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Biomedical subjects

J M Hay

Publications and source records attributed to J M Hay.

At least 19 recordsLinked to original sources
PubMed1992

[Surgical treatment of inguinal hernia in short-term hospitalization. Prospective survey of 500 consecutive unselected cases. Associations Francaises de Recherche en Chirurgie].

Individual medical and social factors associated with the acceptance and success of short stay surgery for unilateral, uncomplicated inguinal hernia were looked for in 500 consecutive unselected patients. The mean duration of postoperative hospital stay was 3.4 days. Sixty percent of the patients were discharged within the first 48 hours following surgery, including 10 percent who left the hospital in the evening of the operation day. Twenty-two percent of the patients who could have left during these 48 hours refused to do so. The most predictive variable for acceptance and success was a profession requiring little physical activity. Local anaesthesia has been associated with success in the so-called ambulatory surgery, but the methodology of the present study did not permit to establish a cause-effect relationship.

Aged↗
PubMed1992

[Appendicitis].

Explore the source record for details and available documents.

Appendicitis↗
PubMed1992

[Quantified symptomatology of acute appendicitis in adults. The signs and their value].

Using a data base of 7,000 acute abdominal pains, we here described the assessed clinical manifestations of the main diseases responsible for right lower quadrant pain. However, percentages of sensibilities have been replaced by adverbs or adjectives, applying a scale of equivalence. The possible modifications of the positive predictive values have been also replaced by verbs or typical expressions. We first described the acute appendicitis syndrome (which covered congestive endoappendicitis and suppurated appendicitis) with the clinical shades or the gathered and gangrenous forms or even of the diffuse peritonitis. Features of the acute appendicitis contrast with those of the so called "non specified abdominal pains" (a new entity), and those of the subacute or chronic appendicitis. We found a good correlation between clinical and pathological findings. One of the difficulties has been to determine if a subgroup of subacute appendicitis should be or not included into the acute appendicitis.

Acute Disease↗
PubMed1992

[Is preoperative systematic chest x-ray useful in general surgery? A multicenter prospective study of 3959 patients. ACAPEM. Association des Chirurgiens de l'Assistance Publique pour les Evaluations Médicales].

In order to define which patients may not require a routine preoperative chest X-ray, a prospective multicenter study was carried out. It included 3,959 consecutive fifteen, or more, year-old patients, free from any cancer, scheduled for a general or gastrointestinal surgical procedure other than thoracotomy, and had a plain chest X-ray beforehand. This investigation was prescribed before surgery, either by the surgeon or the anaesthetist. Patients were classified according to selected risk factors: age, smoking, emergency surgery, a past history of lung, heart or vascular disease, abnormal clinical findings related to the cardiovascular and respiratory systems, and a previous chest film made less than one year before. There were 2,092 patients in Group I (no risk factors), 916 in group II (one risk factor), 645 in Group III (two risk factors), and 276 in group IV (three risk factors). Three endpoints were selected: a modification of operative schedule or anaesthetic technique, a change in surgical procedure, and the diagnosis of postoperative complications. A rate of 23.2% of preoperative chest films were considered to be abnormal. This rate increased with age and the number of risk factors: 6.2% in Group I and 72.5% in Group IV. Surgical and anaesthetic procedures were modified as a result of the chest X-ray in only 0.5% of patients: 0.1% in Group I, 0.3% in Group II, 1.2% in Group III and 1.4% in Group IV. When pulmonary or cardiac complications did occur after the surgery, the preoperative chest film was of no help for making this diagnosis in more than 50% of cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

Prospective evaluation of ultrasonic surgical dissectors in hepatic resection: a cooperative multicenter study.

Blood loss is the major cause of postoperative mortality and morbidity associated with hepatic resection. A prospective multicenter study was conducted to determine if ultrasonic dissectors (USD) were useful in hepatic resection and could reduce this hemorrhagic risk. Forty-seven hepatic resections were performed in 42 consecutive patients during a two month period in 11 public, surgical centers. Twenty-one patients had primary or secondary malignancies, six had benign tumors, two had biliary cysts, one had cholangiocarcinoma, one had Caroli's disease, and 11 had hydatid cysts of the liver. Two different USD devices were evaluated (CUSA System-Lasersonics and NIIC-DX 101 T). The hepatic resections tested included a wide range of procedures. Each surgeon had the possibility of choosing between the USD and his own usual technique for each operative step and according to local conditions. The average volume of blood infused, irrespective of the underlying pathology or the procedure performed, was 1.0 L (range 0-4.8 L). Fourteen patients required no transfusions. No operative or immediate postoperative deaths were recorded. Five major complications, all unrelated to the use of the USD, developed in three patients. Access to intra and extraparenchymal arterial and venous tributaries and particularly the control of the hepatic veins were facilitated by USD. While transection of hepatic parenchyma was neither easier nor faster than with conventional techniques, it was found to be less hemorrhagic. Overall appraisal was expressed on an analog scale; the USD was found to be helpful or very helpful in 75 percent of all resections. With regard to the pathology being treated, total or partial excision of hydatid cysts was greatly enhanced by the use of the USD while this benefit was not found for wedge resections of other hepatic lesions. With regard to user friendliness and maintenance, the NIIC-DX 101 T device was preferred. We conclude that the USD facilitates formal hepatic resections. Converging opinions emerging from various surgical centers reinforce this conclusion.

