Search

The anterior tibial artery arises at the lower border of the popliteus muscle, and passes anteriorly to lie on the interosseous membrane medial to the fibular neck. Injury to the artery results in extravasation of blood, and the tamponade effect of the surrounding tissue may contain acute hemorrhage. The blood clot gradually liquefies resulting in the formation of a fibrous capsule. Consequently, a pseudoaneurysm contains no normal elements of arterial wall, as opposed to a true arterial aneurysm. Pseudoaneurysm of the anterior tibial artery has been reported as a complication of fracture surgery and is usually felt to be iatrogenic. It has occurred following a fracture treated without surgery and may be related to the vessel being tethered by the fascia and interosseous membrane. It has also been reported in cases of blunt trauma to the leg without fracture, and as well following elective orthopedic procedures. We report the case of a patient 7 months following open reduction and plate fixation of a fracture of the distal third of the tibial shaft, who presented with a large painful proximal leg mass thought to be a malignant tumor. Three previous such presentations have been found in the literature and illustrates the importance of suspecting a delayed vascular injury following lower leg trauma. Duplex ultrasound examination should be performed initially to avoid an inadvertent incision and catastrophic bleeding as might occur with an inappropriate biopsy. Preoperative and intraoperative angiograms are essential to confirm the diagnosis, delineate the site and type of injury, and help to plan the treatment. [ABSTRACT FROM AUTHOR]

Presents a letter to the editor about the hand-assisted laparoscopic live donor nephrectomy.

Aims: The purpose of this study was to analyse the outcome and determine the predictors of survival for ampullary neoplasms. Methods: Over an 11-year period, 583 patients were treated for peri-ampullary tumours, 88 of whom had a histologically proven ampullary neoplasm. Prospectively gathered data were analysed to assess predictors of survival, using Kaplan–Meier, t -test and Cox regression. Results: At presentation, five patients (6 per cent) were unresectable. Of those patients operated (n = 83; 94 per cent), 81 were resected (resection rate 92 per cent), with no operative mortality. Pathological examination of the specimen showed benign tumor (n = 10; 12 per cent), carcinoma in situ (n = 1; 1 per cent) and invasive cancer (n = 70; 86 per cent). Median survival was 45.8 months for resectable patients versus 8.0 months for unresectable patients (P < 0.0001). On univariate analysis, age <70 (P = 0.02) and bilirubin <75 mmol/L (P = 0.04) favoured long-term survival. Of the 70 resected cancers, factors associated with a significantly (P < 0.05) worse long-term survival on univariate analysis included poorly differentiated histology, invasion of the pancreas (T3), positive nodes, and perineural invasion. Age, sex, presence of jaundice and type of procedure had no influence on survival. On multivariate analysis, tumour differentiation, perineural invasion and bilirubin level were independently related to survival. Conclusion: An aggressive surgical approach for ampullary tumours is justified by the low proportion of benign lesions, the absence of operative mortality and the improved long-term survival. Resectability, tumour differentiation, absence of perineural invasion and bilirubin level appear to best predict long-term survival. [ABSTRACT FROM AUTHOR]

Myiasis is an infestation by maggots. In humans, it predominates in regions with low socio-economic development. We report on two cases of myiasis acquired during a tropical travel and in Switzerland, respectively. The first one presented as a furunculous-like disease due to the invasion of subcutaneous tissues by Cordylobia sp. larvae. The second corresponded to a chronic wound infestation that resulted in a rarely reported bacteremia due to Ignatzschineria larvae, a commensal bacteria of maggots' digestive tract. Surgery was necessary in both cases, mainly for psychological reasons in the first case. Both the entomologist and molecular biology were instrumental for treatment decisions., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Loin pain haematuria (LPHS) is a rare and difficult-to-diagnose syndrome. Different therapeutic approaches have been used historically with little or no success. We report a case of LPHS in which bilateral renal autotransplantation led to pain relief, cessation of all medication and no recurrence beyond two years of follow-up., (© 2015 S. Karger AG, Basel.)

