[Surgical management of lungs destroyed by tuberculosis]. / Résultats chirurgicaux des poumons détruits post-tuberculeux.

OBJECTIVE: The purpose of this work was to report our experience with surgical management of lungs destroyed by tuberculosis and to analyze our results. MATERIAL AND METHODS: We reviewed the cases of 45 patients who underwent surgery between January 1978 and December 2004 after medical treatment for pulmonary tuberculosis considered successful. The series included 31 men and 14 women, mean age 31 years (range: 7-55 yr). Indications for surgery were chronic bronchorrhea (91.1%) and hemoptoic sputum associated with bronchorrhea (8.9%). Lung function tests were preformed in 42 patients and noted a restrictive syndrome with shunt in all: mean FEV1 was 1 890 ml. All patients were given a preoperative medical regimen for at least four weeks. Pneumectomy (17 right and 28 left) was performed; all bronchial sutures were made manually and protected. Operative bleeding was a constant feature and blood transfusion was needed (mean 1,500 cc). RESULTS: Operative mortality was 4.4% from hemorrhagic and infectious causes. Complications were non-fatal (16.3%) and marked by bleeding (0.9%) empyema with bronchopleural fistulae (8.9%). Mean postoperative hospital stay was 13 days without empyema and 150 days with empyema. Long-term outcome was satisfactory after a mean 7.5 years follow-up (range: 4 months - 20 years). CONCLUSION: Indications are patient comfort and necessity. Morbidity and mortality are acceptable with adequate preoperative preparation.

Typhoid ileal perforation: surgical experience of 64 cases.

OBJECTIVE: Intestinal complications of typhoid fever are quite common in developing countries. In order to contribute to the improvement of the prognosis of typhoid ileal perforation, the authors report their own surgical experience PATIENTS AND METHODS: between May 95 and July 98, 64 patients, (31 men and 33 women), with an average age of 34 years (ranging from 5 to 63 years) underwent surgery for typhoid ileal perforation. The surgical techniques used were excision-suture (n = 31) and resection-ileostomy (n = 33). All the patients were operated under similar pre-, per- and postoperative care facilities. RESULTS: Postoperative complications were observed in 59 patients (88.1%). The mean hospital stay was 30 days (ranging from 8 to 52 days). The overall postoperative mortality was 34% (22/64), mainly due to digestive fistula in 11 cases (8 cases of anastomotic leak after excision-suture, 3 cases of bowel fistula after conservative resection-ileostomy) and to chronic peristomal ulceration in 9 cases, which led to progressive malnutrition, cachexy and death. CONCLUSION: The mortality and morbidity after surgical treatment of typhoid ileal perforation remains very high in developing countries. However some recommendations could improve the outcome: aggressive resuscitation by intravenous hydratation of 4 to 6 hours, associated with adequate antibiotherapy, the resection of the last 60 centimetres of the ileum, in cases of serious abdominal suppuration, and a large abdominal washout.

Wilkie's syndrome.

A superior mesenteric artery syndrome (SMAS) was diagnosed in two young women with, respectively, a 2- and 1-year history of postprandial vomiting and epigastric pain. The patients underwent a laparoscopic duodenojejunal bypass, and resumed a normal diet on the fifth postoperative day. The patients are still symptom-free with patent anastomosis on gastrointestinal radiographic control at 24 and 6 months, respectively, following their operation. Herein we also describe the varying clinical presentation of this rare syndrome, as well as treatment options. We conclude that laparoscopic duodenojejunostomy offers a new therapeutic approach to SMAS. It is reliable and safe; the operating time is acceptable; and diet recovery and hospital stay are both short. However, these preliminary results still need to be confirmed by further observations.

Feline and canine coronaviruses are released from the basolateral side of polarized epithelial LLC-PK1 cells expressing the recombinant feline aminopeptidase-N cDNA.

In this study feline (FECV and FIPV) and canine (CCoV) coronavirus entry into and release from polarized porcine epithelial LLC-PK1 cells, stably expressing the recombinant feline aminopeptidase-N cDNA, were investigated. Virus entry appeared to occur preferentially through the apical membrane, similar to the entry of the related porcine coronavirus transmissible gastroenteritis virus (TGEV) into these cells. However, whereas TGEV is released apically, feline and canine coronaviruses were found to be released from the basolateral side of the epithelial cells. These observations indicate that local infections as caused by TGEV, FECV and CCoV do not strictly correlate with apical release, as suggested by earlier work.

