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Biomedical subjects

H Richelme

Publications and source records attributed to H Richelme.

105 records · Page 6Linked to original sources
PubMedDate not supplied

Infectious complications of endoscopic retrograde cholangio-pancreatography managed in a surgical unit.

The immediate infectious pancreato-biliary complications of endoscopic retrograde cholangiopancreatography (ERCP) warranting transfer to a surgical unit are analyzed, in order to evaluate their frequency and severity as well as means of treatment and prevention. Thirty complications of this type were observed in a series of 3226 ERCP performed with or without endoscopic sphincterotomy (ES) over a six year period (0.9%). ES had been performed in 12 of 30 cases, but the complication could not be attributed to the procedure. Post-ERCP complications included: acute cholangitis: 16 cases (53%); acute cholecystitis: 8 cases (26%); acute pancreatitis: 4 cases (13%); infected pancreatic pseudocyst: 2 cases (6%). The global mortality rate was 16.6% (five patients): Four of the deaths were due to septic complications. Twenty-seven of the 30 patients underwent surgery, and three of them died (11%). Acute cholangitis was responsible for most of the deaths (four of five) and the mortality appeared related to the long interval before surgery (three of four deaths). Strict adherence to good endoscopic procedures (aseptic conditions, injection without excessive pressure, antibiotic prophylaxis) and decompression of the biliary tract (nasobiliary drain or transhepatic catheter) should help reduce the frequency of post-ERCP complications, and especially cholangitis, which appears to benefit from early surgical treatment.

Acute Disease↗
PubMedDate not supplied

[Conservative treatment of epidermoid cancer of the anal canal combining radiotherapy and curietherapy. Experience at the Antoine-Lacassagne Center].

From 1973 to 1987, 33 patients aged from 46 to 86 years (25 female, 8 male) were treated for a tumour of the anal canal with radiotherapy and curietherapy. Tumour distribution was 7 T1, 19 T2, 7 T3, and 4 patients were N+. After treatment it was possible to assess 31 patients; 29 were in complete remission, remission was obtained in 2 others following surgery. Tolerance was comparable to other series but 4 patients developed necrosis of the anal canal; 2 patients died under general anesthesia and 1 patient had a radiation injury of the small intestine. The sphincter was conserved in 65 p. cent of cases. Relapse occurred in 8 patients within 6-92 months, and 6 patients developed metastases. Overall survival was 78 p. cent at 3 years and 74 p. cent at 5 and 10 years. Disease-free survival was 65 p. cent at 3 and 5 years and 52 p. cent at 10 years. Our results confirm those of other series using a similar treatment plan. This treatment is difficult to put into practice. Patients must be carefully selected preferably by a team including proctologist, surgeon and radiotherapist.

Aged↗
PubMedDate not supplied

[Strategy and results in the treatment of squamous cell carcinoma of the anal canal. A review of 51 cases (author's transl)].

In this retrospective study of 51 patients treated for squamous cell carcinoma of the anal canal some aspects of the natural history are touched upon. The authors also discuss their results and define their current therapeutic approach. It is a rare lesion; only 2-3% of all colorectal cancers with a predominance for women (4 to 1) and of 2 histological varieties. The epidermoid type (74%) is made more prevalent though the basal layer type (26%). The prognosis is very poor once the stage T, is passed. The simultaneous finding of a primary lesion and associated inguinal lymphadenopathy is of serious consequences. The proposed therapeutic schema consists of: --Radiotherapy exclusively for T1 lesions. --Preoperative radiotherapy and abdominoperineal resection for all large lesions T3-T4. --For the intermediate T2 lesion: initially radiotherapy (2,500-4,000 rads) followed by careful reevaluation under general anesthesia to define whether further curie-therapy or surgical resection when an unsatisfactory response.

Adult↗
PubMedDate not supplied

[Study of 241 epitheliomas of uterine cervix (T1-T2) treated by radio-surgical procedure (author's transl)].

A casuistic study of 241 epidermoid cancers of the uterine cervix treated at the Cancer Center in Nice is analysed depending upon various protocols. The cases are studied according to the stage and type of treatment, with indication of the incidence of lymph node involvement. Surgical or radiological procedure, pelvic-node-vaginal recurrence, modalities of death and survival control at five years are detailed. Results reveal the advantage of a radio-surgical procedure.

