Biomedical subjects
J Biagini
Publications and source records attributed to J Biagini.
[Gastric leiomyoblastoma, 2 case reports with a selective literature review].
The gastric Leiomyoblastoma is a smooth muscle described in 1960 by Martin and in 1962 by Stout. These rare tumors are generally benign but may have a sarcomatous evolution in 11% of cases. They are characterized by the presence of large round or polygonal cells. Thin filaments are visible on electronic microscopy. Treatment of choice is the surgical resection.
[Inguinal herniorrhaphies by the pre-peritoneal method using surgical mesh].
During a period of 5 years, 314 patients with 427 inguinal hernias were operated. 80 males with bilateral inguinal hernia recurrent, or not, were operated with an insertion of a Crinoplaque by a pre-peritoneal approach. The operative time was 65 +/- 26 minutes. 10 patients (12.5%) had by the same incision a concomitant pelvic procedure (9 varicoceles, 1 benign prostatic hypertrophy). 4 patients (5%) developed minor parietal complications. After 1 to 4 years of follow-up, 1 patient (1,25%) showed one side recurrence, in the beginning of our experience. In conclusion, we consider the pre-peritoneal Crinoplaque insertion as a treatment of choice for bilateral recurrent, or not, inguinal hernia for its simplicity and its lower complication rate.
[Therapeutic problem posed by Gardner's syndrome, report of a Lebanese family].
Gardner's syndrome ie an autosomal dominant disease characterized by the association of a polyposis coli with one or more of specific extracolonic manifestations. A lebanese family is reported. Polyposis coli, desmoid tumors, gastroduodenal polyps, procreation counselling etc. are difficult problems to manage in this syndrome.
[Hypothalamo-hypophyseal and gastric metastasis of a breast neoplasm. Clinical case and a review of the literature].
The authors report the case of a young woman with advanced breast cancer who developed diabetes insipidus due to pituitary involvement and also gastric metastases. This patient had a normal brain CT scan. Gastric metastases were diagnosed when she was operated for a perforated gastric ulcer. Although very rare, and even if the brain CT scan is normal, pituitary metastases should be diagnosed in the presence of suggestive clinical symptoms. Abdominal pain also warrants investigation in these patients in an early attempt to document any possible gastric metastases.
[Jejunogastric intussusception. Apropos of a case].
Jejunogastric intussusception is a rare complication after gastric surgery. The authors report a case of acute jejunogastric intussusception diagnosed in a 57-year-old woman, 22 years after vagotomy and gastroenterostomy for duodenal ulcer. There are three types of jejunogastric intussusception: 1) the acute type, presenting as a surgical emergency, and characterized by a sudden onset of cramp-like epigastric pain, followed by nausea and vomiting, with a palpable epigastric mass. 2) the chronic recurrent type, which may progress to the acute type of may result in severe disability, and may require corrective surgery depending on the severity of the symptoms. 3) the acute post-operative type, presenting on the 4th or 5th post-operative day, and usually improving with conservative treatment.
[Retroperitoneal duodenal rupture during closed abdominal trauma].
Duodenal retroperitoneal wound after blunt abdominal trauma, is a well known, and a classical entity. Most of the patients are operated with delay and this lesion could easily be missed at laparotomy if not searched for. Mortality and morbidity are much higher if the diagnosis is delayed more than 24 hours. These lesions should be strongly suspected after any blunt abdominal trauma, and repeated clinical assessment is mandatory in the conscious patient. Gastrografine upper GI study and CT Scan are interesting diagnosis procedures when the patient is unconscious or should be anesthesized. At laparotomy, the presence of a central retroperitoneal hematoma should guide the surgeon to explore the duodenum. Treatment depend on the time of diagnosis, the severity of the wound, and the associated pancreatic lesions.
Thoracic splenosis. Case report and literature review.
Thoracic splenosis is the autotransplantation of splenic tissue into the thoracic cavity after thoracoabdominal trauma. We report a case of thoracic splenosis in a 35-year-old woman who had had a thoracoabdominal gunshot wound 12 years earlier. A review of the literature revealed 15 cases already reported. All patients had an asymptomatic thoracic lesion discovered on a plain chest film 9 to 32 years (mean 16) after the initial accident. In 13 cases an operation was necessary to establish the diagnosis. In two cases technetium 99m and indium 111 scans established the diagnosis.
[Asymptomatic cholelithiasis. When is a cholecystectomy justified?].
Since the introduction of routine abdominal echography, silent gallstone has become a major medical concern. The management of a patient with silent gallstone, is very controversed, and routine cholecystectomy is not always beneficial. Aged and high operative risk patients, should be treated conservatively. Literature review can identify subgroups of patients in whom cholecystectomy is justified: patients with micro or macro-lithiasis, patients in whom oral cholecystography reveals multiple floating stones, dyskinectic, not opacified or calcified gallbladder, and patients receiving general anesthesia for other reasons than gallbladder disease.
[Jejunogastric intussusception. Apropos of a case].
Jejunogastric intussusception is a rare complication after gastric surgery. The authors report a case of acute jejunogastric intussusception diagnosed in a 57-year-old woman, 22 years after vagotomy and gastroenterostomy for duodenal ulcer. There are three types of jejunogastric intussusception: 1) the acute type, presenting as a surgical emergency, and characterized by a sudden onset of cramp-like epigastric pain, followed by nausea and vomiting, with a palpable epigastric mass. 2) the chronic recurrent type, which may progress to the acute type of may result in severe disability, and may require corrective surgery depending on the severity of the symptoms. 3) the acute post-operative type, presenting on the 4th or 5th post-operative day, and usually improving with conservative treatment.
Four hundred esophageal anastomoses with a stapler.
Four-hundred esophageal anastomoses were performed with a stapler in the Department of Digestive Surgery, Hospital Beaujon in Paris, in a six year period. The experience of the 14 different surgeons in esophageal surgery was very uneven (zero to 25 years). Two-hundred and sixty-eight esophagogastrostomies (220 in the chest and 48 in the neck), 83 esophagojejunostomies and 49 esophagocolostomies were done. The overall mortality rate was 9.2%, three per cent owing to leaks. The average incidence of leakage was 7% falling to 5.5% if cervical anastomoses were excluded. The incidence of stenoses was 8%. Several points which might account for problems are discussed. Stapled anastomoses seem to reduce the mortality and the morbidity rates of esophageal anastomoses, especially for surgeons with no experience in esophageal surgery.
[Complications of colonic esophagoplasty. Radiologic aspects].
Early or late postoperative complications in 52 patients undergoing colic esophagoplasty for benign (27 cases) or malignant (25 cases) lesions of esophagus are discussed in relation to radiologic findings. Immediate postoperative complications due to infection were mainly bronchopneumopathies (14 cases), their incidence being increased by recurrent nerve palsy, and mediastinitis (3 cases). The frequency of upper anastomotic fistulae (16 cases) emphasizes the need for routine radiologic follow up on the 7th postoperative day by upper digestive tract follow-through examination with water-soluble contrast. Stenosis of upper part of graft may be of ischemic or fibrous origin. Ischemic stenosis develops 2 weeks to 4 months after surgery as a long filiform narrowing. Fibrous stenosis occurs in upper anastomosis at a later stage, after the 3rd month, as a short regular narrowing. Other complications are rare.