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Biomedical subjects

A Hamy

Publications and source records attributed to A Hamy.

At least 73 records · Page 4Linked to original sources
PubMed1994

[Intraluminal polyp of the common bile duct corresponding to a metastasis of cancer of the kidney].

The authors report the second case to date of metastatic carcinoma of the common bile-duct from renal cell cancer presenting as an intraluminal polypoid mass. Obstructive jaundice developed in a 55-year old woman 14 years after nephrectomy for renal cell carcinoma. The diagnosis of polypoid tumor of the common bile-duct was established by sonography, endoscopic retrograde cholangiopancreatography and CT-scan. Palliative resection was performed. Postoperative histological examination revealed the resected tumor to be identical to the clear cell type of renal cell carcinoma. The postoperative course was marked by the development of distant metastases 6 months later. Diagnosis and therapeutic features of metastatic malignant biliary obstruction are discussed.

Adenocarcinoma, Clear Cell↗
PubMed1993

[Acute Budd-Chiari syndrome following hepatectomy. Apropos of two cases].

The authors report about 2 cases of Budd-Chiari syndrome occurring during the immediate postoperative period of extensive hepatectomy, after exeresis of a large biliary cyst (20 cm in diameter) through 6/7 sectoriectomy and after exeresis of a large sarcomatous tumor preserving only sectors 2 and 3 of the liver using an "ex-vivo/in-situ" technique. These 2 cases lead to discuss the diagnosis, treatment and, most importantly, the prevention of acute suprahepatic obstruction after extensive right hepatectomy. Similar cases are reported in the literature after partial liver transplantation. Prevention basically consists in tethering the remaining liver to prevent rotation around the vena cava or the remaining suprahepatic vein. The emptied subphrenic fossa may be filled up using the omentum or the right flexure of the colon.

Acute Disease↗
PubMed1993

[Splenic metastases. Apropos of 4 cases].

The authors report about 4 cases of splenic metastases in patients with the following neoplasms: urothelial carcinoma of the left kidney, adenocarcinoma of the uterine body, adenocarcinoma of the left flexure of the colon, adenocarcinoma of the sigmoid loop. On large autopsy series, metastases to the spleen are not rare (7% in average), and rank 10th among the 44 metastatic sites described in the literature. Cancers of the breast, lung, skin (melanoma), ovaries and stomach (cardia) make up more than 60% of the primary tumors. The diagnosis is most often accidental (surveillance of operated patients), rarely clinical (pain, splenomegaly), and it is based on medical imaging (ultrasound, CT). In the absence of hemostatic disorders, percutaneous needle biopsies are possible. Treatment, when at all possible, is surgical (splenectomy) and must comply with carcinological rules.

Adenocarcinoma↗
PubMed1993

[Reoperations of rectal resection for recurrence after previous resection for rectosigmoid cancer].

From June 1986 to December 1992, 16 patients (12 men and 4 women, 63 years-old [36 to 79]) who underwent a prior sphincter-saving resection for colorectal adenocarcinoma were operated on for locoregional recurrence with a surgical resection. Eight patients had a second anterior resection (5 colorectal, 2 coloanal and 1 ileoanal anastomosis), one a resection without anastomosis, and 7 an abdomino-perineal resection. Nine patients received an intraoperative irradiation (10 to 25 Gy). Excisions of surrounding organs were often necessary. Post-operative complications occurred in most of the patients. Excluding 3 post-operative deaths, 9 patients died of disease in a median of 12.9 months after surgery (range: 3 to 32 months). Four patients are still living 5 to 14 months after the second resection. There is little in the surgical literature dealing with these difficult surgical problem of which results are always uncertain. An earlier diagnosis of the recurrence would result in a more satisfactory procedure, but is difficult because of the limited possibilities of detection after surgical treatment and often external irradiation.

Adult↗
PubMed1993

[A new approach to the axilla: functional axillary lymphadenectomy and padding].

