ABSTRACT
The case of a 41 year-old female presenting a voluminous (2 kg) non-functioning tumor of the adrenal cortex with excellent survival at 5 years and 3 months is reported. The tumor extended mainly cephalad and occupied the cerebral right hepatic space. The importance of preoperative inferior cavogram as well as a large thoraco-abdominal approach is stressed. The key to success is exposure and control of the entire segment of the inferior vena cava between renal vein and diaphragm. Particular attention must be paid to the middle (principal) suprarenal vein, a very short vessel (less than or equal to 1 cm) on the right side, which may enter either the inferior vena cava on the right suprahepatic vein.
Subject(s)
Adrenal Cortex Neoplasms/surgery , Abdomen/surgery , Adult , Humans , Male , Thoracic SurgeryABSTRACT
Intra-operative radiomanometry with serial conventional films (panoramic cholangiography) and intra-abdominally placed large dental films (selective low cholangiography) produce a dynamic and static, millimetric study of the lower part of the common duct. It revealed in 2,095 patients with benign biliary pathology 119 cases of stenosis of the papilla of which 34 are detected during secondary operations of 85 patients. With the procedure of the authors a clear definition of the benign stenosis of the papilla is obtained radiomanometrically: 1. moderate hypertony; 2. disappearance of the normal rhythmical sphincter activity; 3. the biliary infundibulum, no longer conical, is wider than the intrapancreatic part of the common bile duct above it; 4. the biliary pancreatic reflux more rarely appears and, if it is discernible, pancreatic reflux is shorter than expected and the pancreatic duct obviously enlarged. These signs are quite characteristic of chronic stasis in both common bile duct and pancreatic duct, from infundibulum to intrahepatic ducts above the stenosic papilla (Acta chir. belg., 1977,76,523-532).
