Pyosalpinx: not always a sexual transmitted disease? Pyosalpinx caused by Plesiomonas shigelloides in an immunocompetent host.

Plesiomonas shigelloides are ubiquitous Gram-negative bacteria that are found in fresh or marine water, particularly in tropical or warm climates; they were recently implicated in diarrhoeal disease. Patients usually present with a history of recent travel to tropical regions or consumption of uncooked seafood. Extraintestinal disease has rarely been reported, occurring generally in neonates or immunocompromised patients, and is often fatal. We report a case of right pyosalpinx due to P. shigelloides acquired by swimming in contaminated water. Laparoscopic salpingectomy led to a good outcome.

Utility and complications of permanent venous access devices (PVAD) in oncological treatments. Follow-up of 100 cases.

BACKGROUND: Permanent venous access devices (PVAD) are nowadays routinely implanted and used with some morbidity for the oncological treatments. The adequate timing of implantation based on the number of treatments, the survival rate and the complications has not yet been well estimated. METHODS: A hundred permanent venous access devices placed in oncological patients were followed-up prospectively. RESULTS: No mortality was seen due to the surgical act. A 11% morbidity rate was noted, largely due to infections, with 6 patients needing a second surgery. On average, 6 chemotherapy cycles were done after placing of the permanent venous access device. CONCLUSIONS: Due to these results and an average survival rate of 10.7 months, we suggest the placing of a permanent venous access device early in the management of oncological patients requiring chemotherapy cycles, so as to increase the comfort of the patient and to safeguard his peripheral venous system.

A case of pediatric Henoch-Schönlein purpura and thrombosis of spermatic veins.

The authors report a case of thrombosis of the spermatic veins associated with Henoch-Schönlein purpura mimicking an acute scrotum, which responded to a low-molecular-weight heparin treatment.

The migrating spilled stone.

Two cases of late complications of laparoscopic cholecystectomy following parietal breach are reported. The escaped unretrievable infected lost gallstones behave subsequently like foreign bodies and migrate out of the peritoneal cavity. Two patients presented seven months and two years later with abscesses containing stones. Early recognition and effective surgical treatment are the only guarantee of success.

Bacteriuria during urinary tract catheterization: suprapubic versus urethral route: a prospective randomized trial.

In this randomized prospective trial urethral and suprapubic routes were compared in terms of tolerance and infectious potential. Daily bacteriuria determined infectious danger and patients were interrogated on the pain and discomfort induced by their catheter every day. Identical single dose pre-operative antibiotic prophylaxis was routinely applied. Patients (n = 50) were divided into two similar groups (25 suprapubic catheters and 25 urethral catheters). Four patients in the suprapubic group were excluded. All specimen cultured by suprapubic catheter remained sterile. Nine patients with urethral catheterization eventually developed bacteriuria. The difference became significant on the third day of catheterization (p < 0.05) and increased on days 4 and 5 (p < 0.01). Between the two groups, pain and discomfort did not achieve statistical significance. Suprapubic catheterization is preferable to the alternative using the urethral route in terms of improving urine sterility.

[Surgical wounds with or without dressings. Prospective comparative study]. / Pansement ou absence de pansement sur les plaies opératoires. Etude prospective comparative.

STUDY AIM: The aim of this study was to compare the infectious local risk when the wound dressing was removed or not after 48 hours, and to look for the other advantages or disadvantages of these two methods. PATIENTS AND METHOD: Two groups of 50 patients who underwent a thoracic or abdominal procedure, class I or II according to Altemeier, have been randomly selected: one received a wound dressing after 48 hours, and the second did not. RESULTS: The clinical features were comparable between the two groups. There was no significant difference in the outcome of the two groups of patients in terms of wound infection (only one infected wound in each group). CONCLUSION: Wound dressing usually seems unnecessary.

[Crohn's disease of the appendix]. / Maladie de Crohn appendiculaire.

A giant appendix is an extremely rare and improbable finding during surgery in suspected cases of acute appendicitis. Although this condition is primarily suggestive of neoplasia, it is usually due to an inflammatory or infectious disease. We report a case of Crohn's disease limited to the appendix, which was diagnosed after a short right ileocolectomy. Only 156 similar diagnoses have been reported in the literature to date. This disease appears to have a benign course and therefore differs from classical Crohn's ileocolitis. For this reason, these patients do not require any specific investigation or follow-up.

[Outcome of nonspecific right iliac fossa pain syndromes]. / Devenir des syndromes douloureux non spécifiques de la fosse iliaque droite.

