[Salmonella pancreatic abscess. Treatment by drainage without cholecystectomy]. / Abcès pancréatique à salmonelle. Traitement par drainage sans cholécystectomie.

We report a case of necrotic collection in the head of the pancreas infected by Salmonella typhimurium. Treatment associated necrosectomy and antibiotic therapy without cholecystectomy. The course of pancreatic disease was uneventful. Complete sterilization was obtained with quinolone antibiotic therapy.

[Echotomographic, scanographic and anatomic study of a case of cystic dilatation of the common hepatic duct]. / Etude échotomographique, scanographique et anatomique d'un cas de dilatation kystique du canal hépatique commun.

The authors describe the case of a 16-year-old African woman presenting with a cystic dilatation of the common bile duct associated with a dilatation of the left intrahepatic bile duct, hepatic fibrosis and portal hypertension. The disease was revealed by a non-infectious cholestatic syndrome. The diagnosis was made before the intervention by abdominal ultrasonography and computed tomography. A choledococyst-jejunostomy was performed which led to progressive normalisation of liver function. This report emphasizes the possibility of simultaneous lesions at different levels of the biliary tree in patients with choledocal cysts. The prognosis depends upon the state of the liver. A liver biopsy is therefore mandatory when an operation is performed. In the present case, the follow-up is too short to assess the regression of the biliary cirrhosis as described in the literature.

[Implantable devices for permanent venous access. A single-center prospective study comparing an AIDS population with a control population (80 cases)]. / Chambres implantables pour accès veineux permanent. Etude prospective unicentrique comparant une population de SIDA à une population témoin (80 cas).

Although the tolerance of indwelling catheters in AIDS patients has been evaluated, the complications of implanted devices in this population are unknown. This encouraged us to compare in a prospective unicenter trial, dealing with 80 consecutive implanted devices, the complications of this kind of system in 20 AIDS patients, versus a control population. The follow-up was 10,658 days. No patient was excluded or lost to follow-up. In the control population, the infection rate was 5% (0.036 per 100 catheter days). We observed 3 thromboses (5%). In the AIDS group, the infection rate was 25% (0.21 per 100 catheter days). We observed 1 thrombosis (5%). This trial shows that implanted devices are more frequently infected in AIDS patients (p less than 0.05) than in a control population; it suggests that the infection rate in AIDS patients is not superior to the indwelling catheter rate, as reported in the literature. The precision of bacteriological tests and use of antibiotic therapy adapted to the clinical context should help to determine, in the presence of suspected infection, whether the implanted device can be maintained or should be removed in this high risk population.

[Experimental models in studying gastric secretion in dogs: innervated pouch, denervated pouch, cervical esophagostomy. Execution, monitoring, use]. / Modèles expérimentaux d'étude de la sécrétion gastrique chez le chien: poche innervée, poche dénervée, oesophagostomie cervicale. Réalisation, surveillance, utilisation.

Different surgical models are used in the dog for studying gastric secretion: gastric fistula, denervated Heidenhain pouch, innervated Amdrup pouch and cervical esophagostomy. The surgical procedures are described as well as the care and the monitoring allowing long-term survival of the animals. The association of gastric fistula - Heidenhain pouch has been assessed 30 times and 8 times with cervical esophagostomy. The death-rate was been 7% and the morbidity 24%. Three dogs were provided with an Amdrup pouch. Calibration of the animals allowed the acid and pepsin secreting dose-response to be platted and translation according to lineweaver-Burk or Dowd and Riggs is used to calculate the efficient dose (ED 50) and the maximal response (maxR). Pharmacological or physiological effects might be analyzed in regard to the modification of these parameters in response to a pharmacological agonist or antagonist substance. Some physiological studies could be made using sham-feeding on dogs fitted with a cervical esophagostomy.

[Emergency treatment of sigmoid volvulus. One-stage resection with mechanical staplers]. / Volvulus du sigmoïde en urgence. Résection en un temps par pinces mécaniques.

