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Biomedical subjects

R Prêtre

Publications and source records attributed to R Prêtre.

86 records · Page 5Linked to original sources
PubMed1992

Results of surgical palliation for cancer of the head of the pancreas and periampullary region.

Between 1977 and 1986, 101 patients underwent surgical bypass for periampullary carcinoma. The hospital mortality rate was 18 per cent and the morbidity rate 43 per cent. Mortality was not influenced by the extent of the tumour. Survival rates at 1,2 and 3 years were 28, 9 and 4 per cent, respectively. The median survival time was 17 months for localized tumours, 10 months for those that had invaded surrounding tissues, 6 months in the presence of lymph node involvement and 3 months with distant metastasis. The quality of survival was good for most patients with localized tumours but poor for those with parenchymal metastasis, in whom palliation was transient for 85 per cent and effective for less than half of their survival time for 60 per cent. These results suggest that patients with distant metastasis but without impending duodenal obstruction should undergo palliation by endoscopic or percutaneous routes while those with less advanced disease or with duodenal involvement remain candidates for surgical bypass.

Adenocarcinoma↗
PubMed1992

Aortoiliac endarterectomy: a 9-year experience.

Thirty-two patients (median age: 51 years) underwent aortoiliac endarterectomy between 1982 and 1990, for disabling claudication (27), rest pain (3), and tissue loss (2). There was no post-operative death and morbidity affected 6 patients. Five patients showed insufficient or suboptimal vascularisation of a limb which justified early reoperation in four. Follow-up was obtained in 31 patients with a median time of 36 months (6 months to 8 years). Five patients experienced recurrence of claudication symptoms: two received an aortofemoral bypass at 6 and 36 months. In the other patients, distal arterial occlusive disease accounted for recurrence alone (2 patients) or in association with aortoiliac involvement (1). Technical problems or disputable indications were responsible for postoperative failure in 3 cases or early recurrence of symptoms in 2. Cumulative patency rates of aortoiliac endarterectomy were 94 and 90 per cent at 2 and 5 years, and actuarial rates of clinical improvement were 90 and 82 per cent at 2 and 5 years, respectively. Aortoiliac endarterectomy provides the advantages of avoiding foreign material. The success of this reconstruction depends on strict criteria of selection and surgical expertise. It is indicated for the relatively young patient with nonectasic disease where atherosclerosis has not attacked the external iliac arteries.

Adult↗
PubMed1992

[Pneumomediastinum and subcutaneous cervical emphysema as signs of rectosigmoid perforation].

Pneumomediastinum and subcutaneous emphysema of the neck occur exceptionally in spontaneous, retroperitoneal perforation of the sigmoid colon. These signs, in association with a septic syndrome and multiple organ failure, mandate the search of a gastrointestinal tract perforation, even in the absence of digestive symptoms. Careful deep palpation of the abdomen may determine the abdominal origin of the septic focus and thereby provide justification for exploratory laparotomy without further diagnostic investigations.

Aged↗
PubMed1992

[Perforation of gastric ulcer in inguinal hernia].

We report about a case of perforation of a peptic ulcer in an inguinal hernia. A 64-year-old female patient had been suffering from bilateral inguinal hernias for several years, without digestive complaints. The sudden occurrence of symptoms resulted not from strangulation, but from a specific complication of the incarcerated organ, ie. the perforation of an ulcer of the antrum, probably secondary to the intake of nonsteroid anti-inflammatories. Surgical treatment consisted in the suture of the perforation and the cure of the hernia with a net.

Female↗
PubMed1991

[Aortoiliac occlusive disease: yesterday and today].

