Biomedical subjects
Publications and source records attributed to M Lautard.
Diffuse cavernous hoemangioma of the rectum is rare. Correct identification is often delayed. The patients usually present with rectal bleeding. We describe two men who had diffuse cavernous hoemangiomas. They complained of rectal pain. One appeared to have a rectal tumor and the other a levator syndrome.
A technique for laparoscopic total resection of the colon performed in six patients is reported. The diseased colon was separated from the mesocolon and the greater omentum by electrocoagulation and sharp dissection. The mesenteric vessels were divided using an Endo GIA stapling device (AutoSuture, France). The whole colon was removed after transection of the rectum and extraction through a right minilaparotomy. A primary stapled end-to-side ileorectal anastomosis was performed through the anus under laparoscopic guidance. This technique can be applied to cases involving a variety of benign lesions of the entire bowel or multifocal small malignant colonic neoplasms with a decrease in patient morbidity and shorter inpatient period.
The records of 22 consecutive patients with a non-traumatic ill-defined acute abdomen having diagnostic closed peritoneal lavage, were reviewed retrospectively. All patients had one or more risk factors. Peritoneal lavage was performed under visual control and its diagnostic value was based on the comparison with the definitive diagnosis, based on laparatomy and complementary tests. There were 12 positive results with 11 true positives (7 cases of peritonitis, and 4 of visceral necrosis) and 1 false positive. There were 10 negative results with 9 true negatives and 1 false negative. Sensitivity of peritoneal lavage was 0.91%, specificity 0.90%, positive predictivity 0.91% and negativity 0.90%. Overall mortality was 45%. The limits of the procedure appear to be the infections or localized abscesses. Peritoneal lavage as a simple and easy method, is suitable for high-risk patients when the choice is between immediate operation with possible side-effects or delay with possible adverse course of the abdominal lesion, and permits immediate indication for surgery in case of positivity.
Automatic circular suture forceps offer new technical possibilities for the confection of colorectal anastomosis. A retrospective study was conducted in 51 patients, representing a homogeneous group of anastomoses performed by the same surgeon using the same operative technique and with routine review by barium enema examination on the 8 th postoperative day. Technical difficulties during operation were encountered in 10 patients (19.6%) requiring supplementary sutures in 3 cases and protective colostomies in 3 others. Review examinations revealed anastomotic dehiscence in 7 cases (13.7%), only 3 (5.9%) of these radiologic fistulae provoking clinical manifestations, and only one of these (1.9%) necessitating recovery operation. Perfect compliance with conditions of use of the mechanical forceps and a minute technique identical to those of manual sutures produced excellent early result with circular mechanical suturing using EEA forceps when compared with manual suturing methods. This was particularly true in Goligher's series in which there were 51% of radiologic fistulae. Under certain difficult conditions, the use of EEA forceps simplifies performance of a colorectal anastomosis, mechanical anastomosis using the circular forceps constituting an undeniable technical progress in colorectal surgery with conservation of anal sphincter.
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The injection of bile under low pressure led in 21 dogs out of 30 to a process of acute pancreatitis and to the reproduction of the different histopathological types of pancreatitis seen in man. This represents a weighty argument in favour of the concept of oedematous pancreatitis, interstitial pancreatitis with sometimes major cytosteatonecrosis and necrosing pancreatitis as different manifestations of the same disease, which is not universally accepted. Our research has once again emphasized the fact that the interstitial phenomena and in particular fatty necrosis precede parenchymatous necrosis. Morphological studies were used to attempt to define the link between fat necrosis and acinar necrosis. Light microscopy showed that there was no topographic evidence of direct involvement of the acinar cell in contact with fat necrosis. By contrast, ultrastructural studies revealed initial involvement of the basal pole of the acinar cell. This would emphasize the responsibility of interstitial phenomena in the maintenance, if not the induction, of acinar necrosis. It cannot be excluded that fat necrosis could indirectly, via the liberation of factors carried by oedema, play a role in these phenomena of acinar necrosis. In addition, it was noted that the apical poles of the acinar cells did not seem to be damaged, the acinar lumina were dilated and there was loss of the intercellular junctions. This would hence indicate the possible passage into the interstitium of a toxic substance (bile salts, enzymes liberated in excess) coming directly from the acinar lumina.
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The purpose of this experimental study was to identify the cause of early cholestatic jaundice occurring after orthotopic liver transplantation. The role of ischaemia was investigated in dogs undergoing auto-transplantation of the liver preserved for two hours. The animals developed early cholestasis with lesions that were markedly different from the graft-rejection lesions observed in a control group, being restricted to the cells and canaliculi of the central lobular area. The results of this work have made it possible to avoid overdosage with immunosuppressive drugs in a patient who had recently undergone orthotopic liver transplantation.
It is now common knowledge that per-operative findings and pathological examination results may be discordant in acute pancreatitis. A study of 25 cases considered as "necrotizing" and subjected to histological examination has prompted the authors to devise a new experimental model of acute pancreatitis in dogs, using Wirsung's canal. They found that steatonecrosis precedes acinic lesions and hypothesize that it might be responsible for necrosis of the glandular tissue.
Chronic intoxication with dimethylnitrosamine (D.M.N.A.) in the rat induced an experimental cirrhosis which seems stable in time. The intoxication was done by forcible feeding either with 7 or 8 mg/kg of D.M.N.A., three consecutive days a week, for 9 weeks. Chronical intoxication resulted in 50% of hepatic cirrhosis in the 7 mg/kg group and 63% in the 8 mg/kg group. --The diagnostic of hepatic cirrhosis was done by pathological study on the left lobe. --In all cirrhotic rats, verified by histology, biological test were disturbed in a significant way, compared to untreated rats, but not to non cirrhotic intoxicated rats. There was no correlation between pathological anatomy and biology. --Cirrhosis persists after the intoxication but survival duration is much shorter in the group intoxicated with 8 mg/kg of D.M.N.A. --There was no difference in the constitution of cirrhosis between Wistar and Sprague Dawley strains. Therefore the best procedure to induce cirrhosis in rats is chronical intoxication by administration of 7 mg/kg of D.M.N.A. during 3 consecutive days a week for 9 weeks. Pathological study are the only reliable tests to determine the constitution of cirrhosis.
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