[Bacterial flora in acute appendicitis].
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Anti-Bacterial Agents↗
Biomedical subjects
M Bernat
Publications and source records attributed to M Bernat.
Surgical reconstruction of the oesophagus.
Reconstructive oesophageal surgery underwent 322 patients in our clinic. The surgery was indicated because of cicatrical obstructions or cancer of the thoracic part of the oesophagus. The continuity of the alimentary tract was re-established by pedunculated intestinal segment from the jejunum, ileum or left side of the colon in the anisoperistaltic position. The right side of colon was used either in iso- or anisoperistaltic position. The follow-up after completion of the reconstructive operation ranges from 1-40 years.
Esophagus↗
["Vitamin resistant" osteomalacia due to a defect in hepatic hydroxylation of vitamin D; reversible secondary-pseudo-hypoparathyroidism due to calcium administration].
The authors report a case of vitamin resistant osteomalacia in an adult due to an apparently acquired absence of hepatic hydroxylation of vitamin D. This case was also of interest as the osteomalacia caused a state of type II pseudo-hypoparathyroidism which proved reversible on calcium drip. Thus a defect of hepatic hydroxylation of vitamin D may be a cause of vitamin resistant osteomalacia in the adult apart from the forms already described related to defect of renal hydroxylation of vitamin D. Hypocalcemia may be responsible for hypoparathyroidism due to the coexistence of a rise of circulating immuno-reactive PTH and an increase in urinary cyclic AMP. Normalisation of the calcemia permitted in this case, restoral of the efficacy of endogenous PTH.
Calcium↗
[Report of a case of Gaucher's disease in adult].
The authors report a case of Gaucher's disease in an adult. This is a rare disease due to the accumulation of a glucoceramide in the reticulo-endothelial cells and may remain for long clinically symptomless, as in this case. The diagnosis suggested by the biological disturbance, viz. moderate thrombopenia, hypergammaglobulinemia, increase in SGPT, was conformed by the presence of Gaucher's cells in the liver and in the bone marrow, and by the existence of an intraleukocytic glucosidase deficiency. The authors recall the clinical forms of this disease, and recent clinical trials.
Adult↗
[Study of 9 cases of the para-osteo-arthropathy of tetanus].
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Elbow↗
[Radiculography with the dimer of methyl glucamine iothalamate (Dimer X)].
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Adult↗
[Evolution of patients with rheumatoid arthritis treated with immunosuppressive agents between 1965 and 1973].
The authors report the results of a study of 139 of their patients with severe rheumatoid arthritis, treated with chlorambucil of cyclophosphamide between 1965 and December 1973, with an observation period of 4 to 12 years. 8 patients were lost to follow-up, 38 died and 93 were reexamined. In this series 7 deaths were attributed to hemolymphoreticulopathy of various cytological types; 6 deaths were due to visceral cancer and 2 others to cancer of the tonsils. They confirm that such treatments increase the risk of hemopathy but apparently not the risk of visceral cancer. The risk was not a function of the total dose of the drug administered since no neoplasia was observed in the 25 subjects who received the highest doses. The addition of chlorambucil to cyclophosphamide seems to increase the risk of hemopathy. It was noticed that the 7 cases of hemolymphoreticulopathy occured after 60 years.
Adult↗
[Massive reconstruction of the acetabulum and proximal femur].
Bone allografts are used in situations of repeated hip surgery to repair bone loss and allow muscle fixation without excessive use of massive metallic prostheses. We examined 51 cases of hip reconstruction after a mean follow-up of 3 and a half years. Indications were: reoperations on arthroplasties, usually after the weight carrying areas of the acetabulum had been destroyed; repeated operations on the upper extremity pellucid femurs; bone tumours (especially chondrosarcomas). Results have been good based on patient satisfaction, mobility and consolidation of the allograft-bone junction. Complications included: post-operative death after major surgery for invasive tumours (n = 4); sepsis (n = 2); hip luxation requiring an anti-luxation crescent (n = 3); and aseptic serous effusion suggestive of possible immunologic reactions against the bone grafts (n = 3). These operations were compared with massive reconstruction prostheses, with arthrodeses with limb shortening and with hanging limbs, and in certain cases with interilioabdominal amputations.
Acetabulum↗
Operative procedure in early carcinoma of the thoracic part of the esophagus.
The authors present four patients with early carcinoma of the thoracic part of the esophagus. In all patients, "blind" esophagectomy was performed without thoractomy. Simultaneously salivary fistula on the neck and gastrostomy was formed. During the second stage of the procedure a retrosternal esophagus was formed out of pedunculated intestinal grafts. No serious postoperative complications were noted. According to the authors, the above-mentioned procedure should be limited to early cases of carcinoma of the thoracic part of the esophagus. The post-operative follow up of the cases was up to four years.
