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2.
Med Trop (Mars) ; 67(5): 529-35, 2007 Oct.
Article in French | MEDLINE | ID: mdl-18225739

ABSTRACT

Abbreviated laparotomy is a recent technique for management of patients with severe abdominal trauma. It is based on a unified approach taking into account the overall extent of injury and the victim's physiologic potential to respond to hemorrhage. It is the first step in a multi-modal strategy. The second step is the critical care phase. The third step consists of "second-look" laparotomy that should ideally be performed on an elective basis within 48 hours and is aimed at definitive treatment of lesions. The goal of abbreviated laparotomy is damage control using temporary quick-fix procedures limited to conspicuous lesions and rapid hemostasis and/or viscerostasis procedures so that the patient can survive the acute critical period. Tension-free closure of the abdominal wall, if necessary using laparostomy, is essential to avoid abdominal compartment syndrome. With reported survival rates of about 50% in Europe and the United States, this simple life-saving technique that requires limited resources should be introduced in Africa where severe abdominal trauma often involves young patients.


Subject(s)
Abdominal Injuries/surgery , Laparotomy/methods , Hemostasis , Humans , Injury Severity Score , Second-Look Surgery
4.
J Mal Vasc ; 28(4): 178-84, 2003 Oct.
Article in French | MEDLINE | ID: mdl-14618106

ABSTRACT

OBJECTIVE: Descending thoracic aorta to femoral artery bypass (DTAFB) has demonstrated usefulness in the treatment of aorto-iliac occlusive disease but related morbidity and mortality are not negligible. We wanted to determine the feasibility of thoracoscopic DTAFB and to report our clinical experience. MATERIAL AND METHODS: An experimental study was performed on 8 pigs in helicoidal position under general anesthesia with right selective ventilation ). Three trocars were inserted and the descending aorta was dissected ). After tunnelisation of a 6 mm graft, a lateral aortic anastomosis was thoracoscopically performed ) then femoral anastomoses were made. At the end of the procedure, an angiogram and then an autopsy were performed ). Subsequently, three patients were operated, two for thrombosis of a previous aortobifémoral bypass and one for infrarenal aortic hypoplasia. Dissection and graft tunnelisation were performed thoracoscopically ). Then, the aortic anastomosis ) was constructed through a left lateral minithoracotomy (10 cm). RESULTS: One pig died during surgery of acute lung oedema due to the difficulties of selective ventilation. Excluding this case, the average times of surgery and of dissection were respectively 246 (205-325) and 68 minutes (50-90). The average aortic clamping and anastomosing times were 135 (105-220) and 120 minutes (80-210) ). Three aortic tears were noted; one was repaired. Angiogram was normal 5 times; one pig had a minor stenosis and a leak, and another one had a leak. All the anastomoses were patent without stenosis at autopsy; no organ lesion was found. In humans, the procedure was performed with simple postoperative course in 2 patients and a conversion (20 cm long thoracotomy) was necessary for the third due to poorly supported selective ventilation. CONCLUSION: Totally thoracoscopic DTAFB can be performed in pigs. In clinical practice, we recommend the use of a mini thoracotomy. This way, the aortic anastomosis can be performed with aortic clamping time under 30 minutes, reducing the risk of spinal cord ischemia. These results allow to propose mini invasive thoracoscopically assisted DTAFB for the patients for whom laparoscopic access of the abdominal aorta appears to be difficult (calcified aorta, hostile belly.).


