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Biomedical subjects

L David

Publications and source records attributed to L David.

At least 289 records · Page 16Linked to original sources
PubMedDate not supplied

[The periampullary carcinoma. Clinical and therapeutic alternatives].

BACKGROUND AND STUDY AIMS: An analysis of the diagnosis difficulties in periampullary carcinoma (PAC) is done, the consequences being the possible therapeutically insufficiencies. PATIENTS AND METHODS: During 10 years (1990-1998) 54 patients have been operated on for a PAC. Sex ratio: 34 males (63%)/20 females (37%). The pick of frequency was in the decade 61-70 years (20 patients) with extremes ages between 20 and 80 years. The main symptom was the cholestatic progressive jaundice with or without neoplasic pain (39 patients--72%). The intermittent jaundice was present only to 7 patients (13%) and the clinical forms without jaundice were manifested to other 8 (15%); superaded colangitic syndrome was present to 17 patients (31%). Other concomitances manifestations of the neoplasic disease were record to 23 cases (43%). Historical evolution of the illness until the cholestatic jaundice appearance was under 2 month to 23 cases, between 2 and 4 months to 24 patients and not sure determined to other 8. The biological preoperative investigations confirmed the clinically evident biliary retention syndrome in 85% of the cases and not yet clinically visible to other 15% of the cases. The ultrasonography was the most conclusive method from the imaging examinations because it have suggested the diagnostic of PAC to 43.5% from the patients submitted to this exploration. Computed tomography was diagnosis relevant only for the in site-regional invasion of the tumors or for the nodes or systemic metastases. Endoscopy and the endobiopsy proved to be valuable especially associated with ERCP (our experience regarding ERCP is not conclusive yet). Therefore the real preoperative diagnostic was established to 11 patients (20%), and for the rest of the cases there have been another presumptive preoperative diagnosis: cancer of the pancreatic head (11 patients), retentive jaundice without determined origin (24 patients), others (8 patients). Intraoperative exploration detected the periampullary tumor through palpation in 30 (55%) cases, through palpation and exploratory duodenectomy in 8 (15%) cases and/or by accessory signs (hydropic gallbladder, dilatation of the main biliary duct etc.). Organic metastases or duodenal stenosis was present in nine cases (6 with nodes metastases). The practiced surgery was: Whipple operations (in one--the majority--or two steps)--35 cases (65%); palliative surgery for biliary drainage 16 (30%) cases; others 3 (6%) cases. The postoperative staging of pT parameter (in situ or ex situ dimensional determined) reveled: pT1-12 patients; pT2--9 patients; pT3--14 patients; pT4--19 patients. Histopathological examinations confirmed the diagnostic of periampullary adenocarcinoma (32 patients) or carcinoma (3 patients) for the 35 patients with resectional operations. The determination of the tissular origin of the periampullary tumor was initially possible only in 11 (31%) operative specimens. A secondary study with many repeated sections in the wax included blocks specified the histogenesis of the tumors to other 10 patients, therefore for a total of 21 cases. We think that this histogenetically diagnosis aspect is important only for some predictive appreciations regarding the outcome of the operated patients and not for the elected therapeutically surgical method. RESULTS: The globally perioperative mortality was 8 (15%) patients. Three from this deceased were a consequence of palliative surgery applied to patients with advanced stages of neoplasic disease. The medium outcome for patients submitted to Whipple operation--in course of evaluation--is between 32 and 41 months to the patients which we can followed. For the patients with palliative operations the same distant survival is between 12 and 24 months.

Adenocarcinoma↗
PubMedDate not supplied

[Frey operation--valuable alternative in the surgical treatment of chronic pancreatitis].

The "golden standard" of the surgical treatment of chronic pancreatitis with an inflammatory mass in the head of the pancreas seems to be the duodenum preserving resection of the head of the pancreas as described by Beger. However, in some cases, the inflammatory process may induce an encasement of the retropancreatic intestinal vessels making the dissection of the portal vein very difficult. The local resection of the head of the pancreas combined with longitudinal pancreaticojejunostomy (Frey operation) was developed in order to provide a simple and less time consuming procedure, that avoids the dissection of the portal vein and is especially indicated in cases with severe inflammatory and edematous alterations of the head of the pancreas at this level and with dilated pancreatic duct. Two patients with chronic pancreatitis with severe pain, addiction to analgesics and weight loss underwent a Frey procedure. In both patients an inflammatory mass in the head of the pancreas and dilated pancreatic duct were demonstrated. The freeing of the head of the pancreas from the portal vein was not possible because of the intense inflammatory process. The local resection of the pancreatic head and the longitudinal pancreatico-jejunostomy was successfully performed. There were no postoperative mortality or morbidity and the short and long term results (pain relief and nutritional status) are excellent.

Anastomosis, Roux-en-Y↗
PubMedDate not supplied

[Upper digestive haemorrhage of a rare cause: benign duodenal schwannoma].

