[Aortocaval fistula resulting from a ruptured aneurysm and a carotid aneurysm].
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Biomedical subjects
Publications and source records attributed to Y Chapuis.
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In the present state of detection and treatment of carcinoma of the head of the pancreas, only palliative surgery is available. The debate concerning the type of bilio-digestive by-pass is far from closed. Although by-passes using the gall bladder remain rare in France, above all reserved for advanced cancer, we prefer to use the common bile duct. The choice of the by-pass depends mainly on the local conditions and on the general state of the patient. Side-to-side choledoco-duodenal anastomosis, provided the technic is perfect and there is no duodenal obstruction, remains the simplest and therefore the most commonly used by-pass. However in cases of large pancreatic carcinomas modifying the relations between the duodenum and the bile duct or stenosing the duodenum, or as a routine whenever possible, it seems to us advisable to undertake a choledoco-jejunostomy on a Y loop (the raised loop is also used for a gastrojejunostomy), and this seems to give the most rapid recovery from the jaundice, a low mortality and ensure the longest survival.
The authors report a clinical study of 101 cases of continuous digestive suture and an experiment comparing intestinal healing after continuous and interrupted sutures. A certain discrepancy exists between the excellent clinical results and the pathological and microscopic findings with continuous sutures, and in particular the presence of pseudo-diverticular pouches in 20% of cases developing at the expense of a mucosal evagination within the suture. If carefully performed, continuous suture seems excellent, preventing by its watertightness, the onset of early fistula.
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The authors report the case of a patient with pancreatic and parathyroid adenomatosis and discuss whether it belongs to Wermer's syndrome. After a study of the various possible endocrine involvements, the complexity of hormonal inter-relations is studied, the prognosis and classification of multiple endocrine tumours are then discussed.
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On the basis of 67 isotope angiograms, the results of which were compared with those of arteriography, the authors present the advantages, indications and limitations of this technique.
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