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Biomedical subjects

A Bourgeon

Publications and source records attributed to A Bourgeon.

At least 19 recordsLinked to original sources
PubMed1992

[Transplantation of a segmental small intestine in dogs. Comparison between jejunal graft and ileal graft].

The purpose of this study was to compare heterotopic jejunal and ileal allografts in the dog under cyclosporine A. Fourteen allografts (8 ileal and 6 jejunal) were successfully performed. There was no case of graft-versus-host disease in this series. Six allografts (42.5 percent), 3 jejunal (50 percent) and 3 ileal (37.5 percent), were rejected during the first 3 months (NS). Eight allografts, 5 ileal and 3 jejunal, were tolerated up to 3 months and then removed; 2 ileal and 2 jejunal were normal; 2 ileal and 1 jejunal showed signs of chronic rejection, and 1 ileal signs of advanced rejection. It is concluded that there is no major difference between jejunal and ileal allografts in the dog.

Acute Disease↗
PubMed1992

[Surgical treatment of pneumothorax by video-thoracoscopy].

Between May and December 1991, 12 patients with spontaneous pneumothorax were treated surgically, using video-thoracoscopy. With this technique bullous lesions could be excised in 10 cases and pleurodesis could be performed in all patients. Morbidity and mortality were nil. The cosmetic and functional advantages of video-thoracoscopy were obvious. Long-term results remain to be evaluated. This technique has shown that it is possible in all cases to create pleurodesis (pleural poudrage or pleurectomy) and to treat parenchymatous lesions (excision of bullous systems). This suggests that the long-term results will be the same as those obtained with conventional surgery.

Adolescent↗
PubMed1992

Jejunal versus ileal segmental allografts in the dog: comparison of immunologic and functional results.

Segmental small-bowel grafts have been advocated as a means of reducing the incidence of rejection and graft-versus-host disease in small-bowel transplant recipients. This study compared the results achieved with heterotopic segmental allografts of the jejunum and the ileum that used 120 cm Thiry-Vella loops in a dog model. Immunosuppressive therapy consisted of 25 mg cyclosporine/kg/day. Results were monitored by histologic examinations, function tests (maltose and xylose absorption), and brush-border enzyme assays. Thirty-three dogs were randomized for use as a donor (n = 11) or recipient of a jejunal allograft (n = 11) or an ileal allograft (n = 11). Eight allografts were technical failures and were excluded from analysis. Fourteen allografts were successful (eight ileal, six jejunal). No case of graft-versus-host disease was observed. Six allografts (42.5%, three jejunal [50%] and three ileal [37.5%]) were rejected during the first 3 months (not statistically significant). Eight allografts (five ileal, three jejunal) were tolerated for up to 3 months and were removed. Two ileal and two jejunal allografts appeared grossly normal at surgical removal, but two ileal and one jejunal allografts exhibited signs of chronic rejection, and one ileal allograft showed advanced rejection. The jejunal and ileal allografts had similar clinical courses, as were revealed by immunologic reactions and functional parameters. We conclude that there is no major difference between jejunal allografts and ileal allografts in the dog.

Animals↗
PubMed1992

[Segmental small intestine transplantation in dogs: comparison between a jejunal graft and an ileal graft].

The aim of this study was to compare segmental grafts of jejunum and ileum in a dog model. 14 segmental grafts, 8 ileal (Il. A) and 6 jejunal (Jej. A.), were successfully allografted as 120 cm-Thiry-Vella segments. Immunosuppressive therapy consisted of cyclosporin 25 mg/kg/day per os. Monitoring was performed by histology and absorption (maltose and xylose) studies as well as analysis of brush border enzymes. No cases of Graft-versus-host disease were observed. Six allografts (42.5 per cent) including 3 Jej. A. (50 per cent) and 3 Il. A. (37.5 per cent) were rejected during the first three months. Eight allografts (5 Il. A. and 3 Jej. A.) were tolerated for up to 3 months and were removed: 2 Il. A. and 2 Jej. A. were normal, while 2 Il. A. and one Jej. A presented with signs of chronic rejection and one Il. A. with advanced rejection. Jej. A. and Il. A. showed a similar course, by means of immunologic reactions as well as functional characteristics. It is concluded that there is no major difference between Jej. A. and Il. A. in the dog. Because of the specialized absorptive functions of the ileum and its adaptative properties, ileal segmental grafts should be preferred to jejunal grafts for the treatment of short-gut syndrome.

