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P Goudet

Publications and source records attributed to P Goudet.

At least 55 records · Page 3Linked to original sources
PubMed1996

Changing referral patterns for surgical treatment of ulcerative colitis.

OBJECTIVE: To determine whether referral patterns for surgical treatment among patients with chronic ulcerative colitis have changed in recent years, especially in view of the introduction of a new operation, the ileal pouch-anal anastomosis (IPAA). MATERIAL AND METHODS: Between January 1976 and December 1986, 981 patients underwent proctocolectomy at Mayo Clinic Rochester. Brooke ileostomy (N = 300), colectomy with ileorectal anastomosis (N = 33), proctocolectomy with Kock pouch (N = 180), or ileal pouch-anal anastomosis (IPAA) (N = 468) was performed. The indications for surgical intervention were categorized as emergent or elective, the latter including intractability, cancer, and cancer prophylaxis. For analysis, the duration from diagnosis of disease to operation, indications for surgical treatment, and types of operation were subdivided into pre-IPAA era (before 1981) and post-IPAA era (from 1981 onward) for the entire group and for distant versus local patients. RESULTS: More continence-preserving operations were done in 1981 and thereafter (76%) than before 1981 (46%). In the later segment of the study period in comparison with before 1981, fewer operations were done for emergent reasons (4% versus 8%) and a greater percentage of operations were done for elective indications, especially intractability (74% versus 61%). With the advent of IPAA in 1981, patients underwent operation sooner after the diagnosis was made (7.4 years versus 8.6 years before 1981). A smaller proportion of patients underwent operation for cancer prophylaxis during 1981 through 1986 (19%), however, than before 1981 (28%). CONCLUSION: Referral patterns for surgical treatment of patients with ulcerative colitis have changed in recent years--patients are being referred for operation sooner, before complications develop that necessitate emergent procedures. Although the changed referral pattern may be due to the availability of IPAA, other factors may also have a role.

Adult↗
PubMed1996

[Prognostic factors of survival in medullary cancers of the thyroid. Apropos of 51 cases. Clinical, biochemical and immunocytochemical study].

The aim of this study was to assess the main clinical biochemical and immunocytochemical factors influencing survival in 51 patients operated for medullary thyroid carcinoma (MTC). There were 55% of women and 37% of familial cases. Mean age was 43 +/- 3 years. The following survival variables were tested: sex, age, stage, familial disease, Serum Carcino Embryonic Antigen (CEA) and Calcitonin (CT) levels three months postoperatively, intensity of CEA and CT immunostaining, percentage of cells stained for CEA and CT. The actuarial survival rate, including postoperative mortality (N = 1), was studied by uni and multivariate analysis using a Cox model (N = 31). The 5-year survival was 69 +/- 7%. By univariate analysis, stages I or II (p < 0.0001), age of 45 years and less (p < 0.0001), normalized CEA levels (p < 0.006), percentage of CT stained cells greater than 80% (p < 0.04) and weak CT and CEA staining (p < 0.02) were significant predictors of increased survival rates. Age less than 45 and stages I or II were significant prognostic factors of goof survival on multivariate analysis (p < 0.001). We conclude that clinical criteria constitute good survival prognostic factors in patients operated for MTC. The better prognosis of familial cases was probably related to their earlier detection. The prognostic value of immunostaining remains controversial and requires further studies.

Actuarial Analysis↗
PubMed1996

[Specific morbidity of substernal goiters. A comparative study with a matched series of cervical goiters].

The operative morbidity rates in patients operated for substernal goiter (SG) vary from one series to another. The aim of this study was to reevaluate the morbidity using a matched technique. Each SG was matched to a cervical goiter for surgical technique, histology and thyroid function. There were 97 SG (75% of women), 43% with normal thyroid function, 28% with mild hyperthyroidism, 29% with hyperthyroidism. 87% of thyroidectomies were bilateral. Mean age was 66.5 +/- 11.5 years versus 55.8 +/- 11.9 years for cervical goiters (p < 0.001). The percentage of men was higher for SG than for cervical goiter (25% versus 10%, p < 0.01). Specimen weighed 166 +/- 109g versus 76 +/- 95g (p < 0.0001). Total volume of drainage was 164.0 +/- 68 ml versus 123.2 +/- 68 ml (p = 0.003). No operative death occurred. Early hypoparathyroidism rate was 3% versus 2% (p = 0.5), and late hypoparathyroidism was 1% versus 0% (p = 0.5). There was a 10 mg/l in serum calcium post-operative drop in both groups but no change in serum phosphate was noted (bilateral thyroidectomies). The early recurrent laryngeal nerve palsy rate was 4% versus 0% (p = 0.06) and 3% versus 0% one year later (p = 0.12). Early postoperative reoperation rate for hemostasis was 2% versus 1% respectively (p = 0.25). We conclude that there is no significant difference in surgical morbidity between thyroidectomies for SG and cervical goiters when patients are operated in specialized centers. Operative fears are not justified.

