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Biomedical subjects

R Detry

Publications and source records attributed to R Detry.

At least 55 records · Page 3Linked to original sources
PubMedDate not supplied

MRI of complicated anal fistulae: comparison with digital examination.

OBJECTIVES: The assessment of complicated anal fistulae is based on digital examination. Our objective was to study the potential role of MRI in this setting by comparing preoperative digital examination with MRI. MATERIALS AND METHODS: Digital examination and MRI were prospectively and blindly interpreted in 13 patients with complicated anal fistulae. Surgical findings were used as standard. RESULTS: Complete agreement between the results of digital examination and the surgical findings was observed in 8 patients and between the results of MRI and the surgical findings in 12 patients. Digital examination misclassified two low transsphincteric fistulae as high transsphincteric and missed high secondary extensions or abscesses in three other patients. Magnetic resonance misclassified only one suprasphincteric fistula as low transsphincteric and did not overlook high secondary extensions or abscesses. CONCLUSION: These findings suggest that MRI may show abnormalities not detected by preoperative digital examination.

Adult↗
PubMedDate not supplied

Colorectal villous tumors accuracy of the preoperative biopsies.

This study was undertaken to assess the reliability of the endoscopic biopsies in the evaluation of colorectal villous tumors (CRVT). In 163 consecutive patients referred for surgical treatment of CRVT, preoperative evaluation had been routinely done by colonoscopy and multiple biopsies. Tumors were classified in 3 groups: low grade tumors, high grade tumors and adenocarcinomas. Infiltration in depth was staged on the postoperative specimens according to the Dukes-Aster-Coller's classification. All the tumors were completely resected by surgery and definitive pathological diagnosis was established. An exact correlation between the pre- and postoperative staging was observed in 48% of the cases. Accuracy averaged 54% in the group-by-group comparison, with an overstaging rate of 6.7%, and an understaging rate of 39%. The incidence of adenocarcinomas was 22% in the group with clearly benign preoperative biopsies and 50% in the other cases. There were significantly more B2 and C tumors among the patients referred after 3 or more endoscopic attempts (33%) than after one or two sessions (10%) (p < 0.0003). We confirm that in spite of multiple endoscopic biopsies, only a complete resection permits an exact staging and an appropriate therapeutic choice.

Adenocarcinoma↗
PubMedDate not supplied

Follow-up after curative surgery for colorectal cancer.

Approximately 1 in 3 colorectal patients treated by surgery with curative intent will develop cancer recurrence, and most of them will die from disseminated disease. Post-operative follow-up aims at improving these ominous figures. Any strategy is justified as far as it influences evolution: global survival, disease-free period, quality of life. The value of follow-up for patients remains controversial. The literature review suggests that more intensive follow-ups lead to an increased number of reoperations, a more aggressive oncological approach in non resectable cases, provide data for an efficient quality control and have a major cost impact. Surveillance is appreciated by the patients who are confident in the efficacy of such policies. On the other hand, the benefit on the outcome of the patients is not formally established. Outcome might depend on tumoural characteristics rather than on the moment of recurrence detection. Not all schedules are alike, and CEA determination is required. Including all patients in intensive programs is not evidence-based medicine and is highly cost ineffective. Follow-ups must be tailored to individual characteristics. The most intensive ones are dedicated to the patients with the highest risk of treatable recurrence: high risk patients (tumour site and stage), able and willing to undergo reoperation (age, general condition,...). Research should try to determine curability tumoural factors (genetic tumour factors). In the meantime, and for the other patients, the most effective follow-ups could be programs in which only a few tests are routinely used: referential colonoscopy, history and physical examination, CEA determination and a rectoscopy for rectal cancers.

Adenoma↗
PubMedDate not supplied

[Familial adenomatous polyposis: what is new for the clinician?].

