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Biomedical subjects

F R Pruvot

Publications and source records attributed to F R Pruvot.

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

[Delayed appearance of left Bochdalek hernia disclosed by intrathoracic gastric perforation].

Late onset congenital diaphragmatic hernia is a rare condition that is difficult to diagnose. Complications such as intestinal obstruction and digestive perforation may occur. A previously healthy three year-old girl was admitted to hospital with dehydration, shock, and ketoacidosis. A chest X-ray film showed a left hydropneumothorax with an indefinable left diaphragm, that was confirmed by ultrasonography. Hexabrix introduced through a nasogastric tube showed opacification of the left hemithorax attributed to an intrathoracic gastric perforation. She recovered after surgery. Gastrointestinal complications of delayed congenital diaphragmatic hernia must be promptly recognized since surgery should not be delayed.

Child, Preschool↗
PubMed1990

[Surgical treatment of gastroesophageal reflux by modified Hill's posterior cardiopexy. Apropos of 441 cases].

Between 1972 and 1986, 490 modified Hill's procedures were performed for gastro-esophageal reflux; 441 cases were retrospectively studied consisting of 245 males and 196 females, aged from 4 days to 83 years, with a mean age of 41 years. Average duration of gastrointestinal symptoms was 5.4 years. The proposed technique is described, allowing cardiopexy without intraoperative manometry. Mortality was 1.4% (6 cases); one death was due to surgery. Morbidity was 5.4% (24 cases). With a mean follow-up of 5.2 years, a clinical cure was obtained in 93.5% of cases. Causes of failures were analyzed: the only possible pre-operative factor was the presence of peptic stenosis. Pylorospasm appeared to be a post-operative cause of failure. The 28 patients for whom surgery failed were medically treated (18), dilated (5) or reoperated (5). Three new cardiopexies and 2 fundoplications cured the last 5 patients with a mean follow-up of 5.8 years. Recurrences of symptoms and discoveries of failure were generally detected early after the operation: 20 before 6 months (71%), 1 between 6 months and 1 year, 2 between 1 and 2 years, 3 between 3 and 4 years, 1 between 4 and 5 years.

Adolescent↗
PubMed1990

[Cervico-mediastinal inflammatory pseudotumors due to esophageal perforation by foreign bodies].

Two patients suffered from superior mediastinal masses producing pain and dysphagia. They were investigated using imagery and endoscopy without a definite diagnosis being made. It was finally decided to perform a cervical exploration in both cases and this enabled a diagnosis of perforation of the oesophagus and pseudo-tumoral abscess to be made. The foreign body responsible was found in one case. The symptoms and signs of oesophageal perforation by foreign body may be misleading when they are chronic or delayed. There remains a place for surgical exploration when other methods have failed.

Abscess↗
PubMed1989

[The lung in brain death. Anatomo-biological correlations for pulmonary transplantation].

Histopathological studies of the lung conducted during multiple organ procurement from 25 subjects in a state of brain death showed that 19 of them had lung lesions pre-existent to coma, viz. alveolitis and lung invasion by dusts increasing with the subject's age. Alveolar or interstitial emphysema and subpleural bullae caused by mechanical ventilation were present in 19 cases; signs of bronchial inertia were found in 6 cases and established superinfection in 3 cases. Finally, 17 subjects showed interstitial and vascular alterations induced by oedema and shock which were related to the time spent in intensive care units, to the cause of the coma and to the quantity and quality of intravenous received while in intensive care unit. There were histological correlations between these various factors, but precise criteria concerning the functional prognosis of the transplant could not be defined. However, this study seemed to confirm the need for a new approach to the intensive care of brain-dead subjects during lung procurement: the time elapsed before procurement should be shortened, the amount of medicinal solutions administered should be reduced, Ringer lactate and packed cells should be used in preference to albumin derivatives, and arterial blood pressure, rather than diuresis, should be maintained.

Adult↗
PubMed1989

Gastro-oesophageal reflux and respiratory disorders treated by Hill's procedure.

