Biomedical subjects

L Brunaud

Publications and source records attributed to L Brunaud.

28 records · Page 2Linked to original sources

PubMed2001

[Successful treatment of gastroesophageal reflux with anterior partial fundoplication under celioscopy].

OBJECTIVE: To study the interest of partial fundoplication under laparoscopy, not only in terms of efficacy but also in the low rate of complications. METHODS: The study included all patients having undergone coelioscopic surgery for gastroesophageal reflux from January 1995 to February. A ventral semi-valve was created in all patients. Complications during surgery and post-surgical follow-up immediately after, six weeks later and then at distance were analyzed. RESULTS: The mean duration of surgery was 81 minutes (40-170 min.) and mean hospital stay 6.2 days (2-12 days). Twelve conversions were observed (9.6%) and post-surgical morbidity was of 9.7% after coelioscopy. At 6 weeks, 72 patients (63.7%) were satisfied with the operation, 13 patients (11.5%) complained of dysphagia and 5 (4.4%) of bloating. At distance, after a mean of 3.2 years (0.5-5.5 years), 72 patients (73%) were totally satisfied; 4 presented recurrent reflux (4.1%) and 3 patients (3.1%) complained of dysphagia. CONCLUSION: The results of laparoscopic surgery for gastroesophageal reflux with creation of a ventral semi-valve are encouraging. Pre-existing symptomatology is eradicated and post-surgical complications are clearly decreased.

Fundoplication↗

PubMed2001

Solitary rectal ulcer syndrome: a series of 13 patients operated with a mean follow-up of 4.5 years.

Solitary rectal ulcer syndrome (SRUS) is an infrequent pathology often associated with pelvic floor disorders. The aim of this retrospective study was to review the long-term results of a surgical series of SRUS. Between 1988 and 1998, 13 patients were operated on for SRUS. Seven patients had associated internal rectal prolapse (58%), two had associated total rectal prolapse (15%), and two had associated mucosal prolapse (15%). We performed simple resection of the SRUS in one case (8%), a stoma as primary operation in one (8%), three rectopexies according to Orr-Loygue (23%), and eight Delorme's operations as modified by Berman (62%). Mean follow-up was 57 months (range 15-112). Simple resection of the solitary rectal ulcer syndrome did not improve symptoms. Colostomy permitted relief of symptoms and healing of the SRUS. Two of the three rectopexies achieved good results, and the third patient relapsed at the 6th postoperative month. A secondary modified Delorme's operation permitted relief of symptoms and healing of the SRUS. Five of the eight patients (62.5%) who received modified Delorme's operations had improved at a follow-up of 46 months. We conclude that, considering the high failure rate after surgery, operations should be performed only in patients with total rectal prolapse or intractable symptoms not amenable to behavioral therapy. Delorme's operation and abdominal rectopexy help in about 60% of cases.

Adult↗

PubMed2001

[Evaluation of somatostatin or octreotide efficacy in the treatment of external pancreatic fistulas].

AIM OF THE STUDY: To evaluate the prevalence of pancreatic pseudocyst after persistent fistula closure with somatostatin or octreotide. To compare the patient characteristics according to the subsequent presence or absence of pseudocyst. PATIENTS AND METHODS: This retrospective study from January 1994 to August 1999 included 15 patients with an external pancreatic fistula. Fistula closure was observed for all patients with somatostatin or octreotide. CT scan was performed 66 +/- 34 days after the end of this treatment. RESULTS: CT scan was normal in 9 patients (favorable group) and showed pancreatic pseudocyst (failure group) in 6 patients. Pancreatic fistula etiologies were different between the two groups. The 5 patients presenting pancreatic fistula after duodenopancreatectomy belonged to the favorable group. Six of the 10 patients presenting pancreatic fistula after pseudocyst drainage belonged to the failure group. There were no other differences between the two groups. CONCLUSION: Persistent pancreatic fistula can be cured with somatostatin or octreotide. However, fistulas occurring after duodenopancreatectomy are more easily cured with somatostatin or octreotide than fistulas occurring after external pseudocyst drainage. Somatostatin or octreotide cannot be considered to be an effective treatment for pancreatic fistula occurring after pseudocyst drainage, despite the fact that 40% of them were permanently cured.

Cutaneous Fistula↗

PubMed2001

Ovarian strumal carcinoid tumor responsible for carcinoid heart disease.

We report a case of right ovarian strumal carcinoid tumor responsible for tricuspid regurgitation. Valve replacement and salpingo-oophorectomy were performed. Serotonin level and tomodensitometry were normal at 3-year follow-up. Rarity of strumal carcinoid tumor explains why this tumor has never been reported with carcinoid heart disease before.

Aged↗

PubMed2001

Acute mesenteric venous thrombosis: case for nonoperative management.

