[Small bowel necrosis induced by jejunal tube feeding].
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Aged↗
Biomedical subjects
P Seguin
Publications and source records attributed to P Seguin.
[Plastic surgery application in artistic studies of breast cosmetic].
As, quest for beauty has always been an aim. There is a need to define the "ideal" beautifull breast with objective caracteristics, usable in plastic, reconstructive and aesthetic surgery. After, we have defined the necessary parameters usable in breast surgery. We realized an anthropomorphic study including 70 volunteer women and one molded model. Multiple pictures have been taken for each volunteer, that were evaluated and noted by five plastic surgeon, five doctors from other speciality, five women, five men. A twenty notation was used for this study. The main values for the ten women that obtained best notation (>or=14/20) were used in order to defined the ideal measures for surgery. Breast arrow and breast arrow over the trunck height were the most significant factors. According statistical studies, this fraction is about 0,387 (P=0,000969). The nice breast has a round shape and look like juvenile breast. Bra size, cup size, base, segments II and III, fraction II/III are not significant in our series of (non operated) natural breast. The ideal breast is in harmony and proportional to the trunck height, with the main fraction of breast arrow on the trunck height about 0,387 in our serie.
Adolescent↗
[Aneurysmal bone cyst of the mandibular condyle].
INTRODUCTION: Aneurysmal bone cyst (ABC) is a pseudotumor of bone consisting of a septated cystic cavity filled with blood. CASE: We report a case of aneurysmal bone cyst of the left mandibular condyle discovered in a 10-year-old child with a history of mandibular trauma which had occurred one year earlier. The treatment consisted in surgical excision of the lesion and reconstruction using a chondro-costal graft. The post operative development led to a chondral hyperplasia. DISCUSSION: We discuss the pathogenesis of the ABC centered on three theories, traumatic, vascular and tumoral of primary lesion. There are several complementary examinations to establish the diagnosis of ABC but the histopathological examination is the only way to confirm the diagnosis. The differential diagnosis of ABC is not an easy task. Surgical management with removal followed by immediate reconstruction is preferred.
Bone Cysts, Aneurysmal↗
Factors associated with multidrug-resistant bacteria in secondary peritonitis: impact on antibiotic therapy.
Secondary peritonitis includes community-acquired and nosocomial peritonitis. These intra-abdominal infections have a common pathogenesis but some microbiological differences, particularly with respect to the type of bacteria recovered and the level of antimicrobial susceptibility. This report describes a prospective observational study of 93 consecutive patients with secondary peritonitis during an 11-month period. Community-acquired peritonitis accounted for 44 cases and nosocomial peritonitis for 49 cases (post-operative in 35 cases). Fifteen multidrug-resistant (MDR) bacteria were recovered from 14 patients. In univariate analysis, the presence of MDR bacteria was associated significantly with pre-operative and total hospital lengths of stay, previous use of antimicrobial therapy, and post-operative antimicrobial therapy duration and modifications. A 5-day cut-off in length of hospital stay had the best specificity (58%) and sensitivity (93%) for predicting whether MDR bacteria were present. In multivariate analysis, only a composite variable associating pre-operative hospital length of stay and previous use of antimicrobial therapy was a significant independent risk-factor for infection with MDR bacteria. In conclusion, knowledge of these two factors may provide a more rational basis for selecting initial antimicrobial therapy for patients with secondary peritonitis.
Adult↗
Expression regulation of the endochitinase-encoding gene sechi44 from the mycoparasite Stachybotrys elegans.
The regulation of the gene encoding the extracellular chitinase sechi44 produced by the mycoparasite Stachybotrys elegans was studied using real-time quantitative reverse-transcription polymerase chain reaction. Alteration of sechi44 expression was observed when S. elegans was in interaction with its host, Rhizoctonia solani, and also when the mycoparasite was grown on minimal media amended with different carbon and nitrogen sources. Direct contact with R. solani leading to mycoparasitism significantly up-regulated the expression of sechi44, although the analysis showed that sechi44 was constitutively expressed but at substantially lower levels. In addition, the study of sechi44 over 12 days showed that its expression followed a cyclical pattern with peaks every 2 days, which suggests that this gene has a role not only in mycoparasitism but also in growth. The addition of external carbon sources, such as N-acetylglucosamine, chitin, and R. solani cell wall (simulated mycoparasitism), triggered an increase in the expression of sechi44, which varied with time and carbon source. Among the carbon sources examined, N-acetylglucosamine induced the highest increase in sechi44 transcript levels. The addition of high concentrations of glucose and ammonium triggered a decrease of sechi44 expression, suggesting that sechi44 is subject to glucose and ammonium repression.
