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Biomedical subjects

G Michotey

Publications and source records attributed to G Michotey.

At least 19 recordsLinked to original sources
PubMed1993

[Analgesic effect of transhiatal splanchnectomy in pain from cancer of the pancreas. Apropos of 51 operated cancers].

The greater splanchnic nerves are responsible for sympathetic innervation of the supra mesocolic viscera, and total bilateral neurotomy is efficient to relieve pancreatic pain. Their dissection is easy by a midline transperitoneal route used for pancreatic cancer surgery. The aim of this study was to evaluate the pain relief related to transhiatal bilateral splanchnicotomy in patients with pancreatic cancer. The tumor was unresectable for all the patients, and nobody was operated only to make neurotomy. Twenty two patients had single bilateral splanchnicotomy, and other had an associated biliary and/or digestive diversion. There was not postoperative specific mortality, and postoperative mortality rate was 3.9%. Specific postoperative morbidity rate was 6%. Most of the patients (83.3%) had immediate pain relief, with or without diversion (respectively 80.7% and 86.3%, p = 0.6). Our data suggest that pain recurs for some patients three months after surgery (pain control in respectively 69.2% and 72.7%), but difference was not significant (p = 0.14). Our results demonstrate that transhiatal bilateral splanchnicotomy relieves pain in patients with pancreatic cancer, with a poor specific morbidity.

Adenocarcinoma↗
PubMed1992

Transhiatal bilateral splanchnicotomy for pain control in pancreatic cancer: basic anatomy, surgical technique, and immediate results in fifty-one cases.

The greater splanchnic nerves are largely responsible for innervation of the supramesenteric viscera; their section is known to be efficient to relieve pancreatic pain. Transhiatal splanchnicotomy (THS) is easily performed through a midline laparotomy. The nerve trunks are readily identified in the submediastinal space, far from the pancreatic cancer motivating splanchnicotomy, and can be sectioned safely and completely. After carrying out an anatomic study to determine the level of origin and mode of constitution of the greater splanchnic nerve trunk and its relations to the posterior and lower mediastinum, 51 patients underwent THS for intractable pain caused by unresectable pancreatic adenocarcinoma. THS alone was performed in 22 cases. THS was performed in association with biliary tract diversion or gastroenteroanastomosis in the other cases. All tumors were considered unresectable during surgery, and no patient was operated on with the sole purpose of performing THS. Two deaths (3.9%) were unrelated to THS. Specific morbidity was 6% (one pneumothorax, one chylothorax, and one splenic injury). Immediate postoperative functional results were good in 86.3% of patients treated by THS alone (group 1) and in 80.7% of patients treated by THS and bypass (group II). Functional results decreased to 72.7% in group I and 62.1% in group II, 3 months after surgery. In conclusion, THS appears to be an efficient technique for relief of pancreatic neoplastic pain and need not be combined or confused with medical percutaneous methods of neurolysis.

Aged↗
PubMed1990

[Immediate and late results of surgical treatment for chronic pancreatitis. Apropos of 127 operated cases].

From 1960 to 1987, 127 patients (105 males and 22 females, mean age: 45.9 years) underwent surgical treatment for CP. The aim of this study was to assess the results of surgical treatment intentionally oriented towards conservative surgical procedures (CPS). Ninety-one patients benefited from either pancreato-intestinal bypasses (84 cases) sometimes associated with other intestinal bypasses and/or transhiatal splanchnicotomy (THS) or isolated biliary (5 cases) or gastric (2 cases) bypasses. Thirty-one resections were carried out: 26 pancreatoduodenal resections (PDR) associated 3 times with TSH and 5 distal pancreatectomies. Other types of conservative treatment were performed in 5 cases. There were 5 post-operative deaths (3.9%): 1 after resection (6.6%) and 4 after CSP (p greater than 0.7). Postoperative complications occurred twice after resections (6.6%) and in 13 cases (16.2%) after CSP (p greater than 0.3). A further surgical procedure was required in 3 cases after pancreatic resection (3/25.12%) and in 14 cases after CSP (14/71, 19.7%) (p greater than 0.5). In the late postoperative course 15 deaths occurred but only 6 of them were directly related to the course of the pancreatitis. Five and 10 year overall survival probability after surgical treatment was respectively 81.5% and 64.7%. This probability was 70.4 and 60.4% after resections and 87.1% and 68.8% after CSP (p = 0.29). After CSP 75% of good functional results were observed between 1 and 4 years and 60% afterwards. Although non statistically significant these results suggest that: CSP and resections have the same operative risk, late reoperations are more frequent after CSP, the chance of late survival rate is better after CSP than after resection.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1989

[Cancers of the sigmoid and upper rectum extending to the bladder or ureter, treated by monobloc resection. Apropos of 13 cases].

