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M Vix

Publications and source records attributed to M Vix.

At least 37 records · Page 2Linked to original sources
PubMed1996

Laparoscopy not recommended for routine appendectomy in men: results of a prospective randomized study.

BACKGROUND: Laparoscopic appendectomy has now gained wider acceptance in clinical practice, particularly in the treatment of women with right iliac fossa pain. However, the precise role of laparoscopic appendectomy in men is unclear, and this study was therefore undertaken to examine this specific issue in a prospective randomized trial. METHODS: One hundred men between the ages of 16 and 65 years who had suspected appendicitis were recruited and randomized to undergo either open or laparoscopic appendectomy. Both groups were compared in terms of their clinical parameters, duration of anesthetic and operation times, postoperative pain, duration of ileus, and length of hospital stay. RESULTS: The histologic confirmation of appendicitis was present in 94% of the cases for both groups of patients. Laparoscopic appendectomy required significantly longer anesthetic time (72.5 minutes versus 55 minutes) and actual operating time (45 minutes versus 25 minutes) compared with open appendectomy. Postoperative pain as measured by visual analog scale on postoperative days 1 and 2 were not significantly different between the patients who underwent laparoscopic and open surgery with values of 4.7 versus 4.4 and 2.1 versus 2.2, respectively. Also no significant difference was seen between the laparoscopic and open appendectomy groups in the recovery of bowel function (24.7 hours versus 21 hours) and in the length of hospital stay (4.9 days versus 5.3 days). CONCLUSIONS: The results of this prospective randomized trial showed that there were no significant advantages of laparoscopic appendectomy over open appendectomy for the treatment of male patients with suspected appendicitis. We recommend that the use of laparoscopy be limited to men with atypical pain of uncertain diagnosis and in obese patients.

Adolescent↗
PubMed1995

[Atrophic thyroiditis: an unusual course of a Basedow-like variation of Hashimoto disease. Apropos of a case].

This case concerns a 27-year-old man with a very high level of anti-thyroid antibody and pretibial elephantiasis myxedema which developed progressively over several years following subtotal thyroidectomy for << hashitoxicosis >>. Complementary resection of the thyroid stump was performed ; under microscopic examination this stump presented an aspect of atrophic thyroiditis. This unusual development towards atrophic thyroiditis raises the problem of the relations between the various forms autoimmune thyroiditis.

Adult↗
PubMed1994

[Implantable insulin pump: the first step towards an artificial pancreas].

Recent improvements in miniaturization of implantable pumps and the ability of their control by teletransmission allow implantation of autonomous pumps which administer insulin into the peritoneal cavity. Fifty-six patients with diabetes mellitus underwent implantation of 66 pumps with a mean function life of 21.8 months per patient. No patient has died to date. Tolerance of implanted components was good. Morbidity was limited to local events, in this series 4 cutaneous erosions, two of them leading to final pump explantation. Mean global blood-sugar, pre- and post-prandial blood-sugar, and glycosylated hemoglobin assays were all lower versus pre-implantation assays. A statistically significant difference was demonstrated regarding mean global blood-sugar. The frequency of severe hypoglycemia incidents (2 in our series) and biochemical hypoglycemia (blood-sugar < 65 mg/100 ml) was decreased, representing a major benefit of the technique. The patients well-being and quality of life were notably improved. Implantable insulin-pump may be offered as alternative treatment to conventional insulin-therapy, especially in cases of diabetes which are difficult to control and particularly in cases with frequent hypoglycemic malaise.

Adult↗
PubMed1994

[Comparative secretory profiles of benign and malignant pheochromocytomas].

Distant metastases are the only clue for diagnosis of malignancy in pheochromocytoma patients. This study was designed to define a secretory profile possibly suggestive of malignancy. Among 79 pheochromocytomas (55 benign, 24 malignant), dopamine-secretion, either exclusive or blended with other catecholamines was found in 34.5% of benign and in 75% of malignant tumors. Dopamine secretion, although if more frequent and more abundant in cases of malignant pheochromocytomas, is therefore not actually diagnostic, but only suggestive of malignancy. It demands life-long follow-up as metachronous metastases may supervene extremely late in the course of the disease.

Adrenal Gland Neoplasms↗
PubMed1994

[Treatment of perforated duodenal ulcer: the celioscopic approach].

