[Echography and CT in mediastinal teratoma].
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Biomedical subjects
Publications and source records attributed to L Hendrickx.
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An operative technique using a mechanical stapling device has been developed to simplify proximal gastric vagotomy. A series of gastric fistula dogs underwent posterior truncal vagotomy and anterior lesser curvature stapling. The basal and pentagastrin-stimulated acid secretion was measured before surgery and 2 weeks and 3 and 9 months after surgery. During the whole period, no change in body weight was noticed. Gastric acid secretion in dogs remained low and stable during the first year after the procedure.
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A patient with an acute abdomen during pregnancy is reported. It was due to perforation of the cystic duct by a cholesterol gallstone. A cholecystectomy and T-tube drainage resulted in recovery and normal delivery twelve weeks after operation. The presence of gallstones, their location at the weakest point of the cystic duct, and the possible hemodynamic changes (as there is a higher pressure in the vena cava) occurring during pregnancy, are discussed as possible causes of this acute abdominal condition.
INTRODUCTION: In laparoscopic inguinal hernia repair the inguinal region is approached and hernia repair performed from the interior side instead of the classical open external access. Exploration and placement of staplers in the internal inguinal region during laparoscopic hernia repair may sever different anatomical structures, or induce specific complications such as nerve entrapment, neuralgia, hematomas or osteitis. The incidence of these complications may be reduced by careful dissection of the preperitoneal tissues and by placing a prosthetic mesh without the use of stapling. As laparoscopic techniques evolved, different sizes of meshes have been used. An exact determination of mesh size was hitherto not investigated. AIM: Cadaver studies of the topography of blood vessels and nerves in the preperitoneal tissue in this region were carried out in order to assess a safe position and adequate size of the prosthetic mesh. METHODS: Dissection in 6 preserved human female cadavers was performed to define the actual surface of the internal inguinal region. A physical model was developed to formulate the ideal size of the prosthesis. Specific measurements were used to define the maximal size of the meshes, so as to place them without stapling, and without inducing neurovascular complications. RESULTS: The designed physical formula defines the size of the mesh as a function of the maximum intra-abdominal pressure, the size of the abdominal wall defect and the abdominal wall tension. CONCLUSION: On mathematical and physical grounds our study points out that the size of the currently used prosthetic mesh (10 x 15 cm) is large enough to be placed without stapling so that with proper placement no recurrences should occur.
A case of delayed diagnosis of colonic injury after blunt abdominal trauma leading to faecal peritonitis is presented. Diagnostic problems and possibilities as well as treatment of these injuries are reviewed. The key to diagnosis remains the serial clinical and ultrasound examinations.
The study of bacterial behavior under space flight conditions is highly important for the early detection of changes in bacterial communities and bacteria with medical, environmental, or life support consequences for survival of the crew in closed space environments. Although many species of prokaryotes have been studied in ground simulation facilities or have been flown in space flights, at present only few hard research data are available to predict the effects of cosmic radiation, microgravity, vibration and hypervelocity on microbial behavior in space flight. The results that are available tend to be fragmentary and often lack a classical, controlled experimental context to interpret them. Thus, many basic questions concerning the effects of space on microbial behavior have yet to be resolved.
The authors describe a patient who was admitted with total necrosis of the oesophageal and gastric mucosa after ingestion of concentrated sodium hydroxide solution. An emergency total gastrectomy and blunt, thoracic oesophageal stripping was performed. Three months later, the continuity of the digestive tract was restored by a retrosternal colon interposition. The necessity of an aggressive diagnostic and therapeutic approach after the ingestion of caustics is recommended. An emergency endoscopic evaluation of the upper G.I. tract is mandatory. If a third degree oesogastric mucosal burn is diagnosed urgent laparatomy should be performed to assess transmural wall necrosis. If present an oesophageal gastrectomy should be performed as a life saving intervention.
The indications for total parenteral nutrition are compared with those for enteral alimentation. The indications for parenteral nutrition (nutrition support and hyperalimentation) in gastro-intestinal surgery, traumatology and burn care are discussed. Prophylactic TPN, supplemental TPN and therapeutic TPN are covered as well as their merit in the treatment of surgical complications.
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Surgical treatment of pericardial effusions are, in general, treated by methods using a subxiphoid or a transthoracic route. The former is criticized for the high recurrence rate, the latter for the high incidence of respiratory complications. To minimize these problems and in view of the growing enthusiasm for using minimal invasive techniques, we treated one patient with pericardial effusion by using video-assisted thoracoscopy for the creation of a pericardial window. We achieved an adequate drainage, and the postoperative pain and pulmonary dysfunction were minimal. The operative technique and pitfalls are discussed in this report. Thoracoscopic pericardial fenestration might facilitate a much less aggressive transthoracic approach to the pericardium which is of great importance, as many of these patients are already in a poor clinical condition.
34 patients with gastric carcinoma, treated by total gastrectomy, had a reconstruction procedure, consisting of a pouch as proposed by Lygidakis or as a variant of the procedure: the beta-modification. In 31 patients a total gastrectomy was performed for histologically proven gastric adenocarcinoma. Two patients presented with a gastric lymphoma and one with a gastric leiomyosarcoma. Operative mortality was 8.8%. Two patients (5.8%) developed leakage of the oesophago-enteral anastomosis and subsequently died from sepsis, while a third patient died from a postoperative pneumonia. Early complications occurred in 4 patients and consisted of dysphagia, due to stenosis of the oesophago-enteric anastomosis. All 4 patients (12.9%) were treated with endoscopic dilatation and were cured of their dysphagia. One patient developed a late peptic ulcer at the pouch anastomosis and needed a reintervention. Nine patients died from extension of their primary disease within the first postoperative year. The 22 surviving patients are all without symptoms and regained their pre-illness weight. In conclusion, the proposed technique of pouch reconstruction has an acceptable operative mortality and morbidity comparable to or even better than in previously described methods. The long term functional results are better and more patients gain weight.
Laparoscopic splenectomy remains a challenging procedure, as haemorrhage causes the most complications. In order to reduce this risk, preoperative selective embolisation of the splicing artery has been performed in a series of six successful laparoscopic splenectomies in one male and five female patients with a mean age of 34.6 years (range 17-53 yrs). Indications for surgery were immune thrombocytopenic purpura (ITP)(n = 3), non-Hodgkin lymphoma with secondary haemolytic anaemia (n = 1), autoimmune haemolytic anaemia (n = 1) and congenital spherocytosis (n = 1). The mean splenic length was 12.3 cm (range 9-16 cm) and no accessory spleens were identified. Mean operative time was 96.7 min (range 90-150 min). There were no deaths nor haemorrhagic or septic complications. Recovery after surgery was excellent with a mean hospital stay of 5.2 days (range 2-10 days). We conclude that selective embolisation of the splenic artery, just prior to laparoscopic splenectomy adds to the safety, and operating time may be shortened.