Jaques-Louis Reverdin (1842-1929): the surgeon and the needle.

SUMMARY OBJECTIVES: With the development and rise of abdominal laparoscopic techniques, the old Reverdin needle has had a revival, because it proved to be useful for the endoscopic closure of laparoscopic access ports, in order to lower the incidence of incisional hernias. Several new modifications of the Reverdin needle, with different names, are in the market now. This new use of an old instrument, prompted a review of the life and work of Jaques-Louis Reverdin, the Swiss surgeon trained in Paris and founder of the modern Swiss surgery. METHODS: Biographical and bibliographical review of Jaques-MLouis Reverdin and his contributions to surgery RESULTS: Jaques-Louis Reverdin (1842-1929), born in Geneva, completed his medical studies in Paris, where he practised in several well-known hospitals such as La Pitié (with Goselin), Saint Louis (with Guérin), Lariboisiére, and Necker (with Guyon). In 1869 he published and presented in several meetings, a pioneering experience of successful free skin graft procedure, that is still performed in some cases and constitutes the first organ transplantation. In 1870 he presented his doctoral thesis "Etude sur l'uréthrotomie interne" with the expeience of his master Guyon (63 operations), gaining the Civiale prize and the bronze medal of the Paris Faculty of Medicine. He returned back to Geneva in 1872 to begin a long surgical practice and Faculty teaching, and he made seminal contributions to the knowledge of thyroid diseases, in particular on the clinical presentation of function deficiency following exeresis of the thyroid gland ( postoperative myxoedema). His contributions paralleled that made by Theodor Kocher in Bern, the surgeon that received in solitary the Nobel prize for these studies in 1909. With Jean6hyphen;Louis Prevost and Constant Picot, they founded the "Revue medicale de la Suisse romande", the most important Swiss medical journal of the 20th century. He is remembered in the field of Urology for a special needle designed to pass through a suture in a time were catgut and silk were the most employed sutures to control organ pedicles. CONCLUSIONS: Reverdin, that pertains to the glorious epoch were surgery -performed under anaesthesia and with the antisepsis postulates of Lister and Pasteur-, reached most of his goals, is remembered for the first human transplant (skin grafting), and, fortunately, one of the several surgical instrument he designed, the Reverdin needle, had a revival in current laparoscopic surgery.

Jacques-Louis Reverdin (1842-1929): El cirujano y la aguja / Jaques-Louis Reverdin (1842-1929): The surgeon and the needle

OBJETIVO: Con el desarrollo y pujanza de las técnicas de laparoscopia abdominal, la aguja de Reverdin ha tenido una nueva vida, porque se ha mostrado útil para el cierre endoscópico de los puertos de acceso de laparoscopia, disminuyendo la incidencia de hernias incisionales. El uso nuevo de este antiguo instrumento sugirió el estudio de la vida y obra de Jaques-Louis Reverdin, el cirujano suizo formado en Paris y fundador de la cirugia moderna en su pais.MÉTODO: Estudio biográfico y bibliográfico de Jaques-Louis Reverdin y su contribución a la historia de la cirugía.RESULTADOS: Jaques-Louis Reverdin (1842-1929), nacido en Ginebra, hizo sus estudios médicos en Paris, y sus prácticas en varios renombrados hospitales como La Pitié (con Goselin), Saint Louis (con Guérin), Lariboisière, y Necker (con Guyon). En 1869 publicó y presentó en varias reuniones, la experiencia pionera de un procedimiento de injerto libre de piel exitoso, que aún se realiza en algunas ocasiones y constituye el primer trasplante de un órgano realizado nunca. En 1870 presentó su tesis doctoral “Etude sur l’uréthrotomie interne” con la experiencia de su maestro Guyon (63 operaciones). Regresó a Ginebra en 1872 para comenzar una larga práctica quirúrgica y de docencia en la Facultad e hizo contribuciones importantes para el conocimiento de las enfermedades del tiroides, en particular sobre la clínica del déficit funcional que sigue a su exéresis (mixedema postoperatorio). Sus hallazgos fueron simultáneos a los hechos en Berna por Theodor Kocher, cirujano que recibió en solitario el premio Nobel por estos estudios en 1909. Junto a Jean-Louis Prevost y Constant Picot, fundó la “Revue Médicale de la Suisse Romande”, la más importante revista médica suiza del siglo XX. Es recordado en el campo de la Urología por una aguja especial creada para pasar una sutura, en un tiempo en que el catgut y la seda eran las más empleadas para el control de los pedículos vasculares(AU)

