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Biomedical subjects

R Parc

Publications and source records attributed to R Parc.

At least 91 records · Page 5Linked to original sources
PubMed1989

Pharmacological effect of somatostatin on bile secretion in man.

Somatostatin (SST) has been shown to induce cholestasis in the dog and in the rat. In man, it is still unknown whether SST modifies bile formation. The present study was undertaken to examine the influence of SST on bile secretion in man. Two volunteers who had a total external biliary fistula received 1-hour SST infusions (3.5 micrograms/kg/h). Bile flow, bile acid, phospholipid and cholesterol biliary outputs were measured before, during and 1 h after the infusion. The SST infusion was associated with a pronounced decrease in bile flow and in bile acid secretion and with an increase in bile cholesterol saturation. These findings suggest that SST has cholestatic properties in man as in other species. This may provide a rational explanation for the formation of gallstones and for the steatorrhea observed in patients with somatostatinomas or during therapeutic SST administration.

Adult↗
PubMed1989

[Must we reject primary colostomy in left colonic obstruction caused by cancer?].

Treatment of left colonic cancer obstruction is not still clear. Many procedures can be done, simple decompressive colostomy by a local incisionnal way to subtotal colectomy with primary anastomosis. What can we do today? Retrospective study from 1983 to 1988 at Centre de Chirurgie Digestive de l'Hôpital Saint-Antoine (Paris) with 36 datas was done. The emergency treatment was 20 decompressive colostomies, 10 primary resections without anastomosis, 2 subtotal colectomies with ileo-sigmoid primary anastomosis, 2 left colectomies with primary anastomosis (2 with decompressive colostomy, one without) and one Hartmann procedure. One patient is dead after decompressive colostomy. After emergency decompressive colostomy, 16 patients (80%) were reoperated for colonic cancer resection, with suppression of the stomy fifteen times. There were 7 extra abdominal complications and 3 stomy complications (2 incisionnal hernias after closure of the stomy and one prolapse of a definitive colostomy). After emergency primary resection without anastomosis, 9 patients (90%) were reoperated for secondary anastomosis. Morbidity was 3 extra abdominal complications. The mean hospital stay was 28 days for these 2 groups. For all the patients with primary or secondary anastomosis there was no anastomotic leak. Decompressive colostomy as emergency procedure for left obstructing carcinoma is simple, efficiency and safe. It can be associated with low mortality and morbidity. To day, we still recommend this procedure.

Adenocarcinoma↗
PubMed1989

[Acute necroticohemorrhagic pancreatitis. Why, when and how to drain? Apropos of 106 cases].

The heavy toll of necrotizing acute pancreatitis led the authors to start developing a new method of treatment in experimental and clinical conditions in 1979. This was aimed on one hand at creating a large channel for the centrifugal drainage of pancreatic or peri-pancreatic foci, and on the other hand at maintaining this draining channel during the first 5 weeks of acute evolution of the acute necrotizing pancreatitis in order to allow the permanent evacuation of purulent or necrotic fragments. From 1979 to 1989, 106 patients were treated with this method, ie. 71 men and 35 women with an average age of 47.9 years. 73 (74%) of these patients had been referred by other hospitals, and 64 only had been initially operated at Saint-Antoine hospital. All patients presented with extensive peripancreatic necrosis. The average Ranson score was 4.8 (not taking the fluid sequestration during the first few hours into account). Visceral failure was observed in 76% of the patients before surgery. The necrosis of the pancreatic gland was focal in 6 cases, extensive in 47 cases and total or subtotal in 25 cases. Out of the 70 CT studies, 64 showed a Ranson grade of E. All patients received enteral feeding on a jejunal site postoperatively. The mortality rate was 16%. The stay of the surviving patients in the intensive care unit averaged 50 days. 29 patients (27%) were reoperated on for complications or insufficient drainage.

Adult↗
PubMed1989

Comparative clinical results of ileal-pouch anal anastomosis and ileorectal anastomosis in ulcerative colitis.

The aim of the study was to compare the results of ileal-pouch anal anastomosis (IAA) and total abdominal colectomy with ileorectal anastomosis (IRA) in the treatment of ulcerative colitis. The number of patients included in the comparative trial was 104 (IAA) and 197 (IRA), respectively. No clear advantage of IRA over IAA was seen: postoperative mortality and morbidity were about the same; functional results as shown by the frequency of stools and daytime continence were virtually equal. A factor favoring IAA was, among others, recurrence of proctitis after IRA which is more difficult to treat than the pouchitis occurring after IAA and is associated with a higher rate of secondary permanent end ileostomy; besides, IRA entails the risk of cancer developing in the rectal stump, while at the same time it is difficult to follow up these patients closely enough. IRA is indicated only if the diagnosis of ulcerative colitis is in doubt; if the patient is more than 60 years of age; and if IAA proves technically too difficult, IAA is usually preferable, however, if there is any doubt as to whether the patient is suffering from ulcerative colitis or Crohn's disease, ileorectostomy is preferred which does not preclude IAA at a later date in case of need.

