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Biomedical subjects

P Ségol

Publications and source records attributed to P Ségol.

8 recordsLinked to original sources
PubMed2001

[Zenker's diverticulum: diverticulopexy versus diverticulectomy].

STUDY AIM: The aim of this retrospective, nonrandomized study was to compare the results of diverticulectomy and diverticulopexy in the treatment of Zenker's diverticulum. Over the 10-year period between 1988 and 1998, surgery for Zenker's diverticulum was performed in 40 patients. PATIENTS AND METHOD: The study group consisted of 23 men and 17 women with a mean age of 72 years. Only 39 patients were evaluated. In 19 patients, treatment consisted of cricopharyngeal myotomy and diverticulum suspension; in the other 19 patients, treatment consisted of diverticulectomy in addition to myotomy. Only one patient had a diverticulectomy without myotomy. RESULTS: There was no mortality and the morbidity rate was low: one fistula, one pneumonia, three cases of transient dysphonia and one hematoma. The results were excellent in 36 patients, and good in 3 patients. CONCLUSION: Cricopharyngeal myotomy with diverticulopexy is particularly suitable for geriatric patients. Diverticulectomy is proposed in the case of a diverticulum larger than 6 cm and for young patients to prevent the risk of malignant transformation.

Age Factors↗
PubMed2000

Liver adenomatosis: reappraisal, diagnosis, and surgical management: eight new cases and review of the literature.

OBJECTIVE: Liver adenomatosis (LA) is a rare disease originally defined by Flejou et al in 1985 from a series of 13 cases. In 1998, 38 cases were available for analysis, including eight personal cases. The aim of this study was to review and reappraise the characteristics of this rare liver disease and to discuss diagnosis and therapeutic options. BACKGROUND: LA was defined as the presence of >10 adenomas in an otherwise normal parenchyma. Neither female predominance nor a relation with estrogen/progesterone intake has been noted. Natural progression is poorly known. METHODS: The clinical presentation, evolution, histologic characteristics, and therapeutic options and results were analyzed based on a personal series of eight new cases and an updated review of the literature. RESULTS: From a diagnostic standpoint, two forms of liver adenomatosis with different presentations and evolution can be defined: a massive form and a multifocal form. The role of estrogen and progesterone is reevaluated. The risks of hemorrhage and malignant transformation are of major concern. In the authors' series, liver transplantation was indicated in two young women with the massive, aggressive form, and good results were obtained. CONCLUSION: Liver adenomatosis is a rare disease, more common in women, where outcome and evolution vary and are exacerbated by estrogen intake. Most often, conservative surgery is indicated. Liver transplantation is indicated only in highly symptomatic and aggressive forms of the disease.

Adenoma, Liver Cell↗
PubMed1998

Bile duct cysts in adults: a multi-institutional retrospective study. French Associations for Surgical Research.

OBJECTIVE: To review the features of adult patients undergoing surgery for bile duct cysts, focusing on the anatomy of the biliary tree as well as the long-term outcome. SUMMARY BACKGROUND DATA: Bile duct cysts (BDCs) are uncommon in Western countries, and the majority of reported cases originate from Asia. Japanese authors have emphasized the frequent association of extra- and intrahepatic bile duct dilatations, but grading of patients based on Todani's classification is often hindered by the absence of an accurate definition of types IC and IVA cysts. Moreover, despite the increasing use of extrahepatic cyst excision, little is known about the long-term outcome in patients with intrahepatic bile duct involvement. METHODS: Forty-two adult patients with BDC were treated between 1980 and 1992 in 17 institutions of the French Associations for Surgical Research. Clinical presentation, radiologic presurgical evaluation, and surgical procedures were analyzed. The long-term postsurgical outcome was derived from patient charts, attending physicians, or direct patient contact. RESULTS: Twelve patients (30%) had recurrent abdominal pain or jaundice from childhood. Seven (17%) had undergone prior cystenterostomy. Twenty-one (50%) had a Todani-type IVA cyst with extra- and intrahepatic bile duct involvement. Of these, nine had segmental, exclusively left-sided intrahepatic bile duct dilatation. Biliary carcinoma was encountered in five patients (12%). Extrahepatic cyst excision with a Roux-en-Y hepaticojejunostomy was performed in 34 patients with type I or IV cysts. The overall operative mortality rate was 2.4%. Long-term results were clearly correlated with cyst type: during a mean follow-up of 8.4 years, 11 of 12 patients (92%) treated by cyst excision for type I cyst remained free of symptoms, whereas 31% of patients who underwent surgery for type IV cyst had episodic or severe cholangitis with intrahepatic stones. CONCLUSIONS: In patients with BDC, particular attention must be given to the associated intrahepatic bile duct dilatations. We propose a modification of Todani's classification to distinguish cystic, segmental, and fusiform dilatations of the intrahepatic biliary tree in type IV cysts. In patients with segmental left intrahepatic cystic dilatations, combined left liver lobectomy and extrahepatic cyst excision is suggested to decrease late postsurgical biliary complications.

