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B Suc

Publications and source records attributed to B Suc.

At least 55 records · Page 3Linked to original sources
PubMed1995

[Surgical treatment of severe ulcerous hemorrhages: predictive factors of operative mortality].

OBJECTIVES: Multivariate analysis of operative mortality in patients with bleeding peptic ulcer. METHODS: Seventy-eight consecutive patients, who underwent emergency surgical treatment for bleeding peptic ulcer were reviewed retrospectively. There were 49 males and 29 females, with a mean age of 64.3 years, 2/3 of whom had associated medical disease. Surgical treatment was conservative in 63 cases: oversewing or ulcer excision, alone (n = 29) or associated with vagotomy (n = 34); and was radical in 15 cases: antrectomy+vagotomy (n = 10) or partial gastric resection (n = 5). RESULTS: There were 17 (21.8%) postoperative deaths and 19 (24.3%) bleeding recurrences. The causes of death included 9 bleeding recurrences, 7 organ failures and one duodenal leakage. On multivariate analysis, previous medical illness (cirrhosis or cardiac insufficiency (P < 0.001), shock at admission (P < 0.001), prolonged delay until surgery (P < 0.001), and bleeding recurrence (P < 0.001) were independently associated with increased mortality. In contrast, the type of surgical procedure did not influence postoperative mortality, whereas bleeding recurrence was more frequent in case of conservative surgery (P < 0.03) and anticoagulation therapy (P < 0.01). CONCLUSION: These results suggest that surgical treatment of bleeding peptic ulcer should be proposed early in high-risk patients. A radical procedure should be favoured since it reduces bleeding recurrence rate without increasing operative mortality.

Adult↗
PubMed1994

[Argument for choledochostomy, intraoperative endoscopy and external biliary drainage in the treatment of lithiasis of the common bile duct. A 15-year experience].

The treatment of common bile duct stones is controversial. The objective of our study was to report the results of choledochotomy, rigid choledochoscopy and systematic external biliary drainage in the treatment of stones of the common bile duct. Over a 15-year period, 555 patients were operated in our department according to a precise surgical protocol. 14% of these patients were operated as an emergency and 11.8% were operated immediately after endoscopic sphincterotomy. One third of patients suffered from cholangitis. The endoscopic investigation of the common bile duct was positive in 81.5% of patients. The investigation was negative in 18.5% and negative choledochotomy was significantly more frequent in patients operated for acute pancreatitis (p < 0.05). External biliary drainage was performed in 95.7% of patients. When necessary, a bilioenteric anastomosis (3%) or a surgical sphincterotomy (1.9%) was also performed. The postoperative mortality rate was 4.8% significantly higher in patients over the age of 70, in patients operated as an emergency and in patients operated immediately after endoscopic sphincterotomy (p < 0.05). The morbidity rate was 8.4%. Residual stones were diagnosed in 4.4% of the patients. The presence of residual stones was significantly more frequent in patients with multiple stones of the common bile duct (p < 0.05). Long-term follow-up was available for 89% of patients, 95% of whom were asymptomatic. These results, based on a homogeneous therapeutic protocol, can be used as a reference for the evaluation of other techniques, especially endoscopic and laparoscopic techniques.

Adolescent↗
PubMed1994

[Clinical development of acute noise-induced acoustic trauma. An evaluation of a study of 250 cases].

Traumatic damage on Cochlea (250 cases) induced by assault gun (F.A.M.A.S.) consists in tinitus and hearing impairement on 6000 Hz. Noise's effects are specific to one Cochlea. Dissociated developments of both tinitus and hearing loss show that their anatomical sites are different. Acoustic injury entails definitive haire cells lesions, cellular biochemical and vascular changes. The treatment that reestablishes or raises cochlear blood flow entails recovery in 80% of cases provided that it is given within 48 hours after the trauma.

Adult↗
PubMed1994

[Transjugular intrahepatic portasystemic shunt and liver transplantation].

From the first one hundred consecutive patients treated by transjugular intrahepatic portosystemic shunt (TIPS), 12 subsequently underwent liver transplantation (a mean of 103 +/- 109 days after TIPS). Fourteen TIPS were created in 12 patients, with advanced cirrhosis (Child B = 5, C = 7) and portal hypertension. Seven patients presented either active variceal hemorrhage or refractory variceal bleeding, and 5 cases of refractory ascites. The shunt could be performed in all cases. Two patients experienced rebleeding (one after a shunt obstruction) and were successfully treated by insertion of a second TIPS. A histological study was performed in 10 cases. The shunt was patent in all cases (except in one case previously described), and the endoluminal surface was covered by a connective tissue layer and a new endothelium. We therefore conclude that this method is a safe and effective therapy for complications of portal hypertension, in patients referred for liver transplantation.

