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Biomedical subjects

R Parc

Publications and source records attributed to R Parc.

At least 235 records · Page 13Linked to original sources
PubMedDate not supplied

Gastroduodenal intussusception secondary to Menetrier's disease.

Menetrier's disease is an uncommon condition of unknown etiology, characterized by a hyperplasia of the gastric mucosal folds. The first case of gastroduodenal intussusception complicating Menetrier's disease is reported herein. Barium study and computed tomography (CT) helped in the diagnosis of intussusception but the nature of the underlying disease was not determined until histological examination of the gastric specimen was performed.

Duodenal Diseases↗
PubMedDate not supplied

Health care delivery system in France: effects on surgical education.

Surgical education in France has changed in recent years. It had to conform to the transformation of surgery into a more scientific discipline, to European Community regulations, and to increasing costs of health care. It is now organized on a national scale and is based on anonymous selection. The main objective is to train general surgeons who only afterward become specialized in various surgical specialties. The aim is to make them able to adapt to the changes that will transform surgery in the near future. In France the obligatory social insurance system, called Social Security, reimburses most medical expenses for 99% of the population. Patients can be reimbursed in a similar way whether they seek treatment in a private or a public institution. However, the system has to face major and presently unsolved problems due to the rapidly increasing cost of health care.

Delivery of Health Care↗
PubMedDate not supplied

Excision of the rectum with colonic J pouch-anal anastomosis for adenocarcinoma of the low and mid rectum.

The results of rectal excision with colonic pouch-anal anastomosis are reviewed from a series of 162 patients covering 7 years. All patients have been operated upon in the same institution and consecutively. The follow-up is now sufficient to allow an accurate evaluation of the outcome of the patients. The main goal of this study was to provide a detailed report of the functional results. Continence was satisfactory in 96% of the patients, with either a perfect continence or minor troubles that would not have been detectable other than by a rigorous questioning. The mean number of bowel movements was 2 per 24 hours. Fragmentation of the defecation and urgency were absent. Twenty-five per cent of the patients had to elicit the evacuation of the reservoir with a suppository or an enema. Improvement of function yielded by a reservoir over straight colo-anal and low colo-rectal anastomoses are significant and, as suggested by manometric studies, are directly related to the restoration of a reservoir function.

Adult↗
PubMedDate not supplied

Anastomic dehiscence and severe peritonitis.

Fifteen years of experience in the management of postoperative complications following GI surgery are reviewed. In the surgical ICU of the Hôpital Saint Antoine, Paris, France, a referral center for these conditions, 385 cases of postoperative peritonitis and 500 cases of enterocutaneous fistulas were observed from 1980 to 1995. Original techniques of management are described in surgical treatment: temporary stomas, intubation irrigation of leaks situated on the upper GI tract, primary closure of the abdominal wall without tension. New methods of intensive care of intestinal conditions have also been designed: control and/or obturation of complex enterocutaneous fistulas, reinfusion of chyme into the distal small bowel and continuous enteral nutrition. In accordance with their experience in this field, the authors review the most controversial points of surgical technique and intensive care.

Cutaneous Fistula↗
PubMedDate not supplied

[Locoregional recurrence of adenocarcinomas of the rectum treated with irradiation combined with or without excision surgery].

PURPOSE: Retrospective study to analyze the results of external beam radiation treatment with or without surgery for loco-regional recurrence of adenocarcinoma of the rectum following previous surgery without pre- or post-operative radiotherapy. PATIENTS AND METHODS: Between March 1973 and November 1991, 211 patients with loco-regional recurrence of rectum cancer were treated with external beam radiation treatment. Radical surgery was the only initial treatment modality. Surgical resection of local recurrence was done in 36 patients and only 17 patients could undergo complete resection. Forty-seven patients underwent radiotherapy (RT) combined with surgery and 164 received external beam radiation treatment alone to a mean total dose of 46 Gy. RESULTS: Among the 151 patients whose recurrence was revealed by pain, 64 (42%) were considered to have a complete symptomatic response after loco-regional treatment with radiosurgery or RT alone. The mean duration of response was 12 months. The 3-year overall survival rate was 16%. Five prognostic factors decreased the overall survival rate in multivariate analysis: high age, sex (male), concomitant distant metastasis, no tumor resection, and low total radiation dose with external beam radiation treatment alone. The 3-year overall survival rate for patients with completely resected recurrences was 39%. CONCLUSION: External beam RT treatment can only be considered a palliative symptomatic treatment. New techniques of early detection of local recurrence and new combined modalities approaches (radiation sensitizers or intra-operative radiotherapy) with surgical resection in some favorable cases should be studied.

Adenocarcinoma↗
PubMedDate not supplied

The role of anatomic factors in nutritional autonomy after extensive small bowel resection.

