Retrotracheal mediastinal goiter with contralateral extension.
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Goiter, Substernal↗
Biomedical subjects
M Ribet
Publications and source records attributed to M Ribet.
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↗
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↗
[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↗
[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↗
[Esophageal mucoceles complicating double exclusion of the esophagus after ingestion of caustics].
A mucocele is rarely observed after esophageal exclusion for corrosive burns. It may represent a contra-indication to esophageal conservation in case of a total gastric resection for necrosis and perforation of the stomach. To evaluate this risk, 15 patients, operated between January 1970 and december 1988, were reviewed: they underwent total gastric resection with esophageal exclusion, followed by a secondary colon transplant between the cervical esophagus and the duodenum. A plain chest film was performed for 13 patients and a CT scan for 11 patients. Mean follow-up was 5.7 years (2 months - 17 years). Four patients died, one of them after resection of a compressive esophageal mucocele. Six mucoceles were detected on 13 chest films and 7 were described on 11 CT scans. On the whole, 8 mucoceles were diagnosed on 15 patients; one of them was complicated by tracheal compression. The formation of a secondary esophageal mucocele is a late sign of incomplete destruction of the esophageal wall. It is a frequent complication of esophageal exclusion performed after total gastrectomy for corrosive burns of the stomach. It must be detected on a chest film which shows the largest dilatations or on a CT scan, which is a better investigation. When the diameter of the mucocele is equal of superior to 50 mm, it can be compressive and must be treated by resection of internal diversion.
Adolescent↗
[Giant cystic lymphangioma of the mediastinum].
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Humans↗
[Rectal conservation after colectomy for Crohn's disease].
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Adolescent↗
[Surgery of inflammatory and neoplastic tracheal stenosis. Apropos of 38 cases].
This is a retrospective study of 38 patients who were operated on for inflammatory (31) or tumoral tracheal stenosis. A cervical approach was possible in 20 cases; a sternotomy was required in 8 cases and a thoracotomy in 5 cases. Per-operative ventilation was satisfactory for all patients. There were 2 deaths in patients suffering from chronic airflow obstruction. There were 2 immediate and 13 late post-operative stenosis; 9 of these were symptomatic and required treatment which was successful in 7 cases. 25 of the 30 patients (among 33 survivors) who were followed-up were symptomless; 4 patients who had operations for a tumour had a larger than 3 years survival.
Adolescent↗
[The lung in brain death. Anatomo-biological correlations for pulmonary transplantation].
Histopathological studies of the lung conducted during multiple organ procurement from 25 subjects in a state of brain death showed that 19 of them had lung lesions pre-existent to coma, viz. alveolitis and lung invasion by dusts increasing with the subject's age. Alveolar or interstitial emphysema and subpleural bullae caused by mechanical ventilation were present in 19 cases; signs of bronchial inertia were found in 6 cases and established superinfection in 3 cases. Finally, 17 subjects showed interstitial and vascular alterations induced by oedema and shock which were related to the time spent in intensive care units, to the cause of the coma and to the quantity and quality of intravenous received while in intensive care unit. There were histological correlations between these various factors, but precise criteria concerning the functional prognosis of the transplant could not be defined. However, this study seemed to confirm the need for a new approach to the intensive care of brain-dead subjects during lung procurement: the time elapsed before procurement should be shortened, the amount of medicinal solutions administered should be reduced, Ringer lactate and packed cells should be used in preference to albumin derivatives, and arterial blood pressure, rather than diuresis, should be maintained.
Adult↗
Gastro-oesophageal reflux and respiratory disorders treated by Hill's procedure.
A retrospective review of 132 patients with respiratory disorders associated with gastrooesophageal reflux is presented. The patients were operated upon according to Hill's technique. In 66 infants and children, recurrent lung infection was the most frequent indication for surgery. The mean duration of respiratory symptoms was 17 months. In 66 adults, asthma was the most frequent indication for surgery. The mean duration of respiratory symptoms was 9.7 years. Suppression of reflux was obtained by operation in 95% of infants and children, with disappearance of respiratory disorders in 78.6% and clinical improvement of symptoms in 16.4%. Suppression of reflux was confirmed in 94% of adults, with disappearance of respiratory disorders in 36% and improvement of symptoms in 28%. The correlation between disappearance of reflux after surgery and cure of respiratory disorders in infants and children must be seen in the light of the natural history of lower oesophageal sphincter maturation. Nevertheless, surgery shortens the period of risk in life-threatening situations. In adults, one patient out of two benefited from operation. Failures were more frequent in asthma and there was no characteristic type of asthma associated with reflux.
