[Activities of the emergency department of a suburban hospital in 1984]. / Activité du service de garde d'un hôpital de Faubourg en 1984.

This is a review of the population coming to the outpatients department along June 1984. Most of the people are coming between noon and midnight. 20% of the patients are driven by ambulance and 59% of them are admitted, while only 23% of the total population and 11% of surgical cases are hospitalized. 56% of the patients are living in the neighbourhood of the hospital and 38% in the other suburbs of Brussels' urban area. Only 26% of the patients are referred by the family physician and 86% of them are admitted, while only 14% are requesting for a specific examination.

Incidence of pre-operative deep venous thrombosis in abdominal surgery.

In order to determine the incidence of pre-operative and postoperative deep venous thrombosis (DVT) in patients not receiving prophylactic anticoagulant therapy, bilateral phlebography was performed in a prospective study pre-operatively and on the 9th postoperative day, in 51 consecutive patients submitted for major abdominal surgery. The presence of a DVT before surgery was demonstrated in 15.7 per cent of the patients. This high frequency confirms objectively the rationale of starting prophylactic anticoagulant therapy before the surgical procedure. Thrombi were demonstrated postoperatively by phlebography in 54.9 per cent of the patients. Thus the true incidence of DVT induced by surgery was 39.2 per cent taking into account the 15.7 per cent pre-operative DVT rate.

Evolution of antithrombin III during the postoperative period.

In a prospective study, antithrombin III (AT III) was performed preoperatively, peroperatively immediately after the surgical procedure and daily during the 8 postoperative days in 57 consecutive patients who underwent major abdominal surgery without prophylactic anticoagulant therapy. On d 8, according to the results of a bilateral radiological phlebography, the patients were divided into 2 groups: Group I: presence of deep venous thrombosis (DVT): n = 28 (49%) and Group 2: absence of deep venous thrombosis: n = 29 (52%). The results of the study showed that the preoperative AT III value did not constitute a marker of the postoperative DVT risk. During the postoperative period, AT III level decreased immediately following the intervention and resumed its preoperative value within 8 d. Nevertheless, this evolution was not different in the 2 groups and was not related to the presence of postoperative DVT.

[Ulcer perforating into the free peritoneum. Review of 70 cases]. / Ulcère perforé en péritoine libre. Revue de 70 cas.

We retrospectively studied a series of 70 patients admitted between 1977 and 1982 with an acute perforated ulcer. As compared to available data our patient's population is characterized by elevated mean age and by important delay between onset of symptoms and admission. Clinical diagnosis supported by plain X-rays and laboratory was confirmed in 91%. In one patient only, treatment was purely conservative; nine vagotomies, four gastrectomies and fifty-six suture plication were performed. Hospital stage was short (mean: 13,5 days) despite 37% morbidity. Mortality (10%) was close correlated with age and delay between onset of symptoms and treatment.

[Parenteral nutrition in gastro-intestinal surgery (author's transl)]. / Alimentation parentérale en chirurgie digestive.

Forty-two postoperative patients received by parenteral route on 24 hours a total of 2,610 calories by means of a simultaneous infusion of 1,500 ml Trivé 1000 and 1,500 ml 10% invert sugar through a central venous line. Of those 42 cases 12 had peritonitis with 7 of them an enteric fistula, 18 underwent an extensive bowel resection and 12 suffered malnutrition secondary to their primary pathology. The average duration of parenteral nutrition was 13 days and the average hospital stay 27 days. No major metabolic derangement was noted except for a temporary transient elevation of SGOT and AF. A systematic bacteriological study of the perfusion lines disclosed an associated morbidity of about 6%. We are convinced that with the used solutions the postoperative catabolism can be managed successfully and that the association of aminoacids, lipids and glucides as used by us facilitates, nursing care.

[Parenteral feeding after total gastrectomy (author's transl)]. / Alimentation parentérale après gastrectomie totale

The authors report on 2 cases of radical gastrectomy for cancer. Parenteral feeding composed of amino acids, solutions of lipids and carbon hydrats insures an intake of 2,500 to 4,000 calories per day in the immediate postoperative phase. Daily nitrogen and measurement of the different blood and urine parameters make it possible to estimate the daily needs of these patients and to provide for a smooth recovery.

Pleural effusion with pancreaticopleural fistula.

Three patients with pleural effusion were found to have pancreaticopleural fistulas passing through an opening in the diaphragm are reported. In one case the effusion was purulent and originated from an abscess of the pancreas. Retrograde pancreatography during operation defined the course of the fistula. In two other cases the fistula was demonstrated by radiography after intrapleural injection of contrast medium. The diagnostic importance of injecting contrast medium early into the pleural cavity in cases of effusion rich in amylase, before lung expansion obscures the fistula, is emphasized. Cases of pancreaticopleural fistula may be commoner than supposed.