[Hepatic lobectomy and extra- and intra-hepatic lithiasis].
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Biomedical subjects
Publications and source records attributed to J Cuilleret.
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Surgical management of chronic pancreatitis remains a difficult problem. On the continent of Europe, the main etiology of the disease is alcoholism; thus, alcohol withdrawal is mandatory before surgical treatment. Left splanchnicectomy is no longer used. Total and left subtotal pancreatectomy are abandoned due to their high mortality rates and their severe metabolic sequelae. Distal pancreatectomy is presently reserved for the cases in which the head of the pancreas is least involved. The choice between pancreaticojejunostomy and pancreaticoduodenectomy remains debated. The former has a low postoperative mortality rate while reoperation is less frequent after the latter. Current trends in Europe are to perform more anastomoses and less resections than some years ago. Pancreaticoduodenectomy, however, retains an important role in cases with biliary or duodenal involvement. Whatever the choice of the procedure, the surgical treatment of chronic pancreatitis remains palliative and does not alter the natural course of the disease. The quality and duration of the results depend mainly on alcohol withdrawal.
The study evaluated the contribution of serum PS100 assay to the detection of lymph node metastases during the follow-up of patients previously treated for a malignant melanoma, in addition to (99m)Tc sestamibi (MIBI) scintigraphy and investigation for gene MDR1, in order to detect chemoresistance phenomena. The study included 37 patients with a clinically questionable lymph node around basin lymphatic areas of the previously surgically-treated malignant melanoma. The sensitivity and specificity of PS100 assay were 91% and 86.5%, respectively. The sensitivity and specificity of MIBI scintigraphy were 95% and 85%, respectively. Overexpression of gene MDR1 was observed in six cases. In the event of negative scintigraphic findings, the concomitant analysis of PS100 levels and the scintigraphic result enabled the metastatic MDR+ patients to be distinguished from the non-metastatic patients. PS100 assay may therefore be proposed for the follow-up of malignant melanoma.
Ideal exeresis with immediate anastomosis protected by an endoluminal shield (Coloshield) was performed in a series of 14 patients with left colic lesions for which the classical treatment would have been exeresis without anastomosis. No post-operative anastomotic fistulas were observed; one case of secondary stenosis of the anastomosis was treated successfully by endoscopic dilatation. The results of this series suggest that this technique is a reliable method of internal intestinal by-pass which offers real progress by allowing left colon exeresis with immediate anastomosis even in case with unfavourable local conditions.
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A technique for performance of portocaval shunt operations using tubular inferior vena cava grafts is proposed. The aim of this method is to avoid prosthetic or venous interposition with their risk of thrombosis. It is based on results of cadaver experimental studies and a clinical case. Different possible grafts are described, including useful sizes, advantages and inconveniences and clinical indications. Two types are selected: that resected from left surface of subhepatic vena cava for portocaval anastomosis and that obtained from anterior surface of infrarenal vena cava for mesentericocaval anastomosis.
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Treatment of 27 large abdominal eventrations by intra-peritoneal prothesis fixed by staples is reported. Only one recurrence (3.5%) in the post-operative period, the good results observed, absence of grave complication, and great simplicity of this procedure lead the authors to recommend the use of intraperitoneal prosthesis in the treatment of post-operative eventration with major loss of parietal substance.