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Biomedical subjects

F Menegaux

Publications and source records attributed to F Menegaux.

At least 37 records · Page 2Linked to original sources
PubMed1995

Should primary hyperparathyroidism be treated surgically in elderly patients older than 75 years?

BACKGROUND: Diagnosis of primary hyperparathyroidism (PHPT) is increasingly suspected in elderly patients after the discovery of hypercalcemia by routine measurement of serum calcium levels. Surgery is commonly accepted as the optimal treatment of PHPT. We wanted to assess risk and results of neck exploration in elderly patients with PHPT. METHODS: We performed a retrospective study of the charts of 78 patients older than 75 years (mean age, 79.1 years) with PHPT who underwent neck exploration during a 15-year period. RESULTS: The most common presenting symptoms were neurologic and psychiatric disorders (47 patients). Preoperative localization investigations, performed in 72 patients, were successful in 42 of them (sensivity, 58%). Single adenoma, double adenomas, and hyperplasia were found in 74 patients (95%), three patients, and one patient, respectively. Overall postoperative mortality was 3.8% (three patients) with no death since 1984. Significant complications occurred in three patients (4%): one myocardial infarction, one pulmonary embolism, and one cerebral hemorrhage. Average length of postoperative hospital stay was 4 days. Among patients who could be followed up (65 cases with a mean follow-up of 3 years), 94% reported an improvement in their symptoms. This was especially marked for fatigue and intellectual function. CONCLUSIONS: These data support a liberal approach regarding surgical treatment in elderly patients with PHPT.

Adenoma↗
PubMed1995

[Abdominal surgical emergencies in human immunodeficiency virus (HIV) infected patients. Apropos of 34 cases].

From September 1986 to September 1994, 34 emergency laparotomies were performed in human immunodeficiency virus (HIV) seropositive patients. Patients were divided into 2 groups. Group A included 11 HIV seropositive patients without acquired immunodeficiency syndrome (AIDS). In these patients, indications for exploration included right lower quadrant pain consistent with appendicitis in 6 patients, right upper quadrant pain consistent with cholecystitis in 3 patients, small bowel obstruction in 1 patient, and blunt abdominal trauma in 1 patient. No postoperative deaths were observed. Group B included 23 AIDS patients. Indications for exploration were diffuse peritonitis in 8 patients, right lower quadrant pain consistent with appendicitis in 6 patients, right upper quadrant pain consistent with cholecystitis in 5 patients, bowel obstruction in 2 patients, diffuse abdominal pain in 1 patient, and massive rectal hemorrhage in 1 patient. The mortality rate in this group was 35% (8 out of 23 patients). Five of the 8 patients with diffuse peritonitis died postoperatively (62%). The importance of early diagnosis and prompt surgery is emphasized to improve the prognosis in AIDS patients, because of their poor general condition and the severity of abdominal complications.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Neurological complications of liver transplantation in adult versus pediatric patients.

Neurological complications are important contributors to morbidity and mortality after liver transplantation. We reviewed 391 patients who underwent 427 consecutive orthotopic liver transplantations to analyze the clinical features of patients who experienced one or more neurological complication (74 patients [19%]) and to compare postoperative neurological problems in adults versus children. Neurological complications were more frequent in adults (64 of 273 patients [23%]) than children (10 of 118 patients [8%]) (P < 0.01). The most common neurological complication was encephalopathy (59%), which ranged widely in severity and occurred with similar frequency in adults and children. Other common neurological complications were seizures (12 patients), brachial plexus and peripheral nerve injuries (16 patients, 15 of whom were adults), stroke (5 patients), and central nervous system infections (5 patients). In 27 patients, drug toxicity was the primary cause of neurological complications, all of which reversed with dosage reduction or discontinuation of drug. Cyclosporine and FK506, primarily during intravenous administration for induction of immunosuppression, accounted for 25 of 27 drug-induced neurological complications, which included encephalopathy, seizures, severe tremor, and severe headache. Despite a higher rate of neurological complications in adults, those in children were more severe and associated with a higher mortality rate. When compared with liver transplant recipients without neurological complications, patients with neurological complications had a higher posttransplant mortality rate (14% vs. 5% for adults, and 50% vs. 7% for children). In conclusion, neurological complications after liver transplantation are more common in adults, more severe and associated with a higher mortality rate in children, and associated with a higher mortality rate in both children and adults when compared with transplant recipients without neurological complications.

