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P Vayre

Publications and source records attributed to P Vayre.

At least 19 recordsLinked to original sources
PubMed1992

[Biliary cysts. Resection of the protruding dome using celioscopy].

After giving the highlights on the few surgical indications of biliary cysts, the authors present a film of the resection of the protruding dome with celioscopy for an 80-mm cyst of the 3rd segment of the liver, in association with cholecystectomy for lithiasis. The simple technique and uncomplicated postoperative period emphasize the merits of this procedure, although this should not lead to inappropriate indications.

Biliary Tract Diseases↗
PubMed1992

[Lymphangioma of the mesentery. A rare cause of acute abdominal pain syndrome in adults].

We report about one case of cystic lymphangioma of the jejunum in a 27-year-old woman admitted to hospital for abdominal pain. The study of this case and the review of the literature enabled us to bring out the main characteristics of the lesion: rarity in adults, benignancy, mode of occurrence--most often painful--, radiological--and particularly CT--features, diagnosis based on histological findings only, and lastly, treatment with surgical exeresis that must be complete to prevent recurrence.

Abdominal Pain↗
PubMed1991

Hepatic trauma: experience with 135 consecutive liver injuries (1982-1989) and arguments for conservative surgery.

Most hepatic traumas are easily cured, but the series of 135 consecutive hepatic wounds reported in the present paper is unusual in that the patients were specifically recruited from among patients subjected to neurosurgical or spinal operations, 25% of whom sustained severe hepatic injuries (classes IV and V) as a result of the surgery. The postoperative mortality was analyzed according to such potentially predictive factors as severity of the hepatic wound, the concomitant extraabdominal lesions, the initial shock, and the kind of surgical treatment. The statistical comparison of the factors affecting the results was analyzed by the Chi-square test. The postoperative mortality rate was 24.4% (33 deaths). This mortality rate is evidently related to the severity of the hepatic lesions and to the frequent associated lesions. The 14 deaths from benign and moderate hepatic injuries were due to concomitant lesions. Among the 19 deaths from severe lesions, 12 were directly related to the severity of the hepatic injury and 7 to associated wounds. Complications directly related to the hepatic trauma occurred in 39 cases with 16 deaths. In general, conservative surgical treatment can be performed with quite low mortality. Among the patients who require hepatic resection one of two dies of hemorrhage or coagulopathy. Among conservative procedures, perihepatic packing has proved to be efficient and safe. If perioperative cholangiography has excluded any leak from a major bilde duct, septic complications are rare. Therefore, the surgical treatment of hepatic trauma should be as conservative as possible, because this can stop hemorrhage and decrease the risk of coagulopathy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

[Severe multiple injuries. Strategy and results. Experience at the Hôpital de la Pitié in 1988 and 1989].

In our series of 97 patients with multiple in juries observed in 2 consecutive years (1988-1989), we have selected only the most severe injuries, of which the patients died within 48 hours, and those that required a long stay in the intensive care department. On admission, we recorded 49 cases of stage II or more severe coma, and 67% of patients under respiratory assistance with an instable hemodynamic state. Out of the 44 deaths recorded, 30 subjects were comatose from the beginning. The justifies the confrontation of 3 specialist teams in 2/3 of cases. The specific recruitment of the hospital and the selection of the most severe cases of these "people under a death sentence" for the study shows a heavy toll of mortality (45,4%), including 60% on the first day. The main cause of death is head injuries (81%). The multivisceral and infectious consequences of long-lasting, heavy intensive care and pulmonary or myocardial contusions account fort secondary deaths in 25% of the patients who had survived. Emergent neurosurgical operations are exceptional, but a neurosurgeon's opinion is always essential. Orthopedic surgical issues are not specific, but the frequency of spinal lesions must be emphasized (27,2%). In this series, 85% of the patients with multiple trauma presented with a lesion of the locomotive apparatus and underwent emergent surgery in every second case in satisfactory conditions. Severe thoracic and maxillofacial lesions requiring surgery are rare. Abdominal lesions are more frequent (17%) and must be dealt with in priority, but they rarely cause death. On the contrary, lesions to the major blood vessels and retroperitoneal compound lesions have a very poor prognosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Emergencies↗
PubMed1991

[Reconstruction of the intestinal tract by intracolonic ileal sleeve. An experimental study and 1st clinical cases].

