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Biomedical subjects

B Lengele

Publications and source records attributed to B Lengele.

At least 19 recordsLinked to original sources
PubMed2006

Complete arterial revascularization in coronary artery bypass grafting in a patient with solitus inversus totalis.

Dextrocardia with complete situs inversus is a rare condition that occurs approximately in 2/10,000 live births. Coronary revascularization management in this setting differs in the technical considerations imposed by the malposition of the heart itself. We report here a case of complete arterial revascularization using both internal thoracic arteries and the left (homologous vessel to the right) gastroepiploic artery in an adult patient with triple-vessel disease and situs inversus totalis. Strategies for the choice of conduits and anastomoses as well as technical details are discussed.

Coronary Artery Bypass↗
PubMed2003

[Peroperative desaturation during gynaecological laparoscopy-hysteroscopy: an unknown aetiology, pleural extravasation].

A 41-year-old patient presented several episodes of desaturation during a gynaecological laparoscopy. The major complication of this procedure is the venous air embolism. Several other side-effects have been reported: heart rate disorders, subcutaneous emphysema or pneumothorax. Pleural effusions during gynaecologic laparoscopy are apparently rare and the volume of effusion must be important to induce clinical symptoms. This fact can probably explain the frequent difficulty of diagnosis. The role of the diaphragmatic lymphatic network and other physiologic aspects are discussed in this article.

Adult↗
PubMed1998

Inadequate detection of accessory spleens and splenosis with laparoscopic splenectomy. A shortcoming of the laparoscopic approach in hematologic diseases.

BACKGROUND: The ultimate goal of surgery for hematological disorders is the complete removal of both the spleen and accessory spleens in order to avoid recurrence of the disease. Whereas splenectomy by open surgery provides excellent results, the validity of laparoscopic splenectomy in this regard remains unknown. OBJECTIVE: The purpose of this study was to evaluate the detection of accessory spleens during laparoscopic splenectomy for hematologic diseases. METHODS: We therefore evaluated the pre-, intra-, and postoperative detection of accessory spleens in a consecutive series of 18 patients treated by elective laparoscopic splenectomy for hematological diseases by using computed tomography (CT) and denatured red blood cell scintigraphy (DRBCS). RESULTS: Preoperative CT, DRBCS, and laparoscopic exploration detected 25%, 25%, and 75% of accessory spleens, respectively. At time of laparoscopy, 16 accessory spleens were detected in seven of the 18 patients (41%). In two patients (11%), laparoscopic exploration failed to detect accessory spleens, whereas preoperative CT (one case) and DRBCS (one case) did reveal them. Postoperatively, during a mean follow-up of 28 months (median, 24; range, 12-44 months), nine patients (50%) showed persistence of splenic tissue by DRBCS, and three of them had signs of disease recurrence. CONCLUSIONS: This prospective clinical study suggests that elective laparoscopic surgery for hematological diseases does not allow complete detection of accessory spleens. Moreover, after such a laparoscopic approach, residual splenic tissue is detectable in half of the patients during the follow-up.

Adolescent↗
PubMed1998

Radical debridement and omental transposition for post sternotomy mediastinitis.

OBJECTIVE: Reported mortality for postoperative mediastinitis treated by debridement alone can reach 40%. The authors' experience with radical debridement and omental transposition is reviewed. METHODS: Between May 1990 and August 1996, 14 patients with untractable mediastinitis had a transfer of the greater omentum: 11 after coronary artery bypass grafting (CABG) (6 bilateral internal thoracic arteries ITA grafts), one after a heart transplant, one after an aortic valve replacement and CABG, and one after a repair of the aortic isthmus related to a motor vehicle accident. The mean age was 63 +/- 8 years. Infection was proven in all patients by cultures of intraoperative specimens. Two patients had such a large sternal defect that no primary closure could be attempted. The remaining 12 patients had a mean of 1.4 +/- 0.7 previous debridement. Five patients had a total sternectomy. After radical debridement, the omentum was transferred over the entirety of the wound and covered with a meshed thin skin graft. All patients had a minimum of 4 weeks of i.v. antibiotic therapy. RESULTS: There was no operative death. Apart from one focal necrosis and one traumatic dehiscence of the omentum, there was no hospital complication. Sepsis was controlled in all patients. The median hospital stay was 31 days (range 20-154 days). At a median follow-up of 20 months (range: 6-44 months), there were two late deaths: one sudden and unexpected death and one after a re-do CABG. The remaining patients had resumed their previous activities. One patient had developed an incisional hernia and another underwent further surgery for cosmetic reasons. CONCLUSION: Radical debridement and omental transposition may achieve a cure for postoperative mediastinitis with good mid-term results.

Aged↗
PubMed1998

Present status of laparoscopic splenectomy for hematologic diseases: certitudes and unresolved issues.

