Biomedical subjects
Publications and source records attributed to P Guiot.
Clinical and pathological findings in a forty-eight-year-old woman with malignant mesenchymatous hamartoma of the liver (embryonic sarcoma) are reported. Special emphasis is put on the monomorphic leiomyosarcomatous aspect of the peritoneal metastases, and on the presence of pseudo-tumorous foci abounding in plasmocytes and centered by recent phlebitis.
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A method for size distribution analysis of liposome suspensions is described. Spray-freezing was used in order to avoid cryoprotectants and fixatives. Light scattering showed that, depending on their composition, liposomes can be modified by the spraying procedure. dipalmitoylphosphatidylcholine liposome suspensions display large modifications of light scattering upon spraying. The commonly used unilamellar phosphatidylserine/phosphatidylcholine (1:4) liposomes, with or without cholesterol, are, however, only slightly affected by the spraying procedure. For liposome suspensions stable upon spraying, size distribution analysis can be performed on freeze-fracture replicas by standard procedures and average size, area and volume of particles are obtained. The number of particles per unit volume cannot be determined by stereological procedures, since the fracture face does not correspond to a plane section through the sample. By combining stereological data with phospholipid mass and specific molecular area of phospholipids, abundance of particles, fractional volume and total membrane area can nevertheless be evaluated. Data on small unilamellar liposomes prepared by sonication are presented as an illustration of the method. In suspensions obtained by this procedure, vesicles may be considered at thermodynamic equilibrium in the aqueous phase. The experimental size distribution compared favourably with that obtained from self-assembly theory for liposomes, considering natural lecithin heterogeneity. For comparison purposes, data on large unilamellar liposomes, obtained by reverse-phase evaporation, are also presented.
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The diagnostic and therapeutic influence of laparoscopy has been studied in 255 patients presenting with nontraumatic acute abdominal pain. Laparoscopy provided a correct diagnosis in 93% (236 of 255) of the cases, the others requiring a laparotomy. An erroneous preoperative diagnosis was corrected by laparoscopy in 50 patients (20%), which called for a change of treatment in 25 patients (10%). Seventy-three percent (186 of 255) of acute abdominal conditions were treated exclusively by laparoscopy, 23% (58 of 255) by conventional surgery, and 4% (11 of 255) by laparoscopically assisted surgery. Mortality was 2% (5 of 247) and morbidity 11% (28 of 247). We conclude that laparoscopy is a valuable tool for the general surgeon facing a patient with an acute abdomen.
We report on the observation of six cases in a family of eight, all under 30, in whom the diagnosis was obtained at first hand by rectosigmoidoscopy. This procedure appears sufficient as the number of polyps tends to decrease with increasing distance from the anal margin. The recent finding of abnormalities of chromosome 5 (long arm) permits the identification of carriers of this genotype by simple blood examination (DNA probe), thus greatly enhancing the possibilities of screening for the disease. Each of our cases was managed with subtotal colectomy and ileorectal anastomosis. Preservation of the rectum was preferred to other techniques as all subjects were young, mildly affected and with good motivation for twice-yearly endoscopic follow-up. The surgical technique appears simple and quite safe with satisfactory functional results and easy feasibility of endoscopic surveillance.
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The authors report five cases of intrinsic duodenal obstruction in neonates, operated upon since 1976 to 1982. In 3 cases, it's a question of atresia and in two cases of annular pancreas. The associated lesions are in one case, a macrocephaly, in a second case, a microcephaly with ocular lesions and in a third case a jejunal atresia. The operating procedure consists four times in a duodeno-jejunostomy and one time in a duodeno-duodenostomy. A complementary jejunal resection with end-to-end anastomosis is necessary in the case of associated jejunal atresia. A discharge gastrostomy is performed once only. The post operative feeding is exclusively parenteral. A cholostatic jaundice appears in two cases but run its course favourably. The postoperative course is simple. There is no death. The five cases evolue normally at long term.
Over the past six years, the authors performed 1 018 biliary tract operations. Surgery for biliary tract cancer is not included. Drainage of the wound was only used for technical reasons and in complicated cases of cholecystitis. Five hundred sixty eight (64,3%) cholecystectomies were performed without drainage. The operative mortality in this group was 0.7% (4 patients). One of those 4 died of hemoperitoneum inspite of a rather late reintervention. From their experience the authors conclude that close postoperative follow-up and, when necessary, early reoperation is far more important than routine drainage which is often ineffective when problems arise. Multiple recent randomised studies support this attitude.
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Between 1957 and 1978 the authors operated 15 patients with an adrenal tumor. This series includes six pheochromocytomas, seven cortical tumors, one adrenal cyst and one neuroblastoma. The specific diagnostic and therapeutic problems encountered in this group of different type tumors are discussed. In the group of six pheochromocytomas one was benign but recurred nine years later, one was a paraganglioma and one a malignant pheochromocytoma with functional glandular metastases. The seven cortical tumors are divided into one functional benign tumor, two non-functional benign tumors of which one was located outside the adrenal gland, two non-functional malignant tumors, one functional malignant tumor and one syndrome of Conn.
BACKGROUND/AIMS: Laparoscopic management of acute small bowel obstruction has potential advantages over classical laparotomy. The aims of this study were to assess the feasibility and the safety of this technique, as well as to find any predictive success factors. METHODOLOGY: A laparoscopic approach was undertaken in 68 out of 150 patients admitted between 1991 and 1997 for acute small bowel obstruction. RESULTS: The cause of obstruction was bands or adhesions in 80% of the patients. A correct laparoscopic diagnosis was established in 66% of the cases. A laparoscopic treatment was performed successfully in 31 patients (46%), and was assisted by minilaparotomy in 4 patients (6%), and by open herniorraphy in 2 patients (3%). Thirty-one patients (46%) needed a conversion to laparotomy. There were 6 bowel injuries (9%), all recognized during laparoscopy. There were 2 deaths in converted patients and 2 early reoperations for persisting ileus in patients treated by laparoscopy alone or by assisted laparoscopy. CONCLUSION: Acute small bowel obstruction can be treated by laparoscopy alone, or assisted by minilaparotomy or open herniorraphy with advantages for the patient and few complications despite a high rate of conversion. There were no pre-operative predictive factors for successful laparoscopy, except for an isolated previous scar from an appendectomy. Pre-operative predictive success factors were parietal intestinal adhesions, as the only cause of obstruction. Multiple adhesions will mostly require conversion to laparotomy.