An experimental study on 15 piglets allowed defining the technical procedure and controlling the anatomical and functional results of various modes of restoration of the ileocolic tract after resection with a terminolateral tubing including and intracolic ileal sleeve. Coloileal fixation was ensured only by a few seromuscular sutures and adhesion with "Tissucol". The clinical application of this procedure was very satisfactory for 9 recent right colectomies, thus confirming the results previously observed for 33 ileal perforations in Africa. The ileocolic tubing technique is easy, reliable, morbidity-free, and causes no leakage of intestinal fluid, no intestinal ischemia and no stenosis. As it prevents coloileal reflux, this assembly may prevent ileitis after right colectomy. Its valvular effect also contributes in the mechanical regulation of transit. The assembly produces a system that can be compared to the ileocecal valve.

Aged↗
PubMed1990

[Peritoneal mesothelioma].

On the basis of 5 personal cases with illustrations and a review of the literature, the authors emphasize the clinicopathological features of peritoneal mesotheliomas, rare primary tumors for which the histological diagnosis is often difficult. The classical evidence by contact with asbestos fibers is obtained in every second case only. The tumor is often associated with a pleural lesion. Ultrasound and CT currently aid in the diagnosis, usually in a context of extensive ascites. The prognosis is poor. For technical reasons, surgical exeresis most often remains partial in the diffuse forms. Chemotherapy is rarely effective.

Adolescent↗
PubMed1990

[Liver traumas].

The high mortality rate in hepatic trauma is a concern for the surgeons on duty, who must know the physiopathological problems and the therapeutic solutions in order to make the decisions needed in view of both hepatic and extra-hepatic injuries according to the available means. The early vital risk is produced by 2 facts: injuries to the liver, in which bleeding account for the death in every second case, especially in case of vascular disinsertion in the caval-suprahepatic junction, which fortunately occurs rarely; associated intra- or extra-abdominal injuries, which are unfortunately frequent, cause death in every second case of multiple trauma. On the basis of a series of 135 cases in our department and of a bibliographic study, this article is aimed at defining a strategy for treatment that will be adapted to the lesions, in order to try and improve the prognosis. With hemodynamically stable patients, a surgical watch and wait policy is possible under strict observation. Conservative surgery still has to play a dominant part. Hepatic resection is only rarely indicated, if absolutely necessary. Temporary tight packing for a few days, with early reoperation in a specialist department if required, is a logical approach in initially unfavorable circumstances.

Extracorporeal Circulation↗
PubMed1990

[Surgical treatment of sigmoid diverticulitis].

Diverticular disease is generally benign but may be life threatening should progressive complications occur. Under these circumstances cure may only be obtained if properly performed surgery is undertaken at the right moment. The end result of a low fibre diet, diverticular disease may affect the entire colon, but always tends to particularly affect the sigmoid region. This is the usual site of complications where the etiology is related to diverticular infection associated with fecal impaction proximal to the high pressure zone at the recto-sigmoid junction. The radical treatment of sigmoid diverticulitis is rectosigmoid resection, however, this concept may be altered according to the circumstances as follows: 1 - sigmoid diverticulitis without pericolic complications 2 - peri-sigmoid complications: peri-sigmoid abscess, intestinal and vesical fistulae. 3 - generalised peritonitis due to perforation into the peritoneal cavity. The advanced age of the patient should be stressed (mean age 65 years and 25% over 75 years) associated with a high incidence of multiple organ failure and hence the high mortality in more than 50% of cases in the event of peritonitis.

Aged↗
PubMed1990

[Restoration of continuity after rectosigmoidectomy by colorectal intubation and transproctoanal anastomosis. An African experience with 10 cases].

On the basis of 10 cases (8 cases of rectosigmoid cancer and 2 of sigmoid volvulus), the authors report about their experience in the restoration of GI tract continuity using colorectal intubation into the rectal lumen and a transproctoanal anastomosis. This technique helps avoiding subperitoneal sutures, which are a cause of fistulae and shrinkage. It is simple enough to be performed by younger surgeons. This technique was initially developed for anterior resections for rectosigmoid cancer, and it can be utilized as an emergency procedure with single-piece resection without untwisting the sphacelous sigmoid loops, so that neither a temporary left iliostomy nor a second operation are needed.

Adult↗