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Biomedical subjects

M Malafosse

Publications and source records attributed to M Malafosse.

At least 55 records · Page 3Linked to original sources
PubMed1990

[New material for needle jejunostomy: technique and preliminary results].

New material for needle jejunostomy was evaluated. They have the following advantages: rapidity and ease of use in jejunostomy, the possibility of a high daily calorie intake, a cutaneous fixation system allowing cleaning of the feeding tube stoma. The material is presented and the insertion technique is described. The preliminary results in 30 patients showed no mortality or morbidity related to the jejunostomy. The authors stress the importance of performing needle jejunostomy whenever long-term high calorie intake is required after the operation.

Digestive System Diseases↗
PubMed1990

[New surgical procedure for the protection of the small intestine before postoperative pelvic irradiation].

A prosthesis was designed to protect the intestinal loop from external beam radiation therapy when post-operative radiation is indicated. It is a silicone inflatable balloon, which, when implanted displaces the intestinal loops out of the pelvic irradiation field. The prosthesis can be deflated between each course of irradiation, without surgery. The device has been used in 8 patients: 6 patients with recurrent pelvic tumor (2 rectal cancers, 1 anal cancer, 1 cancer of the endometrium, 1 cervical carcinoma, 1 ovarian carcinoma), 2 patients with primary tumor (1 malignant paraganglioma, 1 cervical carcinoma). Radiotherapy was administered by means of high power appliances. After radiotherapy, the prosthesis was deflated, then removed through a 3 cm incision under local or peridural anesthesia. The tolerance of the small intestine to the radiation therapy has been satisfactory in each case with no bowel injury due to radiation. Therefore, this simple device might be useful to prevent bowel injury during postoperative radiation in the treatment of abdominal and retroperitoneal tumor masses.

Combined Modality Therapy↗
PubMed1990

[Cloacogenic cancers of the anal canal: a retrospective study of 17 cases].

This study involved 17 cloacogenic cancers classified on the Morson and Jass histological scale and on the TNM clinical classification as T1 (4), T2 (3), T3 (3) and T4 (7) and including 5 N+ cases at the time of diagnosis. Treatment combined radiotherapy and surgery and the overall actuarial survival was 45% after 5 years. These results confirm that the response to treatment of cloacogenic cancers is similar to that of epidermoid cancers, notably with regard to the response to radiotherapy, and that the prognosis depends above all on the initial extent of the cancer. In contrast, cancers showing little or no differentiation (small cell cloacogenic cancers) are distinguished from other duct cancers by their explosive metastatic potential.

Adult↗
PubMed1989

[Treatment of acute obstruction due to left colonic cancer].

Retrospective study on 47 patients (23 men, 24 women); mean age was 70.2 years. The mean delay of complete obstruction was 6.95 days. There were associated pathology and clinical factors of gravity in 53.2%, and local factors of gravity in 43.9% of all cases. Three steps surgery in 22 cases (46.8%), two steps in 14 cases (29.7%): 6 "ideal" colectomies (12.7%), 5 colostomies alone (10.6%). Mortality: 3 patients died (6.8%), post operative complications occurred in 22 patients (46.8%); morbidity due to colostomies itself was 37.4%. All first step-colostomies, except one, has been closed after colectomy. The mean duration of total stays in hospital was 31.5 days, according with the surgical procedure in one (14.3 days), two (37.9 days) or three (43.2 days) steps. Duration of complete obstruction, bioclinical status of patients, staging and complications of the cancer and surgeon's experience are determining therapeutic choices. The choice for colostomy as first step is the best policy. In this series the mortality of the colostomy as first step was none. It must be performed with elective incision, on free colic segment (transverse or sigmoid), with the simplest technical procedure (loop colostomy). Others surgical procedures have only peculiar indications.

Acute Disease↗
PubMed1989

[Intubation of proximal biliary stenoses using a new surgical endoprosthesis].

Thirty patients with high biliary tract strictures were treated by a new surgical endoprosthesis, the tolerance of which has been tested experimentally. It is flexible, radiopaque and incompressible with spurs which prevent migration. Following choledochotomy, the endoprosthesis is positioned surgically above the sphincter of Oddi, thereby avoiding ascending cholangitis. Twenty-nine cases presented with neoplastic compression by an inoperable cancer and one case had an early postoperative stricture with loss of substance after right hepatectomy for hepatic metastases. The 29 cancers included 13 gallbladder cancers, 11 cholangiocarcinomas, 10 of which were hilar, and 5 metastatic compressions due to gastrointestinal adenocarcinomas. In three cases, there was loss of substance of biliary tract after intubation. The operative mortality was 3.3% (one pulmonary complication). Resolution of jaundice was obtained in all but 2 cases and pruritus always resolved. The mean survival of the patients with cholangiocarcinoma was 12.2 months while that of patients with gallbladder cancer was 6.33 months with indices of satisfaction, calculated by Bismuth's method, varying between 71% (gallbladder cancer) and 93.5% (hilar cholangiocarcinoma). The patient operated for benign stricture secondary to a hepatectomy scar for metastases died from lung metastases without jaundice after 48 months. The only late complications were 2 cases of cholangitis treated medically, one of which was due to obstruction of the endoprosthesis at the 13th month. The authors conclude that this new type of surgical endoprosthesis constitutes an alternative in the palliative treatment of neoplastic hilar compressions.

Cholestasis↗
PubMed1988

[Surgical treatment of Oddi's sphincter tumors. Apropos of 56 cases].

