Giant aneurysm of the splenic artery--a case report

Giant aneurysms of the splenic artery larger than 10 cm are rare. The size of splenic aneurysms rarely exceeds 3 cm. Aneurysms that are often symptomatic because of their size must be treated rapidly before rupture. An etiologic and diagnostic evaluation with computed tomography and selective angiography of the visceral arteries is essential before treatment. Operative indication is imperative for these aneurysms. Their mass with portal compression and dense adhesions to adjacent organs allow only aneurysmal exclusion by proximal and distal ligation with preservation of the spleen. The control of the proximal splenic artery is often difficult, justifying the choice of the surgical access. A case of surgically treated giant splenic artery aneurysm associated with right benign renal lesion is presented with a review of the literature on this subject.

[Cystic papillary tumor of the pancreas: a rare etiology of abdominal mass in children]

BACKGROUND

Malignant pancreatic tumors are very uncommon in childhood.

CASE REPORT

A 13-year-old girl was admitted for investigation of an abdominal mass with fever. Ten months earlier, clinical examination performed for similar symptoms found an epigastric mass which resolved spontaneously. Radiological investigations showed a well-encapsulated cystic tumor in the pancreas. Excision revealed a papillary cystic tumor of the pancreas.

CONCLUSION

Papillary cystic tumor of the pancreas is an unfrequent cause of abdominal mass in children. Its excellent prognosis after complete excision is quite different from that of other malignant pancreatic tumors.

[Distension of the digestive tract. A pathology caused by altitude?]

A rare manifestation of digestive tract distension involving all the cavities was observed in a patient who had journeyed at high altitude. There was no organic obstruction suggesting that the increase in organ volume was related to decreased atmospheric pressure according to Maiotte's law. Distension may have been favoured by the diminished abdominal muscle tone, resulting in a lack of adaptation. Dilatation was predominant in the large organs, particularly the stomach and the colon.

Selective contraindications based on multivariate analysis for operative cholangiography in biliary lithiasis

This study was done to select patients with a low risk of common bile duct (CBD) stones in whom operative cholangiography could be avoided. Operative cholangiography was performed upon 511 patients. Two different groups of patients were identified--patients with CBD stones visualized by CBD exploration (n = 90) and patients with no CBD stones at the time of operative cholangiography (n = 421). Multivariate analysis (stepwise logistic regression) showed that five variables were correlated with the presence of CBD stones--size of CBD equal to or greater than 12 millimeters, gallstones equal to or less than 10 millimeters, advanced age, chronic or acute cholecystitis and past history of biliary colic. Using a scoring system, a group of patients with a low risk (less than 2 percent) of CBD stones could be easily determined. In this group of patients, operative cholangiography may be avoided.

[Peripheral nerve block during ambulatory surgery of varicose veins]

This retrospective study of the 46 operations, carried out over a one year period for lower limb varicose veins using peripheral nerve blocks, included 45 patients (35 women and 10 men, mean age 49.3 years), all ASA 1 or 2, except for 4 elderly patients with a varicose ulcer (ASA 2 or 3). In 40 procedures, a sciatic nerve block combined with a "3 in 1" lumbar plexus block at the level of the groin (as described by Winnie) were used. In the remaining six, either a sciatic nerve block (short saphenous vein crossectomy; n = 3), or a "3 in 1" lumbar plexus block alone (short stripping of the long saphenous vein; n = 3) were required. A peripheral nerve stimulator to locate accurately each nerve was used. For each nerve block, the anaesthetic mixture consisted of 20 ml lidocaine 1.5% with 1:200,000 adrenaline, and 10 ml of bupivacaine 0.375% with 1:200,000 adrenaline. Surgery was only performed on one limb at a time, as the required dose of local anaesthetic was too high to safely carry out bilateral nerve blocks. In 71.7% of patients surgery was made on an day-case basis. Of those patients who had to remain in hospital overnight or longer, the peripheral nerve block was never responsible for this. During the same period, nine similar procedures were carried out under general anaesthesia, and two under epidural anaesthesia. They included seven bilateral varicose veins, three patient refusals for peripheral nerve blocks, and one allergy to lidocaine. Already used for some procedures in orthopaedic and casualty surgery, peripheral nerve blocks seem to be well suited for surgery of unilateral varicose veins.

[Neurologic complications of cocaine abuse]

Cocaine is increasingly used by drug addicts. It is considered harmless, but numerous, varied and often serious complications due to its abuse have been published. Among these, neurological complications are in the forefront. They include generalized or partial epileptic seizures, ischaemic or haemorrhagic cerebral vascular accidents, visual loss caused by optic neuropathy or by retinal artery occlusion, headaches and exacerbation of tics. Infections of the central nervous system are possible via endocarditis or septicaemia of venous or nasal origin. Neurological disorders may also occur as a consequence of a major cardiovascular complication induced by cocaine (myocardial infarction and/or dysrhythmia, aortic dissection). These neurological complications are unpredictable, and they weigh heavily on the functional and sometimes vital prognosis in habitual or occasional cocaine abusers.

Tuberculous aneurysm of the femoral artery: a complication of bacille Calmette-Guérin vaccine immunotherapy--a case report

A case of bilateral femoral mycotic aneurysms resulting from bacille Calmette-Guérin vaccine, is reported in a 74-year-old man treated by intravesical immunotherapy. The diagnosis was made after histologic and bacteriologic examinations and biochemical analysis of the acid-fast-baccilli. Treatment consisted of resection and replacement of the femoral arteries, with an expanded polytetrafluoroethylene graft on the left side and a saphenous vein graft on the right side. After surgery the patient was treated with antituberculous chemotherapy for 1 year. The patient was doing well 18 months later.

[Volvulus of the gallbladder. Apropos of a new case]

A case of volvulus of the gallbladder is reported, preoperative diagnostic of this rare lesion being difficult to establish in spite of the contribution of ultrasound imaging. The non-specific clinical findings suggest the need for cholecystectomy.