Adult↗
PubMed1993

Germ cell tumors of the mediastinum. A 30-year experience.

BACKGROUND: The records of 98 consecutive patients (58 males and 40 females; median age, 27 years; age range, 2-64 years) who presented with a primary germ cell tumor (GCT) of the mediastinum between January 1960 and December 1990 were reviewed. There were 45 mature teratomas, 8 immature teratomas, 16 pure seminomas, and 24 malignant nonseminomatous GCT (MNSGCT). RESULTS: All patients with mature teratomas were cured by radical resection alone, except one patient who died intraoperatively. Among the eight patients with immature teratomas, five were treated before the advent of cisplatin treatment (two children younger than 15 years were cured by surgery alone and three adults died within 7 months after operation). Three patients underwent surgery followed by cisplatin-based chemotherapy (two are still alive and one died of an associated rhabdomyosarcoma). Thirteen of 16 patients with seminomas (81%) were cured by surgery either alone (5 patients) or with adjuvant radiation therapy (8 patients). Among the 24 MNSGCT, 10 were treated before 1980 without cisplatin and all but 1 died of disease progression. Fourteen patients were treated by initial high-dose cisplatin combination chemotherapy and 8 (57%) achieved complete remission (2 died of systemic mastocytosis development). CONCLUSIONS: Results indicate the benignity of mature teratomas of the mediastinum, the age-dependent clinical course of immature teratomas, and the excellent prognosis of seminomas. The improved survival advantage resulting from cisplatin-based chemotherapy in MNSGCT is impaired by the propensity to nongerminal solid tumor development and hematologic malignancies.

Adolescent↗
PubMed1992

[Techniques of appendectomy].

Appendicectomy is a century old. McBurney's incision is the oldest but still most frequently used approach. This well-codified surgical procedure can be made difficult by anatomical variations in the situation of the caecum within the peritoneal cavity or by variations in winding of the appendix around the caecum. In uncomplicated appendicectomy abdominal drainage must be installed only when the base of the appendix is of poor quality. Complicated forms of appendicitis (with peritoneal abscess, appendiceal mass, appendicular peritonitis) have their own specific treatment. Laparoscopic surgery has a role to play among the appendicectomy techniques, and this role seems to be particularly interesting in appendicular peritonitis.

Abscess↗
PubMed1992

'Natural history' of hepatectomy.

The aim of this study was to describe biochemical and liver function test changes after hepatectomy in 33 patients with the following characteristics: absence of underlying liver disease, no blood or plasma transfusion during the perioperative period, uneventful postoperative course. Resection with a temporary pedicle inflow occlusion (10-45 min) consisted of unisegmentectomy or less in 15 patients and bisegmentectomy or more in 18. Blood tests showed: a correlation between aminotransferase rise and duration of ischaemia, and a fall in prothrombin time and factor V levels correlating with the weight of resected specimen at day 1; a moderate gamma-glutamyl transpeptidase and alkaline phosphatase elevation and a rise in fibrinogen level correlating with the extent of resection at day 7. Changes in haemoglobin level, white cell count, platelet count, prothrombin time, factor V level and serum bilirubin level tended to return to preoperative levels by day 7. For gamma-glutamyl transpeptidase and alkaline phosphatase, increased levels persisted for 8-12 weeks after resection. These results, in this selected group of patients, allow a description of the 'natural history' of hepatectomy. The knowledge of these 'natural' changes may contribute to the early detection of postoperative complications.

Adult↗
PubMed1992

[Complications of cholecystectomy by laparoscopic approach. Apropos of 6512 cases].

6,512 laparoscopic cholecystectomies have been performed by 141 surgeons. The lithiasis was uncomplicated in 80% of cases. Conversion from laparoscopy to laparotomy was necessary in 350 cases (5.37%), for technical problems (22 cases), complications (87 cases) or surgical difficulties (241 cases): 107 cholecystitis, 68 adhesions, 14 difficulties in finding the cystic duct and 25 common bile duct stones were the principle surgical difficulties. Among the 304 complications, we have observed 35 general and 251 local complications: 58 haemorrhages, 12 common bile duct lesions (10 cases of iatrogenic trauma and 2 accidental ligations), 4 cystic duct problems and 3 cases of intestinal trauma were the principle per-laparoscopic complications. Among the 164 post-laparoscopies cholecystectomy's complications, we have observed 50 biliary fistulae with 32 requiring further surgery (damage to the common bile duct in 14 cases), 3 common bile duct strictures, 20 haemorrhages (7 requiring further surgery), 31 deep or sub-phrenic abscesses (16 requiring further surgery) and 2 peritonitis after intestinal trauma. We have had 7 deaths (0.10%). Prognostic factors are: 1) The degree of surgeon's experience; the first 50 laparoscopies cholecystectomies performed are more likely to require further surgery (P < 0.05). 2) Cholecystitis with an significantly higher rate of conversion to laparotomy (P < 0.001) and morbidity (P < 0.01). For an experienced surgeon the biliary morbidity is near to that observed in classical cholecystectomy.

