[Diffusion of piperacillin in the healthy human peritoneum after administration of a prophylactic dose]. / Diffusion de la pipéracilline dans le péritoine sain de l'homme après administration à dose prophylactique.

The passage of piperacillin into the omentum was evaluated in 23 patients who received one single intravenous injection of 2 grams. Median concentrations were 7.05 micrograms.g-1 at 30 min, 7.2 micrograms.g-1 at 60 min., 4.65 micrograms.g-1 at 90 min. and 3.53 micrograms.g-1 at 120 min. The corresponding maximal values were 36 micrograms.g-1, 59.7 micrograms.g-1, 36 micrograms.g-1 and 32 micrograms.g-1 respectively. Specimens collected beyond 2 hours showed that the concentrations obtained were maintained.

[Unopened colostomy, a protective procedure for high risk colorectal anastomosis]. / La colostomie non ouverte, procédé de protection des anastomoses colo-rectales à haut risque.

The classical "protective colostomy" upstream of a high risk colo-rectal anastomosis is not fully effective and requires subsequent reconstructive surgery. For these reasons, it is little used to date. Unopened colostomy provides complete obturation above the anastomosis and therefore effective protection. When no anastomotic fistula develops, the colostomy loop is re-entered on the 8th postoperative day. In case of fistula, it is opened and becomes functional. The procedure is easy to perform and well accepted by the patient. It increases surgical safety and shortens the duration of stay in hospital.

[The radiolesions of the small bowel (author's transl)]. / Les radiolésions du grêle.

The irradiation of the pelvic abdominal cancers extends beyond the centre of the tumour and may induce actinic digestive lesions. The bowel and more rarely the small bowel--which is the subject-matter of our study--are concerned by those radiolesions that are favoured by therapeutic overdose, post-operative adhesions fastening the bows, radio-surgical or chemicostatic associations, and lastly by vascular or nutritive deficiencies. One may distinguish between two kinds of lesions, depending on the lapse of time before their coming out and on the symptoms. The early or acute types are characterized by a radio-mucitis and give an exsudative enteropathy with anorexia, vomiting, diarrhoea and loss of weight, of which the diagnosis is easy because it occurs during the irradiation and lessens at the end of the treatment. The late radiolesions of the small bowel are characterized by sclerosis and chronic endarteritis and, after a longlasting period of latency, give varied symptoms: disordered intestinal transit which sometimes is irreversible, perforation, fistula, syndrome of malabsorption, giving often rise to be mistaken for a recurrence of the cancer. The treatment varies whether the lesion is segmental or diffuse. In the first case, the failure of the medical means accounts for the surgical cutting away or the internal derivation; in the second case, the digestive mutilation which would result from an enlargement of the lesion commands to be more cautions and to call for the methods of parenteral feeding and digestive setting to rest.

[Surgical management of left colon and rectal radiation injuries (author's transl)]. / Traitement chirurgical des radiolésions du colon gauche et du rectum.

A. First of all, we can affirm after the analysis of 132 records: the predominance of gynecologic cancers and the frequent responsibility of medical associations in the determinism of advanced radiation injuries of colon and rectum; the typically variable appearence of these injuries with an usual delay going from 6 months to a year and limits from 2 months to 35 years; the difficulty of diagnosis between radiation injurie and recurrence of cancer especially in case of fistula and the severe forecost in case of cancer radiation injurie association. B. The surgical management exist only for non-indications and failures of medical treatment; the one stage resection with end to end anastomosis will be made exclusively on advanced, therefore non evolving and limited injuries; in most cases, the multiple stage resection must be preferred: first derivation in selected part (sigmoid or transverse colon) and secondary resection in healthy area; as regards the closure of colostomy, it must never occur before a 6 months delay and anastomosis radiologic check.

[Diagnostic traps and procedure to follow in radio-invisible biliary calculi]. / Pièges diagnostiques et conduite à tenir dans la lithiase biliaire radio-invisible

Instead of the term biliary microlithiasis, the authors prefer the general concept of radio-invisible biliary lithiasis. The size, the homogeneity, the site and chemical composition of the gall stones, which are the usual criteria of biliary microlithiasis, also are valid for radio-invisibility; thus the diagnostic traps are the only original characteristics of a pathology with hazy outlines, defined as one which escapes well conducted a radiological exploration. Biliary micro-lithiasis therefore raises a triple problem. The indications for biliary surgical exploration, in spite of normal cholangiography, seem to us undoubted in acute relapsing pancreatitis, once the usual medical causes have been eliminated. It should be more relative in pure biliary pain which first requires, not only repeated cholangiography, but also constant clinical and laboratory signs which suggest that the symptoms are organic and that gall stones are in formation. After laparotomy, cholecystectomy is required, not only in perceptible lithiasis, but also when the gall bladder bile contains mud, débris, sand or cholesterol spheroids. In the other cases, the choice between abstention or cholecystectomy depends on the clinical and laboratory context. The surgical attitude with regard to the common bile duct is discussed in three possibilities depending on the case, e.g. routine exploration, abstention or exploration in certain cases.