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Biomedical subjects

J Lerut

Publications and source records attributed to J Lerut.

119 records · Page 7Linked to original sources
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Pancreatic pseudocyst. Analysis of surgical therapy in 58 patients.

From 1970 to 1981, 58 patients underwent surgery for pancreatic pseudocyst. The mean duration of follow-up was 37,6 +/- 34,4 SD months. The internal drainage (ID) (50% - 19/28 pat.) is the first choice therapy of pancreatic pseudocyst as it had no mortality, a low morbidity (20,7%) and a rare recurrence rate (3,4%). External drainage (ED) (18,9% - 11/58 pat.) had a high mortality (27,3%), recurrence rate (54,5%) morbidity rate (100%). 18 patients underwent an excisional therapy (31%). A total pancreatico-duodenal resection, realised because of a transmesenteric rupture of an isthmic pseudocyst was unsuccessful (1/18 patients - 5,6% mortality). Cyst recurrence (12,1% - 7 pat.) was increased by the number of urgent interventions, reflecting the higher incidence of ED in these patients (1/41 pat. - 2,4% in the elective operated pat. vs 6/17 pat. - 35.3% in the urgent operated pat.). All four fatal outcomes (6,9%) were related to gastro-intestinal (3) and intra-abdominal (1) bleeding.

Adolescent↗
PubMedDate not supplied

[Injuries of the pancreas].

During the period 1968-1982, thirteen patients were treated surgically for a posttraumatic lesion of the pancreas. Eleven of them had a blunt abdominal trauma. These series of 13 patients show the diagnostic difficulties of the pancreatic lesion, often minimised or even missed. An open abdominal trauma needs an immediate exploration; surgery in blunt abdominal trauma is guided by biology, ultrasonography and scanning. ERCP may be very useful in these difficult cases. All different types of pancreatic lesions, divided into immediate and late sequelae are illustrated. Their appropriate treatment will be discussed. Good results can only be achieved if primary treatment of the pancreatic trauma is adequate and radical.

Adolescent↗
PubMedDate not supplied

[The value of proximal duodenopancreatectomy for tumors of the biliary-pancreatic junction].

56 different ampullary and periampullary lesions were treated by pancreaticoduodenal resection (PDR). There were 26 ampullary, 25 pancreatic and 5 biliary duct tumors. A retrospective pathological study of the resected specimen allowed an exact analysis of type, size and loco-regional extension of all these tumors. These data are correlated with the survival rate following an identical surgical treatment. PDR is the first choice therapy of the ampullary tumor even if lymph node involvement is present. The results of this resectional therapy are very disappointing in pancreatic and biliary duct cancers. Presence of multiple risk factors and/or lymph node involvement in these lesions preclude PDR; palliative surgery will be preferred.

Aged↗
PubMedDate not supplied

Subclavian-carotid transposition. Experience in 33 cases.

Thirty-three patients with a lesion of the proximal subclavian artery are treated by transposition of this endarterectomised vessel into the common carotid artery. The main advantages of this technique are the short operative time, the extra-thoracic approach, the absence of prosthetic material and the construction of an hemodynamic favorable anastomosis. There was a low morbidity and zero mortality in this series. All patients were selected by careful extensive continuous wave ultrasound Doppler examination of the extracranial arteries. Angiography is only required in case of an unclear Doppler finding, a multivessel extracranial or a peripheral arterial disease and in case of a redo-subclavian surgery. Good results of the technique can only be guaranteed if the donor arterial system is free of hemodynamically significant lesions. If not so, these lesions should be repaired first. Vertebral blood-flow is normalized in 97% of the patients (32/33 patients). Because of the excellent hemodynamic and clinical results, the subclavian artery transposition is the method of choice in the operative treatment of the proximal subclavian lesions.

Adult↗
PubMedDate not supplied

Surgical gastro-intestinal complications in 277 renal transplantations.

In 277 consecutive renal transplantations, 49 of 254 patients (19%) developed a gastrointestinal complication causing a mortality rate of 29% (14/49 patients). Oesophageal, gastro-duodenal, pancreatic and ileocolonic complications are reviewed and discussed. Acute gastro-duodenal ulcerations proved to be the most common problem (45--22/49 patients). The loss of allograft in this group of 22 patients was 42% (9/22 patients). To overcome their high mortality (27%--6/22 patients) efforts were made to prevent these complications. After introduction of prophylactic surgery, mortality dropped from 4 to 2%, after systematic long-term prophylactic use of cimetidine, mortality even dropped to 0%. In this last series of 52 patients only one bleeding ulcer was seen immediately after allograft nephrectomy. Ileocolonic complications in renal transplant patients, difficult to diagnose and treat, are associated with a high morbidity and lethality. In 6 patients with colonic complications, 4 could be saved by early and aggressive surgery (67% survival rate). Two recipients developed a de novo gastrointestinal malignancy. Early, accurate, diagnosis and surgical therapy of gastro-intestinal complications after renal transplantation are directly related to the graft and/or patient survival rate. Every effort is therefore necessary to prevent these complications.

