[Open wedge osteotomy of the tibial head. Management of vascular complications]. / Aufklappende Osteotomie des Tibiakopfes. Management von vaskulären Komplikationen.

BACKGROUND: Lesions of the popliteal artery during high tibial osteotomy are rare complications, consequently the majority of publications are case related. The interval between surgery and diagnosis is reported to be as long 3 years; therefore, the current literature probably does not reflect the true incidence of vascular injuries. OBJECTIVE: The case reports published in the literature were further evaluated. The focus was on the normal vascular anatomy of the popliteal region and anatomical deviations that predispose to vascular injury. As the flexion angle of the knee joint is considered to be decisive for vascular injury, this aspect was also an additional focus. For the unlikely event of a vascular injury, recommendations are presented which indicate diagnostic and therapeutic decisions. METHODS: We analyzed the available literature and present own magnetic resonance imaging (MRI) investigations of the popliteal artery with different angles of flexion in six healthy volunteers. RESULTS AND DISCUSSION: A variation of the origin of the anterior tibial artery with a course between the posterior tibial cortex and the popliteal muscle was found in 6% of all patients and predisposes to an accidental injury during osteotomy. The results in the literature and our own MRI findings suggest that a flexion angle of 90° facilitates anatomical dissection and osteotomy but cannot be regarded as a reliable protection against vascular injury.

Management of acute diverticulitis in a tertiary care institution.

BACKGROUND: Diverticular disease of the left colon is a common disease, mainly in the population over 50 years of age. The surgical management of acute diverticulitis is remains controversial, especially in severe forms. OBJECTIVE: This study aimed to evaluate the results of laparoscopic surgery for diverticular disease in a tertiary care institution with a specialist interest in minimally invasive surgery. DESIGN: All patients who had elective laparoscopic sigmoidectomy for diverticulitis within eight years at University Hospital of Luxembourg were selected from a retrospective database to evaluate laparoscopic benefit in moderate and severe disease. RESULTS: A total of 155 patients were divided in two groups: Moderate Acute Diverticulitis (MAD) and Severe Acute Diverticulitis (SAD) respectively. The short-term outcomes, after laparoscopic sigmoidectomy, were evaluated. There were not important differences between two groups. CONCLUSIONS: The laparoscopic management of diverticular disease after moderate and severe crisis gives same benefits and short-term outcomes are similar. Elective Laparoscopic surgery is actually the standard of care for moderate and severe diverticular disease in our institution.

Laparoscopic Roux-en-Y gastric bypass versus laparoscopic vertical banded gastroplasty: results of a 2-year follow-up study.

BACKGROUND: The world's epidemic of obesity is responsible for the development of bariatric surgery in recent decades. The number of gastrointestinal surgeries performed annually for severe obesity (BMI > 40 kg/m2) in the United States has increased from about 16,000 in the early 1990s to about 103,000 in 2003. The surgical techniques can be classified as restrictive, malabsorptive, or mixed procedures. This article presents the results for 2 years of bariatric surgery in the authors' minimally invasive center and analyzes the results of the most used surgical techniques with regard to eating habits. METHODS: Between January 2002 and January 2004, the authors attempted operations for morbid obesity in 110 consecutive patients adequately selected by a multidisciplinary obesity unit. This represented 43% of all consultations for morbidly obese patients. The patients were classified as sweet eaters or non-sweet eaters. All sweet eaters underwent gastric bypass. The procedures included 70 Roux-en-Y gastric bypasses, 39 Mason's vertical banded gastroplasties, and 1 combination of vertical gastroplasty with an antireflux procedure. Revision procedures were excluded. RESULTS: The mean age of the patients was 41.36 years (range, 23-67 years), and 72.3% were female. The mean preoperative body mass index was 44.78 kg/m2 (range, 34.75-70.16 kg/m2). The mean operating time was longer for gastric bypass than for the Mason procedure. Three patients required conversion to an open procedure (2.7%). The two operative techniques had the same efficacy in weight reduction. Early complications developed in 11 patients (10%), and late complications occurred in 9 patients (8.1%). The postoperative length of hospital stay averaged 4.4 days (range, 1-47 days; median, 4 days), and was longer in the gastric bypass group. The mortality rate was zero. Data were available 2 years after surgery for 101 of the 110 patients (91%). Most comorbid conditions resolved by 1 year after surgery regardless of the type of operation used. CONCLUSION: With zero mortality and low morbidity, bariatric surgery performed for adequately selected patients is the most effective therapeutic intervention for weight loss and subsequent amelioration or resolution of comorbidities. The patient's eating habits before surgery play an important role in the choice of the operative technique used.