A retrospective review of 132 patients with respiratory disorders associated with gastrooesophageal reflux is presented. The patients were operated upon according to Hill's technique. In 66 infants and children, recurrent lung infection was the most frequent indication for surgery. The mean duration of respiratory symptoms was 17 months. In 66 adults, asthma was the most frequent indication for surgery. The mean duration of respiratory symptoms was 9.7 years. Suppression of reflux was obtained by operation in 95% of infants and children, with disappearance of respiratory disorders in 78.6% and clinical improvement of symptoms in 16.4%. Suppression of reflux was confirmed in 94% of adults, with disappearance of respiratory disorders in 36% and improvement of symptoms in 28%. The correlation between disappearance of reflux after surgery and cure of respiratory disorders in infants and children must be seen in the light of the natural history of lower oesophageal sphincter maturation. Nevertheless, surgery shortens the period of risk in life-threatening situations. In adults, one patient out of two benefited from operation. Failures were more frequent in asthma and there was no characteristic type of asthma associated with reflux.

Adolescent↗
PubMed1989

[Should a cancer of the bronchi be surgically treated after excision of a cerebral metastasis?].

Between 1964 and 1987 35 patients were operated on for cerebral metastases due to an underlying bronchial carcinoma. In 26 cases (group 1) there was excision of the primary tumour also and in 9 cases combined medical treatment was given with radiotherapy and chemotherapy. The neurological state was improved by the neurosurgical operation in 88% of patients in group 1 and in 66% of patients in group 2. This improvement was maintained in 30% of the patients as long as they survived. 2 patients died following thoracic surgery (7.69%). The median survival was 11 months in group 1 and 9 months in group 2. Three patients in group 1 were living two years after craniotomy whilst. 1 patient in group 2 is still alive four years after the neurosurgical procedure. The heterogeneity of the two groups does not permit a comparative statistical analysis but overall there does not seem to be any difference in duration or quality of life between the two groups. Complementary cerebral radiotherapy did not affect the prognosis.

Adult↗
PubMed1989

[Respiratory signs associated with gastro-esophageal reflux. A retrospective study of 132 surgically treated cases in children and adults].

We carried out a retrospective study of 132 cases of respiratory disorders associated with gastro-oesophageal reflux involving 66 children, 42 boys and 24 girls, 4 days to 10 years old with a mean of 22 months. We also studied 66 adults, 37 men and 29 women, 16 to 74 years old. In the infants the mean duration of respiratory disorders was 17 months and a recurrent broncho-pulmonary infection was the principal indication (40 cases). Alimentary symptoms were present in 34 cases. There was evidence of reflux in 60 cases. The suppression of any reflux was obtained surgically in 95% of cases with a disappearance of the respiratory disorders in 78.6% of cases and their improvement in 16.4% of cases with a mean follow up period of 4.3 years. In the adults the mean duration of the respiratory disorders was 9.7 years and asthma was the principal cause (38 cases). Alimentary symptoms were present in 56 cases with evidence of reflux in 64 cases. A suppression of the reflux was achieved surgically in 94% of cases with a disappearance of the respiratory disorders in 36% of cases and their improvement in 28% of cases with a mean follow up period of 4.7 years. The correlation between the disappearance of reflux and the respiratory symptoms and signs in the children should perhaps be tempered by the natural history of the maturation of the inferior oesophageal sphincter. However surgery shortens the danger period in serious situations which are life threatening.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1989

[2 cases of villous tumor of the appendix].

Villous tumors of the vermiform appendix are uncommon with two cases and a review of the literature, the authors indicate the lack in specific clinical sign, and lay stress on the importance of the pathologic study on the therapeutic management.

Adenoma↗
PubMed1989

[Congenital cysts of the esophageal wall with a respiratory type mucosa].

Eight patients with congenital esophageal cysts are described. They presented with respiratory or gastrointestinal symptoms or an abnormal mediastinal profile on a standard chest film. All cysts were contained in the middle or inferior portions of the thoracic esophagus. They were excised in a submucosal plane. Their coat was composed of a ciliated, respiratory type epithelium. In the embryo and after separation of the tracheal diverticulum, the esophagus is lined with ciliated cells which are able cover a "cystic duplication", which is surrounded by an esophageal muscular coat or can be "included" in a common mesenchyma, which explains the possible presence of bronchial elements in the wall of an esophageal cyst. In this eventuality the cyst may be defined as being "bronchogenic".

Adult↗
PubMed1988

Lympho-epithelial thymomas. A retrospective study of 88 resections.

