Annales de chirurgie
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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.
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Annales de chirurgie · Jan 1991
[Reduction in the incidence of postoperative diaphragmatic paralysis by using a phrenic nerve protector].
A prospective study of a consecutive series of 100 patients in whom a phrenic nerve protector was used during cardiac surgery under CPB demonstrated the existence of one case of postoperative left phrenic nerve palsy and three cases of postoperative right phrenic nerve palsy. Comparison with a previous series taken as the control revealed a very significant reduction in the incidence of left phrenic nerve palsy which decreased from 8% to 1%. The incidence of right phrenic nerve palsy was not significantly decreased which corroborates the role of pericardial cooling in the aetiology of these palsies and the absence of protection of the right phrenic nerve by the system used.
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Annales de chirurgie · Jan 1990
[Does jejunoileal bypass still have a place in the surgical treatment of morbid obesity?].
Jejuno-ileal bypass has been widely used for the surgical treatment of morbid obesity since 1954, but from 1978 onwards the operation has met with increasing disfavor, especially in the USA as a result of its unacceptably high complication rate. From 1982 onwards, 235 morbidly obese patients had a side-to-side jejuno-ileal bypass in our Department. Our data concerning weight loss and the overall incidence of complications show that jejuno-ileal bypass can still play a role in the surgical treatment of morbid obesity.
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Annales de chirurgie · Jan 1989
Case Reports[Resection and reconstruction of the carina with separate two-lung high-frequency jet ventilation].
Carinal resection and reconstruction via a right transpleural approach in an hypoxemic patient provides difficult maintenance of satisfactory gas exchange when one lung ventilation is inadequate. The present case report concerns a 62-year-old patient with chronic obstructive airways disease and a carinal squamous cell carcinoma. He underwent tracheobronchial reconstruction surgery by Barclay's procedure through a right postero-lateral thoracotomy. ⋯ Ten months after the patient is alive, without tumor recurrence. HFJV greatly facilitates surgery by avoiding endobronchial intubation with large cuffed tubes into the surgical field. In patients with low pulmonary reserve, bilateral lung HFJV is required: two JVHF ventilators with different ranges delivering separate ventilation to the right and left lungs avoid left hypoventilation and right surgical emphysema and insure good surgical conditions.
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Annales de chirurgie · Jan 1989
[Value and current role of anterior mediastinotomy in the diagnosis of mediastinal diseases. Apropos of a series of 100 cases].
One hundred anterior mediastinotomies performed between 1981 and 1987 resulted in the diagnosis of 90 malignant mediastino-hilar or anterior mediastinal tumours, 4 benign lymph node diseases and 6 non-specific lesions. This easy to perform biopsy technique was followed by low morbidity (7%) and one death after 48 hours due to major mediastinal compression. Its sensitivity and specificity make it a valuable alternative and, according to the authors, preferable to mediastinoscopy in the diagnosis of tumours of lymph node diseases in the anterior, pulmonary hila, especially on the left side, and anterior mediastinal lymph node chains.