Eye enucleation and exenteration in -cattle: a retrospective study of 38 cases (2013-2020).

INTRODUCTION: The study aimed to describe clinical indications for eye enucleation and exenteration, the occurrence of complications and long-term outcome in cattle, and examine owners' attitude towards enucleation and exenteration and their satisfaction with the surgical outcome. Medical records from the two veterinary teaching hospitals in Switzerland were reviewed to identify cattle that underwent unilateral enucleation or exenteration between January 2013 and December 2020. Data extracted included medical history, ocular examination, clinical diagnosis, surgical procedure including anesthesia, suture material and pattern used, complications, and treatment thereof. Long-term follow-up was evaluated via national animal database inquiries to determine survival time and via owners' interviews with the use of a standardized questionnaire that included questions regarding the occurrence of complications and reason for culling, production performances and perceived quality of life after surgery, concerns, factors affecting the decision to proceed with surgery, and general satisfaction with the outcome. Descriptive statistics, Fisher's exact tests and unpaired t-test were used to summarize the data and assess association between variables. Association was considered significant if p < 0,05. Thirty-eight cases were identified, with a median age of 5 years. More than half of the cases (55,3 %) were diagnosed with non-neoplastic ocular lesions represented by severe trauma with loss of globe content, globe rupture with history of infectious keratoconjunctivitis or hypopyon, or congenital malformations. The remaining cases were diagnosed with neoplastic lesions, including ocular squamous cell carcinoma (OSCC), melanoma, or sarcoma. Complications following surgery were reported in 29 % of cases and included postoperative infection and recurrence of OSCC. There was no significant association between ocular diagnosis and the occurrence of postoperative complications or survival time. Surgery did not seem to influence the animals' postoperative production performance or the perceived quality of life. Most owners (92 %) were satisfied with the surgical outcome. The occurrence of postoperative complications leading to increased overall costs and culling was the main reason for lower owner satisfaction.

INTRODUCTION: La présente étude vise à décrire les indications cliniques de l'énucléation et de l'exentération de l'œil, la survenue de complications et le résultat à long terme chez les bovins et à examiner l'attitude des propriétaires vis-à-vis de l'énucléation et de l'exentération et leur satisfaction quant au résultat chirurgical. Les dossiers médicaux des deux hôpitaux universitaires vétérinaires de Suisse ont été examinés pour identifier les bovins qui ont subi une énucléation ou une exentération unilatérale entre janvier 2013 et décembre 2020. Les données extraites comprenaient les antécédents médicaux, l'examen oculaire, le diagnostic clinique, la procédure chirurgicale y compris l'anesthésie, le matériel et le patron de suture utilisés, les complications et leur traitement. Le suivi à long terme a été évalué en utilisant la base de données nationale sur les animaux afin de déterminer la durée de survie, et par d'entretiens avec les propriétaires à l'aide d'un questionnaire standardisé qui comprenait des questions concernant l'apparition de complications et la raison de la réforme, les performances de production et la qualité de vie perçue après la chirurgie, les réserves, les facteurs affectant la décision de procéder à la chirurgie et la satisfaction générale du résultat. Les données ont été résumées à l'aide de statistiques descriptives et les différences éventuelles entre les variables ont été analysées à l'aide de tests exacts de Fisher et de tests t non appariés. L'association a été considérée comme significative si p < 0,05. Trente-huit cas ont été identifiés, avec un âge médian de 5 ans. Plus de la moitié des cas (55,3 %) ont été diagnostiqués avec des lésions oculaires non néoplasiques causées par un traumatisme grave avec perte du contenu du globe, une rupture du globe avec des antécédents de kératoconjonctivite infectieuse ou d'hypopion ou des malformations congénitales. Les autres cas ont été diagnostiqués comme des lésions néoplasiques, notamment carcinome épidermoïde oculaire, mélanome ou sarcome. Des complications après l'opération ont été signalées dans 29 % des cas, notamment infection postopératoire et récidive du carcinome épidermoïde oculaire. Il n'y avait pas d'association significative entre le diagnostic et l'apparition de complications postopératoires ou la durée de survie. L'intervention chirurgicale n'a pas semblé influencer les performances de production postopératoires des animaux ni la qualité de vie perçue. La plupart des propriétaires (92 %) étaient satisfaits du résultat de la chirurgie. L'apparition de complications postopératoires entraînant une augmentation des coûts globaux et l'abattage des animaux était la principale raison de la baisse de satisfaction des propriétaires.

