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Biomedical subjects

C Guédon

Publications and source records attributed to C Guédon.

33 records · Page 2Linked to original sources
PubMed1991

Endoscopic injection of adrenaline for severe peptic ulcer haemorrhage in high surgical risk patients.

Endoscopic adrenaline-hypertonic injection was attempted in 40 patients admitted for oesophagogastroduodenal ulcer haemorrhage unresponsive to conventional medical treatment and presenting with severe underlying disease or advanced age (less than 80 years). The results were compared with our own historical controls (43 patients) treated by conventional therapy, meeting the same inclusion criteria. Permanent haemostasis was achieved in 32 patients in the injection group and 30 in the control group (NS) but emergency surgery was less frequent in the injection group (2 vs 25, p less than 0.001). Blood transfusion requirements were less in the injection group (8.5 +/- 6.2 vs 10.2 +/- 5.4, p less than 0.05) but length of hospital stay was not really different (15.7 days +/- 9.3 vs 20.9 +/- 14.4). Unfortunately, mortality was not reduced in the injection group (14/40 vs 17/43). Two lethal complications attributable to injection treatment occurred. This treatment could represent an alternative to conventional haemostatic treatment in high surgical risk patients with severe clinical bleeding, avoiding emergency surgery. In spite of the fact that we selected high-risk patients, endoscopic treatment was not able to lower the mortality (about 37%). Due to severe unpredictable side effects and potential risks of long-term massive rebleeding, this treatment should be performed electively in patients with severe clinical bleeding, as first line treatment when surgical risk factors exist or immediately before surgery in low risk patients.

Aged↗
PubMed1990

["Ambulatory" ischemic colitis. Clinical course and etiologic features in 88 cases].

From January 1983 to December 1988, 88 consecutive patients with ambulatory ischemic colitis without severe disease or surgical operation were observed. The diagnosis was established in all cases by endoscopy, and in 64 cases by histologic examination. The study included 55 women and 33 men with a mean age of 65.4 years (22-90). Symptoms included: abdominal pain (73 percent), diarrhea (60 percent) and bloody stools (85 percent). The sequence abdominal pain-diarrhea-bloody stools was noted in 41 percent of cases. Most cases of colitis were located in the sigmoid and left colon. The immediate course was uneventful in 81 patients. Six patients underwent surgery and of these, three died. The mortality rate was 4.5 percent (4 cases). Long-term outcome was known in 41 cases. None of the patients were symptomatic, but a moderate secondary stenosis was noted in 4 of 31 patients who underwent endoscopic or radiological follow-up examination. In 80 cases, one or more potentially etiological factors were observed including vascular obstruction (32 cases), low-flow states (27 cases), and drugs (78 cases). Twenty patients were taking non steroidal anti-inflammatory drugs (23 percent). Drug treatment was recent in 10 cases, and in four, it was the only possible etiological factor. This suggests the responsibility of anti-inflammatory drugs in the onset of certain cases of ischemic colitis.

Adult↗
PubMed1989

[Diarrhea in intestinal inflammatory diseases].

Diarrhoea is a frequent symptom in ulcerative colitis (UC) and Crohn's disease (CD) which it often reveals. Its clinical features, course, physiopathology and treatment are different in these two diseases. UC is accompanied by an imperative, blood-stained, diurnal and often noctural diarrhoea the intensity of which fluctuates with the course of the disease, usually regressing under medical treatment but capable of becoming severe. This diarrhoea is due to several physiopathological mechanisms such as loss of colonic absorption function, exudative enteropathy and disorders of motility. Contrary to the lesions of UC, those of CD involve the whole digestive tract; they are multisegmental, ileal, colonic, ileocolonic or diffuse. Diarrhoea takes different forms depending on the site and evolutive stage of the lesions: malabsorption of bile salts and/or fatty acids in ileal lesions or after surgical resections, bacterial proliferation above stenoses, intestinal shunts due to internal fistulae, reduced absorbing area, exudative enteropathy and motor disorders in colonic lesions. In UC, treatment of the diarrhoea is that of exacerbations: systemic or topical corticosteroids or 5-aminosalicylic acid. In CD, side by side whit the maintenance treatment of the disease with anti-inflammatory drugs, the symptomatic treatments of diarrhoea play an important role and must be tailored to the responsible physiopathological mechanisms; some patients need artificial feeding.

Anti-Inflammatory Agents↗
PubMed1989

[Severe diarrhea caused by Ticlid associated with disorders of small intestine motility].

Ticlopidine is a potent inhibitor of platelet aggregation whose mechanism of action remains unknown. It might act through an increase of intraplatelet PGE1 and PGD2. Benign diarrhea is the most common side effect during ticlopidine treatment. We report four cases of severe chronic diarrhea with fecal incontinence in patients treated by ticlopidine. In two patients manometric recording of jejunal motility was performed. Abnormal motility patterns were observed in both cases: bursts of 3-11 propagated contractions occurring every 2 min and migrating at a rate of 0.6 cm/s, preceded and followed by a brief period of quiescence. Migrating motor complexes and a low percentage of time of quiescence were noted on both recordings. These disorders in intestinal motility may play a role in the pathogenesis of diarrhea observed with ticlopidine.

