Last-resort treatment of status asthmaticus.
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Biomedical subjects
Publications and source records attributed to P Marchand.
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In the last five years, 7 teams, members of a surgical club of lower Normandy, have performed 1,136 colon procedures, including 247 for severe diverticular disease. The patients were grouped in two categories according to the severity of the complications presented: 159 sub-acute complications including 137 acute cases of sigmoiditis (diverticulitis, peri-colic micro abscesses, pseudo-tumoral forms) and 22 fistulae, 88 severe acute complications including 60 generalized peritonites, 12 huge abscesses, 9 occlusions and 7 hemorrhages. The total post-operative mortality is 6 p. cent. It is quite different in the surgery of sub-acute complications (0.6%) and the surgery of acute severe complications (16%). The total morbidity reaches 14.8 p. cent. Complications are more frequent and more severe in acute forms (18.5%) than in subacute forms (10.5%). At long term, 10.8 p. cent of the patients operated upon, kept a permanent colostomy (25 p. cent in acute forms vs 2.3 p. cent in subacute forms). 89.2 p. cent have a normal digestive tract following treatment (97.7 p. cent in subacute forms and 53 p. cent in acute forms).
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Perforation of an esophageal cancer can occur spontaneously or during radiotherapy. If the perforation is the first manifestation of the cancer, the diagnosis depends on X-ray and endoscopy. During radiotherapy, the intending perforation must be carefully watched for. We have treated two perforations appearing as first manifestation of the cancer and 3 developed during evolution, 2 of them during radiotherapy. Various treatments have been applied. In 2 cases, resection was possible, curative in one, palliative in the other. In the other 3 cases, retrosternal by-pass has allowed feeding and radiotherapy. Such a complication generally condemns the patient to a gastrostomy. However, a more aggressive surgical attitude can be adopted if the general status of the patient permits. An esophageal endo-prosthesis can also be used.