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Biomedical subjects

J L Allé

Publications and source records attributed to J L Allé.

12 recordsLinked to original sources
PubMed2002

Primary mechanical stapled anastomosis in surgery for colorectal emergencies.

From May 91 to March 99 a consecutive series of 100 acute obstructions or perforations of the left colon or rectum were treated by primary resection with mechanical anastomosis using a double or triple stapling technique without proximal colostomy. There were 8 postoperative deaths (8%) due to sepsis, acute respiratory distress syndrome, pulmonary embolism, stroke, and cachexy. Complications occurred in 29% of surviving patients. Clinical anastomotic leaks were observed in 7%, respiratory infection in 8%, wound infection in 8% and major cardiovascular problems in 4% of patients. The median hospital stay was 19 days. The morbidity and mortality of this series did not exceed the cumulative morbidity and mortality that can be expected after staged surgery. Compared with staged surgery, immediate resection and anastomosis using an entirely mechanical suture, thereby avoiding the problems of colostomy and reducing the length of hospital stay, has significant advantages for patients.

Aged↗
PubMed1997

Changes in pulmonary mechanics during laparoscopic gastroplasty in morbidly obese patients.

BACKGROUND: Obesity is an important respiratory risk factor after abdominal surgery. Laparoscopic surgical techniques seem beneficial in obese patients in terms of respiratory morbidity, with a faster return to normal respiratory function. However, there is little information about intraoperative respiratory mechanics and about patient tolerance to abdominal insufflation in the morbidly obese. METHODS: We studied respiratory mechanics and arterial blood gases in 15 morbidly obese patients (mean BMI = 45) undergoing laparoscopic gastroplasty under general anaesthesia and controlled ventilation. Respiratory mechanics were analysed using side-stream spirometry. RESULTS: When compared to preinsufflation values, servocontrolled abdominal insufflation to 2.26 kPa caused a significant decrease in respiratory system compliance (31%), a significant increase in peak (17%) and plateau (32%) airway pressures at constant tidal volume with a significant hypercapnia but no change in arterial O2 saturation. Respiratory system compliance and pulmonary insufflation pressures returned to baseline values after abdominal deflation. CONCLUSION: These alterations in pulmonary mechanics are less than those observed with comparable degrees of abdominal inflation in non-obese patients, and were well tolerated. From the point of view of intraoperative respiratory mechanics, laparoscopic surgery is safe in morbidly obese patients.

Adult↗
PubMed1997

Hemodynamic changes during laparoscopic gastroplasty in morbidly obese patients.

BACKGROUND: In nonobese patients, peritoneal insufflation has consistently been shown to influence parameters of preload and afterload as well as cardiac output. Obese patients have an abnormal and particular cardiovascular status. The aim of this study was to investigate the hemodynamic changes induced by an increase of intra-abdominal pressure in morbidly obese patients (MOP). METHODS: Standard general anesthesia was administered to 15 informed MOP (body mass index > 40 kg/m2) scheduled for laparoscopic gastroplasty. Hemodynamic parameters were measured by thermodilution through a pulmonary artery catheter and through invasive blood pressure monitoring. RESULTS: CO2 insufflation with an intra-abdominal pressure of 17 mmHg caused a significant increase of mean arterial pressure (MAP) (33%, P = 0.005), mean pulmonary arterial pressure (MPAP) (40%, P = 0.001), pulmonary capillary wedge pressure (PCWP) (41%, P = 0.001), and central venous pressure (CVP) (55%, P = 0.001). The increase in diastolic filling pressures could be due to an increase in the filling volume or to a decrease in diastolic compliance. Ventricular volumes were not measured but we speculate that the rise in CVP, PCWP and MPAP is due to an increase in intrathoracic pressure as judged by the increase of pulmonary airway pressure. Stroke volume fell slightly (11%, P = 0.008), because of a reduction in transmural pressure and a fall in effective preload. Cardiac output rose slightly (16%, P = 0.005) because of an increase in heart rate (15%, P = 0.014) probably induced by sympathetic stimulation, which only became fully operative after 15 minutes. CONCLUSIONS: When compared to nonobese patients our obese patients tolerated the pneumoperitoneum surprisingly well, without experiencing fall in cardiac output. The hemodynamic consequences of peritoneal insufflation seem to be different in obese and nonobese patients.

Adult↗
PubMed1996

[Retroperitoneal leiomyosarcoma: case report and literature review].

Retroperitoneal sarcomas are rare tumors, 25% of them are leiomyosarcomas. On the other hand, 19% of leiomyosarcomas are located in the retroperitoneum. Generally, the diagnosis is made at late stage due to poor symptomatology. Computed tomodensitometry is the most reliable diagnostic procedure. However, the final diagnosis is always obtained after histologic examination. Complete surgical excision is the best treatment. In fact, survival depends on histologic grading and resectability. The roles of radiation therapy and chemotherapy are not yet established.

Aged↗
PubMed1994

Secondary psoas abscess twenty-seven years after nephrectomy.

Abscesses of the psoas muscle are due to a hematogenous dissemination, to the spread of infection from adjacent intestinal structures, to osteomyelitis of the spine or to tuberculous infection of a disc space. In contrast, psoas abscesses related to the urological tract have only been described on exception. The present report focuses on a right psoas abscess which developed 27 years after a nephrectomy. The infectious process resulted from the spread of an acute vesical infection through the residual ureter. Analysis of 4 other cases reported in the literature allows us to delineate the clinical features of psoas abscesses of urological origin.

Aged↗
PubMedDate not supplied

[Respiratory complications after repair of major abdominal hernia: value of the combination of propofol and epidural anesthesia].

Twenty patients with major abdominal hernia were treated by prosthesis interposed in pre or intraperitoneal position by medial incision. This surgery can produce healthy respiratory morbidity. Indeed, these patients are commonly obeses and smokers. The reintegration of the viscera in the abdominal cavity increases the pressure in this cavity and pertubs the diaphragmatic motility. The association of peridural technique and propofol perfusion gives an excellent awakening combined to a good postoperative analgesia. So this association permits to obtain from patient a helpful collaboration which limits dramatically the postoperative complications.

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