[Indices of severity in acute pancreatitis].
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Biomedical subjects
Publications and source records attributed to J M Fiala.
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Intussusception of the appendix is an uncommon event (200 cases previously reported) and intussusception after appendicectomy is rare (20 cases previously published). Two recent cases are reported, the first with primary appendiceal intussusception and the second ileocolic intussusception after appendicectomy. In the second case the final pathology report revealed an intussuscepted caecal duplication responsible for the ileocolic intussusception. This event has not been previously reported. Symptomatology, investigation, classification, differential diagnosis and surgical tactics are discussed.
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The results of pancreatectomy are compared with those of palliative procedures. Over a 16-year period, 49 patients were operated on and underwent either total or partial pancreatectomy. In spite of the age of the patients, post-operative mortality did not increase (10.2%) but the rate of resectability has improved (32%).
Early surgery for the treatment of acute necrotizing pancreatitis is important. With the CAT-scan we evaluated the extent of the lesions of the pancreatitis in 26 patients with acute necrotizing pancreatitis. Due to severe clinical symptoms and the CAT-results 12 of these patients had to be operated. We found a good correlation between intraoperative extent of disease and the CAT-scan.
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The EEA stapler, for accomplishing stapled anastomoses in the gastrointestinal tract seems of a great interest. It opens new possibilities in case of carcinoma of the middle part of the rectum. It also makes the re-anastomose after a Hartmann procedure much easier. The results of 63 anastomoses on the colon or the rectum are reported.
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One hundred cases of recurrent inguinal or femoral hernia are reviewed in order to find out some common causes of this important problem. The delay of recurrence is usually short and frequently technical errors are responsible for this surgical failure. Considering their own results, the authors propose a few easy solutions in order to lower the recurrence rate. A prospective study now in progress will help us to appreciate our present results.
The use of a prosthesis in the repair of very large inguinal hernias as well as in multiple recurrences is often advocated. A new material is presented: the Rhodergon is a sheet of polyester which is placed through an intraabdominal extraperitoneal approach in order to cover the defect of the wall. One of its surfaces is velvet-like and induces adhesions with the edge of the abdominal defect that will be responsible for the strength of the repair. The other surface is covered with silicone and prevents adhesions with the peritoneum. Our first results with this type of repair are described and so far seem extremely satisfactory.
5 cases of arterio-venous fistula secondary to needle biopsy of the liver are reported. In 4 cases the lesion was a chance radiologic finding during arteriography and did not require a surgical procedure. In two cases spontaneous closure of the fistula was demonstrated by a second arteriography. Only in the fifth case did development of portal hypertension require a surgical procedure, ligature of the right hepatic artery being performed.
Report on surgery in 100 patients with acute sigmoiditis (54 females, 46 males). The overall average age was 65.5 years; that of females was 68.5 years and of males 61.5 years. Of the total of 100 cases, one third had one or more attacks prior to hospitalization. One third of cases were treated by conservative methods and did not undergo surgery. Surgery (resection or simply derivation) was performed in 63 patients. Eleven patients died: from rupture of anastomosis in 1 case and from general causes or superinfection in 10. The surgical indications and type of surgery are discussed. As far as possible, the affected segment of sigmoid must be resected, with or without establishment of continuity. Terminal colostomy is imperative.
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