Biomedical subjects
Publications and source records attributed to P Houdelette.
Oncological uro-intestinal surgical procedures combining a radical resection and functional reconstruction are long and complex operations. The use of mechanical sutures contributes considerably by gaining time and improving safety. The authors propose a technical simplification of the Camey type II plasty by using side-to-side anastomosis forceps.
The authors report a case of malignant adrenal carcinoma associated with nodular adrenal hyperplasia as part of Wermer (N.E.M.I.) type pathological polyendocrinopathy syndrome. They stress the prognostic importance of the glandular degeneration and the type of adrenal involvement in these "multiple endocrine neoplasia".
A case of plasmacytoma of the head of the pancreas in a 75-year-old woman, revealed by obstructive jaundice, is reported. The tumor, which compressed the main bile duct, appeared to be round on sonographic and endoscopic retrograde cholangiographic investigations. Sonographically guided needle biopsy was performed but led to the erroneous diagnosis of pancreatic adenocarcinoma. Choledochojejunostomy and gastrojejunostomy were then performed but the patient died 10 days after the operation. Pathological examination of the specimens obtained at autopsy showed that the pancreatic tumor (as well as an other osseous lesion) were plasmacytomas with cells containing G immunoglobulins of the lambda type. Despite the failure of needle biopsy to lead to correct diagnosis in this case, the potential value of this method remains unequivocal as reported previously. Indeed, when positive results are obtained by this method in visceral localizations of plasmacytoma, hazardous surgery may be avoided and radiation and/or chemotherapy may be chosen preferentially.
The authors describe a case of secondary ilio-ileal fistula revealed by an intestinal haemorrhage which occurred ten years after vascular reconstruction. They stress the importance of arteriography which shows up the pseudo-aneurysm causing the fistularisation and vascular contrast material escaping into the digestive lumen. A complete review of the literature on arterio-colonic fistulas, and more particularly, ileo-ileal fistulas, shows that they usually express themselves clinically in the form of digestive haemorrhages occurring generally after vascular graft and after a variable lapse of time. The association of digestive haemorrhage and a previous vascular reconstruction should suggest the diagnosis of arterio-digestive fistula and should lead to early angiography to enable coherent surgical strategy to be put into operation.
In the absence of palpable testicular tumor one often retains the primitive character of an extragonadal germ-cell tumor with retroperitoneal localization. This motion must be reconsidered in front of the occasionally late discovery of the scrotal origin of those lesions. The usefulness of testicular sonography in the revelation of infra clinical lesions is now perfectly well admitted. Concurrently, testicular biopsies can provide the notion of carcinoma in situ and its links with the retroperitoneal germ-cell tumor must be indicated precisely. The four related observations allow us to stress on the seriousness of this affection which often remains tardily diagnosed. The specific treatment of the testicular lesion, when it is put into evidence, turns out to be absolutely necessary.