Acetylglucosamine↗
[Activated protein C treatment: experience about 23 patients in the operative period].
OBJECTIVE: To evaluate the use of activated C protein (ACP) in a Surgical Intensive Care Unit. STUDY DESIGN: A prospective observational study. PATIENTS AND METHODS: All patients receiving ACP during 20 months in the operative period. RESULTS: Twenty-three patients were treated by ACP. The origin of sepsis was peritonitis (n = 14), infected pancreatitis (n = 3), mediastinitis (n = 2), one urologic sepsis, one facial cellulitis, one catheter related infection, and one postoperative pneumonia. In two cases, the peritonitis was associated with a pleuretic infection, and in two other cases with parietal cellulites. Mean age was 69+/-13 years. Severities evaluated by SAPS II, LODS were 59+/-13 and 7+/-3, respectively. Mean number organ dysfunction was 3.3+/-1.0. Septic shock was present in 91% with concomitant use of catecholamines for a mean period of 87+/-64 hours. Bacteraemia was present in 43% of the patients. A treatment with hydrocortisone was associated in 52% of the patients. The ICU and hospital lengths of stay were 15+/-16 days, and 34+/-38 days, respectively. Mortality at day 28 was 35%. Two significant bleeding were observed, one requiring red blood cell transfusion and the other one a surgical control of the bleeding associated with red blood cell transfusion. CONCLUSION: With global management of severe sepsis, including the use of activated C Protein, this prospective observational study showed a 30% reduction of the predicted mortality by SAPS II scoring without significant increase of bleeding episodes in a surgical context.
Aged↗
[Testing nasogastric tube placement: evaluation of three different methods in intensive care unit].
OBJECTIVE: Evaluation of three methods (aspiration of gastric fluid, pH measurement of gastric fluid, and insufflation of air) in order to determine the right position of the nasogastric (NG) tube. STUDY DESIGN: Prospective, observational study in an intensive care unit. PATIENTS AND METHODS: All patients requiring a NG tube were included. Since the NG tube was inserted three tests were successively performed: aspiration of gastric fluid, pH measurement of the gastric fluid, and auscultation over the epigastrium of air injected through the NG tube. The feasibility and the results obtained for each test were noted and compared to chest X-ray, considered as the reference. Chest X-ray classified the complications as major or minor. RESULTS: A total of 419 NG tube (202 decompressive NG tube and 217 gastric feeding tube) were analysed in 280 patients. Malpositions of the NG tube were observed in 10% (majors, n=11 and minors, n=31). Aspiration of gastric fluid and pH measurement were not sensible (77% and 49%, respectively) and not specific (38% and 74%, respectively). Insufflation of air was sensible (96%) but not specific (17%). The combination of the three methods did not improve the sensibility and specificity. Two complications were only detected by chest X-ray (one insertion in the intrapleural space, and one pneumothorax). CONCLUSION: None of the test evaluated, alone or associated, was sufficient to avoid chest X-ray. Moreover the occurrence of two potential and serious complications only detected by chest X-ray increase this assertion.
Auscultation↗
[Malignant triton tumor of the sinonasal tract].
