Biomedical subjects
Publications and source records attributed to Y Malledant.
After a severe polytraumatism, a 14 year-old boy presents paraplegia without vertebral lesion. Angiocardiography showed rupture of aortic isthmus. Surgical treatment resulted in successful outcome. The authors insist on the rarity of traumatic rupture of aorta in children and or the particularity of the diagnosis revealed by paraplegia.
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A 24 year old woman was delivered by caesarean section after an uncomplicated full-term pregnancy. Non-specific prodromes appeared 48 h later, with development of a severe shock. After confirmation of hypovolaemia, attention was focused on the abnormal haematological findings (a sharp drop in serum proteins with a rise in haematocrit) which suggested major leakage of plasma. Treatment based on infusions of plasma and albumin failed, and the patient died in a state of anasarca and pulmonary oedema with normal wedge pressure. 18 similar cases have already been published, six of which were in obstetric or surgical patients. After analysing the prodromes and its onset, its pathophysiological mechanisms and treatment are discussed.
A new simple device using piped medical gases for the inflation of pressure cuffs used for rapid intravenous infusions is described. The pressure cuffs are maintained inflated with piped medical oxygen delivered by an adjustable pressure regulator. Operating advantages of this device were: 1) inflation time for the cuff and infusion time for fluids kept in collapsible PVC bags (whole blood, plasma, cellular concentrates or other fluids) were considerably shortened, not requiring any manual manipulation throughout the infusion; 2) when the bag is emptied, the large bore tubing used allowed rapid deflation of the cuffs; 3) the procedure was as safe as manual acceleration of transfusion, and simpler, requiring a simple three-way stopcock.
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Between 1972 and 1980, 360 patients were operated upon for the treatment of carcinoma of the esophagus at this university hospital. By adopting a policy of routine endoscopy in all patients with minor esophageal symptoms, early diagnosis was possible. Nutritional and respiratory support preoperatively and postoperatively diminished anastomotic leakages and pulmonary complications. We were able to lower our mortality from 17.6 to 2.6 per cent and to increase our resectablity rate from 60.2 to 85.0 per cent. It is still too early to determine if the Akiyama technique, while permitting an improvement of the results, will increase the five year survival rate.
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Between March 1, 1968 and March 1, 1986, 323 patients underwent surgery for cancer of the pancreas or the periampullary region. Extirpative procedures were performed in 91 patients, of whom 51 had ductal carcinoma of the pancreas. Forty-seven patients had total pancreatectomy, 9 associated with resection of the portal vein and 1 with total gastrectomy. Operative mortality was 15% but fell to zero for the 19 total pancreatectomies performed after 1981. With the introduction of total pancreatectomy, the resectability rate increased from 15% to 32%. Overall mean survival was 14.4 months. Actuarial survival was 42.4% at 1 year, 25.6% at 2 years, 11.9% at 3 years, and 8% at 5 years. Six patients are alive 7, 11, 14, 30, 30, and 73 months, respectively, after operation. Survival was calculated according to the classifications of Hermreck, Tryka and Brooks, and the TNM system. Ductal carcinoma was multifocal in 32% of patients, and 25% had epithelial dysplasia of the pancreatic duct. When portal vein resection was necessary, mean survival was 6.1 months, compared with 18.25 months when it was not performed. We conclude that total pancreatectomy has increased our resectability rate, mainly in patients with tumor spread beyond the usual margins of division for Whipple's procedure. However, the procedure does not appear worthwhile when portal vein resection is necessary or when multicentric cancer or neoplastic emboli are observed in the operative specimen.
The pharmacokinetics of thiopentone administered at infusion rates ranging 4.5-11.5 mg.kg-1.h-1 for 50-130 h was studied in 6 patients with neurologic evidence of severe cerebral damage. Arterial plasma concentrations of thiopentone were measured during and after discontinuation of the infusion. The postinfusion plasma concentrations were fitted to the one compartment Michaelis-Menten model. At the end of the infusion, the level of saturation of the enzymatic systems ranged 67.0-95.7%. Vm was on average 0.93 +/- 0.57 mg.l-1.h-1. The mean plasma clearance was 2.0 +/- 1.4 ml.min-1.kg-1. The apparent half-life of the terminal phase was 5.5 +/- 3.9 h.
Parenteral hyperalimentation and complete bowel rest reduce fistula output, and permit sufficient caloric and nitrogen intakes needed for healing. It corrects metabolic and nutritional deficiencies due to digestive fistulas, and allows spontaneous closure of fistulas in two out of three patients. If spontaneous healing is not obtained after six weeks of parenteral alimentation, surgical treatment may be undertaken more safety, as the patient will be in better nutritional condition.
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