Biomedical subjects
Publications and source records attributed to L Leger.
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After retrograde opacification of be pancreatic ducts by duodenoscopy, pancreatic biologic reactions have been studied, especially by amylasemia and lipasemia measures. These biologic reactions have been all the more frequent and intense as Wirsung's duct and its tributaries filling have been important. Frey's inhibitor had a proptious action on these biologic reactions; therefore, it may be used as a preventive treatment.
On the basis of 67 isotope angiograms, the results of which were compared with those of arteriography, the authors present the advantages, indications and limitations of this technique.
Angiorgrams sometimes show regular and symetrical corrugations of the arterial outline. The shadows have been given various names: pearl string arter, bamboo pattern and so on. Involved arteries are mostly those of the extremities, especially the lower limbs. The authors have found a case involving the mesenteric artery. Usually, there is no pathological state of the arterial wall. Thus, surgical action is unnecessary.
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The authors report a comparative retrospective study of 124 end-to-side portal anastomoses and 63 side-to-side anastomoses. The influence of a certain number of clinical and pathological factors on mortality and immediate and long-term survival, were statistically verified. The quality of the functional result result was analysed in each group of operated patients. Comparison of the results of trunkular anastomoses with or without interruption of the portal vein, showed both as regards, post-operative and late mortality, that the functional results were definitely in favor of end-to-side anastomosis. Thus side-to-side anastomoses gave 40,4 p. 100 of good results and 59,6 average or poor results, as against 60 p. 100 gave rise to portal systemic encephalopathy in 17 p. 100 of cases as against 35 p. 100 in the case of the side-to-side anastomosis. Only the sub-group of operated patients with hepatic vein thrombosis seemed to benefit from side-to-side anastomosis.
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The authors report 6 cases of chronic familial pancreatitis. They review the literature on this disease which is still little recognised and seek the specific characteristics, early onset, transmission as an autosomic dominant with incomplete penetrance, relatively favourable prognosis, together with the suggestive signs, pancreatic lithiasis and certain complications. Apart from these signs, chronic familial pancreatitis differs very little from common chronic pancreatitis. The only cause is apparently genetic. Etiopathogenesis is thus still obscure. Treatment should be started early, but surgical methods are the same as in primary chronic pancreatitis.
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One-hundred and forty eight patients operated upon for chronic pancreatitis were reviewed retrospectively in 5-20 year followup. Treatment was by drainage of the duct of Wirsung to adefunctionalized jejunal loop, distal pancreatectomy, pancreato-duodenectomy, splanchnicectomy with an operative mortality of 5%. Influence of clinical and anatomical data upon long term survival and symptomatic results was studied. Among Wirsungo-jejunostomy, distal or cephalic pancreatic resections, survival rates were highest with drainage of the duct of Wirsung and lowest with the pancreatoduodenectomy. Retrospectively, post-operative alcoholism appeared as the alone factor affecting long-term survival. Pancreatic insufficiency and liver cirrhosis were main causes of death. Among the survivors, the percentage of good symptomatic results ranged from (1/3) with splanchnicectomy to 6 of 8 after duodeno-pancreatic resection. Alcohol abstinence affected sypmptomatic results but at a lesser degree than for survival. It was observed that when left pancreatectomy was performed, drainage of the remaining duct of Wirsung into the jejunum significantly improved the good results from 40% to 75%. In the group of wirsungo-jejunostomies without pancreatic resection, it was found that pancreatic calcifications and a large diameter of the duct of Wirsung at the time of operation were favorable prognostic factors.
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