INTRODUCTION: The combination of a malignant peripheral nerve sheath tumor with rhabdomyosarcomatous elements has been termed Malignant Triton Tumor (MTT). This tumor was first reported in 1932 and the prognosis was poor. Involvement of the sinonasal tract is rare with only 10 case reports. CASE: We report the case of a 80-year-old woman who presented an obstruction of the right nasal fossa which developed over several years without anosmia. She consulted because of recurrent epistaxis. The CT-scan revealed a tumor occupying the right ethmoid the right maxillary sinus and the homolateral nasal fossa. Resection was achieved via an extended mediofacial route. The histological diagnosis was low-grade schwannosarcoma with a discretely extended rhabdomyosarcomatous component, i.e. MTT. No complementary treatment was given. Eight months later, the tumor relapsed with cerebral involvement. Despite new surgery with two teams, a neurosurgical and a radiotherapy team, the tumor relapsed at the ethmoid-nasal level. After five years, the patient is alive with local progression without metastasis. DISCUSSION: MTT of the sinonasal tract is a rare disease that clinicians should be aware of and that must be included in the differential diagnosis of malignant lesions involving the sinonasal tract. Most of the reported cases involving localizations other than the ethmoidonasal cavities, are associated with von Recklinhausen neurofibromatosis and occurr in young subjects (mean age 35 years). There have however been sporadic cases, mainly in older women or after radiotherapy. The prognosis is somewhat better for ethmoidonasal localizations.
Aged↗
Postoperative analgesia and recovery after open and laparoscopic prostatectomy.
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Aged↗
[Functional results and early experience with the Hautmann neobladder. Comparative analysis of the Toulouse series and the Ulm series].
Orthotopic ileal urinary bladder replacement is an established method after radical standard cystectomy for both genders. In 1986 Hautmann described for the first time the technique of bladder reconstruction using the ileum at the University of Ulm. The W shape of the ileum buffers the coordinated peristaltic waves. The detubularized orthotopic ileal reservoir has been used worldwide ever since because of its technical simplicity, its reduced risk, and its good functional results. The good results published in the literature for this technique were reported by larger centers. With regard to these results, we wondered in 1994 if our smaller department with fewer patients might also offer this technique for male and female patients who had undergone cystectomy. The question was if this method would produce the same results as in large series, provided that patients were adequately selected and surgery carefully performed. This would provide the evidence that the surgical technique is simple, reproducible, and has the same complication rates, such as mortality and morbidity, also for departments with less experience.
Adult↗
[Endocarditis prophylaxis: ten years later].
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Antibiotic Prophylaxis↗
[Hepatorenal syndrome: from physiopathology to treatment].
OBJECTIVES: Data synthesis on physiopathology and treatment of hepatorenal syndrome (HRS). DATA SOURCES: Data were searched in the Medline database from 1975 to 2002 using the following key-words: hepatorenal syndrome, ascite, cirrhosis and portal hypertension. DATA EXTRACTION: Publications from 1986 to 2002 were selected depending on the quality of their methodology and their pertinence. One publication from 1975 was kept. DATA SYNTHESIS: Hepatorenal syndrome is a common and severe complication of patients with advanced liver cirrhosis with ascites. It is a functional renal failure due to intense vasoconstriction of the renal circulation secondary to an intense splanchnic vasodilatation. Two types of HRS are differentiated mainly by the speed and the magnitude of the renal failure. Liver transplantation remains the best treatment but is rarely applicable because of the short survival after diagnosis. In the last few years, new therapy have been developed, vasoconstrictor drugs which mainly elicit their effects on the splanchnic circulation as vasopressin and principally its analogues ornipressine and terlipressine are effective in improving renal function and could act as bridge for liver transplantation. The place of the transjugular intrahepatic portosystemic shunt remain to be evaluated. CONCLUSION: Prognosis of patients with HRS remains poor but the pharmacologic treatment by terlipressine has improved the prognosis particularly in order to wait liver transplantation.
Hepatorenal Syndrome↗
Effects of stage of maturity on ensiling characteristics and ruminal nutrient degradability of oat silage.
A study was conducted to determine the effects of stage of maturity on ensiling characteristics and ruminal nutrient degradability of oat silage. Oat was field grown and forage was harvested at the boot or soft dough stage and ensiled in mini-silos for 0, 2, 4, 8, 16 and 45 days. Two lactating Holstein cows fitted with ruminal fistulas were used determine ruminal nutrient degradability. Regardless of the stage of maturity, ensiled forages went through a rapid fermentation with a sharp decline in pH during the first 2 days of ensiling. Extensive proteolysis took place between 0 and 2 days as indicated by a reduction in true protein and neutral detergent insoluble protein (NDICP) and an increase in non-protein nitrogen (NPN). Chemical analysis of the 45 days silage showed that stage of maturity had no effect on neutral detergent fibre (NDF) and acid detergent fibre (ADF) of oat silage. However, oat harvested at the boot stage contained more crude protein (CP) and less starch than that harvested at the soft dough stage. Distribution of protein fractions showed that oat harvested at the boot stage contained lower NPN, NDICP and acid detergent insoluble protein than oat harvested at the soft dough stage. Results of the in situ incubation experiment indicated that oat harvested at the soft dough stage had lower ruminal dry matter (60.6 vs. 66.4%). CP (81.3 vs. 88.7%) and NDF (35.4 vs. 42.2%) degradabilities than oat harvested at the boot stage. It was concluded that chemical composition and ruminal nutrient degradability of oat silage are significantly influenced by stage of maturity.
