Journal de chirurgie
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Journal de chirurgie · Jun 1994
[Results of vascular repairs in trauma of the femoral veins, iliac veins and the inferior vena cava].
We examined the records of 12 patients operated for lesions of the inferior vena cava, the iliac vein, or the common femoral vein were examined. The results of venous grafts, treatment of the lesions of the posterior inferior vena cava or the supra hepatic vena cava and the permeability after repair of these large vessels was studied. Treatment included simple suture (n = 9), venous patch (lateral iliac vein, n = 1), and venous autografts (common femoral veins, n = 2). ⋯ Haemostais of posterior or supra-hepatic lesions to the inferior vena cava was obtained with clamping. In cases with associated hepatic involvement, haemostasis was controlled with a four-way clamp and trans-hepatic access or digitoclasty. Long-term permeability of venous repair was good.
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Journal de chirurgie · Apr 1992
Case Reports[Pneumatic tourniquet paralysis. A differential diagnosis after loco-regional anesthesia of the upper limb].
A case is reported of a severe neurological deficit after hand surgical using pneumatic tourniquet. The 51 year old ASA I patient underwent an axillary block for hand surgery using 50 ml of mepivacaïne 1%. The tourniquet was remained at 300 mmHg for only 45 min. ⋯ As there was no improvement, epineurotomy was carried out on day 60, to liberate the median nerve which was severely compressed in the canal brachial. The patient then started to improve slowly. But many safety factors can decrease the rate complications: the accuracy and integrity of the pressure-monitoring must be verified, a tourniquet pressure above 300-500 mmHg would rarely be required in normotensive patient with compliant vessel, a pressure of 200 mmHg will almost all cases provide a bloodless field, tourniquet must be applied on diaphysis and not on bony relief.
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Diverticular disease is generally benign but may be life threatening should progressive complications occur. Under these circumstances cure may only be obtained if properly performed surgery is undertaken at the right moment. ⋯ The radical treatment of sigmoid diverticulitis is rectosigmoid resection, however, this concept may be altered according to the circumstances as follows: 1 - sigmoid diverticulitis without pericolic complications 2 - peri-sigmoid complications: peri-sigmoid abscess, intestinal and vesical fistulae. 3 - generalised peritonitis due to perforation into the peritoneal cavity. The advanced age of the patient should be stressed (mean age 65 years and 25% over 75 years) associated with a high incidence of multiple organ failure and hence the high mortality in more than 50% of cases in the event of peritonitis.
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Journal de chirurgie · Oct 1990
[Reduction of traumatic dislocation of the shoulder. For a gentler approach....].
Early traumatic anterior dislocation of the shoulder may be reduced very easily using a method combining gentle traction along the axis of the arm, slow external rotation and outwards pressure on the humeral head with the patient seated. This gentle method does not require sedation or analgesia.