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C Avisse

Publications and source records attributed to C Avisse.

At least 37 records · Page 2Linked to original sources
PubMed1997

Anatomic study of the pre- and neonatal hip. Physiopathologic considerations on dysplasia and congenital dislocation of the hip.

Therapeutic success in dysplasia and congenital dislocation of the hip depends on an early diagnosis. The physiopathology remains very debatable and several concepts are propounded. For a better physiopathologic understanding, the authors have carried out a study of the morphology and development of 22 pre- and neonatal hips. At first, the acetabulum is cartilaginous and distorted by the moving femoral head; this acetabulum is histologically affected by the femoral pressure. The pathologic hip is characterized by defective posterior bony coverage of the femoral head by the acetabulum. The acetabulum ossifies during the 3 months following birth, forming a cup-like cavity under the pressure of the femoral head. Therefore, neonatal screening tests such as sonography must take place in the first weeks of life.

Acetabulum↗
PubMed1997

[Comments on emergency treatment of biliary lithiasis in patients over 75 years of age. Apropos of 157 cases].

Surgery remains the ideal emergency treatment for biliary lithiasis in elderly subjects despite perioperative morbidity and mortality. Minimally invasive techniques appear promising but require assessment. The aim of this work was to determine the usefulness of these techniques and evaluate outcome in a series of 157 patients over 75 years of age who were hospitalized in an emergency setting of complicated biliary lithiasis from January 1990 to December 1996. There were 103 women and 54 men, mean age 82 years. The patients' general status was evaluated according to the ASA classification; 66% of the patients were ASA III, IV or V. Diagnoses at admission were acute cholecystitis (n = 71, 45%), angiocholitis (n = 50, 31%) subintrant hepatic colic (n = 17, 10.8%), pancreatitis (n = 10, 6%), isolated jaundice (n = 2), peritonitis (n = 2) and occlusion (n = 5). Within 24 hours of admission, 7 patients underwent emergency surgery, and the 150 others were given medical treatment. Among these 150 patients, cure was considered to have been achieved with medical treatment alone in 41 (subsequent surgery being required in only one 6 months later), semi-emergency was performed in 17, and a minimally invasive procedure was performed in the 92 others (echo-guided percutaneous cholecystostomy in 42, endoscopic sphincterotomy in 50) followed by a subsequent operation in 29. In the 103 patients (65.5%) in this series who did not undergo surgery, mortality was 3.8% and in the 54 patients (34.5%) who did, mortality was 15%, but this rate was only 6.9% when the open procedure followed a minimally invasive technique. Surgical treatment of complicated biliary disease remains the ideal therapy but indications should be carefully weighed in these elderly fragilized subjects. Under surgical observation, abstention from surgery or use of minimally invasive techniques can play an important role in the therapeutic strategy aimed at lowering perioperative mortality.

Aged↗
PubMed1996

[Ultrasound-guided percutaneous drainage in the treatment of retentional pseudocysts of chronic pancreatitis].

25 to 35% of the patients with calculous chronic pancreatitis will develop a pseudocyst in the course of their disease. Up to recent years pancreatic pseudocysts were treated surgically most of the time by internal drainage (cysto jejunostomy). More recently, it was proved that percutaneous drainage could collapse pseudocysts if aspiration was maintained within 3 to 4 weeks. From January 1986 to December 1994, 22 patients with Wirsung communicating pseudocysts were treated percutaneously. Total recovery was achieved in 11 patients (50%). In these cases the pancreatic out flow towards the duodenum was always restored. There were 8 recurrences, always in relation with persistent or recurrent obstruction of the pancreatic main duct. Modern procedures, associating extra corporal lithotripsy and transpapillary endoscopic management should allow to reduce the failure rate of percutaneous drainage. According to their results, the authors state that an unuseful operation can be avoided in 50% of the patients with percutaneous drainage only. This success rate could probably be increased with association of other non invasive procedures aiming at the permeability of pancreatic duct.

Adult↗
PubMed1995

Anatomo-radiological study of the popliteal artery during knee flexion.

We studied the morphological modifications of the popliteal artery during knee flexion. An anatomical, radiological study consisted of analysis of lateral arteriographs in different degrees in joint flexion followed by dissection to reveal the anatomical structures involved in the morphological adaptation of the popliteal artery to joint movement. In five non-atheromatous volunteers, 15 MRI angiographic sequences were done at the level of the knee in extension and flexion. The arteriographs and angio MRI showed that as joint flexion increased tortuosities appeared in the supra-articular upper popliteal artery while the middle and lower parts of the popliteal artery kept an even curve retracted from the posterior surface of the joint. Dissection seemed to show that this arterial adaptation occurred between two fixed points, one proximal (the adductor canal) and the other distal (the origin of the anterior tibial artery). Angio MRI seems to be a future route for the assessment of the limb vessels. The contrasting behaviour of the different segments of the popliteal artery allows us to understand better the pathophysiology of trauma and malpositions of the popliteal arterial trunk.

