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A Fingerhut

Publications and source records attributed to A Fingerhut.

179 records · Page 10Linked to original sources
PubMedDate not supplied

Emergency surgical treatment for bleeding duodenal ulcer: oversewing plus vagotomy versus gastric resection, a controlled randomized trial. French Associations for Surgical Research.

The best surgical procedure to treat bleeding bulbar peptic ulcer is unknown. The rates of postoperative bleeding recurrence, duodenal leakage, and mortality were compared in patients undergoing oversewing plus vagotomy (O+V) or gastric resection (GR) with ulcer excision. Of 202 patients undergoing emergency surgery for massive, persistent, or recurrent bleeding from bulbar peptic ulcer, 120 patients were enrolled in a prospective randomized trial. Fifty-nine were assigned to O+V and 61 to GR. One patient in each group was excluded after randomization. The two groups were well matched with respect to clinical and prognostic factors. The rate of postoperative bleeding recurrence was 17% after O+V and 3% after GR (p < 0.05). The duodenal leak rate was higher after GR than after O+V (13% vs. 3%) (p < 0.10) but was not different when the morbidity of reoperations for bleeding recurrence after O+V was considered on an "intention to treat" basis (12% vs. 13%). Overall postoperative mortality was similar: 22% (O+V) versus 23% (GR). Sixteen deaths were unrelated to the surgical procedure itself. Of 82 nonrandomized patients, 10 were not analyzed. In the 72 other nonrandomized patients, bleeding recurrence, duodenal leakage, and postoperative mortality rates were consistent with the results of the controlled trial, as they were 29% (O+V 32%; GR 0.7%), 16% (O+V 0.7%; GR 26%) and 27% (O+V 18%; GR 33.3%), respectively. We conclude that GR with ulcer excision is the procedure of choice for the emergency surgical treatment of bleeding duodenal ulcer because postoperative bleeding recurrence is lower, and the overall rates of mortality and duodenal leakage are the same as with O+V.

Adolescent↗
PubMedDate not supplied

[Pneumatosis cystoides intestinalis manifested by pneumoperitoneum].

We report the case of a female patient, suffering from chronic respiratory insufficiency and treated with steroids, in whom the discovery of pneumoperitoneum led to exploratory laparotomy. The plain abdominal X-rays demonstrated gas in the walls of the stomach as well as in the peritoneal cavity. Intraoperative exploration revealed the existence of pneumatosis cystoides of the stomach and small intestine. This observation is a reminder that not all cases of pneumoperitoneum are surgical, and notably this is the case for cystic intestinal pneumatosis.

Female↗
PubMedDate not supplied

[3 new cases of pregnancy of the uterine horn].

Three new cases of pregnancy in the uterine cornu are described. Three types of localisation are grouped under this heading : interstitial pregnancies, intra-mural pregnancies and angular pregnancies which all have identical mechanisms of pathogenesis (uterine scars) and identical patterns of clinical progression (complicated by uterine rupture). The authors discuss the methods of diagnosis. A constant feature is pain with an asymmetrical uterus. Laparoscopy is often able to make the diagnosis of pregnancy in the uterine cornu, without being able to determine the exact site. Early diagnosis results in conservative surgical treatment.

Adult↗
PubMedDate not supplied

[Splenic rupture in chronic pancreatitis. Study of 2 cases and review of the literature].

The authors have observed 2 new cases of splenic rupture due to pancreatic pseudocyst and have made a review of the literature on the subject (40 cases). The clinical, diagnostic and therapeutic approaches of this rare but sometimes dramatic complication of chronic pancreatitis have been analyzed. Diagnosis should be suspected in the case of abdominal pain, mass and anemia in the male subject with previously known chronic pancreatic or alcoholic disease. Sonography completed by either angiography or CT scan if time permits are the best diagnostic methods. Ideal management should include treatment (excision or drainage) of the pseudocyst and splenectomy.

Adult↗
PubMedDate not supplied

[Inflammatory pseudo-tumors of appendiceal origin. Study of twelve cases (author's transl)].

The authors relate their experience concerning twelve cases of inflammatory pseudo-tumors of appendiceal origin treated during the last five years. Their personal acquisitions are confronted with the literature and they propose a protocole of clinical, roentgenological and intra-operatory diagnosis thus permitting rational and adapted management.

