[Surgical retroperitoneoscopy in pelvic surgery].
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Biomedical subjects
Publications and source records attributed to A Wurtz.
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Partial splenectomy was performed in a patient with cystic lymphangioma and two patients with splenic pseudo-cysts, one of traumatic origin and the other necrotic following infarct. Anatomical features on which this operation is based, together with the technique employed, are exposed and the criteria of efficacy examined. Partial splenectomy was performed to reduce splenomegaly complicated with hypersplenism, and is also applicable for exeresis of cystic and pseudo-cystic splenic lesions. These indications are worthy of more extensive application in young adults.
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Yeasts are taking a growing place in the development of opportunistic pneumonias in a hospital environment. We report a case of pneumonia due to Torulopsis glabrata in a patient of 58 years in complete remission from a malignant oesophageal tumour after surgery and radiotherapy, and not given immunosuppressive treatment.
In 3 cases of cephalic pancreatoduodenectomy for pancreatitis digestive tract continuity was restored by means of a small bowel graft onto which the pancreatic and biliary ducts were anastomosed. In 2 of these patients who had previous gastrectomy, the graft was inserted above the gastro-jejunal anastomosis; in the patient who had cephalic pancreatoduodenectomy leaving the pylorus untouched, the graft was inserted between the first and the third duodenal segments. The functional results were good in the first two cases. The third case was a failure requiring further surgery for stenosis. For this reason, we would suggest that this technique should only be used in patients who previously had gastrectomy with gastro-jejunal anastomosis.
The authors report two cases of ulcers eroding the duodenal papilla. In one case there is a spontaneous reflux into the canal of Wirsung, causing acute pancreatitis. In the other case, the erosion is not complicated, and is revealed by an opacification of the main bile duct during an X-rays examination of the stomach and duodenum in a patient with a Burnett's syndrome. The erosion of the papilla is secondary to duodenal shrinkage by sclerosis. The choice treatment is exclusion gastrectomy, but resection may be necessary.
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We have performed laparotomy and splenectomy for seventy patients with Hodgkin's disease. Among 43 stages I or II before exploration, primary laparotomy revealed ignored abdominal localizations in 16 cases (37,2%). Involvement of the spleen occurred in 13 of these 16 patients, lonely (5 cases), associated with positive nodes (4 cases) or associated with positive nodes and liver involvement (4 cases). Among 4 stages III before exploration, no regression was found. Among 9 patients with presumed stages I or II above the diaphragm and previously treated by radiotherapy, delayed laparotomy revealed abdominal relapse in 6 cases. At last, among 14 patients with obvious stages II or IV and previously treated by combination chemotherapy, laparotomy, caused by persistent evolutive signs, showed residual localizations under the diaphragm in 8 cases. According to these results, we preconise immediate laparotomy in almost all presumed stages I or II above the diaphragm. About third of these subjects have their staging advanced to stage III or IV and, according to us must be treated by combination chemotherapy while the remaining cases justify of radiotherapy. In obvious stages III and IV delayed laparotomy may be useful in some circumstances, after chemotherapy.
Return to the abdominal cavity of an intestinal loop which had suffered from ischemia, may induce, after a free interval, disordered transit or frank intestinal obstruction, sometimes peritonitis. This is always dangerous, especially in elderly patients. The authors report 5 cases which illustrate this danger, in daily surgery, and recall the rules for treatment of strangulated hernia.