[Treatment of perforated duodenal ulcer by laparoscopy. 35 cases]

OBJECTIVE

Laparoscopic treatment of perforated duodenal ulcer is an alternative to laparotomy. We reviewed our experience to determine feasibility and reliability of the surgical procedure and the subsequent morbidity and mortality.

PATIENTS AND METHODS

This was a retrospective series of 35 patients who underwent laparoscopic repair of perforated duodenal ulcers between January 1994 and November 1999. The perforation was closed by interrupted sutures in 86% of cases associated with irrigation-suction of the abdominal cavity.

RESULTS

Two complications were observed: pyloric stenosis in one patient with a large perforation and Douglas pouch abscess in another. Conversion to laparotomy was necessary in 8 cases: in 2 of them the edges of the perforation were fragile, in 3 the perforation could not be identified (posterior position), and in 3 intraabdominal adhesions were important. There were no deaths. The 2-year results are quite satisfactory.

CONCLUSION

This study shows that the laparoscopic procedure is reliable and adapted to treat ulcer perforation if the size is less than 1 cm.

[Spontaneous colonic ischemia]

Spontaneous ischemic colitis is a frequent disease, affecting mostly elderly people and predominantly localised on the left and sigmoid colon. It is due to alterations of small vessels of the colon and/or modifications of the splanchnic blood flow. Spontaneous evolution is generally favorable with restitution ad integrum of the disease colon. The diagnosis of ischemic colitis is established from the clinical picture, CT-scan and colonoscopy. Surgery, under the form of colonic resection, is required in 15% of cases approximately, in case of colonic necrosis.

Intra-abdominal gastric volvulus. An indication for gastropexy through laparoscopy

Intra-abdominal gastric volvulus is a chronic or acute condition that may be cured by conventional surgery through laparotomy. We report a case of subacute intra-abdominal volvulus who benefited from a gastropexy through laparoscopy. We show that this technique is feasible, safe and efficient. Technical details are described to perform the procedure easily and rapidly.

[Value of a single low-pressure drain in the postoperative care of bilateral thyroidectomies. Retrospective comparison with bilateral Redon drains]

Double "high vacuum drains" are usually recommended following bilateral thyroidectomy. A single "low vacuum drain" is an attractive alternative when the surgeon considers drainage is necessary. This retrospective study was designed to compare the postoperative outcome following the use of two types of drains. The clinical features, biochemical profile and histopathology were comparable between the two groups: group 1 (high vacuum, n = 77), and group 2 (low vacuum, n = 71). The percentage of total thyroidectomies was significantly higher in group 2 (51% versus 34%, p = 0.04) and this discrepancy was adjusted in the statistical analysis. There was no statistical difference in the outcome of group 1 versus group 2 in terms of wound infections (0% vs 0%), haematoma (0% versus 0.04%), duration and volume of drainage (2.1 versus 2.0 days, 118 versus 117 ml), and hospital stay (3.2 versus 3.2 days). A single "low vacuum drain" is therefore a safe and simple alternative to provide adequate post operative drainage following bilateral thyroidectomy.

[Intratumoral chemotherapy in an experimental animal model: another therapeutic possibility in cancerology]

OBJECTIVE

Assess the efficacy of intratumoral chemotherapy in a colonic tumor model implanted subcutaneously in the BD IX rat.

METHOD

In order to determine their antitumoral effect, 5 anticancer drugs were administered via intravenous and direct intratumoral routes 2 or 10 days after subcutaneous inoculation of tumoral cells. Intratumoral diffusion was evaluated using Patent blue injected directly into the tumoral tissue. Cisplatinum was administered via intratumoral, intravenous and intra-arterial routes to determine the intratumoral and intrarenal concentrations achieved with each of these administration routes. Cisplatinum was also administered via intravenous and intratumoral infusion for 30 minutes to determine the antitumoral effect of each of these routes.

RESULTS

Mitomycin and cisplatinum inhibited growth of tumors which had not yet become established and caused advanced stage tumors to regress. For early stage tumors, the intratumoral route was always more effective than the intravenous route. Patent blue diffusion demonstrated a nonhomogeneous intratumoral distribution. Compared with intravenous or intra-arterial infusion, intratumoral infusion gave much higher concentrations of cisplatinum within the tumors and reduced systemic diffusion. At 7 weeks, the antitumoral effect was equivalent for the 2 administration routes while at 13 weeks, the intratumoral treatment was more effective than the intravenous treatment.

CONCLUSION

These findings in an experimental animal model demonstrate that intratumoral chemotherapy is more effective than intravenous chemotherapy. It is however still impossible to consistently cure tumors induced in animals.

[Laënnec, re-inventor of the stethoscope?]

According to our common medical culture, some facts are simply unquestionable, for instance Laënnec invented the stethoscope. But was he the first one? On a recent trip to Egypt we visited the temple of Kom Ombo, built prior to the roman period and renowned as a medical care center. Today, the tourist is fascinated by the magnificent hieroglyphics on the well-preserved walls testifying to significant advances in various fields of medicine including ophthalmology and gynecology. We were particularly interested by the basreliefs presenting vivid drawings of some of the first medical instruments. We easily identified curettes, scissors, a balance, forceps for dental extraction, and a surgical saw, but were captivated by two other instruments. The first one looked a lot like what Laënnec invented around 1820. The second one was amazingly similar to the instrument we use everyday, with a distal opening and flexible tubes (woven papyrus?) leading to proximal ear pieces. Our Egyptian guide was formal: the stethoscope was invented in Egypt. The scientific impact of our observations leaves something to be desired, but did make us think about the huge gap between the advancement of medical knowledge in ancient Egypt and Laënnec's (re)-invention. Exposed to a similar gap in history, what would our documents stored on CD and video tapes have to say to future touring doctors?