A new endoprosthesis designed for surgical intubation of neoplastic strictures of the proximal biliary tract has been developed. The technical aspects of intubation by this endoprosthesis are discussed, and the results in the first 25 patients are given. The results suggest that this device was well tolerated. Mortality and morbidity related to the endoprosthesis were low in comparison to the results given in the literature for intrahepatic cholangioenteric anastomosis. The authors conclude that this procedure could favorably replace intrahepatic cholangioenteric anastomosis as currently used for selected cases of malignant biliary stricture.

Adult↗

PubMedDate not supplied

Preoperative assessment of the extension of rectal carcinoma: correlation of MR, surgical, and histopathologic findings.

Nineteen patients with rectal carcinoma were evaluated prospectively. The extent of tumor and the relationship of the tumor to the levator ani muscle were studied as this determines the choice of the surgical procedure (abdominoperineal resection versus low anterior resection). Peroperative assessment and detailed evaluation of the pathologic specimens were correlated with magnetic resonance (MR) features. Magnetic resonance staging and surgical findings were at variance in four of 15 cases (27%). Magnetic resonance had sensitivities and specificities of 75 and 100% in the detection of perirectal growth. Magnetic resonance demonstrated invasion of adjacent pelvic side wall and sacrum in two of two cases. The comparison with TNM classification demonstrated that MR correctly staged 15 of 19 cases (79%). This study shows that MR is a good examination to evaluate the involvement of perirectal fatty tissues and adjacent structures. The low prevalence of involved lymph nodes in our cases prevents significant positive predictive values. Nevertheless, MR can help to select patients for local excision or for preoperative radiotherapy.

Adenocarcinoma↗

PubMedDate not supplied

The role of anatomic factors in nutritional autonomy after extensive small bowel resection.

BACKGROUND: It is difficult to predict which patients with a postsurgical short bowel will require long-term parenteral nutrition. METHODS: We performed a retrospective prognostic study for the time to home parenteral nutrition or death from malnutrition (nonautonomy), on the basis of 103 patients with a residual short bowel of 17 to 150 cm. The influence of anatomic variables was summarized through the use of Cox regression model. RESULTS: Of the 103 patients included, 24 lost nutritional autonomy. Three anatomic variables were identified as having independent predictive information; remaining small bowel length (measured on small bowel x-rays; p = .0001), and jejunoileal anastomosis (p = .01) promoted autonomy, whereas end jejunostomy (p = .002) increased the risk of losing nutritional autonomy. CONCLUSIONS: On the basis of these results and on the relative weight of these variables, high-risk patients for loss of nutritional autonomy were defined as those with jejunoileal anastomosis and a remaining small bowel length < 35 cm, patients with jejunocolic anastomosis and remaining small bowel length < 60 cm, and patients with an end jejunostomy and remaining small bowel length < 115 cm. This classification was thereafter validated on a prospective series of 32 patients.

Adolescent↗

PubMedDate not supplied

[Leiomyoma of Meckel's diverticulum revealed by a digestive hemorrhage. Preoperative diagnosis by selective arteriography].

The authors report a case revealed by low digestive hemorrhage, and in the light of cases in the literature, discuss the various problems due to leiomyomas in Meckel's diverticulum. They emphasize particularly the risk of late diagnosis at the stage of leiomyosarcoma. As it is impossible to say afterwards whether a muscular tumour of the digestive tract is benign or not, it is important to make an early diagnosis. Arteriography is one of the best means.

Female↗

PubMedDate not supplied

[Routine laparotomy in Hodgkin's disease. Remarks apropos of 50 personal cases].

The authors report fifty personal cases of routine exploratory laparotomy during Hodgkin's disease, carried out in either first or second intention. They compare the results obtained to those in other series published in the literature. The results emphasize the undoubted change in classification after laparotomy, and consequently, changes in therapeutic attitude, but also raise new problems which leave the question open.

Abdominal Neoplasms↗