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Biomedical subjects

G Perrier

Publications and source records attributed to G Perrier.

18 recordsLinked to original sources
PubMed2002

Closure of carotid bifurcation endarterectomy using a polyurethane patch. A multicentre prospective study with 252 patients.

BACKGROUND: In order to evaluate the results of carotid endarterectomy with closure using a polyurethane patch, a multicentre prospective study of 252 patients (263 interventions) undergoing this operation was performed between November 1996 and August 2001. METHODS: One hundred and seventy-one men and 81 women with a mean age of 70 years were studied. Fifty-five percent of the patients had neurological symptoms. The degree of carotid stenosis evaluated using the European carotid surgery trialist's collaborative group (ECST) criteria was greater than or equal to 70% in 95% of cases. RESULTS: The combined mortality-morbidity operation rate (CMMR) was 2% (1 death from cerebrovascular haemorrhage on Day 3, 1 non-regressive cerebrovascular accident (CVA), 3 regressive CVAs). The patients had follow-up clinical examinations and Doppler ultrasound scans for 2 years. Fifteen patients died during follow-up, 8 of these patients died from heart-related causes and 2 patients died from CVA. Four patients presented with CVAs ipsilateral or contralateral to the endarterectomy. Two false aseptic aneurysms and 1 false septic aneurysm required further surgery. Three asymptomatic carotid occlusions occurred during follow-up. The rate of restenosis greater than 50% was 1.2% at 6 months, 2.3% at 1 year and 5.3% at 2 years. CONCLUSIONS: These results confirm the value of po-lyurethane patch closure of carotid endarterectomy.

Aged↗
PubMed2000

Cecostomy is a useful surgical procedure: study of 113 colonic obstructions caused by cancer.

PURPOSE: There is a large choice of treatment for obstructing carcinoma of the left colon. We report our experience of tube cecostomy as the initial treatment for obstructing colonic carcinoma followed by elective resection. METHODS: From 1975 to 1995, 113 patients presenting with colonic obstruction caused by cancer were initially treated by tube cecostomy. RESULTS: The cecostomy was performed under local anesthesia in 26 cases (23 percent) and general anesthesia in 87 cases (77 percent). In the postoperative period 15 patients died (13 percent) and 26 (23 percent) had wound infection in the area around the cecostomy. A second operation performed on the 98 surviving patients comprised 74 left colonic resections with anastomosis, 9 without anastomosis (Hartmann's operation), 1 right colectomy, 3 total colectomies eliminating the cecostomy, 3 internal bypasses, and 8 proximal lateral colostomies. Surgical closure of the cecostomy was performed during six of the second operations. No deaths occurred from any of the second operations. The cecostomy closed spontaneously in 78 patients (89 percent). In ten cases (11.4 percent) a third operation was performed to close the cecostomy, without mortality. CONCLUSIONS: Comparison our cecostomy results with published studies of proximal diverting loop colostomies for the same indications showed comparable mortality after the first operation. Cecostomy decrease mortality of the second operation. This retrospective study suggests that cecostomy is a useful and less invasive surgical procedure for patients presenting with colonic obstruction caused by cancer.

Adult↗
PubMed1999

Usefulness of video thoracoscopy in the management of spontaneous and postoperation chylothorax.

BACKGROUND: The aim of this study was to evaluate indications and results of video thoracoscopy (VATS) in the management of nine chylothorax cases. METHODS: Four spontaneous chylothorax cases were treated by VATS and talc pleurodesis with immediate positive results. Among five postoperation chylothorax cases, two were treated early by VATS and selective lymphatic clipping (VATS group), and three had medical treatment (MT group). RESULTS: Duration of drainage was 4 days for the VATS group versus 15.3 days for MT group. Amount of collected chyle was 2.4 l versus 5.7 l, respectively. CONCLUSIONS: We suggest that VATS should be considered the treatment of choice for spontaneous chylothorax and could be indicated earlier in postoperation chylothorax.

Adult↗
PubMed1997

Sensitivity of objective parameters in the diagnosis of pediatric septic hips.

This study examines the sensitivity of temperature, leukocyte count, and erythrocyte sedimentation rate in the diagnosis of pediatric septic arthritis of the hip by retrospective case analysis of 26 children, aged 0 to 6 years, in hospitals of central Brooklyn. The average presenting temperature was 38.4 degrees C, with 65% of the patients having had a temperature higher than 38 degrees C. The average leukocyte count was 13,500 per mL, with 73% of patients having a leukocyte count greater than 9000 per ml. The average erythrocyte sedimentation rate (21 cases) was 51 mm per hour, with 95% of the patients presenting with an erythrocyte sedimentation rate greater than 20 mm per hour. Of these children with septic hips, only 5% had a normal erythrocyte sedimentation rate, although 35% had a normal temperature and 27% had a normal leukocyte count. Neonates (age younger than 1 month) were not febrile (average temperature, 36.7 degrees C) and did not have an elevated leukocyte count (average leukocyte count, 9300 per mL) but did have an elevated erythrocyte sedimentation rate (average erythrocyte sedimentation rate, 45 mm per hour). Of these 3 values, erythrocyte sedimentation rate is the most sensitive indicator of septic arthritis of the hip in children 0 to 6 years of age.

Arthritis, Infectious↗
PubMed1994

[Evaluation of cholecystectomy by celioscopy. Apropos of a series of 500 operated patients in a general hospital unit].

A series of 500 patients who underwent laparoscopic cholecystectomy is reported. The mean duration of the operation was 46 minutes when completed laparoscopically and 117 minutes when converted to laparotomy. The conversion rate was 10%, and the reoperation rate 2.22%. There were 5 problems related to the bile ducts (1%) including 2 lesions of the common bile duct (0.44%) with only in 21 cases. In one, a stone in the common duct was extracted laparoscopically. Mean hospitalization was 5.5 days. For us, laparoscopic cholecystectomy has become the "gold standard" for the treatment of symptomatic uncomplicated bile stone disease. Reduced hospitalization time should help reduce cost incurred due to the video surgery material.

