Biomedical subjects
Publications and source records attributed to L F Hollender.
Various new more extensive operative procedures have been proposed with the aim of increasing efficacy of vagotomy and ensuring maximum neurotomy. Though based on the principle of neurotomy as accomplished by highly selective vagotomy, it is completed or combined with a seromyotomy along one or both sides of the lesser curvature or with one in the cardiofundal region. Technical aspects of these different methods are discussed.
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One thousand case reports of patients treated in eleven French surgical departments for stones in the common bile duct between 1975 and 1982 were analyzed. One in three cases were asymptomatic and detected by peroperative radiology during treatment of a simple or complicated gallstone, most forms were painful, with jaundice in 9 p. cent, an angiocholitis in 12 p. cent, and biliary pancreatitis in 2 p. cent. The most reliable exploratory procedure for gallstones is ultrasound imaging, as positive results were obtained in 90 p. cent of cases, but it enabled the diagnosis of choledocholithiasis in only one out of five patients. Intravenous cholangiography is a useful diagnostic tod for painful forms (60 p. cent). The failure of these two methods to establish the diagnosis in forms complicated by jaundice, pancreatitis, or angiocholitis has to be compared with the good results (85 p. cent) observed with endoscopic retrograde cholangiography. Treatment was surgical in 99 p. cent of patients, peroperative radiology being performed in 95 p. cent of these cases and endoscopy in 30 p. cent. In one out of two cases a single large stone was present while multiple stones were present in 8 p. cent. A "ideal" choledochotomy was carried out in 77 patients (7,7 p. cent) without mortality. External biliary drainage in 702 cases resulted in a 1.7 p. cent mortality rate, this increasing to 8 p. cent after 192 biliodigestive shunt operations, and 7 p. cent after 146 sphincterotomies, including 18 under endoscopic control. Unrecognized lithiasis, detected during follow-up radiography two weeks after external biliary drainage, accounted for 2-8 p. cent of cases. Of the 30 patients with residual stones and open biliary pathways, 6 were treated by mechanical removal, 6 by endoscopic sphincterotomy, and the others by repeat surgery.(ABSTRACT TRUNCATED AT 250 WORDS)
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Critical evaluation of 22 cases with serious diffuse purulent or fecal peritonitis treated by open abdomen following surgical intervention. Seven (32%) patients died, three because of continuing sepsis and one because of acute haemorrhagic necrotizing pancreatitis. The three other died of general complications (1 coma hepaticum, 2 massive embolisms; at autopsy their abdominal cavity was entirely cleaned. The therapeutic principle of "open abdomen" in cases of severe purulent and fecal peritonitis will be recommendable.
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"Ethibloc" is a zeine-alcohol suspension which polymerizes in an aqueous medium after approximately 15 minutes. The product was injected in the pancreatic duct of 20 dogs. The procedure was free from complications, apart from the development of edematous pancreatitis without clinical manifestations. Healthy pancreases were transformed into fibrous organs within ten days or so, as is found in advanced stages of chronic pancreatitis. No effect occurred on the islets of Langerhans and a diabetes of the experimental type did'nt develop. "Ethibloc" would therefore appear to be of value in humans for the treatment of chronic pancreatitis, in order to reduce the period for transformation of the lesions without increasing the incidence of complications, and also for pancreatic fistulae of various origins, as a result of the rapid sclerosis of exocrine tissue that it provokes.
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The authors present a simple technique of Péan-type gastric resection, using the T.A. 90 stapler to close the gastric stump and the E.E.A. instrument to perform the termino-lateral gastroduodenostomy. No post-operative complications nor anastomotic stenoses were observed.
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