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Biomedical subjects

P Assens

Publications and source records attributed to P Assens.

At least 19 recordsLinked to original sources
PubMed1987

Management of caustic ingestion in adults.

The treatment of 484 adults with caustic ingestion injury is discussed. Signs and symptoms are an unreliable guide to injury and a chest X-ray and fibreoptic endoscopy should be performed as soon as possible. All of the 250 patients who developed superficial lesions of the oesophagus, stomach or duodenum experienced healing without sequelae. Forty-four patients required emergency surgery of whom twenty-four died and oesophagectomy without thoracotomy is now advocated for this group, followed by interval surgery to restore continuity. The remaining 190 patients suffered gastric or oesophageal ulceration without necrosis: 92 recovered without complication, 3 succumbed to aorto-oesophageal fistula, 12 survived following delayed surgery for complications and 83 developed oesophageal and/or gastric stenosis which subsequently required endoscopic or surgical treatment.

Adolescent↗
PubMed1987

Selective intraarterial DSA of the parathyroid glands in patients with hyperparathyroidism after parathyroidectomy.

Eighteen patients with recurrent hyperparathyroidism after parathyroidectomy were prospectively examined with selective intraarterial digital subtraction angiography (DSA) of the brachiocephalic arteries. The results were compared with findings at reoperation. Seventeen of the 21 remaining abnormal parathyroid glands were correctly detected by selective DSA (sensitivity = 81%). In the neck and mediastinum, sensitivities were 73% (8/11) and 90% (9/10), respectively. All patients with histopathologic confirmation of primary hyperparathyroidism (17/18) became normocalcemic postoperatively. We conclude that selective intraarterial DSA is indicated in patients with recurrent hypercalcemia after parathyroidectomy when the results of noninvasive imaging techniques are uncertain.

Adolescent↗
PubMed1987

[Parathyroid adenoma at an atypical site, ectopic or not].

Of 800 patients undergoing operation for primary hyperparathyroidism between 1960 and 1985, 163 presented parathyroid adenomas located in other than typical sites in normal parathyroid glands. A retrospective study of case-reports is used to demonstrate the value of complementary investigations in the localization of these lesions, and to emphasize certain operative factors indispensable for their detection.

Adenoma↗
PubMed1986

[Gastropericardial fistula. Late complication of the treatment of hiatal hernia].

An exceptional case of gastropericardial fistula is reported, the lesion developing from a gastric ulcer on an antireflux valve instituted ten years previously. A literature review showed 31 similar cases: 14 gastropericardial fistulae, 16 esophagopericardial fistulae and one jejunopericardial fistula. Three features common to all these fistulae were determined: the frequency of hiatus hernia in the genesis of these lesions, either from an ulcer on esophagitis or herniated stomach or from surgical complication; the extremely high mortality of these fistulae (68% mortality); the need for aggressive treatment.

Aged↗
PubMed1986

[Diagnostic and therapeutic problems in a severe case of hyperparathyroidism with renal insufficiency].

It may sometimes be difficult to distinguish primary from secondary hyperparathyroidism when advanced renal failure coexists. We report here the case of a patient with end-stage renal failure who had severe hyperparathyroidism. Cervical exploration revealed only the presence of four parathyroid glands normal in size and histological appearance which were removed. Because the existence of severe hyperparathyroidism had been firmly established based on biochemical and radiological evidence, the diagnosis of primary hyperparathyroidism due to an ectopic adenoma became obvious. Digital angiography and computerized tomography were then carried out. The results of angiography were inconclusive but computerized tomography revealed and precisely localized a mediastinal adenoma which was subsequently removed via sternotomy. The existence of a hypoparathyroid state was confirmed over the following two months. Reimplantation of parathyroid fragments which had been cryopreserved during the first operation, was then performed with success.

Adenoma↗
PubMed1985

[Vascular malformations of the digestive tract: a cause of severe digestive hemorrhage. Apropos of 2 cases].

We report on two cases of angiodysplasia of the digestive tract complicated by serious acute bleeding. The preoperative diagnoses were made by angiography. One case concerned a voluminous jejunal lesion which was macroscopically visible; the other concerned a punctiform lesion detected only by angiography and not found on the pathology specimen. The authors insist on the potential gravity of these angiodysplastic lesions, the necessity to perform an emergency celio-mesenteric angiogram when confronted with a serious digestive tract hemorrhage non-explained by conventional methods of exploration when they can be performed.

Adult↗
PubMed1984

[Uni- or bipolar temporary exclusion of the esophagus by stapling. A simple technic, not damaging to the esophagus].

Many surgical procedures have been put forward to treat perforations of the thoracic oesophagus seen late. The authors propose a simple stapling technique which can be applied in the cervical segment or below the lesion if required, and report the results obtained in 4 cases. The spontaneously reversible temporary derivation obtained ensures better healing of the lesion and avoids the need for subsequent reconstructive surgery.

Aged↗
PubMed1984

[Severe tracheobronchial complications of the ingestion of caustics in adults. A case of perforation healed with a pulmonary patch].

Since 1969, in a study of 100 patients hospitalized for severe caustic ingestion meeding intensive surgery, the authors have found 9 cases of critical tracheo-bronchic burns characterized by necrotic lesions. Those lesions constitute a severe complication (6 deaths amongst 9 patients) thus the obsolute necessity of precocius and repeated tracheobronchic fiber endoscopies. In case of an ulcerating or pre-splitting aspect appearing in localised necrotic lesions, the authors preconise in emergency a tracheobronchic plasty using a lung patch. Other treatments are discussed.

Adult↗