CONCLUSIONES: Reverdin, que pertenece a la época gloriosa en que la cirugía -hecha bajo anestesia y con los postulados de la antisepsia de Lister y Pasteur- alcanzó muchas de su metas, es recordado por el primer trasplante humano (injerto de piel) y, afortunadamente, uno de los instrumentos que diseñó, la aguja de Reverdin, ha tenido una nueva vida en la cirugia laparoscópica actual(AU)

OBJECTIVES: With the development and rise of abdominal laparoscopic techniques, the old Reverdin needle has had a revival, because it proved to be useful for the endoscopic closure of laparoscopic access ports, in order to lower the incidence of incisional hernias. Several new modifications of the Reverdin needle, with different names, are in the market now. This new use of an old instrument, prompted a review of the life and work of Jaques-Louis Reverdin, the Swiss surgeon trained in Paris and founder of the modern Swiss surgery.METHODS: Biographical and bibliographical review of Jaques-Louis Reverdin and his contributions to surgery(AU)

RESULTS: Jaques-Louis Reverdin (1842-1929), born in Geneva, completed his medical studies in Paris, where he practised in several well-known hospitals such as La Pitié (with Goselin), Saint Louis (with Guérin), Lariboisière, and Necker (with Guyon). In 1869 he published and presented in several meetings, a pioneering experience of successful free skin graft procedure, that is still performed in some cases and constitutes the first organ transplantation. In 1870 he presented his doctoral thesis “Etude sur l’uréthrotomie interne” with the experience of his master Guyon (63 operations), gaining the Civiale prize and the bronze medal of the Paris Faculty of Medicine. He returned back to Geneva in 1872 to begin a long surgical practice and Faculty teaching, and he made seminal contributions to the knowledge of thyroid diseases, in particular on the clinical presentation of function deficiency following exeresis of the thyroid gland (postoperative myxoedema). His contributions paralleled that made by Theodor Kocher in Bern, the surgeon that received in solitary the Nobel prize for these studies in 1909. With Jean-Louis Prevost and Constant Picot, they founded the “Revue medicale de la Suisse romande”, the most important Swiss medical journal of the 20th century. He is remembered in the field of Urology for a special needle designed to pass through a suture in a time were catgut and silk were the most employed sutures to control organ pedicles.CONCLUSIONS: Reverdin, that pertains to the glorious epoch were surgery -performed under anaesthesia and with the antisepsis postulates of Lister and Pasteur-, reached most of his goals, is remembered for the first human transplant (skin grafting) and, fortunately, one of the several surgical instrument he designed, the Reverdin needle, had a revival in current laparoscopic surgery(AU)

[Extraperitoneal bladder rupture coinciding with bone fragments: the case for surgical treatment]. / Rotura vesical extraperitoneal coincidiendo con esquirlas óseas: necesidad de tratamiento quirúrgico.

INTRODUCTION: In closed traumatic bladder ruptures, a surgical treatment of the intraperitoneal rupture, and a conservative approach to the extraperitoneal one, with bladder catheter, antibiotics and confirmation of bladder wound closure after two to three weeks-, was recommended. Only recently, attention was paid to the importance of the presence of bone fragments of the pelvic fractures, that in the vecinity of a bladder catheter or urinary infection may give raise to either severe pelvic infection or permanent urinary fistula. PATIENTS AND METHOD: The two cases of extraperitoneal bladder rupture here presented, demonstrate the difficulties of a secure diagnosis by CT, and the potential severity of the existence of bone fragments impronting the bladder disruption. COMMENT: Recent consensus on genitourinary trauma emphasizes the need to pay attention to the presence of bone fragments of the pelvic ring fractures in cases of closed bladder rupture. In cases of extraperitoneal bladder rupture with bone fragments in the vecinity, bladder endoscopic examination and surgical treatment may be needed.

