Adenocarcinoma of the appendix.

Thirty-two patients with primary adenocarcinoma of the appendix were studied in this collective review. Immediate operation was performed in 21 patients with a diagnosis of acute appendicitis. At operation, tumor of the appendix was only identified in 50 percent of the 32 patients studied. Survival was unrelated to the histologic tumor type, but significantly correlated with the extent of tumor spread. Right hemicolectomy led to a significant increase in survival compared with appendectomy alone and to a significant decrease in risk of recurrence. In Dukes' B2 and C patients, differences in the survival curves were in favor of right hemicolectomy. Long-term survival was obtained by repeat laparotomy with resection of mucinous material in patients with pseudomyxoma peritonei.

[Retrograde cholangiopancreatography and endoscopic sphincterotomy for biliary lithiasis. Prospective evaluation in surgical circle]. / Cholangio-pancréatographie rétrograde et sphinctérotomie endoscopique pour lithiase biliaire. Evaluation prospective en milieu chirurgical.

Between January 1982 and 1987, 772 consecutive endoscopic retrograde cholangiopancreatographic examinations (ERCP) were performed in 673 consecutive patients suspected of having biliary tract lithiasis (mean age: 62.1 +/- 18.2 years). Two hundred and thirty-two were emergency procedures (30%). Endoscopic sphincterotomy was performed for common bile duct stones (CBDS) in 257 cases (38.0%), of whom 143 (55.6%) had undergone previous cholecystectomy. In 17.2% of cases, ERCP was either a complete (7.8%) or partial (9.4%) failure. In 124 patients for whom microlithiasis was not identified by sonography and who underwent operation, sensitivity and specificity of ERCP was 70% and 87%, respectively. Of 266 patients in whom ES was attempted, 96.6% were achieved and the common bile duct was cleared of stones in 72% of cases. Nineteen percent of patients required two or more attempts at extraction. After ERCP without ES, mortality and morbidity rates were 0.96 and 3.6% respectively. After ES, complications followed in 12.1% of patients and 3.9% died. Mortality and morbidity directly related to ES were 3.1% and 11.3% respectively. The most common complications after ERCP were acute cholangitis and pancreatitis, whereas after ES, acute cholangitis was the most common complication, followed by hemorrhage and duodenocholechocal perforations. These complications occurred independently of age and previous cholecystectomy but was closely related to stone clearance (P < 0.05). Seventy-one patients (10.5%) required operation. Twenty-nine patients underwent emergency surgery for complications with a mortality rate of 17%. Forty-two patients underwent elective surgery for retained CBDS after ES without any mortality.(ABSTRACT TRUNCATED AT 250 WORDS)

[Diagnostic strategy of abdominal contusions in adults]. / Stratégie diagnostique dans les contusions abdominales de l'adulte.

Diagnosis of a deep visceral lesion in an adult following abdominal contusion is almost always difficult as the abdominal signs are late or masked by associated lesions. All of the controlled studies agree on the superiority of peritoneal puncture-lavage over ultrasonography or CT scan in the diagnosis of haemoperitoneum. The diagnostic performance of computed tomography in the identification of lesions of solid organs is very much better than that of ultrasonography. The diagnosis of an isolated lesion of a hollow viscus has benefited from progress in imaging to a much lesser degree and peritoneal puncture-lavage with leukocyte count remains the key examination. The diagnostic strategy must be based on the patient's clinical condition and on this hierarchy of complementary investigations.

[Adenocarcinoma of the appendix. A multicenter study from AURC]. / Adénocarcinomes de l'appendice. Une etude multicentrique de l'AURC.

Thirty-two patients with primary adenocarcinoma of the appendix were studied in this collective review. Diagnosis was never suspected preoperatively. Immediate operation was performed in 21 patients with a diagnosis of acute appendicitis. At operation, tumor of the appendix was only identified in 50 percent of the 32 patients. One patient with an obstructing tumor and peritoneal involvement died postoperatively. Estimated survival rate was 46% at five years. Probability of survival was unrelated to the histologic tumor type but significantly correlated with the extent of tumor spread. Right hemicolectomy led to a significant increase in survival compared with appendectomy alone and to a significant decrease in risk of recurrence. In Dukes' B2 and C patients, differences in the survival curves were in favor of right hemicolectomy. In patients with pseudomyxoma peritonei, long-term survival was obtained by repeated laparotomy with resection of mucinous material. Our results indicate that, in good risk patients, right hemicolectomy performed as first or second operation, provides better results than appendectomy alone.

[Intraperitoneal resorbable mesh in the prevention of postoperative wound dehiscence. A comparative study]. / Le treillis résorbable intra-péritonéal dans la prévention des éviscérations post-opératoires. Une étude comparative.

