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Grève E, Dumas O, Fumex F, Cambou M, Burgard G, Décousus M, Audigier JC. [Solitary pancreatic metastasis four years after curative treatment for rectal carcinoma]. ACTA ACUST UNITED AC 2008; 32:258-60. [PMID: 18456107 DOI: 10.1016/j.gcb.2008.01.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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2
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Abstract
The extreme disturbance of hemodynamics in shock leads to a minimized oxygen delivery to several vital organs. If this state is not rapidly lifted, a multi-organ-failure can occur. In addition to the removal of the underlying causes, for example, bleeding or septic focus, measures must be started to stabilize hemodynamics. In most cases shock can be successfully treated with standard therapeutic interventions including the use of crystalloid or colloid solutions as well as the infusion of inotropes or vasopressors. Up to now, there is not enough evidence to show that hypertonic/hyperoncotic solutions are better for treating hypovolemic shock than standard infusions, other than in situations, where only an inadequate equipment is available. Experimental data support the use of vasopressin instead of fluid loading in case of uncontrolled intra-abdominal bleeding. According to these studies vasopressin seems to be associated with an improved hemodynamic stabilization and a significantly lower mortality rate. However, no clinical tests have been done so far to confirm these results. In septic shock the plasma-levels of vasopressin are low. It has been shown that the infusion of vasopressin contributes to stabilization of hemodynamics in septic shock, in lower, as well as in higher concentrations. On the other hand vasopressin worsens splanchnic perfusion. Therefore the routine use of vasopressin in the treatment of sepsis can not be recommended.
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Affiliation(s)
- A Meier-Hellman
- Klinik für Anästhesie, Intensivmedizin und Schmerztherapie, HELIOS-Klinikum Erfurt GmbH
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3
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Abstract
The risk of thoracic cancer surgery in patients of advanced age, i.e. 75 years or older, was analysed by reviewing 119 consecutive patients from August 1986 to May 1998 with bronchial carcinoma (n = 87), pulmonary metastases (n = 22), mesothelioma and pleural carcinosis (n = 7) and mediastinal or chest wall tumours (n = 3). Repeated surgery in one case of bronchial carcinoma and in another of metastases gave a total of 124 operations. Of the patients, 22 were 80 years or older (21%) and 32% were female. The median age was 77 years (range 75-87 years). Six fatalities occurred within 30 days or during hospitalization. This corresponds to a 4.8% mortality for the whole series and 6.8% for the subgroup of bronchial carcinoma. The causes of death were surgical complications in two patients, one died from heart failure after simultaneous combined coronary artery bypass grafting and left lower lobectomy 2 hours after the operation from heart failure refractory to resuscitation. With this exception all these patients had stage II (n = 2) or stage III A (n = 3) bronchial carcinoma. It is concluded that cancer surgery in the elderly is safe provided appropriate selection is observed. Indications should be very restrictive for advanced cancer and for pneumonectomy.
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Affiliation(s)
- J Hasse
- Department of Thoracic Surgery, University Hospital of Freiburg, Germany
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Fingerhut D, Burgard G. [Fenoterol for section]. Anaesthesist 1997; 46:174. [PMID: 9133180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- D Fingerhut
- Klinik und Poliklinik für Anästhesiologie und operative Intensivmedizin der Westfälischen Wilhelms-Universität Münster
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5
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Abstract
This study was designed to investigate whether the advantages of low- and minimal-flow anaesthesia can be combined with the laryngeal mask airway (LMA). Seventy female patients undergoing routine gynaecological surgery were investigated. After induction of anaesthesia and after positioning a laryngeal mask airway nos 3 and 4, patients were ventilated for 20 min with a fresh gas flow of 6 L min-1. Thereafter, the flow was reduced to 1 L min-1 in 50 patients and to 0.5 L min-1 in 20 patients. Once in the proper position, the LMA allowed flow reduction in all patients, indicating that no gas leakage occurred. It is concluded, that the application of low-flow and even minimal-flow anaesthesia is an alternative to high-flow anaesthesia. It can result in high annual savings and minimization of pollution. However, its use should be restricted to those anaesthesiologists who are experienced with the laryngeal mask airway and minimal-flow anaesthesia.
