[Spontaneous biliary-digestive fistulas (apropos of 21 cases)].
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Biomedical subjects
Publications and source records attributed to R Bricot.
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The case of a 29 year old woman affected by fulminant hepatitis during the third trimester of pregnancy, after a 3 week administration of chlormezanone is reported. Following induced Caesarean delivery, the patient underwent an orthotopic liver transplantation. The mother and her baby were in good condition 26 months after liver transplantation. In this case, chlormezanone was probably responsible for the fulminant hepatitis.
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Out of 268 resections for colonic carcinoma, 44 were extended because of an involvement to adjacent tissues or organs. Abdominal wall (14 cases), vesical dome (12 cases) and small bowel (11 cases) were most frequently resected. Post-operative mortality (15.9%) and five years survival rates (57.5%) of this radical procedures do not significantly differ compared to results after conventional procedures (15.3 and 64.3% respectively). Carcinomatous adhesions are difficult to distinguish from inflammatory ones at the time of laparotomy. They were found in 47% of the specimens only. This had a lesser prognostic significance than lymph nodes involvement. This results are in favour of extensive surgery for locally advanced tumours of the colon.
The authors report 42 cases of pilonidal cyst on which 27 have been operated with the L-shaped skin graft "LLL-plasty". This technic has been applied to large pilonidal lesions, half of which were failures of other methods. Though the excision was large, the suture was easily practised with this technic. The healing time is around 13 days. The rate of relapse is small, but could be improved with more rigor in the indication and with constant medical supervision of the patients, imposing strict hygienic rules.
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Malignant duodenocolic fistula is nearly exclusively the fact of carcinoma of the hepatic flexure; it is one of the most uncommon and particular evolutive complication, because of its rapid nutritional disturbances and difficult surgical management. The authors report the case of a 78 year old man, still alive 18 months after a one staged right colectomy and pancreatico duodenectomy. The analysis of 26 others cases from literature treated with the same procedure or, most frequently, with right colectomy and partial duodenectomy allows to discuss indications and results of radical surgery: though it is possible at least in half cases, it represent a much better functional solution compared to complex by-pass procedures: more over its seems to be prognostically justifiable: out of 23 curative resected patients in this series, 6 at least (26%) are still alive from 9 to 26 years after.
The authors report a case of digestive hemorrhage secondary to isolated duodenal varicosities, in a patient with ethylic cirrhosis. The diagnosis done through optical fibroscope was confirmed by arteriography. The evolution was unfavorable. Lesions were corroborated by autopsy. A review of the literature is done, about the 22 cases already published. With the help of these cases to authors stress the points that can lead to the good diagnosis and what therapeutical management should be done.
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