Background: Laparoscopic cholecystectomy is one of the most frequently performed surgical interventions nowadays in developed countries. While lost gallstones during the procedure represent a commonly encountered issue, there is an ongoing debate whether split gallstones imperatively need to be extracted during the same procedure. The reported case of a wall abscess several years after follow-up lights up this debate., Case Presentation: A 75-year-old male Caucasian with a history of rheumatoid arthritis and congestive heart failure presented with a recurrent subcutaneous abdominal wall abscess with occasional, spontaneous drainage of pus. He underwent laparoscopic cholecystectomy for acute calculous cholecystitis 3 years ago with uneventful and prompt recovery. A computed tomography scan showed a cavity in the periumbilical abdominal wall with peripheral contrast-enhancing, next to a calcified foreign body between the rectus muscle sheets. Wound exploration under general anaesthesia was performed with drainage of the cavity, extraction of the foreign body and closure of the anterior rectus sheet over a drainage catheter. The foreign body turned out to be a gallstone lost in the periumbilical port site during the procedure. Antibiotic treatment with co-amoxiclav was continued for 14 days. The patient was discharged 9 days postoperatively with a clean wound., Conclusion: This case and short review of the literature is a reminder of the importance of careful extraction of split gallstones during cholecystectomy in order to avoid early or late complications. This is especially important in the light of one of the most commonly performed surgical procedures in developed countries with generally low morbidity.

Secondary to severe hospital outbreaks due to hypervirulent strains of Clostridium difficile, several surveillance systems in North-America and Europe observed an increase in infections due to this micro-organism, also in the outpatient setting. The case reported in the present article illustrates the fulminant presentation that a C. difficile colitis can show in a previously healthy person without prior contact with healthcare facilities. It introduces a review of some recent publications on the current changes in the epidemiology, clinical presentation, diagnosis and treatment of this disease.

Background: Acute abdomen in advanced pregnancy is one of the most challenging surgical situations. In life-threatening situations, despite optimal management, foetus distress and preterm delivery may occur. Although laparostomy is a useful treatment of abdominal sepsis, its successful management has not been reported previously in pregnant women., Case: 30-year-old woman at 23 week of pregnancy was investigated for non-specific abdominal pain. Surgical exploration revealed extensive ischemic bowel necrosis. Multiple segmental resections were performed and abdomen was left open with vacuum assisted dressing, maintained for 48 hours. At the third surgical look the continuity was restored and abdominal wall closed. The foetal condition stayed unperturbed under pharmacologic tocolysis. Pregnancy was carried to full term delivery., Conclusion: Open abdomen strategy can be successfully applied in pregnant woman.

Objective: To compare surgical site infection (SSI) rates in open or laparoscopic appendectomy, cholecystectomy, and colon surgery. To investigate the effect of laparoscopy on SSI in these interventions., Background: Lower rates of SSI have been reported among various advantages associated with laparoscopy when compared with open surgery, particularly in cholecystectomy. However, biases such as the lack of postdischarge follow-up and confounding factors might have contributed to the observed differences between the 2 techniques., Methods: This observational study was based on prospectively collected data from an SSI surveillance program in 8 Swiss hospitals between March 1998 and December 2004, including a standardized postdischarge follow-up. SSI rates were compared between laparoscopic and open interventions. Factors associated with SSI were identified by using logistic regression models to adjust for potential confounding factors., Results: SSI rates in laparoscopic and open interventions were respectively 59/1051 (5.6%) versus 117/1417 (8.3%) in appendectomy (P = 0.01), 46/2606 (1.7%) versus 35/444 (7.9%) in cholecystectomy (P < 0.0001), and 35/311 (11.3%) versus 400/1781 (22.5%) in colon surgery (P < 0.0001). After adjustment, laparoscopic interventions were associated with a decreased risk for SSI: OR = 0.61 (95% CI 0.43-0.87) in appendectomy, 0.27 (0.16-0.43) in cholecystectomy, and 0.43 (0.29-0.63) in colon surgery. The observed effect of laparoscopic techniques was due to a reduction in the rates of incisional infections, rather than in those of organ/space infections., Conclusion: When feasible, a laparoscopic approach should be preferred over open surgery to lower the risks of SSI.

