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Biomedical subjects

G Fradet

Publications and source records attributed to G Fradet.

At least 19 recordsLinked to original sources
PubMed1998

Surgical management of adenocarcinoma of the cardia.

BACKGROUND: The incidence of adenocarcinoma of the cardia is increasing. The surgical management remains controversial. The present study reviews our experience with surgically resected adenocarcinoma of the cardia. METHODS: A retrospective review of 153 cases of surgically resected adenocarcinoma of the cardia was performed. Preoperative radiotherapy was used in 31 patients. The surgical approach, morbidity, mortality, impact of preoperative radiotherapy, and survival were determined. RESULTS: The type of resection performed was a transhiatal esophagogastrectomy in 78%, a transthoracic esophagogastrectomy in 21%, and a transabdominal esophagogastrectomy in 1%. The in-hospital mortality rate was 4%. The frequency of complications was not associated with the use of preoperative radiotherapy or surgical approach. The 1-year (61%), 2-year (38%), 3-year (23%), and 5-year (16%) survival were not affected by the use of preoperative radiotherapy or surgical approach. Survival was significantly associated with stage and the presence of lymph node metastasis. CONCLUSIONS: Adenocarcinoma of the cardia is associated with a poor long-term prognosis. The long-term survival does not appear to be affected by the use of preoperative radiotherapy or by surgical approach.

Adenocarcinoma↗
PubMed1997

Upper esophageal sphincter myotomy in oculopharyngeal muscular dystrophy: long-term clinical results.

From 1980 to 1995, 53 patients with oculopharyngeal muscular dystrophy (OPMD) underwent an upper esophageal sphincter (UES) myotomy for the control of marked dysphagia. From this number, a group of 21 patients had been evaluated for preoperative and postoperative symptoms in 1987. The same clinical assessment was performed in 1995 by an independent evaluator for a total of 37 patients including 12 patients from the first group. As a whole, after a mean follow-up of 6.2 years, surgery succeeded in 18 patients (49%), gave a partial improvement in 12 (32%) and failed in seven (19%). The 12 patients evaluated twice (in 1987 and 1995) have had very good early results, 8-69 months after UES myotomy: dysphagia was totally relieved in eight patients, occurred rarely in three and was moderate in one. Nevertheless, the very long-term follow-up (8 years later) has shown a recurrence of the swallowing and tracheobronchial symptoms in many cases.

Adult↗
PubMed1997

Right outflow tract obstruction by a pedunculated neurofibroma: case report and literature review.

Right outflow tract obstruction due to neurofibroma is rare, with only four cases identified in the world literature. Obstruction due to a pedunculated neurofibroma has never been reported. A 36-year-old woman with no known heart disease presenting with dyspnea, palpitations and chest pain was shown on echocardiogram to have a mobile right ventricular mass. Cardiac catheterization revealed normal coronary arteries and right ventricular outflow tract obstruction by a pedunculated mass, which was surgically removed and histologically proven to be a benign neurofibroma. Following surgery the patient's symptoms disappeared, with no recurrence three years postoperatively.

Adult↗
PubMed1997

Extended lung preservation with platelet-activating factor-antagonist TCV-309 in combination with prostaglandin E1.

BACKGROUND: Ischemia-reperfusion injury is one of the major problems in organ transplantation. The role of platelet-activating factor (PAF) in the pathophysiology of ischemia-reperfusion injury and the protective effect of a novel phospholipid PAF analog (TCV-309) alone and combined with prostaglandin E1 (PGE1) is investigated in an extended (20 hours) ex vivo lung preservation. METHODS: Forty-two swine were divided into three groups. Group A was the control. In groups B and C, the effect of PAF was blocked with TCV-309 administered 1 hour before cross-clamping for donor and recipient. Group C received PGE1 50 micrograms bolus in the donor pulmonary plegia, and the recipients received a 50 micrograms bolus plus 0.003 microgram/kg/min infusion at the time of implantation. Donor lungs were perfused with cold modified Collins solution and maintained in hypothermic storage (4 degrees C) for 20 hours. Hemodynamics, lung mechanics, gas exchange, and biochemistry were assessed before transplantation (donor) and at 30 minutes and 24 hours after reperfusion (recipient). At 24 hours after reperfusion, the histopathologic condition of transplanted lungs was evaluated. RESULTS: Radioimmunoassay demonstrated a significant (p < 0.001) increase in the production of PAF and TXB2 in transplanted lungs at 24 hours after transplantation for group A only. Hemodynamics, gas-exchange parameters, and lung compliance were significantly (p < 0.05) better after transplantation for groups B and C. Wet lung weight was significantly less (p < 0.05) for group C. Semiquantitative morphometric analysis demonstrated the highest degree of damage for group A compared with groups B and C. A strong correlation (r2 = 70) between lung weight and histologic injury scores was observed among groups. CONCLUSIONS: This study suggests that PAF is responsible in part for the deleterious effects of ischemia and reperfusion, that PAF-antagonist TCV-309 protects lungs from extended (20 hours) ischemic injury, and that PGE1 seems to have an additional beneficial effect.

