Huguet C

Hepatic resection for colorectal liver metastases. Influence on survival of preoperative factors and surgery for recurrences in 80 patients.

This report analyses an experience with 80 liver resections for metastatic colorectal carcinoma. Primary colorectal cancers had all been resected. Liver metastases were solitary in 44 patients, multiple in 36 patients, unilobar in 76 patients, and bilobar in 4 patients. Tumor size was less than 5 cm in 33 patients, 5–10 cm in 30 patients, and larger than 10 cm in 17 patients. There were 43 synchronous and 37 metachronous liver metastases with a delay of 2–70 months. The surgical procedures included more major liver resections (55 patients) than wedge resections (25 patients). Portal triad occlusion was used in most cases, and complete vascular exclusion of the liver was performed for resection of the larger tumors. In-hospital mortality rate was 5%. Three- and 5-year survival rates were 40.5% and 24.9%, respectively. None of the analysed criteria: size and number of liver metastases, delay after diagnosis of the primary cancer, Dukes stage, could differentiate long survivors from patients who did not benefit much from liver surgery due to early recurrence. Recurrences were observed in 51 patients during the study, two thirds occurring during the first year after liver surgery. Eight patients had resection of “secondary” metastases after a first liver resection: two patients for extrahepatic recurrences and six patients for liver recurrences. Encouraging results raise the question of how far agressive surgery for liver metastases should go.

Dystrophie kystique du deuxième duodénum sur pancréas aberrant: Un cas de traitement chirurgical conservateur

Resume La dystrophie kystique sur pancreas aberrant localisee au niveau de la paroi duodenale est une pathologie rare ; son diagnostic est pose par les techniques d’imagerie dont l’echo-endoscopie, qui permet d’affirmer la localisation des kystes au niveau de la paroi duodenale. Les manifestations cliniques les plus frequentes sont les douleurs abdominales, les vomissements et l’amaigrissement. Les auteurs rapportent une observation de dystrophie kystique du 2 e duodenum sur pancreas aberrant chez un homme de 40 ans, traitee par une resection duodenale segmentaire. Le traitement chirurgical adopte est original et a permis d’eviter une duodenopancreatectomie cephalique.Duodenal cystic dystrophy due to ectopic pancreas deposit is an uncommon pathology. Diagnosis is made by modern imaging techniques, mainly endoscopic ultrasound which localizes precisely cysts in duodenal wall. The most frequent clinical symptoms are pain, duodenal obstruction, and weight loss. We report the case of a 40 year-old man with cystic dystrophy of the 2nd part of the duodenum, without chronic pancreatitis, treated by a conservative surgical procedure including segmental duodenal resection. This original approach is an alternative to the Whipple procedure.

Les diverticules géants du côlon. À propos de deux cas

Giant diverticulum of the colon is a rare complication of the colonic diverticulosis. It generally involves the sigmoid colon. In the chronic form, without symptoms or with only a few non-specific symptoms, an abdominal mass is frequently palpable. A plain abdominal radiogram, showing a gas-filled cyst, can suggest the diagnosis. If needed, an abdominal CT scan is appropriate and seems to be more accurate than a barium enema. The treatment of choice is a segmental resection of the colon involving the giant diverticulum, followed by a direct anastomosis. Despite the old age of these patients, both postoperative morbidity and mortality are low and justify such a radical approach. The acute clinical presentation (about 20%) is generally due to a peritonitis by perforation of the giant diverticulum and requires an emergency colectomy.

Blood flow in auxiliary canine liver homografts

Abstract The blood flow in auxiliary liver homografts revascularized according to Welchs technique was investigated using a Xe133 washout technique. Flow measurements were taken within the first 3 days after transplantation to avoid the influence of rejection. Hemodynamic changes that could account for the atrophy occurring in this type of liver graft were not found.

Dystrophie kystique du deuxième duodénum sur pancréas aberrant

Resume La dystrophie kystique sur pancreas aberrant localisee au niveau de la paroi duodenale est une pathologie rare ; son diagnostic est pose par les techniques d’imagerie dont l’echo-endoscopie, qui permet d’affirmer la localisation des kystes au niveau de la paroi duodenale. Les manifestations cliniques les plus frequentes sont les douleurs abdominales, les vomissements et l’amaigrissement. Les auteurs rapportent une observation de dystrophie kystique du 2 e duodenum sur pancreas aberrant chez un homme de 40 ans, traitee par une resection duodenale segmentaire. Le traitement chirurgical adopte est original et a permis d’eviter une duodenopancreatectomie cephalique.Duodenal cystic dystrophy due to ectopic pancreas deposit is an uncommon pathology. Diagnosis is made by modern imaging techniques, mainly endoscopic ultrasound which localizes precisely cysts in duodenal wall. The most frequent clinical symptoms are pain, duodenal obstruction, and weight loss. We report the case of a 40 year-old man with cystic dystrophy of the 2nd part of the duodenum, without chronic pancreatitis, treated by a conservative surgical procedure including segmental duodenal resection. This original approach is an alternative to the Whipple procedure.

Fait cliniqueDystrophie kystique du deuxième duodénum sur pancréas aberrant: Un cas de traitement chirurgical conservateurCystic dystrophy in heterotopic pancreas of the second part of the duodenum: One case of conservative surgical procedure

Resume La dystrophie kystique sur pancreas aberrant localisee au niveau de la paroi duodenale est une pathologie rare ; son diagnostic est pose par les techniques d’imagerie dont l’echo-endoscopie, qui permet d’affirmer la localisation des kystes au niveau de la paroi duodenale. Les manifestations cliniques les plus frequentes sont les douleurs abdominales, les vomissements et l’amaigrissement. Les auteurs rapportent une observation de dystrophie kystique du 2 e duodenum sur pancreas aberrant chez un homme de 40 ans, traitee par une resection duodenale segmentaire. Le traitement chirurgical adopte est original et a permis d’eviter une duodenopancreatectomie cephalique.Duodenal cystic dystrophy due to ectopic pancreas deposit is an uncommon pathology. Diagnosis is made by modern imaging techniques, mainly endoscopic ultrasound which localizes precisely cysts in duodenal wall. The most frequent clinical symptoms are pain, duodenal obstruction, and weight loss. We report the case of a 40 year-old man with cystic dystrophy of the 2nd part of the duodenum, without chronic pancreatitis, treated by a conservative surgical procedure including segmental duodenal resection. This original approach is an alternative to the Whipple procedure.