Search PubMed⌕ Search

Biomedical subjects

P Goudet

Publications and source records attributed to P Goudet.

At least 37 records · Page 2Linked to original sources
PubMed2001

Characteristics and evolution of extraintestinal manifestations associated with ulcerative colitis after proctocolectomy.

AIMS: Describe the characteristics of extraintestinal manifestations complicating ulcerative colitis present preoperatively and determine their evolution after surgery. METHODS: Between 1976 and 1986, 281 patients with ulcerative colitis exhibiting one or more extraintestinal manifestations (EIM) before either IPAA (n = 147), Brooke ileostomy (n = 71), Kock pouch (n = 48) or ileorectostomy (n = 15) were assessed retrospectively. The clinical evolution of each manifestation was classified as having disappeared, improved, remained unchanged or aggravated postoperatively. An efficacy index was designed to assess the ratio of the number of cases cured or improved over the number of cases unchanged or aggravated. The relationship between EIM and gender, age, duration of disease and the type of surgery was also ascertained. RESULTS: 433 EIM were observed in 281 patients. The most common were arthralgias of the large joints (n = 146), of the sacroiliac joint (n = 59) and the small joints (n = 51). In comparison to patients without EIM having received the same operation during the same period of time, EIM were seen more often in women, younger patients, than those with longer duration of disease and the ileoanal anastomosis group. 60% had only one EIM at a time. Based on the efficacy index, thromboembolic accidents and erythema nodosum were the most commonly cured or improved. Ocular manifestations and primary sclerosing cholangitis were unaffected. The other EIM responded favorably but variably with improvement in two thirds of patients. The presence of a rectal remnant (IRA) or ileal reservoir did not affect the evolution of the EIM. CONCLUSIONS: Thromboembolic complications which are life-threatening, erythema nodosum and arthralgia of the small and large joints which impair quality of life, benefited the most from proctocolectomy. Those conditions may be considered preoperatively when making the decision for surgery.

Adult↗
PubMed2000

[Treatment of perforated duodenal ulcer by laparoscopy. 35 cases].

OBJECTIVE: Laparoscopic treatment of perforated duodenal ulcer is an alternative to laparotomy. We reviewed our experience to determine feasibility and reliability of the surgical procedure and the subsequent morbidity and mortality. PATIENTS AND METHODS: This was a retrospective series of 35 patients who underwent laparoscopic repair of perforated duodenal ulcers between January 1994 and November 1999. The perforation was closed by interrupted sutures in 86% of cases associated with irrigation-suction of the abdominal cavity. RESULTS: Two complications were observed: pyloric stenosis in one patient with a large perforation and Douglas pouch abscess in another. Conversion to laparotomy was necessary in 8 cases: in 2 of them the edges of the perforation were fragile, in 3 the perforation could not be identified (posterior position), and in 3 intraabdominal adhesions were important. There were no deaths. The 2-year results are quite satisfactory. CONCLUSION: This study shows that the laparoscopic procedure is reliable and adapted to treat ulcer perforation if the size is less than 1 cm.

Adolescent↗
PubMed2000

[Insulinomas in multiple endocrine neoplasia type 1. Report of a series of 44 cases by the multiple endocrine neoplasia study group].

STUDY AIM: The aim of this retrospective study conducted by the "Groupe d'étude des néoplasies endocriniennes multiples type 1" (GENEM) was to report a series of insulinomas associated with multiple endocrine neoplasias type 1 (NEM 1) and to determine the most appropriate strategy for the topographical exploration and surgical management. PATIENTS AND METHODS: From 1960 to 1996, 44 patients were included, 16 men and 28 women (mean age: 36.4 +/- 13.9 years). This study concerned morphological investigations, tumoral features, modalities and results of the treatment. RESULTS: Insulinomas were associated with other functional islet tumors in 15 patients: ZE syndrome (n = 8), glucagonoma (n = 6), vipoma (n = 1). Malignant lesions were present in 6 patients: isolated insulinomas (n = 2), insulinomas associated with ZE syndrome (n = 2) and vipoma (n = 1). The sensitivity of the preoperative imaging procedures was less than 70%. Fourty-one patients were operated on: subtotal pancreatectomy (n = 26 including cephalic enucleations in 8), enucleations (n = 8), total pancreatectomy (n = 3), pancreaticoduodenectomy with caudal enucleations (n = 1), and for 3 patients, no details were available. There was no postoperative mortality. Hyperinsulinism disappeared in 27 patients (including 2 after reoperation) with a mean follow-up of 9 years. Among 6 patients with malignant lesions, 3 were alive with a 3, 4 and 10 year-follow-up. CONCLUSION: Subtotal pancreatectomy with splenic conservation and enucleation of cephalic lesions is suggested as the procedure of choice in this group of patients. This procedure allows simplification of preoperative imaging investigations because lesions of the pancreatic head have only to be detected. Preoperative endoscopic ultrasonography and intraoperative ultrasonography are the best investigations.

