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Two cases of end-to-end and end-to-side jejuno-ileal bypass for the treatment of obesity are reported in which both patients underwent reoperation 17 and 23 months later respectively. Macroscopic examination and measurements of length of the various segments of the small intestine have been performed twice in each patient: at the time of the bypass and at the second surgical procedure. In one patient a histological study of both the excluded and functioning small intestine was carried out at the time of each surgical procedure. The functioning intestine had increased in size while the excluded segment had become narrowed. The height of the villi had increased slightly in the functioning ileum and more so in the functioning jejunum compared with the preoperative measurements. In contrast, the height of the villi was moderately reduced in both the bypassed jejunal and Heal segments. These findings confirm the results of experimental studies in animals.

The authors report a case of pseudocyst of the spleen. This is a rare entity which is part of nosological type of nonparasitic splenic cysts. It has most often a post-traumatic origin. The diagnosis is evoked in front of a mass of the left hypochondrium and has to be confirmed by further examinations, in particular by sonography and scanner. A microscopic examination of the surgical specimen is the only way to establish the diagnosis of a pseudocyst. The histological characteristic of pseudocyst is absence of epithelium. The splenic pseudocysts require a surgical treatment. In most cases, a splenectomy is performed. A the moment, cyst resection and partial splenectomies are performed by a few authors. This is the type of technique that we prefer especially when the patient is young.

Angiectasia of the right colon is a new entity which must be considered in cases of lower intestinal haemorrhage. Moore's classification is the one that is generally accepted today; it distinguishes between 3 types the most interesting and best individualized of which is type I. It consists of acquired lesions occurring after the age of 60, often multiple, localized in the right colon and frequently associated with aortic stenosis and atheroma. The diagnosis of these vascular malformations is usually delayed because the lesions are submucosal and not visible at endoscopy. Bimesaraic arteriography may show typical images where extravasation of contrast medium is associated with vascular tuft or "tuff". Even the anatomicopathological confirmation of the diagnosis is difficult, since the lesion can only be located by special techniques, such as intra-arterial injection of a silicone-containing substance. Owing to the failure of modern techniques such as embolization, the only possible treatment is surgical, based on resection of the colonic segment involved.

The authors have reviewed a series of 5 348 cases of appendectomy. They have registered 25 post-operative deaths, of which 22 were due to medical complications and 3 to surgical complications. Surgical complications, which involved a second operation in the early post-operative period, were noted in 31 patients. In over 50 p. cent of the cases, complications have been observed after appendectomies for common appendicitis. Most of the time, they were revealed by an occlusion, a peritoneal syndrome or a setting of intraperitoneal abscesses. In about 50 p. cent of the cases, the post-operative occlusion points to the presence of an abscess, a peritonitis or an hematoma. The most frequent and severe complications are caused by infection. In the present series, an overall mortality of appendectomy of 0.47 p. cent has been observed. In the patients who have to be reoperated, the overall mortality of 6.6 p. cent corresponds to a risk which is 15 times higher.

International audience; The effect of a chronic administration of cholecystokinin (CCK) on the rat pancreas has been studied in rats subjected to a 90% jejunoileal bypass or an intestinal transection (controls). Jejunoileal bypass, when compared to transection, did not modify the size of the pancreas but decreased its enzyme content, especially for amylase, and reduced the number of zymogen granules. These structural and biochemical changes were maintained when bypassed animals were treated three times daily and for six days with cholecystokinin (20 Ivy Dog Units (IDU)/kg). In contrast, CCK treatment in transected animals induced growth of the pancreas due to cellular hypertrophy and hyperplasia; pancreatic enzyme content, especially for chymotrypsin, and the population of zymogen granules in acinar cells were also enhanced. It is concluded that jejunoileal bypass prevents the trophic action of chronic CCK on the pancreas.

The longitudinal and circular deformations of the intestinal wall have been studied simultaneously with the intestinal electrical activity. Tracings were obtained for several weeks by means of a compact device which was implanted on the jejunum in 6 dogs and 4 rabbits. The results showed that the transverse movements of the intestine corresponded to the muscular activity of the circular layer. The longitudinal movements were observed permanently in the rabbit. In the dog they could correspond to a contraction or a relaxation movement. In the two cases, no electrical activity was related to the longitudinal mechanical activity of the intestine.

