Biomedical subjects

J C Le Néel

Publications and source records attributed to J C Le Néel.

At least 19 recordsLinked to original sources

PubMed2002

[Techniques, indications and early results of splenic preservation during left pancreatectomy].

STUDY AIM: Splenic preservation is rarely performed during left pancreatectomy. We compared retrospectively the early results of left pancreatectomy with and without splenic preservation to define the place of this procedure. PATIENTS AND METHODS: From 1979 to 1997, among 54 left pancreatectomies for another indication than adenocarcinoma, 13 were performed with and 41 without splenic preservation. The technique used for splenic preservation was prograde dissection of the left pancreas with (n = 4) and without (n = 9) preservation of both splenic artery and vein. The preoperative characteristics of the patients, peroperative data, postoperative morbidity and length of stay were compared. RESULTS: Mean operative time was longer with splenic preservation (262 +/- 67 min versus 215.6 +/- 59 min, p < 0.05), particularly in case of splenic vessels preservation (295 +/- 38 min, p < 0.02) whereas no difference was noted with splenic vessels ligation (240 +/- 76 min, p > 0.05). No mortality occurred. Prevalence of preoperative or postoperative haemorrhage, morbidity, or length of stay (intensive care unit and whole hospitalisation) did not differ with or without splenic preservation. Five patients developed pancreatic fistula without influence of splenic preservation: 1/13 (7.7%) versus 4/41 (9.7%); conversely, surgery following acute pancreatitis was associated with an higher risk of pancreatic fistula: 3/5 versus 2/49 (p < 0.005). No splenic necrosis occurred after splenic preservation. CONCLUSION: During left pancreatectomy, splenic preservation increases the operative duration (only in case of preservation of splenic vessels) but does not increase morbidity. This technique should be used whenever possible to allow long term immunological benefits of splenic preservation.

Acute Disease↗

PubMed2001

[Accessory cystic duct discovered by intraoperative cholangiography during cholecystectomy].

The study aim was to report a rare biliary variation detected with an intraoperative cholangiography during a laparoscopic cholecystectomy. After the ligation of the cystic duct, the gallbladder was opacified via an accessory cystic duct flowing into a branch of the right hepatic duct. This accessory cystic duct was clipped and the postoperative course was uneventful.

Cholangiography↗

PubMed2001

[Abnormal catheter mobility in a totally implantable venous access depending on the upright or supine position in an obese patient].

The authors advise on an exceptional complication in a totally implantable venous access and give recommendations on how to avoid this problem. In an obese person, one week after the implantation of a totally implantable venous access, a chest X-ray showed that the catheter was too short. In the operative room, at the time of the second intervention, the radioscopy did not find this anomaly. The subcutaneous injection port was positioned too low. When the patient was in a supine position, the subcutaneous injection port was in the correct position but when she was in an upright position, the breast descended and pulled down the subcutaneous injection port and the catheter.

Catheterization↗

PubMed2000

[Complicated colonic diverticulosis. Results of surgical treatment between 1981 and 1998 in 370 patients].

AIM OF THE STUDY: The aim of this retrospective study was to analyze case reports of all the patients with complicated diverticular disease of the colon admitted in the same surgical center during an 18-year period and to report the postoperative results in patients operated on in emergency and in patients operated on electively. PATIENTS AND METHOD: From 1981 to 1998, 501 patients were admitted for complicated diverticular disease. There were 233 men and 268 women. Mean age was 66 years (range: 27-96). One hundred and thirty-one patients were only treated medically and 370 patients were operated on, either as an emergency (n = 211) or electively (n = 159). The complicated diverticular disease was located on the left colon in 362 cases and in the right colon in 8 cases. RESULTS: In the emergency group, 103 patients were operated on for pelvic (n = 24) and generalized purulent (n = 67) or stercoral (n = 12) peritonitis, mainly with Hartmann procedure (n = 80) with 14 postoperative deaths; 67 were operated on for pericolic abscess with 6 deaths, 19 for colonic obstruction with two deaths and 22 for profuse hemorrhage with 4 deaths. The overall postoperative mortality rate was 12.3%, and morbidity rate 38.7%. Intestinal continuity was restored in 74% and eventrations were present in 10%. In the elective group, there were two postoperative deaths in patients with a colic fistula (n = 30), no mortality and a 10.8% morbidity rate in the other patients (n = 129). CONCLUSION: This series of an 18-year duration emphasizes the severity of surgery for acute complications in diverticular disease of the colon and the advantages of elective surgery. Large progress in the management of peritonitis and pericolic abscesses has made possible the improvement of their prognosis.

