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Biomedical subjects

R Parc

Publications and source records attributed to R Parc.

At least 163 records · Page 9Linked to original sources
PubMed1984

[Fistulas of the small intestine with evisceration. New therapeutic approach. 120 cases].

One hundred and twenty cases of post-operative jejuno-ileal fistula with evisceration are reported: 90% of the patients came from other departments. Depending on their mechanism, these fistulae fell into two categories: out-flowing fistulae (93 cases) consecutive to spontaneously opened peritonitis draining through the surgical incision, and in-flowing fistulae (24 cases) resulting from trauma of a superficial small bowel loop; 48% of open small bowel fistulae were due to a questionable operation. Unfavourable prognostic factors were: age over 50, supramesocolic initial lesion, fluid production equal or superior to 1000 ml/24 h, history of at least 2 previous median laparotomies and presence of one or several of 7 severity factors. The overall mortality rate was 46%, falling to 38.5% (inoperable cases excluded) after active treatment. The authors propose to concentrate on prolonged medical intensive care, salvage operations being reduced to a minimum. Over the last 4 years, this approach has brought down to 36% the overall mortality rate.

Adolescent↗
PubMed1984

Postoperative peritonitis due to gastric and duodenal fistulas. Operative management by continuous intraluminal infusion and aspiration: report of 23 cases.

A new surgical procedure is presented for the management of postoperative peritonitis due to a leak from a suture line in the stomach or the duodenum. At re-operation, an intraluminal unit made of three silicone tubes is inserted through the fistula into the bowel lumen. Extraluminal drains are placed near the fistula. A Witzel jejunostomy is constructed in order to provide continuous high energy enteral support. Intraluminal infusion and aspiration starts immediately after operation. Twenty-three patients have been treated according to this technique. Five died (22 per cent): one from mediastinitis and four from complications unrelated to the fistula. Three (13 per cent) patients developed recurrent abdominal abscesses and underwent re-operation for drainage with no mortality. In the first 2 weeks after operation, most of the discharge was collected by the extraluminal drains. Thereafter the intraluminal unit collected the majority of the fluid, thus allowing the extraluminal drains to be removed. At an average time of 27 days after operation the intraluminal unit was withdrawn. The external fistula created by this technique healed spontaneously in 15 of the 18 survivors, and was surgically closed in three, with no complication. This procedure prevents the recurrence of intra-abdominal sepsis and local complications due to the enzymatic action of the gastroduodenal secretions.

Adult↗
PubMed1984

Anatomical and physiological basis of parietal treatment of severe peritonitis and evisceration.

The failures observed in attempts to obtain abdominal closure "at all costs" and the risks and difficulties of laparostomy led us to develop a technique of exclusive cutaneous cover to treat cases of severe peritonitis and evisceration with or without exposed fistula. This method is based on certain anatomical features of the anterolateral abdominal wall and its physiological properties when eventration or evisceration is present. The forces of parietal dehiscence were determined in 6 patients having undergone major surgery of the digestive tract. The magnitude of these forces, the neccessity of obtaining biological protection and the structure and physiology of the superficial layers of the abdominal wall require a cutaneous cover with traction-free sutures via cutaneoaponeurotic incisions of relaxation. The rich vascularization of the abdominal wall, the number and topography of the perforating arteries and the existence of hypodermal, subdermal and subpapillary anastomoses allow the surgeon to perform extensive cutaneoaponeurotic mobilization.

Abdominal Muscles↗
PubMed1984

Radiological anatomy of the right gastroepiploic artery.

Most gastroplasties performed to replace the esophagus are vascularized by the right gastroepiploic artery alone. Its origin, course and anatomical relations are classical and subject to little variation. Conversely, its mode of termination and relations to the left gastroepiploic artery have received quite different descriptions in the literature. This report describes the radiological anatomy of the right gastroepiploic artery based on arteriograms in 50 subjects. The right gastroepiploic artery was much larger (diameter 1.7 to 2.6 mm at its origin) than the left (absent in 3 cases) in our series. Direct end-to-end anastomosis of these two arteries, as described in classical reports, was found in only 23.5% of cases.

Angiography↗
PubMed1984

Rectopexy to the promontory for the treatment of rectal prolapse. Report of 257 cases.

