Biomedical subjects
Publications and source records attributed to X Henry.
We describe an original technique for umbilical hernia repair ("stamps mesh technique") during which no umbilical ring widening is carried out. A non-absorbable mesh is positioned in the preperitoneal space.
INTRODUCTION: There are two types of autoimmune haemolytic anemia, idiopathic or associated to other disorders (infections, thyroidal diseases, cancer.). The treatment of this particular anemia depends on the primary or secondary feature. EXEGESIS: We report the case of a 76-year old woman, presenting an autoimmune haemolytic anemia with a positive direct Coombs test in IgG. The corticodependance of this anemia after 6 months of treatment had indicated a splenectomy. During surgery, a gastric stromal tumor was discovered. After removal of the tumor and splenectomy, the haematological symptomatology quickely disappeared and induced the negativation of the Coombs test within a post operative period going from 7 to 14 months, without any immunosuppressor treatment. CONCLUSION: Splenectomy does not induce the negativation of a Coombs test in an autoimmune haemolytic anemia, someaning that there is a link between the anemia and the tumor. This observation is completed by a review the literature.
In vitro experiments were designed to assess the inhibitory effect of the thiazide diuretic methyclothiazide (MCTZ) on contractile responses to norepinephrine (NE) of mesenteric rings from hypertensive patients and normotensive controls. Arteries were taken from portions of mesocolon from 24 patients: 13 hypertensives and 11 normotensives. Changes in the tension of mesenteric ring preparations were measured isometrically. Histologic studies showed that the arteries from hypertensive patients exhibited 1) a greater media thickness-to-lumen diameter ratio, 2) a smaller lumen diameter, and 3) identical media cross-sectional area as those of normotensive controls. At the physiologic level, the hypertensive and normotensive arteries display similar contractile responses to KCl and NE. Furthermore, our results indicate that MCTZ induces concentration-dependent inhibition of the vasoconstrictor responses to NE. This study provides evidence that hypertension is associated with the remodeling of the human mesenteric artery and that MCTZ is as efficient in inhibiting the contractile response induced by NE on hypertensive than on normotensive arteries.
The easy performance and the efficiency of these repairs should make the surgeon attentive to some related drawbacks, which can scarcely appear when reoperating on the bladder or the prostate, also on the iliac vessels. The encountered difficulties are related to the scar sclerosis much or less extensive and/or effective, invading the Retzius and/or the Bogros' spaces. The authors report their intraoperative and anatomical findings. They propose the following solutions: (1) when the cleavage of the Retzius' space is impossible (for bladder or prostate surgery): a subperiosteal retropubic cleavage, either isolated or combined with a transperitoneal approach. (2) When the cleavage of the Bogros' space is impossible (for a surgery on the iliac vessels): a transperitoneal approach; but the prevention of the perivascular sclerosis after the use of large prostheses relies on the easy preservation of the funicular sheath, able to protect the iliac vessels, providing no slit has been done on the mesh prosthesis.
This original and now classical method was the first tensionless and sutureless repair of groin hernias proposed almost 30 years ago. Its authors recall its principles, technique and results. The discussion justifies the choice of the particular prosthetic material, demythifies the sepsis risk which is balanced by the recurrence risk, the potentially raising problems related to retroparictal sclerosis at reoperation on the bladder or external iliac vessels, and defines the indications and contraindications of the procedure.
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The 247 eventrations operated upon concerned 230 patients (60% women and 40% men) mean age 54.5 years. Eventrations were large (collar greater than 10 cm) in 18, 5% and were in the median line in 81%. Serial laparotomies by the same approach had been performed in 21%, the principal causes of eventration being biliary and gynecologic surgery. Parietal sepsis developed in 31,5% of cases after operation for the original affection. Classical favoring factors found included obesity (51%), multiparity (42% of women) and chronic lung disease (14%). Preoperative preparation involved the use of Goni Moreno's progressive pneumoperitoneum in 18,5% of patients. Procedures used were parietal repair by raphe (22%), the same but with the addition of a dacron prosthesis (6%) or the large dacron tulle prosthesis for wide reinforcement of the visceral sac (67% of cases). Early sepsis was a slightly more frequent occurrence after dacron tulle, predisposing factors being the prosthesis itself, a previous history of parietal sepsis, swabs and the number of Redon tubes. After use of dacron tulle complications were mainly also hematoma (3.2%) and skin necrosis (2,6%). Postoperative course in general was uncomplicated in 91% of the 247 operations. Follow up of 67% of operated patients for a mean of 5 1/2 years showed recurrence in 50% of raphe procedures and 18.5% of prosthesis implantations; factors of aseptic recurrence (16,5%) were multiparity and chronic lung disease. Delayed sepsis after dacron tulle use affected 8% of patients and were related to chronicity of early sepsis, nonresorbable sutures and sepsis complicating the primary laparotomy. Doming of the parietal wall was noted in 4% of cases repaired by prosthesis.(ABSTRACT TRUNCATED AT 250 WORDS)
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To the list of pitfalls of circular mechanical anastomoses the authors add another type of incident involving catching of an intestinal fold. While the pitfalls recently published by M. Adloff include occlusive stapling, those encountered by the authors make mechanical stapling impossible. Two diagrams illustrate the mechanism of failure of circular mechanical anastomoses and suggest an easy way of avoiding this pitfall.
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Initially a simple anatomical curiosity discovered at operation or autopsy, agenesis of the ball bladder has now, and despite its rarity, become of the greatest interest from a pathogenic, physiopathological and diagnostic standpoint. Embryogenesis explains that this a developmental abnormality affecting the hepatic diverticulum which is probably of genetic origin, hence its frequent association with other malformations and the hereditary nature of the condition. The usual finding of a syndrome of blockage of the sphincter of Oddi with dilatation of the common bile duct raises the problem of synergism between the sphincter of Oddi and the gall bladder. The discovery of lithiasis of the hepatic and common bile ducts in agenesis of the gall bladder leads to discussion of the reality of organ lithiasis or the role of the distended wall of the common duct. Cholecystography and echotomography would appear to be the two techniques of investigation to be recommended preoperatively in order to increase support for the presumptive diagnosis once disorders affecting neighbouring structures have been eliminated. The definite diagnosis is made peroperatively by manual exploration, peroperative cholangiography or even coeliac arteriography during the operation. The indication for surgery is based upon clinical symptomatology. This does not treat the agenesis but the associated lesions which are its complications, in particular: lithiasis the common duct, sphincter of Oddi block syndrome and dilatation of the common duct.