OBJECTIVE: Initial treatment in the management of acute mesenteric vein thrombosis (MVT) is controversial. Some authors have proposed a surgical approach, whereas others have advocated medical therapy (anticoagulation). In this study, we analyzed and compared the results obtained with surgical and medical treatment to determine the best initial management for this disease. METHODS: We retrospectively reviewed the records of patients treated for MVT in a secondary care surgical department from January 1987 to December 1999. Before January 1995, our departmental policy was to perform surgery in patients with suspected MVT. Since January 1995, we have preferred a medical approach when achievable. Each patient in this study was assessed for diagnosis, initial management (laparotomy or anticoagulation), morbidity, mortality, duration of hospitalization, the need for secondary operation, portal hypertension, and survival rates. RESULTS: Twenty-six patients were treated, 14 before January 1995 (group 1) and 12 since January 1995 (group 2). Morbidity, mortality, secondary operation, portal hypertension, and 2-year survival rates were 34.6%, 19.2%, 15.3%, 19.2%, and 76.9%, respectively. No statistical difference was observed between the two groups. The mean duration of hospitalization was 51.6 days in group 1 and 23.2 days in group 2 (P < .05). Among the 12 patients treated by means of laparotomy with bowel resection, 10 patients (83%) had mucosal necrosis without transmural necrosis at pathologic study. CONCLUSION: Nonoperative management for acute MVT is feasible when the initial diagnosis with a computed tomography scan is certain and when the bowel infarction has not led to transmural necrosis and bowel perforation. The morbidity, mortality, and survival rates are similar in cases of surgical and nonoperative management. The length of hospital stay is shorter when patients are treated with a nonoperative approach. A nonoperative approach, when indicated, avoids the resection of macroscopically infarcted small bowel (without transmural necrosis) in cases that are potentially reversible with anticoagulation alone.

Acute Disease↗

PubMed2001

[Tamoxifen for metastatic pancreatic adenocarcinoma: a complete response].

Pancreatic adenocarcinoma tissue contains estrogen receptors and some pilot studies have suggested that tamoxifen could increase the survival of patients with unresectable pancreatic cancer. However data of comparative studies are conflicting. We report the case of a woman who presented with unresectable pancreatic head carcinoma with hepatic metastasis. The patient refused chemotherapy and was treated with tamoxifen 30 mg/day. A complete clinical remission of 50 months was observed. A further large-scale study may be required to assess the usefulness of tamoxifen in the second-line treatment of advanced pancreatic carcinoma.

Adenocarcinoma↗

PubMed2000

[The mesorectum: improvement and anatomy of a semantic error].

AIMS: The cancer of the rectum touches 10,000 patients per year in France. Its treatment is mainly surgical. 50% of the treated patients will die of their cancer, either by loco-regional recurrence, or by metastatic disease. The rates of local recurrence vary from 10 to 40%. Heald is first who brought back recurrence rates lower than 4%, results obtained by the only surgical treatment. This treatment included the total exeresis of cellulo-fatty tissue surrounding the rectum, tissue which was baptized mesorectum. The aims of this work is to define and describe this space, and to discuss its Christian name. MATERIAL AND METHODS: The anatomical study carries on the dissection of 2 frozen pelvis of fresh man, one cut transversely on the level of L4, the other half-compartment sagittaly, then defrosted for the dissection. RESULTS: The mesorectum is defined and its various structures, fascia, vessels and nerves, are detailed. CONCLUSION: The mesorectum is an anatomical and surgical structure individualisable. Its recognition and its importance were born from the understanding of the fascia and the rectal anatomy. Its exeresis decreases the rate of the local recurrence (18). The technique of exeresis of the mesorectum must be validated, standardized, in order to be reproducible in the treatment of the cancer of the rectum.

Female↗

PubMed1996

[Adrenalectomy by posterior approach for benign adrenocortical tumors. Apropos of 12 cases].

The posterior extra-peritoneal route is usually preferred for exeresis of benign tumors of the adrenal glands measuring less than 5 cm. We examined the hospital reports for patients in which Young access was used since 1985. From December 1985 to December 1994, 12 patients underwent surgery for benign tumor of the adrenal gland. There were 9 women and 3 men (mean age 49.4 years, range 29-67). In all patients, the tumor was localized pre-operatively on a CT-scan. There was a unique tumor in each case. There were 11 adrenal adenomas including 10 Conn tumors and 1 secreting tumor (Cushing's syndrome). The last case was a cortical cyst. One patient died in the post-operative period, probably due to massive pulmonary embolism although necroscopic evidence was not obtained. Parietal infection occurred in one case and a spontaneously regressive hematoma in another. Mean duration of hospitalization was 7.0 days. At follow-up, 1 patient suffered deinnervation of the oblique muscles of the abdomen which did not require reoperation. Two months after surgery, clinical signs and hormone disorders related to the Conn adenomas had regressed in 7 of the 9 patients. In summary, the posterior route is perfectly adapted to the treatment of benign tumors of the adrenal glands when the exact localization can be identified on pre-operative imaging. This access should be considered as the reference route of evaluating laparoscopic procedures.

Adrenal Cortex Neoplasms↗

PubMedDate not supplied

Intestinal intussusception in adults, treat it like a cancer.

Intussusception in adult is a rare condition. Pathologic process is identifiable in 90% of cases. Emergency clinical diagnosis is generally difficult and CT scan typical features are of use. Surgery is always necessary to treat bowel necrosis and to perform pathologic examination. Diagnosis of cancer must be in mind and lymphadenectomy must be done. We present two recent cases of intussusception in adults due to adenomatosis polyposis and Meckel's diverticulum.

Adenomatous Polyps↗

PubMedDate not supplied

Left hepatic duct injury and thoracobiliary fistula after abdominal blunt trauma.

Thoracobiliary fistula after blunt hepatic trauma is rare. We report a case of pleurobiliary fistula after a blunt hepatic trauma leading to a left hepatic lobe laceration together with a left hepatic duct injury. The management of this traumatic lesion is discussed and related to the existing literature data. The diagnosis of traumatic thoracobiliary fistula rests upon clinical suspicion in the setting of a persistent right pleural effusion. Demonstration of the presence of bile in the pleural cavity by thoracocentesis is considered a proof of pleural biliary fistula. We think that laparotomy is an appropriate route for the treatment of pleurobiliary fistulas. However, when a bronchobiliary fistula is suspected, the patient should be treated with thoracotomy and may require pulmonary resection to remove the fistulous tracts.

Abdominal Injuries↗