Aged↗
PubMed1985

[Postoperative infection in ORL oncologic surgery. The choice of preventive antibiotherapy. Experience of the ORL Department of Hôpital Claude Bernard].

The incidence of infection after cervicofacial surgery for ENT cancer varied between 38 and 60% as a function of the type of operation, and prophylactic antibiotic therapy administered, in a series of 133 cases. Contamination was greatest after operations of longest duration and with the largest exposure of tissue. Previous cobalt therapy was an aggravating factor. The highest risk of infections complications resulted therefore from combined salvage operations and the use of a musculocutaneous flap. Among these infections, a purulent bronchorrhea was a frequent and potentially serious complication sometimes the cause of septicemia. A review of 4 different antibiotic therapy regimens showed the pre-operative administration failed to alter the outcome. Combined penicillin-5 imidazole treatment, effective in preventing local and regional anaerobic infection, resulted in secondary infection developing in about 56% of cases. It was not able, in fact, to cover under certain circumstances during prolonged surgery, the postoperative risk of inhalation of gram-negative anaerobic and aerobic bacteria form the buccal cavity. Short-term antibiotic therapy was totally ineffective. It is suggested that combined penicillin-5 imidazole be reserved for operations provoking little contamination of the tracheobronchial region, such as total laryngectomy and total pharyngo-laryngectomy, and that prophylactic therapy using an antibiotic with a wide spectrum against gram negative germs be administered prior to major buccopharyngeal operations with tracheotomy.

Anti-Bacterial Agents↗
PubMed1985

[Velopharyngeal rehabilitation after transmaxillary buccopharyngectomy extending to the soft palate].

Two types of velopharyngeal rehabilitation are proposed after transmaxillary buccopharyngectomy extending to the soft palate region. The first method is by velopharyngoplasty, when exeresis has not involved a half or a quarter of the soft palate and at least half of the posterior pharyngeal wall. The second procedure is for use after exeresis involving all or almost all of the soft palate and a half of the posterior pharyngeal wall, and makes use of velum palatinum reconstruction. The method of choice is velopharyngoplasty, excellent functional results being obtained for both phonation and feeding.

Humans↗
PubMed1985

[Total glossectomy with preservation of the larynx and immediate reconstruction. Apropos of 27 cases].

Total glossectomy with preservation of larynx was performed in 27 patients with lesions affecting the whole tongue and developing from the base, the tonsilloglottal recess, of the junction zone and of the posterior wall, or from the mobile tongue. Results in patients followed up for more than one year (27 cases) showed: 11 survivors only, with 12 deaths from local, regional or metastatic recurrence. Among the 11 survivors, 7 presented very satisfactory functional rehabilitation--they no longer required tracheotomies, were free from pain and fed themselves without problem with mixed types of food. Phonation could be understood and they were reasonably autonomous. When tumoral excision is possible in patients with extension not evident as palpable glands, this operation appears quite justified for patients who are psychologically motivated and very insistent on some therapy, the modalities and risks of which have been exposed.

Adult↗
PubMed1984

[Survival of bone after osteomuscular transposition. Histological study in man and an experimental model].

Most bone cells in homografts fail to survive, and several months are required before live bone tissue structures develop in the graft. Various attempts have been made to preserve or re-establish homograft vascularization. One method involves the use of free bone transfer with revascularization of the supply artery or the total periosteal network, this enabling the majority of the bone cells to survive. Another procedure uses osteomuscular transplants in which the muscle acts as a pedicle for the transplanted bone segment, but whether bone elements in these flaps remain viable is a very debatable point. Experimental and clinical studies were conducted to evaluate, histologically, the viability of bone after osteomuscular transplantation. Fluorescence examination of bone sections from 40 osteomuscular flaps in the rat demonstrated bone formation on the external cortical surface but marked diminution of endosteal moulding in other zones. Examination of bone biopsies from 10 patients treated by mandibular reconstitution using an osteomuscular flap provided data comparable with those obtained during the experimental study. These findings demonstrate that osteomuscular transplantation is responsible for endosteal ischemia, preventing survival of cells other than those lying most externally to the cortex.

Animals↗
PubMed1982

[Mandibular reconstruction employing a costomyocutaneous flap of pectoralis major. Anatomical and technical aspects and viability of graft (author's transl)].

Costomyocutaneous flaps of pectoralis major were employed for reconstruction of the mandible. The various unconventional procedures for mandibular reconstruction reported in the published literature are reviewed, a critical analysis conducted of the different tests of viability of the graft employed, anatomical and technical aspects discussed, and results presented. This flap is suggested as being an excellent method for reconstruction after interrupted pelvimandibulectomy or mandibulectomy involving the skin.

Graft Survival↗
PubMed1978

[Preventive treatment in caustic stenosis of the oesophagus (author's transl)].

The authors review the varioux forms of treatment used experimentally and clinically in an attempt to prevent oesophageal stenosis following ingestion of caustic substances. Corticosteroid therapy is still used by certain authors though its effectiveness is far from obvious. However, promising results have been obtained experimentally using substances such as amino-nitriles, which alter the properties of newly formed collagen.

Adrenal Cortex Hormones↗