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P Bonnichon

Publications and source records attributed to P Bonnichon.

At least 37 records · Page 2Linked to original sources
PubMed1995

[Laparoscopic splenectomy. The "hanging spleen technique" in a series of nineteen cases].

We have used an new patient position for laparoscopic splenectomy: the patient is placed in the right lateral supine position on a "bean bag" positioning apparatus and the left arm is elevated. The operator stands to the patient's right, the first assistant is on the patient's right and the second is on the patient's left. This position provides very good exposure of the spleen, which hangs from the diaphragm by the peritoneal attachments and the inferior pole splenic vessels, short gastric vessels and splenic hilus vessels can be released successively. We have now performed 19 splenectomies using the "Hanging Spleen Technique" with three conversions to open surgery. Splenectomy was always possible with the use of a plastic bag through the 12 mm trocar hole in 12 cases and through this enlarged hole in 2 cases. The mean post-operative stay was 4.3 days and the mean time to return to work was 19 days. Laparoscopic splenectomy is a feasible and safe procedure with this patient position. Obesity and splenomegaly are no longer absolute contra-indications.

Acetaminophen↗
PubMed1994

[Surgery of primary hyperparathyroidism by unilateral approach under local anesthesia and intraoperative determination of PTH 1-84].

Between July 89 and June 92, 70 patients with primary hyperparathyroidism underwent adenomectomy by unilateral incision under local anesthesia (Ul/LA), without exploration of the remaining glands. The procedure was carried out with intraoperative monitoring of urinary cyclic AMP (n = 35), Calcemia was measured 6-monthly for one year in every patient. 62 (88.6%) patients were cured after Ul/LA, whereas 5 patients required conversion to bilateral cervicotomy under general anesthesia because of abnormal hormonal levels, thus giving an overall success rate of 97% (67/70). The reasons for treatment failure of Ul/LA included misleading conclusions of cervical ultrasonography (n = 5), agitation of the patient (n = 1) and deep localization of the adenoma (n = 1). When cervical ultrasonography is suggestive of a parathyroid adenoma in expert hands, the probability of a second localization or associated hyperplasia is very low, so that adenomectomy by Ul/LA can be attempted safely, provided that the serum level of intact parathyroid hormone returns to normal values within one hour following resection. In our experience, parathyroidectomy by Ul/LA should not be considered in case of non conclusive ultrasonography, familial history pf hyperparathyroidism of MEN-I, ultrasonic evidence of several enlarged glands or associated thyroid nodule requiring simultaneous treatment.

Adult↗
PubMed1993

[Hyperparathyroidism disclosed by forward sagging of the head].

An unusual clinical presentation of hyperparathyroidism is reported. The 73-year-old patient was unable to maintain her head upright after ten minutes of walking or standing. Parathyroid adenoma was diagnosed on the basis of ultrasound and pathological findings and parathyroid hormone assays. Following surgery the forward sagging of the head no longer occurred and serum levels of calcium and phosphorus returned to normal. Pathophysiological hypotheses are discussed. No similar cases with isolated weakness of the cervical and dorsal paravertebral muscles has been reported to date.

Adenoma↗
PubMed1992

Biometry of the infrarenal inferior vena cava measured by computed tomography. Clinical applications.

In a previous study based upon the cavography of 100 patients, we determined that the average diameter of the infrarenal inferior v. cava (IIVC) was 21.3 mm (range 10-31 mm) at its end [1]. We discuss the value of different methods to measure IIVC, and particularly computed tomography (CT) scans reviewed in our department. It showed that the largest diameter of IIVC was not in a frontal plane and the width observed in a cavography was in fact the projection of a transverse diameter on the film. The real diameter of the IIVC is larger than that showed by cavography. This present study shows the results of measurements of the IIVC obtained from 50 consecutive CT scans. The average transverse diameter is 24.26 mm (range 14-33.3). The average anteroposterior diameter is 13.4 mm (range 5-22) and the average angle alpha between the transverse diameter and the frontal plane is 30 degrees 45' (range 12 degrees-55 degrees). We discuss the different methods of measurement of IIVC and we conclude that at present, CT scan is one of the most reliable methods to measure the real diameter of IIVC.

