an efferent loop with end-to-end ileo-anal anastomosis. The W reservoir is equivalent to a double J reservoir. The side-to-side iso-peristaltic reservoir consists of two iso-peristaltic limbs and an efferent loop with end-to-end ileo-anal anastomosis. After analysing the specific characteristics of each type of reservoir, the authors conclude that the necessity of a reservoir no longer needs to be demonstrated, but that there is no formal argument in favour of one particular model.

Anal Canal↗
PubMed1988

Single-layer anastomosis in surgery of the large bowel. A prospective study on 316 cases in a university hospital.

A prospective study was undertaken to evaluate the results of a single layer appositional technique for large bowel anastomoses used in a University Hospital. 316 patients were entered during an 18-month period. Anastomoses were situated within the peritoneal cavity in 277 patients and below the peritoneal reflection in 39. No covering stoma was made. The incidence of clinical leakage was 1.6% and of wound infection 1.9%. These results compare favourably with those obtained by stapling. For intraperitoneal anastomoses and high anterior resection manual suture remains the standard technique and is less expensive than stapling. For low rectal tumours, there is still debate on the relative merits of stapling and various manual techniques of colo-anal anastomosis in terms of morbidity, tumour clearance and functional results.

Adolescent↗
PubMed1988

Septic necrosis of the midline wound in postoperative peritonitis. Successful management by debridement, myocutaneous advancement, and primary skin closure.

Wound management following laparotomy for postoperative peritonitis and varying degrees of parietal necrosis remains a challenging and controversial problem. Because maintained peritoneal integrity and primary wound closure offer the best opportunity for survival, an original technique involving bilateral incisions to relax skin and rectus fascia is proposed. This technique permits medial myocutaneous advancement and primary tension-free skin closure of midline laparotomy incisions. Sixty-nine patients with severe postoperative peritonitis were treated according from 1980 through 1985. Nine of these patients died of advanced multiple organ failure soon after referral, and eight more died after prolonged treatment. Fourteen patients had one or more reoperations for complications. Only nine wound failures resulted, including five eviscerations and four wound infections followed by progressive dehiscence. The bilateral relaxing incisions healed secondarily without complication. Survivors developed midline wound hernia; ten of the 52 surviving patients have had these repaired. This method of primary closure is safe when performed in conjunction with rigorous surgical care of intraperitoneal infection and may enhance survival. We recommend the technique to surgeons who treat severe postoperative peritonitis and septic necrosis of midline laparotomy wounds.

Debridement↗
PubMed1987

[Colo-anal anastomosis with reservoir in the treatment of rectal cancer].

Preservation of the anal sphincter system is now often considered in the treatment of adenocarcinomas of the mid-rectum (inferior limit between 11 and 6 cm of the anal margin). Direct anastomosis of the rectum to the anus or the last two centimeters of the rectum after resection of the rectal pouch is a source of discomfort. The construction of a colon pouch, placed directly above the anus, has been devised in order to improve these results. In the last three years, a J-shaped colon pouch, measuring 8 centimeters X 2, was constructed in 76 patients and anastomosed in its portion to the anal canal, after complete rectal resection. The functional results of this procedure, with uneventful post-operative course, were evaluated in 66 patients with a mean follow-up of 17 months. Continence was satisfactory in 96% of patients, with an average number of stools of 1.4 in 24 hours. Thirty one per cent of the patients require a small enema or a suppository to induce defecation.

Adenocarcinoma↗
PubMed1986

Resection and colo-anal anastomosis with colonic reservoir for rectal carcinoma.

Sphincter-saving operations are now generally accepted for the treatment of mid-rectal cancers. Many techniques have been described: low colorectal anastomosis, pull-through procedures, and colo-anal anastomosis. The functional results following these operations are impaired by loss of the reservoir function of the rectum. In order to improve these results, a modification of Parks' colo-anal anastomosis is proposed. A J-shaped colic reservoir is constructed and its end is anastomosed to the anal canal. We have operated upon 31 patients using this technique. Mortality was 3.3 per cent. Functional results were evaluated in 24 patients having a follow-up of more than 3 months. All were continent; mean number of bowel movements was 1.1 per day. Defaecation was spontaneous in 75 per cent of cases; in the remaining 25 per cent, evacuation of the reservoir was elicited by a small enema each two days. This technique, creating a neo-rectum, can achieve an important place among the sphincter-saving operations.

Adult↗