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Biomedical subjects

S Rohr

Publications and source records attributed to S Rohr.

At least 91 records · Page 5Linked to original sources
PubMed1986

Incidence of gastroesophageal reflux following repair of esophageal atresia.

Gastroesophageal reflux (GER) was looked for retro- and prospectively by various diagnostic methods in 67 patients, subdivided into three groups according to age at time of investigation. Pathological reflux was found in only one-quarter of the patients aged 16-23 years, but in three-quarters of both younger groups followed up for 1.5-14 years so far. Whereas pathological findings were most frequently disclosed by manometry in the older patients, radiological findings were most often decisive in younger patients. Following closure of recurrent tracheoesophageal fistulas and resection of anastomotic stenoses, eight patients developed reflux complications during the first months of life; these were so severe that antireflux plasty became unavoidable. Factors influencing the incidence of GER following esophageal repair were: the definition of GER based on the diagnostic method employed, the patient's age at the time of diagnosis, and anastomotic complications requiring a second operation. The essential time for treatment was the first year of life.

Adolescent↗
PubMedDate not supplied

Reliable procedure for closing the duodenal stump for bleeding posterior duodenal ulcer.

Bleeding posterior duodenal ulcers is a critical problem especially in patients of advanced age. Surgical treatment should obtain efficient and stable hemostasis and avoid digestive fistulas due to leakage of the duodenal stump. The main difficulty lies in the closure of the duodenal stump. A procedure using intramural dissection of the duodenum and closure by means of a stapler is reported for a series of 40 patients without recurrent bleeding or duodenal fistula. Seven patients (17%) died from associated diseases, especially respiratory insufficiency (3 patients) and cirrhotic liver failure (2 patients).

Adult↗
PubMedDate not supplied

[Prevention of stress ulcer: A practical approach].

Critically ill patients are at risk to develop stress ulceration of the gastric mucosa. Although the evidence for efficacity of specific medications to prevent stress ulcer is discordant, there is general agreement in favor of prophylaxis to prevent stress ulceration in patients at high risk - i.e., surgical patients in the ICU setting with mechanical ventilation, anticoagulation, or instability. Although no medication is specifically authorized in France for this indication, H2 blockers and proton pump inhibitors (PPI's) are generally the agents of choice. While PPI's are the most potent inhibitors of gastric acidity, no evidence exists to prove their superior efficacity. Numerous questions remain unanswered (which drug? at what dose? for how long?) which underline the need to develop intra-institutional consensus.

Humans↗
PubMedDate not supplied

[The remaining indications for open surgery in common bile duct lithiasis].

Once with the continuous development of mini-invasive procedures, the open surgery indications in the treatment of CBD stones are decreasing. Between January 1986 and December 1987, 514 patients with average age 60 years old (18-94) were treated for suspected or confirmed CBDS. Three distinctive periods were studied function of how the conventional surgery were either exclusive (group I), either together with the beginning era of laparoscopy (group II), or together with institutionalised laparoscopy (group III). Group I had 110 cases, group II--207 cases and group III--197 cases. The conventional surgery were 100% performed in group I, 26% (52 cases) performed in group II, 14% (28 cases) performed in group III. If the laparotomy was the only therapeutical option in patients with CBDS from group I, the therapeutical procedures become more various after 1990. It was done endoscopic sphincterotomy in 59% (124 cases) in group II and in 64% (126 cases) in group III. The laparoscopic extraction of CBDS was 12% (cases) in group II and 19% (37 cases) in group III. The overall mortality in conventional surgery was 1.5% with 1.8% in group I and 0% in group II and III. The complications rate was 13% with 8% in group II and 21% in group III. The postoperative hospitalisation time average was 16 days for laparotomy of the 3 groups. The conventional surgery is main indicated when laparoscopic surgery for CBDS extractions or endoscopic sphincterotomy is contraindicated or failed; also it is useful in some complicated forms of CBDS.

Adolescent↗
PubMedDate not supplied

Gastric cancer: the French survey.

Presentation of a multicentric retrospective french study concerning 4,655 cases of gastric cancer operated between 1980 and 1996. The mean age was 67.4 years old with a male predominance of 63.1%. Pains was the predominant presenting symptom (60%) followed by alteration of the general condition (44%) and anaemia (20%). 35.5% of tumors were of distal, 18.8% of middle and 18.6% of proximal localisation. As regard cancer stages, 40% were of stage I,-II and 60% of stages III,-IV. Subtotal gastrectomy was realised in 44%, total radical gastrectomy in 42.1% and other surgical procedures in 14% of cases (proximal gastric resection or atypical resection). D1 lymphadenectomy was associated in 58.4% and D2 in 41.6%. Morbidity was of 23% and mortality of 11.9% which passed from 19% during the first (1980,-85) to 8% in the last interval of time (1990,-96). The 5 years survival was 41% in case of gastric resection. In univariate analysis the 5 years relative survival was better in female patients (44% at 5 years), in patients younger than 50 years old (46%), when pain was the only clinical symptom (52.7%), in middle and distal third localisation (47%), in case of subtotal distal resection (47%) and in less advanced stages (79% at 5 years for stage I cancer). In multivariate analysis the 5 years survival was essentially correlated to the stage of the tumor and no real prognosis improvement was shown during the period of the study.

