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Biomedical subjects

J Lerut

Publications and source records attributed to J Lerut.

At least 73 records · Page 4Linked to original sources
PubMed1990

[Technic of papilloduodenectomy].

Local excision of preiampullary tumours first described in 1989 has been relegated in the background after introduction of pancreaticoduodenectomy in 1935. Recent reports suggest that ampullary excision may give good results. In order to define the place of this operation which may be a simple excision of the duodenal mucosa (ampullectomy) or a wide excision of the papilla encompassing the posterior duodenal wall and the distal bile and pancreatic ducts (papilloduodenectomy) it is important to make a clear distinction between these two techniques. We describe the technique of papilloduodenectomy and define the place of this operation, which may be useful in selected cases.

Ampulla of Vater↗
PubMed1990

Multiple tumors of the biliary tract.

Multiple synchronous tumors of the extrahepatic biliary tree are not frequently reported. Over a 2-year period, 54 operative procedures were performed for tumors of the extrahepatic biliary tract or periampullary region. In five of these cases, unsuspected tumors were observed. Of these, one patient had multiple benign papillomatosis of the extrahepatic biliary tree. All four of the other patients were found to have unsuspected small carcinomas of the gallbladder in association with mid- or low bile duct cancer. Multiple tumors of the extrahepatic biliary apparatus may occur more frequently than previously thought, and the incidence of unsuspected gallbladder cancer in association with bile duct cancer may be high. These tumors should be suspected and looked for in each instance by intraoperative endoscopy and careful histologic examination of the gallbladder.

Adenocarcinoma↗
PubMed1990

[Diagnosis and treatment of traumatic injuries of the duodenum and pancreas: 21 cases].

Twenty one consecutive patients who sustained injuries to the duodenum or/and pancreas were admitted to our hospital over a ten year period. Sixteen blunt injuries and 5 penetrating injuries were encountered. Penetrating injuries were always suspected and treated by time; following blunt injury diagnostic delay was encountered in 7 patients and insufficient surgical procedure because of intraoperative misinterpretation in 2 patients. Most of the patients had associated intra-abdominal organ injuries. Adjuncts to diagnosis such as abdominal roentgenograms, serum amylase levels and gastroduodenography were not helpful. CT-Scan and ultrasound allowed to confirm the suspected diagnosis in 3 cases only. Intraoperative diagnosis was also challenging. Complete mobilization of the structures surrounding the duodenum and the pancreas to provide entire exposure was necessary. In 6 patients treated first in a peripheral hospital, diagnosis of the injury have been missed at first laparotomy and reoperation was necessary in all of them. Suture closure of the duodenum and drainage of the pancreatic region were the most common reparative technique used. More complicated procedures with pancreatic and/or duodenal resection were performed in 6 patients. Overall mortality in patients surviving more than 24 hours was 14% (suture line dehiscence after delayed operation and one death due to brain injury).

Adolescent↗
PubMed1990

Percutaneous transhepatic venous sampling of the pancreas in localizing insulinomas.

Fourteen percutaneous transhepatic venous samplings of the pancreas were performed in 13 patients. Ten patients undergoing 11 samplings were operated, while 3 patients were not operated. Surgical intervention disclosed a single tumor in 8 patients, a double tumor in 1 patient and diffuse hyperplasia in 1 patient. The method allowed correct localization of 5 insulinomas and correct regionalizing of 4 insulinomas in 9 of 10 small tumoral lesions. In 1 double localization of the pancreatic body percutaneous venous sampling only detected 1 lesion. In 1 case of diffuse hyperplasia of the pancreatic tail, the venous sampling was suggestive for a tumor in the pancreatic tail. The method appears to be highly accurate in diagnosing and localizing insulinomas of the pancreas. However, a need persists for 3-dimensional localization of the lesions to facilitate enucleation. Intraoperative ultrasound could become the method of choice for localization of insulinomas.

Adult↗
PubMed1990

The technique of papilloduodenectomy.

Papilloduodenectomy consists of precise and wide resection of the papilla of Vater, performed by stepwise incision of the posterior duodenal wall around the papilla, with sequential hemostasis followed by suture placement between the duodenal wall and bile duct. The end results after completion of the resection assures fixation of the biliary and pancreatic duct to the posterior wall of the duodenum, which minimizes the risk of biliary or pancreatic leakage. Results of local excision of the papilla of Vater for periampullary tumors appear satisfactory and this procedure may be particularly indicated for older or higher risk patients. Pancreaticoduodenectomy should probably remain the procedure of choice for reasonably fit patients with established malignant disease.

Adenocarcinoma↗
PubMed1989

"Piggy back" adult orthotopic liver transplantation.

In analogy to liver transplantation techniques developed in children, a method of adult liver grafting is described in which the recipient, intra- and retrohepatic, inferior vena cava is completely preserved.

Adult↗
PubMed1989

[Follow-up after surgery of the bile ducts].

The main emphasis of aftercare after surgery of the biliary tract is on monitoring the bile flow as a means of assessing the underlying disease and the patient's postoperative condition. If there is evidence of a bile flow disturbance, the cause must be discovered and eliminated in order to prevent secondary lesions from occurring in the liver.

Bile Duct Diseases↗
PubMed1989

[After-care following surgery of the pancreas].

