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Biomedical subjects

J Barbier

Publications and source records attributed to J Barbier.

At least 73 records · Page 4Linked to original sources
PubMed1991

Remote arteriovenous fistula with infrapopliteal polytetrafluoroethylene bypass for critical ischemia.

Between January 1985 and January 1989, 13 patients underwent femorotibial bypass using a polytetrafluoroethylene graft with a remote distal arteriovenous fistula. Indications for operation were gangrene in six patients, rest pain in five patients, and nonhealing ulcer in two patients. No patient had a usable autogenous saphenous vein. Eight patients had a previous failed femorodistal bypass. Standard femorotibial bypass was performed using a 6 mm thin-walled polytetrafluoroethylene graft. The distal remote arteriovenous fistula was done on the same artery. Warfarin was given postoperatively. Graft patency was assessed by duplex scan and digital arteriography. There was no postoperative mortality. All grafts and fistulas remained patent initially with improvement in symptoms and limb salvage. In the follow-up period there was continued graft patency in all but two patients who had a below-knee amputation. Three patients died with a patent graft. In two additional patients the graft remained patent but the fistula closed. We believe that in selected situations, the remote distal arteriovenous fistula is a potentially valuable adjunct for obligatory polytetrafluoroethylene femorotibial bypass.

Aged↗
PubMed1990

[Intestinal perforation occurring at the beginning of treatment: a severe complication of bacillary tuberculosis].

We report 2 cases of intestinal perforation caused by tuberculosis and affecting the small intestine in one case and the colon in the other case. The patients were men aged 49 and 51 years respectively. Both were cachectic and presented with advanced open pulmonary tuberculosis. Perforation in free peritoneal cavity occurred 2 and 8 days respectively after an antituberculous treatment was initiated. The outcome was rapidly fatal in both cases. Tuberculous enteritis has become rare, but it can still be observed in patients with severe open pulmonary tuberculosis, where the gastro-intestinal tract is contaminated by the large number of virulent mycobacteria swallowed. In such patients clinicians must be alert to abdominal premonitory signs. Intestinal perforations in free peritoneal cavity are uncommon. Most perforation are small, single or multiple, and located on the antimesenteric side of the terminal ileum. They may occur at any time, and particularly just after an antituberculous therapy has been instituted. Clinical presentation is one of acute peritonitis requiring emergency laparotomy. Mortality has been reduced by technical improvements, notably temporary enterostomy, but perforation remains a serious and often fatal complication of tuberculosis in patients with severe malnutrition.

Antitubercular Agents↗
PubMed1989

[Long-term results of surgery of primary hyperparathyroidism].

The late results of operation for primary hyperparathyroidism were analysed in 52 patients operated between 1971 and 1987. All patients have a minimal 5 years follow-up, and answered a mailed questionnaire concerning their present state of health and recent serum calcium level. Recurrent hypercalcemia occurred in 5.7%. Hypocalcemia occurred in 30% immediately after operation; in 11.5% at six months, and in 7.7% at the final follow-up. The pathogenesis of such hypocalcemia is discussed. 66% of patients with urinary calculi are cured after neck exploration and urologic procedure. Finally 86.6% of the patients are normocalcemic at the final follow up, acting for the efficient and lasting character of the surgical treatment in primary hyperparathyroidism.

Adenoma↗
PubMed1989

[A case of parathyroid adenoma localized in the middle mediastinum].

The discovery of a parathyroid adenoma in the middle mediastinum is exceptional and fewer than 10 cases have been reported. On the basis of a new case, the authors propose several pathogenic hypotheses: this adenoma develops and/or migrates from the fourth branchial pouch. Preoperative imaging is very useful for guiding the operation via sternotomy. The absence of any CT signs in the present case caused us to explore the retro-aortico-caval region. Sternotomies performed for the treatment of primary hyperparathyroidism are unsuccessful in one third of patients. In more than 30% of cases, the cause for this failure is related to the persistence of a cervical adenoma: when the pathological gland is actually located in the mediastinum, the possibility of middle mediastinal ectopia should be considered when investigation of the classical sites in the neck and mediastinum remains negative.

Adenoma↗
PubMed1988

[Treatment of major eventrations. Original use of polyglactin 910 plaques].

An original procedure for treating major incisional hernias is described. A polyglactin 910 plate is hemmed around the edges of the hernia, then tightened by degrees with wide separate stitches until these edges are closely approximated on the midline under low tension, all the forces being distributed over the whole surface of the plate. This procedure can be used alone or associated with another procedure.

Hernia, Ventral↗
PubMed1988

[Major hypertriglyceridemia, associated with severe acute pancreatitis, successfully treated with plasma exchange].

A 27 year-old alcoholic patient with severe acute pancreatitis (4 Ranson's objective prognostic signs), complained of abdominal pain and vomiting and presented fever and rigors. The plasma was of milky turbidity and the concentration of triglycerides (TG) very high (26 Mmol/l, Normal: 3-1.6). Serum pancreatic amylase was elevated (262 U/l, Normal: 10-200). The electrocardiogram (ECG) showed S-T depression. The diagnosis was confirmed by computed tomography which showed a pancreatic phlegmon and a collection in the left pararenal space (Ranson's grade D). After PE on days 1 and 2: the amylase became normal, plasma clear, TG decreased (7.8 Mmol/l), the clinical picture improved and the ECG normal. Assisted ventilation was necessary over 10 days. Pancreatic morphology remained unchanged. The patient was discharged to intensive care on day 18. There was no indication for surgery. The fast drop in TG levels, the precursors of free fatty acids, may have limited their toxicity the pancreas, allowing a difficult stage to be over come and the course of the illness to interrupted. Normalization of the ECG requires emphasis. The association of HG, increased plasma amylase and abdominal pain justifies early iterative PE.

