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Biomedical subjects

M Carretier

Publications and source records attributed to M Carretier.

At least 91 records · Page 5Linked to original sources

[Primary cancers of the gallbladder. Apropos of a homogeneous series of 75 cases].

Seventy-five cases of primary carcinoma of the gallbladder are reviewed retrospectively under observation of a fifteen year period, representing 2.4 per cent of the number of biliary tract surgery performed during the same period. The majority of the patients presented with advanced disease with extension and metastases to the liver (56%) and to the adjacent organs (53.3%) and to the lymph nodes along the common bile duct (21.3%). Eleven patients had localized disease at the time of the operation; they were treated with cholecystectomy. Eight patients had clinically inapparent carcinoma at the time of the cholecystectomy; the diagnosis being established post-operatively by histologic examination of the excised gallbladder. There were no five years survivors in this second group of patients, but five of them are one year survival (62.5%) and one is still alive three years and six months after surgery. The remaining patients with inapparent carcinoma died within three years of the time of the operation. The present report emphasize the poor prognosis associated with carcinoma of the gallbladder and the presence of gallstones. Carcinoma of the gallbladder in our experience has proved curable only when accidentally discovered at cholecystectomy for presumed benign biliary tract disease. This fact plus the frequent and serious non neoplastic complications of neglected gallstones are strong indications for early elective cholecystectomy and extended resection may improve the survival rate.

Adult↗

[How many cirrhotic patients may receive propranolol after digestive hemorrhage?].

The aim of the present study was to evaluate how many cirrhotics may receive propranolol after upper gastrointestinal bleeding. One hundred and twelve patients were consecutively admitted in a digestive intensive care unit during a two-year study, for bleeding of esophageal (63 p. 100) or gastric (4 p. 100) varices, or acute gastric erosions (33 p. 100). Twenty-one per cent of patients were initially class A (Child's classification). 26 p. 100 were B, and 53 p. 100 were C. Eighteen patients (16 p. 100) died within the first 10 days. Eighty patients (71 p. 100) did not receive propranolol because of: a) contraindication for this drug (asthma, heart failure, diabetes, n = 25); b) carcinoma, mainly of the liver (n = 11); c) foreseeable lack of compliance with the treatment (n = 8); d) criteria for which the efficacy of propranolol has not been demonstrated (small esophageal varices, jaundice, or ascites, n = 36). Only 14 patients (13 p. 100) received propranolol therapy: 5 stopped their treatment, 3 because of gastrointestinal rebleeding. Our experience suggests that propranolol can be used only in a few cirrhotics for prevention of recurrent gastrointestinal bleeding.

Adult↗

[Generalized peritonitis of non-traumatic colonic origin. Reflexions on 62 cases].

The authors analyze sixty-two cases of acute generalized peritonitis with a non-traumatic colonic etiology. They point out that the prognosis depends on three main factors: the age of the patient, the time spent in diagnosis and the therapeutic difficulties. They recommend a gastrographin colonic enema to obtain earlier diagnosis, in the absence of radiological evidence of pneumoperitoneum, in elderly patients presenting with abdominal signs. They also recommend multistage surgical management combining effective drainage of the abdominal cavity with resection of the perforated segment of the colon, whenever there is extensive damage to the colon, or in the presence of a tumor. In their view, conservative surgery should be confined to strictly selected cases not involving tissue resection. These indications are essential if a satisfactory result is to be achieved.

Adult↗

[Pancreatitis: a little-known cause of ureteral obstruction].

Left ureteral stenosis induced by pancreatitis was observed in one case. Five similar cases have been reported in the literature. Ureteral obstructions may be found in two clinical contexts--patent pancreatitis or retroperitoneal fibrosis. The ureter may be simply compressed mechanically, or there may also be enzymatic or ischemic necrosis. The clinical approach should be directed towards treating primarily the pancreatitis and secondarily the urological pathology. As regards the urological treatment, ureterolysis or ilio-ureteroplasty are indicated in cases of organized irreversible ureteral stenosis.

Adult↗

[Localized tetanus after esophagogastrectomy].

Post-operatory partial tetanus is a more and more rare event. It can outcome after any type of surgery but especially after abdominal surgery. The contamination is usually endogenous through the digestive bacteria and it develops in anaerobic context. These different factors were united in this report. The diagnosis is difficult if not keep in mind. The treatment is usual, but prevention might be pointed out.

Esophagus↗

[The hemostatic assistance after sub-total or total hepatectomy in the dog (author's transl)].

After subtotal (90%) or total hepatectomy in the dog, coagulation disturbances appear early and exclude survival beyond 40 hours. These disturbances are the result of a fall in the synthesis of coagulation factors, but may also reflect a consumption syndrome. The ensuing clinical finding is an intravascular coagulation which can give way to fibrinolysis. A substitutive therapy aiming to replace the missing factors and avoid or prevent an eventual consumption thus appears necessary. The hemostatic disturbances after subtotal or total hepatectomy in the dog can be totally corrected by a substitutive therapy based on fresh frozen plasma. The first hepatic segment (caudate lobe) cannot insure by itself the coagulation functions during the first 4 post-op days. The hemostatic assistance is an other step towards the treatment of hepatic insufficiency. It must become an integral part of existing artificial liver support.

Animals↗

Cooper ligament repair: an update.

This study had 4 objectives: first, to define the place of the Cooper ligament in hernial repairs by recalling its anatomic importance within the inguinal region; second, to describe our technique using the Cooper ligament, a technique based on suture of the conjoined tendon to the Cooper ligament without a relaxing incision into the rectus sheath and also to describe other authors' variants; third, to report the results obtained for 1,040 patients operated on by our technique from 1970 to 1978; fourth, to define the value and limits of these herniorrhaphy methods in repairs of groin hernias. These methods are inexpensive and virtually exclude the risk of serious infections because no foreign material is used. The procedures can be used in most patients. The only limits are suture tension during the repair and the presence of parietal deterioration. In such situations, it is necessary to perform a prosthetic repair or to reinforce the herniorrhaphy with prosthetic mesh.

Hernia, Inguinal↗