Adolescent↗
PubMed1992

[3606 cholecystectomies under celioscopy. The Register of the French Society of Digestive Surgery].

Early results of laparoscopic cholecystectomy must be evaluated. In this way, the "Société Française de Chirurgie Digestive" started to collect records of laparoscopic cholecystectomies from December 1989. 119 surgeons from 67 departments of surgery have been included in this study. By February 1992, 3,606 procedures were collected. The mean age of these patients was 51 years. Sex ratio was 0.29. 21.5% of patients had a history of acute cholecystitis. An operative cholangiogram was performed in 6.4% of cases. The mean operating time was 80 minutes. An immediate laparotomy was required in 7.1% of cases including 12 common bile duct injuries. Postoperative complications were detected in 4.3% of patients. Among these, 51 patients needed a second operative procedure including 13 common bile duct injuries. Two patients died in the postoperative period (mortality: 0.056%). The mean hospital stay was 4.8 days. History of acute cholecystitis increased significantly the immediate laparotomy required (p less than 0.01) and the incidence of postoperative complications (p less than 0.01). The mortality of laparoscopic cholecystectomy seems to be equivalent to that of open cholecystectomy. On the other hand, the incidence of common bile duct injury seems to be increased. However, the absence of controlled study prevents us from comparing the results with the open cholecystectomy. Furthermore, the incomplete nature of this register prevents us from concluding whether it reflects the real dangers of laparoscopic cholecystectomy. A more rigorous evaluating method should be considered in the future.

Adolescent↗
PubMed1980

[Solitary tumors of the vagus nerve in the carotid sulcus: neurofibroma and schwannoma. Apropos of 2 cases].

Neurinoma of the vagus is a rare disease (less than a hundred cases published) and even more exceptional when it develops in the carotid cervical sulcus. Indeed, nevous tumors of the neck are usually situated in a high position, in the lateo-pharyngeal space. Clinical diagnosis is difficult: a chronical enlarged lymph node is the usual suggestion. Nevertheless, two signs, albeit inconsistent are very important: cough and bradycardia on palpation of the tumefaction. Enucleation, when possible, is the best procedure for exeresis, leaving the recurrent fibers intact. But in most cases, the tumor cannot be separated from the nervous fibers and the vagus nerve must be severed at both ends. This results in definitive paralysis of the homolateral vocal cord. Microscopically, it is not always easy to distinguish between neurofibroma and schwannoma because both tumors share a common cytogenetic origin and many intermediary forms are found. Only electronic microscopy can solve litigious cases. The importance of this distinction is not only speculative, a schwannoma assumes a solitary course but a neurofibroma may belong to Recklinghausen's disease. Both schwannoma and the rare solitary neurofibroma of the cervical portion of the vagus nerve can be surgically removed, their prognosis is favorable. nervous tumors of the neck in Recklinghausen's Disease must not be operated on account of possible aggravation.

Adult↗
PubMedDate not supplied

The role of selective visceral angiography in the management of pancreatic and periampullary cancer.

A prospective study was undertaken to evaluate selective visceral angiography (SVA) in the management of patients with pancreatic and periampullary cancer. Over a 30-month period 52 patients with potentially resectable pancreatic or periampullary cancer underwent SVA; 4 patients had obvious angiographic evidence of widely disseminated disease and were not subjected to laparotomy while 2 further patients were eventually considered too frail for resection. The remaining 46 patients (median age 58 years, range 37-73 years, males 26, females 20) had no evidence of disseminated disease on ultrasonography and/or CT scanning and had both SVA and surgery and form the basis of this study. Vascular anomalies were detected in 16/46 (35%) patients. Hepatic metastases were wrongly diagnosed by angiography in 7 out of 9 patients (77%). SVA correctly predicted resectability or irresectability in 28/46 patients (overall predictive value 61%). Of the 27 patients who proved to have irresectable disease at operation, 11 were correctly identified by SVA (sensitivity 41%). Of the 13 patients reported to have irresectable disease, 2 underwent resection (false-positive rate 15%). Of the 33 patients reported to have resectable disease, 16 were irresectable (false-negative rate 48%). Overall there was a poor relationship between resectability and the angiographic features. On the basis of these data, SVA cannot be considered a sufficiently accurate means of assessing resectability. Its use for this purpose in patients with pancreatic and periampullary cancer is not justified.

Adult↗