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Biomedical subjects

P Bret

Publications and source records attributed to P Bret.

At least 145 records · Page 8Linked to original sources
PubMedDate not supplied

Radical and nonradical hepatic resection for alveolar echinococcosis: report of 18 cases.

The authors report their experience with 18 patients who underwent liver resection for alveolar echinococcosis of the liver from June, 1982 to January, 1989. Preparation for surgery included transhepatic biliary external-internal drainage in order to alleviate jaundice in 8 cases and catheterization of infected necrotic cavities in 7 cases. Resection was radical in 9 patients who underwent either right lobectomy (5 cases) or right trisegmentectomy (4 cases) with "en bloc" extension to the bifurcation of the hepatic ducts in 3 cases. Resection was nonradical in another group of 9 patients who had either atypical right hepatectomy (6 cases) or atypical left hepatectomy (3 cases). All patients were submitted to a periodic follow-up. The 9 patients treated by radical resection are alive and symptom-free and appear to be disease-free at radiologic imaging, except for 1 patient who had a small area of parasitic recurrence on computed tomography scan 4 years after operation. Among the 9 patients treated by palliative resection, 3 patients died during the follow-up period, the cause of the death having been related to the disease in 2 cases and nonrelated in 1 case. The 6 surviving patients had no noticeable growth of the parasitic mass during the period of follow-up. When feasible, radical liver resection is the best form of therapy. When massive parasitic invasion of both lobes of the liver and the porta hepatis and vena cava precludes radical hepatectomy, palliative resection associated with percutaneous procedures has to be considered before embarking on orthotopic liver transplantation.

Adult↗
PubMedDate not supplied

Is reoperation for recurrence of glioblastoma justified?

The purpose of the present study was to determine the effect of surgery on the time length and quality of survival in patients with recurrent glioblastoma multiforme. Two groups were compared; the first included 18 patients who underwent surgery at the time of tumour recurrence. The second group included 36 patients who did not undergo surgery at the time of tumour recurrence. Both groups were matched according to the following criteria: gender, age, Karnofsky Performance Scale (KPS) score, at the time of initial surgery and of tumour recurrence, extent of initial surgery, interval between initial surgery and tumour reccurence. Both groups received conventional treatment after initial surgery. There are no statistically significant differences between the two groups as regards to the previously mentioned criteria. After tumour recurrence, the median survival time was 5 months in the group of patients undergoing a second resection and 2 months in the group of patients not undergoing repeat surgery. The difference was statistically significant on univariate analysis. Moreover, the median length of time spent in an acceptable condition (KPS >/=60) from the time of tumour recurrence was found to be significantly longer in patient who underwent a second resection (4 months) compared with patients who did not undergo repeat surgery (1 month). Even in a relatively favorable subgroup of reoperated patients, the survival benefit although significant was only 3 months. It was impossible to completely match the two groups of patients suggesting that the difference might have been even less. Although symptomatic improvement is modestly achieved by repeat surgery, its transient nature necessitates clear discussion with patient and family on an individual basis.

Adult↗
PubMedDate not supplied

[Microsurgical treatment of a series of intracranial subtentorial arterial aneurysms].

A series of 60 arterial aneurysms is reported, pateints pre-operatively being from grade I to grade IV of the classification of Botterell. Microsurgical technique is emphasized : patients are operated on through the fronto-lateral approach described by Yasargil. The most patients with anterior communicating artery aneurysm are operated on from the right side, except for patients with only one left anterior cerebral artery. Middle cerebral artery aneurysms are approached by the proximal way, along the internal carotid artery and then following the main trunk of middle cerebral artery. Concerning the internal carotid artery aneurysms, the carotid bifurcation aneurysms, the true posterior communicating artery aneurysms, dissection is generally performed without particular difficulty, except for the low internal carotid artery aneurysms (carotido-ophtalmic aneurysms); in these latter, the anterior clinoid process and the internal part of sphenoidal ridge must be removed. In case of intra-cerebral hematoma, only a part of hematoma is at first sucked away, up to a sufficient view of the chiasmatic cistern; then, releasing of cerebro-spinal fluid allows the management of the aneurysm and the remaining part of hematoma is totally evacuated after clipping of aneurysm. Reduction of the neck and sometimes of the whole aneurysm is performed with bipolar forceps. Every aneurysm was treated with metal clip (Yasargil, Scoville, Heifetz, Sundt's clip-graft). In no case a silk ligature was used...

