Biomedical subjects
C Letoublon
Publications and source records attributed to C Letoublon.
[Conservative attitude in the treatment of closed injuries of the liver].
Progress made in surgical treatment of blunt hepatic trauma (BHT) are numerous. Some procedures are sophisticated, but the best results seem to be due to conservative trends. These conservative trends are observed on one hand during the laparotomy with limited hepatectomies, and peri-hepatic packing, on the other hand in non operative management (NOM). Among 55 patients treated over a 10 years period for BHT, NOM. (18 cases) is reported: incidence of NOM increased along the period (from 3 cases on 35, to 15 cases on 20). No deaths and no complications were observed. Secondary exploration was required in three patients: no one was objectively useful. Detection of hemoperitoneum greater than 500 cc and initial blood hypotension (if well corrected by resuscitation) do not exclude this NOM.
[The repair of recurrent postoperative incisional hernias. Objectives and therapeutic indications (68 cases)].
Among 327 surgical repairs of incisional hernias done between 1974 and 1989, 68 repairs (21%) were performed because of a primary treatment failure. Failed primary attempts of cure had been unique in 71%, and multiple in 29% of cases; their procedure had been essentially suture or herniorrhaphy. Site of recurrent incisional hernia (R.I.H.), was midline or lateral incision in respectively 84% and 16% of cases. Size of R.I.H. was considered as large in two third of cases. Operation was performed electively in majority of cases (93%). More than half of the patients were "prepared" by preoperative pneumoperitoneum and/or weight reducing regimen. Mersilene* mesh was used in 81% of cases. Results of treatment of R.I.H. are reported, depending on procedure. Among 55 cures by use of Mersilene* mesh, 1 patient died (from myocardial infarction), and 5 recurrences occurred, 4 of which from sepsis. Study of complications and failures suggests: 1) careful attention to indications, 2) advantages of a large size Mersilene* mesh, 3) attention to preoperative treatment, especially weight loss regimen and progressive pneumoperitoneum.
[Variations of division of the extrahepatic bile ducts: significance and origin, surgical implications].
As opposed to congenital anomalies, the anatomical variations, as well as the modal type, are issued from a normal morphological development. The variations of division of extra-hepatic biliary ducts are very frequent. They are clearly explained by the sequence of embryological development in man, and also by compared anatomy. Lots of variations occur, some of them being more frequently encountered than others during cholecystectomy for gallbladder lithiasis. A cysto-hepatic duct draining a large hepatic territory is the most dangerous variation. As a matter of fact, it can look as if the junction between the cystic duct and the common biliary duct was of the modal type. In surgical practice, the dissection of cystic duct must never go over the right side of the common biliary duct in order for it never to be injured. Radiological exploration of biliary tree during cholecystectomy for gallbladder lithiasis has to be routine, in order to discover the obviously unpredictable individual variations of division of extra-hepatic biliary ducts.
[Articular fractures of the calcaneus: value of horizontal tomography in diagnosis].
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[Budd-Chiari syndrome in paroxysmal nocturnal hemoglobinuria. Report of a case and review of the literature (author's transl)].
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Increase in amylase clearance in relation to creatinin clearance during acute pancreatitis.
Renal amylase clearance in relation to creatinin clearance (Cam/Ccr) was determined for 20 patients suffering from acute pancreatitis (AP). For each of them, the diagnosis rested upon operative or laparoscopic observation of characteristic anatomical or histological lesions. The average clearance relationship in these patients reached 16 +/- SEM 3.8%. These results were significantly higher than those obtained from 132 patients who had been hospitalized for other medical or surgical diseases, as well as from 51 test patients (p less than 0.001). The authors stressed the diagnostic importance of this test, in particular in the presence of a normal amylasemia level.
[Treatment of post-operative ventral hernia: elementary biomechanical basis. Report of 51 cases treated by mersilene mesh (author's transl)].
