Biomedical subjects
M Ribet
Publications and source records attributed to M Ribet.
[Surgical treatment of chronic pancreatitis. Retrospective study of 221 cases].
221 patients have been operated for chronic pancreatitis, secondary to alcoholic intoxication in 92% of cases. Surgery was performed for a complication of the disease (69%), for intractable pain (30%), or for a false diagnostic of cancer; 265 operations were done, among which 41% of resections, 18.5% of internal derivations, and 14.3% of external derivations. Post-operative morbidity was 23.4% and hospital mortality was 6.4%. Late mortality was 35.5%, pancreatitis being responsible for more than half of those deaths during the first three post-operative years. Iterative surgery was necessary in 37 cases. The risk of diabetes was multiplied by 3.2 after resection. Results were good in 50% of cases after 5 years. An important factor was the arrest of alcoholic intoxication. There was no significant difference between resection and derivation. Internal drainage should be preferred when possible. Surgery must be reserved to grave or invalidating complications of chronic pancreatitis.
Vertebrobasilar insufficiency in a patient with anomaly of the thyroscapular trunk: an unusual steal syndrome?
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[Massive rectal hemorrhage by colonic fistulization of a pancreatitis lesion].
Rectal hemorrhage of massive proportions in 4 patients was due to vascular erosion of a necrotic pancreatitis focus, and fistulization at the splenic angle of colon. This serious complication may arise during the course of acute pancreatitis or an acute episode of chronic pancreatitis. A literature review showed 22 similar cases reported. Diagnosis is suggested by the discovery of a stenosis of colon in a case of pancreatitis, and can be confirmed by emergency arteriography or operative findings. Hemorrhage is usually from the splenic artery but erosion of a left renal artery has been described. Treatment is by embolization during angiography followed by drainage of the pancreatic necrosis and a colon bypass operation, or by splenopancreatectomy combined with colectomy. Use of these two procedures led to recovery in the 4 cases reported.
[Surgery of perforated duodenal ulcer. Treatment of the perforation or the ulcer?].
Treatment of duodenal ulcer disease with an anti-acid preparation significantly reduces early postoperative complications after simple suture of a perforation, in relation to the course of the disease. Future prognosis of the latter is unpredictable even when those parameters, normally considered as being important, are allowed for. Percentage recovery is comparable with or without cimetidine. Treatment proposed is a two-stage operative procedure: 1) treat the peritonitis; 2) conduct recovery surgery at a later stage for recurrent lesions or those resistant to medical treatment. This therapy is based on the belief that emergency conditions do not require a complicated procedure and that the latter is useless in 45% of cases, which cannot be predetermined. This attitude is reinforced by the working conditions and the increased postoperative safety after simple suture as a result of the use of cimetidine.
[Technics for artificial ventilation of a single lung during thoracotomy].
Different means of limiting the fall in arterial PO2 produced by single artificial ventilation were studied in 60 patients during thoracotomy. Changing from ventilating both lungs to the one healthy lung in the lateral recumbent position, without modifying tidal volume and frequency, brought about a fall in arterial PO2 from 180 +/- 56 to 67 +/- 40 mmHg. The alveolar to arterial oxygen gradient increased to 110 +/- 45 mmHg (the alveolar oxygen pressure being calculated). Reducing the tidal volume so as to keep the inflation pressure at its initial level did not improve the arterial PO2 but slightly increased the arterial PCO2 (2.3 mmHg). The use of 6 to 8 cm H2O positive end-expiratory pressure did not significantly modify the arterial PO2 or PCO2. Increasing the inspired oxygen fraction from 0.5 to 0.7 increased the arterial PO2 from 100 +/- 89 mmHg to 165 +/- 59 mmHg, whilst the alveolar to arterial oxygen gradient increased to 118 +/- 60 mmHg. Clamping the pulmonary artery increased the arterial PO2 and dual lung ventilation restored it to its initial value. Therefore, the only effective means of increasing oxygenation was to increase the inspired oxygen fraction. Unilateral continuous positive airway pressure was not used so as not to impair surgery. Dual lung ventilation may be necessary if the arterial PO2 remains low.
[Treatment of patients with multiple injuries].
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[Peritonitis caused by sigmoid diverticular perforation].
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[Blood lipase in pancreatic diseases].
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[Crohn disease. Results of surgical treatment].
The aim of this study was to describe and to analyze the results of surgery for Crohn's disease in a retrospective series of 155 operations performed in 124 patients from 1949 to 1981 by the same surgical team. Indications for surgical treatment were as follows: acute complications (25 p. 100), intestinal obstruction (35 p. 100), systemic inflammatory manifestations (40 p. 100). Three patients died postoperatively and complications necessitated a reintervention in 10 other subjects. Surgical indications and late postoperative prognosis were significantly different in patients with right-sided bowel lesions (i. e. terminal ileitis, ileocolitis of the ascending colon) and in those with left colonic involvement (i.e. colitis of the whole or descending colon, rectitis and anoperineal lesions). Surgery was required because of failure of medical treatment in 73 p. 100 of Crohn's disease affecting the left colon and in 17 p. 100 of the right-sided lesions (p less than 0.001). After resection a recurrence rate after 1 year and 3 years of respectively 50 and 62 p. 100 was observed in the left colonic disease group and in 5 and 23 p. 100 of the cases respecting the left colon. Finally 31 reoperations were necessary; no surgical mortality occurred in 12 patients with right-sided lesions whereas 5 among 19 patients with involvement of the left colon died postoperatively. These results: a) confirm the high postoperative rate of recurrence (or relapse) after surgical bowel resection for Crohn's disease (especially when the left colon is affected), b) emphasize the need for the surgeon to be very cautious when determining the extent of resection.
[Duodenal ulcer eroding the papilla. 2 cases].
The authors report two cases of ulcers eroding the duodenal papilla. In one case there is a spontaneous reflux into the canal of Wirsung, causing acute pancreatitis. In the other case, the erosion is not complicated, and is revealed by an opacification of the main bile duct during an X-rays examination of the stomach and duodenum in a patient with a Burnett's syndrome. The erosion of the papilla is secondary to duodenal shrinkage by sclerosis. The choice treatment is exclusion gastrectomy, but resection may be necessary.
[Scintigraphy in spleen injuries].
Scintiscans of the spleen were performed in 62 hospital patients under observation for abdominal contusion. No abnormality was detected in 82% of the cases, and the course of events showed that the spleen was intact. Lesional images were found in the remaining 18%. Injury to the spleen was excluded by other investigations in 10% (false positive results) but confirmed in 8% who underwent laparotomy. This fast and non aggressive method can be recommended outside emergencies to exclude rupture or haematoma of the spleen.
[Repeated recurrences of hepatic amoebiasis with failure of metronidazole treatment].
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Transient ischaemic attacks on patient with endothoracic goitre and congenital anomaly of the carotid arteries.
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[Bifocal excision in the treatment of bronchial carcinoma revealed by cerebral metastasis (author's transl)].
Between 1964 and 1980, 17 patients operated upon for cerebral metastasis as initial presentation of bronchial cancer underwent excision of the thoracic tumour 24 to 131 days later. One patient died post-operatively of acute pneumopathy. Nine patients showed signs of recurrent cerebral malignancy after a 55 to 904 days' delay. Increase in life expectancy and regression of neurological symptoms justify this bifocal surgical strategy. Using cerebral and thoracic radiotherapy as well as chemotherapy as supplementary measures seems rational and likely to improve the present results.
[Renal transplantation (82 cases)].
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[Feeding jejunostomy in mid thoracic carcinoma resection].
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