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Biomedical subjects

G Breton

Publications and source records attributed to G Breton.

At least 37 records · Page 2Linked to original sources
PubMed1996

Is laparoscopic adrenalectomy indicated for pheochromocytomas?

BACKGROUND: Since the introduction of laparoscopic adrenalectomy there has been major concern about proper indications for its use, including in pheochromocytoma. In this study we reviewed pheochromocytomas resected by means of laparoscopy to establish that procedure's usefulness. METHODS: Between January 1992 and June 1995, 90 laparoscopic adrenalectomies were performed in 82 patients. Three to five trocars were used intraperitoneally in each patient to remove the gland, and extraction was performed with a sterile plastic bag. RESULTS: Twenty-three pheochromocytomas were operated on. Six patients had a bilateral adrenalectomy. Pheochromocytomas were significantly larger than other tumors, required more operating time, and necessitated longer hospital stays in patients. Of all the intraoperative complications 87% occurred in the pheochromocytoma group; 67% of all postoperative complications occurred in this group. In four patients metastasis from pheochromocytoma to the liver was unexpectedly found, and in one case metastasis from a medullary thyroid carcinoma was found. There has been no local recurrence after laparoscopic adrenalectomy. CONCLUSIONS: Laparoscopic adrenalectomy for pheochromocytomas is difficult because tumors are larger and more complications are seen related to their hormonal secretions, in spite of adequate pharmacologic blockade. However, metastatic extensions can be diagnosed and laparoscopic ablation can be performed in most instances without recurrence. It is not, therefore, a contraindication for this approach.

Adrenal Gland Neoplasms↗
PubMed1996

Clinical impact of contrast-enhanced MR imaging reports in patients with previous lumbar disk surgery.

OBJECTIVE: We wanted to assess the clinical impact of the reports of contrast-enhanced MR imaging on the decision to repeat surgery and on the results of repeat surgery in patients with previous lumbar disk surgery. SUBJECTS AND METHODS: We interviewed 257 patients who had undergone lumbar disk surgery and who showed symptoms suggesting persistent or new disk herniation. We conducted our interviews 6-18 months after patients had undergone contrast-enhanced MR imaging. We then correlated patient outcome with original MR findings. RESULTS: Fifty-two patients underwent new surgical procedures after their MR examination. Findings of disk herniation on MR images were associated with a significantly greater frequency of repeat surgery. The size of main herniation seen on MR images was also a significant variable. Patients with Worker's Compensation Insurance files had significantly worse prognoses: Only two (8%) of 26 of these patients reported 50% improvement 1 year after repeat surgery. However, only 6 (23%) of 26 non-Worker's Compensation patients reported 50% improvement 1 year after surgery. CONCLUSION: Despite its documented high anatomic accuracy, the clinical usefulness of enhanced MR imaging for patients with previous lumbar disk surgery needs further evaluation. In our series, findings of disk herniations on enhanced MR examinations were associated with a greater frequency of repeat surgery, but such surgery relieved symptoms in few patients. The influence of enhanced MR imaging on the decision for repeat surgery and on the type of surgery may be misleading. Selection criteria for repeat surgery need to be reassessed using rigorous outcome research protocols.

Adult↗
PubMed1995

Focal sparing of liver parenchyma in steatosis: role of the gallbladder and its vessels.

The purpose of this study was to determine the prevalence and localization of focal areas of sparing in a population of patients with fatty infiltration (steatosis) of the liver. We also sought to determine if the blood supply of the gallbladder has an effect on fatty infiltration of the liver adjacent to it. We studied 290 patients with sonographic signs of fatty infiltration of the liver with gray scale sonography. In 58 of the patients, the gallbladder had been removed previously. A zone of focal sparing was found in 67% of patients with liver steatosis (78% in patients with an intact gallbladder versus 33% in patients with previous cholecystectomy). In patients with an intact gallbladder, segments 4 and 5 were spared most often. These segments were rarely spared in patients with previous cholecystectomy. Other sites of focal sparing were observed with the same frequency in the two groups. We conclude that focal sparing occurs frequently in patients with liver steatosis, especially in segments 4 and 5. When the gallbladder is absent, areas of focal sparing are less frequent, and they rarely involve segments 4 and 5. This suggests that the blood supply of the gallbladder plays a role in the distribution of the fat in the adjacent liver. Focal sparing might serve as an additional sign in the diagnosis of steatosis of the liver, especially in patients with an intact gallbladder.

Adolescent↗
PubMed1995

Doppler sonography of the inferior mesenteric artery: a preliminary study.

