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C Rebuffat

Publications and source records attributed to C Rebuffat.

At least 37 records · Page 2Linked to original sources

[Use of a new compression circular mechanical stapler in surgery of the large intestine].

Clinical application in surgery of the large bowel of a compression anastomotic device developed by the Authors is described. The device consists of three plastic rings carried by an instrument that assembles the rings while the bowel is being joined. The rings remain by the anastomotic site until complete healing of anastomosis, then fall into the intestinal lumen and are evacuated with the feces. Sixty-nine patients underwent large bowel anastomosis using this device in our department from May 1986 through June 1989. Forty percent of the anastomoses were located at less than 8 cm from the anal verge. Five intraoperative diverting colostomies were performed (7.2%). The rings were evacuated in average 11 days after the operation, with no or very little discomfort. Operative mortality was 1.4% (one patient died of myocardial infarction). Anastomotic complications were: two (2.8%) clinical and two (2.8%) subclinical dehiscences. This initial clinical experience shows that the anastomotic device is reliable.

Adult↗

[Segmental splenectomy. Usefulness of linear surgical staplers].

As the high risk of sepsis after splenectomy is well recognized, reliable conservative surgical techniques in splenic surgery are widely advocated. Among these, segmental splenectomy carries specific and increasing indications. The use of linear staplers makes this operation quicker and safer. On the basis of a personal observation, Authors examine the anatomical features on which this operation is based, the surgical technique and the technical details to be followed using these devices. The advantages offered by staplers in this surgery allow to widen the indications to partial splenectomy, so as to yield a true primary prophylaxis of the post-splenectomy sepsis.

Adolescent↗

A new mechanical device for circular compression anastomosis. Preliminary results of animal and clinical experimentation.

The authors report the preliminary results obtained in animal and clinical experimentation of a new mechanical device for circular anastomosis which they have developed. It is a gun that places an apparatus consisting of three polypropylene rings that, through the compression among them of the severed edges of the bowel, realize a sutureless anastomosis and are spontaneously evacuated. Fifty-eight colonic anastomoses were performed in dogs with this device; 23 stapled colonic anastomoses were also executed concurrently. Forty-four animals underwent a relaparotomy to remove the colonic specimen containing the anastomoses. Bursting pressure and the histologic features of the anastomoses were evaluated at different time intervals after operation. A good healing of all compression anastomoses was observed, thereby allowing them to initiate the experience in humans. Thirteen anastomoses (6 colorectal extraperitoneal, 1 colorectal intraperitoneal, 5 colocolonic, 1 ileorectal) were performed at the 1st Surgical Department, Milan University. One subclinical leakage (7.7%) spontaneously healed in a few days. No stenoses were observed.

Adult↗

Acid load after intravenous aminoacid infusion: comparison of clorurated vs. acetated solutions.

Ten patients who underwent elective abdominal surgery were given a daily load of one liter of a 10% aminoacid solution randomly containing cationic aminoacid as clorure or acetate salt during the first four post-operative days. None of the patients developed acidosis but the mean daily urinary excretion of titratable acidity and ammonium ions was significantly higher in clorure treated patients. An aminoacid solution containing aminoacid as acetate acts as a sparing solution for tubular buffer activity, and therefore should be preferred for patients with tubular impairment.

Abdomen↗

[Clinical aspects and therapy of malignant neoplasms of the anal margin and canal].

The Authors, on the base of their experience by the Institutes of Surgical Semeiotics at the Trieste University and of Surgical Pathology at the Padua University, report 30 cases of malignant neoplasms of the anus and the anal canal. 17 patients were males and 13 females. Pathological, clinical and diagnostic problems are discussed. The Authors stress the value of surgical therapy, consisting in a simple local excision or in a wide abdominoperineal resection in conformity with the distinctive features of every single neoplasm. The surgical strategy against nodal metastases is proposed, and the results which are obtained by combining surgery and irradiation are analysed. It is opinion of the Authors that surgical therapy is the most suitable approach for radical treatment of these neoplasms, even if early experience with multimodality therapy is promising to be a great success.

Adenocarcinoma↗

Irrigation vs. natural evacuation of left colostomy: a comparative study of 340 patients.

A comparative study of two methods of managing left colostomy (irrigation and natural evacuation) was carried out on 340 patients who were examined and interviewed at the Stoma Rehabilitation Clinic of the Institute of Surgical Pathology of the University of Padua. Ninety-two per cent of patients who irrigated their colostomies gained fecal continence. No patient who irrigated his colostomy had any cutaneous problem, and this group had significantly better results in preventing leakage of gas and odors compared with those patients using natural evacuation. For most patients who irrigated, the ability to predict or control bowel movements overcame fears of "being dirty" and related psychological problems. These patients also had more normal social and working lives than did those patients not irrigating their colostomies. Only one patient in our series had a colonic perforation, and any chance of a repeat incident will probably disappear with the cone-shaped catheters now available. The authors conclude that in properly selected patients, irrigation is the method of choice for management of left colostomy.

Aged↗

Management of the perineal wound after rectal excision for neoplastic disease: a controlled clinical trial.

Two methods of management of the perineal wound after rectal excision for neoplastic disease were compared in a prospective randomized clinical trial in 65 patients. Twenty-eight patients (Group A) were treated by partial closure of the perineal wound and cigarette drainage of the pelvic space, according to the method proposed by Gabriel. Thirty-seven patients (Group B) were treated by complete suture of the perineal wound and suction drainage of the pelvic space according to the method proposed by Altemeier. Immediate and late results were better in patients in Group B. They achieved healing per primam in 62.82 per cent of cases and had significantly shorter hospital stays than patients in Group A. Three months postoperatively, 91.42 per cent of patients in Group B and 59.25 per cent of those in Group A had complete healing of the perineal wounds, with a statistically significant difference (chi2 with Yates correction = 7.27, P less than 0.01). The development in 10 patients of Group B of perineal abscesses or hematomas necessitated reopening of the perineal wounds: however, the postoperative courses were similar to those of patients in Group A. It is concluded that healing by primary intention with use of the method described herein is the treatment of choice for managing the perineal wounds in patients undergoing rectal excision for neoplastic disease.

Abdomen↗

[Videothoracoscopic approach in the treatment of intralobar pulmonary sequestration. Report of a case].

The Authors report on the use of a videothorascopic approach in the treatment of a patient with intralobar bronchopulmonary sequestration. The latter is a rare malformation which more often than not manifests itself in young patients with hemophthisis, recurrent infection and cough. The condition is difficult to diagnose and is often diagnosed intraoperatively. The treatment is surgical resection. The videothorascopic approach was used in a young patient presenting a lesion of the left inferior lobe with polycyclic contours suspected of being an intralobar bronchopulmonary sequestration, along with medical history findings of cough and hyperpyrexia. The approach permitted identification of the lesion in the context of the left inferior lobe, safe identification and section of the abnormal systemic vessel supplying the lesion and subsequent inferior lobectomy. The postoperative course was uneventful and the patient was discharged on postoperative day 5 with an excellent esthetic and functional outcome. The videothorascopic approach should be taken into consideration for the diagnosis and treatment of intralobar bronchopulmonary sequestrations.

Adult↗