Peritoneal lavage after abdominal trauma: indications, technique, results.

This study represents our experience with 1461 patients who were seen in the Emergency Room of the University Hospital in Ghent with multiple traumatic lesions, between 1978 and 1982. In 43% of these polytraumata, we did an explorative peritoneal lavage in order to obtain a quick evaluation of intrabdominal haemorrhage. In 65% of the patients, the lavage was negative; 221 positive lavages (35%) underwent abdominal exploration; in 85% of these there were evident positive findings. The remaining 15% showed either no lesions, or minor lesions not involving risk of life. The overall accuracy-rate of the technique described above is at least 93%.

Polydioxanone suture material in growing vascular anastomoses. Experimental study.

We studied the growth of vascular anastomoses after use of absorbable suture material in 21 piglets. In six piglets, end-to-end anastomosis of the infrarenal aorta was performed with 5-0 continuous polypropylene suture; stenosis developed in two of these animals. In 15 piglets, continuous polydioxanone sutures were used for the anastomoses, and no stenosis developed. On the contrary, 14 of these anastomoses showed some degree of dilation at the anastomotic site. Burst testing to 300 mm Hg caused no disruption. On histologic examination, only scar tissue at media and intima with good degree of differentiation was noted. Growth of a vascular anastomosis after use of absorbable polydioxanone suture material seems to be perfectly possible without stricture formation. Because the growing process takes years instead of months in human beings, with obviously less stress at the anastomotic site, it is likely that dilatation at the level of the suture line will not occur in clinical use.

[Surgical experiences with traumatic diaphragmatic rupture]. / Chirurgische ervaringen met traumatische diafragmaruptuur.

Between 1970 and 1981, 35 patients with traumatic rupture of the diaphragma were treated. Blunt trauma, mostly caused by traffic accidents, predominates. The localization, type and dimensions of the diaphragmatic tear are studied. Among the associated visceral lesions, lacerations of the spleen and the liver are most often seen. Clinical and diagnostic aspects are discussed. Traumatic diaphragmatic rupture is an absolute surgical indication. In the early cases, with few exceptions, a primary abdominal approach is advocated. In the delayed category a thoracotomy is mostly preferred. Operative mortality in the early cases is mainly due to the magnitude of the associated lesions. No mortality occurred in the delayed category. Long term results in controlled patients were very satisfactory.

Carotid endarterectomy for cerebrovascular insufficiency. Long term follow-up of 141 patients followed up to sixteen years.

Between 1962 and 1978 one hundred and fifty-nine endarterectomies were performed on 141 patients. The operation was done under general anesthesia with the use of a shunt and hypertension as cerebral protection. The arteriotomy was closed using a dacron patch. The postoperative evolution of every neurological symptom was analysed after a follow-up of up to sixteen years. The patients were divided in three groups following their neurological and anatomical situation. On 43 totally asymptomatic patients (group I), there was one perioperative death, 41 remained totally asymptomatic and one developed a transient ischemic attack on the non operative side. On 25 patients (group II) operated after symptomatic contralateral total occlusion, fifteen became asymptomatic, six improved seriously, one remained unchanged, and one suffered from a stroke with complete recuperation. Two perioperative deaths were encountered in this group. On the 73 patients from group III, there were three perioperative deaths. Fifty-two patients became totally asymptomatic, nine patients had a serious amelioration of their residu. Three remained unchanged. Five patients suffered from a long term deterioration of their neurological condition and one patient developed an anastomotic aneurysm.

[Surgical treatment of abdominal aortic occlusion (author's transl)]. / De chirurgische behandeling van de totale aortatrombose.

Forty-seven cases treated for atherosclerotic occlusion of the abdominal aorta are reported. The classical trans-abdominal approach used in all our cases is compared with alternative approaches. The reasons for this preference are discussed.

[The McVay technic for inguinal hernia cure. Results of treatment in a teaching center (author's transl)]. / Resultaten van de behandeling van hernia inguinalis volgens McVay in een opleidingscentrum.

Over a 20 year period 390 adults underwent 454 operations for inguinal hernia using the technique of McVay. The recurrence rate after primary repair was 7.61% and 18.33% for secondary hernias. This was usually early in the postoperative period. These results must be interpreted taking into a ccount that the operations were performed at a teaching institution.

[Hyperplasia of the thyroid gland. Surgical indications and treatment (author's transl)]. / Schildklierhyperplasie. Chirurgische indicaties en behandeling.

The surgical indications of a benign multinodular euthyroid struma are: compression of trachea and oesophagus or a possible malignity of the lesion. The operation of choice is a bilateral subtotal lobectomy. To avoid postoperative vocal cord paralysis or hypocalcemia due to damage of the parathyroid glands, it is important to demonstrate systematically the recurrent nerve and spare the inferior thyroid artery.

[Haemagnioma of the liver in newborn infant (author's transl)]. / Haemagnioom van de lever bij een prematuur

A case of a giant cavernous and capillary haemangioma of the liver in newborn infant occurred. Resection of the tumor by right hepatic lobectomy was carried out without morbidity or permanent derangement of liver function. There was regeneration of the liver.