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Biomedical subjects

P A Lehur

Publications and source records attributed to P A Lehur.

At least 19 recordsLinked to original sources
PubMed2005

Clinical spectrum and surgical approach of adult intussusceptions: a multicentric study.

BACKGROUND: The preoperative diagnosis of adult intussusceptions (AIs) remains difficult, and the assessment of the radiological methods has been evaluated very little in the literature. The aim of this study was to evaluate the interest of the different imaging modalities for the preoperative diagnosis of AI and describe causes of AI. PATIENTS AND METHODS: Consecutive patients of 15 years and older with the postoperative diagnosis of intussusception from 1979 to 2004 were reviewed retrospectively for this multicentric study. Data concerning clinical considerations, morphological examinations, surgical procedure, histological conclusions, mortality rate and recurrence were analysed. RESULTS: Forty-four patients with documented intussusception were included. The mean age was 51 years (15-93 years). The preoperative diagnosis of intussusception was made in 52% of the cases. The sensitivities of the different radiological methods were abdominal ultrasounds (35%), upper gastrointestinal barium study (33%), abdominal computed tomography (CT) (58%) and barium enema (73%). An organic lesion was identified in 95% of the cases. There was 29 enteric and 15 colonic (including appendicular) intussusceptions. Thirty-seven percent of the enteric lesions were malignant, and a bit less than 50% of them were metastatic melanomas. The benign enteric lesions were Meckel's diverticulum and Peutz-Jeghers syndrome in half of the cases. Fifty-eight percent of the pure colonic lesions (excluding appendix) were malignant, and 85% of them were primary adenocarcinomas. The benign colonic lesions were lipomas in 80% of the cases. All patients, except one, had a surgical treatment, and 13 of them had a complete reduction of the intussusception before resection. The mortality rate was 16% and recurrence occurred in three patients; two of them had a Peutz-Jeghers syndrome. CONCLUSION: Intussusception rarely occurs in adults, but nearly half of their causes are malignant. The CT scan is a helpful examination for enteric intussusceptions whether barium enema seems to be the most performing method for colonic lesions. Surgery is the recommended treatment, with or without a primary reduction of the intussusception. During the surgical procedure, this reduction can lead to a more limited bowel resection.

Adolescent↗
PubMed2003

Changes in chemical coding of myenteric neurones in ulcerative colitis.

BACKGROUND: Morphological and functional changes in the enteric nervous system (ENS) have been reported in inflammatory bowel diseases but it is still uncertain whether neurochemical coding of myenteric neurones is altered in ulcerative colitis (UC). AIMS: In this study we investigated transmitter co-localisation in myenteric neurones of normal colon and the colon of patients with UC. METHODS: Choline acetyltransferase (ChAT), neurone specific enolase (NSE), vasoactive intestinal peptide (VIP), and substance P (SP) were detected by immunohistochemical methods in whole mounts of colonic myenteric plexus of UC patients (n=10) and controls (n=8). RESULTS: The proportion of ChAT positive and VIP positive neurones relative to the NSE population did not differ in inflamed (33.3% and 9.3%, respectively) and non-inflamed segments (33.6% and 9.7%) of UC colon compared with controls (35.0% and 6.9%). The proportion of SP positive neurones was significantly larger in both inflamed (15.5%) and non-inflamed (20.3%) segments than in controls (5.9%). Analysis of changes in subpopulations showed that 26.9% of neurones were only ChAT positive in controls but that the proportion was significantly smaller in inflamed (18.8%) and non-inflamed (15.8%) areas of UC. The proportions of neurones containing ChAT and SP were significantly higher in inflamed (11.8%) and non-inflamed (13.9%) areas than in controls (5.0%). CONCLUSION: Remodelling of myenteric neurones in UC involves a shift from mainly cholinergic to more SP positive innervation. This effect may constitute part of the neuronal basis for the motility disturbances observed in UC.

Adult↗
PubMed2002

[Intensive care unit hospitalization after colorectal surgery].