In sigmoid volvulus, most authors recommend an emergency detorsion with transrectal intubation and delayed resection. In 25% of cases, detorsion in unsuccessful, necessitating multi-stage laparotomy. However, this approach can be harmful in these patients who are often elderly or with multiple diseases. When detorsion is impossible, we now use a one-stage resection with staplers. Using a median laparotomy, detorsion is performed and viability of the colon is confirmed; a Faucher tube placed freely in the rectum, is pushed by the nurse into the dilated colon; the colon is then deflated by applying gentle suction. After removing the tube, we perform a side-to-side anastomosis at the lower ends of both limbs with mechanical staplers, after economic resection of the mesosigmoid. We have used this procedure in five patients with a median age of 82 years; the mean operating time was 92 minutes. There was no mortality, no fistulae, or stenosis with a median follow-up of 16 months. The patients stayed in hospital for 12 to 18 days. In volvulus cases which cannot be reduced immediately, this procedure obviates multi-stage operations, often the cause of mortality, morbidity or loss of autonomy in patients who are often elderly or with multiple disease.

[Intraductal papillary adenocarcinoma of the pancreas. Case report and review of the literature]. / Adénocarcinome papillaire intracanalaire du pancréas. Un cas et revue de la littérature.

In 1974, cephalic duodeno-pancreatectomy was performed in a 48-year old patient with papillary adenocarcinoma within the pancreatic duct. The patient is still alive without overt recurrence. The authors emphasize the rarity of such lesions (8 cases published to date), the diagnostic value of retrograde contrast radiography of the main pancreatic duct, the need for wide pancreatectomy, the quality of survival and the possibility of cure.

[Rehabilitation of Mikulicz's drain. An irreplaceable procedure in difficult drainage]. / Réhabilitation du sac de Mikulicz. Un procédé irremplaçable dans les drainages difficiles.

Following technical consideration on the use of Mikulicz's drain, with emphasis on introduction and irrigation with hydrogen peroxide, the authors describe its advantages: wide drainage, extraperito-nealization of the septic focus and removal without general anaesthesia. Such advantages clearly overcome the drawbacks which are now reduced by a strict and well codified application of this type of drain: prolonged purulent discharge, fistulae and incisional hernias are rare. Nowadays, the Mikulicz's drain is mainly indicated in diffuse peritonitis (notably post-operative) difficult bleeding control, pelvectomy and hepatectomy.

[Large non-covered abdominal eviscerations. Secondary parietal repair]. / Grandes éviscérations non couvertes de l'abdomen. Réparation pariétale secondaire.

In the technique described, the area of granulation tissue is first separated from the small bowel from which it originates and entirely removed. The internal borders of the rectus abdominis sheath are then brought together after being released by a wide lateral dissection of the skin and by a long counter-incision in the anterior surface of the sheath. The presence of a fistula or an enterostomy does not preclude the operation : indeed, they can be suppressed at the same time. Eight patients were treated by this simple technique which does not require prosthetic material. The results were satisfactory, with a durably strong abdominal wall.

[Causes for surgical interventions in HIV seropositive patients. 226 interventions]. / Causes des interventions chirurgicales chez les malades séropositifs pour le VIH. 266 interventions.

Between January 1, 1983 and October 1, 1990, we performed 266 surgical operations in 255 patients with human immunodeficiency virus (HIV) infection. We report the reasons for these operations and compare them with those recorded in all patients operated upon in our department between January 1, 1988 and December 31, 1989 (4,960 operations in 4,498 patients). During the 1988-89 period, 2.4 percent of these patients had HIV infection, which suggests that the proportion of patients operated upon is the same in an HIV-infected population as in the general population. The proportion of HIV-infected patients who underwent surgery for diagnostic purposes or as adjuvant treatment was 42.7 percent as compared with 37.3 percent in the general population. Among laparotomies, 37.3 percent were exploratory in the HIV group versus 7.3 percent in the control group. The emergency surgery rate was the same in both groups. In gastrointestinal surgery, proctological operations were performed in 33.5 percent of the HIV group versus 7.4 percent of the control group. Among other types of surgery, only splenectomies were more frequent in HIV-infected patients than in the general population (6.3 versus 1.7 percent).

