[Value of octreotide in the treatment of postoperative enterocutaneous fistula]. / Intérêt de l'octréotide dans le traitement des fistules entérocutanées postopératoires.

Two patients with enterocutaneous fistulas (ileal and duodenal) were successfully treated with bowel rest, total parenteral nutrition and the somatostatin analogue octreotide (150 micrograms.day-1 and 300 micrograms.day-1 respectively). At the time octreotide was started the first patient had a high output fistula (1 000 mL.day-1), the second had a low output fistula (120 mL.day-1). Within 24 hours of treatment, a reduction of at least 40% of the output was observed. The time intervals to fistula closure were respectively 6 days and 10 days after initiation of octreotide therapy. Glucose intolerance was not observed. The efficacy of octreotide combined with total parenteral nutrition supports its routine use instead of somatostatin, more expensive, less tolerated and presenting the risk of rebound effect.

[Traumatic dislocation of the knee treated by early surgical repair (author's transl)]. / Luxations traumatiques du genou traitement chirurgical précoce. A propos de 12 cas.

The authors have treated twelve traumatic dislocations of the knee. Three were treated conservatively with one satisfactory result. Nine were treated by early surgical repair with seven satisfactory results. The technique of ligamentous repair is described. The authors emphasise the frequency and severity of associated vessel and nerve damage. They found acute lesions of the popliteal artery in five cases, three of which had to be operated upon immediately with arterial suture or graft. In one case, ischaemia appeared four days after dislocation and the thrombosed artery was repaired by a venous graft. In one case a lesion of the lateral popliteal nerve which did not recover was treated by palliative surgery. In one case, secondary skin necrosis was treated by skin flap transplantation using micro-surgical technique with a satisfactory result. It is concluded that ligamentous and vascular repairs should be undertaken at the same procedure after arteriography.

[Esophagectomy without thoracotomy in cancer of the esophagus. Apropos of 10 cases]. / L'oesophagectomie sans thoracotomie dans le cancer de l'oesophage. A propos de 10 cas.

Esophagectomy without thoracotomy was performed in 10 cases of cancer of the esophagus, whatever its site of origin. Advantages of this procedure include the absence of a third right thoracic approach and of secondary hemostatis, complications, the cervical anastomosis, and the ascension of the gastroplasty into the esophageal bed. Though less carcinolytic than excision through a thoracic approach, this technique provides identical survival with a lower mortality and a very reduced morbidity. This therapeutic strategy could represent progress for patients who usually have generalized spread of the disease at the time of diagnosis.

[An economic analysis of ambulatory surgery of inguinal hernias]. / Analyse économique de la chirurgie ambulatoire des hernies inguinales.

A cost-analysis study has been carried out on ambulatory surgery of inguinal hernias, in 1991, at Béziers hospital, in France. Analytical book-keeping allows to approach real costs, that is to say 3,061 FF for all medical care spending, and 2,100 FF for the hospital stay. The overall profitability of this surgery questions the urgency of its spreading within the French health care system.

[Local anesthesia and ambulatory surgery for inguinal hernia. Apropos of 737 patients]. / Anesthésie locale et chirurgie ambulatoire pour hernie inguinale. A propos de 737 patients.

737 cases of ambulatory herniorrhaphy performed under local anaesthesia are reported. The Shouldice technique is used. Two pharmacokinetic studies (lidocaine bupivacaine) confirm the innocuity of local anaesthesia. The authors focus their discussion on an other approach of surgery, and the medical network.