Daratumumab: Therapeutic asset, biological trap!

OBJECTIVES: Recently, daratumumab has been included in the therapeutic strategies for myeloma patients. This molecule is an antibody directed against CD38, strongly expressed on plasma cells. Nevertheless, as CD38 is also present on erythrocyte membrane, daratumumab interferes with immunohaematological tests, complicating the selection of compatible blood. METHODS: A total of 14 patients treated by daratumumab have been followed in our transfusion laboratory. Among them, 11 have been transfused. Dithiotreitol (DTT) has been used to inhibit the daratumumab's interference, in the pre-transfusion tests (irregular antibody screening and cross-match). RESULTS: The red blood cell treatment with DTT has been very efficacious to inhibit the daratumumab's interference in 13 patients out of 14. Some precautionary measures had to be taken into account, especially the pH and the storage conditions. An extended pheno/genotype was an additional security element in the selection of compatible blood. To simplify and to optimize the laboratory practices, a decisional flow chart has been written. CONCLUSION: DTT red blood cell treatment is very useful and efficacious in the pre-transfusion tests of patients treated with daratumumab. It allows to avoid the selection of blood bags only on the basis of an extended pheno/genotype, what is more secure and more ethical with respect to other at higher risk patients. A clear decisional flow chart allows a quality assurance gait. Collaboration with physicians is essential.

Efficiency of a Lactobacillus plantarum-xylanase combination on growth performances, microflora populations, and nutrient digestibilities of broilers infected with Salmonella Typhimurium.

Three experiments were performed to assess the ability of a Lactobacillus plantarum probiotic combined with a xylanase to reduce the effects of Salmonella Typhimurium infection in broiler chickens from 1 to 30 or 42 d of age. Chicks were challenged at 3 d of age with 10(8) or 10(5) cfu Salmonella Typhimurium/chick. Four diets were studied: a wheat-based diet (C+) supplemented with 0.1 g/kg of xylanase (E) or 10(6) cfu/g of L. plantarum (P), or both (PE). Uninfected chicks fed the C diet were used as negative control (C-). Six or 8 chicks were housed per cage with 9 cages/treatment. Growth performance and feed conversion ratio (FCR) were recorded weekly. In experiment 1, bacterial enumeration in ceca was achieved using the fluorescent in situ hybridization technique. Salmonella enumeration was realized in excreta by microbiological cultures (experiments 2 and 3). Nutrient digestibilities and AME(n) were determined in experiment 3 from d 35 to 39. Infection with Salmonella Typhimurium led to a significant decrease in the daily weight gain (DWG) by 23.6 to 32.8%, whereas FCR was increased by 1.0 to 19.7%. Chickens fed the PE diet showed significantly improved performance in comparison with C+ birds (DWG: +12.5% in experiment 1; FCR: -2.1 to 8.6%), and in comparison with the P and E treatments (DWG: +6.3 to 8.3% in experiment 1; FCR: -2.7 to 6.4%). In experiment 3, the FCR was significantly improved by 3% with the PE diet in comparison with C- chickens. The PE combination tended to restore a microflora similar to that of uninfected broilers, whereas the P and E diets had less of an effect on the profile of bacterial communities. At slaughter age, Salmonella contamination was reduced by 2.00 and 1.85 log colony-forming units for the E and PE treatment, respectively. The PE diet significantly reduced the crude fat digestibility by 9.2%, in comparison with the C+ chickens. These results suggest that the combination between L. plantarum and a xylanase as feed additive could be effective for reduction of the detrimental effect after Salmonella Typhimurium infection of broilers.

Lyophilized preparations of bacteriocinogenic Lactobacillus curvatus and Lactococcus lactis subsp. lactis as potential protective adjuncts to control Listeria monocytogenes in dry-fermented sausages.

