Carotid artery obliteration and pharyngoesophageal reconstruction by free jejunal autograft.

Free jejunal autografting is increasingly recognized as a safe procedure of pharyngoesophageal reconstruction with good functional results, following circular total pharyngolaryngectomy for extended tumors of the pharynx or larynx. Very often, past history of irradiation and/or surgery of the neck have created severe atheromatous lesions of the cervical vessels. We report the case of a patient with obliteration of the right carotid artery and large recurrence of a tumor of the larynx in which simultaneous arterial venous bypass and free jejunal autograft were performed for pharyngoesophageal reconstruction.

[Accidents caused by arteritis after fracture or tibial osteotomy]. / Accidents évolutifs dus à une artérite après fracture ou ostéotomie tibiale.

In five cases of fracture or osteotomy of the tibia complicated by delayed union, non-union or infection, a latent chronic vascular insufficiency was belatedly discovered, often after failure of local treatment. It was responsible for the complication, since, in all the cases, the restoration of arterial patency resulted in healing. A study of the arterial circulation should be made, especially in smokers, when there is delay in union.

[Bacterial environment and infectious complications of arterial prostheses. Retrospective study of 111 cases]. / Environnement bactérien et complications infectieuses des prothèses artérielles. Etude rétrospective de 111 observations.

648 pre-, per-, or post-operative bacteriological sample or 111 arterial prosthesis operated in a general surgical word were reviewed. Per operative cultures were positive in 2,5 per cent (intra-arterial thrombus or aneurysm wall), systematic post-operative cultures in 2,7 per cent (IV and urinary catheters, drains) and clinically oriented post-operative cultures in 10 per cent. No correlation between open pre-operative infection or bacterial contamination far from the wound and prosthetic infection was noted. Never the less, positive per-operative cultures or drains cultures has to be considered as a potential sepsis. According to the prevention of infection in a word including septic patients, the rate of prosthetic contamination was 1,8 per-cent and the rate of sub-cutaneous wound infection was 3,6 per-cent, which does not seem to be greater than usual results.

[Cure of an external biliary fistula complicating pancreatic pseudocyst by an endocholedochal prosthesis]. / Guérison d'une fistule biliaire externe compliquant un faux-kyste du pancréas par prothèse endo-cholédocienne.

A persistent and abundant external biliary fistula appeared following the three-stage surgical treatment of a pseudocyst of the head of the pancreas. This fistula was probably due to a leak from the stump of the cystic duct maintained by peri-choledochal sclerosis. It was successfully treated by an intra-hepatico-choledochal prosthesis inserted endoscopically.

Surgical approach to the superior mesenteric artery by the Kocher Maneuver: anatomy study and clinical applications.

The Kocher maneuver allows approaching the origin of the superior mesenteric artery. This affords adequate exposure for procedures such as embolectomy or mesenteric arterial reimplantation into the aorta. Because of its simplicity, this technique may be better than the classical interpancreaticoduodenal or splenopancreatic methods. The results of 11 cadaveric dissections and two surgical operations for mesenteric ischemia using this technique are reported.

One liver for two: an experimental study in primates.

The need for liver grafts is critical in countries where brain death is not accepted as a legal criterion for organ retrieval. This experimental study was conducted with nonhuman primates in order to evaluate the feasibility of liver transplantation using a living donor. An original technique was employed to remove the left part of the liver from the donor: transection of the parenchyma was done while the blood flow was kept to the left part of the liver. In the recipients, the graft was placed heterotopically. No blood transfusions were administered to donors or recipients. In spite of a few failures, due to consequences of intraoperative bleeding, several donor operations using this original technique were successful, in the immediate postoperative period as well as several months later. Among the recipients, the large number of early failures suggests that the heterotopic position is probably not the appropriate one and that orthotopic transplantation should be preferred.