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Biomedical subjects

M Ribet

Publications and source records attributed to M Ribet.

At least 19 recordsLinked to original sources
PubMed1992

Accessory spleen in recurrent chronic immune thrombocytopenic purpura.

From 1969 to 1985 we discovered accessory spleens in 8 patients with chronic immune thrombocytopenic purpura (ITP) who relapsed or failed after splenectomy. Imaging of accessory spleen used a liver spleen scintigraphy with heat-treated RBC labeled with Tc-99m. Platelet kinetic studies with 51Cr or 111In, including sequestration index, were performed. Five patients had accessory splenectomy. Disappearance of bleeding symptoms was achieved in the 5 splenectomized patients but with only partial response of platelet counts. These results are discussed in the context of diagnosis and therapeutic management of accessory spleens in patients with chronic immune thrombocytopenic purpura who relapsed or failed after splenectomy.

Adolescent↗
PubMed1992

Plication of the diaphragm for unilateral eventration or paralysis.

Unilateral diaphragmatic paralysis and eventration have the same appearance and provoke the same disturbances. Diaphragmatic plication is intended to decrease lung compression, to make the thoracic base and mediastinum more stable, and to strengthen the respiratory action of intercostal, perithoracic, and abdominal muscles: 13 infants and children were operated upon, 7 in acute respiratory failure and ventilator-dependent, 4 in chronic respiratory failure; 11 adults were operated upon, 8 with respiratory and 3 with digestive symptoms. Four infants who had been operated upon before the 10th day of life died: 3 from associated diseases and 1 from a lung infection. The 9 survivors have been followed up for a mean period of 6.6 years. All were asymptomatic and the position of the plicated diaphragm was maintained. The 11 adults have been followed up for a mean period of 8.5 years. Nine were asymptomatic; in 1, dyspnea had decreased; in 1, reflux persisted and was surgically cured. In 5 adults, the respiratory tests showed a mean amelioration of 20% of vital capacity and 15% of forced expiratory volume in 1 s. In infants, the prognosis depends on associated malformations and on the condition of the lung. Plication should be performed after 2 weeks on a ventilator. In older children and adults, plication is justified when the anomaly produces symptoms (malignancy excluded). Plication is simple, efficient, and durable, but there is no indication of subsequent diaphragmatic function: its effects on respiratory mechanics are probably indirect.

Adolescent↗
PubMed1992

[Esophagectomy for advanced malpighian cancer of the thoracic esophagus. Esogastric anastomosis in the neck or in the thorax? Late results of a "randomized" prospective study].

During a 2 1/2 year period, 60 consecutive patients with cancer of the thoracic esophagus were randomized to undergo cervical (CA) or thoracic (TA) esophago-gastrostomy. The tumors were staged post-operatively and were almost equally distributed between the two groups. The esophageal specimens were macroscopically studied on the fresh specimens with vital staining, then microscopically. The prevalence of peri-tumoral mucosal and sub-mucosal lesions was confirmed. Microscopic malignant invasions of esophageal sections were more frequent in TA (10) than in CA (3). Resected positive lymph nodes were more numerous in CA (17) than in TA (7). The mortality was identical in the two groups. Respiratory complications and recurrent laryngeal nerve trauma were more frequent in CA. Long-term survivors had N0 disease with a healthy esophageal section. Even though subtotal esophagectomy reduces the prevalence of microscopic esophageal wall invasion at the upper section level and allows more complete unilateral exploration and resection of invaded lymph nodes, it offers no significant benefit concerning survival of patients with advanced cancer and malignant lymphadenopathy, after resection with post-operative radiotherapy.

Adult↗
PubMed1992

[Role of accessory spleen in recurrent chronic hematologic diseases].

Among 533 patients who were splenectomized between 1967 and 1981 for a chronic haemopathy, 8 were reoperated because of the reappearance of an accessory spleen, which was responsible for the relapse of the disease. Five patients were followed for idiopathic thrombopenic purpura (ITP), 2 for hereditary spherocytosis and 1 for a Hodgkin disease (this patient had been operated for an abdominal exploration and splenectomy). In all patients, a hepato-splenic scintigram with Tc 99 m permitted the discovery of the accessory spleens and the exploration was completed by the study of the half lifetime and sequestration of platelets or red blood cells. The disappearance of the haemorrhagic syndrome after removal of the accessory spleen was frank and didn't need any complementary treatment for 3 cases of ITP and 2 cases of spherocytosis and was incomplete and had to be completed by a secondary treatment for 2 cases of ITP and for the Hodgkin disease. The analysis and the interpretation of the results of this study can be helpful to establish the diagnosis and decide the treatment of accessory spleens which are discovered by a relapse of a chronic haemopathy, primarily treated by splenectomy.

Adolescent↗
PubMed1992

[Distal splenorenal shunt without deconnection in the prevention of recurrent digestive hemorrhage in the cirrhotic patient].

