[Spleno-portography: a hemostatic precaution].
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Biomedical subjects
Publications and source records attributed to A Louvel.
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Clinical, radiological and histopathological features of 31 duodenopancreatectomies for chronic pancreatitis with lithiasis are analysed in relation to whether or not there was dilatation of the duct of Wirsung. Two groups of patients may be defined in the basis of this criterion: -- the first, without dilatation of the duct of Wirsung, with lithiasis predominantly affecting the head of the pancreas and irregular fibrosis, corresponding patients aged approximately 30 years, suffering from the disease for about 10 years, often already operated upon for pancreatitis; gastrointestinal bleeding is common; -- the second, with dilatation of the duct of Wirsung, with disseminated lithiasis, and very marked fibrosis, affecting patients aged over 50 years, suffering from the disease for less than 5 years and not yet operated upon for their pancreatitis. The problem of the independance of the two groups or of the possibility of progression of forms without dilatation of the duct of Wirsung to dilated forms remains.
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These sarcomas fall within a precise definition and must be differentiated from gastrointestinal involvement in a haematological disorder. For certain histological forms (nodular forms), the prognosis is less bad than that of carcinomas. Pre-operative diagnosis, often difficult, must be established by large biopsies. The best results are likely to result from a combination of surgery and radiotherapy or of surgery and chemotherapy.
The authors report 8 new cases of heterotopic pancreas and the clinical signs of each case. The emphasise the difficulties of preoperative diagnosis owing to their usually small size and the necessity of surgical treatment justified by the same lesions which affect the normally placed pancreas including cancer.
The term "endocrine polyadenomatoses" includes two types of pathological entities in which there are an association of at least two endocrine tumors having no physiological relationships, and hereditary familial characteristics: Wermer's syndrome (Type I): pancreatic endocrine tumor, pituitary adenoma, and hyperplasia or adenoma of the parathyroids. Sipple' syndrome (Type II): medullary thyroid cancer, one of two pheochromocytomas, and parathyroid hyperplasia. The multifocal character of the pancreatic D-cell lesions in the first type, and the bilateral nature of the thyroid and adrenal lesions in the second type are particular features of each of them. Apart from some parathyroid lesions, for which the origin is still debatable, these endocrine tumors enter into the framework of the apudomes and are derived therefore from the neural crest. The association of other tumoral varieties of the APUD (carcinoid) type with nervous tissue tumors, and with dysmorphic anomalies suggests that these syndromes are the expression of a dysgenesis affecting more or less completely, structures derived from the neural crest.
On the basis of pancreatography findings and the study of operative specimens in 32 cases of duodenopancreatectomy, it was possible to distinguish two groups according to whether or not the duct of Wirsung was dilated. When the duct was not dilated, fibrosis was relatively marked, but disseminated and more notable in sections of the head than in sections of the isthmus. Lithiasis was essentially cephalic, but distributed more or less equally between the duct of Wirsung and the canaliculi. When the duct was dilated, there was marked fibrosis, distributed equally. Lithiasis was radiologically diffuse throughout the organ, but situated in particular in the duct of Wirsung itself.
Anorectal lesions in Crohn's disease are usually associated with colonic involvement. Under other circumstances, they reflect an additional localisation of the disease, being indicative of its progression. However, they may remain strictly isolated and pose a diagnostic problem. The authors report here a case of anoperineal lesions which remained isolated after a 5 year course of the disease and which led to the need for anoperineal excision.
The authors report two cases of acquired diverticulae of the small intestine with complications and study of pathological, clinical and therapeutic characteristics of this rare disease. Usually latent, these diverticulae were recognised generally during diverticulitis, intestinal obstruction, perforation or hemorrhage. The treatment was either removal of the diverticulum or segmental resection of the small intestine. Diverticulitis of the terminal ileum may lead to right ileo-colectomy.
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The authors report 115 cases of acute pancreatitis who were either operated on or autopsied and emphasise the severity of the glandular parenchymatous involvement which remains, furthermore, difficult to recognise during manual exploration. Necrosis is sometimes limited to the peripheral interstitial tissue and spares the gland itself (the prognosis is then less serious) and has led many surgeons to resections which did not always seem justified a posteriori. The authors refer to pancreatic decapsulation, described by rumanian authors, and suggest a method of operative diagnosis of the extent of glandular necrosis.
The authors report the case of a 62-year-old woman in whom, 18 months following the development of bilateral parotid hypertrophy followed by a dry syndrome, there was the onset of an angioimmunoblastic lymphadenopathy (AIL) which consisted of the association of a multiple lymphadenopathy with a characteristic histological appearance, although poor in plasmocytes, and a febrile syndrome, but in the absence of a complete syndrom from a laboratory standpoint. This fact, incombination with the richness of the nodes in epitheloid cells, is such that this case resembles the type II "dysimmune and pseudo-lymphomatous lymphadenopathies" (DPLL) of Delsol et al. Although the term AIL has never been used before in the title of previous publications of pseudo-lymphomas occuring during Sjögren's syndrome, it would seem possible, as has already been suggested by Diebold et al. (3) with regard to several cases, that certain of these pseudo-lymphomas are true AIL. The rapidly fatal course with visceral spread shown at autopsy and above all the presence of exclusively immunoblastic plaques in several mode areas led, on the basis of the criteria of Nathwani et al. (22), to acceptance of the coexistence of an immunoblastic sarcoma.
Nine hypoglycaemia-inducing pancreatic tumours were studied by electron microscopy. In 8 of these tumours, it was possible to identify, within the cell cytoplasm, secretory granules with a "paracrystalline" content, identical in appearance to the granules of the B cell of the normal human pancreas. Thus electron microscopy would appear to be a reliable and sensitive method for the morphological identification of these endocrine tumours of the pancreas.
The surgeon should take pains to section and study himself the operative specimen after excision for acute pancreatitis, in order to understand the true nature of the lesions, which the most attentive and competent pathological examination cannot describe as vividly as direct examination by the operator. Often he will be surprised to find that the lesions, predominant in the capsule, are less profound and less severe than he had thought at first sight. Findings of this sort, if they were to be confirmed, would put into doubt the principle itself of routine pancreatectomy for acute pancreatitis.
In a case of giant cell tumour of bone, electron microscopy revealed filamentous inclusions within the nuclei of all the giant cells. Although not invariably present in such tumours, their similarity with the nucleocytoplasmic inclusions seen in osteoclasts in Paget's disease is underlined. This raises interesting questions as to their nature and the histogenesis of these disorders.
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.
The authors report three rare localisations of endometriosis: ileal, appendicular and free endometrioma of the pouch of Douglas and study the diagnostic difficulties of digestive endometriosis and the interest of routine histological examination of structures found apparently free in the pouch of Douglas.
The authors report a personal experience of 16 cases and in the light of data in the world literature, the authors discuss the controversial method of treatment of very severe obesity when medical treatment has failed. The onset of various complications linked mainly to intestinal malabsorption, should make one careful in the indications for surgery which may, however, be applicable in certain cases.