Annales de chirurgie
-
Annales de chirurgie · Jan 1991
Randomized Controlled Trial Clinical Trial[Prolonged epidural analgesia following thoracotomy. Clinical study and serum levels over five days].
Prolonged continuous epidural analgesia allows perithecal infusion with fentanyl and bupivacaine for 5 postoperative days after thoracic surgery. This study included 27 thoracotomized patients randomised into two groups: group X consisted of 15 subjects, group Y consisted of 12 subjects. Each patient received 33 micrograms/hr or fentanyl for 48 hours, associated with 0.25% bupivacaine in group X, and 0.125% bupivacaine in group Y. ⋯ Mean fentanyl levels did not increase beyond 0.8 ng/ml. The use of 0.125% bupivacaine improved the margin of safety but did not impair clinical analgesia in the study. This method provides good analgesia for thoracotomized patients.
-
From April 1978 to 1st October 1990, 19 patients underwent liver transplantation for primary or secondary cancer of the liver. Eleven patients were transplanted for hepatocellular carcinoma secondary to cirrhosis, generally alcoholic (9 cases), hepatitis B (1 case) or secondary to haemochromatosis (1 cas). Three patients developed hepatocellular carcinoma in a normal liver, including one fibrolamellar cancer and three a proximal bile duct cancer. ⋯ The poorest survival was observed for cancers in a normal liver, with the exception of the fibrolamellar cancer in which recurrence was delayed. The longest survival was observed for cancers secondary to cirrhosis. At three years, the results of liver transplantation were equal to those of hepatic resections with a survival of 37%, despite the fact that the transplantation was generally performed for very large tumours.
-
Annales de chirurgie · Jan 1991
Case Reports[Surgical repair of a tracheal tear caused by an endotracheal tube via dual surgical approach].
We report a case of large tracheal (cervical thoracic) rupture after using an endotracheal tube, which needed to be repaired via a double surgical approach: cervicotomy and right thoracotomy. To our knowledge, no similar cases have been previously reported in the medial literature.
-
Annales de chirurgie · Jan 1991
Case Reports[Streptococcus pneumoniae thyroid abscess associated with a toxic nodular goiter. Apropos of a case].
An unusual case of acute suppurative thyroiditis in association with toxic nodular goiter is reported by the authors. Surgical therapy was necessary due to the severity of the local and systemic inflammation induced by this association.
-
Annales de chirurgie · Jan 1991
The diagnosis of acute abdominal pain with computer assistance: worldwide perspective.
This presentation describes the use of computer aided decision support in acute abdominal pain. The development of such support and the feasability of providing it are described with reference to worldwide studies involving nearly 100,000 patients in the UK, the European Community and worldwide. ⋯ As a result of this experience, it will be suggested: a) The diagnosis of acute abdominal pain by inexperienced emergency surgeons remains a difficult problem. 2) Doctors who have been assisted by a computer have, in many instances, improved their diagnostic and decision-making performance. 3) This improvement has not been due to superior "artificial intelligence" of the computer--but due to the computer acting as an educational focus and a stimulus to good clinical practice. 4) On an international level, these studies have been immensely valuable. They have helped bring together different national groups and helped to develop common medical terminology--as well as foster collaborative "spin-off" in terms of research around the world.