Popliteal aneurysms. Our experience apropos of 119 cases

The authors report their experience of 119 popliteal aneurysms diagnosed in 76 patients. They feel that the prevalence of such aneurysms is underestimated. In 56% of cases there were bilateral aneurysms and in 24% of cases there was an associated aortic aneurysm. In 68% of cases, the popliteal aneurysm presented with complications. Clinical examination of the popliteal fossa gave a diagnosis in 66% of cases. In 1/3 of cases, arteriography failed to provide direct visual evidence of the aneurysm. The arteriographic diagnosis was then that of a femoro-popliteal thrombosis, of stenosis or isolated popliteal thrombosis. In all these difficult cases, echotomography is essential to diagnosis. The authors feel that indications for surgery should be as wide as possible. They consider that there are three types of contraindications: an excessively precarious physical condition, absence of a distal vascular network, an asymptomatic thrombosed popliteal aneurysm.     

Duodenopancreatic injuries. Diagnostic and therapeutic considerations apropos of 25 cases

A review of a homogeneous series of 25 cases of duodenopancreatic injuries emphasizes the serious nature of the lesions operated upon at the acute pancreatitis stage. An early diagnosis of these duodenopancreatic lesions is essential since they are often included in the context of multiple injuries. Principal diagnostic difficulties arise in lesions due to contusion without associated intra-abdominal injuries. In these cases ultrasound and CT scan imaging provide valuable data, particularly the latter exploration which is 89% reliable in demonstrating pancreatic morphology. Treatment differs as a function of presence of isolated or combined duodenal and pancreatic lesions and of lesional type. It should be as conservative as possible, although exeresis for lesions of body and tail of pancreas is currently performed more frequently.     

Tracheal and cricotracheal resection for laryngotracheal stenosis: experience in 54 consecutive cases.

OBJECTIVE: Partial tracheal resection (Küster operation (KO)) and cricotracheal resection (Pearson operation (PO)) are currently the standard operative techniques in the curative treatment of tracheal and cricotracheal stenosis, respectively. This study aims to analyze the outcomes of tracheal and cricotracheal resection when a specific protocol is applied. METHODS: Between 1990 and 2004 we treated 54 patients with laryngotracheal stenosis. The mean age was 44.9 years with a sex ratio of 1:1. All patients were treated according to the random protocol "Lesions of the main airway (MA) protocol," which considers the following stenosis variables: stage of development (S), caliber (C), and length (L). We performed 38 Küster operations, 14 Pearson operations, and 2 combined Pearson-Küster-Rethi operations (ROs). RESULTS: Overall mortality of the series was 1.85%, with a specific morbidity of 27.7%. A total of 96.2% of patients were cured (85.6% of Pearson operation and 100% of Küster operation). We performed 3.7% re-interventions (14.2% of Pearson operation and 0% of Küster operation), and the failure rate was 3.7% (14.4% of Pearson operation and 0% of Küster operation). We had 27.5% who had postoperative complications (28.5% of Pearson operation and 26.3% of Küster operation). The most frequent complications were restenosis (14.2%), granulation tissue (13.1%), edema (10.5%), anastomotic dehiscence (7.1%), and tracheoesophageal fistula (7.1%). In terms of the SCL variables, significant differences were only observed with respect to morbidity between the S4 group and the other cases without tracheoesophageal fistula in the Küster operation group; we found no differences in Pearson operation. CONCLUSIONS: Application of the Main Airway protocol allowed development of a strategy for the surgical treatment of main airway stenosis. This, in turn, enabled a strict selection of cases and meticulous preoperative preparation that, coupled with a highly effective surgical technique, led to excellent outcomes with minimal sequel. The presence of tracheoesophageal fistula could increase the complications.     

Radiofrequency ablation of malignant hepatic tumors. Preliminary experience apropos of 25 cases

STUDY AIM: Radiofrequency (RF) ablation of malignant hepatic tumors is an interesting and recent technique which offers new treatment possibilities. In this study, the preliminary findings have been reported on 25 patients with hepatic tumors who received RF treatment between January 1998 and February 2000. PATIENTS AND METHODS: Twenty-five patients (11 cases of hepatocellular carcinoma, HCC; and 14 cases of liver metastases, LM) underwent RF treatment. Thirty tumors (range: 10 to 54 mm in diameter) out of a total of 63 were destroyed by RF: 13 HCC (average diameter: 32 mm) and 17 LM (average diameter: 26 mm). Treatment consisted of six percutaneous and 19 surgical RF procedures. In the surgical group, there were 11 cases of hepatectomy: right hepatectomy in five patients with segment IV enlargement in one case, and sub-segmentectomy in six other patients. In all cases, hepatic tomodensitometry was performed at one month post-treatment and then every three months. RESULTS: Postoperative portal thrombosis occurred in two patients, one of whom died. Other postoperative complications were observed in five patients. During the mean follow-up period of 14 months (range: 2 to 28 months), two patients died (carcinosis, ascitic decompensation), two and four months respectively after RF treatment. In situ recurrence occurred in four HCC and two LM patients. Three HCC and four LM patients developed new hepatic or extra-hepatic lesions. CONCLUSION: RF is a particularly interesting technique for the treatment of bilobar or unresectable metastases. It appears to be equally as efficient as other local treatments for small-sized HCC. However, technical improvements remain necessary to increase the destructive field covered by RF. A more important follow-up is needed so that the long-term efficacy and specific role of this new therapy can be accurately assessed.     