Humans↗
PubMed1995

[Leiomyosarcoma of the inferior vena cava. Apropos of a new case].

A leiomyosarcoma was diagnosed in the mid portion of the inter-renal inferior vena cava. Survival was long (6 years) but required 14 reoperations to remove metastases. During the first operation, vascular integrity was reestablished with a cava-cava prosthesis after exeresis of the upstream cava without removal of the left renal vein ostium. The right renal vein was sectioned and directly implanted onto the prosthesis. The pathology report confirmed the diagnosis of leiomyosarcoma with multiple metastases presenting cytonuclear anomalies which worsened with time.

Blood Vessel Prosthesis↗
PubMed1995

[Evolution of indications for Hartmann's operation. Reflexions on a series of 160 cases].

The authors report the results and indications of 160 Hartmann's procedures performed over a period of 15 years. Between 1978 and 1992, 160 patients (90 males, 70 females), with a mean age of 72, underwent Hartmann's procedure for rectosigmoid carcinoma in 55% of cases, for complications of sigmoid diverticulitis in 36% and for other lesions in 14%. Hartmann's procedure was performed either electively (42%) or as an emergency (58%) with a mortality of 6% and 32% respectively. The majority of complications included wound infections or intraperitoneal abscess, and the overall morbidity was 30%. Re-establishment of bowel continuity was performed in 30.7% of patients, most of whom had been initially operated as an emergency for a benign lesion. These 160 cases of Hartmann's procedure represent 27% of the 590 operations performed during the same period as an emergency or electively for rectosigmoid lesion. Hartmann's procedure remains a most effective technique for emergency surgery for benign or malignant lesions with colonic septic complications, and is also indicated electively for palliative treatment of rectosigmoid carcinoma.

Aged↗
PubMed1994

[Abscesses of the spleen. Value of echoguided percutaneous drainage apropos of 4 new cases].

Curative treatment in 4 patients with splenic abscesses was obtained after echoguided percutaneous drainage. An analysis of the literature from 1986 to 1992 revealed that both splenectomy (87 cases) and percutaneous drainage (47 cases) have had their indications. This could appear rather surprising since that in 1986 several reports had already indicated the safety and effectiveness of percutaneous drainage which leads to cure in 70% of the cases and reduces both the cost of the surgical procedure and he long-term risks of splenectomy. The analysis of the recent literature would suggest, with certain reservations related to the nature of this type of analysis, that percutaneous drainage is a superior technique compared with splenectomy. Mortality reported after splenectomy was high (14%) compared with mortality after percutaneous drainage (2%) (1 out of 47 cases). Percutaneous drainage was unsuccessful in 5 patients (11%) who then underwent successful splenectomy. Global cure rate for percutaneous drainage alone was 87%. Based on the results of this analysis of the data in the literature, and on our own personal experience, we conclude that splenectomy should be performed only exceptionally for splenic abscesses, usually in cases with multifocal abscesses or complicated with rupture.

Abscess↗
PubMed1993

[Is there still a place for surgery in the treatment of communicating pseudocyst in chronic pancreatitis?].

The purpose of this study was to evaluate the results of long term percutaneous catheter drainage in the treatment of chronic pancreatic pseudocysts communicating with pancreatic ducts. Since 1986, 13 consecutive patients with symptomatic pseudocysts were treated prospectively. All pseudocysts were associated with chronic pancreatitis. The location was head (n = 8), body (n = 3) or tail (n = 2). The procedure included fine needle aspiration under ultrasonic control, percutaneous drainage along a guide wire and closed suction aspiration. A radiological control was performed weekly and the catheter was left in place until total resolution of pseudocyst. Immediate relief of pain and resolution of pseudocyst were obtained in all 13 patients. The average length of hospital stay was 12.2 +/- 8 days (1 to 23). The average duration of drainage was 36 days. There was no mortality of morbidity related to the drainage. There were two asymptomatic recurrences, but long-term follow-up (mean 3 years) showed that all 13 patients were symptom-free. The clinical results of such a long-term catheter drainage seem better in our study than in other previous series. It is a simple and innocuous procedure, and could be carried out in an outpatient unit. Such drainage represents an efficient alternative to endoscopic or surgical treatment of chronic pancreatic pseudocyst with ductal communication. In our experience surgery is no longer indicated.

Adult↗
PubMed1993

[Value and limitation of ultrasound-guided percutaneous drainage in acute lithiasic cholecystitis].

