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Biomedical subjects

H Joyeux

Publications and source records attributed to H Joyeux.

At least 73 records · Page 4Linked to original sources
PubMed1986

Internal jugular vein cannulation using 2 silastic catheters. A new, simple and safe long-term vascular access for extracorporeal treatment.

Subclavian vein cannulation, although a major progress in temporary vascular access, was associated with a significant morbidity and mortality. A safer alternative technique would therefore be welcome. For the last 2 years, we developed a new approach consisting in internal jugular vein cannulation (IJVC) with 2 silicone rubber catheters with a long-term proved biocompatibility. 138 pairs of cannulae were inserted in 129 uremics patients. Mean duration of use was 54 days (1 day to 17 months). More than 3,000 high-performance HD sessions were performed. IJVC handling and care was easily managed by nurses. Low incidence of complications was observed: 2 thrombosis episodes, 3 skin infection with 2 septicemiae, 1 air embolism, 1 anaphylactoid reaction. No death was related to the technique itself. IJVC offers a new method of percutaneous central vein cannulation, providing a safe and reliable temporary vascular access immediately usable for all kinds of extracorporeal treatment.

Adult↗
PubMed1986

Single photon emission computerized tomography (SPECT) for monitoring regeneration of the human liver after partial hepatectomy for secondary tumours.

In 18 patients, the liver volume during regeneration after partial hepatectomy for secondary tumours was estimated by single photon emission computerized tomography (SPECT). Hepatic weight index (HWI) was subsequently calculated to follow evolution of the regeneration as a function of postoperative complications over a 30-day period. In patients with postoperative complications the HWI curves initially rose progressively and either reached a plateau or declined thereafter. The same pattern of HWI evolution was observed in patients with tumour recurrence, which was diagnosed later. On the other hand, in patients without postoperative complications the HWI curves rose continuously. These findings showed that a regenerative response was not the same in patients with or without postoperative complications; whereas in patients with tumour recurrence it could additionally provide prognostic information.

Adult↗
PubMed1986

[Cannulation of the internal jugular vein with 2 silastic catheters. A new method of vascular access for hemodialysis].

The internal jugular vein cannulation (IJV) using two silastic catheters (CT) is a new vascular access method for temporary and immediate use in hemodialysis. From November 1982 to November 1984, 138 pairs of CT were used in 129 uremic patients for a mean duration of 54 days per patient (1 to 17 months) permitting to carry out more than 3000 dialysis sessions. Five complications were observed: 3 skin exit infections with 2 septicemias cured with antibiotics and CT removal, 2 vascular thrombosis treated with urokinase and anticoagulant; 1 anaphylactoid reaction at the time of insertion. IJV CT offers a convenient alternative to conventional percutaneous vascular access method that can be safely proposed in long term hemodialysis.

Anaphylaxis↗
PubMed1986

[Muscular tumors of the esophagus. Apropos of 9 cases and review of the literature].

Between 1970 and 1983, nine cases of tumors of esophageal muscle and connective tissue were treated at the Centre Paul Lamarque. Leiomyoma (LM) (6 cases in this series) represented 0.8% of esophageal tumors reported from among 1,200 patients, while leiomyosarcoma (LMS) (3 cases in this series) were observed in 0.25%. LM is usually detected fortuitously and is asymptomatic, LMS provoking dysphagia of the "foreign body" type contrasting with the "monstrosity" of the radiologic image. Endoscopy and biopsy is justified only when LMS in suspected, since it could interfere with enucleation. Treatment is surgical, by enucleation without mucosal effraction for LM and esophageal resection for LMS. Adjuvant therapy has failed to provide evidence of efficacy.

Adult↗
PubMed1985

[Hepatic metastases. Medicosurgical treatment or priority to surgery?].

Not all patients with liver metastases should be referred to the surgeon. Selection is necessary, based on the patient's general and hepatic condition, on the nature of the primary cancer and on the intra-hepatic spread of the metastases. At the moment, less than 1% of patients with metastatic liver are operated upon. In the absence of clinical or biochemical evidence of hepatic dysfunction, surgical specialists may consider operating patients under 75 with synchronous or metachronous metastases from colorectal cancer or endocrine tumours. If clinical and laboratory evaluation is favourable, the decision to operate and the type of partial hepatic resection selected depend on pre-operative investigations which are, successively: ultrasonography, computerized tomography, radioisotope scanning and possibly arteriography for endocrine tumours (not all these examinations are necessarily required). Other possible referrals are patients with liver metastases from non-colorectal or non-endocrine primary tumours of low evolutive potential, as evaluated by changes in levels of biological markers and by monthly morphological studies of metastatic tissue over 3 to 6 months. The major limiting factor in these patients is previous heavy chemotherapy which makes this type of surgery extremely hazardous. Recently published data justify primary surgical reduction of the tumour followed by systemic or regional chemotherapy at the end of the liver tissue regeneration period. In marker-dependent subjects the susceptibility to chemotherapy of the remaining malignant tissue can be evaluated by changes in marker levels if these were still above normal values after partial hepatectomy.

Adenocarcinoma↗
PubMed1985

Testosterone secretion is severely impaired after hepatectomy in rat, dog and man.

In 90%-hepatectomized rats, the plasma testosterone level (0.34 +/- 0.07 ng.ml, mean +/- SEM) is significantly lower (P less than 0.001) than in sham operated male rats (1.7 +/- 0.26 ng.ml, mean +/- SEM). In dogs, after 90% hepatectomy, the mean plasma testosterone concentration fell to 1/10 of the plasma testosterone level measured in sham operated animals either 24 or 72 h after surgery. In hepatectomized men, plasma testosterone is markedly decreased in contrast to what is observed after duodeno-pancreatectomy performed under the same conditions of anesthesia. These results suggest that 90% hepatectomy severely alters the Leydig cell function.