The purposes of this study were to look for the inferior mesenteric artery in patients undergoing abdominal sonography, to determine in what percentage of patients it is visible, and to characterize Doppler flow patterns of the inferior mesenteric artery in fasting patients without intestinal vascular disease. The inferior mesenteric artery was sought in 100 consecutive fasting adults (mean age, 54 years; 63 women, 37 men), as follows: the infrarenal aorta was scanned in a transverse plane; the origin of the inferior mesenteric artery was identified on the left anterolateral surface of the aorta; the inferior mesenteric artery was then traced caudally along the left side of the aorta. The inferior mesenteric artery and the superior mesenteric artery were studied with Doppler sonography in 50 different subjects without clinical or Doppler sonographic evidence of abdominal vascular disease (mean age, 44.9 years; 17 men, 33 women). Pulsed Doppler samples were taken within the inferior mesenteric artery in sagittal planes. The resistive index was calculated from the superior mesenteric artery and the inferior mesenteric artery. The inferior mesenteric artery was detected in all but eight patients (92%). In seven patients obesity prevented visualization. The eighth patient had undergone abdominal surgery on the previous day, limiting the sonographic examination. The diastolic flow in the inferior mesenteric artery was less than that in the superior mesenteric artery in all patients. The resistive index was 0.959 +/- 0.045 in the inferior mesenteric artery and 0.856 +/- 0.046 in the superior mesenteric artery (P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Radiating pain to the lower extremities caused by lumbar disk rupture without spinal nerve root involvement.

PURPOSE: To locate the origin of the pain during lumbar diskography by means of a limited intradiskal injection of a local anesthetic. METHODS: Lumbar diskography by the direct central posterior approach was performed in 235 consecutive patients. In 17 patients, severe and persistent low back pain, with unilateral or bilateral radiation to the lower extremities, was provoked by contrast injection into only one disk. One milliliter of 1% lidocaine was then slowly injected in the center of these disks. RESULTS: A 75% to 100% reduction of the low back pain was experienced by 13 patients, and a 75% to 100% reduction of the radiating pain was experienced by 16 patients within 60 seconds after the intradiskal injection of lidocaine. Radiographs demonstrated radial tears through the entire annulus thickness in 16 of 17 disks. CONCLUSION: Our results suggest that, in some patients with low back pain and unilateral or bilateral radiation to the lower extremities, the pain arises from within the disk. In these cases, pain radiating to the lower limb seems to be a referred type and seems unrelated to direct nerve root compression or irritation by a disk fragment in the epidural space.

Adult↗
PubMed1993

Hepatic artery: effect of a meal in healthy persons and transplant recipients.

Thirty healthy volunteers and 12 liver allograft recipients (two with cirrhotic changes seen at microscopy) were given a standard meal. Doppler sonography of the right and left hepatic arteries, the superior mesenteric artery, and the portal vein was performed. The change in hepatic arterial resistance was evaluated with the resistive index (RI). After the standard meal, portal venous flow increased in both the healthy volunteers and allograft recipients (more so in the latter group). Superior mesenteric arterial RI decreased in all subjects. A postprandial increase in hepatic arterial RI, likely reflecting constriction of the hepatic artery, was seen in both groups. It was absent in the two patients with recurrent transplant cirrhosis. These results show the importance of examining hepatic arterial flow in the fasting subject, since high resistance after a meal may be falsely interpreted as a sign of disease. Absence of a postprandial change in resistance of the hepatic artery could signal abnormal liver function.

Adult↗
PubMed1992

Patent paraumbilical vein: anatomic and hemodynamic variants and their clinical importance.

Fifty-five of 353 patients with suspected portal hypertension studied with Doppler sonography had a patent paraumbilical vein. Of these 55 patients, 39 had the classic intrahepatic venous circulation found in Cruveilhier-Baumgarten syndrome: hepatopetal flow in all segmental portal veins and hepatofugal flow leaving the liver in a paraumbilical vein in the falciform ligament to join veins of the anterior abdominal wall. Sixteen patients had variants of the classic pattern: Flow in one or more segmental portal veins of the left lobe or the entire liver was hepatofugal. In addition, new venous channels connecting the left portal vein with the extrahepatic paraumbilical vein were found. Assessment of liver function with the Pugh score showed severe impairment in the majority of patients with a patent paraumbilical vein. Patients with the classic intrahepatic circulation had smaller esophageal varices than those with hemodynamic or anatomic variants. The presence of a patent paraumbilical vein did not prevent formation of esophageal varices in the patients studied.

Adolescent↗
PubMed1992

Evaluation of pulmonary function in laparoscopic cholecystectomy.

Historically, values of pulmonary function tests, when taken on the day after open upper abdominal surgery and cholecystectomy, show decreases of 45% to 60% compared with preoperative determinations. In a group of 54 consecutive patients in whom many pulmonary function parameters were studied, forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1), measured the morning after laparoscopic cholecystectomy, revealed a 22% decrease (3.31/2.59 L) and a 21% decrease (2.68/2.11 L), respectively, on average compared with preoperative values, demonstrating better pulmonary function after laparoscopic cholecystectomy. Furthermore, there was no difference between patients above or below 60 years of age and between smokers and nonsmokers. Improved pulmonary function after laparoscopic cholecystectomy may account for the observed reduced rate of pulmonary complications after laparoscopic cholecystectomy.