Adult↗
PubMed1992

Hepatic arterial infusion of floxuridine in patients with liver metastases from colorectal carcinoma: long-term results of a prospective randomized trial.

PURPOSE: A multicentric randomized study that compared patients who received intrahepatic arterial infusion (HAI) to a group of patients who did not receive HAI (control group) was performed for unresectable hepatic metastases from primary colorectal carcinoma. PATIENTS AND METHODS: One hundred sixty-six patients were assigned randomly to HAI of floxuridine (5 fluoro-2'deoxyuridine [FUDR]) 0.3 mg/kg/d for 14 days every 4 weeks or to the control group; this latter group, depending on the investigator's choice, was either under observation or received systemic fluorouracil (5-FU). The same regimen of systemic 5-FU also was administered to the HAI group in the event of extrahepatic progression. No crossover from the control group to the HAI group was permitted. The mean duration of follow-up was 54 months (range, 31 to 72), and 163 patients were analyzed. RESULTS: A significant improvement was observed in the survival rate for the 81 patients assigned to HAI group (P less than .02) with a 1-year survival rate of 64% versus 44% in the control group (82 patients). The 2-year survival rate was 23% versus 13%. The median survival was 15 months versus 11 months for the HAI group and the control group, respectively. Survival was better for patients with a less than 30% liver involvement, and for those treated in more specialized centers. The hepatotoxic effects of HAI were observed in 47 patients (chemical hepatitis [n = 28], and biliary sclerosis [n = 19]). The 1-year rate of sclerosing cholangitis was equal to 25%. Gastrointestinal toxicity was infrequent and consisted of gastritis or diarrhea. CONCLUSIONS: Therapy with HAI of FUDR improves the survival of patients with liver metastases over colorectal carcinoma. However, the methods that are used to diminish the toxicity of HAI and efficient systemic chemotherapy, such as a combination of 5-FU and leucovorin, are required to prevent extrahepatic metastases.

Colorectal Neoplasms↗
PubMed1991

[Antibiotic prophylaxis in abdominal surgery. Prospective randomized study organized by the French Surgical Research Association].

The effectiveness of cefazolin or cefotaxime as antibiotic therapy was compared with that of ceftriaxone in a multicentre prospective randomized trial involving 1,254 consecutive patients operated upon for abdominal diseases. Patients about to undergo surgery of the colon or who had localized or generalized peritonitis at the time of operation were excluded from the study. The patients entered were divided into 4 strata according to the degree of operative contamination and to risk factors. In each stratum, the patients were allocated at random to one or the other of 2 treatment groups. Group 1 patients received cefazolin or cefotaxime in 3 doses of 1 g administered 8-hourly, the first dose being injected during induction of general anaesthesia. Group 2 patients received one single 1 g dose of ceftriaxone injected during induction of anaesthesia. There was no significant difference between the two groups in the wound infection rate and in the frequency of post-operative intra-abdominal abscesses. Although the percentage of post-operative pulmonary and urinary tract infections was lower in the ceftriaxone group than in the cefazolin/cefotaxime group, no significant difference was observed between the two groups in the number of patients who required curative antibiotic therapy. This study shows that one single dose of ceftriaxone is as effective as three doses of cefazolin or cefotaxime in preventing would infections and post-operative intra-abdominal abscesses, and that it is more effective in preventing extra-abdominal infections complicating surgery.

Adolescent↗
PubMed1991

An analysis of the sequence of an infectious clone of rice tungro bacilliform virus, a plant pararetrovirus.

The nucleotide sequence of an infectious clone of rice tungro bacilliform virus (RTBV) DNA has been determined. The circular genome has 8002 bp and one strand contains four open reading frames (ORFs). One ORF is potentially capable of encoding a protein of 24 kD (P24) and has no initiation (ATG) codon. The other three ORFs potentially encode proteins of 12 kD, 194 kD and 46 kD (P12, P194, P46) respectively. The functions of P24, P12 and P46 are unknown. Comparative analyses with retroviruses and Commelina yellow mottle virus suggest that the 194 kD putative product is a polyprotein that is proteolytically cleaved to yield the virion coat protein, a protease and replicase (reverse transcriptase and RNase H) characteristic of retroelements. The DNA sequence reveals other features which strongly support our belief that RTBV is a pararetrovirus. These include sequences at the mapped positions of two discontinuities in the virion DNA which are complementary to tRNA metinit and purine-rich, and may be the priming sites for minus- and plus-strand DNA synthesis respectively. As the positions of likely transcriptional signals suggest, a full-length viral transcript is observed by northern analysis. The predicted folding of the 645 bp 5'-region of this RNA resembles that of caulimoviruses. Comparisons with other reverse transcribing elements are discussed.