The influence of a 90% jejunoileal bypass on the rat exocrine pancreas was studied by morphometrical procedures. In sham-operated animals exocrine acinar cells accounted for 80.3% of the pancreas volume. These cells are composed of 9.9% nuclei, 8.4% mitochondria, 12.2% zymogen granules, 0.3% lipid droplets and 69.2% of a compartment (“ERGLS”) composed of endoplasmic reticulum, ribosomes, Golgi areas, lysosomes and the cytoplasmic ground substance. Intestinal bypass did not change the volume density of exocrine cells nor that of nuclei in the cells during the three postoperative months. The means nuclear diameter was approximately the same in both groups. However, the volume density of secretory granules diminished by 50%. This was accompanied by a decrease in mean granular diameter, but not in their numerical density. The volume density of lipid droplets increased 10 fold, that of mitochondria increased slightly from the 15th postoperative day but significantly from the 45th day. The remaining cellular compartment composed of “ERGLS” was not modified by intestinal bypass. These findings suggest that a 90% jejunoileal bypass induces major changes in the composition of pancreatic acinar cells but not in their size.

The rare instance of a gastrointestinal hemorrhage caused by a lithiasis of the duct of Wirsung is described. The world literature records only 13 other cases. Pancreatic calculi cause hemorrhage by either migrating through the pancreatic parenchyma to perforate the duodenum, ulcerating the vessels of the periductal parenchyma, or rupturing the pancreas. The usual sign of this complication of chronic calcifying pancreatitis, difficult to diagnose, is repeated gastrointestinal hemorrhages and sometimes pain, as in epigastric colitis. The immediate therapy is control of the hemorrhage. With transcatheter occlusive techniques, radical surgery can be postponed until it is more tolerable.

The anatomic account brings to bear particularly on anomalies of the affluents and the various forms of long saphenofemoral junctions. The different anastomoses of short saphenous veins are also described. Following the anatomic account there is a run-down of the history of these disorders and of mainstream current views of their treatment.

Protein kinase activity and histone kinase isozyme distribution have been determined in soluble extracts of adenocarcinoma of the human colon and compared to adjacent normal mucosa. The results show an enhancement in endogenous protein kinase activity and the presence of an additional isozyme (PKI) for histone kinase activity in the tumour tissue. PKI activity exhibited a peculiar behaviour in comparison to the isozyme. PKII present in both carcinoma and normal mucosa after dialysis of the soluble extracts. It is suggested that alteration of intracellular regulatory processes involved in PKI activity might be related to the maintenance of the proliferate state in human colon carcinoma.

Three observations including one cyst and two pseudocysts of the adrenals are reported. Such lesions are uncommon and are only detected fortuitously or because of poorly specified pains. Diagnosis, formerly based upon intravenous urography and arteriography, has largely benefited from echotomography and computed tomography. Endothelial cysts and pseudocysts account for most of these lesions. The possibility of malignancies justifies the systematic surgical approach.

An objective review of the experimental and clinical literature comparing stapled- and hand-sutured anastomoses in gastrointestinal surgery is presented. Experimental studies support the hypothesis that stapled-sutured lines heal by primary intention, thus avoiding the inflammatory time lag, and resulting in a stronger wound during the first post-operative week. In contrast, manual sutures always produce an early inflammatory reaction with a transitory rise in collagenase activity in the submucosa, which explains the particular fragility of the anastomosis during that phase. Nevertheless, it was difficult to find a concordance between this histological quality of the stapled suture line and clinical results. In oesophageal surgery, a slightly higher rate of stenosis and a lower rate of anastomotic leakage were observed. In gastric and colorectal surgery, the superiority of the stapled suture was not proved. However, in colorectal randomized studies, the presence of "withdrawn" group for which the stapler was the only technically possible alternative, provides undeniable proof that this technique is an indispensable adjunct in modern digestive surgery. Conversely, its value seems negligible in surgery of the small bowel or of the intraperitoneal colon where manual suturing remains the technique of choice.

A group of 25 patients having to undergo laparotomy were prescribed thrombo-embolic preventive stockings of graduated elasticity to be worm from 48 hours before the operation until 9 days afterwards. This group was compared to another group of 25 patients. The thromboses were detected using the fibrinogen test and the Doppler. This study demonstrates the efficiency of prophylactic anti-thrombotic stockings using graduated compression.