Adolescent↗
PubMed1996

Contribution of cervical ultrasound and ultrasound fine-needle aspiration biopsy to the staging of thoracic oesophageal carcinoma.

This study was performed to evaluate the use of cervical ultrasonography and ultrasound-guided fine-needle aspiration for pretherapeutic staging of oesophageal cancer. 50 patients with a thoracic-oesophageal cancer (upper third = 8, middle = 36, lower = 6), previously untreated, underwent cervical ultrasonography to detect supraclavicular lymph node metastases (LN). An ultrasound fine-needle aspiration biopsy was attempted in 12 cases of suspected LN. 26 patients were operated on, of which 13 had surgical exploration of the neck. All patients were followed after treatment with special attention to the supraclavicular area. 14 patients (28%) were ultrasonography positive, 5 of 8 in the upper third, 9 of 42 in the two other thirds. Of the 12 patients where a fine-needle biopsy was attempted, 9 showed neoplastic cells (75%). 5 patients had cervical metastatic LN at surgery, and 5 other patients demonstrated supraclavicular LN metastases during the follow-up. There was one false positive and six false negatives from cervical ultrasonography and two false negatives of UGFAB (ultrasound-guided fine-needle aspiration biopsy). The sensitivity and the specificity of the cervical ultrasonography were 68 and 97%, respectively. The pretherapeutic staging was modified: 7 patients initially stage II-III were regraded to stage IV. Cervical ultrasonography is a reliable method of assessment of supraclavicular LN in thoracic oesophageal carcinoma.

Biopsy, Needle↗
PubMed1987

[Multiple-organ procurement for transplantation].

In the last few years, the tremendous growth of clinical transplantations has greatly increased the need for grafts. Combined heart, liver and kidney harvesting in a same donor could provide an answer. The results are presented of multiple organ retrieval (MOR) carried out in an University hospital located in an area with 1,350,000 inhabitants. In addition to the usual problems of donor maintenance and legal aspects, it was necessary to carry out a specific work-up for each organ to be harvested. The job of the local coordinator was extremely important in the search for potential recipients and the organization of the procedure (time-table, air transport) in order to give optimal conditions. The priority given to retrieving the heart and in situ cooling of the liver and kidneys guaranteed the good quality of the harvested organs. Over a period of three years, 28 MOR have been carried out. Of the 94 organs harvested, 88 were transplanted in France or another European country (49 kidneys, 23 hearts, 16 livers); 75 are still functioning (47 kidneys, 19 hearts, 9 livers). As a result of this experience, and taking into account the need for organs, all brain dead patients should be considered as potential multiple organ donors, and not just as kidney donors. The intervention of several teams, often quite distant from the site of retrieval, requires careful planning. The surgical procedure, even when performed by a trained team, is often complex, perfect synchronization of the surgical steps of the operation being the most important point.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1986

[Gastroesophageal 99mTc scintigraphy in gastroesophageal reflux].

The aim of this study was to compare gastroesophageal 99mTc scintiscanning (GES), the pH reflux test (TRA) and esophageal manometry in the assessment of gastroesophageal reflux (GER). GES was performed after oral intake of sulfur colloid labeled with 99m technetium and 300 ml of water. Calculation of an index of reflux gave a semi-quantitative assessment of the GER. Sixty patients with symptoms of GER (typical in 51 cases, atypical in 9 cases) had the three tests. A GES was also performed in 17 normal volunteers and in 12 patients of the series after fundoplication. The diagnostic specificity of GES was 1.0 in GER. GES was less frequently positive than the pH reflux test in GER (68.6 p. 100 versus 80.4 p. 100) but the difference was not significant. These two tests were more sensitive than manometry. The index of reflux was higher in patients than in control subjects (p less than 0.0005) and returned to normal values after fundoplication. A correlation between the index of reflux and the stage of pH-reflux test was observed. It is suggested that GES can be used in the initial assessment of GER as an alternative to TRA and performed repeatedly during the follow-up of patients treated surgically.

Adult↗
PubMed1981

[Lethal complication related to the per-operative insertion of a naso-gastric tube. A case (author's transl)].

The patient who was operated on for the recurrence of a colic cancer had an unknown pituitary adenoma. The adenoma was destructing partly the anterior basis of the skull and was protruding in the nasal fossae. The naso-gastric tube entered without any difficulty the right cerebral hemisphere creating lethal cerebral lesions. Some reflexions determined by this very rare condition are discussed.

Adenoma↗