Acute Disease↗
PubMed1987

[Primary cancers of the gallbladder. Apropos of a homogeneous series of 75 cases].

Seventy-five cases of primary carcinoma of the gallbladder are reviewed retrospectively under observation of a fifteen year period, representing 2.4 per cent of the number of biliary tract surgery performed during the same period. The majority of the patients presented with advanced disease with extension and metastases to the liver (56%) and to the adjacent organs (53.3%) and to the lymph nodes along the common bile duct (21.3%). Eleven patients had localized disease at the time of the operation; they were treated with cholecystectomy. Eight patients had clinically inapparent carcinoma at the time of the cholecystectomy; the diagnosis being established post-operatively by histologic examination of the excised gallbladder. There were no five years survivors in this second group of patients, but five of them are one year survival (62.5%) and one is still alive three years and six months after surgery. The remaining patients with inapparent carcinoma died within three years of the time of the operation. The present report emphasize the poor prognosis associated with carcinoma of the gallbladder and the presence of gallstones. Carcinoma of the gallbladder in our experience has proved curable only when accidentally discovered at cholecystectomy for presumed benign biliary tract disease. This fact plus the frequent and serious non neoplastic complications of neglected gallstones are strong indications for early elective cholecystectomy and extended resection may improve the survival rate.

Adult↗
PubMed1986

Papaverine-induced chronic liver disease.

The case history of a women with jaundice and laboratory evidence of chronic active hepatitis and cirrhosis is reported. The patient had taken papaverine for 6 yr for cerebral arterial disease. Jaundice improved after the drug was discontinued but reappeared when papaverine therapy was reintroduced. Antinuclear antibody and smooth muscle antibody were present. Clinical manifestations disappeared and laboratory results again returned to normal upon withdrawal of papaverine. This case suggests that papaverine should be added to the list of drugs known to produce chronic active hepatitis and cirrhosis.

Aged↗
PubMed1986

[Trapped popliteal vein and artery].

A report is made of 3 observations of vascular constrictions in the knee hollow of three young adults: two constrictions of the popliteal artery, one by abnormal insertion of a tendon of the gastrocnemius muscle and of the arterial passage, the other by a fibrous band surrounding the artery. In one observation, the disorder was revealed by acute ischemia of one limb. The third observation was of a sural phlebitis with secondary repetition at the constriction of the popliteal vein by Soleaire's arcade. In all cases examination using the Doppler effect, in baseline and especially dynamic position, gives a diagnosis and allows postoperative monitoring. Bilateral arteriography, both static and dynamic, allows a precise diagnosis to be given and reveals the extent of vascular lesions, which conditions the operative technique. Treatment is always surgical, with exploration of the contralateral side if a constriction is suspected, even if it is asymptomatic.

Adult↗
PubMed1985

[Changes in levels of plasma fibronectin after surgery for digestive cancer].

Fibronectin is a large, adhesive glycoprotein, also called opsonic alpha 2 surface-binding glycoprotein. This glycoprotein which participates in all adhesions may modulate wound healing; plasma fibronectin, because it is opsonically active, may mediate reticulo-endothelial activity. Citrated plasma samples were analysed from twenty surgical patients with digestive cancer. The samples were obtained preoperatively and on 1st, 3rd, 7th, 14th and 28th postoperative days. Fibronectin assay was made by laser immunonephelometry. Other samples were obtained from a population of 340 healthy male and female subjects whose age ranged from 10 to 70 years, so that reference could be made to the standard mean of fibronectin related to the age of each patient. In the surgical patients, there was a significant decrease in fibronectin from the first to the third postoperative day. On the 7th day, there was a secondary increase of fibronectin levels which exceeded the preoperative values at the 14th and 28th days. There was no plasma dilution when the samples were collected, this being shown by protidaemia, osmolarity and haematocrit which were measured at the same time. "Septic" and "non septic" patients were compared. For septic patients, fibronectin levels were lower and the secondary increase occurred later than in the non septic patients. Patients with no secondary increase did not recover and died. Fibronectin levels were compared with other classical parameters of nutritional assessment, i.e. albumin, prealbumin, transferrin and urinary creatinine indexes. These parameters were not well correlated. However, this study may indicate the usefulness of fibronectin as an indicator of nutritional status and of non specific host defence.

Aged↗
PubMed1984

[Generalized peritonitis of non-traumatic colonic origin. Reflexions on 62 cases].

The authors analyze sixty-two cases of acute generalized peritonitis with a non-traumatic colonic etiology. They point out that the prognosis depends on three main factors: the age of the patient, the time spent in diagnosis and the therapeutic difficulties. They recommend a gastrographin colonic enema to obtain earlier diagnosis, in the absence of radiological evidence of pneumoperitoneum, in elderly patients presenting with abdominal signs. They also recommend multistage surgical management combining effective drainage of the abdominal cavity with resection of the perforated segment of the colon, whenever there is extensive damage to the colon, or in the presence of a tumor. In their view, conservative surgery should be confined to strictly selected cases not involving tissue resection. These indications are essential if a satisfactory result is to be achieved.

Adult↗