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Resume L'elimination biliaire du cefotaxime (CTX) et du desacetylcefotaxime (DSCTX) a ete etudiee par chromatographie liquide a haute performance chez 9 malades operes recemment pour une lithiase des voies biliaires. Un systeme original de recueil de la bile, consistant a placer une sonde de Fogarty, ballonnet gonfle, dans la branche distale d'un drain de Kehr, a permis un recueil total de la bile secretee par les malades durant les 8 heures de l'etude cinetique. Des clairances biliaire et metabolique du CTX ont ainsi pu etre calculees chez ces malades. Le pic biliaire du CTX, a la 90e minute, est de 34,5 ± 15,3 μg/ml. Dans l'echantillon 7–8 h, la concentration etait de 2,7 ± 1,7 μg/ml. Le pic biliaire du DSCTX, egalement a 90 minutes, et le taux residuel, a 7–8 h, sont respectivement de 49,3 ± 17 et 4,6 ± 3,2 μg/ml. Les rapports bile/serum du CTX et du DSCTX sont superieurs a 1 de la premiere a la huitieme heure (1,35 ± 1,08 a 11,0 ± 3,1). La clairance biliaire du CTX s'eleve a 0,190 ml/min, et les quantites totales de CTX et DSCTX eliminees dans la bile sont respectivement de 1050,0 ± 472,8 μg et 1902,7 ± 804,1 μg (soit 0,093 ± 0,041 p. 100 et 0,186 ± 0,077 p. 100 de la dose administree). En regard des CMI de la majorite des germes rencontres dans les infections biliaires, le CTX devrait etre un antibiotique a considerer favorablement pour le traitement de ces infections, ceci d'autant plus qu'il ne perturbe pas l'ecosystmeme bacterien intestinal.

Le taux du facteur VIII circulant a ete etudie a differents niveaux au cours de catheterismes veineux, d'arteriographies, d'interventions chirurgicales abdominales et thoraciques. Les donnees ainsi obtenues ont ete analysees soit par la methode directe qui compare au taux arteriel afferent d'un territoire le taux veineux efferent, soit le plus souvent par une methode indirecte qui compare le taux local au taux de la veine du membre superieur, pris selon l'usage comme taux de reference exprimant le taux de base du facteur VIII de l'organisme. La conclusion a laquelle tend notre analyse et qu'il serait necessaire d'etayer ou d'infirmer par des recherches plus nombreuses et plus systematisees, sous-traites aux hasards hospitaliers, est qu'il existe des zones de regulation a balance (feed backs tel que le poumon, la rate, peut-etre le foie) susceptibles d'accroitre ou de diminuer le taux du facteur VIII selon la quantite qu'elles en recoivent et sans qu'il soit possible de savoir si elles agissent par synthese ou destruction, par mise en circulation ou depot, par activation ou neutralisation. D'autres zones (les masses osteomusculaires, les reins) paraissent n'avoir qu'une regulation simple, epargnant ou diminuant le facteur VIII qu'elles recoivent. Mais aucun lieu privilegie, ni le foie, ni la rate, ne paraissent pretendre au role d'organe de formation de ce facteur dont l'origine toujours mysterieuse connue en 1954 est peut-etre ubiquitaire (Brinkhaus) [1].

The aim of this study is to objectively review the experimental and clinical literature comparing stapled and hand-sutured anastomoses in gastrointestinal surgery. Experimental studies support the hyp

Two cases of a rare complication of this tumor have been reported. A hepatoma can provoke an intra-peritoneal hemorrhage in two different ways: either by tearing through the hepatic tissue which surrounds it or by necrosis and hemorrhage of the tumor itself. This complication may be the initial symptom and may require emergency surgery. Local hemostasis if often precarious and does not resolve the underlying oncological problem. At best, survival is limited to several months. Rapid removal of the tumor seems to be the only means of prolonging survival although there is not yet much data on this in the literature. At any rate the poor general condition of the patient, the frequent multiplicity of the tumoral locations and the habitual cirrhotic nature of the rest of the liver would rule out any possible surgical removal in 90% of cases. In the remaining 10% where surgery is possible, the average survival rate is 13 months.