The aim of this retrospective study is to assess the operative and functional risks and the results of "en bloc resection" performed for tumors of the sigmoid colon or of the rectum extending to the bladder. Thirteen patients required this resection, the sigmoid was involved in ten cases, the rectum in three. The urinary tract involvement was an operative finding in ten cases, while recurrent cystitis was observed in three cases. This extension reached the dome of the bladder in 11 cases, and the terminal portion of the ureter in 2 cases. All the patients underwent curative "en bloc resection" including colectomy and partial cystectomy or cysto-ureterectomy: operative mortality was 7.6%. Precise histological staging of lymph node and bladder involvement was only obtained in 11 cases; all were Astler Coller's stage B2. In 9 cases the malignant tissue involved the urinary tract; in 2 cases there were only inflammatory adhesions. In all cases the functional urinary results were good. The 5 year direct survival rate was 50%; following Kaplan Meier's actuarial method this rate was 68%. Bladder involvement by a colonic or rectal adenocarcinoma does not seem to have any "en bloc resection" is worthwhile for this kind of extensive prognostic valve.

Adenocarcinoma↗
PubMed1987

[Retro-pancreatic inflammatory pseudotumor].

The authors report a case of retro-pancreatic tumor in a 65 year-old man associated with impaired general condition. At gross examination by the surgeon, the pancreatic gland seemed to be enlarged. Histologic analysis found fibrous tissue and inflammation with lymphoid cells. The diagnosis of inflammatory pseudotumor was based on similar aspects found in some orbital lesions. The "tumor" disappeared under steroid therapy but recurred as soon as the treatment was stopped. Several etiologic factors related to the unusual location of the lesion were discussed.

Aged↗
PubMed1987

[Malignant tumors of the ampulla of Vater treated by cephalic duodenopancreatectomy. Apropos of 20 case reports].

Between 1966 and 1986, 27 tumors of the ampulla of Vater were operated on and 20 patients underwent potentially curative pancreatico-duodenal resection (PDR) (74% of resecability). The retrospective study of those 20 cases (13 men, 7 women, mean age: 59.9 +/- 9.8 years old) was done to evaluate the risks and the results of this type of wide resection. 15 patients (75%) had jaundice and gallbladder was palpable among 20 p. cent (4 cases) of the patients without cholecystectomy. Endoscopy was performed in 13 cases; endoscopic biopsies, done in 12 cases, were positive in 5 cases (45.4%), uncertain in three (25%) and falsely negative in four (33.3%). All the patients underwent Child's procedure. Histological analysis pointed out 15 adenocarcinomas and 5 malignant villous tumors; lymph node involvement was present in 11.1 p. cent; the staging following Martin's classification listed 6 stage 1, 3 stage II, 10 stage III and 1 stage IV. Operative mortality was of 5 p. cent; one patient died after an emergency procedure performed for massive bleeding but no death was observed in the group of patients treated out of emergency. Post-operative complications occurred in 5 patients (26.3%); none of the patient had pancreatico-jejunal or hepatico-jejunal anastomotic leakage. Hospitalisation had a mean duration of 22.8 +/- 6.4 days. The age over 65 years old, preoperative jaundice and preoperative endoscopic or surgical biliary drainage done to improve jaundice had no statistical influence upon post-operative morbidity. The 5 years survival rate following Kaplan Meier's method reached 44.5 p. cent.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗
PubMed1986

[Splanchnicectomy using the Dubois transhiatal approach. Current technical modifications].

Technical modifications were applied during 47 splanchnicectomies using Dubois' trans-hiatal approach, with major simplification of the method, mainly by the absence of freeing of the abdominal esophagus. The approach to the right and left greater splanchnic nerves involved displacement of the esophagus to the left, avoiding the need to perform a gastro-esophageal antireflux procedure at the end of the operation. Furthermore, the most effective plane for pleural detachment is situated in fact in contact with the aortic adventitia. The simplicity and safety of this modified surgical method makes it an indication of choice for the treatment of intractable supramesocolic pain.

Abdomen↗
PubMed1984

[Localized Caroli's disease associated with mucosecreting papillary adenocarcinoma. Value of hepatic resection].