Adult↗
PubMed2000

[Treatment of diaphragmatic ruptures by laparoscopic approach in the lateral position].

STUDY AIM: The aim of this retrospective study was to assess the feasibility of the treatment of recent diaphragmatic ruptures through laparoscopic approach in lateral position in patients with stable hemodynamic condition. PATIENTS AND METHOD: From 1994 to 1999, seven patients, 16 to 68 years old, were operated on for diaphragmatic rupture after a 6 hours to 15 days delay. Diaphragmatic rupture was located on the left side in 6 patients, on the right side in 1. Diagnosis was confirmed by CT-scan with reconstructions; there was no associated visceral injury. Patients were operated on by laparoscopic approach in lateral position, herniated viscera reintegrated by moderate pulling and diaphragmatic rupture repaired with non resorbable continuous suture. RESULTS: Stomach was the usual herniated viscera (n = 6); hemothorax was less than 300 cL; diaphragmatic rupture was 8 to 12 cm long. Duration of surgery was no more than 120 minutes. The seven patients after a two months to two years delay had normal chest X-rays. CONCLUSION: The laparoscopic approach in lateral position provides good visibility of the diaphragmatic lesions, easy reduction of herniated organs, complete thorax exploration and cleaning, and easy diaphragmatic repair. This technique is only feasible in patients with stable hemodynamic conditions and does not provide a complete abdominal exploration.

Adolescent↗
PubMed2000

[Repair of midline incisional hernias using the Lazaro da Silva aponeuroplasty technique].

STUDY AIM: The aim of this retrospective study was to assess Lazaro da Silva's rectus sheath aponeuroplasty technique for repair of midline incisional hernias situated above the arcuate line. PATIENTS AND METHOD: Twenty-six patients underwent surgical repair of a supraumbilical (n = 19) or periumbilical (n = 7) incisional hernia. Six patients had had repeated laparotomies and two of them had recurrent incisional hernia. There were 11 obese patients (42%). Muscle diastasis ranged from 4 to 20 centimeters (mean: 9.7 cm). Three overlapping aponeurotic and peritoneal layers were used. The peritoneal sac was partially or totally incorporated in the repair. RESULTS: There was one postoperative death at day 5 from acute pancreatitis in a patient with associated cholecystectomy. Postoperative complications occurred in six patients. There were 3 abdominal wall infections. Obesity was the main factor associated with operative complications (p = 0.03). Mean follow-up was 19.1 months. There were 2 recurrences, one of them related to an abdominal wall infection. CONCLUSION: The Lazaro da Silva aponeuroplasty technique compares favourably with alternative techniques using mesh implants. It is indicated for incisional hernias less than 20 centimeters wide, situated above the arcuate line.

Female↗
PubMed2000

Primary hyperparathyroidism with normal serum intact parathyroid hormone levels.

To evaluate the features of primary hyperparathyroidism (HPT) with normal serum intact parathyroid hormone (iPTH) levels, we studied 271 consecutive patients undergoing surgery for primary HPT. In 20 patients, serum iPTH levels were within the normal range (10-65 ng/l). In their records, the most common clinical features were fatigue (n=13), polyuria (n=6), renal stone (n=5), and hypertension (n=5). Mean serum calcium and phosphorus were 2.78 and 0.85 mmol/l, respectively: 14 had serum phosphorus within the normal range. Mean serum iPTH was 48.5 ng/l, and was <45 ng/l in nine patients. Cervical ultrasound demonstrated a parathyroid adenoma in nine, and was normal in four. Tc sestamibi parathyroid scintigraphy always demonstrated an adenoma (9/9). In eight patients, normal iPTH values delayed diagnosis. Physicians should be aware of the possibility of HPT in patients with hypercalcaemia, even when serum phosphorus and iPTH levels are within the normal limits. Particularly, HPT cannot be excluded when serum iPTH levels are below the upper part of the normal range. In such cases, cervical imaging, which has the same sensitivity as in other HPT, should be undertaken. These explorations are useful, because many patients are symptomatic and can take advantage of surgery.

Adenoma↗
PubMed1999

[Value of a single low-pressure drain in the postoperative care of bilateral thyroidectomies. Retrospective comparison with bilateral Redon drains].

Double "high vacuum drains" are usually recommended following bilateral thyroidectomy. A single "low vacuum drain" is an attractive alternative when the surgeon considers drainage is necessary. This retrospective study was designed to compare the postoperative outcome following the use of two types of drains. The clinical features, biochemical profile and histopathology were comparable between the two groups: group 1 (high vacuum, n = 77), and group 2 (low vacuum, n = 71). The percentage of total thyroidectomies was significantly higher in group 2 (51% versus 34%, p = 0.04) and this discrepancy was adjusted in the statistical analysis. There was no statistical difference in the outcome of group 1 versus group 2 in terms of wound infections (0% vs 0%), haematoma (0% versus 0.04%), duration and volume of drainage (2.1 versus 2.0 days, 118 versus 117 ml), and hospital stay (3.2 versus 3.2 days). A single "low vacuum drain" is therefore a safe and simple alternative to provide adequate post operative drainage following bilateral thyroidectomy.

