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Biomedical subjects

P Rat

Publications and source records attributed to P Rat.

At least 73 records · Page 4Linked to original sources
PubMed1993

Results of bilio-digestive derivative surgical procedures for benign lesions.

Short and long term results of 52 derivative-surgical procedures (43 choledocho-duodenal and 9 hepatico-jejunal with 45 latero-lateral and 7 termino-lateral approaches) were examined. The procedures were performed on patients with benign bilio-digestive conditions: 46 cases of lithiasis, 2 of which were sump syndromes after latero-lateral derivations, and 6 cases of chronic pancreatitis. Several patients were in poor pre-operative condition, which may have influenced postoperative mortality rates (6%). Morbidity was 15 per cent. Four patients (8%) without anastomotic stenosis had infections of the hepatobiliary system within four years of choledochoduodenostomy. In some cases of benign bilio-digestive lesions, derivative surgery is the procedure of choice, being preferable to endoscopic sphincterotomy. In derivative surgery, a termino-lateral approach has better results than a latero-lateral approach. Furthermore, due to the risk of stasis following a choledochoduodenostomy, a hepaticojejunostomy may be preferable.

Aged↗
PubMed1992

[Kidney procurement after rapid cooling in situ through a double intra-aortic balloon].

We report a series of 12 kidneys harvested from 8 brain-dead patients with unstable haemodynamic condition after in situ renal cooling using the double balloon technique. Material and technique are described. The outcome of the renal grafts is known at 3 and 12 months: 92 percent of the renal grafts were functioning at 3 months and 87 percent at 12 months. The mean serum creatinine level of the recipients with functioning graft was 135 mumol/l at 3 months and 113 mumol/l at 12 months. These results suggest that the in situ renal cooling technique makes it possible to obtain kidneys under unstable haemodynamic conditions.

Catheterization↗
PubMed1992

Split-liver orthotopic liver transplantation: how to divide the portal pedicle.

It is possible to obtain two good-quality hepatic transplants from a single cadaveric liver by separation of right and left lobes of the liver or section between the left medial segment and the left lateral segment medial to the umbilical cleft. We attempt to define the ideal basis of separation of the structures of the portal pedicle, based on anatomic study of 25 livers. Ideally, the following should be sectioned: the left portal vein, longer and more constant than the right; the right branch of the hepatic artery, larger and more constant than the left; and the left hepatic duct, being aware of the vascularization of the common hepatic duct. Use of the left portal vein necessitates the interruption of all left venous portal branches of segment I, which should be systematically resected. A section between the left medial segment and the left lateral segment interrupts all portal venous branches of the left medial segment, which should then be resected. Before hepatic division, a cholangiogram and arteriogram are indispensable to detect variations and avoid an extensive dissection that may endanger bile duct vascularity.

Bile Ducts↗
PubMed1991

[Comparison of 2 antibiotic combinations used for peritonitis. Cefotaxime-clindamycin versus cefotaxime-metronidazole].

In this prospective and randomized trial involving 38 patients operated upon for generalized or localized peritonitis, 2 combinations of antibiotics were assessed on the basis of 5 predetermined criteria: number of successes and failures, duration of fever, leucocytosis, antibiotic therapy and stay in hospital. No significant difference was observed between the two therapeutic groups. The spectrum of sensitive organisms and the effectiveness of treatment could be considered satisfactory whatever the combination utilized. The 86.8 percent clinical success rate suggests that the cefotaxime-clindamycin combination should be used more frequently than it is now.

Adolescent↗
PubMed1991

[One liver for 2 transplantation recipients. How to divide the portal pedicle?].

It is possible to obtain two hepatic transplants from a single cadaveric liver by separation or right and left livers or by separation of the right lobe from the left lobe medial to the umbilical cleft. We attempt to define the ideal basis of separation of the structures of the portal pedicle, based on anatomical study of 25 livers. One should ideally section the left portal vein, the right branch of the hepatic artery, the left hepatic duct. The segment I must be systematically resected, the segment IV must be resected after a separation of the right lobe from the left lobe. A cholangiogram and an arteriogram are indispensable prior to hepatic division.

