[Gastric leiomyoblastoma: literature review and report of a case]. / Léiomyoblastome gastrique: revue de la littérature et à propos d'un cas.

Leiomyoblastoma is a rare, smooth muscle tumor of the stomach that occurs chiefly in the antrum. We present the case of a 51 year old man suffering from asthenia and mild upper abdominal pain. Investigations showed a big exculcerated tumor of the lesser gastric curvature. He underwent a subtotal gastrectomy for a non-metastasizing leiomyoblastoma, grade 1. But already 5 months later, he developed an invasive non-resectable local recurrence of high grade malignancy and died 3 month after a second look. Those tumors affect middle-aged patients who present usually upper gastrointestinal bleeding or peptic ulcer-like symptoms. Although the large majority of leiomyoblastoma are benign, malignancy occurs in up to 10% of cases. A large surgical resection of the tumor (including the total thickness of the gastric wall) or a partial gastrectomy is recommended.

[Personal experience with preventive use of antibiotics in elective colon surgery. A retrospective study]. / Unsere Erfahrung mit der Antibiotikaprophylaxe in der elektiven Kolonchirurgie. Eine retrospektive Studie.

We reviewed in a retrospective study all our 616 electively operated colons over 15 years from 1976 to 1990 for morbidity and mortality depending the antibiotic prophylaxis. Interventions were performed on 578 patients with a mean age of 65.5 + 13.7 years; in 38 cases there was an earlier elective colic operation. The sex ratio was 1.26 men to 1 woman. 71.8% of the indications were adenocarcinomas of the colon. All other diagnostics, as well as different types of interventions were included in the study. All interventions was preceded by large bowel preparation. The colic anastomosis were almost always handswen in two layers. Until 1982 systematically, we gave prophylaxis by combination of aminoglycoside with metronidazole or clindamycin, n = 329 (53.4% of 616). We then changed to ceftriaxone, n = 287 (46.6% of 616). Ceftriaxone was applied in single dose (n = 142), in multi doses (n = 71) and combined in almost all cases with metronidazole (n = 74). We found significantly better morbidity and mortality results with ceftriaxone than in the aminoglycoside combined group: The ceftriaxone group had a septicemia or colocutaneous fistulas requiring reoperation incidence of 1.4% (4/287) versus 4.6% (15/329) (p = 0.023). Mortality decreased from 4.9% (16/329) under aminoglycoside combined prophylaxis to 1.74% (5/287) in the ceftriaxone group (p = 0.033). The infection rate of the surgical accesses diminished from 13.1% (43/329) to 8% (23/287) under ceftriaxone (p = 0.043).(ABSTRACT TRUNCATED AT 250 WORDS)

[Prevention of pulmonary embolism with the Günther filter]. / La prophylaxie de l'embolie pulmonaire par le filtre de Günther.

From 1987 to 1989 a Günther vena caval filter was implanted in the inferior caval vein in 37 patients to prevent pulmonary embolism. 20 patients had already suffered from lung emboli and full anticoagulation did not prevent reembolization (11) or was contra-indicated because of hemorrhagic complications (5) or recent operation (4). 17 patients had developed severe deep venous thrombosis with a free ending thrombus (15) as shown by phlebography and in 2 other patients of old age prophylaxis seemed indicated to prevent migration of the thrombi. This device can be inserted percutaneously via a 10-French introduction system. No local complications were observed. 3 patients showed an oedema of a leg 2 to 7 days after insertion with spontaneous regression. One patient had the filter 12 days after implantation completely obstructed by a new embolus that needed to be removed surgically. One patient had an acute caval obstruction 1 1/2 years after implantation. it could not be determined if this was due to new embolisation or to thrombosis of the filter. No pulmonary reembolization was observed. Even if long-term results with the Günther vena caval filter can not be reported yet, it seems to be a satisfactory device for preventing pulmonary embolism.

[Clonogenic culture of identified cells of lung tumors and correlation with certain histopathologic aspects of the tumor mass]. / Croissance clonogène des cellules provenant de tumeurs pulmonaires et sa corrélation avec certains aspects histopathologiques de la masse tumorale.

Clonogenic cultures from 27 lung cancers were realised. For 68% of cases a clonogenic growth was observed, but no direct correlation could be done with the differentiation of the tumor or with the presence of ganglion metastases. EGF in medium increased the number of colonies obtained in 60% of cases.