Alprostadil↗
PubMed1996

[Iatrogenic drug-induced diseases, requiring hospitalization, in patients over 65 years of age. 1-year retrospective study in an internal medicine department].

Iatrogenic pathology is mainly seen in the elderly. In a one year retrospective study, we showed that drug toxicity was responsible for 87 cases requiring hospitalisation in patients aged 65 years and above (7.7% of hospital admission for patients over 65 years). The major manifestations were: 21 cases of sera electrolyte disturbance, 19 concerning gastro-intestinal tract and liver, 16 cardiological disorders, 13 neurological complications, ten involving the endocrine system, six hematological complications. The most common drugs involved were: antihypertensive agents (36%), of which 20.5% were diuretics, psychotherapeutic drugs (24.8%), anti-inflammatory drugs (17.8%). The average cost per patient was calculated to 20,602 FF per patient. Impossibility for direct return to the original dwelling place was another complication in 29% of hospitalisations related to iatrogenic disorders. The high number of drugs taken daily increases the risk of drug interactions which was responsible for iatrogenic accidents in 12.6% of the patients of this study.

Aged↗
PubMed1996

Development of a sensitive clinical facial grading system.

Clinicians require a reliable and valid method of evaluating facial function after facial nerve injury. This tool should be clinically relevant and easy to administer, provide a quantitative score for reporting purposes, and be sensitive enough to detect clinically important change over time or with treatment. The proposed facial grading system has all essential information, including precise definitions for each item, presented on one page. The facial grading system is based on the evaluation of resting symmetry, degree of voluntary excursion of facial muscles, and degree of synkinesis associated with specified voluntary movement. Different regions of the face are examined separately with the use of five standard expressions. All items are evaluated on point scales, and a cumulative composite score is tabulated. Construct validity was addressed by comparing the proposed facial grading system to prerehabilitation and postrehabilitation treatment scores of 19 patients with varying degrees of facial nerve injury. All patients had documented change in a controlled study of feedback training. The proposed system reports results in a more continuous manner with a wider response range than the House-Brackmann grades. Each component of the grading system is sensitive to change and individually contributes to a change in the composite score. Tests of interrater reliability are currently near completion.

Facial Expression↗
PubMed1996

[The excision of branchial parapharyngeal cysts by transbuccal or l cervical approach].

Branchial cysts located in the parapharyngeal space are extremely rare; only seven cases were described in the literature between 1927 and today. In Quebec City, two cases were operated on during the last 3 years. Often, many antibiotic and surgical treatments have been inefficiently used, before getting to the correct diagnosis and final curative treatment. We stress the importance of a detailed evaluation of the lesion and of a noninvasive surgery. Magnetic resonance imaging is the primary imaging modality for parapharyngeal space masses, and surgical excision using the transoral approach is advantageous in selected cases.

Adolescent↗
PubMed1995

Gastrointestinal function following esophagectomy for malignancy.

BACKGROUND: The frequency and causes of gastrointestinal complications following esophagectomy for malignancy are unknown. PATIENTS AND METHODS: We reviewed 295 esophagectomies performed for malignancy between January 1980 and September 1994 in order to determine the frequency and causes of early and late gastrointestinal complications. RESULTS: Compared to transhiatal and left thoracoabdominal esophagectomies, esophagectomies carried out through a right posterolateral thoracotomy with cervical esophagogastric anastomosis had a higher incidence of delayed gastric emptying (11%), pneumonia (26%), and hospital death (9%). The same operation had a higher incidence of gastroesophageal reflux (20%) and dysphagia requiring esophageal dilatation (53%). We found no independent effect of gastric drainage procedures, feeding jejunostomy, preoperative radiotherapy, pathology, or age on these outcomes. Women had no operative mortality, but a higher incidence of gastroesophageal reflux and diarrhea following esophagectomy. CONCLUSIONS: Surgical techniques aimed at improving gastric emptying following esophagectomy for cancer should improve operative morbidity and mortality.

Adenocarcinoma↗
PubMed1995

Perforated atherosclerotic ulcer of the aorta presenting with upper airway obstruction.

The authors describe an unusual presentation of penetrating atherosclerotic ulcer of the aorta in an 84-year-old man. The ulcer perforated the aorta, and hematoma extended into the soft tissues of the neck, causing upper airway and esophageal obstruction. The results of autopsy proved the findings of prior chest radiography and computed tomography.

Aged↗
PubMed1994

Pulmonary hypertension associated with primary biliary cirrhosis in the absence of portal hypertension: a case report.

