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D Benchimol

Publications and source records attributed to D Benchimol.

At least 91 records · Page 5Linked to original sources
PubMed1990

[Is the excision surgery of bronchial cancer in patients over 70 years of age justified?].

The retrospective analysis of 331 files relating to primary bronchial cancer shows that 30% of the patients are 70 years old or over. This patient group is compared to younger subjects who were operated during the same period. For this surgical series, the disease studied is the same whichever the age (detection conditions, excision types, TNM classification). Mortality for excision is comparable (5.1% vs 8.2%), but the type of mortal complications differs according to the age. Our analysis allows isolating two factors of risk (cardiovascular defects and obstructive chronic respiratory failure). Provided that a pre-operation rigorous selection of the patients over 70 years has been made, pneumonectomy does not seem more serious than lobectomy (mortality 3.7% vs 10.3%). For identical stages, remote survival after excision can be compared to that of operated patients under 70 years old. Excision beyond 70 years old seems justified provided that: a selection of patients, from which subjects having major defects (cardiovascular and respiratory) should be excluded, is carried out by appreciating physiological age and not actual age, a pre-operation respiratory preparation is performed, a careful operating technique which allows avoiding surgical complications is used, a peri-operating assistance is provided.

Age Factors↗
PubMed1990

[What is the value of tracheobronchial fibroscopy in the assessment of esophageal cancer?].

The aim of this study is to evaluate the role of bronchoscopy in the assessment of resectability of esophageal carcinomas. From 1981 to 1986, 125 patients were referred for a carcinoma of the esophagus. Bronchoscopy was performed in 105 cases. Patients were classified into 3 groups: group I: normal bronchoscopy (58 cases: 55.2%); group II: compression, localized inflammation (35 cases: 33.3%); Group III: invasion (12 cases: 11.5%). Tracheo-bronchial abnormalities were found whatever the site of the esophageal carcinoma: 60% of cases for the upper third, 40% for the middle third and 36% for the lower third. They were significantly more frequent when the esophageal tumor was larger than 5 centimeters. Correlation with CT scan was good in 75% of cases. Sensitivity and specificity of these two exams were similar and they appeared to be complementary. In group I, resection was impossible or palliative for bronchial reasons in 10% of cases, while resection was impossible or palliative in 35% of cases in group II. Lastly, resection was curative in 73.5% of cases in group I and in only 39% of cases in group II. Bronchoscopy must be systematically performed in carcinoma of esophagus. It may predict the palliative nature of resection if abnormalities are present, and may contraindicate the resection when invasion of the bronchial tree is discovered.

Bronchial Diseases↗
PubMed1990

[Pulmonary metastases of colorectal origin].

From January 1979 to December 1988, 18 patients with pulmonary metastases from colorectal cancers were operated in our division. This series included 11 men and 7 women (average age 57 years). The primary cancer was colic in 6 cases and rectal in 12. In 3 cases, the metastases were synchronous and discovered during the initial assessment. In 15 cases, they were metachronous, without symptoms in 12 cases and symptomatic in 3. These metastases were single in 14 cases, multiple in 3, bilateral in 1. They were peripheral in 15 cases. The histological diagnosis was obtained preoperatively in 5 cases (27.7%). The procedures uses were lobectomy for 11 patients, segmentectomy for 1, wedge resection for 10. Postoperative chemotherapy was given to 7 patients. Benign complications occurred in 2 cases during the postoperative period. No perioperative death was noted. One patient was lost to follow-up without recurrence after 1 year, 6 patients died from neoplastic evolution 4, 8, 15, 17, 22 and 28 months after being operated. In May 1989, 11 patients were still living: -2 scheduled for the excision of a contralateral lesion, -2 with pulmonary recurrence. 7 patients were alive without recurrence 12, 14, 17, 46, 52, 68 and 108 months after being operated. The probability of occurrence of pulmonary metastases in the evolution of colorectal cancer is estimated between 20 and 50%. Only 1% of the patients can be treated surgically. When screening these lesions, one must bear in mind that their appearance is sometimes quite delayed, and often asymptomatic. The repeated use of tracers is necessary but not sufficient.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

[Role of coloproctectomy with colonic-anal anastomosis in the treatment of rectal cancer].

