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Biomedical subjects

J Leborgne

Publications and source records attributed to J Leborgne.

At least 19 recordsLinked to original sources
PubMed2005

[Multivisceral resections of extracolorectal lesions in familial adenomatous polyposis].

AIMS: 1/ To report our experience with multivisceral resections in familial adenomatous polyposis (FAP) for extracolorectal lesions in a cohort of nine patients. 2/ Discuss the long term results of an agressive surgery. PATIENTS AND METHODS: Nine patients (7 males and 2 females) were operated at the University Hospital of Nimes (N=4) and Nantes (N=5). The median age at the first operation was 29 years (range 18-43). A genetic study was performed in six patients and confirmed the mutation on APC gene (exon 11, 13 and 15). All the patients were operated through a classic laparotomy. RESULTS: All patients have underwent a mean of three operations (range 2-5). Eight patients have had initially a total colectomy and 4 underwent subsequent proctectomy. Seven patients had pancreaticoduodenectomy for extensive duodenal adenomas and/or carcinoma. Three had one or multiple small bowel resections for development of carcinoma and one had partial gastric resection for large adenovillous tumor. The median follow up was 25 years (range 15-37) since the first operation. Three patients were died: one of gastric cancer with hepatic metastases, one of peritoneal carcinosis after ileal resection and one of astrocytoma. CONCLUSION: With regard to these nine observations, the authors underline the possibility of multivisceral resection in FAP. Despite a major digestive mutilation, it permits a long survival with acceptable quality of life. The prognosis depends on the aggressiveness of the duodenal or jejunoileal lesions more than of the colorectal tumors if found at the first resection.

Adenoma↗
PubMed2005

Clinical spectrum and surgical approach of adult intussusceptions: a multicentric study.

BACKGROUND: The preoperative diagnosis of adult intussusceptions (AIs) remains difficult, and the assessment of the radiological methods has been evaluated very little in the literature. The aim of this study was to evaluate the interest of the different imaging modalities for the preoperative diagnosis of AI and describe causes of AI. PATIENTS AND METHODS: Consecutive patients of 15 years and older with the postoperative diagnosis of intussusception from 1979 to 2004 were reviewed retrospectively for this multicentric study. Data concerning clinical considerations, morphological examinations, surgical procedure, histological conclusions, mortality rate and recurrence were analysed. RESULTS: Forty-four patients with documented intussusception were included. The mean age was 51 years (15-93 years). The preoperative diagnosis of intussusception was made in 52% of the cases. The sensitivities of the different radiological methods were abdominal ultrasounds (35%), upper gastrointestinal barium study (33%), abdominal computed tomography (CT) (58%) and barium enema (73%). An organic lesion was identified in 95% of the cases. There was 29 enteric and 15 colonic (including appendicular) intussusceptions. Thirty-seven percent of the enteric lesions were malignant, and a bit less than 50% of them were metastatic melanomas. The benign enteric lesions were Meckel's diverticulum and Peutz-Jeghers syndrome in half of the cases. Fifty-eight percent of the pure colonic lesions (excluding appendix) were malignant, and 85% of them were primary adenocarcinomas. The benign colonic lesions were lipomas in 80% of the cases. All patients, except one, had a surgical treatment, and 13 of them had a complete reduction of the intussusception before resection. The mortality rate was 16% and recurrence occurred in three patients; two of them had a Peutz-Jeghers syndrome. CONCLUSION: Intussusception rarely occurs in adults, but nearly half of their causes are malignant. The CT scan is a helpful examination for enteric intussusceptions whether barium enema seems to be the most performing method for colonic lesions. Surgery is the recommended treatment, with or without a primary reduction of the intussusception. During the surgical procedure, this reduction can lead to a more limited bowel resection.

Adolescent↗
PubMed2004

[Anatomical study of the nerve supply of the trapeziometacarpal joint. Fifteen dissections].

