PubMed Health⌕ Search

Biomedical subjects

J P Palot

Publications and source records attributed to J P Palot.

At least 19 recordsLinked to original sources
PubMed2002

[Retromuscular prosthetic repair: experience from France].

Large incisional hernias cannot be cured without prosthetic material. A large pore size prosthetic tissue seems to be the best alternative, since connective invasion of the mesh provides a very strong fixation of the prosthesis. In our view, the mesh should be placed in the rectus sheath, in a position we have described as "retromuscular prefascial". With this technique, a good result can be achieved in 98% of very large incisional hernias.

Abdominal Muscles↗
PubMed1998

Right nonrecurrent inferior laryngeal nerve and arteria lusoria: the diagnostic and therapeutic implications of an anatomic anomaly. Review of 17 cases.

The authors report 17 cases of a right non-recurrent inferior laryngeal n. (NRILN) observed during 15 years of practice of thyroid and parathyroid surgery. In their last two cases, the existence of an aberrant right subclavian a., constantly associated with NRILN, was confirmed by MRI angiography. On the basis of the literature and their own experience, the authors review the incidence of this double anomaly, its embryologic explanation and its anatomic and surgical importance. They stress the diagnostic factors and the therapeutic implications, very different in children and adults, of a particular vascular anomaly whose outcome is little understood.

Adult↗
PubMed1997

[Comments on emergency treatment of biliary lithiasis in patients over 75 years of age. Apropos of 157 cases].

Surgery remains the ideal emergency treatment for biliary lithiasis in elderly subjects despite perioperative morbidity and mortality. Minimally invasive techniques appear promising but require assessment. The aim of this work was to determine the usefulness of these techniques and evaluate outcome in a series of 157 patients over 75 years of age who were hospitalized in an emergency setting of complicated biliary lithiasis from January 1990 to December 1996. There were 103 women and 54 men, mean age 82 years. The patients' general status was evaluated according to the ASA classification; 66% of the patients were ASA III, IV or V. Diagnoses at admission were acute cholecystitis (n = 71, 45%), angiocholitis (n = 50, 31%) subintrant hepatic colic (n = 17, 10.8%), pancreatitis (n = 10, 6%), isolated jaundice (n = 2), peritonitis (n = 2) and occlusion (n = 5). Within 24 hours of admission, 7 patients underwent emergency surgery, and the 150 others were given medical treatment. Among these 150 patients, cure was considered to have been achieved with medical treatment alone in 41 (subsequent surgery being required in only one 6 months later), semi-emergency was performed in 17, and a minimally invasive procedure was performed in the 92 others (echo-guided percutaneous cholecystostomy in 42, endoscopic sphincterotomy in 50) followed by a subsequent operation in 29. In the 103 patients (65.5%) in this series who did not undergo surgery, mortality was 3.8% and in the 54 patients (34.5%) who did, mortality was 15%, but this rate was only 6.9% when the open procedure followed a minimally invasive technique. Surgical treatment of complicated biliary disease remains the ideal therapy but indications should be carefully weighed in these elderly fragilized subjects. Under surgical observation, abstention from surgery or use of minimally invasive techniques can play an important role in the therapeutic strategy aimed at lowering perioperative mortality.

Aged↗
PubMed1995

[Evolution of indications for Hartmann's operation. Reflexions on a series of 160 cases].

The authors report the results and indications of 160 Hartmann's procedures performed over a period of 15 years. Between 1978 and 1992, 160 patients (90 males, 70 females), with a mean age of 72, underwent Hartmann's procedure for rectosigmoid carcinoma in 55% of cases, for complications of sigmoid diverticulitis in 36% and for other lesions in 14%. Hartmann's procedure was performed either electively (42%) or as an emergency (58%) with a mortality of 6% and 32% respectively. The majority of complications included wound infections or intraperitoneal abscess, and the overall morbidity was 30%. Re-establishment of bowel continuity was performed in 30.7% of patients, most of whom had been initially operated as an emergency for a benign lesion. These 160 cases of Hartmann's procedure represent 27% of the 590 operations performed during the same period as an emergency or electively for rectosigmoid lesion. Hartmann's procedure remains a most effective technique for emergency surgery for benign or malignant lesions with colonic septic complications, and is also indicated electively for palliative treatment of rectosigmoid carcinoma.

Aged↗
PubMed1993

[Is there still a place for surgery in the treatment of communicating pseudocyst in chronic pancreatitis?].

The purpose of this study was to evaluate the results of long term percutaneous catheter drainage in the treatment of chronic pancreatic pseudocysts communicating with pancreatic ducts. Since 1986, 13 consecutive patients with symptomatic pseudocysts were treated prospectively. All pseudocysts were associated with chronic pancreatitis. The location was head (n = 8), body (n = 3) or tail (n = 2). The procedure included fine needle aspiration under ultrasonic control, percutaneous drainage along a guide wire and closed suction aspiration. A radiological control was performed weekly and the catheter was left in place until total resolution of pseudocyst. Immediate relief of pain and resolution of pseudocyst were obtained in all 13 patients. The average length of hospital stay was 12.2 +/- 8 days (1 to 23). The average duration of drainage was 36 days. There was no mortality of morbidity related to the drainage. There were two asymptomatic recurrences, but long-term follow-up (mean 3 years) showed that all 13 patients were symptom-free. The clinical results of such a long-term catheter drainage seem better in our study than in other previous series. It is a simple and innocuous procedure, and could be carried out in an outpatient unit. Such drainage represents an efficient alternative to endoscopic or surgical treatment of chronic pancreatic pseudocyst with ductal communication. In our experience surgery is no longer indicated.

