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Biomedical subjects

L Hannoun

Publications and source records attributed to L Hannoun.

123 records · Page 7Linked to original sources
PubMed1980

[Heparin-induced thrombopenia. Vascular complications in six cases (author's transl)].

The most frequent complication during heparin treatment is hemorrhage from overdosage. Heparin-induced thrombopenia is more rarely observed but is a more serious disorder. Six such cases are reported, of which three were complicated by gangrene of the limbs. Clinical findings are described, together with the methods of detecting the presence of heparin-induced antiplatelet antibodies. The affection becomes evident on the 9th day of treatment by the presence of a thrombopenia and accompanying clinical signs. These may be those of a hemorrhagic syndrome directly related to the thrombopenia, or manifestations of thrombotic lesions. The latter can cause worsening of the condition for which heparin was prescribed, arterial thrombosis of a large vessel, venous thromboses disappearing after interruption of heparin treatment, of distal thrombosis of the microcirculation with a rapidly irreversible onset of gangrene requiring amputation. The lesions are provoked by an immune mechanism and heparin has to be discontinued.

Adult↗
PubMed1980

[Venous fistulization of an iliac aneurysm (author's transl)].

The first reported case of a left iliac arteriovenous fistula from rupture of an aseptic atheromatous aneurysm is described. The fistula occurred proximally to a primary iliac vein thrombosis which explains the clinical picture observed of very severe "blue" phlebitis and the absence of any cardiac complications. The fistula was treated by the endo-aneurysmal approach and arterial continuity re-established with a prosthesis. The postoperative result was excellent.

Aged↗
PubMed1979

[Selective distal spleno-renal shunt. A report of 14 patients (author's transl)].

Fourteen cirrhotic patients underwent distal splenorenal shunt to prevent recurrent hemorrhage from oesophageal varices. No post-operative mortality was observed. Transitory chylous ascites occured in 1 patient, portal thrombosis with concomitant early rebleeding in another one. Hypersplenism was improved post-operatively. Porto-caval encephalopathy was not observed. With a follow-up between 3 and 27 months, one single patient died from hepatic failure, variceal bleeding did not reccur in long term survivors.

Adult↗
PubMed1977

[Role of neck-head arthroplasty in the treatment of per-trochanteric fractures after the age of 70. Apropos of 140 cases].

The authors compare the results obtained in two series of trochanteric fractures in patients aged more than 70 years. In the first series, the fractures in 64 patients were all treated by nail-plate fixation. In the second series, fractures in 76 patients were treated either by nail-plate fixation (39 cases) or insertion of a prosthesis (37 cases). Prostheses were inserted in unstable fractures. It is concluded that, in all main respects, the results in unstable fractures were better after prostheses than after fixation. This finding is thought to be due to the greater speed of the operation and the possibility of early weight bearing.

Aged↗
PubMedDate not supplied

Excision of the rectum with colonic J pouch-anal anastomosis for adenocarcinoma of the low and mid rectum.

The results of rectal excision with colonic pouch-anal anastomosis are reviewed from a series of 162 patients covering 7 years. All patients have been operated upon in the same institution and consecutively. The follow-up is now sufficient to allow an accurate evaluation of the outcome of the patients. The main goal of this study was to provide a detailed report of the functional results. Continence was satisfactory in 96% of the patients, with either a perfect continence or minor troubles that would not have been detectable other than by a rigorous questioning. The mean number of bowel movements was 2 per 24 hours. Fragmentation of the defecation and urgency were absent. Twenty-five per cent of the patients had to elicit the evacuation of the reservoir with a suppository or an enema. Improvement of function yielded by a reservoir over straight colo-anal and low colo-rectal anastomoses are significant and, as suggested by manometric studies, are directly related to the restoration of a reservoir function.

Adult↗
PubMedDate not supplied

Surgical resection of liver metastases from colo-rectal cancers.

