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P Wind

Publications and source records attributed to P Wind.

49 records · Page 3Linked to original sources
PubMed1994

The infrapyloric artery and cephalic pancreatoduodenectomy with pylorus preservation: preliminary study.

Cephalic pancreatoduodenectomy (CPD) with pylorus preservation has been suggested to improve the functional and nutritional result of surgery. At operation, the first two centimeters of the duodenum are preserved, the vascular arch of the lesser gastric curvature is saved and the right gastroepiploic artery is resected at its origin. The aim of this study on 15 fresh cadavers was to determine the origin of the vascularization of the remaining duodenum and also the possibilities of preserving an optimal vascularization after CPD and pylorus preservation. All of the arteries supplying the remaining duodenum and arising either from the right gastric artery or the right gastroepiploic artery were identified. The distances between the origin of the infrapyloric artery and the termination of the gastroduodenal artery on the cranial and ventral pancreaticoduodenal artery and the left gastroepiploic artery were measured. At CPD with pylorus preservation, the study demonstrated that: 1) the cranial side of the remaining duodenum remains vascularized in 80% of the cases by one or two supraduodenal branches coming from the right gastric artery; 2) ligation of the right gastroepiploic artery eliminates all vascular supply to the caudal side of the remaining duodenum in almost half of the cases; 3) in these cases, the dissection of the bifurcation of the gastroduodenal artery and the vascular section beyond the origin of the infrapyloric artery allowed a direct vascular supply to the remaining duodenum to be preserved.

Arteries↗
PubMed1994

Cholecystectomy for cholecystitis in patients with acquired immune deficiency syndrome.

Acalculous cholecystitis, a recognized manifestation of acquired immune deficiency syndrome (AIDS), causes abdominal pain which can be relieved by cholecystectomy. The indications for cholecystectomy have remained undefined, however, because the cholecystitis is usually accompanied by generalized cholangitis and it is difficult to distinguish the relative clinical importance of the two problems. Since 1985, we have performed cholecystectomy on 8 patients with AIDS who had clinical manifestations of acute cholecystitis associated with a thickening of the gallbladder wall by 5 mm to 12 mm. Two of the 8 had gallstones and 4 had associated cholangitis. All had been treated with antibiotics for 20 to 180 days before surgery, but physical deterioration had progressed in every case. At the moment of surgical intervention, 4 patients had multiple organ failure. One patient died 3 days postoperatively, but the rest recovered rapidly with resolution of the abdominal pain and sepsis. Two patients died 20 days after surgery due to complications of AIDS. The remaining 5 died due to AIDS at 6, 9, 10, 12, and 14 months after surgery. Two of this group developed progressive cholangitis with raised serum alkaline phosphatase. Our experience indicates that cholecystectomy should be considered for the treatment of severe and persistent symptoms of hepatobiliary manifestations of AIDS notwithstanding the presence of cholangitis.

AIDS-Related Opportunistic Infections↗
PubMed1992

[Hepatobiliary manifestations in AIDS in adults. Place of cholecystectomy].

In AIDS patients an acalculous cholecystitis may be responsible for abdominal pain subsiding after cholecystectomy. But the indications for cholecystectomy are not clear: cholecystitis is usually associated with diffuse cholangitis and this might cause the symptoms. Since 1985, 8 AIDS patients have undergone cholecystectomy for acute cholecystitis. Ultrasonography revealed a 5 to 12 mm thickening of the gallbladder wall in all of them and gallbladder stones in two; four patients had cholangitis. The decision to operate was based on persistent pain associated with fever, poor general condition and muscular rigidity at palpation. Four patients had septic shock at the time of surgery; one died in the immediate postoperative period. In all other patients pain and septic syndrome subsided. Two patients died of AIDS complications 20 days after surgery; the remaining five died of AIDS 6, 9, 10, 12 and 14 months respectively after surgery; in two of them cholestasis had reappeared due to cholangitis. To summarize, in the 8 AIDS patients studied cholecystectomy was performed for clinical deterioration. Gallbladder pathology was responsible for the abdominal pain and the febrile general condition which was relieved by cholecystectomy.

Acquired Immunodeficiency Syndrome↗
PubMed1992

[Pancreas divisum, chronic pancreatitis and diabetes mellitus. Improvement by pancreaticojejunostomy].