OBJECTIVE: Intensive care units (ICU) support critically ill patients during the perioperative period. Few studies exist focusing on ICU hospitalisation after colorectal surgery. The objective of the study was to 1) detect predictive factors of mortality and length of stay in ICU after colorectal procedures, and 2) compare the autonomy status of the patients before and 30 days after their ICU stay. PATIENTS AND METHODS: This study followed a prospective non randomized cohort in our colorectal surgery unit. During a period of one year (January 1st to December 31th, 2000) 351 colorectal procedures were performed and 54 patients were admitted to ICU after surgery. For each patient, 37 parameters were collected on a standardized register. Predictive factors of mortality (30 days after the procedure) and ICU stay (up to 3 days) were studied by univariate and multivariate statistical analysis. Self autonomy before surgery and 30 days after was also investigated. RESULTS: "Multiple-intervention" was the only independent factor influencing mortality. Both "low autonomy status before surgery" and "pulmonary comorbidity" increased the length of stay. Regarding the 48 survivors, 45 (94%) recovered the same autonomy index as in the preoperative period 30 days after the procedure. CONCLUSION: This study highlights the poor predictive factors influencing mortality during or after ICU stay following colorectal surgery, and emphasizes two preoperative parameters increasing the length of stay up to 3 days. This should guide the informations given to the patients families. Finally, this study confirms the good quality of self-sufficiency after ICU stay even for a long time (over 3 days).

Adult↗
PubMed2002

[Bilateral compartment syndrome after colorectal surgery in the lithotomy position].

Lower limb compartment syndrome is an unusual but severe complication of prolonged surgery more than four hours in lithotomy position. It is usually a consequence of hypoperfusion of the lower extremities and muscle necrosis may occur. Several risk factors are pointed out: trendelenburg, the hardness of operating table, hypothermia, control hypotension, occlusion of arterial blood flow of the lower extremity, arteritis (and smoking), diabetes, obesity, arterial hypertension, myopathy and an important muscle mass. The symptoms are postoperative pain with neurological signs. A rapid diagnosis and aggressive management (i.e. resuscitation and aponevrotomy) is recommended. Neurological sequelae are sometimes invalidating. Reporting a case of bilateral syndrome, we reviewed the literature and describe the present diagnosis and therapeutic management as well as prevention modalities of this iatrogenic complication.

Adenocarcinoma↗
PubMed2001

[Colorectal endometriosis. Diagnosis and management].

Endometriosis occurs in 5 to 10% of the female population. Bowel involvement present in 6 to 30% of cases is predominantly localized in the pelvic parts of the colon and rectum, close to the uterus. The goal of this work was to describe the present diagnostic and therapeutic management of deep colorectal endometriosis defined as infiltrating the digestive wall and usually requiring surgery. Colorectal endometriosis is a disabling disease. Anatomic lesions mimic those of a cancer. Modern investigations include endorectal endosonography, recognized as the best mean to assess the depth of invasion into the intestinal wall, and magnetic resonance imaging. Associated to exploratory laparoscopy, these investigations allow to select the optimal operative strategy for multifocal and complex lesions. Surgical objective is a total resection of endometriomas, to guarantee symptom relief and avoid recurrence. Difficulties in these procedures are usually due to fibrotic and vascularised lesions and associated gynaecological disorders. In elective cases, preoperative GH-RH analog hormonal treatment makes easier the surgical procedure. Colonic and/or rectal restorative resections, performed through laparoscopic approach or more frequently through laparotomy, have to be done according to the usual standards of colorectal surgery. Conservative surgery of the ovaries is mandatory in premenopausal patients.

Colorectal Neoplasms↗
PubMed2001

Circular stapled anopexy for haemorrhoidal disease: results.

OBJECTIVE: Stapled anopexy is a new approach for haemorrhoids requiring surgical treatment. This study reviews the available information concerning the present results of this procedure. METHODS: Medline and hand search of the literature was conducted to identify available information on the procedure, with a special interest for the on-going or published randomized clinical trials. RESULTS: The advantages of the stapled approach of haemorrhoids were analyzed in the different areas of concern, including postoperative pain reduction, length of hospital stay and sick-leave, postoperative wound care and type and rate of complications. Continence status, symptom cure and patient satisfaction following stapled anopexy are also reported. CONCLUSION: Stapled anopexy is probably less painful than conventional haemorrhoidectomy. Other advantages in the short term result from this new approach. Long term efficacy of the procedure is still unknown.

Journal Article↗
PubMed2000

Artificial anal sphincter: prospective clinical and manometric evaluation.