Animal Feed↗
Pubourethral ligaments in women: anatomical and clinical aspects.
The anatomy and histological structure of the proximal (PPUL), distal (DPUL) and intermediate (IPUL) pubourethral ligaments in women was examined to improve the understanding of their roles in female urethral physiology. An anatomical study of the pelvis was carried out in 10 adult female cadavers (60-102 years), the pelvis being removed and frozen prior to dissection. The pubourethral ligaments (PUL) were dissected in sagittal sections in seven specimens and in a frontal section in one specimen; the remaining two pelves were dissected using a hypogastric approach. The location, insertion, direction and histological structure of the ligamentous structures were studied. The PUL were identified in all 10 dissections, being paired, symmetrical, pearly-white, fibrous and resistant to stretching. The bony (parietal) insertion was variable on the posterior surface of the pubis, while the visceral insertion was located on the dorsal aspect of the proximal third of the urethra and neck of the bladder for the PPUL and on the distal third of the urethra for the DPUL. Histologically, the ligaments were composed of dense collagen fibres and bundles of axially orientated smooth muscle fibres. The PPUL was closely associated with the sphincter urogenitalis muscle, whereas the DPUL appeared to reinforce the role of the compressor urethra. It is suggested that the PUL plays an effective role in passive and active suspension of the urethra. The pubourethral ligaments are a constant anatomical entity which should be spared in urethral surgery in women in order to ensure an intact urogenital sphincter.
Aged↗
A modified intussuscepted nipple in the Kock pouch urinary diversion: assessment of perioperative complications and functional results.
OBJECTIVE: To assess the complications and continence of a modified intussuscepted nipple in Kock pouch urinary diversions. PATIENTS AND METHODS: From February 1992 to December 2000, 40 patients (mean age 55.8 years, range 21-74) with bladder cancer (24), gynaecological tumours (eight) or previous lower tract reconstructive surgery (eight) underwent cystectomy and cutaneous continent urinary diversion using the Kock pouch procedure. The first 23 procedures (group I) used Henriet's technique, whereas a modified fixation of the intussuscepted efferent limb was applied in the last 17 (group II). Complications and functional results (focused on continence and the upper urinary tract) were reviewed. RESULTS: The median (range) follow-up was 47.6 (10-124) months; one patient died 4 weeks after surgery. Early complications occurred in 11 (28%) and re-operation was required in two (5%). Of the late complications reported (38%), extussusception (8%) and efferent nipple prolapse (3%) only occurred in group I and required surgical revision. Late complications were minor (15%) including two asymptomatic refluxes and four with stoma sclerosis. The continence rate at 6 months in groups I and II were 78% and 94%, respectively (P = 0.13). CONCLUSION: Efferent limb prolapse and extussusception of the Kock pouch were the main complications requiring surgical revision. Applying the modified nipple fixation the complications can be reduced and reservoir continence improved.
Adult↗
Effects of cultivars on ensiling characteristics, chemical composition, and ruminal degradability of pea silage.