Gastrointestinal Diseases↗
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Reevaluation of surgical therapy in acute deep venous thrombosis of the lower limbs.

Surgical treatment of phlebothrombosis is not uniformly accepted. The presented results in a series of 53 patients, show nevertheless that thrombectomy and valvular destruction are no longer synonyms. Adequate "vein-respecting" technique - and severe patient selection guarantee better results than thrombolytic or heparin therapy as well in relation to patency as valvular function. Surgical therapy consists of a venous thrombectomy and a distal arterio-venous fistula. The importance of the ultra-doppler-sonography (UDS) in pre- and postoperative examinations is stressed. Forty-seven of the 53 patients had a complete repermeabilization of the venous system (90 %). Forty-four patients with complete repermeabilization could be followed-up for 1 to 3 1/2 years. Ninety-four per cent (42 patients) have an adequate valvular function reflected in a good clinical result. All normalized UDS-curves of the early postoperative period remained unchanged at repetitive postoperative controls up to 3 1/2 years and guaranteed a good clinical results. Phlebographic resolution of the thrombi doesn't mean a restored venous function, the post-thrombotic syndrome can only be avoided in case of competent venous valvular function. Any treatment of acute deep phlebothrombosis should therefore be evaluated functionally by UDS rather than by phlebography.

Acute Disease↗
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Viral infections and liver transplantation.

Viral infections after liver transplantation represent a major cause of morbidity and mortality. These agents may be introduced into the patient through the allograft, infusion of blood, blood products, and intravenous lines... Reactivation of latent viruses related to immunosuppression is also frequently observed after liver transplantation. Finally, a persistent infection due to hepatitis B, C or D viruses frequently occurs after liver transplantation and still presents serious problems when evaluating the therapeutic benefits of liver grafting. In this review, the clinical, biochemical, and histological characteristics of most frequent viral pathogens observed after liver transplantation are described. Particular features of each of these viruses are underlined.

Cytomegalovirus Infections↗
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Sequential treatment of hepatorenal syndrome and posthepatic cirrhosis by intrahepatic portosystemic shunt (TIPSS) and liver transplantation.

The results of liver transplantation are compromised in cirrhotic patients presenting with renal insufficiency from hepatorenal syndrome. A case of cirrhosis and hepatorenal syndrome, treated sequentially with transjugular intrahepatic porto-systemic stent shunting (TIPSS) and liver transplantation, is discussed. TIPSS may be useful for correcting renal dysfunction and/or hepatorenal syndrome in end-stage cirrhotics, thus permitting subsequent elective liver transplantation under good conditions.

Adult↗
PubMedDate not supplied

Mesenterico-left intrahepatic portal vein shunt: original technique to treat symptomatic extrahepatic portal hypertension.

UNLABELLED: MESENTERICO-LEFT INTRAHEPATIC PORTAL VEIN SHUNT: Original technique to treat symptomatic extrahepatic portal hypertension. OBJECTIVE: Revascularization of the intrahepatic portal system as decompressive surgery for chronic extrahepatic portal hypertension. SUMMARY BACKGROUND DATA: In patients with extrahepatic portal hypertension (portal trunk thrombosis in presence of a normal liver), shunt surgery is indicated when patient is bleeding from varices at a site not accessible for the endoscopist. Although surgical portal decompression is an efficient procedure, there is a risk of depriving the liver from the splanchnic venous flow and a risk of developing porto-systemic shunt related side effects. METHOD: A shunt was created between the superior mesenteric vein and the umbilical portion of the left portal vein. This technique allows to bypass the thrombosed portion of the portal vein but avoiding dissection of the cavernoma in the liver hilum and related risk of intraoperative hemorrhage. RESULTS: The procedure was successfully performed in one adult patient considered unshuntable in view of classic surgical procedures and in whom sclerotherapy was unsuccessful. This operation achieved an effective decompression of the splanchnic venous system. CONCLUSION: Rerouting the venous splanchnic flow through the liver was possible. It had the major physiological advantage of restoring the normal hepatic vascularization. It also avoided putting the patient at risk of developing porto-systemic shunt related side effects. This option should be considered when shunt procedures are indicated in patients with extrahepatic portal hypertension.

Humans↗