[Anterior desinsertion of the transversus abdominalis in the prosthetic treatment of major eventrations]. / La désinsertion antérieure du transverse dans le traitement prothétique des grandes éventrations.

An original procedure is suggested for the prosthetic treatment of major incisional hernias: transversus abdominalis muscle desinsertion. The aim is to create an opening between two cleavage planes which are the underperitoneal space externally and the posterior face of the rectus abdominalis muscle internally. The single space thus created allows the wide implantation of a subperitoneal Mersilene prosthesis which is isolated from the viscera as well as from the skin. A strong abdominal wall is then reconstituted. Ten patients were operated upon using this technique with excellent results in all cases.

[Response to hepatic intra-arterial chemotherapy for metastases of colorectal cancer. Anatomo-pathological evaluation apropos of 3 cases of secondary hepatic excision]. / Réponse à une chimiothérapie intra-artérielle hépatique pour métastases de cancer colo-rectal. Evaluation anatomo-pathologique à propos de 3 exérèses hépatiques secondaires.

Following intra-arterial chemotherapy (5-fluorouracil), wide hepatic resection was performed in three patients with metastases from colorectal cancer. These surgical procedures had been considered to be unfeasible before chemotherapy in two of the three cases because of the extension of the metastases. In contrast to the results of preoperative imaging techniques (CT scan, ultrasonography), the histologic response of tumors to chemotherapy was found to be significant (1/3) or complete (2/3). Since after chemotherapy these imaging procedures are unable to determine whether the observed lesions are tumoral, fibrotic or necrotic, a laparotomy after hepatic intra-arterial chemotherapy is proposed to obtain specimens for histopathologic examination and an assessment of resectability. This procedure should be reserved for patients in whom substantial benefit can be expected considering the extension of primary and metastatic disease.

[Infectious complications of diverticular sigmoiditis: can the failure of medical treatment be predicted?]. / Les complications infectieuses des sigmoïdites diverticulaires: peut-on prévoir l'échec du traitement médical?

A retrospective study of case histories of 36 patients with infectious complications of sigmoid diverticulitis (excluding peritonitis) compared clinical, biologic and radiologic signs in a group responding favorably to medical treatment (24 cases) and a group requiring surgery after a mean of 9 days of treatment in a surgical ward (12 cases). Six signs were found to be related to the course of the disease: a painful left iliac mass on admission, persistence or increase in pain after 48 hours, absence of restoration of normal intestinal transit, temperature below 36.5 degrees C or above 37.8 degrees C, leucocytosis of less than 2,500 or more than 13,500/mm3, evidence of radiologic stenosis by simple contrast enema. A prospective study could assess the prognostic value of these signs as determinants of failure to respond to medical treatment.

[Peripheral intravenous infusions. Reduction of morbidity owing to an electronic controller of infusion flow rate]. / Perfusions intraveineuses périphériques. Diminution de la morbidité grâce à un contrôleur électronique des débits de perfusion.

The ability of an electronic infusion controller (IVAC 230) to reduce morbidity in peripheral intravenous infusions was investigated in a controlled randomized trial. The results were assessed on the number of sites of injection in relation to the total duration of perfusion, with an adjustment for the quality of the fluids infused. Using the controller resulted in a 50% decrease in the number of sites of injection (risk alpha = 1%, beta = 10%).

[Acute pancreatitis: severity factors. Retrospective analysis of 78 cases]. / Pancréatites aiguës: les facteurs de gravité. Analyse rétrospective de 78 observations.

Retrospective analysis of clinical and laboratory findings was undertaken in 78 patients in which pancreatitis was confirmed pathologically. In our experience, severity factors are as follows: age over 55 years and, during the first 48 hours, fall in haematocrit of more than 10%, corrected plasma calcium lower than 8 mg %, plasma creatinine greater than 30 mg/1, hypoxia less than 60 mm Hg, resistant to assisted ventilation, liquid sequestration more than 6 litres. These objective parameters define the group of patients who, in our experience, should derive benefit from new suggested forms of treatment.

[Postoperative cholecystitis. Apropos of 9 cases (3 lithiasic and 6 alithiasic)]. / Les cholécystites post-opératoires. A propos de 9 observations (3 lithiasiques et 6 alithiasiques).

Postoperative cholecystitis (three cases with and six cases without associated stones) was found following 25.00 operations performed over a period of 8 years. Analysis of these cases and a literature review suggest that the onset of a postoperative lithiasic cholecystitis is probably only the result of coincidence, where as alithiasic cholecystitis is a definite postoperative complication, these affections having to be considered within the more general framework of post-aggression cholecystitis.

Celiac artery aneurysm.

Aneurysms of the celiac axis are rare, since only 50 cases were reported in 1976, 14 of which were operated on successfully. We report here the 15th case. This celiac aneurysm involved the origin of the splenic left gastric and common hepatic arteries. After controlling the aorta by a thoraco-phrenolaparotomy, the celiac artery was ligated at its origin, the anterior wall of the aneurysm was incised and the splenic and the left gastric arteries ligated by an obliterative endoaneurysmorrhaphy. The hepatic vascularization was restored from the gastroduodenal artery with a restorative endoaneurysmorrhaphy. The control arteriogram showed a good arterial revascularization.