[Volvulus of the cecum and sigmoid].
Five cases of volvulus, four of the sigmoid and one of the cecum are presented. Etiology, symptomatology, diagnosis and therapy are discussed.
Aged↗
Biomedical subjects
E Eyskens
Publications and source records attributed to E Eyskens.
[Villous adenoma of the duodenum].
Explore the source record for details and available documents.
Adenoma↗
[Giant fibrovascular polyp of the esophagus].
The observation of a giant fibrovascular polyp of the esophagus is presented. Diagnostic and therapeutic implications of this rare affection are discussed.
Esophageal Neoplasms↗
[A gallbladder filled with barium sulfate: an enigma].
We report an unusual observation in a 60-year-old patient with a Ba-sulfate filled gallbladder. A thorough search of the literature failed to disclose a similar case. Several hypotheses are proposed. We could not find a satisfactory explanation for this phenomenon.
Barium Sulfate↗
[Gastrocolic and gastrojejunocolic fistulas. 6 cases].
On occasion of the observation of five peptic gastrojejunocolic fistulae and of one gastrocolic fistula by Crohn's disease, the authors analyse the etiopathogenesis and the pathophysiology of this rare complication in the light of recent advances of the literature.
Adult↗
[The influence of an aboral and isoperistaltic transplantation of a jejunal segment on the motility and evacuation of the bowel].
Explore the source record for details and available documents.
Animals↗
[Volvulus of the stomach].
Volvulus of the stomach. On occasion of three observations the volvulus of the stomach is studied in the light of recent advances of the literature. Different types of gastric volvulus are defined by etiopathogenic analysis. Symptomatology and diagnosis are examined and possibilities of treatment are emphasized. The therapeutic behaviour which is required towards this rare affection is discussed.
Aged↗
[Formation of a phytobezoar following surgery of the stomach. Review of the literature].
Phytobezoar after partial gastrectomy. An observation on phytobezoar formation after partial gastrectomy, attended by an intestinal obstruction is presented. According to a review of the literature bezoar formation following gastric surgery seems to develop in the stomach after vagotomy, and rather in the small intestine after partial gastrectomy. The etiopathogenesis of this phenomenon is analysed, and the physiopathology, the clinical manifestation, the diagnosis and therapeutic possibilities of this affection are discussed.
Bezoars↗
[Aneurysms of the splanchnic region].
Splanchnic artery aneurysms. The management of 16 patients, presenting with splanchnic artery aneurysms is reviewed in a retrospective study. 5 patients presented with aneurysms of the hepatic arteries, 6 patients had an aneurysm of the splenic artery and 5 patients developed aneurysms of the remaining branches of the splanchnic arteries (1 gastroduodenal, 3 pancreaticoduodenal and 1 superior mesenteric), 8 patients were treated conservatively. 8 patients had a surgical procedure performed. Two patients died from a complication of their aneurysm. Ligation of the hepatic artery, was insufficient to avoid a recurrent and fatal hemobilia in a man presenting, with a centrally located intrahepatic ruptured aneurysm. Another patient developed a fatal necrohemorrhagic pancreatitis after ligation of the splenic artery for an aneurysm that ruptured in the stomach.
Adult↗
Intrapulmonary lymph nodes in the differential diagnosis of solitary pulmonary nodules: case report and review of the literature.
A 49-year-old man was admitted for further investigation of a coin lesion with a diameter of 1 cm. He was a heavy smoker with no professional exposure. Since the percutaneous needle biopsy did not yield a definitive diagnosis, a thoracoscopy was performed. The solitary pulmonary nodule was found to be an intrapulmonary lymph node with anthracosilicotic pigment and a thoracoscopic wedge resection was performed. A review of the case reports in the period 1961-1993 shows that intrapulmonary lymph nodes could be more frequent than originally thought. All patients were smokers but professional exposure was not a constant finding. The differential diagnosis and management of the indeterminate solitary pulmonary nodule are discussed.
