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L de Cannière

Publications and source records attributed to L de Cannière.

16 recordsLinked to original sources
PubMed1999

Laparoscopic adrenalectomy for phaeochromocytoma: endocrinological and surgical aspects of a new therapeutic approach.

OBJECTIVES: To evaluate the results of laparoscopic resection of phaeochromocytoma with a focus on pre- and intra-operative endocrinological and pharmacological aspects. DESIGN: Retrospective study based on review of case notes and intraoperative anaesthetic records. PATIENTS: Eight patients (four men, four women) aged 13 to 70 (median: 45) years with symptomatic phaeochromocytoma (two patients with MEN IIa syndrome) diagnosed 6-36 months before adrenalectomy in four patients and just before operation in the four remaining patients. All patients presented with hypertension. MEASUREMENTS: Pre- and postoperative blood pressure (BP) was assessed using a sphygmomanometer, intraoperative measurements being obtained by intra-arterial line. Adrenaline (A), noradrenaline (NA), metadrenaline (metA), normetadrenaline (normetA) and vanillylmandelic acid (VMA) were measured in 24-h urine samples. Adrenal imagery consisted in all patients of abdominal computed tomography and [131I] metaiodobenzylguanidine (MIBG) scintigraphy, and in 2 patients, adrenal magnetic resonance imaging and octreotide scintigraphy. Determination of plasma volume was performed by isotopic method. RESULTS: Median (range) preoperative systolic and diastolic BP was 140 (130-240) and 90 (80-150) mm Hg, respectively. Predominant catecholamine secretion consisted of A in four patients (A pattern) and of NA (NA pattern) in the other four. Tumours smaller than 30 mm usually secreted A while larger ones secreted NA. Pre- and intra-operative BP control was straightforward in all but two patients with preferential NA secretion. The median number of systolic and diastolic BP peaks were higher in patients with NA pattern (n = 6, range: 3-9) than in those with A pattern (n = 1.5, range: 1-6). Total duration of pneumoperitoneum ranged from 120 to 240 (median: 195) min. Intra- and post-operative complications included intra-abdominal bleeding, laparoscopically controlled (in one case), and upper pole kidney ischaemia in another. Postoperative hospital stay ranged from 4 to 11 days. All patients were asymptomatic postoperatively and pharmacologically controlled hypertension persisted in two of them. CONCLUSIONS: Laparoscopic adrenalectomy is a safe and efficient technique to remove phaeochromocytoma in terms of intra- and postoperative morbidity, with a low complication rate. Pre- and intra-operative pharmacological blood pressure control is as effective as in conventional adrenalectomy, with greater instability in noradrenaline secreting tumours.

Adolescent↗
PubMed1999

Asymptomatic adrenal tumours: criteria for endoscopic removal.

OBJECTIVE: Assessment of criteria for videoscopic removal of adrenal lesions discovered incidentally. DESIGN: Open prospective study. SUBJECTS: 63 patients operated on for 65 adrenal tumours. OUTCOME MEASURES: Relevance of proposed criteria: secreting adrenal lesion; diameter larger than 4 cm or increase in size at any re-evaluation; computed tomogram of intratumoral necrosis, haemorrhage, or irregular margins; high concentrations of dehydroepiandrosterone (DHEAS). RESULTS: Laparoscopic adrenalectomy was successful in 61 patients (97%). There were 4 minor complications. Criteria allowed us to identify correctly : phaeochromocytoma (n = 23), primary hyperaldosteronism (n = 18), Cushing's adenoma or disease (n = 7), single metastasis (n = 4), adenoma with DHEAS or cortisol hypersecretion (n = 3). 8 non-secreting incidental tumours (13%) were operated on. CONCLUSION: Simple criteria for videoscopic adrenalectomy for lesions discovered incidentally allowed us to reduce the number of doubtful indications (positive predictive value 87%).

Adolescent↗
PubMed1999

Heart failure induced by pheochromocytoma: laparoscopic treatment and intraoperative changes of several new cardiovascular hormones.

