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Biomedical subjects

J C Ollier

Publications and source records attributed to J C Ollier.

At least 37 records · Page 2Linked to original sources
PubMed1991

Colorectal cancer in patients over 80 years of age.

Between January 1, 1973, and December 31, 1986, 1,734 patients underwent colorectal resections for carcinoma. Patients were divided into two groups: Group I included 163 patients aged greater than or equal to 80 years on first presentation; Group II comprised 1,571 patients aged less than 80 years. The total perioperative mortality rates for the elderly and young group were 15.3 percent and 5 percent, respectively (P less than 0.001). The surgical mortality rates after elective operations in Groups I and II were 7.4 and 4.5 percent, respectively, and were not statistically different. Emergency surgery was associated with a significantly higher incidence of perioperative deaths at any age (P less than 0.001). In the elderly group, most deaths (88 percent) resulted from complications of coexisting medical disorders or thromboembolic complications. The 5-year survival for the young and elderly group were 46.2 percent and 35 percent, respectively (P less than 0.05). However, excluding patients dying from nonmalignant disease, the 5-year survival rate did not differ significantly between the two groups of patients (49.5 percent vs. 41.2 percent).

Adenocarcinoma↗
PubMed1991

[Role of pancreaticojejunostomy in the treatment of chronic pancreatitis. A study of 105 operated patients].

105 patients with intractable pain due to chronic pancreatitis were selected for treatment by lateral pancreatico-jejunostomy (according to the procedure of Partington Rochelle) after pre operative endoscopy had revealed a dilatation of the main pancreatic duct (mean : 6 mm). Pancreatico-jejunostomy was the unique procedure in 59 patients; it was associated with a biliary or duodenal diversion in 46 others patients. 2 patients died post-operatively and 12 required a second operation some years subsequent to the pancreatic drainage, for biliary stenosis due to the progress of the sclerosis. 8 of the 22 late death were in direct relation with the persistence of alcohol intake and 4 others died from an extra pancreatic cancer. Peptic ulcer complicating pancreatico-jejunostomy appeared in three patients and two of them died from hemorrhage. Mean observation time was 65 years. Long term results were excellent or improved in 93.4% what pain relief concern, but the progression of exocrine or endocrine pancreatic insufficiency indicates that decompression of the dilated pancreatic duct does not prevent continuing destruction of pancreatic glandular tissue. In spite of these good results, the rational for duct drainage as a mean to decrease the intraductal pressure secondary to stricture is unclear. Neither the patency of the anastomosis, nor the presence or not of pancreatic lithiasis or the size of the dilated pancreatic duct seem to be crucial for pain relief after pancreatico-jejunostomy. Notwithstanding of the dubiousness of the mechanism of action of the drainage procedure, pancreato-jejunostomy remains the most effective procedure for relief of pain in chronic pancreatitis with dilated duct.

Adolescent↗
PubMed1990

[Coloproctectomy with ileo-anal pouch. A simplified technique].

Coloproctectomy with pelvic ileal pouch allows normal transit while preserving and sphincter function. Using stapplers facilitates the construction of the ileal reservoir. Avoiding distal mucosectomy makes the anastomosis with the rectal stump easier and eliminates the need for a protective ileostomy as well as the morbidity associated with its closure.

Anastomosis, Surgical↗
PubMed1990

Progress in the assessment of lymphatic spread in rectal cancer. Rectal endoscopic lymphoscintigraphy.

Rectal endoscopic lymphoscintigraphy was performed in 10 control subjects and in a series of 85 patients with adenocarcinoma of the rectum as a prospective study to evaluate lymphatic drainage of the rectum and lymphatic spread in rectal cancer. Complete cranial drainage was demonstrated in all control subjects, and internal iliac nodes were also visible in 50 percent of cases. Results were correlated with histologic node examination in all patients operated upon for rectal cancer. Rectal endoscopic lymphoscintigraphy was assessed for sensitivity (85 percent), specificity (68 percent), overall accuracy (76 percent), positive predictive value (71 percent), and negative predictive value (83 percent). False-negative and false-positive results are discussed. Rectal endoscopic lymphoscintigraphy represents the only method currently available for evaluation of lymphatic spread in rectal cancer.