Adolescent↗
Impaired bacterial flora in human excluded colon.
We compared the rectal microflora of 16 patients with surgically excluded colorectum with 16 healthy controls. The cause of diversion was inflammatory bowel disease (n = 10), colon cancer (n = 3), miscellaneous (n = 3). Six patients had a diversion colitis. In the excluded colorectum, the total bacterial count was only slightly lower than controls but the variety of the flora was significantly reduced. This reduction was confined to strict anaerobes, mainly the genus Eubacterium and Bifidobacterium. Among aerobes, enterobacteria were more often isolated than in controls. This altered microflora of excluded colorectum could be involved in the mucosal damage observed in some cases.
Adult↗
[Should a cancer of the bronchi be surgically treated after excision of a cerebral metastasis?].
Between 1964 and 1987 35 patients were operated on for cerebral metastases due to an underlying bronchial carcinoma. In 26 cases (group 1) there was excision of the primary tumour also and in 9 cases combined medical treatment was given with radiotherapy and chemotherapy. The neurological state was improved by the neurosurgical operation in 88% of patients in group 1 and in 66% of patients in group 2. This improvement was maintained in 30% of the patients as long as they survived. 2 patients died following thoracic surgery (7.69%). The median survival was 11 months in group 1 and 9 months in group 2. Three patients in group 1 were living two years after craniotomy whilst. 1 patient in group 2 is still alive four years after the neurosurgical procedure. The heterogeneity of the two groups does not permit a comparative statistical analysis but overall there does not seem to be any difference in duration or quality of life between the two groups. Complementary cerebral radiotherapy did not affect the prognosis.
Adult↗
[Respiratory signs associated with gastro-esophageal reflux. A retrospective study of 132 surgically treated cases in children and adults].
We carried out a retrospective study of 132 cases of respiratory disorders associated with gastro-oesophageal reflux involving 66 children, 42 boys and 24 girls, 4 days to 10 years old with a mean of 22 months. We also studied 66 adults, 37 men and 29 women, 16 to 74 years old. In the infants the mean duration of respiratory disorders was 17 months and a recurrent broncho-pulmonary infection was the principal indication (40 cases). Alimentary symptoms were present in 34 cases. There was evidence of reflux in 60 cases. The suppression of any reflux was obtained surgically in 95% of cases with a disappearance of the respiratory disorders in 78.6% of cases and their improvement in 16.4% of cases with a mean follow up period of 4.3 years. In the adults the mean duration of the respiratory disorders was 9.7 years and asthma was the principal cause (38 cases). Alimentary symptoms were present in 56 cases with evidence of reflux in 64 cases. A suppression of the reflux was achieved surgically in 94% of cases with a disappearance of the respiratory disorders in 36% of cases and their improvement in 28% of cases with a mean follow up period of 4.7 years. The correlation between the disappearance of reflux and the respiratory symptoms and signs in the children should perhaps be tempered by the natural history of the maturation of the inferior oesophageal sphincter. However surgery shortens the danger period in serious situations which are life threatening.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
[Pseudo-tumor of the upper mediastinum].
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Adult↗
[Esophageal mucoceles complicating double exclusion of the esophagus after ingestion of caustics].
A mucocele is rarely observed after esophageal exclusion for corrosive burns. It may represent a contra-indication to esophageal conservation in case of a total gastric resection for necrosis and perforation of the stomach. To evaluate this risk, 15 patients, operated between January 1970 and December 1988, were reviewed: they underwent total gastric resection with esophageal exclusion, followed by a secondary colon transplant between the cervical esophagus and the duodenum. A plain chest film was performed for 13 patients and a CT scan for 11 patients. Mean follow-up was 5.7 years (2 months - 17 years). Four patients died, one of them after resection of a compressive esophageal mucocele. Six mucoceles were detected on 13 chest films and 7 were described on 11 CT scans. On the whole, 8 mucoceles were diagnosed on 15 patients; one of them was complicated by tracheal compression. The formation of a secondary esophageal mucocele is a late sign of incomplete destruction of the esophageal wall. It is a frequent complication of esophageal exclusion performed after total gastrectomy for corrosive burns of the stomach. It must be detected on a chest film which shows the largest dilatations or on a CT scan, which is a better investigation. When the diameter of the mucocele is equal of superior to 50 mm, it can be compressive and must be treated by resection of internal diversion.
Adolescent↗