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Biomedical subjects

J P Marmuse

Publications and source records attributed to J P Marmuse.

At least 19 recordsLinked to original sources
PubMed2003

[Umbilical hernia. New repair technique with a minimal scar].

OBJECTIVE: Describe a surgical technique concerning the treatment of umbilical hernias that have a diameter less than 5 cm, with a reduction of scars. PATIENTS AND METHOD: After analysing the different techniques of umbilical hernias repair, the authors suggest a new personal technique. The surgical treatment consists in removing the hernia sack after double M incision of the umbilical skin, repairing the abdominal wall by Quenu technique, folding the abdominal muscles and reconstructing the umbilicus. RESULTS: The results, which are achieved on nine patients, with check up two years after, confirm the validity of the technique. DISCUSSION AND CONCLUSIONS: The scars after umbilical hernia surgical treatment are very important and visible because of their being located on the middle line of the abdominal wall. For the female patient in particular, this scar represents a great psychological annoyance. The double M technique leaves only an invisible scar with a good functional result.

Cicatrix↗
PubMed2001

Prevalence of high-grade dysplasia and cancer in the anal canal in human papillomavirus-infected individuals.

BACKGROUND & AIMS: The incidence of anal cancer is higher in patients with anal canal condyloma, a sexually transmitted disease, than in the general population. We determined the prevalence of anal dysplasia and cancer in patients with anal canal condyloma with respect to human immunodeficiency virus (HIV) status, immunity status, and human papillomavirus types. METHODS: In 174 consecutive patients (114 HIV positive, 60 HIV negative) with anal canal condyloma, lesions were cured, and the patients were then followed up prospectively. Langerhans cells (LCs) in normal anal mucosa were quantified, and viruses (Epstein-Barr virus, cytomegalovirus, human simplex virus 1, and various human papillomavirus [HPV] types) were characterized on inclusion. During follow-up (median 26 months), relapsed condylomas were resected and examined histologically. HIV load and CD4 T-lymphocyte counts in serum were determined at each visit. RESULTS: Several factors differed significantly between HIV-positive and HIV-negative patients: LCs/mm anal tissue (15 vs. 30), oncogenic HPV (27% vs. 13%), other current anal infections (44% vs. 0%), and sex ratio (93% vs. 73% male). During follow-up, condylomas relapsed in 75% of the HIV-positive patients, with 19 high-grade dysplasias (HGDs) and 1 invasive carcinoma, but in only 6% of HIV-negative patients, with 1 HGD. Male sex, HIV positivity, and <15 LCs/mm tissue were independent risk factors for condyloma relapse. HIV positivity, HGD before inclusion, and condyloma relapse were independent risk factors for HGD and cancer. Serum HIV load was associated with relapse, whereas CD4 T-lymphocyte counts were not. CONCLUSIONS: The prevalence of HGD and carcinoma is higher in HIV-positive than in HIV-negative patients, probably because of HPV activity. HIV-positive patients with high serum HIV load and/or a history of anal dysplasia should be examined by anoscopy, and condylomas should be analyzed histologically.

Adult↗
PubMed2000

Laparoscopy for acute small-bowel obstruction secondary to adhesions.

BACKGROUND AND PURPOSE: Postoperative adhesions are the leading cause of small-bowel obstruction in developed countries. Several arguments suggest that laparoscopy may lead to fewer adhesions than does laparotomy. We report here the short-term results of laparoscopy in patients admitted on an emergency basis for acute small-bowel obstruction secondary to adhesions. PATIENTS AND METHODS: This prospective trial included 134 consecutive patients: 39 underwent emergency surgery, and 95 had laparoscopic adhesiolysis shortly after resolution of the obstruction with nasogastric suction. Of the previous operations for which the dates were known, 16% had taken place within 1 year of the obstruction and 33.5% within 5 years. In all, 27% of the patients had open laparoscopy, and 16% had conversions: 7% after elective laparoscopy and 36% after emergency laparoscopy. RESULTS: There were no operative deaths. One patient underwent a reoperation the following day for fistula after incomplete adhesiolysis attributable to multiple adhesions found during elective laparoscopy. If laparoscopy is considered to have failed when adhesiolysis was incomplete or conversion or reoperation was necessary, our success rate was 80% after elective laparoscopy and 59% after emergency laparoscopy. CONCLUSION: Emergency situations in acute small-bowel obstruction combine several circumstances unfavorable for laparoscopy: a limited work area and a distended and fragile small bowel. Laparoscopic adhesiolysis after the crisis has passed may produce better results, but only long-term follow-up can confirm the role of elective laparoscopy for this indication.

