Biomedical subjects
B Geoffray
Publications and source records attributed to B Geoffray.
Effects of preoperative intentional hemodilution on the extravasation rate of albumin and fluid.
OBJECTIVE: To evaluate the effects of preoperative intentional hemodilution with 4% albumin solution on the extravasation rate of intravascular albumin and fluid in surgical patients. DESIGN: A prospective, randomized, clinical study. SETTING: University teaching hospital. PATIENTS: Two groups (control group [group 1] and hemodiluted group [group 2]) of 13 healthy patients were studied during a long-term (>4 hrs) surgical procedure. INTERVENTIONS: Autologous technetium-99m (99mTc)-labeled red blood cells and indium-oxine ((111)In)-labeled human serum albumin were injected intravenously during anesthesia at T = 0 min in the two groups for the determination of total blood volume and albumin diffusion space, respectively. In addition, body tetrapolar electrical impedance was used to assess extracellular fluid volume. In the hemodiluted group (group 2), 15 mL/kg of blood was withdrawn over 30 mins (T = 20 mins to T = 50 mins) and simultaneously replaced by an equal volume of 4% albumin solution (0.6 g/kg). MEASUREMENTS AND MAIN RESULTS: The albumin diffusion space, the colloid oncotic pressure, the plasma albumin concentration and the electrical impedance were measured before (T = 10 mins) and after (T = 60, 120, and 240 mins) hemodilution. Urine was collected from T = 10 mins to T = 240 mins. The total blood volume was calculated at T = 10 mins. No differences in the initial values were found between the two groups. In group 2, hemodilution (hematocrit 30 +/- 3%) resulted in a steeper increase in the albumin diffusion space (p < .05) and a progressive decrease in the body electrical impedance (p < .05). The extravasation rate of albumin was 0.052 +/- 0.007 mL/kg/min in group 2 vs. 0.038 +/- 0.020 mL/kg/min in group 1 (p < .05). The value of calculated plasma volume at T = 0 min did not shown any difference between the two groups. This value was then lower than expected in group 2, corresponding to a loss of plasma volume of >3 mL/kg. Urine output was significantly lower in group 2 than in group 1 (0.7 +/- 0.4 vs. 1.4 +/- 1.0 mL/min, respectively; p < .05). A comparable decrease in colloid oncotic pressure and in plasma albumin concentration was observed in both groups. CONCLUSIONS: These results suggest that preoperative hemodilution using 4% albumin on a 1:1 volume basis for blood substitution during a prolonged surgical procedure with reduced blood losses enhances the extravasation rate of albumin and fluid to the interstitial tissues, impeding the maintenance of isovolemia. These findings support the use of a volume of infused colloid solution higher than that of withdrawn blood during preoperative hemodilution.
[Submucosal resection of the inferior nasal turbinates].
Nasal obstruction is frequently related to hypertrophy of the bony inferior nasal conchae. Medical management and/or isolated correction of deviation of the nasal septum are often inadequate. Surgical management, although it has raised controversy, becomes the only therapeutical course. Submucosal resection of the conchae was performed in 104 patients between 1986 and 1988. Subjective analysis of postoperative data shows 82% of successful surgery cases yielding good nasal repermeabilization with some minor unpleasant effects, such as nasal crusts or discharge in 46% of cases. The authors describe the surgical technique as well as its indications, and its advantages as compared to medical treatment, cauterization or subtotal resection of the conchae in incapacitating nasal obstruction cases.
[Monitoring of thyroid function in patients treated for cancer of the upper respiratory and digestive tract].
A study was carried out at Hôpital Boucicaut to determine the incidence of iatrogenic biological thyroid dysfunction in patients treated for cancer of the upper digestive and respiratory tracts, and to define the risk profile (tumor localisations, practical therapeutical procedures). Two studies were conducted: a prospective on including 18 patients and a retrospective one including 58 patients. Only partial results are currently available. They permit emphasizing the frequency of biological thyroid dysfunction associated both with combination surgical and radiotherapeutical regimens and radiotherapy or radiotherapy alone for the treatment of lesions of the piriform sinus, although they fail to provide conclusive evidence regarding the real frequency of this type pathology or the time of its occurrence.
