[Right hepatectomy, extensive right hepatectomy or trisegmentectomy? Surgical applications related to in intrahepatic anatomy (author's transl)].
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Biomedical subjects
Publications and source records attributed to C Couinaud.
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The authors report 4 cases of hyperlipemia and show the great benefit which results from ileal exclusion when there is an atherogenic risk. The considerable reduction in total lipid, cholesterol, triglycerides, and prebeta-lipoproteins is constant together with clarification of the serum. In one case, angina pectoris regressed considerably, as did arteritis of the lower limbs (unlimited walking became possible, oscillometry in the leg improved from 2 to 7). Surgery is indicated whenever by lack of will power, the diet and medical treatment cannot be followed, when social and economic conditions make proper medical treatment impossible, or when the latter has failed. The existence of arterial lesions, cardiac or cerebral complications makes surgery even more urgent. Gall-stones were observed in gall bladder. The authors raise the problem of oxalate stones. Only type II familial hyperlipemia in homozygotes should be excluded: and end-to-side portacaval anastomosis seems to be preferable.
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The strength of the eosophageal wall has been tested in 20 autopsy specimens: it proved to be as resistant as the stomach and the jejunum. It dépends as elsewhere in the digestive tract on the deep layer of the mucosa (Halstedt's submucosa): the success of an anastomosis depends on the passage of sutures through this submucosa. Vascularization does not seem to be a problem, provided certain precautions are taken. The necrotizing properties of saliva and infection especially in cancerous surgery might be the main causes of fistulas.
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