Efficient computer assisted surgery dealing with soft tissues remains a complex task. In most cases, the preoperative information such as 3D organ reconstructions and the planning built upon are no longer valid during the surgical process itself due to the deformations of the organ of interest. In this article, we describe the foundation parts of a framework that enables updating preoperative 3D models with intraoperative measurements in case of liver resection. The technique can be summarized as follows. During the planning stage, the discrete skeleton of hepatic veins is created out of the CT-reconstruction. It is used at time of surgery as the core component of an elastic registration between the model and measured points located on vessels centerline. Intraoperative data points are automatically computed from navigated ultrasound images with a real-time segmentation method. Our approach was tested on simulated and real datasets and has demonstrated to be fast and effective.

Objective: To evaluate the effect of a 4-day carbohydrate overfeeding on whole body net de novo lipogenesis and on markers of de novo lipogenesis in subcutaneous adipose tissue of healthy lean humans., Research Methods and Procedures: Nine healthy lean volunteers (five men and four women) were studied after 4 days of either isocaloric feeding or carbohydrate overfeeding. On each occasion, they underwent a metabolic study during which their energy expenditure and net substrate oxidation rates (indirect calorimetry), and the fractional activity of the pentose-phosphate pathway in subcutaneous adipose tissue (subcutaneous microdialysis with 1,6(13)C2,6,6(2)H2 glucose) were assessed before and after administration of glucose. Adipose tissue biopsies were obtained at the end of the experiments to monitor mRNAs of key lipogenic enzymes., Results: Carbohydrate overfeeding increased basal and postglucose energy expenditure and net carbohydrate oxidation. Whole body net de novo lipogenesis after glucose loading was markedly increased at the expense of glycogen synthesis. Carbohydrate overfeeding also increased mRNA levels for the key lipogenic enzymes sterol regulatory element-binding protein-1c, acetyl-CoA carboxylase, and fatty acid synthase. The fractional activity of adipose tissue pentose-phosphate pathway was 17% to 22% and was not altered by carbohydrate overfeeding., Discussion: Carbohydrate overfeeding markedly increased net de novo lipogenesis at the expense of glycogen synthesis. An increase in mRNAs coding for key lipogenic enzymes suggests that de novo lipogenesis occurred, at least in part, in adipose tissue. The pentose-phosphate pathway is active in adipose tissue of healthy humans, consistent with an active role of this tissue in de novo lipogenesis.

Background: Gastroesophageal reflux disease (GERD) may be associated with episodes of bronchoaspiration, sometimes leading to life-threatening respiratory complications. GERD is frequently observed in the setting of type 1 (sliding type) hiatal hernia, but only infrequently complicates the course of type 2 (paraesophageal) hernia., Methods of Study: We performed a retrospective analysis of 50 patients operated for type 2 hiatal hernia in our hospital, to determine the prevalence of respiratory complaints related to GERD in this setting., Results: We found 7 cases (14%) of type 2 hiatal hernia complicated by pulmonary manifestations as the only symptoms of GERD. These ranged from dyspnea to severe bronchoconstriction and acute respiratory failure. The series is illustrated by the report of 1 patient who experienced acute bronchospasm and cardiopulmonary arrest as a complication of GERD. In all patients, surgical repair of the hiatal hernia, together with an antireflux procedure, resulted in complete resolution of the respiratory complaints for follow-up periods up to 160 months., Conclusions: Our data emphasize the particular prevalence of respiratory involvement in the case of GERD complicating type 2 hiatal hernia, and also the excellent symptomatic results obtained by surgical therapy for this condition.

