Rational Surgical Treatment Research Articles

Principles of the surgical approach in human liver cystic echinococcosis

Ultrasonography (USG) has recently contributed much to the diagnostic of hepatic cystic echinococcosis (CE). The use of portable ultrasonograph allowed us to perform a community survey among 9482 people living in a high risk area for CE in the Florida Department (Uruguay). Positive USG results were found in 123 asymptomatic patients. 48 out of 51 USG positive cases were surgically confirmed and 3 were found to be false positive. The results of this survey allowed us to propose a new classification of the echographic imaging based on the parasite's various evolutive and involutive stages. The Echinococcus granulosus cyst size was compared with the parasite's evolutive stages. The cyst's segmentary topography and the related risk of CE is evaluated. The importance of cystic-biliary communication is pointed out and its rational surgical treatment described. Finally, an algorithm is presented facilitating the choice of a rational treatment.

Carcinoma of the hepatic hilus with superficial spreading to the intrahepatic segmental bile ducts: Report of a case

A case of superficially-spreading carcinoma of the hepatic hilus is presented. Percutaneous transhepatic biliary drainage was performed to alleviate jaundice and to evaluate the biliary system. A nodular tumor originating in the upper part of the common hepatic duct was found to be invading the confluence of the right and left hepatic ducts. Extensive superficial spread was observed in the proximal portion of the right anterior superior, right anterior inferior, right posterior superior, right posterior inferior, and caudate bile duct branches. Preoperative surgical planning was carried out on the basis of an evaluation of the findings of ultrasonography, computed tomography, percutaneous transhepatic cholangiography, and percutaneous transhepatic cholangioscopy. Absolute curative surgery, which included right hepatic lobectomy with total caudate lobectomy and bile duct resection, was performed. Bilioenteric continuity was reestablished with a Roux-en-Y jejunal loop. The histological diagnosis was well-differentiated tubular adenocarcinoma of the common hepatic duct. Postoperative recovery was very good; the patient has now enjoyed a good active social life for the past 4 years and 10 months, with no signs of recurrence. In this case report, we discuss the precise preoperative diagnosis and rational surgical treatment for carcinoma of the hepatic hilus with superficial spread.

Surgical treatment of malunited fracture of zygoma with diplopia and with comments on blow-out fracture

Summary Blow-out fracture is discussed and its classification is described, based on the factors producing the restriction of extra-ocular muscle (EOM) movement. Zygomatic fracture is complicated by EOM restriction and diplopia is present in 15% of recent and 56% of late fractures respectively. The mechanism of EOM restriction in malunited fracture of the zygoma if postulated and the rational surgical treatment is described in detail, together with the favourable results. Surgical intervention is aimed at the creation of a normal bony orbit and thus the establishment of conditions under which the EOM are minimally affected by tethering by intra-orbital scars. Orbital and antral approaches to the orbital contents are available via a single incision and an en bloc resection of a segment of the orbital rim, anterior part of orbital floor and anterior wall of antrum. Partial ostectomy along the proposed line of section is sometimes useful for easy reduction of a malunited fracture of the zygoma. For reconstruction of an extensive bony defect of the orbital floor, or for the fixation of a bone graft or for the creation of the base on which the bone graft is to be placed, the insertion of a short Kirschner wire (K-wire) is useful.

Ventricular aneurysm: Fourteen cases subjected to cardiac bypass repair using the pump oxygenator ∗

Ventricular aneurysm is a frequent late complication of extensive myocardial infarction. Although cardiac rupture is rare, serious and frequently incapacitating symptoms result from the impairment of cardiac function produced by the noncontractile, expansile aneurysm. Embolism from mural thrombi may also produce disastrous complications. Fourteen patients with aneurysm of the left ventricle following myocardial infarction have been treated by surgical excision of the aneurysm utilizing an extracorporeal pump oxygenator for temporary cardiopulmonary bypass, with three deaths. Cardiac catheterization studies performed prior to surgery in twelve of these patients revealed a reduction in cardiac output and significant pulmonary hypertension. After operation cardiac function improved and the eleven survivors received clinical benefits. The optimum time for surgical intervention following myocardial infarction is probably governed by the pathologic state of the diseased myocardium. At 3 months fibrous tissue develops at the margin of the aneurysm and firm repair of the ventricle after aneurysmectomy is facilitated. Surgical excision and ventricular repair is a feasible and rational surgical treatment for ventricular aneurysm following myocardial infarction when the lesion is of sufficient size to cause impairment of cardiac function.