A new case of carcinoma arising in Caroli's disease in a 48-year old male patient is reported. Since dilatation of the bile ducts was localized to the left lobe, left hepatectomy was performed. Histological examination showed that the tumour was a papillary mucoid adenocarcinoma. There was no recurrence of cholangitis while the patient survived. This case and a review of the literature shows that left hepatectomy suppresses repeated attacks of cholangitis in patients with Caroli's disease restricted to the left lobe, and that the incidence of carcinoma in Caroli's disease is higher than was formerly believed, which should encourage early surgical treatment when the disease is localized in the left lobe.

Adenocarcinoma, Mucinous↗
PubMed1984

Prophylactic use of cefotaxime in colonic and rectal surgery.

Two hundred and seventeen patients, undergoing abdominal colonic and rectal surgery, received after randomization, the following regimen: group A (74 patients): cefotaxime 1 g intravenous at the induction of anaesthesia, the beginning of the resection, 4 and 8 h later; group B (72 patients): cefotaxime in the same regimen associated with ornidazole or metronidazole 0.5 g intravenous at the induction of anaesthesia and 0.5 g intravenous with the last injection of cefotaxime; group C (71 patients):cefotaxime following the same regimen as groups A and B and metronidazole orally 0.5 tds 3 days before surgery. All wounds were assessed daily, until discharge from hospital. Severe sepsis included: septicaemia, peritonitis, intra-abdominal abscess and extra-abdominal infections with death. Non-severe sepsis included all others. All the patients having a history of allergy to beta-lactam antibiotics and those with pre-operative infection were excluded. Mean age of the population was: 64.5 years. Seventy-seven patients had rectal cancer and 82 patients cancer of the colon; Twenty-five patients had inflammatory bowel disease, and in 33 others disease such as polyposis was present. Risk factors of post-operative infection were present in 115 cases (A, 36 patients; B, 37 patients; C, 42 patients). All three groups were very well matched for age, sex, type of intervention and diagnosis. Non-infectious complications appeared in 56 patients. Sepsis developed in 76 patients (A, 27 patients; B, 27 patients; C, 22 patients, no significant difference). Severe sepsis occurred in 14 patients (A, 6 patients; B, 4 patients; C, 4 patients, no significant difference) and in 62 patients non severe sepsis (A, 21 patients; B, 23 patients; C, 18 patients, no significant difference). Post-operative peritonitis was not seen. This study suggests that cefotaxime alone 4 g peri-operatively is useful in prophylaxis during rectal and colonic surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1984

[Role of formalin in the occurrence of sclerosing lesions of the bile ducts. Experimental approach in dogs. Apropos of 3 clinical cases].

The authors experimentally reproduced in dogs, sclerosing lesions of biliary tract similar to those that they noticed in clinical practice, after the use of a formalin solution for sterilization of the hydatid cysts of the liver. These lesions have been found with formalin solutions more concentrated than those used in surgical treatment of liver echinococcosis. Nevertheless, even with the use of lower concentrated solution in every case, inflammatory scars are produced in the liver and the biliary tract with persist several months after the formalin injection consequently, the authors recommend to forsake the abandonment of this product for surgical treatment of hydatid cyst.

Adult↗
PubMed1981

[Fistula-type pararectal mucinous carcinoma. A case report (author's transl)].

A case of the exceptionally rare fistula type of pararectal mucinous carcinoma is reported, the patient presenting with clinical signs of a chronic abscess in the ischiorectal hollow. The unusual gelatinous secretion suggested the need for a biopsy of the fistula cavity. Pathological examination confirmed the diagnosis, where as a barium enema and rectoscopy gave negative results, eliminating the possibility of a digestive tract origin for the tumour. Local recurrence occurred two and a half years after an abdominoperineal resection, and was treated by local excision. Aetiopathogenic hypotheses and current therapeutic procedures are discussed.

Adenocarcinoma, Mucinous↗
PubMed1975

[Our experience with reoperations in abdominal surgery. (54 reoperations in 46 patients in the last 4 years)].

The authors analyze 54 reinterventions in abdominal surgery in 46 patients, and present the lesions found on reintervention. In one out of two cases there is an intra-peritoneal septic focus. In more than 25 p. 100 of the cases the lesions were multiple. They oppose the localized septic foci and the occlusions which are of good prognosis, with the diffuse septic foci, acute pancreatitis and fistulae whose course is more often than not fatal.

Abdomen↗