The surgical management of aortoiliac atherosclerotic occlusive disease includes endarterectomy and prosthetic by-pass in either the anatomical or extraanatomical position. Aortoiliac endarterectomy is only indicated in localized disease which spares the external iliac artery and does not exhibit aneurysmal changes. Prosthetic by-pass is easier to perform, but carries graft-related risks including anastomotic pseudoaneurysms in 5 to 10% of cases at 10 years. Extraanatomical shunts are performed when there are general or abdominal contraindications to an anatomical by-pass. Simultaneous revascularisation of the aortic visceral branches mainly involves the renal, inferior mesenteric and hypogastric arteries. Correction of celiac and superior mesenteric artery stenosis is less frequently indicated. The appropriate approach and surgical technique depend on the artery and the lesion involved. Suprarenal implantation of aortoiliac by-passes is performed at the celiac, descending aortic and ascending aortic levels. Indications include suprarenal coarctation of the aorta, reoperation following ligature of the juxtarenal aorta, and some cases of extensive thoracoabdominal atherosclerosis. The surgical management of aortoiliac occlusive disease in 353 patients treated in our clinic between 1976 and 1986 is reported. Mean follow-up exceeded 5 years. Operative mortality for endarterectomy (15 patients) was nil, and was 3.9% for by-pass graft. Early complication rate was 6.5% and late complication rate 23.2%. Half of the late complications were due to progression of the atherosclerotic process. Pseudoaneurysms at the aortic (3.1%) and femoral (9.9%) levels occurred between the fifth and tenth years. Prosthesis infection occurred shortly after operation in 3 patients and much later in 2 patients.

Anastomosis, Surgical↗
PubMed1991

[Experience with a surgical mesh covering a hepatectomy incision].

A polyglycolic acid net (Vicryl) has been applied against the hepatectomy section of 27 patients (14% of all our liver resections) to complete its hemostasis. The indications for the use of this net were: the persistence of blood oozing and/or the necessity to shorten the operation. In one patient suffering from severe coagulopathy, active bleeding continued until the patient died; another patient bled until his blood dyscrasia was corrected. One case of abscess was encountered, and treated through a percutaneous approach. Although the achievement of perfect hemostasis is usual in surgical exeresis of the liver, a minority of patients can present with resistant bleeding of the resection slice, for which packing with a net may prove to be useful.

Adult↗
PubMed1990

[Cervico-thoracic outlet compression syndrome].

This retrospective study compares the results of two surgical procedures, a transaxillary and a transthoracic (i.e. antero-lateral thoracotomy) approach, in the treatment of the thoracic outlet syndrome by first rib resection. Following transaxillary first rib removal (13 cases), initially our procedure of choice, 84% of patients had symptoms improved, 8% were unchanged and 8% were worse after one year. One permanent, disabling brachial plexus injury occurred after this operation. Transthoracic first rib resection (18 cases), presently our preferred technique, resulted in improvement in 87% of cases, with 13% of symptoms unchanged after one year. While two female patients felt mild paresthesia of their mammary gland, no one has been made worse following this route. These two approaches have achieved similar results in the surgical management of this syndrome. Nevertheless, when first rib resection is indicated, our favored and recommended procedure is the transthoracic one, as this appears less hazardous for brachial plexus damage.

Axilla↗
PubMed1989

Transthoracic approach in the thoracic outlet syndrome: an alternate operative route for removal of the first rib.

This retrospective study compares the results of two surgical procedures, a transaxillary and a transthoracic (that is, anterolateral thoracotomy) approach, in the treatment of the thoracic outlet syndrome by first rib resection. After transaxillary first rib removal (13 cases), initially our procedure of choice, 84% of conditions were improved, 8% were unchanged, and 8% were worse after 1 year. One permanent, disabling brachial plexus injury occurred after this operation. Transthoracic first rib resection (18 cases), presently our preferred technique, resulted in improvement in 87% of cases, with 13% of symptoms unchanged after 1 year. Although two female patients felt mild paresthesia of the mammary gland, no one has been made worse following this route. These two approaches have achieved similar results in the surgical management of this syndrome. Nevertheless, when first rib resection is indicated, our favored and recommended procedure is transthoracic, because this route appears less hazardous for brachial plexus damage.

Adult↗
PubMed1988

Hepatic trauma: risk factors influencing outcome.

This retrospective study analyses the fate and associated risk factors of 99 patients who underwent laparotomy for hepatic trauma from 1977 to 1986. Blunt trauma (88 patients) and stab wounds (7 patients) had mortality rates of 36 and 14 per cent respectively. The overall death rate was 35 per cent. Multiple trauma patients had a significantly higher mortality for each additional system that was seriously injured. Pre-operative shock raised the mortality from 20 to 58 per cent (P less than 0.001). For patients over 50 years of age, the mortality rate increased from 30 (younger patients) to 63 per cent (P = 0.028). Minor hepatic wounds required relatively simple surgical measures in 60 patients, yet 13 died (22 per cent) of other causes. More sophisticated surgical management was applied to 27 major hepatic lesions, with 10 deaths (37 per cent). Twelve patients (seven with minor and five with major hepatic wounds) died before surgical treatment of the liver injury could be undertaken. The overall mortality rate of major hepatic wounds was 47 per cent and for minor wounds 30 per cent. However, the difference was not significant (P = 0.152). Resection was resorted to in 15 patients, 5 of whom subsequently died (33 per cent). Classical hepatic lobectomy led to 4 deaths (50 per cent). Among the 35 deaths, 6 were due to the hepatic trauma itself (5 exsanguinations and 1 intra-abdominal sepsis). Isolated hepatic injury was fatal in three patients. We believe that conservative surgical measures should be used whenever possible in patients with hepatic trauma, especially when risk factors are encountered.

