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Biomedical subjects

M Gelin

Publications and source records attributed to M Gelin.

At least 91 records · Page 5Linked to original sources
PubMedDate not supplied

What did the laparoscopic Nissen approach of the gastro-oesophageal reflux really change for the patients 8 years later?

BACKGROUND: Nissen fundoplication (NF) is recognized as the surgical treatment of the gastro-oesophageal reflux disease (GERD). NF can be achieved either by open surgery or by laparoscopic approach. METHODS: From 1987 to 1997, 210 patients were treated for GERD by NF: 61 by open and 149 by laparoscopic approach. All the patients were followed more than 1 year and were scored by clinical assessment (Visick scale adaptation). In case of Visick score > 1, GI-endoscopy, X-ray series or 24-hour pH-study complete the evaluation. RESULTS: The operative time was comparable between both groups. The postoperative recovery was statistically faster in the laparoscopic group (p = 0.0001). The mean time of follow-up was 6 years after open NF and 4 years after laparoscopic NF. After open NF or laparoscopic NF, 72% and 67% of the patients are respectively scored Visick 1, 13% and 21%--Visick 2, 6.8% and 6%--Visick 3 and 8.2% and 6%--Visick 4 (NS). Patients with recurrence of GERD were scored Visick 4, so failure of the surgical treatment is observed in 5 patients after open NF and 9 patients after laparoscopic NF. The occurrence of incisional hernia was significantly higher in the open group (p = 0.0001). CONCLUSION: NF remains a safe procedure for surgical treatment of GERD and can be achieved by laparoscopic approach with comparable results to those by open laparotomy. In our experience, the advantages of the laparoscopic approach is a faster postoperative recovery and a lower risk of incisional hernia.

Adult↗
PubMedDate not supplied

Hepatic myelopathy after splenorenal shunting: report of one case and review of the literature.

Hepatic myelopathy is a rare complication of cirrhosis, usually associated with surgical or spontaneous porto-systemic shunts. Its pathophysiology is unknown. It is characterized by a motor involvement of the lower limbs without clinical sensory abnormality, leading to spastic paraparesis. These neurological features are related to a symmetric loss of myelin in the lateral corticospinal tracts. Usefulness of liver transplantation in this setting is not yet determined. We describe here the case of a 29-year-old male who presented with progressive spastic paraparesis of the lower limbs 3 years after a spleno-renal shunt.

Adult↗
PubMedDate not supplied

[Acute hepatitis and poisoning by Amanita phalloides].

We report the case of a 69-year-old woman who presented acute hepatitis due to Amanita Phalloides poisoning complicated of acute renal failure. Her clinical evolution was favorable under medical treatment whose actual modalities are discussed.

Acute Kidney Injury↗
PubMedDate not supplied

Hepatobiliary cystadenoma with mesenchymal stroma: presentation of one case and review of the literature.

We present one case of hepatobiliary cystadenoma with mesenchymal stroma (CMS) which is a very unusual tumor of the biliary tract. These rare neoplasms have been identified as a distinct clinicopathological entity. They occur exclusively in middle-aged women with an average age of 45 years, and are located on the right hepatic lobe. Histologically, CMS are characterized by the presence of a typical dense stroma between an inner epithelial lining and an outer loose connective layer. Malignant transformation may occur and therefore a complete surgical resection of these premalignant neoplasms is indispensable.

Adult↗
PubMedDate not supplied

[Emergency intrahepatic shunt via transjugular approach].

We report the case of a cirrhotic 65 year-old woman presenting with persistent and recurrent variceal hemorrhage in spite of endoscopic sclerotherapy with bucrylate, glypressin infusion and balloon tamponade. At the time of intrahepatic shunt placement via the transjugular route, Child-Pugh score was 14 (Child C category) and surgical variceal decompression or liver transplantation were contraindicated. At the end of the procedure, which included the placement of two Palmaz stents, varices were no more opacified and the wedge hepatic venous pressure gradient had decreased from 70%. Evolution of the patient was excellent with a permeable shunt after one month. Emergency placement of intrahepatic shunt with metallic stent has certainly a place in case of failure of initial management of variceal bleeding with pharmacotherapy, sclerotherapy or balloon tamponade.

Aged↗
PubMedDate not supplied

Oesophageal perforation by an anterior cervical fixation device: management in debilitated patients.

Oesophageal perforation following anterior cervical fixation has been reported in the neurosurgical and orthopaedic literature as a rare complication of such procedure. The complications associated with oesophageal perforation may range from minor symptoms to mediastinitis and death. We report two oesophageal perforations following cervical fixation device migration in patients with poor prognosis, managed successfully with conservative surgical and endoscopic techniques.

Bone Plates↗
PubMedDate not supplied

Endoscopic treatment of esophagogastric varices.