Combined treatment of cancer of the posterior oral cavity and oropharynx.
Ninety composite resections were carried out as primary treatment for a squamous carcinoma of the tonsillar region between 1970 and 1978. All patients have been followed-up for at least 3 years, except for 5 who have been lost to follow-up. All patients received postoperative radiotherapy (between 50 Gy and 65 Gy depending on the tumour resection status). Sixty-one patients received preoperative chemotherapy and 42% had clinical reduction of tumour size. The overall survival was 45.5% at 3 years and 43% at 5 years. Local recurrences were the most frequent oncological failure (25%). Tumours classed T3, insufficient tumour resection and lymph node invasion had poor prognostic value. We emphasize the necessity for primary surgery with preoperative chemotherapy and postoperative radiotherapy for squamous carcinoma of the posterior oral cavity and oropharynx.
[Tympanic reconstruction by molded grafts. Value and results. Apropos of experience in 158 cases].
Use of a moulded aponeurotic graft, shapened and then made rigid by heat and formalin, is a seductive method of tympanic reconstruction because of its simplicity and availability. Indications for and results of the application of this method are analyzed based on experience of 158 cases, with sufficient follow up in 90. The principal indication for use is large perforations, when it is possible to exteriorize the whole canal and almost all the tympanic remains, while doubt exists as to its advantages for treatment of small perforations. Its essential advantage is in fact the ease with which the graft can be positioned on external surface of malleus and inside the remains of tympanic membrane. Overall anatomical results were very satisfactory (83.5%) if one includes in failures of treatment the apparent lateralizations of graft. Functional results were poorer, with rarely complete recovery of hearing and a certain number of labyrinthizations possibly due to injury to handle of malleus or even perforation of canal. Secondary degradation of favorable results may develop because of some degree of lateralization of the newly formed tympanic membrane. These could perhaps be avoided by the technical artifices proposed by other authors.
[Functional surgery of cancer of the hypopharynx. Hemilaryngopharyngectomy, posterior pharyngectomy by bilateral cervical approach].
The authors report on 48 patients operated by hemi-laryngo-pharyngectomy for spinous carcinoma of the piriform sinus. They try to precise the indications by analysing the factors influencing survival and relapses. They compare surgery to the other methods. In a second part, they report 3 cases of posterior pharyngectomy by bilateral cervical incision.
[Choice of the 3d portion of the jejunum for reconstruction of the pharynx in circular pharyngolaryngectomies. Indications and advantages].
Many procedures are used for reconstruction of a pharyngeal gutter after circular pharyngolaryngectomy, interrupter of digestive continuity. The operation chosen was used of third part of jejunum for reconstruction, and its indications and limitations are described. The choice was based on anatomic data from dissection of 100 cadavers and values for different measurements performed (length of transplant, height of mesentery, caliber and length of vessels), and more particularly on constancy and reliability of vascularization of this digestive segment. To these advantages are added bacteriologic, technical, histologic and physiologic reasons. Results are analyzed of 11 operations carried out in the same department, from among a larger group comprising now 45 cases. Postoperative course was usually uncomplicated with rapid restoration of deglutition (a mean of 11.77 days in 9 of the 11 cases). Preoperative radiotherapy is not a contraindication and postoperative radiotherapy should be given routinely as a complement to surgery. It is usually well tolerated and transplant necrosis is not provoked. Nevertheless, the seriousness of this type of lesion is underlined by the high incidence of carcinologic failures, with an elevated risk of local and regional recurrence and of distant metastases.
Total reconstruction of the hypopharynx and cervical esophagus.
