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Biomedical subjects

M Celerier

Publications and source records attributed to M Celerier.

At least 19 recordsLinked to original sources
PubMed2000

Extensive abdominal surgery after caustic ingestion.

OBJECTIVE: To report the authors' experience in extensive abdominal surgery after caustic ingestion, and to clarify its indications. SUMMARY BACKGROUND DATA: After caustic ingestion, extension of corrosive injuries beyond the esophagus and stomach to the duodenum, jejunum, or adjacent abdominal organs is an uncommon but severe complication. The limit to which resection of the damaged organs can be reasonably performed is not clearly defined. METHODS: From 1988 to 1997, nine patients underwent esophagogastrectomy extended to the colon (n = 2), the small bowel (n = 2), the duodenopancreas (n = 4), the tail of the pancreas (n = 1), or the spleen (n = 1). Outcome was evaluated in terms of complications, death, and function after esophageal reconstruction. RESULTS: Five patients required reintervention in the postoperative period for extension of the caustic lesions. There were two postoperative deaths. Seven patients had secondary esophageal reconstruction 4 to 8 months (median 6 months) after initial resection. Three additional patients died 8, 24, and 32 months after the initial resection. Three survivors eat normally, and one has unexplained dysphagia. CONCLUSIONS: An aggressive surgical approach allows successful initial treatment of extended caustic injuries. Early surgical treatment is essential to improve the prognosis in these patients.

Adult↗
PubMed1996

The thoracoscope as diagnostic tool for solid mediastinal masses.

BACKGROUND: Despite the accuracy of percutaneous biopsy of mediastinal masses under CT scan or sonographic control, there is still a need for surgical biopsy because of difficult location or because of insufficiency of the percutaneous biopsy, especially for those tumors requiring an immunological classification. METHODS: The thoracoscopic approach to mediastinal masses is an alternative to the usual surgical biopsies performed through thoracotomy, sternotomy, or anterior mediastinotomy. The procedure is performed under general anesthesia and one-lung ventilation. RESULTS: In a series of 47 cases, a histological diagnosis was obtained in 44 cases (93.6%). There was one hemorrhagic complication requiring thoracotomy (2.1%). The mean postoperative duration of stay was 3.2 days. CONCLUSIONS: Thoracoscopy is the method of choice in case of failure or contraindication of percutaneous biopsy. There is still a role for mediastinoscopy in treating paratracheal lymph nodes.

Adult↗
PubMed1996

Mediastinoscopy vs thoracoscopy for mediastinal biopsy. Results of a prospective nonrandomized study.

OBJECTIVE: To assess the results and the morbidity of thoracoscopy compared with conventional mediastinoscopy for the approach of mediastinal solid masses and lymph nodes, we have performed a prospective study about the respective yields, complication rates, and the length of hospital stay for patients. MATERIAL AND METHODS: We have included 114 patients in the study. The criteria of inclusion were the accessibility of the lymph nodes and/or mass to cervical mediastinoscopy through CT scan view. There were 2 groups: 52 patients underwent a mediastinoscopy (group M) and 62 underwent a thoracoscopy (group T). RESULTS: There were 3 failures in group M (5.7%) and 5 failures in group T (8.1%) (not significant; NS). In group M, the three procedures were converted to anterior mediastinotomy (two cases) and to thoracoscopy (one case). In group T, the five procedures were converted to anterior mediastinotomy (two cases), mediastinoscopy (two cases), and thoracotomy (one case). The diagnostic yield was 94.3% in group M and 91.9% in group T (NS). After conversion, a diagnosis was reached in all patients in group M (100%) and in all but 1 patient in group T (98.3%) (NS). There was no intraoperative complication in group M, while 2 complications occurred in group T (3.2%) (p < 0.05). The overall morbidity was zero in group M and 4.8% in group T (p < 0.05). CONCLUSION: The diagnostic yield of mediastinoscopy is comparable to thoracoscopy. Complication rate and hospital stay of patients undergoing mediastinoscopy are significantly inferior. Thoracoscopy should be indicated only for lesions that are not within the reach of the mediastinoscope or when multiple biopsy specimens are necessary.

Biopsy↗
PubMed1995

Can the morbidity of esophagectomy be reduced by the thoracoscopic approach?