AIM: Study of the effectiveness of in situ bacteriocin production by lactic acid bacteria (LAB) to control Listeria monocytogenes in dry-fermented sausages. METHODS AND RESULTS: Two bacteriocin-producing strains: Lactococcus lactis subsp. lactis LMG21206 and Lactobacillus curvatus LBPE were grown in a pilot scale fermentor and lyophilized to be directly used in dry sausage fermentation. A commercial starter culture (Bel'meat SL-25) not inhibitory to L. monocytogenes (Bac- starter) was mixed (1 : 1) with each of the two lyophilized bacteriocin-producing strains to obtain starters active against the pathogen (Bac+ starter). Anti-Listeria effectiveness of the Bac+ starters was studied in dry-fermented sausages. The meat batter was experimentally contaminated with a mixture of four different strains of L. monocytogenes (10(2)-10(3) CFU g(-1)). The results showed that L. monocytogenes did not grow in any of the contaminated batches, but no significant decrease (P > 0.05) was observed either in the positive control (no added starter culture) or in samples fermented with the Bac- starter culture during the fermentation period and up to 15 days of drying. When the Bac+ starter contained Lb. curvatus LBPE, cell counts of L. monocytogenes decreased to below the detectable limit (<10 CFU g(-1)) after 4 h of fermentation and no survivors could be recovered by enrichment beyond day 8 of drying. When the Bac+ starter culture containing Lc. lactis LMG21206 was used, a decrease in Listeria counts to below the detectable limit was achieved after 15 days of drying. CONCLUSIONS: The bacteriocin-producing strains studied may be used as adjunct cultures for sausage fermentations to control the occurrence and survival of L. monocytogenes. SIGNIFICANCE AND IMPACT OF THE STUDY: Addition of the Bac+ strains, especially the Lb. curvatus strain would provide an additional hurdle to enhance the control of L. monocytogenes in fermented meat products.

Preferential reduction in vascular responses to endothelin-1 in rats with streptozotocin-induced diabetes.

The effects of vasodepressor (acetylcholine and bradykinin) and pressor [electrical stimulation of the spinal sympathetic outflow, norepinephrine and endothelin-1 (ET-1)] stimuli were determined in rats with 2- and 5-week untreated streptozotocin-induced diabetes (blood glucose 400 and >500 mg/dl, respectively). In pentobarbital-anesthetized animals, the hypotensive response to an intravenous dose of acetylcholine or bradykinin was unaffected in animals treated for 2 weeks with streptozotocin but was significantly reduced (22% and 48%, respectively) after 5 weeks. However, the pressor responses to ET-1 were significantly decreased in animals that had been given streptozotocin 2 (38%) and 5 (45%) weeks previously. In contrast, the vasoconstrictor effects of electrical stimulation of the spinal cord outflow and norepinephrine were significantly inhibited (47% and 30%, respectively) at 5 weeks, but not at 2 weeks, after streptozotocin administration. These results indicate that, in untreated streptozotocin diabetes, a substantial impairment of vascular reactivity to ET-1 appears more rapidly than inhibition of the pressor responses to endogenous and exogenous norepinephrine or to vasodilator substances that require integrity of vascular endothelial cell function to produce their normal effects.

[Pancreatico-jejunal anastomosis with invagination on isolated loop after cephalic pancreatoduodenectomy]. / L'anastomosi pancreatico-digiunale con invaginazione su ansa esclusa dopo duodenopancreatectomia cefalica.

The most frequent and most dangerous complication of the duodenopancreatectomy is pancreatic fistula due to dehiscence of the pancreatic anastomosis. A technique that uses a separate Roux en Y loop for pancreatic anastomosis, to reduce the fatal risks of the pancreatic fistula, has been initially reported more than 50 years ago. With the development of the pancreaticogastrostomy, it seems interesting to present a procedure using an isolated loop for the pancreas; this technique is derived from those previously published, allowing a good intussuception of the pancreas in the intestinal loop. This method has been performed in 35 duodenopancreatectomy (malignant pancreatic disease: 32 patients, benign pancreatic disease: 3 patients). The mean age of the patients was 64 years (range 34-74). There were four operative deaths unrelated to the pancreaticojejunal anastomosis and two pancreatic fistulas with spontaneous healing. The pancreatico-jejunostomy using a separate Roux en Y loop represented in this short experience a safe procedure to prevent pancreatic fistula.

Pharmacological evidence that NK-2 tachykinin receptors mediate hypotension in the guinea pig but not in the rat.