Dissection↗
PubMed1990

Surgical results of intrathoracic gastric volvulus complicating hiatal hernia.

From 1981 to 1988, 138 patients with hiatal hernia were treated surgically at our centre. Twenty-one (mean age 76.6 years, 17 women, four men) had an associated intrathoracic gastric volvulus. Eleven patients (mean age 73.2 years), of whom eight were asymptomatic, had an elective procedure. Ten patients (mean age 80.3 years) had emergency surgery, six for acute complications of the volvulus (five cases of strangulation and one of perforated ulcer) and four because of other, unrelated causes of acute abdomen. There were four deaths after operation, all in the emergency surgery group. Four other patients had significant morbidity, all in the emergency group. In the elective cases, all hernias were easily reduced. In one emergency case a gastrotomy was necessary for decompression, and in another gastrectomy was necessary because of gastric gangrene. Our results indicate the need for elective intervention when intrathoracic gastric volvulus is first diagnosed.

Aged↗
PubMed1990

Inhibition of ethoxyresorufin deethylase activity by natural flavonoids in human and rat liver microsomes.

Several flavones and flavonols (chrysin, quercetin, luteolin, flavone and 7, 8-benzoflavone) were found to inhibit ethoxyresorufin deethylase (EROD) activity in human and rat liver microsomes. In man, molecules without hydroxyl groups are more powerful inhibitors than polyhydroxylated flavonoids (7, 8-benzoflavone greater than flavone greater than chrysin greater than luteolin greater than quercetin greater than morin). In rat, chrysin was the strongest inhibitor and the less effective were morin and 7,8-benzoflavone. For all molecules human microsomes were more sensitive than rat microsomes. The most important difference concerned 7,8-benzoflavone which was 10,000-fold more potent in man.

Animals↗
PubMed1990

[Surgical treatment of diverticula of the thoracic esophagus].

Pathogeny of thoracic esophageal diverticuli, divided into parabronchial and epiphrenic, appears to have been modified by development of functional esophageal motility measurement. We present 23 patients with epiphrenic diverticuli and 3 with parabronchial diverticuli (15 male and 11 female with a mean age of 61 years). Twenty-four underwent surgery: 4 isolated diverticulectomy, 7 diverticulectomy and associated myotomy, 5 myotomy alone, 3 antireflux procedure alone. Three patients required esophagectomy for carcinoma in a diverticulum, for a huge diverticulum adherent to the inferior pulmonary vein. One patient presenting with perforation of a carcinomatous diverticulum in the pleura was treated with pleurotomy and has died. No fistula has been notified. Long term results had been analysed with a mean follow up of 4 years. Special attention has been reported on development of gastro-esophageal-reflux. The finding of a thoracic diverticulum requires evaluation by barium swallow, fibroscopy and functional test which should indicate the operation required. Long term analysis should include functional manometric evaluation and a pHanalysis as long term results are reduced by the appearance of gastro-esophageal-reflux.

Aged↗
PubMed1990

Pancreatic carcinoma developing in chronic pancreatitis: a report of four cases.

Although chronic pancreatitis microscopically surrounding pancreatic carcinoma is common, cancer developing in chronic pancreatitis has rarely been shown. We present four such cases seen between 1983 and 1988. All were male, mean age 56.7 years, and all had had previous surgery for complications of chronic pancreatitis (two a pancreatectomy, two a bypass). Chronic pancreatitis was caused by alcohol in three cases, and calcification was present in three. The delay between chronic pancreatitis and pancreatic carcinoma was 2 to 10 years, and in all, pancreatic carcinoma was at an advanced state, with post-surgical survival of 1.5 to 6 months. CA 19.9 level was very high in the three cases in which it was measured. That pancreatic carcinoma is more frequent in populations with chronic pancreatitis, occurring later in life than pancreatic carcinoma that has no coexisting chronic pancreatitis (sixth decade vs. fifth), often with intermediate histology, argues for chronic pancreatitis degenerating into pancreatic carcinoma rather than for a common toxic etiology. Pancreatic carcinoma occurs particularly in calcified chronic pancreatitis, and diagnosis is frequently quite late, due to the non-specificity of symptoms vs. chronic pancreatitis. Delay of appearance is variable, and previous surgery and histological examination excludes obvious coexisting pancreatic carcinoma. Aggressive surgery appears justified if needed for chronic pancreatitis, and chronic pancreatitis should be carefully followed, probably by serial CA 19.9 determinations and guided percutaneous fine needle biopsies when elevated, or when new symptoms are present in chronic pancreatitis.