Ten patients underwent laparoscopic surgery for typical perforated peptic ulcer symptomatology. Two conversions to open surgery were due to technical problems related to delayed hospital admission. Nine patients underwent duodenal suture reinforced with fibrin glue, and one perforation was only glued. The postoperative course was uneventful without abdominal septic or abdominal wall complications in the eight patients treated by laparoscopy. Laparoscopic surgery may become the method of choice for the treatment of perforated peptic ulcer.

Adult↗
PubMed1993

[Severe complications after cholecystectomy by celioscopy: lessons from yesterday and today].

The case of a series of grave complications after a laparoscopic cholecystectomy is reported: a common bile duct section diagnosed rather late, hemoperitoneum, inappropriate common bile duct reconstruction and late anastomic leakage, stenosis of an hepatico-jejunal anastomosis, haemorrhage through the external biliary drainage and iterating sepsis. The final outcome was good. The stenotic hepatico-jejunal anastomosis was dilated by a Gianturco self-expanding prosthesis percutaneously placed. As an evidence, this alternative treatment is only exceptional, the treatment of choice for postsurgical benign strictures being surgical repair.

Anastomosis, Surgical↗
PubMed1992

High incidence of malignant pheochromocytoma in a surgical unit. 26 cases out of 100 patients operated from 1971 to 1991.

In this surgical series of 100 pheochromocytomas (PH), where 91 cases were studied and followed up, the frequency of malignancy appears high (29%) on macroscopic criteria observed at the first operation (25 out 26 cases of malignant PH) or thanks to the occurrence of metastases (1 case out of 26 malignant PH). While some clinical signs are suggestive, there is no excretory profile predictive of malignancy. Isolated or predominant secretion of dopamine is not specific of malignancy event if it occurs more frequently and severely in malignant PH. Bilateral involvement, occurring in the setting of phacomatosis or of multiple endocrine neoplasia (MEN II), or in a sporadic case, is not a predictor for malignancy. Contrarily, extraadrenal involvement is a major feature indicative of malignancy. A CT scan which demonstrates possible locoregional invasion, and a MIGB scan revealing distant localizations raise the suspicion of malignancy. The preferred surgical approach is via a laparotomy, thus allowing the exploration of all possible abdominal chromaffin site and the search for intraabdominal metastases. Intraoperative MIBG scanning checks the completeness of the excision. Flow cytometric DNA ploidy studies have been performed in 25 of our patients. The follow up of benign or malignant PH, after excision "for cure" must be life-long: clinically, biologically and by MIGB scan. Persistence of the disease after surgery or recurrence with unresectable metastases can benefit from MIGB and chemotherapy.

3-Iodobenzylguanidine↗
PubMed1992

[Can pheochromocytoma be considered a benign unilateral intra-adrenal sporadic hypertensive tumor ? Reflections on a series of 105 surgically treated subdiaphragmatic chromaffin tumors].

In a 20 year period, from 1971 through 1991, 105 chromaffin tumours--excluding cervical ones--were operated by the same surgeon: 50 during the first 15 years and 55 during the last 5 years. Pheochromocytomas are defined as intra-adrenal chromaffin tumours, and paragangliomas--or ectopic pheochromocytomas--as of extra-adrenal location. Among those tumours, 30 were malignant (i.e. metastatic) and 75 benign. Among the 30 malignant tumours, 14 were ectopic, 2 occurred in a MEN II A setting and were bilateral, 2 were associated with liver adenoma and liver hemangioma respectively suggesting Von Hippel-Lindau syndrome, and one case was associated with a seemingly sporadic primary hyperparathyroidism. 9 out of those 30 malignancies were not associated with hypertension. Among 75 benign pheochromocytomas or paragangliomas, 10 were ectopic, 7 occurred in a MEN setting (6 type II, 1 type I). 3 patients without evidence of MEN or other neuroectodermal abnormalities presented bilateral pheochromocytoma, either synchronous (2) or metachronous (1). 7 cases occurred in a Von Hippel-Lindau syndrome (3 bilateral) and 4 in a neurofibromatosis setting (1 bilateral). 3 other cases were familial without evidence of MEN (including a case of triple tumour: bilateral and ectopic and another ectopic case). 2 other cases were associated with seemingly sporadic hyperparathyroidism. As a whole, in 34 of 75 benign pheochromocytomas or paragangliomas, the tumour was not intra-adrenal, unilateral and sporadic. Among those 75 tumours, 22 were not overtly hypertensive, including 10 out of the 41 seemingly intra-adrenal, solitary and sporadic. The pheochromocytoma, benign, intra-adrenal sporadic, hypertensive accounts for no more than 30% of the subphrenic catecholamine-secretin chromaffin tumours.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenal Gland Neoplasms↗
PubMed1992

[Recurrence of cervical lymph node involvement in surgically treated thyroid cancer. Uselessness of routine cervical lymph node excision (medullary carcinoma excluded)].

