Chirurgie; mémoires de l'Académie de chirurgie
-
Randomized Controlled Trial Clinical Trial
[Relation between oxygen delivery and consumption during septic states. Value of an early dobutamine test].
From previous studies it has been hypothesized that multiple organ failure and high level of mortality, seen in critically ill septic patients, may be due to defective oxygen extraction and tissue hypoxia occurring early in the course of sepsis. Oxygen flux test has been proposed as a method of revealing an occult oxygen debt. We used a one hour dobutamine infusion test, in septic patients, without increase in blood lactate. ⋯ The RD+ patients improved more rapidly when compared with RD-, NRD+, NRD-. We concluded that a one hour dobutamine test is able to identify R and NR critically ill septic patients. The response is associated with significant difference in outcome.(ABSTRACT TRUNCATED AT 250 WORDS)
-
Thyroid carcinoma and familial intestinal polyposis are not accidentally associated. A new case is described which, along with the other 32 cases already published, reveals an incidence of thyroid carcinoma 100 times higher in patients with polyposis than in the general population, and 160 times higher in female patients under 35 years of age. Several features of these thyroid carcinomas can be pointed out: greatest incidence in women, occurrence at a young age, existence of a papillary tumor appearing independently from the evolution of the polyposis, and probably familial disease. It is therefore necessary to systematically examine the thyroid body in all subjects with familial intestinal polyposis.
-
The initial management of multiple trauma must achieve a triple aim: performing the actions required by a vital emergency, preventing as well as possible the complications associated with the initial lesions, and, most importantly, bringing the injured person into hospital in the best possible conditions for emergency surgery. Achieving these aims requires a perfect coordination of medical and nonmedical rescue. A rough initial categorization is important to decide whether additional medical staff is desirable, choose the type of transport planned (by ambulance, helicopter...) as well as the department or hospital due to receive the patient. ⋯ The indications of ventilatory support must be very wide whenever coma or signs of respiratory distress are noted, more so with an associated shock. The indications of aspiration of a gaseous or fluid pleural effusion must also be discussed. Maximal suppression of pain must be kept in mind throughout all these operations.(ABSTRACT TRUNCATED AT 250 WORDS)
-
Case Reports
[Anatomoclinical forms of fractures of the sternum. Role and methods of osteosynthesis of unstable fractures].
In general, fractures of the sternum are of little interest. This is unfair since unstable fractures may be the cause of paradoxical respiration and hence respiratory distress. Fractures often result from automobile accidents and occur in passengers wearing seat belts. ⋯ With reference to several cases this variety of injury is studied from the anatomo-pathological, clinical and therapeutic viewpoints. Osteosynthesis using a plate and screws limited to the sternum or including neighbouring rib fractures would appear to be the method of choice. Surgical fixation of the fracture site, the methods of which are discussed, is of value for both isolated lesions of the thoracic cage, and also in the context of single stage surgery in certain patients with multiple trauma.
-
Benign in more than 90% cases, dumbbell neurogenic tumors are rare. It was 3 thoracic schwannome and 1 thoracic ganglioneuroma and 1 lumbar schwannoma are reported. In 2 cases complete removal was performed by thoracotomy, in another case thoracic removal was incomplete with leateag of spinal fluid, laminectomy was necessary 3 months later and in a third case laminectomy was performed first because of paraplagia and thoracotomy one month later. ⋯ In thoracic localization a one stage combined resection gives the lowest morbidity. In lumbo-sacral localization tumoral large size requires a combined approach, which can be performed in a single stage. Recklinghausen's association in neurofibroma (4 to 16%) exposes to malign evolution risk (12 to 13%).