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Affiliation(s)
- T Möllhoff
- Klinik und Poliklinik für Anästhesiologie und operative Intensivmedizin, Westfälische Wilhelms-Universität Münster, Germany
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Abstract
STUDY OBJECTIVE To study the effect of laryngeal mask airway (LMA) cuff pressure on the incidence of postoperative sore throat. DESIGN Prospective, randomized, observational study. SETTING Operating room of a university hospital. PATIENTS 200 consecutive adult patients requiring anesthesia for gynecologic procedures. INTERVENTIONS Anesthesia was induced with thiopental 3-5 mg/kg, fentanyl 2 micrograms/kg, vecuronium bromide 0.05mg/kg, and enflurane 0.8% to 2% and maintained with nitrous oxide and oxygen (65%/35%) and enflurane. MEASUREMENTS AND MAIN RESULTS In Group 1, cuff pressure measurement was continuously performed until the end of the operation. In Group 2, 5 minutes after induction of anesthesia and 2 minutes after insertion of the LMA, cuff pressure was also continuously observed and reduced to the minimal pressure required for airtightness. In the recovery room, after the operation, patients were questioned for postoperative sore throat 4, 8, and 24 hours after the operation following a scoring protocol (score 0 = no complaints, score 1 = minimal sore throat, score 2 = moderate sore throat, score 3 = severe sore throat: "never a LMA again". Continuous monitoring of cuff pressure revealed a steady increase of pressure (during the first 60 minutes increases of 43 cm H2O) in Group 1. In Group 2, after release of air, cuff pressures were significantly lower through the entire operation when compared with Group 1. In Group 1, 8 patients claimed to have a sore throat (Score 1, n = 4; Score 2, n = 3; Score 3, n = 1). In Group 2, no patient complained of sore throat. CONCLUSIONS A significant increase in cuff pressure is seen during the first 60 minutes. Three minutes after insertion of the laryngeal mask, cuff pressure can significantly be reduced without any major gas leakage. Postoperative sore throat can be reduced when cuff pressure is continuously monitored and kept on low-pressure values.
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Affiliation(s)
- G Burgard
- Klinik und Poliklinik für Anästhesiologie und operative Intensivmedizin, Westfälische Wilhelms-Universität Münster, Germany
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Abstract
This study investigated 22 patients with histologically proven primary bronchial carcinoids and in particular the relationship between assessment parameters and survival. In each patient, age, sex, smoking habits, mode of presentation, results of diagnostic investigations, methods of treatment and pathological examination of resected specimens were recorded. Follow-up was possible in all patients for at least 5 years. Patients with atypical carcinoids were 10 years older than patients with typical ones. Eleven patients were smokers, all the patients with atypical and 4 patients with typical carcinoid. The most common presenting mode was pneumonia. Fiberoptic bronchoscopy was diagnostic in 11 cases. The survival rate for patients with typical carcinoid was 100%, while it was 57% in patients with atypical carcinoids. Patients with limited disease had a survival of 100%, while in stage III/IV patients showed a lower survival rate (50%). In conclusion, carcinoid tumors of the lung are tumors showing a good prognosis. Five-year survival indicated a significant difference between typical and atypical carcinoids and between limited and extensive disease. A precise staging is recommended for a better treatment and follow-up.
