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Biomedical subjects

J F Cuttat

Publications and source records attributed to J F Cuttat.

At least 19 recordsLinked to original sources
PubMed1998

Thoracoscopic splanchnicectomy for control of intractable pain in pancreatic cancer.

BACKGROUND: Pain is the most distressing feature of pancreatic cancer. Thoracoscopic splanchnicectomy, first performed in 1993, has caused a resurgence of interest in surgical treatment of such excruciating pain. METHODS: Twenty patients underwent splanchnicectomy for pancreatic cancer pain over a period of 50 months. All were opiate dependent and unable to pursue normal daily life activities. We evaluated the type of splanchnicectomy performed and the long-term results procured. RESULTS: The number of splanchnicectomies was 24: unilateral videothoracoscopic splanchnicectomy, n = 11; unilateral videothoracoscopic splanchnicectomy with associated vagotomy, n = 5; and bilateral videosplanchnicectomy, n = 4. There was no postoperative complication. Pain was totally relieved and drug addiction stopped in 16 patients: 10 with unilateral videothoracoscopic splanchnicectomy, 2 with unilateral videothoracoscopic splanchnicectomy and associated vagotomy, and 4 with bilateral videosplanchnicectomy. Pain was not relieved after 4 unilateral videothoracoscopic splanchnicectomies, but bilateralization was not attempted in that subgroup. CONCLUSIONS: Unilateral videothoracoscopic splanchnicectomy is the treatment of choice of intractable pancreatic pain, affording drug cessation and recovery of daily activity in most patients. Failure may be treated secondarily by bilateralization with excellent results. Bilateral videosplanchnicectomy need not be performed by first intention.

Adult↗
PubMed1998

CT-guided methylene-blue labelling before thoracoscopic resection of pulmonary nodules.

OBJECTIVE: Evaluation of the efficiency of our technique of methylene-blue labelling of pulmonary nodules to facilitate thoracoscopic recognition and excision. DESIGN: Patients with a peripheral pulmonary nodule smaller than 2.5 cm and not in contact with the visceral pleura were included. Under tomodensitometric guidance, the nodules were labelled with methylene-blue within hours before thoracoscopic wedge resection. If frozen section revealed a primary bronchial carcinoma, thoracotomy and classical resection were performed during the same anesthesia. RESULTS: Between July 1992 and August 1996, 54 nodules were removed in 51 patients. Labelling was performed between 75 and 270 min before surgery and was complicated in 13 patients (25.4%) by a small pneumothorax without any clinical consequence. Labelling allowed successful thoracoscopic recognition of 50 nodules (92%) and thoracoscopic wedge resection was possible in all but one cases (91%). Five patients (9%) required thoracotomy. Histology showed a benign lesion in 22 cases, a primary lung carcinoma in 17 and a metastases in 15. Twenty of the 22 benign nodules (91%) were removed without thoracotomy. According to the protocol, 13 patients with a primary lung tumour underwent lobectomy during the same session. There was no mortality nor morbidity amongst patients who had thoracoscopy only. CONCLUSIONS: Our technique of labelling peripheral pulmonary nodules with methylene-blue is very effective and is not associated with any relevant complication. Thoracoscopic excision and diagnosis is possible in more than 90% of the cases. We therefore recommend this simple, low-cost and reliable technique for nodules not in contact with the visceral pleura before thoracoscopic wedge resection.

Adult↗
PubMed1997

Liver of the "visible man".

Endoscopic surgery, also called minimally invasive surgery, is presumed drastically to reduce postoperative morbidity and thus to offer both human and economic benefits. For the surgeon, however, this approach leads to a number of gestural challenges that require extensive training to be mastered. In order to replace experimentation on animals and patients, we developed a simulator for endoscopic surgery. To achieve this goal, a first step was to develop a working prototype, a "standard patient," on which the informatic and microengineering tools could be validated. We used the visible man dataset for this purpose. The external shape of the visible man's liver, his biliary passages, and his extrahepatic portal system turned out to be fully within the standard pattern of normal anatomy. Anatomic variations were observed in the intrahepatic right portal vein, the hepatic veins, and the arterial blood supply to the liver. Thus, the visible man dataset reveals itself to be well suited for the simulation of minimally invasive surgical operation such as endoscopic cholecystectomy.

Adult↗
PubMed1997

Thoracoscopic pleurodesis for prolonged (or intractable) air leak after lung resection.

