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Biomedical subjects

N Cheynel

Publications and source records attributed to N Cheynel.

At least 19 recordsLinked to original sources
PubMed2003

Anatomical basis for the interposition of a gastric pouch between the ileum and the anus after total proctocolectomy.

After a total proctocolectomy, ileoanal continuity is achieved by an ileal pouch-anal anastomosis. This anastomosis is not possible when the ileum cannot reach the anus. To avoid definitive ileostomy in this circumstance, we devised a gastric pouch, taken from the left half of the vertical portion of the stomach, vascularized by the right gastroepiploic pedicle, then interposed it between the ileum and the anus. The aim of this anatomical study on seven cadavers was to estimate the capacity of this gastric pouch to reach the anus. The distance between the caudal edge of the pubic symphysis and the apex of the pouch was measured. It is accepted that an ileal pouch always reaches the anus without tension if it comes down 6 cm below the caudal edge of the pubic symphysis. The apex of the gastric pouch reached a mean of 13.3 cm (range 10-18 cm) below the caudal edge of the pubic symphysis. This technique was then performed on four patients. The apex of the gastric pouch reached a mean of 12.5 cm (range 10-14 cm) below the caudal edge of the pubic symphysis and always reached the anus. These findings emphasize that a gastric pouch interposed between the ileum and the anus after a total proctocolectomy has an excellent capacity to reach the anus without tension.

Anal Canal↗
PubMed2003

[Perforation and rupture of the oesophagus: treatment and prognosis].

AIM OF THE STUDY: To analyze treatment and prognosis of perforations and ruptures of the oesophagus. MATERIAL AND METHODS: This retrospective study included 40 patients (26 men and 14 women; mean age = 59 +/- 17 years) with a perforation or a rupture of the oesophagus. Seven perforations were cervical: iatrogenic (n = 6) or following ingestion of a foreign body (n = 1). Thirty-three perforations were thoracic: iatrogenic (n = 15), spontaneous rupture (n = 14), following ingestion of foreign body (n = 3) or traumatic (n = 1). All patients with cervical perforations were operated on (suture or drainage). One patient with thoracic perforation died before surgery, 2 underwent non-operative treatment and 30 were operated on. Twenty-eight underwent an oesophageal procedure: suture (n = 13), oesophagectomy (n = 11) or double exclusion (n = 4). Two uderwent surgery without oesophageal procedure (one pleural decortication, and one ablation of a pleural foreign body). RESULTS: The overall mortality rate was 17% (7/40), 21% (3/14) after spontaneous ruptures and 19% (4/21) after iatrogenic perforations (no death for other aetiologies). The mortality rate was 14% (1/7) for cervical lesions and 18% (6/33) for thoracic ones. It was 8% (1/13) after intrathoracic suture, 18% (2/11) after oesophagectomy and 50% (2/4) after double exclusion. CONCLUSION: Iatrogenic perforation and spontaneous rupture had the same poor prognosis. Non-surgical treatment is rarely indicated. oesophagectomy is a good option in case of non suturable oesophagus or delayed operation.

Adult↗
PubMed2002

[The "pneumoneck" in videocervicoscopy: operative technique and anatomic limits].

The aim of this study was to describe a technic in order to create a gas space "pneumoneck" during videoendoscopic surgery of the neck and to determine the anatomical limits of this space. Data were based on a surgical experience and on the dissection of two corpses. This space was located between the two layers of the pre-tracheal lamina of the cervical fascia. This space was enclosed and favourable to detachment with insufflated gas without subcutaneous emphysema. This approach can be used for parathyroid and thyroid surgery.

Cadaver↗
PubMed2002

[Surgical treatment of pancreatic metastases from renal carcinoma].

OBJECTIVES: Pancreatic metastases from renal carcinoma are poorly known. The aim of this study was to report clinical and radiological manifestations, the treatment performed, and the observed survival in 7 patients with this rare entity. RESULTS: All patients were operated on. One patient had nonresectable tumor. Six patients underwent curative resection. There was one postoperative death. Follow-up after pancreatectomy ranged from 6 months to 3 years. Two patients developed extra-pancreatic metastases one year and 3 years after pancreatectomy respectively. CONCLUSIONS: Pancreatic metastases from renal carcinoma are rare and often occur several years after nephrectomy. However their resection is often possible and allows a good long-term survival. PATIENTS AND METHODS: From 1988 to 2000, 7 patients (5 men and 2 women, mean age = 66 years) with pancreatic metastases from a renal cell carcinoma were observed in the same center. One patient had synchronous metastasis; in the 6 others, metastases were diagnosed 4 to 16 years after nephrectomy, and were revealed by pain (n = 2), gastrointestinal bleeding (n = 1), faintness (n = 1) or routine follow-up (n = 2). The diagnosis of metastases was made by contrast-enhanced abdominal CT-scan.

