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H Mosnier

Publications and source records attributed to H Mosnier.

65 records · Page 4Linked to original sources
PubMed1977

[Study of anastomoses between the left renal vein and the internal vertebral plexus].

Anastomosis between the left renal vein and the rachidian plexus exists in about 80% of the cases (16 cases out of 20); they are important in 25% of the cases (5 cases) ; their origin is constant ; their ending has a high frequency for the rachidian plexus of the intervertebral foramen L1-L2. These anastomoses are of great importance : as they are the only renal circulation's safety device in seven of our cases : their hypertrophy in some pathological cases can explain some neurological clinical pictures of compression, reversible after the ligature of the hypertrophic anastomotic veins.

Collateral Circulation↗
PubMedDate not supplied

Preoperative assessment of the extension of rectal carcinoma: correlation of MR, surgical, and histopathologic findings.

Nineteen patients with rectal carcinoma were evaluated prospectively. The extent of tumor and the relationship of the tumor to the levator ani muscle were studied as this determines the choice of the surgical procedure (abdominoperineal resection versus low anterior resection). Peroperative assessment and detailed evaluation of the pathologic specimens were correlated with magnetic resonance (MR) features. Magnetic resonance staging and surgical findings were at variance in four of 15 cases (27%). Magnetic resonance had sensitivities and specificities of 75 and 100% in the detection of perirectal growth. Magnetic resonance demonstrated invasion of adjacent pelvic side wall and sacrum in two of two cases. The comparison with TNM classification demonstrated that MR correctly staged 15 of 19 cases (79%). This study shows that MR is a good examination to evaluate the involvement of perirectal fatty tissues and adjacent structures. The low prevalence of involved lymph nodes in our cases prevents significant positive predictive values. Nevertheless, MR can help to select patients for local excision or for preoperative radiotherapy.

Adenocarcinoma↗
PubMedDate not supplied

[Laparoscopic rectopexy: our experience in the treatment of complete rectal prolapse].

Surgical treatments of rectal prolapse still await a final arrangement. The aim of this work is to present Authors' experience with 12 female patients who underwent laparoscopic rectopexy. The patients, aged between 67 and 84 years, were suffering of a different degree of incontinence classified according to the Browing and Parks scale. Pneumoperitoneum was induced through the Veres needle end 5 trocars were placed. The technique used was the modified Orr-Loygue. One no death was observed and only two not serious intraoperative complications were registered, in both conversion to laparotomy was not necessary. Functional result as for incontinence has been really good (disappeared in 11 cases and improved in one). Whereas regarding the constipation, no improvement was observed in those in who in it was preexisting the operation, not appearing nevertheless, as on the contrary reported by other Authors, in those in whom it wasn't present before surgical treatment. The patients, all in follow-up (range between 10 and 36 months, average 25.08), still now experienced no relapse. In conclusion, on the base of Authors' experience, laparoscopic rectopexy is considered free of particular risks and excellent in the results even if, due to the slight number of series, any definitive judgement can be expressed.

Aged↗
PubMedDate not supplied

[Importance of a loco-regional follow-up after curative operation in cancer of the rectum or sigmoid].

After curative surgery for rectal or sigmoid cancer, loco-regional recurrence occurs in about 30% of the patients. Among them, one third presents no other tumor localization and a new curative surgical excision may, therefore be considered. A review of the literature shows that in these repeated procedures, the only good results, carcinologically, are observed when the original procedure consisted in a recto-colic anastomosis. Re-operations after abdomino-perineal resections have, until now, resulted in carcinologic failures. The location of the pelvic recurrence, after procedures which preserve the anal sphincter function, may be at the level of the anastomosis or most of the time around the anastomosis. If endoscopy is an easy mean of surveillance of the anastomosis, the screening of peri-anastomotic recurrences presents more of a problem. It seems necessary to use, in addition to rectal examination, other techniques which are more easily reproduced and compared with each other in the long run. This could be the case for endo-rectal sonography and pelvic tomodensitometry. As for re-operation itself, it consists essentially in an abdomino-perineal resection possibly associated with radiotherapy.

Follow-Up Studies↗
PubMedDate not supplied

[Ileostomy after total colectomy].

Ileostomy is a safe operative procedure following total colectomy, when the small intestine remains intact. Most problems are essentially psychological, occasional dietetic considerations apart. In contrast, the effects are totally different once resection, even minimal, of the small intestine has been performed. In this case continuous enteral feeding of variable duration is essential. Oral feeding within very strict dietetic constraints may be resumed upon adaptation of the small intestine. Intensive surveillance remains necessary in the long term.

Adaptation, Physiological↗
PubMedDate not supplied

[Post-surgical or traumatic anal incontinences. Prospective study in 40 patients explorated by endorectal ultrasonography and electromyography].

OBJECTIVES: Anal endosonography is used to assess anal canal structure and external anal sphincter. The purpose of this study was to compare findings at anal endosonography with electromyographic tests in patients with faecal incontinence. METHODS: Fourty patients (31 women; median age: 47 years) were referred for exploration of the anal sphincter: 15 patients had previous anal surgery, 16 patients had obstetrical trauma, 3 patients had accidental trauma, 6 women had obstetrical trauma and previous anal surgery. RESULTS: Anal endosonography demonstrated an external sphincter defect in 19 patients (partial n = 4, complete n = 15); 18 of these patients had an electromyographic study: an external sphincter defect was demonstrated by mapping in 15 cases; 3 partial defects were not found. Eight patients had associated pudendal nerve terminal motor latency delayed due to neuropathic impairment of pudendal nerve. Surgery was performed in 12 patients; external sphincter lesion was confirmed in all cases. CONCLUSIONS: Anal endosonography and electromyography mapping easily recognize external sphincter disruption with high concordance. Partial defects are better diagnosed by anal endosonography. A study of pudendal nerve terminal motor latency is useful in the exploration of faecal incontinence because pudendal neuropathy occurs frequently in association with a sphincter defect.

Adult↗
PubMedDate not supplied

[Reoperation for locoregional recurrence of cancer of the rectum].

71 recurrences after rectal resections for adenocarcinoma have been operated upon. After 43 initial anterior resections (AR), the treatment of recurrence was in 19 patients a new resection and in 18 a simple colostomy. When the initial treatment was a Mile's operation (APR in 23 patients), it has been performed 10 new exerses and 5 electrocautery. In the whole series, mortality and morbidity were respectively 17.5 per cent and 8 per cent. After AR the long term survival was 40 months when the initial tumour was classified Dukes A, and only 12 months when it was classified Dukes B or C. After APR the median long term survival was only 12 months. 75 per cent of the recurrences are observed during the first two years after initial resection. The screening includes repeated clinical examination, CEA dosage, endorectal sonography, endoscopy and CT scan. The appreciation of extirpability requires clinical examination, CT scan, MRI imaging. The aim is 1. to avoid exploratory and/or palliative operations. 2. to appreciate operating difficulties and to choose an adequate approach. The indication of systematic enlarged resections has to be appreciated related to patient's comfort and survival.

Aged↗