Animals↗
PubMed1985

[Liver function after 65% hepatectomy in the dog: role of pancreatic blood flow].

The effects of different types of porto-systemic shunts were judged on vitamin D 25-hydroxylation and proaccelerin synthesis, in 65% hepatectomized dogs. Three types of shunts were performed: termino-lateral porto-caval shunt, mesenterico-caval shunt and spleno-pancreatico-caval shunt. The mesenterico-caval shunt provided better results than the other shunts, probably because of a better preservation of pancreatic hormone supplies to the liver.

Animals↗
PubMed1985

[Cancer of the endometrium: analysis of the comparative results and causes of failure in radiosurgical treatment and physical agents alone. 215 cases treated between 1968 and 1978].

Two groups of patients (215 cases) with endometrial cancer were treated between 1968 and 1978 either by a combination of radiotherapy and surgery or by radiotherapy alone. In the first group (99 cases) with a mean age of 59 years, results were very favorable for stage T1 and T2 (49/60, 82%) which confirm other results in the literature. The combination of radiotherapy and surgery comprising external irradiation and intracavitary irradiation prior to total hysterectomy did not appear to increase the number of complications to the urinary or digestive tracts. The second group (116 cases) comprised patients treated exclusively by radiotherapy due to the presence of metastatic disease (74 cases) or excessive local-regional extension (37 cases). The cure rate at 5 years appeared satisfactory for stage T1 (35/54, 65%). The differing results between combined radiotherapy and surgery with methods using radiotherapy alone should be partially corrected to take into account the older average age of the second group (69 years). Failures due to the appearance of metastases were approximately similar in both groups (near 6%); on the other hand, local-regional recurrences were more frequent when radiotherapy alone was used, which accounts for the differing results between the two groups. In the second period (1972 to 1978), the group treated exclusively with radiotherapy benefited from a technique used with cervical cancer: external irradiation followed by intracavitary irradiation with a Fletcher-Suit applicator with results similar to those treated in the first period with intracavitary irradiation.(ABSTRACT TRUNCATED AT 250 WORDS)

Endometrium↗
PubMed1985

[Epithelial tumors of the ovary. Therapeutic results apropos of 165 cases of stage II and III tumors].

A report on the treatment of 165 epithelial tumours of the ovary (60 of which were stage II and 105 were stage III) by medical means after surgery. The results are far better in stage II cases for the length of survival without disease and the 5 year survival rate when surgical excision was complete (40 months and 43%) as compared with the disease-free interval and survival when surgical excision was incomplete (14 months and 27%) (p less than 0.05). There was a significant difference (p less than 0.05) in favour of pelvic and total abdominal irradiation as compared with other added therapeutic measures: 41 months as a median of disease-free interval and 60% survival at 5 years for patients who had pelvic and total abdominal irradiation combined with chemotherapy as against 26 months and 38% survival for patients who had only pelvic irradiation with chemotherapy. In the 105 stage III cases the median interval of disease-free survival and the survival at 5 years are quite different (p less than 0.01) for the 57 cases who had complete surgical excision (30 months and 17.5%) as compared with those who only had incomplete surgical treatment (1.4 months and 2%). There was no significant difference in the disease-free interval and the 5 year survival rate according to the different post-surgical therapeutic measures, whether these were chemotherapy alone or pelvic irradiation or pelvic and abdominal irradiation. These results are compared with those of other treatments following surgery of tumours of the ovary (a historical comparison and random trials).

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1984

[Regional pancreatectomy in the treatment of pancreatic adenocarcinoma. Apropos of 41 cases].

Out of 88 carcinomas of the pancreas observed from 1973 through 1981, 41 regional total (19 patients) or subtotal (22 patients) pancreatectomies were performed. Routine histological examination of 12 lymph nodes areas and pancreatic peritoneal involvement were used to determine three stages: 1) stage I without metastatic lymph nodes involvement (18 patients), 2) stage II with peripancreatic metastatic lymph node involvement (14 patients), 3) stage III with pedicular and/or retroperitoneal metastatic lymph node and/or peritoneal involvement. Six patients died in the postoperative period (14.6 p. 100). Complications were infections (11 patients), pancreatic anastomotic leakage after subtotal pancreatectomy (11 patients), digestive bleeding (8 patients). No patients need insulin two months after subtotal pancreatectomy. After total pancreatectomy diabetes mellitus was controlled by 0.30 UI/kg/day of insulin (mean). The three years survival was 38 p. 100 (Kaplan-Meier). In the author's experience, regional pancreatectomy seems to be the best surgical procedure in patients with carcinoma of the pancreas except in patients with poor general condition, age over 75, and stage III.

Adenocarcinoma↗
PubMed1983

[Segment I of the liver or spigelian lobe. Anatomic study and surgical value].

Spigel's lobe, or segment I of the liver, currently represents the "smallest amount of hepatic parenchyma capable of regeneration". It is an autonomous lobe by virtue of its site and vasculo-biliary distribution, a true "accessory" liver connected to the "main" liver. Lesions of Spigel's lobe are rare, which is explained by the anatomy of the portal bifurcation. Hence the value of making every effort to preserve this segment during hepatectomy because of the possibilities of additional hepatic vein drainage. Segment I surgery is difficult and falls within the context of extended hepatectomies. Can Spigel's lobe be considered to be a "safety liver"? The possibility of subtotal hepatectomy, retaining only segment I, is being studied in the animal. It may be possible in man in the case of extensive hepatic lesions where only segment I is unaffected, as soon as effective artificial liver support is developed.

Animals↗