Familial adenomatous polyposis (FAP) is a rare autosomal-dominant disease characterized by the development of more than 100 colorectal adenomatous polyps in young adults. In the absence of surgical intervention, colorectal cancer ineluctably develops in all affected patients. Recent progress in the isolation of the gene responsible for the disease allows to detect gene carriers before they present with symptoms attributable to polyps. Moreover, the presence of four or more lesions of congenital hypertrophy of the retinal pigment epithelium is an extracolonic manifestation of FAP allowing presymptomatic screening of this disease. An effective screening programme combined with the elaboration of a registry for FAP and prophylactic colectomy should reduce mortality related to colorectal cancer. Two other extracolonic manifestations of FAP remain major causes of death: abdominal desmoid tumors and duodenal adenocarcinoma. At this time, no effective medical or surgical therapy has been found to cure these lesions. Restorative proctocolectomy with ileal reservoir is another major advance. This procedure is now regarded as the treatment of choice for patients with FAP because radical removal of all premalignant colorectal mucosa eliminates the risk of subsequent development of a colorectal adenocarcinoma.

Adenomatous Polyposis Coli↗
PubMedDate not supplied

[The surgical treatment of obstructive cancers of the left colon. Apropos of a series of 66 cases].

From 1977 to 1989, 66 patients were operated on in emergency, without any bowel preparation, for acutely obstructing left-sided colon cancer. Two synchronous cancers were diagnosed and the 68 tumours were located as follows: 13 on the left transverse colon or at the splenic flexure, 7 on the descending colon, 37 on the sigmoid, and 11 at the rectosigmoid junction or below. According to Astler-Coller staging, 15 patients were classified as B, 17 as C and 25 as D. Initial treatment was a colostomy in 58 patients (88%), or a resection with or without anastomosis in 2 and 6 cases respectively. Most patients underwent a two- or more rarely a three-stage resection and 44 patients left the hospital without either tumour or stomy. Cumulative operative mortality was 12%. Five-year survival rates were 21% for the patients with a minimal potential follow-up of 5 years, and 39% for curative resections (disease-free survival of 33%). From these results, we think that two-staged resection, with close proximal colostomy followed by resection and anastomosis, remains an appropriate approach for most obstructing left-sided colon cancers; more tempting procedures such as resection with primary anastomosis or subtotal colectomy are probably indicated in selected patients.

Adult↗
PubMedDate not supplied

[Surgical approach to villous tumors of the rectum].

The authors report the results of the surgical treatment of 39 villous adenomas of the rectum operated on during a 10-year period. Twenty-nine tumours were treated by a local excision, and 10 by a subtotal rectal resection. The choice for the procedure was mainly determined by the level of the lower tumour margin. Thirty-four operations were performed with a curative goal, and the 5 others for debulking. There was no operative mortality, and the morbidity was very low. Four invasive carcinomas were detected in the operative specimens and the four patients were withdrawn from the follow-up. In the "curative group", local recurrence rate was 21% after a mean follow-up period of 46 months. The tumour recurrences were small, and 2/3 among them were easily treated by reoperation (1 case) or further coagulations. With some complementary coagulations, surgery yielded a full control of 100% of the C1, 83% of the C2 and 66% of the C3 lesions. Full tumour clearance was achieved in two patients of the debulking group, with some postoperative coagulations. Our series and the literature confirm the efficiency of the surgical approach, which, moreover, allows the best histological assessment in one single session.

Adenoma↗
PubMedDate not supplied

[Liposarcoma of the ischiorectal fossa, an unusual tumoral site].

The main locations of the liposarcoma, the most common of the soft tissue sarcomas, are the lower limbs and the retroperitoneal space. We report the case of a 58 year-old male patient presenting with a huge and painless mass of the left fossa ischiorectalis. Preoperative tests and CT-scan of the pelvis evoked the diagnosis of liposarcoma, laminating and lifting the rectum and bladder. Visceral walls were respected. The patient underwent a en-bloc excision of the tumour by a combined perineal and abdominal route. Pathological examination of the mass (1.7 kg) confirmed the diagnosis of well differentiated liposarcoma. No further treatment was initiated, but, because of the high risk of local recurrence, the patient has been placed under a close follow-up schedule.