Acute Disease↗
PubMed2000

Postoperative recovery after desflurane, propofol, or isoflurane anesthesia among morbidly obese patients: a prospective, randomized study.

UNLABELLED: Recovery from anesthesia might be compromised in obese patients. Because of its pharmacological properties, desflurane might allow rapid postoperative recovery for these patients. We compared postoperative recovery for 36 obese patients randomized to receive either desflurane, propofol, or isoflurane to maintain anesthesia during laparoscopic gastroplasties. Anesthesia was induced with propofol and succinylcholine IV and was maintained with rocuronium, alfentanil, inhaled nitrous oxide, and the study drug. Immediate recovery (i.e., times from the discontinuation of anesthesia to tracheal extubation, eye opening, and the ability to state one's name) was measured. At the time of postanesthesia care unit (PACU) admission, arterial saturation and the ability of patients to move were recorded. In the PACU, intermediate recovery was measured by using sedation and psychometric evaluations, 30, 60, and 120 min postoperatively. Data were compared between groups by using the Kruskal-Wallis and chi(2) tests. Results were reported as means +/- SD. P: < 0.05, compared with desflurane, was considered significant. Immediate recovery occurred faster, and was more consistent, after desflurane than after propofol or isoflurane (times to extubation were 6 +/- 1 min, 13 +/- 8 min [P: < 0.05, compared with desflurane], and 12 +/- 6 min [P: < 0.05, compared with desflurane], respectively). At PACU admission, SpO(2) values were significantly higher and patient mobility was significantly better after desflurane than after isoflurane or propofol. Sedation was significantly less pronounced with desflurane at 30 and 120 min postoperatively. In morbidly obese patients, postoperative immediate and intermediate recoveries are more rapid after desflurane than after propofol or isoflurane anesthesia. This advantage of desflurane persists at least for 2 h after surgery and is associated with both an improvement in patient mobility and a reduced incidence of postoperative desaturation. IMPLICATIONS: In morbidly obese patients, postoperative immediate and intermediate recoveries are more rapid and consistent after desflurane than after propofol or isoflurane anesthesia.

Adult↗
PubMed2000

[Interest in several surgeries for serious abdominal trauma].

Abbreviated laparotomy and planned reoperation(s) is a new concept in severely injured patients with multivisceral failure by hemorrhagic shock, coagulopathy and hypothermia. The aim of an abbreviated laparotomy is to control hemorrhage, prevent digestive contamination and close the abdominal wall without tension. After a delay for reanimation during 24 to 96 hours, discovery of unknown lesions and anatomic reconstruction will be possible through planned reoperation in better conditions. Emergency reoperation for hemorrhage and abdominal hyperpression severely worsens prognosis.

Abdominal Injuries↗
PubMed1999

Post-operative course after conventional or laparoscopic gastroplasty in morbidly obese patients.

The post-operative period is particularly dangerous for obese patients. The aim of this study was to compare the immediate post-operative course after either laparoscopic or open gastroplasty. We studied retrospectively 20 and 14 consecutive patients who underwent laparoscopic or open adjustable silicone gastric banding, respectively. After the laparoscopic procedure, patients had a significantly shorter stay in the post-anaesthesia care unit (0.3 +/- 0.4 and 1.1 +/- 1 days), reduced analgesic requirements, a shorter period of intravenous catheter use (2.3 +/- 1.9 and 4.8 +/- 1.4 days), were able to walk sooner (1 +/- 0.4 and 2.1 +/- 1.6 days) and had a significantly shorter duration of in-hospital stay (5.4 +/- 2.3 and 15.8 +/- 4.5 days) than after an open procedure. This report suggests that the use of laparoscopy for gastroplasty in morbidity obese patients may significantly improve the immediate post-operative course.