Esophagectomies have a high morbidity rate, mainly related to pulmonary complications. The aim of this work was to assess whether the thoracoscopic approach could reduce this morbidity. We have made a prospective study of the results of 29 attempts of esophagectomy using a right thoracoscopic approach. There were 20 males and 9 females having an average age of 47. The indication was a squamous cell carcinoma in 22 patients, an adenocarcinoma in 1 patient, a melanoma in 1 patient, and a caustic stenosis in 5. The whole esophagus was mobilized thoracoscopically and the esophagectomy was completed through the abdomen. The reconstruction was achieved using a gastric pull-through and a cervical anastomosis. There were five failures for the following reasons: unresectable carcinoma (one case), large tumor making a thoracoscopic dissection unsafe (two cases), and incomplete lung collapse making the exposure of the posterior mediastinum difficult (two cases). The average time of the thoracoscopic procedure was 135 min. The postoperative course was uneventful in all but five patients who had a pulmonary complication: atelectasis (three cases), right purulent pleural effusion (one case), acute respiratory disease syndrome (one case). The latter complication was lethal. Four out of five respiratory complications occurred in patients for whom the dissection was considered difficult. Among the other complications, there were five anastomotic leakages and three cases of laryngeal nerve palsy. The mortality rate was 3.8%. These initial results do not show a real benefit of the thoracoscopic approach for esophageal dissection, especially with respect to difficult esophagectomies. Further evaluation of the technique is needed.

Adenocarcinoma↗
PubMed1995

[Effects of intraperitoneal insufflation on hematogenous seeding of abdominal infections. Preliminary results of an experimental study in rats].

Most laparoscopic procedures require the creation of a pneumoperitoneum. In order to evaluate the potential hazards of bacteriemia related to insufflation, we conducted a study in the rat. Two groups of 20 Wistar rats were used for this study. Peritonitis was induced by opening the terminal ileum. Twenty-four hours later, 20 rats were insufflated at a mean pressure of 6 mm Hg (Group I). After one hour of insufflation, an hemoculture was performed via direct intracardiac puncture and in the other group of 20 non-insufflated rats (Group NI). Five of the 18 hemoculture were positive in the Gr. I (27.7%) and 6 out of 20 in the Gr. NI (30%) (chi 2 = 0.238 p = 0.62 non significant difference). These results suggest that insufflation does not facilitate hematogenous dissemination of bacteria from intraperitoneal sepsis in this animal model.

Animals↗
PubMed1995

[The diagnostic value of thoracoscopy in solid masses of the mediastinum].

Despite the accuracy of percutaneous biopsy of mediastinal masses under CT scan or sonographic control, there is still a need for surgical biopsy either because of difficult location or because of insufficiency of the percutaneous biopsy, especially for those of the tumors requiring an immunological classification. The thoracoscopic approach of mediastinal masses is an alternative to the usual surgical biopsies performed through thoracotomy, sternotomy or anterior mediastinotomy. The procedure is performed under general anaesthesia and one-lung ventilation. In a series of 44 cases, an histological diagnosis was obtained in 41 cases (93.1%). There was one haemorrhagic complication requiring thoracotomy (2.3%). The mean post-operative duration of stay was 3.2 days. We conclude that thoracoscopy is the method of choice in case of failure or contraindication of percutaneous biopsy. There is still a role for mediastinoscopy for laterotracheal lymph nodes.

Adult↗
PubMed1994

[Thoracoscopic approach of pericardial effusion].

We report the technique of pericardial approach through the thoracoscope. This approach has several advantages. Extensive pericardial fenestration can be performed as well as pericardoscopy whenever indicated and additional biopsies such as mediastinal or lung parenchyma biopsies. Among the 12 patients operated on, the procedure was possible in all but one case. When there is no contraindication to selective tracheal intubation or lateral positioning, the thoracoscopic approach is the method of choice. In other cases, the subxiphoid approach remains indicated.

Acute Disease↗
PubMed1994

The hook-wire technique for localization of pulmonary nodules during thoracoscopic resection.

