Surgical attitude towards carcinoid tumour of the appendix. Review of the literature.

Carcinoid tumours of the gastrointestinal tract are most frequently located at the appendix. We report two cases: In the first case, we realized a simple appendicectomy. In the second case, two weeks after the appendicectomy was performed, according to the histological characteristics of the tumoral specimen, the patient underwent a laparoscopic right hemicolectomy with regional lymphadenectomy. In both cases, 5-HIAA (5 HydroxyIndolAceticAcid) is assayed regularly and remains normal.

Guidelines to laparoscopic management of acute cholecystitis.

OBJECTIVE: The present work aims at identifying preoperative variables that may help the surgeon choosing the most appropriate operative approach in various clinical presentation of acute cholecystitis. SUMMARY BACKGROUND DATA: Conversion rates up to 60% have been reported for laparoscopic management of acute cholecystitis. Previous works indicate that the severity of the gallbladder inflammatory process represents the main cause of laparoscopic conversion. The influence of converting a laparoscopic cholecystectomy for acute cholecystitis to open surgery on the post-operative course remains questionable. Objective preoperative variables correlated to the severity of cholecystitis and predictive of laparoscopic cholecystectomy failure remain to be identified. METHODS: Seven preoperative and five post-operative variables were compared among a continuous series of 62 patients operated for acute cholecystitis either by a successful laparoscopic procedure (37 patients) or by a laparoscopic procedure converted to open surgery (14 patients) or directly by open surgery (11 patients). The post-operative outcome of patients in the 3 groups were compared. Determinant preoperative factors correlated with the need to convert a laparoscopic procedure were searched by the CHI square test for independance and by a multivariate logistic regression analysis. RESULTS: Converting a laparoscopic cholecystectomy for acute cholecystitis to open surgery does not worsen the patients early post-operative course as long as conversion is decided rapidly and before peroperative complications arise. Three preoperative independent variables predictive of the need to convert a laparoscopic cholecystectomy for acute cholecystitis were identified: The thickness of the gallbladder wall, preoperative C reactive protein seric levels and finally the delay between the start of acute symptoms of cholecystitis and surgery. CONCLUSIONS: The post-operative outcome of patients operated for acute cholecystitis depends more on the severity of the disease than on the type of the surgical procedure. Patients with a perforated cholecystitis (grade III) should better be handled immediately by open surgery. Patients with acute edematous cholecystitis (grade I) or with empyema or gangrenous cholecystitis (grade II) coming early to surgery (within 72 hrs) and having seric preoperative CRP levels less than 10 mg/% represent the best candidates to laparoscopic surgery.

Cranio-facial and humeral melorrheostosis.

First described by LERY and JOANNY in 1992, melorrheostosis is an uncommon linear hyperostosis of unknown aetiology, which may be associated with soft tissures changes. Although all bones may be affected, cranio-facial involvement is very rare. Only six such cases have been found in the literature. This report describes a case of cranio-facial and left humeral melorrheostosis with symptomatic radial nerve involvement. Resection of the melorrheostotic bone was performed because of involvement of the radial nerve.

Mucinous cystadenocarcinoma of the appendix. A rare tumour of the right iliac fossa.

A case of mucinous cystadenocarcinoma of the appendix is presented. The clinical feature is a painful syndrome of the right iliac fossa. In our observation, the diagnosis was not allowed by preoperative imaging. Appendectomy was initially performed and completed by right hemicolectomy and lymphadenectomy after histological diagnosis of the appendicular malignant tumour was forwarded. The prognosis of this tumour is generally excellent providing early diagnosis and wide enough surgery.

Laparoscopic repair of perforated duodenal ulcer. A prospective multicenter clinical trial.