Axillary lymph node dissection, which is now mandatory in the conservative breast cancer surgery and classically involves Berg's two lower levels, is burdened with numerous complications. In 1988 and 1989, two technical modifications were introduced and are described here: padding of the axilla as preventive treatment of postoperative lymphocele and, more recently, functional axillary lymphadenectomy (FAL) in which the medial cutaneous nerve of the arm, the two perforating intercostal nerves and above all the lateral thoracic pedicle (external mammary artery and vein) are spared. These two technical innovations, more respectful of anatomy, are aimed at reducing the morbidity of conservative breast cancer at a time when detection enables breast cancers to be treated at an increasingly early stage, which results in a increase of negative axillary dissections. The postoperative period is simplified (no drainage, immediate mobilization), and the hospital stay is reduced to 2 days. Complementary treatments can thus be started early on, without any functional or cosmetic damage while the number of lymph nodes removes remains the same as in the conventional axillary dissection technique. The authors describe the operative procedures and analyse the 100 cases of conservative breast cancer they have treated with padding and FAL. These two technical modifications are now systematically used by them in the management of breast cancers.

Axilla↗
PubMed1993

[Cytological study in case of gastric leiomyoblastoma. Review of the literature].

The authors describe the fine-needle aspiration cytologic features of leiomyoblastoma. Aspirated tumor cells occur singly, not in clusters. The tumor cells are globular in shape or sometimes have a spindle appearance. The nuclei are round, central or eccentric, with small nucleoli. The cells have well-defined cytoplasmic borders. The cytoplasm is abundant and, to some extent, granular, with sometimes a microvacuolar peripheral pattern. To date five cases of leiomyoblastoma with a cytological study have been published, two of them located to the stomach. A review of the literature is presented.

Humans↗
PubMed1992

[Aimed fistulization in spontaneous ruptures of the thoracic esophagus after delayed diagnosis. Apropos of 4 cases].

Of four cases of spontaneous rupture of thoracic esophagus treated, three were the object of direct fistulization on a Kehr's drain because of the delay in diagnosis. This technique remains valid since it provides satisfactory drainage without excluding the focus, reduces the time of hospital care when compared with that for simple suturing, and appears preferable to methods of esophageal exclusion which often require a secondary surgical procedure.

Aged↗
PubMed1992

[Signet-ring cell adenocarcinoma involving the bladder and the rectum. Apropos of two cases].

Two cases of primary signet-ring cell carcinoma involving the urinary bladder, with invasion of the rectum, are presented. Pelvic exenterations were performed, followed by a rapidly fatal outcome (6 and 7.5 months). These cases of signet-ring cell carcinoma of the bladder were reviewed with 33 previously reported cases in the literature. The clinical characteristics, histologic findings, pathogenesis, and effectiveness of aggressive treatment of this rare bladder malignancy are discussed.

Humans↗
PubMed1992

[Familial form of primary cancer of the parathyroid glands. A disease entity or incidental association?].

Three cases of parathyroid neoplasms in familial hyperparathyroidism are reported. There were not associated with other endocrine glands or parathyroid glands lesions. Parathyroid gland carcinoma was diagnosed in 2 cases. Review of 7 cases of familial parathyroid carcinoma, diagnosed in 5 different families and issued from the literature, indicates that it can be associated to multiple endocrine neoplasia or other parathyroid lesions. The familial parathyroid carcinoma entity needs further studies before to be fully recognised.

Adenocarcinoma↗
PubMed1992

[Linitis plastica of the stomach. Factors influencing prognosis].

The authors make a retrospective study of a series of 57 patients aged 63 years in average, followed up from 1979 to 1989 for linitis plastica of the stomach. Surgical exeresis was performed in 49 patients (34 total gastrectomies and 15 partial gastrectomies, including five 2/3 gastrectomies, two 3/4 gastrectomies, four 4/5 gastrectomies and four upper polar esogastrectomies). The overall actuarial survival rate (n = 57) was 62.5% at 1 year, 40% at 2 years and 12.5% at 5 years. The prognosis did not vary with the delay of diagnosis, the invasion of the area of resection, the associated tissue differentiation and the invasion of lymph nodes. It did very according to the height of the tumor: 22% survival at 5 years for tumors under 6 cm, against 0% for tumors exceeding 6 cm (p < 0.001).