Aged↗
PubMed1995

[Intraoperative radiotherapy. Preliminary results].

We report a series of 40 patients treated by intraoperative radiotherapy between 1988 and 1992 (18 primary tumors, 13 local recurrences and 9 nodal extensions). The doses delivered were 15 Gy to 25 Gy, completed by external radiotherapy (15 to 45 Gy) in 13 cases. The local tumor control rate was 61% for initial therapy in primary tumors (70% for adenocarcinoma of the stomach) and 80.9% after complete en bloc surgery. The local control rate after palliative surgery for local recurrences is 38% and 33% for nodal extension. Two patients died (5%) during the postoperative period. We observed 2 hemorrhages and 3 cases of stone-free cholecystitis. The value of this approach must be confirmed in rigorous indications in comparison with surgery alone in controlled and randomised clinical trials.

Adult↗
PubMed1995

[The thoraco-lumbar junction. Orientation of zygapophyses, mamillary process and vertebral rotation].

The orientation of the zygapophyseal joints at the thoraco-lumbar level is an important factor involved in the axial rotation of the human spine. The functional role of the Mamillary Processes (MP) is unknown. This study was carried out on 55 adult dried spines. The aims were 1) to record the interzygapophyseal joint angles. 2) to determine morphological and functional angle types. 3) to correlate the various types and the corresponding MP lengths. 4) to propose hypotheses about the MP role. There were 2 distinct morphotic types founded on 2 different populations of angles clearly visible on histograms at the T12 level and statistically detectable at the T11 and L1 levels. T11-T12-L1 realized an homogeneous anatomical unit with 2 separate groups depending on the zygapophyseal joint orientations. A functional classification was also possible depending on the location of the geometric axial center of rotation. The "thoracic" type which center was on vertebral body. 95% of T10 vertebrae and 88% of T11 vertebrae belonged to the "thoracic" type whereas 97% of L1 ans 98% of L2 belonged to the lumbar type. At the T12 level, we found 35% of "thoracic" type and 65% of "lumbar" type. Long MP were found on "lumbar" type vertebrae with little interzygapophyseal angles (p < 0.001). "Anatomical" types were not related to different MP lengths. On the contrary, the "functional" classification showed shorter MP on "thoracic" type vertebrae than on "lumbar" vertebrae (1.9 +/- 2.9 mm vs 4.5 +/- 3 mm, p < 0.03). A large interzygapophyseal angle is known to enhance the axial rotation of the thoraco-lumbar junction. We infer that MP also play a role in axial rotation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

[Intestinal infarctions. A re-evaluation of prognostic factors of postoperative mortality].

The aim of this study, based on a series of 67 patients, was to assess the prognostic factors of postoperative mortality of intestinal infarctions (small and large bowel). Known risk factors were studied (age, sex, shock, Concomitant disease, use of arteriography and vasodilators), together with less studied factors, such as recent vascular or cardiac surgery less than 4 months before the infarction and length of bowel infarction. Postoperative mortality was defined as any death occurring within 45 days after surgery. The risk factors were assessed by univariate and multivariate analysis with logistic regression. The postoperative mortality was 63%. Age, shock, other medical diseases, recent cardiovascular surgery, and length of bowel infarction were significant predictive factors of postoperative mortality on univariate analysis. Shock, age greater than 70 years and recent cardiovascular surgery were three independent risk factors selected on multivariate analysis with equivalent weights.

Adult↗
PubMed1994

Antibiotic prophylaxis in pulmonary surgery. A prospective randomized double-blind trial of flash cefuroxime versus forty-eight-hour cefuroxime.

The aim of this study was to determine whether a 48-hour antibiotic prophylaxis regimen with a second-generation cephalosporin was more efficient than a flash antibiotic prophylaxis regimen in pulmonary operations. All the included patients underwent lung resection. Patients with preoperative infection were excluded. All the patients were given cefuroxime (1.5 gm intravenously) at the time of the anesthetic induction and again 2 hours later. The randomization was done postoperatively: group 1 was given placebo intravenously (n = 102) and group 2 was given cefuroxime intravenously (n = 101), each every 6 hours for 48 hours. The overall rate of infections was 46% in the 48-hour cefuroxime group versus 65% in the flash group (p = 0.005). The difference remained significant even after an adjustment with prognosis variables (p = 0.01). Six empyemas (6%) in the flash group were noted versus one (1%) in the 48-hour group (p = 0.03). From day 3 to day 8 after the operation, chest x-rays films were more often assessed as being normal in the flash group than in the 48-hour group (p = 0.005). On day 3 after operation, white blood cell counts were 13,020 +/- 1,220 elements/mm3 in the flash group versus 11,620 +/- 1,220 elements/mm3 in the 48-hour group (p = 0.03). A 48-hour antibiotic prophylaxis regimen decreases the rate of deep infections and particularly the rate of empyemas.