The aim of this study was to determine the efficacy and long term results of straight colo-anal anastomosis (CAA) after resection for rectal carcinoma as described by Parks. From January 1986 to June 1989, 40 patients underwent this operation: 27 men and 13 women with a mean age of 63.5 years (range 37-81). In 36 cases, the indication was for carcinoma of mid and low rectum and in 4 cases for carcinoma of the upper rectum associated with a low rectal benign tumour (3 Dukes A, 19 Dukes B, 13 Dukes C, and 5 Dukes D). A diverting colostomy was constructed in all cases. Operative mortality was one patient (2.5 per cent) by pulmonary embolism. Anastomotic dehiscence occurred in four patients. None of these patients required reoperation and all colostomies have been closed. 6 patients presented a local recurrence (15.4 per cent) 6 to 34 months after CAA, of whom two were treated by abdomino-perineal resection. 5 patients died 6 to 34 months after CAA from local recurrence (2 cases) or distant metastasis (3 cases) and one patient has liver disease. All others patients are alive free of disease with a mean follow-up of 21.7 months (range 3-46 months). Actuarial survival is 77 per cent at 40 months. Functional results were assessed in the 26 patients followed up more than one year. The mean stool frequency was 2.4 per day (range 0, 3-6). All patients are continent, with a good discrimination gas-stool. 4 patients (15.4 per cent) suffer from soiling, 5 (19 per cent) from stool frequency, and 2 (7.7 per cent) from urgency. In conclusion, CAA is a good alternative of abdominoperineal resection for some mid and low rectal carcinomas. Functional results might be improved by the construction of a colonic reservoir.

Adenocarcinoma↗
PubMed1989

[Low molecular weight heparin: an real alternative in thrombolysis in hemodialyzed patients. A trial of coronary thrombolysis].

Fibrinolytic treatments pose serious problems in subjects at high risk for hemorrhage, such as those requiring chronic dialysis. A 36-year-old patient requiring dialysis for the last 14 years due to chronic kidney failure was hospitalized for unstable angina combined with calcified mitral stricture. Prompt coronary arteriography revealed recent intracoronary thrombi. The failure of drug treatment and the surgical indication in light of unstable angina led the authors to use low-molecular-weight heparin b.i.d. for 12 days with monitoring of laboratory parameters (anti-Xa activity, APTT). No thrombotic or hemorrhagic episode was recorded. Control angiography indicating partial lysis of the left and right intracoronary thrombi led to exact evaluation of the residual underlying stenoses. A double aortocoronary bypass was subsequently performed combined with replacement of the mitral valve. This case gives a glimpse of the potential value of low-molecular-weight heparin as a valid alternative to conventional fibrinolysis in subjects requiring dialysis.

Adult↗
PubMed1989

Risk factors for myocardial infarction during coronary artery bypass graft surgery.

Patients with a particular thrombotic profile may be at greater risk of myocardial infarction during coronary artery bypass graft surgery. The thrombotic profile of 50 patients admitted to hospital with stable angina pectoris was determined prior to haemodynamic investigation. ECG results and determination of cardiac enzymes showed that 12 patients had suffered a perioperative myocardial infarction. These patients had a higher mean atherosclerotic score (42.1 +/- 10.5 vs 32.9 +/- 13, P less than 0.02), a longer aortic cross clamp time (59 +/- 15.2 vs 45.7 +/- 16.3 min, P less than 0.05), lower serum levels of protein C (101.2 +/- 26 vs 124.7 +/- 31.4%, P less than 0.05) and tissue plasminogen activator (322 +/- 580 vs 2307 +/- 2830 IU ml-1, P less than 0.01). There were no differences between the two groups in Jenkin's coronary score, the number and type of grafts, ejection fraction, left ventricular end-diastolic pressure, lipid profile or levels of markers of platelet release. In addition to a more severe distal coronary atheroma and a longer aortic cross-clamp time, patients with impaired endothelial fibrinolytic activity appeared to be at greater risk of myocardial infarction during coronary artery bypass graft surgery.

Aged↗
PubMed1989

[Surgical excision of the cancer of the stomach after 75 years of age].

A retrospective study of 302 patients hospitalized for gastric adenocarcinoma in the period between 1976 and 1987 revealed that 133 of the patients (44%) were over 75 years of age. In order to bring out the characteristics of stomach cancer in the elderly, these patients were compared with younger subjects, as a comparison with a population of under seventies emphasizes the existing differences. Clinical signs, the time necessary for reaching diagnosis, as well as the evolutive stage of the pathology at the time of diagnosis were the same. The incidence of the intestinal histological type, which has a better prognosis, was significantly higher after the age of 75. Operability was decreased due to contraindications related to the patients' general status. Resectability (86 patients, i.e., 77.2%) did not differ significantly. Complications imputable to surgery did not occur more frequently. Anastomotic fistulas were rare, although invariably fatal in the over-seventy-five group. Overall mortality for excision patients over 75 was 12.8%, and did not rise significantly (or exponentially) before the age of 79. Mortality was 14.3% in case of palliative excision versus 9.8% for curative excision. This parameter was nil for the 48 patients classified ASA 1 and 2, and 30% for the 38 patients classified ASA 3 and 4. In this latter group, it was 20% when the operation was curative versus 43% in palliative surgery situations. Post-surgery survival rates were similar to those obtained for the younger subjects. In conclusion, the course of stomach cancer is the same for both the elderly and younger subjects. This study permits to set up certain rules for excision surgery after the age of 75.

