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Biomedical subjects

R Parc

Publications and source records attributed to R Parc.

At least 55 records · Page 3Linked to original sources
PubMed1992

[Ex situ-in vivo hepatic resection. Technique and initial results].

Extracorporeal liver surgery has been proposed with the aim to increase the resectability rate in patients with advanced tumors. In order to avoid the inherent section of the hepatic pedicle we propose ex situ-in vivo liver surgery. The surgical procedure comprises complete mobilization and exteriorization of the liver which is rocked on the axis of the porta hepatis following section of the hepatic veins. Protection of the liver parenchyma against prolonged ischemia is obtained through cold portal perfusion (UW solution) and the use of an heat exchanger on which liver resections and vascular procedures are performed. The procedure also encompasses the use of veno-venous bypass during liver vascular exclusion. This procedure was performed in 2 patients with tumoral invasion of the 3 main hepatic veins and in 1 patient whose hemangioma was surrounding the hepatocaval confluence. Duration of hypothermic ischemia was 205, 225 and 230 minutes respectively. Postoperative course was uneventful in the 3 cases with an hospital stay of 25, 28 and 18 days. Ex situ-in vivo liver surgery allows completion of a surgical treatment in patients whose tumor appears unresectable with the use of conventional technics. This procedure may constitute an alternative to liver transplantation in highly selected cases.

Female↗
PubMed1992

[Familial adenomatous polyposis: early diagnosis by genetic mapping].

The use of probes detecting polymorphic loci within the human population has enabled accurate localization of the genetic defect responsible for familial adenomatous polyposis on chromosome 5. This was used to screen two families for the presymptomatic diagnosis in children of an affected parent. In both cases, the use of 8 polymorphic probes located on either side of the gene provided information which could be used in the management of children born from the patients at risk. The set of probes used in this work should be informative in most of the affected adenomatous polyposis families.

Adenomatous Polyposis Coli↗
PubMed1992

[Value of screening of familial adenomatous polyposis for the prevention of colorectal cancer].

Familial adenomatous polyposis coli is a hereditary autosomal dominant disease which spontaneously and inevitably leads to degeneration of colorectal adenomas and requires preventive surgical treatment. The aim of this study was to evaluate the age of colorectal degeneration and the need for a screening technique in family members. Between 1983 and 1989, 141 patients were treated for familial adenomatous polyposis in our surgical center. Mean age at surgery was 32 years and 64 patients (45.4 percent) had a colorectal carcinoma. Thirty had an in situ tumor (mean age: 30 years) and 34 had an invasive adenocarcinoma (mean age: 45 years), 7 of whom died of their cancer. No colonic cancer was found in patients younger than 20. Thirty-eight percent of the patients under 40 years of age, 73 percent of the patients older than 40 years and 81 percent of those older than 50 had an adenocarcinoma. Fifty percent of the patients with carcinoma were younger than 40 years and 7 percent were less than 25 years old. Seventy-one patients were symptomatic at the time of operation (mean age: 40 years), 32 (45 percent) had a colonic cancer. In 70 patients, familial adenomatous polyposis was detected by screening (mean age: 24) and 2.8 percent had a colonic carcinoma. We conclude that the age-related risk of developing colonic carcinoma requires prophylactic surgery in asymptomatic patients before 20 years of age, and that routine familial screening would be of some benefit.

Adenocarcinoma↗
PubMed1992

[Comparison of functional results of ileorectal and ileo-anal anastomoses in familial adenomatous polyposis. Conversions of ileorectal anastomoses into ileo-anal anastomoses].

The aim of this study was to compare the functional results of ileo-rectal anastomosis and ileal pouch-anal anastomosis in a group of patients with familial adenomatous polyposis who had conversion of a ileorectostomy into a ileal pouch-anal anastomosis. In 2 cases (8.3 percent), the conversion was impossible because of abdominal desmoid tumors. For the remaining 21 patients, with more than 1 year follow-up, the number of bowel movements per 24 hours was 3.8 +/- 0.2 before and 4.6 +/- 0.3 after conversion. Daytime and nighttime continence and sensation of the need to defecate were unchanged. The number of patients having nocturnal bowel movements were higher after the pouch procedure (40 vs 10.5 percent). After ileorectostomy and after conversion, 89.5 and 80 percent of the patients had good functional results respectively. Ninety percent of the patients said that results were unchanged or improved after the conversion. In familial adenomatous polyposis the functional results of ileal pouch-anal anastomosis are similar to those of ileorectostomy but the first procedure eradicates the risk of rectal cancer. A conversion to ileal pouch-anal anastomosis should to be proposed to patients with ileorectostomy and at high risk for rectal cancer.

