N Biance

Army Training Hospital, Laveran, Marsiglia, Provence-Alpes-Côte d'Azur, France

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Publications (16)6.78 Total impact

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    ABSTRACT: The purpose of this study was to assess the impact of transjugular intrahepatic portosystemic shunting (TIPS) on liver transplantation (LT). Seventy-two patients transplanted after TIPS insertion between 1996 and 2008 were compared with 136 matched patients transplanted without prior TIPS. At time of LT, 10% of the TIPS were occluded and 32% were misplaced. Shunt removal was difficult in 17% of the TIPS patients and required vena cava clamping in 10%. Collateral venous circulation was less extensive and intra-operative portocaval anastomosis was required more frequently in the TIPS group. No significant difference in transfusion requirements and operative times were observed between the two groups. Postoperatively, liver and renal function tests, in-hospital stay, graft rejection, re-transplantation and 1-year mortality rates were not statistically different. Ascites volume in the first week was greater in the TIPS group (7.6 L vs 6.9 L, P=0.036). In the TIPS group, ascites and collateral circulation were greater if the shunt was occluded at the time of LT. Shunt misplacement or occlusion was not associated with higher intra-operative or postoperative complication rates. TIPS did not impair LT and can provide a safe bridge for LT in the end-stage cirrhotic patients.
    Gastroentérologie Clinique et Biologique 10/2013; · 0.80 Impact Factor
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    ABSTRACT: Negative pressure therapy (NPT) is a proven safe and effective technique to promote healing of complex adominoperineal wounds using either an open or closed approach. Specifically designed devices are available in industrialized countries but high cost is a limiting factor for their use in developing countries. The purpose of this report is to describe a simple, easy-to-use technique that is suitable for austere environments. In addition to low-cost, the main advantage of this technique is that it can be performed by anyone using resources readily available in any operating room.
    Médecine tropicale: revue du Corps de santé colonial 10/2009; 69(5):434-6.
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    ABSTRACT: The incidence of fortuitously discovered stones in the common bile duct is about 5%. The purpose of this study was to determine the rate of spontaneous clearance of asymptomatic stones in the common bile duct discovered fortuitously during cholecystectomy. Intraoperative cholangiography was performed in all patients undergoing cholecystectomy for symptomatic gallbladder stones. If a filling defect of the common bile duct was discovered, a transcystic drain was inserted. Surgical or endoscopic extraction was not proposed initially. A control cholangiogram was performed on the second postoperative day then during the sixth postoperative week. If a stone persisted at the sixth week, endoscopic extraction was undertaken. Cholecystectomy was performed in 124 patients with symptomatic gallstones and no signs predictive of stones in the common bile duct. A stone was found fortuitously in the common bile duct in 12 patients. The control cholangiogram was normal in two of these patients on day two (16.7%) and in six others (50%) at the six-week control. All 12 patients remained free of symptoms suggesting the presence of a stone in the common duct. Presence of the drain had no impact on quality-of-life. Endoscopic extraction was finally performed for four patients (33.3%) to remove a stone from the common bile duct. Early surgical or endoscopic extraction of stones in the common bile duct should not be undertaken systematically in asymptomatic patients. Spontaneous asymptomatic clearance of the common bile duct is observed in about half of patients.
    Gastroentérologie Clinique et Biologique 05/2008; 32(4):408-12. · 1.14 Impact Factor
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    ABSTRACT: Obturator hernia is a rare event with poor clinical signs. Delayed diagnosis is a cause of increased mortality due to ruptured gangrenous bowel. We report a case of incarcerated obturator hernia which highlights the usefulness of computed tomography (CT) scanning in diagnosing this condition.
    Hernia 05/2008; 12(2):199-200. · 1.69 Impact Factor
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    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.
    Médecine tropicale: revue du Corps de santé colonial 11/2007; 67(5):529-35.
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    ABSTRACT: Authors report a case of a 31 years old patient who eliminate a urinary stone which contains a platinium coil. Five years ago, this patient had a percutaneous nephrolithotomy. A persistent hematuria was successfully managed with angioembolization of a lower polar artery branch. One of the coils was deployed too distally. It was not efficient, it rolled itself up in the pseudoaneurysm cavity. Different physio pathological hypothesis are developed to explain this expulsion.
    Progrès en Urologie 07/2007; 17(4):869-71. · 0.80 Impact Factor
