Search PubMed⌕ Search

Biomedical subjects

F Fekete

Publications and source records attributed to F Fekete.

At least 37 records · Page 2Linked to original sources
PubMed1989

[Exeresis of liver metastases: indications and results].

Between 1980 and 1987, 38 patients with liver metastases have been operated on. In 28 cases the primary tumor was a colo-rectal carcinoma. 11 lobectomies and 27 minor resections or segmentectomies have been performed. The post-operative mortality was 5%. The actuarial survival for the metastases of colo-rectal carcinomas was 54% at 2 years, 27% at 3 years and 18% at 5 years. The results of this series are compared to those of the literature, to discuss indications, technical modalities and prognostic factors of the surgical treatment of liver metastases.

Adult↗
PubMed1989

[A surgical etiology of respiratory distress in necrotizing pancreatitis: pancreato-bronchial fistula. 3 cases].

Adult respiratory distress syndrome (ARDS) is a frequent feature in acute pancreatitis, but précise etiology of hypoxemia remains unclear. Determinations of lipase and amylase levels are made in samples of bronchial secretion, in three intubated patients receiving assisted ventilation for severe hypoxemia occurring in the course of pancreatitis. This determination appeared to be valuable to incriminate the responsibility of a pancratico-bronchial fistula. In the first case, emergency laparotomy was able to show the fistulous track. In the second described case, an endoscopic retrograde pancreatography was performed, showing a fistula from pancreatic body to left bronchial tree. In the third case, the presence of a bronchial fistula was proved by a fistulography trough the abdominal pancreatic necrosis. A decrease of arterial PO2 followed pancreatography and fistulography. The surgical treatment was splenopancreatectomy, necrosectomy associated with left pulmonary lobectomy, and necrosectomy with colonic diversion. In the third case, pancreatico-bronchial fistula was the final evolution of an infected intra-abdominal necrosis, despite multiple surgical drainages. In the first and second cases, surgical treatment obtained a prompt and uneventful recovery. Few published cases of pancreatico-bronchial fistulae are reported. A retrospective study of 12 ARDS was made among 40 patients underwenting laparotomy, with an objective recognition of necrotizing pancreatitis, from 1980 to 1987. A pancreatico-bronchial fistula could be incriminated in three cases of these 12 ARDS. Such a prevalence of 25% has to be reevaluated after serial determinations of lipase and amylase levels in bronchial samples of intubated patients suffering from ARDS in the course of pancreatic disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1988

[A case of esophageal papillomatosis in adults].

The authors report the case of a 60 year-old woman patient with esophageal papillomatosis, revealed by slowly progressive dysphagia and digestive hemorrhage. Multiple warty tumors were found at endoscopy, starting at approximately 23 cm from the dental ridge, increasing in size into the lower esophagus where they were responsible for stenosis. Pathological examination demonstrated epithelial proliferation with lengthened papillae, hyperkeratosis, hyperacanthosis and severe dysplasia. No extra-esophageal papillomata were discovered. Subtotal esophagectomy was performed and pathological examination with immune markers suggested a human papilloma virus (HPV) infection. However, search for HPV DNA was negative. To our knowledge, this constitutes the fifth case reported in the literature. The principal problem posed by this rare disease is the possible association with and/or progression to carcinoma, the diagnosis of which may be difficult, and particularly, with verrucous carcinoma. With this diagnostic uncertainty in mind, the authors suggest total surgical removal of the esophagus in this situation.

Esophageal Neoplasms↗
PubMed1987

Results of esophagogastrectomy for carcinoma in cirrhotic patients. A series of 23 consecutive patients.

