[Is visceral surgery justified in patients over 90 years of age?]. / La chirurgie viscérale chez les patients de plus de 90 ans est-elle licite?

The objective of this study was to evaluate the results of visceral surgery in patients over the age of 90 years by defining the indications, prognostic factors and short-term and intermediate results. This study was based on 50 patients operated between 1983 and 1987, consisting of 46 women and 4 men with a mean age of 92 years and a range of 90 to 98 years. 74% of the patients lived in long-stay hospitals, 26% lived at home, 28% were autonomous, 30% were semi-autonomous and 42% were bed-ridden. The majority of the patients were classified as ASA III. The mean number of visceral lesions was 3. 20% suffered from a malignant disease and 80% from a benign disease. 60% underwent emergency surgery and 40% underwent elective surgery. Postoperative complications were observed in 48% of cases, 58% of which had a fatal outcome. Sixteen patients (32%) died during the first postoperative month. The factors with a significant influence on mortality were: emergency in institutionalized patients (p less than 0.05), the ASA classification (ASA III and more, p less than 0.05), autonomy (bed-ridden patients, p less than 0.05), medical history (more than 4 associated organ defects, p less than 0.01) and malignant disease (p less than 0.001). The most pejorative complications in terms of mortality appeared to be postoperative septic shock, a pulmonary complication or a neurological complication. Cardiovascular disease, frequently reported in the history of theses patients, did not appear to specifically affect mortality. Surgery in patients over the age of 90 years appears to be justified in active patients in good general health presenting with a benign disease likely to become complicated if not treated, which should be preferably operated electively.

The arteriovenous fistula in segmental pancreatic transplantation in dogs--a hemodynamic study.

Arterial and/or venous thrombosis is a frequent complication in experimental or human pancreatic transplantation. A canine experiment was used to study the hemodynamic effects of spleno-splenic arteriovenous fistula during segmental pancreatic transplantation. An increase in blood flow, without "steal" syndrome in the pancreatic blood supply or pressure increase, was found. Thus this technique can help prevent vascular thrombosis in pancreatic transplant in dogs.

Biliary lithiasis in the over seventy-five age group: a new therapeutic strategy.

Sixty-four gallstone patients aged 75 or more (mean age 83 +/- 5.1 years) were divided prospectively into two groups. They were mostly high-risk patients (average number of major risk factors, 2.2 +/- 0.9). Thirty-three showed one or several signs of lithiasis of the common bile duct and were treated with endoscopic sphincterotomy (ES) (31 successful cases, two technical problems) followed by early cholecystectomy (33 cases). Choledocholithiasis was present in 26 cases and stones were extracted in 25 cases. Two patients (6 per cent) died. ES caused no complications. Thirty-one other patients showed no sign of choledocholithiasis and were treated by cholecystectomy with operative cholangiography. Choledocholithiasis was found in two of these patients and treated by extraction and external drainage. Five of these patients (16 per cent) died. In 30 cases acute cholecystitis was found at operation, 15 in each group. ES is therefore an efficient procedure in high-risk patients, which facilitates operation, especially in cases of acute cholecystitis, and it is recommended in all cases of complicated biliary lithiasis. Early cholecystectomy is justified for these patients by the high frequency of associated acute cholecystitis.

[Heterotopic segmental autotransplantation of the pancreas with digestive system anastomosis in the dog]. / Autotransplantation hétérotopique segmentaire du pancréas avec anastomose digestive chez le chien.

Segmental autotransplantation of pancreas in the heterotopic position, with digestive anastomosis protected by an epiploplasty was performed in a series of 22 dogs. Twenty dogs survived the operation and nine were followed up for 4 weeks: the histologic and morphologic qualities of the graft were very favorable from both endocrine and exocrine points of view. This morphohistologic quality can be related to the digestive anastomosis performed, which failed to provoke any specific complications to a large extent. This study should be completed by improvement in the vascularization of the graft by a splenic arteriovenous fistula and a concomitant study of the endocrine function of the transplanted pancreas in dogs with experimentally-induced diabetes.

[Pubic osteoarthropathy caused by symphyseal instability or chronic painful symphysiolysis: treatment by symphysiodesis. Apropos of a case and review of the literature]. / Ostéo-arthropathie pubienne par instabilité symphysaire ou "symphysiolyse chronique douloureuse": traitement par symphysiodèse. A propos d'un cas et revue de la littérature.

The authors describe a case of pubic pain in a 42 year old woman engaged in leisure sporting activity. She had had, 17 years earlier, a difficult delivery. Standard X-Ray showed narrowing of the symphysis pubis. Radiographs when bearing weight on one leg showed instability of the symphysis pubis. Conservative treatment was unsuccessful and grafting and plating was performed. The result was most satisfactory. A review of the literature shows ten similar cases. The obstetrical consequences are discussed.

Large abdominal incisional hernias: repair by fascial approximation reinforced with a stainless steel mesh.

One hundred and fifty large abdominal incisional hernias were treated following a standardized operating technique using metallic mesh (Toilinox) and approximation of the anterior sheath of the rectus abdominis. The average follow-up was four years. Good clinical results without pain were found in more than 95 per cent of the patients. Recurrence occurred in 9.5 per cent of the patients. The complications, wound infection or parietal necrosis, never necessitated removal of the prosthesis. These results justify the use of this technique even when intra-abdominal septic procedure is associated.

[Surgery of the bile ducts in patients 75 years of age and older. 144 patients surgically treated over a 5-year period]. / Chirurgie des voies biliaires du sujet âgé de 75 ans et plus. 144 patients opérés en 5 ans.

A series of 144 patients of over 75 years of age (average 83.2 years) were operated over a 5 year period for gall stones. Factors associated with a poor prognosis were age, infection and jaundice. The therapeutic indications are discussed.

[Early enteral feeding with a jejunal catheter in digestive surgery. 100 cases]. / Alimentation entérale précoce par cathéter jéjunal en chirurgie digestive. 100 cas.

Catheterization through a jejunostomy was employed in 100 patients undergoing major digestive surgery. Early enteral feeding was possible by this route in 69 cases, using either simple or, more frequently, complex nutrient solutions. In spite of several incidents due mainly to the initiation of this procedure, and a high proportion of functional disorders (diarrhoea and meteorism in 23 and 28% of cases respectively), this method appears to be favorable both in respect of nutrition and from the practical point of view.

[Early jejunal catheter feeding in heavy gastrointestinal surgery (author's transl)]. / Alimentation entérale précoce par cathéter jéjunal en chirurgie digestive lourde.

Fifty patients undergoing extensive gastrointestinal surgery were fed through a jejunal catheter introduced during the operation. After surgery, feeding was started 48 hours, except for 10 patients who had pre-operative intestinal obstruction or a suture below the site of liquid food instillation. The decision to feed patients enterally must by taken during surgery, and the method requires a trained nursing team, but it considerably improves the patient's nitrogen balance and, accessorily, his comfort. There does not seem to be any contra-indication. The onset of enteral feeding only depends upon the type of operation performed.