[Ileum intussusception in an adult: a case report]. / Invagination iléo-iléale chez un adulte.

Intussusception in adults is a rare cause of intestinal obstruction and is usually secondary to some lesion in the gastrointestinal tract. We report a case of intestinal obstruction due to ileo-ileal intussusception, an inflammatory fibroid polyp formed the leading edge of the intussusceptum, which is a rare polypoidal lesion of the gastrointestinal tract.

Dirithromycin versus amoxiclav in the treatment of acute exacerbations of chronic bronchitis.

A total of 334 patients with acute exacerbation of chronic bronchitis were treated with either dirithromycin for 5 days (n = 169) or amoxiclav for 7-10 days (n = 165) in an open randomized trial. The efficacy and tolerability of the two drugs were compared. There was no statistically significant difference in outcome between the two treatment arms. Clinical success (cure or improvement) was obtained in 94.5% and 93.1% of patients treated with dirithromycin and amoxiclav, respectively. Adverse events (mostly gastrointestinal) occurred in both groups, but led to discontinuation of treatment (in only seven patients). We conclude that the two drugs are equally efficacious and safe.

[Laparoscopic surgery of gastroesophageal reflux]. / Chirurgie laparoscopique du reflux gastro-oesophagien.

Complete fundoplication according to Nissen's technique and partial posterior hemifundoplication (Toupet's and Lind's techniques) are effective treatments for gastrooesophageal reflux. Their application in open surgery has already been largely assessed. Since 1991, these operations have been performed by laparoscopic surgery. In this study, the course of 368 patients treated via a laparoscopic approach was evaluated. For 363 patients (98.6%), the operation was completed under laparoscopic control with no operative mortality. The operative morbidity was 4%. Two patients (0.5%) had to be reoperated 6 and 8 months after the initial operation for persistent dysphagia. In september 1993, 126 patients with a minimum postoperative follow-up of 12 months (median: 16.2 months) accepted a follow-up assessment. Visick I and II score were observed for 90.4% of patients. These short-term results are encouraging and suggest that the results obtained are comparable to those of conventional surgery, with a lower morbidity and a reduced hospital stay. Precise selection of patients and surgical techniques is essential.

[An unusual case of clear-cell carcinoma of the pancreas]. / Une observation exceptionnelle d'un carcinome pancréatique à cellules claires.

This case of clear-cell carcinoma of the pancreas was a rare for three reasons: a) discovery: the investigation was indicated after sudden digestive hemorrhage revealed by melena and anaemia; b) morphology: the tumour began in the head with a spheric tumoural bud and a pediculated extension into the duodenum; c) pathology a clear-cell tumour similar to the type seen in renal localizations. Only one other case of such a primitive tumour was found reported in the literature.

[Cecal and right colonic perforation on a single or multiple diverticulum. Apropos of three new cases]. / Perforation caecale et colique droite sur diverticule unique ou multiple. A propos de trois nouvelles observations.

There are two types of cecal diverticula: in the first type, the diverticula are often multiple, and they really are false diverticula like in sigmoiditis. The second type, the so-called single type, is a frequently single diverticulum with a complete wall, which may have a congenital origin. Cecal diverticula are often expressed between 45 and 55 years of age by symptoms mimicking appendicitis. Two signs may suggest the diagnosis: the virtual absence of nausea and vomiting, and the long delay before the onset of pain. The surgical treatment, in case of acute complications (perforation, abscess), varies according to the surgical findings. In fact, if a pseudotumoral inflammatory mass is discovered, the correct diagnosis is established in 58% to 72% of all cases only. The treatment can therefore range from simple diverticulotomy to righ hemicolectomy.

[Acquired diverticulosis of the small bowel]. / La diverticulose acquise de l'intestin grêle.

The authors report about their surgical experience? On the basis of one case of pneumascos and one case of gastrointestinal hemorrhage with collapse, for which no origin was found preoperatively and which was attributed to the presence of diverticula in the small bowel. The analysis of the literature shows that this rare condition (0.1% of the population) is mainly expressed as acute complications: diverticulitis, perforation, hemorrhage, obstruction. The treatment is surgical as a rule, but it can be medical if the condition is included in the scope of a malabsorption syndrome.

[Gallbladder volvulus]. / Le volvulus de la vésicule biliaire.

We report two new cases of gallbladder volvulus. This rare condition principally affects elderly patients but is due to a congenital malformation related to the presence of a long mesocyst. Various factors such as kyphoscoliosis, multiparity and peristalsis of neighbouring organs favorise the occurrence of volvulus, the role of lithiasis is debatable. The diagnosis may be suggested on ultrasound but is most often confirmed at laparotomy. Diagnosis should be made rapidly in order to avoid progression towards a potentially fatal secondary peritonitis. Certain clinical elements such as the presence of a "floating mass" on palpation may suggest the diagnosis.

Isolation of Campylobacter jejuni from the bile of a cholecystic patient.

Described is the isolation of Campylobacter jejuni from the bile of a cholecystic patient admitted for abdominal pain to an intensive care unit. A cholecystectomy was performed, and the patient responded to erythromycin therapy. Details of this uncommon isolation are given.