Actuarial Analysis↗
PubMed1992

[Cancer of the cardia. Prognostic factors and treatment].

Pronostic of carcinoma of the esogastric junction is worsened by the potential two-way route of spread in case of lymph node metastasis: mediastinum and abdomen. During the last 10 years the authors observed 71 cases of adenocarcinoma of the gastric cardia, including 7 cases of linitis plastica. Histopathologic and clinical follow-up data are presented. The aims of the study were to evaluate prognostic factors and to define the best surgical treatment. There were mainly elderly patients with a poor physical status. Ten patients did not undergo surgery (14%). Among 57 patients undergoing radial resection (80.3%), total gastrectomy and upper polar esogastrectomy were performed in respectively 29 and 28 cases. The carcinomas were truly located to the gastric cardia in only 37 cases (65%). Operative mortality was 12.3%, not depending of the surgical technique. All patients five-year survival rate was 10.2%, improving to 15% in case of curative resection. The value of lymph node metastasis (80.7% of the patients) as a prognostic factor depended of the proximal or distal localization of the nodes. A positive surgical margin (15.7% of the patients) was a poor prognostic factor with a 6.9 months mean survival. The authors conclude that an aggressive surgical approach is worthwhile, because of the carcinoma invasion (nodes, margin), but not always possible (poor physical status).

Adenocarcinoma↗
PubMed1992

[Cystic dystrophy of aberrant pancreatic tissue in the duodenal wall. Diagnostic and therapeutic problems].

The authors report the case of a 28-year-old man with a cystic dystrophy of aberrant pancreatic tissue (C.D.A.P.T.) presenting with a history of major abdominal pain. First diagnosis was chronic pancreatitis because of clinical presentation, alcoholic intoxication, and the results of medical imaging techniques. A vagotomy associated with a gastroenterostomy was performed. Several years later the abdominal pain relapsed and failed to be cure by means of medical treatment. A duodenopancreatectomy was performed. Histology demonstrated the diagnosis of C.D.A.P.T. C.D.A.P.T. is a benign disease of the pancreas, limited to its cephalic portion, without demonstrated pathogenesis. C.D.A.P.T. can be either isolated or associated with a chronic pancreatitis. Clinical diagnosis can be particularly difficult as indicated by a literature review. Abdominal pain is the main symptom. Clinical presentation is rarely related to a complication (stenosis). Endoscopy, sonogram, and CAT scan are three techniques of diagnosis value, but intraluminal-sonography is more efficient. Tumor excision is not recommendable. Treatment of C.D.A.P.T. by duodeno-pancreatectomy (D.P.) is often indicated because of concurrent chronic pancreatitis or suspected pancreatic carcinoma. In case of clinical diagnosis of C.D.A.P.T., fenestration of the cysts under endoscopic control is the only local treatment that can avoid D.P.

Adult↗
PubMed1992

[Leiomyosarcomas of the rectum. Amputation of the rectum or local resection?].

Two cases of high grade leiomyosarcoma of the rectum treated by local excision are reported. The first patient presented a local recurrence associated with liver and pulmonary metastases and eventually died, respectively 11 and 22 months after resection. The second patient's tumor recurred 3 months after excision and was treated with pelvic exenteration and CYVADIC regimen as chemotherapy and died 3 years later from local recurrence. A review of the literature indicates that local surgical excision in comparison to a more radical surgical approach, such as abdominoperineal resection, is as effective in improving survival. Lesions less than 2.5 cm in diameter, confined to the bowel can be treated by local surgical excision. To date no adjuvant therapy is effective in terms of survival or local control.

Female↗
PubMed1990

[Wadding of the axilla in the conservative treatment of cancer of the breast. Prevention of lymphocele].

A randomized prospective study was carried out on 53 consecutive female breast cancer cases hospitalized at the Centre René Gauducheau, In Nantes (France), with the intent of investigating whether surgical wadding of the axillary fossa with the use of proximate muscular tissue can prevent lymphocele from occurring, and avoid placement of suction drains usually required in conservative management of breast cancer. Results have been significant regarding the incidence of lymphocele (p less than 0.001), as well as the mean puncture volume and the total number of punctures needed (p less than 0.001), thus reflecting the efficacy of a simple method, which yields satisfactory cosmetic results. Failures with this method were related to the technical procedure per se, and not to its principle. The lapse of time required before additional treatment was initiated as subject to a factor not related to the method, but depended upon the recovery of normal shoulder mobilization.