Alkaline Phosphatase↗
PubMed1991

[Excision of bronchogenic cyst by video-thoracoscopy].

We report what is probably the first case of para-oesophageal bronchogenic cyst treated by video-thoracoscopy. The patient was a 26-years old woman who presented with dysphagia to solid foods. Preoperative investigations showed that the lesion was a cyst and that it was located in the superior and posterior mediastinum; they also enabled us to determine its relations with nearby structures, notably the oesophagus, and to make the diagnosis of para-oesophageal bronchogenic cyst. Treatment consisted of excision of the cyst by video-thoracoscopy. The postoperative period was uneventful, and the patient was discharged on the fourth day.

Adult↗
PubMed1991

Anatomic and experimental basis for the insertion of a screw at the first sacral vertebra.

The authors present the anatomic and experimental basis of an original technique for screwing at the first sacral level employed in lumbosacral fusion. The anatomic studies were based on specimens from the anatomy museum, frozen sections of the sacrum and CT examinations with three-dimensional reconstruction and assessment of the density of the different structures of S1 in Hounsfield units (HU). The findings were that the ala and lateral portions of S1 contain yellow marrow forming what amounts to a fatty sphere bounded by the cortical bone of the sacroiliac joint, the linea terminalis and the spongy bone of the pedicles and of the body of S1. The experimental study was made by avulsion of sacral screws (system of Cotrel Dubousset), each of 7mm diameter. No screw perforated the sacral cortex. Three directions were tested. The insertion of a screw through the pedicle and body of S1 is advised, with the point of insertion below and lateral to the articular process of S1 and an oblique course forward and inward at an angle of 10 degrees to the sagittal plane. This internal obliquity is limited by the posterior prominence of the iliac ala.

Adult↗
PubMed1991

[Bronchogenic cysts of the esophagus. Classical surgery or video-surgery?].

Two cases of bronchogenic cysts involving esophagus are reported. The first case concerns a 30 year-old man, who admitted for dysphagia, regurgitation and abdominal pain. Barium esophagography, esophagoscopy and CT scan showed a cystic mass involving the lower third of the esophageal wall. Treatment consisted in the resection of the cyst by left thoracic approach. The second case concerns a 26 year-old woman, admitted for dysphagia. MRI and endoscopic ultrasonography had contributed to define the exact nature, internal composition and location of the cyst: upper and posterior mediastinum, close to the esophagus but respecting all the esophageal layers. Treatment consisted in the resection by video-thoracoscopy. Histologically, these two cysts were typical bronchogenic cysts. These two cases allowed us to discuss the benefits of new imaging methods (CT scan, MRI, endoscopic US) in the diagnosis of cystic masses of the mediastinum, and to emphasize video-surgery in their treatment.

Adult↗
PubMed1991

[Complicated solitary biliary cysts].

With development of ultra sound, solitary hepatic cyst (SHC) appears as a common and benign affection. Complications can occur in 10 per cent of cases. We report here four cases of complicated SHC: vena caval obstruction, intracystic bleeding, rupture, intracystic infection. Those four patients were successfully treated by partial excision of the cyst in the first 3 cases, and by percutaneous drainage with CT scan guidance in the latter. Complications of SHC occur only in large cysts, with a diameter up to 8 cm. So, small SHC do not require any treatment, while large SHC must be treated to avoid complications. Percutaneous aspiration and direct injection of alcohol can lead to recurrence. Surgical therapy by partial excision is successful, with low rates of mortality and morbidity.