Present state of the Mini-Invasive Surgery (MIS) in esophageal and gastric cancer.

The purpose of this review is to stress the role of the Mini-Invasive Surgery (MIS) in the treatment of the esophagogastric malignant illnesses, supporting ourselves on the most relevant publications of the literature as well as on our own experience in this subject. In short, although no randomised prospective study has proven the MIS advantages in relation to the traditional surgery in the esophagectomy due to cancer, some authors preferently indicate this approach to selected and informed enough patients, who present the following: - High grade dysplasia, preferently choosing from laparoscopic transhiatal esophagectomy (LTE). - Carcinoma in situ, preferently choosing the LTE vs thoracoscopy. - Esophageal tumour locally advanced, in resectable patients with contraindication for a thoracotomy or, in initially non-resectable patients with tumoral reduction after neo-adjuvant chemo-radiotherapy. The arguments given by the authors are the postoperative spectacular improvement in relation to the comfort and quality of life and, the absence of oncological negative effects in the long-term followup. Concerning gastric cancer, the MIS, as exeresis surgical tool in the so-called <> gastric forms, is such a definite and oncological approach as the traditional approach, and superior to this as far as quality of life is concerned. When the MIS is used for treating locally advanced forms of gastric cancer, it is as safe as the laparotomic way and it seems to obtain the same oncological outcomes in the long-term.

[Postoperative care following hip fracture in a hospital or a psychogeriatric nursing home? A comparative study of short or long-stay demented hospitalized elderly]. / Post-operatieve zorg na een heupfractuur in een ziekenhuis of een psychogeriatrisch verpleeghuis? Een vergelijkend onderzoek tussen demente bejaarden die kort of langdurig in het ziekenhuis verblijven.

In this article the question under discussion is, whether a short stay in hospital, for an inmate of a psychogeriatric nursing home with a hip-fracture, shows better results for mortality, morbidity and mobility than a long stay. Two matched groups, of 27 inmates each, have been compared retrospectively. The first remained in hospital for a week or more (long stay), the second for a period of less than a week (short stay). There was no significant difference in mortality risk between both groups. There were less urinary infections in the short-stay group and one month after the operation mobility was better. Decubitus, wound infection and bronchopneumonia appeared equally frequent. The results justify to continue the policy in this nursing home. More research in other nursing homes is pleaded.

Radiological diagnosis and therapy of pulmonary arteriovenous fistulae in a patient with an atypical clinical history: a case report.

Pulmonary arteriovenous fistulae were first managed nonsurgically by Porstmann in 1977 with homemade metallic coils (1). During the intervening twenty years better catheterization techniques have been developed and our understanding of the clinical outcomings of these lesions has improved. This report discusses the natural history of pulmonary arteriovenous fistulae, including the neurological and other complications, the importance of family screening in the detection of asymptomatic family members, the diagnostic strategy and the description of improved techniques for embolotherapy with stainless steel coils.

[Spontaneous regression of pulmonary metastases in renal cancer]. / Régression spontanée de métastases pulmonaires d'un cancer rénal.

Spontaneous regression of lung-metastases in kidney cancer (a case report) A case is reported of a 56-year old woman with renal cell carcinoma operated and treated adjuvantly for a year with Interferon alpha. Ten months thereafter the patient had histologically proven a large pulmonary metastatic disease that regressed spontaneously. Duration of the spontaneous remission was 8 months.

