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Biomedical subjects

J M Collard

Publications and source records attributed to J M Collard.

63 records · Page 4Linked to original sources
PubMedDate not supplied

[Surgery in patients with previous heart surgery. Apropos of 21 patients].

Authors relate 22 non cardiac operations among 21 patients having previously undergone cardiac surgery. Oral anticoagulant therapy was discontinued before non cardiac operation while subcutaneous heparine therapy was initiated. There were no bleeding or thromboembolic complications during the perioperative period or later in the follow-up. In order to prevent bacterial endocarditis, prophylactic antibiotherapy was associated with careful surgical asepsis. No case of endocarditis was encountered during a mean follow-up of 22 months. Cardiac medications such as digitalis and beta adrenergic blockers were maintained as long as possible during the perioperative period while their dosage and clinical effects were closely monitored. No patient did present cardiac failure, significant arrhythmia or blood pressure impairment. No perioperative myocardial infarcts occurred in the group of coronary artery bypass graft patients. Those patients were managed in order to maintain their myocardial muscle work in optimal ranges thanks to selective premedication, brief interruption of beta adrenergic blockers, strict control of fluid balance and careful postoperative pain relief.

Adult↗
PubMedDate not supplied

[5-year survival after subtotal extensive esophagectomy for cancer].

Over a seven year period, subtotal esophagectomy for cancer was performed on 125 patients (79.6% of the referred patients). Resection was potentially curative in 92, and it was palliative in 33. Potentially curative esophagectomies were carried out either by right thoracotomy, cervicotomy and laparotomy (n = 77), by combined transhiatal and transcervical approach without formal thoracotomy (n = 14), or by median sternotomy, cervicotomy and laparotomy (n = 1) depending on the tumor location in the esophagus and the general status of the patient. It included resection of the esophagus itself, and the lymph nodes and adjacent soft tissues located in the posterior mediastinum from the apex of the chest down to the diaphragm in patients operated on by right thoracotomy, in the posterior inferior mediastinum from the pulmonary veins down to the hiatus in those operated on by a transhiatal approach, and in the upper and lower mediastinum in those operated on transsternally. Twenty-eight patients operated on by potentially curative esophagectomy were given adjuvant radiotherapy or radiochemotherapy. Thirty-day and in-hospital postoperative mortalities were 0 and 2.4% (3/125), respectively. Five-year actuarial survival was 30% in the whole series, and 41% after potentially curative resection. In the latter instance, it was 48% for adenocarcinomas v.s. 38% for squamous cell carcinomas (p > 0.05), 38% after transthoracic resection v.s. 61% after transhiatal resection (p > 0.05), 44% after surgery alone v.s. 38% after surgery plus adjuvant therapy (p > 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Belgium↗
PubMedDate not supplied

Clinical, radiological and functional results of remedial antireflux operations.

Fifty-five patients were reoperated on for an unsatisfactory outcome after antireflux surgery. Presenting symptoms were heartburn alone (27), heartburn and dysphagia (10), dysphagia alone (9), chest pain (4), left shoulder pain (1), left shoulder pain and fever (1), and signs of anemia (3). The symptom of dysphagia was usually of immediate onset whereas heartburn reoccurred after a symptom-free period (p = 0.014). The most common failed antireflux procedure was a Nissen fundoplication (37). The incompleteness of the residual wrap, its location around the stomach and the irreducibility of the gastro-oesophageal junction below the diaphragm were accurately predicted by barium swallow study in 70, 83 and 92% of the patients, respectively. Abnormal oesophageal body motility was related to oesophagitis, herniation of the residual repair into the chest or both (16/20), and it normalized in 6 of the 11 patients evaluated at follow-up. Oesophageal acid exposure and prevalence of oesophagitis were higher in patients with heartburn than in those with other symptoms (p < 0.02). Intraoperative findings were breakdown of the repair, its location around the stomach, its herniation into the chest, its too excessive tightness, a gastric fistula, or any combination. Remedial surgery consisted of a new antireflux procedure (42), a new antireflux procedure combined with closure of a gastric fistula (3), a closure of a gastric fistula alone (1), a closure of the crura (4), an oesophageal resection (3), a total gastrectomy (1), and a duodenal diversion (1).(ABSTRACT TRUNCATED AT 250 WORDS)

Barium Sulfate↗
PubMedDate not supplied

Extensive lymph node clearance for cancer of the esophagus or cardia: merits and limits in reference to 5-year absolute survival.