Esophagogastrectomy for carcinoma of the esophagus or cardia has been performed in 23 patients with histologically proven hepatic cirrhosis. All but two patients were classified as Child's class A and all but three had a prothrombin time over 60% of normal values. Twenty-two esophagogastrostomies were performed through a separate abdominal and right thoracic approach in 15 patients, a left thoracoabdominal approach in five patients, and without thoracotomy in two patients. One patient had a colon interposition. Six patients died after operation (26%) as a result of anastomotic leakage in two patients, hepatorenal in three patients and portal thrombosis in one patient. The type of procedure did not influence mortality. The most common postoperative complication was the development of ascites (65%), and when associated with hepatorenal syndrome there was a significant mortality (p less than 0.05). Sepsis was present in the terminal stages of all nonsurvivors. A prothrombin time less than or equal to 60% of normal values was the only significant preoperative predictive factor of mortality, with none of the three patients surviving below this level (p less than 0.05). It is concluded that the presence of cirrhosis is not a contraindication to esophagogastrectomy for carcinoma when curative resection can be undertaken. Hepatic reserve is the determinant factor of operative prognosis. Operative risk is acceptable if patients are classified as Child's class A and prothrombin time is over 60% of normal values. Operation should be delayed when acute alcoholic hepatitis is present. Intraoperative discovery of cirrhosis is not a contraindication to resection where the above criteria are met. This strict selection allows one to anticipate a lower mortality rate.

Adult↗
PubMed1987

[pH and the bacteriology of gastroplasties after esogastric resection].

A study of pH of digestive fluid in 24 patients six days after esophagogastric resection (EGR) showed conservation of acidity (pH: 3 or less) in one-thirds of cases. Immediate postoperative course was invariable with respect to incidence of pneumopathy and fistulae. Fungal infection is almost a constant finding in digestive grafts together with microbial pullulation, with a linear relation to pH. Ecology of germs was that of digestive flora of patients with obstruction, selected by the antibiotic cover administered. Group D streptococci and Gram negative bacilli were usually resistant to cephalosporins. Regurgitation pneumopathy therefore requires modification of antibiotic therapy and possible antifungal treatment. When functional disturbance is provoked by EGR, as for example a reflux syndrome; only those patients (1/3) with a pH of 3 or less can obtain relief from treatment with antacids.

Adult↗
PubMed1987

Radicality in esophageal cancer surgery.

This study concerns a series of 355 carcinomas of the thoracic esophagus treated over a six-year period. 5 points of the pre operative work up are discussed: total endoscopy, respiratory and hepatic function as most of the patients were heavy smokers and alcoholics, nutritional status and C.T. scan in order to precise the preoperative nutrition value and the true correlation between surgical and CT scan findings. As far as curative resection is concerned, the indications of cervical and intra-thoracic anastomoses and of phi en bloc- posterior mediastinectomy versus blunt dissection are discussed. The mortality rate in this series of 135 curative resections was 8 p. cent due to pulmonary infection and to fistulas. The late results are studied according to the Japanese classification. The overall five-year actuarial survival is 19 p. cent, and 30 p. cent for the group of curative resection in stage 0, 1 and II.

Actuarial Analysis↗
PubMed1986

[Pancreatic cystadenoma: diagnostic value of ultrasonics and x-ray computed tomography].

We report six cases of pancreatic cystadenoma (three mucinous cysts, three microcystic adenomas). All patients were women. The mean age at the time of diagnosis was 50 years (with a range from 24 to 70 years). The mean age of patients having mucinous cysts (36.6 years) was lower than that of patients having microcystic adenomas (63.3 years). Abdominal pain was the first symptom in five patients. A palpable abdominal mass was found in three cases. The type of the tumor was demonstrated by ultrasonography and computed tomography and was confirmed by laparotomy in five cases. The tumors involved the body and tail of the pancreas. A distal pancreatectomy was performed in five cases, with a splenectomy in four cases. The post-operative course was uneventful. One patient was not operated. The histological examination of the three mucinous cysts showed benign tumors. This study emphasizes the usefulness of ultrasonography and computed tomography for the diagnosis of pancreatic cystadenomas. Surgical therapy is mandatory for mucinous cysts because of their potential malignancy, but a careful follow-up might be proposed for poor-risk patients having a microcyst adenoma, since this tumor is benign.

Adult↗
PubMed1986

Prevention of coagulopathy after placement of peritoneovenous shunt with replacement of ascitic fluid by normal saline solution.

Consumptive coagulopathy may complicate the early postoperative course of peritoneovenous shunting and be responsible for diffuse bleeding or even death. Since this complications has been related to procoagulant substances in ascitic fluid getting access to the systemic circulation, it was demonstrated that the replacement of the ascitic fluid by normal saline solution during shunt insertion decreases the prevalence and severity of postoperative coagulopathy.

Adult↗
PubMed1984

[Mechanical anastomoses with the ILS stapler in surgery of the esophagus. 73 cases].

