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Biomedical subjects

A Gainant

Publications and source records attributed to A Gainant.

At least 37 records · Page 2Linked to original sources
PubMed1994

Surgical treatment of 724 carcinomas of the gallbladder. Results of the French Surgical Association Survey.

OBJECTIVE: The objective of this study was to evaluate the benefit of an aggressive approach to gallbladder carcinoma on long-term survival. SUMMARY BACKGROUND DATA: Recent studies have shown that an aggressive surgical treatment of bile duct carcinoma can be associated with a surprising long-term survival. However, recent data on gallbladder carcinoma are not available. METHODS: Data were obtained from a questionnaire sent to 73 institutions in France, Europe, and overseas, and they were analyzed retrospectively. The review included an analysis of patient sex and age, associated hepatobiliary diseases, symptoms and signs, diagnostic tests, operative management, pathology reports, and survival. RESULTS: Seventy-eight per cent of the patients were women, and 22% were men (p < 0.001). Gallstones were present in 86% of the cases. Four per cent of the patients had Tis stage lesions, 11% had T1 to T2 stage lesions, and 85% had T3 to T4 stage lesions (p < 0.001). Pain was the most frequent symptom (77%). Twenty-three per cent of the patients underwent curative operations, and 77% had a palliative treatment (25% of the patients underwent exploratory laparotomy). Exploratory laparotomy was followed by the highest mortality rate (66%), and older patients (> 70 years) had a higher operative risk (p < 0.04). The overall median survival was 3 months, and long-term survival correlated with the cancer stage (Tis, > 60 months; T1 to T2, > 22 months, and T3 to T4, 2 to 8 months). No differences were observed among the different surgical procedures adopted. CONCLUSIONS: No progress has been made in the last 10 years in the treatment of gallbladder malignancies.

Adult↗
PubMed1992

[Digestive surgery in patients over 80 years of age. Apropos of 690 operations].

Between January 1981 and December 1990, 690 patients over the age of 80 years underwent gastrointestinal surgery. These operations were performed for diseases of the biliary tract in 248 cases (28%), colon or rectum in 238 cases (27%), stomach or duodenum in 130 cases (15%), small bowel in 32 cases (1.6%), oesophagus in 16 cases (1.8%), and for peritoneal carcinologic dissemination in 26 cases (3%). Emergency operation was performed in 43% of patients. Surgery was considered to be curative in 61% of patients. Overall postoperative mortality was 23%. The six following factors were associated with increased mortality: age over 85 years, ASA categories 3, 4, 5; surgery for malignant disease, peritonitis, palliative surgery, emergency surgery.

Aged↗
PubMed1992

[Early postoperative complications of resection anastomosis in colonic and colorectal surgery. An analysis of 624 cases].

Six hundred twenty seven patients have been studied retrospectively to evaluate early complications after sewn or staples colonic anastomosis. Seventy four per cent of the patients underwent surgery because of malignant lesions and seventy seven per cent had an elective operation. Fourty seven per cent of the patients had a sewn anastomosis, 53% a stapled anastomosis. In elective surgery, most of the right hemicolectomies and partial proctocolectomies have been performed using stapler devices (p < 0.05). In emergency surgery, most of the anastomosis after partial and total colectomy have been hand sewn (p < 0.05). Operative mortality was 5.6%. It was significantly higher in older patients (> 80 years old) (p < 0.01) and after emergency operations (p < 0.0001). The rate of anastomotic leak was 3.7% and it was significantly higher after right hemicolectomy and partial proctocolectomies when anastomosis has been hand sewn compared to stapled anastomosis (p < 0.05). With regard to postoperative mortality, intra-abdominal abscess, intestinal obstruction, evisceration, pulmonary embolism and anastomotic stenosis 1.4% (global: after a 6 months follow-up) no significant differences have been observed between sewn and stapled anastomosis.

Adolescent↗
PubMed1992

[Prognosis in surgical treatment of cancer of extra-hepatic biliary ducts].