The relationship between pancreas divisum and chronic pancreatitis is controversial. We report the cases of two patients aged 40 and 53 years suffering from recurrent pancreatitis and known to have histologically proven idiopathic chronic pancreatitis. One patient had insulin dependent diabetes. Pancreatography demonstrated in these two cases a pancreas divisum with a dilated dorsal pancreatic duct. A pancreatico-jejunostomy was performed, associated in one case with splenopancreatectomy for pseudo-cyst. With a follow-up of 32 and 78 months, both patients were free of symptoms and the diabetic patient had normal blood glucose levels with diet alone. The clinical history of the patients suggests a relationship between pancreas divisum and chronic pancreatitis and that pancreatico-jejunostomy may improve pancreatic pain and pancreatic function.

Adult↗
PubMed1992

[Diverting loop ileostomy, effective prevention of colonic complications in necrotizing acute pancreatitis].

The operative diagnosis of colonic ischaemia in association with acute necrotizing pancreatitis (ANP) may be difficult in the absence of unequivocal transmural necrosis or perforation. We introduced in May 1988 a new policy whereby, when colonic viability was dubious, resection was avoided and a diverting loop ileostopy (DLI) was performed. If necrosectomy led to extensive mobilization of the splenic flexure with a capillary drainage system placed in close contact, a DLI was again performed. Colectomy was only performed for unequivocal transmural necrosis. Among 30 patients operated on for ANP, 12 underwent DLI. This policy allowed us to spare potentially ischaemic colons. No secondary colonic complication occurred and there was no rise in the mortality rate. Among patients whose colon was kept in circuit there were bouts of bowel distension and unexplained bacteriemia ultimately leading to death from multiorgan failure. When colonic viability is dubious and when drainage is brought up in close contact with the bowel wall DLI might allow colonic resection to be avoided. In our experience DLI also seemed to prevent secondary colonic complications.

Acute Disease↗
PubMed1990

[Implantation of pancreatic islets in arteriolar epiploic flap. Preliminary note on 3 cases].

Presently, no long-term insulin withdrawal after islet graft in a diabetic patient has been reported. From October 1988 to December 1989 we have performed 3 pancreatic islet grafts in 3 type I diabetic patients. Islets were isolated from pancreatic glands collected during multiple organs harvesting. Implantation was conducted in an original site, by an arteriolar embolization of an epiploic flap pedicled from the right gastroepiploic vessels. Those grafts were combined twice with a kidney and in one occasion with a liver transplant. After 15 months, this last case is an unique metabolic success with complete insulino-independence. Endogenous insulin-secretion determined by C-peptide measurement was not detectable before surgery but was normalized and stimulable 6 months after the graft. Insulin injections were stopped one month later. Blood glucose is fully normal since 8 months without insulin. For the two other cases with kidney transplants after two months, endogenous insulin is already detectable. Compared with 3 segmental pancreatic grafts performed during the same period, islet graft in diabetic patients appears as a promising approach.

Adult↗
PubMed1989

[Surgical emergencies and pseudo-surgical syndromes in the course of acquired immunodeficiency syndromes in adults].

Numerous abdominal manifestations were noted among 600 patients undergoing treatment at Hospital Laennec for various stages of infection by the acquired immunodeficiency virus. These included violent abdominal pain in 30% of cases, the development of abdominal lymphoma, and occasionally alarming pseudo-surgical syndromes. Diagnosis is difficult, all the more so since authentic emergencies may be aggravated by the immunodeficiency state. 18 cases were collected in 3 years and included 6 cases of acute cholecystitis and 2 of appendicitis. The gangrenous and extensive nature of infection was generally noted and required appropriate antibiotic therapy.

Abdominal Pain↗
PubMedDate not supplied

[Ileocolic linitis in Crohn's disease].

Intestinal cancer is uncommon in Crohn's disease but the risk of developing such a tumor is increased. Linitis plastica of the small bowel or colon is very rare. We report a case of ileocolonic linitis plastica which occurred 21 years after an ileocecal resection for Crohn's disease. Partial small bowel obstruction in relation with stricture of the preanastomotic loop prompted us to suspect disease recurrence. The tumor was not diagnosed either on preoperative work-up, or during surgery but only on the histological examination of the resected specimen. Palliative chemotherapy with 5 FU and folinic acid was performed. The patient was asymptomatic after a 17-month follow-up. This observation focuses on the clinical signs and course of linitis plastica. It also illustrates the difficulty of tumor diagnosis in Crohn's disease. Malignant transformation must be suspected if signs of active disease re-occur after a lengthy quiescent period.

Aged↗