The authors report the case of a man aged 59 years, with primary hyperparathyroidism; removal of a first adenoma, did not lead to recovery. Later, an egg-shell calcification was found together with a second large cervico-mediastinal parathyroid adenoma, the removal of which caused all the symptoms to disappear. After a review of other cases in the world literature with calcification of the parathyroid glands, the authors consider, before using more complicated techniques for preoperative localisation of parathyroid adenomas, one should carry out careful radiological examination of the cervical and mediastinal region. Under these conditions, one may detect significant calcifications which have escaped routine examination and may contribute to the topographic diagnosis of the parathyroid lesion sought.

Primary linitis plastica carcinoma of the colon is rare. Only 19 cases have previously been described in the american literature and three french cases are reported. Clinically, this entity appears as an inflammatory lesion. It revolves to a stenotic lesion and death by metastases. Eighty-four per cent of carcinomas are beyond the splenic angle and sixty-six per cent are localized on rectum or distal sigmoid. These tumours are accessible to rectoscopic examination and biopsy which is the only examination able to assert the diagnosis of linitis. Histologically, nothing can distinguish a primary colonic localization from a metastasis. Therefore, it is very important to search for a primary localization especially gastric. Surgical resection is efficient with or without X ray-therapy as we have seen it with control of carcino-embryogenic antigene evolution in one of our cases. Prognosis is bad, especially among people over 50 years with metastasis.

The biliary elimination of cefotaxime (CTX) and its metabolite desacetylcefotaxime (DSCTX) were measured by HPLC in nine recently cholecystectomised patients following the i. v. injection of 15 mg/kg body weight of CTX. All of the bile was collected by an original procedure: the inflated balloon of a Fogarty catheter was introduced into the distal branch of a Kehr drain T-tube. Biliary clearance of CTX and DSCTX was measured for 8 h. Cefotaxime peaked at 90 min after injection at 34.5 +/- 15.3 mg/l; in the 7-8 h sample it was 2.7 +/- 1.7 mg/l. DSCTX peaked at the same time at 49.3 +/- 17.0 mg/l, and was 4.6 +/- 3.2 mg/l at 8 h. The bile/serum ratio of CTX and DSCTX concentrations was above 1 from the first to the eighth hours (range: 1.35 +/- 1.08 to 11.0 +/- 3.1). The biliary clearance of CTX was 0.190 ml/min. The total amounts of CTX and DSCTX eliminated in bile were respectively 1050 +/- 472.8 micrograms and 1902.7 +/- 804.1 micrograms (0.093 +/- 0.041% of the dose and 0.186 +/- 0.077% of the dose). Considering the minimum inhibitory concentration of the pathogens currently encountered in biliary sepsis, CTX should be a suitable antimicrobial agent for the treatment of biliary infections.

The biliary excretion of cefotaxime (CTX) and its metabolite desacetylcefotaxime (DSCTX) was measured by HPLC in 9 recently cholecystectomized-patients following the IV injection of 15 mg/kg body weight of CTX. The totality of bile was collected by an original procedure: the inflated balloon of a Fogarty catheter was introduced into the distal branch of a Kehr drain T-tube. Biliary clearance of CTX and DSCTX was measured for 8 h. Cefotaxime peaked at 90 min. after injection at 34.5 +/- 15.3 micrograms/ml; in the 7-8 h sample it was 2.7 +/- 1.7 micrograms/ml. DSCTX peaked at the same time at 49.3 +/- 17.0 micrograms/ml, and was 4.6 +/- 3.2 micrograms/ml at 8 h. The bile/serum ratio of CTX and DSCTX concentration was 1 from the 1st to the 8th hours (range: 1.35 +/- 1.08 to 11.0 +/- 3.1). The biliary clearance of CTX was 0.190 ml/min. The total amounts of CTX and DSCTX eliminated in bile were respectively 1050 +/- 472.8 micrograms and 1902.7 +/- 804.1 micrograms (0.093 +/- 0.041 p. 100 of the dose and 0.186 +/- 0.077 p. 100 of the dose). Considering the minimum inhibitory concentration of the pathogens currently encountered in the biliary sepsis, CTX should be a suitable antimicrobial agent for the treatment of biliary infections.

