Liver resection for cystic lesions: a 15-year experience.

AIM: The aim pf this paper was to review the management strategies in patients who had hepatic resection for cystic lesions. If symptomatic, a simple liver cyst (SC) is best treated by unroofing. A hydatid cyst (HC) is treated by simple cystectomy or pericystectomy. Many procedures have been described for the management of complex non-HCS including aspiration, sclerosing therapy, drainage, unroofing, and resection. METHODS: A retrospective review of patients who had liver resection for cystic lesions between January 1, 1992, and December 31, 2006. The study was carried out at a University Hospital and a General Community Hospital affiliated with a University program. Management strategies were detailed, including clinical, biological, and imaging features. Operative morbidity and mortality as well as long-term outcome were also assessed. A comparison between preoperative and postoperative diagnoses was performed. RESULTS: Thirty-three patients (24 women and 9 men) underwent 39 liver resections, including 14 left lateral resections, 12 right hemi-hepatectomies, 7 left hemi-hepatectomies and 6 segmentectomies or wedge resections. The final diagnosis included hydatid cyst in 10 patients (30%), cystadenoma in 6 (18%), simple cysts in 6 (18%), Caroli's disease in 4 (12%), cystadenocarcinoma in 3 (9%) and miscellaneous in the 4 remaining (12%). There was no mortality and the postoperative morbidity rate was 15%. Long-term follow-up revealed that, besides patients with malignancies whose outcome was dismal, overall prognosis was positive with efficacious symptom control. CONCLUSION; Accurate preoperative diagnosis of liver cystic lesions may be difficult. However, liver resection for such lesions is a safe procedure that provides long-term symptomatic control in benign disease and may be curative in cases of underlying malignancy. Even if nearly 50% of liver cystic lesions treated by resection were either symptomatic SC or HC, we recommend en-bloc liver resection for all liver cystic lesions that are not clearly parasitic or simple cysts.

[Obesity, diabetes mellitus, and gas gangrene: a major therapeutic challenge]. / Gangrène gazeuse sur terrain d'obésité morbide et de diabète.

Soft tissue infections are uncommon but prognosis is severe (20 to 50%). Management consists in surgical debridement, antibiotic therapy against anaerobic and aerobic bacteria, and appropriate intensive care. When available, hyperbaric oxygen therapy is an integral part of the treatment. We report the case of 56-year-old female patient with diabetes (150 kg) was hospitalized in our unit a few days after surgical treatment of a buttocks abscess for clinical signs of peripheral gas gangrene. Surgical exploration showed necrotizing soft tissue infection with fasciitis. Adequate therapy using antibiotics, surgery daily and hyperbaric oxygen was given. Therapy had to be adapted to the patient's obesity. Outcome was good with recovery and few sequelae, allowing transfer to a medical ward.

[Diagnosis of ventilator-associated pneumonia: a prospective comparison of the telescoping plugged catheter with the endotracheal aspirate]. / Diagnostic non invasif des pneumopathies nosocomiales acquises sous ventilation mécanique: comparaison entre le prélèvement distal protégé et l'aspiration endotrachéale.

OBJECTIVE: Quantitative culture of endotracheal aspirates (EA) is widely accepted for the diagnosis of ventilator-associated pneumonia (VAP). The aim of the study was to compare the diagnostic accuracy of the EA with the blinded plugged telescoping catheter (PTC) in patients suspected of VAP. STUDY DESIGN: Prospective non-randomised observational study. PATIENTS AND METHODS: 31 patients suspected of having VAP underwent 46 bronchial samplings. An EA and a blinded PTC were performed successively in each case; the PTC result was taken as the reference standard. The EA and PTC cultures were defined positive if the result of bacterial cultures yielding were > or = 10(5) cfu.mL-1 and > or = 10(3) cfu.mL-1 respectively. RESULTS: The diagnosis of VAP could be established in 19 cases when PTC was taking as gold test. The overall agreement between the two techniques was 76%. EA had a sensitivity of 89.5%, a specificity of 66.7%, a negative predictive value of 90% and a positive predictive value of 65.4%. CONCLUSION: EA is a good diagnostic test when a non-invasive test has been chosen. The diagnosis of VAP could be excluded in 90% of cases when the EA cultures yielding were < 10(5) cfu.mL-1. His low specificity could drive in an over treatment of bronchopulmonar bacterial colonization. The accuracy of the EA compares well with that of the TPC for the diagnostic of VAP.

Neisseria meningitidis C:2b:P1.2,5 with decreased susceptibility to penicillin isolated from a patient with meningitis and purpura fulminans.

This report describes the case of an 18-year-old woman with meningococcal meningitis and purpura fulminans. Cerebrospinal fluid culture revealed Neisseria meningitidis serogroup-serotype-serosubtype C:2b:P1.2,5 as the pathogenic organism. Following treatment with cefotaxime and management of multiple organ failure, the patient survived without sequelae. To the best of our knowledge this report represents the first case of a meningococcal strain with a minimum inhibitory concentration of 1.5 mug/ml for penicillin, without beta-lactamase production, to be documented in France. The prevalence of meningococci with reduced susceptibility to penicillin is increasing. The emergence of such strains might represent a serious problem affecting the empirical antibiotic treatment of meningococcal disease.