[Small bowel obstruction induced by a I.U.C.D. (author's transl)].
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Biomedical subjects
Publications and source records attributed to J H Alexandre.
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One hundred patients with gastric ulcer underwent surgery without gastric mutilation by a technique initially directed against stasis by pyloroplasty, vagotomy and, according to the site of the ulcer, its limited resection or biopsy. In half of the cases, the indication was that of the development of a complication. Eight patients died, 6 of them from amongst the 44 haemorrhagic ulcers. Two deaths were favourised by a complication specific to the procedure used. 86% of the patients followed up had an excellent or good result. Six recurrences of ulcers were seen, including two which again recurred after gastrectomy. Morbidity and mortality, in particular in the case of bleeding, appear to be less after vagotomy than after gastrectomy. The long term results in terms of ulcer disease of the two methods are similar.
In five patients with a phaeochromocytoma, axial computerised scanner tomography made it possible to localise the tumour without ambiguity, even when intravenous urography had been interpreted as normal. Although all the tumours diagnosed were relatively large (between 3 and 9 cm), this is nevertheless a non-invasive examination, free of danger and worthy of consideration in the preoperative assessment of a case of phaeochromocytoma.
Eight patients undergoing cholecystectomy received a single injection of nitroglycerin (0,9 mg) and 8 received amyl nitrite, during a cholangio-kinesimetry. The maximum fall in common bile duct pressure was similar in both group; 3.2 +/- 0.3 torr after nitroglycerin (NTG),3.8 +/- 0.6 torr after amyl nitrite (AN). NTG caused a more persistent lowering of pressure than AN; 614 +/- 42 seconds/343 +/- 27 seconds (p < 0.001). This study showed that it is possible to produce a relaxation of biliary tract muscle fibres with an injection of nitroglycerin and then replace amyl nitrite during anesthesia.
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The place of total pancreatectomy in the treatment of pancreatitis is still not clear: the author is in favour of this operation and gives the indications, surgical technique, complications and results. The operation is indicated in cases of necrosis involving more than 2/3rds of the whole of the head and part of the body of the pancreas. The duodenum and pancreas should be removed in one piece and intestinal continuity should be restored performing choledocho-jejunal and gastro-jejunal anastomoses. It is important to carry out this operation early, between the 3rd and 6th days, treating all areas of necrosis before the lesions become the site of uncontrollable infection. Seven patients out of 9 are still alive, on the 25th of July 1975; they all have easily controlled diabetes, a low fat diet and are receiving pancreatic extract. We have recently operated a 10th case, and the patient is alive 2 months later.
The place of total pancreatectomy in the treatment of pancreatitis is still ill- defined. The author makes a plea for this operation and notes the indications, the surgical technique and its results and possible complications. The operation is indicated in cases of total or 2/3 rds necrosis of the gland, in cases involving the head of the pancreas and part of the body. The gland should be dissected out and continuity should be restored by choledoco-jejunal and gastro-jejunal anastomoses. The important thing is to carry out this operation early, between the 3rd and 6th day, treating the areas of necrosis before the lesions become the site of uncontrolled infection. 7 patients out of 9 operated on in this way, are alive with easily controlled diabetes, a low fat diet and pancreatic extract.
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