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R Parc

Publications and source records attributed to R Parc.

268 records · Page 15Linked to original sources
PubMedDate not supplied

Continuous high-energy low-flow-rate enteral support: a panoramic review of 1000 cases.

One thousand intensive care digestive surgical cases are reviewed concerning continuous low-flow-rate enteral support (CLFRES), using Nutripompe: 607 males and 393 females, average age 51 years. The average duration of CLFRES is 21.5 days +/- 13, range 4 to 180 days. CLFRES was used postoperatively in 76 per cent, preoperatively in 10 per cent, and pre- and postoperatively in 14 per cent of cases, respectively. The enteral support route was 63 per cent nasogastric, 20 per cent gastrostomy and 17 per cent jejunostomy. Five hundred and ten patients required extensive digestive surgery with temporary exclusions. More than 100 patients with either temporary enterostomies or enterocutaneous fistulas have had continuous reinstillation of digestive chyme (CRDC) associated with their intensive care unit treatment management. CRDC in the lower end of an enterostomy has shown a specific retrograde inhibitory effect on the upper digestive secretions, particularly on the intestinal secretions during pathologies associated with one or several interruptions of the continuity of the gastrointestinal tract. This technique and its physiological implications were discussed. The principal pathologies in this important study group are: severe digestive fistulas, 24 per cent; acute diffuse peritonitis, 18 per cent; acute enterocolitis, 14 per cent; digestive tumours, 35 per cent; and acute necrotizing haemorrhagic pancreatitis, 9 per cent. A comparative analysis of nutritional energy nitrogen requirement was presented in view of the cancer, the septic, and the non-cancer non-septic patient groups. Enteral support nutritional solutions were primarily mixed non-degraded food, 70 per cent, and semi-elemental diets, 30 per cent. Certain pathology groups required variations in protein and lipid percentage. An up-to-date evaluation of nutritive formulas based on small peptides in normal and small bowel postoperative patients was discussed. Four CLFRES administration programmes were discussed: normal gastrointestinal tract, 38 per cent; abnormal gastrointestinal tract, 44 per cent; pancreatitis, 11 per cent; short bowel, 7 per cent. Nutrition evolution parameters (clinical), were: weight gain curve (minimum 10 days), local regional healing, biological positive changes in protein metabolism, nitrogen balance, lipid metabolism and glucose regulation. Impact on complications such as thrombosis, embolism and haemorrhage were discussed. Clinical and biological results using CLFRES were most satisfactory in more than 90 per cent of patients.

Adolescent↗
PubMedDate not supplied

[Megacolon in adults. Apropos of 76 cases].

27 patients with Hirschsprung's disease and 49 patients with idiopathic megacolon were followed for a period ranging between 6 months and 15 years. The diagnosis is essentially based on the barium enema and functional ano-rectal investigations. Duhamel's operation was performed in 26 patients with Hirschsprung's disease and in 34 patients with idiopathic megacolon. There was no mortality, but 10 cases of pelvic suppuration required colostomy, 9 of which were temporary. 8 cases of anastomotic stenosis developed as a late complication, but they were easily dilated by a simple surgical procedure. One patient developed sexual dysfunction (retrograde ejaculation). A good result was obtained in all patients with Hirschsprung's disease, except for one case of adynamic colon. Two patients with idiopathic megacolon were lost to follow-up. All but two of the remaining patients obtained a good or excellent result. Other operations were performed for idiopathic megacolon: 6 sphincterotomies, with 3 successes and 3 failures; 15 sigmoidectomies, including 3 with sub-peritoneal anastomosis (State's operation). There were 5 good results, 6 mediocre results and 4 failures which subsequently required a Duhamel's operation. Other techniques were performed more rarely: Swenson's operation with a short-term technical failure, 3 side-to-side ileo-sigmoid anastomoses with 3 failures which required a sub-total colectomy with ileo-sigmoid anastomosis. The longterm result was mediocre. The trans-rectal, colo-anal descent of the colon therefore appears to be the treatment of choice in megacolon in adults of whatever cause.

Adult↗
PubMedDate not supplied

[Extensive ulceronecrotizing anorectitis caused by abuse of analgesic suppositories].

Usually considered as totally unoffensive, antalgic suppositories can, under certain conditions, lead to extensive anorectal injury with anatomic, functional and legal implications which we evaluated on the basis of two cases and a review of the literature. Clinicians, surgeons, pathologists and pharmaceutical firms should be aware of these pathophysiological events. Consumer information is required to reduce the risk of self-medication. There are characteristic psychologic situations and "dose-dependent" toxic effects which, as the saying goes "errare humanum est, perseverare diabolicum". Careful use of scientific knowledge and wise decisions by both experts and judges are required to avoid misinterpreting the pathogenesis of this particular anatomoclinical entity.