Adolescent↗
PubMedDate not supplied

[Treatments of inguinal hernia under local anesthesia].

Potentiated local anaesthesia has been generally used for repair of inguinal hernia since the Shouldice technique was first introduced in France in the early 80s. The technique requires a correct understanding of inguinal innervation and the properties of the local anaesthetic. The local anaesthetic is injected into the abdomino-genital and genito-crural nerves and at the line of incision allowing smooth surgical repair. Potentiation relieves patient apprehension. This method can be used for all types of inguinal hernia, whether simple or complicated and in all patients. There is no limitation for age or general condition. Contraindications are rare and include allergy or uncontrolled (no pacemaker) arrhythmias.

Anesthesia, Local↗
PubMedDate not supplied

Routine intraoperative cholangiography is feasible and efficient during laparoscopic cholecystectomy.

BACKGROUND/AIMS: This is the evaluation of the feasibility and results of routine laparoscopic intraoperative cholangiography. PATIENTS AND METHODS: A multicentric prospective study in 315 consecutive patients undergoing elective or urgent laparoscopic cholecystectomy. RESULTS: The success rate was 94%. Mean duration of intraoperative cholangiography was 12 min. Sixteen of 18 failures were related to a narrow cystic duct. One cystic duct avulsion (ligated under laparoscopy) and 2 false positive cholangiograms (1 transcystic exploration, 1 conversion) were noted. Intraoperative cholangiography revealed aberrant bile ducts possibly at risk to injury from dissection in four patients (1.3 per cent). Intraoperative cholangiography disclosed unsuspected stones in 10 patients (4%). Forty-five patients had a preoperative suspicion of choledocholithiasis: choledocholithiasis were found at intraoperative cholangiography in 3 of 13 patients who had preoperative endoscopic sphincterotomy for stone extraction, in 1 of 11 patients with normal preoperative endoscopic cholangiography, and in 11 of 21 patients undergoing surgery alone (57%). CONCLUSION: If complete clearance of choledocholithiasis is to remain the objective of surgical treatment of biliary lithiasis including laparoscopic cholecystectomy, then routine intraoperative cholangiography is feasible and efficient.

Adolescent↗
PubMedDate not supplied

Laparoscopic treatment for choledocholithiasis: a prospective evaluation in 247 consecutive unselected patients.

BACKGROUND/AIMS: Evaluation of the feasibility and results of the one-stage treatment combining routine intraoperative cholangiography and laparoscopic common bile duct exploration for choledocholithiasis. PATIENTS AND METHODS: Multicentric (5 centers-9 surgeons) prospective study in 247 consecutive patients (mean age 68 years; range 21-92) during a 50-month period (November 1991-December 1995). Laparoscopic treatment of choledocholithiasis was attempted irrespective of the circumstances leading to the diagnosis of biliary lithiasis or the preoperative suspicion of choledocholithiasis. RESULTS: One out of four patients (n = 61) had unsuspected choledocholithiasis disclosed by routine intraoperative cholangiography. A laparoscopic complete clearance of choledocholithiasis was achieved in 208 of 236 attempted cases (88%), with either transcystic duct extraction (n = 116) or choledochotomy (n = 92). Open surgery was required in 20 patients for failure of laparoscopic treatment and in 3 patients despite successful extraction. Twenty-one of 25 patients (84%) referred for failure of retrograde endoscopic stone extraction had successful laparoscopic choledocholithiasis clearance. The mean duration for the laparoscopic transcystic approach and choledochotomy were 108 min (range 50-300) and 173 min (range 70-480), respectively. Eleven patients had retained stones (4.4%). Minor and major complications were recorded in 9 and 22 patients respectively. The operative mortality was 0.4% (95% confidence interval: 0-1.2%). CONCLUSION: Intraoperative cholangiography during laparoscopic cholecystectomy and laparoscopic common bile duct exploration when required should be considered as the simplest and most efficient treatment for choledocholithiasis. The multicenter character of this study including consecutive patients from public and private practices, strengthens our conclusions and is consistent with a wide diffusion of this diagnostic and therapeutic strategy.

Adult↗