The purpose of this study was to compare efficiency of polyamide mesh externally applied to the skin and intraperitoneal resorbable mesh of polyglactine 910, for the prevention of wound dehiscence. Two consecutive and homogenous groups of 100 patients, operated by the same surgical team and presenting one or more risk factors of evisceration, were retrospectively compared. Use of intraperitoneal polyglactine mesh, significantly reduced rate of wound dehiscence (4% vs 13%), lowered frequency of reoperation in eviscerated patients (25% vs 61%), but did not improve prognosis of this complication (50% mortality). Potential effect of resorbable mesh on late fascial disruption remains controversial.

[Intracystic hemorrhages of pancreatic pseudocysts]. / Les hémorragies intra-kystiques des pseudo-kystes pancréatiques

The authors report ten personal cases and review the literature on 99 other cases, and study primary intra-cystic hemorrhage or post-operative hemorrhage, occurring during the course of pancreatic pseudo-cysts. These hemorrhagic pseudo-cysts are very often associated with chronic pancreatitis; they may rupture into a hollow viscus, the peritoneal cavity or into Wirsung's duct. Arteriography and duodenoscopy with retrograde pancreatography, should permit one to reduce the frequency of these latent, undiagnosed forms until surgical operation has been carried out. Even more dangerous, post-operative bleeding often represents a recurrence of primary intra-cystic hemorrhage which has been undiagnosed or neglected. Surgical treatment should give a greater place to operations of excision which simultaneously treat false cyst, the responsible vascular lesion and the chronic casual pancreatitis.

[Eosinophil ileitis (author's transl)]. / Les iléites à éosinophiles.

Eosinophilic ileitis is observed mainly in three coastal areas: Holland, Japan and Brittany. It presents in the form of a parietal inflammation, stenosing the intestinal lumen or a sessile tumour of limited volume. The symptoms are generally those of appendicitis but a past history of allergy and the discovery of eosinophilia greater than 10 p. cent may lead to the diagnosis of eosinophilic granuloma which only histology can confirm. Surgical treatment consists of segmental resection of the small intestine. The pathogenesis of the granuloma, which was for long attributed to the presence in the wall of the intestine of ascaris larvae, is at present debated. Are there non-parasitic eosinophilic granulomas? The case reported here is perhaps an example.

[Wirsung's duct and chronic pancreatitis. Changes in the morphology of the pancreatic ducts after pancreatic duct shunts. 23 cases followed-up]. / Canal de Wirsung et pancréatite chronique. evolution de la morphologie des voies canalaires aprés dérivations wirsungo-digestives

The authors study in chronic pancreatitis the morphology of Wirsung's duct in 31 patients who had undergone repeated operations, 23 of them were submitted in a first stage to an anastomosis between the pancreatic duct and the digestive tract. The main causes of failure were obstructions of the anastomosis, biliary complications and continuation of the pancreatic disease. The difference in prognosis between pancreatitis with a dilated pancreatic duct, and those with a filiform duct, is perhaps due to lesions of different histological appearance and course. The best results were obtained in patients able to give up alcohol and in whom it was possible to carry out a broader anastomosis on a dilated and unobstructed pancreatic duct.

[Study of 187 portacaval anastomoses. Statistical analysis of prognostic factors. II. Comparative study of the results of anastomoses with and without interruption of the portal trunk. Discussion]. / Bilan de 187 Dérivations porto-caves tronculaires. Analyse statistique des facteurs pronostiques. II.--Etude comparée des résultats des anastomoses avec et sans interruption du tronc porte. Discussion

The authors report a comparative retrospective study of 124 end-to-side portal anastomoses and 63 side-to-side anastomoses. The influence of a certain number of clinical and pathological factors on mortality and immediate and long-term survival, were statistically verified. The quality of the functional result result was analysed in each group of operated patients. Comparison of the results of trunkular anastomoses with or without interruption of the portal vein, showed both as regards, post-operative and late mortality, that the functional results were definitely in favor of end-to-side anastomosis. Thus side-to-side anastomoses gave 40,4 p. 100 of good results and 59,6 average or poor results, as against 60 p. 100 gave rise to portal systemic encephalopathy in 17 p. 100 of cases as against 35 p. 100 in the case of the side-to-side anastomosis. Only the sub-group of operated patients with hepatic vein thrombosis seemed to benefit from side-to-side anastomosis.

[Rupture of the abdominal wall in highway accident victims wearing seat-belts]. / Ruptures pariétales abdominales chez les accidentés de la route porteurs d'une ceinture de sécurité.

Rupture of the rectus abdominis muscle represents one of the rare specific lesions due to seat-belts. Two cases are presented which illustrate diagnostic difficulties and the value of the warning provided by these lesions, which are very frequently associated with severe contusion of the small intestine or colon.