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J C Le Neel

Publications and source records attributed to J C Le Neel.

At least 37 records · Page 2Linked to original sources
PubMed1990

[Traumatic rupture of the bladder. Apropos of 11 cases].

Eleven cases of rupture of bladder were observed within 7 years. Four of them were due to a direct trauma on a full bladder (group I), the other seven occurred during a complex trauma, constantly with a fracture of the pelvis (group II). In group I, the rupture was situated on the apex of the bladder. The symptoms were a suprapubic pain in four patients, a hematuria in two, and an anuria in one. In the four patients, intraperitoneal fluid was clinically evident, and confirmed ultrasonographically. An urography was performed in two patients and showed an intraperitoneal leak in our patient, and intravesical clots in the other one. The four patients were operated on within 48 hours, and were successfully treated by suture and vesical catheter. In group II, the vesical injury was revealed by hematuria (2 patients) hemorragic shock (2 patients) or both (2 patients). In the last patient, an abdominal pain after 10 days was the only symptom. Clinical signs of hemoperitoneum were present in only four patients and were confirmed ultrasonographically in two out of five patients. The urogram was normal in two of four patients. In one patient it showed a small bladder, and in another one a vesical leak. Five patients were operated on among where three in emergency and two after 9 and 10 days. Four patients with intraperitoneal rupture were successfully tread by suture of the bladder. Among three patients with extraperitoneal rupture, one had an additional tear of the mesentery and died from intravascular coagulation, the second was successfully treated by a suture, and the last one by a vesical catheter only.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

[Diffuse esophageal leiomyomatosis. Apropos of 3 cases].

Three cases of diffuse esophageal leiomyomatosis are discussed. Two of these are familial one, the mother being affected. These familial cases can occur in association with Alport's syndrome. The occurrence of a case of esophageal leiomyomatosis imply a familial survey and the search of a renal or ocular disease. The surgical treatment of this affection in sub total oesophagectomy with esophageal substitution (with the colon especially). The long term prognosis is unknown, with the risk of renal failure if Alport's syndrome is associated or of other leiomyomatous localisation.

Child↗
PubMed1989

[Diffuse esophageal leiomyomatosis. Apropos of 5 cases with 2 familial cases].

Diffuse esophageal leiomyomatosis is characterized by diffuse muscular hypertrophy chiefly marked in the lower end of the esophagus looks at a large tumor. It involves the entire length of the esophagus and down to the upper part of the stomach (esogastric leiomyomatosis). Diffuse leiomyomatosis is a extremely rare pathology encountered in children (13 previous report cases) and young adults. Il may be isolated or found in association with other intrathoracic and genital localisations or Alport syndrome (nephropathy, sensorineural deafness, ocular lesions). Extensive leiomyomatosis, engulfing the trachea and stem bronchi, may involve acute respiratory insufficiency. Genital localisations, exclusively in women (clitoral hypertrophy, vulvar leiomyomatosis), in association with esophageal leiomyomatosis, realize the esophago vulvar syndrome. Recently, familial diffuse leiomyomatosis cases were described with, in association, esophageal and extra-esophageal leiomyomatosis and Alport syndrome. The majority of the patients developed esophageal or respiratory symptoms. The radiological appearance is that of a mediastinal tumor or achalasia. CT Scans findings can give evidence diffuse muscular thickening of esophageal wall. Prognosis depends on the associated lesions. In that reports, two young adults (27 and 39 years old) died of inhabitual carcinomas (esophageal and gallbladder carcinoma). The only surgical treatment for symptomatic esogastric leiomyomatosis is subtotal esophagectomy with proximal gastrectomy and esocoloplasty. Myotomy is ineffective (2 cases). Five cases of esophageal leiomyomatosis are described (3 children, 2 young adults). Among these, two are familial leiomyomatosis cases. An esophageal resection was performed in four patients.

Adult↗
PubMed1989

[Volvulus of the sigmoid colon].

The authors report of 34 cases of sigmoid colon volvulus occurring in young subjects (15%) and in elderly subjects (60% over the age of 75 years). The diagnosis is frequently suggested by the clinical features and the history (30% of patients have a history of a previous identical episode) and is confirmed by a plain abdominal x-ray and/or an opaque enema. Endoscopy is performed in every case, except in the presence of peritoneal signs, in an attempt to perform detorsion and colonic intubation under direct vision in order to avoid emergency surgery; this procedure is effective in 87% of cases. Emergency surgery has a high mortality rate (43.5%). Elective or deferred emergency surgery after preparation is much safer (6.6% mortality). In patients with multiple diseases, non-surgical conservative management after detorsion too frequently results in repeated complications, leading to decompensation of the concurrent illnesses and a mortality rate of 34%. Endoscopic detorsion followed by surgical resection after a short 3 to 4 day preparation seems to be the best guarantee of therapeutic success.

Adolescent↗
PubMed1987

[The caudal lobe of the liver. Anatomical study. Surgical applications].

The caudal lobe of liver is an independent sector astride the right and left liver regions. It is formed of two parts, right and left, distinguished exteriorly by the caudal and papillary processes, and can now be explored (ultrasound and CT imaging) allowing its surgical removal (tumoral lesion of the superior biliary confluent).