Adolescent↗
PubMedDate not supplied

Approach to the mitral valve through a right thoracotomy in potentially hazardous reoperation.

BACKGROUND: Repeat sternotomy for mitral valve surgery may be hazardous in some patients. A right thoracotomy avoids the densely scarred area beneath the sternum and provides adequate in-line exposure of the mitral valve. METHODS: Between 1994 and 1997, five patients were reoperated for a mitral valve or prosthesis dysfunction through a right thoracotomy. Indications were three second redo-mitral valve surgeries and two first redo, once in a patient with an aortic prosthesis and once in a patient with patent aortocoronary grafts. The operation was performed without clamping the ascending aorta in moderate hypothermic (four patients) or normothermia (one patient). RESULTS: Exposure of the mitral valve for replacement (four patients) or for repair of a paraprosthetic leak (one patient) was optimal in all patients. Resumption of cardiac function occurred rapidly after repair without specific support. Postoperative course was uncomplicated. Blood loss ranged from 300 to 700 mL. Patients were discharged from 7 to 12 days postoperatively. They are in New York Heart Association (NYHA) functional Class I (four patients) and II (one patient), from 3 to 42 months postoperatively. CONCLUSION: Right thoracotomy provides a direct "in the line of vision" access to the mitral valve. Because complete de-airing of the heart is difficult and respiratory function depressed after a right thoracotomy, this approach seems suitable when technical difficulties are expected in sternal reopening.

Adult↗
PubMedDate not supplied

Less invasive surgical treatment of renal cell carcinomas extending into the right heart and pulmonary arteries: surgery for renal cell carcinoma.

BACKGROUND: Radical resection using deep hypothermic circulatory arrest improves the survival of patients with transvenous intracardiac tumor extension of renal cell carcinomas. A less invasive surgical approach avoiding deep hypothermia, circulatory arrest, and cross-clamping of the aorta is presented. METHODS: Between 1987 and 1999, 12 patients (mean age 57+/-8 years) underwent resection of a renal cell carcinoma extending into the right atrium, right ventricle, or pulmonary arteries. After median sterno-laparotomy, normothermic cardiopulmonary bypass is used cannulating the ascending aorta, superior caval vein, and inferior caval vein below the renal veins. The tumor and the corresponding kidney are radically excised, including the renal vein. Tumor fragments from the inferior caval vein, the right heart, and pulmonary arteries are removed either on the fibrillating or beating heart. RESULTS: Operative mortality was 0%. Mean cardiopulmonary bypass time was 53+/-27 minutes (median 36; range 32-110 minutes). Mean blood loss per patient was 1200 mL. Mean duration of postoperative mechanical ventilation was 36+/-12 hours (median 36; range 30-77 hours), mean intensive care stay 5.5+/-5 days (median 3; range 1-48 days), and mean duration of hospitalization 22+/-12 days (median 21; range 10-58 days). All patients were discharged home. Patients with multiple tumor manifestations outside the cardiovascular systems died within 9 months after the operation. CONCLUSIONS: The use of normothermic cardiopulmonary bypass is a less invasive method for radical resection of renal cell carcinoma with intracardiac tumor extension. Radical resection does not improve survival in patients with multiple distant metastases.

Adult↗
PubMedDate not supplied

Resection of ascending aorta aneurysm in redo surgery through an anterior thoracotomy.

Resection of an aneurysm of the distal ascending aorta was performed under hypothermic circulatory arrest and retrograde cerebral perfusion though a right anterior thoracotomy. Seven years before, the patient had undergone orthotopic cardiac transplantation and had required pectoral muscle plasty to heal an infectious mediastinitis. This new approach avoided a potentially hazardous sternotomy and allowed successful resection of the aneurysm and reconstruction of a thrombosed innominate vein.

Aortic Aneurysm↗