Acute Disease↗
PubMed1994

[Value of appendectomy by celioscopy: apropos of a series of 73 cases].

The practice of coelioscopic approach in acute appendicitis is still very much debated. A study of the results of 73 patients carried out over two and half years leads one to conclude to the interest of this technique also for the treatment of appendicular peritonitis. Full exploration of the abdominal cavity, easy discovery of ectopic appendix, treatment of associated lesions, extended peritoneal washing, are the observed advantages together with reduced length of hospitalisation and few post-operative complications, in particular parietals problems and obstructions at long term. The experience of the surgeon becomes of prime importance to reduce operating time, frequency of open-surgery converting and complications.

Acute Disease↗
PubMed1992

Instantaneous axis of rotation as a function of the three columns of the spine.

A knowledge of the rotatory motion of the vertebral bodies is needed to understand the normal biomechanical behavior of the spine. The aims of this investigation were 1) to define the instantaneous axis of rotation of the lumbar spine in rotation; and 2) to study the effect of the loss of the anulus, facet joints, and ligamentous structures on the location of the instantaneous axis of rotation. The instantaneous axis of rotation was found in 10 human cadaver thoracolumbar spines by the method of Reuleaux from superimposed serial photographs. Long-segment specimens were tested to minimize the effect of the imposed axis of the testing device. The instantaneous axis of rotation was consistently posterior to the anulus in the intact spine. With isolated destruction of the columns of the spine, the instantaneous axis of rotation migrated to the remaining intact structures. Anterior releases enhance derotation by removing the primary rotatory stabilizer. Ultimate control of a rotatory deformity or instability lies in the recognition that the anterior structures have a mechanical advantage in resisting torsion.

Biomechanical Phenomena↗
PubMed1990

[Anti-basement-membrane antibody mediated, rapidly progressive, glomerulonephritis. Diagnostic and therapeutic strategy based on a retrospective study of 14 cases].

Fourteen cases of anti-GBM antibody-induced RPGN were evaluated retrospectively in terms of renal function improvement and therapeutic risks. Nine men and 5 women (mean age: 55.3 years) were observed over a 9 year period; in three patients, hemoptysis was associated with renal disease (Goodpasture's syndrome). Most of these patients had received combinations of steroid therapy (ST), immunosuppressive drugs (IS) and plasma exchanges (PE). Age, duration of symptoms prior to diagnosis, initial renal function, therapeutic modalities and complications were assessed according to renal outcome: 9 patients (group A, "non-responders") remained on dialysis irrespective of the treatment administered; 5 patients (group B, "responders") recovered renal function. Complications, especially infections, were twice as frequent in group A. Two of the 4 recorded deaths were related to the disease or the treatment. Analysis of clinical and pathological values at the time of entry into the study for both groups indicated that oliguria/anuria, serum creatinine greater than 500 mumol/l and greater than 50% crescents, when associated, were factors predictive of poor renal outcome; in these patients, dialysis may be required except in cases of pulmonary hemorrhage. In all other patients, treatment with ST, IS and PE is recommended. Active hemoptysis necessitates pulse steroids or PE; if absent, further tests (carbon monoxide uptake, bronchoalveolar lavage, lung biopsy) are indicated before use of aggressive therapy.

Adrenal Cortex Hormones↗
PubMedDate not supplied

Arterial erosions in acute pancreatitis.

Acute pancreatitis was observed in 492 patients. Fourteen (2.8%) developed an arterial erosion revealed by a haemorrhage either in the digestive lumen, in the peritoneum or via previously placed drainage. The eroded artery was the splenic artery in six patients, a pancreatico-duodenal artery in five patients. An initial haemostasis was attempted by: a) embolization in four patients: one died; the three others had bleeding recurrence. b) splenocorporeal pancreatectomy in four patients, three had bleeding recurrence. c) arterial ligature in four patients: three had bleeding recurrence. Secondary haemostatic procedures were performed in ten patients but a durable haemostasis was achieved in only five patients: two had a pancreatic resection and three were treated by a redo-binding. It is noteworthy that durable haemostasis could not be obtained neither by embolization nor by ligature in necrotic tissues. This could explain the difference in the results of arterial erosion treatments in chronic and in acute pancreatitis. Therefore, it is suggested that haemostatic procedures should be performed away from necrotic tissues, or eventually done after their removal.

Adult↗
PubMedDate not supplied

Squamous cell carcinoma of the thoracic esophagus following radiation therapy for breast cancer.

Between 1981 and 1995, 4 patients (3 females, 1 male; aged 48-80) were diagnosed with squamous cell carcinoma of the esophagus, following mediastinal irradiation for breast cancer. The interval between irradiation and the presentation of esophageal cancer was 10.75 years on average (7-19). The treatment consisted of: radiotherapy only; a partial esophagectomy with proximal gastrectomy without post-operative radiotherapy; laser photocoagulation for a superficial tumor; and, palliative treatment including gastrostomy, tracheal photocoagulation and chemotherapy for 1 patient suffering from advanced stage cancer with tracheal invasion, respectively. Radiotherapy of the esophageal cancer (exclusive or adjuvant) should take into account previous esophageal radiation therapy. The indications of curative excision surgery are the same as for other types of esophageal cancer, but the anastomoses should be performed in a non-irradiated area. Excision by esophageal stripping without thoracotomy is contraindicated because of the presence of peri-esophageal sclerosis. Preventive measures in radiation therapy for breast cancer are suggested.

Aged↗