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Biomedical subjects

J Lataste

Publications and source records attributed to J Lataste.

At least 19 recordsLinked to original sources
PubMed1977

[Upper gastrointestinal haemorrhage after venous bypass in cirrhotics (author's transl)].

In a series of 76 patients who had undergone venous bypass for upper gastrointestinal haemorrhage, the authors noted 13 recurrences of bleeding, six resulting in death directly or secondary to hepatic failure. Repeated rupture of esophageal varices after thrombosis of an anastomosis is well known but in one out of two cases a second bypass involving another part of the portal territory resulted in cure. The important problem remains that of the precise aetiological diagnosis of the haemorrhage, there often being a doubt between esophageal varices and haemorrhagic gastritis. In certain cases there is no good indication for a bypass, as indicated by the absence of further bleeding after certain anastomotic thromboses. Ulcers due to venous bypass are rare. Secondary medical or surgical treatment in patients with a patent anastomosis should be undertaken with caution, in particular in the case of splenectomy for residual hypersplenism.

Gastrointestinal Hemorrhage↗
PubMed1977

[Surgical treatment of acute hemorrhagic pancreatitis. Report of 75 cases. (author's transl)].

Out of 75 definite cases of acute hemorrhagic pancreatitis, 39 were associated with a biliary lesion of which 16 were definitively the cause of the pancreatitis (11 embedded gall stones = 1/5th of the gall stones embedded in the ampulla of Vater and producing acute hemorrhagic pancreatitis). The biliary pancreatites were twice as severe as the primary pancreatites. This justifies the emergency exploration of the bile duct in any case of severe pancreatitis, suggesting acute hemorrhagic pancreatitis. The course of the disease is unforeseeable, certain large hematomas may become reabsorbed without sequelae. Thus one should be very circumspect concerning evaluation of the lesions during the first two weeks. This is why we reject any removal of pancreatic tissue during the first two or three weeks. We noted 30 deaths out of 70 cases of acute hemorrhagic pancreatitis during the postoperative period, 19 occurred during the first week. Concerning the 11 other deaths, they were in 9 cases very severe cases of acute hemorrhagic pancreatitis. Out of 41 cures, only 11 required secondary sequestrectomy, the 30 others were obtained without reoperation, often in spite of a large hematoma and clinical signs of severity. Our present attitude includes emergency operation of any severe case of pancreatitis in order to seek a biliary lesion with cholecystectomy (certain non-palpable calculi were thus discovered), radiomanometry of the common bile duct and, if necessary, sphincterotomy. The second operation is not always necessary, it should be carried out as late as possible after the 3rd week, sequestrectomy which is generally easy, may be carried out electively and under greater conditions of safety than necrosectomy or pancreatectomy.

Acute Disease↗
PubMed1977

[Stenosing odditis: diagnosis and treatment. Report of 109 cases (author's transl)].

Stenosing odditis represents only 4.5 p. cent of all benign lesions of the extrahepatic bile ducts. Their diagnosis is made by peroperative radiomanometry, but clinically they are suggested by a past history and serious clinical signs. The pancreatic involvement is rarely macroscopic (10 p. cent of cases of which 5 p. cent are severe) and acute pancreatitis due to stricture of the sphincter without gall stones is exceptional. Associated biliary lesions are frequent; in 50 p. cent of cases, of lithiasis of the common bile duct or pancreatitis, in 66 p. cent of cases of residual odditis. The treatment is surgical. Sphincterotomy should be reserved for young subjects with a slightly dilated common bile duct, or when necessary to extract a gall stone from the lower end of the bile duct. Biliary by pass operations are all the more indicated when the patient is elderly or the common bile duct more dilated. Local complications are the most frequent and the most serious after sphincterotomy; the local complications of biliary by pass operations are usually very simple. The late results of biliary by-pass operations are better than those of sphincterotomy, which confirms that the pancreatic complications of odditis are rare or well tolerated. The presence of chronic pancreatitis in association is not an aggravating factor.