Subject(s)
Aorta, Thoracic/surgery , Femoral Artery/surgery , Thoracoscopy/methods , Aged , Anastomosis, Surgical/methods , Animals , Aorta, Thoracic/abnormalities , Female , Humans , Male , Middle Aged , Postoperative Complications/surgery , Swine , Thrombosis/surgery
5.
J Mal Vasc ; 27(4): 199-204, 2002 Oct.
Article in French | MEDLINE | ID: mdl-12457123

ABSTRACT

OBJECTIVE: To study the feasibility and the tolerance of a combined laparoscopic transperitoneal aortic and renal restoration performed on animals. METHODS: Six pigs (mean weight: 79.5 kg, range 73-86) underwent laparoscopic replacement of the abdominal aorta using a 6-mm Dacron(R) graft, with direct reimplantation of the left renal artery. The study protocol was approved by the Advisory committee of Animal Ethics. The animal was placed supine on the operative table with a pillow under the lumbar region in order to raise the aortic area. A first midline, 10-mm diameter trocar was placed under direct vision, 5 cm above the pubis and allowed the insufflation of a 12-mm Hg pneumoperitoneum. One 30 degrees optic was used during the intervention. The pig was then tilted to a 30 degrees Trendelenbourg's position and two other 10-mm trocars were introduced 5 cm medially to the right and left antero-superior iliac spines ). Four other 10-mm incisions were necessary for introduction of an intestinal retractor, a suction-irrigation device and two laparoscopic aortic clamps. RESULTS: The procedure was performed in all animals in a mean operative time of 320 min (292-366), including ): - a time for aortic and renal artery dissection of 104 min (90-120), - a supra-renal aortic clamping time of 221 min (180-276), - a time for confection of proximal and distal aorto-prosthetic anastomosis of respectively 59 min (40-75) and 64 min (50-80), - a time for the left renal artery reimplantation of 72 min (40-140). Average blood loss was 525 ml (250-1050), and the mean pre and postoperative hemoglobin and pH values were 9.9 g/dl (8.9-10.7) versus 9.4 g/dl (8.5-11.3) and 7.36 (7.31-7.38) versus 7.30 (7.21-7.43) respectively. An angiogram ) performed before the sacrifice of animals showed a wide patent anastomosis in 18 (56%) cases, a<50% stenosis in 4 cases (22%), a > 50% stenosis in 1 case (5%) and a thrombosis of the first three renal artery restorations (17%) probably due to insufficient intraoperative heparinization. CONCLUSION: This experimental study shows the feasibility of laparoscopic transperitoneal abdominal aortic restoration with re-implantation of the left renal artery (fig. et ). The techniques of arterial sutures must be improved in order to decrease aortic and renal clamping times.


Subject(s)
Aorta, Abdominal/surgery , Blood Vessel Prosthesis Implantation , Laparoscopy , Renal Artery/surgery , Anastomosis, Surgical , Animals , Blood Loss, Surgical , Feasibility Studies , Male , Polyethylene Terephthalates , Postoperative Complications , Renal Artery Obstruction/etiology , Swine , Thrombosis/etiology
6.
Chirurgie ; 124(4): 406-11, 1999 Sep.
Article in French | MEDLINE | ID: mdl-10546394

ABSTRACT

AIM OF THE STUDY: The aim of this prospective study was to report early results of videothoracoscopic truncal vagotomy in non-complicated chronic duodenal ulcers. PATIENTS AND METHODS: From 1995 to 1998, 250 patients suffering from chronic duodenal ulcer without pyloric stenosis were operated on in the main hospital of Dakar. They underwent videothoracoscopic truncal vagotomy without gastric drainage. The quality of gastric emptying and the incidence of secondary side-effects were assessed in the postoperative course and after one and three months. RESULTS: There were two intraoperative deaths, one due to aortic wound and the other one due to a poor surveillance after premature extubation. Postoperative complications included bronchopulmonary infection (n = 9), one septic pleural effusion and one chylothorax. A postoperative gastroplegia occurred in 12 patients, which was always spontaneously regressive without endoscopic pyloric dilatation. After one month, 204 patients (82%) were classified Visik 1, and 44 (18%) classified Visik 2. An endoscopic control examination showed a healed peptic ulcer and open pylorus in all patients, and a gastric stasis present in 40 cases (16%). After three months and a new evaluation, 234 were classified Visik 1 (94%) and 14 Visik 2 (6%). Dumping syndrome was not observed in this series and the incidence of diarrhea, which was 40% after one month, decreased to 3% after three months. CONCLUSION: The functional results of truncular vagotomy without gastric drainage were good or very good and improved with time. The quality of digestive comfort and the low frequency of side-effects are good arguments in favor of this procedure as an elective treatment of duodenal ulcers in developing countries.