The authors describe a modification of Hunter's technique of flexor tendon grafting. The operation is performed in two stages. At the first stage, a silastic prosthesis is inserted and the proximal end of the flexor digitorum profundus is sutured to the tendon of palmaris longus. This suture will represent the proximal suture of the future graft. At the second stage, six weeks later, the palmaris longus is divided proximally and the graft is passed distally to be sutured to the terminal phalanx. This modified technique allows a gain in time, a better blood supply to the graft and a safer proximal suture.

Some prognostic features out of 57 cases at upper gastrointestinal hemorrhage, in people more than 65 years old, are reported. The age has no significance but after 70, gastroduodenal ulcers represent the more frequent etiology, with a very particular severity in cases of chronic and acute gastric ulceration. The mortality is still high, mainly due to decompensation of pre-existent renal, cardio-vascular or pulmonary taints, frequent in aged people.

We describe a case of pancreatic cystadenoma (PC) concerning a 66 year-old woman. This PC was a highly vascular cystic tumor, with typical signs: pulsatile tumor, systolic epigastric souffle and demonstrative phonangiography; the selective angiography revealed a hypervascular mass. Microscopically, tiny cysts lined by small, cuboid and columnar cells containing no glycogen, and numerous capillaries. With this case and 210 cases from the literature, two problems have been studied in this paper: the problem of the vascularity of the PC and the problem of the associated diseases. The vascularity allows to distinguish two types of PC: PC with hypervascular pattern and hypo- or avascular PC. The study of the associated diseases shows the high incidence of the tumors (23%), benign and malignant (13%) and of the cysts in other organs (5%). Comparison with polycystic disease of the kidney and the Von Hippel-Lindau disease and hypothesis concerning angio-genesis and cystogenesis in the PC are discussed.

Acute primary ulcer of the small intestine is an exceptional occurrence. Diagnosis is established only after a complication occurs. In most instances, this complication is perforation of the gut. Acute primary ulcer of the small intestine is accurately defined by specific histologic criteria. It can be unequivocally distinguished from the many other causes of spontaneous perforation of the small intestine. Experimental studies, although numerous, have not improved understanding of pathophysiology. Nosologic classification remains unclear. Many features are similar to those encountered in acute peptic ulcer but stress is usually absent. Other features resemble those of transient necrotizing enterocolitis ; acute primary ulcer of the small intestine may be a very localized form of this latter condition. Ischemia seems to be the most significant factor. However, for an ulcer and finally perforation to occur, ischemia must probably be associated with a number of other factors.

343 white Wistar rats were divided into three groups of 113, 115 and 115 animals in each group. A control group received an injection of acetic acid into the wall of the antrum whereas the two other groups underwent first, in one group, a vagotomy and pyloroplasty, in the other, a pyloroplasty alone. In all the control animals there was observed, during the days following the injection, the existence of a severe antral ulcer. This ulcer improved with time upon 40th day, then around the 70th day appeared a second ulcer cycle. In the operated animals, the ulcers were definitively less frequent, and the course was linear without a second ulcer cycle. In the light of physiological and morphological evidence, it was shown that injection of acetic acid caused a submucosal lesion with a constant linear course towards the development of a callus which became hyalinised all the more quickly when it was submitted to endogenous agression by gastric juice. Above this callus, the gastric mucosa attempts to regenerate and, owing to the poor quality substratum, becomes ulcerated again, thus constituting the various cycles of peptic ulcer disease. Pyloroplasty and to a lesser degree, vagotomy-pyloroplasty, reduce stasis of the gastric juice and reduce endogenous agression of the callus and thus slow the unfavourable course.

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.