Laparoscopic splenectomy is considered to be the "gold-standard" treatment of benign hematologic diseases, with normal or slightly enlarged spleens. Laparoscopic treatment of malignant diseases and splenomegalies remains more controversial. The procedure requires a great surgeon's laparoscopic expertise, appropriate positioning of the patient and trocar insertion, and gentle and meticulous dissection of the spleen. The technique is feasible in 91% of the patients with a 0.9% operative mortality and a postoperative complications rate of 12%. When compared with open splenectomy in retrospective case-controlled studies, the laparoscopic approach includes a longer operative time and higher operative room costs. However, advantages include reduced postoperative hospital stay and faster return to normal activities. Despite scarce reported data, long-term hematologic cure rate seems to be equivalent in patients with idiopathic thrombocytopenic purpura. The accuracy of laparoscopic exploration to detect all accessory spleens is however questioned, and residual postoperative accessory splenic tissues have been observed. Prospective randomized controlled trials comparing short- and long-term results of open and laparoscopic splenectomies are required to confirm definitely the role of laparoscopy in the management of hematologic disorders.

Costs and Cost Analysis↗
PubMed1996

Elective Laparoscopic Splenectomy: Person Experience and Literature Review.

Laparoscopic splenectomy has become an attractive treatment for patients with selected hematologic disorders. Almost 200 observations have been reported. The rate of conversion to laparotomy is 10% to 15%, and the complication rate is between 0% and 30%. Adequate selection of patients, preoperative administration of intravenous immunoglobulin in patients with idiopathic thrombocytopenic purpura, meticulous surgical techniques, and careful preoperative and intraoperative search for accessory spleen are critical factors for success in these patients. The procedure should be confined to expert laparoscopic surgeons with considerable experience in the management of hematologic diseases.

Journal Article↗
PubMed1996

Heller-Dor procedure for achalasia: from conventional to video-endoscopic surgery.

A Heller-Dor procedure was performed by laparotomy (group A: n = 8) or by laparoscopy (group B: n = 12) after failure of one to 17 sessions of intraluminal dilatations (n = 13) or as a primary treatment of oesophageal achalasia (n = 7). The oesophagomyotomy was extended over the thoracic oesophagus by thoracoscopy in two patients having vigorous achalasia. Injury to the oesophageal mucosa occurred in two group A patients who had previously been dilated. At follow-up (range: 1 to 113 months), 6 patients of group A (75%) and 10 of group B(83.3%) had no residual dysphagia. The four patients (group A: n = 2; group B: n = 2) who complained of heartburn prior to the operation were asymptomatic, only one group A patient developed symptoms of reflux, and oesophageal pH-monitoring was normal in the 6 group B patients investigated at follow-up. The laparoscopic approach reduces the magnitude of the operation, and the magnified overview permits precise dissection of the intraparietal adhesions which may develop after numerous sessions of dilatation.

Adult↗
PubMed1994

[Liposuction as a help for radiologists. Technical note].

Based on a series of eight cases of severe extravasations of contrast medium injected under pressure, the authors suggest the use of liposuction for the elimination of the toxic agent and of the infiltrated cellular tissue. If applied promptly, this simple and semi-conservative treatment salvages the skin and prevents the development of scar sequelae of the soft tissues.

Aged↗
PubMed1993

En bloc and standard esophagectomies by thoracoscopy.

Subtotal esophagectomy was attempted by right thoracoscopy on 13 patients, 10 having cancer and 3 long caustic stenosis. Thoracoscopy was converted into thoracotomy in 2 patients, owing to loss of selectivity in one-lung ventilation in 1 and injury to a right intercostal artery flush to the aorta in the other. One patient with cancer underwent an esophageal bypass operation only, owing to tumor invasion into the lung at exploratory thoracoscopy. The ten esophagectomies that could be performed in totality by thoracoscopy consisted of seven en bloc resections of the esophagus with extensive lymph node clearance in the posterior mediastinum, and three standard resections without any lymph node dissection. Postoperative complications included one death due to hepatic failure, two cases of acute pneumonitis, and one persistent chest wall discomfort at the trocar sites. Up to 51 lymph nodes were found in the resected specimens of the cancer patients. Six of the 7 cancer patients who were discharged from the hospital after esophagectomy completed by thoracoscopy were alive at 2 to 20 months of follow-up. Five of them were disease free. The study shows that esophageal resections as extensive as those carried out by thoracotomy can be performed by thoracoscopy. It suggests that prompt management of untoward injury to any mediastinal structure adjacent to the esophagus is less easy by thoracoscopy than by thoracotomy, and that classic complications of open thoracic surgery may occur after thoracoscopy as well.

Burns, Chemical↗
PubMed1993

A peri-implant capsule flap.

Spherical expanders (30 ml) were implanted under the skin vascularised by the left inferior epigastric pedicle in rats. When expansion was complete, the expander was removed and the animals divided into three groups of 15. In the first group, the floor of the capsule was simply everted. In the second group, a capsule island flap was raised; in the third group, a capsule free flap was raised, transferred to the heterolateral vessels by microanastomosis; the inner side of the various capsule flaps was covered with autologous skin graft. In the three experimental groups, there was complete "take" of the skin grafts in 80% of the animals. Pedicle or free flaps of capsular tissue may be raised and transferred safely in rats.

