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Biomedical subjects

L F Hollender

Publications and source records attributed to L F Hollender.

At least 37 records · Page 2Linked to original sources
PubMed1989

[Injuries of the spleen: conservative treatment or exeresis?].

The authors report their experience with splenic preservation in a series of 36 patients. 77 patients with splenic injury were seen during the period from 1982 to 1987. In 41 cases splenectomy had to be carried out. This was for splenic contusions secondary to road traffic accidents in 36 cases and iatrogenic per-operative lesions in 5 cases. Intra-omental splenic autotransplantation was performed in 4 cases. In 36 other patients, the spleen was able to be preserved. Hemostasis was fairly obtained using infra-red photocoagulation (24 cases), splenorrhaphy (8 cases), surrounding the spleen with a resorbable mesh (3 cases) or by partial splenectomy (1 case). Only 1 case of transient and moderate secondary hemorrhage was seen and did not require further surgery. The authors define the legitimacy of splenic preservation and its indications and also stress its limitations. They insist on the following contraindications: preexisting splenic disease, subject on anticoagulants, labile blood pressure, multiple intra-abdominal lesions, presence of intra-peritoneal infection, severe cranio-encephalic lesions, age over 70 years. Study of this series shows that conservative treatment is most often justified for splenic trauma. Nevertheless, in view of the real but rare risk of OPSI, it is better to have a correct splenectomy than an incorrectly preserved spleen.

Aged↗
PubMed1989

[Colonic occlusion. Apropos of a surgical series of 63 cases].

63 colonic occlusions were operated on from 1975 to 1988. Cancer and stenotic diverticular sigmoiditis were found to be the main causes of colonic obstruction in respectively 36 cases (55%) and 8 cases (13%). Other etiologies were represented by neoplasic gynecologic diseases (9.5%). The rectosigmoid was involved in 50% of the cases (31) while transverse colon and caecum were respectively concerned in 25% and 17%. The 2 main therapeutical procedures used were colic resection (35 cases-55%) with immediate anastomosis in 1 case out of 3 and derivation (26 cases 41%) mostly in the proper from of a colostomy (20 cases). Operation was undertaken during the first 48 hours in 65% of the cases. Death occurred in 8 patients (12.5%). Related to etiology the death rate was 11% in cancers and 25% in stenotic diverticulitis. Where linked to treatment this mortality rate reached 27% in derivations and 3% in colic resections. 38% of non lethal complications were recorded, two-third being due to the bad general conditions of the patients. Several times operations, such as first colostomy or resection without anastomosis, should remain the basic rule one should not depart from without great carefulness. However a new interesting trend toward one time surgery with intraoperative colonic lavage is taking shape.

Adolescent↗
PubMed1989

[Locoregional recurrence of breast cancer. Long-term course of 49 cases treated by excision and omentoplasty].

Extensive local recurrence of breast cancer may require wide parietal resection, demanding the use of other tissues to compensate for the loss of substance. We preferably resort to omentoplasty when the defect is larger than 300 cm2. A group of 49 patients with recurrence of the tumor in the breasts (treated with omentoplasty) has been studied, with special emphasis on long-term results. In our series, 86% of the patients were followed up for more than 4 years, with an actuarial survival rate of 46% after 7 years. It thus appears that this procedure can be advocated for slow-developing cancers, the local recurrence of which is extensive and usually isolate for various reasons (most often a deficient initial local treatment).

Aged↗
PubMed1989

[Current ideas in the treatment of severe acute pancreatitis].

The aim of this study is a current review of multidisciplinary therapeutic concepts in severe acute pancreatitis, the following being envisaged in succession: --severity criteria and factors involved in surveillance, --medical methods of intensive therapy, --surgical treatment in terms of its indications and tactical implications. Remaining in overall control, the surgeon must pay careful attention to the techniques used, and results achieved, by the intensive care specialist. In the presence of concomitant lithiasis of the common bile duct, it is essential to request endoscopic sphincterotomy first. The surgeon must interpret with the radiologist CT scan films in order to be able to wait, whilst remaining alert at all times, for the appropriate moment for any possible surgery. The surgeon must above all avoid being too active too early.

Acute Disease↗
PubMed1989

[Gastroduodenal ulcer. New therapy and new clinical practice?].

Duodenal, prepyloric, and gastric ulcers are based on different pathophysiological processes. The achievements obtained from therapeutic medication, using H2-blockers, have reduced indications for surgical treatment, primarily for duodenal ulcer. Surgery has continued to be required for failure of medicamentous therapy, recurrence, development of intercurrent diseases calling for corticoid or anti-coagulant treatment, patients above 55 years of age with haemorrhage, occurrence of severe side effects, and, occasionally, for economic reasons. Optional methods are left-side selective vagotomy for duodenal ulcer, antrectomy with bilateral subdiaphragmatic vagotomy for prepyloric ulcer, and hemigastrectomy with gastroduodenal anastomosis for gastric ulcer.

Gastrectomy↗
PubMed1989

[Current concepts of the treatment of cholelithiasis in aged patients].