Extracorporeal shockwave lithotripsy and cystine lithiasis. Our experience apropos of 11 cases

The authors report their experience of the treatment of cystine lithiasis by ESWL on the basis of 11 cases from 1984 to 1987.     

Iatrogenic urethral stenosis. Apropos of 100 cases

Iatrogenic causes of stenosis of urethra appear to be increasing in frequency. 100 cases out of a total of 582 patients being of iatrogenic origin. The principal cause is the use of a urethral catheter. Various therapeutic methods are used, preference being given quite clearly to internal urethrotomy. Prevention is of fundamental importance and is based on the less untimely routine use of urethral catheters, particularly after general surgical operations and in intensive care.     

Iatrogenic strictures of the bile ducts: Our experience with 66 cases

The authors report their experience with 66 patients operated on for iatrogenic strictures of the bile ducts. Among the factors that are considered to predispose to or to cause iatrogenic strictures, all of which have been accurately analyzed, urgent operations for acute cholecystitis have particular importance. The percutaneous transhepatic and duodenoscopic retrograde cholangiographies represent a complementary means for a precise diagnosis of the stricture. Treatment consists of a Roux-en-Y hepaticojejunostomy, but in recent years, a biliary-duodenal interposition utilizing a defunctionalized jejunal limb was preferred. Postoperative morbidity was 22.7%, mortality 3%. Consideration is given to the technique of anastomosis and to the use of transanastomotic drainage. Finally, the results of follow-up with particular reference to the treatment of strictures of the hepaticojejunostomy, with an incidence of 15.4% in this series of patients, have been analyzed.

---

Résumé Les auteurs font part de leur expérience en s'appuyant sur 66 interventions pour sténose iatrogène des canaux biliaires. Parmi les facteurs qu'il faut considérer comme cause de ces sténoses et qui ont tous été analysés avec précision, il faut attacher une importance toute particulière aux interventions pour cholecystite aiguë. Les cholangiographies par voie per-cutanée transhépatique et par duodénoscopie rétrograde sont des moyens adjuvants permettant de préciser le diagnostic de la sténose. Le traitement consiste en une hépatico-jéjunostomie sur anse montée en Y. Cependant dans ces dernières années nous avons préféré une interposition bilio-duodénale en utilisant une anse grêle défonctionnalisée. La morbidité post opératoire a été de 22,7% et la mortalité de 3%. Des précisions sont données sur la technique de l'anastomose ainsi que sur l'usage d'un drainage trans anastomotique. Enfin, les suites post opératoires ont été analysées en donnant une attention particulière au traitement des sténoses suivant des hépatico-jéjunostomies qui représentent 15,4% dans cette série de patients.

     

Surgical treatment of benign laryngotracheal stenosis. Apropos of 12 cases

The authors report a series of twelve benign laryngotracheal strictures. In almost every case, these lesions were secondary to tracheal intubation and consisted of extensive, circumferential and almost complete stenosis. All were treated surgically. The authors obtained enlargement of the airway be means of an interposed cartilaginous graft and an intraluminal prosthesis which was left in place. In nine cases, this procedure was combined with posterior cricotomy. One eight month old infant died during the postoperative period. Ten patients had an uneventful postoperative course with a satisfactory anatomical and functional result.     

The Devine urethroplasty. Our experiences apropos of 18 cases

Our experience with a 1-stage procedure using free patch graft for correction or urethral stricture is reported. Eighteen cases of urethral stricture have been treated. Fourteen of the 18 cases (77%) had a good result. The follow up is more than 5 years. This procedure is recommended with considerable enthusiasm.     

Radical prostatectomy in cancer of the prostate. Our experience apropos of 55 cases with 3-year follow-up

The authors report their experience of retropubic radical prostatectomy for prostatic cancer. They have performed 55 prostatectomies over a period of 3 years. Their indications are essentially stage B (35 cases) and stage C1 (20 cases). The post-operative morbidity was low and no cases of incontinence were observed. Post-operative impotence generally occurs when the cavernous nerves are interrupted. However, erection was preserved in two cases when Walsh's technique was used.     

Partial subfascial abdominoplasty. Our technique apropos of 36 cases]

With the help of a liposuction performed behind the abdominal superficial fascia, followed by a dissection first located at the deep side of this fascia, then changing plane to the level of the umbilicus to reach the premuscle fascia plane, a new abdominoplasty is performed, that ensures safer vascularisation of skin and fat as well as better preservation of the lymphatic system. In our experience (March 1989, 36 cases), this technique avoids the most frequent risk of the abdominoplasty: seroma.     

Improved canine model for laryngotracheal stenosis.

Laryngotracheal stenosis (LTS) is a serious challenge for the otolaryngologist. Although progress has been made in preventing and treating LTS, more research is required. Existing canine models for LTS incur high mortality and morbidity, require relatively complicated procedures or costly equipment, entail lengthy waiting periods, or have unpredictable results. A simple, reliable, and inexpensive procedure, requiring no tracheotomy, is described for creating a canine model for LTS research. The new improved model is compared with previous models described in the literature. It will be especially useful for short-term studies of subglottic or tracheal stenosis.