[Complications of cholecystostomy].
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Biomedical subjects
Publications and source records attributed to M Ribet.
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A radiological opacity of the posterior and inferior mediastinum should evoke a lesion of vascular origin. The venous nature of the mass can be easily confirmed by morphological changes apparent during the respiratory cycle and changes in position. Investigations to establish etiology of this venous ectasia arising from the azygos vein require more extensive radiological examinations, and computed tomography may be of value. Portal hypertension is one cause of increased venous blood flow in the azygos systems, and should be systematically considered.
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Concerning acute pancreatitis following splenectomy, the authors studied the arterial blood supply of the pancreas, by means of 30 dissections, injections and radiographies; they described three types of arteries, of which origin, length, diameter, entry-point in the gland and distribution were studied; the vascular etiology pancreatitis following splenectomy does not appear probable.
Peritoneal lavage is a simple and useful method for the detection of visceral damage. It decreases the number of late diagnoses and deaths in closed traumas without overt symptoms, in multiple injuries and unexplained collapses, in alcoholic patients, or when transportation or anaesthesia are required. The results proved reliable in 91.8 p. cent of 378 cases of peritoneal lavage. The incidence of false positive results (mainly due to retroperitoneal haematoma) was 7.4 p. cent, and the risk of false negative results was estimated at 0.8 p. cent. The precautions required are recalled, and the problem of minimal intraperitoneal lesions is discussed. All patients with negative or doubtful results must be kept under close clinical surveillance.
An accurate, quick, and reproducible method to assay serum lipase activity allowed a parallel study of lipase and amylase in 147 patients. Lipase appeared very specific of pancreatic distress. In acute pancreatitis its increase was constant, frank, quick and lasting. It brought a diagnostic argument superior to the dosages of amylase activities in serum and/or urine. But its value as an evolutive and pronostic test was as much limited. Its interest as a negative argument for differential diagnosis was not superior either. In chronic pancreatic diseases, it gave evidence of massive spread or complications.
Insulinaemia and glucagonaemia were measured in two cases of hypercholesterolaemia type II, before and after portacaval shunt. The results show an increase of both hormones although these variations are not concomitant with the decrease in cholesterolaemia. The data still do not explain the mechanism of the decrease.
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The possible role of pleural drainage in the occurrence of diaphragmatic palsy in newborns in considered.
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Thirty cadaver dissections and injections of the pancreatic caudal arteries brought the authors to the conclusion that the ligature of a recurrent artery (going from the splenic hilum to the pancreatic cauda) is an exceptional cause of acute pancreatitis after splenectomy : this complication is more often due to direct trauma to the pancreas.
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