Strangulated lesser sac hernia.

Internal hernias account for less than 1% of acute mechanical bowel obstruction. Because of their rarety, they are often not considered in the clinical or radiologic diagnosis of bowel obstruction; diagnosis is often delayed, and is most often made at the time of surgery. We present images obtained during the management of a strangulated transomental internal hernia; computerized tomography permitted timely preoperative diagnosis and specifically adapted surgical therapy.

[Ultrasound guidance of central venous catheterisation]. / Echoguidage 2D pour la pose de chambres implantables.

Portacath implantation with introduction of a catheter into the superior vena caval system is a commonly performed procedure. Catheterization of the internal jugular vein can be difficult due to anatomical variation, individual patient morphology, or as a result of previous catheterization. Use of 2D ultrasonography facilitates localization of the internal jugular vein and decreases the risks of catheter placement.

[Spontaneous perforation of a retroperitoneal duodenal diverticulum]. / Perforation spontanée d'un diverticule rétropéritonéal du duodénum.

Spontaneous perforation is a rare complication of a retroperitoneal duodenal diverticulum; diagnosis and treatment are both difficult. We report a case of perforated duodenal diverticulitis diagnosed by CT, which required surgical intervention after failure of medical treatment.

Vestigial retrorectal cystic tumors in adults: a review of 30 cases.

OBJECTIVES: Retrorectal tumors are uncommon. This is a report on a series of vestigial retrorectal cystic tumors in adults that were surgically removed at two medical centers in France. We also assessed the significance of imaging and, in particular, magnetic resonance imaging (MRI) in the management of these lesions. METHODS: The medical files of adult patients operated on for vestigial retrorectal cystic tumors over the past 15 years were retrospectively studied and, in particular, the radiological studies, the treatment and the histopathology. RESULTS: Thirty patients underwent surgery for vestigial retrorectal cystic tumor. A preoperative diagnosis was possible in almost all cases. The surgical procedure was justified by preoperative imaging and included the transanal approach (three cases), posterior approach (23 cases), anterior approach (two cases) and combined posterior and anterior approach (two cases). Imaging can identify a multilobular lesion that may require the use of a coccygeal approach to achieve complete resection. During a mean follow-up of 3.2 years (range 0.5-15 years), two patients had a local recurrence (successfully surgically removed), and a further two patients were lost to follow-up. Only one lesion was malignant. CONCLUSIONS: Preoperative imaging, and especially magnetic resonance imaging, enables both a specific diagnosis and the selection of the optimal surgical procedure for the treatment of vestigial retrorectal cystic tumors in adults.

Risk factors of unplanned readmission after colorectal surgery: a prospective, multicenter study.

PURPOSE: Unplanned readmission after colorectal surgery is a relatively frequent event, knowledge of which often is inaccurate. This study was designed to examine the incidence and causes of readmissions and to determine the criteria that could predict them. METHODS: From June to September 2002, 1,421 patients were enrolled in a prospective, multicenter study performed by the Association Francaise de Chirurgie. The goal of the study was to determine mortality and morbidity after colorectal surgery for elective or emergency surgical management of diverticular disease or cancer. In the study, readmissions within three months after discharge were assessed. RESULTS: Of 1,421 patients, 342 patients (27 percent) were readmitted once after a mean period of 53 days. Among the readmissions, 248 (19.5 percent) were planned and 94 (7.5 percent) were unplanned (mainly for septic complications). With the multivariate logistic regression analysis, five independent factors were significantly associated with a higher risk of unplanned readmission (in order of importance): surgical field contamination, long duration of operation, need for an associated surgical procedure, hemoglobin level <12 g/dl, and absence of air testing after colorectal anastomosis. CONCLUSIONS: The study permitted to individualize several factors significantly associated with a higher risk of unplanned readmission after colorectal surgery.

[Surgical and forensic problems of body-packing]. / Transport de stupéfiants in corpore: problèmes médico-chirurgicaux et médico-légaux.