The main problem related to the thoracoscopic resection of lung nodules is the difficulty in locating the target nodule. Among the several methods proposed, one of the most efficient is the preoperative placement of a localization wire into the nodule while it is under computed tomography scan control. After our initial series of 22 thoracoscopic resections of lung nodules without preoperative localization, we have used the hook-wire technique in 21 patients. In our initial series, we had four failures while we have had only one in the hook-wire series. Only two minor complications related to the wire localization technique occurred: a poorly tolerated pneumothorax and an intrapulmonary hemorrhage. There was no postoperative complication. The mean duration of postoperative stay was 1 to 6 days. We conclude that the preoperative localization of lung nodules using a hook wire is a safe and accurate method before thoracoscopic resection in selected patients.

Humans↗
PubMed1994

[Video-assisted pneumonectomies: lessons learned from an experimental study on an animal model].

In order to test the feasibility of video-assisted pneumonectomy, we conducted an experimental study in an animal model. We performed 12 attempts of video-assisted pneumonectomy (7 on the right side and 5 on the left side) in pigs with an average weight of 43.5 kg. We used a combined technique of conventional and endoscopic dissection. A complication-free pneumonectomy was possible in 7 animals. Among the remaining 5 animals, 6 vascular injuries occurred, one of which was lethal. Two other animals died during the procedure for unknown reasons. We conclude that: 1) the vascular risk of video-assisted pneumonectomy appears to be prohibitive; 2) the value of animal models for vats feasibility studies is questionable because of the major differences in anatomical conditions.

Animals↗
PubMed1994

Thoracoscopic ultrasonic localisation of lung nodules: initial results of an in-vitro and in-vivo study.

The main problem in thoracoscopic resection of lung nodules is the difficulty in localising the target. In the following we describe the use of an ultrasonographic, deflectable linear array probe of 7.5 MHz which was first tested during an in-vitro study. This study has provided useful information with respect to the US inspection of normal parenchyma and lung nodules. Initial results in clinical use in 14 patients demonstrate some limitations linked to the difficulty in manoeuvering the probe and to the remaining air in the parenchyma. However, endoscopic US is an interesting additional tool during thoracoscopic exploration of the lung.

Equipment Design↗
PubMed1994

Decreased mesenteric blood flow supplying retrosternal esophageal ileocoloplastic grafts during positive-pressure breathing.

Esophageal replacement after esophagogastric injury caused by ingestion of lye may require the interposition of a retrosternal ileocolic graft. In this new anatomic situation, the mesenteric circulation supplying the graft is subjected to the intrathoracic pressure surrounding the graft. Thus, mesenteric blood flow supplying the graft may be impaired when intrathoracic pressure is increased during mechanical ventilation. This study was designed to evaluate the effect of increasing intrathoracic pressure by application of a positive end-expiratory pressure on mesenteric blood flow supplying esophageal ileocolic grafts. Eight cases were studied in the immediate postoperative period. Miniaturized implantable Doppler microprobes were sutured to the single artery supplying the graft and connected to an 8 MHz pulsed Doppler flowmeter. Two sets of measurements were successively performed with zero end-expiratory pressure ventilation and after application of a 15 cm water positive end-expiratory pressure. Positive end-expiratory pressure induces mean arterial pressure (-12%); p < 0.05) and cardiac output (-17%; p < 0.05) decrease. Mesenteric blood flow also decreases (-38%; p < 0.05) as did the mesenteric blood flow/cardiac output ratio, suggesting a potential mesenteric vasoconstriction assessed by mesenteric vascular resistance increase and mesenteric diastolic blood flow velocity decrease. These results suggest that, in the particular anatomic situation of the graft, increased intrathoracic pressure induces mesenteric blood flow decrease in relation to systemic hemodynamic alterations associated with perivisceral pressure increase. This change may be deleterious to graft perfusion.

Adult↗
PubMed1993

Splenectomy in human immunodeficiency virus-related thrombocytopenia.

To evaluate the efficacy and safety of splenectomy in patients with human immunodeficiency virus (HIV)-related thrombocytopenia, 30 HIV-infected patients with thrombocytopenia (platelet count < 50 x 10(9)/l) who underwent splenectomy were followed prospectively for a mean period of 42 months. There were no perioperative deaths and morbidity was minimal. Twenty-one patients had a persistent complete response, six had a partial response and were asymptomatic after splenectomy, and only three showed no response. Three patients developed acquired immune deficiency syndrome during follow-up, an incidence that was no different from that expected. Splenectomy is a safe and effective treatment in HIV-infected patients with severe symptomatic thrombocytopenic purpura resistant to medical therapy.