Adenomatous Polyposis Coli↗
PubMed1992

[Diverting loop ileostomy, effective prevention of colonic complications in necrotizing acute pancreatitis].

The operative diagnosis of colonic ischaemia in association with acute necrotizing pancreatitis (ANP) may be difficult in the absence of unequivocal transmural necrosis or perforation. We introduced in May 1988 a new policy whereby, when colonic viability was dubious, resection was avoided and a diverting loop ileostopy (DLI) was performed. If necrosectomy led to extensive mobilization of the splenic flexure with a capillary drainage system placed in close contact, a DLI was again performed. Colectomy was only performed for unequivocal transmural necrosis. Among 30 patients operated on for ANP, 12 underwent DLI. This policy allowed us to spare potentially ischaemic colons. No secondary colonic complication occurred and there was no rise in the mortality rate. Among patients whose colon was kept in circuit there were bouts of bowel distension and unexplained bacteriemia ultimately leading to death from multiorgan failure. When colonic viability is dubious and when drainage is brought up in close contact with the bowel wall DLI might allow colonic resection to be avoided. In our experience DLI also seemed to prevent secondary colonic complications.

Acute Disease↗
PubMed1992

[Total pharyngolaryngoesophagectomy. Indications and results apropos of 17 cases].

Pharyngolaryngoesophagectomy (PLO) allows one-stage treatment of synchronous tumors involving both esophagus and hypopharynx and may also be advocated when the pharyngo-esophageal junction (PEJ) is involved. Less radical surgery may be advocated in the case of hypopharyngeal malignancy sparing the pharyngoesophageal junction. The authors report the results of 17 PLO carried out in 11 cases for a tumor involving the PEJ, and in 4 cases for synchronous tumors involving esophagus and hypopharynx. In 2 instances, PLO was performed for primary hypopharyngeal malignancy requiring total circular excision (i.e. which did not involve the PEJ). Five patients had previously received chemotherapy and 6 had had an association of chemotherapy and radiation therapy as initial treatment before surgery. Reconstructive procedure used the stomach and colon in 12 and 5 cases respectively. Hospital mortality was 4 cases out of 17. There was 1 cervical fistula secondary to pharyngogastric anastomosis necrosis. One and 2 year actuarial survival rates were 73% and 37%. Tumor recurrence and a remote new tumor were noted in 6 and 4 cases respectively, despite extensive surgical procedures and the use of chemotherapy and/or radiotherapy. When esophagectomy was added to total circular excision in case of hypopharyngeal tumor sparing the PEJ, no significant benefit was noted. Good functional results obtained by means of PLO shall lead to therapeutic trials including surgery, chemotherapy and radiotherapy with the aim of improving long-term results.

Adult↗
PubMed1991

Bleeding pseudocysts and pseudoaneurysms in chronic pancreatitis.

Spontaneous haemorrhage associated with chronic pancreatitis in 17 patients was related to a pseudocyst in 15 (88 per cent) patients and to pancreatic lithiasis (one patient) or to infarction-rupture of the spleen (one patient). Bleeding was massive in six patients and intermittent in 11. It resulted from erosion of the gastroduodenal or the splenic artery in four patients. Bleeding into the pancreatic duct occurred in four patients and erosion of the duodenum by a bleeding pseudocyst in five. Haemorrhage was confined to a pseudocyst in six patients and was intraperitoneal in two. Of the 15 patients with bleeding pseudocysts, ten underwent primary pancreatic resection (eight proximal and two distal pancreatectomies) with no mortality but four had early complications. Four of the five patients who underwent transcystic ligation of bleeding vessels and pseudocyst drainage had postoperative complications: one died from sepsis and liver failure and three underwent reoperation for severe postoperative bleeding. Of these, two had proximal pancreatic resection with one death. The third patient had further suture ligation and external drainage. The overall postoperative mortality rate was 12 per cent and following emergency surgery 33 per cent. Favourable results were achieved in two-thirds of patients when the primary operative strategy could be directed towards the control of bleeding and removal of the affected pancreatic segment. Primary pancreatic resection, although technically demanding in the presence of haemorrhage, is recommended whenever possible for the treatment of bleeding pancreatic pseudocysts and pseudoaneurysms associated with chronic pancreatitis.