Diagnosis, Differential↗
Operations for failed vertical banded gastroplasty.
Although vertical banded gastroplasty is considered as a safe and efficient bariatric procedure, reoperation rates either because of failure, or the induction of unacceptable side effects are important. In this study we evaluated 54 obese subjects with a history of vertical banded gastroplasty. One patient (2%) died postoperatively due to pulmonary embolism. Seven patients (13%) underwent a reoperation. A new vertical banded gastroplasty because of dilatation of the pouch with weight regain resulted in a loss of 26% of the initial weight after 3 years (1 patient). The vertical staple line disrupted in 4 patients: restapling failed after 1.5 year (1 patient), conversion into a gastric bypass resulted in a loss of only 12% of the initial weight after 3 years (1 patient), conversion into a biliopancreatic diversion resulted in a loss of 43 and 32% of body weight after 18 and 6 months, respectively (2 patients). In 2 cases a Nissen fundoplication was performed with good result for reflux oesophagitis. Since regastroplasty was not entirely successful in our hands, we consider biliopancreatic diversion as the method of choice for failed vertical banded gastroplasty.
Biliopancreatic Diversion↗
Acute aortic dissection.
Acute aortic dissection is initiated by an intimal tear most often found in the ascending or descending thoracic aorta. A high index of suspicion is necessary to establish diagnosis. In the acute setting, transoesophageal echocardiography is very helpful to confirm the diagnosis, locate the intimal tear and demonstrate the extent of dissection. Acute type A dissection is a surgical emergency contrary to type B dissection which is treated medically unless complications arise. With correct treatment, mortality of these life-threatening disorders has been reduced during the last decade and long-term survival of discharged patients is around 50%. Careful follow-up is necessary to detect late complications, mainly the occurrence of a post-dissection aneurysm.
Aged↗
Staged peritoneal lavages with the aid of a Zipper system in the treatment of diffuse peritonitis.
A major problem in the surgical treatment of diffuse peritonitis is to obtain a complete clearance of septic foci in the peritoneal cavity which may lead to persistence of sepsis and multiple organ failure. We describe our experience with staged abdominal re-explorations using a Zipper system in 23 patients with a mean APACHE II score of 20.3 (s.e.m: 1.5). A total of 91 lavages were done in these patients. Overall mortality was 39%. None of the patients having an APACHE II score between 10 and 20 died whereas the predicted mortality was 15%-45%. After successful treatment, primary closure was possible in 8 of the 14 surviving patients. Large incisional hernias developed in 6 patients. One patient eviscerated two years after complete granulation of his laparostoma. Staged abdominal re-explorations using a Zipper system is an useful tool in the treatment of diffuse peritonitis.
Adolescent↗
Ethics in actual surgery. Ethics and organ transplantation.
Actual organ transplantation evokes more and more ethical questions. There is scarcity of donor organs. The waiting lists of potential recipients for organ transplantation are steadily growing as is the number of dead among the waiting patients. In Belgium the mortality rate of traffic victims during the first thirty days of hospital admission has been reduced by half. Among this group the number of potential cadaveric donor candidates is further reduced following complications of sustained intensive care. Shortage of cadaveric organs prompts some to select candidates for transplantation with exclusion of those considered responsible for their illness. Some centres incline to reconsider the definition of cerebral death by extending this notion to the irreversibly unconscious and therefore socially dead. Organ donation by living donors opens the way to commercialism specially in case of unrelated living donation. Living donors are often insufficiently informed about their risks and the final outcome of these transplantations. The use of implantable artificial organs should be the solution to many ethical problems. But some experience with the Jarvik heart as a temporary implant increases so far the shortage of donor heart supply and the number of patients on the waiting lists as well. It also excludes patients who became unsuitable for transplantation after complication of the Jarvik implantation. Xenotransplantation is largely under investigation. However, it is out of question that primates, which are threatened already with extinction should act as organ suppliers for mankind. Xenograft organs should be found in animals for food consumption, sufficient in number and more easily accepted as organ donors on ethical ground.