Since 1992, adrenalectomy for pheochromocytoma has been recognized as a safe and efficient technique when performed by a laparoscopic approach. Most of the cases of pheochromocytomas treated as such and published in the literature were not associated with malignant hypertension and acute heart failure. We report the case of a 23-year-old woman who presented with this clinical picture and show that laparoscopic adrenalectomy may be as safe and efficient as conventional adrenalectomy when performed in this situation. The intraoperative changes in the secretion of catecholamines, endothelin-1, angiotensin II, N- and C-terminus of atrial natriuretic factor prohormone were also analyzed. Noradrenaline release during tumor dissection was associated with a stimulation of atrial natriuretic factor.

Adrenal Gland Neoplasms↗
PubMed1997

Multicentric experience of the Belgian Group for Endoscopic Surgery (BGES) with endoscopic adrenalectomy.

BACKGROUND: Adrenalectomy is not a frequent operation. Therefore the newly developed laparoscopic approach is sporadically performed by surgeons dealing with endocrine disorders. METHODS: Some 54 videoendoscopic adrenalectomies performed on 52 patients by five surgical teams between October 1993 and December 1996 were prospectively evaluated. RESULTS: Indications for endoscopic adrenalectomy were pheochromocytoma (n = 17), primary hyperaldosteronism (n = 15), Cushing's adenoma or disease (n = 7), nonsecreting adenoma (n = 7), single metastasis from adenocarcinoma (n = 2), adenoma with dehydroepiandrostenedione (DHEAS) hypersecretion (n = 3), and ACTH-secreting metastases from a thymoma (n = 1). Of the 54 adrenalectomies performed, 31 were of the left gland, 19 of the right and two bilateral. Laparoscopic adrenalectomy was successful in 50 patients (96%). Median tumor size was 4 cm (range 1.5-12), median operation duration was 80 min (range 59-360), and median postoperative stay was 4 days (range 2-13). One patient required blood transfusion. CONCLUSIONS: Endoscopic adrenalectomy can safely be performed-even sporadically-by surgeons well versed in adrenalectomy techniques for endocrine disorders and trained in endoscopic surgery.

Adenoma↗
PubMed1997

Direct carbon dioxide insufflation of the retroperitoneum under laparoscopic control for renal and adrenal surgery.

OBJECTIVE: Assessment of the videoscopic approach to the retroperitoneal space in the vicinity of the kidney and the adrenal gland. DESIGN: Open study. SETTING: University hospital, Belgium. SUBJECTS: 10 patients who underwent 11 operations (adrenalectomy, n = 3, nephrectomy, n = 5, partial nephrectomy, n = 2, and renal cystectomy, n = 1). INTERVENTIONS: Direct CO2 insufflation of the retroperitoneal space in order to obtain a convenient retroperitoneal working space for renal and adrenal surgery. OUTCOME MEASURES: Feasibility, morbidity and mortality. RESULTS: 8 patients were operated on exclusively by the retroperitoneoscopic approach; 2 required the retroperitoneal and transperitoneal routes to be combined to complete an adrenalectomy. No patients required blood transfusion and no patient died. Median postoperative stay was 3 days. CONCLUSION: The CO2 insufflation technique of the retroperitoneum is safe and reproducible. Nevertheless, far from excluding each other, both approaches-laparoscopic and retroperitoneoscopic-are complementary in difficult cases, particularly for adrenal endoscopic surgery and for larger renal lesions.

Adolescent↗
PubMed1997

Adrenal and renal surgery by the laparoscopic and/or retroperitoneoscopic approach.

Since its introduction 6 years ago, almost all abdominal procedures have been attempted laparoscopically. Despite their retroperitoneal location, kidneys and adrenals have also been reached by the blitz of endoscopic surgery since 1992. We present here the techniques, indications, advantages or disadvantages of the videoscopic approach-either laparoscopic or retroperitoneoscopic- of those solid retroperitoneal organs. Preliminary results of the international literature are presented, while objectively comparing currently available data about the efficacy and cost of endoscopic versus open procedure. Despite the time-consuming nature and high operative cost of the endoscopic approach, decreased convalescence and better patient comfort are evident. Furthermore videoendoscopic adrenal surgery performed, even sporadically, by surgeons experienced in laparoscopic surgery is as safe as the open approach, provided that those surgeons are also familiar with the rules and potential drawbacks of adrenal surgery for endocrine disorders.

