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J J Duron

Publications and source records attributed to J J Duron.

At least 19 recordsLinked to original sources
PubMed2006

Use of icodextrin 4% solution in the prevention of adhesion formation following general surgery: from the multicentre ARIEL Registry.

INTRODUCTION: Intra-abdominal adhesions occur in many patients following major abdominal surgery and represent a serious burden to patients and healthcare providers. The multicentre ARIEL (Adept Registry for Clinical Evaluation) Registry was established to gather clinical experiences in the use of icodextrin 4% solution, an approved adhesion-reduction agent, during routine general surgery. PATIENTS AND METHODS: General surgeons from five European countries completed anonymised data collection forms for patients undergoing laparotomy or laparoscopy. Surgeons recorded patient demographics, use of icodextrin 4% solution and adverse events, and made subjective assessments of ease of use and patient acceptability with the agent. RESULTS: The general surgery registry included 1738 patients (1469 laparotomies, 269 laparoscopies). Leakage of fluid from the surgical site did not appear to be affected by icodextrin 4% solution and was classified as 'normal' or 'less than normal' in most patients (laparotomies 86%, laparoscopies 88%). Overall, satisfaction with ease of use was rated as 'good' or 'excellent' by the majority of surgeons (laparotomies 77%, laparoscopies 86%). Patient acceptability was also good, with ratings of 'as expected' or 'less than expected' in most cases for both abdominal distension (laparotomies 90%, laparoscopies 91%) and abdominal discomfort (laparotomies 91%, laparoscopies 93%). Adverse events occurred in 30.6% of laparotomy patients and 16.7% of laparoscopy patients; the most common events were septic/infective events (4.2% and 3.4% in the laparotomy and laparoscopy groups, respectively). Anastomotic wound-healing problems were reported in 7.6% of patients in the subset of laparoscopy patients undergoing anastomotic procedures (n = 66). DISCUSSION: Volumes of icodextrin 4% solution used as an irrigant and instillate were in line with recommendations. Surgeons considered the agent to be easy to use and acceptable to patients. The reported frequencies of adverse events were in line with those published in the literature for surgical procedures, supporting the good safety profile of this agent. CONCLUSIONS: Icodextrin 4% solution can be used in a wide range of surgical procedures. In combination with good surgical technique, it may play an important role in adhesion reduction.

Glucans↗
PubMed2003

[Post-operative bowel obstruction. Part 1: Intraperitoneal bands and adhesions--causes and prevention].

Postoperative peritoneal bands and adhesions are very common and may occur after any surgical procedure within the peritoneal cavity. Certain factors have been shown to contribute to their formation. The abdominal surgeon should take account of these factors in his daily practice; a reasoned and preventive surgical approach and the use of techniques and products with proven clinical efficacity are to be recommended. This should permit the surgeon to simplify and minimize post surgical work and to diminish the incidence and complications of adhesions in both the immediate and long-term post-operative periods such as post-surgical pain syndromes, mechanical bowel obstruction, and adhesive peritonitis complicating reinterventional surgery.

Aged↗
PubMed2003

[Gastrointestinal tract in the elderly].

Patient's age no longer is a major factor when discussing the diagnosis and treatment of hepatobiliary and gastrointestinal diseases. However, discussing with the physician in charge of the patient is the only adequate way to propose the quickest, least invasive and most comfortable imaging modality that will give a proper answer to the clinical problem. Cross sectional imaging, especially ultrasound, CT and in some cases MRI, plays an important role in the diagnosis of these diseases.

Age Factors↗
PubMed2003

[Post-operative bowel obstruction. Part 2: Mechanical post-operative small bowel obstruction by bands and adhesions].

Small Bowel obstruction due to post-operative adhesions is a common problem in a general surgical practice. Any laparotomy initiates the lifelong risk of this complication. Mortality rates have improved dramatically in the last three decades. The basic evaluation and treatment of small bowel obstruction is well defined but many individual strategies may result from the variety of clinical presentations and from techniques and equipment available to a local surgical practice. Recent advances in surgical techniques and preventive strategies may improve overall results. Results will remain linked to the continuous aging of the populations of Western countries.

Female↗
PubMed2001

[Acute intestinal occlusions].

