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Biomedical subjects

M J Boudet

Publications and source records attributed to M J Boudet.

29 records · Page 2Linked to original sources
PubMed1997

[Diagnosis of inguinal hernias].

The diagnosis of inguinal hernia is more often obtained by the history on an intermittent inguinal tumefaction spontaneously reducible or using maneuvers well known by the patient and the clinician. The complementary explorations have a small interest, but the ultrasonography and the CT-scan can confirm the parietal defects in case of diagnostic doubt. The research of risk factors is necessary, in order to avoid recurrences after surgery. In a same way, associated severe diseases, like colorectal cancers and aneurysms of the abdominal aorta, have to be researched. The precise diagnosis will indicate the type of surgical procedure, inguinal or laparoscopic, but the validity of this last approach has to be proved.

Diagnosis, Differential↗
PubMed1997

Hepatic venous outflow block caused by short-length hepatic vein stenoses.

In contrast with the well-recognized membranous obstruction of the inferior vena cava, short-length hepatic vein stenoses are not well-recognized causes of hepatic venous outflow block. The aim of this study was to ascertain the prevalence, causes, manifestations, and outcome of short-length hepatic vein stenoses. We performed a retrospective study of patients with short-length hepatic vein stenosis among 86 patients with hepatic venous outflow block who were seen between 1970 and 1992. There were 25 patients with short-length hepatic vein stenosis. A thrombogenic condition was identified in 14 patients (56%). The lesions of the accompanying hepatic veins in these patients were variable (short-length stenoses, thromboses, or nonspecific changes) and similar to that seen in patients without short-length hepatic vein stenosis. In 3 necropsied cases, the venous lesions were suggestive of fibrous sequela of prior thromboses. In patients with short-length hepatic vein stenosis, splenomegaly (28% vs. 55%, P < .05) and hypersplenism were significantly less common; serum transaminase (P < .001) and creatinine levels (P < .02) were lower, prothrombin was higher (P < .001), and 5-year survival was significantly better (Kaplan-Meier estimates: 80% vs. 50%, P < .05). In patients with hepatic venous outflow block, short-length hepatic vein stenosis is a common lesion that appears to be the sequela of localized thrombosis. Long-term anticoagulation and percutaneous angioplasty (with or without stenting) are potentially applicable in these lesions. The long-term results of these treatments merit further evaluation.

Adult↗
PubMed1995

[Diagnosis and treatment of colonic and anorectal hemorrhages].

In lower gastrointestinal bleeding, the first step is the exclusion of an upper gastrointestinal cause, responsible in 15 to 20% of cases, and the assessment of the severity of blood loss, so that an adequate resuscitation can be rapidly performed. Eighty percent of these bleeding episodes stop spontaneously; among these, 25% recurs, sometimes severely. When bleeding episode stops, it is essential to repeat the examinations to find out the cause of bleeding. The therapy may be endoscopic, radiologic, surgical or medical. For patients who require an emergent surgical procedure, intraoperative endoscopic techniques can be helpful. In 95% of cases, the source of bleeding is the colon or the rectum: the most common causes are diverticular disease, in particular from the right colon, colorectal tumours, angiodysplasia and colitis, but there are some simple causes easy to diagnose such as hemorrhoids, anal fissures and thermometric ulcerations.

Aged↗
PubMed1995

A prospective multicenter evaluation of preoperative hemostatic screening tests. The French Associations for Surgical Research.

BACKGROUND: Several retrospective and four prospective reports have questioned the need for routine preoperative hemostatic screening tests (PHST) in general surgery. PATIENTS AND METHODS: The results of four standard tests (prothrombin time, activated partial thromboplastin time, platelet count, and bleeding time) were prospectively compared with patient history and clinical data in a multicenter study of 3,242 consecutive patients. The patients were divided into four groups: group A (n = 1,951) had no clinical or PHST abnormalities; group B (n = 340) had no clinical and one or more PHST abnormalities; group C (n = 779) had one or more clinical and no PHST abnormalities; group D (n = 172) had both clinical and PHST abnormalities. RESULTS: Preoperative modifications of guidelines (postponed operations and ordering of additional hemostatic tests) were significantly more frequent in both groups of patients with PHST abnormalities (groups B and D), but specific treatment to correct hemostatic disorders was prescribed only when clinical abnormalities were also present (group D). Intraoperatively, modifications of anesthetic and surgical vigilance (planning of increased number of blood units, vascular catheter placement, and number of patients requiring transfusion) were significantly more frequent in group D. Postoperatively, all groups had similar incidences of hematoma or bruises, volumes of blood loss per drainage, reoperations to control hemorrhage, and mortality due to bleeding (n = 5). CONCLUSIONS: Our results suggest that PHST should not be performed routinely, but only in patients with abnormal clinical data. Such a policy necessitates a thorough history--including answers to a specific questionnaire like those used in prospective studies--and a rigorous, well-conducted physical examination.

Adolescent↗
PubMed1995

Shouldice inguinal hernia repair in the male adult: the gold standard? A multicenter controlled trial in 1578 patients.

