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Biomedical subjects

H Blanchard

Publications and source records attributed to H Blanchard.

At least 73 records · Page 4Linked to original sources
PubMed1987

Hemodynamic changes in portal circulation after portosystemic shunts: use of duplex sonography in 43 patients.

Forty-five patients with 46 surgical portosystemic shunts were examined by duplex Doppler sonography, and the results were compared with those of esophageal endoscopy, angiography, surgery, and clinical follow-up. Thirty-eight shunts were patent, and in 33 of these, the shunt was directly visualized and flow was observed with Doppler sonography. Eight shunts were obstructed. After a successful portosystemic shunt procedure, flow in the shunted splanchnic vein was directed toward the shunt and the systemic vein. We studied the intrahepatic portal venous circulation in all of the patients; we found that in the presence of patent portosystemic shunt, portal flow is hepatofugal. This reversal of blood flow occurred in all but four patients. In the end-to-side portacaval shunt, where the portal vein is ligated, blood in intrahepatic portal branches presumably reaches the shunt through perihepatic collaterals. In the presence of a thrombosed shunt, intrahepatic portal venous flow was hepatopetal. To our knowledge, this is the first noninvasive in vivo study of intrahepatic portal circulation after portosystemic shunt surgery. The duplex Doppler evaluation of portosystemic shunts appears to be reliable and should be the method of choice for shunt patency assessment in patients with recurrent signs of portal hypertension. In addition to demonstrating flow at the site of the anastomosis, the Doppler study may yield an easy and reliable sign of shunt patency: reversed flow (hepatofugal flow) in the intrahepatic portal veins probably signals a patent shunt, even if the site of the anastomosis cannot be visualized directly by sonography.

Adolescent↗
PubMed1987

[Hepatobiliary scintigraphy using 99m Tc-DISIDA and obstructive cholangiopathy in children].

Technetium 99m-labeled diisopropyl iminodiacetic acid (99m Tc-DISIDA) hepatobiliary scintigraphy of 26 patients with pathologically proven infantile obstructive cholangiopathy are retrospectively studied according to two types of criteria. Those of type 1 consider 1) hepatocyte clearance 2) hepatobiliary transit time and 3) visualisation of intestinal activity. For biliary atresia, sensitivity of 88.2%, specificity of 88.9%, positive predictive value of 93.8% and negative predictive value of 80.0% were obtained. For neonatal hepatitis, those parameters were 57.1%, 94.7%, 80.0% and 85.7% respectively. Criteria of type 2 identify only biliary atresia. They consider 1) presence or absence of intestinal radioactivity through 24 hours and 2) birth weight. Sensitivity, specificity, positive and negative predictive values were 88.2%, 88.9%, 93.8% and 80.0% respectively. Even if all these values are inferior to many reported in literature, we consider that the two types of criteria are relatively sensitive and specific to detect biliary atresia. Even through there are a few false negatives, biliary scintigraphy does remain one of the most important diagnostic tests in the context of biliary atresia.

Biliary Atresia↗
PubMed1986

Partial splenectomy for benign cystic lesions of the spleen.

Cystic lesions of the spleen are uncommon, about 600 cases being reported in the world literature. This report concerns three pediatric patients treated by partial splenectomy for benign cyst. In the world literature most of the cystic lesions of the spleen are treated by splenectomy and more recently by partial splenectomy. The infected lesions are treated by splenectomy or by incision and drainage only. Partial splenectomy has evident advantage over splenectomy. Although in the world literature we have not found a single case of infected splenic benign cyst treated by partial splenectomy, we believe that this procedure also has an advantage over drainage as the infected and necrotic part of the cyst is removed, thereby reducing morbidity and further possible complications.

Adolescent↗
PubMed1986

Tracheal growth after resection and anastomosis in puppies.

Tracheal morphology, morphometric changes, and growth and histologic changes were studied in puppies submitted to tracheal resection and anastomosis. Fifteen mongrel puppies about 12 weeks old and weighing on an average 5.5 kg were operated under general anesthesia using fluothane. A median cervicotomy incision was made in ten puppies (experimental group, EG) and the proximal 14 tracheal rings were resected (average length 5.08 cm or about 35% to 38% of total tracheal length). One layer anastomosis was done using vicryl 4.0 maintaining the average tension of 1,450 g. Five puppies (control group, CG) were submitted to tracheal transection and anastomosis and the following parameters were studied. Tracheal morphology the trachea of the EG was a rounded triangle whereas in the CG it was oval in shape, there was increase in the intercartilageneous spaces in the EG, no granulation tissue was present, two mucous webs were seen in the EG and one in the CG. Morphometric changes average tracheal length EG 13 cm, CG 17.7 cm, intercartilagenous space EG 3.08 mm, CG 1.3 mm, intercricothyroid space EG 1.2 cm, CG 0.53 cm, sagittal and transverse tracheal thickness at the anastomosis EG 2.6 and 3.3 mm, CG 2 and 1.5 mm, sagittal and transverse diameter reduced on an average 2 mm in EG. Histology Moderate fibrosis was found at the level of anastomosis with no modification of chondrocytes at the cartilagenous rings in the EG. Even with high anastomotic tension, the dogs had normal tracheal growth without stenosis; the sagittal and transverse growth at the anastomosis in the EG was 90% and 85%, respectively, when compared with the CG.

Animals↗
PubMed1984

[Splenic injuries: therapeutic orientation. Apropos of 46 cases].