Analgesics↗
PubMedDate not supplied

[Influence of ano-perineal lesions on the outcome of the rectum in colonic and rectal Crohn disease].

Between 1960 and 1988, 83 patients (38 men, 43 women) underwent colectomy and ileorectal anastomosis (IRA) for severe colonic or rectal Crohn's disease. The mean age at IRA was 28.5 years. The mean interval from diagnosis was 4 years. There were two post-operative deaths. Among the 81 survivors 5 patients who had a covering ileostomy have never had their stomas closed and 24 patients required exclusion or excision of their IRA and rectum. (= 10 defunctioning IRA, 14 proctectomies with definitive ileostomy). The mean interval between IRA and the creation of a permanent ileostomy was 4.1 years. The mean interval between the onset of problems following IRA and permanent ileostomy was 2 years. 25 patients had perianal lesions prior to IRA. 5 of these patients had unhealed perianal disease at IRA and 7 required defunctioning ileostomy (28%). The need for rectal excision or exclusion following IRA was not related to the presence of perianal disease prior to IRA but functional results were worse. 33 patients developed perianal lesions following their IRA, among whom 19 required exclusion or excision of the rectum. Failure of IRA was then significantly higher amongst those who developed lesions following IRA. Rectal preservation after IRA may be proposed with success to patients with a healthy rectum or with minimal or moderate proctitis, even if there is perianal disease that could be safely treated before IRA. In this last setting the patient has to be informed of the risk of rectal preservation and the possible risk of requiring ulterior protectomy.

Adult↗
PubMedDate not supplied

Study of cyclosporin A blood level during the early post-liver-transplantation period.

Correlations between acute rejection rate, cyclosporin A(CsA) blood level and CsA dose were studied in a group of 58 patients for 1 month following liver transplant. Therapy included prednisolone, azathioprine and CsA administered by continuous IV infusion. Blood CsA levels were measured by high performance liquid chromatography. No patient required renal dialysis. An acute rejection episode was recorded in 24 patients (group 1) between days 4 and 28 (mean 8 days), while 34 patients (group 2) showed no signs of rejection. A significant difference was observed (p < 0.05) between blood CsA levels (mean +/- SEM over the 6 days preceding the rejection episode in group 1 patients, and the first 6 postoperative days in group 2 patients (101 +/- 7 vs 121 +/- 5 ng/ml). The mean daily dose of CsA calculated over the same time period was significantly lower (p < 0.001) in group 1 patients (46 +/- 2 vs 60 +/- 2 mg/day). In addition, over the 8 days following surgery, only 54% of patients in group 1 attained a mean blood CsA level of a least 100 ng/ml, compared to 94% in group 2.

Cyclosporine↗
PubMedDate not supplied

Ruptured subcapsular hepatic haematoma secondary to "HELLP syndrome".

We report the history of a pregnant woman who suffered from a ruptured hepatic subcapsular haematoma, responsible for a major haemoperitoneum. This rare event, final evolution of the "HELLP Syndrome" led us to review pathophysiology and treatment of the syndrome.

Adult↗
PubMedDate not supplied

Fibrin glue effectiveness and tolerance after elective liver resection: a randomized trial.

BACKGROUND/AIMS: The propensity of fibrin glue to achieve ultimate control of the liver raw surface and its tolerance after hepatic resection, were evaluated by a prospective study. MATERIALS AND METHODS: Seventy seven patients undergoing elective liver resection for benign lesions (n = 35) and malignant lesions (n = 42) including 7 with cirrhosis were studied. Randomization took place only at peritoneal closure and after completion of hemostasis and biliostasis. RESULTS: In the group with fibrin glue (n = 38), a single dose of 5 ml was applied to the liver cut surface. The appearance of the liver margin at abdominal closure was judged as dry in 34/35 (97%) patients with fibrin glue, versus 34/42 (81%) in those without (p = 0.016). Although postoperative morbidity and mortality were not different between the 2 groups, the mean total fluid drainage during the three postoperative days and bilirubin concentration were significantly lower in the group with fibrin glue; respectively 242 +/- 249 ml vs 505 +/- 666 ml and 24 +/- 21 mmoles/l vs 65 +/- 47 mmoles/l. CONCLUSIONS: Our results indicate that fibrin glue application to the hepatic stump after hepatic resection provides effective sealing with good systemic and local compatibility.