Abdominal Abscess↗

PubMed1999

[Surgical treatment of colonic cancer after 75 years of age. Study of a series of 240 patients].

AIM OF THE STUDY: The aim of this retrospective study was to report the results of the surgical treatment for large bowel cancer in patients over 75 years of age. PATIENTS AND METHOD: From 1985 to 1996, 240 patients. 114 men and 126 women, aged 75 years or over (mean age: 82, range: 75 to 95 years) underwent surgical treatment for large bowel carcinoma. Tumors were located in the right colon (n = 120), left colon (n = 100), transverse colon (n = 5), or were multiple (n = 15). Clinical presentation was failure of general condition (25%), intestinal obstruction (20%), rectal bleeding (20%), abdominal pain (17%). ASA score was I (n = 1), II (n = 69), III (n = 134), or IV (n = 36). Emergency surgery was mandatory in 110 cases (43 urgent and 67 delayed procedures) and 130 patients underwent elective surgery. Surgical resection was performed in 221 cases, including 177 cases with curative intent (67%). Surgical procedures included right colectomy (n = 119), left colectomy (n = 59), transverse colectomy (n = 9) or subtotal colectomy (n = 31). Histopathological staging was Astler--Coller A (n = 8), B (n = 116), C (n = 54) et D (n = 62). RESULTS: The postoperative course was uneventful in 157 cases (65.4%). Medical complications occurred in 46 patients with 34 deaths; and surgical complications in 39 patients with 20 subsequent reoperations and 15 deaths. The overall postoperative mortality rate was 20.4% (n = 49). Postoperative mortality rate was higher after emergency operations (32.7% vs 10%), higher with the level of ASA grading (class II: 8.6%, Class III: 17.1%, Class IV: 38.8%), higher in patients over 90 years (37.4% vs. 19.1%) and in patients without surgical resection (42% vs 18.5%). Disease specific 5-year survival rate was 45% and did not differ when compared to patients younger than 75 years (42%, data not reported). CONCLUSIONS: Patients older than 75 years remain a high risk group, specially if operated on emergency. Nevertheless, age is not a limiting factor in the surgical treatment of colon cancer. Prognosis is mostly depending on ASA grading. Colectomy with curative intent has to be performed when possible.

Age Factors↗

PubMed1999

Predictive factors for node involvement in papillary thyroid carcinoma. Univariate and multivariate analyses.

For patients with papillary thyroid carcinoma, lymph node involvement is a common complication, resulting in node dissection and its resulting morbidity. To determine means of limiting lymph node dissections, we attempted to define intra-operative criteria predictive of node metastasis and so identify the patients likely to benefit from this procedure. This retrospective study concerned 158 patients (118 female) treated between 1974 and 1996 for papillary thyroid carcinoma by total thyroidectomy associated with bilateral (central and lateral) (n = 119) or unilateral (n = 39) dissection. The following criteria were used to study the predictive value of node involvement: age, sex, tumour size, tumour site, uni- or multifocality, existence or not of a tumour capsule, existence or not of perithyroid involvement and presence or not of vascular invasion. 99 patients (63%) had node involvement. Four factors showed predictive value for node involvement in univariate analysis: vascular invasion (P = 0.02), male sex (P = 0.008), absence of a tumour capsule (P < 0.0001) and perithyroid involvement (P < 0.0001). Two factors were predictive in multivariate analysis: absence of a tumour capsule and perithyroid involvement. Our results enabled us to calculate the risk of node involvement for each patient as a function of the existence of a peritumoral capsule and/or perithyroid involvement and to determine the indication for dissection. When neither of these factors was present, the risk of node involvement was 38.3% and dissection was not considered essential. If both risk factors were found, the risk was 87.1% and dissection was considered necessary.