Vascular NK-1 and NK-2 tachykinin receptors in the rat and the guinea pig were characterized pharmacologically by using available agonists and antagonists exhibiting varying degrees of selectivity for these receptors. Because the anesthetized guinea pig has unusually low blood pressure, these animals were pithed and vagotomized and infused, throughout the experimental procedure, with norepinephrine (6 micrograms/kg/min). This treatment raised their blood pressure to a level appropriate for the determination of dose-hypotensive response curves. The NK-1 receptor agonists substance P (SP) and septide (0.004 to 1 microgram/kg iv) decreased carotid artery blood pressure in a dose-dependent manner in both species, but they were more potent (13- and 33-fold, respectively) in guinea pigs than in rats. The NK-2 receptor agonist [beta Ala8]-NKA(4-10) (0.06 to 1 microgram/kg) also dose-dependently lowered blood pressure in the pithed guinea pig with noradrenaline-supported blood pressure, although it failed to do so in the same rat preparation. RP 67580, a selective NK-1 antagonist, antagonized the SP- or septide-induced hypotensive response in rats, but not in guinea pigs. Conversely, RPR 100893, a novel NK-1 receptor antagonist chemically related to RP 67580, dose-dependently inhibited hypotension induced by SP, and even more, that induced by septide only in guinea pigs. In the latter species, neither RP 67580 nor RPR 100893 affected decreases in blood pressure induced by [beta Ala8]-NKA(4-10). These decreases were, however, inhibited by the NK-2 receptor antagonist SR 48968. The selectivity of this compound for the latter receptor was confirmed by its failure to affect SP- or septide-induced hypotension in either guinea pigs or rats. These results confirm that the hypotensive responses to SP and septide are mediated by NK-1 receptors in the two species studied. However, functional NK-2 receptors appear to be present in the vascular bed of the guinea pig but not that of the rat, since in the former species the hypotensive responses induced [beta Ala8]-NKA(4-10) were inhibited by SR 48968 but not by the NK-1 receptor antagonists studied. This conclusion is, to our knowledge, drawn here for the first time from clear-cut pharmacological results.

[Complicated colonic diverticulosis. Changes in treatment and results over 22 years]. / Diverticulose colique compliquée. Evolution du traitement et des résultats en 22 ans.

OBJECTIVES: The aim of this study was to analyse the clinical course, surgical strategy and results in patients with complicated colonic diverticular disease. METHODS: We retrospectively compared two groups of patients who underwent surgery for complicated colonic diverticulosis from 1970 to 1984 (Group A, n = 94, mean age 60 years, 49 males, 45 females) and from 1985 to 1992 (Group B, n = 76, mean age 63.5, 32 males, 44 females). RESULTS: Patients in the two groups were comparable; only the rate of peritonitis (20 vs 8%) was different (p < 0.05). The most frequent operations in Group A were colostomy-drainage (43%) and Hartman's procedure (26%) in emergency situations and resection with immediate anastomosis (63%) or resection-anastomosis with diverting stomy (19%) in elective cases. In Group B, surgical strategy led to a different pattern of operations, 4 and 56% in emergency, and 94 and 2% in elective surgery, respectively. Overall mortality was 11%, with 17% and 4% in Groups A and B respectively (p < 0.01). This major drop in mortality was particularly important in emergency cases (31 vs 4%; p < 0.02). Morbidity in emergency surgery fell from 21 to 4% (P < 0.0006). Interrupting the use of colostomy-drainage was a major factor in reducing mortality followed by a sharp fall in mortality after Hartmann's procedure (28.5 vs 0%). CONCLUSION: The marked improvement in results between the two groups was mainly due to preferring resections of pathological colonic segments over colostomy-drainage.

Differential inhibition of the pressor effects of natural pro-endothelins by phosphoramidon in rats.

The vasopressor responses of three natural endothelins (ET-1, ET-2, ET-3) and their precursors, pro-ETs, were studied in a pithed rat preparation, which allows the profile and the potency of vasoconstrictor agents to be determined in the absence of central control of the cardiovascular system. ET-1 was found to be 4- and 8-fold more potent in raising blood pressure than ET-2 and ET-3, respectively. The immediate precursors of these isopeptides, h-pro-ET-1 (human), p-pro-ET-1 (porcine), pro-ET-2 and pro-ET-3, produced significantly smaller pressor responses than their respective ETs, when measured either as peaks or as areas under the time-effect curve. Hence, the bioavailability of h-pro-ET-1, p-pro-ET-1 and pro-ET-2, assessed on the basis of these two parameters, was approximately 50% of that of their corresponding ET, whereas the bioavailability of pro-ET-3 was only 25% that of ET-3. Phosphoramidon inhibits metallopeptidases, the enzymes that convert pro-ETs to ETs. The approximate i.v. doses of phosphoramidon reducing by 50% the pressor effects of the pro-ETs were 2.5, 0.625, less than 2.5 (this dose produced 75% inhibition) and 5 mg/kg i.v. for h-pro-ET-1, p-pro-ET-1, pro-ET-2 and pro-ET-3, respectively. In conclusion, these results indicate that the rat may have more than one pro-ET converting enzyme, each specific for one of the natural pro-ETs studied, although the alternative explanation, that there is a single enzyme with different affinities for these pro-ETs, cannot be entirely dismissed.