Elementary functional anatomy of the normal abdominal wall and following incisional hernia are described. The treatment of postoperative hernia should be based on this: its object is to restore the morphology and functions of the abdominal wall, in particular its respiratory function. It may be necessary to carry out gradual pneumo-peritoneum before parietal repair. A mersilene mesh was used by the authors in 51 cases. Certain rules should be observed when this prosthesis is placed in position so that the abdominal muscles find the conditions closest to their normal function.
[Interest and limits of arteriography in one case of abdomino-pelvic trauma (author's transl)].
Hepatic and pelvic arteriography were carried out in one case of trauma of the liver and pelvis. Initial hepatic arteriography did not give more information than per-operative cholangiography. Secondary hepatic arteriography suggests the presence of lesions which, in fact, do not exist. Pelvic arteriography permitted us to localise on one obturator artery, the origin of a voluminous retroperitoneal hematoma. We were able to stop the hemorrhage by embolisation and this facilitated surgical removal of the hematoma.
[Benign tumor of the liver after oral contraceptives].
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[The problem of the remaining limb in the amputee with arteritis. Prognostic and therapeutic study of 256 cases].
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[Treatment of fractures of the humerus by intramedullary fixation].
The Hackethal's technique of intramedullaring wiring for humeral fracture represents the immobilisation procedure particularly convenient for this bone. This procedure can be realised without special instrumentation with Kirschner's wires and image intensifior. To allow the approach of the fracture, the patient's position is choosed upon the topography of the lesion. The intramedullaring wiring is always done from down to up. Indications for this procedure are: humeral shaft fracture, humeral neck fracture, and fractures of the shaft and of the neck. During the reduction of the fracture, the immoderate use of a image intensifior seams to be the major risk. Hackethal's technique for medullary wiring was used in 21 patients, only one pseudarthrosis was noted. The fonctionnal recovery of the arm is usually realised in three months.
[Case of spontaneous rupture of a hepatic angiosarcoma in a worker exposed to vinyl chloride].
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[Mesenteric compression syndrome in undernourished patients. Value of parenteral hyperalimentation].
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[Post-traumatic hepatic ischemia. Etiopathogenic problems posed by the presence of the medial arcuate ligament compressing the celiac trunk].
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[Synthetic prostheses used in surgery to repair abdominal wall defects (excluding groin hernias). Characteristics, in situ behaviour and applications].
This study is an updating on synthetic prostheses used today to repair incisional hernias, eviscerations and abdominal wall defects due to a severe infection or a parietal excision of malignant tumours. The present prostheses are the fruits of the constantly developing plastic industry. Their characteristics and types (mesh or patch), together with the materials they are made of, are studied taking this development into account. The tissular reactions caused by prostheses are different depending on whether the material they are made of is an absorbable one or not. Published data on animal experimentation are largely used in this part of the study. A significant part is also allocated to the pathobiology of prostheses infection on which is based prevention of risk infection in the surgical practice. A synthetic prostheses has to be chosen depending on its characteristics and the tissular reactions it generates. In a septic environment, only absorbable prostheses can be used without risk. As for incisional hernias, which allows the authors to refer to their own expérience, the choice also depends on both the surgeon's own conception of the treatment and its purpose. The defect recovery after parietal excision of malignant tumours is eased by the use of a synthetic prostheses. In the future, synthetic prostheses will be even more used than today in the repair of abdominal wall. A present, the materials they are made of keep on being developed.
[Surgical treatment of calcanear fractures (103 cases). Reconstruction-arthrodesis, or reconstruction (author's transl)].
In a twelve-year period, 103 calcanear fractures (thalamus) were operated on, either by the Stulz procedure (calcanear Reconstruction-subtalar Arthrodesis [83 cases]), or by Reconstruction (20 cases). During the first seven years, the Stulz procedure had been performed systematically. During the following five years, indications were shaded between 28 reconstruction-arthrodesis and 20 reconstructions. A complete preoperative radiological study, including especially horizontal calcanear tomography enables to precise what type of injuries affects the four different parts of the calcaneus, and to choose between either procedure.
[Value of arteriography in abdominal contusions. The surgeon's viewpoint].
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