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Biomedical subjects

J H Alexandre

Publications and source records attributed to J H Alexandre.

At least 55 records · Page 3Linked to original sources
PubMed1987

[Cholangiocarcinoma associated with Caroli's disease. Apropos of a case. Review of the literature].

This is a report of a rarely observed occurrence of complication in Caroli's disease, i.e. the emergence of a cholangiocarcinoma in the course of the disease. There are 20 observations reported in the literature, and the hypotheses of pathogenesis set forth are reviewed. The frequency of a malignant transformation during the course of Caroli's disease is compared to the frequencies of other hepatic-biliary congenital cystic tumours. The excision of the cyst resulted in an appreciable period of survival for the patient.

Adenoma, Bile Duct↗
PubMed1987

[Diverticular peritonitis. Clinical, prognosis and therapeutic aspects].

The results of diagnosis and management of perforated sigmoid diverticulitis were studied retrospectively over a 10 years period. 23 patients underwent operation, 17 for generalized peritonitis and 6 for local peritonitis. The mean age of patients was 65.7 years. Diverticular disease were known previously in 5 patients (21%) and complicated (diverticulitis) in 2 patients (8.6%). Depending on the symptoms and the spreading of the peritonitis 4 types of the disease can be described: primary generalized peritonitis, secondary generalized peritonitis, progressive generalized peritonitis and local peritonitis. Hartman procedure was performed in 16 patients, and proximal colostomy with drainage in 6 patients, ideal resection in one. The over all mortality was 34.7%, 43% after resection, 16% after conservatrice procedure, depending on the clinical status, duration of symptoms, type of peritonitis, surgical procedure. Improved results will require early diagnosis, adapted surgical procedure, appropriate antibiotics therapy and extension of prophylactic segmentation colectomie after one acute diverticulitis.

Adult↗
PubMed1987

[Biliary pancreatitis: when is surgery indicated?].

Retrospective analysis of a homogeneous group of 48 patients admitted with acute pancreatitis of biliary origin showed that 60% were in a serious condition. A total of 41 patients were operated upon, 25 in the early stages, 13 within a month, and 3 at some time after the acute episode. Lithiasis of the common bile duct was detected in 48, 23 and 33% of cases respectively; 9 calculi were enclaved including 7 in the early operated group. Cholecystectomy was combined with external drainage in 24 cases, choledocho-duodenal anastomosis in 3 and sphincterectomy in one; surgery to pancreas was necessary 17 times (necrosectomy in 13 and pancreatectomy in 4). 3 patients received endoscopic treatment and 4 were not operated upon. Ten patients died, including 8 in the early operated group. A literature review suggests that operation should be deferred (10th day), reducing severity of immediate surgery and avoiding risk of short or long term recurrence. The place of endoscopic sphincterectomy, notably in severe forms, has not been established.

Acute Disease↗
PubMed1986

[Should colonic anastomoses be inspected radiologically?].

Routine early radiologic review examinations were conducted in 100 patients after colocolic or colorectal anastomosis. Postoperative course was assessed as clinically uncomplicated in 77 cases, a barium enema producing normal images in 67 and abnormal images in 10 cases, and recovery operations were not necessary. The course was more difficult in 23 patients: recovery operation to repair a gap was needed in 9 cases, while results were evaluated as satisfactory in 14 with 3 false negatives. Recovery operations (including 6 for fistula) in 9 patients followed acute clinical manifestations. Clinical evaluation is therefore of primary importance, a barium meal being justified only when intra-abdominal complications are suspected, while recognizing the risk of false negative results for this examination.

Aged↗
PubMed1985

Survival and rehabilitation after total pancreatectomy. A follow-up of 36 patients.

Thirty-six totally depancreatectomized patients were followed up for 4-124 months. Pancreatectomy had been performed because of fulminant pancreatitis (in 10), chronic hyperalgic otherwise untractable pancreatitis (in 7), exocrine carcinoma of the pancreas (in 16), cystadenocarcinoma of the pancreas (in 2) and insulinoma (in 1). The longest survival duration was in chronic pancreatitis patients: 57 +/- 17 months. A normal socio-professional reinsertion was obtained in 16 patients, mainly those with non-malignant pancreotopathies. At the end of the survey, ten of the carcinoma patients had died, versus none in the other groups. Diabetes mellitus was characterized by the absence of ketonuria, and the frequent occurrence of hypoglycemia (in 15 patients) and infection (in 6). Malabsorption caused osteomalacia in one patient.

Acute Disease↗
PubMed1985

[Contribution of intraoperative echography in hepatic metastases].

Current research is devoted to the most appropriate treatment for hepatic metastases. Intra-operative ultrasonography is very valuable for assessing metastatic lesions, their exact number and their topography in relation to surgical landmarks such as the fissures and the hepatic pedicles. Surgery can then be adapted (metastasectomy, segmentectomy, hepatectomy) in relation to the peripheral parenchyma and the remaining parenchyma. The authors present the results of intra-operative ultrasonography performed at the hôpital Broussais in the diagnosis and treatment of 41 hepatic masses. In every case, the treatment of choice was surgical resection and chemotherapy was only administered as second line therapy in cases of failure.