Adenocarcinoma↗
PubMed1989

[Hemorrhagic duodenal ulcer: which procedure should be performed?].

The authors reviewed the emergency treatment of 64 duodenal ulcers operated during the haemorrhagic period in order to evaluate the results of an approach adapted to the site of the ulcer and to the lesions observed. Twenty-four ulcers were situated in the post-bulbar region (37.5%) and need to be considered separately as their anatomical situation and the frequently callous and burrowing nature raise difficult problems in the diagnosis and surgical approach. Conservative treatment (vagotomy, pyloroplasty, direct suture) was possible in 75% of cases. Sixteen gastrectomies (25%) were necessary because of the severity of the duodenal disease with a significantly higher rate in the case of post-bulbar ulcers. The overall postoperative mortality was 25%; it was due to a surgical cause in one half of cases. The surgical morbidity was dominated by recurrent haemorrhages (11%) with 85% mortality. The authors believe that suture vagotomy, which is the basic treatment for bulbar ulcers, also constitutes treatment of choice in the post-bulbar variety when the duodenum appears to be suturable after haemostasis. In the opposite case, duodenal resection is necessary and should extend beyond the ulcer crater. In every case, identification of the common bile duct and the papilla constitutes an essential precaution.

Adult↗
PubMed1989

[Inflammatory and neoplastic esophagotracheal fistula. Intubation or surgery?].

There are two principal aetiologies for oesophago-tracheal fistulae: cancer of the oesophagus opening into the airways and assisted ventilation (tracheotomy or nasotracheal intubation). Oesophago-tracheal fistulae are rare. Over a period of 6 years, the authors have treated 9 neoplastic oesophago-tracheal fistulae in a series of 150 cases of oesophageal cancer and 2 inflammatory oesophago-tracheal fistulae out of a series of more than 20 stenoses of the same nature. The two types of oesophago-tracheal fistulae have the same degree of severity but very different significance, treatment and prognosis: neoplastic oesophago-tracheal fistulae, an advanced, often terminal form of oesophageal cancer, justify palliative treatment to exclude the respiratory tract. Endoscopic intubation of the oesophagus is generally appropriate treatment. Exceptionally, a surgical bypass of the oesophagus may be proposed. Inflammatory oesophago-tracheal fistulae require treatment to restore the continuity of the trachea and oesophagus in patients with respiratory autonomy. In agreement with H. Grillo, we consider treacheal resection-suture and repair of the oesophageal defect to constitute the most satisfactory procedure.

Adult↗
PubMed1988

Serum type III procollagen peptide levels in coronary artery disease (a marker of atherosclerosis).

The known shift in collagen synthesis from procollagen type I to type III in patients with atherosclerosis, suggested measurement of serum procollagen III peptide (PIIIP) levels in patients with coronary artery disease (CAD). Two groups of patients were studied: group I--thirty-six patients with CAD (male, mean age 56.9 +/- 7.5 years, hospitalized for coronary angiography. Risk factors included 16 patients with high blood pressure, four diabetics, 31 smokers and 15 with hypercholesterolaemia. Five patients had no significant lesions, seven had one vessel with over 50% stenosis, 10 had two vessels and 14 had three vessels. Group II--35 patients (male, mean age 39.4 +/- 13.3 years), with normal physical examination and ECG according to WHO criteria, formed the control group: the risk factors included nine patients with high blood pressure, 14 smokers and one with hypercholesterolaemia. Procollagen III peptide levels were determined by radioimmunoassay. In group I, PIIIP levels were 26.8 +/- 16 ng ml-1 vs. 10.4 +/- 3.2 for group II. Sixty-one per cent of group I had pathological levels of PIIIP with an absence of correlation with the severity of atherosclerosis or risk factors. Only 2.8% of patients in group II had pathological levels. Procollagen III peptide determination would appear to be a sensitive, specific and predictive test for atherosclerosis in patients with CAD.

Adult↗
PubMed1988

[Protease inhibitors and ectasia in coronary atherosclerosis].

