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Biomedical subjects

A Gelet

Publications and source records attributed to A Gelet.

At least 127 records · Page 7Linked to original sources

[Microsurgery of the renal arteries].

The extracorporal microsurgery of renal artery branches has improved the therapeutic possibilities of complicated vascular abnormalities. Intrarenal stenoses can only be treated by this technique and excellent therapeutic conditions are rendered possible, if more than two artery branches have to be replaced. The technical results are satisfactory, if the quality of the renal parenchyma is considered, which has been abnormal in a number of cases at the moment of the surgical treatment. The results concerning the arterial hypertension and the renal function are remarkable, when considering the fact that most of the kidneys treated by this technique would have been removed some years ago.

Adult↗

Intravesical instillation of mitomycin C in the prophylactic treatment of recurring superficial transitional cell carcinoma of the bladder.

Twenty-six patients with an elevated recurrence rate of stage O or A bladder tumours were treated prophylactically after transurethral resection (TUR) with short-term intravesical instillations of mitomycin C in a non-randomised study. The data before intravesical chemotherapy (IVC) were taken as the internal control for each patient. Mitomycin C was administered in one course of 10 daily doses of 40 mg, starting 24 to 48 hours after TUR. The average follow-up was 13.9 months before and 28.5 months after IVC. Before IVC, the average number of recurrences was 2.6, with an average recurrence rate of 1 every 5.3 months. After IVC there was no tumour recurrence in 4 patients, with a mean of 12.2 months' follow-up, but there was tumour recurrence in 22 patients. For 17 patients (77%) the free interval averaged 2.3 times longer than the mean interval of recurrence before IVC and for 18 patients (82%) the recurrence rate averaged 3.3 times less than the recurrence rate before IVC.

Aged↗

Progress in segmental neoprene-injected pancreas transplantation. Advantages and disadvantages of using Cyclosporin A.

We performed 39 neoprene-injected pancreatic transplants (38 segmental and 1 total) in 37 insulin-dependent diabetic recipients from October 1976 to May 1983. The best results were obtained when the pancreas was transplanted simultaneously with the kidney (25 cases). The use of Cyclosporin A (CyA) for immunosuppression did not reduce the early pancreatic failures, but it seems to have slightly improved the long-term survival. The glycaemic control was better in patients treated by CyA alone than in those receiving steroids. The main side effects of CyA were nephrotoxicity and some immunoglobulin abnormalities with or without lymphoproliferative disorders occurring after treatment with CyA and ALG.

Adult↗

[Arteriovenous fistula for vascular access in childhood leukemia. Value of microsurgical technique (author's transl)].

Acute leukemia are now in progress with intensive and prolonged polychimiotherapy but such medicine is difficult to manage because veins are rapidly unserviceable. In order to simplify hematological treatment and psychological approach of this patients we have constructed arterio-venous fistula in children with malignancy. The operation of choice is a subcutaneous cephalic-vein to-radial-artery arterio-venous fistula on the fore arm at the distal part. 103 of this vascular access procedures are performed in 93 children and in infants weighing less than 10 kg: 57 are performed without magnification, 46 with the aid of operative microscope. The comparative study of this two procedures show that microsurgical technique is necessary to improve results, especially in the youngest patients. This vascular access are well accepted by the children and his families, and very useful for the medical staff.

Adolescent↗

[Progression and severity of arterial hypertension in aged subjects (12 cases].

We analyzed retrospectively 12 patients, aged from 63 to 73 years, with renovascular hypertension due to unilateral or bilateral atheromatous lesions (4 out of 12). Malignant or accelerated hypertension with multiple visceral involvement was frequent (8 out of 12). The proximal lesions (stenosis) of the renal arteries were rapidly progressive, leading to complete thrombosis in 8 cases. Five patients received medical treatment only, but 2 worsened their GFR and 2 had a poor blood pressure control. Of the 5 patients who underwent renal surgery 2 had nephrectomy, 2 had an aorto-renal bypass and 1 a bypass plus nephrectomy; 2 of them recovered a normal GFR, but 2 died in the post-operative period. Three patients had selective embolization of a renal artery, but only one was definitely improved. So far, the treatment of such cases still is very difficult.

Aged↗

Clinical experience in pancreas transplantation in Lyon: long-term survival of duct injected pancreatic grafts.

Ninety-seven pancreatic grafts in 92 insulin-dependent diabetic patients were performed during the last 11 years. Eighty-three of these grafts were carried out after neoprene duct injection, the other patients underwent pancreato-duodenal transplantation. In 80 cases, a double pancreas and kidney graft was performed. Five different immunosuppressive protocols were subsequently applied. Actuarial survival of patients and pancreata was 75.1% and 47%, after one year and 54.6% and 22.1%, respectively, 4 years after transplantation. Slightly better results were observed in double pancreas and kidney transplantation. The survival of both patients and pancreas improved when the most recent immunosuppressive protocols including cyclosporin A and only small doses of steroids were applied. The main causes of loss of the pancreatic graft were rejection, vascular thrombosis and death of the patient with functioning organ. Metabolic studies showed good insulin secretion with normal or impaired glucose tolerance as well as good short and half-term glycemic control. Whole pancreas grafts with enteric diversion yielded prompter and higher insulin secretion but the incidence of surgical complications was increased. In comparison to the data recorded at 6 months after pancreas transplantation, 5 patients of our series with still functioning organ showed an equally satisfactory and unchanged glycemic control after more than 4 years from surgery. In these patients, the previously high insulinemic values decreased to normal levels. However, 3 of these patients showed a decrease in post-prandial peaks as confirmed also by OGTT. However, mean blood glucose level was not altered. In our series the suppression of exocrine pancreatic secretion by neoprene duct injection did not appear to represent a relevant cause of decrease in endocrine function. The results obtained do not yet allow us to draw definite conclusions as to the efficacy of pancreas transplantation in the treatment of degenerative complications in diabetic patients.

Adult↗

[100 percutaneous endopyelotomies. Technique, indications, results].

100 percutaneous endopyelotomies were performed in 95 patients from October 1985 to February 1991 to treat 46 cases of acquired stenosis and 54 cases of congenital hydronephrosis. The acquired stenoses were treated by scalpel incision, while the congenital hydronephrosis were generally treated by electrocautery. The evaluable results for 81 ureteric units with a mean follow-up of 37 months showed an overall success rate of 84%. No significant difference in the results was observed in relation to the patient's age, the technique used or the stage of the hydronephrosis (81% success rate): the results in the treatment of congenital hydronephrosis (86%) are slightly inferior to the results of surgical pyeloplasty.

Adolescent↗