Reversible hypersplenism after splenopexy for wandering spleen.

Wandering spleen is a rare condition characterized by a normal spleen with extreme mobility associated with an elongated pedicle. The most common presentation is an acute surgical abdomen related to acute torsion. A case of wandering spleen complicated by symptomatic hypersplenism in a 29 year-old woman is presented. The hypersplenism was diagnosed after bleeding delivery, requiring blood transfusion. Wandering spleen was suspected after pre-operatively performed CT scan. The patient was successfully treated by splenopexy. This report illustrates that conservative surgical management may result in complete reversal of hematological symptoms.

[Intravenous glucose tolerance test in the functional exploration of segmental pancreatic autografts in the dog]. / L'épreuve d'hyperglycémie provoquée par voie intraveineuses dans l'exploration fonctionnelle de l'autogreffe pancréatique segmentaire chez le chien.

The aim of the present study is based on the comparison of intravenous tolerance testing before and after segmental pancreas autotransplantation in the dog. The results show that such testing must take in account the "glucose diffusion space", using the same glucose load in order to avoid the bias related to the post-operative loss of body weight.

[Functional and morphological study of the pancreatic graft after segmental heterotopic autotransplantation in dogs]. / Etude fonctionnelle et morphologique du greffon pancréatique après autotransplantation segmentaire hétérotopique chez le chien.

Segmentary heterotopic autotransplantation of the body and tail of the pancreas, with visceral exocrine drivation and splenosplenic arterio-venous fistulation, was performed in 12 Beagle dogs. An in vivo glucose tolerance test was conducted before the transplantation and 21 days after the operation. There was a significant decrease in the k coefficient (2.884 +/- 0.234 before and 1.878 +/- 0.128 after transplantation) due to reduced peripheral glucose uptake after transplantation (p < 0.001). Overall glucose-stimulated insulin production was decreased after < 0.001). Two populations were identified retrospectively: in 7 dogs insulin response was satisfactory after transplantation (insulin production > or = 50% pretransplantation level) and in 5 the response was below 50%. Glucose tolerance was tested in vitro in the isolated perfused pancreas transplant in 9 dogs, 30 days after the transplantation. Secretory response was assessed according to the early peak of insulin secretion after glucose stimulation. The patterns of insulin secretion were not different before glucose stimulation but became statistically different after stimulation (p < 0.001). In 5 dogs, the response to in vitro glucose stimulation showed an early peak in insulin secretion and in 4 dogs the insulin response came late with no early peak. On histological examination normal (or subnormal) pancreas grafts and grafts in which extensive sclerosis impaired function could be distinguished. There was a significant correlation between the quality of function and the histology, suggesting that containing post-operative sclerosis to a minimum is an important factor in human transplantations.

Ex vivo evaluation in normal dogs of insulin released by a bioartificial pancreas containing isolated rat islets of Langerhans.

In bioartificial pancreatic systems, isolated islets of Langerhans are protected against immune rejection by an artificial membrane, permeable to glucose and insulin, but not to immunoglobulins and lymphocytes. Some of these devices, referred to as vascular systems, are set up to be connected to a vascular site in the recipient, with blood circulating in contact with one side of the membrane, and the islets on the other side. Such a bioartificial pancreas, containing isolated rat islets of Langerhans, was connected to an arteriovenous shunt of a normal anesthetized dog. The aim of this experiment was to investigate the kinetics of the insulin secretory response of the system to a glucose load. Glucose was infused upstream of the system, increasing the glucose concentration inside the bioartificial pancreas from 7 to 14 mmol/l, without altering the blood glucose concentration of the dog. Insulin concentration was determined simultaneously upstream and downstream of the bioartificial pancreas. Insulin production was calculated by multiplying the difference between these values by the blood flow rate. Blood flow rate (Q) was estimated from the change in the glucose concentration produced by the glucose infusion using a mass transfer analysis derived from Fick's principle. Insulin production increased from 20 +/- 8 to 59 +/- 15 microU/100 islets/min within 15 min following the beginning of the stimulation (n = 6, p less than 0.05). Five min after the end of the stimulation, insulin production decreased from 75 +/- 13 to 50 +/- 9 microU/100 islets/min (p less than 0.05) to reach the basal level (21 +/- 3 microU/100 islets/min) 30 min after the end of the glucose stimulation.(ABSTRACT TRUNCATED AT 250 WORDS)

[Thrombosis of the superior mesenteric artery and perforation of the appendix in a young girl]. / Thrombose de l'artère mésentérique supérieure et perforation appendiculaire chez une jeune fille.

Intestinal infarction is due to arterial occlusion or to a thrombosis of the superior mesenteric vein in the case of intra-abdominal sepsis. We report a case unique as far as we know of thrombosis of the superior mesenteric artery due to an appendicular abscess in a young girl without any vascular-risk.

[Is visceral surgery justified in patients over 90 years of age?]. / La chirurgie viscérale chez les patients de plus de 90 ans est-elle licite?

