Biomedical subjects
Publications and source records attributed to J Grosdidier.
2 cases of rectal metastatic breast carcinoma were treated by an abdomino-perineal resection. The rectal involvement is quite uncommon, and only 6 others cases treated with surgery have been described in the international literature. We think that only radical surgery can give a good palliation.
Sixty-two cases of hydatid cyst of liver were treated and followed up between 1968 and 1982. Current pre-operative investigations include immunologic tests (immunoelectrophoresis, tests for hemagglutination inhibiting antibodies) and medical imaging (ultrasound, scanner). Vascular exploration is now very rarely performed. Surgical treatment is mainly by pericystectomy and was conducted in 90% of cases with a postoperative mortality of 5,2%. Chemotherapy with Albendazole was combined routinely.
The authors have retrospectively studied 17 patients with acute pancreatitis to see if computed tomography (CT) findings were correlated with the clinical type of acute pancreatitis. This study permit to say that a normal CT scan is possible with an edematous pancreatitis. There is no necrotizing pancreatitis with normal CT scan. But, in 11 CT scan with severe appearance, 6 patients had an edematous pancreatitis of good prognosis. Several explanations are given, but the important thing is the lack of correlation that make CT scan of a bad prognosis value. Any way, CT scan is still the best examination for diagnosis of acute pancreatitis.
This article describes a case of "non-functional" beta cell tumor of the pancreas. A review of the literature confirms the exceptional nature of these tumors. They produce the same symptoms as cancers of the exocrine tissues, although they are often diagnosed radiologically before the appearance of any clinical symptoms. Surgical treatment is necessary to extirpate the tumor, and permit histological examination.
Twenty-five patients with toxic megacolon are reported. The most frequent etiology of this syndrome was ulcerative colitis and the main complication colonic perforation. Toxic dilatation generally involved the transverse colon. Twenty patients were treated by a surgical procedure, namely two enterostomies and eighteen colectomies. A total colectomy with ileorectal anastomosis was performed in ten patients. Mortality for the whole series was 32%, but was reduced to 14% in the last 4 years. There were no deaths and no complications needing surgical management in the group of patients treated by total colectomy with ileorectal anastomosis. However, the method resulted in one failure. The satisfactory results obtained with this procedure must be emphasized. Despite the small number of so-treated patients reported in world literature, it is suggested that total colectomy with ileorectal anastomosis must be regarded as the procedure of choice for toxic megacolon without peritonitis.
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A new procedure is described for closing the abdominal wall in patients expected to have poor wound healing. The technique uses rigid steel wires passed through both abdominal thicknesses perpendicularly to the incision with an extraperitoneal course and passed through a large Silastic tube laid on the skin surface parallel to the incision. This method considerably reduces the two detrimental effects of one layer stitches: sawing of tissues by the thread and ischemic compression of the abdominal wall. We have used this procedure in 33 patients, with 31 satisfactory results. In 10 eviscerations that occurred after other methods of closure, only 1 recurrent evisceration was observed.
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Esophageal location of bronchogenic cysts is rare especially if two cysts are present. We report such a case in a girl 17 years old who had several intramural esophageal smooth defects which looked like multiple leiomyomatosis of the esophagus. At surgery there were two bronchogenic cysts arising in the wall of the esophagus and lying on each side of the azygos arch.
The authors present their experience of the toxic colonic dilatation after 21 cases. The frequency of this serious syndrom seems to be in augmentation, and is not any more exclusive of the ulcerative colitis. Actually, pathogeny is not yet known. Diagnosis is established by the standard abdominal X Ray. A continuous clinical, radiological and biological survey is essential, in order to avoid perforation, that is the main complication of the toxic dilatation. The surgical treatment becomes imperative as soon as the failure of the limited medical management is recognized. In this series, total colectomy with or without ileo-rectal anastomosis has been considered as the best surgical operation. Ileo-rectal anastomosis would be possibly protected by a temporary ilestomy.
On the basis of immediate and long term results obtained by surgery in a consecutive series of 46 patients with Crohn's disease (1968-1978), the authors establish the salutory efficiency of a therapy which is often too delayed. Some of the patients could have advantage of an earlier resection complications occur. Thus the rate of mortality and morbidity could be lowered. This principle may become of great interest in opposite to the feebleness of the actual medical treatment.
Pulmonary complications frequently occur during the postoperative period following surgery for neoplasms of the oesophagus. The aetiology varies according to the time of their onset but the clinical signs and treatment are essentially the same. The problems encountered and related either to anaesthesia, to the surgical approach to the position of the patient. It is after the third day that complication develop related at one and the same to the past history, classical in such patients, (tobacco, chronic bronchitis, alcoholism) and the ectopic position of an abdominal viscus.
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