Adolescent↗
PubMedDate not supplied

[Extra-intracranial anastomosis: radio-clinical correlations].

25 patients have been operated on by means of extra-intracranial anastomosis (22 with STA-MCA anastomosis, 3 with occipital-MCA anastomosis). 23 patients underwent an angiographic study early after surgery (two weeks). The patency rate is 14 out of 23 (13 STA, 1 occipital anastomosis). In comparison of its pre-operative size, the afferent artery has enlarged in the most cases, particularly in patients with complete obliteration, either of the carotid artery, or of the middle cerebral artery. In every case, only a limited part of the MCA territory is visualized through the anastomosis. In no case was the complete MCA field visualized; the frontal branches, particularly, are not supplied through a temporal anastomosis. In the case of occipital anastomosis, both upper and lower branches of MCA are supplied through the new channel. 11 patients underwent a second angiographic study, from one year through 28 months after the first one. In three patients with no patency on the first angiography the anastomosis remained non patent. So, in this series, no anastomosis was seen to became patent secondarily. In 8 patients with patency on the first control, the anastomosis remained patent on the second angiography. In patients with a pre-operative stenosis, no increasing of the size of the vessel could be noticed. The filling of the MCA branches is difficult to be discussed, for in these cases, the angiographies were not performed selectively through the external carotid artery. In patients with a pre-operative thrombosis, an enlarging of the vessels was seen, as well as an extension of the intra-cranial filling through the anastomosis. Clinical correlations are the following ones: the most patients with TIA's had a stenosis. They presented no increasing of the size of the vessels. They were doing well after operation, as if a little more of blood supply was sufficient to improve the general blood perfusion. Every patient with stroke had a pre-operative thrombosis and presented an enlarging of the vessels with a better filling on the second angiography, as if a great deal of additional blood supply was required; the clinical improvement is slow (3 out of 5) and remains often incomplete.

Brain↗
PubMedDate not supplied

[Catheterization of the sylvian aqueduct. Its present role in the surgical treatment of sylvian aqueduct stenosis of PCF tumors, and of syringomyelia].

Catheterization of the Sylvian aqueduct is an elective technique for the surgical treatment of syringomyelia with Chiari's defect. It completes efficiently the decompression of the defect and makes possible exclusion of the IV th. ventricle and of the ependymal orifice of the syringomyelic cavity. The operative results appear thus more regular and more stable than those obtained with simple decompression. Intubation of the aqueduct has opportune indications in the treatment of tumors of the P.C.F. in the case of incomplete exeresis or when a secondary blockade of the spinal fluid is to be feared. Intubation of the aqueduct constitutes a useful complement for those patients treated during childhood for hydrocephalon with sylviduct stenosis and that evidence lately a poor functioning of the ventricular tube with ventricles exhibiting a reduced volume and hypereacute accidents of intra-cranial hypertension.

Adolescent↗
PubMedDate not supplied

[Use of atypical antipsychotics in Charles Perrens psychiatric hospital (Bordeaux) analysis of prescribing practices for Amisulpride, Clozapine, Olanzapine and Risperidone].