Between 1979 and june 1983, 46 splenic trauma, with or without associated lesions, have been treated at Sainte'-Justine's Hospital. 8 children had a splenectomy, 3 had a laparotomy for other lesions without a splenectomy was done. 35 had a non operative management of splenic trauma. The ultrasound shows the splenic lesions and the blood in the peritoneal cavity. So, the "Routine Abdominal TAP" does not seem necessary in every abdominal trauma. The splenic scintigraphy is, for, now, the best exam to confirm the diagnosis and to assess the resolution of splenic lesion in 1 to 4 months. Transfusions were done in 8 of 11 operated patients and in 11 of the 35 children wo underwent a conservative management. The average stay in the hospital was 11 days in these 35 last patients. No mortality or morbidity were in relation with the conservative management in our series. The exact diagnosis of splenic trauma by ultrasound and scintigraphy allows the pediatric surgeon to choose a non operative treatment, when the child has stable vital signs. Monitoring these patients in intensive care unit is mandatory and allows a careful evaluation of the course of these splenic trauma.

Adolescent↗
PubMed1983

[Cure of esophageal atresia types 1 and 2. Deferred primary anastomosis. Apropos of 6 cases].

From 1976 to 1981 six patients with esophageal atresia types 1 and 2 underwent a successful delayed primary anastomosis. At birth a gap between the upper and lower pouch (5 to 7 vertebras) was present. 9 to 14 weeks later, at surgery, the mean gap was 3 vertebras and the anastomosis was carried out without excessive tension. No upper pouch elongation was done before surgery and end-to-end esophageal anastomosis was accomplished without the need of circular myotomy. All patients are alive and well after a follow up period from 6 months to 6 years. We have to mention post-operative complications; 3 anastomotic extrapleural leaks were managed conservatively by peripheric parenteral nutrition, 1 post operative tracheo-esophageal fistula required a closure and 2 patients with a symptomatic gastro-esophageal reflux were managed by antireflux fundoplication. No anastomotic stricture was observed. The functional results are excellent.

Down Syndrome↗
PubMed1982

[Kasai's operation for extrahepatic bile duct atresia: a cure or palliative treatment?].

The only surgical treatment currently available for patients with extrahepatic biliary atresia is portoenterostomy or portocholecystostomy, the Kasai operation. Seventeen such patients were operated upon at the Hôpital Sainte-Justine; 11 had bile excretion. Eight are still alive 12 to 60 months after operation. They have good to fair bile excretion. Twelve of the 17 patients had infectious or hemorrhagic complications and hepatic deficiency is evident in 6 of the 8 living patients. The progressive deterioration of liver function in the majority of the patients still alive raises the question of whether the Kasai procedure should be considered a curative or only a palliative procedure.

Bile Duct Diseases↗
PubMed1982

Surgical treatment of Crohn's disease.

Of 93 children with Crohn's disease treated at the Hôpital Sainte-Justine between 1967 and 1979, 39 were operated on. Ten had abscesses and anal fistulas drained and in 29 the bowel was resected. The mean age of the children was 13 years. The average time between onset and diagnosis for both the medical and surgical groups was 13 months. Medical treatment failed in 25 patients after an average time of 22 +/- 17 months. Fourteen patients had an initial laparotomy, with a false diagnosis of appendicitis in 8, abdominal tumour in 2 and Meckel's diverticulum in 1. Indications for operation were: intestinal obstruction, bowel fistula, intra-abdominal abscess, gastrointestinal hemorrhage, growth failure and toxic megacolon. There were no deaths and only two postoperative infections. Crohn's disease seems to be becoming more frequent, more severe and starting earlier in life. Three to 6 weeks of preoperative preparation with enteral and parenteral nutrition allows operation to be performed under safer conditions. Although the recurrence rate after operation is still high, there is no doubt that the children enjoy a better quality of life, growth and a 50% chance of being disease-free 10 years later.

Adolescent↗
PubMed1979

Neurogenic tumors and VIP-induced diarrhea.

The authors report a case of cervical ganglioneuroblastoma associated with intractable watery diarrhea and hypokalemia. The probable physiopathologic mechanism of the diarrhea and its relation to the vasoactive intestinal peptide secretion (VIP) by the tumor are discussed.

Diarrhea, Infantile↗
PubMed1979

Assessment of Brescia-Cimino fistula blood flow rates in pediatric patients.

Blood flow rates were measured using an isotopic dilution method in the main drainage segments of Brescia-Cimino arteriovenous fistulas in 9 pediatric patients who had undergone successful renal transplantation, 3 patients on hemodialysis and 2 patients with end-stage renal disease. Blood flow rates varied from 68 to 882 ml/min. The possibility that such high flow rates may have deleterious effects on limb growth, cosmetic appearance and cardiac function without any benefit to the patient is discussed.

Adolescent↗
PubMed1979

[Treatment of hyperthyroidism in childhood and adolescence (author's transl)].

33 cases of hyperthyroidism have been treated at "L'Hôpital Sainte-Justine" of Montréal, during the period 1961-1974. Nearly all patients were submitted to medical treatment. 15 were cured with medical treatment only, and 18 had to be submitted to a subtotal thyroidectomy. These two groups are compared and show the clear advantage of surgery in the treatment of this disease. There was no major post-operative complication. Two patients became definitively hypothyroid. The mean follow-up is five years and six months.

Adolescent↗
PubMed1975

The pathogenesis of intestinal atresia.

The records of 28 patients with duodenal and 31 with jejunoileal intestinal atresia or stenosis were studied. Vomiting and abdominal distention were the most prominent symptoms; an unusual colon may be present in jejunal as well as ileal obstruction and is not pathognomonic for ileal obstruction. Intestinal atresia is associated with a high incidence of preterm babies but with a low incidence of intrauterine growth retardation. Fifty-three infants were operated upon; the overall survival rate was 79 per cent. The high percentage of mortality in duodenal obstruction is due to associated malformations. Theories of the pathogenesis of intestinal atresia do not seem to fit current clinical and experimental evidence in all patients. Possibly, different factors play a role in separate situations.

Abnormalities, Multiple↗