The authors report on their experience of 200 anastomoses of the oesophagus, 73 of which were performed with the ILS stapler. They describe the instrument and the way it should be used and insist on the check-ups required to make sure that the anastomosis is leak-proof. The results are reviewed by category of anastomosis (with the stomach, jejunum or colon). In view of its advantages and notably its safety, this type of instrument deserves to be widely used.

Esophagus↗
PubMed1983

[Severe peptic esophagitis. Treatment by total duodenal diversion].

Total duodenal bypass, as described by Holt and Large and by Herrington consists of antrectomy with Y-loop gastro-jejunal anastomosis and total vagotomy. It is performed in patients with severe oesophagitis for which oesophageal resection often proves inadequate. It applies not only to acid reflux oesophagitis but to oesophagitis caused by alkaline or mixed reflux, the severity of which has been emphasized in numerous publications. This technique was used in 12 patients operated upon for severe oesophagitis consecutive to oesophageal resection or to Heller's operation for megaoesophagus or after failure of conservative treatment of peptic oesophagitis. Seven patients benefited from the operation performed by first-intention. Total duodenal bypass was considered indicated in severe peptic stenosis (impassable with an 11 mm fiberoscope) or in severe oesophagitis with moderate stenosis (passable with an 11 mm fiberoscope) or in severe non-stenotic oesophagitis on brady--or endobradyoesophagus. The favourable results obtained, based on clinical, radiological, endoscopic and pH-metric data, confirm that the technique is effective. The risk of anastomotic ulcer is avoided by truncular vagotomy, a procedure which must not be performed by the abdominal route in patients who previously underwent Heller's operation.

Esophageal Achalasia↗
PubMed1983

Surgical implications of malnutrition and immunodeficiency in patients with carcinoma of the oesophagus.

A nutritional and immunological assessment was respectively performed in 75 patients with squamous cell carcinoma of the oesophagus. Abnormal nutritional and/or immunological values were present in 37 patients (50 per cent) and absent in 38. The tumour was resectable in 27 patients (71 per cent) with normal values and only in 11 among the 37 (29 per cent) with abnormal values (P less than 0.001). Complications after resection including death, pneumonia and anastomotic failure were not significantly different in the two groups of patients except for anastomotic failure. This observation suggests that reduction of surgical complications by preoperative nutritional therapy might be expected only in few patients with oesophageal carcinoma.

Adult↗
PubMed1983

Impaired in vitro bactericidal power of polymorphonuclear leukocytes in patients with protein calorie malnutrition.

Bactericidal power of polymorphonuclear leukocytes was determined in eight patients with protein calorie malnutrition before and after nutritional therapy. Oxygen consumption associated with the uptake of zymosan particle by polymorphonuclear leukocytes, which is an exact reflection of the bactericidal power of leukocytes, was significantly decreased in untreated patients in the presence of both autologous and AB serum when compared with two control groups of eight normal patients. After nutritional therapy, oxygen consumption was found to be in the normal range in the presence of both autologous and AB serum. It is concluded that, in patients with protein calorie malnutrition, polymorphonuclear leukocytes have an intrinsic dysfunction, and this dysfunction is corrected after nutritional repletion.

Adult↗
PubMed1983

[Warren's anastomosis. Clinical and angiographic results (presentation of a series of 23 cases)].

Twenty-three patients with portal hypertension due to alcoholic cirrhosis were treated by distal splenorenal shunt and gastrosplenic mesenteric disconnection. In the post-operative period, two patients died; in one patient gastro-intestinal bleeding recurred 7 days after surgery and was due to ruptured varices with thrombosis of the splenorenal shunt; ascites developed in 14 patients. Twenty patients were followed up 6 months or more after surgery. Intestinal bleeding occurred in 3 patients with patent shunt. Ascites always disappeared within 3 months after operation. Four patients developed encephalopathy. Seventeen patients were investigated by angiography 3 months or more after surgery. The shunt was patent in 15 and occluded in 2 patients. In all patients with patent shunt a collateral circulation between the portomesenteric to gastrosplenic systems developed. In all patients, the portal flow decreased as suggested by diminution of the diameter of the portal vein. The authors conclude that 3 months after operation, results of distal splenorenal shunt with gastrosplenic disconnection are not hemodynamically different from those of side-to-side portocaval shunt.

Adult↗