Adult↗
PubMed1991

Benign lymphoid polyposis of the colon. Report of a case in an adult.

A new case of benign lymphoid polyposis of the colon in an adult is presented. Relatively frequent in childhood, this disease remains exceptional in adults. The main concern is differentiation from adenomatous polyposis; the differential diagnosis can be particularly difficult for complex forms of polyposis with coexistent adenomatous and lymphoid polyps. Benign lymphoid polyposis of the colon does not appear to have any propensity for malignant degeneration, and major surgical resection is not indicated.

Colonic Neoplasms↗
PubMed1991

The thoracic esophagus: sectional anatomy and radiosurgical applications.

The relationships of a tumor of the thoracic esophagus to the adjacent mediastinal structures are currently studied by means of computed tomography (CT), magnetic resonance imaging (MRI) and, more recently, by echoendoscopy. However, the assessment of axial mediastinal CT and of MRI in the coronal and sagittal planes calls for some degree of experience. To further this training a sectional anatomy is proposed in correlation with imaging of the thoracic esophagus and the posterior mediastinum. Ten fresh subjects whose vascular networks had been previously injected with colored resin were sectioned along the three planes of space after positioning under CT monitoring. The axial sections were compared with the CT images made with a GE 9800 Quick scanner. Three frontal and sagittal sections were compared with the MRI images made with a GE Signa apparatus using a high magnetic field. The relations of the esophagus were studied at three levels: the supra-azygo-aortic segment, where it is related to the left subclavian artery; the inter-azygo-aortic segment, where access to the esophagus is barred on the left by the aortic arch and on the right by the arch of the azygos vein, section of which provides ample access; and the sub-azygo-aortic segment, where the esophagus passes behind the left main bronchus and to the right of the descending aorta, two organs whose invasion contraindicates excision of a tumor of the esophagus but is difficult to assess by current thoracic imaging techniques. The esophagus then descends behind the left atrium; the investigation of the kinetics of the heart cavities by transesophageal echocardiography is an application of this anatomic relationship.(ABSTRACT TRUNCATED AT 250 WORDS)

Esophagus↗
PubMed1991

Genetic characterization of the APC locus involved in familial adenomatous polyposis.

Familial adenomatous polyposis is a rare disease inherited in a Mendelian dominant fashion. It is characterized by the occurrence of more than 100 adenomatous polyps in the large bowels of affected individuals. The genetic defect responsible for adenomatous polyposis resides at a locus called APC which has been localized to the long arm of human chromosome 5. In this study, the APC locus was mapped with respect to 11 markers known to map to this chromosomal segment. Linkage of APC to four of these markers had been previously reported. Three additional markers are shown here to be linked to APC. By multipoint analysis, the APC locus maps to an interval bounded by D5S49 and D5S58. The refined map of the APC locus and the new markers described here improve the informativeness and accuracy of the presymptomatic diagnosis of familial adenomatous polyposis.

Adenomatous Polyposis Coli↗
PubMed1991

["Ex situ-in vivo" surgery of the liver: a new technique in liver surgery. Principles and preliminary results].

Major liver resections with complex vascular reconstruction require ischemia lasting from 2 h 30 to 5 h thus exceeding hepatic tolerance to warm ischemia. We describe a new technique of "ex situ-in vivo" liver surgery with prolonged ischemia with an intact hepatic pedicle. The surgical procedure encompasses complete mobilization of the liver and inferior vena cava, inferior mesenteric and femoral to axillary vein bypass, complete vascular exclusion of the liver, cold perfusion (U. W. solution), section of the hepatic veins allowing exteriorization of the liver ("ex situ") which remains connected by the hepatic pedicle ("in vivo"). The liver is placed on a heat exchanger at 4 degrees C. This procedure was performed in three patients: one each with hepatocellular carcinoma, huge metastasis of colorectal carcinoma and a "diffuse" hemangioma. Duration of ischemia was 225, 205, and 230 min respectively. The postoperative course was uneventful in all 3 cases and patients are alive at 15, 12, and 6 months. As it improves resecability rate of liver tumors and provides radical margins of resection, this procedure may be a beneficial alternative to liver transplantation for which poor results in cancer therapy with a high rate of recurrence are mainly due to immunosuppression.

Carcinoma, Hepatocellular↗
PubMed1991

[Evaluation of the efficacy of a new generation of hemostatic collagen compresses. Results of a multicenter prospective study in visceral surgery and neurosurgery].