Adenocarcinoma↗
PubMed1990

[Colonic cancers. A retrospective study of 1122 surgically-treated patients].

A retrospective study of 1122 cancers of the colon operated by the same surgical team from 1973 to 1989 makes a number of statements possible: In spite of the improved diagnostic means, 66 (5.8%) only of the cancers were of Dukes' type A. 116 patients had complications, ie. perforation in 9 cases and obstruction in 107, among which 59 were operated within 24 hours. The rate of resection is very high: 93.8%. In 8.1% of all cases the excision was extended because of invasion of neighboring tissues. Curative resection was performed in 844 patients, while surgery was palliative in 278, including 205 excisions. The total operative mortality was 5.8%, sinking to 3.9% for curative surgery. It is as high as 22% in emergent surgery. Since 1981, it has been lower than 1% and only caused by general factors. The survival rate of 557 patients after more than 5 years is 46.6%. This rate was studied according to various parameters (sex, location, features of excision, Dukes' stage, involvement of lymph nodes). Lymph node involvement and Dukes' stage are the only factors having a significant influence on survival. In 90.0% of cases, the long-term death of patients followed up for more than 5 years is caused by hepatic metastases (66.6%), local recurrence (13.3%) or both (20%). The occurrence of local recurrence or hepatic metastases can sometimes be treated by second surgery, which has been performed in 20 patients: 11 hepatic resections with a 26.8% survival at 5 years, and 9 excisions for local recurrence with 12.4% survival at 5 years.

Adult↗
PubMed1990

[Superficial gastric cancer. Report of a series of 57 cases].

We have studied a total of 395 patients with gastric cancer during the past 16 years 57 of whom presented with superficial gastric cancer. The most frequent symptom was gastric pain in 47 patients. Barium weal was not helpful in the diagnosis and failed to define the nature of this disease in 43 patients. Endoscopy enabled visualization of an abnormality in 55 patients, the lesion seen was considered to be compatible with a diagnosis of superficial gastric cancer in 42 cases. The combined results of endoscopy and biopsy diagnosed malignancy in all cases, but a sufficient number of endoscopic biopsy specimens must be taken (5 to 7). Cases of superficial gastric cancer had an 24% incidence of other non gastric malignancies in our series. All patients were treated by surgical resection. The tumor was confined to the mucosa in 38 patients and had infiltrated the submucosa in 19 patients. Four patients had lymph node metastases. The five year actuarial survival was 75% for all the patients and 85% when the lesion was confined to the mucosa. In contrast, the five year survival for the 283 patients with resected gastric cancer was only 23%. Although the prognosis of superficial gastric cancer is remarkably good, patients should be carefully followed over a long period for late recurrent (one patient in our series) of the primary cancer and possible metachronous cancer of other organs.

Actuarial Analysis↗
PubMed1990

[Hepatic metastasis of colorectal cancer. Should it be surgically treated? Report of 55 cases].

Surgical resection currently represents the best chance of improving survival for some patients with hepatic metastases (H.M.) of colorectal origin. Out of a total of 288 patients with H.M. from colorectal cancer, 55 only had a surgical exeresis (hepatectomy or removal of the metastasis). These were 36 cases of synchronous H.M. and 19 of metachronous H.M. The operative mortality is as high as 2%. The overall actuarial survival rate at 5 years is 19.6%. The single-factor analysis of the factors connected with survival reveals 2 deciding factors: the margin of normal peritumoral hepatic parenchyma resected (p less than 0.01) and the degree of tumoral differentiation (p less than 0.05). A preoperative CEA level higher than 30 ng/l may be a pejorative factor (p less than 0.05). The results of this series are likely to be improved: 1 degree by a better selection of the patients scheduled for resection, especially as it is necessary to extend resection into the normal parenchyma more than 1 cm from the tumor, and 2 degrees by the addition of an adjunctive regional chemotherapy.