A series of 30 cases of post-operative peritoneal irrigation dialysis for generalised peritonitis. In the light of peritoneal physiology, details are given of the technique for insertion of the peritoneal drains as well as the composition of the dialysate. In addition to its mechanical role, continuous lavage of this type is useful in restoring and maintaining water and electrolyte balance, the limitations of which are described, together with a direct anti-infectious action and temperature equilibration. P.I.D. seems to be associated with a considerable reduction in mortality from acute generalised peritonitis (1 case out of 30). It also limits morbidity, since only 5 minor complications were seen. The simplicity and harmlessness of the method makes it possible to widen, without major reservations, the scope of therapeutic solution to the problem of acute generalised peritonitis.

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.

Gastric lesions in severe cranial trauma are almost constant, whether the patients have bled or not. Routine fiber endoscopy in 63 cases permited the authors to discover various types of lesion, some in association, whether diffuse or localised, e.g. oedema or congestion, viz. congestion, purpura, various sized ulcers, usually situated high up in the stomach, sometimes in the antrum ; their course, whether rapid or not, was often intermittent. Endoscopy is the best method of diagnosis permitting appropriate treatment.

The authors present a case of pheochromocytoma observed in a 49 year old man suffering from the cutaneous form of von Recklinghausen's disease. In this patient, they noted the constant absence of the inferior abdominal cutaneous reflex on the right side, contrasting with the briskness of the other abdominal cutaneous relexes. From this they concluded that the chromaffin tumor was very probably situated in the right adrenal region. This hypothesis was confirmed by retro-pneumoperitoneum, selective arteriography and finally surgical intervention. After having reviewed the essential medical data from the literature concerning the conditions associated with pheochromocytoma and especially phacomatosis, and having looked at the problem of hypertension related to neurofibromatosis, they make a critical study of the behaviour of the abdominal reflexes in case of pheochromocytoma and emphasize the part that it is possible to draw from this in view of its' topographic diagnosis. The present case is the fourth in which one of the authors has noted the abolition of the inferior abdominal reflex on the side corresponding to the site of the pheochromocytoma.

Conservative surgery to spleen is an ancient concept brought up-to date by improved knowledge of its fundamental roles in immunity and anti-bacterial defences. Suture of spleen and partial splenectomy ensure the best possible functional results but have technical limitations resulting frequently in splenectomy to provide hemostasis. Data from clinical and experimental studies and reports in the literature have demonstrated that autotransplantation of spleen is a simple, safe and effective method for preventing the true dangers of asplenia. Optimal results from autotransplantation of spleen are obtained when the injured organ is broken into small fragments which are then implanted into small spaces fashioned in the greater omentum. Clinical and biological tests to evaluate functional value of these transplants have shown that results approach those of a normal or sutured spleen. It is concluded that this procedure, which completes other conservative methods of splenic surgery, should definitely exclude hemostasis splenectomy from therapy of injuries to spleen.

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.

On 200 Wistar white rats the authors experiment the effects of an original solution administered by the mouth on the evolution of a chronic gastric ulcer experimentally induced. This solution tuning for the prevention or the treatment of the stress ulcer seems to aggravate the chronic ulcers in the way of formation but on the contrary accelerates in a way highly significant the cicatrization of constituted chronic ulcers. The local and general effects of different components of this solution produce these double actions and do not contraindicate its clinic utilisation.

Conservative surgery of the spleen only has to overcome certain prejudices to become generally accepted. Today, we are convinced of the essential role of the spleen in the body's anti-infection defence mechanisms and the surgeon now has the means to repair a damaged spleen. We report the simplicity, effectiveness and reliability of three techniques of splenorraphy. Two of these techniques are our own and have been well tested in very extensive animal experiments and in our first clinical applications. Capsular sutures or partial splenectomy can treat the great majority of the lesions seen. When this is not possible, devascularisation of the spleen or autotransplantation of the splenic tissue are simple palliative measures, although there functional value has not been clearly established. The results of this approach are now numerous with adequate follow-up and have revealed no complications, immediate or delayed, inherent in the technique.