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Affiliation(s)
- M Froudarakis
- Department of Thoracic Medicine, University of Crete, Medical School, Heraklion, Greece
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8
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Abstract
OBJECTIVE To investigate the occurrence of postoperative nausea and vomiting (PONV) in relation to the menstrual cycle in patients anaesthetised with isoflurane and propofol. METHODS 150 patients were randomly allocated to two groups (n = 75). All patients received antiemetic treatment with 20 micrograms/kg droperidol i.v. before induction of anaesthesia. In the isoflurane group, patients were anaesthetised with thiopental, fentanyl, vecuronium, and isoflurane; in the propofol group, with propofol, fentanyl, and vecuronium. Patients were ventilated with nitrous oxide/oxygen in both groups. RESULTS Under isoflurane-based anaesthesia PONV occurred in 22 (29%) patients, under propofol-based anaesthesia in 4 (5%) patients (p < 0.05). 41 study participants underwent laparoscopy during the first 8 days of the menstrual cycle. 12 (29%) of these patients developed PONV (p < 0.05 vs second and third phase of the menstrual cycle). 10 of these 12 study participants were in the isoflurane group. Postoperative shivering occurred in 38 (51%) patients anaesthetised with isoflurane and in 12 (16%) patients of the propofol group (p < 0.05). CONCLUSIONS The incidence of PONV is significantly higher when patients undergo laparoscopy during the first 8 days of the menstrual cycle. When compared to isoflurane, propofol results in a significantly lower incidence of PONV and postoperative shivering and a lower occurrence of postoperative pain.
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Affiliation(s)
- T Möllhoff
- Klinik und Poliklinik für Anästhesiologie und operative Intensivmedizin, Westfälische Wilhelms-Universität, Münster
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Maachi K, Berthoux P, Burgard G, Alamartine E, Berthoux F. Results of a 1-year randomized controlled trial with omega-3 fatty acid fish oil in renal transplantation under triple immunosuppressive therapy. Transplant Proc 1995; 27:846-9. [PMID: 7879202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- K Maachi
- Service de Néphrologie, Dialyse et Transplantation Rénale, Hôpital Nord, Centre Hospitalo-Universitaire de Saint-Etienne, France
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Burgard G, Marmorale A, Breullie G. [Treatment of endoscopic colonic perforations by anastomosis in non exclusive lateral colostomy]. J Chir (Paris) 1994; 131:554-7. [PMID: 7738128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The authors report two cases of colonic endoscopic perforation with peritonitis treated by minimal lateral colostomy. The evolution was favorable in this two cases with spontaneous closure of colostomy. We intended to remind the usefulness of this old and simple technique sometimes omitted in the therapeutic armentorium of the iatrogenic colic perforation, especially from endoscopic origin. Thus the risk of complications of an ideal surgery or the necessity of a second-time anastomosis after the initial colostomy can be avoided.
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Affiliation(s)
- G Burgard
- Service de Chirurgie Digestive, Hôpital Nord, C.H.R.U. de Saint-Etienne
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Cathebras P, Burgard G, Bouchou K, Rousset H. [Late infectious complications of celioscopic cholecystectomy]. Presse Med 1994; 23:1452. [PMID: 7824463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
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Burgard G, Marmorale A, Cuilleret J. [Treatment of large abdominal eventrations with an intraperitoneal stapled plate. Apropos of a series of 27 patients]. J Chir (Paris) 1994; 131:351-4. [PMID: 7844193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Treatment of 27 large abdominal eventrations by intra-peritoneal prothesis fixed by staples is reported. Only one recurrence (3.5%) in the post-operative period, the good results observed, absence of grave complication, and great simplicity of this procedure lead the authors to recommend the use of intraperitoneal prosthesis in the treatment of post-operative eventration with major loss of parietal substance.