Acute intestinal obstruction comprises a vast clinical entity characterized by the items of the obstruction syndrome. It encompasses numerous etiologies, and in Western countries adhesions are currently the main cause. The work up of this urgent surgical condition must above all be clinical, even though new techniques will probably improve their diagnosis and treatment (CT scan, stent). These new technologies still have to be documented and validated. Likewise, the laparoscopic approach of acute intestinal obstruction has to be prudent. The overall mortality of this urgent condition is still high, more than 10% of the patients.

Abdominal Pain↗
PubMed2000

Prevalence and mechanisms of small intestinal obstruction following laparoscopic abdominal surgery: a retrospective multicenter study. French Association for Surgical Research.

HYPOTHESIS: The prevalence and mechanisms of intestinal obstruction following laparoscopic abdominal surgery have not been studied extensively. DESIGN: Retrospective review of cases of intestinal obstruction after laparoscopic surgery. SETTING: Sixteen surgical units performing laparoscopy in France. PATIENTS: Twenty-four patients with intestinal obstruction. MAIN OUTCOME MEASURES: Prevalence values and descriptive data. RESULTS: The 3 most frequent primary procedures responsible for intestinal obstruction were cholecystectomy (10 cases), transperitoneal hernia repair (5 cases), and appendectomy (4 cases). Prevalences of early postoperative intestinal obstruction after these procedures were 0.11%, 2.5%, and 0.16%, respectively. Intestinal obstruction was due to adhesions or fibrotic bands in 12 cases and to intestinal incarceration in 11 cases. Obstruction was located at the trocar site in 13 cases (9 incarcerations and 4 adhesions), mainly at the umbilicus, and in the operative field in 10 cases (2 incarcerations in a wall defect after transperitoneal inguinal hernia repair, 4 adhesions, and 4 fibrotic bands). The small intestine was involved in 23 of 24 cases; the other was due to cecal volvulus following unrecognized intestinal malrotation. Intestinal obstruction was treated by laparoscopic adhesiolysis in 6 patients and by laparotomy in 18 patients, 6 of whom required small intestine resection. Three postoperative complications but no deaths occurred. CONCLUSION: Intestinal obstruction following laparoscopic abdominal surgery can occur irrespective of the type of operation; the prevalence is as high as (cholecystectomy and appendectomy) or even higher than (transperitoneal hernia repair) that seen in open procedures.

Abdomen↗
PubMed2000

[Patients, surgeons and surgical gloves].

Consumption of surgical gloves in progressing constantly. All proposed products do not have the same qualities in terms of protection, comfort, and safety for the surgeon, the surgical team and the patient. Latex is the basic material used to manufacture surgical gloves even if it does raise the problem of side-effects and requires use of starch powder for lubrification. The surgeon should be aware of the different products and participate in choosing this indispensable tool. There is a general and advisable trend to using non-powdered gloves.

Equipment Design↗
PubMed1999

Survey of the impact of randomised clinical trials on surgical practice in France. French Associations for Research in Surgery (AURC and ACAPEM). Association Universitaire de Recherche en Chirurgie. Association des Chirurgiens de l'Assistance Publique pour l'Evaluation Médicale.

OBJECTIVE: To evaluate the impact of randomised clinical trials (RCT) on decision-making and therapeutic policies among general and gastrointestinal surgeons in France. DESIGN: Telephone questionnaire. SETTING: Multicentre study, France. SUBJECTS: A random sample of 152 surgeons, mean (SD) age 50 (8) years. INTERVENTIONS AND MAIN OUTCOME MEASURE: Surgeons were asked 12 questions about their knowledge of RCT and how trials were conducted; influence of RCT on their treatment policies; means of obtaining information about treatments; how they evaluated their own results; whether they were willing to take part in RCT; and personal details including age, speciality, and type of practice. Surgeons were stratified according to age and type of practice. RESULTS: 148 questionnaires were suitable for analysis. 83 surgeons (56%) were under 50 years old, 38 (26%) were exclusively gastrointestinal surgeons, 82 (56%) worked in private practice, and 36 (24%) worked in teaching and university hospitals. The rest undertook mixed duties. When asked to say where they obtained their knowledge about antibiotics, 91 (61%) referred to RCT; these were mainly hospital-based, gastrointestinal, and younger surgeons. Asked to name a RCT-based policy, 81 (55%) gave medical rather than operative examples. 80 (54%) had already participated in a RCT; 79 (53%) said that they were willing to participate in a RCT that included random allocation of patients (there were no statistically significant differences in answers according to speciality or type of practice, although younger surgeons answered "yes" to both questions). Specialised journals were the main source of information for 115 (78%), and surgeons read a mean of 40 issues/year. 142 (96%) read journals in French and 66 (45%) in English, but this number fell to 10 (15%) of the 65 surgeons aged 50 or more. Personal experience was considered a more important source of therapeutic knowledge by older and specialist surgeons. 109 surgeons (74%) recalled patients during the first month postoperatively to evaluate their results. CONCLUSIONS: French surgeons, particularly those aged 50 or over, are not well informed about the nature, conduct, and value of RCT. Most of their information is acquired through reading and attending scientific meetings and congresses. Surgeons tended to attach more importance to the fame of the author than to the conduct of the study. The overall impact of RCT was weak among the surgeons questioned.