Adult↗
PubMed1999

Methicillin-resistant Staphylococcus aureus as a causative agent of postoperative intra-abdominal infection: relation to nasal colonization.

In the surgical intensive care unit of a university hospital, we investigated the frequency of and the risk factors for acquisition of methicillin-resistant Staphylococcus aureus (MRSA) during postoperative intra-abdominal infection (pIAI). We conducted a prospective MRSA nasal screening and case evaluation for 17 months among 73 consecutive patients with having pIAI. MRSA pIAI was diagnosed when MRSA was obtained from culture of intraperitoneal fluids. The identity of nasal and peritoneal MRSA strains was assessed by genomic analysis. Twelve patients had MRSA pIAI, representing 21% of all MRSA infections acquired by the 73 patients. An organ system failure score of >/=1 and MRSA nasal carriage prior to pIAI were the independent risk factors for acquisition of MRSA pIAI. Patients with MRSA pIAI had a longer intensive care unit stay and more reoperations than did those free of MRSA pIAI. We conclude that MRSA may be a causative pathogen in pIAI and may be related to nasal colonization.

Adult↗
PubMed1999

Nodular lesions of the liver revealing multiple myeloma.

Liver involvement in multiple myeloma (MM) has been reported very rarely in living patients. Here we describe a rare case in whom investigation of liver nodules by biopsy, revealed MM. The Role of cytadhesin molecules in the spread of plasma cell neoplasia is discussed and a review of the Literature is given.

Aged↗
PubMed1999

[Respiratory morbidity and mortality following transhiatal esophagectomy in patients with severe chronic obstructive pulmonary disease].

In order to assess the influence of severe chronic obstructive pulmonary disease on the pulmonary morbidity and mortality following transhiatal oesophagectomy, the authors reviewed 136 consecutive patients who underwent oesophageal cancer resection by a transhiatal approach. Nineteen patients had a forced expiratory volume in one second (FEV) lower than 60% of the theoretical value, indicating severe chronic obstructive pulmonary disease. The other group of 117 patients had a FEV higher than 60% of the theoretical value. Pulmonary complications occurred in 36 patients: 23 (64%) were minor and 13 (36%) were major. Severe chronic obstructive pulmonary disease did not significantly increase pulmonary morbidity. However, pulmonary complications occurring in this group of patients appeared more severe with a significant increase in major pulmonary complications (21% versus 8%, p = 0.05) and respiratory mortality rates (10% versus 1.6%, p = 0.04). One factor was significantly correlated to respiratory mortality: age higher than 75 years (p = 0.006). Severe chronic obstructive pulmonary disease does not constitute a contraindication for transhiatal oesophagectomy. However, this approach should be reserved for patients under 75 years of age, in order to obtain respiratory morbidity and mortality rates comparable to those of patients with normal spirometry.

Adult↗
PubMed1999

[Laparoscopic treatment of recurrent inguinal hernia after only mesh].

The recurrences of inguinal hernia after onlay mesh may cause technical difficulties for a new repair. The aim of our study was to assess intraoperative findings, feasibility and results of laparoscopic transpreperitoneal mesh onlay in this indication. Twenty-one repairs were performed. In all cases, direct, internal, inguinal recurrences were observed, associated in two cases with an external or femoral recurrence. In 16 cases, there were no adhesions in the peritoneal cavity. The were no conversions and peritonealisation was always completed. The mean length of hospitalization was 2.7 days. Our study suggests that technical errors during the first procedure, insufficient mesh or wrongly positioned are responsible for recurrence and allow reinsertion of a mesh laparoscopy via transpreperitoneal in this indication.

Adult↗
PubMed1999

[Acute occlusions of the small intestine caused by adhesions. Indications and results].