BACKGROUND: A series of 100 consecutive patients with perforated peptic ulcer were prospectively evaluated in a multicenter study. The feasibility of the laparoscopic repair was evaluated. METHODS: All patients had peritonitis, 20% were in septic shock, and 57% had delayed perforation. Conversion to laparotomy was necessary in eight patients. The morbidity rate was 9% and mortality rate 5%. RESULTS: The mean delay of postoperative gastric aspiration (mean 3.4 days) and resumed food intake (mean 4.4 days) as well as the mean postoperative hospital stay (mean 9.3 days) were comparable to conventional surgery, but postoperative comfort was subjectively increased by laparoscopy and noticed by all laparoscopic surgeons participating in this study. CONCLUSIONS: Laparoscopic repair of perforated peptic ulcer proves to be technically feasable and carries an acceptable morbidity and mortality rate, compared with conventional surgery.

[Indications for and limitations of celioscopic digestive surgery]. / Indications et limites de la chirurgie digestive coelioscopique.

Digestive laparoscopic surgery, which appeared in 1987, has developed rapidly, and has effected many procedures. After seven years, the time has come for surgeons to analyse whether their operative results are conclusive in justifying the continual use of this surgical procedure. If laparoscopic surgery respects the basic principles of conventional surgery, it should increase the patient's comfort during the postoperative period. In this article we shall consider similar fields where this new surgical technique could be beneficial.

Elective cholecystectomy without drainage and without prophylactic antibiotics. A prospective randomized trial with clinical and bacteriological aspects.

A consecutive series of 50 patients undergoing elective cholecystectomy without prophylactic antibiotics entered a prospective randomized trial to compare the post-operative clinical course whether the subhepatic space was drained or not. 26 patients (mean age 58 yrs) were drained and 24 patients (mean age 59 yrs) were not. The incidence of positive gallbladder bile cultures were respectively 8 and 19% (N.S.) in the drained and undrained groups. The incidence of post-operative mortality, thrombo-phlebitis and intra-abdominal sepsis was zero in both groups. In the drained or undrained series, the incidence of wound infection was respectively 4% and 0% (N.S.), that of urinary infection was 8% and 13% (N.S.) and that of pulmonary atelectasis was 15 and 17% (N.S.). A further consecutive series of 100 undrained elective cholecystectomies (18% positive bile cultures) without prophylactic antibiotics was then performed with the same uneventful postoperative course. This study therefore indicates that even in the presence of bacterobilia elective cholecystectomy can be safely performed without subhepatic space drainage and without prophylactic antibiotics.

[Jejunal perforation indicating the metastatic extension of a bronchial neoplasm]. / Perforation jéjunale traduisant l'extension métastatique d'une néoplasie bronchique.

After curative pneumonectomy for bronchogenic carcinoma, the first sign of generalization was a peritonitis secondary to the perforation of a jejunal metastasis. The authors review the frequency and etiology of this type of intestinal metastasis as well as the mechanism of perforation.

[Analysis of 66 cases of colorectal side-to-end anastomosis by the Baker method]. / Analyse de 66 cas d'anastomose colo-rectale latéro-terminale selon Baker.

From 1976 to 1985, 66 elective side to end colorectal anastomosis according to Baker's technique were performed. 36 of those 66 anastomoses (54.5%) were performed lower than 10 cm from the anal verge. Our series includes 17 cases of diverticular disease, 1 case of post radiotherapy stenosis of the rectosigmoïd junction and 49 carcinomas. 50% of all carcinomas were Dukes' C or D lesions and more than 34.8% of all lesions were subobstructive. The method of preoperative colonic preparation is described. The results are the following:--clinical fistulas: 2 (3.0%)--wound infections: 3 (4.5%)--deaths: 4 (6.1%). None of the colorectal sutures were protected by a colostomy whereas 4 colostomies previously instaured were suppressed at the time colorectal continuity was restored. This study clearly demonstrates that manual colorectal anastomosis following Baker's technique are as secure as stapled anastomosis although very less expensive.

[Clinical trial of Trive 1000 in long-term parenteral nutrition (author's transl)]. / Essai clinique de Trive 1000 en alimentation parentérale de longue durée.

The authors report a study of long-term parenteral nutrition with a homogeneous media (produce? Solution?) containing glucido-lipidic calories and essential amino-acids. This solution has the advantage of an easy dosage of the number of calories and of grams of nitrogen to administer; it also decreases the risks of bacterial contamination from "handicraft" mixing and excessive manipulations.