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Biomedical subjects

P Monnier

Publications and source records attributed to P Monnier.

At least 19 recordsLinked to original sources
PubMed1992

[Transtracheal jet ventilation in the operating room].

For the last 40 years transtracheal ventilation has been suggested as a means of bypassing the glottis in emergency in patients unable to be intubated or ventilated by mask. A catheter has been designed to be easily inserted into the crico-thyroid membrane. The outer part of the device, with its dual attachment system, can be connected to conventional resuscitation equipment by its 15 mm male end or to a high-pressure oxygen source by its Luer-Lock fitting. The advantages of transtracheal ventilation are: a clear vision of the operative field, a good gas exchange, an elimination of airway trauma from intubation, a reduction of the hazard of airway fires and a decreased risk of aspiration of blood and debris. Barotrauma is the main danger. However, this method of providing oxygen and/or mechanical ventilation may be extended to the postoperative period, the exit of the insufflated gas mixture being assured at all times.

Anesthesia, Inhalation↗
PubMed1992

[Fatigue fracture below the internal tibial plateau after locked intramedullary nailing].

The authors present a case of stress fracture of the medial condyle of the tibia following intramedullary nailing with distal locking. This complication, which appeared two years after the surgical procedure and one year after the removal of the nail, has not yet been described in the literature. The patient was a young man without any excessive physical load. The presence of the intramedullary nail was accompanied by a bone clearness in the medial part of the superior epiphyseo-metaphyseal level of the tibia.

Adult↗
PubMed1991

[Is papilloma of the esophagus a preneoplastic lesion? Study of 33 cases].

The etiology of esophagus papilloma is much debated: some authors attach greater importance to irritation factors, while others give preference to the viral hypothesis and suggest that this disease could eventually lead to squamous cell carcinoma of the esophagus. To verify the viral hypothesis, we reviewed the histological slides of the 33 cases of esophageal papilloma diagnosed in our Institute of Pathology between 1973 and 1988. We evaluated the histological diagnosis using Winckler's criteria. HPV typing was done using probes of HPV DNA types 6-11, 16-18, 31-33-35 applied to paraffin sections according to the in-situ hybridization method. Clinical and endoscopic data of 15 cases (from the CHUV) are reviewed. Oncological data was provided by the Vaud Cantonal Tumor Register. No patient in our series fulfilled all the histological criteria set by Winckler to diagnose an HPV condition. Viral DNA 31-33-35 was found in a small minority of the papillomas. The clinical impact of esophageal papilloma on epidermoid carcinogenesis is nil.

DNA Probes, HPV↗
PubMed1991

An extensive morphological and comparative study of clinically early and obvious squamous cell carcinoma of the esophagus.

Squamous cell carcinoma of the esophagus appears mainly as an isolated tumor, frequently diagnosed in its latest stage. However, current advances in endoscopy, systematically used for high risk subjects, allow the detection of very early lesions such as epithelial dysplasia or in situ carcinoma. Twenty-eight squamous cell carcinomas were extensively studied: Group A contained 15 clinically "early cancers"; Group B 12 clinically obvious carcinomas and group C one clinically obvious bifocal carcinoma. All 15 "early cancers" were multicentric and composed of large fields of invasive, microinvasive or in situ carcinoma around which were found epithelial dysplasias of various degrees. Lymph node metastases at surgery were found in 26% of these cases. Obvious squamous cell carcinomas were contiguous with dysplastic areas in 16.6% and with in situ carcinomas in 33% of these cases. Half (50%) had lymph node metastases at surgery. There was no dysplasia or in situ carcinoma around the two main tumors of group C. A comparison between the different morphological features of the three groups leads us to question whether the solitary tumor of the esophagus really represents the final evolution of an early multifocal carcinoma.

Carcinoma in Situ↗
PubMed1991

Squamous cell carcinoma of the lung in a nonsmoking, nonirradiated patient with juvenile laryngotracheal papillomatosis. Evidence of human papillomavirus-11 DNA in both carcinoma and papillomas.

Malignant transformation of laryngeal juvenile papillomatosis most often occurs in patients with previous radiation therapy or smoking histories. We report the case of a 35-year-old, nonsmoking, nonirradiated man who developed squamous cell carcinoma of the lung with a 33-year history of laryngotracheal juvenile papillomatosis. Postmortem examination showed pulmonary cavitating papillomatosis and chest wall, vertebrae, and peribronchial lymph node involvement by tumor. Molecular studies (Southern blot, polymerase chain reaction) showed extrachromosomal human papillomavirus-11 (HPV11) DNA in both carcinoma and two laryngotracheal squamous cell papillomas, including one excised 20 years previously. Our observation is analogous to the previously reported cases of spontaneous (not related to irradiation or smoking) malignant transformation of juvenile laryngotracheal papillomatosis. Although HPV11 viral infection likely played a role in the malignant transformation, other less likely factors, such as drugs given for treatment and radiography performed throughout the illness, should be considered. Repeated pulmonary infections and the host immune response are additional considerations.