Laparoscopic live-donor nephrectomy has gained wide acceptance. However, the vast majority of surgeons perform left nephrectomies only, which may not always be in the best interest of the donor. Of 17 consecutive laparoscopic donor nephrectomies, 13 were done on the right side. The function of these grafts was compared with that of 17 kidneys previously procured by an open technique and with that of the four left laparoscopic grafts. Ischaemic damage was evaluated by post-operative nuclear scanning and urinary lysozyme, and graft function by creatinine and creatinine clearance. Results show that operating time was longer in the laparoscopic donors, but identical in right and left laparoscopic procurements. Ischaemic damage and function were similar, regardless of the side or the surgical technique. We can conclude that right laparoscopic donor nephrectomy is feasible and results in good graft function. Systematic harvesting from the left side may, therefore, not be justified.

Traumatic hernia of the abdominal wall is a rare and easily missed injury in the presence of major pelvic and abdominal lesions. We present a radiographically documented case of combined pelvic and acetabular fracture with a major contralateral traumatic hernia with avulsion of the internal oblique, the external oblique and the transverse abdominal muscles diagnosed four months after the initial trauma. To our knowledge no similar case has been described in the current literature.

The ATLS concept is a strategy for the treatment of the injured patient and a teaching method. ATLS originates from the USA and it was introduced in the French speaking part of Switzerland two years ago. This article describes the principles that made ATLS successful, as well as its objectives and impact on the treatment of injured patients. As a consequence, a trend is now emerging towards a standardisation of care of the trauma patient.

The use of laparoscopic surgery has increased rapidly. However, a technically feasible procedure is not automatically recommendable. Thus, if cholecystectomy and fundoplication are currently fully validated techniques, this does not hold true for gastroplasty and kidney harvesting for transplantation: these operations are feasible indeed but their efficacy remains to be proved. Laparoscopic oncology has been shown to be feasible too, but its efficacy has not been documented yet.

The shortage of organs available for transplantation has rekindled the interest for the kidney living donor, and has recently induced the use of living donors for liver transplantation too. Both methods raise many medical and ethical interrogations. The aim of this paper is to analyse this type of organ harvesting, and to report our experience and results with kidney and liver living donors.

Introduction: The shortage of organs available for renal transplantation has focussed attention on the use of live donors. Techniques for laparoscopic nephrectomy have recently been described, which have limited morbidity, duration of hospitalization and the period off work. However, these surgical procedures are difficult, and may be risky for the organ to be transplanted., Method: The laparoscopic live donor nephrectomy was introduced in stages, including the use of a videoconference from a reference center. In this article, the prospective analysis of the present authors' preliminary results has been presented., Results: Ten kidneys were removed by laparoscopy, i.e., three from the left and seven from the right side. No conversion of this technique to laparotomy was necessary. The mean warm ischemic time was five minutes, and in the last six operations it did not exceed three minutes. The patients were able to leave hospital between four and eight days following surgery. After a mean follow-up of 10.5 months, organ survival was 100%, and in all grafts excellent function was observed., Conclusion: The quality of these preliminary results which may act as a reference and the careful introduction of a live donor laparoscopic program could provide an incentive to potential donors, and thereby increase the pool of organs available for transplantation.

Hypothesis: Liver transplantation results in hepatic denervation. This may produce alterations of liver energy and substrate metabolism, which may contribute to weight gain after liver transplantation., Design: Prospective clinical study., Setting: Liver transplantation clinics in a university hospital., Patients: Seven nondiabetic patients with cirrhosis were recruited while on a waiting list for liver transplantation. Seven healthy subjects were recruited as controls., Intervention: Orthotopic liver transplantation., Main Outcome Measures: Evaluation of energy and substrate metabolism after ingestion of a glucose load with indirect calorimetry was performed before, 2 to 6 weeks after, and 5 to 19 months after transplantation. Whole-body glucose oxidation and storage and glucose-induced thermogenesis were calculated., Results: Patients with cirrhosis had modestly elevated resting energy expenditure and normal glucose-induced thermogenesis and postprandial glucose oxidation and storage. These measures remained unchanged after liver transplantation despite a significant increase in postprandial glycemia. Patients, however, gained an average of 3 kg of body weight after 5 to 19 months compared with their weight before transplantation., Conclusion: Liver denervation secondary to transplantation does not lead to alterations of energy metabolism after ingestion of a glucose load.