Surgical resection is currently the only potentially curative treatment in some selected patients with colo-rectal liver metastases (LM). Unfortunately only a minority of patients are candidates for resection. Only solitary or unilobar LM that can be removed by partial liver resection, are considered to be resectable. The second condition for the resection of LM is that the primary cancer must be resected. The third condition for resection is that the patient must be able to undergo a major liver resection if it is necessary. Small metastases which do not exceed 5 cm, and appear on the surface of the liver can be removed by a simple wedge resection. If the tumor is larger than 5 cm, or if multiple unilobar nodules are discovered, a major liver resection becomes necessary. Hospital mortality does not exceed 5% in most published series. Five year survivals are very rare when histologically proven colo-rectal LM are left in place. After surgical resection of LM, five year survival rates are close to 25% and range from 18% to 52%. Surgical resection is of benefit to approximately one fourth of the patients, who survive five years or more, but three fourths of the patients have early recurrences. None of the studied criteria can predict which patients will benefit from surgical resection of LM. In order to try to reduce the rate of early recurrences adjuvant chemotherapy has been proposed. No positive data have yet been obtained.

Colonic Neoplasms↗
PubMedDate not supplied

Hepatic vascular exclusion (HVE) for major liver resections.

One hundred fifty-three patients underwent hepatic resection. Hepatic venous exclusion (HVE) was utilized in 23%. Aortic clamping was used in 20% of cases with hepatic venous exclusion. The mean duration of liver ischemia was 33 minutes. HVE increases the resectability of massive posterior or hypervascular liver tumors and prevents the risk of massive bleeding or air embolism. The only counterindication is the presence of severe preexisting cardiac dysfunction.

Hemodynamics↗
PubMedDate not supplied

[Renal arteriovenous fistulae (author's transl)].

Five cases of renal arteriovenous fistulae are described: four after needle biopsy of the kidney, one due to intrarenal aneurysmal rupture. One fistula closed spontaneously, the other four patients were operated on and treated by nephrectomy. 243 other cases from the literature were reviewed. The clinical manifestations involve the cardiovascular (arterial hypertension, congestive heart failure) or the urologic (hematuria, renal colic, flank pain) systems. The diagnosis is usually made by flank auscultation (which detects a continuous sound) and by use of renal arteriograms. The causes of these fistulae are numerous: congenital or acquired from biopsy examinations, trauma, surgery, neoplasia, infection, aneurysmal rupture. The usual treatment of these fistulae is a nephrectomy but selective embolization or direct surgical repair make possible, with greater frequency now, renal parenchymal preservation.

Adenocarcinoma↗
PubMedDate not supplied

Study of cyclosporin A blood level during the early post-liver-transplantation period.

Correlations between acute rejection rate, cyclosporin A(CsA) blood level and CsA dose were studied in a group of 58 patients for 1 month following liver transplant. Therapy included prednisolone, azathioprine and CsA administered by continuous IV infusion. Blood CsA levels were measured by high performance liquid chromatography. No patient required renal dialysis. An acute rejection episode was recorded in 24 patients (group 1) between days 4 and 28 (mean 8 days), while 34 patients (group 2) showed no signs of rejection. A significant difference was observed (p < 0.05) between blood CsA levels (mean +/- SEM over the 6 days preceding the rejection episode in group 1 patients, and the first 6 postoperative days in group 2 patients (101 +/- 7 vs 121 +/- 5 ng/ml). The mean daily dose of CsA calculated over the same time period was significantly lower (p < 0.001) in group 1 patients (46 +/- 2 vs 60 +/- 2 mg/day). In addition, over the 8 days following surgery, only 54% of patients in group 1 attained a mean blood CsA level of a least 100 ng/ml, compared to 94% in group 2.

Cyclosporine↗
PubMedDate not supplied

Hepatectomy with hypothermic perfusion of the liver.

Whereas most liver resections can be performed within 60 min, the period of vascular clamping and resulting ischemia may prove too short to allow complex major liver resections (MLR) especially on diseased livers. To overcome this problem, cooling of the liver with 4 degrees C preservations solution routinely used in liver transplantation may be used in three different approaches to MLR: I "In situ": the liver remains in the abdomen and integrity of afferent and efferent vessels is conserved. II "Ex situ-in vivo": the liver exteriorized from the abdomen by transecting all hepatic veins, remains connected to the porta hepatis. III "Ex vivo": the liver being removed from the abdomen, the MLR is performed extracorporeally. Of 15 MLR reported here, 11 were performed "in situ" and 4 "ex situ-in vivo"/Nowadays, the liver surgeon's "toolbox" must contain hypothermic liver perfusion. In carefully selected cases, these techniques allow MLR on diseases livers or mandating complex vascular procedures.

Blood Loss, Surgical↗