A study was conducted to determine the effects of cultivar on ensiling characteristics, chemical composition and ruminal nutrient degradability of pea (Pisum sativum L.) silage. The cultivars evaluated were Lenca (L), Carneval (C), and Delta (D). Peas were field-grown and forage was harvested and ensiled in mini-silos for 0, 2, 4, 8, 16, and 70 d. The ensiled forage of all cultivars went through a rapid fermentation with a sharp reduction in pH during the first 2 days of ensiling. Extensive proteolysis took place between 0 and 2 d as indicated by a reduction in true protein and neutral detergent insoluble protein (NDICP) and an increase in nonprotein nitrogen. Chemical analysis of the 70 d silage showed that cultivar L contained higher neutral detergent fiber (NDF) and acid detergent fiber and lower starch levels than C and D. Crude protein was highest for C (20.5% DM), intermediate for D (19.0% DM) and lowest for L (17.9% DM). Distribution of protein fractions showed that L contains lower soluble protein and higher NDICP levels than the other two pea cultivars. However, no difference in acid detergent insoluble protein levels was observed between the three cultivars. Results of the in situ incubation experiment indicated that L had lower ruminal DM (69.2 vs 74.0%) and CP (84.1 vs 90.6%) degradabilities than C or D. However, ruminal degradability of NDF was similar among the three cultivars (average of 32.9%). It was concluded that chemical composition and ruminal nutrient degradability of pea silage are significantly influenced by cultivars.
Acetic Acid↗
[The measurement of end-tidal carbon dioxide (PETCO2) is not a significant parameter to monitor in patients with severe traumatic brain injury].
PURPOSE: To evaluate the agreement between end-tidal carbon dioxide (PETCO2) and arterial CO2 (PaCO2) in patients with traumatic brain injury and to document the course of the (PaCO2-PETCO2) gradient over time. METHODS: Twenty one traumatic brain injury patients (Coma Glasgow Scale < or = 8) were included in this prospective observational study over a period of six months. Simultaneous determinations of PaCO2 and PETCO2 (by infrared capnometry) were recorded. Agreement between PaCO2 and PETCO2 was determined by the statistical method described by Bland and Altman. Changes in PETCO2 over time were compared with changes in PaCO2. Factors likely to explain a gradient superior to +/- 4 mmHg were explored. RESULTS: One hundred and eleven data pairs were obtained. The bias was 5.5 mmHg with a precision of 5.1 mmHg and limits of agreement ranged from -4.5 mmHg to 15.5 mmHg. The latter exceeded the predefined limits of agreement established to determine interchangeability between methods (+/- 4 mmHg). PETCO2 and PoCO2 changed in opposite directions in 20% of 90 consecutive measurements. Only the duration of ventilation was found to be significantly associated with a gradient superior to +/- 4 mmHg. CONCLUSIONS: In this selected population of patients with severe traumatic brain injury, measurements of PETCO2 and PaCO2 are not interchangeable. Further the PoCO2-PETCO2 gradient is not stable over time and cannot predict variations of PaCO2. The use of PETCO2 instead of PaCO2 could be deleterious in patients in whom strict control of PaCO2 values is required.
Adult↗
Retroperitoneal laparoscopic versus open pyeloplasty with a minimal incision: comparison of two surgical approaches.
OBJECTIVES: To compare the complications, hospital stay, and functional results of retroperitoneal laparoscopic (RL) pyeloplasty versus open pyeloplasty (OP) with a minimal subcostal incision. METHODS: From October 1997 to January 2000, 53 consecutive nonrandomized patients underwent 26 RL pyeloplasties, of which 1 was bilateral (group 1), and 28 OP (group 2). The decision between the two techniques depended on the patient's anesthetic ability to tolerate RL, previous ureteropelvic junction surgery, associated renal pathologic findings, and the surgeon's laparoscopic experience. Subjective outcomes as to postoperative pain and convalescence and objective findings on intravenous urography were assessed at 3 months postoperatively in both groups. RESULTS: The mean operating time (165 versus 145 minutes) and mean blood loss (92 versus 84 mL) were similar in both groups. No intraoperative complications occurred in either group; in group 1, 1 patient required open conversion. Postoperative complications occurred in 11.5% of group 1 and 14.3% of group 2. The mean hospital stay was 4.5 days for group 1 and 5.5 days for group 2. At 3 months, 23 patients (92%) in group 1 and 25 (89.2%) in group 2 were pain-free or improved. Intravenous urography showed a patent ureteropelvic junction in all cases and improvement of hydronephrosis in 88.5% of group 1 and 89.3% of group 2. CONCLUSIONS: The incidence of complications, hospital stay, and functional results were equivalent for RL pyeloplasty and OP with a minimal incision, but the return to painless activity was more rapid with laparoscopy in younger patients.
Adolescent↗