BACKGROUND: It is difficult to predict which patients with a postsurgical short bowel will require long-term parenteral nutrition. METHODS: We performed a retrospective prognostic study for the time to home parenteral nutrition or death from malnutrition (nonautonomy), on the basis of 103 patients with a residual short bowel of 17 to 150 cm. The influence of anatomic variables was summarized through the use of Cox regression model. RESULTS: Of the 103 patients included, 24 lost nutritional autonomy. Three anatomic variables were identified as having independent predictive information; remaining small bowel length (measured on small bowel x-rays; p = .0001), and jejunoileal anastomosis (p = .01) promoted autonomy, whereas end jejunostomy (p = .002) increased the risk of losing nutritional autonomy. CONCLUSIONS: On the basis of these results and on the relative weight of these variables, high-risk patients for loss of nutritional autonomy were defined as those with jejunoileal anastomosis and a remaining small bowel length < 35 cm, patients with jejunocolic anastomosis and remaining small bowel length < 60 cm, and patients with an end jejunostomy and remaining small bowel length < 115 cm. This classification was thereafter validated on a prospective series of 32 patients.

Adolescent↗
PubMedDate not supplied

Results of coloanal anastomosis for rectal cancer.

It is now accepted that, in the absence of direct invasion of the anal sphincter, cancers of the middle and lower rectum can be successfully treated with sphincter-preserving surgery. Conservation of the sphincter mechanism should never compromise the oncologic outcome of surgery and the method of neorectum construction must provide acceptable function for patients. This review describes the results of coloanal anastomosis following rectal excision. The oncological and functional results of both straight coloanal and colonic-J-pouch anal anastomosis are presented in detail. The authors discuss recent evidence supporting the functional superiority of colonic-J-pouch reconstruction after rectal excision.

Anal Canal↗
PubMedDate not supplied

[Leiomyoma of Meckel's diverticulum revealed by a digestive hemorrhage. Preoperative diagnosis by selective arteriography].

The authors report a case revealed by low digestive hemorrhage, and in the light of cases in the literature, discuss the various problems due to leiomyomas in Meckel's diverticulum. They emphasize particularly the risk of late diagnosis at the stage of leiomyosarcoma. As it is impossible to say afterwards whether a muscular tumour of the digestive tract is benign or not, it is important to make an early diagnosis. Arteriography is one of the best means.

Female↗
PubMedDate not supplied

[Role of remaining ductal cephalad obstruction on the results of lateral pancreaticojejunostomy in chronic pancreatitis].

AIMS: To report the results of a pancreaticojejunostomy in the treatment of chronic pancreatitis, and to assess the role of residual cephalic ductal obstruction in pain recurrence. METHODS: Thirty seven patients with painful chronic pancreatitis whose pancreatic duct diameter exceeded 6 mm were treated by lateral pancreaticojejunostomy and were retrospectively studied. Deobstruction of the cephalad portion of the main pancreatic duct was complete in 21 patients (group A), while residual obstruction was noted in 16 patients (group B). RESULTS: One patient died post-operatively (2.7%) and 6 patients underwent complications (16%) that were treated without reoperation. With a median follow-up of 52 months, 26 patients were pain free (70%). Pain recurrence occurred in 3 patients in group A (14%) who were treated medically, versus in 8 patients in group B (50%) of whom 4 needed iterative surgery. Ongoing alcoholic addiction did not influence pain recurrence, which onset significantly altered the weight increase observed after pancreaticojejunostomy. CONCLUSION: Lateral pancreaticojejunostomy has a low morbidity rate and offers long lasting pain relief in 86% of patients whose cephalad main pancreatic duct is completely deobstructed.

Adult↗
PubMedDate not supplied

[Ileo-anal pouch anastomosis: results in ulcero-hemorrhagic rectocolitis and in familial adenomatous polyposis].

Two hundred twenty-four ileal pouch-anal anastomoses have been made, 122 for ulcerative colitis and 102 for familial adenomatous polyposis. All the patients had a J pouch and a diverting temporary ileostomy. Mortality was 0.5%. Twenty-eight % of the patients with ulcerative colitis and 24% of the patients with familial adenomatous polyposis had various postoperative complications. Seventy-two patients with ulcerative colitis had a follow-up of more than one year. They had a mean of 4.6 stools per 24 hours; 84% had a normal day-time continence and 70% a normal nocturnal continence. Sixty-nine patients with familial adenomatous polyposis had a follow-up of more than one year. They had a mean of 4.1 stools per 24 hours; 93% had a normal daytime continence and 91% a normal nocturnal continence. In conclusion, ileal pouch-anal anastomosis can be made safely, with good functional results.

Adenomatous Polyposis Coli↗