Subject(s)
Duodenal Ulcer/surgery , Thoracic Surgery, Video-Assisted , Vagotomy, Truncal , Adult , Cause of Death , Chronic Disease , Chylothorax/etiology , Developing Countries , Diarrhea/etiology , Drainage , Dumping Syndrome/prevention & control , Female , Follow-Up Studies , Gastric Emptying/physiology , Gastroparesis/etiology , Humans , Incidence , Intraoperative Complications , Lung Diseases/microbiology , Male , Pleural Effusion/etiology , Prospective Studies , Senegal , Thoracic Surgery, Video-Assisted/adverse effects , Vagotomy, Truncal/adverse effects , Wound Healing
7.
Rev Pneumol Clin ; 55(1): 47-50, 1999 Mar.
Article in French | MEDLINE | ID: mdl-10367317

ABSTRACT

A 50-year-old man developed a bronchogenic cyst complicated by hemorrhage. A complete radiographic chest work-up provided a reliable diagnostic approach. Bronchogenic cysts are usually asymptomatic incidental discoveries. Chest ultrasonography confirms the cystic nature of the mediastinal mass. Computed tomography scan and especially magnetic resonance imaging further support the diagnosis and are helpful for guiding surgery. Surgery is required because of the unpredictable risk of hemorrhage, infection or enlargement.


Subject(s)
Bronchogenic Cyst/diagnosis , Biopsy , Bronchogenic Cyst/complications , Bronchogenic Cyst/surgery , Bronchoscopy , Diagnosis, Differential , Disease Progression , Hemoptysis/etiology , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Tomography, X-Ray Computed
8.
J Mal Vasc ; 23(3): 191-4, 1998 Jun.
Article in French | MEDLINE | ID: mdl-9669222

ABSTRACT

BACKGROUND: Progress in abdominal laparoscopy led us to study end-to-end anastomoses performed laparoscopically. METHOD: An experimental protocol in 10 castrated male pigs weighing 74-95 kg was approved by the ethics committee. After conventional anesthesia, each animal was positioned in lateral decubitus and a retropneumoperitoneum was created. CO2 inflation was maintained at 14 mmHg for insertion of 3 trocars, 5 to 10 mm width. The entire infrarenal aorta was dissected and resected with insertion of a 6 mm dacron prosthesis. Postoperative arteriography was performed in all cases. The animal was sacrificed for direct examination. RESULTS: One animal died during anesthesia induction and the entire protocol was conducted in 9 animals. Mean operative time was 397 min (305-535 min) including a mean 123 min (65-150) for aortic dissection, 82 min (30-155) for proximal anastomosis and 70 min (45-105) for distal anastomosis. Total blood loss varied from 100 to 450 cc (mean 252 cc). Mean difference between pre- and postoperative hematocrits was 4% (0-6%). Among the 18 aortic anastomoses performed, arteriography showed one with moderate leakage and one anastomotic thrombus. Stenosis > 50% was found in 4 cases and < 50% in 4 cases. Analysis of the different operative parameters showed a learning curve with decreasing operative time and improved quality of the anastomoses. CONCLUSION: This study demonstrates the feasibility of aortic reconstruction via retroperitoneal laparoscopy in the animal. This procedure could be introduced in man.


Subject(s)
Anastomosis, Surgical , Aorta, Abdominal/surgery , Laparoscopy , Plastic Surgery Procedures , Animals , Feasibility Studies , Male , Retroperitoneal Space , Swine
9.
Rev Pneumol Clin ; 54(5): 275-8, 1998 Oct.
Article in French | MEDLINE | ID: mdl-9894285

ABSTRACT

We report a case of dual parathyroid adenoma associated with an ectopic gland in the right latero-esophageal region of the mediastinum revealed by asymptomatic hypercalcemia. Because of this dual localization and the lack of MBI uptake on the mediastinal scintigram, thoracotomy was used as the first line approach instead of cervicotomy.


