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Biomedical subjects

L F Hollender

Publications and source records attributed to L F Hollender.

At least 19 recordsLinked to original sources
PubMed1992

[Hemorrhagic ulcer of the bulb. Plea for gastric resection].

Bleeding remains on of the most fearsome complications of duodenal ulcer disease. It is, as if H2 Blockers, while never curing the ulcer, were in fact promoting its most severe forms, i.e., posterior huge ulcers, the control of which has to be a gastric resection. On the basis of a short but consecutive serie of 10 patients, the authors plead in favor of the exclusion of the ulcer from the digestive tract, using the wheeling off procedure to close the duodenal stump.

Adult↗
PubMed1991

[Outpatient surgery. Why? How?].

One day surgery--defined by the fact that the patient enters the clinic in the morning and returns at home late in the afternoon--requires the observation of a whole of criteria which are absolutely necessary to guarantee the highest security as possible. At first an outstanding collaboration with the anesthetist is mandatory. Material conditions of its practice should'nt be neglected. Rooms and medical staff have to be appropriate. Indications of its performance are large but depend of the experience of the surgeon. Limits are ruled by the general status of the patient and also by his social conditions and his surroundings, not to forget an excellent collaboration with the general practitioner. Economic advantages seem obvious but have to be calculated. It is above all necessary to persuade the public hospital administrations and the social Security structures, of the interest and the advantages of one day surgery.

Ambulatory Surgical Procedures↗
PubMed1991

[How much general surgery does the specialist surgeon need? French considerations?].

General surgery is the basis of surgery and the prerequisite for any type of surgical intervention. General surgery is also the coordinating factor for all those patients whose state of health, requires the attendance of several specialists. Four conditions are mandatory for optimal training: 1. Criteria for admission 2. Duration of training: 4 years of basic surgical training with 2-3 more years for specialization 3. Criteria for the standardization among the training centres (hospital accreditation system) 4. Quality control: at the end of the 1st year control of manual ability and after 4 years theoretical, clinical and practical examinations. These points are discussed and defended.

Clinical Competence↗
PubMed1990

[Criteria for selection and contra-indications of ambulatory surgery].

Ambulatory surgery means to us the scheduled surgery and investigations carried out under various modes of anaesthesia in patients who are admitted in the morning and discharged in the evening. Now the strictness and guarantees required and the essential conditions of safety and efficiency can only be achieved if a number of selection criteria and contraindications are complied with. The authors first study the lesions for which ambulatory treatment is possible, as well as the criteria regarding both the patient and the attending physician responsible for the follow-up at home. Since a close co-operation between the anaesthesist and the surgeon proves to be essential, the criteria of anaesthesia must also be dealt with. The contraindications are connected to the type of surgery, to the type of anaesthesia, to the patient, to the patient's circle, to the medical team, and finally to the equipment and organization of the unit in which ambulatory surgery is performed. These many aspects of the problem are analyzed and discussed.

Ambulatory Surgical Procedures↗
PubMed1990

[Severe acute intestinal hemorrhage. Value of investigation tests].

Episodes of intestinal bleeding likely to endanger vital functions require detailed etiological and topographical examination before surgical intervention. Forty-two cases of serious haemorrhage of the lower digestive system in adults were studied retrospectively. The origin of the bleeding was localized preoperatively in 37 cases (88%). Four exploratory laparotomies were carried out after etiological examination including at least digestive arteriography. Hence it was always possible to localize the source of bleeding. We found it convenient to establish the order of the complementary pretherapeutic tests by taking into account two symptoms, acute active bleeding (AAB) and haemorrhage with acute anemia (HAA).

Acute Disease↗
PubMed1989

A multicentric study of netilmicin once daily versus thrice daily in patients with appendicitis and other intra-abdominal infections.