The aim of this study was to evaluate the results of ultrasound guided percutaneous cholecystostomy in the treatment of acute calculous cholecystitis. From July 1987 to December 1980, 32 patients (mean age = 80) were treated prospectively by this procedure. There was only one death (3%). Successful treatment was achieved in 70% of the patients and was related with mobilization of the gallstone impacted in the infundibulum of the gallbladder. When mobilization of the impacted stone cannot be obtained, surgery is indicated within one week, as later surgery is much more difficult. Twenty-three percent of the patients successfully cured later died from non biliary disease; this indicates the very poor condition of most of the patients. In our experience, percutaneous cholecystostomy is a safe and minimally invasive procedure in the treatment of elderly high-risk patients presenting with acute calculous cholecystitis.

Acute Disease↗
PubMed1991

Anatomic basis for use of a distal pedicle leg flap.

The cutaneous blood-supply of the limbs is ensured by three types of arteries: the large septo-cutaneous arteries, the slender musculocutaneous arteries, and the rare satellites of the cutaneous nerves. The skin cover of the outer aspect of the leg is particularly well vascularized thanks to its special situation, centered on the intermuscular septa bounding the outer compartment of the leg. Neuromuscular arteries are rare at this site, but there are numerous septo-cutaneous arteries at intervals along the septa. This anatomic study is based on 20 dissections and a radiologic survey and provides findings confirming the reliability of a distally based lateral leg flap. This pedicle arises from the fibular artery behind and the anterior tibial artery in front. It is situated, on average, 10.8 cm from the lateral malleolus, thus allowing coverage of peripheral losses of substances at the malleoli and heel.

Blood Vessels↗
PubMed1991

[Ultrasound-guided percutaneous drainage of intraperitoneal fluid collections. An experience of a surgical team with 205 patients].

Percutaneous drainage has become, during the last ten years, the treatment of choice of abdominal abscesses. From January 1986 to January 1990, 205 patients have been treated in our department for an abdominal collection. In this prospective work we have realised percutaneous drainage in every patients who would have been operated, according to the classical indications. In 28 patients (acute cholecystitis), the indication has been elective because of the surgical risk, depending to the age (mean 80 years). We have treated 67 intra abdominal collections (34 post operative), 39 pseudocysts of the pancreas, 40 liver collections (18 abscesses); and we have done 37 biliary drainages. 15% of the patients showed communication of the collection with the digestive tract. Mortality was less than 5%. Half of these deaths occurred during the evolution of necrotic pancreatitis. 78% of the patients have been cured by the percutaneous drain. The other patients have been operated upon but the drainage facilitated the operation. In our experience percutaneous drainage is a secure technique and every abdominal surgeon would be able to practice this technique.

Abdomen↗
PubMed1989

[Cardiopexy using the umbilical ligament of the liver in the treatment of gastro-esophageal reflux. Results of experience with 100 cases].

The authors report their experience of the surgical treatment of gastroesophageal reflux using a circular cardiopexy with the ligamentum teres (Rampal-Marchal's procedure) associated with a 180 degrees posterior fundoplication. 100 patients with severe reflux (76% oesophagitis) were operated on with this procedure over a 6 year period. Symptoms of reflux disappeared immediately in 99% cases, which corresponded to the healing of oesophagitis with 45 out of the 46 patients controlled with endoscopy, and to a significant increase of inferior sphincteric pressure (from 12 cm H20 to 24 cm H20). Objective controls by post prandial pHmetry evidenced persistent reflux with 4 patients, but 3 of them are totally free of symptoms. Operative mortality was 2%. Transient dysphagia was observed in 25% cases. 96 patients were reviewed with a mean follow up of 23 months. 3 clinical recurrence of reflux were observed (4%) but no oesophagitis was found on endoscopic controls with these 3 patients and none had to be reoperated on. Actuarial chance to remain free of recurrence was estimated at 96.6% up to 48 months according to the Kaplan-Maier's method. Cardiopexy with the ligamentum teres ensures the lengthening of the abdominal portion of the esophagus and anchors the antireflux assembly within the positive pressure environment of the abdomen in a strong and flexible way. It seems to be an advisable procedure for the treatment of GE reflux.

Adult↗
PubMedDate not supplied

[Value of parathyroid scintigraphy in preoperative localization of parathyroid adenoma. Study apropos of 138 tests].

The authors have studied, about a total of 138 exams, the value of parathyroid nuclide scan. All the patients, who had primary hyper parathyroidism, have been operated upon. The results of parathyroid scintigraphy have been compared to the results of surgical exploration. Overall sensibility of the exam has been 80%, better with the MIBI (89%) than with the Thallium (78%). The specificity has also been better with the MIBI (95%) than with the Thallium (87%) with a global result of 88%). Computerized treatment of images with automatized subtraction especially studied in Institut Jean-Godinot, Rheims, explain the quality of these results.

Adenoma↗