The records of 56 patients operated upon for ampullary tumors were reviewed in order to determine the best way to diagnose and treat these tumors. Thirty six males and 20 females, 30 to 89 years old, were operated upon between October 1970 and October 1985. Eighty six p. 100 had jaundice and 21 p. 100, anemia. In recent years, ultrasonography, duodenoscopy and ERCP appeared to be the most useful tests for diagnosis. Mean size of the tumors was 2.3 cm (0.5 to 5 cm). Five tumors were benign (8.9 p. 100) and 51 were malignant. According to the classification of Martin, 5 were grade I: 10, grade II: 18, grade III: and 18, grade IV. The correct histologic diagnosis was obtained on biopsy specimens taken during endoscopy in 7 of 12 patients. Nine patients underwent palliative choledocoduodenostomies: only one is alive at 3 years; 47 underwent resection of the tumor: 3 local excisions associated with sphincterotomy for small benign tumors, 6 ampullectomies (followed in 3 by a Whipple procedure for recurrence) and 41 Whipple procedures. After pancreatic resection, 3 patients died during hospital stay and 12 had reversible complications; overall 5 year survival was 41 p. 100. It was 75 p. 100 in grade I, 50 p. 100 in grade II, 40 p. 100 in grade III and 10 p. 100 in grade IV. Patients who received an ampullectomy were alive with a follow up of 1, 2, and 3 years. All patients operated upon for a benign tumor were alive except one who died of cardiac failure.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Loss of substance in bile ducts treated by a new surgical endoprosthesis.

Three cases of loss of substance of the common bile duct in patients with neoplastic disease treated by a new surgical endoprosthesis are reported. In all patients a good biliary drainage was obtained without a biliary fistula. There were no complications related to this method. Long-term follow-up showed persistence of the good immediate results. Surgical endoprostheses might be an alternative in cases with peroperative loss of substance of the common bile duct in patients with neoplastic disease to hepato-enteric anastomoses.

Aged↗
PubMed1986

[Results of choledoco-duodenostomy for common bile duct lithiasis].

One hundred and sixty-seven choledoco-duodenostomies for lithiasis of the common bile duct (CBD) were performed. The mean age of the patients was 74 +/- 1 years. Sixty p. 100 of the patients presented with at least one operative risk factor, usually related to their general condition. An anastomosis of at least 20 mm in diameter was possible as the diameter of the CBC was always larger than 10 mm. Immediate postoperative complications (within one month) were observed in 29 cases (17 p. 100). In 14 cases (8 p. 100), these complications were directly related to the operative procedure and, in 15 cases (9 p. 100), bronchopulmonary or cardiovascular complications occurred. Operative mortality was 4 p. 100 (7 cases); in 2 cases, death was directly related to the operative procedure, and in 5 cases, death was not directly due to surgery. Operative complications were significantly higher in the case of emergency procedures, impaction of the CBD by multiple stones, and associated acute cholecystitis. One hundred and thirty-four of the 160 survivors (84 p. 100) have been followed for a mean duration of 5 years (63 +/- 7 months); 115 (86 p. 100) have remained asymptomatic. Eleven patients had non specific findings; 8 (6 p. 100) had cholangitis, half of them having suffered from only one episode. The first (or only) episode occurred during the first postoperative year in 7 out of 8 patients. No cholangitis developed after the second postoperative year in patients still asymptomatic. No anastomotic stenosis was found in any of these cases. One case of stump syndrome was observed. These results suggest that choledocoduodenostomy is a reliable procedure for treatment of choledocolithiasis and related late complications are rare.

Aged↗
PubMed1985

[Myenteric plexuses and colonic diverticulosis: results of a histological study].

The implication of intraluminal hyperpressure in the pathogenesis of colonic diverticulosis was investigated. Since colonic motricity depends on the anatomical integrity of the myenteric plexuses, we looked for morphological abnormalities of these plexuses in diverticulosis of the sigmoid, using the silver impregnation technique devised by Smith. Fifteen sigmoidectomy specimens (including the rectosigmoid junction) were studied in patients afflicted with diverticulosis. Operations were not performed during the acute phases of the illness. The results were compared to those obtained in 5 colectomy specimens in patients with cancer of the rectum, without colonic diverticulosis (control series). Conventional histology as well as the silver impregnation did not reveal any morphological abnormalities of the myenteric plexuses in the rectosigmoid junction or in the remaining sigmoid. The count of argyrophilic ganglion cells (10 to 15 per plexus) was identical in the colons affected with diverticulosis and in the control specimens. These results show that impairment of motricity in sigmoid diverticulosis is not a consequence of morphological abnormalities of the myenteric plexuses. They do not, however, exclude chemical or functional modifications in these plexuses.

Aged↗
PubMed1984

Rectopexy to the promontory for the treatment of rectal prolapse. Report of 257 cases.

From 1953 to 1982, 257 patients with complete rectal prolapse were operated upon. To the procedure described by Orr, we have added mobilization of the rectum prior to its suspension and eliminated the pouch of Douglas, and nylon strips have been used for suspension in most patients. There were 57 male and 200 female patients. Ages ranged from 11 to 90 years. Sixty-one patients had already undergone surgery for rectal prolapse with another procedure and prolapse had recurred. The postoperative course was uneventful in 96 per cent of patients. Two patients, aged 79 to 83 years, died of cardiac failure. Follow-up of 115 patients ranged from five to 23 years. Recurrent rectal prolapse was observed in 4.3 per cent of the patients in whom nylon strips were used to suspend the rectum. In 136 patients anal incontinence was associated with rectal prolapse. Normal continence was restored in 84.1 per cent of 107 patients with rectopexy alone and in 64.2 per cent of 14 patients who underwent rectopexy and anal sphincter repair. It is concluded that rectopexy to the promontory with nylon strips after mobilization of the rectum is a safe and efficient procedure for the treatment of rectal prolapse.

Adolescent↗