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Biomedical subjects

J H Alexandre

Publications and source records attributed to J H Alexandre.

At least 19 recordsLinked to original sources
PubMed1992

[Chylous ascites caused by retroperitoneal neoplastic obstruction of lymphatic vessels. Treatment by peritoneo-jugular shunt. A case].

A case of chylous ascites due to retroperitoneal tumoral compression is reported. Following failure of a medical treatment which consisted of paracentesis and medium-chain triglyceride (MCT) diet, the ascites dried up after installation of a peritoneum-jugular vein shunt valve. This operation is seldom performed in patients with chylous ascites since the medical treatment with paracenteses, MCT diet or even total parenteral nutrition succeeds in drying the effusion in almost 50 percent of the cases, notably those with postoperative lesion.

Adenocarcinoma↗
PubMed1992

Percutaneous surgery of biliary cyst: a case report.

Biliary cysts are uncommon and often asymptomatic. Once symptoms occur, treatment is needed. Though percutaneous drainage is possible, the recurrence rate is high. Open drainage is associated with the morbidity of laparotomy. We report a case of laparoscopic treatment of a large biliary cyst.

Bile Duct Diseases↗
PubMed1991

[Hemorrhagic gastro-duodenal ulcers. In which cases should emergency surgery be performed?].

From January 1983 to December 1987, 127 patients with bleeding peptic ulcer were admitted to hospital. The mean age of the 85 males was 57 years and 72 years for 42 females. All but four of the patients were managed medically after emergency endoscopy. Twenty-seven patients required surgical operations (21.2%): seven for cataclysmic haemorrhage, eight for persistent haemorrhage, twelve for recurrent bleeding. An analysis of factors leading to the necessity of surgical haemostasis was undertaken by considering the clinical status, endoscopic findings and laboratory results. The size of the ulcer (greater than 2 cm) was the most significant parameter (less than 0.01). Five other criteria (rectal bleeding) shock, endoscopic signs of recent haemorrhage, gastric or duodenal posterior ulcer) were also significant (p less than 0.05). Considering the gravity of these patients (six deaths among twenty-seven), clinical trials in bleeding peptic ulcer disease should only include patients in the high risk group.

Adult↗
PubMed1991

[Cost of the surgical treatment of inguinal hernias].

The hospital stay of 100 patients admitted to hospital in 1988 for surgical repair of inguinal and crural hernias was analysed. Fifty-three per cent of patients were over the age of 60 years and more than one half of them has a medical history. There was no mortality and only a single serious complication. The mean hospital stay was 7.6 days, influenced by the age of the patients. The complementary investigations only constituted a small proportion of the cost of the hospital stay. The authors conclude on the necessity for further reduce the length of hospital stay (principal cost factor) and even propose day admission, although this alternative can only be proposed to a minority of patients.

Adult↗
PubMed1989

[Colonoscopic surveillance of patients operated on in colorectal cancer. Retrospective evaluation of 269 tests in 125 patients].

The ideal frequency of endoscopic surveillance of patients operated on for colorectal cancer is not known. We report our experience of colonoscopic follow up of 125 patients after excision of a colorectal cancer. The median interval between resection and the first check colonoscopy was 12 months. The median duration of follow-up was 28 months (range: 3 months to 10 years). 269 colonoscopies allowed diagnosis of 8 anastomotic recurrences within a median delay of 21 months after surgery (range: 3 months to 5 years). In 6 of these patients, the recurrence was clinically suspected. In 2 patients, it was asymptomatic and was discovered on systematic colonoscopy. Potentially curative surgery was only possible in 1 case. Follow up colonoscopies also allowed excision of 113 adenomatous polyps in 39 patients and the discovery of 4 new invasive cancers within a median delay of 7.4 years after excision of the first cancer. Due to the disappointing value of colonoscopy in the detection of anastomotic recurrences and the propensity of the remaining colon to develop new polyps, in the absence of a comparative trial, we arbitrarily adopted a follow up rhythm based on early post-operative colonoscopy (3 months post-surgery) and then yearly for the first 2 years. Further follow-up was similar to that adopted for patients with a past history of endoscopic polypectomy.

Aged↗
PubMed1989

[Surgery of pheochromocytoma. An approach apropos of 17 cases].

From a series of 17 recently operated cases, the authors report their experience, both in terms of diagnosis and preoperative assessment, and also in terms of operative technique. A confirmed biological diagnosis, accurate topographical diagnosis using CT scan or MIBG scintigraphy scanning, anterior route of approach and good medico-surgical cooperation enable the operative mortality and the morbidity to be reduced to a maximum.

Adrenal Gland Neoplasms↗
PubMed1988

[Peroperative echography in 14 cases of pancreatic insulinoma and gastrinoma].