Photo-reflex-rheography is a noninvasive method of measuring the filling of the subcutaneous venous plexuses. Daily recording during the pre- and post-operative period permits comparison of the amplitude of the curves and measurement of the time for refilling. Any diminution of these two parameters suggestive of a deep vein thrombosis is an indication for phlebography.

The compression therapy of the lower extremities is based on strong patho-physiologic lines and is well codified. The necessary values of pression for any case and the exact indication for compression stockings and pantys for each compression class are well known. The physician has to prescribe thoroughly the adequate compression stocking, thus protecting the patient best against further complications.

Biochemical, structural, and functional studies of the exocrine pancreas were performed in adult male Wistar rats over a 3-month period following a 90 per cent jejunoileal bypass or sham operation. The wet weight of the gland, its content in total protein and DNA, as well as its structural organization were similar in both groups. The enzyme content was globally reduced after bypass surgery. However, amylase was much more and earlier affected than lipase and chymotrypsinogen. In addition, zymogen granules diminished in size while lipid droplets deposited in acinar cells. Enzyme secretion stimulated or not by increasing concentrations of caerulein in vitro was generally reduced after intestinal bypass and approximately parallel to the depressed amount of enzymes in the pancreas. These findings suggest that jejunoileal bypass does not modify the size of the rat pancreas despite protein deficiency, but its enzymatic composition and secretory function is altered.

The differences between venous and reversible lymphatic oedema are minimal. Save a few rare exceptions, venous oedema are complicated at some stage by lymphatic oedema and become irreversible because of the fixation of water by the interstitial proteins and the hypertrophy of the conjunctival tissue.

Morphologic and functional adaptations of the functioning intestine were evaluated in 41 patients before and after biliopancreatic bypass for morbid obesity. This surgical procedure diverts pancreatobiliary secretions via the duodenum and the jejunum into the colon, the remaining small intestine being anastomosed to the stomach after antrectomy. In the proximal ileum there was an 80% increase of the height of villi; the specific activities of maltase, sucrase, and aminopeptidase in brush border membranes remained unaffected, and that of lactase tended to decrease. In the distal ileum villi heights increased only by 58%, and disaccharidase activities (except for maltase) were slightly enhanced. In the colon the mucosa displayed, in some patients, focal appearance of true villi, and brush border enzyme activities increased concomitantly. We conclude that biliopancreatic bypass induces an adaptation of all intestinal segments of the functioning intestine; this adaptation tends to compensate for the shortening of the gut continuity.

Peritoneal mesothelioma ranks second in frequency after pleural mesothelioma. A well-established clinical entity since 1960, mesothelioma is increasingly frequent due to improvements in diagnostic methods and to the fairly wide industrial use of asbestos, a well-known carcinogenic substance for mesothelial cells. The diagnosis of malignant peritoneal mesothelioma rests on a corpus of convergent data. Treatment consists of surgery combined with radiotherapy and chemotherapy. The mean survival from the time of diagnosis is 8-10 months.

Investigations we carried out in man and animals in order to study the relationships between the electrical and the mechanical activities of the intestine, and to precise the role of BER in the regulation of intestinal motility. In the dog, an intestinal movements transducer allowed to establish that spiking activities were concomitant with circular contractions, and that these two phenomena were rhythmed by the slow waves. Under basal conditions, the longitudinal movements occurred independently; under stimulation longitudinal movements occurred independently; under stimulation longitudinal relaxations were observed to correspond to circular contractions. In man, the post-laparotomy paralytic ileus provoked abnormalities in the BER which seemed to be related to a disturbance of the coordination of the motility, resulting in the absence of intraluminal propulsion. Administration of coherin, a postpituitary extract, was followed by a regularization of the BER and by a decrease of paralytic ileus duration. This confirms the important role of the BER in the myogenic regulation of the intestinal motility.

The authors report a series of 22 patients operated for primary hyperparathyroidism. The parathyroid adenoma was located preoperatively by MRI and ultrasonography. Measurement of the relaxation time was performed in vitro at 37 degrees C in a 0.47 Tesla field during the 30 minutes following resection. The relaxation times obtained at a precession frequency of 20 mHz were 0.844 +/- 0.16 sec for T1 and 0.082 +/- 0.025 sec for T2. MRI had a sensitivity of 73% and a specificity of 88% for the localization of the parathyroid adenoma, while ultrasonography had a sensitivity of 73% and a specificity of 98%.