Annales de chirurgie
-
Annales de chirurgie · Jan 1993
Case Reports[Para-hiatal gastric strangulation after Toupet's operation].
An exceptional case of incarcerated para-hiatal hernia with gastric necrosis, developing 7 years a Toupet procedure, is reported. To our knowledge, this is the first reported case of this complication after a surgical anti-reflux procedure without diaphragmatic counter incision. The mechanism, diagnostic difficulties and treatment are discussed.
-
From 1974 to 1990, 61 patients were admitted for pulmonary (55) or bronchial (6) aspergilloma; 50 were treated by surgery. Operative treatment was mandatory because of disabling symptoms in 17 patients, rapid growth on radiological survey in 7 others, diagnostic doubt in 10 and association with bronchogenic cancer in 2. 14 were operated on in order to prevent evolutive complications. Complete resection was possible in 39 patients: with lobectomy or segmentectomy in 34 and with pleuro-pneumonectomy in 5. ⋯ Nevertheless, among 10 patients with either bronchial aspergilloma or pulmonary aspergilloma without underlying disease, only one had a complicated outcome. In conclusion, surgical treatment is well tolerated in the absence of underlying parenchymal disease. However, despite the major operative risk, surgery remains the only efficient treatment in symptomatic patients.
-
With intensive care, pleural drainage and judicious physiotherapy most thoracic injuries can be treated adequately. 571 patients were treated for severe thoracic injuries over the last 10 years. A thoracotomy was necessary in 14% of the patients with blunt trauma (BT) and 33% with penetrating trauma (PT). Thoracotomy for PT was performed earlier and had better results than thoracotomy for BT. ⋯ Postoperative mortality for PT was three times lower than for BT (18% vs 56%). Reasons for this are the higher rate of injuries associated with BT. Surgical procedure depends on the type and extent of the thoracic and general injuries and on the patient's general condition.
-
Annales de chirurgie · Jan 1992
Randomized Controlled Trial Comparative Study Clinical Trial[Comparison of the effects of epsilon-aminocaproic acid and aprotinin on intra- and postoperative bleeding in heart surgery].
Excessive bleeding during and after cardiac surgery with cardiopulmonary bypass is a real problem in this kind of surgery. The use of prophylactic high doses of aprotinin (APROT) reduces blood loss in this context but this treatment is expensive. Some investigators have advocated that epsilon-aminocaproic acid (EACA), a cheaper antifibrinolytic drug, could reduce blood loss in cardiac surgery. ⋯ No complication, directly due to the treatment administered, was observed. EACA seems to be as effective as APROT to reduce intra and post cardiac surgery blood loss. EACA has the advantage of being cheaper (treatment is approximately 200 times cheaper), therefore allowing a wider use.
-
Tactics in blood transfusion have evolved considerably during the last ten years. Awareness of infectious risks and economic considerations have lead legislators to draw the guidelines for a safer transfusion. Their aim is to promote a better transfusion in smaller quantities at a lower risk. ⋯ The choice of an autologous technique depends on the type of surgical procedure, the expected blood loss and the economic resources available. Autologous blood transfusion may be optimized by the association of various techniques. This transfusion strategy must be elaborated by all the medical protagonists implicated in transfusion procedures.