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Biomedical subjects

A Sezeur

Publications and source records attributed to A Sezeur.

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

Classification of the sequelae of bowel resection for Crohn's disease.

A postoperative handicap index designed to predict diarrhoea and malnutrition following bowel resection in patients with Crohn's disease is proposed. The index takes into account the location and extent of resection, and its value can be calculated from operative records. Retrospective (n = 218) and prospective (n = 68) series of patients were studied. Diarrhoea and malnutrition developed in 102 patients (47 per cent) and 13 patients (6 per cent) respectively in the retrospective series, and in 40 (59 per cent) and one (1 per cent) of those in the prospective series. The handicap index correlated with faecal weight and faecal fat in 112 patients tested. Positive and negative predictive values of an index score greater than 20 for the development of diarrhoea, and over 50 for the development of malnutrition, were 0.64 and 0.90, and 0.60 and 0.99 respectively in the retrospective series; values were 0.80 and 0.71, and 0.25 and 1.00 in the prospective series. The postoperative handicap index is a useful tool for predicting the functional consequences of bowel resection for Crohn's disease.

Adult↗
PubMed1994

[Circulatory arrest after splanchnic neurolysis with phenol in unresectable cancer of the pancreas].

One of the treatments for pain in patients with unresectable pancreatic cancer is chemical splanchnicectomy by phenol. We report two cases of severe cardiac arrhythmia followed by circulatory arrest, during intraoperative chemical splanchnicectomy. The cardiac toxicity of phenol is known in plastic surgery (face peeling). The reasons for this toxicity are not well known. We recommend that phenol be replaced by alcohol during chemical splanchnicectomy, because of its safety.

Aged↗
PubMed1993

[Serious heart rate disorders following perioperative splanchnic nerve phenol nerve block].

The cardiac toxicity of phenol is known. A variety of cardiac arrhythmias has been noted, particularly after application to the skin, more rarely when used for neurolysis. We report a case of severe cardiac arrhythmia followed by circulatory arrest in a patient with pancreatic cancer which occurred a few minutes after injecting 30 ml phenol 6.66% to produce splanchnic neurolysis. Due to the cardiotoxicity of phenol, recommendations are made for the prevention of cardiac arrhythmias. When high doses of phenol are used on the skin, e.g., face peeling, applications should be over small areas with division of the phenol to each area a sufficient iv fluid load should be given, forcing diuresis with furosemide may be given, and lidocaine hydrochloride used as a prophylactic antiarrhythmic agent. In these cases, as for neurolysis (low doses of phenol), ECG monitoring is mandatory. For neurolysis, alcohol could with advantage replace phenol.

Aged↗
PubMed1993

[Medical innovation. Patents and confidentiality].

Enhanced knowledge of medicine and commercialization of an innovation (product, equipment, drug ...) are the classical aims of all medical research. Only the successful commercialization of the innovation allows the largest number of patients to benefit from the achievements of this research. Successful commercialization depends on the effective cooperation between the medical researcher who possess the potential for innovation and industry which provides the means necessary for its development. This cooperation is facilitated if the innovation is patented and if researcher ans industry work together under a contract of confidentiality. In order to improve the cooperation necessary between industry, research scientists, and clinicians, we review the current rules and regulations pertaining to patents and confidentiality. An annex is included with examples of a consultants contract and a secrecy agreement.

Confidentiality↗
PubMed1992

[Hartmann's procedure. A retrospective study of 86 cases].

The purpose of this retrospective study is to define current indications and results of Hartmann's procedure (H). From 1978 to 1989, 86 H were performed, 52 (60%) as emergency surgery. Indications were: colo-rectal cancer (37): 15 complicated and 22 as an elective procedure, diverticular disease acute or complicated (24), ischemic colitis (10), volvulus of the pelvic colon (5), inflammatory bowel disease (4), colonic perforation (3), traumatic hematoma of the sigmoid mesocolon (1). Fourteen patients died after operation (mean age: 79). There was no death after elective H for cancer. Post-operative complications were numerous: pulmonary (25%), abdominal would sepsis or disruption (21%), rectal strump leakage (14%), the later being harmless due to the associated Mickulicz drainage. Seven patients were reoperated on for necrosis of the colonic stoma. Mean initial hospital stay was 31 days. Restoration of the gastrointestinal continuity was done in 27 cases (37% of the surviving patients, 76% of the diverticular diseases). The authors conclude that for complicated diverticular disease H procedure improves survival without preferable continuity. For cancer, H procedure is permanently compromising gastrointestinal in the elderly to hazardous low anastomosis, and to palliative abdomino-perineal resection.

Adult↗
PubMed1990

[Value of peroperative scintigraphy in detecting accessory spleens].

We report a case of accessory spleen, 1 cm in diameter, responsible for recurrence of an idiopathic thrombocytopenic purpura after splenectomy. This case is original in that the accessory spleen could only be detected by transoperative scintigraphy. Transoperative scintigraphy is a simple method to be used when one or several unrecognized accessory spleens are responsible for recurrence of a blood disease after excision of the principal spleen.

Aged↗
PubMed1990

[New material for needle jejunostomy: technique and preliminary results].

New material for needle jejunostomy was evaluated. They have the following advantages: rapidity and ease of use in jejunostomy, the possibility of a high daily calorie intake, a cutaneous fixation system allowing cleaning of the feeding tube stoma. The material is presented and the insertion technique is described. The preliminary results in 30 patients showed no mortality or morbidity related to the jejunostomy. The authors stress the importance of performing needle jejunostomy whenever long-term high calorie intake is required after the operation.