[Status of resection-anastomosis in emergency left-sided colon surgery]. / Place de la résection-anastomose en chirurgie colique gauche d'urgence.

Resection and primary anastomosis (RPA) in emergency left-side colon surgery is not universally performed because of anastomotic healing difficulties of unprepared, dilated, or inflamed colons. Ninety-three patients underwent emergency surgery for left-side colon disease. Sixty-three primary anastomoses were performed with a 16% mortality rate and a 6% incidence of anastomotic leakage. These results are similar to those reported in the literature, depending upon the pathology involved, and appear to justify resection and primary anastomosis in case of hemorrhage, trauma, and left-colonic obstruction. As for diverticular perforation with localized peritonitis, RPA can be attempted in some instances, if a protective stoma is added. Finally, in case of diffuse peritonitis, the Hartmann procedure still remains the safest method.

[Chronic pancreatitis: natural history and development in relation to alcoholism]. / Pancréatite chronique: histoire naturelle et évolution en relation avec l'alcoolisme.

42 cases of chronic pancreatitis treated between 1976 and 1986, presenting 0.2% of all patients seen at the surgical clinic in the same period, have been reviewed. 37 patients (88%) were alcoholics and the prevalence of males was 83%. -Study of dietary habits showed a very high alcohol intake of 135.3 g alcohol per day, contrasting with the control group's alcohol consumption of 44.9 g per day. Alcohol intake calculated per life of patient with chronic pancreatitis represented 850.4 kg, whereas the control group consumed 344.1 kg (beer and wine). -Patients with chronic pancreatitis had started excessive alcohol consumption at an average age of 18 +/- 2 years and continued for an average of 18.0 +/- 1 years. These data correspond to zone A, i.e. Southern Europe. The evolution was analyzed with regard to persistence or cessation of alcoholism. Repeated attacks of chronic pancreatitis were seen in both groups. Patients abstaining from alcohol had only one attack during an average period of 10 years. Painful recurrences after surgery seem to be more frequent with persistent alcoholism (4 out of 5 patients), whereas in 15 patients without alcoholism they were observed only 3 times. -This shows that alcoholism remains the main factor in the natural history and evolution of chronic pancreatitis.

[Clinical study and gastroscopy of biliary gastritis following gastric resection and Roux-en-Y anastomosis]. / Recherche clinique et gastroscopique de gastrite biliaire après résection gastrique et anse en Y de Roux.

Between 1981 and 1985, seven patients (mean age 44 years) underwent surgery for benign gastroduodenal ulcer in the Department of Surgery. Cantonal Hospital, Fribourg, Switzerland. Surgical indications were a double subcardial and prepyloric ulcer recurring after medical treatment, a duodenal and jejunal anastomotic ulcer after gastroenterostomy, two duodenal ulcers which recurred after vagotomy, and three perforated ulcers (subcardial, prepyloric, duodenal). All patients underwent two-thirds gastrectomy with a Roux-en-Y loop. Clinical investigations and gastroscopy were performed 1-5 years postoperatively. Clinical results were excellent in 5 cases (Visick 1), good in one (Visick 2), and moderate in one (Visick 3). Symptoms and signs associated with biliary gastritis were found as follows: vomiting 1 patient; epigastric pain 1 patient; weight loss 1 patient; anemia 1 patient. No bile staining was seen in any patient. Gastric biopsy demonstrated a normal mucosa in 2 patients and gastritis in 5 patients. Roux-en-Y gastrectomy gives satisfactory results in certain benign gastroduodenal ulcer situations. Perianastomotic and gastric stump gastritis may exist without biliary reflux.

[The continent ileostomy--indication and results]. / Die kontinente Ileostomie--Indikation und Resultate.

Proctocolectomy with conventional ileostomy cures patients with severe ulcerative colitis, however ileostomy appliances had to be worn for the rest of their lives. The continent ileostomy as devised by Kock provides the patient with an intraabdominal ileal reservoir and a valve constructed by invaginating the efferent ileal segment into the reservoir. The patient empties his reservoir 2 to 3 times a day by inserting a catheter through the valve. Our experience with 45 patients is reported. In most cases the continent ileostomy was constructed as a second procedure after proctocolectomy. The construction of a continent ileostomy as a secondary procedure can be recommended in patients with proctocolectomy. It offers patients a life situation differing only insignificantly from that of normal persons.