Bronchopneumonia↗
PubMed1993

[Colorectal cancers associated with ulcero-hemorrhagic rectocolitis. Detection of and prognosis for postoperative patients].

Between January 1976 and December 1986, 86 patients underwent surgery for colorectal adenocarcinoma (AC) complicating ulcerative colitis (UC) at Mayo Medical Center in Rochester, Minnesota. Seventy-two percent were men, contrasting with only 55% in the population operated for UC without AC during the same time period at the same institution (p = 0.001). The mean duration of UC symptoms was 19.2 years. The diagnosis of cancer was established preoperatively in 65% of patients, while the remainder of patients, except for three (n = 30, 35%) were at high risk for cancer. A colonoscopy performed in 16 of those 30 patients less than six months prior to the operation did not detect cancer. Overall, cancer was either proven or highly suspected preoperatively in 96.5% of patients, while the sensitivity of colonoscopy was 78%. During the study period, histological tumor features, such as number of tumors, Dukes' stage, Broder's stage, and curative/palliative ratio, remained unchanged, and the five-actuarial survival of 50% did not improve with time (p = 0.37). Multivariant analysis indicated that Dukes' stage and male gender were two poor prognosis factors. For patients with long-standing UC, we offer either proctocolectomy, possibly with ileal pouch-anal anastomosis, or surveillance colonoscopy, emphasizing their respective hazards and limitations.

Adenocarcinoma↗
PubMed1993

[Spontaneous pneumothorax. A comparison of thoracoscopy and thoracotomy].

The aims of this study were to assess the advantages of surgical thoracoscopy versus thoracotomy. Two 16-patient groups (thoracotomy, thoracoscopy) were compared. They were equivalent with regards to technique, age, etiology and lung dystrophy. Patients were called by phone to evaluate the surgical and functional results. The questionnaire was filled out by an independent physician who ignored the surgical technique used. Hospital stay was 7 +/- 2 days for thoracoscopy versus 11.5 +/- 5 days for thoracotomy (p < 0.003). During the J30 to J60 period of time, pain was mild in 94% of thoracoscopy cases and severe or unbearable in 69% of thoracotomy cases (p < 0.002). Mobility of the shoulder was fully recovered in all thoracoscopy patients within the first month versus only 62% of recovery at 3 months in the thoracotomy group (p < 0.0001). Working was possible at 1 +/- 0.8 month in the thoracoscopy group versus 2.6 +/- 0.8 months in the thoracotomy group (p < 0.002). Leisure activities were resumed at 2 +/- 1 month in the thoracoscopy group versus 4 +/- 1 months in the thoracotomy group (p < 0.0005). Only one relapse occurred in the thoracoscopy group. Thoracoscopy prevents the drawbacks of thoracotomy but keeps the same efficiency in the treatment of pneumothorax.

Adult↗
PubMed1992

[Substernal goiters. 218 operated cases].

The authors are presenting a retrospective study on 218 retrosternal goiters operated between 1968 and 1991. 33% of the goiters were incidentally discovered on a plain X-ray of the chest. Symptoms of compression were present in 50.5% of patients and hyperthyroidism in 16.5%. Respiratory manifestations were more frequent and more severe in patients aged 70 and more. Moreover 90% of those old patients were symptomatic. Goiters migrated anteriorly in 57.7% of cases, posteriorly in 33.9%, both anteriorly and posteriorly in 5.5%. Type of migration was unknown in 2.5%. 3.7% were malignant. 27 patients with respiratory symptoms received corticosteroids to reduce the airway compression. Among 52 patients with hyperthyroidism, 36 were given antithyroid drugs. Among them, some received corticosteroid drugs in order to reduce risks of mediastinal compression. A simple cervicotomy was adequate in 92.7% of case and was completed by sternotomy in 7.3%. The operation was iterative for relapsing or forgotten thoracic goiters in 24 cases. Morbidity was slight even for sternotomized patients. Mortality was noted in 2 cases (0.9%) one of them operated on for poorly-differentiated and suffocating carcinoma of the thyroid. We advise a straightforward surgical attitude as a result of the slight morbidity and mortality, even in sternotomized patients in order to avoid severe compressive complications of the airways.

Adult↗
PubMed1992

[Peristomal pyoderma gangrenosum after colectomy for Crohn disease. Successful medical treatment].