Air leaks are common after lung resection, and normally seal with conservative therapy. Re-thoracotomy is rarely indicated. We present three patients with prolonged air leak and partial pneumothorax treated by thoracoscopy. Complete lung re-expansion followed immediately. Postoperative air leak was minimal. The chest tubes were removed after three or four days. Complete division of adhesions and sealing of the leak(s) are essential. Thoracoscopy may be the method of choice for prolonged air leak unresponding to conservative therapy provided the bronchial stump or suture have been verified by endoscopy.

Humans↗
PubMed1995

The rationale to switch from postoperative hyperfractionated accelerated radiotherapy to preoperative hyperfractionated accelerated radiotherapy in rectal cancer.

PURPOSE: To demonstrate the feasibility of preoperative Hyperfractionated Accelerated RadioTherapy (preop-HART) in rectal cancer and to explain the rationales to switch from postoperative HART to preoperative HART. METHODS AND MATERIALS: Fifty-two consecutive patients were introduced in successive Phase I trials since 1989. In trial 89-01, postoperative HART (48 Gy in 3 weeks) was applied in 20 patients. In nine patients with locally advanced rectal cancer, considered unresectable by the surgeon, 32 Gy in 2 weeks was applied prior to surgery (trial 89-02). Since 1991, 41.6 Gy in 2.5 weeks has been applied preoperatively to 23 patients with T3-T4 any N rectal cancer immediately followed by surgery (trial 91-01). All patients were irradiated at the department of radiation-oncology with a four-field box technique (1.6 Gy twice a day and with at least a 6-h interval between fractions). The minimal accelerating potential was 6 MV. Acute toxicity was scored according to the World Health Organization (WHO for skin and small bowel) and the Radiation Therapy Oncology Group criteria (RTOG for bladder). This was done weekly during treatment and every 3 months thereafter. Small bowel volume was estimated by a modified "Gallagher's" method. RESULTS: Acute toxicity was acceptable both in postoperative and preoperative setup. The mean acute toxicity was significantly lower in trial 91-01 compared to 89-01. This difference was due to the smaller amount of small bowel in irradiation field and lower total dose in trial 91-01. Moreover, there was a significantly reduced delay between surgery and radiotherapy favoring trial 91-01 (median delay 4 days compared to 46 days in trial 89-01). Nearly all patients in trial 89-02 and 91-01 underwent surgery (31 out of 32; 97%). Resection margins were negative in 29 out of 32. Hospitalization duration in trial 91-01 was not significantly different from trial 89-01 (19 vs. 21 days, respectively). CONCLUSIONS: Hyperfractionated accelerated radiotherapy immediately followed by surgery is feasible as far as acute toxicity is concerned. Preoperative HART is favored by a significantly lower acute toxicity related, in part, to a smaller amount of irradiated small bowel, and a shorter duration of the delay between radiotherapy and surgery. Moreover, the hospital stay after preoperative HART is not significantly increased.

Adult↗
PubMed1995

[Gastric rupture secondary to barotrauma in the framework of a diving accident. Apropos of a case report and literature review].

Gastric perforation secondary to barotrauma is rare. The case of a diver suffering from gastric rupture due to a decompression accident is presented here. This rupture was a linear one, localized on the lesser curvature and responsible for a large pneumoperitoneum. Rupture occurs with an excluded stomach, a condition implying cardio-pyloric occlusion. The expansion of intra-gastric air, further worsened by accelerated surfacing provokes excessive gastric dilatation leading to partial or complete rupture (by virtue of the Boyle-Mariotte law: Pressure x Volume = constant). The lesion is always on the lesser curvature. However, it is often difficult to locate, even when peroperative gastroscopy is performed.

Adult↗
PubMed1994

[The role of emergency laparoscopy in abdominal pain syndrome and in the assessment of abdominal trauma].

From January 1991 to June 1993 we performed 106 emergency laparoscopies. The patients' mean age was 31 years (17-90). There were 73 females (69%) and 33 males (31%). 8 (8%) laparoscopic evaluations of abdominal traumas were performed. Laparoscopy yielded a diagnosis in 89% of the cases. In 12 cases (11%) the laparoscopy was negative. Morbidity was 2% and mortality 3%. The mean hospital stay was 4.5 days. Today emergency laparoscopic evaluation of abdominal syndromes is performed routinely in most centers. The diagnostic rate is reported to be between 87-96% according to individual series. Laparoscopy may shorten the diagnostic delay, diminish the number of paraclinical investigations and in particular reduce the number of negative laparotomies.

Abdominal Injuries↗
PubMed1994

CT-guided localizations of pulmonary nodules with methylene blue injections for thoracoscopic resections.