Postoperative treatment after pancreas surgery is concentrated on the function of the exocrine and endocrine part of the gland. While functional disturbances of the endocrine pancreas may give rise to serious problems associated with diabetes, functional disturbances of the exocrine pancreas are less important. On the other hand, flow disorders of the exocrine pancreas may lead to pancreatitis, fistulas, cysts, and abdominal sepsis. Pancreatic tumours are not infrequently apudomas whose biology has an important bearing on the after-treatment. Thrombophlebitic splenomegaly may lead to portal and possibly to segmental portal hypertension. In this event, a careful follow-up examination will be needed to decide whether further surgery is necessary.

Humans↗
PubMed1989

[Long-term follow-up following liver resection].

There are various benign or malignant conditions which may necessitate a liver resection. The long-term follow-up after such an operation calls for precise knowledge of the causal affection and of the local conditions encountered at that time. Certain complications can arise during the immediate postoperative phase and others at a later stage. Also, the condition which necessitated the hepatectomy may continue to develop or recur. The diagnosis of the complications occurring after a liver resection is important, as it often reveals a need for treatment.

Hepatectomy↗
PubMed1989

[After-care in liver transplantation].

Liver transplantation is assuming an increasingly important role in present-day hepatology; it is the preferred treatment in many cases of acute or chronic liver disease. The results have shown constant improvement thanks to the introduction of standardized techniques for removal and implantation of the liver, improved immunosuppression and postoperative care. Good long-term results--a five-year survival rate in up to 70% of the cases--can only be achieved by strict self-discipline on the part of the patient and careful postoperative follow-up, with close collaboration between the general practitioner, the hepatologist and the transplant surgeon.

Combined Modality Therapy↗
PubMed1989

[Long-term results of orthotopic liver transplantation during the cyclosporin era. 393 orthotopic liver transplantations accomplished in 313 consecutive patients at the Pittsburgh Transplantation Center].

During the cyclosporine era 1980-1984, 393 consecutive orthotopic liver transplantations (OLT) were performed in 313 patients at the University of Pittsburgh. This paper analyses the long-term results in this group of patients who have been followed-up for a minimum of three years. The results of OLT for different indications are discussed. The five-year survival rates after OLT for metabolic diseases, biliary atresia, primary biliary cirrhosis, posthepatic cirrhosis and primary hepatobiliary cancer are 75%, 68%, 60%, 58.9%, 53.2% and 23.8%, respectively. Recurrence of the primary disease after OLT is rare for benign diseases but rather frequent for malignant ones. The incidence of retransplantation for delayed rejection and for extrahepatic complications is discussed. The quality of life for most of the long-term survivors is good. Because of its good long-term results, OLT should become the therapy of choice in a lot of acute and chronic hepatopathies.

Cyclosporins↗
PubMed1988

[Radiologic diagnosis of early complications following kidney transplantation].

Postoperative complications after renal transplantation, such as hematomas, abscesses, urinomas, lymphoceles and obstruction of the ureter, can be diagnosed by means of sonography. Early vascular complications, such as venous thrombosis and arterial occlusion or stenosis, can be recognized by duplex sonography and accurately depicted by angiography to allow planning of surgical intervention. Stenosis of the renal artery is amenable to treatment by percutaneous angioplasty. Parenchymatous complications (acute tubular necrosis, acute rejection, cyclosporin-A-toxicity) can cause changes in the intrarenal flow patterns at duplex sonography, but this examination does not allow accurate diagnosis and differentiation of these changes. Magnetic resonance imaging is a very promising method for the differential diagnosis of parenchymatous complications.

Humans↗
PubMed1988

Intrahepatic bile duct strictures after human orthotopic liver transplantation. Recurrence of primary sclerosing cholangitis or unusual presentation of allograft rejection?

One of 55 patients transplanted for sclerosing cholangitis during the cyclosporin-steroid era (March 1980-June 1986) developed intrahepatic biliary strictures in the absence of allograft rejection within the 1st year posttransplantation. Although many causes underlie biliary pathology in the postoperative period (i.e., arterial injury, ischemia, chronic rejection, cholangitis), recurrent disease remains a possibility.

Adult↗
PubMed1988

Single-dose prophylaxis with cefotetan in elective abdominal surgery. A controlled trial.

Single dose cefotetan was compared with either a combination of metronidazole and cefazolin given for 24 hours or 3 doses of cefuroxime as prophylaxis in elective abdominal surgery. Wound infections and infections at remote sites (UTI and RTI) were similar in all groups. In a third group prophylaxis of abdominal surgery using a single 2g dose of cefotetan was compared to 2 doses of the same drug, given 12 hours apart. There was no demonstrable advantage to giving 2 doses. The low incidence of post-operative infections seen in all groups indicates the efficacy of cefotetan in the surgical prophylaxis of elective abdominal surgery.

Abdomen↗
PubMed1987

Complications of venous reconstruction in human orthotopic liver transplantation.

In 313 consecutive recipients of 393 orthotopic liver grafts, there were 51 (16.3%) and nine (2.9%) patients who had pre-existing portal vein and inferior vena cava abnormalities, respectively. These abnormalities required adjustments in the transplant operation and were a source of morbidity and mortality. The incidence of thrombosis of the reconstructed portal vein was 1.8%. Only three (0.8%) vena caval thromboses were seen after 393 liver replacements. Venous stenoses or disruptions were rare. Six women with the Budd-Chiari syndrome had liver replacement. Although this disorder is a veno-occlusive disease, five of the recipients achieved prolonged survival, only one had recurrence of disease, and three are alive after 2-6 years.

Adolescent↗