Biliary lithiasis in elder patients is characterized by the physical defects usually present--therefore surgery is less mandated than endoscopic procedures or extra corporeal lithotripsy. However, if surgery is undertaken, then it should be carried out as completely as possible. In this paper, the authors emphasize the special aspects of its indications and technics--for more than any where else this surgery required perfection.

Aged↗
PubMed1989

[The development of surgical therapeutic concepts of acute severe pancreatitis].

The actual surgical concepts concerning the treatment of acute pancreatitis are described. Owing to sonography and above all to computed tomography, constantly compared with clinical data, the surgical decisions can be more easily conducted. In acute pancreatitis of biliary origin, endoscopic sphincterotomy is mandatory in a great number of cases, followed by complete de-obstruction of the common bile duct. That procedure has the advantage of reducing notably mortality and morbidity. In idiopathic pancreatitis, 4 therapeutic behaviours which correspond to 4 different clinical types, are to be faced: --or after 5 to 6 days, division of the left hypochondrium with performing of a meticulous cleaning, followed by a large drainage lavage, --if all reanimation measures have failed, earlier surgery, often of the last chance, consisting in necrosectomy as extended as necessary, --in right away appearing pancreatic phlegmon, a very large drainage, --or, a more expecting attitude in cases in which resorption of the necrotic spots appears to be very slow on CT-Scan, but without any clinical abnormality. Figures support these concepts and prove their warranty.

Acute Disease↗
PubMed1989

[What are the surgical indications for non-complicated duodenal and gastric ulcers?].

Taking into account recent medical progress and on the basis of their own experience, the authors define the up-to-date surgical management of non-complicated duodenal and gastric ulcers. Chronic duodenal ulcers still remain to be submitted to surgery in case of resistance to different types of medical drugs, in case of concomitant disease requiring a specific treatment contraindicated in ulcer disease, in case of patients refusing drugs or developing side-effects, and last, in posteriorly localized or bleeding ulcers. In these situations proximal gastric vagotomy (P.G.V.) still remains the best procedure owing to its low mortality (less than 0.5%) and morbidity rates, and its very satisfactory functional results. The recurrence risk, estimated between 10 to 15%, might burden the long-term results. But in a high percentage of cases it is related to technical inefficiencies. It has to be recalled that only 30% of these patients will undergo reoperation. But it should be emphasized that prepyloric ulcers are a poor indication for P.G.V. and should be submitted to truncular vagotomy with antrectomy. In gastric ulcers, the surgical treatment is mandated whenever endoscopic signs don't disappear under medical treatment or if biopsies remain suspicious. The most satisfying procedure is a gastric resection always involving the lesion and followed by a gastroduodenal anastomosis according to Péan-Billroth I.

Duodenal Ulcer↗
PubMed1988

[Surgery of the left colon].

Some basic technical principles make the left colon surgery as safe as possible. The authors recall the surgical anatomy and the vascularization of the left colon and describe the technic of a left hemicolectomy, of the Hartmann procedure with restoration of the intestinal continuity and the closure of a lateral colostomy. Mastering these technics should help to face and resolve any urgent or regular pathological pattern of the left colon.

Colectomy↗
PubMed1987

[Results of a French survey on the use of surgical staplers in gastrointestinal surgery].

Results of an inquiry in 40 French hospitals (28 universities and 12 private clinics). With 2 exceptions, all questioned surgeons use stapler instruments in oesophagus, stomach and colon rectal surgery. 50% of the surgeons noticed the same percentage of fistulae by stapler as by hand suturing and the severity of these leakages was more or less identical in both series. As contraindications for using stapler machines oedema of the visceral wall, small size of the lumen, important visceral distension and insufficient practice with such instruments, were mentioned.

France↗
PubMed1987

[Current status of perioperative preventive use of antibiotics in colorectal surgery].

The rate of postoperative wound infections following colorectal surgery can be considerably reduced by rational perioperative short-time antibiotic prophylaxis. The anaerobic and aerobic microflora of the colon as well as the half-life of the medicaments used have to be taken into due consideration for good choice of antibiotics. Persistent orthograde intestinal flushing, using physiological electrolyte solution without any addition of antibiotics, on the eve of surgery as well as perioperative antibiotic prophylaxis "en flash", using slow-drop intravenous infusion of 1 g Ornidazole and 2 g Mezlocilline along with introduction of anaesthesia, made for a good approach to reducing wound infections following colorectal surgery to two per cent. Twice as much antibiotics were administered for 24 to 28 hours in emergency cases in which preoperative intestinal flushing was not possible. This helped to reduce the rate of postoperative infections from 32 to six per cent.

Anti-Bacterial Agents↗
PubMed1987

[Long-term recurrence and complications of 300 supra-selective vagotomies for simple chronic duodenal ulcer].

Three hundred H.S.V. for chronic duodenal ulcer, performed between 1972 and 1982, are reviewed. A thorough analysis of intra and post-operative complications points out that only ulcer recurrence still set problems. These concern their definition, frequency, diagnosis and treatment. The personal experience of the authors leads them, in case of failure of the medical treatment with and endoscopically proved ulcer--what happened in 6 patients of 17 (35,8%)--to prefer gastric resection to re-vagotomies, the performance of which is often difficult and the results uncertain.

Chronic Disease↗