Biomedical subjects
C Letoublon
Publications and source records attributed to C Letoublon.
[Conservative attitude in the treatment of closed injuries of the liver].
Progress made in surgical treatment of blunt hepatic trauma (BHT) are numerous. Some procedures are sophisticated, but the best results seem to be due to conservative trends. These conservative trends are observed on one hand during the laparotomy with limited hepatectomies, and peri-hepatic packing, on the other hand in non operative management (NOM). Among 55 patients treated over a 10 years period for BHT, NOM. (18 cases) is reported: incidence of NOM increased along the period (from 3 cases on 35, to 15 cases on 20). No deaths and no complications were observed. Secondary exploration was required in three patients: no one was objectively useful. Detection of hemoperitoneum greater than 500 cc and initial blood hypotension (if well corrected by resuscitation) do not exclude this NOM.
[The repair of recurrent postoperative incisional hernias. Objectives and therapeutic indications (68 cases)].
Among 327 surgical repairs of incisional hernias done between 1974 and 1989, 68 repairs (21%) were performed because of a primary treatment failure. Failed primary attempts of cure had been unique in 71%, and multiple in 29% of cases; their procedure had been essentially suture or herniorrhaphy. Site of recurrent incisional hernia (R.I.H.), was midline or lateral incision in respectively 84% and 16% of cases. Size of R.I.H. was considered as large in two third of cases. Operation was performed electively in majority of cases (93%). More than half of the patients were "prepared" by preoperative pneumoperitoneum and/or weight reducing regimen. Mersilene* mesh was used in 81% of cases. Results of treatment of R.I.H. are reported, depending on procedure. Among 55 cures by use of Mersilene* mesh, 1 patient died (from myocardial infarction), and 5 recurrences occurred, 4 of which from sepsis. Study of complications and failures suggests: 1) careful attention to indications, 2) advantages of a large size Mersilene* mesh, 3) attention to preoperative treatment, especially weight loss regimen and progressive pneumoperitoneum.
[Variations of division of the extrahepatic bile ducts: significance and origin, surgical implications].
As opposed to congenital anomalies, the anatomical variations, as well as the modal type, are issued from a normal morphological development. The variations of division of extra-hepatic biliary ducts are very frequent. They are clearly explained by the sequence of embryological development in man, and also by compared anatomy. Lots of variations occur, some of them being more frequently encountered than others during cholecystectomy for gallbladder lithiasis. A cysto-hepatic duct draining a large hepatic territory is the most dangerous variation. As a matter of fact, it can look as if the junction between the cystic duct and the common biliary duct was of the modal type. In surgical practice, the dissection of cystic duct must never go over the right side of the common biliary duct in order for it never to be injured. Radiological exploration of biliary tree during cholecystectomy for gallbladder lithiasis has to be routine, in order to discover the obviously unpredictable individual variations of division of extra-hepatic biliary ducts.
Anatomical and physiological basis of parietal treatment of severe peritonitis and evisceration.
The failures observed in attempts to obtain abdominal closure "at all costs" and the risks and difficulties of laparostomy led us to develop a technique of exclusive cutaneous cover to treat cases of severe peritonitis and evisceration with or without exposed fistula. This method is based on certain anatomical features of the anterolateral abdominal wall and its physiological properties when eventration or evisceration is present. The forces of parietal dehiscence were determined in 6 patients having undergone major surgery of the digestive tract. The magnitude of these forces, the neccessity of obtaining biological protection and the structure and physiology of the superficial layers of the abdominal wall require a cutaneous cover with traction-free sutures via cutaneoaponeurotic incisions of relaxation. The rich vascularization of the abdominal wall, the number and topography of the perforating arteries and the existence of hypodermal, subdermal and subpapillary anastomoses allow the surgeon to perform extensive cutaneoaponeurotic mobilization.
[Colovesical fistula of diverticular origin. Diagnostic and therapeutic aspects. 17 cases].
Seventeen patients presenting with diverticular colovesical fistula were treated surgically between 1975 and 1979. Any treatment of the fistula must aim at the cause--colonic diverticulitis--by resection of the colon and colorectal anastomosis. Colostomy was performed in two cases. The bladder was closed by simple suture and a urethral catheter was left in place for ten days. There were few complications, though one patient died. Pneumaturia and fecaluria are specific symptoms. Intravenous pyelography and cystoscopy are of little assistance and only a barium enema should be performed for preoperative diagnosis.
[Solitary cyst of the liver disclosed by jaundice].
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[Late complications of a cholecystotomy].
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[The cysticohepatic duct and the subvesicular duct. Apropos of 2 types of bile ducts of different significance].
A cysticohepatic duct drains a particular region of the liver. It represents an anatomical variation of the biliary tree. On the contrary, a subvesicular duct represents an abnormality of the biliary ducts development. It belongs to aberrant biliary ducts (vasa aberrantia) and has all their morphologic characteristics.
[Pancreatic injuries. Report on 42 cases (author's transl)].
Between 1975 and 1980, 42 pancreatic injuries have been managed, they represented 9.5 per cent of abdominal injuries. Nine patients received penetrating trauma and thirty three patients sustained blunt trauma, the majority of them was a road accident. Associated and concomitant injuries of abdominal organs were present in 81 per cent of cases with the pancreatic trauma. More than 66 per cent have multiple brain, thoraco, abdominal, and bones injuries. Thirty two patients have been treated before the sixth hour. The emergency surgical treatment has been conservative in twenty six patients and a primary resection has been performed in twelve patients, (with eleven partial pancreatectomy and one pancreatoduodenectomy). But four patients died on the operating table because they have extensive injuries to several abdominal organs. Postoperative complications were present in 66 per cent of cases. They obliged the drainage of abscesses, three distal pancreatectomy and one pancreatoduodenectomy. The global mortality is 31 per cent, the secondary mortality is 21.4 per cent. The authors conclude thanks to the study of this series and of literature that the frequency of pancreatic trauma increased, and that its gravity is directly related to the number of other organs damages, missed or delayed diagnostic and to an inappropriate emergency treatment, which let necrosis and infection making their deadly evolution.
[Choleperitoneum following perforation of the liver. The role of the vasa aberrantia ].
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[Colovesical fistula arising from diverticulitis. Diagnosis and therapy. Seventeen cases ].
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[Embolic splenic infarction with an abscess caused by Salmonella panama].
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[Gastric heterotopy of the cystic duct. Apropos of a case].
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[Leg paralysis due to hematoma of the iliac muscle. Revealed by tomodensitometry].
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[Traumatic rupture of the isthmic region with bowel ischemia (author's transl)].
One case of traumatic rupture of the isthmic region of the aorta is reported. Acute ischemia of the inferior limbs, anuria and paraplegia have led to the diagnosis. During the first hours after the trauma bowel ischemia appeared. The repair of the aorta was achieved within the seven hours after the accident but the bowel ischemia stayed irreversible. A such complication has not been reported in the literature as long as we know and we are think that it is possible to range this complication among some of the ischemic enterocolitis.
[Calcanear fractures. Advantages of horizontal tomography in exact diagnosis of the type of injuries (author's transl)].
The usual radiographic projections do not enable to do a complete diagnosis of the pattern of the calcanear fractures. Horizontal tomograms, performed since 1975 by the authors with a complex movement tomographe show the superior surface of the calcaneus. Compared with the sagittal and frontal tomograms, they are absolutely necessary to know the shape of the fractured calcaneus and to precise the anatomical basis of its treatment.