Humans↗
PubMed1985

[Injuries of the liver in children. Review apropos of 30 cases].

Between 1970 and 1983, 30 children have been treated for a liver trauma. 16 were from 5 to 10 years old. 6 had solitary hepatic lesions and 24 had visceral or polytraumatic associated lesions. All but one were operated and 27 underwent an emergency laparotomy. Superficial tears and subcapsular hematoma were found in 11 cases while penetrating wounds (14), vascular injuries (3) and ruptures (2) represent 2/3 of the whole lesions. In five cases, hepatectomy was necessary. Half of the 6 deaths result of a vascular injury, the others of the associated lesions. We have a resolutely surgical behavior when collapse or polyvisceral lesions are patent, while in isolated blunt injury a single clinical and echographic follow up is justified. A CT scan is necessary when a penetrating wound is suspected completed with an angiography.

Adolescent↗
PubMed1985

Bilateral phaeochromocytomas in pregnancy: anaesthetic management of combined caesarean section and tumour removal.

A 25-year-old primigravida with bilateral phaeochromocytomas was managed from 6 weeks' gestation until 2.5 years following combined Caesarean section and removal of adrenal tumours. Pre-operative alpha-blockade was achieved by oral prazosin without deleterious effects. Intra-operative management comprised neuroleptanalgesia, arterial and pulmonary pressure monitoring, adequate heart loading with fluid replacement and sodium nitroprusside. Post-operatively, mother and baby remained normotensive.

Adrenal Gland Neoplasms↗
PubMed1985

[Preoperative vascular loading. A guide for the management of volume expansion in the surgery of pheochromocytoma].

The most acurate fluid replacement is needed for the operative management of patients with pheochromocytoma. Pulmonary capillary wedge pressure monitoring must be incorporated into routine practice for assessing left ventricular filling pressure because discrepancies between central venous pressure and left-sided filling pressure may occur, even in patients apparently free of cardiopulmonary dysfunction. The response to preoperative acute volume loading was used in 11 patients--to detect preoperatively patients in whom fluid infusion was associated with a dangerous increase in pulmonary wedge pressure without improvement in forward flow and--to provide a guide for intraoperative volume replacement. This method confirmed informations suspected from baseline pressure data in one patient: distorsion between right and left ventricular filling pressures. Furthermore it showed an unsuspected ventricular dysfunction in a second patient with normal baseline pulmonary capillary wedge pressure. Both volume and speed of operative fluid challenge were adapted to this preoperative ventricular response.

Adrenal Gland Neoplasms↗
PubMed1984

[Wirsung's duct hemorrhage in chronic pancreatitis. Report of 4 cases and study of the literature].

Hemorrhage from Wirsung's canal complicated chronic pancreatitis in 4 patients. Excision (2 cephalic and 1 corporeocaudal) in 3 cases provided successful results, the 4th patient dying from intraperitoneal rupture of the false cyst responsible for the hemorrhage, during recurrence of the latter after simple ligature. A literature review indicated pancreatic disease, mainly chronic, as the cause in 76.5% of the 64 cases documented. Diagnosis is difficult from clinical findings, and is dependent mainly on results of endoscopy and particularly retrograde catheterization of the papilla, while arteriography is essential for confirmation of the diagnosis and the site of the lesion, and for assisting choice of therapy. When a chronic pancreatitis exists, the only logical attitude is selective excision, mortality being minimal (5%). Embolization could be a valid method for ensuring hemostasis temporarily to allow delayed radical surgery.

Aged↗
PubMed1984

[Problems posed by massive hemorrhages of colorectal origin. Apropos of 12 case reports].

Urgent surgical operation to treat massive hemmorrhage of colorectal origin was necessary in 12 patients: --colon diverticulosis: 7 cases, --cecal angiodysplasia: 1 case, --pancreatocolic fistula: 1 case, --ischemic colitis: 2 cases, --post-radiation therapy rectitis: 1 case. Lesions exclused from discussion in this report and provoking hemorrhage were colorectal tumors, chronic inflammatsry colitis, rectosigmoid angiomatosis, and post-traumatic or iatrogenic lesions. After a definition of massive hemmorrhage based on pre-operative transfusional requirements, the exploratory procedures necessary for localization of the site of the hemorrhage or for detecting a right colon angiodysplasia are discussed. Bimesenteric arteriography represents the exploration of choice, but its usefulness is limited in patients with several risk factors and an average age of 70 years. The respective values of a barium enema and peroperative endoscopy in this particular context are also discussed. Elective surgery should be performed only when the exact site of bleeding has been determined or when an angiodysplasia is present. Particular problems arise when treating diffuse colon diverticulosis hemorrhage, and that provoked by the association of an angiodysplasia and a diverticulosis, as well as hemorrhagic lesions that may require emergency therapy in much rarer affections: ischemic colitis, pancreatocolic fistula, iliosigmoidal fistula, colorectal varices, colon and rectal ulcers, and colorectal radiolesions.

Aged↗