This multicentric, randomized, double-blind trial compared the efficacy and safety of netilmicin, 4.5 mg/kg od and 1.5 mg/kg tid, in patients with intra-abdominal infections. Of 114 patients enrolled, 57 patients (mean age 40.3 years) in the od group and 55 (mean age 36.8 years) in the tid group were evaluated for efficacy; 58 and 56 patients in corresponding groups were evaluated for safety. Among those evaluated for efficacy were 12 od-treated and 11 tid-treated patients with documented septicaemia, and 32 and 30 patients of respective groups with polymicrobial infections. Initially, 86 and 81 netilmicin-susceptible causative microorganisms were isolated in corresponding groups. Of these pathogens, 55% in the od group and 62% in the tid group were Escherichia coli. Daily dosage of netilmicin ranged from 3.70 to 4.71 mg/kg (mean 4.50) for the od group and from 3.06 to 4.76 mg/kg (mean 4.46) for the tid group. Duration of netilmicin therapy ranged from six to 13 days (mean 8.7 days) for od-treated patients and from seven to 16 days (mean 8.8 days) for tid-treated patients. Concomitant metronidazole was administered to 41 patients of the od group and 34 of the tid group; one patient in the tid group received clindamycin. Clinical and bacteriological responses were assessed, and peak and trough serum netilmicin levels were measured periodically, during therapy. Laboratory tests, including determinations of serum creatinine and blood urea nitrogen values, were performed throughout the trial. A clinical cure was achieved in 57/57 od-treated patients and 54/55 tid-treated patients; treatment failed in one tid-treated patient (1/55). In od and tid groups, 86/86 and 80/81 netilmicin-susceptible pathogens initially isolated were considered to be eliminated, respectively; one isolate (Esch. coli) persisted in the tid group. Mean peak serum netilmicin concentration in the od group was approximately two-fold greater than that in the tid group; mean trough serum netilmicin concentrations were similar for the two groups. Adverse reactions were limited to mild pain at the site of netilmicin administration in several patients in each treatment group. Netilmicin od and tid (alone or in combination with metronidazole) were similarly efficacious in the treatment of patients with appendicitis and other intra-abdominal infections caused by netilmicin-susceptible pathogens. Both dosage regimens of netilmicin were safe and well tolerated.

Abdomen↗
PubMed1989

[Perforations of the colon. Apropos of 74 cases].

74 colic perforations were surgically handled between 1975 and 1988. Among the non-traumatic perforations, which represent 74% of this series, 39 cases (71%) complicated the course of acute diverticulitis, 9 cases (15%) were due to cancers and 7 cases (13%) were of miscellaneous origin. Traumatic perforations (26%) were iatrogenically induced in 84% (16 cases). In 78% the perforation was located in the sigmoid or recto-sigmoid. The treatment consisted in performing either a diverting colostomy (30 cases--40%) or a colic resection (44 cases--60%) with or without immediate anastomosis (respectively 10 cases--13.5% and 34 cases--46%). The overall mortality was 10.8%, which referred to etiology, turns to be 15% (3/19 cases) in traumatic perforations, 13% (5/39 cases) in diverticulitis and 0% in cancer. Related to treatment, mortality reached 23% for derivation and drainage procedure and 2% for resection. Post-operative complications were respectively 10% and 47%. Among post operative complications (22 cases--29%) 11 patients were reoperated on with an additional mortality of 18%. These results give strong evidence to the reliability and value of urgent colic resection in perforated colon and enhance the necessity of undelayed operation.

Adolescent↗
PubMed1989

[Injuries of the spleen: conservative treatment or exeresis?].

The authors report their experience with splenic preservation in a series of 36 patients. 77 patients with splenic injury were seen during the period from 1982 to 1987. In 41 cases splenectomy had to be carried out. This was for splenic contusions secondary to road traffic accidents in 36 cases and iatrogenic per-operative lesions in 5 cases. Intra-omental splenic autotransplantation was performed in 4 cases. In 36 other patients, the spleen was able to be preserved. Hemostasis was fairly obtained using infra-red photocoagulation (24 cases), splenorrhaphy (8 cases), surrounding the spleen with a resorbable mesh (3 cases) or by partial splenectomy (1 case). Only 1 case of transient and moderate secondary hemorrhage was seen and did not require further surgery. The authors define the legitimacy of splenic preservation and its indications and also stress its limitations. They insist on the following contraindications: preexisting splenic disease, subject on anticoagulants, labile blood pressure, multiple intra-abdominal lesions, presence of intra-peritoneal infection, severe cranio-encephalic lesions, age over 70 years. Study of this series shows that conservative treatment is most often justified for splenic trauma. Nevertheless, in view of the real but rare risk of OPSI, it is better to have a correct splenectomy than an incorrectly preserved spleen.

Aged↗
PubMed1989

[Colonic occlusion. Apropos of a surgical series of 63 cases].