UNLABELLED: The commercial introduction of atypical antipsychotics (AAP) constitutes a considerable step forward in the sense that it has led to a world-wide reappraisal of the established treatment strategies for people with psychoses (including schizophrenia and affective psychoses). They have allowed refinements in the pharmacologic management of psychoses but they have a higher acquisition cost than conventional neuroleptics. The cost of the newer AAP had a substantial effect on medical resources: the AAP account for only 43.2% of neuroleptic prescriptions, but 76.1% of medical costs associated with neuroleptic drugs, and in terms of treatment costs, a reduction (50%) was found with risperidone compared with olanzapine for a same number of treated patients. The aim of this paper was to examine the use of these drugs, to compare them and to assess their impact within the context of psychiatric hospital practice, by means of analysis of prescribing practices for amisulpride, clozapine, olanzapine and risperidone for all treated patients. We conducted an observational, naturalistic study at Charles Perrens psychiatric Hospital in Bordeaux (France) that reproduced the clinical conditions in which these new drugs are used. Four photographies of all the medical prescriptions concerning atypical antipsychotic drugs were done between October 1999 (four months after the introduction in France of the olanzapine, the last of the new antipsychotics) and June 2001 (n=682 prescriptions). The total amount of these prescriptions corresponded to 527 patients. Treatment groups were compared - first overall and after by considering 2 groups: psychotic and non-psychotic patients - through descriptive analyses of sociodemographic characteristics of patients, diagnosis, percentages of patients receiving concomitant psychotropic medication and/or receiving treatment-emergent side effects and mean dosages of AAP therapy according to concomitant medication. In the same way, we compared the four AAP through their prescribing practices'evolution during the four survey. RESULTS: AAP drugs account for 43.2% of prescriptions (and conventional neuroleptics 56.8% of them). We recorded a significant increase between the four surveys (p<0.02): 36.6% at the beginning to 47.8% at the end of the study. From the 682 collected prescriptions, 72 (10.6%) included clozapine, 130 (19.1%) amisulpride, 229 (33.6%) olanzapine and 251 (36.8%) risperidone. Sixty five percent of AAP prescriptions involved psychotic patients. A relative stability in characteristics of AAP prescriptions during the four surveys was found. So, no significant differences were observed between amisulpride, olanzapine, risperidone, in terms of age, sex, sociodemographic characteristics, unlike clozapine. However, there were statistical differences between all the AAP in the concurrent use of other neuroleptic agents (p<0.02), hypnotic drugs (p<0.006), mood stabilizer drugs (p<0.03), and anticholinergic drugs (p<0.007). Statistically, the mean dosage of amisulpride increased when a mood stabilizer drug was coprescribed (p<0.0007), but it decreased with an antidepressant drug (p<0.004) or an hypnotic drug (p<0.02); clozapine 's one decreased every time an antidepressant drug was coprescribed (p<0.02); with olanzapine, there was a significant increase every time an other neuroleptic agent (p<0.03) or an anticholinergic drug (p<0.006) was associated; then for risperidone, the mean dosage increased with the coprescription of an other neuroleptic agent (p<0.00002), an anticholinergic (p<0.00003) or an adrenolytic drug (p<0.04). The pattern of prescribing practices that emerges from our four surveys suggests that these new AAP are significantly more and more often associated with a stabilizer mood drug (p<0.009) (particularly the olanzapine) or/and an anxiolytic drug (p<0.05) (like the amisulpride in particular). Considering the four AAP globally, but more with the risperidone, the association with a neurovegetative corrector agent decreased (p<0.004) during the four surveys. Then, concerning the psychoticng the four surveys. Then, concerning the psychotic patients, the AAP were significantly more often associated with other neuroleptic agents (p<0.03), the amisulpride in particular, with anticholinergic drugs (p<0.00005), but significantly less with mood stabilizer drugs (p<0.00003) principally the amisulpride and the risperidone, with antidepressant drugs (p<0.02) particularly the risperidone. This kind of survey, however it is too much rare, is very important because it shows the clinical conditions in which these new drugs are really used. The results show that AAP appear to be the replacements of the older neuroleptics used in the treatment of psychoses, including particularly schizophrenia, but also in the treatment of mood disorders, and they reflect actual clinical practices. Other surveys must be achieved to see if our study confirms the general trend concerning the use of these drugs and so as to reassess these prescribing practices.

Adolescent↗