Adolescent↗
PubMed1991

[Pharyngoesophageal diverticula. Results of a series of 41 diverticulectomies].

The aim of this study was to evaluate the short-term results of surgical treatment of pharyngoesophageal diverticulum (POD). From 1970 to 1988, 41 patients underwent diverticulectomy for POD and in 10 cases, myotomy was associated. Patients were divided into two groups: group I (10 cases) in which patients required nutritional and/or respiratory preparation before surgery; group II (31 cases) in which patients underwent surgery without delay. In group I, the mean age was 79.8 years and the delay before diagnosis and treatment was 80.6 months versus 66 years and 34.6 months in group II. In group I, all patients presented with weight loss and suffered from pulmonary infections. Mortality in this series was 3 patients (7.3%) and 4 complications occurred. In group I, mortality was 2 patients (20%) and 3 complications occurred (30%), while in group II, mortality was one patient (3.2%) and one complication occurred (p less than 0.05). Long-term results showed 90% of good results. Local complications might be avoided by perfect surgical procedure. The mortality can be explained by the patients' previous status and the long history of disease.

Aged↗
PubMed1990

[Pulmonary metastases of colorectal origin].

From January 1979 to December 1988, 18 patients with pulmonary metastases from colorectal cancers were operated in our division. This series included 11 men and 7 women (average age 57 years). The primary cancer was colic in 6 cases and rectal in 12. In 3 cases, the metastases were synchronous and discovered during the initial assessment. In 15 cases, they were metachronous, without symptoms in 12 cases and symptomatic in 3. These metastases were single in 14 cases, multiple in 3, bilateral in 1. They were peripheral in 15 cases. The histological diagnosis was obtained preoperatively in 5 cases (27.7%). The procedures uses were lobectomy for 11 patients, segmentectomy for 1, wedge resection for 10. Postoperative chemotherapy was given to 7 patients. Benign complications occurred in 2 cases during the postoperative period. No perioperative death was noted. One patient was lost to follow-up without recurrence after 1 year, 6 patients died from neoplastic evolution 4, 8, 15, 17, 22 and 28 months after being operated. In May 1989, 11 patients were still living: -2 scheduled for the excision of a contralateral lesion, -2 with pulmonary recurrence. 7 patients were alive without recurrence 12, 14, 17, 46, 52, 68 and 108 months after being operated. The probability of occurrence of pulmonary metastases in the evolution of colorectal cancer is estimated between 20 and 50%. Only 1% of the patients can be treated surgically. When screening these lesions, one must bear in mind that their appearance is sometimes quite delayed, and often asymptomatic. The repeated use of tracers is necessary but not sufficient.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

[Role of coloproctectomy with colonic-anal anastomosis in the treatment of rectal cancer].

The aim of this study was to determine the efficacy and long term results of straight colo-anal anastomosis (CAA) after resection for rectal carcinoma as described by Parks. From January 1986 to June 1989, 40 patients underwent this operation: 27 men and 13 women with a mean age of 63.5 years (range 37-81). In 36 cases, the indication was for carcinoma of mid and low rectum and in 4 cases for carcinoma of the upper rectum associated with a low rectal benign tumour (3 Dukes A, 19 Dukes B, 13 Dukes C, and 5 Dukes D). A diverting colostomy was constructed in all cases. Operative mortality was one patient (2.5 per cent) by pulmonary embolism. Anastomotic dehiscence occurred in four patients. None of these patients required reoperation and all colostomies have been closed. 6 patients presented a local recurrence (15.4 per cent) 6 to 34 months after CAA, of whom two were treated by abdomino-perineal resection. 5 patients died 6 to 34 months after CAA from local recurrence (2 cases) or distant metastasis (3 cases) and one patient has liver disease. All others patients are alive free of disease with a mean follow-up of 21.7 months (range 3-46 months). Actuarial survival is 77 per cent at 40 months. Functional results were assessed in the 26 patients followed up more than one year. The mean stool frequency was 2.4 per day (range 0, 3-6). All patients are continent, with a good discrimination gas-stool. 4 patients (15.4 per cent) suffer from soiling, 5 (19 per cent) from stool frequency, and 2 (7.7 per cent) from urgency. In conclusion, CAA is a good alternative of abdominoperineal resection for some mid and low rectal carcinomas. Functional results might be improved by the construction of a colonic reservoir.