Characterization of adherence of nontypeable Haemophilus influenzae to human epithelial cells.

The adherence of 58 nontypeable Haemophilus influenzae isolates obtained from patients with otitis media or chronic obstructive pulmonary disease (COPD) and obtained from the throats of healthy individuals to Chang and NCI-H292 epithelial cells was compared. Otitis media isolates, but not COPD isolates, adhered significantly more to both cell lines than did throat isolates. Since high-molecular-weight (HMW) proteins are major adhesins of nontypeable H. influenzae, the isolates were screened for HMW protein expression by Western blotting with two polyclonal sera and PCR with hmw-specific primers. Twenty-three of the 32 adhering isolates (72%) and only 1 of the 26 nonadherent strains were HMW protein or hmw gene positive. Among the 32 isolates adhering to either cell line, 5 different adherence patterns were distinguished based on the inhibiting effect of dextran sulfate. Using H. influenzae strain 12 expressing two well-defined HMW proteins (HMW1 and HMW2) and its isogenic mutants as a reference, we observed HMW1-like adherence to both cell lines for 16 of the 32 adherent isolates. Four others showed HMW2-like adherence to NCI-H292. Of the three other patterns of adherence, one probably also involved HMW protein. Screening of the isolates with six HMW-specific monoclonal antibodies in a whole-cell enzyme-linked immunosorbent assay showed that the HMW proteins of COPD isolates and carrier isolates were more distinct from the HMW proteins from H. influenzae strain 12 than those from otitis media isolates. Characterization of the HMW protein of a COPD isolate by adherence and DNA sequence analysis showed that despite large sequence diversity in the hmwA gene, probably resulting in the antigenic differences, the HMW protein mediated the HMW2-like adherence of this strain.

Splenic metastasis of a fallopian tube adenocarcinoma.

Clinical, diagnostic and therapeutic characteristics of a case of a fallopian tube adenocarcinoma splenic metastasis are reported. This case illustrates the diagnostic difficulties of this situation. These difficulties are both related to the poorly specific symptomatology and the low specificity of the current imagery. Percutaneous biopsy aspiration guided by ultrasonography or CT-scan could be helpful. The treatment is surgery, eventually combined with adjuvant radiotherapy: it can allow a long survival time. Splenic metastasis should be systematically checked up in every tumoral context.

[Evolution of the surgical treatment of chronic pancreatitis over the last 25 years]. / Evolution sur 25 ans du traitement chirurgical de la pancreatite chronique.

The author briefly reminds us of the physiopatholopy of chronic pancreatitis (CP) and of its two principal surgical therapies: the excision (mainly cephalic or caudal) and the derivations (essentially towards an excluded jejunal ring). In order to avoid such a mutilation, either pancreatic or jejunal for the treatment of obstructive "pancreatic lithiasis", the author proposes to classify the lesional repercussions in cavitary CP (in which the existence of a pseudocyst is dominant) and in parenchymatous CP (ensheating the ducts, that are more or less dilated). He infers from this the possibility of a treatment that is as physiological as possible, essentially by cystoduodenostomy (CD) with a tripod forceps, for CP with a dominant cavitary type (with pseudocysts showing a cephalic and/or a corporeocaudal localization) and by wirsungosphincteroclasia (W-SC) for the CP with a parenchymatous prevalence. This therapeutic evolution, aiming at abandoning the classical operations of excision or derivation is based upon the author's experience acquired since 1970. During these 25 years, the author operated on 549 patients showing a CP with several severe evolutive complications. Beside 75 exopancreatic operations, the author performed 474 operations selectively concerning the pancreas: 245 excision operations and 228 derivation operations. Since the introduction, in October 1986, of the W-SC operation, among the 169 recent pancreatic operations for severe CP, only 10 exeresis operations were performed: 66 CD (41.5%) and W-SC 92 (57.9%), coupled in two thirds of the cases with a biliodigestive cholecystoplasty. The very encouraging results of this more physiological and non-mutilating treatment of severe CP justify, according to the author, forsaking the classical techniques of parenchym-exeresis or of derivation to an excluded ring an favour of a direct drainage into the duodenum both for a cavitary CP by CD as for a parenchymatous CP by W-SC.