Subject(s)
Adenoma/diagnosis , Choristoma , Mediastinal Diseases/diagnosis , Parathyroid Glands , Parathyroid Neoplasms/diagnosis , Adenoma/diagnostic imaging , Adenoma/surgery , Bronchoscopy , Choristoma/surgery , Humans , Magnetic Resonance Imaging , Male , Mediastinal Diseases/surgery , Middle Aged , Parathyroid Glands/diagnostic imaging , Parathyroid Neoplasms/diagnostic imaging , Parathyroid Neoplasms/surgery , Radionuclide Imaging , Tomography, X-Ray Computed
10.
Rev Pneumol Clin ; 53(1): 21-6, 1997.
Article in French | MEDLINE | ID: mdl-9181148

ABSTRACT

We report a case of fortuitously observed Castleman's disease. An mediastinal opacity was observed on the chest x-ray. At surgery, the apparently benign tumor was well individualized. Pathology reported Castleman's disease. Pathogenesis is unknown. Recent data on localized and more diffuse forms of this disease are presented. Diffuse forms occur more readily in immunodepressed patients.


Subject(s)
Castleman Disease/diagnostic imaging , Adult , Castleman Disease/pathology , Castleman Disease/therapy , Humans , Male , Prognosis , Radiography, Thoracic
11.
Rev Pneumol Clin ; 53(4): 198-202, 1997.
Article in French | MEDLINE | ID: mdl-9616819

ABSTRACT

The authors report a case of american pulmonary histoplasmosis discovered by chance on a chest radiograph in a non immunocompromised patient, back from a stay in French Guyana. Confronted with the negativity of usual mycotic research, diagnosis has been made thanks to wedge excision by video-assisted thoracic surgery. The authors briefly sum up the recent facts regarding this imported infection, stressing the interest of a direct approach by surgical practices not very invasive that allow to eliminate with certainty neoplasm or tuberculosis.


Subject(s)
Histoplasmosis/diagnostic imaging , Lung Diseases, Fungal/diagnostic imaging , Adult , Histoplasmosis/diagnosis , Histoplasmosis/surgery , Humans , Lung Diseases, Fungal/diagnosis , Lung Diseases, Fungal/surgery , Male , Radiography
12.
Ann Thorac Surg ; 61(2): 533-7, 1996 Feb.
Article in English | MEDLINE | ID: mdl-8572762

ABSTRACT

BACKGROUND: Although thoracoscopy was originally described in 1910, recent developments in video-assisted surgical techniques and endoscopic equipment has expanded the application of video-assisted surgical procedures in the field of thoracic surgery. METHODS: In an effort to define both high-risk patients for video-assisted thoracic procedures and high-risk video-assisted thoracic surgical procedures, we reviewed the experience of four surgical institutions from June 1991 through May 1995. We looked specifically at complications resulting from the 937 video-assisted thoracic procedures performed during this period. RESULTS: Perioperative incidents or complications occurred in 35 patients (3.7%), and 116 procedures (12.4%) were converted to a thoracotomy. The in-hospital mortality rate was 0.5%, and death occurred principally in patients operated on for malignant pleural effusion. The overall incidence of postoperative complications was 10.9%, and the most prevalent complications were prolonged air leak (6.7%) and pleural effusion (0.7%). CONCLUSIONS: The incidence of complications was acceptable and, except for that of prolonged air leak, did not differ significantly from that resulting from analogous open procedures. Video-assisted thoracic surgery appears safe and particularly useful for some indications. However, the possibility of dramatic life-threatening perioperative complications requiring emergency conversion to thoracotomy justifies the fact that only trained thoracic surgeons should perform video-assisted thoracic surgical procedures.