The objective of this study was to evaluate the results of visceral surgery in patients over the age of 90 years by defining the indications, prognostic factors and short-term and intermediate results. This study was based on 50 patients operated between 1983 and 1987, consisting of 46 women and 4 men with a mean age of 92 years and a range of 90 to 98 years. 74% of the patients lived in long-stay hospitals, 26% lived at home, 28% were autonomous, 30% were semi-autonomous and 42% were bed-ridden. The majority of the patients were classified as ASA III. The mean number of visceral lesions was 3. 20% suffered from a malignant disease and 80% from a benign disease. 60% underwent emergency surgery and 40% underwent elective surgery. Postoperative complications were observed in 48% of cases, 58% of which had a fatal outcome. Sixteen patients (32%) died during the first postoperative month. The factors with a significant influence on mortality were: emergency in institutionalized patients (p less than 0.05), the ASA classification (ASA III and more, p less than 0.05), autonomy (bed-ridden patients, p less than 0.05), medical history (more than 4 associated organ defects, p less than 0.01) and malignant disease (p less than 0.001). The most pejorative complications in terms of mortality appeared to be postoperative septic shock, a pulmonary complication or a neurological complication. Cardiovascular disease, frequently reported in the history of theses patients, did not appear to specifically affect mortality. Surgery in patients over the age of 90 years appears to be justified in active patients in good general health presenting with a benign disease likely to become complicated if not treated, which should be preferably operated electively.

[Surgical imperatives in pancreatic transplantation in dogs]. / Impératifs chirurgicaux de la transplantation pancréatique chez le chien.

The authors report their experience of segmental pancreatic autotransplantation in dogs. The most reliable model seems to be: segmental heterotopic pancreas transplantation with bladder diversion of the exocrine secretion and spleno-splenic arterio-venous fistula allowing monitoring of the exocrine secretion and a reduction in the thrombosis rate.

Insulin release from isolated islets of Langerhans after segmental-pancreas autotransplantation in dogs.

Pancreas transplantation is warranted essentially by the quality of glucose regulation. Although the fasting blood glucose is invariably normal, this may not be the case during glucose load tests. The purpose of this study was to examine dysregulation within the isolated islet originating from a segmental-pancreas autograft in the dog. Results show an increased basal insulin secretion by the graft islets in static incubation compared with that of islets originating from the head of the pancreas and left in situ. This abnormal secretion may be accounted for by various factors intervening within the graft or the isolated islet, thus suggesting a possible improvement in the surgical model.

The arteriovenous fistula in segmental pancreatic transplantation in dogs--a hemodynamic study.

Arterial and/or venous thrombosis is a frequent complication in experimental or human pancreatic transplantation. A canine experiment was used to study the hemodynamic effects of spleno-splenic arteriovenous fistula during segmental pancreatic transplantation. An increase in blood flow, without "steal" syndrome in the pancreatic blood supply or pressure increase, was found. Thus this technique can help prevent vascular thrombosis in pancreatic transplant in dogs.

Biliary lithiasis in the over seventy-five age group: a new therapeutic strategy.

Sixty-four gallstone patients aged 75 or more (mean age 83 +/- 5.1 years) were divided prospectively into two groups. They were mostly high-risk patients (average number of major risk factors, 2.2 +/- 0.9). Thirty-three showed one or several signs of lithiasis of the common bile duct and were treated with endoscopic sphincterotomy (ES) (31 successful cases, two technical problems) followed by early cholecystectomy (33 cases). Choledocholithiasis was present in 26 cases and stones were extracted in 25 cases. Two patients (6 per cent) died. ES caused no complications. Thirty-one other patients showed no sign of choledocholithiasis and were treated by cholecystectomy with operative cholangiography. Choledocholithiasis was found in two of these patients and treated by extraction and external drainage. Five of these patients (16 per cent) died. In 30 cases acute cholecystitis was found at operation, 15 in each group. ES is therefore an efficient procedure in high-risk patients, which facilitates operation, especially in cases of acute cholecystitis, and it is recommended in all cases of complicated biliary lithiasis. Early cholecystectomy is justified for these patients by the high frequency of associated acute cholecystitis.

[Heterotopic segmental autotransplantation of the pancreas with digestive system anastomosis in the dog]. / Autotransplantation hétérotopique segmentaire du pancréas avec anastomose digestive chez le chien.

Segmental autotransplantation of pancreas in the heterotopic position, with digestive anastomosis protected by an epiploplasty was performed in a series of 22 dogs. Twenty dogs survived the operation and nine were followed up for 4 weeks: the histologic and morphologic qualities of the graft were very favorable from both endocrine and exocrine points of view. This morphohistologic quality can be related to the digestive anastomosis performed, which failed to provoke any specific complications to a large extent. This study should be completed by improvement in the vascularization of the graft by a splenic arteriovenous fistula and a concomitant study of the endocrine function of the transplanted pancreas in dogs with experimentally-induced diabetes.

Large abdominal incisional hernias: repair by fascial approximation reinforced with a stainless steel mesh.

One hundred and fifty large abdominal incisional hernias were treated following a standardized operating technique using metallic mesh (Toilinox) and approximation of the anterior sheath of the rectus abdominis. The average follow-up was four years. Good clinical results without pain were found in more than 95 per cent of the patients. Recurrence occurred in 9.5 per cent of the patients. The complications, wound infection or parietal necrosis, never necessitated removal of the prosthesis. These results justify the use of this technique even when intra-abdominal septic procedure is associated.

[Surgery of the bile ducts in patients 75 years of age and older. 144 patients surgically treated over a 5-year period]. / Chirurgie des voies biliaires du sujet âgé de 75 ans et plus. 144 patients opérés en 5 ans.

A series of 144 patients of over 75 years of age (average 83.2 years) were operated over a 5 year period for gall stones. Factors associated with a poor prognosis were age, infection and jaundice. The therapeutic indications are discussed.