Adrenalectomy↗
PubMed1996

Unusual hypokalaemia.

A 72-year-old man, presenting with hypernephroma and infraclinic adrenal adenoma, developed severe hypokalaemia in the course of treatment for colonic perforation. Amikacin-induced hyperkaliuric hypokalaemia was suspected, and confirmed by withdrawal of the drug as well as observation of an unnoticed similar episode in the medical record of the patient.

Abscess↗
PubMed1995

From laparoscopic training on an animal model to retroperitoneoscopic or coelioscopic adrenal and renal surgery in human.

So far, laparoscopic approaches to kidney and adrenal have been limited because of their retroperitoneal location. We here report eight renal and adrenal endoscopic procedures performed in seven patients: two adrenalectomies for hyperaldosteronism, one adrenalectomy for isolated metastasis from an adenocarcinoma of the lung; two nephrectomies for end-stage infected hydronephrosis, two partial nephrectomies for small circumscribed lesions of the kidney, and one endoscopic resection for pain relief of a voluminous cyst at the kidney. The approach was transperitoneal in two cases and retroperitoneal in five cases using the retropneumoperitoneum insufflation technique. One patient was operated by a combined approach using the retro- and transperitoneal routes. All procedures were successfully completed endoscopically. The retroperitoneoscopic approach of the kidney is safe and does not interfere with the peritoneal organs. Its working space is tenuous, but allows a direct access on the kidney with good exposure of its pedicle. For adrenal surgery, the retroperitoneoscopic dissection is more difficult, because movements of instruments are often impaired by the closeness of the costal margin and the iliac crest. However, in case of difficulties we found it very convenient to switch from a retroperitoneal endoscopic approach to a combined coelioscopic and retroperitoneoscopic operation. Far from excluding each other, both approaches are complementary, particularly for difficult situations (i.e., previous peritoneal or retroperitoneal surgery).

Adrenal Gland Diseases↗
PubMed1994

Noninvasive imaging of the biliary tree before or after laparoscopic cholecystectomy: use of three-dimensional spiral CT cholangiography.

OBJECTIVE: The purpose of this study was to determine the feasibility of using three-dimensional spiral CT after IV administration of a cholangiographic agent for noninvasive detection of anatomic variations of the bile ducts and common bile duct stones before or after laparoscopic cholecystectomy. SUBJECTS AND METHODS: Three-dimensional spiral CT cholangiography was performed before laparoscopic cholecystectomy in 24 patients and after surgery in two patients who had recurrent symptoms. After slow infusion of 250 ml of iodipamide, spiral CT was performed. Three-dimensional images of the bile ducts and a secondary reformation through the long axis of the common bile duct were obtained. Visualization of the biliary tract was evaluated by two observers. Detection of anatomic variations and common bile duct stones was assessed in 19 patients for whom a gold standard (operative or retrograde cholangiogram) was available. RESULTS: In all 26 patients, the common bile duct and the confluence of the hepatic ducts were seen on three-dimensional spiral CT cholangiograms, and in 21 patients second- or higher-order branches were also seen. Seven patients had anatomic variations and two had common bile duct stones. These anomalies were proved by operative cholangiography in each case, except for a low junction of the cystic duct and a common bile duct stone, which were shown by retrograde cholangiography. Six of the seven anatomic variations were adequately detected with spiral CT cholangiography, as were the two cases of common bile duct stones. CONCLUSION: Three-dimensional spiral CT cholangiography is a feasible method for noninvasive detection of biliary anatomic variations and common bile duct stones before or after laparoscopic cholecystectomy.

Bile Ducts↗
PubMed1993

Synchronous abdominoperineal resection without transfusion.