Adult↗
PubMed1989

[Can the prognosis of patients treated surgically in cancer of the rectum or colon be improved by follow-up? Prospective study of 909 patients].

Outpatient follow up may be performed to detect early recurrence or metastasis in the hope to be cured by further surgery. 909 patients have been prospectively followed after resection for cure of colorectal carcinoma. The mean duration of this follow up was 48 months. 1. Only 322 (35.4%) patients agreed to be submitted to an strict regiment of frequent check up. 2. Only 92 recurrences were diagnosed at times of follow up, the 308 others were discovered between regular follow up examination. 3. Only 32 recurrences out of 92 detected by the follow up schedule were totally without symptoms. 4. In the follow up group 30 patients (32.6%) benefited from second surgery versus 7 for the others (7.8%) p less than 0.001. 5. The comparison about the five years actuarial survival rates between the follow up group and the others is statistically significant: p less than 0.01.

Adult↗
PubMed1988

[Trans-sutural anastomosis. A technical procedure which facilitates the low colorectal anastomosis].

How colorectal anastomosis using a circular suture forceps introduced transanally can be considerably facilitated by the "trans-sutural" anastomosis technique, this avoiding the sometimes difficult operative phase of the distal bursa and allowing reduction of septic phase and performance of anastomosis of surfaces of identical caliber. Crossing of clipping lines, of linear and circular shape, resulting from use of this method lacks any inconveniences. Results are reported in 66 patients treated in this way, confirming the reliability of this type of anastomosis.

Adult↗
PubMed1987

[Technical modification facilitating low colorectal anastomosis by mechanical suture].

The creation of a low colorectal anastomosis with an EEA or ILS stapler is considerably facilitated by the trans-suture anastomosis technique which avoids the sometimes difficult stage of distal purse. The crossing of circular and linear stapled closures has no untoward effect on the anastomosis. Our experience in 46 patients confirms that this technique is reliable.

Adult↗
PubMed1987

Does the histologic appearance at the margin of resection affect the postoperative recurrence rate in Crohn's disease?

Is there a role for radical surgery in the management of Crohn's disease or is it feasable to perform limited resections without increasing the risk of recurrence? Fifty eight patients with Crohn's disease underwent resection with subsequent anastomosis. A follow-up of at least 3 years (range, 3-15 years) was undertaken in all cases. All resected specimens at primary surgery were reviewed by one gastrointestinal pathologist to evaluate, retrospectively, the influence of residual microscopic disease at resectional margins on recurrence rate. No statistically significant difference was reported between patients with involved margins and those without such findings as to recurrence rate, interval between primary surgery and reoperation at site of recurrent disease. This review does not provide evidence for adverse influence of residual microscopic disease at the margins of resection. Therefore, limited resection of macroscopically diseased bowel is recommended. One must bear in mind the high rate of recurrence with the necessity of reresection.

Adolescent↗
PubMed1985

[Does the histological status of the surgical section have any influence on the follow-up of Crohn disease treated surgically?].

Can we decrease the risk of recurrence of Crohn's disease by wide resection on either side of the pathological zone? A retrospective study of 58 cases of operated Crohn's disease analysed on the basis of the histological appearance of the limits of resection revealed that this element had no influence on the outcome of the disease. The patients were divided into two groups according to the histology of the limits of resection: Group A: healthy tissue at the limits of resection Group B: pathological limits Out of the 18 cases of recurrence, 13 occurred in cases with healthy limits of resection and 5 occurred in cases with pathological limits of resection (N.S. X2 = 0.435). There was no significant difference in the interval between the initial operation and the recurrence in the 2 groups of patients. These results justify the limited resection for Crohn's disease, with the removal of a small border of healthy tissue, which is best evaluated by intraoperative macroscopic examination.

Adolescent↗