One-third of all cases of abdominal pain and a quarter of cases of right iliac fossa pain urgently admitted to hospital leave hospital with no precise diagnosis. Based on a series of 400 patients hospitalised for right iliac fossa pain, comprising 107 cases with no identified aetiology, this prospective study was designed to assess the medium-term outcome of these patients, with or without surgical exploration. 67 cases were reviewed at five years. No major diagnosis was missed. Over this 5-year period, 30 patients (45%) experienced another episode of abdominal pain. Among the third of patients (21 cases, 31%) reviewed for another episode of right iliac fossa pain, 7 were readmitted to hospital, with 5 operations, for histologically confirmed acute appendicitis in 3 cases (5% of the series). The patient and his attending physician must be informed of the nonspecific diagnosis established during the first hospitalisation. There is no significant evidence to suggest a psychological component in the recurrent nature of the pain. Cancer must be formally excluded in patients over the age of 50. When surgical exploration is performed, nowadays by laparoscopy, appendicectomy is recommended. This procedure does not decrease the risk of recurrent pain, but confirms the real absence of histopathological abnormality and decreases the number of subsequent hospitalisations.

[Laparoscopic treatment of small bowel obstruction arising on adhesions]. / Traitement laparoscopique des occlusions du grêle sur brides.

OBJECTIVES: Determine the feasibility of laparoscopy, with the objective as well as the subjective benefits offered to patients, and the possible contra-indications of this type of surgery in the treatment of mechanical intestinal ileus. PATIENTS AND MATERIAL: This concerned 20 patients who came to the hospital with a picture of intestinal obstruction. All had a history of at least one abdominal operation. The diagnosis of mechanical occlusion due to band adhesions was presumed on the basis of the clinical and complementary examinations, particularly x-rays, and confirmed in the course of the operation. All patients were operated by laparoscopy after failure of non-invasive treatment. RESULTS: Results obtained are encouraging since 60% of the patients were successfully treated by laparoscopy alone. The patients' comfort and length of hospital stay are improved by laparoscopy. There is no relation between previous surgical history and the results of the technique. CONCLUSIONS: Most failures were due to the time interval between onset of symptoms and the operation. Early operation therefore seems to increase the chances of success.

[Activities of the general surgeon in a non-university hospital]. / Activités du chirurgien général en hôpital non-universitaire.

There is little difference between the work of the general surgeon as the head of a provincial hospital (B2) or in a central non-university one (A2). The operative statistics of such a service show that the type of operations is varied and requires broad polyvalence. Surgical services in provincial hospitals should not be subdivided into several specialised department. There is a real need for general surgeons in our country. Their quality depends on a broad and adequate training including the majority of surgical specialities. Such an activity requires constant postgraduate training, analysis of the results and ability to self criticism. Frequent contacts should be encouraged with other colleagues and university hospitals. The head surgeon in a provincial hospital should be able to evaluate the majority of the cases which are submitted to him and to decide whether the patient will be operated by him personnally or by a specialized consultant, or whenever he should be transferred to a specialized unit. This type of work has certain advantages: the possibility of independent decisions, a broad ability in the different surgical fields, allowing an easy adaptation when unexpected situations happen during operation.

[Prevention of recurrent nerve paresis and parathyroid lesions in thyroidectomy]. / Prävention der Rekurrensparese und der Nebenschilddrüsen-Läsion bei Thyreoidektomie.

At present the risk of a post-operative nerve lesion or of hypothyroidism occurring after surgery of the thyroid still exists. Those surgeons who expose the entire length of the nerve are few but they obtain the lowest rate of post-operative vocal cord palsy. In a series of a 100 patients undergoing thyroid surgery, the nerves were visually exposed along their entire length. A nerve stimulator was used to facilitate recognition and identification. During electrical stimulation, spasmodic contractions of the larynx could be observed behind the crico-thyroid muscle, close to the ligatures of the superior thyroid vessels. The lobe was freed as for a total lobectomy. During this procedure, due to their anatomical relations, the parathyroid glands are unendangered as only the vessels which reach the thyroid itself are ligated. The safety of this operative technique was demonstrated by the absence of either nerve lesions or hypoparathyroidism in this series of 100 patients. The ensuing security allows modification of the surgical technique or procedure according to the situation. For all solid cold nodules total lobectomy is unequivocably indicated. In Graves' disease and endemic goitre the classical subtotal thyroidectomy is replaced by total lobectomy on one side and subtotal lobectomy on the other.

[Medial epicondylitis. Etiology, diagnosis, therapeutic modalities]. / Epitrochleite. Causes, diagnostic, modalités thérapeutiques.

