[Left pancreatectomy with preservation of the spleen without its pedicle. Apropos of 13 cases]. / Pancréatectomies gauches avec conservation de la rate sans son pédicule. A propos de treize cas.

Overwhelming post splenectomy infections in childhood were first described by King and Shumaker in 1952. This septic risk, although a matter of controversy, also exists in adults. Thus, splenic conservation must become a surgical concern in left pancreas resections for benign or traumatic diseases. The authors report their experience with a simplified procedure in which the splenic pedicle is resected "en bloc" with the left pancreas. This technique has been employed in thirteen patients, in whom spleen could be preserved in twelve, without operative mortality and a low morbidity rate.

[Mesenterico-atrial shunt in Budd-Chiari syndrome with inferior vena cava thrombosis. Report of 2 cases]. / Le pontage mésentérico-atrial dans le syndrome de Budd-Chiari avec thrombose cave inférieure. A propos de 2 observations.

Two new cases of Budd-Chiari syndrome associated with thrombosis of the inferior vena cava are reported. The predominant clinical sign was ascites, and the diagnosis was suggested by ultrasound and confirmed by angiography and the imaging techniques. In one case, the etiological assessment revealed an association with an oral contraceptive treatment; the etiological research remained negative in the other case. A mesenterico-atrial shunt was performed in both patients, and its patency was controlled with magnetic resonance imaging: both shunts are functional after 38 and 45 months respectively. On the basis of these two cases, the diagnostic process, the surgical indications and the choice of the techniques are discussed. The mesenterico-atrial shunt described by Cameron and Maddrey in 1978 seems to be an interesting and reliable therapeutic choice for the Budd-Chiari syndrome with thrombosis of the inferior vena cava.

[Double transplantation of the liver and kidney. A study of curarization using continuously perfused atracurium]. / Double transplantation hépatique et rénale. Etude de la curarisation par atracurium en perfusion continue.

We report the use of atracurium besylate with monitoring of neuromuscular function in a young women with primary hyperoxaluria and no renal function. She underwent orthotopic liver transplantation and also a kidney graft during the same operation. The bolus dose (0.5 mg.kg-1) and the mean infusion rate (0.405 mg.kg-1.h-1) were similar to those reported in references. The infusion rate decreased during anhepatic period. Spontaneous recovery time from TR 25 to 75% was 36 mn and TR 90% was 127 mn, after the end of atracurium infusion. The depression of neuromuscular function was potentiated with isoflurane use, acidemia, hypocalcemia, hypothermia but without cumulative effect. It was concluded that the administration of atracurium by infusion is suitable for long surgical procedures despite impaired hepatic and renal function.

Pharmacokinetics of fazadinium in patients with renal failure.

The serum concentrations of fazadinium and its metabolites were measured in 14 surgical patients with end-stage renal failure and in 11 patients free from kidney disease undergoing abdominal surgery. A two-compartment open model was used in the pharmacokinetic analysis of the data. The elimination half-life (T 1/2 beta) was prolonged by 60% in patients with renal failure (from 85 to 140 min) and corresponded to a 30% decrease of the plasma clearance. The plasma concentration of the metabolites never exceeded 7% of the unchanged fazadinium. These results suggest that the duration of action will be less prolonged for fazadinium than for other non-depolarizing neuromuscular blocking drugs in patients with renal failure. A supplementary biliary pathway appears to be a possible explanation for the rapid elimination of fazadinium, even in patients with renal failure.