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Biomedical subjects

F Menegaux

Publications and source records attributed to F Menegaux.

At least 19 recordsLinked to original sources
PubMed2006

Household exposure to pesticides and risk of childhood acute leukaemia.

OBJECTIVES: To investigate the relation between childhood acute leukaemia and household exposure to pesticides. METHODS: The study included 280 incident cases of acute leukaemia and 288 controls frequency matched on gender, age, hospital, and ethnic origin. The data were obtained from standardised face to face interviews of the mothers with detailed questions on parental occupational history, home and garden insecticide use, and insecticidal treatment of pediculosis. Odds ratios were estimated using unconditional regression models including the stratification variables parental socioeconomic status and housing characteristics. RESULTS: Acute leukaemia was observed to be significantly associated with maternal home insecticide use during pregnancy (OR = 1.8, 95% CI 1.2 to 2.8) and during childhood (OR = 1.7, 95% CI 1.1 to 2.4), with garden insecticide use (OR = 2.4, 95% CI 1.3 to 4.3), and fungicide use (OR = 2.5, 95% CI 1.0 to 6.2) during childhood. Insecticidal shampoo treatment of pediculosis was also associated with childhood acute leukaemia (OR = 1.9, 95% CI 1.2 to 3.3). CONCLUSION: The results reported herein support the hypothesis that various types of insecticide exposure may be a risk factor for childhood acute leukaemia. The observed association with insecticidal shampoo treatment of pediculosis, which has never been investigated before, requires further study.

Acute Disease↗
PubMed2005

[How to prevent recurrent nerve palsy during thyroid surgery?].

Recurrent laryngeal nerve (RLN) injury and hypoparathyroidism can occur after thyroid surgery. The rate of RLN injury, mostly transient, ranges from 0.5% to 5% of patients. The risk is more important in patients who undergo reoperative thyroid surgery and in patients with thyroid cancer or hyperthyroidism. Rationales for technique of thyroidectomy are discussed. Meticulous and reproductive surgical technique can lower the postoperative morbidity. However, the potential for RLN injury still exists and must be explained to the patients who are candidate for thyroid surgery. The fact that this information has been delivered during the preoperative visit must be written by the surgeon in the patient's chart.

Humans↗
PubMed2003

[Polytrauma is more severe after a free fall from a height than after a motor vehicle accident].

AIMS: To compare specific features and prognosis of polytrauma victims requiring urgent laparotomy, after a free fall from a height (FFH) or a motor vehicle accident (MVA). PATIENTS AND METHODS: Urgent laparotomy was performed only in case of massive hemoperitoneum associated with hemodynamic instability. Injury severity score (ISS) and hospital mortality rate were used to determine the severity of trauma. RESULTS: Two hundred and four patients underwent urgent laparotomy for blunt abdominal trauma: 79 after FFH (intentional defenestration: 65, accident: 14), and 125 after a MVA. Mean ISS was higher after FFH (39 +/- 11) than MVA (35 +/- 12) (P< 0.05). Spine injury and pelvic fractures were more frequent and more severe in FFH patients, with a high incidence of retroperitoneal hemorrhage. Juxta-hepatic veins and inferior vena cava tears usually occurred after FFH. Hospital mortality was 48% (38/79) after FFH and 30% (37/125) after MVA (P< 0.01). Predominant cause of death was associated injuries. The height of the fall was not a prognostic factor, unlike the quality of the landing surface: the mortality dropped from 59% (34/58) when patient fell onto a hard ground, to 19% (4/21) in case of soft landing surface (P< 0.05). CONCLUSION: Blunt abdominal trauma requiring urgent laparotomy is more severe after FFH than after MVA. The usual cause of death is associated injuries in both groups. Quality of the landing surface is a discriminating factor for mortality after FFH.

Accidental Falls↗
PubMed2001

Initial imaging assessment of severe blunt trauma.

OBJECTIVES: Total body computed tomography (CT) scan is increasingly used in traumatised patients, but the need for an initial rapid imaging assessment beforehand remains unknown. To address this problem, we assessed the value of an initial imaging assessment (chest X-ray, pelvic X-ray, abdominal ultrasonography) in severely traumatised patients in a prospective study. DESIGN AND SETTING: Prospective study of a cohort in a level 1 trauma centre of an university teaching hospital. PATIENTS AND INTERVENTIONS: 400 patients with severe blunt trauma. Within 30 min of arrival in the hospital, these patients underwent a rapid imaging assessment at the bedside, including chest and pelvic X-ray, and an abdominal ultrasonography. The decision taken for each imaging technique (chest drainage or thoracotomy, pelvic angiography, and laparotomy, respectively) was judged as appropriate or inappropriate. MEASUREMENTS AND RESULTS: Emergency chest drainage or thoracotomy was performed in 78 cases (78 appropriate), pelvic angiography in 8 cases (5 appropriate) and immediate laparotomy in 48 cases (47 appropriate). Emergency treatment was decided in 108 patients, and the decisions were considered appropriate in 392 (98%, 95% CI: 97%-99%) cases. Three variables (heart rate, systolic arterial pressure and Glasgow Coma Scale) were independent predictors of the need for an emergency decision, but among patients who had none of these criteria, 16% required an emergency decision. CONCLUSIONS: A simple and rapid initial imaging assessment enabled appropriate emergency decisions before further imaging assessment was performed. We recommend that every patient with severe blunt trauma receive this initial assessment.