Postoperative adhesions are the first cause of small bowel occlusion in developed countries. Nevertheless no progress was done in prevention and treatment of this disease. The aim of this trial is to report results of 276 small bowel occlusions caused by adhesion recently operated and consecutive between first january 1993 and 31 december 1996. These patients had 400 previous surgical procedures, within 67.4% infra mesocolic or pelvic. 15.1% of previous surgical procedures took place less than one year before and 36% less than 5 years. Thirty five per cent of patients were operated during 24 hours following admission 23.2% of patients had a digestive resection, caused by necrosis or iatrogenic dissection. Operative mortality was 4.3% without resection and 16.6% with resection. Progress are warranted to reduce the rate of redux of occlusion and mortality and morbidity in this benign disease: more peri operative attention and place of laparoscopy should be considered.

Acute Disease↗
PubMed1998

A diffuse T lymphocytic gastrointestinal mucosal infiltration associated with Sjögren's syndrome resulting in a watery diarrhea syndrome and responsive to immunosuppressive therapy.

We report the case of a 45-yr-old white man, investigated for chronic diarrhea, malabsorption and weight loss associated with sicca syndrome. Endoscopic and x-ray examinations showed normal macroscopic mucosa in gastrointestinal tract (GIT). Immunohistochemistry showed diffuse polyclonal T cell lymphocytes infiltrating either epithelium and lamina propria in GIT. There was no villous atrophy in the jejunum and ileum. Corticosteroids, azathioprine, and cyclosporine failed to improve symptoms. Monthly intravenous cyclophosphamide administered over 1 yr, stopped the diarrhea and weight loss. The patient is free of symptoms up to a 5-yr follow-up.

Cell Movement↗
PubMed1997

False-positive somatostatin receptor scintigraphy due to an accessory spleen.

A patient with previous left caudal pancreatectomy and splenectomy presented with Zollinger-Ellison syndrome. Abdominal CT and endoscopic ultrasonography revealed a mass in the splenic area. Somatostatin receptor scintigraphy showed a nodular increase of the uptake corresponding to the lesion detected with conventional imaging. A second laparotomy was performed and the mass was resected. Histological analysis showed that the nodular lesion was an accessory spleen. Since physiologic uptake of 111In-pentetreotide is seen in the spleen, an accessory spleen mimicking a tumor, specially after previous splenectomy, may result in false-positive somatostatin receptor scintigraphy.

False Positive Reactions↗
PubMed1997

[Surgical hemostasis for hemorrhage after liver biopsy].

Bleeding after needle liver biopsy (NLB) is well known but surgical hemostasis in these circumstances is rarely assessed. We report 7 cases of laparotomy for hemostasis after NLB. The 7 NLB were done for 6 diffuse hepatopathies and one focal lesion. Three patients had hemostasis disorders at the time of the biopsy. None had cirrhosis. Five patients were operated few hours after the biopsy. Direct hemostasis was performed in 6 cases and in hepatectomy in one. Two patients were reoperated for three repeated hemostasis. Two died. The occurrence of hemoperitoneum after NLB is very rare but serious, occasionally occurring a few days after the biopsy. The respect of contre-indications and technical precautions are the best prevention of this kind of accident.

Adolescent↗
PubMed1996

Peritoneal carcinomatosis in patients with digestive endocrine tumors.