Adult↗
PubMed1977

[Reflux into the pancreatic duct during peroperative biliary radiomanometry. Report of 200 cases (author's transl)].

The authors have observed 200 cases of reflux into the pancreatic duct out of 2,500 biliary operations with radiomanometry. Out of the 200 cases, 109 were functional, i.e. due to a common duct with or without an ampoule of Vater, or due to duodenal stockage whether there was a common duct or not. They had no therapeutic consequence. 38 were organic due to an obstruction (impacted gall stone, or odditis which favours reflux) and needed sphincterotomy especially when the pancreatic duct was dilated. In 53 cases, no organic or anatomical explanation was found. Reflux occurring at physiological pressures is more likely to be functional. The degree of reflux does not always depend on the increase in perfusion pressure. The time of the reflux depends partly on its nature. Early reflux is found mainly in cases of obstruction. Reflux secondary to passage into the duodenum is mainly found in functional reflux with stockage. Wirsung's duct is dilated in more than 75% of cases with obstruction and in only 3 cases out of 20 with functional reflux. Reflux into Santorini's duct is 3 times more common when there is papillary obstruction.

Biliary Tract Diseases↗
PubMed1977

[Pancreatic reflux into Wirsung's duct during peroperative biliary radiomanometry in acute and chronic pancreatitis (author's transl)].

Pancreatic reflux during radiomanometry is more frequent during acute and chronic pancreatitis. In acute pancreatitis, it is due in 1 case out of 3, to distal obstruction which must be overcome very rapidly. There is no prognostic significance. Santorini's duct when opacified and when it opens into the duodenum, permits one to suggest a better prognosis than in cases of canalicular pancreatitis. In chronic pancreatitis, reflux is twice as common and 3 times more often organic. When Wirsung's duct is dilated, there is almost always a distal obstacle at the level of the sphincter of Oddi due to a gall stone. If chronic pancreatitis is associated with gall stones, sphincterotomy should be carried out.

Acute Disease↗
PubMed1976

[Surgical treatment of villous tumors of the rectum].

Out of 36 villous tumours observed in 31 patients, 50 p. 100 were sessile and 1/3rd were degenerated, their degeneration was much more frequent in the case of sessile villous tumours. There were 5 biopsy errors. Out of 23 villous tumours, class A, 11 underwent local removal with two relapses, 7 recto-sigmoidal resections and 3 amputations of the rectum and 2 Hartmann operations. Out of 12 villous tumours classified as B and C, 5 underwent local removal, 4 resections, 3 palliative amputations. In all, there were 5 relapses. Tumours class C are severe and have the same prognosis as carcinoma of the rectum. Certain benign villous tumours are very difficult to remove locally owing to their broad base and their volume, which may necessitate mutilation. The present therapeutic attitude of the authors is due to the severity of relapses which may be seen late and possible biopsy errors. Broad removal is recommended for benign villous tumours which are broadly implanted and very voluminous. If the villous tumour is above the pouch of Douglas, resection is preferable to local removal. On the other hand, local removal is justified for benign villous tumours placed above the pouch of Douglas, which may be pediculated or sessile with a narrow base and with normal neighbouring mucosa.

Adult↗
PubMed1975

[Colo-anal invaginations in adults].

Colo-anal intussusception is exceptional, there are only 6 published cases including ours, intussusception of the colon into the rectum is rare. It raises numerous diagnostic and surgical problems. The cause is always a tumour, usually malignant. The diagnosis is easy in the case of colo-anal intussusception, in which one may see the tumour and determine its nature. It is sometimes difficult in the case of colo-rectal intussusception, hence the interest of sigmoidoscopy and biopsy of the tumour. Surgical treatment includes simple reduction in the case of colo-rectal intussusception. On the other hand, in the case of colo-anal intussusception, one should first reduce the condition, otherwise it is very difficult to remove the tumour, but there is very frequently necrosis of the prolapsed segment, which may require removal in two stages, limited low resection of the necrotic segment and high removab after reduction. This operation is more easily carried out by two surgical teams operating simultaneously.

Colonic Diseases↗