[High intensity focused ultrasonic destruction of hepatic parenchyma]. / Destruction de parenchyme hépatique par ultrasons focalisés.

OBJECTIVE: High intensity focused ultrasound (HIFU) is an effective and precise method of focal tumoral destruction since it is associated with imagery. This method is widespread for the endorectal treatment of prostatic adenocarcinomas. HIFU seem appropriate for the treatment of liver tumors but its use needs to be experimentally tested in vivo. The aim of the work is to study the feasibility, tolerance and effectiveness of the destruction of porcine liver by HIFU. MATERIAL AND METHODS: Ten pigs had liver destruction by HIFU after coeliotomy. Four to 5 2,3 cm(3) HIFU lesions were performed per animal under ultrasonographic control. The study included biological surveillance and an autopsy was performed 4 to 24 hours later for histological examination of the liver. RESULTS: The destruction of the liver was feasible in all cases and the 4 lobes of the liver could be treated. The general and biological tolerance of the procedure was excellent. Ultrasonographic features of the HIFU lesions were defined. The histological examination of the lesions showed well-circumscribed necrosis areas associated with cavitation or histological deficiencies of various degrees. CONCLUSION: This work demonstrated that liver destruction by HIFU is a feasible and effective method with low morbidity. A long-term experimental study is necessary before comtemplating its clinical use.

[Three-luminal nasojejunal tube in digestive surgery: preliminary feasibility study]. / Sonde nasojéjunale triple lumière en chirurgie digestive: étude préliminaire de faisabilité.

STUDY AIM: The benefit of enteral nutrition is an established fact for severely burned or multiple injured patients with a reduction of septic morbidity. Enteral nutrition is now possible in upper gastrointestinal tract surgery with the development of nasojejunal triple lumen tube and we report a new application with an operative placement. The aim of the study was to evaluate the nasojejunal triple lumen tube in digestive surgery. MATERIAL AND METHODS: From November 1999 to August 2001, a nasojejunal triple lumen tube was placed during surgery for high surgical risk patients (n = 17) or under radioscopic control for the treatment of post operative complications (n = 6). RESULTS: The surgical placement was possible in all cases. The radioscopic placement failed in two cases, one of which being solved with endoscopic procedure. There was no morbidity during the tube placement. Four patients were excluded because of early post operative death (n = 3) or premature removal of the tube by the patient (n = 1). The enteral nutrition was early in 18 patients and its mean duration was 18.2 days (range 3-75). Technical problems occurred in 9 patients and the replacement of the tube was necessary in 8 cases. CONCLUSION: The nasojejunal triple lumen tube is a feasible, safe and relatively well-tolerated procedure in upper gastrointestinal tract surgery.

[Cryosurgery of primary and metastatic cancers of the liver]. / Cryochirurgie des cancers primitifs et métastatiques du foie.

Cryosurgery is a method of in situ destruction of tissue by a freezing process. Results of hepatic cryosurgery are now available for more than 2100 patients and allow to assess its place in the treatment of hepatic malignancies. Mechanisms of tissue destruction and indications of cryosurgery are detailed. With a peri-operative mortality rate of 1.5%, the safety of hepatic cryosurgery is now admitted. Cryosurgery has its own morbidity: increase of transaminases levels, platelets drop, myoglobinuria and rarely renal failure or cryoshock. In selected patients, hepatic cryosurgery is feasible with a laparoscopic or percutaneous approach. Long term results do not support cryosurgery as an alternative to liver resection. This technique enlarges possibilities of surgical treatment for patients with primary and metastatic liver cancers.

[Value of preoperative drainage of the bile ducts in obstructive jaundice]. / Intérêt du drainage préopératoire des voies biliaires en cas d'ictère obstructif.

Hepato-biliary surgery for obstructive jaundice is associated with high morbidity and mortality rates. Experimental and clinical studies on obstructive jaundice revealed endotoxaemia, coagulation disorders and depressed immune function. Many studies have been carried out to identify the operative risk factors. The serum bilirubin level seemed to be a significant factor. Biliary decompression via a percutaneous or endoscopic retrograde approach was therefore proposed to improve the surgical outcome. The first retrospective studies have suggested a reduction of morbidity and mortality. Subsequent randomized studies have not confirm the benefit of preoperative biliary drainage because of procedure-related complications. The article reviews the literature on preoperative biliary drainage and proposes the indications, choice of method and optimal duration of biliary drainage.