Adult↗
PubMed1991

[Excision under local anesthesia of parathyroid adenomas. Criteria of selection and control of effectiveness. 35 cases].

Primary hyperparathyroidism caused by an adenoma that has been identified and localized by ultrasonography can be treated through a limited approach route, under local anaesthesia, provided the effect of excision is controlled by a perioperative assay of urinary cAMP or, preferably, of plasma parathormone level, and provided the contra-indications of this method are respected. Thirty-three out of 35 patients have been successfully operated upon by this method. In case of failure confirmed by laboratory tests, local anaesthesia was only a prelude to cervicotomy under general anaesthesia.

Adenoma↗
PubMed1991

Monobloc resection of the upper extremity of the leg for bone tumor with distal vascular reconstruction.

A patient with juxtacortical osteosarcoma of the upper extremity of the left tibia which encased the popliteal neurovascular bundle was treated by monobloc resection of the superior extremity of the tibia and the tibial nerve. The knee joint was replaced by a Guepar prosthetic knee. Arterial and venous continuity was reestablished by a double bypass using the contralateral greater saphenous vein. One year later the patient had good lower limb function and was free of local or general disease. This observation confirms that preservation of lower limb function is possible using reconstruction techniques of bone, nerves, and vessels in sarcoma of the musculoskeletal system.

Adult↗
PubMed1991

Intraoperative ultrasonography for location of proximal limit of inferior vena caval thrombosis.

Appropriate surgical management of inferior vena caval thrombosis is dependent on the proximal limit of the thrombus. Cavograms, computed tomography, or magnetic resonance imaging all have their shortcomings in locating this limit. Intraoperative ultrasonography has allowed us to determine the exact proximal limit of vena caval thrombosis in two patients, one with suprarenal thrombosis, the other with infrarenal thrombosis. In the first patient, caval interruption and clearance of the inferior vena cava was greatly enhanced by the use of this method. Intraoperative sonography is useful in the surgical treatment of thrombosis of the inferior vena cava.

Adult↗
PubMed1990

Presence of villin, a tissue-specific cytoskeletal protein, in sera of patients and an initial clinical evaluation of its value for the diagnosis and follow-up of colorectal cancers.

Villin is an actin-binding protein found in a few normal adult epithelia, namely epithelial cells in the digestive and urogenital tracts. Moreover, villin production is maintained in malignant cells. We assumed that cell lysis and necrosis of solid tumors producing villin might result in villin release into blood. We analyzed the villin content of sera from 788 patients and controls using an enzyme-linked immunosorbent assay. Patients and controls were classified into healthy donors, patients with benign diseases of the gastrointestinal tract, patients with colorectal cancers, and patients with malignant nondigestive diseases. In the panel of sera analyzed, the sensitivity of the assay for colorectal cancers was 50.5%, and its overall specificity for malignant digestive tumors was 94.5%. Results were statistically analyzed comparing each group of sera with each other. We conclude that the presence of villin is indicative of a pathological state in the gastrointestinal tract (P less than 0.001). Finally, we followed villin levels after tumor resections (60 patients). We found that the villin level in sera remains low in remissions but is raised in recurrences. We suggest that the villin assay may have clinical utility as a diagnostic adjunct for adenocarcinoma of the gastrointestinal tract. It may also have some value in monitoring patients with advancing colorectal carcinomas after resection of these tumors.

Adult↗
PubMed1990

[Non-functioning tumors of the endocrine pancreas. Concept, diagnosis, treatment].

Five cases of nonfunctioning islet cell tumors of the pancreas are reported. There were 3 males and 2 females aged from 34 to 83 years (Average: 55.8 years). Two tumors were malignant since already metastatic, one tumor was probably malignant and two tumors were judged as benign. One patient died post-operatively. The four remaining patients are alive without recurrence after from 1.4 to 7.3 years. The concepts of nonfunctioning tumors of the pancreas and APUD system are discussed in view of these 5 cases and the relevant literature. The value of tumor markers as well as the radiographic appearances of these tumors are reported. Having a better prognosis than the adenocarcinoma of the exocrine pancreas, the nonfunctioning tumors of the endocrine pancreas are best managed by surgery. The indications and the results of surgery and chemotherapy are discussed.