Adult↗
PubMed1999

[Pancreatectomy and diabetes].

Post total pancreatectomy diabetes is a clearly defined form of unstable diabetes, requiring low doses of insulin, with frequent and severe hypoglycemic events. This is due to both deficiency of pancreatic glucagon, hormone of primary importance for hepatic gluconeogenesis and glycogenolysis, and exocrine failure. The management of this form of diabetes is difficult, involving exact correction of malabsorption and low doses of insulin. Whenever possible, partial pancreatectomy should therefore to be preferred. After partial pancreatectomy, the likelihood of diabetes depends on the volume of the remaining pancreas, the type of resection and above all the preexisting pancreatic status. Prevention of postoperative hyperglycemia could minimize the risk of long-term diabetes. Pancreatic cancer is a particular case: the onset of diabetes could be a manifestation of occult pancreatic cancer and glucose metabolism may improve after tumour excision with preservation of some pancreatic tissue.

Diabetes Mellitus↗
PubMed1998

[Acute mesenteric ischemia: changes in 1985-1995. Surgical Research Associations].

AIM OF THE STUDY: Acute mesenteric ischaemia (AMI) resulting in intestinal ischaemia and/or infarction is associated with an extremely serious prognosis and a mortality rate ranging from 40% to 100%. The aim of the study is to appreciate the epidemiological, therapeutic and prognostic changing aspects of the AMI over a decade. PATIENTS AND METHODS: Two retrospective and multicentric series (492 and 305 patients, respectively) identically collected between 1980-1985 and 1990-1995 by the French Associations of Surgical Research were compared. Comparisons concerned the patients' clinical features, the aetiology of AMI and the surgical management. The mortality was analysed taking into account the former items. RESULTS: The overall mortality rate decreased from 77% to 59% (P < 0.0001). The patients' preoperative clinical features improved but collapse remained the main serious factor. The rate of venous origin AMI increased significantly (P < 0.02) with a mortality decrease (51% to 19%, P < 0.0001). The mortality rate of thrombotic origin AMI decreased (83% to 63%, P < 0.0001). The results of surgical management improved, even though the frequency of angiographies, vascular and second-look procedures did not increase. CONCLUSION: Even though the prognosis of AMI remains extremely serious, a significant decrease of the overall mortality rate is observed. Two ways of progress can be recommended: the first, successfully initiated involving better management of the patients with a greater number of classical surgical procedures; the second, more aggressive treatment advocated by more specialised surgical teams.

Acute Disease↗
PubMed1998

Differential transferrin receptor density in human colorectal cancer: A potential probe for diagnosis and therapy.

Transferrin receptor density was investigated in human colorectal surgical specimens. Crude membranes were prepared from 23 cancer tumors (adenocarcinoma or malignant villous tumor) and 3 non-cancer tumors (polyadenoma or villous tumor) and 26 adjacent control mucosa. Contrary to non-cancer tumors, Scatchard analysis of 125I-transferrin binding data evidenced higher maximal transferrin binding capacity and lower dissociation constant in cancer tissues (Bmax cancer 1.828+/-0.320 nmol/g, Kd 24.1+/-4.7 nM), as compared to paired control colonic mucosa (Bmax contol 0.851+/-0.182 nmol/g, Kd 30.7+/-7.3 nM), paired t-tests: Bmax p<0.001, Kd p<0.05). As the cancer/control Bmax ratio was 2.6+/-0.4,transferrin carrier constructs should be proposed for cancer imaging or therapy.

Adult↗
PubMed1998

[Preoperative skin preparation in abdominal surgery].