Adenocarcinoma↗
PubMed1989

[Polycystic liver. Is Lin's operation still justified?].

Eleven patients with by polycystic liver disease were operated according to Lin's procedure. All cases were symptomatic forms. Sonography was diagnostic examination in 9 cases. Lin's procedure was not associated with any postoperative mortality or morbidity and no recurrences were observed after an average follow up of 4 years. Rarely, a feminale predominance and association with polycystic kidney disease are noted. Sonography establishes the diagnosis and reveals complications (most intracystic bleeding frequently). Lin's procedure is better than sonographic aspiration which must be repeated and can be complicated by severe infection. Operative aspirative drainage is necessary. Hepatectomy is rarely justified.

Adult↗
PubMed1987

[Injuries to the liver. Study of 54 cases].

The records of 54 consecutively treated patients with hepatic trauma were reviewed. Diagnosis, treatment and results were analyzed. Clinical features and ultra sonography were deciding for diagnosis. Frequent associated injuries are due to mechanism of injury 74% of road accident. 50% of lesions were major. Treatment were hemostasis, by suture and packing. Only 6 major hepatectomy were realised. Total mortality is 15% due to incomplete initial treatment or to extra-hepatic injury. Morbidity is important due to sepsis and hemorrhage. Therapeutic evolution showed decline of resection for conserving operation.

Adult↗
PubMedDate not supplied

One liver for two: partition of the portal elements.

A cadaver liver is divisible into two transplants by section between right and left lobes, or section between left medial segment and left lateral segment medial to the umbilical cleft. To establish the ideal basis of partition of the portal elements, an anatomic study of 33 livers was performed. It is preferable to section the left portal vein, longer and more constant than the right, the right branch of the hepatic artery, larger and more constant than the left, and the left hepatic duct because of the vascularization of the common hepatic duct. To use the length of the left portal vein, it is necessary to section all its branches to segment I and then to resect this segment. After a section between the left medial segment and the left lateral segment medial to the umbilical cleft, the left medial segment always loses its total portal venous vascularization and should be resected. Before a split-liver, cholangiography and arteriography should be performed to detect anatomical variations without performing an extensive dissection which may endanger the vascularity of the bile ducts.

Adult↗
PubMedDate not supplied

[Long-term prognosis of gastric cancer in the population of Côte-d'Or].

AIMS: The aim of this study was to determine long term prognostic factors of gastric cancer in a population-based series. METHODS: Out of 1 462 gastric cancers diagnosed in the Côte-d'Or area (494 000 residents) over a 20-year period (1976-1995), 649 (44.4 %) were resected for cure. Prognostic factors were determined using the actuarial method and relative survival and a multidimensional relative survival model. RESULTS: The 10-year crude survival rate was 8.7 % and the corresponding relative survival rate was 14.9 %. Age, stage and period of diagnosis were independent prognostic factors. After surgery for cure, operative mortality decreased from 18.3 % (1976-1979) to 6.6 % (1988-1991) and 10-year relative survival increased from 30.8 % to 37.2 % (NS). After resection for cure (postoperative mortality excluded), the 10-year survival rate remained stable over time. Stage at diagnosis was the main prognostic factor: the relative risk of death was more than 10 times higher at stages IIIB and IV than at stage I. Age, site and macroscopic type of growth were prognostic factors independently of stage. Prognosis did not improve over time after resection for cure. CONCLUSION: Although improving, the overall prognosis of gastric cancer remains poor. Improvement in prognosis was mainly due to decrease in operative mortality. Earlier diagnosis and effective adjuvant treatment represent two ways to improve prognosis.

Aged↗