[Is continence possible in digestive system stomies?].
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Biomedical subjects
Publications and source records attributed to R Salmon.
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The Maclet magnetic stoma seal already used by the authors for colostomies was applied to the closure of permanent terminal ileostomies. A reservoir is constructed upstreams of the closure with the last loop of ileum, so that the faeces accumulate and can be evacuated by intermittence. Patients empty the reservoir by removing the cap which blocks the intestinal lumen and introducing a probe into it. The technique was used on 2 patients who had undergone total proctocolectomy for familial polyposis of the colon. One patient has now been followed up for 3 years and the other for 6 months. The perfect continence obtained by this method favourably compares with Kock's continent ileostomy.
The high incidence of hepatic lesions in sarcoidosis contrasts with the extreme rarity of portal hypertension. The mechanism of the latter is as obscure as the pathogeny of the disease. The liver may contain many or very few tuberculoid follicles, and its structure may be normal and non-fibrotic (as in our first two patients) or sclerotic, though rarely cirrhotic. In most cases the spleen is enormous, which raises the problem of portal hypertension by overload. Our third patient seems to be an unique case of progressive change to malignant hepatoma with osseous metaplasia, complicated with cervical metastases.
One case of primary linitis plastica of the rectum is presented, adding to the 20 previous cases reported in the literature, the diagnosis was made aften excluding the stomach as a primary source by per operative palpation and radiographic examination. Absence of blood in the stools and predominant symptomatology of diarrhea explains the delay of diagnosis in this patient with chorea. About 20% of all reported cases occur in association with ulcerative colitis. The prognosis is poor; the maximal survival reported is 2 1/2 years; the mean survival time is about 4 months.
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One hundred patients with gastric ulcer underwent surgery without gastric mutilation by a technique initially directed against stasis by pyloroplasty, vagotomy and, according to the site of the ulcer, its limited resection or biopsy. In half of the cases, the indication was that of the development of a complication. Eight patients died, 6 of them from amongst the 44 haemorrhagic ulcers. Two deaths were favourised by a complication specific to the procedure used. 86% of the patients followed up had an excellent or good result. Six recurrences of ulcers were seen, including two which again recurred after gastrectomy. Morbidity and mortality, in particular in the case of bleeding, appear to be less after vagotomy than after gastrectomy. The long term results in terms of ulcer disease of the two methods are similar.
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11 complications were observed in 2,346 cases of needle biopsy (frequency 0.47%) carried out in 1,529 cases under laparoscopy, 527 cases by the intercostal route, and in 290 cases during operation. The symptoms usually appeared early, indicating bleeding. The lesions, isolated or associated were six hemoperitoneums, and 9 hematomas (including 2 subcapsular), 3 intrahepatic (1 FAV), one of the gall bladder, 3 undetermined; 5 patients out of 11 were operated on, 4 out of 11 died. The place of surgical treatment is discussed: one hemoperitoneum led to early surgical operation. An intrahepatic or subscapular hematoma may regress without sequelae. An arteriography after a liver scan should eliminate a major vascular lesion which may eventually require surgery.
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A case of lumbar hernia is reported here. The likelihood of the traumatic etiology of this case and the technics of parietal reparation are discussed. The risk of strangulation justify the preventive treatment.
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