[Laparoscopic treatment of gastroesophageal reflux. Cardiopexia with the round ligament versus Nissen's type fundoplication]. / Traitement laparoscopique du reflux gastro-oesophagien. Cardiopexie par le ligament rond versus fundoplicature de type Nissen.

Thirty nine patients with a symptomatic gastrooesophageal reflux (RGO), resistant to or relapsing after medical treatment, were prospectively studied and operated on with a laparoscopic approach: 8 which a ligamentum teres cardiopexy, 31 with a 360 degrees fundoplicature. Both groups were comparable concerning clinical, endoscopic, mano- and pHmetric features (Anova test at 95% for all comparison in the study). There was no operative mortality. Conversion and morbidity rate were significantly higher (p = 0.04) in the "cardiopexy" group, even if data suggest a responsibility of the learning curve only. During follow-up patients were interviewed at 1, 3 and 12 months and proposed for mano- and pHmetry at 3 and 12 months. Late results at 12 months showed a relapse of RGO in 5 out of 8 patients of the "cardiopexy" group, with no relapse in "fundoplicature" group (p = 0.01). Mano- and pHmetric records showed at 3 months a persistent hypotony of the lower oesophageal sphincter and a persistent acid reflux in the "cardiopexy" group, with a significant (p = 0.01 and = 0.03) difference with "fundoplicature" group, in which lower oesophageal sphincter was hypercorrected and no reflux appeared at pHmetry. Despite some rare evidence in literature, cardiopexy do not give good late results, and laparoscopic 360 degrees fundoplicature seems to be the better procedure for surgical treatment of symptomatic RGO.

[Pancreaticojejunal anastomosis by intussusception of an isolated loop in pancreaticoduodenectomy]. / L'anastomose pancréatico-jéjunale par invagination sur anse isolée dans la duodénopancréatectomie céphalique.

The most frequent and severe complication of pancreaticoduodenectomy is pancreatic fistula due to dehiscence of the pancreas anastomosis. The technique that uses a separate Roux en Y loop for pancreas anastomosis, to reduce the fatal risks of pancreatic fistula, has been described for more than 50 years. With the development of pancreaticogastrostomy, it seems interesting to present a procedure using an isolated loop for the pancreas; this technique, derived from those previously described allows a good intussusception of the pancreatic stump into the intestinal loop. This method was performed in 22 pancreaticoduodenectomies. There were 2 operative deaths unrelated to the pancreaticojejunal anastomosis and one pancreatic fistula, which healed under medical treatment.

[Cancer of the rectum: clinical and therapeutic aspects. What changes occurred during the last 2 decades?]. / Le cancer du rectum: aspects cliniques et thérapeutiques. Quels changements au cours des deux dernières décennies?

This retrospective study of 440 cases of cancer of rectum was done over a period of 2 decades (1970-1993) which was divided in 3 periods (1970-79, 1980-89, 1990-93) and a comparative analysis was done with respect to clinical features, histo-pathology, treatment and results. At least one predisposing lesion (polyp, villous tumour) was noted in 26.7%, 41.5% and 41.5% respectively. The topographic distribution was unchanged in all three periods. The Dukes staging showed increase in stage A with 1.9%, 9.8% and 10% respectively and decrease in stage D with 26.1%, 20.2% and 16% respectively. The operability rate was 92.3%, 94% and 96.5% respectively, resectability rate was 80%, 91.3%, 94% and 96.5% respectively, resectability rate was 80%, 91.3% and 95.9% and curative resection rate was 83.3%, 86% and 88.2% respectively. Amongst the operations done, abdomino-perineal resection was done in 55.8%, 39.5% and 7.2%; anterior resection was done in 5.5%, 36.6% and 81.4%; thus these two curves crossed in 1985. Hartmann's procedure was done in 11%, 8.7% and 4.1%. The radiotherapy was given in 6.9%, 23.9% and 75.8% respectively. Overall hospital mortality rate was 5.8% which showed progressive decrease in the 3 groups with 13.8%, 1.24% and 2% respectively. The principal factors influencing the mortality rate were the emergency presentation the type and the palliative type of operation. Overall early complication rate was 42% which showed progressive decrease in the 3 groups with 64.8%, 37% and 21% respectively. Rate of local recurrence was 17.2% which was related to the topography of the tumour, Dukes staging, type of operation, margin of resection and preoperative radiotherapy. 5 year survival rate was 43% which in relation to the curative or palliative nature of the operation and the Dukes staging. The expected progress in terms of survival depended on surgery in early stages of disease and use of radiotherapy and chemotherapy.