Adult↗
PubMed1994

Comparison of transjugular and surgical portosystemic shunts on the outcome of liver transplantation.

OBJECTIVE: To analyze the effect of previous transjugular intrahepatic portosystemic shunt (TIPS) vs surgical portosystemic shunt (SPS) on the outcome of orthotopic liver transplantation (OLT). DESIGN: A case series of 38 patients who underwent OLT: 25 with a previous TIPS and 13 with a previous SPS. SETTING: A liver transplant center and interventional radiology service in a private, tertiary referral medical center. PATIENTS: Eighteen men and seven women who had a TIPS before OLT were compared with nine men and four women who had an SPS before OLT. MAIN OUTCOME MEASURES: Operative transfusion requirements, operative time, length of hospital stay, postoperative liver chemistry studies, and graft and patient survival. RESULTS: Compared with patients who had an SPS, patients who had a TIPS had significantly less median transfusion requirements for packed red blood cells (5 vs 12 U), fresh-frozen plasma (0 vs 8 U), and thrombocytes (0 vs 1 U). The median operative time (9 vs 13 hours), length of intensive care unit stay (3 vs 5 days), and length of hospital stay (12 vs 24 days) were also significantly less in patients who had a TIPS. The 2-year actuarial patient survival rate was 92% in both groups. CONCLUSIONS: In patients undergoing OLT, TIPS is associated with reduced operative transfusion requirements, operative time, and length of intensive care unit and hospital stays compared with SPS. In the potential liver transplant candidate with refractory complications of portal hypertension, TIPS is preferred to SPS.

Adult↗
PubMed1993

Pancreatic insulinomas.

We report a series of 30 patients with pancreatic insulinoma treated from 1967 to 1990. Twenty-nine patients underwent surgery. In 24 patients, the lesion was a benign adenoma. The pancreatic lesion was localized preoperatively in 59% of cases (94% since 1980), and all lesions that were identifiable histologically were palpable intraoperatively. Endoscopic pancreatic ultrasonography, performed twice, appeared to be a very promising method of investigation. In the 24 patients with adenoma, 14 enucleations and 10 pancreatic resections were performed, with the enucleation rate increasing over time. One patient died during the postoperative period. Pancreatic fistulas (43%) were the most common cause of morbidity and were more common after enucleation (57% versus 29% after pancreatectomy). The mean follow-up period was 7 years. Excluding the patients with adenocarcinomas, the recovery rate was 92% (23 of 25 among whom 2 patients had transitory recurrent hypoglycemia), 2 patients who underwent corporeo-caudal pancreatectomy being diabetic (8%).

Adenocarcinoma↗
PubMed1993

Severe blunt trauma of the liver: study of mortality factors.

One hundred three victims of blunt trauma of the liver with serious hepatic lesions (classes III through V of Moore's classification) were seen over a period of 18 years, the total duration of this retrospective study being divided in two: 1973-1981 and 1982-1990. During the first period, indications for hepatic resection were extensive (56% of all surgical procedures), and overall perioperative mortality was 24%. Preference was shown for conservative treatment during the second period (71% of patients) and there was an increase in perioperative mortality to 34%. This increase was not attributable to the decrease in the number of excisions but rather to an increase in the severity of hepatic lesions between the two periods (the rate of class V lesions rising from 17% to 26% of cases) and the rate of multiple trauma (rising from 41% to 95%), with mortality linked to the presence of extra-abdominal lesions rising from 20% to 50% of all deaths. These results may bring into question the validity of conservative treatment for liver trauma at the present time.