Abdominal Injuries↗
PubMed2001

[Acute abdominal pain in immunodepressed patients].

Abdominal pain in immunodepressed patients is a challenge. Clinical presentation is often initially very vague and it is difficult to know if a patient needs early surgical exploration or not. Even in case of peritonitis, bowel function is normal in most of the patients, and signs of peritoneal irritation are minimal and frequently absent. Mortality and morbidity should decrease if diagnosis of peritonitis is made at an early stage. A high level of suspicion must be maintained when an immunodepressed patient presents with any abdominal pain. If pain persists, aggressive diagnostic efforts should be made, and early abdominal exploration should be considered. Laparoscopy has been demonstrated to be a secure and effective method for abdominal exploration and can be considered for diagnosis. Laparotomy should stay the procedure of choice when surgical treatment is needed in these critically ill patients.

Abdomen, Acute↗
PubMed2001

Survival and therapeutic modalities in patients with bone metastases of differentiated thyroid carcinomas.

Data for patients with bone metastases (BMs) of differentiated thyroid carcinoma (DTC) were retrospectively studied to identify factors associated with survival. We especially studied the impact of therapies. Among the 1977 patients followed for DTC in our department from 1958 to 1999, 109 (77 females and 32 males; age range, 20--87 yr) presented BMS: All patients except 1 underwent total thyroidectomy, followed by radioiodine therapy (> or =3.7 gigabecquerels) in 95 cases. Survival rates at 5 and 10 yr were 41% and 15%, respectively. Univariate analyses indicated that a young age at BM discovery (P < 0.005) and the discovery of BM as a revealing symptom of DTC (P < 0.05) were features significantly associated with improved survival as well as radioiodine therapy (P < 10(-4)) and BM complete surgery (P < 0.02). Using multivariate analysis, the detection of BMs as a revealing symptom of thyroid carcinoma (P < 0.0005), the absence of metastasis appearance in other organs than bones during the follow-up (P < 0.03), the cumulative dose of radioiodine therapy (P < 0.0001), and complete BM surgery in young patients (P < 0.04) appeared as independent prognostic features associated with an improved survival.

Adult↗
PubMed2000

[Cholelithiasis in heart transplant patients].

UNLABELLED: The incidence of cholelithiasis is increased in heart transplant recipients. STUDY AIM: The aim of this retrospective study was to report a series of 27 heart transplant recipients operated for cholelithiasis and to assess the indications and safety of cholecystectomy in this population. PATIENTS AND METHODS: Over a 9-year period, from January 1991 to December 1999, 27 heart transplant recipients (21 men and 6 women; mean age: 54.6 years, mainly transplanted for ischemic or dilated cardiomyopathy) underwent cholecystectomy. All patients received immunosuppressive therapy with a combination of corticosteroids and cyclosporin and 10 also received azathioprine. Five patients admitted urgently with calculous acute cholecystitis and one patient with previous gastrectomy underwent laparotomy, while the other 21 patients were operated by laparoscopy. RESULTS: There were no postoperative deaths. In patients operated by laparoscopy, there was no conversion to laparotomy and oral immunosuppressive drugs were continued without interruption. There was one postoperative hemoperitoneum related to liver biopsy performed concomitantly. In patients operated by laparotomy, intravenous cyclosporin was necessary until return to bowel function and the only complication was a wound abscess. Mean length of hospital stay was 3.1 days after laparoscopy and 8.8 days after laparotomy. CONCLUSION: Systematic ultrasound screening of cholelithiasis after heart transplantation is necessary because cholelithiasis carries a risk of septic complications in these patients. Laparoscopic cholecystectomy, associated with a low morbidity, is justified even in asymptomatic cases. In patients with acute cholecystitis, "open" cholecystectomy must be preferred in order to minimize the risk of biliary complications which would be very serious in these immunosuppressed patients.

Adult↗
PubMed1999

Isolated retroperitoneal intradiaphragmatic bronchogenic cyst. A case report.

