Is emergency aorto-superior mesenteric artery by-pass worthwhile?

Out of 9 superior mesenteric artery (SMA) revascularizations made in emergency, only an early direct aortic reimplantation was successful. The other cases were bypasses and their failures were due either to shock at revascularization (2 cases), or to thrombosis of a by-pass (4 cases), or to persistent ischemic lesions (2 cases). It is suggested: (1) that late mesenteric revascularization should be excluded and let place to extensive bowel resection, (2) that, in emergency, direct SMA aortic reimplantation is preferable to aorto-SMA by-pass.

[Sub-adventitial cystic degeneration of the popliteal artery. One case (author's transl)]. / La dégénérescence kystique sous-adventicielle de l'artère poplitée. A propos d'un cas.

On the basis of a new case of sub-adventitial cystic degeneration of the popliteal artery, the authors review the characteristics of this condition. The diagnosis may be suspected on the basis of clinical and arteriographic findings in an individual in whom the arterial system is otherwise normal. The various aetiological hypotheses are recalled. Treatment in the majority of cases consists of simple excision of the cyst. Intimal changes or segmental obstruction impose the need for resection with restoration of continuity by bypass.

[The superior mesenteric artery syndrome. Apropos of a case and review of the literature]. / Le syndrome de la pince mésentérique. A propos d'une observation et revue de la littérature.

During laparotomy for an appendicular peritonitis, the authors found an acute mesenteric artery syndrome. Conservative treatment consisted of mobilisation of the 4th part of the duodenum with section of the suspensory muscle of Treitz, but this was not sufficient to cure the patient. Two weeks later the patient completely recovered after a duodenojejunal anastomosis. A review of the literature confirmed that surgical treatment for scoliosis and anorexia nervosa play an important role in the aetiology of this disease.

[Cholecystectomy by celioscopy. Experience in two Upper Normandy hospital units. Apropos of 178 procedures]. / La cholécystectomie par coelioscopie. Expérience de deux services hauts normands. A propos de 178 procédures.

Laparoscopic cholecystectomy (LC) emerges as an effective alternative to classical cholecystectomy, but its safety, benefits and indications still need to be clarified. From September 1989 to March 1991, 178 LC were performed by 8 surgeons in 2 hospitals, on 142 women and 36 men with a mean age of 48.2 years. The gall bladder wall was thin in 160 cases and thick in 18 cases (with 6 cases acute cholecystitis). We observed no deaths, 147 simple procedures with a hospital stay and drug requirement lower than with the usual cholecystectomy via laparotomy. But in 21 cases, the procedure needed a laparotomy, and in 10 cases complications occurred, requiring laparotomy in 6 cases. Our results suggest: a) LC is an improvement in the treatment of uncomplicated gallstones; b) a trained surgeon and extreme caution are required in complicated cholelithiasis; c) classical cholecystectomy is still useful in many circumstances.

[Late revascularization of the renal artery: what are the prognostic criteria?]. / Revascularisation tardive de l'artère rénale: Quels critères pronostiques?

Two patients with non functioning silent kidney on excretory urography and renal artery occlusion on angiography, underwent renal artery revascularization without severe hypertension or renal failure. Angiographic appearance of collateral circulation, histologic evidence of intact viable glomeruli and a normal sized kidney are necessary for successful results. Renal blood flow was restored in the two patients but one had slight return of function and the other patient showed no evidence of improvement. Both patients presented criteria for revascularization. The first case was a minor success on the renal scintigraphy. The return of renal function did not occur in the second case because of preexisting renal pathology. We therefore recommend histologic examination before every renal artery revascularization for chronic occlusion.

["Suspended" popliteal artery shunts. A report on 15 cases (author's transl)]. / Pontages sur "artère poplitée suspendue". A propos de 15 cas.

A "suspended" popliteal artery (S.P.A.) constitutes one of the most pejorative anatomical forms for atheromatous lesions of the lower limbs, as obliteration of the superficial femoral artery is often associated with atheromatous lesions in the tibial arteries, making them inaccessible to arterial reconstruction. Operations have been conducted on 5 cases (14 patients) over a period of 3 years. The average age of the patients was 71.6 years and the average follow-up period was 13 months. In each case operation was required to avoid amputation. Venous material was used for the shunt in 10 cases, while 5 had composite (n = 3) or prosthetic (n = 2) material. Postoperative mortality was nul, but 28% died by the end of the first year. Thrombosis occurred in 3 cases, at the 2nd, 7th, and 9th month respectively (actuarial permeability rate after 1 year: 72%), and 4 patients had high amputations (leg: 3, thigh: 1) in spite of permeability of the shunt is two cases (actuarial conservation rate of the limbs after 1 year: 67.5%). An analysis of the results of these 15 cases and those rare series reported in the published literature, enables definition of the indications for revascularization of an S.P.A.