Amino Acid Sequence↗
PubMed1991

[How to express the percentage of words expressing the frequency (or sensitivity) of symptoms in a disease?].

A prospective multicenter study concerning 30 vocabulary terms was undertaken to determine if: 1) these terms could be equated with specific percentages; 2) observer assessment varied with time; 3) teachers and students used the same words with the same meaning; 4) certain words were more discriminant than others, and 5) terms corresponding to numbers were the same in French as in English. Three hundred and thirty medical professionals, coming from general and digestive units of 45 University, regional, or private institutions, were asked to answer three types of questionnaires pertaining to the same 30 words, but in a different order. One to 3 months later, 170 of them were asked to fill out the same questionnaire with the same words but in a different order. Sixteen percent were University professors, 15 percent were hospital or private surgeons, 19 percent were senior residents, 29 percent were interns or junior residents and 21 percent were medical students.(ABSTRACT TRUNCATED AT 250 WORDS)

Analysis of Variance↗
PubMed1991

Postoperative radiation therapy does not increase survival after curative resection for squamous cell carcinoma of the middle and lower esophagus as shown by a multicenter controlled trial. French University Association for Surgical Research.

In 1978, postoperative radiation therapy was suggested to be an additive treatment of carcinoma of the esophagus. In 1987, we began a multicenter trial of patients with epidermoid carcinoma of the middle third or the lower third of the esophagus. Isolated surgical treatment (119 patients) was compared with surgical treatment followed by radiation therapy (102 patients). Randomization was performed according to the results of pathologic examination of all resected lymph nodes. Patients were divided into three groups: N0, no lymph node invasion; N+1, invasion of paraesophageal lymph nodes, and N+2, invasion of distal lymph nodes (recurrent, tracheal and celiac). All patients included in this trial had a curative esophageal resection. In the group receiving radiation therapy (102 patients), a total dose of 45 to 55 Grays was delivered in the mediastinal, right and left supraclavicular areas and also to the celiac area when celiac lymph node invasion was present. Two hundred and twenty-one patients were randomized and observed from three to nine years; life table method (log rank method) was used to compare survival and local recurrence. In all patients studied, the survival rate was significantly higher (p less than 0.01) in patients without lymph node invasion (group N0) than in patients with lymph node invasion (groups N+1 and N+2). Postoperative radiation therapy did not improve survival in any group. This lack of improvement in survival was present regardless of lymph node status. However, there were significantly fewer recurrences in patients receiving radiation therapy as compared with those not receiving radiation therapy.

Carcinoma, Squamous Cell↗
PubMed1991

[Distal splenorenal anastomosis in the treatment of digestive hemorrhage in portal hypertension].

One hundred and ten distal splenorenal anastomoses (DSRA) were performed between 1976 and 1988 for gastrointestinal haemorrhages secondary to portal hypertension. Thirty five patients underwent DSRA (Warren's operation) followed by a mesenteric disconnection procedure. Eleven patients (10%) died (nine Child B and two Child A), including two after an emergency shunt. The mortality was influenced by age (p less than 0.01) and by the number of previous episodes of ictero-ascitic decompensation (p less than 0.02). A single anastomotic thrombosis was observed; the high flow rate of the anastomoses (mean: 1200 +/- 650 ml/min) explains the high patency rate (more than 90%). Eleven patients developed partial or total thrombosis of the portal trunk less than 6 weeks after the operation. The quality of hepatic perfusion was not significantly influenced by the mesenterico-splenic disconnection and this was omitted in 75 patients. The mesenterico-splenic collateral venous circulation was more developed in the absence of disconnection (p less than 0.05). The long-term actuarial survival was 83% at one year, 53% at five years, 47% at eight years and 28% at ten years. Survival was not influenced by the disconnection. Warren's operation is more difficult to perform than a porto-caval or mesenterico-caval shunt. DSRA appears to have three advantages: 1) a high flow rate as it is arterialised by the splenic artery, 2) hepatopetal portal perfusion maintained for several days, weeks or months, possibly reducing the risk of encephalopathy, 3) the absence of dissection of the hepatic pedicle preserves the possibilities of liver transplantation.