Subject(s)
Endoscopy/adverse effects , Thoracoscopy/adverse effects , Thoracotomy/adverse effects , Videotape Recording , Adolescent , Adult , Aged , Aged, 80 and over , Chylothorax/etiology , Endoscopy/mortality , Female , Humans , Infections/etiology , Lung Neoplasms/complications , Lung Neoplasms/surgery , Male , Mediastinal Neoplasms/complications , Mediastinal Neoplasms/surgery , Middle Aged , Nervous System Diseases/etiology , Pleural Effusion/etiology , Pleural Effusion/surgery , Survival Rate , Thoracotomy/mortality
13.
Chirurgie ; 121(1): 51-6, 1996.
Article in French | MEDLINE | ID: mdl-8761706

ABSTRACT

The exceptional interest in endoscopic surgery, both in laparoscopic surgery and video-assisted thoracoscopic surgery have led many teams to widen their indications. This movement has developed into a revolution in techniques demanded by patients, the public, and the medias, requiring many practicians to use these techniques more and more often and consequently to attempt very delicate operations. This "explosion" of endoscopic techniques has largely benefited from advances in equipment development (optics, video instrumentation) but has also required that operators acquire rigorous procedures for the proposed techniques. With the development of new thoracoscopic techniques for therapeutic indications, there are an unavoidable number of incidents and complications. These incidents and complications are related both to the use of instruments undoubtedly not well enough adapted to the procedures used and also to "forced" indications. We humbly recognize that a certain number of incidents are related to the necessarily inadequate experience of the operators during the "run in" period. We emphasize that video-assisted thoracoscopic surgery is a complementary technique among the available therapeutic armamentarium. We evaluated the mid and long term results of cancerology exeresis with these two techniques and underscore that morbidity and complications are rare but sometimes unacceptable. In conclusion, whatever the form of the technique used, it is an important evolution in surgery which must abide by the classical rules, in particular for indications in cancer surgery.


Subject(s)
Endoscopy/adverse effects , Thoracoscopy/adverse effects , Thoracotomy/adverse effects , Endoscopy/mortality , Endoscopy/statistics & numerical data , Humans , Intraoperative Period , Postoperative Period , Thoracoscopy/mortality , Thoracoscopy/statistics & numerical data , Thoracotomy/mortality , Thoracotomy/statistics & numerical data
14.
Rev Pneumol Clin ; 51(2): 83-6, 1995.
Article in French | MEDLINE | ID: mdl-7569565

ABSTRACT

A case of agenesia of the right pulmonary artery was observed. The epidemiological and clinical characteristics of this congenital anomaly as well as treatment were reviewed: Surveillance or surgery?


Subject(s)
Pulmonary Artery/abnormalities , Adult , Humans , Male , Prognosis , Pulmonary Artery/diagnostic imaging , Pulmonary Artery/surgery , Radiography
15.
Med Trop (Mars) ; 55(1): 55-60, 1995.
Article in French | MEDLINE | ID: mdl-7637611

ABSTRACT

From 1989 to 1994, 71 patients were hospitalized for diagnosis of round lung lesions including 49 servicemen under the age of 45 years who had been stationed in tropical areas. In 6 of these servicemen, the diagnosis was pulmonary histoplasmosis at the tertiary stage of histoplasmoma. All had done duty in French Guyana and were negative for human immunodeficiency virus. The subpleural lung opacity was the only lesion in 5 out of 6 patients and was calcified in 4 out of 6 patients. Since skin tests with histoplasmin and serologic testing for histoplasmosis failed to achieve definitive diagnosis, surgical biopsy was performed by conventional thoracotomy in 2 cases and video-assisted thoracic surgery in 4 cases. The specimens obtained confirmed diagnosis of histoplasmosis on mycologic criteria in 3 cases and on a combination of findings including compatible histologic evidence in 3 cases. Treatment consisted in surgical excision of the nodules, for which video-assisted thoracoscopic surgery proved to be an excellent technique because of its simplicity and rapidity.