From 1966 throughout September 1990, 753 patients underwent surgery for thyroid carcinoma, in the same institution, covering all pathological types. Complete follow-up was achieved in 96% of them, being at least 7 years in 50% of cases. 599 (80%) are currently alive. Neck dissection was not routinely done, except for medullary thyroid carcinoma, but rather selectively, if nodes were palpable either pre or intraoperatively, and also (since oct. 1983 i.e. the last 400 cases) if, after routine sampling of mid jugular nodes, frozen sections assessed nodal invasion. On the grounds of this policy, 205 patients underwent unilateral or bilateral neck dissection; 17% of them died during follow-up whereas 5.9% (12 cases) exhibited a cervical nodal recurrence, 6 of them occurring less than two years post-operatively, including 3 medullary thyroid carcinomas. 548 had no neck dissection; 9% died during follow-up whereas 0.9% (5 cases) exhibited a cervical nodal recurrence, 3 of them occurring less than two years post-operatively. Routine neck dissection seems not to be justified in the surgery of non medullary differentiated thyroid carcinoma, in as much as late occurrence of cervical node metastases is uncommon and does not obviously impair life-expectancy.

Carcinoma, Papillary↗
PubMed1992

[Validation of the measurement of hepatic volume by three-dimensional computed tomography].

The aim of this work was to verify experimentally the reliability of 3D CT scan in measuring hepatic volumes. Eight livers were dissected from corpses. The referring liver volume was determined by measure of its hydric shift. The correlation coefficient R was 0.93 (p < 0.001) on 5 mm/5 mm 3D sections, 0.92 (p < 0.001) on 10 mm/10 mm 3D sections and 0.94 (p < 0.0006) on 5 mm/10 mm 3D sections. The paired t-test also showed a 5% risk correlation between the two measurements. Although in vivo imaging is slightly different from in vitro, 3D CT scan seems to be a reliable method to determine an hepatic volume without increased X-ray irradiation.

Humans↗
PubMed1991

Usefulness and limits of quick intraoperative measurements of intact (1-84) parathyroid hormone in the surgical management of hyperparathyroidism: sequential measurements in patients with multiglandular disease.

This study was designed to assess whether reliability of quick intraoperative assay of intact (1-84) immunoreactive parathyroid hormone (iPTH) could allow us to quit after removing one (or several) enlarged parathyroid gland(s) and obtaining a normal iPTH level. Intact iPTH was assayed during surgery before removal of enlarged parathyroid gland(s) and 5, 10, and 20 minutes afterward. Forty-seven patients entered the study: 40 with primary hyperparathyroidism (32 with uniglandular disease and eight with multiglandular disease) and seven with secondary hyperparathyroidism; all underwent bilateral neck exploration. Among 32 patients with uniglandular disease, five had normal basal intraoperative levels, 25 demonstrated a clear-cut drop from supranormal to normal levels, and two had elevated levels. Among the eight patients with multiglandular disease, two had undetectable levels and two had normal levels after removal of the first enlarged gland. The seven patients with secondary hyperparathyroidism demonstrated a decline in PTH levels, suggesting hormone clearance similar to that of patients with primary hyperparathyroidism. In conclusion, quick intraoperative assay with intact (1-84) iPTH (1) is not hampered by renal insufficiency, (2) may overlook a second enlarged gland after removal of a first adenoma and obtaining normal iPTH levels, and (3) should not be used as a substitute for bilateral neck exploration.

Humans↗
PubMed1990

[Cancer of the upper cervico-thoracic esophagus].