The possibility of elastase contributing to degradation of the arterial wall in atherosclerosis and to the formation of ectasia has prompted us to assay the main protease inhibitors, alpha 1-antitrypsin and alpha 2-macroglobulin, in patients with angiographic coronary disease with and without coronary ectasia. Serum concentrations of these two proteins were measured by immunonephelometry in 203 patients admitted for coronary arteriography. The results obtained were analyzed according to the presence of atheromatous lesions and their severity and to the presence or absence of ectasia. There was no correlation between the values observed and the presence or severity of coronary atherosclerosis, but the concentration of alpha 1-antitrypsin was significantly higher in patients with coronary ectasia (247.2 +/- 40.5 mg/ml) than in patients without ectasia (213.5 +/- 36.6 mg/100 ml; p less than 0.001). This study shows that coronary ectasia is associated with disturbances in the protease-antiprotease system, which may be consecutive to initial changes in elastase activity. Our results support the theory that elastase and protease inhibitors play a specific role in some atheromatous processes.

Adult↗
PubMed1987

[Oral flecainide in the treatment of refractory arrhythmias. Long-term follow-up of 98 patients].

Oral flecainide was administered to 98 patients with arrhythmias regarded as resistant to other antiarrhythmic agents: quinidines (82), propafenone (40), beta-blockers (30), amiodarone alone (38) or combined with a class I compound (19). Therapeutic effectiveness was assessed on clinical date, repeated Holter recordings (64 patients), exercise tests (8) and electrophysiological exploration (15). Mean follow-up was 11.7 +/- 11 months; the patients treated have now been followed up for 18.2 +/- 12 months (range: 7-58 months). Fifty-three patients had atrial arrhythmia (fibrillation or flutter in 45, atrial tachycardia in 8). Flecainide was effective in 26 patients (49%) and ineffective in 27 (51%). There was no significant difference in dosage between these 2 groups: 231 +/- 62 mg/day and 265 +/- 61 mg/day respectively. Paroxysms of re-entrant junctional tachycardia were controlled in 6 of the 8 cases observed. Eleven patients presented with Wolff-Parkinson-White syndrome: treatment was successful in the 3 patients with atrial fibrillation and in 8 of the 10 patients with orthodromic reciprocating rhythms. Among 30 patients with episodes of ventricular tachycardia, 9 (30%) responded to flecainide and 21 (70%) failed to respond. Flecainide reduced the repetitive forms by more than 90% in 7/15 patients and suppressed exercise-induced ventricular tachycardia in 2/8 patients. Fifteen out of 18 patients had ventricular tachycardia reproducible by programmed stimulation; under flecainide, the ventricular tachycardia spontaneously recurred in 4 cases, was provoked by stimulation in 5 other cases, was more easily inducible in 3 cases and was not inducible in a sustained manner in the last 3 cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

[Effectiveness of double fibrinolytic treatments in subacute deep vein thrombosis of the lower limbs].

The purpose of this study was to evaluate the effectiveness and desirability of a double fibrinolytic treatment in subacute venous thrombosis of the lower limbs. Thirty-four patients (mean age 55.2 +/- 15.4 years) hospitalized for thrombosis of deep lower limb veins were treated with two different fibrinolytic drugs administered successively: 23 patients received streptokinase first followed urokinase, and 11 patients received urokinase first followed by streptokinase. The overall results that improvement of the phlebographic score (Ph.s) was significantly greater in double fibrinolytic treatment (delta Ph.s. = 4.41 +/- 6.45, p less than 0.001) than after a single fibrinolytic treatment (delta Ph.s. = 3.14 +/- 4.76, p less than 0.001). Individual analysis of the results showed that 28% of the patients were improved by a second fibrinolytic treatment. It would appear that two fibrinolytic treatments are truly effective, albeit inconstantly and in most cases partially. We were unable in this study to determine the characteristics of patients likely to benefit from a double treatment.

Adult↗
PubMed1987

[Metabolism of collagen in coronary patients].