Adult↗
PubMedDate not supplied

Bleeding of the pancreatic stump following pancreatoduodenectomy for cancer.

BACKGROUND/AIM: The purpose of this study was to determine the characteristics of bleeding of the pancreatic stump after pancreatoduodenal resection with pancreatojejunal anastomosis. PATIENTS AND METHODS: Between February 1970 and December 1990, 223 patients underwent a Whipple resection for cancer. RESULTS: Twenty patients (9%) had post-operative hemorrhage. In 10 patients bleeding arose within the operative field and in the 10 later within the gastrointestinal tract. Six patients bled from the gastroenterostomy and 4 (1.7%) from the pancreatic cut surface. In all four severity of the hemorrhage required urgent relaparotomy. CONCLUSIONS: Diagnosis and hemostasis could be achieved through a jejunostomy near the pancreatic anastomosis. Two patients had pancreatic fistula,one of them died.

Aged↗
PubMedDate not supplied

[Comparison of long-term course of perforating and non-perforating Crohn disease].

OBJECTIVES: To evaluate the influence of the indication of the first surgical procedure on the prognosis of Crohn's disease. METHODS: We compared retrospectively the long-term course of 179 patients operated on for a perforating disease and 322 patients operated on for a nonperforating disease. Mean follow-up was 11 years and 2 months in the two groups. RESULTS: Forty of 179 (25%) and 106 of 322 (33%) patients with perforating and nonperforating diseases underwent a second intestinal resection, respectively. The patients who had been operated on for a perforating disease were significantly more often reoperated on for the same indication, and conversely. Patients with perforating diseases experienced less second resections (actuarial rates: 37 +/- 11% vs 51 +/- 8% at ten years respectively), less post-surgical handicaps (mean index 24.9 vs 27.9), and fewer patients required immunosuppressive drugs (25 vs 35%). CONCLUSION: Long-term prognosis of perforating Crohn's disease does not appear to be more severe than that of nonperforating disease.

Adult↗
PubMedDate not supplied

Mycobacterium paratuberculosis and Mycobacterium avium subsp. silvaticum DNA cannot be detected by PCR in Crohn's disease tissue.

BACKGROUND: The etiology of Crohn's disease remains unknown. A putative mycobacterial cause of the disease is still controversial. AIMS: To assess the mycobacterial hypothesis in Crohn's disease using a polymerase chain reaction technique. PATIENTS AND METHODS: Nested polymerase chain reaction with primers on the 16S-rRNA coding region (16S-rDNA) and with primers specific both to the insertion sequences (IS) 900, and IS 901/902 were used to amplify Mycobacterium paratuberculosis or Mycobacterium avium subsp. silvaticum DNA in frozen endoscopic intestinal biopsies or surgical resection specimens from patients with Crohn's disease (n = 47: 25 endoscopic biopsies and 22 surgical resection samples, +/- lymph nodes), ulcerative colitis (n = 27), and non inflammatory bowel diseases (n = 20: colonic tumors and diverticulitis). Positive as well as negative controls were used throughout the study. RESULTS: All strains of Mycobacterium paratuberculosis and Mycobacterium avium subsp. silvaticum tested were positive for both primer systems. Of the 94 biopsies tested, 5 (2 Crohn's disease, 1 ulcerative colitis and 2 controls) were positive with the 16S-rDNA primers but did not correspond to Mycobacterium paratuberculosis or Mycobacterium avium subsp. silvaticum. None of the specimens was positive with the IS primers. CONCLUSION: These results do not support the hypothesis that Mycobacterium paratuberculosis, or Mycobacterium avium subsp. silvaticum play a role in Crohn's disease.

Adult↗
PubMedDate not supplied

[The perforation complication in diverticulitis: the evolution of the surgical procedure].

The ideal treatment for perforative complication in diverticular disease of the colon is still now rather controversial. Fundamental remains the simple and practical classification of Hinchey for perforated diverticulitis, especially for a meaningful evaluation of different experience. Without a common reference classification the percentage differences in mortality are completely devoid of scientific value. From a "three-stage" procedure the preferences are shifted towards a "two-stage procedure", thanks to the improvement of anesthetic and surgical modern facilities. The Hartmann procedure, performed not earlier than 4-6 months is the experience of the authors, but the ultimate choice is conditioned by the degree of peritoneal contamination.

Adult↗