The hemostatic potential, tolerance and handiness of a new generation of hemostatic sheets (Hemostagene) were compared with those of reference collagen sheets in a randomized parallel-group multicenter study. Both types of hemostatic sheets, issued from calf derm, have been evaluated in digestive and neurosurgical pathologies. The comparability of both groups (52 patients in the Hemostagene group A, 54 in the reference group B) has been verified on morphological data, coagulation records and hemostasis conditions. The time required to achieve hemostasis was slightly, yet not significantly, shorter in group A (3 min 27 sec) than with the reference sheet (4 min 10 sec). This new sheet was judged significantly handier than the reference sheet. Adherence to the gloves and instruments was very significantly (p less than 0.0001) more frequent in the reference group B than in the group A. Both collagen sheets have quite similar clinical, biological and immunological tolerances which confirms the literature data. So, this new sheet, together with an hemostasis at least as good as the one obtained with the reference sheet, brings a highly improved handiness.

Bandages↗
PubMed1990

[Elemental feeding into the distal segment of a temporary small bowel].

Patients who have an interruption of the small bowel with a high enterostomy usually need parenteral supply or reinfusion of chyme to maintain nutritional and electrolytic balances before restoring intestinal continuity. Ten patients (aged 28-76 years) with a terminal jejunostomy located within the first meter of jejunum were treated by infusion of an elemental diet into the distal small bowel (IEDDSB). In addition, five of these patients had an extensive small bowel resection. IEDDSB was started 32 days after operation and lasted 4 to 8 weeks. Mean daily caloric infusion was 1,732 +/- 666 kcal diluted in 2,860 +/- 808 ml; mean associated oral intake was 1,187 +/- 480 kcal/24 hr, and jejunal fecal losses averaged 3 kg per day. IEDDSB was well tolerated in 4 patients; 5 experienced transient abdominal pain or diarrhea; 1 developed severe and protracted diarrhea. Biological cholestasis was seen before IEDDSB and persisted in most patients; 1 patient developed biliary sludge. Through IEDDSB, nutritional status improved or remained satisfactory in 9 patients, and worsened in 1 patient with sepsis and a short lower intestine. Mean body weight, triceps skin fold, muscle circumference, serum albumin, serum transferrin did not change significantly. Digestive nitrogen balance performed in 6 patients showed a net absorption between 5 and 15 g/24 hr. Fluid and electrolyte balance was maintained in 9 patients and 1 received iterative intravenous saline. Digestive sodium balance showed a net absorption rate greater than 60 mmol/24 hr. in all patients, except the one who required intravenous supply. Postoperative recovery was uneventful in all patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Repeat hepatic resection for primary and metastatic carcinoma of the liver.

During the last 15 years, 19 patients underwent repeated hepatic resections for malignant lesions of the liver. The first hepatic resection had been performed four to 40 months earlier for treatment of hepatocellular carcinoma (nine patients) or hepatic metastases (ten patients), eight of which were of colorectal origin. Repeat resection was an extensive hepatectomy in six, a segmentectomy in six and a local excision in seven. In one patient, three wedge resections and, finally, hepatic transplantation were subsequently performed after an initial extended right lobectomy. The operative mortality rate was 5.2 per cent. The three year actuarial survival rate was 64 per cent after the second resection.

Adult↗
PubMed1990

[Hepatectomy with total vascular exclusion. Anatomical principles based on 64 dissections].

Intra-operative hemorrhage is the main surgical risk during liver resections. Nowadays hepatectomies for large or posterior liver tumors close to the hepatocaval junction can benefit from total hepatic vascular exclusion (HVE) involving portal triad exclusion and clamping of the inferior vena cava (IVC) below and above the liver. Anatomical aspects of HVE have been studied in 64 subjects by segmental occlusive phlebographies of the IVC, injection of corrosive substances into the hepatocaval network, biometry of the retrohepatic IVC and serial sections of injected livers. A total HVE should exclude the right suprarenal and phrenic veins. Clamping of the suprahepatic IVC depends on the termination of the left inferior phrenic vein. Clamping of the subhepatic IVC must be retrohepatic: the right lobe of the liver has to be mobilized to free the right border of the retrohepatic IVC into which flows the right suprarenal vein 40 +/- 20 mm above the right renal vein and under the superior right hepatic vein. Both suprahepatic and retrohepatic clamps excluding the retrohepatic portion of the IVC (46.6 +/- 13 mm) and the hepatocaval junction should come in contact behind the IVC without overlapping.

Constriction↗