The alterations observed in connective tissue of the arterial wall and dermis in atherosclerosis incited us to investigate collagen metabolism in patients with coronary disease. We first studied collagen metabolism in fibroblast cultures, then measured serum levels of type III procollagen aminoterminal peptide. Fibroblast collagen metabolism was investigated in 12 consecutive patients of less than 45 years of age presenting with coronary disease and coronary atherosclerosis was found to be preserved in patients with atherosclerosis, but less type III type I procollagen was synthesized (14.6 +/- 6.6% versus 22.3 +/- 4.3%). This abnormality, found in 83% of our coronary patients, seemed to be unrelated to risk factors or to the severity of atherosclerosis. Serum type III procollagen aminoterminal peptide was assayed comparatively in 36 patients with coronary atherosclerosis confirmed at coronary-ventriculography and in 35 patients free from coronary disease as defined by the W.H.O. criteria. Serum levels of this peptide were significantly higher in patients with coronary atherosclerosis (26.76 +/- 16 ng/ml) than in controls (10.43 +/- 3.18 ng/ml). 61% of coronary patients had a peptide level higher than the normal value (17 ng/ml). No correlation was found between this rise in type III procollagen aminoterminal peptide and the severity of coronary lesions or the importance of risk factors. Thus, collagen metabolism is altered in coronary patients, and this alteration can be detected by a peripheral marker. However, the use of this marker to diagnose the presence or evaluate the course of atherosclerosis requires clarification.

Adult↗
PubMed1985

[Testicular exploration by Doppler ultrasonography in children. Importance, indications, limitations. Apropos of 90 cases].

The authors evaluate the testicular blood flow by Doppler stethoscope in 90 infants and children; they tell two indications: In emergency the most common is "acute scrotal swelling": 78 cases, 4 false negative are reported in diagnosis of torsion of the spermatic cord; the limit of the Doppler examination are the possibility of a interepididymo-testicular torsion and, above all, the inflammation of the scrotal wall. If Doppler examination are in agreement, unnecessary surgical explorations must be avoided. Outside emergency, Doppler examination may be help-full to evaluate varicocele and to control some surgical operation involving spermatic cord (12 cases).

Child↗
PubMedDate not supplied

[Colostomy vs self-expanding metallic stents: comparison of the two techniques in acute tumoral left colonic obstruction].

UNLABELLED: Self-expanding metallic stents is an alternative treatment to colostomy that is the treatment of choice in acute tumoral left colonic obstruction. AIM OF THE STUDY: To compare morbidity, mortality, length of hospital stay and treatment performed after desobstruction using the two methods. PATIENTS AND METHODS: Thirty-three patients admitted for acute obstruction of the left colon were retrospectively separated in two groups depending on the type of intervention performed to treat the obstruction ("colostomy" group: 17 patients and "self-expanding stent group": 16 patients). We studied complications after desobstruction, hospital courses and surgical strategy performed after the acute phase. RESULTS: Time between desobstruction and colectomy was shorter in the "self-expanding stent group" than in the "colostomy group" (18.5 days versus 73 days). Age superior than 75 years and colostomy were the two main factors predicting the risk of definitive colostomy (P < 0.05). Global mean hospital stay was longer in the colostomy group (32.7 days versus 19.3 days, P = 0.02). Two perforations and one local recurrence occurred in the "self-expanding stent group". CONCLUSIONS: Self-expanding metallic stent can decrease the permanent colostomy rate and the number of interventions. The recurrence rate seems to be theoretically increased with the stenting method. Then, colostomy must be done for patients in curative situation. The self-expanding metallic stent should be used as a palliative care.

Acute Disease↗
PubMedDate not supplied

Short- and long-term risk factors for sudden death in patients with stable angina.

Sudden death is most common and often the first manifestation of coronary heart disease although its risk is difficult to predict. It has been studied mainly in patients with severe ventricular arrhythmia or recent myocardial infarction, but little is known about the different risk factors for short- and long-term risk of sudden death in patients with stable angina. To assess risk factors for sudden death in patients with stable angina and angiographically proven coronary artery disease, 319 consecutive patients were recruited prospectively and followed-up. Patients with clinical heart failure or recent myocardial infarction were excluded. Clinical, angiographic and biological variables were recorded. The association between each variable and the risk of sudden death was assessed in univariate and logistic multivariate analysis. There were 25 sudden deaths during the follow-up period (97+/-29 months). The univariate predictors in the short-term (2 years) were: peripheral arterial disease, left ventricular hypertrophy, low density lipoprotein cholesterol and ejection fraction. The independent predictors were: peripheral arterial disease (relative risk: 6.3), ejection fraction (relative risk 1.05) and low density lipoprotein (relative risk: 1.8). In the long-term (8-10 years), body mass index, coronary score, ejection fraction and fibrinogen were univariate predictors. Only body mass index (relative risk: 1. 2), ejection fraction (relative risk: 1.06) and fibrinogen (relative risk: 2) remained independent predictors. The risk factors for sudden death in stable angina were time-dependent, peripheral arterial disease appeared as the best predictor with LDL for short time, and body mass index (obesity: index >27) and fibrinogen for long time. Ejection fraction was the only time-independent predictor.

Adult↗