Isolated retroperitoneal bronchogenic cysts are extremely rare. We report a case which was intradiaphragmatic intimately associated with the musculature of the left crus diaphragmatic and unconnected with any other structures. Ultrasound and computed tomography findings were consistent with a pancreatic or an adrenal mass. Pathology confirmed a bronchogenic cyst. The outcome is favourable and the overall prognosis is good.

Bronchogenic Cyst↗
PubMed1999

Secondary thyroidectomy in patients with prior thyroid surgery for benign disease: a study of 203 cases.

BACKGROUND: The goal of this study was to evaluate the complication rate of secondary thyroidectomy in patients with prior thyroid surgery for benign disease. METHODS: Over an 8-year period, 203 thyroid reoperations were performed on 202 patients. All information relating to operative procedures, pathology, and complications was recorded prospectively. RESULTS: There were 24 men and 178 women with a mean age of 52 years. Prior surgery was unilateral in 136 cases (67%) and bilateral in 67 cases (33%), and 14 patients (6.9%) had more than 1 previous thyroid operation. For euthyroid or pretoxic recurrent nodular goiter, 190 reoperations were performed and 13 reoperations were performed for recurrent thyrotoxicosis. Twenty-three cancers were found in a specimen (11.4%). Completion thyroidectomy was done in 143 patients. Postoperative complications occurred in 21 patients (10.4%): recurrent laryngeal nerve palsy (7 patients), hypocalcemia (8 patients), hematoma requiring surgical evacuation (5 patients), and wound infection (1 patient). Complications remained permanent in 4 patients (2%). CONCLUSIONS: The permanent complication rate is higher in thyroid reoperations than in primary thyroid operations. However, we believe that this 2% rate is low enough to allow reoperation whenever it is necessary, provided precise operative rules are respected.

Adult↗
PubMed1998

Biliary surgery after heart transplantation.

BACKGROUND: Biliary tract diseases are frequent in heart transplant recipients, with significant morbidity and mortality. Since the first presentation of gallstones in this population is often acute cholecystitis, asymptomatic cholelithiasis should not be considered benign. PATIENTS AND METHODS: We retrospectively reviewed 18 heart transplant recipients who underwent cholecystectomy from January 1991 to June 1997. We intentionally chose to perform a straightforward open procedure when acute cholecystitis was suspected (3 patients). A laparoscopic cholecystectomy was performed in all the other cases (15 patients) without conversion to open procedure. CONCLUSION: Since no significant complications were observed in our patients, we believe that transplant recipients with cholelithiasis should undergo laparoscopic cholecystectomy in their posttransplantation course regardless of the symptomatic status of their biliary tract.

Adult↗
PubMed1998

Diffuse peritonitis in steroid-treated patients.

Patients on systemic steroid therapy are at increased risk of diffuse peritonitis, specially from gastrointestinal perforation. We performed a retrospective study of 37 patients on systemic steroid therapy who underwent surgery for diffuse peritonitis. Clinical presentation of peritonitis was usually aspecific, making the diagnosis difficult. The median interval between onset of symptoms and surgery was 3.3 days, reduced to 2.0 days between hospitalization and surgery. The mortality rate was 46% (17 of 37 patients). We emphasize aggressive diagnostic efforts and early abdominal exploration in front of any persisting abdominal pain in patients on systemic steroid therapy.

Abdominal Pain↗
PubMed1997

[Repeated thyroid surgery. Indications and results].

OBJECTIVES: To analyze the histology results and to assess operative risk of iterative operations for thyroid surgery. PATIENTS AND METHODS: A total of 249 re-operations were performed in 248 patients over a 6.5 year period. Two groups of patients were defined according to the indications for re-operation. Group 1: 80 patients; pathology examination of the surgical specimen discovered thyroid cancer. Group 2: 169 patients; recurrent nodular goitre after an initially benign disease. RESULTS: In group 1, 14 cancers were bilateral (17.5%) and 7 patients had cervical node metastases (8.8%). In group 2, 19 cancers were discovered (11.1%), including 5 cases with cervical node invasion (26.3%) and 4 with visceral metastases (21.1%). Twenty complications occurred in 20 patients (8%): compressive cervical hematomas (n = 3, 1.2%), recurrent nerve palsy (n = 7, 2.8%), hypoparathyroidism (n = 9, 3.6%; including 3 definitive cases, 1.2%) and mediastinitis (n = 1). These complications were significantly more frequent in patients re-operated for hyperthyroidism or those who had a past history of more than one cervicotomy. CONCLUSION: The frequency of bilateral cancer justifies completing thyroidectomy after partial thyroidectomy. The rate of definitive complications after re-operations is greater than first line cervicotomy but is low enough to allow iterative surgery using rigorous procedure in selected patients.

Goiter, Nodular↗