A case of Pyoderma gangrenosum with two different abdominal sites in a female patient suffering from colonic Crohn's disease is presented. Local trauma on the midline scar of an incisional hernia and around the stoma were the possible triggering factors. Despite the major abdominal wall defect and an infected parietal collection, steroid therapy was very effective without the need for surgery.

Aged↗
PubMed1991

[Dumbbell-shaped nerve-tissue tumors of the posterior mediastinum. Apropos of 5 cases].

The authors present 5 cases of dumbbell neurogenic tumors with intraspinal extension. There were 4 neurilemmomas in four adults and 1 ganglioneuroma in one child. These tumors were benign. Neurological signs were observed in two cases. Widening of the intervertebral foramen at the level of the tumor is a very suggestive sign of dumbbell tumor confirmed by CT-Scan or MRI. Precise morphologic features must be assessed before embarking on the operation. The procedures used were: thoracotomy only in two cases, laminectomy then thoracotomy because of neurological signs in two cases, thoracotomy then laminectomy to fully remove tumor remnants in one case. No major morbidity was noted. The neurological symptoms resolved in two cases. A combined two-team approach with thoracic and neurosurgeons working together has not been used so far, but this possibility is probably the best choice for the future.

Adult↗
PubMed1991

[Dumbbell neurogenic tumors of the posterior mediastinum. Apropos of five cases].

The authors present 5 cases of dumbbell neurogenic tumors with intraspinal extension. There were 4 neurilemmomas in four adults and 1 ganglioneuroma in one child. These tumors were benign. Neurological signs were observed in two cases. Widening of the intervertebral foramen at the level of the tumor is a very suggestive sign of dumbbell tumor confirmed by CT-Scan or MRI. Precise morphologic features must be assessed before embarking on the operation. The procedures used were: thoracotomy only in two cases, laminectomy then thoracotomy because of neurological signs in two cases, thoracotomy then laminectomy to fully remove tumor remnants in one case. No major morbidity was noted. The neurological symptoms resolved in two cases. A combined two-team approach with thoracic and neurosurgeons working together has not been used so far, but this possibility is probably the best choice for the future.

Adult↗
PubMed1991

[Practical role of ultrasonography and clinical examination for the diagnosis of acute appendicitis. Prospective study].

The aim of this 100-patient prospective study was to compare three types of investigations in the diagnosis of acute appendicitis: initial clinical examination, initial appendicular ultrasound examination, and final results of repeated clinical examinations carried out within the first 48 hours. Final results included initial evaluation, obvious clinical results and definitive results from patients under 48 hour observation for uncertain diagnosis. Clinical initial or appendicular ultrasound examinations were poorly contributive to diagnosis (overall accuracy: 76 percent). On the contrary, repeated clinical examinations yielded a 100 percent sensitivity, a 94 percent specificity, a 94 percent positive predictive value, a 97 percent negative predictive value and a 97 p. 100 overall accuracy. No morbidity was noted in observing patients for 48 hours. Unwarranted appendectomies were carried out in 3 percent of cases. Ultrasonography of the appendix seems useful for the differential diagnosis of acute appendicitis.

Acute Disease↗
PubMed1990

[Post-traumatic retroligamentary pneumatocele. Apropos of a case].

A case-report of a 17 year-old man admitted for thoracic trauma associated with a vertical air and fluid collection located behind the pulmonary ligament raises the question of the exact nature of retroligamentary pulmonary pneumatoceles. They may be intraparenchymatous pneumatoceles or simple loculated pneumothorax but whatever the actual lesion, exact recognition of this radiological image avoids drainage and operation. This lesion resolves spontaneously within several weeks.

Adolescent↗
PubMed1989

[Dumbbell neurogenic tumors. 5 cases (4 thoracic, 1 lumbar)].

Benign in more than 90% cases, dumbbell neurogenic tumors are rare. It was 3 thoracic schwannome and 1 thoracic ganglioneuroma and 1 lumbar schwannoma are reported. In 2 cases complete removal was performed by thoracotomy, in another case thoracic removal was incomplete with leateag of spinal fluid, laminectomy was necessary 3 months later and in a third case laminectomy was performed first because of paraplagia and thoracotomy one month later. In lumbar case a two ways procedure in 3 weetes space permitted complete removal, a monoparesia and sphincters troubles, regressive spontaneously in 5 months, complicated first performed laminectomy. Schwannome and benign neurofibroma are the most frequent tumors. Latero vertebral situation in chest radio or in abdominal ultrasonography must induce neurogenic tumors diagnosis. Myelography or tomodensitometry confirms intraspinal extension when osseous signs are present on vertebral radiographies. In thoracic localization a one stage combined resection gives the lowest morbidity. In lumbo-sacral localization tumoral large size requires a combined approach, which can be performed in a single stage. Recklinghausen's association in neurofibroma (4 to 16%) exposes to malign evolution risk (12 to 13%).

Adult↗