[Bullous dystrophy of the lung. Percutaneous resection by Endo GIA].
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Biomedical subjects
Publications and source records attributed to G Champault.
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Between the simple parietoplasties reserved for small eventrations and the insertion of non-resorbable prostheses, veritable "second" walls for large parietal defects, the place of a resorbable prosthesis is still open to debate. The latter acts, in fact, as a temporary internal contention at a time when the wall is weakened by the repair operation and is exposed prematurely to recurrence. A true "reinforced parietoplasty", this technic was used in 42 patients over" the last four years, without mortality or infectious complication and with only one partial recurrence after a mean follow up of 28 months.
325 implantable catheters (PAC) were successfully used for treatment of 310 patients with neoplastic diseases in 21 French medical centers. 263 were placed in central venous sites; 43 in the hepatic artery and 11 in intra-portal sites. There was no failure at insertion time nor was there any death attributable to the method. While average duration of catheterization was 182 days, 72 catheters remain patent after one year of use or longer. Occlusion risk was found to be 3.6%: 1.5% for IV sites and 13.9% for intra-arterial sites (due to smaller inner diameter). 2.4% of the implantations showed cutaneous necrosis and in 2.7% sepsis occurred. Sepsis was much more likely to occur after percutaneous insertions. These results support the use of this device for long term chemotherapy.
Synthetic absorbable sutures, copolymers of sugars absorbed slowly by hydrolysis within defined periods of time and well tolerated by tissues, are resistant to infection and in biological fluids. They represent, after 15 years of use, more than 50% of suture material employed in surgery, and although limited for a long time to thread they are now available as trellis, clips, visceral prostheses and staples in all surgical disciplines. Future perspectives are discussed.
The authors report their experience of the surgical treatment of duodenal ulcer disease and its complications over a 10 year period (1976-1986), i.e. 336 cases from a group of 10748 digestive tract endoscopies performed and 1126 duodenal ulcers identified (10.4%). The efficacy of new types of medical treatment (anti-secretory drugs, endoscopic hemostasis techniques, prostaglandins) and the improved follow-up of patients tend, despite the value and proven safety of Parietal-cell Vagotomy (elective procedure in 76% of the group), to modify: the epidemiological aspect of the disease in the sense of a decrease in the rate of ulcers with complications related to stenosis and perforation; the therapeutic aspect with more limited surgical indications. Is this the end of surgery for duodenal ulcer and its complications?
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Non-woven textiles are still not widely used in France, despite the great variety of their presentations. These products are clearly superior to traditional textiles in terms of a bacteriological barrier, which results in a lower rate of post-operative sepsis. It costs the same or less than classical textiles and it reduces the tasks of personnel and administration. Its presently limited used is essentially due to the reticence of surgeons, based on a poor understanding of the products and a psychological barrier which is difficult to overcome.
Three hundred and twenty five implantable catheters (PAC) were used in the treatment of 319 patients with neoplastic disease in 21 French centers. Two hundred and sixty three were inserted in central venous position, 43 in hepatic artery and 11 were intraportal. There were no failures at the time of insertion nor any deaths imputable to the method. Whilst the mean duration of use was 182 days, 72 catheters remain patent after one year of use or more. The risk of obstruction is 3,6% : 1,5% for I.V. sites and 13,9% in intra-arterial because internal caliber are smaller. There were 2,4%, of cases of skin leakage or necrosis and sepsis rate was 2,7%, more frequent er after percutaneous insertion. These result justify the use of this device in long term chemotherapy.
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Cellular immunity was assessed in 120 patients by simple skin tests (tuberculin, candidine, varidase, C.C.B., trichophyton). There is a close relationship between total anergism and the risk of severe infection in digestive surgery, and between anergism and deficient nutrition as determined by laboratory and anthropometric criteria. Preoperative correction of nutritional deficiency, which is often underestimated, has an inconstant effect upon skin test responses, but seems to decrease severe postoperative infective complications.
Perforation into the free peritoneum of ulcers of the neck of hiatal hernias is a rare complication. On the basis of one case, which would appear to be the third reported in the literature but the only one in which the special circumstances resulted in the diagnosis being made preoperatively, the authors propose a new therapeutic attitude based upon the physiopathology of ulcers of the neck, combining suturing and reduction of the hernia with anterior repositioning of the greater curvature of the stomach, mobilised according to Thal's technique, and thereby simultaneously producing an anterior hemi-valve.