From 1953 to 1982, 257 patients with complete rectal prolapse were operated upon. To the procedure described by Orr, we have added mobilization of the rectum prior to its suspension and eliminated the pouch of Douglas, and nylon strips have been used for suspension in most patients. There were 57 male and 200 female patients. Ages ranged from 11 to 90 years. Sixty-one patients had already undergone surgery for rectal prolapse with another procedure and prolapse had recurred. The postoperative course was uneventful in 96 per cent of patients. Two patients, aged 79 to 83 years, died of cardiac failure. Follow-up of 115 patients ranged from five to 23 years. Recurrent rectal prolapse was observed in 4.3 per cent of the patients in whom nylon strips were used to suspend the rectum. In 136 patients anal incontinence was associated with rectal prolapse. Normal continence was restored in 84.1 per cent of 107 patients with rectopexy alone and in 64.2 per cent of 14 patients who underwent rectopexy and anal sphincter repair. It is concluded that rectopexy to the promontory with nylon strips after mobilization of the rectum is a safe and efficient procedure for the treatment of rectal prolapse.

Adolescent↗
PubMed1984

[Superficial and extensive epidermoid cancer of the esophagus].

A case of extensive squamous cell carcinoma of the esophagus in a 56 year old man, with an history of excessive alcoholic and tobacco consumption, is reported. After subtotal esophagectomy, the course was favorable 10 months after surgery. The pathological study of the surgical specimen showed that the tumor was superficial and confined to the mucosa and submucosa. The lesion measured 65 mm in length (after fixation) and was circumferential. Foci of moderate and severe dysplasia and inflammatory erosions were also observed. The relationship between extensive squamous cell carcinoma, dysplasia, esophagitis and the concept of "carcinogenic fields" are discussed. The necessity of large radical resection of the esophagus is emphasized.

Carcinoma, Squamous Cell↗
PubMed1983

[Colovesical fistula of diverticular origin. Diagnostic and therapeutic aspects. 17 cases].

Seventeen patients presenting with diverticular colovesical fistula were treated surgically between 1975 and 1979. Any treatment of the fistula must aim at the cause--colonic diverticulitis--by resection of the colon and colorectal anastomosis. Colostomy was performed in two cases. The bladder was closed by simple suture and a urethral catheter was left in place for ten days. There were few complications, though one patient died. Pneumaturia and fecaluria are specific symptoms. Intravenous pyelography and cystoscopy are of little assistance and only a barium enema should be performed for preoperative diagnosis.

Aged↗
PubMed1983

[Protection of the pancreaticojejunal anastomosis after cephalic duodenopancreatectomy for tumor].

The main risk in cephalic duodeno-pancreatectomy for cancer is disruption of the anastomosis between the jejunum and the fragile pancreatic isthmus, as it may result in pancreato-biliary fistula with highly damaging local and regional repercussions. This risk can be reduced by inserting a 60 cm jejunal loop between the pancreatic and biliary anastomoses. The loop prevents biliary reflux and turns any possible disruption into a pure pancreatic fistula, better tolerated. The authors have used this techniques in 20 consecutive patients. The mortality rate was nil. In each of the four-fistulae that occurred, discharge of pancreatic juice ceased within 3 weeks.

Duodenum↗
PubMed1983

Inhibition of upper gastrointestinal secretions by reinfusion of succus entericus into the distal small bowel. A clinical study of 30 patients with peritonitis and temporary enterostomy.

We prospectively studied peritonitis secondary to small bowel leakage in 30 critically ill patients, each of whom had complete diversion of intestinal continuity by stoma, fistula, or both. All patients received total parenteral nutrition during implementation of the protocol. The proximal intestinal effluent was collected and recycled into the distal small bowel. During reinfusion of succus entericus, a significant reduction in the output of the proximal stoma was observed (mean 30.2%, p less than 0.001). The reinfusion also significantly reduced the volume from isolated small bowel loops in six patients (32.6%, p less than 0.001). When isotonic dialysate solution was infused into the distal intestine, a lesser though significant reduction in stoma output occurred (mean 20.3%, p less than 0.001). These findings demonstrate a consistent inhibitory effect upon upper gastrointestinal secretions by reinfusion of succus entericus. Clinical benefits of this technique include simplified control of fluid and electrolyte balance in patients with high output stomas and optimal utilization of remaining absorptive capacity for enteral nutrition.

Colostomy↗