Adult↗
PubMed1991

Air in the portal vein: sonographic and Doppler manifestations.

Three patients with portal venous gas (one with radiographic and computed tomographic findings) had similar sonographic and Doppler patterns in the portal vein (PV). These patterns consisted of hyperechogenic foci moving within the lumen of the PV, producing sharp bidirectional spikes superimposed on the usual Doppler tracing of the PV. An injection of 0.25-0.50 cm3 of air, oxygen, nitrogen, and carbon dioxide into the jejunal vein of nine dogs yielded identical portal venous sonographic and Doppler patterns. In addition, the liver parenchyma of the dogs became hyperechogenic after the injection of gas. Gas in the PV is accompanied by the following signs: echogenic, moving foci within the lumen of the PV; sharp spikes on Doppler spectral display; and hyperechogenic foci within the liver parenchyma.

Adult↗
PubMed1991

Segmental anatomy of the liver: a sonographic approach to the Couinaud nomenclature.

The authors developed a simplified description of the segmental anatomy of the liver on the basis of the Couinaud nomenclature. This approach was demonstrated with normal in vivo sonographic images and livers dissected in corresponding planes. The branches of the portal vein, which lead to the center of individual segments, are used as key landmarks in the determination of segmental location. The hepatic veins, ligaments, fissures, and gallbladder are used as external boundaries of the segments.

Adolescent↗
PubMed1991

[Clinical and hemodynamic evaluation of cholecystectomies performed under laparoscopy].

Hundred patients who underwent laparoscopic cholecystectomy and 25 consecutive patients where multiple hemodynamic parameters were measured were included in the study. The mean operative time was 84 minutes and operative cholangiography was selective. No deaths and five major complications were reported. Months after laparoscopic cholecystectomy, two patients needed open surgery for pathology missed at initial exploration. One patient sustained minor trauma to the biliary tree. Despite generally normal vital signs and few cardiac arrhythmias, cardiac output dropped in many patients during laparoscopic cholecystectomy. This was specially marked at the end of peritoneal insufflation when the Fowler position was assumed, emphasizing the need for close anesthetic monitoring, specially during the first half hour of this procedure.

Adolescent↗
PubMed1990

Temporal lobe abnormalities in panic disorder: an MRI study.

Brain mapping studies have shown abnormal changes in cerebral blood volume and oxygen consumption, or other neurophysiological abnormalities, in panic disorder (PD) patients. Because of these intriguing reports, we decided to assess the neuroanatomical aspects of patients with PD using magnetic resonance imaging (MRI). We included 31 consecutive cases with a diagnosis of PD according to the DSM-III criteria, and 20 controls. All subjects had to be right-handed and between 20 and 40 years of age. The usual exclusion criteria were applied. We carried out the MRI tests with a General Electric Signa Machine operating at 1.5 Tesla. Over 100 images were obtained per patient with an emphasis on assessing temporal lobe. There were no significant differences in age, gender, or weight between the patients and controls. We found a statistically significant higher number of abnormalities in PD patients (40%), as compared with the controls (10%). The most striking findings were focal abnormalities in the temporal lobes: areas of abnormal signal activity, and asymmetric atrophy of the temporal lobe occurred mostly on the right side. These results implicated the limbic system and may prove to be of particular relevance in panic and phobic disorders. However, the significance of our findings remains unknown and challenging. Further MRI studies in PD will be required for a better understanding of the illness.

Adult↗
PubMed1989

Effect of corticosteroids on post-intubation tracheal stenosis.

A 57 year old patient presented with progressive tracheal stenosis two months after intubation. An intraluminal polypoid lesion was found at the site of the cuff of the endotracheal tube. It disappeared within five days of treatment with inhaled beclomethasone. Further improvement of forced expiratory and inspiratory flow occurred after systemic corticosteroid treatment, with resolution of peritracheal oedema. Topical and systemic corticosteroids may be useful in the management of early post-intubation tracheal stenosis.

Adrenal Cortex Hormones↗
PubMed1989

Correlation of severity of panic disorder and neuroanatomical changes on magnetic resonance imaging.

Thirty consecutive lactate-sensitive panic disorder patients were studied with magnetic resonance imaging (MRI) to investigate the relationship between temporal lobe abnormalities and panic disorder. Neuroanatomical abnormalities, most involving the right temporal lobe, were found in 43% of patients, compared with 10% of the control subjects. Patients with temporal lobe abnormalities were significantly younger at the onset of panic disorder and had more panic attacks compared with patients with normal MRI scans (p less than .05). These results suggest that panic disorder could be secondary to temporal lobe dysfunctions and that panic disorder patients with abnormal MRIs could have a worse prognosis than those with normal MRIs and would require long-term pharmacological treatment.

Adult↗