BACKGROUND: Peritoneal carcinomatosis (PC) in patients with digestive endocrine tumors (DET) is considered rare but its prevalence is unknown. The objectives of this study were to assess the prevalence and prognostic implications of PC in patients with various types of DET. METHODS: One hundred and sixteen consecutive patients with DET seen over a 3-year period were studied. Fifty-nine had gastrinomas, 30 had carcinoid tumors, and 27 had other types of endocrine tumors, mainly nonfunctioning ones. Diagnosis of PC was based on clinical symptoms (ascites and König's syndrome), findings of computed tomography scans that were performed at least yearly, and pathologic confirmation of tumor nodules or positive cytology in the peritoneal fluid. Factors associated with PC were investigated and the influence of PC on patients' survival was assessed. RESULTS: PC was found in 11 patients (overall PC prevalence: 10%; with 27% in patients with carcinoid tumors, 11% in those with nongastrinoma pancreatic endocrine tumors, and 0% in patients with gastrinomas). Nine of 11 patients with PC also had liver metastases. PC was metachronous to detection of the primary tumor in 7 of 11 patients, occurring 54 months (range, 23-273 months) after the diagnosis. In addition to the nature of the primary tumor, a greatest dimension of more than 5 cm was associated with the presence of PC in two of three patients with pancreatic endocrine tumors. In patients with carcinoid tumors, an ileal primary tumor occurred more frequently in patients with PC (87.5%) than in those without PC (50%). Prevalence of liver and other metastases was not significantly increased in patients with PC. Although five patients died of their disease, no deaths were related to PC. Actuarial survival rates at 5 years were 64% and 84% in patients with and without PC, respectively (P = not significant), whereas they were 73% and 93% in patients with and without liver metastases, respectively (P < 0.02). CONCLUSIONS: PC is not a rare event in the course of DET, especially in patients with carcinoid tumors. It did not occur in the patient population with gastrinomas, which are less often malignant but may also differ from the other types of DET by several cell characteristics. In contrast to liver metastases, PC is not associated with a significant decrease in life expectancy.

Actuarial Analysis↗
PubMed1996

Preoperative detection of duodenal gastrinomas and peripancreatic lymph nodes by somatostatin receptor scintigraphy. Groupe D'etude Du Syndrome De Zollinger-Ellison.

BACKGROUND & AIMS: Duodenal gastrinomas and peripancreatic lymph nodes are difficult to localize. The aim of this study was to evaluate the ability of Octreoscan scintigraphy to detect such tumors. METHODS: Results of Octreoscan scintigraphy in 21 consecutive patients with Zollinger-Ellison syndrome were compared with those of conventional imaging techniques, including endoscopic ultrasonography, and with the surgical findings. RESULTS: Surgical exploration found 27 duodenal and/or lymph node gastrinomas in 19 patients. None had pancreatic gastrinoma. Octreoscan scintigraphy was the only positive preoperative technique in 32% of the patients. The sensitivities of conventional techniques, Octreoscan scintigraphy, and their association were 58%, 58%, and 90%, respectively, for all resected gastrinomas. The smallest duodenal gastrinoma detected by Octreoscan scintigraphy measured 3 mm. Endoscopic ultrasonography detected all the tumors visualized by any other conventional technique and was considered falsely positive, as was Octreoscan scintigraphy, in 1 patient. Follow-up and comparison between the number of resected gastrinomas and the number of preoperative hot spots suggested that surgeons should find at least as many tumors as the number of hot spots. CONCLUSIONS: Octreoscan scintigraphy improved the preoperative detection of extrapancreatic gastrinomas, mainly by endoscopic ultrasonography. Surgeons should find at least as many gastrinomas as the number of hot spots.

Adult↗
PubMed1996

Emergence of antibiotic-resistant bacteria in cases of peritonitis after intraabdominal surgery affects the efficacy of empirical antimicrobial therapy.

In cases of community-acquired peritonitis, the adequacy of emprical antibiotic treatment has been shown to attenuate mortality and morbidity. The impact of empirical antibiotics on the outcome of postoperative peritonitis has never been evaluated. This study included 100 consecutively studied patients with postoperative peritonitis. The adequacy of emprical treatment was determined by means of culture and susceptibility data obtained at the time of reoperation, and the effect of such treatment on outcome was evaluated. One hundred resistant pathogens were isolated from 70 patients, of whom 45% died; by comparison, mortality among those from whom susceptible organisms were isolated was 16% (P < .05). Inadequate empirical treatment was administered to 54 patients and was associated with poorer outcome (P < or = .05). The outcome of postoperative peritonitis is affected by the choice and adequacy of the initial empirical antibiotic therapy. Late changes in antibiotic therapy based on culture results did not affect outcome when the initial regimen was inadequate.

APACHE↗