The emergent treatment of gastrointestinal hemorrhage caused by the rupture of esophageal varices in cirrhotic patients is based on sclerotherapy. The prevention of frequent recurrence may be an indication of portocaval shunting. Over an 8-year period, 72 patients were operated with a distal splenorenal shunt without deconnection aimed at preventing gastrointestinal rebleeding. This was non-emergent surgery. The Child-Pugh grade was 41 A and 31 B. All patients had an angiography, which demonstrated the lack of arterioportal reflux. Operative mortality was 2.7%. Actuarial survival at 5 years was of 67%, respectively 71% for grade A and 60% for grade B. Patency of the shunt was estimated to be 90%. Persistence of hepatopetal flow on control arteriography has been established in 65% of cases. Rebleeding was observed in 10% of cases, and episodes of encephalopathy in 10% as well out of 60 studied cases, 29 presented with a chronic increase in ammoniemia (48%). Two risk factors of mortality have been demonstrated: age higher than 60 years, and relapse of ethylic intoxication, which has been observed in 40% of cases. Later hepatic transplantation has been performed in one case, without success. These results are similar to those obtained with Warren's procedure. Further development of hepatic transplantation may limit its indications.

Actuarial Analysis↗
PubMed1992

[Bronchial cancers invading the chest wall].

One hundred and twenty five patients, considered as having a bronchial carcinoma invading the chest wall, suffered from a thoracic pain in 40 cases. They were operated on by pneumonectomy (23), bilobectomy (5), lobectomy (83) and atypical resection (1). Resection was impossible in 13 cases (10.4%), for anatomical (10) or functional reasons (3). Considering the chest wall, an extra-pleural resection was performed in 49 cases, a muscular resection in 25 cases and a skeletal resection in 38 cases. Parietal invasion was microscopically confirmed for 78 tumours out of 112 resections specimens and for 10 tumours out of 13 which were not resected: 65 T3 N0, 8 T3 N1, 15 T3 N2. Operative mortality was 12.5%. Global survival was 62.8% at 1 year, 14.2% at 3 years, 11.1% at 5 years. Median survivals were 393 days after resections dating back to more than 5 years and 158 days when the tumours were not resected. Thoracic pain is a symptom of chest wall invasion in 87.5% of cases, but the invasion is symptomless in 24% of cases. Sensitiveness, specificity and predicting values of imaging modalities are discussed: on the whole the negative predictive values are feeble (0.23 to 0.42). The operative estimation is also uncertain, especially considering invasion limited to the extra-pleural space. Practically, a fixed tumour with broad and firm adhesion to the chest wall is an indication for chest wall resection which gives better results, although this advantage is not statistically significant. Surgical prognosis of T3 cancers is, in this series, much worse than the prognosis of T2 tumours. Mortality is analyzed according to its causes.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Resection for advanced cancer of the thoracic esophagus: cervical or thoracic anastomosis? Late results of a prospective randomized study.

During a 2 1/2-year period, 60 consecutive patients with cancer of the thoracic esophagus were randomized to undergo a cervical or thoracic anastomosis. The tumors were staged postoperatively (stage I, n = 2; stage II, n = 19; stage III, n = 9; and stage IV, n = 30) and were almost equally distributed between the two groups. The upper limit of three tumors was above the convexity of the aortic arch. The esophageal specimens were studied with regard to measurements of the tumor and of the resected esophagus. The microscopic aspects were evaluated by serial sections after vital staining. The prevalence of ignored plurifocal cancers, of submucosal infiltrations, and of distant areas of dysplasia in both groups was confirmed. Malignant invasions of esophageal sections were more frequent in patients undergoing thoracic anastomosis (10 versus 3), and diseased upper mediastinal lymph nodes were more frequent in those undergoing cervical anastomosis (17 versus 7). Mortality was equally divided between the two groups. Respiratory complications and recurrent laryngeal trauma were more frequent in patients having cervical anastomosis. Long-term survivors had stage N0 disease, with a healthy esophageal section. Even though subtotal esophagectomy reduces the prevalence of microscopic esophageal wall invasion above the tumor and allows more complete unilateral exploration and resection of invaded lymph nodes, it offers no significant benefit concerning survival of patients with advanced cancer and malignant lymphadenopathy.

Adult↗
PubMed1991

[Liver injuries].

Explore the source record for details and available documents.

Abdominal Injuries↗
PubMed1991

[Pulmonary arteriovenous malformations].

This study concerns 11 patients; 7 had a Rendu-Osler-Weber disease. They were 5 males and 6 females, including 3 children. In addition to the thoracic symptoms of cyanosis, clubbing and polycythemia, 4 had been treated for a cerebral abscess. Standard chest films were normal in 2 cases. The anatomy of the malformations was studied by CT scans and angiographies. The 11 patients had 25 malformations, bilateral in 5 cases. All were hypoxennic. Four solitary lesions were resected by 3 lobectomies and 1 excision. Seven multiple lesions were treated by 1 pneumonectomy, 1 lobectomy, 1 segmentectomy + 1 excision and by 1 excision. In 2 of these cases radiology and surgery were associated. Two patients were treated by radiological vaso-occlusion. The 9 operated patients have remained cured with a mean 4.7 year follow-up, one still has a small, non evolutive anomaly. The 2 radiologically treated patients still have 2 non evolutive lesions. This cases allow a discussion concerning the diagnosis and treatment of arteriovenous malformations of the lung which can provoke grave complications. A long follow-up of treated patients is necessary.