[Imaging evaluation of an alobar holoprosencephaly with cyclopia]. / Bilan radiologique d'une holoprosencéphalie alobaire avec cyclopie.

A case of an alobar holoprosencephaly with cyclopia diagnosed by prenatal ultrasound is reported. At 23 weeks of gestation, abortion was performed. The holoprosencephalic aborted foetus was studied as completely as possible. Skull X-rays, cranial computed tomography, and magnetic resonance images are discussed and compared with the necropsy findings.

[Prostatic leiomyoma]. / Leiomyome prostatique.

Large leiomyomas of the prostate are rare tumors. The authors report the case of a 78-year-old patient with two large prostatic leiomyomas who presented with chronic obstructive urinary symptoms. The US and CT aspects are illustrated; the signs are not specific but rather suggest a benign process. The tumor, probably of embryologic origin, must be distinguished from neoplasms when presenting in association with the classical benign prostatic hypertrophy. The definite diagnosis is obtained histopathologically. Prognosis is good with no evidence of recurrent disease.

Primary aortic thrombosis: role of enhanced multislice CT demonstrated in three exceptional cases.

Primary aortic thrombosis remains a rare entity that can be defined as clotting of the vessel without any obvious atheromatous lesion. Cancer chemotherapy, cocaine intake, essential thrombocythemia, some hypercoagulable states, heparin-induced thrombocytopenia, inflammatory disease of the digestive tract and acute pancreatitis are, beside some cases of rather unknown etiology, the causes of primary aortic thrombosis. Intravenous contrast-enhanced multislice CT, which is widely available, noninvasive and affordable in terms of cost, is the imaging modality of choice for the investigation of primary aortic thrombosis and the assessment of potential complications. Three cases due to chemotherapy, antiphospholipid syndrome and acute pancreatitis are reported.

Liver abscess caused by an unnoticed swallowed toothpick perforating the colonic wall.

We present an unusual case of a liver abscess caused by a swallowed toothpick in a 43-year-old man. The abscess was first punctured under percutaneous ultrasound control and intraveneous administration of antibiotics whereas the diagnosis of the foreign body stuck in the sigmoid bowel wall was only made by a follow-up computed tomography since the patient had no complains indicating a colonic pathology. Even more, the patient did not remember ever having ingested a foreign body. The wooden toothpick was then successfully removed by endoscopy. The case report stresses the need for a search of the cause of unexplained liver abscesses and highlights the importance of computed tomography as the first imaging technique as the foreign body was missed on the ultrasound examination. Finally, the non-surgical treatment as first line management of liver abscesses will be discussed.

Advance directives: legal remedies and psychosocial interventions.

Although the legal basis to refuse life supports is firmly embedded in the laws of all 50 states, there is evidence that a gap exists between patients' preferences and physicians' actions. Patients and their families have increasingly begun to turn to the courts for redress, requesting damages when a physician has ignored their request to forgo life-sustaining treatment. This article explores the reasons why patients' end-of-life medical choices are often ignored by the medical profession and the results of recent attempts to remedy these situations through the courts. Implications for practice are discussed, including practical suggestions for increasing the likelihood that a patient's wishes will be respected by medical providers.

Neurosarcoma of the face: MRI.

Neurosarcoma is a rare tumour originating from the sheath of peripheral nerves. Facial lesions have been reported in about 20 patients. We describe the MRI appearances of neurosarcoma with histological correlation in three patients. The lesions lay in the submandibular region, the left parapharyngeal space and the right orbit. MRI showed a well-defined mass with mixed components. The lesions were moderately heterogeneous on T1-weighted images in two cases and on T2-weighted images in all cases. Gadolinium enhancement occurred in all cases to variable degrees. In two cases, small high signal foci were seen on T2-weighted sequences. MRI appearances of neurosarcoma are not specific.