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Biomedical subjects

C Vons

Publications and source records attributed to C Vons.

At least 73 records · Page 4Linked to original sources
PubMed1990

[Treatment of local recurrence of colonic and rectal cancer initially treated by resection-anastomosis].

Between 1970 and 1988, 32 patients underwent laparotomy for local recurrence following a curative and restorative resection for carcinoma of the colon and rectum. Histological confirmation was obtained in 30 cases. Of the 28 patients for whom the site of local recurrence could be defined, the previous anastomosis was involved in 25. At laparotomy, 12 patients had disseminated lesions: 5 of these patients had complete resection of lesions which were, however, considered as palliative. Twenty patients had a local recurrence without metastasis. Five of them had unresectable lesions and 15 were amenable to curative resection. After curative resection, the median survival time was 34 months, and 5-year actuarial survival time was 26 percent. After palliative surgery, the median survival time was 5 months, but 1 patient is still alive 12 years after radiationtherapy. These results emphasize the importance of follow-up, given the high salvage rate in patients in whom curative resection can be performed.

Adult↗
PubMed1989

[Results of the excision of benign tumors of the liver in 22 patients].

Between 1979 and 1987, 22 patients underwent resection for a benign liver tumor. A total of 24 tumors were resected: 8 adenomas, 8 focal nodular hyperplasias and 8 hemangiomas. In two patients, focal nodular hyperplasia was associated with hemangioma. Preoperative diagnosis of the nature of the tumor by radiologic investigations (ultrasonography, CT-scan, and selective angiography) was made in only 4 patients (18 p. 100), 3 with hemangioma and one with focal nodular hyperplasia. Ten patients underwent major hepatectomies and 12 had either a segmentectomy (8 patients) or atypical resection (4 patients). Progress in operative management significantly decreased transfusion of packed red cells (p less than 0.05) and that of fresh frozen plasma (p less than 0.02). Ten patients received no blood for fresh frozen plasma. Suppression of abdominal drainage when surgery was uneventful significantly decreased postoperative in-hospital stay (p less than 0.05) to a low 7.8 +/- 0.8 days and improved comfort of patients. These results confirm that preoperative diagnosis of a benign liver tumor is uneasy. They suggest that resection has become a benign procedure in selected surgical centers. The risk of ignoring malignant tumors or leaving a tumor with potential complications should prompt resection when the nature of a liver tumor has not been precisely determined by usual radiologic investigative procedures.

Adenoma↗
PubMed1988

Should portosystemic shunt be reconsidered in the treatment of intractable ascites in cirrhosis?

Fifty-seven cirrhotic patients with intractable ascites had a portosystemic shunt. In 35 patients, a peritoneovenous shunt had previously failed. Forty-six patients were in Pugh's class B and 11 were in class C. There were three operative deaths (5.3%). Fifty-three (98.2%) of the 54 survivors were cleared of ascites. In one patient, ascites persisted because of postshunt heart failure that resulted in a marked increase of caval pressure. Twenty-seven patients (50%) had late encephalopathy, which was severe and disabling in 12 (22%). One- and three-year survival rates were 72% and 36%, respectively. These results suggest that although portosystemic shunts are remarkably effective in dealing with ascites, the high rate of postoperative encephalopathy is a strong argument against their routine use in the management of intractable ascites in cirrhosis.

Adult↗
PubMed1987

Bleeding from intestinal varices after a Warren shunt.

A 62-year-old man with alcoholic cirrhosis presented with massive gastrointestinal bleeding 4 years after a Warren operation. Angiographic examination suggested that the bleeding was due to ruptured jejunal varices. Treatment by propranolol and a side-to-side portacaval shunt failed to prevent further bleeding. An emergency laparotomy for life-threatening gastrointestinal (GI) rebleeding disclosed dense hypervascular adhesions between the second jejunal loop and the retroperitoneum, and a large submucosal varix of the jejunum that had ruptured. Development of intestinal varices after a Warren operation is facilitated by the persistence of a high pressure in the mesenteric territory and by adhesions between the initial part of the intestine and the area of dissection of the renal vein. This case illustrates one of the possible causes of rebleeding after a Warren operation.

Esophageal and Gastric Varices↗
PubMed1986

Treatment of local recurrence after primary restorative resection or Hartmann's operation for carcinoma of the colon and the rectum.