[Spontaneous transuretero-ureterostomy after complete stenosis of an ileal conduit, with four years of conservative follow-up]. / Transuretero-ureterostomía espontánea después de estenosis completa de un conducto ileal, con cuatro años de seguimiento conservador.

INTRODUCTION: Stenosis of an ileal conduit is a rare complication of this urinary diversion. In the case here described, such a complication was neglected for some weeks and left the patient in a high risk situation. After implantation of a bilateral nephrostomy, a spontaneous transuretero-ureterostomy was found. CLINICAL CASE: A 70-year-old man with an ileal conduit performed 15 years before because of bladder tumour, was admitted with signs of severe intraabdominal infection and oliguria. The image studies shown intraabdominal abscess, and an almost complete stenosis of the ileal conduit, that was conservatively treated with a bilateral percutaneous nephostomy. After discharged, he reported an accidental falling-out of the right nephrostomy, collecting normal diuresis from the only left nephrostomy. The spontaneous appearance of a transuretero-ureterostomy was demonstrated. The patient refused surgery and remained with a nephrostomy that is periodically changed, and after four years of follow-up he has neither significant kidney dysfunction nor other incidences. COMMENT: The origin of this ileal conduit stenosis is related to the inflammatory or immunologic changes induced by the chronic presence of the urine on the wall of the intestinal segment. This case is singular because of the curious result of an in situ transuretero-ureterostomy, and because of the long conservative follow-up, without significant complications, in a patient that keeps a good quality of life.

Rotura vesical extraperitoneal coincidiendo con esquirlas óseas: necesidad de tratamiento quirúrgico / Extraperitoneal bladder rupture coinciding with bone fragments: the case for surgical treatment

Introducción: En las roturas vesicales traumáticas cerradas, se ha recomendado reparar quirúrgicamente la rotura intraperitoneal y tratar de manera conservadora la extraperitoneal, mediante sonda, antibióticos y comprobación del cierre de la herida vesical a las dos o tres semanas. Sólo recientemente, se ha prestado importancia a la existencia de esquirlas óseas de las fracturas pelvianas vecinas a la lesión vesical, que en presencia de una sonda permanente o de una orina infectada pueden dar lugar a fístulas persistentes o infecciones pelvianas graves. Pacientes y Método: Los dos casos de rotura vesical extraperitoneal que presentamos ponen de manifiesto la dificultad del diagnóstico seguro mediante TAC, y la gravedad de la existencia de esquirlas óseas improntando en la disrupción de la vejiga. Comentario: Los consensos recientes en traumatismo genitourinario destacan la necesidad de prestar atención a la presencia de esquirlas óseas de las facturas del anillo pelviano en los traumatismos vesicales cerrados. En caso de rotura vesical extraperitoneal con fragmentos óseos en la vecindad, la exploración endoscópica y la reparación quirúrgicas pueden ser necesarias (AU)

Introduction: In closed traumatic bladder ruptures, a surgical treatment of the intraperitoneal rupture, and a conservative approach to the extraperitoneal one, with bladder catheter, antibiotics and confirmation of bladder wound closure after two to three weeks-, was recommended. Only recently, attention was paid to the importance of the presence of bone fragments of the pelvic fractures, that in the vicinity of a bladder catheter or urinary infection may give raise to either severe pelvic infection or permanent urinary fistula. Patients and Method: The two cases of extraperitoneal bladder rupture here presented, demonstrate the difficulties of a secure diagnosis by CT, and the potential severity of the existence of bone fragments impronting the bladder disruption. Comment: Recent consensus on genitourinary trauma emphasizes the need to pay attention to the presence of bone fragments of the pelvicring fractures in cases of closed bladder rupture. In cases of extraperitoneal bladder rupture with bone fragments in the vecinity, bladderendoscopic examination and surgical treatment may be needed (AU)