Gastro‐Duodenal Ulcer in Childhood

Summary.The writer reports the case histories of 2 girls, aged 9 and 11 respectively. The younger girl had been suffering from periodic vomiting for 5 years, whereas the other patient had suffered from vomiting for 2 years as well as periodic, partly tardy pain in the epigastric region and exhibited melsena twice. In both patients Ewald's test meal was of a large quantity and X‐ray examination revealed a typical duodenal ulcer.Ulcerations of the stomach and duodenum are most frequently encountered in the first year of life and around puberty. In infancy the ulcers nearly always have appeared in conjunction with infections, intoxications, traumata, circulatory disorders, burns, or cachexia, but the ulcers occurring in children above 5 years of age in the vast majority of cases are based on actual gastroduodenitis.The disease may manifest itself by (a) a gastroduodenitic syndrome just as in adults, (b) the sudden occurrence of complications (haemorrhage or perforation) and finally, presumably most often by (c) vague and uncharacteristic symptoms.Mention is made of complications and differential diagnosis. The treatment should be conservative, considering that the operation most in use for the moment (resection), which presumably is the only rational surgical treatment, entails a high primary mortality apart from being apt to cause lasting disorders. Operation is called for only in cases of severe stenosis and perforation.In the conclusion the writer emphasizes that gastro‐duodenal ulcers in childhood presumably occur more frequently than is generally supposed and that a more extensive use of X‐ray in the examination of children with uncharacteristic dyspeptic symptoms no doubt would lead to a recognition of ulcer more frequently than the procedures used at the present moment.

Occlusion of the Aqueduct of Sylvius by Neoplastic and Non-neoplastic Processes, with a Rational Surgical Treatment for Relief of the Resultant Obstructive Hydrocephalus. (Bull. Neur. Inst. New York, vol. v, p. 348, Aug., 1936.) Stookey, B., and Scarff, J.

Occlusion of the Aqueduct of Sylvius by Neoplastic and Non-neoplastic Processes, with a Rational Surgical Treatment for Relief of the Resultant Obstructive Hydrocephalus. (Bull. Neur. Inst. New York, vol. v, p. 348, Aug., 1936.) Stookey, B., and Scarff, J. - Volume 83 Issue 342

Gastro‐Duodenal Ulcer in Childhood

SummaryThe writer reports the case histories of 2 girls, aged 9 and 11 respectively. The younger girl had been suffering from periodic vomiting for 5 years, whereas the other patient had suffered from vomiting for 2 years as well as periodic, partly tardy pain in the epigastric region and exhibited melsena twice. In both patients Ewald's test meal was of a large quantity and X‐ray examination revealed a typical duodenal ulcer.Ulcerations of the stomach and duodenum are most frequently encountered in the first year of life and around puberty. In infancy the ulcers nearly always have appeared in conjunction with infections, intoxications, traumata, circulatory disorders, burns, or cachexia, but the ulcers occurring in children above 5 years of age in the vast majority of cases are based on actual gastroduodenitis.The disease may manifest itself by (a) a gastroduodenitic syndrome just as in adults, (b) the sudden occurrence of complications (haemorrhage or perforation) and finally, presumably most often by (c) vague and uncharacteristic symptoms.Mention is made of complications and differential diagnosis. The treatment should be conservative, considering that the operation most in use for the moment (resection), which presumably is the only rational surgical treatment, entails a high primary mortality apart from being apt to cause lasting disorders. Operation is called for only in cases of severe stenosis and perforation.In the conclusion the writer emphasizes that gastro‐duodenal ulcers in childhood presumably occur more frequently than is generally supposed and that a more extensive use of X‐ray in the examination of children with uncharacteristic dyspeptic symptoms no doubt would lead to a recognition of ulcer more frequently than the procedures used at the present moment.

GENEVA

<h3>Surgery of the Sympathetic</h3> The Revilliod-Julliard lecture was recently delivered to the Medical Society of Geneva by Prof. René Leriche of Strasbourg. His subject was "The Surgery of the Sympathetic and Its Results." The nervous mechanism of angina pectoris is always the same, no matter what may be the cause of the attack. A rational surgical treatment should aim to interrupt the ascending fibers. A study of one hundred operative cases of angina pectoris, ninety-four of which can be used in statistical analyses, shows that the attacks disappear in about 62 per cent of the cases. In most of these, attacks have been absent for more than three months, but a longer time is necessary before conclusions can be reached as to the permanence of the results. The few failures and most of the mortality (which is 13 per cent) are to be attributed to defective technic and to operations