Medial epicondylitis is rather uncommon, less frequent than external epicondylitis. For this reason, the diagnosis is thought of rather late. While taking the history, one should try to find out the possible causative effects. Symptoms of irritation of the cubital nerve, which are present in one out of five cases should be looked for. Several sports such as baseball, javelin or weight throwing, volleyball, climbing, tennis, golf, which need a strong flexion of the hand and fingers can induce this condition. However, in more than half of our patients, sports or professional activities were not in cause. The majority were housewives and do-it-yourself enthusiasts. Among our 55 operated cases, out of which few had professional or sports activities, we did not encounter during the operation the macroscopic tendinous lesions that are sometimes described by some authors. The treatment should be conservative in all cases. This includes rest, anti-inflammatory drugs, physiotherapy, muscular stretching, immobilisation in a cast, steroid infiltrations. One patient out of ten will have to be operated on. The operative techniques differ on some details, but they all include the desinsertion of the flexor muscles on the medial epicondyle. When there are clinical signs of irritation of the cubital nerve, it should be transposed anteriorly. The result of these operations is good in more than 90 per cent of the cases. However, a come back to professional sport can take as long as 8 months.

[Is extracorporeal cholelithotripsy still justified as treatment in cholelithiasis?]. / La cholélithotripsie extra-corporelle est-elle encore justifiée comme traitement de la cholécystolithiase?

This prospective study evaluates the results of extracorporeal shock-wave piezoelectric lithotripsy in 52 patients, 41 with radiolucent and 11 with calcified shell gallstones. The fragmentation rate was above 90% and the complication rate 31%, with pain or intolerance to the adjuvant dissolution therapy in particular. At the end of the treatment, 7 cholecystectomies were carried out among the 31 patients in whom lithotripsy failed. After 18 months, the success rate was 23% and only 12 patients remained stone free. Nowadays, thanks to the new laparoscopic therapy, extracorporeal shock-wave lithotripsy is no longer judged appropriate, particularly in view of its poor cost-effectiveness and high recurrence ratio.

[Prevention of infection at the operative site: irrigation with iodine derivatives, or NaCl. A prospective and randomized study in general surgery]. / Prévention de l'infection de la plaie opératoire: lavage par dérivé iodé, ou NaCl. Etude prospective et randomisée en chirurgie générale.

A prospective randomized study was undertaken among 540 patients submitted to a surgical operation. The operative site and the wall before skin closure have been washed either with saline or with Betadine-R solution. Bacteriological samples were taken before irrigation. The contamination rate reached 60% in visceral surgery, 30% in bone surgery. Postoperative wound sepsis nearly reached 6%. There was no difference between the NaCl and Betadine groups.

[E. Delorme correction of rectal prolapse]. / Correction du prolapsus rectal selon E. Delorme.

Rectal prolapse is a distressing condition. Among the multiple corrections described, the perineal approach has generally been abandoned. However, Delorme's procedure is a good, simple and efficient intervention with a low morbidity for certain elderly selected patients. The purpose of this paper is to recall the details of this technique and review its results.

[Complications in gerontologic surgery: role of nutritional status and serum albumin]. / Complications en géronto-chirurgie: rôle de l'état nutritionnel et de l'albuminémie.

Surgery in the elderly is not a challenge anymore. Yet, malnutrition stays one of the principal adverse factors in surgery, particularly in the aged. In ten months, 250 patients aged 65 years or older (mean: 75) have been operated in our general surgery department, with 25% of major complications and a mortality 3.6%. Nutritional state was evaluated on a clinical basis and by measurement of the serum albumin level. In case of malnutrition, morbidity was multiplied by 2, mortality by 3. These results emphasize the necessity for identification of this high risk population and the need to correct their nutritional state preoperatively by hyperalimentation.

[Recurrence of hiatal hernia. A study of 20 cases]. / Récidives de hernie hiatale. Etude de 20 dossiers.

After surgical correction, hiatus hernia recurs in 5--15%. Papers dealing with these recurrences are rare. Among 140 hiatus hernias operated in our service, quite a few had some residual symptoms such as intermittent dysphagia, epigastric pain and flatulence. Three of them had to be reoperated on for a recurrence. In this paper 20 patients operated for recurrent hiatus hernia are reviewed. Some factors predispose to recurrence: inadequate initial operation, stage 3--4 oesophagitis, kyphosis, very broad hiatal orifice at initial operation. When the cases reoperated upon are reviewed some of them are not improved. Most of these patients have psychosomatic problems or are under psychiatric treatment. This is why a patient coming for a recurrent hiatus hernia should be investigated thoroughly. Psychosomatic cases are as bad an indication for a second operation as they probably were for the first one. When reoperation has been decided, several procedures can be used. The choice depends on what was done at the first operation, on the radiological, endoscopic and peroperative findings. In the majority of the cases, an abdominal approach can be used, but occasionally a thoracic or thoraco-abdominal route is preferable. Associated vagotomy does not improve the results and adds its own morbidity.