[Contusions of the liver in adults. Initial non-operative management with computerized tomography follow-up is a reasonable therapeutic option. Report of 16 cases]. / Contusions du foie de l'adulte. L'abstention opératoire initiale sous contrôle tomodensitométrique est une option thérapeutique raisonnable. A propos de seize observations.

Nonoperative management of blunt liver injury in adults still remains controversial. From February 1985 through September 1989, 27 patients were treated for blunt hepatic trauma: 11 required immediate operation and 16 (59%) were initially managed nonoperatively after evaluation of intraabdominal injury by computerized tomography. All of these 16 patients were hemodynamically stable and had no significant peritoneal signs. CT criteria for nonoperative management included subcapsular and intrahepatic hematoma, capsular tear or unilobar fracture, absence of large hemoperitoneum, absence of large devitalized liver and absence of other intraabdominal organ injuries. Clinical follow-up, repeated radiologic examinations and surgery confirmed the accuracy of CT. Only 2 patients required delayed operation (12.5%). Serial abdominal CT studies are an integral part of the conservative treatment of blunt hepatic injuries and showed complete resolution of hepatic injuries in the fourteen nonoperated patients in less than six months. No death and no delayed septic or biliary complications were noted. Mean hospital stay was seventeen days for all of the patients (multiple injuries or not) and only ten days for isolated blunt liver injury. These good results depend on identification of candidates for nonoperative management on strict clinical and CT criteria. Nonoperative management of adult blunt liver injury based on these findings is a useful alternative in a selected group of hemodynamically stable patients and decreases the rate of non-therapeutic coeliotomy.

[Acute pancreatitis: prognostic value of early x-ray computed tomography coupled with Ranson's criteria and its role in surveillance of the course]. / Pancréatites aiguës: valeur pronostique de la tomodensitométrie précoce couplée aux critères de Ranson et son rôle dans la surveillance de l'évolution.

Fifty nine patients suffering from a first attack of acute pancreatitis were investigated during the first ten days of illness with computerized tomography (CT scan) and biological signs of Ranson. The prognostic value of the combination of these two classes of signs was evaluated. The grading of initial CT scan findings was accorded to the Ranson and Balthazar classification. In addition, the authors evaluated the presence and extent of necrosis and studied phlegmonous extrapancreatic spread. A high risk group of patients was determined: grade C, D, E, with at least three prognostic signs. Twelve of these high risk patients with grade D and E had a glandular necrosis as detected on initial contrast enhanced CT scan. This was an important prognostic value sign (sensibility 100 percent; specificity 92 percent) as all morbidity was 100 percent compared with 8.5 percent among the 47 other patients who did not exhibit this CT sign; mortality was 25 percent compared with 0 percent among the other patients. Phlegmonous extrapancreatic spread in three or more areas also influenced the prognostic but to a lesser extent (sensibility 100 percent; specificity 62 percent). Forty-four patients among the fifty-nine had a morphologic follow-up of the course of lesions by repeated CT scan. Local complications occurred only in patients at high risk: 9 pancreatic abscesses (20.4 percent) and 6 pseudocysts (15 percent). One-third of the twenty-one grade D and E patients had spontaneous resorption of the phlegmonous extrapancreatic areas.(ABSTRACT TRUNCATED AT 250 WORDS)

[Esophagectomy without thoracotomy in cancer of the esophagus. Apropos of 10 cases]. / L'oesophagectomie sans thoracotomie dans le cancer de l'oesophage. A propos de 10 cas.

Esophagectomy without thoracotomy was performed in 10 cases of cancer of the esophagus, whatever its site of origin. Advantages of this procedure include the absence of a third right thoracic approach and of secondary hemostatis, complications, the cervical anastomosis, and the ascension of the gastroplasty into the esophageal bed. Though less carcinolytic than excision through a thoracic approach, this technique provides identical survival with a lower mortality and a very reduced morbidity. This therapeutic strategy could represent progress for patients who usually have generalized spread of the disease at the time of diagnosis.

[Acute pancreatitis from obstruction of Wirsung's canal by Taenia saginata (author's transl)]. / Pancréatite aiguë par obstruction taeniasique du canal de Wirsung.

A case is reported of acute edematous pancreatitis due to obstruction of Wirsung's canal by Taenia saginata rings. The patients recovered after release of the obstruction by sphincterotomy followed by drainage of the biliary tract.