PURPOSE OF THE STUDY: When the radiological signs are minimal in patients with a painful carpal syndrome involving the trapeziometacarpal joint (TMCJ), selective articular denervation can be proposed as an alternative after failure of conservative treatment. Results have been variable, sometimes disappointing, suggesting the anatomic basis of denervation should be revisited. The purpose of this work was to study the nerve supply to the TMCJ in order to acquire the indispensable elements necessary for performing effective selective articular denervation. MATERIAL AND METHODS: This anatomical study was performed by dissection under magnification (4.5-x350) of 15 upper limb cadaver specimens. The median nerve, its thenar and volar cutaneous branches and the terminal sensorial branches of the radial nerve were dissected. Articular branches to the TMCJ were carefully identified. Histological samples were taken to verify the neurological nature of the elements dissected. RESULTS: All TMCJs dissected exhibited radial and median nerve supply. Branches of the median nerve predominated in number and caliber. The volar cutaneous branch gave rise to articular branches in eleven dissections and the thenar branch gave rise to articular branches via a retrograde arciform trajectory between the short abductor and the opponens digiti pollicis in thirteen. For five dissections, the TMCJ branches arose directly from the median nerve within the carpal tunnel. At histological analysis the dissected elements were identified as nerves. DISCUSSION: There have been few anatomic studies concerning the nerve supply of the TMCJ. Unlike the findings reported by Cozzi in 1960, we did not find the dorsal sensorial branch of the radial nerve to play an exclusive or preponderant role in the innervation of the TMCJ. The median nerve supply to the TMCJ appeared to be more significant, particularly for the volar cutaneous and especially thenar branches. CONCLUSION: Total and definitive selective denervation of the TMCJ appears to be a most difficult procedure which would require a very wide access and extensive dissection, including the thenar branch which would raise the risk of significant complications.

Cadaver↗
PubMed2003

What is the arcuate eminence?

A study was made of 100 homogeneous CT scans of the petrous part of the temporal bone to determine whether or not the arcuate eminence (AE) is a good landmark for the superior semicircular canal (SSCC) in the suprapetrous approach to the internal acoustic meatus which is used in the extirpation of acoustic neuromas. Direct measurements were made on consecutive coronal sections, 1 mm thick. The AE was absent from the petrous surface in 15% of cases. It corresponded to the relief of the SSCC in 37% of cases; laterally, however, it was separated from the petrous cortex by bone whose thickness varied from 0.5 to 5 mm. Finally, in 48% of cases, the AE was not a good landmark for the canal although nonetheless it participated in the development of this bulge in 46% of cases, always lying towards the medial border of the pneumatized eminence. In addition, study of the coronal sections with MRI allowed us to confirm that the AE does not routinely correspond to the imprint of a temporal sulcus. The AE, whose presence on the petrous surface is due to the combined effects of the SSCC, the air cells of the petrous part of the temporal bone and the temporal sulci, is only a good guide to the SSCC in 37% of cases and should not be considered as a reliable surgical landmark.

Humans↗
PubMed2002

[Massive hemoperitoneum from rupture of an intra-peritoneal varix].

Rupture of an intra-abdominal varix in a patient with portal hypertension is a rare but severe cause of massive hemoperitoneum. The authors report the case of a patient with alcoholic cirrhosis that presented to the emergency department with hypovolemic shock. Imaging showed massive hemoperitoneum, severe portal hypertension and suggested the diagnosis of spontaneous rupture of an intra-abdominal varix, confirmed at laparotomy.

Abdomen↗
PubMed2001

[The inferior rectal nerve. Anatomical bases of perineal pain].

MATERIAL: 4 corpses (1 fresh, 3 formoled) without preliminary injection; age: 84 to 90. METHOD: a front access enabled us to show the origin of the inferior rectal nerve from the pudendal plexus, its course across the Alcook canal and the ischiorectal fossa. Then a posterior transgluteal access showed the short intragluteal course across the "biligamentary tunnel" (between sacrospinal and sacrotuberal ligaments) of nerves and vessels related to the anus, in particular the inconstant Morestin's nerve. RESULTS AND CONCLUSION: the compression of nerves causing perineal pain can occur at different places. Depending on the localisation of the origin and the course of the inferior rectal nerve (which change) in relation to the place of that compression, and also the existence or not of Morestin's nerve, the changing topography of these pains can be explained.

Aged↗
PubMed2001

[Cystic dystrophy of heterotopic duodenal pancreas].

