[Surgical treatment of acute pancreatitic with infected necrosis by necrosectomy-pancreatostomy]. / Traitement chirurgical des pancréatites aiguës avec nécrose infectée par nécrosectomie-pancréatostomie.

UNLABELLED: Technical modalities of surgical treatment of infected pancreatic necrosis remains controversial. The aim of this retrospective study was to assess the results of necrosectomy associated by pancreatostomy using active drainage according Mikulicz, which is currently an unusual technique. PATIENTS AND METHODS: From 1985 to 1997, 18 consecutive patients (median age = 63; range = 35-88 years) were operated on through laparotomy for infected necrosis and treated by necrosectomy combined with Mikulicz drainage. Fourteen patients were referred from another center, including 9 who had previous surgery. Necrosectomy was performed after a median delay of 22 days (1-45) after onset of pancreatitis, in all patients because of severe sepsis (including 12 patients with persisting shock) and presence at CT scan of necrotic collections containing gas bubbles (n = 15) and/or infection proven by percutaneous aspiration (n = 3). RESULTS: After the first procedure, patients underwent between 2 and 25 (median: 5) additional necrosectomies through the pancreatostomy tract. Thirteen surgical complications were observed in 8 patients: digestive fistula (n = 7), intraabdominal bleeding (n = 3), gastrointestinal haemorrhage (n = 1), colic stenosis with colectasy (n = 1). Five patients, all referred from another center, died (28%) between the 47th and the 140th day from multiorgan failure (n = 4) or gastrointestinal haemorrhage (n = 1). The median hospital stay was 109 days (26-265) including 51 in intensive care unit (1-134). The 13 surviving patients were followed during an average of 2 years (4 months-7 years). All developed an incisional hernia of the pancreatostomy tract, which was surgically treated in 6 cases. CONCLUSIONS: Necrosectomy-pancreatostomy is an appropriate treatment of acute pancreatitis with infected necrosis, despite the usual need of additional but easy necrosectomies, and the frequent occurrence of incisional hernia. Results observed in patients referred to our center suggest that earlier diagnosis of necrosis infection using percutaneous aspiration could improve the prognosis.

[Megaduodenum in chronic intestinal pseudo-obstruction: management by duodenectomy-duodenoplasty]. / Traitement du mégaduodénum de la pseudo-obstruction intestinale par duodénectomie-duodénoplastie.

BACKGROUND: Surgical management of primitive chronic intestinal pseudo-obstruction involving the duodenum (megaduodenum) is an uncommon but still difficult problem. PATIENTS AND METHODS: Six patients who experienced severe symptoms were managed by an original surgical procedure including partial duodenal resection and reconstruction of a duodenal tract using a large duodenal anastomosis (duodenectomy-duodenoplasty). RESULTS: There was no postoperative complication. All preoperative symptoms completely regressed in all but one patient who had previously undergone a vagotomy and experienced transient early post-operative gastric stasis. With a median follow-up of 6 years (range 4-9), all patients had good functional results without any evidence of other motility disorders. The mean weight gain was 10 kg (range 7-15). CONCLUSIONS: Duodenectomy-duodenoplasty is a safe procedure resulting in efficient symptom relief in patients suffering from megaduodenum.

[Emergency lung resections for invasive aspergillosis in neutropenic patients]. / Résections pulmonaires en urgence pour aspergillose invasive chez des patients neutropéniques.

Mortality due to Invasive Pulmonary Aspergillosis (IPA) remains high in neutropenic patients due to pulmonary haemorrhage. The aim of this study was to evaluate the emergency surgical management of IPA. Seven neutropenic patients, with a mean age of 47 years (range: 30-64) (4 women and 3 men) were treated for (6 cases) acute leukaemia one Myeloma (1 case). Presumptive diagnosis of IPA was based on: Halo sign (n = 6) or air-crescent sign (n = 1) on CT scan, positive serology (n = 4), positive antigenemia (n = 3) and positive broncho-alveolar lavage (n = 1). In 2 cases, IPA diagnosis was only based on CT scan. In all cases, aspergillosis lesions were located near the left (n = 5) or right (n = 2) pulmonary artery. The type of pulmonary resection was: left superior lobectomy in 3 cases, left superior lobectomy and Fowler's segmentectomy in 1 case, Left inferior lobectomy in 1 case, right superior lobectomy in 1 case and middle lobectomy and paracardiac segmentectomy. Sleeve resection of the pulmonary artery was performed in two patients. There were no deaths or major postoperative complications. Mean hospital stay after surgery was 12 days (rang: 8-19). Histological examination confirmed the diagnosis of IPA. CT is essential to determine the optimal timing for surgery.

[The value of Mackenzie and Harries's technique in detecting pleural thickenings: results of a systematic study in 64 patients exposed to the risk of asbestosis (author's transl)]. / Intérêt de la technique de Mackenzie et Harries dans le dépistage des épaississements pleuraux. Résultats d'une enquête systématique chez 64 patients exposés au risque asbestosique.

The authors stress the difficulty of detecting pleural thickenings due to asbestos by radiography, before the late stage when calcification appears. Using Mackenzie and Harries's technique, they radiographed 64 subjects working in the naval shipbuilding yard in Nantes, who had previously been examined by radiophotography. Their results confirmed the superiority of the 45 degrees oblique incidence for demonstrating patches of pleural thickening in those areas where they occur most frequently. The value of this early detection is purely social and occupational at the present time, as it cannot be used to give a prognosis as to the possible appearance of a more serious lesion such as mesotheliomas.