Fourteen cases of endocrine tumors (10 insulinomas and 4 gastrinomas) were to studied by intraoperative ultrasonography (IOU). Localization was established by preoperative ultrasonography in 1/14, by CT scan in 1/11, by arteriography in 6/12 and by pancreatic venous sampling in 7/8. Tumor size ranged from 0.5 cm to 2.5 cm. Manual palpation was positive in 10/14. The tumor was accurately and completely localized by IOU in 9/10 insulinomas: the one false negative was probably due to micro-adenoma. The intrapancreatic tumor was localized only in 1/14 gastrinomas. Intraoperative sonography localized lymph nodes in all cases. One distal pancreatectomy was improperly performed because of an accessory spleen. After reviewing 59 other cases in the literature, we propose: a) to abandon venous sampling in insulinomas because of adequate performance of IOU; b) to use IOU as a complementary investigative method along with other preoperative methods of localization in gastrinoma.

Adenoma, Islet Cell↗
PubMed1988

[Mesocoloplasty of sigmoid volvulus. An alternative to colonic resection].

Based on 4 operations, the authors stress the value of intestinal preservation in subjects with poor general suffering from volvulus or with signs of sigmoid torsion by means of mesocolonoplasty. The technical simplicity of this operation allows it to be proposed in the course of laparotomies indicated for any other abdominal pathology.

Aged↗
PubMed1988

[Role and results of surgery in Crohn disease in adults].

Because of new medical treatments, the authors propose a review of the principal surgical indications in Crohn's disease in adults and the current prognosis based on the literature. Schematically, these indications correspond to failures of drug treatment, apart from emergency situations. Relapses are still very frequent, but may remain responsive to medical treatment. However, coloproctectomy, a fairly invasive operation, provides the best results in the colonic forms.

Crohn Disease↗
PubMed1988

[Pancreatic transplantation: technics--results].

Renewed interest is occurring in organ transplantation due to improvement of results. Pancreatic transplantation, carried out in more than 60 centers worldwide, has evolved since the first transplant in Minneapolis in 1966. Until 1978 an average of 6 operations per year were performed with a 1-year graft survival of 3%. The initial technic used was mainly duodenopancreatic transplantation with digestive by pass of external pancreatic secretions. Serious surgical complications led to progressive abandon of this procedure. Segmental transplantation, particularly after the appearance of methods of obliteration of wirsung's duct in 1978, has simplified the surgical act and stimulated renewed interest in pancreatic transplantation. The improvement in the technic, selection of donors and recipients and protocols of immunosuppression can hopefully allow a 1-year survival of graft of 55%. The current tendency is also to restore use of duodenopancreatic or total pancreatic transplants with intestinal or bladder drainage of secretions, providing improved survival of the graft in technically successful transplantations.

Humans↗
PubMed1988

[Perineal eventration after amputation of the rectum. Apropos of 3 cases].

Three cases of perineal eventration after amputation of rectum are reported. Defined as the issue of intraperitoneal contents at the perineum secondary to surgery, perineal eventration occurs after 1% of abdominoperineal amputations, more frequently in women. Predisposing factors are a wide pelvis, extensive excision of levator muscles, hysterectomy, factors of postoperative increased abdominal pressure, absence of postoperative adhesions between intestinal loops and infection of perineal scar. The influence of primary or secondary wound closure is more difficult to determine. The eventration is manifest by pain and perineal bulging, sometimes marked and preventing walking, but asymptomatic forms are frequent. Intestinal loops are visible below a thinned skin, cutaneous ulcers, urinary disorders and rupture of sac being the common complications. Surgical treatment is necessary for patients free from neoplastic recurrence, those inconvenienced by the eventration and those with large eventrations, the most effective procedure being uterine fixation to promontory, and use of a plate to close lower region of pelvis, using an abdominal approach alone.

Aged↗
PubMed1988

[Pancreatic fistula following cephalic duodenopancreatectomy. Directed fistulization or total pancreatic exeresis?].

A frequent complication (8.5 to 52.8%) of pancreatoduodenectomy (PD) for cancer, pancreatic fistula (PF) is difficult to treat, and an analysis of 30 cases of PD (27 for cancer, 3 for chronic pancreatitis) is used to determine risk factors and most effective therapy. Fistula developed in 6 cases (20%) and three risk factors were determined: preoperative renal impairment and hypoalbuminemia and ligature of pancreatic stump. Although not statistically significant, other factors--cancer, emergency surgery, fragile pancreatic tissue, thin Wirsung, pancreatojejunal anastomosis, absence of decompression of the raised jejunal loop--in this small series nevertheless provoked a marked increase in PF. One patient recovered after medical treatment, all five patients operated upon by whatever technique failing to survive. This agrees with literature data indicating heavy mortality (44.4 to 100%) after surgery. This should therefore be reserved for cases of PF failing to respond to adequate medical treatment, or with hemorrhage or intra-abdominal sepsis not controlled medically. The most effective therapy for PF is prophylactic, combining selection of patients as a function of risk factors, and treatment of pancreatic stump adapted to caliber of Wirsung and quality of remaining pancreatic tissue.

Adult↗