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Affiliation(s)
- G Burgard
- Service de Chirurgie Digestive, Hôpital Nord, C.H.R.U. de Saint-Etienne, Saint-Priest en Jarez
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Cathébras P, Thibaudin D, Burgard G, Gouilloud S, Bouchou K, Rousset H. [Recurrent Alcaligenes xylosidans intra- and retroperitoneal abscess following celioscopic cholecystectomy]. Rev Med Interne 1994; 15:432. [PMID: 8059179 DOI: 10.1016/s0248-8663(05)81462-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Gilly FN, Carry PY, Sayag AC, Brachet A, Panteix G, Salle B, Bienvenu J, Burgard G, Guibert B, Banssillon V. Regional chemotherapy (with mitomycin C) and intra-operative hyperthermia for digestive cancers with peritoneal carcinomatosis. Hepatogastroenterology 1994; 41:124-129. [PMID: 8056398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Intraperitoneal chemo-hyperthermia with mitomycin C was used to treat 28 patients with far advanced digestive adenocarcinoma and histologically confirmed peritoneal carcinomatosis. Surgical resection of the primary tumor was possible in 17 cases. After closure of the abdominal wall, intraperitoneal chemo-hyperthermia was performed for 90 to 120 minutes under general anesthesia and 32 degrees C hypothermia, through 3 intraperitoneal drains forming a closed circuit, using 10 mg/l of mitomycin C in 6 liters of peritoneal dialysate heated to an inflow temperature of 46-49 degrees C. No mortality occurred, and there were 2 post-operative complications, with transitory biological side effects. In 9 out of 10 patients with preoperative malignant ascites, the ascites cleared after treatment. One-year survival rate was 54.2%. These encouraging preliminary results show that intraperitoneal chemohyperthermia with mitomycin C is a safe and reliable treatment for peritoneal carcinomatosis in far advanced digestive cancers.
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Affiliation(s)
- F N Gilly
- Department of General and Thoracic Surgery, Centre Hospitalier Lyon Sud, France
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Cathébras P, Burgard G, Poulard G, Marion A, Bouchou K, Ninet J, Rousset H. [Digestive arterial obstructive diseases in three young women]. J Mal Vasc 1994; 19:46-50. [PMID: 8027681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The authors report three cases of severe intestinal ischaemia occurring in young women (age 29-44), all of them being smokers. In all cases, intestinal ischaemia was recognized lately and lead to death within two years. The occlusive arterial lesions concerned nearly exclusively the intestinal arteries. Microscopic lesions were heterogeneous and non-specific. In a case, an occlusive intimal fibrosis was noted; in another case, fibrosis of the media and the adventitia was observed; and in the last case, the lesions were suggestive of thromboangiitis obliterans. The authors advocate for the systematic recording of cases of intestinal ischaemia in young women, in order to identify the risk factors and pathogenic features of this rare condition.
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Affiliation(s)
- P Cathébras
- Service de Médecine Interne, Hôpital Nord, CHU de Saint-Etienne
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Burgard G, Cathebras P, Bouchou K, Thibaudin D, Rousset H. Les tumeurs cervicales pseudo-thyroïdiennes. Étiologies et problèmes diagnostiques: à propos de vingt cinq observations. Rev Med Interne 1993. [DOI: 10.1016/s0248-8663(05)80574-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Burgard G, Cuilleron M, Cuilleret J. [An unusual complication of perforated sigmoid diverticulitis: gas in the portal vein with miliary liver abscesses]. J Chir (Paris) 1993; 130:237-239. [PMID: 8345021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
A patient presented with gas in the portal vein and miliary liver abscesses due to perforation of a sigmoid diverticulitis abscess. The outcome was favorable after surgical treatment. Gas in the portal vein, a sign of extreme seriousness, is generally the result of intestinal necrosis from ileo-mesenteric artery infarction, responsible for more than 75% of deaths. Diagnosis of this exceptional complication, suggested from a straight abdominal film, was confirmed by hepatic ultrasound and scan imaging. Urgent surgical intervention can hopefully, as in the present case, result in the patient's survival.
