Biomedical subjects
Publications and source records attributed to J M Hay.
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The authors report 3 cases of acute complicated duodenal ulcers occurring during the course of Listeria meningitis. These three adults (2 females and 1 male) suffered from localised neurological involvement and, in 2 cases neurovegatative disorders an altered level of consciousness. The ulcers were situated in the duodenal cap, and in each case there were at least 2 large excavated ulcers. These ulcers were the site of late complications on the 13th and 15th days after the onset of neurological disease. In two cases the major symptom was haemorrhage, whilst in the third it subsided leaving a syndrome of peritonitis due to perforation. Treatment in all three cases consisted of vagotomy with pyloroplasty (the ulcers being excised or sutured). All the patients recovered from their digestive complications without relapse despite the persistence 6 and 10 months later of the same neurological problems in two of them. All these facts would be in favour of a neurogenic aetiopathogenesis, via the vagal nerve. Thus acute late duodenal ulcers in patients with neurological disease from a separate enity within the context of stress lesions.
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Nine cases of severe gastrointestinal haemorrhage as the presentation of oesophageal lesions are reported. Haemorrhages complicating oesophageal varices, carcinoma of the oesophagus and oesophageal surgery were eliminated from the study, as were haemorrhages associated with hiatal hernias or Mallory-Weiss syndrome. Amongst these 9 cases of severe haemorrhage, 5 were due to an ulcer of the oesophagus, 2 to acute oesophagitis, 1 to rupture of the oesophagus and one to a traumatic aneurysm of the aorta rupturing into the oesophagus. The location and cause of bleeding were determined only 3 times before operation and only when a fibroscopic examination had been carried out. At fibroscopy, an irregular lesion responsible for a severe haemorrhage has every chance of being a benign ulcer and not a carcinoma. Treatment directed at the aetiology was carried out in 6 cases and success obtained in 3 patients. The aetiological diagnosis who was not made in 3 patients, who died. The aetiology, diagnosis and therapeutic approach required in such cases of severe haemorrhage of oesophageal origin are considered. In the light of these cases, a possible oesophageal aetiology should be considered as a possible cause of an unexplained severe gastrointestinal haemorrhage. An attempt at proving such a hypothesis by fibroscopy is necessary and, in general, urgent thoracotomy since the bleeding is in most instances of arterial origin.
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On the basis of two fatal cases of perforation of the caecum secondary to dilatation of the colon without obstruction, the authors discuss the measures which should be instituted in the presence of this condition. These consist, preventively, of decompression of the colon by caecostomy if the diameter of the caecum reaches 10 cm and, curatively, a right hemi-colectomy, not associated with immediate re-establishment of the continuity of the digestive tract.
Seventy-one hamarto-chondromas were operated on at the Centre Chirurgical Marie-Lannelongue from January the 1st 1958 to September the 1st 1975. Pulmonary hamarto-chondroma is always a slowly evolving benign tumour, usually found in patients between 40 and 60, and twice as frequent in males as in females. There are two different kinds. 1) Intraparenchymal hamarto-chondromas, which have a noteworthy clinical latency and in 2 cases out of 3 are situated anteriorly and peripherally. The usual treatment consists of simple enucleation. 2) Endobronchial hamarto-chondromas, on the other hand, have a striking symptomatology of bronchial obstruction. If operated on after some delay, they will cause the destruction of distal parenchyma. Treatment depends on their topography. Segmental resection is often the sole recourse.
The effects of anoxia on orthotopic small bowel autotransplantation were studied in 22 pigs respectively on the operative day (before and after transplantation) and post-operatively (on the 1st, 3d, 5th, 7th and 15th day). Absorption of D-xylose (as evaluated by xylosemia curve) and several brush border enzyme activities were compared with histological and histoenzymological data. After transplantation D-xylose test, enzymatic assays and to a lesser degree histoenzymology showed some impairment until the 15th day. By contract mucosal morphology as evaluated by optical microscopy was normalized as soon as the 3d post-operative day. From these data it may be assumed that in allotransplantations, optical microscopic abnormalities seen after the fourth post-operative day are no longer due to anoxia but may be related to early rejection. Other functional tests could be of some value only after the 15th day.
The authors report a new technique of heterotopic transplantation of the small intestine : reno-mesenteric transplantation. The advantages of this technique are recalled, especially when intestinal transplantation is carried out some time after removal of the intestine. In fact, in this case, orthotopic transplantation is difficult owing to the relationship between the mesenteric stump and the fibrous scar.
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