Accidents, Traffic↗
Ethics in actual surgery. The surgeon and HIV seropositive and AIDS patients.
Surgeons feel threatened by the risk of contamination when operating on HIV-seropositive or AIDS patients. Observations on the likelihood of contamination in literature are most divergent due to variables in seropositive prevalence, in frequency of contamination risk and in distinction between HIV seropositive and AIDS patients. Except in emergency the surgeon may refuse to treat a patient. Screening seropositively for selection is hampered by the inconsistency of false positives and false negatives depending on the method used and on costs appropriate to large scale controls. Exclusion of patients from treatment is unethical. Referring them to other colleagues on ground of contamination risk is ethically unjustified. Denial of care to a HIV infected patient may be justified when the operative risk is considered too high and the expected benefit too low because of the precarious condition of the patient and his shortened life expectancy. However the surgeon and his team need not to expose themselves to even a limited but real risk of contamination. Therefore the surgeons have to reconsider their surgical strategy and technique in order to keep chances of contamination as low as possible. A search for safer working methods for all operations and without any discrimination with regard to the patient is needed and should be taught to the surgical team.
Acquired Immunodeficiency Syndrome↗
Giant ovarian cyst.
Case report of a patient with a giant ovarian cyst. On the basis of literature data, surgery and histology problems, as well as oncological therapy are discussed.
Chemotherapy, Adjuvant↗
Pulmonary metastasectomy.
Between 1988 and 1994, 24 patients underwent 32 procedures for pulmonary metastases. Primary tumours were gastrointestinal, malignant melanoma, osteogenic sarcoma, renal cell carcinoma, head and neck cancer and finally testicular carcinoma. Age ranged from 16 to 78 years, with a female/male ratio of 7/17. Pulmonary metastasectomy was performed in 9 cases through median sternotomy, in 21 cases through thoracotomy and in 2 cases by thoracoscopy. In 9 cases repeated resection was necessary. Overall mortality was 0% (95% confidence limits are 0.00 +/- 14.25). Computed tomography of the chest in combination with tumour markers, were most important during follow-up to detect recurrent disease. The overall 5-year actuarial survival and disease-free survival were 0.56 +/- 0.17 and 0.30 +/- 0.14 respectively. With regard to testicular carcinoma 5-year actuarial survival was 100%. Pulmonary metastasectomy is a recommended procedure in the treatment of selected patients with metastatic pulmonary disease. Resections should be as conservative as possible and if necessary, repeated. In our study this procedure proved especially effective in case of testicular carcinoma.
Adolescent↗
Scheduled relaparotomies using a zipper system for the treatment of diffuse generalized peritonitis in children.
In the treatment of diffuse peritonitis, planned relaparotomies with peritoneal lavages using a zipper system (EthiZip Ethicon) are sometimes necessary to obtain a complete eradication of the infectious focus. While most reported series are dealing with an adult population, this review focuses on the treatment of peritonitis using a zipper system in a paediatric age group. In a period of 3 years, insertion of a zipper device and peritoneal lavages were considered necessary to control intraabdominal sepsis in 7 children (age varying from 5 days to 13 years). They consequently underwent planned relaparotomies with peritoneal lavages every 24 to 48 hours. The peritonitis was caused by necrotizing enterocolitis (3 patients), postoperative complications (3 patients) and long existing perforated appendicitis (1 patient). Physical status, assessed by the Acute Physiologic Score (A.P.S.), varied from 12 to 22 (mean 17.7). Usually more than one lavage was necessary (1 to 3, mean 1.9) before the abdomen was considered clean and the zipper could be removed. Closure of the abdominal cavity could be achieved primarily in all cases. All patients survived. Although no statistically significant conclusions can be drawn from this small series and although it is unclear whether these children would not have survived without the zipper, this review shows that planned relaparotomies with peritoneal lavages using a zipper system can be performed safely even in very small children.
Adolescent↗