Chirurgie; memoires de l'Academie de chirurgie最新文献

The authors report their experience of laparoscopic management of sigmoid diverticulitis in 86 patients operated from november 1991 to december 1996. Out of them, 9 patients in whom sigmoiditis was revealed by an acute complication underwent an emergency procedure and 76 patients were operated electively. The mean hospital stay was 9.2 days (range 5 to 15 days) and the mean time of passage of flatus was 2.4 days. Benefits of laparoscopic management of sigmoid diverticulitis consist of improvement of early postoperative course and absence of abdominal wall sequelae. The decrease in mean hospital stay in not significant except for patients who underwent an emergency procedure.

Ambulatory surgery has been organized and regulated in France since 1991. We report the organisation of this activity in our unit and the results in 22,476 patients. Endoscopies, not specifically surgical, were 25.7% of procedures. Over night hospitalization was needed in 3.1% of patients, including about 40% of them for social and familial conditions or follow up of diagnosis or therapeutic sequences. This rate is growing, because we developed diagnosis or therapeutic sequences for interest of the patient. Since 1994, we operated more patients in ambulatory surgery than in classical hospitalization.

Renewed interest in heart valve homografts is related to recent advances in viability. Increased viability is achieved by collecting explanted hearts from multi-organ donors and cryopreservation. Right access is usually used in case of hereditary cardiopathy to resect or repair the aortic, mitral and tricuspid valves. Life-long anticoagulant treatment can thus be avoided. Current mid-term and long-term results are very promising.

We reported a case of papillary and cystic tumor (Frantz's Tumor) associated with familial adenomatous polyposis in a young man, 29 years old. This case emphasized the interest of fine needle biopsy and the difficulties for determination of the final pathology. Close long term follow up is essential as local recurrencies and metastasis in the long term had been recorded, undergoing resection with curative intent. Papillary and cystic tumors should be resected.

Introduction: The prostate cancer, which is the second cause of cancer, is in constant increase. This is linked to the ageing of population which is in fact a medical and socioeconomic problem. The curative therapeutic attitude of the localized prostate cancer are either wath-full waiting, radiotherapy or radical prostatectomy. With the actual clinical and radiological techniques of stadification, 40% of the localized prostate cancer are extraglandular on the prostatectomy specimen. Recently, the RT-PCR seems to be a more specific and sensitive technique to detect circulating epithelial cells compared to others techniques (immunocytochemistry or flow cytometry). The detection of these circulating cells, would be correlated to the anatomopathologic stage. The use of RT-PCR as a tool of molecular stadification should be considered.

Methods: This study evaluates and compares with in vitro pattern, the different techniques of separation (ficoll, gradient, osmotic shock) and detection (immunocytochemistry, flow cytometry and RT-PCR).

Results: The ficoll gradient is the best technique of cellular separation preserving cellular morphology and RNA. The detection level are 1 cell LnCap per 40,000 lymphocytes cell by immunocytochemistry, 1/1000 by flow cytometry, 1/10,000 to 1/1,000,000 by RT-PCR.

Conclusion: The RT-PCR with its low detection level and its high specificity, is the best technique of detection of epithelial circulating cells in localized stage. The advantage of immunocytochemistry is its simplicity. Its use for circulating cells caracterization can be considered for metastatic stage.

The aim of this study was to assess retrograd cholangiogram findings and first-line endoscopic sphincterotomy followed by laparoscopic cholecystectomy for the treatment of main bile duct lithiasis. Clinical, biological and echographic criteria predictive of main bile duct lithiasis were observed in 125 patients (32 men, 93 women, mean age 44.2 years) who underwent retrograde cholangiography. Results suggested lithiasis of the main bile duct in 105 case (87.5%) and were confirmed at endoscopic sphincterotomy in 99. There were no deaths; four complications occurred (3 moderate cases of pancreatitis, 1 cholecystitis). Conversion was required in 11.6%, usually because of difficulties in dissecting. No residual lithiasis was observed. Mean duration of hospitalization was 11.4 days. This sequential treatment scheme for main bile duct lithiasis appears to be effective, minimally invasive and safe.

Radiotherapy remains the basic treatment of anal cancer especially for epidermoid carcinomas. Tumorectomy and rectal amputation still have indications in the many others histological types and also in aguamous cell carcinomas (> T2) which cannot be totally healed by radiotherapy or after recurrences.

According to the literature and the study of 158 patients who have been examined, operated and analysed by the same medicosurgical staff, the authors have found a great frequency of clinical and echographic recurrencies. This frequency has also been found by others teams. The study of the different factors for goitrogenesis, either in multiplication of thyrocytes or tissular differentiation shows the pathogenic polymorphism. For the polynodular lesions, most of them located in the 2 lobes, total thyroidectomy seems to be the only procedure to prevent recurrencies. For the nodular lesions, most of the time unilateral, recurrencies are due to the fact that infracentimetric lesions have not been detected by preoperative ultrasonography and scintigraphy. They are discovered by postoperative ultrasonography and the long time follow-up is not to this date sufficient. The palpation and the peroperative ultrasonographic verification of the remaining lobe seem to be the best attitude to avoid the growth of small undetected lesions.

Several reports have shown that an antisense oligonucleotide directed against c-myb (AS 18) inhibits the proliferation of smooth muscle cell. The aims of this study were to confirm the specificity of a new c-myb antisens and to evaluate changes in vasoreactivity following treatment with a c-myb antisense. Five groups of rats were constituted. All underwent desendothelialisation of the abdominal aorta. A solution containing pluronic gel, or one of the following oligonucleotides: AS 18, 15 mere antisense directed against c-myb, an aleatory 4G sequence containing 4 consecutive guanosines, a 15 mere antisense mismatch (n = 11), was applied around the aorta. After 21 days, the thickness and mean surface areas of the media and intima were calculated. Four groups of rats were constituted for the reactivity study: control (A), desendothelialisation (B), desendothelialisation + application of AS 18 (C), and application of AS 18 alone (D). One ring per aorta was sampled at the 21st day and analysed in an organ chamber. The following results were obtained: the thickness and average surface areas of the intima were smaller (p < 0.05) in the 4G and AS 18 groups; in group B, none of the 8 segments responded to acetylcholine; in group C, 6 out of 8 segments responded. The contraction study showed no difference between groups A and D or between B and C. The mode of action of AS 18 antisense of c-myb is non specific but due to the presence of 4 consecutive guanosines in the oligonucleotide. Oligonucleotide with this sequence inhibits myo-intimal hyperplasia and improves endothelium-dependent relaxation in this model without affecting the contraction.

Since asplatin salts have been used in chemotherapy, the efficiency of this treatment has changed the destiny of advanced forms of testicular cancer. The universally recommended treatment of post-chemotherapy residual retroperitoneal tumor masses is radical retroperitoneal lymph node dissection. Results of our 74 limited expresses of these tumor masses confirm that the chosen treatment was appropriate. It guarantees the future and limits genital sequellae in young patients. It is perfectly consistent with the therapeutic history of this model in cancerology: precisely defined indications for the therapeutic means of a pluridisciplinary pool of resources always increases efficiency, reduces the need for invasive treatment, and limits sequellae.