The upper gastrointestinal bleeding is a common cause of admission to hospital. Neurogenic tumors of the duodenum are extremely rare and represent an unusual cause of gastrointestinal hemorrhage. The treatment is endoscopic or surgical total excision. In case of ulcerated large tumors situated periampullary pancreaticoduodenectomy (Whipple's or Traverso-Longmire's) represents an efficient solution. In addition, their high index of malignancy justifies this trend. We present a case of schwannoma of the second portion of the duodenum with several episodes of upper GI bleeding treated by Trasverso-Longmire pancreaticoduodenectomy.

Duodenal Neoplasms↗
PubMedDate not supplied

[A rare cause of lower digestive hemorrhage--jejunal diverticulosis].

Small bowel diverticula are usually asymptomatic and rare. Digestive bleeding is a rare complication of jejunal diverticulum whose diagnosis and treatment are difficult. We report a rare case of hematochezia whose origin was a proximal jejunal diverticulum and not determined by endoscopic investigations. Bowel resection with primary anastomosis was the chosen surgical procedure. There was no complication until discharge nor was any recurrent bleeding or functional disorder of the bowel reported during follow-up. The clinical presentation, the different value of diagnostic tools and the therapy are discussed.

Aged↗
PubMedDate not supplied

[Double localization of pancreatic insulinoma. Diagnostic and therapeutic difficulties].

Insulinomas are the most common cause of hypoglycemia resulting from endogenous hyperinsulinism. Because most of insulinomas are less than 2 cm in size and rarely they not may be visible by CT scan or transabdominal ultrasonography. Intraoperative ultrasonography may be a solution. Although as surgical method is preferred enucleation because operative time is shorter and easier and the low frequency postoperative complications, pancreaticoduodenectomy Whipple is indicated in selected cases. We report a case of double insulinoma located in the head of the pancreas in which the diagnosis and surgical treatment presented difficulties which determined a particular clinical evolution.

Female↗
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[Association of a bifocal nephroblastoma with Beckwith's syndrome].

A nephroblastoma occurred in the evolution of a case of Beckwith's syndrome. This rare association is not fortuitous. The bifocal character of the tumor is noted for the first time in the Beckwith's syndrome; however, it has already been observed in other conditions, which are known to promote the development of nephroblastomas. Wilm's tumor is only one of the tumors which may be associated with Beckwith's syndrome. These morbid associations and certain histological features bring together some material for the understanding of the nature of the histo-genetic relationship between different aspects of constitutional pathology and tumors.

Abnormalities, Multiple↗
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[Group meetings for patient recruitment in clinical trial in pediatrics].

Recruitment of patients in a clinical trial is often difficult and probably more difficult in pediatrics where parents are asked to give the informed consent. In order to recruit infants in a randomized clinical trial we organized group meetings with families (4 to 40 at a time) in order to describe the study procedures: random allocation to treatment or placebo and double blind assessment, and ask them to allow their child to participate. All meetings were conducted by both a pediatrician and a RCT specialist. Parents asked questions about the effects of the drug, the evaluation process and the follow-up procedures. Forty nine % of all eligible infants participated in the study. The success rate was related to franc and open communication with the family, provided by highly qualified physicians.

Child↗
PubMedDate not supplied

[Evaluation of the protocol for management of the first uncomplicated febrile convulsion].

A protocol of rationalized management of the first non complicated febrile seizure was used in 42 children and the results were compared with those observed in the past without the new protocol. The quality of medical data collected from the parents and those given to the family and their practitioner have been improved; the duration of the hospitalization was shorter, the examinations were fewer and the savings realised per child were 3,175 francs.

Child, Preschool↗
PubMedDate not supplied

[Complications of pyelo-ureteral duplications in children and their surgical treatment. Apropos of 69 cases (78 pathogenic duplications)].

The authors report their experience on the surgical treatment of 69 infants and children with pyelo-ureteral duplication. Urinary infection was the main revealing symptom (52 cases). Vesico-ureteral reflux was the major associated anomaly (39 cases) involving most often the lower pole ureter; the surgical correction of the reflux was performed according to the technique of Cohen with a favorable outcome in all cases. Because of poorly functioning and dysplastic upper renal segment, partial upper pole nephrectomy was performed in 8 among 12 cases of associated ectopic ureteral orifice and in 9 among 15 cases of associated ureterocele. A reimplantation of the ureter was made possible in 3 cases of ectopic ureteral orifice and in 5 cases of ureterocele with little corresponding renal lesions. With the experience of one neonate who died from septic shock following partial nephrectomy there were no other post-operative complications in this series.

Adolescent↗
PubMedDate not supplied

[Amyloidosis following juvenile chronic arthritis in a 3-year-old child].

A case of amyloidosis revealed by a nephrotic syndrome in a 3 years old girl with juvenile chronic arthritis is reported. The child died from this amyloidosis at the age of 4 years. The main biochemical, clinical and therapeutics aspects of this form of secondary amyloidosis (amyloidosis AA) are discussed.

Amyloidosis↗