Humans↗
PubMed1985

[Risk factors in surgery of obstructive jaundice. Retrospective studies apropos of 176 patients].

With the help of 28 criteria, the authors analyze the factors influencing mortality and morbidity related to surgery in jaundiced patients. The results differed according to whether the patients were examined as a whole or whether patients with benign and malignant lesions were considered separately; there was a significant difference in mortality between these two groups. Five factors were noted to predict an unfavorable outcome in patients with malignant lesions: the duration of symptoms, the presence of preoperative diabetes, renal failure, hypoalbuminemia and the type of surgical procedure. In patients with benign lesions, five factors were also significant: previous biliary surgery, decreased prothrombin level, leucocytosis, renal failure and an age greater than 80 years. It is thus possible to isolate a population "at risk" for whom surgery should be preceded by the correction of disorders due to cholestasis, and particularly the renal consequences.

Aged↗
PubMed1984

[Mucosecreting tumors of the appendix. 3 cases].

The three cases reported here illustrate the diagnostic, therapeutic and prognostic problems raised by these tumours. These are rare lesions with little suggestive symptoms, which explains why they are exceptionally diagnosed before surgery. Mucosal hyperplasias and cystadenomas are benign formations with a 90-100% survival rate 5 years after appendicectomy, even when non-cellular mucoid effusion is present. Cystadenocarcinomas are malignant tumours with mucoid secretion containing epithelial cells; they have a tendency to recur despite repeated evacuations, and their 5-year survival rate is approximately 25%; death results from intestinal obstruction or compression of intra-abdominal viscera by the mucoid substance.

Aged↗
PubMed1984

[Conservative surgical treatment of acute pancreatitis. Strategy and technic].

Not all patients with acute pancreatitis can be cured by medical treatment alone; surgery is mandatory when signs of aggravation or complications are present. The authors propose a new strategy involving bilateral subcostal laparotomy, wide approach to the pancreas, evaluation of the lesions and therapeutic decision: either abstention or excision which may be performed according to rules or adapted to each case. The abdominal wall is then closed, often around a pre- and peripancreatic Mikulicz's drain. This method has substantial advantages: the dangers of hasty and inappropriate surgical procedures on ill-defined lesions are avoided, necrotic areas can be removed, drainage is facilitated and possible reoperations are restricted to the supramesocolic cavity.

Acute Disease↗
PubMed1984

[Treatment of inguinal hernia with unsplit mersylene prosthesis. Significance of the parietalization of the spermatic cord and the ligation of epigastric vessels].

The authors describe their technique of "thorough" dissection of the spermatic cord by the inguinal route. After parietalization of the cord and ligature of the epigastric vessels, a wide prosthesis of unsplit mersylene can be inserted through the groin behind the muscular layer brought down to Cooper's ligament. From their experience of 120 patients operated upon and without relapse at follow-up, they feel able to recommend this method in cases of recurrent hernias with weak walls and large sac and of hernias occurring in elderly of obese subjects.

Hernia, Inguinal↗
PubMed1984

Anatomical bases of echography of the liver. Applications in peroperative echography.

Peroperative echography is bound to play an increasingly important role in indications for hepatic exeresis, particularly as this type of surgery is anatomical and patterned. It is not easy however to have a clear idea of the stereo-spatial representation of one segment or another when the liver is in situ. The aim of this investigation is to define precisely, with the help of echographic sections, the topography of the different hepatic segments, thereby enabling the surgeon to carry out a complete and systematised exploration. It provides the surgeon with information which has not been accessible until now with classic peroperative explorations.

Hepatic Veins↗
PubMed1984

Early histological changes in acute necrotizing hemorrhagic pancreatitis. A retrospective pathological study of 20 total pancreatectomy specimens.

Settled lesions of acute necrotizing hemorrhagic pancreatitis have been commonly reported. Early alterations remained unknown. In a retrospective pathological study of 20 total pancreatectomy specimens, early changes have been evidenced in "grossly unmodified" areas of pancreas: acinar cells homogenization, ductal dilatation with epithelial degeneration, diffuse interstitial edema and fibroblastic reaction, necrotic angeitis . These alterations were identical to the changes described in experimental studies.

Acute Disease↗
PubMed1984

[Pancreatic cystadenocarcinomas. Apropos of a case and review of the literature].

A patient with a pancreatic cystadenocarcinoma was treated initially for a false pancreatic cyst by means of a Y loop, and then by total pancreatectomy three weeks later. Although the prognosis for these tumors amongst the group of pancreatic carcinomas is usually greatly improved, the patient died 6 months after detection of the lesion. However, a literature review also suggested possible prolonged survival in these cases when the tumors are discovered early enough and local or regional spread is absent: wide excision of the tumor without the need for total pancreatectomy may then be sufficient. The "false cyst" appearance frequently taken by this slowly progressing malignant affection has to be emphasized, as well as the need for the renewed classification of these tumors: serous cystadenomas are always benign and must be separated from mucinous cystadenomas that are malignant or are potentially malignant. A CT scan appears to be the investigational procedure providing the most accurate data for determining the limits of surgical excision.

Cystadenocarcinoma↗