Subject(s)
Histoplasmosis/diagnostic imaging , Lung Diseases, Fungal/diagnostic imaging , Travel , Adult , Decision Trees , France/ethnology , French Guiana , Histoplasmosis/surgery , Humans , Lung Diseases, Fungal/surgery , Male , Middle Aged , Military Personnel , Radiography , Thoracoscopy , Thoracotomy
16.
Rev Pneumol Clin ; 51(4): 239-45, 1995.
Article in French | MEDLINE | ID: mdl-7501942

ABSTRACT

Two cases of pulmonary alveolar proteinosis are reported. Emphasis is placed on imaging techniques for diagnosis with bronchofibroscopy and bronchoalveolar lavage. Treatment of symptomatic forms is based on classical alveolar lavage with a rigid bronchoscope or currently with the fibroscope.


Subject(s)
Pulmonary Alveolar Proteinosis/diagnosis , Adult , Bronchoalveolar Lavage Fluid , Humans , Male , Middle Aged , Pulmonary Alveolar Proteinosis/diagnostic imaging , Pulmonary Alveolar Proteinosis/pathology , Pulmonary Alveolar Proteinosis/therapy , Radiography, Thoracic , Tomography, X-Ray Computed
17.
Rev Pneumol Clin ; 51(6): 351-3, 1995.
Article in French | MEDLINE | ID: mdl-8746026

ABSTRACT

The catheter of an implantable chamber migrated into the pulmonary infundibulum in a patient given chemotherapy for bronchogenic cancer. Current management of such cases is to remove the catheter under pulmonary angiography control using a basket system.


Subject(s)
Catheters, Indwelling/adverse effects , Foreign-Body Migration/diagnosis , Infusion Pumps, Implantable/adverse effects , Antineoplastic Agents/administration & dosage , Humans , Lung , Male , Middle Aged
18.
Ann Chir ; 45(8): 695-8, 1991.
Article in French | MEDLINE | ID: mdl-1768027

ABSTRACT

The authors report an exceptional case of giant cell tumour of the third thoracic vertebra revealed by its mediastinal development. Despite intimate involvement of the large mediastinal vessels, a double surgical approach, starting with sternotomy to ensure vascular control then anterolateral thoracotomy, allowed curative resection of this tumor. Treatment was completed by a second neurosurgical operation followed by 5,000 rads of radiotherapy. Based on a review of the literature, the authors discuss the pathogenesis and consider the various therapeutic problems raised by giant cell tumours of the vertebrae (situated above the sacrum).


Subject(s)
Bone Neoplasms/surgery , Giant Cell Tumors/surgery , Mediastinal Neoplasms/surgery , Adult , Bone Neoplasms/diagnostic imaging , Bone Neoplasms/radiotherapy , Combined Modality Therapy , Giant Cell Tumors/diagnostic imaging , Giant Cell Tumors/radiotherapy , Humans , Magnetic Resonance Imaging , Male , Mediastinal Neoplasms/diagnostic imaging , Mediastinal Neoplasms/radiotherapy , Radiation Dosage , Radiography , Thoracotomy
19.
J Urol (Paris) ; 96(7): 399-402, 1990.
Article in French | MEDLINE | ID: mdl-2290042

ABSTRACT

The authors report one case of post-traumatic hematic pseudocyst of the right adrenal demonstrated with magnetic resonance imaging. Total adrenalectomy was performed; the clinicopathological examination confirms the absence of any underlying tumoral process and allows the hypothesis that stress was a fostering factor. After a review of the literature noting that the risk of hemorrhagic recurrence is underestimated, while the number of underlying cancers is small and easily detected since imaging of the adrenals has been refined, the authors discuss the procedure of treatment and the technical aspects of surgery for the hematomas confined to the adrenal space: surgical exeresis is proposed as a rule, but this should be qualified, as a medical alternative can be justified provided the causal affection disappears and a strict observation with computed tomography or magnetic resonance imaging is ensured.


Subject(s)
Adrenal Gland Diseases/diagnostic imaging , Hematoma/diagnostic imaging , Lumbar Vertebrae/injuries , Adrenal Gland Diseases/surgery , Adrenalectomy , Adult , Hematoma/surgery , Humans , Magnetic Resonance Spectroscopy , Male , Radiography , Ultrasonography
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