Adolescent↗
PubMed1990

Oesophagectomy for severe corrosive injuries: is it always legitimate?

Twenty total gastric resections were performed on 80 patients admitted to surgery for severe oesophagogastric corrosive injuries, with immediate or delayed full-thickness necrosis or perforation of the stomach. The duodenum, cardia and cervicothoracic oesophagus were sutured. A cervical oesophagostomy and a feeding jejunostomy were done. The oesophagus was thus excluded. All the corrosive agents were liquid. The ingested quantities were higher than 150 ml in 11 cases. Oesophagoscopy was performed in 12 patients: 4 lesions were stage III, 5 stage II, 2 stage I, while in 1 the mucosa appeared normal. Five patients died, but only 1 from an oesophageal complication, an oesophago-tracheal fistula on the 33rd post-operative day. The survivors had a secondary colon bypass and 5 patients developed a secondary mucocele. We suggest that the low incidence of tracheo-oesophageal fistula in our series and the possible formation of a mucocele in the excluded oesophagus are two arguments for a conservative attitude towards the oesophagus in most cases of emergency gastric surgery for corrosive lesions. Immediate oesophagectomy adds another traumatic factor to the effects of the burns. A subsequent oesophagectomy should be contemplated during coloplasty to prevent the formation of a mucocele.

Burns, Chemical↗
PubMed1990

Congenital cystic adenomatoid malformation of the lung.

Twenty cases of cystic adenomatoid malformation of the lung were observed: 2 had died in utero; the diagnosis was made at birth in 13 infants of which 3 were premature. A Bochdalek's hernia had been diagnosed before birth in 2 cases by echo-tomography. The correct antenatal diagnosis had been made in 2 cases. Two infants had no symptoms, 3 were dyspneic, 8 were in respiratory distress and had to be intubated and ventilated. Two had a prune belly syndrome. Eight infants had a thoracotomy during their first week of life. Pulmonary resections concerning those 13 patients comprised 10 lower lobectomies, 1 of which was associated with a lingulectomy, and 2 upper lobectomies, 1 of which was associated with a middle lobe resection. Five patients were diagnosed and operated upon between 10 months and 8 years of age; 4 had recurrent bronchitis and 1 was diagnosed during the treatment of a gastroenteritis. They had 3 lower and 2 upper lobectomies. Recovery was uneventful in all patients except for 1 who was reoperated upon for intestinal obstruction. Antenatal diagnosis of cystic adenomatoid malformation should become standard. The malformation may be mistaken for a pulmonary sequestration or bronchogenic cyst. Differential diagnosis of a congenital hernia is important.

Child↗
PubMed1990

[Surgical treatment of gastroesophageal reflux by modified Hill's posterior cardiopexy. Apropos of 441 cases].

Between 1972 and 1986, 490 modified Hill's procedures were performed for gastro-esophageal reflux; 441 cases were retrospectively studied consisting of 245 males and 196 females, aged from 4 days to 83 years, with a mean age of 41 years. Average duration of gastrointestinal symptoms was 5.4 years. The proposed technique is described, allowing cardiopexy without intraoperative manometry. Mortality was 1.4% (6 cases); one death was due to surgery. Morbidity was 5.4% (24 cases). With a mean follow-up of 5.2 years, a clinical cure was obtained in 93.5% of cases. Causes of failures were analyzed: the only possible pre-operative factor was the presence of peptic stenosis. Pylorospasm appeared to be a post-operative cause of failure. The 28 patients for whom surgery failed were medically treated (18), dilated (5) or reoperated (5). Three new cardiopexies and 2 fundoplications cured the last 5 patients with a mean follow-up of 5.8 years. Recurrences of symptoms and discoveries of failure were generally detected early after the operation: 20 before 6 months (71%), 1 between 6 months and 1 year, 2 between 1 and 2 years, 3 between 3 and 4 years, 1 between 4 and 5 years.

Adolescent↗
PubMed1990

[Cervico-mediastinal inflammatory pseudotumors due to esophageal perforation by foreign bodies].

Two patients suffered from superior mediastinal masses producing pain and dysphagia. They were investigated using imagery and endoscopy without a definite diagnosis being made. It was finally decided to perform a cervical exploration in both cases and this enabled a diagnosis of perforation of the oesophagus and pseudo-tumoral abscess to be made. The foreign body responsible was found in one case. The symptoms and signs of oesophageal perforation by foreign body may be misleading when they are chronic or delayed. There remains a place for surgical exploration when other methods have failed.

Abscess↗