Annales de chirurgie
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We report a series of 40 patients treated by intraoperative radiotherapy between 1988 and 1992 (18 primary tumors, 13 local recurrences and 9 nodal extensions). The doses delivered were 15 Gy to 25 Gy, completed by external radiotherapy (15 to 45 Gy) in 13 cases. The local tumor control rate was 61% for initial therapy in primary tumors (70% for adenocarcinoma of the stomach) and 80.9% after complete en bloc surgery. ⋯ Two patients died (5%) during the postoperative period. We observed 2 hemorrhages and 3 cases of stone-free cholecystitis. The value of this approach must be confirmed in rigorous indications in comparison with surgery alone in controlled and randomised clinical trials.
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Gunshot or stab wounds with equivocal evidence of intraabdominal injury lead to negative laparotomy in 20% to 30% of cases. The aim of this prospective study was to evaluate, in hemodynamically stable patients, the role of laparoscopy in order to reduce the rate of unnecessary laparotomies for such wounds. This study was carried out in 21 patients. ⋯ Thirteen unnecessary laparotomies were avoided (62%). Laparoscopy was found to have a 100% specificity and sensitivity for the diagnosis of peritoneal effraction and diaphragmatic injury. Laparoscopy is very effective for evaluation of equivocal penetrating wounds.
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Annales de chirurgie · Jan 1995
[Surgical treatment of pneumothorax. Study of a series of 400 cases].
Surgical management is indicated for recurrent forms of pneumothorax as well as for failures of tube drainage. We report a series of 400 patients treated surgically mainly by pleural abrasion over the past 17 years. Statistical analysis of the results identifies two groups: 308 patients under the age of 45 years had surgery mainly for spontaneous idiopathic pneumothorax, where as 92 patients over the age of 45 years had surgery mainly for emphysema. ⋯ The main complication was a residual pneumothorax after drain removal requiring further drainage (10%). A single recurrence occurred (0.25%). Pleural abrasion is a very effective way to treat recurrent forms of pneumothorax.
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Annales de chirurgie · Jan 1995
[Voluminous inguinal hernias can also be treated under local anesthesia].
In patients with a large inguinal hernia, surgeons are usually reluctant to use a local anesthesia as described in the Shouldice technique. The purpose of this study was to appreciate the efficiency of such a technique. Routine local anesthesia used 200 cc of 0.5% lidocaine injected subcutaneously in the groin area and more deeply, near the anterior superior iliac spine in order to achieve a nerve block of the genital branches of the ilioinguinal and genitofemoral nerves. ⋯ All patients had a Shouldice repair and none required the use of a prosthesis. Patients were reviewed after a mean of 36 months of postoperative course (from 5 to 79 months). No hernia recurrence was observed, five patients had "residual" pain.