Adolescent↗
PubMed1998

[Laënnec, re-inventor of the stethoscope?].

According to our common medical culture, some facts are simply unquestionable, for instance Laënnec invented the stethoscope. But was he the first one? On a recent trip to Egypt we visited the temple of Kom Ombo, built prior to the roman period and renowned as a medical care center. Today, the tourist is fascinated by the magnificent hieroglyphics on the well-preserved walls testifying to significant advances in various fields of medicine including ophthalmology and gynecology. We were particularly interested by the basreliefs presenting vivid drawings of some of the first medical instruments. We easily identified curettes, scissors, a balance, forceps for dental extraction, and a surgical saw, but were captivated by two other instruments. The first one looked a lot like what Laënnec invented around 1820. The second one was amazingly similar to the instrument we use everyday, with a distal opening and flexible tubes (woven papyrus?) leading to proximal ear pieces. Our Egyptian guide was formal: the stethoscope was invented in Egypt. The scientific impact of our observations leaves something to be desired, but did make us think about the huge gap between the advancement of medical knowledge in ancient Egypt and Laënnec's (re)-invention. Exposed to a similar gap in history, what would our documents stored on CD and video tapes have to say to future touring doctors?

Egypt↗
PubMed1998

Intestinal infarctions: a reappraisal of the factors predictive of operative mortality.

OBJECTIVE: To assess the factors that predict operative mortality after intestinal infarction, and show what effect referral patterns have on mortality. DESIGN: Retrospective study. SETTING: Two university departments of surgery, France. SUBJECTS: 144 patients with intestinal infarctions operated on between January 1980 and August 1995. INTERVENTIONS: Univariate and multivariate analyses. MAIN OUTCOME MEASURES: Operative mortality and the factors associated with it. RESULTS: Operative mortality was 67% (96/144) during the first 45 days postoperatively. The univariate analysis showed that age over 75 years (p=0.0002), female sex (p=0.007), the presence of shock (p < 0.0001), and referral from cardiovascular medical or surgical unit (p=0.01) were significantly associated with mortality. However, the multivariate analysis reduced these to extent of infarction (p=0.0001), the presence of shock (p=0.0002), age over 75 years (p=0.0001), and recent cardiac or vascular operation (p=0.03). CONCLUSIONS: The influence of referral pattern was related to previous cardiac or vascular operation, and the risk among women to the fact that their age was 10 years older than that of men. This study shows how the type of referral may explain the wide variations in reported mortality. To compare published series, care should be taken to avoid any selection bias.

Adult↗
PubMed1998

Germ-line mutation analysis in patients with multiple endocrine neoplasia type 1 and related disorders.

Multiple endocrine neoplasia type 1 (MEN1) is an autosomal dominant syndrome predisposing to tumors of the parathyroid, endocrine pancreas, anterior pituitary, adrenal glands, and diffuse neuroendocrine tissues. The MEN1 gene has been assigned, by linkage analysis and loss of heterozygosity, to chromosome 11q13 and recently has been identified by positional cloning. In this study, a total of 84 families and/or isolated patients with either MEN1 or MEN1-related inherited endocrine tumors were screened for MEN1 germ-line mutations, by heteroduplex and sequence analysis of the MEN1 gene-coding region and untranslated exon 1. Germ-line MEN1 alterations were identified in 47/54 (87%) MEN1 families, in 9/11 (82%) isolated MEN1 patients, and in only 6/19 (31.5%) atypical MEN1-related inherited cases. We characterized 52 distinct mutations in a total of 62 MEN1 germ-line alterations. Thirty-five of the 52 mutations were frameshifts and nonsense mutations predicted to encode for a truncated MEN1 protein. We identified eight missense mutations and five in-frame deletions over the entire coding sequence. Six mutations were observed more than once in familial MEN1. Haplotype analysis in families with identical mutations indicate that these occurrences reflected mainly independent mutational events. No MEN1 germ-line mutations were found in 7/54 (13%) MEN1 families, in 2/11 (18%) isolated MEN1 cases, in 13/19 (68. 5%) MEN1-related cases, and in a kindred with familial isolated hyperparathyroidism. Two hundred twenty gene carriers (167 affected and 53 unaffected) were identified. No evidence of genotype-phenotype correlation was found. Age-related penetrance was estimated to be >95% at age >30 years. Our results add to the diversity of MEN1 germ-line mutations and provide new tools in genetic screening of MEN1 and clinically related cases.