Animals↗
PubMed1989

Microradiographic and histological study of the styloid process of the temporal bone.

In order to establish the mechanisms underlying the morphogenesis of the so-called 'elongated styloid process', a comparative microradiographic and histological study was performed on 19 long and short processes. Some morphological differences between short and long processes are noticed. Numerous partially calcified cartilaginous islets are observed within the trabecular bone of very long styloid processes or covering their tip. Calcified fibrous tissue or calcified fibrocartilage sometimes contributes to the thickening of enlarged styloid processes. But the growth of the process does not seem to be due either to calcification or to ossification of the stylohyoid ligament, as thought in the past. Mechanical stresses stretching the second branchial arch during the fetal development probably induce a variable involvement of the different parts of Reichert's cartilage in the morphogenesis of the styloid process. The so-called 'elongated styloid process' should thus be congenital. However, a further growth is still possible through the activity of the cartilaginous cap of the tip.

Aged↗
PubMed1989

Unusual variations of the vasculonervous elements of the human axilla. Report of three cases.

Three cases of multiple anomalies involving the vessels and nerves of the axilla are reported. The main common characteristic between them was the unilateral existence of a superficial brachial artery. The other arterial variations encountered were mostly represented by an assembling of some of the usual branches of the axillary artery in a common trunk which we called thoracdorso-subscapular trunk. In two cases, this trunk gave rise to the posterior circumflex humeral artery. Several nervous anomalies accompanied these atypical vascular patterns. The medial fasciculus of the brachial plexus was absent in one subject and an aberrant course of the brachial artery through the median loop was then observed. The two other cadavers showed variations in the distribution of the intermediate trunk and lateral fasciculus of the plexus. Embryologically, the persistence of various segmental arteries in the axilla seems to be responsible for the described anomalies. Otherwise, the present study indicates that the segmental origin of the axillary artery and its pattern of branching may determine the arrangement of the brachial plexus during the fetal development.

Aged↗
PubMed1987

Hepatic ascaridiasis.

Adult Ascaris, which are usually found in the intestine, can enter the ampulla of Vater if the sphincter of Oddi is not efficient. This situation seems common in children; in adults it occurs after endoscopic or surgical sphincterotomy. The worms can then migrate up into the intrahepatic bile ducts and provoke biliary stasis which may become infected and complicated by abscesses. It is inside such abscesses that we may find fragments of adult Ascaris. In the 4 cases reported in the literature during the last 20 years, we note in particular that the clinical signs vary considerably, according to the age of the patient. In children, the parasitic infestation is often massive and the clinical features are extremely serious, namely shock and acute abdominal pain, which lead to a laparotomy being done. In adults, the clinical feature is that of a biliary infection. Here we describe a fifth case of hepatic ascaridiasis which differs from the others in that the diagnosis was established by ERCP and CT scan and that treatment was medical.

Aged↗
PubMed1984

The function of Meckel's and secondary cartilages in the histomorphogenesis of the cat mandibular symphysis.

Cat mandibular symphysis was investigated with histological methods in animals of ages between 3 weeks of intra-uterine life and 56 days post-natal. As in rodents, carnivores and insectivores, Meckel's cartilages fuse in the midline and form a cartilaginous nodule which persists in the symphysis until birth. This nodule, which we have called the symphyseal Meckelian islet, is isolated from Meckel's cartilage, of which only very small calcified islets are left as intramandibular traces after endochondral ossification. Both hemimandibles are bordered by secondary cartilage, which undergoes endochondral ossification, and by chondroid tissue, which is less abundant than in man. At birth, secondary cartilage of both hemimandibles forms a synchondrosis, the lingual part of which undergoes gradual resorption in the 4-week-old cat. The vestibular part is still present at 8 weeks.

Aging↗
PubMedDate not supplied

Adult-to-adult living related liver transplantation: initial experience.

The number of adult patients on the liver transplantation waiting lists is growing steadily. Adult living related liver transplantation (LRLT) represents the ultimate means to expand the donor pool. The success of this model of "small for size" grafting relies on strict donor and recipient selection. The choice of the graft (2 left and 4 right hepatectomies) was made on the minimal ratio between estimated graft and recipient body weights (0.8-1%), necessary to meet the recipient's metabolic demands. Our experience with six adults is reported. Donor morbidity was minimal (one wound infection); there was no mortality. Four (66%) recipients are doing well, two died of infectious complications. All recipients had a complicated post-transplant course. Due to its complexity, both in donor and recipient, LRLT should only be developed very carefully in experienced liver transplant centers.

Adolescent↗
PubMedDate not supplied

[Left caudal vena cava: report of a case].

The infrarenal part of the vena cava inferior running at the left side of the abdominal aorta has been observed in a 70 years old caucasian man without any other anomaly in the position of the abdominal viscera. This atypical vascular pattern was associated with the persistence of a rudimentary right inferior vena cava corresponding to the right supracardinal vein. The embryonic origin of this anatomical variation and its clinical importance are discussed.

Aged↗