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Biomedical subjects

J Trotoux

Publications and source records attributed to J Trotoux.

At least 145 records · Page 8Linked to original sources
PubMedDate not supplied

[Medullary carcinoma of the thyroid (author's transl)].

Medullary carcinoma of the thyroid develops in the parafollicular C cells, the origin of which is in the neural crest. It is characterized clinically by the presence of motor diarrhea, vasomotor attacks, and immunologically by the presence of an amyloid stroma and the appearance of an anaplastic carcinoma. It is frequently associated with a pheochromocytoma (Sipple's syndrome), parathyroid adenomas and cytaneo mucosal manifestations (phacomatosis, multiple mucosal neuromas). The C cells may secrete thyrocalcitonin and the estimation of the substance may be sometimes used in pre-operative diagnosis and, above all, subsequent observation and examination for the presence of metastases. Treatment is based upon surgery (total thyroidectomy) with lymphnode dissection. Complementary treatment (radiotherapy, chemotherapy, opotherapy) is given only when surgery is inedequate or recurrences occur.

Adolescent↗
PubMedDate not supplied

[Salvage esophagoplasty using free jejunal transplant after repeated failure of other esophagoplasties. 25 cases].

Salvage oesophagoplasty using a free jejunal transplant is the ultimate reconstruction possible after repeated failures using the classic procedures of oesophagoplasty. The free jejunal transplant appears to be the best choice. Twenty-five free jejunal transplants were performed by the same surgeon for such reconstructions including 13 cases involving benign lesions and 12 cases of cancer. There were no post-operative death and none of the transplantations was a complete failure although three cases of stenosis and fistulization occurred. Several recommendations can be made: save the existing digestive tract, redissect the residual digestive plasty and pull it up. The residual digestive flap can be examined by opacification or endoscopically in order to evaluate its length. An arteriography of the pediculated plasty gives information on its vascularization. A free jejunal graft can safely cover 25 to 30 cm. When possible, residual plasties should be positioned subcutaneously. The reconstruction of the cervico-thoracic oesophagus usually requires a vascular bypass with a saphene graft. In difficult cases, it may be necessary to remove a part of the sternal manubrium and the head of the clavicular bone in order to avoid compressing the jejunal graft. When the length of the reconstruction is greater than 30 cm, a long jejunal transplant with two pedicules (1 pedicule revascularized from the cervical vessels and the other pedicule from the internal thoracic vessels) is needed. An alternative technique would be a free antebrachial flap (six cases operated with two post-operative deaths at 6 weeks and two fistulas).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

[Posterior pharyngectomy. Reconstruction using a free antebrachial transplant].

Cancers of the posterior wall of the oro or hypopharynx are rare and do not invade the larynx or the oesophageal orifice. Previously, these cancers were treated with radiotherapy alone, but since 1981 new techniques in reconstruction surgery have allowed a surgical approach. Cancerological non-mutilating exeresis is possible, but reconstruction is difficult since the flap must be very thin to allow normal food intake. In addition, flap reliability is extremely important due to the gravity of cervical salivary fistulation. We treated 15 patients with a lesion of the posterior wall of the pharynx using posterior pharyngectomy and reconstruction with a free antebrachial transplant which was revascularized and reinnervated. In two cases, the operation was performed in patients who had had previous radiotherapy. A branch of the external carotid and the internal jugular vein were used for vascular microanastomoses and reinnervation was obtained using the superficial cervical plexus. The transplant was placed over the prevertebral aponevrosis and sutured to the remaining pharyngeal mucosa. One postoperative death due to heart disease occurred at D + 11. All reconstructions were successful and two salivary fistulas on irradiated tissue closed spontaneously. Postoperative radiotherapy was performed in 11 cases (50-65 Gy) and was well tolerated. These results demonstrate that a highly flexible and thin free forearm transplant is perfectly adapted to reconstruction after posterior pharyngectomy. It is more reliable than local pediculated flaps.

Adult↗
PubMedDate not supplied

[Reoperation of tumors of the parotid gland, surgical approach and consequences for the 7th cranial nerve. Apropos of 42 cases].

Second or more surgical procedures on parotid are usually difficult and may induce injury on the facial nerve. The authors report their experience about 42 patients. The choice between a total parotidectomy or a surgical excision of a tumor depends on the number of surgical procedure, the type of initial procedure and the histological type of the tumor. Second surgical procedures for a wrong initial diagnosis (11 cases) were always a total parotidectomy with facial nerve preservation. The risk of a partial or total facial palsy is higher after several recurrences (3 of 8 cases). The facial nerve had to be resected in 3 of 9 cases of malignant tumors recurrences. The initial treatment of a tumor of the parotid must be radical so it can prevent for further surgical procedures and then avoid a facial nerve injury.

Adenocarcinoma↗
PubMedDate not supplied

[Sclerosis of esophageal varices. Results of 10 years experience].

Before they give their results, the authors, whose experience of sclerosis of oesophageal varices under the oesophagoscope has so far involved 157 patients, deal specifically with the problems facing the anaesthetist and resuscitator when this technique is used, tolerance of the product injected and possible accidents. Firstly, they point out the unsuitability of the patients referred to them by their medical or surgical colleagues. By implication therefore, treatment should only be undertaken with the assistance of a team of experienced resuscitators and every precaution taken to mitigate the effects of possible accidents to these patients who are particularly at risk. These cases are mainly characterized by serious haemorrhages (seven cases described, one resulting in death). Oesophageal injury is, on the other hand, the exception where trained personnel are involved (2 minor mucosal tears out of more than 800 oesophagoscopies). Finally, secondary parietal oesophageal necrosis occurs. Quininaemia assessment after injection of quinine-urea confirms that the product is being efficiently eliminated. Overall results reveal a survival rate of 61 p. 100 after more than a year and 20 p. 100 after more than than three years. These figures underline the limitations of therapeutic possibilities and the serious prognosis for this result of portal hypertension. This leads the authors to express a wish that the procedure should be used as a measure to prevent haemorrhage as soon as the presence of varices is realized. On the other hand, they reject on practical grounds emergency sclerosis of oesophageal varices, as a direct heamostatic method, since, according to their statistics, this almost invariably results in failure.

Esophageal and Gastric Varices↗