Adult↗
[Benign esophageal tumors].
The authors present seven cases of benign oesophageal tumours treated in hospital in the years 1972-1990. Among the treated patients were six men and one woman, aged from 30 to 70 years. In four patients the tumour was situated in the middle part of the thoracic segment, and in three cases in the lower part of the supradiaphragmatic segment of the oesophagus. The diagnosis od benign oesophageal tumour was made on the basis of X-ray examination, oesophagoscopy, and histopathological examination. Five patients were treated surgically. In two patients the access to the tumour was from the right pleural cavity, and in three other cases--from the abdominal cavity. The result of histopathological examination of the removed tumours was as follows: in two patients--benign polyps, in one patient--mature teratoma, in one female patient--myxofibroma, and in one case--fibromyoma. In all patients operated on complete cure was achieved.
Adult↗
[Diagnosis and treatment of osteogenic sarcomas, techniques of reconstructions. Future prospects].
PATIENTS AND METHODS: We have performed 34 massive bone-cartilage grafts with a follow-up of 2 to 7 years (1988-1993) including 5 complete joint grafts of the knee. Between 1988 and 1993, 8 massive diaphyso-metaphyseal bone grafts were performed. Joint reconstructions using massive bone-cartilage allografts are increasingly used in routine oncology surgery. Long-term rehabilitation and possibilities of immediate anatomic reconstruction of the articular surface, together with mid-term results suggest that the functional results are promising compared with major reconstruction prostheses. Indications for operations are being increasingly widened to younger subjects who have undergone partial or total joint exeresis for tumour. Sleeved prostheses were used for 12 reconstructions (1988-1993) for sarcoma of the knee. RESULTS The risk of sepsis are comparable for the different groups and are mainly related to the quality of the skin repair during chemotherapy. Fractures of the graft occur when the fixation is insufficient or when rehabilitation exercises were too aggressive. Non-consolidation was exceptional when the junction between the allograft and the receiver bone is not surrounded with autologous spongious autografts. Joint instability and arthrosis depend on the stability of the ligament reconstruction. To this day, no Charcot type joint disease has been demonstrated, periarticular innervation has maintained joint trophism. DISCUSSION: There are still some incompletely resolved problems concerning the revascularization of the graft, its integration into the skeleton, the outcome of the grafted cartilage and that of the ligament formations attached to the graft or used as allografts. These massive grafts must be studied over a longer period of time but the early results are encouraging. Sleeved grafts using bone-bank specimens could be an intermediary solution which appears to be indicated in cases where the tumoural resection was particularly large removing bone, cartilage, ligaments and muscles. With these sleeved prostheses, the muscles can be refixed onto the graft thus reducing the risk of shank fracture and loosening. The use of a tibial graft with the patellar tendon is helpful in reconstructing the extensor apparatus. However, if rehabilitation is not undertaken rapidly and followed regularly for several months, the graft favours the development of muscular adherances which can be a major limitation to joint mobility.
Adolescent↗
[Study of circulating 25 hydroxyvitamin D].
The levels of circulating 25 OH-D were determined by a direct radio-competition methods both in normal subjects and in subjects with various pathological conditions. In normal subjects, the average level of 25 OH-D was higher in summer (42.3 ng/ml) than in winter (29.1 ng/ml), P less than 0.005. Monthly variations in the 25 HO-D levels were found in relation to insolation The level of 25 OH-D was practically normal in osteoporosis (28.9 ng/ml), clearly lower in the mixed forms called "osteoporomalacia" (13.5 ng/ml, P less than 0.005) and very low in osteomalacia (5.8 ng/ml, P less than 0.001). In cases of cortisone osteopathy the average level was 22.8 ng/ml (NS). The level of 25 OH-D was also found to be lower in hepatic cirrhosis (11.7 ng/ml, P less than 0.01), in subjects treated with anticonvulsants (P less than 0.01), and in the course of hyperparathyroidism (P less than 0.002). There was no corelation between the level of 25 OH-D and calcaemia, phosphoraemia, circulating immunoreactive parathyroid hormone, or the relative osteoid volume. In contrast, there seemed to be a good correlation with the level of alkaline phosphatasaemia. The level of 25 OH-D was also determined in 4 subjects with vitamin-resistant osteomalacia: in 3 cases hepatic hydroxylation seemed normal, indicating the possibility of a subsequent disorder of vitamin D metabolism; in one case the absence of hepatic hydroxylation was noted.
Alkaline Phosphatase↗