[1000 cases of cholecystectomy: 500 by laparotomy versus 500 by laparoscopy]. / 1.000 cas de cholécystectomie: 500 par laparotomie versus 500 par laparoscopie.

The authors report 1,000 cases of cholecystectomy for cholelithiasis, excluding all cases with associated common bile duct surgery. The aim of the study was to compare two groups of cholecystectomies, one of 500 laparotomic procedures, evaluated retrospectively, and one of 500 laparoscopic ones, evaluated prospectively. Sex ratio was the same in both groups, and mean age was higher in the second group (54 vs 60) (p < 0.05): acute cholecystitis ratio was similar in both groups (23% vs 19%; NS). During the laparoscopic period, 84 laparotomic interventions were performed (17%), with a 0% mortality and a 18% morbidity rate. Mean operating time was 69' in the first group vs 91' in the second one, with a mean hospital stay of 11 vs 4.5 days (p < 0.001). Mortality rate was 1% vs 0% (p < 0.03) for laparotomic and laparoscopic procedures, and morbidity rate was respectively 11% and 1% (p < 0.001). Conversion rate in laparoscopic surgery was 7%. Two cases (0.4%) in laparoscopic group had a common bile duct lesion diagnosed intraoperatively and 1 case (0.2%) had a residual stone in common bile duct. Laparoscopic surgery is at present the standard technique for the treatment of cholelithiasis and laparotomic cholecystectomy seems only indicated when laparoscopic procedure is contraindicated or impossible.

[The musculocutaneous flap of the latissimus dorsi in the treatment of recurrences of breast cancer]. / Le lambeau musculo-cutané du grand dorsal dans le traitement des récidives de cancer du sein.

Breast cancers local recurrence treatment usually requires a large chirurgical resection. Latissimus dorsi myocutaneous flap was used after mastectomy in 27 patients. This technique was performed in 14 patients who had a recurrence after exclusive radiotherapy treatment. The follow-up of all the patients was more than 5 years. A 42% survival rate has been quoted in this group, after a 11 years period. Latissimus dorsi myocutaneous flap seems to be a satisfactory alternative when performing reconstruction after wall excision under 300 cm2, excepted for recurrence of fast kinetic cancers.

[Parietal prosthetic mesh in the treatment of large incisional hernias]. / Le pontage prothétique pariétal dans le traitement des grandes éventrations.

The repair of abdominal wall deficiencies has been simplified by the introduction of synthetic prostheses. The aim of this work was to describe the treatment of very large incisional abdominal hernias with a technique using a prosthetic mesh anchoring to the fibro-aponeurotic layers without closure the fascia. The procedure described has been used in 32 cases between 1974 and 1991 (15 male, 17 female). The median age was 62 years. All the patients were reexamined (median time: 4 years, range: 6 months-14 years). There was no operative mortality. Six patients had a subcutaneous seroma treated by multiple punctions. Three patients presented in the postoperative time a respiratory failure which necessitated artificial ventilation during 7 to 15 day. Two patients were reoperated, 6 months and 3 years after the first incisional hernia operation (1 cutaneous fistula, 1 hernia recurrence). Extremely large incisional hernias can be closed safely and effectively using this technique, without mortality and with a low morbidity.

[The surgical therapy of liver trauma]. / La terapia chirurgica dei traumi epatici.

The different therapeutic patterns of liver trauma are presented; they should be chosen on the basis of both clinical assessment, particularly looking for hemodynamic impairment and associated bowel lesions, and CT scan data. Surgical abstention should be considered for a great number of blunt liver trauma; open or severe blunt trauma should be preferably treated by elective hemostasis and biliostasis, with only rare use of hepatic resection "à la demande", on partially sectioned or devitalized tissues. Cavo-suprahepatic wounds remain the most important technical problem and continue to worse the prognosis in liver trauma.