We report our current management of variceal bleeding with endoscopic sclerotherapy. We emphasize the importance of resuscitation and of recording at time zero and within the first 72 hours clinical and laboratory indicators, as these influence the management of these patients. Primary sclerotherapy using Histoacryl for active bleeding and Ethoxysclerol for recent bleeding should be performed as soon as the patient is stable hemodynamically. As we have identified factors related to the severity of hemorrhage and of liver failure degree which can predict early failure of sclerotherapy, patients presenting with these findings should be, in the future, referred quickly toward alternative therapies among which non-surgical intrahepatic shunt appears a promising modality.

Cyanoacrylates↗
PubMedDate not supplied

Non-surgical management of achalasia.

Pneumatic dilatation of the cardia is an effective procedure to treat patients suffering from achalasia. Eighty percent of these patients can be expected to have excellent or good results for 6 years after the first dilatation. A repeat dilatation should be performed as soon as the patient has recurrent symptoms, usually every 2 years. Calcium channel blockers (nifedipine and verapamil) or nitrates (isosorbide dinitrate) decrease LES pressure but do little to the clinical symptomatology of patients with achalasia; however such drug therapy may be tried as an adjunct in patients who remain symptomatic after pneumatic dilatations or myotomy. Pneumatic dilatation and surgical myotomy both reduce LES pressure; with pneumatic dilatation, enough residual LES pressure is retained to prevent gastroesophageal reflux. Indeed, reflux esophagitis seems to occur more often after surgery than after forceful dilatations. We think that pneumatic dilatation should be performed as the primary therapy and surgery reserved for the failures of this procedure.

Adult↗
PubMedDate not supplied

[Primary sclerosing cholangitis: contribution of retrograde cholangiography in follow-up: apropos of 15 case reports].

From 1975 to 1989, primary sclerosing cholangitis (PSC) was diagnosed in 15 patients especially based on cholangiographic features associated with clinical, biological and histological findings. 93 p. cent of patients had altered liver enzymes at the diagnosis time but only 26% was asymptomatic. 33 p. cent had a concomittant inflammatory bowel disease. Retrograde cholangiography showed injuries of the intrahepatic ducts in 93 p. cent; the more frequently observed lesions were short and multifocal strictures, associated with irregularities of the biliary wall or decreased arborization of intrahepatic bile ducts, but without marked dilatation. Mean follow-up was 44 months (3 to 120). Actuarial survival was 48 p. cent at 5 years. In 4 patients, because of poor clinical and biological (serum bilirubin greater than or equal to 4 mg/dl) evolution, a second retrograde cholangiography was performed showing in all cases apparition of marked ductal dilatation in extra-hepatic (one case) or in intra-hepatic bile ducts (three cases). We diagnosed one benign extra-hepatic stricture, two cholangiocarcinoma and one biliary cirrhosis complicating PSC. We concluded that retrograde cholangiography is necessary if jaundice appears to diagnose every complications of PSC. Apparition of marked ductal dilatation should be the witness of pejorative evolution, especially apparition of cholangiocarcinoma that must be excluded.

Adult↗
PubMedDate not supplied

[Selection of patients with parenchymal cirrhosis for hepatic transplantation].

The aim of our study was to design simple and practical quantitative scores or indices suitable for deciding a pre-liver transplantation work-up in patients with parenchymal cirrhosis. A Pugh score (combining five variables) superior to 8 or a p value inferior to 0.7 of a logistic regression equation containing only two variables (score of ascites and result of 14C aminopyrine breath test) were found to be highly effective for making this decision.

Aminopyrine↗
PubMedDate not supplied

[Flat crossleg flaps in the repair of large skin, muscle and bone defect of the leg. Present indications, new techniques (author's transl)].

This is a report on a patient who suffered a large skin, muscle and bone defect of the leg following a Volkmann's ischemia. The author's indications for a flat crossleg flap are explained : extended skin defect at the anterior and inner aspect of the broken tibia or a skin defect associated to a tibial defect making a secondary bone graft necessary. Finally the authors describe an original technique of crossleg flap : this consists in a trapezoidal flap with the large side being the implantation basis.

Adolescent↗
PubMedDate not supplied

[Digestive system surgery in octogenarians].

Between October 1, 1977 and June 30, 1983, 139 G.I. tract operations were performed in patients over 80 years-old. 45,3% were post-operatively admitted to the I.C.U.; the criteria for admission were emergency surgical interventions, the type and duration of the operation. The operative mortality was 15,8%. Contributory factors were the type of the intervention, its curative nature and the necessity for post-operative reanimation. The urgent nature of the intervention as well as the histology of the lesion had no bearing on the mortality. Local complications were noted in 34,5% of the cases and were mainly superficial and deep wound infections. General complications, mainly involving the cardio-pulmonary and urinary tract systems, occurred in 68,3% of the cases. Morbidity was mainly associated with the timing of the intervention.

Aged↗