Of 113 lympho-epithelial thymomas retrospectively studied, 56 were epithelial, 20 lymphocytic, 30 mixed and 7 were undefined forms. There were 88 resections (20 stage I, 47 stage II, 13 stage III and 8 stage IV). There were 69 primary resections (followed by radiotherapy in 54 cases) of which 57 were complete and 12 were incomplete. There were 19 secondary resections after radiotherapy: 10 were complete and 9 were incomplete and 25 patients were not operated upon and were treated by radio- and chemotherapy. After primary resection, the actuarial 5-year survival is 64.07% and the 10-year survival is 50.86%. After a secondary resection, the 5 year-survival is 43.74%. After non-surgical treatment, it is 18.67%. After surgery, the prognostic importance of staging is confirmed as more important than the cellular structure. Myasthenic patients are subject to late accidents. Postoperative radiotherapy seems to be justified, but its effect is not statistically significant when resection is complete. Post-radiotherapy surgery is beneficial only in cases of complete resection. The metastatic evolution of thymomas has been underrated and seems to depend upon the local control of the tumour. The use of chemotherapy remains to be defined.

Actuarial Analysis↗
PubMed1988

[Lympho-epithelial thymoma. Anatomo-clinical and therapeutic study of 113 cases].

One hundred and thirteen cases of lympho-epithelial thymomas were studied retrospectively: 56 were of epithelial type, 20 of lymphocytic type, 30 were mixed and 7 were not defined. Eighty-eight were operated on (20 stages I, 47 stages II, 13 stages III and 8 stages IV). There were 69 primary resections (57 complete and 12 incomplete), followed by radiotherapy in 54 cases and 19 secondary resections after radiotherapy (10 complete and 19 incomplete). Twenty-five patients did not have an operation and were treated with radio- and chemotherapy. After primary resection the actuarial survival at 5 years was 64.07% and at 10 years 50.86%. After a secondary resection it was 43.74% at 5 years. After radiotherapy it was 18.67% at 5 years. In operated cases the prognostic importance of staging was confirmed. The cytological structure was not. In myasthenic cases the secondary respiratory complications worsened the prognosis. Post-operative radiotherapy seems to be justified in all cases, but its effect is not statistically significant when resection was complete. Those operated after radiotherapy only showed a benefit if the resection was complete. The outcome of metastatic disease in TLE has been under-estimated and seems to depend on local control of the tumour. The use of chemotherapy remains to be defined.

Adolescent↗
PubMed1987

[Surgery of giant bullae of emphysema in adults].

Over a 20 years period 50 patients with giant emphysematous bullae (bilateral in 20 cases) were operated upon. Fifteen had been exposed to an occupational risk (coal mining, steel milling, chemicals); all were, or had been, tobacco smokers; 11 were in acute respiratory distress at the time of surgery. Respiratory function tests showed mixed restrictive and obstructive impairment. Ten patients had chronic cor pulmonale. There were 8 post-operative deaths, 4 of them with right-sided heart failure. Mortality was highest in patients with bilateral lesions and in emergency situations. Late complications involved the lungs in 10 cases and the heart in 2 cases. The results of pre- and post-operative lung function tests could be compared in 13 patients.

Aged↗
PubMed1987

Peptides of human bronchial mucus glycoproteins. Size determination by electron microscopy and by biosynthetic experiments.

Secreted human bronchial mucins, directly collected from macroscopically healthy bronchial mucosa, were prepared in the presence of six proteinase inhibitors, and analysed by electron microscopy. These mucins were similar in length distribution to molecules prepared from sputum [Slayter, Lamblin, Le Treut, Galabert, Houdret, Degand & Roussel (1984) Eur. J. Biochem. 142, 209-218], although they were a little longer, their lengths ranging up to about 1,650 nm. This length corresponds to an extended mucin peptide of about 450 kDa. In order to compare these peptide lengths with the molecular size of biosynthetic precursors, an antiserum raised against trifluoromethanesulphonic acid-treated highly glycosylated regions of human bronchial mucins was used to isolate mucin precursors synthesized in explants of human bronchial mucosa during pulse-labelling with [3H]threonine or [3H]glucosamine. A main precursor labelled with [3H]threonine and with an apparent molecular mass of about 400 kDa was detected by fluorography following SDS/polyacrylamide-gel electrophoresis. This band was observed as early as 20 min; it was more intense after a 40 min chase and had disappeared after a chase period of 280 min in unlabelled medium, presumably owing to glycosylation. Much fainter bands at about 200 kDa and between 200 and 400 kDa, also labelled with [3H]threonine, were observed mainly after a 40 min chase and had disappeared after a 280 min chase. None of these bands was labelled with [3H]glucosamine, nor did they disappear after multiple treatments with immobilized lectins. After a 280 min chase, [3H]threonine-labelled material appeared in the stacking gel, which also contained [3H]glucosamine label. The results indicate that the 200-400 kDa species are mucin precursors, whose size is comparable with that obtained by electron microscopy for respiratory mucins collected directly from the macroscopically healthy bronchial mucosa.