Adolescent↗
PubMed1990

[Surgical treatment of portal hypertension].

The surgical treatment, by means of shunts or disconnections, of ruptured oesophageal varices in portal hypertension is always indicated but not always on the forefront. However, it remains the first-line treatment in segmental portal hypertension and in Budd-Chiari syndrome. It is on a par with the non-surgical treatments in case of prehepatic block but ranks second in case of pre- and intrasinusoid blocks. In all the hepatic diseases with threatening hepatocellular deficiency, liver transplantation is the most spectacular of current and future achievements.

Ascitic Fluid↗
PubMed1990

[Colorectal preparation for excision surgery. Development after 4 randomized multicenter studies].

1,265 patients having elective surgery with colectomy for cancer or sigmoiditis have been included in four successive randomized multidepartmental studies in order to define the most effective preparation, reducing the rate of postoperative infections, and the shortest one. The first study included 202 patients divided up into 2 groups, and compared a three-day conventional preparation (CP) (low-residue diet, laxatives and enemas) with a total digestive irrigation (TDI) (9 liters in 6 h) with Mannitol. Both preparations were associated with a three-day preoperative antibiotic therapy with Neomycin and Tetracyclin. Intolerance to TDI (50% of cases) and the greater number of fistulae with this method lead to preferring CP. The second study (326 patients in 4 groups) compared on one hand, a CP with the single absorption of a sachet of Sennosides or 2 liters of 10% Mannitol, and on the other hand, the preoperative antibiotic treatment utilizing Neomycin or Tetracyclin over three days with a 24-hour treatment with Metronidazole. Its conclusions are that the absorption of Sennosides is better tolerated than Mannitol and significantly more effective than the CP. There is no significant difference between the antibiotic therapy over three days and that over 24 h. The third study (335 patients in 4 groups) compared on one hand, lukewarm water enemas to enemas with iodinated polyvidone diluted to 5%, and on the other hand an antibiotic therapy utilizing Metronidazole on the day before, the same day and the three following surgery with a 24-hour antibiotic therapy utilizing Metronidazole (1.5 g) and/or Cefotaxime (4 g) on the same day as the operation.(ABSTRACT TRUNCATED AT 250 WORDS)

Anti-Bacterial Agents↗
PubMed1989

Prophylactic antibiotherapy in abdominal surgery. First- vs third-generation cephalosporins.

To compare the efficiency of antibioprophylaxis by cefazolin sodium or cefotaxime sodium, 3137 consecutive patients undergoing abdominal surgery were included in a prospective, randomized, controlled, multicenter study. The patients were divided into four strata, according to the degree of contamination during the operation and the risk factors. Within each stratum, the patients were randomized into three groups of treatment: (1) cefazolin, (2) cefotaxime, and (3) nontreatment (control). Antibiotics were administered perioperatively in three intravenous doses of 1 g at eight-hour intervals. Patients undergoing colon surgery or with peritonitis at the time of the operation were excluded from the study. The wound abscess rate was significantly lower in the treated groups than in the control group, except in stratum 3 (contaminated surgery). The percentage of postoperative peritonitis was twice as low in the treated groups as in the control group. There was no difference between the groups receiving cefazolin or cefotaxime. The patients in the treated groups received significantly less postoperative antibiotics than the patients in the control group. In terms of cost, antibioprophylaxis by cefazolin seems to be warranted in all operations with a low anaerobic contamination.

Abdomen↗
PubMed1989

Nucleotide sequence of the coat protein gene of a necrotic strain of potato virus Y from New Zealand.

The sequence of the 3'-terminal 1,134 nucleotides of the genome of a New Zealand isolate of a necrotic strain of potato virus Y (PVYN) has been determined. This sequence contains one large open reading frame of 796 nucleotides, the start of which was not identified, which is capable of encoding a protein of 264 amino acid residues with a molecular weight of 29,631. Comparison of the amino acid sequence with a published coat protein sequence of another strain, PVY-D, and with the amino acid sequence deduced from PeMV cDNA sequence data, confirms that the 3' cistron encodes the viral coat protein in PVYN. Adjacent to the 3' end of the coding region there is an untranslatable sequence of 326 nucleotides terminating in a polyadenylate tract. An alignment of the PVYN amino acid sequence with the coat protein sequences of six other potyviruses revealed significant sequence similarities in the internal and carboxy terminal regions. Much amino acid sequence similarity was found between PVYN, PVY-D, and PeMV (91-93%), suggesting that PeMV should be regarded as a PVY strain. An analysis of the 3'-untranslated region of the six potyviruse revealed PVYN and PeMV as the only viruses displaying sequence similarity in this region. The 3'-untranslated sequences of PVYN and PeMV were further examined for secondary structure.

Amino Acid Sequence↗