Pulmonary hypertension is well described in association with portal hypertension of any cause including end stage primary biliary cirrhosis (PBC). The essential feature of this association is the presence of portosystemic shunting, including surgically created shunts. A patient with primary pulmonary hypertension and PBC without portal hypertension is reported. This suggests that primary pulmonary hypertension may be associated with PBC in the absence of portal hypertension. Decisions regarding appropriate organ transplantation may depend on whether pulmonary hypertension is primary or secondary to portal hypertension.

Adult↗
PubMed1993

Intratympanic gentamicin instillation as treatment of unilateral Menière's disease: update of an ongoing study.

A prospective study using intratympanic gentamicin instillation as treatment for disabling unilateral Meniere's disease has been ongoing at our institution for 4 years. Treatment effectiveness is evaluated based on the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) 1985 guidelines. This report is based on 30 patients who have become eligible for assessment. We conclude that gentamicin intratympanic instillation as currently used in our protocol is an effective, safe, and easily administered method of achieving a predictable measure of vertigo control.

Adult↗
PubMed1992

Transhiatal esophagectomy for carcinoma of the esophagus and cardia. Experience with 160 cases.

We reviewed our experience from 1979 to 1990 with 160 cases of transhiatal esophagectomy for carcinoma of the lower esophagus and cardia to evaluate trends in patient selection, management, and outcome. Patients treated in the past 6 years (n = 110) and those treated before 1985 (n = 50) were similar in terms of age and sex distribution, medical history, and weight loss. The majority of tumors seen were adenocarcinoma, with patients in the latter group having significantly lower stages. Significant decreases in anesthetic time, units of blood transfusions, chest tube insertions, length of postoperative ventilation, incidence of postoperative pneumonia, and length of hospital stay were seen during the past 6 years. Wound infections increased significantly during the same period. The decrease in the 30-day mortality rate from 6% to 0.9% was not significant. Survival rates did not differ between groups, with overall rates of 62%, 40%, and 21% at 1, 2, and 5 years, respectively.

Adenocarcinoma↗
PubMed1992

Esophagogastrectomy and the variant left hepatic artery.

A variant left hepatic artery occurs at a rate of approximately 10%. In standard esophagogastrectomy and some proximal gastric operations this variant artery is sacrificed, which has led to reported fatalities secondary to hepatic necrosis. We report our method of esophagogastrectomy in the presence of an aberrant left hepatic artery.

Esophagectomy↗
PubMed1992

Structural valve deterioration in elderly patient populations with the Carpentier-Edwards standard and supra-annular porcine bioprostheses: a comparative study.

From 1975 to 1989, over 1400 patients in the elderly population and over 1700 patients under 65 years of age received the Carpentier-Edwards standard (CE-Standard) and supra-annular porcine (CE-SAV) bioprotheses. The mean ages of the patients receiving the two protheses within the three subgroups of the elderly population-65-69 years, 70-79 years, and 80 years and over-were relatively similar. There was no statistically significant difference in the performance of the prostheses regarding structural valve deterioration (SVD) at seven years. The freedom from SVD for aortic valve replacement in the 65-69 years group at seven years was 98.7% +/- 1.3% for the CE-Standard and 98.7% +/- 1.0% for the CE-SAV, for both the 70-79 years group and the 80 years and over group the figure was 100% for both prostheses (p = NS). The freedom from SVD after mitral valve replacement in the 65-69 years group at seven years was 90.0% +/- 4.3% for the CE-Standard and 84.8% +/- 7.5% for the CE-SAV, for the 70-79 years group it was 95.3% +/- 3.2% and 95.5% +/- 3.6% respectively and for the 80 years and over group the figure was 100% for both prostheses (p = NS within groups). The long term freedom from SVD after aortic valve replacement was 98.4% +/- 3% at 15 years for the CE-Standard in the 65-69 years group, 94.9% +/- 5% at 13 years for the 70-79 years group and 100% at 13 years for the 80 years and over group.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Distribution↗
PubMed1990

Management following heart and lung transplantation: five years experience.

Since April 1984, 70 patients have received heart-lung transplants at our institution. Actuarial survival is 76% at 1 year and 68% at 2 years. All but 4 surviving patients have an unrestricted life style. Rejection was confirmed by lung transbronchial biopsy (TBB) on 277 occasions in 66 patients. Forty-two percent of episodes occurred within 1 month of surgery. Eight patients have developed evidence of chronic rejection with progressive irreversible fall in FEV1, of whom 4 have died or undergone single lung retransplantation. Seven patients had primary cytomegalovirus (CMV) of whom 4 patients died. Eight patients developed pneumocystis pneumonia of whom 1 died. Seven episodes of herpes simplex pneumonitis occurred of which one episode was fatal. Heart-lung transplantation is a valuable treatment for terminal cardiopulmonary disease and offers increasing hope of long-term survival.

Biopsy↗