[Value of appendectomy by celioscopy: apropos of a series of 73 cases]. / Intérêt de l'appendicectomie par coelioscopie: à propos d'une série de 73 cas.

The practice of coelioscopic approach in acute appendicitis is still very much debated. A study of the results of 73 patients carried out over two and half years leads one to conclude to the interest of this technique also for the treatment of appendicular peritonitis. Full exploration of the abdominal cavity, easy discovery of ectopic appendix, treatment of associated lesions, extended peritoneal washing, are the observed advantages together with reduced length of hospitalisation and few post-operative complications, in particular parietals problems and obstructions at long term. The experience of the surgeon becomes of prime importance to reduce operating time, frequency of open-surgery converting and complications.

[Infection of vascular sutures: a report on 26 cases (author's transl)]. / Infection intéressant directement une suture vasculaire. A propos de 26 cas.

The authors describe 26 cases of infection after vascular surgery, affecting a Dacron prosthesis in 13 cases and venous grafts in the other 13 patients. The site of infection was usually the region of Scarpa's triangle (15 cases) with the presence of enterobacterium in 40% of cases. The most frequently isolated germ was staphylococcus aureus (20 cases). Infection was revealed by hemorrhage in 17 patients and was evidence of breaking down of the anastomosis. Results of surgical treatment in the two groups were evaluated by using three criteria: --persistence or not of infection, --vital prognosis, --functional prognosis. Surgical treatment methods and possible contamination sources are discussed. When the operative zone is infected, the authors recommend ablation for the prostheses and conservative therapy for venous autografts. The prosthesis was left in place in 5 patients, and only one patient recovered, while two deaths occurred. In the 10 cases where ablation of the prosthesis was performed, however, the infection was cured, and in 4 patients there was revascularization in the infected area. Apart from these cases, conservative therapy was applied in 11 cases and healing occurred in all of them.

[Traumatic chylothorax with dorsal spinal fracture. A case report (author's transl)]. / Rupture du canal thoracique et fracture du rachis dorsal. A propos d'un cas.

We related there a traumatic chylothorax due to a thoracic vertebral fracture. It has been recognized at the 13st day, after a lost of 11 liter of lymph and a down of albuminemia by lymphography. The direct ligature has been only partly successful leaving still a tiny lymph leak during a fortnight.

[Evaluation of cholecystectomy by celioscopy. Apropos of a series of 500 operated patients in a general hospital unit]. / Evaluation de la cholécystectomie par coelioscopie. A propos d'une série de 500 patients opérés dans un centre hospitalier général.

A series of 500 patients who underwent laparoscopic cholecystectomy is reported. The mean duration of the operation was 46 minutes when completed laparoscopically and 117 minutes when converted to laparotomy. The conversion rate was 10%, and the reoperation rate 2.22%. There were 5 problems related to the bile ducts (1%) including 2 lesions of the common bile duct (0.44%) with only in 21 cases. In one, a stone in the common duct was extracted laparoscopically. Mean hospitalization was 5.5 days. For us, laparoscopic cholecystectomy has become the "gold standard" for the treatment of symptomatic uncomplicated bile stone disease. Reduced hospitalization time should help reduce cost incurred due to the video surgery material.

[Evaluation of the haemostasis before a central block in children: what is the French anaesthesiologist's attitude?]. / Bilan d'hémostase avant un bloc central chez l'enfant : quelles sont les pratiques françaises ?

OBJECTIVE: Because of the lack of controlled studies, there is no consensus regarding the practice of routine haemostasis tests before neuraxial blockade in children. The purpose of this study was to describe the French surgical practice about the preoperative evaluation of coagulation in children who were scheduled for paediatric neuraxial anaesthesia. STUDY DESIGN: Descriptive analysis of the practice. METHODS: A telephone survey for coagulation screening was conducted in French surgical paediatric units, known to perform paediatric neuraxial anaesthesia on a routine basis. The aim of the standardized questionnaire was to evaluate the expertise in performance of neuraxial block, the modalities of the preoperative haemostasis screening, and the indications of biological tests and to assess whether a standardized team procedure was used. RESULTS: Forty-two hospitals (27 universities, 10 general hospitals and five private institutions) were contacted; 61 anaesthesiologists with an expertise with central block answered the survey. Thirty-five institutions used a standardized procedure and 57,1% of them undertook routines tests only in children who are not walking. In the remaining 42,9%, the strategy was to screen systematically all patients whatever their age, familial and personal history as well as physical examination. However, only 54% of the anaesthesiologists performed an extensive physical examination in order to detect symptoms in favour of signs of haemostatic disorders. CONCLUSION: While numerous data suggest that routine testing does not to provide much extra information in the absence of a positive history, a systematic strategy is still widely applied in children. Guidelines need to be developed to insure the safety of oriented tests.