As only peripheral subpleural lesions can be visualized at thoracoscopy, deep nonpalpable pulmonary nodules have to be identified before performing wedge resections. We evaluate the efficiency of computed tomographic (CT) guided methylene blue injections to localize these nodules before their thoracoscopic resection. Twenty-three nodules in 21 patients were preoperatively localized under CT guidance and marked with methylene blue injections. The localizations under CT guidance of the 23 nodules were successful in all cases. The surgeon confirmed accurate localization of 22 nodules. In one case, the injected methylene blue could not be identified during thoracoscopy. Complications of this technique included six cases of asymptomatic pneumothorax, four cases of local and asymptomatic pulmonary hemorrhage, and two cases of fit of coughing. Because of this technique, 22 thoracotomies could be avoided and the duration of the hospital stay was then reduced. Computed tomographic-guided localization with methylene blue injection is a simple, effective, and rapid technique enabling good thoracoscopic surgery results.

Evaluation Studies as Topic↗
PubMed1994

[Adenocarcinoma of the duodenum. Contribution to the study of a rare pathology].

Primary adenocarcinoma of the duodenum is a rare lesion and represents 0.35% of all tumors of the gastrointestinal tract. 75% of the primary tumors of the duodenum are adenocarcinomas and 33-45% of the adenocarcinomas of the small bowel arise in the duodenum. The incidence of these tumors has been estimated to be 0.03%. The diagnosis is usually made at a very late stage because the symptoms are often non-specific. The mean diagnostic delay between beginning of symptoms and the diagnosis is of 10 months. Oesogastroduodenoscopy is the diagnostic procedure of choice and upper GI series is still of interest since it permits a topographic analysis of the lesion. Pancreatico-duodenectomy is recognized by a majority of authors as the standard curative procedure, in the absence of regional nodes. Survival after pancreaticoduodenectomy in the absence of local lymph node invasion is 68% at 5 years whereas there is no survivor after 3 years when there is regional invasion of the lymph nodes. Survival rates after palliative excisions are generally of 15 months, after bilio-digestive derivation of 6 months. Radical excision is preferable in as much as it is technically feasible.

Adenocarcinoma↗
PubMed1994

[Endorectal ultrasound of rectal cancers].

Endorectal ultrasonography has become the preferred exam to assess the local extent of rectal cancers. From 1990 to 1992, we have examined 28 patients with a rectal cancer. The tumours were classified according to the TNM. The objective of this exam is to identify patients whose tumours have invaded the perirectal fat. These patients are first treated in our clinic by an accelerated hyperfractionated radiotherapy and then operated. The preoperative staging made with the endorectal ultrasound was then compared with the anatomopathologic staging. The depth of the invasion was assessed precisely in 78.5% of cases. The exam's sensitivity to detect the invasion of the perirectal fat was 96% and its specificity 75%. Lymph node involvement was accurately identified in 67.8% of cases with a sensitivity of 81% and a specificity of 50%. This short retrospective study confirms that endorectal ultrasonography is a highly accurate tool for the staging of rectal carcinoma prior to operation and hence to select the patients that can benefit from preoperative irradiation.

Adenocarcinoma↗
PubMed1994

[Thoracoscopic treatment of recurrent pneumothorax].

Spontaneous pneumothorax (PNO) is usually due to rupture of a small subpleural bleb into the pleural cavity and affects mainly young men. After simple drainage, recurrence occurs in about 50% of cases. The risk of recurrence increases after each new PNO. Secondary PNO complicates an underlying pulmonary disease, especially chronic obstructive pulmonary disease with emphysema. A new form of secondary PNO has emerged in the recent years in AIDS patients with pneumocystis carinii pneumonia. We have shifted to a thoracoscopic therapy of PNO since May 1991. 25 PNO in 24 patients (1 bilateral) have been treated since that time up to April 1993. 19 PNO were primary, whereas 6 were secondary, included 3 iatrogenic PNO. Resection of the leaking parenchymal area was performed in 20 patients, and parietal partial pleurectomy was done in 20 cases. In the remaining cases, fibrin glue was applied on the lesion and in 3 cases, chemical pleurodesis was attempted using silver nitrate or talc. 1 AIDS patient died of ARDS. 3 patients had recurrent PNO and had thoracotomy without complication. 21 patients did well. Partial PNO recurred in one of them 4 months later, and was treated by simple needle aspiration. Thoracoscopy is a useful method to treat recurrent or persistent spontaneous PNO. After only 25 cases, our success rate in primary PNO is 90%. There should be a learning curve. On the basis of our experience, we believe that recognition of the lesion and its resection as well as apical parietal pleurectomy are necessary to obtain good results and a low recurrence rate.

Adolescent↗
PubMed1993

Adjuvant postoperative accelerated hyperfractionated radiotherapy in rectal cancer: a feasibility study.