Digestive System Diseases↗
PubMed1990

[New surgical procedure for the protection of the small intestine before postoperative pelvic irradiation].

A prosthesis was designed to protect the intestinal loop from external beam radiation therapy when post-operative radiation is indicated. It is a silicone inflatable balloon, which, when implanted displaces the intestinal loops out of the pelvic irradiation field. The prosthesis can be deflated between each course of irradiation, without surgery. The device has been used in 8 patients: 6 patients with recurrent pelvic tumor (2 rectal cancers, 1 anal cancer, 1 cancer of the endometrium, 1 cervical carcinoma, 1 ovarian carcinoma), 2 patients with primary tumor (1 malignant paraganglioma, 1 cervical carcinoma). Radiotherapy was administered by means of high power appliances. After radiotherapy, the prosthesis was deflated, then removed through a 3 cm incision under local or peridural anesthesia. The tolerance of the small intestine to the radiation therapy has been satisfactory in each case with no bowel injury due to radiation. Therefore, this simple device might be useful to prevent bowel injury during postoperative radiation in the treatment of abdominal and retroperitoneal tumor masses.

Combined Modality Therapy↗
PubMed1989

[Treatment of acute obstruction due to left colonic cancer].

Retrospective study on 47 patients (23 men, 24 women); mean age was 70.2 years. The mean delay of complete obstruction was 6.95 days. There were associated pathology and clinical factors of gravity in 53.2%, and local factors of gravity in 43.9% of all cases. Three steps surgery in 22 cases (46.8%), two steps in 14 cases (29.7%): 6 "ideal" colectomies (12.7%), 5 colostomies alone (10.6%). Mortality: 3 patients died (6.8%), post operative complications occurred in 22 patients (46.8%); morbidity due to colostomies itself was 37.4%. All first step-colostomies, except one, has been closed after colectomy. The mean duration of total stays in hospital was 31.5 days, according with the surgical procedure in one (14.3 days), two (37.9 days) or three (43.2 days) steps. Duration of complete obstruction, bioclinical status of patients, staging and complications of the cancer and surgeon's experience are determining therapeutic choices. The choice for colostomy as first step is the best policy. In this series the mortality of the colostomy as first step was none. It must be performed with elective incision, on free colic segment (transverse or sigmoid), with the simplest technical procedure (loop colostomy). Others surgical procedures have only peculiar indications.

Acute Disease↗
PubMed1989

[Ultrasonographic and x-ray computed tomographic aspects of Mirizzi's syndrome].

The Mirizzi syndrome is due to common hepatic duct obstruction secondary to the impaction of a large gallstone in the neck of the gallbladder or the cystic duct. The sonographic and computed tomography features in 3 cases of Mirizzi syndrome are described and compared with percutaneous transhepatic cholangiography or endoscopic retrograde cholangiography findings. The Mirizzi syndrome was diagnosed preoperatively on sonography in 2 out of 3 cases and on plain computed tomography scans in all 3 cases. However pre or intraoperative visualization of the biliary tract is mandatory in suspected Mirizzi syndrome to detect the presence or absence of cholecystobiliary fistula, in order to adapt the operative strategy.

Adult↗
PubMed1989

[Intubation of proximal biliary stenoses using a new surgical endoprosthesis].

Thirty patients with high biliary tract strictures were treated by a new surgical endoprosthesis, the tolerance of which has been tested experimentally. It is flexible, radiopaque and incompressible with spurs which prevent migration. Following choledochotomy, the endoprosthesis is positioned surgically above the sphincter of Oddi, thereby avoiding ascending cholangitis. Twenty-nine cases presented with neoplastic compression by an inoperable cancer and one case had an early postoperative stricture with loss of substance after right hepatectomy for hepatic metastases. The 29 cancers included 13 gallbladder cancers, 11 cholangiocarcinomas, 10 of which were hilar, and 5 metastatic compressions due to gastrointestinal adenocarcinomas. In three cases, there was loss of substance of biliary tract after intubation. The operative mortality was 3.3% (one pulmonary complication). Resolution of jaundice was obtained in all but 2 cases and pruritus always resolved. The mean survival of the patients with cholangiocarcinoma was 12.2 months while that of patients with gallbladder cancer was 6.33 months with indices of satisfaction, calculated by Bismuth's method, varying between 71% (gallbladder cancer) and 93.5% (hilar cholangiocarcinoma). The patient operated for benign stricture secondary to a hepatectomy scar for metastases died from lung metastases without jaundice after 48 months. The only late complications were 2 cases of cholangitis treated medically, one of which was due to obstruction of the endoprosthesis at the 13th month. The authors conclude that this new type of surgical endoprosthesis constitutes an alternative in the palliative treatment of neoplastic hilar compressions.

Cholestasis↗
PubMed1987

Loss of substance in bile ducts treated by a new surgical endoprosthesis.

Three cases of loss of substance of the common bile duct in patients with neoplastic disease treated by a new surgical endoprosthesis are reported. In all patients a good biliary drainage was obtained without a biliary fistula. There were no complications related to this method. Long-term follow-up showed persistence of the good immediate results. Surgical endoprostheses might be an alternative in cases with peroperative loss of substance of the common bile duct in patients with neoplastic disease to hepato-enteric anastomoses.

Aged↗