Video endoscopic surgery in the community hospital.

After proper training and observation, I started performing laparoscopic cholecystectomy at the community hospital in August 1990. Since then, and after further advanced training, I have performed 172 procedures, including appendectomy, hernia repair, lysis of adhesions, retroperitoneal biopsy, paraesophageal hernia repair, exploration of the common bile duct, repositioning of CAPD catheters, and colon resection with excellent results. This experience confirms that video endoscopic surgery can become the approach of choice in the community for many of what today are still considered open procedures, without undue risk, as long as adequate training is obtained and proper preparation observed when more advanced procedures are attempted.

[Growth of children treated for leukemia or malignant lymphoma. Influence of cranial radiotherapy]. / Croissance des enfants traités pour leucémie ou lymphome malin. Influence de la radiothérapie crânienne.

We studied the height growth of 96 children presenting with acute leukemia or non Hodgkin lymphoma, together with an investigation of GH and TSH in 41 of them. There were 2 groups: group I consisting of 19 patients without brain irradiation and group II consisting of 77 patients with prophylactic brain irradiation. Initial average height was identical in both groups. Growth rate was significantly decreased in group II but not in group I (p less than 0.01). There is a correlation between the decrease of growth rate and the decrease of GH to arginine stimulation test (p less than 0.03). A lack of response to GRF-44 was noted in 4 of 11 investigated patients. TSH and prolactin secretions were unchanged.

Primary aortoduodenal fistula. Case presentation and review of literature.

One hundred and twelve cases of primary aortoduodenal fistulas were reviewed. The most common etiological agent was an atherosclerotic infrarenal abdominal aortic aneurysm. There was a male to female predominance of 9:2 with an average age of 62 years. Most fistulas occurred between an infrarenal aneurysm and the third portion of the duodenum because of the relatively fixed position of the duodenum and its direct anatomical relationship posteriorly with the aorta. Patient symptoms may vary from abdominal or back pain with gastro-intestinal bleeding to just hematemesis or melena. Twenty per cent gave a history of abdominal aneurysm while up to 70% may have an abdominal mass on physical examination at the time of admission. Tentative diagnosis is established by history and physical examination with duodenoscopy, barium duodenogram and angiography available only if temporally feasible. Surgical exploration is the only treatment with resection of the aneurysm, synthetic graft placement and duodenal suturing as the procedure of choice.

Urinary osmolal changes in renal dysfunction following open-heart operations.

Forty consecutive patients who underwent open-heart procedures using a hyperosmolar perfusion prime were studied to determine the significance of free-water clearance and urinary osmolality early after bypass in predicting the likelihood of postoperative renal dysfunction, defined as a blood urea nitrogen (BUN) level over 50 mg/100 ml. Urinary osmolality increased in all patients during the first 18 hours after bypass, but the increase was substantially less for those who subsequently developed renal dysfunction. Free-water clearance, which was significantly less negative in the patients with renal dysfunction by 2 hours after bypass and remained so throughout the 18 hours of this study, served as an early postoperative indicator of impaired renal function in the patients who eventually developed BUN elevation. Moreover, it was more sensitive as an index of renal dysfunction than was osmolality alone. Early recognition of renal impairment is important, as it may prevent dangerous fluid overloading and allow for corrective measures to be undertaken before frank renal failure develops.