Adolescent↗
PubMed1993

Thoracoscopic esophagectomy: technique and initial results.

To reduce the high morbidity rate associated with esophageal surgery, we have developed a technique of thoracoscopic esophagectomy. A feasibility study was first carried out in an animal model and a specific instrument was developed for this purpose. Esophagectomy using a right thoracoscopic approach was attempted in 15 patients, 13 males and 2 females whose average age was 48 years. Indications consisted of squamous cell carcinoma in 10 patients, adenocarcinoma in 1, and caustic stenosis in 4. We used a technique that consisted of double-lumen tracheal intubation and the creation of five ports. The whole esophagus was mobilized thoracoscopically and the esophagectomy was completed through the abdomen. The reconstruction was achieved using a gastric pull-through, and the anastomosis was made in the neck. There were three failures: in 1 patient there was a large tumor, making the exposure unsafe, and, in 2 patients, incomplete lung collapse made exposure of the posterior mediastinum difficult. These 3 cases were converted into a thoracotomy. The thoracoscopic dissection was successful in the remaining 12 patients. The average time of the thoracoscopic stage was 125 minutes. The postoperative course was uneventful in 10 patients. Two patients had a left atelectasis. Although our series is limited, these initial results indicate that thoracoscopic esophagectomy is feasible. However, further evaluation of the technique is needed to assess its benefit in terms of respiratory morbidity.

Burns, Chemical↗
PubMed1993

Laparoscopic splenectomy: initial laboratory experience.

An experimental study was conducted in an animal model to test the feasibility of laparoscopic splenectomy. Twelve pigs were operated on. The splenectomy was feasible in 10 cases. However, a splenic injury occurred in five cases and the average blood loss was 80 ccm. We concluded that laparoscopy is feasible in an experimental model but is not a safe and easy procedure. Clinical applications should probably be limited to selected cases.

Animals↗
PubMed1993

[Problems related to thoracoscopic resection of pulmonary nodules].

We present the initial results fo thoracoscopic resection of pulmonary nodules, based on a report of 23 patients. The resection was performed through a sole thoracoscopy in 12 cases, but was associated with a mini-incision in 11 cases. In 4 cases, the procedure had to be converted to thoractomy. We discuss the problems encountered and the indications of the technique.

Adult↗
PubMed1992

Usefulness of perioperative pulsed Doppler flowmetry in predicting postoperative local ischemic complications after ileocolic esophagoplasty.

Regional ischemia may induce cervical anastomosis leakage or stenosis or graft necrosis after esophageal reconstruction by retrosternal interposition of an ileocolic graft. These complications may be related to systemic or local hemodynamic alterations. This study was designed to evaluate the relationship between immediate postoperative arterial blood supply to the graft, arterial patency monitored by angiography, and clinical outcome. Eight patients (mean age 30 +/- 4 years; standard deviation) were studied. Miniaturized Doppler implantable microprobes were sutured to the single artery supplying the graft and connected to an 8 MHz pulsed Doppler flowmeter. Systemic hemodynamic parameters and mesenteric hemodynamic data were collected 3 hours after the end of the surgical procedure. These data were compared with the angiogram of the right superior colic artery supplying the graft, systematically performed on the fifteenth postoperative day, and with the clinical course of follow-up for 3 months. Five patients (group 1) had excellent clinical and angiographic results. Mean mesenteric blood flow in these patients was 51 +/- 49 ml.min-1 (+/- standard deviation, ranging from 9 to 122). Three patients (group 2) had a poor clinical outcome. One had early complete graft necrosis and the two others had leakage of the cervical anastomosis with poor distal arterial vascularization of the graft on the angiogram. Mean mesenteric blood flow was nul in the first patient and, respectively, 24 and 28 ml.min-1 in the two others. Cardiac output and mean arterial pressure were in the same range for all patients. Phasic velocity shape analysis revealed that the three group 2 patients had an end-systolic or end-diastolic reverse flow pattern that was not observed in the five group 1 patients, which suggested a submaximal increase in downstream vascular resistance. This reverse flow pattern seems to be a good predictor of ischemia-related complications. We conclude that perioperative pulsed Doppler blood flow monitoring in an ileocolic graft may be useful for the diagnosis and prevention of ischemic complications.

Adult↗