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Affiliation(s)
- G Burgard
- Service de Chirurgie Digestive, Hôpital Nord, Saint-Priest en Jarez
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Mahul P, Burgard G, Costes F, Guillot B, Massardier N, el Khouri Z, Cuilleret J, Geyssant A, Auboyer C. [Postoperative respiratory function and cholecystectomy by laparoscopic approach]. Ann Fr Anesth Reanim 1993; 12:273-7. [PMID: 8250365 DOI: 10.1016/s0750-7658(05)80653-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Open cholecystectomy is associated with characteristic changes in pulmonary function showing a restrictive pattern. Laparoscopic cholecystectomy without opening of the peritoneal cavity could be an alternative in reducing postoperative respiratory dysfunction. Having given their informed consent, 13 healthy ASA1 patients (age: 41 +/- 18 yrs) undergoing laparoscopic cholecystectomy were enrolled in this study, in order to assess their postoperative pulmonary function tests (forced vital capacity [FRC], forced expiratory volume [FEV1], functional residual capacity [FRC]) before operation (T0) and 4 h (T4), 24 h (T24), 48 h (T48) after surgery. Anaesthesia technique was the same associating propofol-atracurium-fentanyl, 50% N2O/O2. Ventilation was adapted to maintain end-tidal carbon dioxide pressure up to 30-35 mmHg. Postoperative analgesic regimen consisted of paracetamol-ketoprofen. Mean length of surgery was 84 +/- 15 min; mean duration of anaesthesia was 110 +/- 24 min. An immediate and harmonious restrictive breathing pattern developed postoperatively. Postoperative FVC measured 65% (T4), 63% (T24), 72% (T48) of preoperative function (p < 0.025); postoperative FEV1 measured respectively 60, 66 and 75% of preoperative function (p > 0.001), without change in FEV1/CV and FRC; a significant hypoxia occurred (T0: 86 mmHg, T4: 80 mmHg, T24: 75 mmHg, T48: 81 mmHg [p < 0.05]). Laparoscopic cholecystectomy resulted in less postoperative respiratory dysfunction than conventional cholecystectomy, as previously reported; this restrictive pattern observed without changes in FRC was similar to that following lower abdominal surgery.
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Affiliation(s)
- P Mahul
- Département d'Anesthésie-Réanimation, Hôpital Nord, Saint-Priest-en-Jarez
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Gilly FN, Carry PY, Brachet A, Sayag AC, Panteix G, Salle B, Bienvenu J, Banssillon V, Burgard G, Manchon M. Treatment of malignant peritoneal effusion in digestive and ovarian cancer. Med Oncol Tumor Pharmacother 1992; 9:177-81. [PMID: 1342062 DOI: 10.1007/bf02987754] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Intra Peritoneal Chemo Hyperthermia (IPCH) with Mitomycin C (MMC) or Cisplatinum (CP) was used to treat 32 patients with far advanced digestive or ovarian cancers and peritoneal carcinomatosis. Surgical resection of the primary tumor has been possible in 18 cases. After closure of the abdominal wall, a 90 minutes IPCH as performed under general anaesthesia and 32 degrees C general hypothermia, through 3 intraperitoneal drainages realizing a closed circuit, using 10 mg/l of MMC or 15 to 25 mg/l of CP in 6 l of peritoneal dialysate heated at the inflow temperature of 46 to 49 degrees C. The mortality rate was 3% and the morbidity rate was 3%. In 11 out of 12 patients with preoperative malignant ascites, no more ascites could be found after IPCH. For peritoneal carcinomatosis from digestive origin, median survival was 11.2 months and 1 year survival rate was 46.9%. These encouraging preliminary results show that IPCH is a safe and reliable treatment for peritoneal carcinomatosis in far advanced digestive or ovarian cancers.
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Affiliation(s)
- F N Gilly
- Department of General and Thoracic Surgery, Centre Hospitalier Lyon Sud, France
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Berthoux FC, Guerin C, Burgard G, Berthoux P, Alamartine E. One-year randomized controlled trial with omega-3 fatty acid-fish oil in clinical renal transplantation. Transplant Proc 1992; 24:2578-82. [PMID: 1465872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- F C Berthoux
- Service de Néphrologie, Dialyse et Transplantation Rénale, Chu de Saint-Etienne, Hôpital Nord, Saint-Priest-en-Jarez, France
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Burgard G, Gilly F, Braillon G, Cuilleret J. Anatomic basis of the surgical approach to the retropancreatic common bile duct. Surg Radiol Anat 1991; 13:352-3. [PMID: 1803551 DOI: 10.1007/bf01627773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- G Burgard
- Laboratoire d'Anatomie, Faculté de Médecine, Lyon Sud, France
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Bou B, Jouffre C, Burgard G, Coppere H, Audigier JC, Cuilleret J. [Malignant cutaneous melanoma with metastases in the small intestine]. J Chir (Paris) 1990; 127:425-6. [PMID: 2229219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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