[Surgery in patients with chronic renal failure on maintenance dialysis (author's transl)]. / La chirurgie chez les insuffisants rénaux en dialyse chronique itérative.

Among 606 patients on maintenance dialysis in the same unit, 111 (18.3%) underwent various surgical procedures. 14 additional patients on dialysis in other units were included in this group. A total of 138 surgical procedures were performed in these 125 patients, of which 112 were on hemodialysis. In 57 patients, surgery was warranted by a complication directly related to the chronic renal failure. In 81 patients, surgery was indicated because of an associated condition, a complication resulting from therapy, or a coincidental surgical affection. After these 138 procedures, 27 post-operative complications (19,6 %) and 15 deaths (10,86 %) were reported. The mean age for deceased patients is 66 years. These findings show that surgical morbidity and mortality, even after major procedures, are not prohibitive in patients on dialysis, if certain measures are taken during dialysis, anesthesia, surgery, and post-operative care. These measures are reviewed in the study.

[Abdominal complications of heart surgery]. / Les complications abdominales de la chirurgie cardiaque.

Abdominal complications after cardiac surgery (excluding "medical" jaundice) are rare. Twenty six cases were observed out of a total of 7 847 operations (0.33%) performed between 1973 and 1980. The causes were very diverse; the most common being gastroduodenal ulceration, usually acute (9 cases). Other cases included intestinal (3 cases of postoperative ileus, 4 cases of mesenteric infarction, 2 cases of necrosing enterocolitis), biliary (2 cases of acute cholecystitis) and splenic pathology (2 cases of splenic infarction, one associated with necrosing enterocolitis). Anticoagulant therapy was implicated in 3 cases. Diagnosis is difficult in the immediate postoperative period, some complications only being recognised at autopsy. The clinical signs may be misleading and the interpretation of complementary investigations difficult. Therefore, the possibility of abdominal complications must be kept in mind, especially in patients with one or more predisposing factors. Excluding accidents due to anticoagulant therapy the following factors were associated with an increased risk of abdominal complications: previous history of gastro intestinal pathology (ulcer, gall stone, alcoholism) the nature of the underlying cardiac disease (coronary artery and aortic valve disease), cardiopulmonary bypass, and, above all, per- and postoperative incidents: hypovolaemia, low output syndrome (half the patients in this series) respiratory and infectious complications. The inappropriate use of vasoconstricting agents may also play a role. The majority of abdominal complications seemed to be related to ischaemia and anoxia in the splanchnic territory, which explains the important role of the preceding factors. The prognosis of abdominal complications after cardiac surgery was poor, mortality reaching 50 to 100% in some causes: in this series, 12 of the patients died. This justifies certain prophylactic measures: strict selection of patients, diagnosis and treatment of associated abdominal pathology before operation, prevention of low output states, respiratory and infectious complications ... and careful examination of the abdomen after operation to ensure the early diagnosis and treatment of complications, should they develop.

[Parietal complications of cholecystectomy : results of prophylactic antibiotic therapy with cefazoline (author's transl)]. / Complications pariétales après cholécystectomie. Intérêt d'une antibiothérapie prophylactique par le céfazoline.

Patients undergoing cholecystectomy were randomly divided into two groups. The effects of a single injection of one gram of cefazoline given thirty minutes before operation to 30 patients were compared with those obtained in a second group of 29 untreated cases. The efficiency of the second generation cephalosporins in preventing postoperative complications of this type was confirmed. Prophylactic administration of this antibiotic therapy before uncomplicated biliary tract surgery can significantly reduce the incidence of postoperative parietal infections and therefore the duration of hospitalization.