63 colonic occlusions were operated on from 1975 to 1988. Cancer and stenotic diverticular sigmoiditis were found to be the main causes of colonic obstruction in respectively 36 cases (55%) and 8 cases (13%). Other etiologies were represented by neoplasic gynecologic diseases (9.5%). The rectosigmoid was involved in 50% of the cases (31) while transverse colon and caecum were respectively concerned in 25% and 17%. The 2 main therapeutical procedures used were colic resection (35 cases-55%) with immediate anastomosis in 1 case out of 3 and derivation (26 cases 41%) mostly in the proper from of a colostomy (20 cases). Operation was undertaken during the first 48 hours in 65% of the cases. Death occurred in 8 patients (12.5%). Related to etiology the death rate was 11% in cancers and 25% in stenotic diverticulitis. Where linked to treatment this mortality rate reached 27% in derivations and 3% in colic resections. 38% of non lethal complications were recorded, two-third being due to the bad general conditions of the patients. Several times operations, such as first colostomy or resection without anastomosis, should remain the basic rule one should not depart from without great carefulness. However a new interesting trend toward one time surgery with intraoperative colonic lavage is taking shape.

Adolescent↗
PubMed1989

[Locoregional recurrence of breast cancer. Long-term course of 49 cases treated by excision and omentoplasty].

Extensive local recurrence of breast cancer may require wide parietal resection, demanding the use of other tissues to compensate for the loss of substance. We preferably resort to omentoplasty when the defect is larger than 300 cm2. A group of 49 patients with recurrence of the tumor in the breasts (treated with omentoplasty) has been studied, with special emphasis on long-term results. In our series, 86% of the patients were followed up for more than 4 years, with an actuarial survival rate of 46% after 7 years. It thus appears that this procedure can be advocated for slow-developing cancers, the local recurrence of which is extensive and usually isolate for various reasons (most often a deficient initial local treatment).

Aged↗
PubMed1989

[Current ideas in the treatment of severe acute pancreatitis].

The aim of this study is a current review of multidisciplinary therapeutic concepts in severe acute pancreatitis, the following being envisaged in succession: --severity criteria and factors involved in surveillance, --medical methods of intensive therapy, --surgical treatment in terms of its indications and tactical implications. Remaining in overall control, the surgeon must pay careful attention to the techniques used, and results achieved, by the intensive care specialist. In the presence of concomitant lithiasis of the common bile duct, it is essential to request endoscopic sphincterotomy first. The surgeon must interpret with the radiologist CT scan films in order to be able to wait, whilst remaining alert at all times, for the appropriate moment for any possible surgery. The surgeon must above all avoid being too active too early.

Acute Disease↗
PubMed1989

[Gastroduodenal ulcer. New therapy and new clinical practice?].

Duodenal, prepyloric, and gastric ulcers are based on different pathophysiological processes. The achievements obtained from therapeutic medication, using H2-blockers, have reduced indications for surgical treatment, primarily for duodenal ulcer. Surgery has continued to be required for failure of medicamentous therapy, recurrence, development of intercurrent diseases calling for corticoid or anti-coagulant treatment, patients above 55 years of age with haemorrhage, occurrence of severe side effects, and, occasionally, for economic reasons. Optional methods are left-side selective vagotomy for duodenal ulcer, antrectomy with bilateral subdiaphragmatic vagotomy for prepyloric ulcer, and hemigastrectomy with gastroduodenal anastomosis for gastric ulcer.

Gastrectomy↗
PubMed1989

[Current concepts of the treatment of cholelithiasis in aged patients].

Biliary lithiasis in elder patients is characterized by the physical defects usually present--therefore surgery is less mandated than endoscopic procedures or extra corporeal lithotripsy. However, if surgery is undertaken, then it should be carried out as completely as possible. In this paper, the authors emphasize the special aspects of its indications and technics--for more than any where else this surgery required perfection.

Aged↗
PubMed1989

[The development of surgical therapeutic concepts of acute severe pancreatitis].

The actual surgical concepts concerning the treatment of acute pancreatitis are described. Owing to sonography and above all to computed tomography, constantly compared with clinical data, the surgical decisions can be more easily conducted. In acute pancreatitis of biliary origin, endoscopic sphincterotomy is mandatory in a great number of cases, followed by complete de-obstruction of the common bile duct. That procedure has the advantage of reducing notably mortality and morbidity. In idiopathic pancreatitis, 4 therapeutic behaviours which correspond to 4 different clinical types, are to be faced: --or after 5 to 6 days, division of the left hypochondrium with performing of a meticulous cleaning, followed by a large drainage lavage, --if all reanimation measures have failed, earlier surgery, often of the last chance, consisting in necrosectomy as extended as necessary, --in right away appearing pancreatic phlegmon, a very large drainage, --or, a more expecting attitude in cases in which resorption of the necrotic spots appears to be very slow on CT-Scan, but without any clinical abnormality. Figures support these concepts and prove their warranty.

Acute Disease↗