[Biliary cancer developing on a congenital cystic dilatation of the common bile duct. Apropos of a case]. / Le cancer biliaire développé sur une dilatation kystique congénitale de la voie biliaire principale. A propos d'une observation.

The authors report a new case of biliary cancer occurring in a 23 year old asiatic girl with congenital cystic dilatation of the common bile duct. After a review of the world literature, the authors recall the principal features of this congenital disease, which is becoming more common in France with the influx of Asian refugees. They stress the risk of malignant degeneration which is related to irritation of the mucosa and biliary stasis. Ideal treatment involves complete excision of the cyst.

[Post-operative subphrenic abscess. Information supplied by analysis of 62 recent unpublished cases (author's transl)]. / Les abcés sous-phréniques post-opératoires. Renseignements fournis par l'analyse de 62 observations récentes et inédites.

We have collected 62 cases of post-operative subphrenic abscess. Two thirds of these patients were sent to us by another unit for post-operative complications. Subphrenic asbcess is still very dangerous as the mortality is still 38%. They occurred after a gastro-duodenal operation (26 times), spleno-pancreatic operation (21 times), intestinal operation (15 times), hepato-bilary operation (11 times) appendicectomy (twice). They were situated usually on the right, but 11 patients had a double subphrenic abscess and 14 an associated submesocolic abscess. Gram negative bacteria were usually the cause. These abscesses often started early. They occurred in 80% of cases in patients operated under the antibiotic cover. Chest X-ray was the best method of detection, but experience is necessary to read them. The abscesses were drained by the abdominal route in order to verify th whole peritoneal cavity. 22 patients died. 11 from septicemia. 21 out of 22 had a digestive fistula. Among the factors in prognosis, the most obvious were age, type of operation, the notion of reoperation, multiple abscess, and finally the delay in starting treatment.

[Primary gastric non-Hodgkin malignant lymphoma. Report of 38 new cases (author's transl)]. / Le lymphome malin non hodgkinien gastrique primitif. A propos de 38 observations nouvelles.

38 cases of primary gastric non-Hodgkin malignant lymphoma operated on between 1961 and 1978 are reported. They note two changes in the study of this localisation of malignant lymphomas: a diagnostic difference as the latter is more and more often made with certainly although histological difficulties persist, and a therapeutic difference as surgical removal is now associated with radiotherapy and chemotherapy. The relative importance of these three methods depends on each case, and in the future will depend on careful assessment of the lesions, of which classification is now accepted by everyone.

[Isolated traumatic rupture of the gallbladder. Apropos of a case]. / Rupture traumatique isolée de la vésicule biliaire. A propos d'un cas.

A case of isolated rupture of the gallbladder following a closed injury to the abdomen is reported. Various anatomical forms of this very rare lesion have been described. The mechanism, diagnosis, and treatment of this traumatic lesion are discussed, based on a review of the published literature.

[Hemolymphangioma of the pancreas]. / Les hémo-lymphangiomes du pancréas.

The authors report a case of hemo-lymphangioma from the body and the tail of the pancreas. Through a review of the literature, the histological, histogenetical and clinical features of this disease are recalled and the diagnostic and therapeutic modalities are considered. These are benign tumors and their treatment must be surgical and radical. Two operative attitudes are possible: the tumoral enucleation and the partial pancreatectomies.

[The glucagonoma syndrome. Review of the literature. Apropos of a case]. / Le syndrome de glucagonome. Revue de la littérature. A propos d'un cas.

A patient with typical clinical and biochemical features of a glucagonoma also presented obvious signs of hypokalemia, indicating combined secretion of renin by the tumor. The latter was voluminous, was located in the tail of the pancreas and was of a malignant nature as shown by the development of secondary hepatic metastases. Syndromes associated with glucagonoma and mixed or combined insular tumors are reviewed in detail.

