Biomedical subjects
Publications and source records attributed to J S Azagra.
We present a patient who developed a right anterior leg compartment syndrome and bilateral common peroneal nerve paralysis following radical hysterectomy in the lithotomy position. We describe the physiopathology of the syndrome, its various etiologies, the treatment, and prevention of this complication.
The sizes of thyroid lobes and lesions estimated by ultrasonography have been compared to surgical specimens in 92 cases of thyroid pathology. Volumes can be calculated with a reasonable accuracy for parenchymatous and cystic lesions from measurements of their diameters when considered as ellipsoids. This easy method, currently used by ultrasonographers, is however unsatisfactory for estimation of the volumes of thyroid lobes. More reliable results are obtained by computation of volumes from planimetry of cross-sections through the gland.
The authors present a case report of recurrent peristomal variceal bleeding resulting from portal hypertension induced by hepatic metastases of a rectal cancer. They propose mucocutaneous disconnection as a simple and effective palliative surgery in order to prevent new bleeding. Discussion is based on a review of the literature and illustrates the different therapeutic options for this complication.
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An appendectomy operation was undertaken in a 29-year-old patient with signs of an acute crisis of hereditary coproporphyria. Anaesthetic induction with ketamine 75 mg IV was uneventful. The safety of ketamine in patients with coproporphyria is discussed.
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The authors present a series of 17 emergency subtotal colectomies as treatment of malignant occlusions of the left colon. They insist on the advantages of this operation as well as for the short term results (morbidity, mortality) and for the rare functional disease (diarrhea).
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Forty patients presenting midline incisional hernias either recurring or larger than 10 cm in transversal diameter were treated using Teflon prosthesis. Implantation site was the retromuscular space following the J. Rives technique. There were no postoperative deaths. Nor have we observed any recurrence among the 40 patients for a period of 6 to 56 months. Three wound infections completely exposing the prosthesis were recorded. These infections healed and it was necessary in only one case to remove a portion to the prosthesis. The low percentage of pulmonary complications can be attributed to 1) an intensive preoperative respiratory therapy, 2) standardized surgical technique, 3) epidural anesthesia permitting early effective postoperative respiratory therapy.
Contribution to the anterior seromyotomy and posterior truncal vagotomy in the treatment of chronic duodenal ulcer. The authors report a technique of anterior seromyotomy of the gastric lesser curvature with posterior truncal vagotomy for the surgical treatment of chronic duodenal ulcer disease. This technique offers more advantages than the highly selective vagotomy: it is an easier operation to perform, less time consuming and reproducible. Our results are similar to those following highly selective vagotomy.
Spontaneous rupture of the esophagus (Boerhaave's syndrome) is a very rare but the most lethal perforation of the gastro-intestinal tract. A 62-year old male was successfully treated for this condition developing on the second post-operative day after coronary artery bypass. Two hours after extubation respiratory insufficiency and circulatory collapse necessitated reintubation and energetic resuscitation with prompt drainage of a massive pleural effusion. Left thoracotomy on post-operative day 17 confirmed the diagnosis and the esophagus was excluded by cervical esophagostomy and duodenostomy. After a six week recovery, reconstruction was achieved by total esophagectomy through a right thoracic incision and gastric bypass with cervical gastro-esophageal anastomosis. The patient left the hospital in good condition 112 days after the initial operation.
Having chosen the utilization of a Teflon prosthesis, interposed in preperitoneal position by medial incision, in a series of 58 patients presenting 94 hernias, the authors wish to express a preference to this method for reoccurring and bilateral hernias. They underline the simplicity of the technique, its reduced morbidity, and they focus on the infrequency of reoccurrence in 47 patients reseen 6 months to 4 1/2 years in follow up. The authors have not observed a difference in the local results, recent and long term, after intervention using this technique under general or local-regional anesthesia. But they do appreciate however, a low percentage of general complications encountered in the group operated without general anesthesia, which thus permits an enlarged spectrum of indications for patients at risk. Previous operations by low midline incisions (prostatectomy, etc...) do not constitute a contra-indication.
Gallbladder volvulus, a rare disease generally affecting older aged women, is generally due to an abnormal anatomical fixation of the gallbladder. As clinical and radiological signs are poor the diagnosis is generally made at laparotomy. The prognosis is excellent when early surgical treatment is performed.
Twenty-two cases of diverticulitis with perforation and peritonity have been treated whether by colostomy (13 cases) or primary resection (9 cases). Primary resection reduces mortality and morbidity of the emergency operation and the combined mortality and morbidity of all operative procedures.