Adolescent↗
PubMed1993

[Unusual association of somatostatin-secreting thyroid cancer and a calcitonin-secreting duodenal endocrine tumor. Is it an entity?].

We report a patient with a vesicular thyroid carcinoma secreting somatostatin and associated to an endocrine duodenal calcitonin secreting tumour. Increase of plasm somatostatin level induced an endocrine syndrome which completely resolved after thyroidectomy. By contrast, the digestive tumour remained asymptomatic. Six months after surgery, the course was marked by a relapse of the thyroid tumour along with pulmonary metastasis. At that time, pathological analysis showed only indifferentiated tumoural tissue.

Aged↗
PubMed1993

The surgical treatment of Graves' disease.

A series of 215 patients treated surgically for Graves' disease between 1981 and 1988 were studied and compared with an earlier series of 105 patients operated upon in the same establishment between 1966 and 1980. More than 85 percent of the patients in the two series had long term follow-up evaluation. Surgical complications were rare in both series, with an overall morbidity rate of 2.7 percent, the rate of permanent recurrent laryngeal paralysis decreasing from 1 to zero percent and that of permanent hypoparathyroidism increasing from 1.0 to 1.9 percent. The incidence of residual or recurrent hyperthyroidism decreased markedly from 11.0 to 3.7 percent. This improvement can no doubt be attributed to bilateral subtotal lobectomy having been abandoned in favor of total lobectomy on one side and subtotal on the other. In contrast, this approach increases the incidence of hypothyroidism, with the rate rising from 13.0 to 48.7 percent. Long term monitoring is always necessary because results change during the course of time.

Adolescent↗
PubMed1991

Hepatic trauma: experience with 135 consecutive liver injuries (1982-1989) and arguments for conservative surgery.

Most hepatic traumas are easily cured, but the series of 135 consecutive hepatic wounds reported in the present paper is unusual in that the patients were specifically recruited from among patients subjected to neurosurgical or spinal operations, 25% of whom sustained severe hepatic injuries (classes IV and V) as a result of the surgery. The postoperative mortality was analyzed according to such potentially predictive factors as severity of the hepatic wound, the concomitant extraabdominal lesions, the initial shock, and the kind of surgical treatment. The statistical comparison of the factors affecting the results was analyzed by the Chi-square test. The postoperative mortality rate was 24.4% (33 deaths). This mortality rate is evidently related to the severity of the hepatic lesions and to the frequent associated lesions. The 14 deaths from benign and moderate hepatic injuries were due to concomitant lesions. Among the 19 deaths from severe lesions, 12 were directly related to the severity of the hepatic injury and 7 to associated wounds. Complications directly related to the hepatic trauma occurred in 39 cases with 16 deaths. In general, conservative surgical treatment can be performed with quite low mortality. Among the patients who require hepatic resection one of two dies of hemorrhage or coagulopathy. Among conservative procedures, perihepatic packing has proved to be efficient and safe. If perioperative cholangiography has excluded any leak from a major bilde duct, septic complications are rare. Therefore, the surgical treatment of hepatic trauma should be as conservative as possible, because this can stop hemorrhage and decrease the risk of coagulopathy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

[Thyroid abcess. Apropos of 5 cases].

Thyroid abcess and acute suppurative thyroiditis are uncommon, representing 0.1 to 0.7% of surgically treated thyroid pathologies. More common in children than in adults, this rarity is associated with poorly indicative clinical symptoms, thus making diagnosis difficult. Five cases reports are presented, 4 of them in adults, illustrating the diagnostic difficulties and the various etiopathological mechanism, thereby explaining the wide diversity of pathogenic agents responsible. Treatment includes surgery (drainage or (partial) thyroidectomy, depending upon the presence or not of an underlying thyroid pathology) and intravenous antibiotics. It is absolutely necessary to eliminate the source of the infection, often a piriform sinus fistula whose total resection effectively prevents a relapse (1 case in this series).

Abscess↗