Adult↗
PubMedDate not supplied

Study of survival and prognostic factors in patients undergoing resection for gastric linitis plastica: a review of 86 cases.

A retrospective study was conducted in a series of 86 patients (51 men and 35 women; mean age 63.4 years) treated from 1979 to 1995 for linitis plastica of the stomach (LP). The mean interval between the first manifestations and surgery was 3.5 months. The most frequent clinical sign was epigastric pain which occurred in 80.4% of cases. Biopsies were positive in 75.6% of cases. Typical features of LP were found in only 46% of esogastric barium enemas and 11.8% of upper gastrofiberscopic examinations. Seventy-four patients had surgical excision (51 total and 23 partial gastrectomies). There were 6 (7%) postoperative deaths and 10 (11.6%) surgical complications. Node involvement was found in 54 (72.9%) patients. Overall actuarial survival (n = 86) was 50% at 12 months, 40% at 18 months and 7.5% at 84 months. Survival did not depend on the delay in diagnosis, histological analysis of the extremities of the excised piece, associated tissue differentiation, node involvement or the type of surgical excision. The prognosis differed according to tumor height (P<0.01) and involvement of the deep stomach wall (P<0.001). No independent prognostic factor was found in multivariate analysis. Surgery remains the sole possibility for curative therapy in these patients.

Female↗
PubMedDate not supplied

[Malignant obstructive jaundice: the role of percutaneous metallic stents].

OBJECTIVES: Efficiency evaluation of percutaneous metallic stents in palliative treatment of malignant biliary obstruction. METHODS: One hundred sixteen percutaneous metallic stents were implanted in 80 patients with malignant biliary obstruction. Thirty-five patients had hilar obstruction, 32 patients obstruction of the common bile duct and 12 patients obstruction of a bilioenteric anastomosis. RESULTS: Adequate biliary drainage was achieved in 79 patients. Early complications occurred in 23.75% of patients; 12.5% of patients died within 30 days. The procedure-related mortality rate was 5%; 18.75% of patients showed recurrent jaundice after an average of 175 days. CONCLUSION: Percutaneous metallic stents are an efficient means of treating malignant biliary strictures, particularly of upper biliary obstructions. However, this treatment has risks and limits that require careful patient recruitment.

Adult↗
PubMedDate not supplied

Endocrine tumors of the duodenum. A study of 55 cases relative to clinicopathological features and hormone content.

BACKGROUND/AIMS: Study of prognosis of duodenal endocrine tumors. METHODOLOGY: Retrospective study concerned 55 duodenal endocrine tumors discovered in biopsy or surgical specimens. Follow-up records available for 49 patients indicated that inconspicuous associated clinical manifestations were often found subsequently. Seven patients were classified as Zollinger-Ellison syndrome and seven as multiple endocrine neoplasia (6 MEN I and 1 MEN II). RESULTS: Tumors were small (mean 1.28cm) and located preferentially in the first and second part of the duodenum. Fifty-four were well-differentiated and one poorly differentiated. Immunochemistry revealed 30 G-cell tumors (54.6%), 15 D-cell (27.3%), two plurihormonal (EC cell and G cell), and one GRH-cell, whereas seven could not be classified. Fifteen patients died (five in relation to their disease). Twenty-one had metastases (liver, nodes, lung), eight of whom are still alive. CONCLUSIONS: Eighty-eight percent of duodenal endocrine tumors were gastrinomas, small plurifocal tumors and somatostatinomas preferentially located in the ampullar region and diagnosed because of hematemesis or icterus. Size is an important prognostic factor in determining whether surgery is required. The prognosis is better for D- and G-cell tumors than pancreatic endocrine tumors. Duodenal endocrine tumors in multiple endocrine neoplasia have a good prognosis, but can be associated with pancreatic plurihormonal tumors and metastases.

Adolescent↗