[Hartmann's intervention in emergencies. Reflections apropos of 50 cases].
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Biomedical subjects
Publications and source records attributed to G Fourtanier.
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A retrospective multicenter study involving 12 digestive surgery centers was conducted on 497 cases of colon obstruction. The most frequent cause of colon obstruction was colo-rectal cancer (71 p. cent of cases), but many other etiologies were involved, including 61 cases of torsion and 37 patients with occlusive sigmoiditis. Differential clinical and radiological features in each etiological group are discussed, the results of therapy undertaken analyzed, and a reasonable line of conduct proposed, adapted to each situation, with the objective of attempting to reduce mortality which still affects 25 p. cent of cases operated upon.
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Renal colic in a young adult led to the discovery of very extensive bilateral ureteral stenosis. Exploration and biopsy showed metastatic lesions of an asymptomatic gastric cancer. Gastrectomy and subtotal bilateral ureteral replacement by prosthesis gave excellent short term results.
Diverticulectomy and esophagomyotomy provided a successful result in a patient with idiopathic muscular hypertrophy of the esophagus complicated by a pulsion diverticulum. The anatomical, clinical, and etiopathogenic features of this affection are described and problems concerning differential diagnosis discussed.
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The anastomotic clamp described may be used to perform end-to-end anastomoses in digestive surgery. After a description of the instrument and its mode of use in its most suitable application -- colo-rectal anastomosis -- the authors report the first results of their clinical experience in 13 anastomoses, which are highly satisfactory.
Vasopressin was infused intra-arterially or intravenously during 12 portal bypass operations. In comparison with a control group (without vasopressin), there was a very significant reduction in blood loss and portal pressure, and a moderate increase in arterial blood pressure.
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The authors present a new transcystic drain which offers the possibility of per-operative cholangiograms of excellent quality and provides an highly satisfactory means of external drainage of the common bile duct.
The results obtained in a series of 200 patients, using the transjugular approach to the common bile duct for the differential diagnosis of cholestasis, are presented and discussed. 1. The advantages of the method are: --the simplicity of the technique and the rapidity with which it can be mastered, the negligeable investment required; --the safety in use if the only contra-indication is respected: recent acute infection of the biliary tract; --the possibility of obtaining a cholangiography and a liver needle-biopsy at the same time, even in cases with disorders of the blood. 2. The limitation of the method is the failure to visualize the CBD, which is seen in 30% of cases when the latter is not dilated by an obstruction. 3. The respective indications for either transjugular cholangiography or retrograde catheterization of the papilla can be defined. 4. A preliminary series of 37 explorations of the portal system by the transjugular approach with embolization of bleeding oesophageal varices is reported.