Abdominal Pain↗
PubMed2002

[Mesenteric-portal confluence aneurysm].

The authors take interest in the portal aneurysm about the observation of a 52 year-old woman with an echographic lesion in the head of the pancreas. Radiological examination was done with abdominal CT and MRI. Because of no accurate diagnosis, an explorative laparotomy was done and showed an aneurysm at the junction of the portal and superior mesenteric veins. These lesions are rare: they can be acquired particularly with underlying hepatocellular diseases and portal hypertension; they can be congenital due to an incomplete obliteration of the right vitelline vein. If asymptomatic, only a close surveillance must be proposed.

Aneurysm↗
PubMed2002

[Standing-up/sitting-down movement. Electromyographic analysis of 4 muscles of lower limb and the erector spinae muscle: study of anticipatory postural adjustments].

This study was conducted to evaluate the activity of the Erector Spinae and four other muscles of the lower limb during the 1500 first milliseconds of the sitting movement. Electromyographic activities of the Soleus, Tibialis Anterior, Biceps Femoris, Vastus Lateralis, and Erector Spinae muscles were recorded together with cinematic and kinematic data. An inhibition of the Erector Spinae activity was found at the beginning of the movement. It preceded the displacement of the first mobile kinematic marker in 8 of 15 trials. This muscular inhibition created a postural forward movement before the voluntary backward movement. This inhibition of the Erector Spinae could be considered as an anticipatory adjustment movement because of its postural function and its precocity. These results, obtained in healthy young people, should be compared with results in old people, especially with people who suffer from psychomotor dysadaptation syndrome, in whom this inhibition of the Erector Spinae seems to be absent.

Adult↗
PubMed2001

Lateral approach to laparoscopic repair of left diaphragmatic ruptures.

Video-assisted repairs of traumatic diaphragmatic ruptures have been described where thoracoscopy or laparoscopy in the supine position were used. This study aims to validate a new lateral laparoscopic approach for left diaphragmatic repairs. Six consecutive patients were operated on for left diaphragmatic rupture using a lateral approach (Gagner's position). A series of 362 consecutive patients presenting with abdominal or thoracic trauma with or without diaphragmatic rupture over a 2-year period were reviewed retrospectively. Contraindications for immediate or delayed lateral laparoscopic approach were studied. The lateral approach provided complete visibility of the subdiaphragmatic space, easy reduction of herniated organs, easy thoracic inspection and cleaning, the use of low peritoneal pressure, full range of instrumental motion, and rapid diaphragmatic repair. No operative mortality or morbidity was noted. Altogether, 14% to 50% of the patients with diaphragmatic ruptures were candidates for immediate lateral laparoscopic repair. Associated spleen injury in 50% of the cases was the main contraindication. The lateral laparoscopic approach provides better exposure of the diaphragm on the left side and facilitates the diaphragmatic repair especially with a large herniation. Immediate repair is possible in selected cases (14-50%). There is no contraindication in case of delayed diagnosis.

Abdominal Injuries↗
PubMed2001

Absence of the portal bifurcation at the hilum of the liver due to intrahepatic origin of the left branch of the portal vein.

The authors report a rare anomaly of portal vascularization which was detected by CT-scan and MRI and then confirmed surgically. There was no portal bifurcation at the hilum of the liver. After giving off its right dorsal branch, the portal vein entered the right liver and divided in the parenchyma into the right ventral and left branches. The arteriobiliary distribution was normal. Only a few similar cases have been reported. The left branch of the portal vein is reported to have few variations in contrast with the right one, which has many. The venous structure of the liver varies increasingly with the distance from the left umbilical vein. During a right hepatectomy, the possibility of such a vascularization makes it necessary to ensure that the left branch of the portal vein starts upstream before dividing a portal branch entering the right liver.

Adenocarcinoma↗
PubMed2001

[Portal hypertension in a patient with hepatitic C revealing an iatrogenic arterioportal fistula].

A 67-year-old man with anti-HCV positive serum, was admitted for hematemesis by variceal bleeding. Portal hypertension, which initially was thought to be caused by a post-hepatitis C cirrhosis, was due to a fistula between a right hepatic artery and a right branch of the portal vein. The fistula located under the right liver and the adjacent atrophic hepatic segments, were resected by a bi-segmentectomy VI-VII. The postoperative course was simple. The pathological study of the resected liver showed no cirrhosis but active hepatitis. This arterioportal fistula was probably iatrogenic. Sixteen years before, this patient had undergone a total gastrectomy for cancer, followed by a serious haemorrhage requiring a massive transfusion, which was responsible for the transmission of hepatitis C.

Aged↗
PubMed2001

[Bleeding gastroduodenal ulcer: results of surgical management].