Aged↗
PubMedDate not supplied

[The surgical therapy of liver trauma].

The different therapeutic patterns of liver trauma are presented; they should be chosen on the basis of both clinical assessment, particularly looking for hemodynamic impairment and associated bowel lesions, and CT scan data. Surgical abstention should be considered for a great number of blunt liver trauma; open or severe blunt trauma should be preferably treated by elective hemostasis and biliostasis, with only rare use of hepatic resection "à la demande", on partially sectioned or devitalized tissues. Cavo-suprahepatic wounds remain the most important technical problem and continue to worse the prognosis in liver trauma.

Embolization, Therapeutic↗
PubMedDate not supplied

[Anorectal malignant melanomas. Apropos of 2 new cases].

Clinical and therapeutic characteristics of anorectal melanoma have been studied about 2 new cases. The initial symptoms were often misdiagnosed with hemorrhoids disease. This cancer carries a bad prognosis but the best treatment seems to be abdominoperineal resection (APR) when the thickness of the melanoma is under 3 mm. Over this limit, APR alone will not cure this disease. Curative treatment will probably involve a combined therapy with local and systemic therapies.

Anus Neoplasms↗
PubMedDate not supplied

[Colo-rectal surgery, through laparoscopic approach. Considerations concerning a personal experience of 613 cases].

The start of colo-rectal laparoscopic surgery, after an initial period of enthusiasm tempered by predictable technical difficulties, was finally slowed down by the risk of port site metastases. However, this kind of surgery continued to be used for benign colonic pathology, allowing the achievement of surgical skill. Some well-trained teams reported comparable loco-regional relapse rate and 5-years survival in both laparoscopic and conventional trials. The some good results concern also mortality and morbidity in both kind of trials. Based on 613 personal cases, the authors reveal this surgery's peculiarities, justifying a predictable development.

Adolescent↗
PubMedDate not supplied

[Adenocarcinoma developing from an ileal diverticulum. Apropos of a case].

The rare case is reported of a cylindrical cell epithelioma developing in the base of an ileal diverticulum. This infrequent association was further complicated by the fact that the patient was in the early stages of Kahler's disease. After presentation of the case the literature on ileojejunal adenocarcinoma associated with small intestine diverticula is reviewed.

Adenocarcinoma↗
PubMedDate not supplied

[Laparoscopic treatment of gastroesophageal reflux. Cardiopexia with the round ligament versus Nissen's type fundoplication].

Thirty nine patients with a symptomatic gastrooesophageal reflux (RGO), resistant to or relapsing after medical treatment, were prospectively studied and operated on with a laparoscopic approach: 8 which a ligamentum teres cardiopexy, 31 with a 360 degrees fundoplicature. Both groups were comparable concerning clinical, endoscopic, mano- and pHmetric features (Anova test at 95% for all comparison in the study). There was no operative mortality. Conversion and morbidity rate were significantly higher (p = 0.04) in the "cardiopexy" group, even if data suggest a responsibility of the learning curve only. During follow-up patients were interviewed at 1, 3 and 12 months and proposed for mano- and pHmetry at 3 and 12 months. Late results at 12 months showed a relapse of RGO in 5 out of 8 patients of the "cardiopexy" group, with no relapse in "fundoplicature" group (p = 0.01). Mano- and pHmetric records showed at 3 months a persistent hypotony of the lower oesophageal sphincter and a persistent acid reflux in the "cardiopexy" group, with a significant (p = 0.01 and = 0.03) difference with "fundoplicature" group, in which lower oesophageal sphincter was hypercorrected and no reflux appeared at pHmetry. Despite some rare evidence in literature, cardiopexy do not give good late results, and laparoscopic 360 degrees fundoplicature seems to be the better procedure for surgical treatment of symptomatic RGO.

Adult↗
PubMedDate not supplied

[The musculocutaneous flap of the latissimus dorsi in the treatment of recurrences of breast cancer].

Breast cancers local recurrence treatment usually requires a large chirurgical resection. Latissimus dorsi myocutaneous flap was used after mastectomy in 27 patients. This technique was performed in 14 patients who had a recurrence after exclusive radiotherapy treatment. The follow-up of all the patients was more than 5 years. A 42% survival rate has been quoted in this group, after a 11 years period. Latissimus dorsi myocutaneous flap seems to be a satisfactory alternative when performing reconstruction after wall excision under 300 cm2, excepted for recurrence of fast kinetic cancers.

Adult↗