Adolescent↗

PubMed1999

[Severe pancreaticoduodenal trauma: review of a series of 30 patients].

Retrospective study of a series of 30 patients (mean age: 25.5 years), including 8 children with severe duodenopancreatic trauma, treated over a period of 15 years. This series consisted of 14 cases of duodenal perforation, 3 cases of duodenal haematoma, 11 cases of isolated pancreatic lesions (including 5 isthmic ruptures) and 2 cases of associated duodenal and pancreatic lesions. Injuries were due to road accidents in 60% of cases. Eight patients were considered to have multiple injuries. Twelve patients required emergency surgery. Eighteen were observed in a surgical unit. Two duodenal haematomas were operated. Duodenal perforations were operated urgently in 8 cases and electively in 6 cases. The surgical procedure consisted of simple suture (n = 3), suture combined with diversion (n = 7), or resection-anastomosis (n = 4). Five patients with pancreatic contusion were operated, in a context of acute pancreatitis in four cases and for associated lesions in one case. Isthmic ruptures were treated by left pancreatic resection. This was a rare lesion (1.8 to 9% of organ lesions). Duodenal haematomas justify first-line medical treatment, while duodenal perforations must be operated. The presence of a lesion of the pancreatic duct frequently justifies pancreatic resection.

Accidents, Traffic↗

PubMed1999

[Outcome in cervical recurrences of papillary or follicular thyroid cancer].

The aim of this study was to evaluate the treatment and outcome of patients with local recurrence (LR) of differentiated thyroid carcinoma. This retrospective study concerned patients treated between 1974 and 1990 for papillary or follicular thyroid cancer. Our patients had at least one LR. LR diagnosed within 6 months after thyroidectomy and patients with increased serum thyroglobulin levels were excluded. Thirty one patients (80% female) aged 15 to 84 years had at least one LR. LR was diagnosed 7 to 200 months after thyroidectomy (mean 63.7). There were 25 papillary and 6 follicular cancers. There were 1.5 LR per patient (range 1-6). LR were treated by radioiodine in 21 cases and by surgery in 22 cases. Among the 22 surgically treated patients, 7 had nodal recurrences, 7 had nodes and tumor, 3 had only tumor, 1 had recurrence in the remnant thyroid. After a mean follow-up of 75.8 months, 11 patients had distant metastases, 11 had died from their thyroid carcinoma (7 after metastases). Three of the 7 patients with nodal recurrence died. In one third of cases, LR announced distant metastases. Node recurrence had a poor prognosis.

Adenocarcinoma, Follicular↗

PubMed1995

[Stomach duplications apropos of a case revealed by digestive hemorrhage. Value of ultrasonic endoscopy. Review of the literature].

Double stomach is a relatively rare inborn malformation. Manifestations are usually observed during the neonatal period or in early childhood. In adults, complications usually lead to diagnosis. Echographically and endoscopically, the malformation takes on the aspect of a tumour of the gastric mesenchyme. Echo-endoscopy is required for diagnosis. Surgery is the only treatment with or without exeresis of the gastric collar surrounding peripheral often pediculated lesions. Laparoscopic control may be helpful. Other procedures may be adapted on a case by case basis. Prognosis depends on associated malformations.

Adult↗

PubMed1994

[Discovery of an insulinoma during the first trimester of pregnancy].

