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Biomedical subjects

J H Alexandre

Publications and source records attributed to J H Alexandre.

At least 73 records · Page 4Linked to original sources
PubMed1983

[Pheochromocytomas: diagnosis, anesthesia and treatment. Apropos of 17 recent cases].

This article summarizes 5 years of systematic observation of 17 patients presenting with benign pheochromocytoma. The diagnosis was based on clinical and biological findings which were consistently positive. The topographical diagnosis was based on CT scans, and a combination of intravenous urograms and nephrotomography. The preoperative preparations were made with labetalol, and the anesthetic used was narconeuroleptanalgesic. The hemodynamic study was carried out with a Swann-Ganz catheter, which proved indispensable in the surveillance of the patient at operation. The surgical procedure is best performed with transperitoneal subcostal incisions, which the authors prefer. Morbidity was negligible, and mortality, zero.

Adolescent↗
PubMed1983

[Common bile duct lithiasis. Reflections apropos of 1000 cases].

One thousand case reports of patients treated in eleven French surgical departments for stones in the common bile duct between 1975 and 1982 were analyzed. One in three cases were asymptomatic and detected by peroperative radiology during treatment of a simple or complicated gallstone, most forms were painful, with jaundice in 9 p. cent, an angiocholitis in 12 p. cent, and biliary pancreatitis in 2 p. cent. The most reliable exploratory procedure for gallstones is ultrasound imaging, as positive results were obtained in 90 p. cent of cases, but it enabled the diagnosis of choledocholithiasis in only one out of five patients. Intravenous cholangiography is a useful diagnostic tod for painful forms (60 p. cent). The failure of these two methods to establish the diagnosis in forms complicated by jaundice, pancreatitis, or angiocholitis has to be compared with the good results (85 p. cent) observed with endoscopic retrograde cholangiography. Treatment was surgical in 99 p. cent of patients, peroperative radiology being performed in 95 p. cent of these cases and endoscopy in 30 p. cent. In one out of two cases a single large stone was present while multiple stones were present in 8 p. cent. A "ideal" choledochotomy was carried out in 77 patients (7,7 p. cent) without mortality. External biliary drainage in 702 cases resulted in a 1.7 p. cent mortality rate, this increasing to 8 p. cent after 192 biliodigestive shunt operations, and 7 p. cent after 146 sphincterotomies, including 18 under endoscopic control. Unrecognized lithiasis, detected during follow-up radiography two weeks after external biliary drainage, accounted for 2-8 p. cent of cases. Of the 30 patients with residual stones and open biliary pathways, 6 were treated by mechanical removal, 6 by endoscopic sphincterotomy, and the others by repeat surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1983

[Malignant adrenal cortex tumors responsible for primary hyperaldosteronism and biological hypercorticism. Remarks apropos of 2 surgically-treated cases].

Two cases of malignant adrenal cortex tumors revealed by primary hyperaldosteronism with hypertension, and associated with a biological hypercortisonism, are reported. Diagnosis of this very rare affection depends on the finding of marked biological hyperaldosteronism associated with a large adrenal tumor. The outcome appears to be rapidly fatal for tumors exceeding 5 cm in diameter and associated with lymph node invasion. This raises the problem of the utility of surgery in these cases, operative intervention apparently accelerating progression of the lesion. In practice, however, a laparotomy is always justifiable, the most rational biopsy being excision of the tumor.

Adrenal Cortex Neoplasms↗
PubMed1982

[Is there any justification to the scintigraphy and echotomography B association for the tracking down of hepatic metastases? (author's transl)].

Regarding the tracking down of hepatic metastases, a study was made on 58 patients presenting either digestive or genital adenocarcinoma. The determining criterion of selection was the carrying out of the three following tests within the same month (Technetium 99 Scintigraphy, Echotomography B and surgery). The global breakdown of exact answers is in favour of echography (72% against 53%), echography being more reliable than scintigraphy. Therefore echotomography B seems to be the first morphological method that should be proposed; and for improving the tracking down, scintigraphy makes the interpretation of the results more difficult, and reduces the number of correct answers.

Humans↗
PubMed1982

[Indications and future of the Hartmann operation. Cooperative study of 126 cases (author's transl)].

The main indications for the Hartmann operation are cancer and sigmoiditis. It is done as an emergency in 70% of the time, more often for peritonitis, generally from diverticulitis. (45% of the time) than for occlusion usually due to cancer (30% of the time). The high mortality (33%) is due to the precarious condition of the patients, and only 25% are due to the operation, usually from disruption of the rectal stump. The reestablishment of the intestinal continuity, now facilitated by the clip forceps, was possible in 37 cases with no mortality. This represents 28.9% of the group, but only 52.1% were alive six months later. Only 6.8% of the cancer cases were benefited; however, 51% of the sigmoiditis cases and 87.5% of the cases of traumatic perforation were benefited. These results plus the advantages furnished by the autosuturing forceps justify renewal of interest in this operation first described 60 years ago.

Adult↗
PubMed1981

[Pre-operative preparation of the colon: a controlled prospective multicentre study in 215 patients (author's transl)].

Three procedures for pre-operative preparation of the colon were compared during a controlled multicentre study in 215 patients. Though mechanical irrigation with a 10 p. cent mannitol solution is definitely superior as far as the degree of intestinal emptying obtained, no significant difference was noted in the frequency or severity os postoperative infections after conventional preparations by digestive tract irrigation with or without intestinal antibiotics. This method is limited by its tolerance (67 p. cent), its advantages are its rapidity and cost, elective indications being ascending colon lesions with little or no stenosis in young subjects. In other circumstances it has to be compared with the conventional methods of preparation, which should still be employed before operation in subjects who are elderly and/or have moderate to severe stenosis. The addition of antibiotics (neomycin, metronidazole by mouth) reduces the incidence of postoperative sepsis to a marked but non-significant degree, independently of the lesion (cancer, sigmoiditis) and its site. A recent study by F. Lazorthes has led him to prefer an association of antibiotics active against aerobic and anaerobic flora: orally preoperatively, and systemically during surgery.

Adult↗