Biomedical subjects
Publications and source records attributed to D Louis.
The authors report one case of omentum fistula after an earlier amniocentesis. It is an uneventful complication which has not yet been described. Based on the study of the literature, they describe the different fetal's trauma which have been encountered.
The authors study the incidence of urethral strictures after transurethral resection of prostate. A retrospective study of 135 patients and a prospective study of 187 patients found respectively 74% and 3.2% of urethral stenosis. Two important data are seen in this study, the duration of urethral catheter of 24 hours post operatively and the internal urethrotomy when they found a pathologic urethra pre operatively reduce the incidence of urethral strictures. With a normal urethra pre operatively and 24 hours of urethral catheter post operatively, any stenosis occurred, equally when an internal urethrotomy is done with a pathologic urethra pre operatively.
The review of the literature and our study of 15 tumors in bladder diverticula (IDT) show us that these tumors are rare and mainly observed in elderly adult males. Bleeding is the major symptom. Diagnosis is difficult and treatment is not well defined. Prognosis is good for low stage tumors and catastrophic in the short term for high stage tumors. Nearly half of IDT were primary tumors, and one third of them stay primary until death of the patients. Most of the high stage tumors contained a squamous cell differentiation and all the tumors with these features were deeply invasive. The bad prognosis is mainly related to the difficult and delayed diagnosis, with a long symptomatic period, regardless of treatment. This emphasizes the need for further investigations (biopsies, sonography, computer tomography) when the diagnosis is not evident. The treatment of these tumors depends on the general status of patients and the volume and stage of tumors. Low stage tumors (Ta) and diverticula could be treated either by transurethral resection or by open surgery with good results. In (T1) tumors, only open surgery is recommended to avoid loco-regional relapse. High stage tumors (greater than or equal to P T3) were treated by either TUR or open palliative surgery with the same bad prognosis. No radical treatment was indicated since patients have a bad performance status and most of the tumors extended beyond the diverticulum. Adjuvant treatments were not helpful. While preventive diverticulectomy is to be discussed case by case, we think that an important step in improving the prognosis of these tumors is to make the diagnosis at an earlier stage.
The authors report three cases of cystic tumors of the kidney: one benign papillary tumor and two renal cell carcinomas. Although the clinical features were atypical, the authors emphasize the role of computer tomography which make easier the diagnosis of these scarce tumors. When the diagnosis is doubtful a guided needle biopsy is recommended.
The authors study the incidence of urethral strictures after transvesical prostatectomy. A retrospective study of 90 patients and a prospective study of 78 patients found respectively 2% and 0% of urethral stenosis. The important data of this study is the duration of urethral catheter post operatively.
The authors report their experience with 37 patients treated by internal urethrotomy for urethral strictures. The results were appreciated on urethral calibration and flow rate after a median follow-up of 33,5 months and a minimal follow-up of one year. The rate of satisfying results was 78,3%. The authors emphasize the need of dilatations associated to low-doses of cortico-steroids in the post-operative period during the first three months, to improve the results.
Six neonates with midgut malrotation and volvulus were explored with ultrasonography before surgery. In each case, ultrasound detected an abnormal position of the superior mesenteric vein with regard to the superior mesenteric artery, indicating a midgut malrotation. In 4 patients, a propeller-like image was present around the superior mesenteric axis, demonstrating an associated volvulus. In 2 patients, there was a tumor-like presentation of the volvulated small intestine. Compared to the intestinal opacification, ultrasound seems to be a simple and rapid method to explore the neonate with vomiting or acute abdomen.
The aim of this study was to describe the etiological, clinical, rectoanal manometric findings as well as the results of biofeedback therapy in a series of 65 patients (34 males, 31 females, aged between 5 and 77 years) presenting with severe primary constipation due to pelvic abdominal asynchronism. Pelvic abdominal asynchronism was statistically more frequent in males during childhood and in female patients during adult life (p less than 0.005). This study disclosed a high frequency of psychogenic factors in the onset of pelvic abdominal asynchronism (26 p. 100) as well as a high frequency of soiling (46.2 p. 100) in constipated patients. In 36.2 p. 100 of cases, pelvic abdominal asynchronism was the only abnormality. In contrast, in most of the patients, asynchronism was associated with miscellaneous rectoanal disorders: increased anal closure pressure (43.3 p. 100), decreased anal closure pressure (11.8 p. 100), impaired rectal conscious sensitivity (11.7 p. 100), and increased rectal compliance (31 p. 100). This study demonstrated that when high-fiber diet and laxatives fail, biofeedback therapy is a very interesting alternative, providing 80 p. 100 of good results in selected cases. However, we were unable to find any clinical or manometric parameters predictive of results of treatment. Follow-up studies are needed to determine long-term results of biofeedback training.
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The prognosis of high risk congenital diaphragmatic hernia and eventration diagnosed in the early neonatal period (before 24 h) is studied based on a series of 64 cases. Eventration has a poor prognosis with 5 deaths out of 7 cases. The replacement of the hemidiaphragm by an abdominal muscular flap seems to be the best surgical procedure (2 recoveries on 4 cases). A high mortality rate remains in the diaphragmatic hernias which are undiagnosed before birth. Out of 54 operated cases with systematic homolateral drainage, there were 35 survivors (65%). Post-operative alveolar-arterial PO2 difference less than 53 kPa appears to be a reliable criterion of good prognosis with a survival rate of 91% in this series. Thus, despite major progresses in post-operative resuscitation, the recovery rate in high risk neonatal congenital diaphragmatic hernia and eventration is only 75%. This seems to be partly related to the existence of lethal forms due to bilateral pulmonary hypoplasia and structural anomalies of the pulmonary arteries.