This work reports a retrospective multicenter study of the treatment and prognosis of 746 patients with gall bladder cancers and 684 patients with extrahepatic biliary duct cancers. Gallbladder cancers: Adenocarcinoma was encountered in 92.6% of cases, 107 were limited to the gallbladder. Removal was possible in 27% of the patients. Overall operative mortality was 21%. Overall survival at one year was 14%. The projected five-year survival for cancers limited to the gall bladder treated by simple cholecystectomy was 93% for noninvasive, "in situ" cancers. The survival was 18% with mucosal involvement, and 10% with extension to the gall bladder wall. Extrahepatic biliary duct cancers: Adenocarcinoma was encountered in 99.7% of assess; 40 were limited exclusively to the biliary ducts. 384 involved the upper 1/3 segment of the biliary duct, 86 the middle 1/3, and 121 for the lower 1/3. Cancers involving two or more of these segments were encountered in 93 cases. Removal of the cancer from these four locations was possible in respectively 30%, 50%, 50% and 7% of cases. Overall operative mortality was 27.7% and after removal: 13.5% for the upper biliary duct segment, 18.1% for the middle 1/3, and 20% for the lower 1/3. The mortality was 25% for cancer that involved two or more of these segments. Analysis related to age demonstrated a postoperative mortality of 16% in patients less than 70 years of age and 59.1% after 70 years. The five-year survival after surgery was projected to be 12% for cancers of the upper 1/3 segment, 15% in middle and 30% in the lower 1/3.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed1991

[Hartmann's procedure. Indications, results. Apropos of 105 cases].

The authors report in this retrospective study, 105 cases of patients operated with Hartmann's technic since 1979 to 1990. There were 55 men and 50 women with average age of 70 years (34-90 years old), 71 patients were strucked down by malign disease, 34 by benign disease. 42 surgical operations were performed immediately, 63 were delayed, 26 operations were immediately performed for serious sepsis, 11 for occlusives syndromes. Delayed surgical operations were performed for malignant diseases in 50 cases, elsewhere, there were 6 sigmoiditis with malignant aspect. The upper half rectum was resected at a rate of 38%, the original technic was performed at a rate of 65%. Post operatory mortality was at a rate of 13% (14 died) concerning 25% of immediately operated patients and 6% of delayed operations. Post operatory mortality was at a rate of 15.4% for malignant disease and 8.8% for benign disease. Post operatory results were complicated with 4 occlusives syndromes, 3 fistula from the rectum, 1 cholecystis, 1 small intestine perforation. There were 10 parietal complications and 10 general complications with 7 urinary infections, 4 lung infections and 2 venous thrombosis. The colon anastomosis was performed in a manual way in 23.4% of cases, in a mechanical way in 23% of cases (with EEA or PCEA forceps) with a 8 month average interval between the 2 surgical operations. The mortality rate of this surgical operation is high because patients are old and have heavy deficiencies and are immediately operated for serious diseases.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Physicochemical and bacteriological analysis of the contents of occluded biliary endoprostheses.

The deposits obstructing 12 biliary endoprostheses were examined by scanning electron microscopy and analyzed quantitatively by Fourier transform infrared spectroscopy. Calcium palmitate and bilirubinate associated with proteins were found in all the deposits. Apart from the small amount of cholesterol, this composition closely resembled that of brown pigment gallstones and suggested an infectious cause. Facultative aero-anaerobic organisms were found on bacteriological investigation. beta-Glucuronidase activity was only detected in one sample, suggesting that the calcium bilirubinate may have been formed through tissue glucuronidases. In our study, deposit formation was thought to have been caused by the action of bacterial phospholipases (although not measured) rather than beta-glucuronidases.

Aged↗
PubMed1990

[Alithiasic cholecystitis and viral hepatitis B disclosing periarteritis nodosa].

The authors report the case of a patient with acute alithiasic cholecystitis associated with viral B hepatitis revealing periarteritis nodosa. Histopathological results showed signs of focal arteritis in the gallbladder and liver. Because of the negativity of the viral DNA in serum and the lack of histopathological necrosis in hepatic specimen, the patient was treated by steroid therapy only with a rapid regression of signs of vasculitis and the disappearance of the hepatitis markers.