Cystic dystrophy of heterotopic pancreas is characterized by the presence of cystic formations in the duodenal wall with or without associated pancreatitis. The mechanism by which the cystic dystrophy develops in heterotopic pancreatic pancreas is poorly understood. These lesions are found in young men (40-50 years old) with abusive alcohol intake. The patients are referred for suspected pancreatic neoplasm or for acute pancreatitis. Endoscopic ultrasonography features allow preoperative diagnosis. First line, treatment is medical with parenteral nutrition and octreotide. Then, if the lesions are complicated, surgery (pancreatoduodenectomy or bypass procedure) is indicated.

Choristoma↗
PubMed2000

Arterial vascularisation of the atrioventricular node.

The aim of this study was to define the anatomic characteristics of the principal arterial source of the atrioventricular node, known as the artery of the atrioventricular node. Forty hearts were studied by various anatomic and radiologic methods: dissection, injection-dissection, injection-corrosion and injection-radiography, but only 23 results were interpretable. The right coronary artery represented the commonest arterial source of the atrioventricular node (21/23 hearts) but numerous variations in the origin and topography of the nodal artery were found.

Aged↗
PubMed1999

[Radio-anatomic study of the ophthalmic artery].

It is possible to have a good definition of structures with modern neuro-imaging. Ophthalmic artery is a neat vessel with lot of branches and sinous pathway, which are difficult to have in the same frame. A good knowledge of the classical anatomy is necessary to interpret correctly the pictures obtained with neuro-imaging. The aim of this study is to compare classical dissections (dissections after latex injection, corrosion with Altufix P.10, radiography after Minimum injections) with radio-anatomical images (computed scanns, angiographies, MRI). We have also studied origin, pathway, collateral branches of ophthalmic artery.

Artifacts↗
PubMed1998

Anatomic basis of chronic perineal pain: role of the pudendal nerve.

Our anatomic findings have led us to define conflictual relations that may be encountered in their course by the pudendal n. and its branches. Starting from the clinical study of a group of patients suffering from chronic perineal pain in the seated position, we have defined, beginning with the cadaver, three possible conflictual settings: in the constriction between the sacrotuberal and sacrospinal ligaments; in the pudendal canal of Alcock; and during the straddling of the falciform process of the sacro-tuberal ligament by the pudendal n. and its branches. Consequently, considering so-called idiopathic perineal pain as an entrapment syndrome, the clinical and neurophysiologic arguments and infiltration tests have led us to define a surgical strategy which has currently given 70% of good results in 170 operated patients. Earlier diagnosis should improve on this.

Cadaver↗
PubMed1998

Outcome of patients with an implanted artificial anal sphincter for severe faecal incontinence. A single institution report.

Implantation of an artificial sphincter is an alternative treatment for patients with severe faecal incontinence. This prospective study from one institution has evaluated the results from 13. Preoperative and postoperative incontinence scores, anal manometry, and quality of life were evaluated in 13 patients who had undergone implantation of an artificial sphincter over a 7-year period. Two patients were definitive failures. One developed acute total colitis after 5 years of satisfactory function, and a second had discomfort and demanded removal of an otherwise functioning device. After a median follow-up of 30 (range 5-76) months, 11 patients had an activated and functional device. These included 6 with a urinary AMS 800 and 5 with the newly designed anal ABS. The mean incontinence score decreased from 17 to 4, and quality of life improved markedly. Two of the 11 patients had undergone successful reimplantation, one following rupture of the cuff and the second following ulceration of the control pump through the labia. In no case was infection or erosion of the anal canal a cause of failure. While the cause of incontinence and age did not affect outcome, psychological reaction had a significant impact. The artificial anal sphincter may have a role to play in severe faecal incontinence.

Adult↗
PubMed1998

[Percutaneous self-expanding metallic endoprosthesis and malignant biliary stenoses].

METHOD: Thirty-five patients with malignant obstructive jaundice were given palliative treatment by percutaneous self-expandable metallic stents. Cholangiocarcinoma was the most frequent cause of biliary obstruction. The stricture was located in the hilum in more of 50% of cases. RESULTS: Adequate biliary drainage was achieved in 97% of cases. Median survival was 182 days. 11% of patients have died within 30 days. Early complications occurred in 31% of patients. 25% of patients have shown recurrent jaundice after an average of 180 days. CONCLUSION: Percutaneous self-expandable metallic stents are an efficient means treating malignant biliary strictures, particularly of upper biliary obstructions.