Adult↗
PubMed1991

[The role of a new method for occlusion of fistula tracts].

Digestive fistulae have a quite variable clinical presentation, depending on their origin and topography. Even when very small, they can cause considerable mechanical or metabolic derangement. Surgical correction often implies an operation with important consequences. The injection of an occlusive emulsion can, in a certain number of cases, close off the fistulous tract with minimal inconvenience. We have injected several invalidating fistulae between the digestive or respiratory tract and the skin with Ethibloc. Total occlusion of the fistulae was accomplished after one or more injections. The emulsion is resorbed after around 10 days, leaving a scar. The inclusion of radio-opaque material allows intraoperative control of injection. This technique widens the therapeutic modalities applicable to a difficult medical condition. When confronted with advanced inflammatory or neoplastic disease, for example, Ethnibloc injection can be considered if the tissue quality is sufficient. Gross infection or tissue necrosis are, in our experience, relative contraindications; the occlusive emulsion cannot adhere and is rapidly evacuated by the fistula.

Aged↗
PubMed1990

The consumption of tobacco, alcohol and the risk of adenocarcinoma in Barrett's oesophagus.

The relationship between tobacco, alcohol and the risk of oesophageal adenocarcinoma in Barrett's oesophagus was evaluated in an endoscopy-clinic-based case-control study of 30 histologically confirmed cases of adenocarcinoma and 140 controls with Barrett's oesophagus but no evidence of malignant lesions. Among the cases, 18 (60%) were non-smokers and 14 (47%) non-drinkers, the corresponding proportions in the controls being 52% and 44%. Thus, there was no apparent relation between tobacco, alcohol and the risk of adenocarcinoma of the oesophagus, the age- and sex-adjusted point estimates being 1.0 for moderate and 0.9 for heavy smokers, 0.7 and 1.5 respectively for moderate and heavy drinkers. Upper 95% confidence limits were 1.6 for ever-use of tobacco and 1.9 for ever alcohol drinking. The findings of this study, although based on a limited number of cases, indicate that alcohol and tobacco are unlikely to play a major role in the aetiology of adenocarcinoma in Barrett's oesophagus.

Adenocarcinoma↗
PubMed1990

[Histology of the endobrachyesophagus: its value in the monitoring of patients].

Two histological classifications of Barrett's esophagus are posited in the literature: (1) a layered disposition (Paull); (2) a mosaic pattern (Thompson). Only specialized epithelia are potentially neoplastic. Our experience, based on two histological studies, confirms the heterogeneity of Barrett's esophagus. These studies show that the mosaic pattern is more frequent than the layered disposition. Therefore we consider it extremely important to perform multiple biopsies (centimeter by centimeter on the four faces of the esophagus) to allow histological diagnosis of the specialized form of columnar epithelium and/or of dysplasia.

Barrett Esophagus↗
PubMed1990

[Drug-induced esophagitis and its complications. Retrospective study of 30 case reports and review of 650 published cases (1970-1987)].

Prevalence and incidence of drug-related esophagitis are probably underestimated. The condition can often be diagnosed on the basis of history alone. Tetracyclines and emepronium bromide were implicated in most published cases. Endoscopy usually shows erosions in the upper two thirds of the esophagus. These esophageal lesions generally heal after the medication has been stopped. Complications such as stricture, hemorrhage or perforation are very rare.

Adolescent↗
PubMed1989

[Pathogenic heterogeneity of Barrett's ulcers. Apropos of 38 case reports].

Barrett's ulcer is thought to develop in the columnar epithelium of Barrett's esophagus. In our series there is evidence that at least some Barrett's ulcers develop in squamous epithelium which may correspond to islets within Barrett's esophagus; in other cases Barrett's mucosa may surround a preexisting reflux-induced ulcer and thus transform it into Barrett's ulcer. In some individual cases of Barrett's ulcer development of the ulcer primarily in the columnar epithelium could not be ruled out. These ulcers may be produced by local acid secretion, by acid or alkaline gastroesophageal reflux in patients with reduced resistance of the columnar epithelium. Exceptionally, Barrett's ulcer may result from local irritation by medication (pill-induced ulcer) or by nasogastric intubation.

Adult↗