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    ABSTRACT: Primary peritonitis (PP) is an infection of the peritoneal cavity occurring in the absence of a documented intraabdominal source of contamination. It is one of the main infectious complications of cirrhosis but is rare in healthy subjects. The purpose of this retrospective study is to describe a series of 15 cases of PP treated over a 3-year period at the Principal Hospital in Dakar, Senegal. The patient population was young (all but 2 under age of 13 years) and predominantly female (87%) with no predisposing factors. Clinical presentation always involved typical peritonitis. Surgical exploration was performed in all cases by laparotomy (n=13) or laparoscopy (n=2). Intra-operative bacteriologic sampling was performed systematically. Probabilistic antimicrobial therapy was administered in all cases using a triple-drug combination including a cephalosporin or betalactamine, an aminoside and metronidazole. This unconventional combination was designed to allow low-cost wide-spectrum coverage. As in patients with cirrhosis, the most common microbial agents were gram-negative bacteria (47%). Streptococcus pneumoniae was identified in 40% of cases. Infectious ORL and pulmonary sites were suspected in some cases. Although no supporting bacteriologic evidence was obtained, the high frequency of pneumococcal involvement as well as the age and female predominance of the patient population is consistent with contamination via the female genital tract. The cases in this series present unusual epidemiological, clinical and bacteriologic features. In Europe surgical treatment can be avoided thanks to the availability of modern facilities to support further laboratory examinations. In Africa antimicrobial therapy and peritoneal lavage are the mainstay treatments. Use of laparoscopy should be expanded.
    Médecine tropicale: revue du Corps de santé colonial 05/2007; 67(2):154-8.
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    ABSTRACT: Authors report a case of a 31 years oldpatient who eliminate a urina-ry stone which contains a platinium coil. Five years ago, this patient had a percutaneous nephrolithotomy. A persistent hematuria was suc-cessfully managed with angioembolization of a lower polar artery branch. One ofthe coils was deployed too distally. It was not efficient, it rolled itselfup in the pseudoaneurysm cavity. Différent physio patho-logical hypothesis are developed to explain this expulsion.
    Progres En Urologie - PROG UROL. 01/2007; 17(4):869-871.
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    ABSTRACT: Stab wounds to the colon are a frequent surgical emergency. Local wound exploration under local anaesthesia is not required systematically. We recommend surveillance based on clinical observation and laboratory testing to detect peritoneal signs. If progression of symptoms is suspected, diagnostic peritoneal lavage (DPL) should be performed. Immediate surgical exploration is indicated in two cases, i.e., generalized peritonitis and haemodynamic instability due to internal bleeding. The preferred repair technique is direct suture or resection followed by a handsewn or mechanical anastomosis. The morbidity, cost and social consequences of colostomy must be taken into account. It should be considered as a salvage procedure for patients in critical condition or extensive colonic injury.
    Médecine tropicale: revue du Corps de santé colonial 07/2006; 66(3):302-5.
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    Journal de Chirurgie 06/2006; 143(3):199-201. · 0.50 Impact Factor
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    ABSTRACT: Mesenteric trauma, i.e., injuries located in the bowel or organs supplied by the superior mesenteric artery, can be life-threatening. The incidence of these lesions is low. Most occur as result of blunt and penetrating abdominal trauma due mainly to gunshot wounds or road accidents. Management of these serious injuries can be challenging in the military field hospitals. The major problem in austere environment is the unavailabiity of computerized axial and other tools gene rally used for diagnosis. As an alternative to tomography diagnostic peritoneal lavage can be used with a high sensitivity for the detection of mesenteric trauma. The second difficulty is technical. General surgeons without vasular training or supplies must prepared to suspect and reonstuct lesions of the superior mesenteric available resources.
    Médecine tropicale: revue du Corps de santé colonial 05/2006; 66(2):199-204.
  • Journal de Chirurgie 03/2006; 143(2):129-132. · 0.50 Impact Factor
  • Journal De Chirurgie - J CHIR. 01/2006; 143(3):199-201.
  • Journal de Chirurgie 143(3):199-201. · 0.50 Impact Factor
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    ABSTRACT: The authors report an isolated common femoral artery injury caused by blunt trauma with dissection and secondary ischaemia. A 21-year-old man was admitted to hospital after being stabbed during acute alcoholic intoxication. He presented with a stab wound on the left leg and blunt trauma in the right groin. The surgical exploration of the left-sided wound did not disclose any vascular injury. After a 12-hour period of observation, the patient was discharged. Six hours later, he came back with severe ischaemia on the right leg caused by a femoral artery dissection. The patient underwent surgical revascularization, and fully recovered. Isolated artery blunt trauma is a rare event. In this observation, the absence of early symptoms resulted in delayed diagnosis.
    Acta chirurgica Belgica 108(6):744-6. · 0.36 Impact Factor
  • Journal de Chirurgie 143(2):129-32. · 0.50 Impact Factor