Body-packing has increased as a means of illicit drug transportation, particularly since the intensification of customs control and luggage inspection which followed the terrorist attacks of September 11, 2001. This mode of drug transport may result in intestinal obstruction or systemic intoxication; diagnostic measures are discussed; management may require specific precautions and occasionally surgical intervention. The problem of how to handle and dispose of large quantities of drugs removed from or passed by a patient who may not be under arrest presents specific medicolegal considerations.

[Retrospective and comparative study of the medicoeconomical impact of a new mesh in the treatment of anterior abdominal wall incisinal hernia]. / Etude comparative rétrospective de l'impact médicoéconomique d'un renfort innovant dans la cure des éventrations de la paroi abdominale antérieure.

STUDY AIM: Determine the gain of hospitalization cost using a new intraperitoneal mesh compared to the retro-muscular pre-fascial implantation of a polyester mesh. PATIENTS AND METHODS: From January 1998 to June 2000, 52 patients with incisional hernia of the anterior abdominal wall were operated using intraperitoneal Parietex composite Mesh. The cost of surgery, anesthesia and hospitalization in this group were compared to similar data from a group of 21 patient where a Mesrsuture mesh in a prefascial retromuscular position was used. RESULTS: Parietex Composite Mesh in intraperitoneal position allows a significative reduction in surgery time, anesthesia time and hospitalization. The clinical results were confirmed by cost savings. CONCLUSION: Using new innovative medical device changing surgery technique insures significant cost saving despite its initial additional cost and increases patient's comfort during hospitalization.

[A false peritoneal carcinomatosis]. / Une pseudocarcinose péritonéale.

Abdominal actinomycosis is an unusual peritoneal disease due to actinomyces, which are Gram-positive bacillus bacteria. Those saprophytes pathogens of digestive tract and genital mucous, can appear accidentally in the peritoneum cavity, in tumor form, simulating a neoplasic disease. We report the case of a 43-year old woman, with abdominal actinomycosis, revealed by feverish bowel obstruction. During laparotomy, several nodes were removed. Their histologic study permitted the diagnosis. Long-term antibiotics treatment allowed patient recovery.

[Intrathyroidal parathyroid adenoma. Study of a case]. / L'adénome parathyroidien en position intrathyroidienne: à propos d'un cas clinique.

Intrathyroidal parathyroid adenoma is an infrequent lesion which can be explained by abnormalities during embryonic migration of the parathyroid glands. That abnormality can be a cause of failed cervical exploration for primary hyperparathyroidism. From a case report and literature data, we propose an exploration processes to search those ectopic parathyroid adenoma.

[Water balance in the european eel (Anguilla anguilla L.). Role of the oesophagus in the utilisation of drinking water and a study of the osmotic permeability of the gills (author's transl)]. / L'équilibre hydrique de l'anguille européenne (Anguilla anguilla L.). Etude du rôle de l'oesophage dans l'utilisation de l'eau de boisson et étude de la perméabilité osmotique branchiale

10 New experimental devices are described which allow chonic measurements of drinking rate and osmotic gill permeability in the eel. 20 The oesophagus of the seawater (SW) silver eel plays a role in osmoregulation. It decreases the concentration of Cl- and Na+ of the ingested SW without losing water in the serosal to mucosal direction. This allows for immediate water absorption in the intestine and decreases the quantity of ions actively absorbed by the intestine. In the freshwater (FW) silver eel, the oesophagus is impermeable to water, Cl- and Na+. The ionic impermeability exists only in the serosal to mucosal direction. A mucosal to serosal permeability to Cl- and Na+ exists in the FW oesophagus receiving hypertonic drinking water, this promotes seawater adaptation. 30 The osmotic gill permeability, measured in vivo in the silver eel, is very low in FW and decreases slightly in SW. Thus, the silver eel has an osmotic gill permeability preadapted to SW life. The kinetics of FW to SW adaptation are described.