INTRODUCTION: Artificial anal sphincter has been proposed in severe anal incontinence when local treatment is unsuitable or has failed. The outcome after implantation of this newly developed device has not yet been determined. METHODS: Twenty-four consecutive patients (7 men; median age, 44; standard deviation, 18; range, 14-80 years) implanted since May 1996 for a minimum of six months at three centers were prospectively evaluated. Continence (scoring system, 0 (normal) to 120 (complete incontinence)), rectal emptying, and general satisfaction were assessed clinically and at anal manometry preoperatively and postoperatively at a six-month interval. The causes of incontinence included anal trauma (9 cases), neuropathy (6 cases), neurologic disorders (4 cases), congenital malformations (3 cases), and prolapse (2 cases). Median duration of incontinence was 7.5 (standard deviation, 8) years. Stomas pre-existed in two cases and was created at implantation in one. RESULTS: Median follow-up was 20 (standard deviation, 8; range, 10-35) months. Seven patients had their devices explanted, and reimplantation was successfully performed in three of these cases. At the end of follow-up, 20 (83 percent) patients had an implanted activated device. Fecal incontinence score dropped significantly from a median 106 (standard deviation, 13) preoperatively to 19 (standard deviation, 32), 25 (standard deviation, 29), and 25 (standard deviation, 25) at six months, one year, and the end of follow-up, respectively (P<0.0001). Minor and major emptying difficulties occurred in seven and two patients, respectively. A high degree of satisfaction was achieved at the end of follow-up in 18 (75 percent) of the total series. Median anal pressures at rest on manometry increased significantly from 28 (standard deviation, 17; range, 5-76) mm Hg preoperatively to 60 (standard deviation, 17; range, 38-96) mmHg with a closed cuff at the end of follow-up. These pressures dropped to 30 (standard deviation, 16; range, 9-65) mm Hg with an open cuff, and reocclusion time lasted a median of 4.6 minutes (standard deviation, 3 minutes; range, 38 seconds to 10 minutes). CONCLUSION: Artificial anal sphincter provided prolonged and reasonably good functional results in severe incontinence, reproducing an efficient sphincteric mechanism and allowing satisfactory anal occlusion and rectal emptying in approximately 75 percent of cases in this study. The definitive explantation rate was kept low by careful patient selection and appropriate surgical and perioperative management.

Adolescent↗
PubMed2000

Standards for anal sphincter replacement.

PURPOSE: Anal sphincter replacement offers a new treatment option for patients with severe refractory fecal incontinence or for those who require abdominoperineal resection for localized malignancy. The purpose of this study was to review the current status of anal sphincter replacement, formulate a consensus statement regarding its current use, and outline suggestions for future development. METHODS: Four areas of interests were selected: indications for sphincter replacement, continence scoring and quality of life, choice of therapy, and dissemination of new technology. A questionnaire regarding these issues was developed and circulated to working party members; its results served as the basis for this consensus document. RESULTS: Both electrically stimulated skeletal muscle neosphincter and artificial anal sphincter are options for patients with end-stage fecal incontinence. Electrically stimulated skeletal muscle neosphincter is also appropriate for reconstruction after surgical excision of the anorectum in selected cases. Avoidance of complications requires strict attention to sterile technique, prophylactic antibiotics, and deep venous thrombus prophylaxis. A standardized scoring system is proposed that evaluates both continence and evacuation. Quality of life is a critical endpoint for assessing sphincter replacement, and use of The American Society of Colon and Rectal Surgeons incontinence-specific quality-of-life instrument is recommended. As the efficacy of sphincter replacement becomes proven, dissemination of the technique should occur in a controlled manner to ensure adequate surgeon training, minimization of complications, and optimization of results. CONCLUSIONS: Sphincter replacement by electrically stimulated skeletal muscle neosphincter and artificial anal sphincter provide a continent option for patients with end-stage fecal incontinence and those requiring abdominoperineal resection. The guidelines offered in this document are intended to facilitate the controlled and safe development and acceptance of these new techniques.

Anal Canal↗
PubMed2000

[Surgical treatment of anterior rectoceles in women. The perioneal-vaginal approach].

Rectoceles are best repaired via a perineal approach. The transperineovaginal approach provides access to the outer side of the rectocele: the rectal hernia is repaired with two or three purse-string sutures and suture of the rectal fascia. Levatorplasty, performed without narrowing of the vagina, reinforces the repair and strengthens the lax pelvic floor. Unilateral sacro-spinofixation of the vagina is a useful adjunct to restore normal anatomy. Rectocele repair via a perineovaginal approach has a low morbidity rate and achieves good functional results. Concomitant sphincteroplasty may be performed in the case of symptomatic rupture of the anal sphincter, treating as well urinary incontinence or prolapse of the uterus. Surgery is indicated in symptomatic rectocele when retraining the pelvic floor by biofeedback and medical therapy have failed to relieve symptoms. There are no clear predictive factors of outcome and the patient must be informed about the risk of persisting symptoms or failure.

Female↗