Anal Canal↗
PubMed1989

[Ileo-anal anastomosis: various types of ileal reservoir].

The creation of an ileal reservoir ensures an improvement in the functional result obtained after ileo-anal anastomosis. As a result of its storage function, the reservoir allows a reduction in the number of stools per day. Several types of reservoir have been described. The S-shaped reservoir consists of three aniso-peristaltic limbs and an efferent loop with end-to-end ileo-anal anastomosis. The W reservoir is equivalent to a double J reservoir. The side-to-side iso-peristaltic reservoir consists of two iso-peristaltic limbs and an efferent loop with end-to-end ileo-anal anastomosis. After analysing the specific characteristics of each type of reservoir, the authors conclude that the necessity of a reservoir no longer needs to be demonstrated, but that there is no formal argument in favour of one particular model.

Anal Canal↗
PubMed1988

Continuous enteral nutrition during the early adaptive stage of the short bowel syndrome.

Sixty-two patients with the short bowel syndrome (30-150 cm) were managed by continuous enteral nutrition (CEN) in the early adaptive phase. In all, 82 per cent were referrals from other units and 85 per cent of referrals had failure of one or more organ systems on admission. There were intra-abdominal abscesses in 41 per cent of patients and 37 per cent had an enterocutaneous fistula. The diet included polysaccharides, medium chain triglycerides and protein hydrolysates, mixed with a high-viscosity tapioca suspension. An elemental diet was used initially in 15 per cent of patients. Thirty-three patients had an interruption of the gastrointestinal tract by a temporary enterostomy. Chyme was re-infused into the distal intestine in 20 cases. 'Zero-time' was taken as the time of operation or, for referred patients treated conservatively, the date of admission. CEN was commenced at a mean of 14 days from zero-time. Total parenteral nutrition could be discontinued at a mean of 36 days and exclusive oral alimentation was resumed at a mean of 87 days. Patients with small bowel longer than 80 cm attained enteral autonomy earlier than patients with a shorter length. Mean faecal volume did not increase following institution of CEN, suggesting tolerance to the high-viscosity diet. In cases with re-infusion of enteric content, the distal circuit (length of distal small intestine 46 cm) was able to absorb 70 per cent of the volume re-infused (mean volume 2700 ml). Body weight and nutritional markers increased significantly during the course of CEN. This study suggests that enteral autonomy can be attained early in the short bowel syndrome, even under challenging conditions. Elemental formulae do not appear to offer a benefit over polymeric diets.

Adolescent↗
PubMed1988

Single-layer anastomosis in surgery of the large bowel. A prospective study on 316 cases in a university hospital.

A prospective study was undertaken to evaluate the results of a single layer appositional technique for large bowel anastomoses used in a University Hospital. 316 patients were entered during an 18-month period. Anastomoses were situated within the peritoneal cavity in 277 patients and below the peritoneal reflection in 39. No covering stoma was made. The incidence of clinical leakage was 1.6% and of wound infection 1.9%. These results compare favourably with those obtained by stapling. For intraperitoneal anastomoses and high anterior resection manual suture remains the standard technique and is less expensive than stapling. For low rectal tumours, there is still debate on the relative merits of stapling and various manual techniques of colo-anal anastomosis in terms of morbidity, tumour clearance and functional results.

Adolescent↗
PubMed1988

Septic necrosis of the midline wound in postoperative peritonitis. Successful management by debridement, myocutaneous advancement, and primary skin closure.

Wound management following laparotomy for postoperative peritonitis and varying degrees of parietal necrosis remains a challenging and controversial problem. Because maintained peritoneal integrity and primary wound closure offer the best opportunity for survival, an original technique involving bilateral incisions to relax skin and rectus fascia is proposed. This technique permits medial myocutaneous advancement and primary tension-free skin closure of midline laparotomy incisions. Sixty-nine patients with severe postoperative peritonitis were treated according from 1980 through 1985. Nine of these patients died of advanced multiple organ failure soon after referral, and eight more died after prolonged treatment. Fourteen patients had one or more reoperations for complications. Only nine wound failures resulted, including five eviscerations and four wound infections followed by progressive dehiscence. The bilateral relaxing incisions healed secondarily without complication. Survivors developed midline wound hernia; ten of the 52 surviving patients have had these repaired. This method of primary closure is safe when performed in conjunction with rigorous surgical care of intraperitoneal infection and may enhance survival. We recommend the technique to surgeons who treat severe postoperative peritonitis and septic necrosis of midline laparotomy wounds.