In 210 surviving cases of oesophageal atresia treated by anastomosis, 34% presented a gastro-oesophageal reflux. Half of these patients needed surgical treatment of the reflux to prevent complications.
Hepatic vascular changes are generally associated to fibrotic lesions of the liver but their role in the development and extension of fibrosis is not well known. By performing a portacaval anastomosis in rats, a proliferation of hepatic vessels was attained progressively, comparable to proliferations seen in cirrhosis and schistosomiasis. Such a modification of the hepatic vasculature was accompanied by changes in the connective matrix of the liver, mainly related to the vascular walls. Moreover, sinusoidal capillarization was detected at the electron microscopical level whereas no alterations could be seen neither in the distribution nor in the quality of the connective matrix proteins with immunofluorescence technique. The only modification detected by light microscopy, at this zone, was the shrinked aspect of reticulin fibers which could be related to the important liver atrophy provoked by the anastomosis. It can be assumed that in liver pathology, selective changes occur in the connective matrix components depending on the type of injury. Necrotic and inflammatory processes lead mainly to the deposition of interstitial collagens and associated proteins, related to a diffuse stroma reaction resultant from activation of specific cell populations whereas in portacaval anastomosis, a selective increase of vascular connective matrix (mainly basement membrane components) occurs as a direct consequence of vessel proliferation.
Surgical bile flow restoration in extrahepatic biliary atresia (EHBA) does not prevent the development of ongoing hepatic fibrosis and cirrhosis. Portal connective matrix was studied on liver biopsies obtained from seven children submitted to portoenterostomy. Electron microscopy and immunohistochemical techniques (using specific antibodies directed against collagen isotypes and associated glycoproteins) were performed. The study of extracellular and cellular components of connective matrix demonstrated the existence of two distinct areas according to their situation with regard to ductular proliferation: loose connective matrix--mainly composed of fibronectin, type III collagen, type IV collagen and laminin--associated with microvessels and myofibroblasts proliferation characterized periportal zones adjacent to bile ductules; in areas distant from ductular proliferation, connective matrix appeared dense, composed of type I and type III collagen associated with fibroblasts. The connective matrix pattern observed in periductular areas can be compared to that described in cicatricial and hypertrophic processes where the myofibroblastic cell population is known to play an important role in fibrosis development. Although the connective matrix activation process remains unclear in EHBA, it may be suggested that activation of a connective tissue cellular clone might be responsible for this portal fibromatosis.
The authors report a case of respiratory distress secondary to inhalation of meconial amniotic fluid treated by mechanical ventilation, which was complicated by severe interstitial emphysema. Treatment by pleurotomy allowed a favorable evolution. The various therapies of interstitial emphysema of the neonate, in particular surgical technics are described.
We report the cases of two siblings, both suffering from familial hypercholesterolemia in homozygotic form, followed up before and after portacaval shunt. A total parenteral nutrition failed to decrease plasma cholesterol levels. However, on the basis of clinical data, a portacaval shunt was performed at the age of seven and five and a half. The two patients showed great effectiveness of the shunt with dramatic regression of clinical signs, reduction of plasma cholesterol, without serious complications over a five to six years period after the shunt.
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The 247 eventrations operated upon concerned 230 patients (60% women and 40% men) mean age 54.5 years. Eventrations were large (collar greater than 10 cm) in 18, 5% and were in the median line in 81%. Serial laparotomies by the same approach had been performed in 21%, the principal causes of eventration being biliary and gynecologic surgery. Parietal sepsis developed in 31,5% of cases after operation for the original affection. Classical favoring factors found included obesity (51%), multiparity (42% of women) and chronic lung disease (14%). Preoperative preparation involved the use of Goni Moreno's progressive pneumoperitoneum in 18,5% of patients. Procedures used were parietal repair by raphe (22%), the same but with the addition of a dacron prosthesis (6%) or the large dacron tulle prosthesis for wide reinforcement of the visceral sac (67% of cases). Early sepsis was a slightly more frequent occurrence after dacron tulle, predisposing factors being the prosthesis itself, a previous history of parietal sepsis, swabs and the number of Redon tubes. After use of dacron tulle complications were mainly also hematoma (3.2%) and skin necrosis (2,6%). Postoperative course in general was uncomplicated in 91% of the 247 operations. Follow up of 67% of operated patients for a mean of 5 1/2 years showed recurrence in 50% of raphe procedures and 18.5% of prosthesis implantations; factors of aseptic recurrence (16,5%) were multiparity and chronic lung disease. Delayed sepsis after dacron tulle use affected 8% of patients and were related to chronicity of early sepsis, nonresorbable sutures and sepsis complicating the primary laparotomy. Doming of the parietal wall was noted in 4% of cases repaired by prosthesis.(ABSTRACT TRUNCATED AT 250 WORDS)
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