Insulinoma is a rare tumour reported in 10 cases during pregnancy. In most cases, hypoglycaemia occurred during the first trimester and no fetal malformations were noted. We report a new clinical case of insulinoma diagnosed at 6 weeks of amenorrhoea in a 25-year-old woman. Surgery performed at 17 weeks of amenorrhoea confirmed the presence of a 7 mm diameter endocrine tumour in the head of the pancreas and led to a cure. The pregnancy continued without complications, and at 35 weeks the patient gave birth to a 3.5 kg infant with no malformation. This case was investigated in terms of a possible physiopathological cause of insulinoma during pregnancy. There is good evidence that insulin secretion increases rapidly from the beginning of pregnancy because of beta-cell proliferation and enhanced beta-cell sensitivity to glucose stimulus as a result of hormonal changes, i.e., prolactin and/or placental lactogen secretion. Moreover, some studies have suggested that insulin sensitivity is enhanced during early pregnancy. Taken together, these phenomena may explain why insulinoma occurs early during pregnancy. Although repeated hypoglycaemia has caused teratogenic effects in animal models, no fetal malformation has been described in previous reports of insulinoma during pregnancy, whether cured or not. This is in agreement with prospective studies in insulin-treated pregnant diabetic women showing no correlation between hypoglycaemia and malformations. These results are encouraging with respect to such pregnancies which, however, require careful supervision.

Adult↗

PubMed1992

[What is the role of elective surgery in diverticular sigmoiditis?].

From 1981 to 1991 inclusive, 188 operations were carried out for diverticular sigmoiditis. One hundred and thirty-nine patients were operated in emergency for acute complications (123) or fistulae (16), and another 49 had surgery scheduled outside acute crisis periods. Mortality and morbidity respectively are 16.5 and 31% in the first group, against 0 and 12% in the second one. Similarly, the stay in hospital varies from 13 days for scheduled surgery to 23 days for emergent surgery, the latter also requiring to account for risks and for the duration of a second operation that is far from exceptional (40%). Considering the severity of some evolutive complications, the authors advocate early radical surgery for symptomatic diverticular sigmoiditis, after the second crisis or as soon as the first one if it has been severe, and in young subjects and patients at risks.

Adult↗

PubMed1991

[Incidentally discovered adrenal tumors. Apropos of 20 cases].

According to Glazer, the term of incidentaloma describes an adrenal tumor discovered incidentally during acomputed tomographyscan and by extension to all masses discovered whatever the imaging process. Twenty patients have been operated during the last 10 years. The discovering circumstances are not specific, except the ecography and CT Scan. Complementary examinations include biological tests aiming at showing a possible hormonal secretion and more specific examinations MIBG scintygraphy and magnetic resonance imaging. The tumors often large (80% more than 5 cm long) and solid (75%) have all been removed by transperitoneal approach (13) or lombotomy. Post operative course was approach unevertful. The histological study showed 6 metastasis, 5 benign kystic lesions, 3 hematomas, 3 adenomas, 2 adrenalcortical carcinoma and 1 ganglioneuroma. A review of the literature series leads us to evaluate the frequency and risk of incidentalomas and to consider the necessary examination and the strategy to be adopted in front of such lesions. The evaluation of hormone status, the recourse to specific imaging seems necessary whereas the guided needle biopsy does not present any risk and should be reserved for very special cases. A decisional scheme is proposed, which ains at removing all voluminous and/or secreting tumors. Small lesions behind 35 mm will have to be examined closely and will be removed if they grow larger or persist.

3-Iodobenzylguanidine↗

PubMed1989

[Retro-rectal cystic tumors of developmental origin in adults. Apropos of 2 cases].

Two cases of recto-rectal congenital developmental cysts are described in young women (37 and 38 years). One was a duplication cyst of the rectum in association with two epidermoid cysts detected by US exploration in an asymptomatic woman, during pregnancy. The other case was a Tailgut cyst revealed by a retro-rectal abcess. In two cases, a pelvic CT Scan with rectal barium instillation for contrast and MRI exploration, revealed relationships and components of the developmental cysts. The treatment was a complete surgical excision via a Karske's approach, with coccygeal resection.

Adult↗

PubMed1988