Transuretero-ureterostomía espontánea después de estenosis completa de un conducto ileal, con cuatro años de seguimiento conservador / Spontaneous transuretero-ureterostomy after complete stenosis of an ileal conduit, with four years of conservative follow-up

Introducción: La estenosis del conducto ileal es una complicación infrecuente de esta derivación urinaria. En el caso que describimos pasó durante un tiempo inadvertida y llevó al paciente a una situación de riesgo. Después de implantar una nefrostomía bilateral, se encontró una transuretero-ureterostomia espontánea. Caso Clínico: Un varón de 70 años con un conducto ileal realizado 15 años antes por tener tumor vesical, ingresó con signos de infección intraabdominal grave y oliguria. Los estudios radiológicos mostraron absceso intraabdominal, y se encontró estenosis casi completa del conducto ileal, que se trató conservadoramente mediante una nefrostomia bilateral. Después de ser dado de alta ocurrió la caída accidental de la nefrostomía derecha, recogiendo cantidades normales de orina por la única nefrostomía izquierda. Se comprobó la existencia de una transuretero-ureterostomía espontánea, con estenosis de la porción distal del conducto ileal. Desde entonces permanece con la nefrostomía, que se cambia periódicamente y en cuatro años de seguimiento no ha tenido deterioro renal significativo. Comentario: El origen de esta estenosis se atribuye a los cambios inflamatorios o inmunológicos en la pared del segmento intestinal, inducidos por la presencia crónica de la orina. Nuestro caso es singular por el curioso resultado de una transuretero- ureterostomía in situ y por el largo seguimiento conservador que se hizo, en un paciente que mantiene una calidad de vida buena (AU)

Introduction: Stenosis of an ileal conduit is a rare complication of this urinary diversion. In the case here described, such a complication was neglected for some weeks and left the patient in a high risk situation. After implantation of a bilateral nephrostomy, a spontaneous transuretero-ureterostomy was found. Clinical case: A 70-year-old man with an ileal conduit performed 15 years before because of bladder tumour, was admitted with signs of severe intraabdominal infection and oliguria. The image studies shown intraabdominal abscess, and an almost complete stenosis of the ileal conduit, that was conservatively treated with a bilateral percutaneous nephostomy. After discharged, he reported an accidental falling-out of the right nephrostomy, collecting normal diuresis from the only left nephrostomy. The spontaneous appearance of a transuretero-ureterostomy was demonstrated. The patient refused surgery and remained with a nephrostomy that is periodically changed, and after four years of follow-up he has neither significant kidney dysfunction nor other incidences. Comment: The origin of this ileal conduit stenosis is related to the inflammatory or immunologic changes induced by the chronic presence of the urine on the wall of the intestinal segment. This case is singular because of the curious result of an in situ transuretero-ureterostomy, and because of the long conservative follow-up, without significant complications, in a patient that keeps a good quality of life (AU)

Idiopathic chronic hematocele of the vaginal sac

We report a 39-year-old male who presented non-traumatic testicular swelling and pain. Physical examination and sonography presented a suspicion of testicular tumor and both surgical exploration and inguinal orchiectomy were performed. Hematocele may both clinically and sonographically resemble a testicular tumor. The diagnostic study of choice is magnetic resonance, establishing the diagnosis and differentiating it from neoplasms.

Idiopathic chronic hematocele of the vaginal sac.

We report a 39-year-old male who presented non-traumatic testicular swelling and pain. Physical examination and sonography presented a suspicion of testicular tumor and both surgical exploration and inguinal orchiectomy were performed. Hematocele may both clinically and sonographically resemble a testicular tumor. The diagnostic study of choice is magnetic resonance, establishing the diagnosis and differentiating it from neoplasms.