BACKGROUND/AIMS: The present study evaluates both merits and limits of extensive lymph node clearance in the mediastinum and upper abdomen on patients operated on more than 5 years ago. MATERIALS AND METHODS: One hundred forty-four esophageal cancer patients underwent subtotal (n = 97) or distal (n = 47) esophageal resection more than 5 years ago. Twenty-six patients operated on in a curative attempt were given radiotherapy (n = 14) or radiochemotherapy (n = 12). RESULTS: Esophagectomy with extensive lymph node clearance was feasible in 102 of the 144 patients (70.8%). In-hospital mortality was 1.4%. Thirty-six patients lived more than 5 years, ie. 25% of all the esophagectomized patients and 35.3% (36/102) of those who were operated on in a curative attempt. Five-year absolute survival was 38.4% after combined therapy v.s. 34.2% after surgery alone (p > 0.05). In the latter instance, it was 57.1% for those patients with normal lymph nodes v.s. 14.6% for those with metastatic lymph nodes, and it was 64% for those with non-transmural tumors v.s. 19.6% for those with transmural tumors. One half of those patients who were not given adjuvant therapy following esophagectomy with extensive lymph node clearance died of neoplastic spread, namely distant metastases (27.6%), cervical spread (3.9%), and local recurrence (10.5%). CONCLUSIONS: Esophagectomy with extensive lymph node clearance is not feasible in 30% of the patients in whom it is attempted, and it does not prevent further neoplastic spread in one half of those in whom it is feasible. It is capable of curing 15 to 20% of those patients with locally advanced neoplasms and shelters 90% of the patients from local recurrence.

Abdomen↗
PubMedDate not supplied

New insights into the assessment of gastro-oesophageal reflux disease.

Surgeons now have at their disposal various techniques to investigate both function and anatomy of the foregut in patients suspected to have gastro-oesophageal reflux disease (G.O.R.D.). These are the 24-hour intraoesophageal and intragastric pH-monitoring, 24-hour intraoesophageal and intragastric bilimetry conventional oesophageal manometry, vectometry of the lower oesophageal sphincter, gastric scintigraphy scanning, upper digestive tract endoscopy, and Barium swallow study. These investigative tools permit to settle the diagnosis of excessive gastro-oesophageal reflux, to evidence the functional disorder which is at the origin of G.O.R.D., and to detect eventual complication of the latter. They also provide information for making the right choice of the approach to the gastro-oesophageal junction (transabdominal v.s. transthoracic), performing the most relevant antireflux operation (partial v.s. complete fundoplication), and identifying those patients who require a duodenal diversion procedure for concomitant duodenogastric reflux. Recent studies indicate that the concept of reflux of the gastric contents (mixture of gastric secretion, duodenal refluxate and saliva) into the oesophageal lumen should take over from the classic one of gastro-oesophageal acid reflux. Precise evaluation of the lower oesophageal sphincter competence by oesophageal vectometry permits to identify the patients who are liable to experience recurrence of their reflux symptoms when discontinuing medical therapy.

Barium Sulfate↗
PubMedDate not supplied

Video-assisted thoracic surgery (VATS) for cancer. Risk of parietal seeding and of early local recurrence.

Both parietal seeding and early local recurrence have been anecdotally (24 cases) reported in the surgical literature after video-assisted thoracic surgery (VATS) for cancer. However, not all the cases reported were undoubtedly related to the thoracoscopic approach itself, several of those thoracoscopic procedures addressed locally advanced neoplastic processes, and protective measures against parietal contamination were not taken in one half of the patients. Strict adherence to the classic principles of carcinologic surgery should minimize the risk of both parietal and pleural grafting after VATS for cancer.

Humans↗