Bronchi↗
PubMed1987

[Diffuse pulmonary contusion].

Seventy-two cases of diffuse pulmonary contusion, 50 of which concerned multiple injury patients, are retrospectively described. The pleuro-parietal and associated lesions, the clinical, radiological and laboratory findings and the extent of the damage are analyzed. Treatment of shock (50 cases), mechanical ventilation (51 cases), thoracotomy (7 cases) and surgery of associated lesions are studied. Morbidity and mortality (34.7%) are detailed. The nosology of pulmonary contusion is discussed in relation to several factors, including shock, perfusions and associated lesions. The principles of treatment are restated. The most important complication is pulmonary superinfection. Diffuse pulmonary contusion is a serious condition. Associated lesions and their treatment contribute to its outcome.

Adult↗
PubMed1987

Barrett's esophagus and adenocarcinoma.

Sixty-two cases of Barrett's esophagus were observed among 707 patients with hiatal hernia (8.7%). The symptomatology of this condition is described. An additional 10 adenocarcinomas were associated with a Barrett's esophagus--a carcinoma prevalence of 13.8%. Differences in pathology and clinical manifestations of nonmalignant and malignant cases were determined. Fifty-one patients with nonmalignant Barrett's esophagus were operated upon conservatively, while 11 underwent resection. Our results favor conservative surgery via an abdominal approach. The patients with adenocarcinomas underwent esophageal resection with six apparent cures from 6 months to 5 years. Histological study showed specialized epithelium in 8 of 10 cases and severe dysplasia in 5. Our clinical study of Barrett's esophagus shows an incidence of malignancy equal to 1 new case per 274 patient-years (1.72%). It is still not firmly established whether correction of reflux will influence the level of columnar epithelium in the esophagus, esophageal dysplasia, and the risk of malignancy.

Adenocarcinoma↗
PubMed1987

[Splenic complications of chronic pancreatitis. Clinical and experimental study].

Splenic complications of chronic pancreatitis appear to be less exceptional than is usually accepted, particularly since preoperative diagnosis has been facilitated by ultrasound and abdominal scan imaging. Complications noted in 37 cases were: infarcts (2 cases), hematoma or false blood cysts (26 cases) and rupture (9 cases). The splenic infarcts were revealed by digestive hemorrhage, the false blood cysts of spleen by a painful mass in left hypochondrium associated with pleural effusion and rupture of spleen by an acute hemoperitoneum. Treatment included splenectomy in 19 cases, splenectomy caudal pancreatectomy in 17 cases and drainage of a splenic hematoma in one patient. Operative mortality was 16.2% and the long-term prognosis was poor and related to underlying condition. Data from an experimental study suggest that the effect of an episode of acute pancreatitis on the splenic pedicle is the most important physiopathologic factor. A hemorrhagic infarct or infarction of splenic parenchyma are common starting points for all clinicopathologic forms described.

Animals↗
PubMed1987

[Pure bronchial adenoma. Anatomico-clinical and ultrastructural study of a case].

We report a case of monomorphic bronchial cystadenoma (or mucous gland adenoma). This exceptional tumor (only 34 cases reported up to now) is benign, but a lobectomy is often necessary because of severe inflammatory lesions of the surrounding lung. Ultrastructurally it was different from the other tumors of bronchial glands, since it contained mucous cells, myoepithelial cells, and oncocytic cells, and the basement membrane was thickened.

Adenoma↗