Amino Acid Substitution↗
PubMed1998

[Incidence and prevalence of colostomies. The future of stoma societies. Results of a Côte-d'Or survey. Federation of Stoma Patients in France].

Few data are available in France about the impact of Ostomy Associations in the population of patients with permanent colostomy. The aim of this study was to assess the percentage of patients with permanent colostomy involved in local Ostomy Associations in a well-defined population (Côte-d'Or department, 493,931 inhabitants) in 1992. A minimum number of incident colostomy cases was computed using data from the Digestive Tract Tumor Registry in case of cancer and using the surgical reports from the University Hospital in case of benign disease. The maximum number of incident cases was computed using results from a survey conducted by the Public Administration (Social Security) during the same period. An interval of prevalent cases was assessed the number of collecting pouches based on sold during 1992 in the same area. A colostomy was set up in 37 to 84 patients. The number of prevalent cases was in a range of 274 to 410 patients. The corresponding percentages of Ostomy Associations members were included in a 8.3% to 19% range for incident cases and 9.5% to 19% for prevalent cases. These percentages are less than 30%, which is the presumed value previously evaluated in a survey conducted among physicians. As the incidence of colostomy cases continues to decline regularly, more effective methods must be developed to maintain a constant number of members.

Colostomy↗
PubMed1998

[Videocervicoscopy in surgery of primary hyperparathyroidism. Preliminary study of 19 patients].

The aim of this study was to assess the feasibility of a minimally invasive parathyroidectomy performed by videocervicoscopy. 19 patients were operated. Preoperative localization by ultrasonography and/or technetium 99 m sestamibi scan was performed in 17 patients. The technique was first attempted in two pigs, using three 2.5 mm trocars and a 2.5 mm endoscope. However, this technique failed in the first two human cases because of the lack of optical clarity of the 2.5 mm endoscope. A 5 mm endoscope was subsequently used. Carbon dioxide insufflation was maintained at 10 mmHg with a low 3 L/min flow. Three trocars were inserted in to the cervical space: one 5 mm trocar for the endoscope, two 3 mm trocars for the instruments. A unilateral neck exploration was carried out in 5 cases and a bilateral neck exploration in 14 cases. Enlarged glands were discovered in 13 patients (12 adenomas, 1 hyperplasia of the 4 glands). 8 adenomas were removed via a short midline incision, 4 others via a short lateral incision. Horizontal cervicotomy was required in 7 cases (4 failures to identify the abnormal gland, 1 thyroid cancer discovered incidentally, 1 hyperplasia of 4 glands and 1 anterior jugular vein bleeding). Except for the case of bleeding, no other complication occurred. Subcutaneous emphysema resorbed in 3 hours. 17 patients were discharged within 48 hours and 2 patients were discharged within 24 hours. 18 patients had normal serum calcium two months postoperatively. This study demonstrates that videocervicoscopy is safe and feasible in primary hyperparathyroidism.

Adenoma↗
PubMed1997

[Acute intra-abdominal gastric volvulus in adults. Defect of dorsal mesogastrium fusion].

A case of acute intra-abdominal gastric volvulus in an adult patient is presented. It was caused by the absence of dorsal mesogastrium fusion and was responsible for a gastric necrosis and peritonitis. The mobile spleen displaced the greater curvature of the stomach to the right. This case-report illustrates an association between an anatomical abnormality and a case of intra-abdominal gastric volvulus.

Abdomen↗
PubMed1997

Population-based study of the treatment and prognosis of carcinoma of the rectum.

BACKGROUND: Few population-based studies address the issue of treatment of carcinoma of the rectum (15 cm or less from the anal verge) both from surgical and epidemiological aspects. METHODS: Some 827 patients were analysed in the cancer registry of the Côte-d'Or (Burgundy, France) from 1976 to 1990 (493,931 inhabitants). RESULTS: Resection for cure increased from 57.2 per cent before 1981 to 77.0 per cent after 1985 (P < 0.001), and the proportion of Dukes A and B cases from 35.8 to 52.5 per cent (P < 0.001). Among patients resected for cure, continence-preserving resections were performed more frequently during the 1986-1990 period (48.0 per cent) than during the two previous 5-year periods (20.0 per cent; P < 0.001), more often in women, in the upper half of the ampulla and for tumours of less than 45 mm. The operative mortality rate after curative surgery decreased from 13.9 to 3.7 per cent (P < 0.001) between the first and the last period whereas the 5-year crude survival rate rose from 25.8 to 42.6 per cent (P < 0.001). Age, stage of disease and period of diagnosis were independent prognostic factors of death in a relative survival model. CONCLUSION: This study indicates that significant advances have been achieved at a population level in the treatment of rectal cancer in terms of diagnosis, continence-preserving procedures and survival.

Aged↗