Adult↗
PubMed1991

[Cardiopexy using the hepatic ligament in the treatment of gastroesophageal reflux. Apropos of 200 cases].

The authors report 200 cases of cardiopexy with the ligamentum teres (Rampal-Marchal's procedure) associated with a 180 degree posterior fundoplication, in the surgical treatment of gastroesophageal reflux. 200 patients with severe reflux (76% oesophagitis) were operated on with this procedure over a 10 year period. Symptoms of reflux disappeared immediately in 99% cases, with healing of oesophagitis in 124 out of the 127 patients controlled with endoscopy, and a significant increase of inferior sphincteric pressure (from 11 cm H2O to 25 cm H2O). Objective controls by post-prandial pHmetry evidenced persistant reflux with 10 patients, but 9 of them are totally free of symptoms. Operative mortality was 1.5%. Transient dysphagia was observed in 32% cases. All the patients were reviewed with a mean follow up of 23 months. 4 clinical recurrences of reflux were observed (2%) but no oesophagitis was found on endoscopic controls with these 4 patients, and only one had to be reoperated on. Actuarial chance to remain free of recurrence was estimated at 97.8% up to 48 months according to the Kaplan-Maier's method. Cardiopexy with the ligamentum teres ensures the lengthening of the abdominal portion of the oesophagus and anchors the antireflux assembly within the pressure environment of the abdomen in a strong and flexible way. It seems to be the best procedure for the treatment of GE reflux.

Cardia↗
PubMed1991

[Ultrasound-guided percutaneous drainage of intraperitoneal fluid collections. An experience of a surgical team with 205 patients].

Percutaneous drainage has become, during the last ten years, the treatment of choice of abdominal abscesses. From January 1986 to January 1990, 205 patients have been treated in our department for an abdominal collection. In this prospective work we have realised percutaneous drainage in every patients who would have been operated, according to the classical indications. In 28 patients (acute cholecystitis), the indication has been elective because of the surgical risk, depending to the age (mean 80 years). We have treated 67 intra abdominal collections (34 post operative), 39 pseudocysts of the pancreas, 40 liver collections (18 abscesses); and we have done 37 biliary drainages. 15% of the patients showed communication of the collection with the digestive tract. Mortality was less than 5%. Half of these deaths occurred during the evolution of necrotic pancreatitis. 78% of the patients have been cured by the percutaneous drain. The other patients have been operated upon but the drainage facilitated the operation. In our experience percutaneous drainage is a secure technique and every abdominal surgeon would be able to practice this technique.

Abdomen↗
PubMed1989

[Cardiopexy using the umbilical ligament of the liver in the treatment of gastro-esophageal reflux. Results of experience with 100 cases].

The authors report their experience of the surgical treatment of gastroesophageal reflux using a circular cardiopexy with the ligamentum teres (Rampal-Marchal's procedure) associated with a 180 degrees posterior fundoplication. 100 patients with severe reflux (76% oesophagitis) were operated on with this procedure over a 6 year period. Symptoms of reflux disappeared immediately in 99% cases, which corresponded to the healing of oesophagitis with 45 out of the 46 patients controlled with endoscopy, and to a significant increase of inferior sphincteric pressure (from 12 cm H20 to 24 cm H20). Objective controls by post prandial pHmetry evidenced persistent reflux with 4 patients, but 3 of them are totally free of symptoms. Operative mortality was 2%. Transient dysphagia was observed in 25% cases. 96 patients were reviewed with a mean follow up of 23 months. 3 clinical recurrence of reflux were observed (4%) but no oesophagitis was found on endoscopic controls with these 3 patients and none had to be reoperated on. Actuarial chance to remain free of recurrence was estimated at 96.6% up to 48 months according to the Kaplan-Maier's method. Cardiopexy with the ligamentum teres ensures the lengthening of the abdominal portion of the esophagus and anchors the antireflux assembly within the positive pressure environment of the abdomen in a strong and flexible way. It seems to be an advisable procedure for the treatment of GE reflux.

Adult↗
PubMed1987

Dynamic modifications of the popliteal arterial axis in the sagittal plane during flexion of the knee.

The authors have studied, on the basis of purely radiologic data, the modifications of the popliteal arterial axis during flexion of the knee. They note the appearance in the sagittal plane of very marked flexures of the upper part of the artery, while the lower part describes a harmonious curve. These modifications take place between two fixed points: a cranial fixed point, represented by the origin of the descending artery of the knee, and a caudal fixed point represented by the origin of the anterior tibial artery. The pathologic importance of these modifications of the course of the artery should not be underestimated when obtaining revascularization by means of an arterial prosthesis.

Humans↗