Blood loss and hypovolaemic shock affect the immune system significantly, and perioperative blood transfusion has been shown to be associated with a higher rate of tumour recurrence in patients with cancer and increased susceptibility to infectious complications. Data obtained from patients undergoing synchronous abdominoperineal excision of the rectum were analysed to assess whether such surgery is feasible without transfusion. Twenty-two consecutive unselected patients were studied. There were 16 men and six women of median age 66 (range 48-80) years. The tumour stage was Dukes' B in 11 patients and Dukes' C in 11. Six patients were severely obese according to body mass index. Four patients required blood transfusion (1, 1, 2 and 2 units). There was no hospital mortality and all perineal wounds healed primarily with no wound infection. Fifteen patients received radiation therapy 6 weeks after surgery. Abdominoperineal resection with minimal blood transfusion is feasible in unselected patients.

Abdominal Muscles↗
PubMed1993

Thrombosis of splenic artery pseudoaneurysm complicating pancreatitis.

The natural history of pseudoaneurysms complicating pancreatitis is unknown. A patient with chronic pancreatitis is described in whom thrombosis of a splenic artery pseudoaneurysm occurred. Early diagnosis and radical treatment of a bleeding pseudoaneurysm are mandatory. When elective treatment is considered, however, contrast enhanced computed tomography may be useful just before surgery as thrombosis may occur.

Adult↗
PubMedDate not supplied

Duodenal ulcer hemorrhage treated by embolization: results in 28 patients.

BACKGROUND: To assess the effectiveness and prospects of transcatheter gastroduodenal artery embolization in the control of massive duodenal bleeding and to relate our experience. METHODS OF STUDY: The study is based on the retrospective analysis of 165 patients with endoscopically detected bleeding duodenal ulcer who presented between 1991-1998. 28 patients were considered eligible for endovascular treatment either at initial presentation or following hemorrhage recurrence after endoscopic therapy. RESULTS: Technical failure was noted in 3 cases, thereafter treated by surgery. In the other 25 patients, embolization was performed: bleeding recurrence occurred in 7 cases. Four were treated only endoscopically. One was reembolized and the last two were treated by surgery. In 6 cases, a coaxial technique was used (guiding catheter in 2 and 3F microcatheter in 4). No complication related to the catheterization was observed. CONCLUSION: Transcatheter embolization of the gastroduodenal artery appears to be an efficient procedure even in the absence of active bleeding at the time of the procedure. Failure and recurrence rates can be reduced by using a coaxial technique in the uneasy cases. Embolization seems to have a low recurrence rate and a very low complication rate.

Aged↗
PubMedDate not supplied

[Pneumoperitoneum solely diagnosed with CT scanning].

The authors report 3 cases of pneumoperitoneum due to visceral perforation and whose diagnosis was not performed on plain abdominal radiographs. In the 3 cases, pneumoperitoneum diagnosis and laparotomy decision were based on the results of an emergency abdominal CT Scan. Each time, the origin of the pneumoperitoneum was also clearly evidenced. When visceral perforation is suspected, we advice to perform CT Scan of the abdomen if pneumoperitoneum diagnosis has not been made by plain abdominal radiographs. CT Scan is an accurate exam for pneumoperitoneum diagnosis that permits undelayed surgical treatment.

Aged↗
PubMedDate not supplied

Early diagnosis of adult intestinal intussusception at four different locations.

Four cases of adult intestinal intussusception at four different locations (two ileocolic type, two colocolic type involving the transverse and the rectosigmoid colon) are reported. The most beneficial diagnostic procedures were emergency contrast studies of the colon or computed tomogram of the abdomen. Three cases were associated with primary malignancy. Surgical resection without reduction is favoured because an underlying primary malignancy should be suspected in adult patients. The literature about the causes and the more recent considerations involved in the management of adult intussusception is reviewed.

Aged↗
PubMedDate not supplied

Infected abdominal aortic aneurysm associated with a psoas abscess, aorto-duodenal and sigmoid fistulas. Case report and review of the literature.

A case of atherosclerotic abdominal aortic aneurysm, complicated by aortoenteric fistulizations and infected by Escherichia coli, is presented. Chronic contained rupture resulted in the formation of a huge left psoas abscess which was responsible for the symptoms. No similar case has been reported in the literature. Resection and extra-anatomic vascular reconstruction were curative.

Aged↗