Between 1984 and 1990, 90 operations were performed for carcinoma of cervical and cervicothoracic esophagus. All tumors were squamous cell carcinoma. Of these patients, 78 underwent esophagectomy, and 12 had had a gastric by pass. Visceral remplacements employed the whole stomach. Only one cervicothoraco-laparotomy was performed. The operative mortality was 6.6% (no difference between mortality rate associated with pharyngogastric anastomosis (5.3%) and that with cervical esogastric anastomosis (7.1%). The 78 resections included 55 esophagectomies for cure (70.5%) and palliative procedure for the 23 other patients. Post operative complication rate was 38% and 5-year survival rate was 12%. One study suggested that resectability and immediate post operative results of cervical or cervicothoracic esophagus cancer are not different from these of intrathoracic esophageal cancer. These results encouraged an aggressive surgical approach; whole gastric pull up seems to be the safest and most reliable method for cervical anastomosis as well as for pharyngeal anastomosis, difficulty of correct lymphadenectomy, low 5-year survival, advocated adjuvant radiotherapy and/or chemotherapy.

Adult↗
PubMed1990

[Thalamic fractures of the calcaneus. Value of computed x-ray tomography in therapeutic decisions].

The authors have studied 35 fractures of the calcaneal thalamus and compared the information provided by plain radiology and CT scans of the calcaneal tuberosity, especially those connected with the condition of the posterior subtalar joint. In 8 cases out of 35, the study of the CT sections yielded information that allowed changing the indications for treatment. The authors emphasize the quality of the data obtained, which makes it possible to justify a functional treatment or to establish a preoperative schedule.

Adult↗
PubMed1989

[Neonatal pulmonary fibrosarcoma].

The authors report a case of pulmonary fibrosarcoma in a newborn. The respiratory distress imposed an urgent thoracotomy at the fifth hour of live. A lobectomy was performed. Three months later a relapse occurred. A second thoracotomy permitted an incomplete resection. The total involution was achieved after 6 months of chemotherapy. Actually no recidive is shown after 20 months of follow up. Its an exceptional case. A unique one was published in 1977.

Fibrosarcoma↗
PubMedDate not supplied

"The" pheochromocytoma: a benign, intra-adrenal, hypertensive, sporadic unilateral tumor. Does it exist?

This study aims to examine the frequency of the pheochromocytoma (pheo), defined as a "benign, intra-adrenal, hypertensive, sporadic, unilateral tumor." Three large series amounting to 310 subphrenic chromaffin tumors operated over periods of 17, 23, and 41 years, respectively, have been reviewed. Among those combined 310 pheos, 48 (15.5%) were malignant (i.e., metastatic) and 262 (84.5%) were benign; 42 (13.5%) were ectopic (35% of malignant tumors versus 9.5% of benign tumors); 230 (74.2%) were hypertensive (74% of benign tumors versus 73% of malignant tumors); 29 (9.4%) were bilateral, including 23 patients with a family history; 41 (13.2%) of patients had MEN II type A or B syndrome; and 20 (6.5%) occurred in a phacomatosis setting. Some of the patients had a non-MEN family history of pheo (n = 5), seemingly sporadic hyperparathyroidism (n = 4), or other associated neuroendocrine tumor (n = 9). Sometimes several of these features were combined. Finally 125 (40.3%) cases fitted the classic description of the tumor, 47.0% at the time of initial presentation and 40.3% at the end of follow-up. Late occurrence of metastases or metachronous diagnosis of familial disease make lifelong follow-up mandatory. Genetic studies may be indicated in pheochromocytoma patients.

Adrenal Gland Neoplasms↗
PubMedDate not supplied

A difficult case of mediastinal parathyroid adenoma: theoretical and clinical considerations.

About one quarter of patients with primary hyperparathyroidism have ectopic parathyroid tissue. The majority of parathyroid glands can be reached through a cervical approach, but in about 2% of the cases the ectopic gland is in the mediastinum in a location that requires a thoracic approach. Failure to remove ectopic mediastinal parathyroid tissue results in persistent hyperparathyroidism. Reoperative exploration for persistent hyperparathyroidism is often difficult even in the hands of experienced surgeons. Recent advances in preoperative localization techniques and intraoperative parathyroid hormone measurement have improved the rates of successful resection. We present a difficult case of persistent hyperparathyroidism secondary to an ectopic middle mediastinal parathyroid adenoma, which was eventually successfully managed in a specialised unit.

Adenoma↗