PURPOSE: To assess the acute toxicity and hence feasibility of postoperative hyperfractionated accelerated radiotherapy in rectal cancer. METHODS AND MATERIALS: Twenty patients were submitted to accelerated hyperfractionated radiotherapy after resection of rectal cancer. A total dose of 48 Gy was given in 3 weeks. Two fractions of 1.6 Gy were used with a mean interfraction interval of at least 6 hours. The pelvic volume was treated by a four-field box technique using a linear accelerator (6-18 MV). Acute toxicity was assessed once per week. Small bowel and skin toxicity were scored according to the criteria of the World Health Organization. Bladder toxicity was scored according to the criteria of the Radiation Therapy Oncology Group. RESULTS: All the patients underwent the treatment as planned except one. No patient presented grade 3 or 4 bladder toxicity. There was only one patient who complained from grade 3 skin toxicity at the end of the treatment. Fourteen patients had some degree of intestinal toxicity. This was the most frequently occurring acute side-effect. Only two out of the fourteen patients had intestinal toxicity exceeding grade 2. CONCLUSION: Hyperfractionated accelerated radiotherapy on a pelvic volume is feasible as far as acute toxicity is concerned.

Adenocarcinoma↗
PubMed1993

[Laparoscopic cholecystectomy in a teaching center. Apropos of 208 interventions].

Laparoscopic cholecystectomy is a relatively recent acquisition and still remains limited to a few surgeons. We started an education program for surgeons used to open biliary surgery. Between September 1990 and December 1991, 208 patients have been operated on day 14 operators flanked by 2 teachers. Technique was standardized and all patients were examined preoperatively for absence of stones in bile ducts using i.v. cholangiography and tomography. Only 6 patients (< 3%) needed to be converted to laparotomy. Morbidity was less than 6% and due to minor complications. Only one patient needed reoperation because of incisional hernia. Mortality was nil. Mean postoperative hospitalization time was less than 3 days. We conclude that laparoscopic activity in a teaching center allows acquisition of a new technique modality while remaining safe for patients.

Cholecystectomy, Laparoscopic↗
PubMed1993

[Laparoscopic cholecystectomy in a medical training center. Apropos of 208 interventions].

Laparoscopic cholecystectomy is a relatively recent acquisition and still remains limited to few surgeons. We started an education program for surgeons used to open biliary surgery. Between september 1990 and december 1991, 208 patients have been operated on by 14 operators flanked by 2 teachers. Technique was standardized and all patients were looked preoperatively for absence of stones in bile ducts using i.v. cholangiography and tomography. Only 6 patients (< 3%) needed to be converted to laparotomy. Morbidity was less than 6% and due to minor complications. Only one patient needed a reoperation because of incisional hernia. Mortality was null. Mean postoperative hospitalization time was less than 3 days. We conclude that laparoscopic activity in a teaching center allows acquisition of a new technique modality while remaining safe for patients.

Cholecystectomy, Laparoscopic↗
PubMed1992

Small bowel protection with "STEP". Silastic tissue expander prosthesis.

This is a case report of a patient presenting with rectal carcinoma and Crohn's disease. Adjuvant treatment was considered to be mandatory on the basis of local extension. Therefore a Silastic Tissue Expander Prosthesis (STEP), connected with a subcutaneously located self-sealing valve system, was introduced surgically to push small bowel up out of the treatment portals. Patient received 55 Gy without any acute or late complication. This easy technique allows radiotherapy in conditions where complete elimination of small bowel outside the treatment volume is required.

Adenocarcinoma↗
PubMed1991

[Radiation protection of the small intestine in the lesser pelvis using an inflatable silicon prosthesis].

The combination of radiotherapy and surgery plays a major role in treating pelvic cancer. However, this technique is chiefly limited by the radiosensitivity of the small bowel following postoperative radiotherapy. In this situation the small bowel is not protected because of its lack of mobility. A radioprotective prosthesis is presented which is readily removable and whose purpose is to push the small bowel out of the pelvis during radiotherapy, thus protecting it from radiotherapy. If required, a simple system allows the prosthesis to be emptied and refilled between courses of radiotherapy, if required, without reoperation. This technique has been used in 4 patients: 2 had rectal carcinoma secondary to ulcerative colitis in one case and to Crohn's disease in the other; the other 2 cases were recurrent rectal carcinoma, one of which was partially resectable. When radiotherapy was completed the prosthesis could be deflated and removed through a short incision under local anesthetic. In the medium term, no small bowel complications were observed in spite of high-dose radiotherapy. When used for radiosensitive pelvic tumors, this technique combines low cost and ease of use with very low morbidity and the possibility of administering high-dose radiotherapy.

Adenocarcinoma↗