Biomedical subjects
Publications and source records attributed to P Houdelette.
The occurrence of a peri-renal hematoma on anticoagulant therapy does not classically indicate underlying renal pathology and has a favorable spontaneous prognosis. The authors report two cases of peri-renal hematoma on anticoagulant therapy involving a pathological kidney, giving serious complications and requiring surgery for nephrectomy.
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Based on a case showing testicular localisation of sarcomatous degeneration in the context of the progression of chronic lymphoid leukemia (Richter's syndrome), the authors discuss the classification of intrascrotal lymphomatous conditions.
The authors report a case of spontaneous rupture of the upper urinary tract in a solitary kidney which resolved towards cure after pyelostomy and evacuation of an encysted urinoma. The rarity of similar cases reported in the literature seems to prove that solitary kidney is not a predisposing condition.
The authors report a case of bilateral uretero-hydronephrosis following aorto-bifemoral prosthesis for termino-aortic aneurysm due, on one side, to stenosis of incorrect repair of an operative injury to the ureter and, on the other side, to a syndrome of ureteric compression due to its retroprosthetic course, which is the central feature of this aetiological, pathophysiological and therapeutic discussion. Although the objective of treatment is to preserve the kidney, the risk of treatment is dominated by the threat to the future of the vascular prosthesis. The usual technical problem can be summarised by the question: should one cut the ureter or the prosthesis? and it would appear that a urinary problem does not necessarily imply a urological solution.
Based on two cases of epidermoid cyst of the testes, one exceptional case was that of a four year old boy, the authors mention the absence of clinical and ultrasonic evidence to identify this benign tumor. The histological characteristics, described by Price, are quoted: intratesticular cyst, keratin sediment deposits, with a normal remaining parenchyma. Orchidectomy is the safest treatment; the tumoral enucleation or the partial orchidectomy is particularly appropriate when the opposite testes is missing or if it is functionally altered.
Gastric ulcer, an uncommon complication of Nissen technique, is nevertheless reported in all series (between 1 and 5% of cases). The authors report a case occurring after a complete fundoplication associated with a longitudinal stapling of the cardia (Rignault's procedure) which resolved after reoperation and transformation into a posterior hemi-valve. The pathogenesis of post-Nissen gastric ulcer is discussed; the mechanical factor appears to be decisive in the subcardial site. Surgical revision according to various modalities is generally unavoidable.
Following a case of traumatic rupture of the 3 lobes of the right lung without any parietal lesion, the authors found three similar cases in the literature. However, uni or bilobar rupture was more frequently described. The pathological mechanisms are considered. The treatment of these lesions, in contrast to pulmonary laceration due to fractured ribs, most often requires limited parenchymal excision.
The use of high thoracic epidurals for post-thoracotomy pain relief in 156 patients is reviewed. Analgesia was maintained with a continuous infusion of a local anaesthetic, bupivacaïne 0.5% 40 ml, mixed with a narcotic, fentanyl 10 ml (perfusion rate between 3 and 7 ml/h). There was successful analgesia in 92%, with efficient ventilation, effective cough, no respiratory distress and only 8 cases of fibroaspiration. Only two significant respiratory complications occurred, due to incorrect management of the peridural route: the analgesic mixture was too concentrated and was injected by bolus instead of by continuous infusion. Other complications occurred, 8 cases of nausea or pruritus, 4 hallucinations, 10 cases of urinary retention lasting more than 24 h, 14 superior limb palsies and 22 Horner's oculopapillary syndrome. All of these complications were minor, easy to manage, and resolved after stopping peridural infusion. In conclusion, peridural analgesia is highly effective and improves the atmosphere in post-thoracotomy wards.
Parasternal (or anterior) mediastinostomy--a thoracic diagnosis surgery--is a simple, safe and rapid procedure which can be used either to gain access to the anterior or superior mediastinum and to the pulmonary pedicles ("hiloscopy" for exploration and biopsy, or to perform a wide lung biopsy without true thoracotomy.
On the basis of 2 cases of tumour of the intrathoracic vagus nerve, the authors recall the characteristics of these tumours which are rare in this situation. The right latero-tracheal localisation in the middle mediastinum, the small volume and the poorly vascularised features of these tumours allowed complete resection via mediastinoscopy.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.