Between 1970 and 1985, 20 patients underwent laparotomy for local recurrence following a restorative resection or Hartmann's operation for carcinoma of the colon and rectum. Histological confirmation was made in 18 cases and in 2, recurrence not confirmed at surgery became apparent during subsequent follow-up. Of the 16 patients in whom the site of local recurrence could be defined, there was involvement of the previous anastomosis in 13. At laparotomy 7 patients had disseminated disease and in 5 patients without dissemination, local disease was unresectable. Ten recurrences were amenable to resection. Of these 8 patients had a curative operation with a median survival of 26 months and a 5-year actuarial survival rate of 50%. In 10 patients no resection was performed. Median survival in this group was 5 months but 1 patient is still alive at 10 years after radiotherapy. The results emphasise the importance of follow-up given the high salvage rate in patients in whom a curative resection was possible.

Adult↗
PubMed1986

Results of portal systemic shunts in Budd-Chiari syndrome.

Nine patients with Budd-Chiari syndrome (BCS) were treated by a portal systemic shunt. One had thrombosis of the superior mesenteric vein (SMV) and another had complete obstruction of the retrohepatic inferior vena cava (IVC). All other patients had a marked stenosis of the retrohepatic IVC with caval pressure ranging from 12 to 24 mmHg (mean: 17 mmHg). Seven patients had an interposition mesocaval shunt using an autologous jugular vein. The patient with a thrombosed SMV had a portoatrial shunt. The patient with an obstructed IVC had a cavoatrial shunt after an erroneous portacaval shunt had failed to relieve ascites. There were no operative deaths and no major postoperative complications. One patient died 19 months after operation of acute leukemia complicating polycythemia rubra vera. All other patients were alive and well 8 months to 6 years after operation. None of them had encephalopathy. These results suggest several comments: Portal systemic shunts are a good treatment for BCS and have a low operative risk. The mesocaval shunt is an efficient procedure, even when there is stenosis of the IVC with high caval pressure; shunts to the right atrium should be performed only in the case of complete obstruction or inaccessibility of the IVC. The long-term prognosis is excellent, except in patients with potential malignancies. Therefore, portal systemic shunts should be indicated early in patients with symptomatic BCS.

Adolescent↗
PubMed1986

Portoatrial shunt in Budd-Chiari syndrome.

It is now well accepted that mesoatrial bypass is an efficient treatment of Budd-Chiari syndrome and that it is indicated when the inferior vena cava is obstructed. This report presents a patient in whom the superior mesenteric vein was thrombosed after a previous mesocaval shunt. A bypass was constructed between the left side of the portal vein and the right atrium with a 16 mm diameter reinforced polytetrafluoroethylene prosthesis. The prosthesis passed between the left lobe of the liver and the caudate lobe and had a direct trajection. The procedure was simple, the postoperative course was uneventful, and the patient was well 20 months later. This observation suggests that portoatrial shunt is a good alternative to mesoatrial shunts in patients with Budd-Chiari syndrome and unavailable inferior vena cava and superior mesenteric vein.

Adult↗
PubMedDate not supplied

Role of surgical therapy in management of intractable ascites.

Almost 10% of patients with cirrhosis and ascites develop intractable ascites. When large-volume paracentesis fails to relieve ascites, patients may be submitted to one of the three following surgical options: portosystemic shunting, peritoneovenous shunting, or liver transplantation. Portosystemic shunting is efficient in clearing ascites, but it is associated with a high rate of encephalopathy and liver failure. The indications for portosystemic shunting are therefore limited for treatment of intractable ascites and should be performed only in patients with good liver function in whom all other treatments failed. Peritoneovenous shunting has been associated with a high rate of early complications and valve obstruction. Improvements in perioperative care and in the material used have greatly reduced the operative risks and increased the patency rate. Mortality remains high in patients with severe liver failure or with a history of spontaneous bacterial peritonitis or variceal bleeding. Peritoneovenous shunting should not be done when these risk factors are present. In the absence of such risk factors, peritoneovenous shunting is a good procedure and may provide definitive relief of ascites and long-term survival in more than 50% of the operated patients. In patients with poor risk factors liver transplantation may be preferable, and the onset of intractable ascites in a patient with a severely compromised liver should trigger the indication of liver replacement.

Ascites↗