Mechanical skin preparation is a daily nursing procedure in abdominal surgery. Even though a single procedure has not yet been adopted, several evidence-based points can be found in the literature: non-shaving or depilation of the surgical field with and electric clipper give the lowest rate of wound infection. The same is true for shaving of the operative field just before the operation. The beneficial effects of depilatory cream have not been demonstrated. Finally, there are no current data dealing with the acceptability and the overall cost of depilation procedures.

Abdomen↗
PubMed1997

Foreign bodies and intraperitoneal post-operative adhesions.

The presence of foreign bodies is one of the recognized causes of fibrous bands and intraperitoneal post-operative adhesions. The objective of this study was to identify foreign bodies actually present in fibrous bands and intraperitoneal post-operative adhesions. From a series of 211 consecutive patients re-laparotomized by the same surgeon over a period of two years, 193 (91%) showed fibrous bands or adhesions; of these, 133 (69%) also showed reactions to foreign bodies. Comparison with a reference list established in animal work showed than in 127 (66%) of the cases the foreign bodies were of cellulose textile origin; in 3% of the cases, they were of diverse origin--starch powder, synthetic textiles, sutures, or unidentifiable particles.

Animals↗
PubMed1997

Post-operative peritoneal adhesions and foreign bodies.

One of the proven causes of adhesions is foreign microbodies which are present in up to 93% of all re-operated patients in which adhesions are analysed for evidence of external contamination. Studies are described which show the changing nature of foreign microbodies with time, associated with the development of new surgical practices. This paper concludes that although foreign bodies found today may not be the same as those found 30 years ago, they remain prominent in the aetiology of adhesions--the main cause of postoperative intestinal obstruction. Every effort should be made to minimise tissue contamination during operations with particulate debris such as glove powder.

Foreign Bodies↗
PubMed1996

Foreign material in postoperative adhesions.

OBJECTIVE: The authors determined the prevalence of foreign body granulomas in intra-abdominal adhesions in patients with a history of abdominal surgery. PATIENTS AND METHODS: In a cross-sectional, multicenter, multinational study, adult patients with a history of one or more previous abdominal operations and scheduled for laparotomy between 1991 and 1993 were examined during surgery. Patients in whom adhesions were present were selected for study. Quantity, distribution, and quality of adhesions were scored, and adhesion samples were taken for histologic examination. RESULTS: In 448 studied patients, the adhesions were most frequently attached to the omentum (68%) and the small bowel (67%). The amount of adhesions was significantly smaller in patients with a history of only one minor operation or one major operation, compared with those with multiple laparotomies (p < 0.001). Significantly more adhesions were found in patients with a history of adhesions at previous laparotomy (p < 0.001), with presence of abdominal abscess, hematoma, and intestinal leakage as complications after former surgery (p = 0.01, p = 0.002, and p < 0.001, respectively), and with a history of an unoperated inflammatory process (p = 0.04). Granulomas were found in 26% of all patients. Suture granulomas were found in 25% of the patients. Starch granulomas were present in 5% of the operated patients whose surgeons wore starch-containing gloves. When suture granulomas were present, the median interval between the present and the most recent previous laparotomy was 13 months. When suture granulomas were absent, this interval was significantly longer--i.e., 30 months (p = 0.002). The percentage of patients with suture granulomas decreased gradually from 37% if the previous laparotomy had occurred up to 6 months before the present operation, to 18% if the previous laparotomy had occurred more than 2 years ago (p < 0.001). CONCLUSIONS: The number of adhesions found at laparotomy was significantly larger in patients with a history of multiple laparotomies, unoperated intra-abdominal inflammatory disease, and previous postoperative intra-abdominal complications, and when adhesions were already present at previous laparotomy. In recent adhesions, suture granulomas occurred in a large percentage. This suggests that the intra-abdominal presence of foreign material is an important cause of adhesion formation. Therefore intra-abdominal contamination with foreign material should be minimized.

Adult↗
PubMed1996

[Peroperative contamination of the peritoneal cavity with micro-foreign bodies].

This prospective study examined the presence of foreign bodies in postoperative adhesion specimens and parietal peritoneum removed in a given patient at the same operative site. Fifty-two consecutive patients were enrolled. A significantly larger number of foreign bodies were observed in adhesion specimens than in peritoneum specimens. Inflammatory processes were also found to develop preferentially on the perioneum. In man, foreign bodies participate in the mechanism of development of postoperative intraperitoneal adhesions.

Adult↗