Adenocarcinoma↗
PubMed1989

Biomechanics of the lumbar spinal nerve roots and the first sacral root within the intervertebral foramina.

This study consists of 3 sections: a descriptive study of the intervertebral foramen by dissection, supplemented by millimetric sections made with the cine-microabrasive apparatus (patented) on 12 specimens frozen with liquid nitrogen; a study of the attachments of the roots made during manipulations testing the resistance to avulsion of the rootlets, the roots, the dural sheath and the fibrous expansions at the periphery of the intervertebral foramen; and a study of the mobility of the roots in the foramina during movements effected within and outside the spine. We concluded that the classical description of an intervertebral foramen as occluded by a taut membrane like a drum-head is false as only perforated expansions attach the root to the foramen. Further, the points for attachment of the roots are the dura mater and the fibrous expansion passing from the foramen to the sheath of the spinal n. Finally, from the aspect of mobility, there are 2 distinct compartments and movements in one are not perceived in the other compartment if the attachments are unbroken. These attachments are a barrier interposed between the two compartments.

Biomechanical Phenomena↗
PubMed1989

[Surgical excision of the cancer of the stomach after 75 years of age].

A retrospective study of 302 patients hospitalized for gastric adenocarcinoma in the period between 1976 and 1987 revealed that 133 of the patients (44%) were over 75 years of age. In order to bring out the characteristics of stomach cancer in the elderly, these patients were compared with younger subjects, as a comparison with a population of under seventies emphasizes the existing differences. Clinical signs, the time necessary for reaching diagnosis, as well as the evolutive stage of the pathology at the time of diagnosis were the same. The incidence of the intestinal histological type, which has a better prognosis, was significantly higher after the age of 75. Operability was decreased due to contraindications related to the patients' general status. Resectability (86 patients, i.e., 77.2%) did not differ significantly. Complications imputable to surgery did not occur more frequently. Anastomotic fistulas were rare, although invariably fatal in the over-seventy-five group. Overall mortality for excision patients over 75 was 12.8%, and did not rise significantly (or exponentially) before the age of 79. Mortality was 14.3% in case of palliative excision versus 9.8% for curative excision. This parameter was nil for the 48 patients classified ASA 1 and 2, and 30% for the 38 patients classified ASA 3 and 4. In this latter group, it was 20% when the operation was curative versus 43% in palliative surgery situations. Post-surgery survival rates were similar to those obtained for the younger subjects. In conclusion, the course of stomach cancer is the same for both the elderly and younger subjects. This study permits to set up certain rules for excision surgery after the age of 75.

Adenocarcinoma↗
PubMed1987

[Sclerosing cholangitis and biliary sequelae of hydatid cyst of the surgically treated liver].

Worldwide literature and ten or so personal cases are reviewed as a basis for distinction or intrication of two aspect of post-hydatid sclerosing cholangitis; that of a localized lesion of diffuse lesions of the biliary tract. In both cases the action of the hydatid cyst is not due to toxins but to pressure on biliary duct walls, very variable according to site and size. This local action may be the only cause, provoking a specific type of lesion, a true sequela of an incomplete or delayed operation. In certain regions, or in the presence of biliary stasis and angiocholitis, passage of hydatid fluid into biliary tracts, normally tolerated by healthy biliary pathways, leads to a diffuse sclerosing cholangitis. The serious consequence of this eventuality is proved by the failure of many treatments, with subsequent inevitable liver transplants. Clinical circumstances and data explaining this complication allow necessary precautions to be taken. Furthermore, early treatment of hydatidosis or as radical as possible therapy for advanced lesions is curative of localized forms of the disease.

Bile Ducts↗