Adult↗
PubMed1990

[Villous tumors of the rectum. 50 cases treated surgically].

The authors report a study of 50 patients who underwent surgery for a villous adenoma between 1978 and 1988 (29 men and 21 women). Mean age was 70 years old. 84% of the lesions were sessile. They ranged from 1 to 15 centimeters in size. They were associated 12 times with colon adenomas and 3 times with adenocarcinomas. All these lesions were biopsied preoperatively. Removal was performed: in 38% of cases vie a transanal approach in 38% of cases by colorectal resection vie an abdominal approach in 12% of cases by rectal amputation vie both an abdominal and perineal approach, in 12% of cases by Kraske's procedure. 22 adenocarcinomas and 28 benign lesions were discovered. 2 patients died in the early post-operative course after colorectal resection performed vie an abdominal approach. At long term (minimum of 2 years) there were 5 complications and 9 recurrences, the later occurring after tumorectomies. It is essential to know the lesions histologic characteristics in order to administer appropriate therapy, but this is not only possible to determine precisely before excision. Even biopsy specimens may miss the malignant portion of a lesion. Only complete pathological examination of the tumor can establish the diagnosis of a malignancy. Surgery remains the principal method of treatment of these lesions because it permits complete histologie examination and properly adapted management: simple removal for benign tumors or those with malignant degeneration in situ, wide excision for invasive tumors.

Adenocarcinoma↗
PubMed1989

[The incidence, clinical and biologic diagnosis, and prognosis of cancer of the exocrine pancreas and biliary tract].

Cancers of the pancreas and biliary tract have increased in frequency during the last decades. The severity of these cancers is partly due to the difficulty of their early diagnosis. Clinical signs, such as jaundice and abdominal mass perceptible at palpation, betray advanced tumours extending to neighbouring organs. Laboratory examinations are not specific, and the sensitivity of tumoral markers is unsatisfactory unless the tumour is more than 3 cm in diameter. To date, the 19-9 carbohydrate antigen seems to be the most interesting of these markers. The delayed diagnosis accounts for the sombre prognosis of these cancers which have a global survival rate of approximately 5% at 5 years. After excision for curative purposes, which can be performed in 20% of the patients, the mean survival rate at 5 years is about 20-25%.

Adult↗
PubMed1989

[Effect of age on the results of surgical treatment of cancer of the gallbladder].

The aim of the study was to define the influence of age on the surgical treatment of cancer of the gall bladder. From a population of 731 patients: 104 were over 80 years (14%) and 230 were between 70 ant 80 years (32%). The histological stages T1, T2, T3, T4 were also distributed throughout the various age groups. There were however significantly more in situ lesions before the age of 70 years than after. The incidence of resection was similar in the various age groups but extended right hepatectomy was only carried out in patients under 70 years. The mortality rate was low for patients who underwent surgery for lesions graded Tis, T1 and T2. High survival rates were only obtained in the Tis and T1 patient groups. T2 grade cancers had a significantly improved prognosis when resection was carried out. Duration of survival after bilio-intestinal anastomosis was very short regardless of the age of the patient. In summary, age did not appear to constitute a contraindication to resection for early lesions, but it did have an effect for the lesions graded T1, T2, on the degree of hepatic resection around the gall bladder. Lesions graded Tis were all treated by simple cholecystectomy regardless of age. Patients with T3 or T4 lesions did not benefit from resection, regardless of age, and in these cases the value of bilio-intestinal anastomosis is debatable.

Actuarial Analysis↗
PubMed1989

[Treatment of splenic injuries. Retrospective study of 101 cases].