Debridement↗
PubMed1988

[Current role of total esopharyngo-laryngectomy in cervico-facial cancerology. Apropos of 11 cases].

Eleven patients underwent total esophagopharyngolaryngectomy for cancer, with colic or gastric digestive reconstructive surgery. Postoperative course is analyzed, contraindications and indications outlined and other methods of pharyngeal reconstruction discussed. An extension to the technique is proposed to include tumors requiring a circular pharyngolaryngectomy. Improvement in the very poor prognosis of these tumors can only be envisaged by the use of enlarged surgery combined with chemotherapy and radiotherapy.

Adult↗
PubMed1988

[Surgical treatment of Oddi's sphincter tumors. Apropos of 56 cases].

The records of 56 patients operated upon for ampullary tumors were reviewed in order to determine the best way to diagnose and treat these tumors. Thirty six males and 20 females, 30 to 89 years old, were operated upon between October 1970 and October 1985. Eighty six p. 100 had jaundice and 21 p. 100, anemia. In recent years, ultrasonography, duodenoscopy and ERCP appeared to be the most useful tests for diagnosis. Mean size of the tumors was 2.3 cm (0.5 to 5 cm). Five tumors were benign (8.9 p. 100) and 51 were malignant. According to the classification of Martin, 5 were grade I: 10, grade II: 18, grade III: and 18, grade IV. The correct histologic diagnosis was obtained on biopsy specimens taken during endoscopy in 7 of 12 patients. Nine patients underwent palliative choledocoduodenostomies: only one is alive at 3 years; 47 underwent resection of the tumor: 3 local excisions associated with sphincterotomy for small benign tumors, 6 ampullectomies (followed in 3 by a Whipple procedure for recurrence) and 41 Whipple procedures. After pancreatic resection, 3 patients died during hospital stay and 12 had reversible complications; overall 5 year survival was 41 p. 100. It was 75 p. 100 in grade I, 50 p. 100 in grade II, 40 p. 100 in grade III and 10 p. 100 in grade IV. Patients who received an ampullectomy were alive with a follow up of 1, 2, and 3 years. All patients operated upon for a benign tumor were alive except one who died of cardiac failure.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Hepatic resection for colorectal liver metastases. Influence on survival of preoperative factors and surgery for recurrences in 80 patients.

This report analyses an experience with 80 liver resections for metastatic colorectal carcinoma. Primary colorectal cancers had all been resected. Liver metastases were solitary in 44 patients, multiple in 36 patients, unilobar in 76 patients, and bilobar in 4 patients. Tumor size was less than 5 cm in 33 patients, 5-10 cm in 30 patients, and larger than 10 cm in 17 patients. There were 43 synchronous and 37 metachronous liver metastases with a delay of 2-70 months. The surgical procedures included more major liver resections (55 patients) than wedge resections (25 patients). Portal triad occlusion was used in most cases, and complete vascular exclusion of the liver was performed for resection of the larger tumors. In-hospital mortality rate was 5%. Three- and 5-year survival rates were 40.5% and 24.9%, respectively. None of the analysed criteria: size and number of liver metastases, delay after diagnosis of the primary cancer, Duke's stage, could differentiate long survivors from patients who did not benefit much from liver surgery due to early recurrence. Recurrences were observed in 51 patients during the study, two thirds occurring during the first year after liver surgery. Eight patients had resection of "secondary" metastases after a first liver resection: two patients for extrahepatic recurrences and six patients for liver recurrences. Encouraging results raise the question of how far agressive surgery for liver metastases should go.

Actuarial Analysis↗
PubMed1987

[A case of acute sensory and autonomic neuropathy with regression].

The authors report the case of a 24 year old man with no previous disease who presented with a severe autonomic neuropathy. This included major gastrointestinal dysfunction characterised by decreased peristalsis without distension and paralysis of the gall bladder, and orthostatic hypotension with a normal cardiac tachycardia reflex. There was an associated sensory neuropathy affecting heat sensitivity without motor dysfunction and an increased CSF protein content. The proprioceptive nerve fibre conduction was decreased but another nerve conduction was normal initially. The mesenteric plexuses examined during sigmoidectomy performed for peritonitis due to multiple bowel perforations caused by fecoliths, showed no significant changes. Peripheral nerve biopsy revealed massive rarefaction of myelinated fibres which were of small diameter, and of the unmyelinated fibres, mainly due to axonal degeneration. Only two similar cases with incomplete recovery were found in the literature. In our case, a complete recovery was observed. The cause of the condition is unknown.

Acute Disease↗