Adenocarcinoma↗
PubMed1997

Detection of disseminated tumor cells in peripheral blood of colorectal cancer patients.

All cancer staging systems seek to identify clinical and pathological features that can predict outcome or guide therapy. In particular, a non-invasive method for the early detection of disseminating disease would be of great interest. We investigated the use of cytokeratin genes expression to detect blood metastases from colorectal tumors. Epithelial tumor cells were isolated from whole blood using the monoclonal antibody (MAb) BerEP4 and magnetic beads, and detected by reverse transcription-polymerase chain reaction using oligonucleotides derived from the cDNA sequences of cytokeratins 8, 19 and 20. The sensitivity of this assay was determined by spiking SW620 colon carcinoma cells in normal blood. Using cytokeratin 19 expression we were able to detect 1 epithelial tumor cell in 1 ml of whole blood. The clinical applicability of this technique was explored by evaluating patients with a colorectal carcinoma. Epithelial cells were detected in the blood of 12 out of 23 patients, 2 (20%) of 10 with Astler-Coller stage A or B, and 10 (77%) of 13 with stage C or D cancer. In conclusion, this test is a non-invasive, sensitive, and specific assay for detecting circulating epithelial cells in blood. It may be useful for the early diagnosis of disseminating disease, to determine whether the presence of micrometastatic cells at the time of surgery is correlated with an early relapse and for monitoring adjuvant therapeutic trials.

Adult↗
PubMed1997

The mandibular marginal ramus of the facial nerve: an anatomic and clinical study.

Injury to the mandibular marginal ramus of the facial n. constitutes a risk in cervicofacial surgery. The aims of this study were to define the origin of this nerve branch and its course and relations, especially with the lower border of the mandible and the facial vessels. Our observations revealed differences from the classical description of a single nerve branch traveling on the outer aspect of the body of the mandible above its lower border. We found several marginal branches, which become closely related to the facial pedicle, particularly the intermediate ramus, which can form a neural plexus around the facial a. They may follow a submandibular course, before but also after crossing the facial vessels. They are difficult to classify because of their great variability.

Facial Nerve↗
PubMed1997

Percutaneous self-expandable metallic stents and malignant biliary strictures.

Thirty-five patients with malignant obstructive jaundice received palliative treatment using percutaneous self-expandable metallic stents. Cholangiocarcinoma was the most frequent cause of the biliary obstruction. In more than 50% of cases, the stricture was located in the hilum. Adequate biliary drainage was achieved in 97% of cases. Median survival was 182 days, and 11% of patients died within 30 days. Early complications occurred in 31% of patients, and 25% of patients showed recurrent jaundice after an average of 180 days. Percutaneous self-expandable metallic stents are an efficient means of palliatively treating malignant biliary strictures, particularly high biliary obstructions.

Aged↗
PubMed1996

Results of artificial sphincter in severe anal incontinence. Report of 14 consecutive implantations.

PURPOSE AND METHODS: Fourteen AMS 800 (American Medical Systems, Minneapolis, MN) urinary artificial sphincters have been consecutively implanted in 13 patients with total incontinence for stool of various causes (traumatic or postoperative, 7; congenital, 3; neurologic, 2; idiopathic, 1). No proximal stoma was constructed but was already present in one patient before implantation. RESULTS: Sepsis occurred in two patients. Removal of sphincter and colostomy was necessary in three patients: one of these two had developed sepsis, one had perineal ulceration before activation of the sphincter in a severely scarred perineum, and one had severe pain in a radiation-injured anorectum. Sphincter-related failure occurred once by rupture of the cuff in a constipated woman after two years of satisfactory function. Reimplantation of a new cuff restored normal continence in this patient. After median follow-up of 20 (range, 4-60) months, nine of ten patients with a functioning sphincter were continent for stool, and five were also continent for gas. Failure occurred in one patient because the cuff was too large to occlude the anal canal. This patient is awaiting reimplantation. Four patients experienced easily controlled difficulties with evacuation of feces. Anal pressure with inflated cuff varied from 43 to 94 (mean, 58 +/- 12) cm H2O. CONCLUSION: These results show that an artificial sphincter has a role in the treatment of severe anal incontinence when local therapies are not applicable or have failed.

Adult↗