Carcinoma↗
PubMedDate not supplied

[Perforations of the colon and rectum during administration of barium enema. Six cases report (author's transl)].

Perforations of the colon and rectum during administration of barium enema. Six cases report. The authors have stated six cases of accidental perforation occurring during barium enema examination. They recall their principal modality of unexpected arrival, in particular: the type of nozzle used, the means of injecting the contrasting liquid, the role played by the pathological associated colon-rectum lesions. The diagnosis may be postponed especially when the perforation is under the peritoneal seat. The pain during or after the opacification as well as the rectorragies are the most frequent alarming symptoms observed. The prognosis is on the whole serious but is can be improved by a rapid and appropriate therapy.

Aged↗
PubMedDate not supplied

[Cancer of the gastric stump. Apropos of 14 recent cases].

14 primary cancers of the gastric stump developing after low partial gastrectomy for a benign ulcerative gastroduodenal lesion have been treated in 7 years (1976-1982). The necessarily cautious criterion of definition is a postoperative interval of over 15 years. Indeed, it seems very unlikely that a gastric cancer could remain unrecognised and asymptomatic throughout this period. This personal series, together with a review of the recent literature (352 cases), makes it possible to clarify various facts concerning this non-fortuitous anatomic and clinical entity. The clinical aspect is quite characteristic, marked after a silent latent interval (average postoperative delay 27 years) by epigastric pain, vomiting, dysphagia and eventual change in general condition. The frequency is increasing, even though gastric cancer is on the decline whatever the geographic zone considered (in France from 1952 to 1968 the incidence per 100,000 inhabitants fell from 27.2 to 19 per cent). The average frequency of cancer of the gastric stump is estimated as 2.5 per cent of the totality of cancers of the stomach. The risk of developing a cancer of the gastric stump varies around 3 per cent in those undergoing gastrectomy for an ulcer. Moreover, this risk increases with the passage of time. The marked preponderance of the male sex remains unexplained. The initial site of the ulcer is so often unknown as to permit no definitive conclusion. It must therefore be considered that cancer of the gastric stump is really the direct consequence of the surgical procedure of excision.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMedDate not supplied

[Tumor markers in the follow-up of colorectal cancers].

The aim of this work was to review the usefulness of tumour markers in the follow-up of colo-rectal cancers after operation. The carcinoembryonic antigen (CAE) is the most sensitive marker for early detection of relapse. It can be combined with CA 19-9 assay, increasing the sensitivity and specificity of the tests. These assays are useful because one half of the relapsing tumours can be resected leading to a survival rate of 40%. CAE and CA 19-9 must be assayed within 2 months to 2 years after surgery to be effective screening tests. Presently, the widespread use of labelled monoclonal antibodies can, in certain tests, localize recurrent tumours before a second look operations.

Antibodies, Monoclonal↗
PubMedDate not supplied

[Neuroma of the common bile duct].

After a surgical operation on the biliary tract, stenoses can occur, most of the time due to fibrotic lesions, and more rarely due to granulomas or traumatic neuromas. The latter generally develop on the cystic stump after a cholecystectomy. The occurrence of a traumatic neuroma on the common bile duct is much more rarely described. We report the case of a 64 year-old man presenting, four years after a surgical removal of the gallbladder, with a cholangitis, due to neuroma located on the choledochus. He was treated by surgical resection of the common bile-duct at the site of the stenotic zone, and choledocojejunal anastomosis; post-operative course was satisfactory.

Cholangitis↗
PubMedDate not supplied

[Prognostic factors in colorectal adenocarcinoma].

Aim of this study was to analyse prognostic factors of improved survival after resection of colorectal cancer. We studied 715 patients by retrospective review operated for colorectal adenocarcinoma. Survival was analyzed by the Kaplan-Maier method. Comparisons were made by log rank analysis. The overall survival is 75% at 1 years, 41.0% at 5 years, 29.7% at 10 years. A significant difference was noted in the survival rate according to age of the patients (p < 0.01), preoperative serum level of carcinoembryonic antigen (CEA) (p < 0.05), the performance status (p < 0.05), intestinal obstruction (p < 0.01), clinicopathological stage of the tumour (p < 0.05). Other factors including the sex, the clinical diagnosis of anaemia, the site of the tumour and histological grade had no apparent influence on survival. To define high-risk groups of recurrence is important for adjuvant therapy and follow-up study.

Adenocarcinoma↗