AIM OF THE STUDY: The aim of this retrospective study was to report the mortality and morbidity after surgery for bleeding peptic ulcer while the population is aging and while the medical treatment and endoscopic procedures are improving. PATIENTS AND METHODS: This retrospective study between 1994 and 1999 included 49 patients, 15 women, 34 men, aged 72 +/- 14 years. Patients were separated into three groups: ten with uncontrollable haemorrhages, 28 with recurrent haemorrhages and 11 with persistent haemorrhages. These patients were classified ASA II (n = 6), ASA III (n = 20), ASA IV (n = 21) and ASA V (n = 2). The surgical procedures for gastric ulcers (n = 5) were resection-oversewing (n = 2) or partial gastric resection (n = 3). The surgical procedures for duodenal ulcers (n = 44) were oversewing (n = 30), partial gastric resection (n = 10) or exploratory duodenotomy (n = 4). RESULTS: The overall postoperative mortality rate was 20.4% (10/49). The mortality rate was 40% (4/10) in patients with massive haemorrhage, 7% (2/28) in patients with recurrent haemorrhage, and 36% (4/11) in patients with persistent haemorrhage. There was no significant difference in the mortality rate in relation to the surgical procedures. The morbidity rate was 45%, including three bleeding recurrences after suture and three duodenal leakages after partial gastric resection. CONCLUSION: The morbidity and mortality rate after surgery for bleeding peptic ulcer is still high. Recurrent haemorrhages don't worsen the prognosis. Delayed surgery for persistent haemorrhage is associated with a severe prognosis.

Adult↗
PubMed2001

[Composite, non-resorbable parietal prosthesis with polyethylene terephtalate-polyurethane (HI-TEX PARP NT): prevention of intraperitoneal adhesions. Experimental study in rabbits].

The authors report an experimental study in the rabbit with a new composite non absorbable mesh in Polyethylene Terephtalate-Polyurethane used for incisional hernia repair in intraperitoneal positioning. This new mesh has one permeable side in polyethylene terephtalate for rapid tissue fixation and another side in polyruethane, hydrophob in order to avoid cell penetration. Eighteen rabbits were operated. A wound was created in aponeurose, muscle and peritoneal abdominal wall. The mesh was placed in intraperitoneal positioning and was taken off at 4, 9 and 13 months for histologic examination and electronic microscopical examination. Tolerance, adhesion, tissular reaction and neoperitoneum formation have been studied. All the meshes were well integrated and without sepsis. In 18% of cases small and monocclusive intraperitoneal adhesions were found. This new composite mesh in intraperitoneal positioning gave good results at medium-term in the rabbit. It's an attractive alternative for incision hernias repair with intraperitoneal mesh.

Abdominal Muscles↗
PubMed2001

[Intraperitoneal chemo-hyperthermia with "overflow" open abdomen].

The authors report an original procedure of open-abdomen intraperitoneal chemo-hyperthermia. The skin edges are watertightly stapled with a soft "abdominal cavity expander", supported by a Thompson self-retaining retractor positioned over the abdomen. So, the level of the liquid can be widely raised above the level of the skin edges. The anterior wall peritoneum, the wall edges are constantly exposed to the liquid. Large amplitude movements become possible: introduction into the abdomen of two forearms, even two arms, does not induce loss of any liquid. The small bowel, the stomach can be partially exteriorized. It becomes very easy to expose all the peritoneal spaces, to maintain an homogeneous hyperthermia within the abdomen, while using only one inflow drain, and one outflow drain.

Abdominal Neoplasms↗
PubMed2001

Population-based study of factors influencing occurrence and prognosis of local recurrence after surgery for rectal cancer.

BACKGROUND: Few data are available from population-based statistics on the risk of local recurrence after surgery for rectal cancer. The aims of this study were to determine factors influencing local control and to analyse treatment and prognosis of recurrences in a well defined population. METHODS: Data were obtained from the cancer registry of the Côte d'Or (France). From 1976 to 1995, 682 patients resected for cure for a rectal carcinoma were included. Recurrence rates and survival rates were calculated using actuarial methods. A relative survival analysis and Cox multivariate analysis were performed. RESULTS: During the study 135 local recurrences were registered. The 5-year cumulative local recurrence rate was 22.7 per cent. In multivariate analysis the two variables significantly associated with local recurrence risk were stage at diagnosis and the macroscopic type of growth. There was a non-significant decrease in local recurrence rate in patients treated by preoperative radiotherapy compared with that in patients treated by surgery alone. The proportion of patients re-resected for cure was 25.2 per cent, and increased from 13.0 per cent in 1976-1985 to 37.9 per cent in 1986-1995 (P = 0.001). The 5-year relative survival rate was 13.6 per cent overall and 40.6 per cent after resection for cure (P < 0.001). CONCLUSION: Local recurrence of rectal cancer following resection remains a substantial problem. Improvement can be expected from better care and earlier diagnosis.

