Primary carcinoma of the gallbladder--review of 143 cases.

BACKGROUND/AIMS: We reviewed a consecutive series of patients with primary cancer of the gallbladder and looked for specific symptoms, signs, laboratory tests, radiological examinations, operative procedures, operative findings and survival. MATERIAL AND METHODS: The records of 143 patients with gallbladder carcinoma operatively treated between 1975 and 1990 were retrospectively reviewed. RESULTS: Abdominal pain was the most common symptom and present in 72% of our patients. Jaundice was present in 83 patients (58%) and weight loss in 68 (47.5%). The pre-operative diagnosis was made in only 28.7 per cent of the cases. Surgical procedures included cholecystectomy alone (24 patients), cholecystectomy and resection of the hepatic bed (17 patients), and exploration with biopsy or bypass (20 patients). Only 21.5% of patients underwent curative surgery. Overall five year survival rate was 11%. For patients whose tumor was limited to the gallbladder wall (T1, T2, T3), the acturial 5-year survival rate was respectively 100%, 29% and 23%. For patients with T4 and T5 tumor, the 5 year survival rate was nil.

A prospective multicenter evaluation of preoperative hemostatic screening tests. The French Associations for Surgical Research.

BACKGROUND: Several retrospective and four prospective reports have questioned the need for routine preoperative hemostatic screening tests (PHST) in general surgery. PATIENTS AND METHODS: The results of four standard tests (prothrombin time, activated partial thromboplastin time, platelet count, and bleeding time) were prospectively compared with patient history and clinical data in a multicenter study of 3,242 consecutive patients. The patients were divided into four groups: group A (n = 1,951) had no clinical or PHST abnormalities; group B (n = 340) had no clinical and one or more PHST abnormalities; group C (n = 779) had one or more clinical and no PHST abnormalities; group D (n = 172) had both clinical and PHST abnormalities. RESULTS: Preoperative modifications of guidelines (postponed operations and ordering of additional hemostatic tests) were significantly more frequent in both groups of patients with PHST abnormalities (groups B and D), but specific treatment to correct hemostatic disorders was prescribed only when clinical abnormalities were also present (group D). Intraoperatively, modifications of anesthetic and surgical vigilance (planning of increased number of blood units, vascular catheter placement, and number of patients requiring transfusion) were significantly more frequent in group D. Postoperatively, all groups had similar incidences of hematoma or bruises, volumes of blood loss per drainage, reoperations to control hemorrhage, and mortality due to bleeding (n = 5). CONCLUSIONS: Our results suggest that PHST should not be performed routinely, but only in patients with abnormal clinical data. Such a policy necessitates a thorough history--including answers to a specific questionnaire like those used in prospective studies--and a rigorous, well-conducted physical examination.

[Stenosis of the rectum secondary to an invasive adenocarcinoma of the prostate. Apropos of 3 cases]. / Sténose du rectum secondaire à un envahissement d'un adénocarcinome de prostate: a propos de trois observations.

There exist rare cases in which a prostatic carcinoma invades the perirectal space producing an extrinsic rectal stenosis. Three cases are discussed. Differential diagnosis with a rectal tumor is difficult clinically, but endorectal ultrasound and deep rectal biopsies must provide the correct diagnosis in most cases. Hormonotherapy is recommended, but prognosis is reserved.

[Palliative treatment of cancer of the rectum using an urologic prostate resectoscope]. / Traitement palliatif du cancer du rectum à l'aide du résecteur urologique à prostate.

Palliative treatment for patients with rectal carcinoma concerns more than 10% of the 8000 cases diagnosed each year in France. Seventeen patients (median age: 83 years) underwent 27 endoscopic transanal resections using a urological resectoscope. The morbidity was 18.5% and there were no postoperative deaths. The median hospital stay for the procedure alone was 4 days. Local control was obtained in 13 (76%) patients with good palliation of obstruction, bleeding and tenesmus. The mean survival time was six months. This simple, minimally invasive and economic method should be part of palliative treatment for patients with rectal carcinoma together with laser destruction and external beam radiotherapy.

[Intraoperative colonic irrigation in the emergency treatment of occlusive lesions of the left colon]. / L'irrigation colique per-opératoire dans le traitement en urgence des lésions occlusives du côlon gauche.