Adenoma, Islet Cell↗
PubMed1989

Biometry of infrarenal inferior vena cava measured by cavography. Clinical applications.

Placement of a transvenous vena cava filter has became a common way to control recurrent pulmonary embolism. However few studies have been reported on the diameter of the infrarenal inferior vena cava (IIVC) where the device is usually placed. This study based upon 100 cavographies has showed the calculated average diameter of IIVC was 20.9 mm (range 12-27 mm) in its middle part and 21.3 mm (range 10-31 mm) in its terminal end. The calculated average IIVC length was 96 mm (range 80.3-142 mm). There was no statistical correlation between caval size and age, sex, height, weight and corporeal area. There was a statistical difference of left renal vein location between patients presenting with lumbar arthrosis and those without. We discuss different methods to measure IIVC in particular tomodensitometry. CT scans reviewed in our department show that the largest diameter of IIVC is not in a frontal plane and that the width seen on cavography is the projection of the largest diameter on the film. Therefore, the range of the real caval diameters is greater than indicated above.

Adolescent↗
PubMed1988

[Anal plasty after excision of giant condyloma acuminata].

Giant condyloma acumination, also called Bürschke-Loewenstein disease, is a pseudo-tumoral epithelial proliferation of viral origin (human papilloma virus). Surgery is the most effective of all treatments, but it results in loss of all tissues covering the anal canal. We suggest a reconstruction technique, performed under colostomy, in which the rectal mucosa is brought down and three sliding flaps are constructed from the skin of the ischio-anal fossae.

Anal Canal↗
PubMed1988

[Pancreatic fistula after left pancreatectomy. Frequency and severity].

In order to study the frequency and complications related to pancreatic fistula following distal pancreatectomy we have reviewed 19 patients operated on between January 1st 1981 and February 28 1986. There was no mortality but the incidence of pancreatic fistula was 52%. 40% of these cases developed a subphrenic abscess (21% of the total number of cases). These fistulas closed after an average post-operative period of 42 days. Reoperation for an infected collection was required in 4 cases. The incidence of pancreatic fistula was not related to the initial pancreatic pathology. Splenectomy did not influence the incidence of subphrenic abscess. Different techniques of closure of the distal pancreas after resection have not changed the incidence of this complication. The use of somatostatin appears to favourably influence the course of the fistula. These conclusions tend to confirm the results of other reported series.

Adolescent↗
PubMed1987

[Surgery of primary hyperparathyroidism. Contribution of the peroperative assay of urinary cyclic AMP].

The increase of nephrogenic cyclic AMP is an excellent index of parathyroid hypersecretion. A successful treatment of primary hyperparathyroidism results in a rapid fall in nephrogenic cAMP. In a series of 24 patients with proven primary hyperparathyroidism (hyperplasia 3, adenoma 21) and 2 patients with suspected hyperparathyroidism, the success of surgical excision was evaluated by measuring the urinary cAMP/urinary creatinine ratio (R), which in the absence of renal impairment, is proportional to the level of nephrogenic cAMP. Sequential assays of urinary cAMP and creatinine were performed during surgery; laboratory results were available within less than one hour. Among 22 patients with elevated baseline value or R, R became normal in 18 and decreased by more than 50% in 3; these findings suggested that the operation would be successful. In 1 case, R was not measured as the patient had impaired renal function. In another patient with normal baseline value of R, R did not significantly decrease after excision. Surgery failed in 1 patient, although the high value of R at the end of the operation should have prompted us to continue. Finally, in 2 patients the diagnosis was erroneous since R was lower than 0.5 as in controls. Surgeons, therefore, now have a reliable biochemical method at their disposal, but its use will be limited by its cost and complexity.

Aged↗