Humans↗
PubMedDate not supplied

[Digestive fistulas in Crohn's disease].

From 1977 up to 1983, 29 patients were operated upon for Crohn's disease with digestive fistula (dead fistulae, ileocecal and contiguous ileoileal fistulae being excluded). The majority of the fistulae arose from the distal ileum (n = 22). After an average duration of the disease of 7 1/2 years, the patients were admitted for surgical treatment, either electively (group I, n = 19), or in urgency (group II, n = 10). Eleven patients exhibited some signs of malnutrition, 13 needed a total parenteral nutrition for an average of 10 days; one patient had to be operated upon in emergency (hemorrhage and sepsis); the others had a normal bowel preparation. The resection of the diseased bowel at the origin of the fistulae included right ileocolic resections (n = 25), left (n = 1) or total (n = 3) colectomies, with primary anastomosis in all but two cases. The "target bowel" was treated as conservatively as possible: limited small bowel resection, single suture of the gastric, duodenal or sigmoidal walls, and bladder drainage. A segmental resection of the sigmoid colon was realized in 5 cases where a single closure of the wall defect was impossible. There was no postoperative death, no septic complications, and no signs of anastomotic dehiscence. Fistula recurrence "in situ" occurred only once. A spectacular health improvement, with a significant weight gain, was observed in 85% of the cases. Further outcome of the disease remains out of control.

Adolescent↗
PubMedDate not supplied

[Classification and diagnosis of anal fistulas].

Parks' classification of the anal fistulas is based on the knowledge of the pathogenesis of the disease. It relates fistula tracks to the anatomy of the anorectal musculature. Four main types are described, with some variations in each group: inter-, trans-, supra- and extrasphincteric fistulas. A circumferential spread occurs in the horseshoe fistulas. Positive diagnosis of fistula is difficult when the secondary opening lies distant from the anus. Aetiological factors, topography of the tracks, and clinical form (benign or necrotizing fasciitis) are systematically established. Anal fistulas must be differentiated from other suppurations of the anorectal area: intestinal (tumours, actinomycosis, piles,...) and extravisceral diseases (pilonidal cyst, hidradenitis suppurativa, bartholinitis...).

Crohn Disease↗
PubMedDate not supplied

[Radiological aspects of peri-diverticular disease of the colon. An anatomo-pathological correlation (author's transl].

Sixty consecutive cases operated for diverticular disease of the colon within the last 10 years are reviewed. A comparative study is made of the anatomopathological examination of the specimens and their radiological aspect trying to establish the precise radiological picture of acute, chronic and fibrotic peri-diverticular disease. Plain films of the abdomen, intravenous uro- and cystography are very useful in acute cases. A baryum enema just prior to surgery (33 cases) heralds by the rigid aspect of the involved bowelsegment the acute case; spasms, thick disorderly folds and localized extravasation characterize the acute peridiverticulitis. Fibrotic peri-diverticular disease shows disorderly, fine but "ragged" folds associated with extrinsic fistulae. In many cases the inflammation is not purely acute nor chronic or fibrotic. The distinguishing histological types are simultaneously present and render the radiological picture complex.

Barium Sulfate↗
PubMedDate not supplied

[Peridiverticulitis of the colon: confrontation of pre- and postoperative diagnosis (author's transl)].

The authors report their experience with the surgical management of the peridiverticulitis coli (60 cases). It is frequently uneasy to have an accurate pre- and peroperative diagnosis of the nature and the grade of severity of the illness. So, the indication for surgery, the choice of the procedure, and the evaluation of the results are somewhat subjective. The microscopical study of the resected colons give objective data about the status of the bowel. Our pathological findings have shown major inflammatory lesions in the colons which were resected in emergency, in the cases operated upon for stenoses and fistula. On the other hand, when patients underwent an elective surgical procedure, after a primary conservative (medical or surgical) treatment, the inflammation could be absent. The risks of leaving in place some of these colons seem to be small.

Abdomen, Acute↗