101 patients with splenic trauma were treated during the period 1978 to 1988. They included 76 men and 25 women aged between 16 and 85 years, with a mean age of 38 years 6 months. Exclusively splenic lesions were present in 33 cases (32.67%) and bony or visceral lesions were also present in 68 cases (67.33%). 61 cases (60.39%) suffered from multiple trauma. 97 patients underwent laparotomy, 86 (85.1%) subsequently underwent total splenectomy and 11 (10.8%) conservative surgical treatment (10 partial splenectomies and 1 splenorrhaphy). Four patients did not undergo surgery and were kept under surveillance in a surgical ward for 3 weeks. The majority of partial splenectomies were carried out after 1985 though the first was performed in 1981. There was no operative mortality and post-operative mortality was 9.9% (10 deaths). The overall mean duration of hospitalisation was 20.2 days: 15.6 days for patients who underwent partial splenectomy, 19.6 days for patients who underwent total splenectomy and 21 days for cases involving simple surveillance. Operative complications occurred in 28 patients who underwent laparotomy. Complications did not occur in the 4 patients who received simple surveillance. The most frequent complications were sepsis, pneumonia, thrombo-embolic complications and four patients required reoperation for hemoperitoneum. Conservative surgical treatment is increasingly being used in splenic trauma. The criteria for avoidance of surgical intervention remain difficult to define at the present time.

Accidents↗
PubMed1989

[Results of surgical treatment of cancer of the common bile duct as a function of age].

The aim of this study was to determine whether an age greater than 70 years constitutes a risk factor in subjects who undergo surgery for cancer of the common bile duct. From a total population of 758 cases, 216 patients belonged to this age group. Tumour lesions did not appear to be more progressive in patients over 70 years, however there was a significantly higher incidence of visceral involvement in the latter group. The rate of palliative procedures was comparable in the under 70 and over 70 years groups. However, hepatectomy and hepatic transplantation were only carried out in patients under 70 years. Mortality increased with age both for palliative and curative surgery. The mortality rates were respectively 10% and 10.1% under 70 years and 41% and 49.1% over 70 years. These results should therefore lead to the choice of endoscopic drainage procedures in more elderly patients. However, in the absence of a contraindication to anaesthesia, surgery remains indicated when curative resection is envisaged, in cases of distal stenosis of the bile duct or for failure of other methods.

Adult↗
PubMed1989

[Surgical treatment of postoperative eventration with a prosthetic grid. 62 cases].

The treatment of post-operative eventration with major loss of parietal substance often justifies the use of prosthetic material. 62 post-operative patients from a series of 345 benefited from such a procedure. In the majority of cases they were patients who had undergone multiple surgery and also one or many attempts to cure the eventration (55%). The eventrations were of large volume and complex and one or more operative risk factors were present (81%). A Mersilene grid, implanted retromuscularly in all but one case, was the prosthetic material used in 96% of cases. Operative mortality in this series was zero, but unfortunately post-operative hematomas occurred in 27% of cases and one half of these became infected. Recurrent eventration (11%) was seen in all but one case where post-operative infection occurred. In five out of six cases under these circumstances this became apparent during the first post-operative year. The authors stress the fundamental importance of peri-operative care during such interventions; the quality of post-operative results depends, to a large extent, on this care and on the respect of the peroperative technical principles defined by the authors.

Adult↗
PubMed1989

[Treatment of inguinal hernia by Shouldice type herniorrhaphy. Analysis of a series of 403 cases surgically treated].

The authors report a statistical analysis of 403 patients operated on between 1981 and 1987 for inguinal hernias using the Shouldice kelorraphy procedure. The majority of patients were men and 62% of them were under 50 years. The early operative results were assessed in all patients; recurrences were assessed at one and six years in patients who were either reviewed or who had replied to a questionnaire. Post-operative mortality was 0.5% and the recurrence rate was 1.6%. In 94.2% of patients the course was uncomplicated. A morbidity study demonstrated parietal hematoma formation in 2.5% and sepsis in 1.7%. These results are compared with those in the literature. A comparison was also made with an already published study of 399 keloplasties with reinforcement of the peritoneal sac using the technique proposed by R. Stoppa. It would appear in fact that the two groups of patients were completely different and that the two forms of treatment were not in opposition but rather were complementary.

Adult↗