This study reports the use of an intraoperative antegrade colonic irrigation in the management of left-sided large bowel obstruction requiring emergency surgery. 35 consecutive patients had primary bowel resection with immediate anastomosis (without colostomy) after intraoperative antegrade colonic irrigation. The cause of the obstruction was large bowel carcinoma in 26, diverticulitis in seven and volvulus in two cases. There were two post-operative deaths (5.7%). No digestive fistula was observed. The results of this study suggest that intraoperative colonic irrigation is an effective method, enabling the surgeon to perform a primary anastomosis with reasonable safety after emergency resection of selected distal colonic lesions.

[Protruding dermatofibrosarcoma. An unusual cutaneous tumor]. / Le dermatofibrosarcome protubérant. Une tumeur cutanée inhabituelle.

Local reoccurrence of protuberant dermatofibrosarcoma was seen in a female patient 3 years after exeresis. We reviewed the data in the literature on the physical examination, outcome, histology and therapeutic approach. The Darier and Ferrand dermatofibroma is a very unusual skin tumour which develops in the dermal layer. Diagnosis can only be confirmed by histologicaal examination of the specimen. Wide surgical exeresis is required to avoid local relapse. Despite the high risk of reoccurrence, the prognosis is excellent.

[Hypersecreting villous rectosigmoid tumors. Apropos of 14 cases]. / Tumeurs villeuses recto-sigmoïdiennes hypersécrétantes. A propos de 14 cas.

Villous recto-sigmoidal tumors with severe fluid and electrolyte loss are rare. We report here fourteen new cases with severe electrolyte imbalance (hypokalemia, hyponatremia, renal failure). We analysed too electrolyte loss in stools and we researched electrocardiographic disorders. Finally, we reported a long-term evolution of these patients.

[Correction of substance losses in the abdominal wall by an aponeurotic graft]. / Cure des pertes de substance de la paroi abdominale par un procédé de plastie aponévrotique.

A series of 123 patients presenting with abdominal eventrations were treated by an aponeurotic graft. Operative mortality was 0.8%. Recurrent eventration was observed in eventrations with a diameter superior to 4 cm (38% at 55 months). The authors recommended this technique only in case of small eventrations or for the parietal reparation following closure colostomies.

[Pancreato-gastric anastomosis after cephalic duodenopancreatectomy. Apropos of 36 cases]. / Anastomose pancréato-gastrique après duodénopancréatectomie céphalique. A propos de 36 cas.

After pancreaticoduodenal resection, a pancreatic fistula is observed in 10% of cases with a mortality rate of 20-30%. The pancreatogastrostomy was evaluated as an alternative method of restoring pancreaticointestinal continuity. From 1989 to 1991, 36 patients have undergone pancreatogastrostomy, after pancreaticoduodenectomy. The mortality rate was 2.7% (one pulmonary embolism). The morbidity rate was 2.7% (one pancreatic fistula). A endoscopic examination with injection of pancreatic duct was performed in 12 patients: in 9 cases we had a visualization of the anastomosis between the stomach and the pancreatic duct. These results confirm that pancratogastrostomy is a safe method of pancreatic drainage after pancreatoduodenectomy.

[Cholecystectomy by celioscopy. Apropos of 126 cases]. / Cholécystectomie par coelioscopie. A propos de cent vingt-six cas.

One hundred twenty-six cases who underwent laparoscopic cholecystectomy were included in the study: 28 males and 98 females with a mean age of 44.2 years. Laparoscopic cholecystectomy was performed for uncomplicated cholelithiasis (111 cases), acute cholecystitis (10 cases), biliary pancreatitis (2 cases) and cholangitis (3 cases). The mean operative time was 78 minutes. In 7 cases, a transformation into open surgery was necessary (5.5%). There were no deaths and one major complication was reported: an iatrogenic injury to the bile duct requiring secondary laparotomy. The mean hospital stay was 3.4 days. However, despite several advantages, this new technique must be performed by a surgeon with experience of biliary tract surgery.

[Trans-suture anastomosis. Choice of procedure in the management of colorectal anastomosis]. / L'anastomose "trans-suturaire". Procédé de choix dans la confection des anastomoses colo-rectales.

The double stapling technique was used to perform low anterior resection for rectal tumors in 122 patients (68 men, 54 women) with a mean age of 65 years (range, 28 to 87 years). There was no perioperative death. Technical problems related to the stapling technique and requiring transitory colostomy occurred in one patients. The clinical anastomotic leak rate was 5 per cent (six patients); in 2 patients, the fistula was treated successfully with a defunctioning transverse loop colostomy. Hospital stay ranged from 6 to 23 days (mean 10.2 days). Continence was normal in all patients at 6 weeks. One soft colo-anal anastomotic stenosis required dilatation. These results appear promising. The double stapling technique appears to facilitate low anterior resection of the rectum with safety.