Adult↗
PubMed2001

[Role of the lymphatics of the diaphragm in the absorption of intraperitoneal liquids].

The diaphragm is the major site of the lymphatic absorption of the intra peritoneal liquids. Known since the middle of the last century, this lymphatic network is at present studied under transmission electron microscopy. The stomata which are intercellular sluices between adjacent mesothelial cells, are the entry of the diaphragmatic network. These stomata open into the lacunae which are dilatations the diaphragmatic subserous lymphatic network. The architecture of these structures explains their one-way character from the abdomen to the thorax and the role of the respiratory movements. This network collects the fluids into the trans diaphragmatic lymphatics. Pleural effusion appears when the quantity of liquids in the diaphragmatic lymphatic network exceeds the capacities of drainage of the lymphatic efferents, thus explaining the reactional pleural effusion caused by underdiaphragmatic inflammatory processes.

Absorption↗
PubMed2000

Tubular duplication of the esophagus. Contribution of magnetic resonance imaging in anatomical analysis before surgery.

The authors report a tubular duplication of the thoracic esophagus in a 17-year-old male. This anomaly, rare in the adult, can be explained either by a failure of esotracheal compartmentalisation, or a notochordodysraphy or more probably by an error during vacuolisation of the esophagus. The anatomical characteristics of the duplication were clearly seen on MRI. This investigation showed the intramural duplication, with only a thin barrier without muscle, between the esophageal lumen and the duplication channel: two communications were present between the esophageal lumen and the duplication. The esophagus was accessed by right thoracotomy. The close contact between the duplication and the esophagus did not allow them to be separated. A subtotal esophagectomy was necessary, with digestive continuity being restored by coloplasty after a left cervicotomy and a laparotomy. The anatomy seen on the MRI should have predicted that an esophagectomy was necessary and that a thoracotomy could have been avoided by performing the procedure with a closed thorax.

Adolescent↗
PubMed2000

Identification of prognostic factors determining risk groups for lung resection.

BACKGROUND: Pulmonary resection belongs to a group of surgical procedures with significant morbidity and mortality. The aims of this study were to classify postoperative complications and to identify prognostic factors determining risk group. METHODS: In a prospective study 500 patients undergoing lung resection (wedge resection, n = 141; lobectomies, n = 245; bilobectomies, n = 12; and pneumonectomies, n = 102) were included. In 178 patients (36%) pulmonary resections were extended to structures or thoracic organs. Sleeve resection of the bronchus to preserve lung parenchyma was performed in 22 patients. RESULTS: Classification of postoperative complications fell into four categories: patients without postoperative complications; patients with moderate complications (n = 137); patients with severe complications (n = 38); and death (n = 33). Factors adversely affecting postoperative complications by multivariate analysis included pulmonary pathology, bronchoplastic technique, forced expiratory volume in 1 second (FEV1), extended resection, type of lung resection, comorbidity indices, and preoperative chemotherapy. Four risk groups were determined. Risk group I (n = 60) with the best prognosis included patients with FEV1 greater than or equal to 80% undergoing wedge resection for a benign lesion or metastasis. Risk group II (n = 161) included patients with FEV1 greater than or equal to 80% undergoing major pulmonary resection for a benign lesion or metastasis or lung cancer, or patients with FEV1 less than 80% undergoing wedge resection for benign lesion or metastasis. Risk group III (n = 233) with a fair prognosis included patients with comorbidity indices less than 4 and FEV1 greater than or equal to 80% undergoing extended pulmonary resection for a benign lesion or metastasis or lung cancer, or patients with FEV1 less than 80% and emphysema. Risk group IV (n = 46) with the worst prognosis included patients with FEV1 less than 80% undergoing an extended lung resection or bronchoplastic procedures for a benign lesion or metastasis or lung cancer, or patients with comorbidity indices greater than or equal to 4 undergoing extended lung resection for lung cancer. CONCLUSIONS: In a prospective study, based on these prognostic factors, a practical, easy-to-use risk group system of lung resection is proposed as a tool to aid the decision to perform lung resection.

Adolescent↗
PubMed2000

[Bilobar Thyroid Agenesis].

A case of a 27-year-old female patient presenting with bilateral agenesis of the thyroid gland and a benign euthyroid adenoma of the isthmus and the pyramidal lobe is reported. The patient had for several years been followed for a cystic nodule that was presumed to have developed from the left thyroid lobe, having recently increased in size. Scintigraphic and echographic studies evoked the absence of right lobe. Direct examination at cervicotomy found hypoplasia of the two lobes. This report highlights the similarity of this rare anomaly to widely known hemiagenesis.

Adult↗