[Splenectomy for hematologic indications. Indications, early results (author's transl)]. / Les splénectomies "d'indication hématologique" Indications. Résultats précoces.

In the light of their personal experience of 1,036 splenectomies, the authors review the hematological diseases which still require surgery, viz. certain hemolytic anemias, idiopathic thrombocytopenic purpura, Hodgkin's disease under certain conditions, and sometimes the splenic lesions in certain malignant blood diseases; they analyse their results. Thanks to close collaboration between hematologists and intensive care specialists, the mortality has been reduced to 1.35 p. cent and the morbidity to 3.46 p. cent which leaves 95.19 p. cent without any immediate postoperative complications. The late results depend on the initial disease process.

[110 consecutive laparotomies for hepatic metastasis]. / 110 laparotomies consécutives pour métastases hépatiques.

From 1978 to 1988, we performed 110 laparotomies for hepatic metastases. With 41 resections for colorectal metastases, the survival was 34% at 3 years. The operative mortality was 7%. With 25 resections for non colorectal liver metastases, the survival was 42% at 1 year, 12% at 3 years. The results, compared with those of literature justify, in the absence of any other potential curative treatment, to remove colorectal liver metastases. For metastases from other tumours, results of resection for endocrine tumours and few sarcomas invite us to an aggressive approach.

[Massive digestive hemorrhage caused by aorto-esophageal fistula]. / Les hémorragies digestives massives par fistule aorto-oesophagienne.

A very rare diagnosis before a terminal hemorrhagic accident, aorto-esophageal fistula (FAO) is almost always fatal. Three cases of this exceptional lesion are reported. The first patient died within a few minutes of admission from a cataclysmic hematemesis. This 52 year old man had a recurring adenocarcinoma of the cardia that had been treated by laser. A "premonitory hematemesis" of bright red blood had occurred eight hours before admission. In the two other cases the problem arose with an "open abdomen" in exsanguinated patients operated upon as emergencies for massive hematemesis. In both cases, an intra-esophageal balloon catheter and controlled hypotension allowed performance of a left thoracotomy and aortic clamping. One patient had a cancer of middle third of esophagus that had perforated into the descending aorta. A resection-graft of the aortic isthmus and a retrosternal gastric esophagoplasty was successfully carried out at the time of exploration. The other patient had an FAO in the aortic isthmus region probably due to a foreign body. Operation involved an esophagectomy with cervical esophagotomy and gastrotomy combined with a resection-graft of aortic isthmus using a Dacron prosthesis. This patient died on the 21st postoperative day from rupture of the brachiocephalic trunk over a tracheotomy tube. In both of these patients a "premonitory hematemesis" with dysphagia had preceded the severe hemorrhagic accident. Successful treatment is rarely obtained with such lesions, since difficulties in ensuring rapid hemostasis in exsanguinated patients operated upon usually without diagnosis and for massive hemorrhage only, are associated with the risks of aortic repair surgery in a hemorrhagic field and with a mediastinum infected from the esophageal wound.(ABSTRACT TRUNCATED AT 250 WORDS)

[Pancreatic trauma: diagnostic and therapeutic emergency. Apropos of 35 cases]. / Traumatismes du pancréas: urgence diagnostique et thérapeutique. A propos de 35 cas.

35 consecutive pancreatic trauma were operated (21 blunt trauma and 14 penetrating injuries). 30 patients were operated in emergency and diagnosis was suspected before laparotomy in only one case. 12 patients had a superficial lesion, 21 had a wirsung disruption (14 in the left pancreas, 7 in the right pancreas), 2 had a diffuse pancreatitis. For the 30 patients operated in emergency, 20 had a conservative treatment, 10 had a resection. 5 patients died (14.2%), from exsanguination (2 cases), missed diagnosis or inadequate treatment (2 cases), sepsis after adequate management (1 case). Our experience suggests that an aggressive diagnosis management in emergency, with pre or pre-operative wirsungography, could determined with precision the type of the lesion and permit an adequate management, to decrease mortality.