BACKGROUND: Hernia repair is the second most frequently performed operation in France and in the United States, the prevalence being 36 for every 1000 males. Lowering the recurrence rate by 1% would mean 1000 fewer operations for hernia repair per year in France. METHODS: Between 1983 and 1989, 1578 adult males with a total of 1706 nonrecurrent inguinal hernias were prospectively and randomly allotted to undergo either a Bassini's repair, Cooper's ligament, or Shouldice repair with polypropylene or a Shouldice repair with stainless steel for determination of which technique was associated with the lowest recurrence rate. Fifty-nine hernia repairs were withdrawn after inclusion. Of the 1647 remaining hernias, 52.2% were indirect, 25.6% were direct, and 23.2% were combined. Patients were seen every 6 months for 3 years and then every year. Median follow-up was 5 years 8 months (range, 3 months-8.5 years). RESULTS: At 8.5 years, 5.6% of hernias were lost to follow-up. Ninety-seven hernia repairs failed, 50% during the first 2 years. The actuarial recurrence rate was 7.94% at 8.5 years. The Shouldice repair (stainless steel or polypropylene) was associated with fewer recurrences (6.1%) than either the Bassini's (8.6%) or Cooper's ligament repair (11.2%) technique (p < 0.001). This difference remained significant even when the maximal bias test was used. Fewer recurrences (5.9%) were observed with the stainless steel wire Shouldice repair than with polypropylene version (6.5%), but the difference was not significant. CONCLUSIONS: Shouldice hernia repair provides the patient with the best chances of nonrecurrence regardless of the anatomical type of hernia. The Shouldice hernia repair should be the gold standard for inguinal hernia repair in men and serves as the basis for comparison with all other techniques, be they prosthetic or laparoscopic.

Follow-Up Studies↗
PubMed1995

Villous tumors of the duodenum: a retrospective study of 47 cases by the French Associations for Surgical Research.

BACKGROUND: We evaluated villous tumors of the duodenum in regard to preoperative diagnosis of malignancy and the choice of treatment. STUDY DESIGN: From January 1974 to October 1992, forty-seven patients with a benign or malignant tumor arising from the duodenal mucosa were studied. Forty-two patients underwent a macroscopically complete resection of the tumor. Nineteen tumors were malignant. RESULTS: Preoperative endoscopic biopsy results had a 52 percent sensitivity and 100 percent specificity for the diagnosis of malignancy. For the 42 patients who underwent complete resection, jaundice was predictive of malignancy (p < 0.01), whereas tumor size was not (p < 0.2). The five-year survival rate of this group was 69.5 percent (confidence interval: 50 to 84). The recurrence rate was higher (p < 0.01) and the survival rate shorter (p < 0.001) for patients who underwent ampullectomy (n = 8) compared with patients treated by limited resection (n = 20) or pancreatoduodenectomy (n = 14). CONCLUSIONS: Preoperative diagnosis of malignancy is difficult for villous tumors of the duodenum. For tumors located near the papilla, it seems that pancreatoduodenectomy is the best treatment.

Actuarial Analysis↗
PubMed1995

[Surgical treatment of severe ulcerous hemorrhages: predictive factors of operative mortality].

OBJECTIVES: Multivariate analysis of operative mortality in patients with bleeding peptic ulcer. METHODS: Seventy-eight consecutive patients, who underwent emergency surgical treatment for bleeding peptic ulcer were reviewed retrospectively. There were 49 males and 29 females, with a mean age of 64.3 years, 2/3 of whom had associated medical disease. Surgical treatment was conservative in 63 cases: oversewing or ulcer excision, alone (n = 29) or associated with vagotomy (n = 34); and was radical in 15 cases: antrectomy+vagotomy (n = 10) or partial gastric resection (n = 5). RESULTS: There were 17 (21.8%) postoperative deaths and 19 (24.3%) bleeding recurrences. The causes of death included 9 bleeding recurrences, 7 organ failures and one duodenal leakage. On multivariate analysis, previous medical illness (cirrhosis or cardiac insufficiency (P < 0.001), shock at admission (P < 0.001), prolonged delay until surgery (P < 0.001), and bleeding recurrence (P < 0.001) were independently associated with increased mortality. In contrast, the type of surgical procedure did not influence postoperative mortality, whereas bleeding recurrence was more frequent in case of conservative surgery (P < 0.03) and anticoagulation therapy (P < 0.01). CONCLUSION: These results suggest that surgical treatment of bleeding peptic ulcer should be proposed early in high-risk patients. A radical procedure should be favoured since it reduces bleeding recurrence rate without increasing operative mortality.

Adult↗
PubMed1993

[Strangulated hernia and eventration].

Incarcerated hernia or wound dehiscence are responsible for more than 10% of small bowel obstructions. The complication is easily recognized when hernia or wound dehiscence was previously diagnosed. Difficulties occur when mass is deeply located in a thick abdominal wall or inside the inguinal canal. Femoral hernias and direct inguinal hernias are those which strangulate the most. Strangulation in wound dehiscence is the most severe. Strangulated hernia should be routinely excluded in patient with intestinal obstruction, to avoid inappropriate surgical approach.

Hernia↗