Patients with extensive circumferential tumors of the hypopharynx and those with carcinomas of the cervical esophagus usually require resection of a cylindrical segment of the upper digestive tube. These patients present similar difficulties of reconstruction and also share a very poor prognosis. At times, the same complicated technical effort is required for palliation and definitive cure alike. From 1970 through 1982 at the University of Texas-M.D. Anderson Hospital at Houston, 78 patients underwent complete resection of the hypopharynx (54 patients) or the cervical esophagus (24 patients) for advanced malignant tumors. Seventy-three tumors were squamous cell carcinomas, and the remaining 5 were cancers that originated in the salivary gland. These large tumors were not staged according to the TNM system, since they frequently involved two different anatomic structures and a precise clinical assessment was not always possible. The only criterion for inclusion of patients in this series was the need to replace the entire pharynx or cervical esophagus after removal of the cancer. Of the 78 patients, 64 received their entire treatment at our institution, and of this group, 44 patients had only one surgical procedure. All patients in the series had circumferential resection as the final surgical step at our institution. The types of repair used in this group of patients were a cutaneous flap or graft in 44 patients, a colon bypass in 16 patients, a lateral trapezius musculocutaneous flap in 9 patients, and a pectoralis major musculocutaneous flap in 6 patients. In three additional patients, the reconstruction was initially delayed for various reasons and was ultimately abandoned. Technical considerations and a detailed analysis of the complications and palliative value of each procedure are presented. The merit of these procedures is judged according to the quality and the length of the patient's survival. Although the degree of palliation varies considerably according to the technique used, the survival rates were similar in all cases, the average being 43 percent at 5 years after the first treatment attempt and 27 percent at 5 years after the surgical resection that required a complete circumferential reconstruction.
[Plastic surgery after circular pharyngectomy. Apropos of 78 cases].
78 patients with hypopharyngeal and/or cervical oesophageal squamous cell carcinoma underwent a total pharyngectomy from 1970 to 1982. The pharyngeal and/or cervical oesophageal reconstruction was carried out with cutaneous flaps, myocutaneous flaps or colon interposition. The advantages and disadvantages of these techniques as well as their complications are discussed. Following this experience, a therapeutic attitude is presented. The authors insist on the quality and duration of survival of patients after the surgical procedure.
[Intubation or tracheotomy in severe subglottic laryngitis].
A retrospective study to assess safety of nasotracheal intubation for subglottic laryngitis in children was conducted in 44 cases treated in the Intensive Care Unit of Hôpital Bretonneau, France between 1971 and 1981. Intubation had been performed in 40 children, and immediate tracheotomy in the other 4. The course of the affection was favorable in 37 (92,5%) of intubated children, secondary tracheotomy being necessary in only 3 cases. A mean duration of 84 hours of intubation was sufficient in 24 children, a total mean duration of 180 hours being required in the 13 other cases. The catheter employed in the 3 tracheotomized children with morbilous laryngitis was too large, and laryngeal stenosis developed in 2 of them. These findings demonstrate that when a catheter of correct size (1/2 size below that indicated by the weight and age of the child) is employed, nasotracheal intubation for severe subglottic laryngitis is a safe procedure.
[Ethmoidal mucocele in a nursing infant. Apropos of 1 case].
Characteristic features of mucoceles of the paranasal sinuses in infants are their extreme rarity, their localization exclusively in the ethmoidal sinuses, and the specific nature of their clinical expression. Partial explanation of these specific features is provided form knowledge of the embryology of the facial sinuses and the various pathogenic theories developed concerning these mucocele lesions. Two out of four cases observed were associated with viscidosis, and a sweat test must be routinely performed in all cases.
[Cat scratch disease. Apropos of a misleading case].
An unusual case of cat scratch disease was reported. A pharyngeal form of the disease, with a primary site of inoculation in the nasopharynx was observed. The histology showing pseudo-tubercular follicules was misleading the diagnosis finally made by a strongly positive Hanger Rose reaction. From this case we are reviewing the main caracteristics of this disease and especially forms with mucosal inoculation.