CT-guided methylene-blue labelling before thoracoscopic resection of pulmonary nodules.

Objective: Evaluation of the efficiency of our technique of methylene-blue labelling of pulmonary nodules to facilitate thoracoscopic recognition and excision.

Design: Patients with a peripheral pulmonary nodule smaller than 2.5 cm and not in contact with the visceral pleura were included.

Thoracoscopic splanchnicectomy for control of intractable pain in pancreatic cancer.

Background: Pain is the most distressing feature of pancreatic cancer. Thoracoscopic splanchnicectomy, first performed in 1993, has caused a resurgence of interest in surgical treatment of such excruciating pain.

Methods: Twenty patients underwent splanchnicectomy for pancreatic cancer pain over a period of 50 months.

Thoracoscopic pleurodesis for prolonged (or intractable) air leak after lung resection.

Air leaks are common after lung resection, and normally seal with conservative therapy. Re-thoracotomy is rarely indicated. We present three patients with prolonged air leak and partial pneumothorax treated by thoracoscopy.

Liver of the "visible man".

Endoscopic surgery, also called minimally invasive surgery, is presumed drastically to reduce postoperative morbidity and thus to offer both human and economic benefits. For the surgeon, however, this approach leads to a number of gestural challenges that require extensive training to be mastered. In order to replace experimentation on animals and patients, we developed a simulator for endoscopic surgery.

The rationale to switch from postoperative hyperfractionated accelerated radiotherapy to preoperative hyperfractionated accelerated radiotherapy in rectal cancer.

Purpose: To demonstrate the feasibility of preoperative Hyperfractionated Accelerated RadioTherapy (preop-HART) in rectal cancer and to explain the rationales to switch from postoperative HART to preoperative HART.

Methods And Materials: Fifty-two consecutive patients were introduced in successive Phase I trials since 1989. In trial 89-01, postoperative HART (48 Gy in 3 weeks) was applied in 20 patients.

[Gastric rupture secondary to barotrauma in the framework of a diving accident. Apropos of a case report and literature review].

Gastric perforation secondary to barotrauma is rare. The case of a diver suffering from gastric rupture due to a decompression accident is presented here. This rupture was a linear one, localized on the lesser curvature and responsible for a large pneumoperitoneum.

CT-guided localizations of pulmonary nodules with methylene blue injections for thoracoscopic resections.

As only peripheral subpleural lesions can be visualized at thoracoscopy, deep nonpalpable pulmonary nodules have to be identified before performing wedge resections. We evaluate the efficiency of computed tomographic (CT) guided methylene blue injections to localize these nodules before their thoracoscopic resection. Twenty-three nodules in 21 patients were preoperatively localized under CT guidance and marked with methylene blue injections.

[Endorectal ultrasound of rectal cancers].

Endorectal ultrasonography has become the preferred exam to assess the local extent of rectal cancers. From 1990 to 1992, we have examined 28 patients with a rectal cancer. The tumours were classified according to the TNM.

[The role of emergency laparoscopy in abdominal pain syndrome and in the assessment of abdominal trauma].

From January 1991 to June 1993 we performed 106 emergency laparoscopies. The patients' mean age was 31 years (17-90). There were 73 females (69%) and 33 males (31%).

[Thoracoscopic treatment of recurrent pneumothorax].

Spontaneous pneumothorax (PNO) is usually due to rupture of a small subpleural bleb into the pleural cavity and affects mainly young men. After simple drainage, recurrence occurs in about 50% of cases. The risk of recurrence increases after each new PNO.

[Adenocarcinoma of the duodenum. Contribution to the study of a rare pathology].

Primary adenocarcinoma of the duodenum is a rare lesion and represents 0.35% of all tumors of the gastrointestinal tract. 75% of the primary tumors of the duodenum are adenocarcinomas and 33-45% of the adenocarcinomas of the small bowel arise in the duodenum.

Adjuvant postoperative accelerated hyperfractionated radiotherapy in rectal cancer: a feasibility study.

Purpose: To assess the acute toxicity and hence feasibility of postoperative hyperfractionated accelerated radiotherapy in rectal cancer.

Methods And Materials: Twenty patients were submitted to accelerated hyperfractionated radiotherapy after resection of rectal cancer. A total dose of 48 Gy was given in 3 weeks.

[Laparoscopic cholecystectomy in a teaching center. Apropos of 208 interventions].

Laparoscopic cholecystectomy is a relatively recent acquisition and still remains limited to a few surgeons. We started an education program for surgeons used to open biliary surgery. Between September 1990 and December 1991, 208 patients have been operated on day 14 operators flanked by 2 teachers.

[Laparoscopic cholecystectomy in a medical training center. Apropos of 208 interventions].

Laparoscopic cholecystectomy is a relatively recent acquisition and still remains limited to few surgeons. We started an education program for surgeons used to open biliary surgery. Between september 1990 and december 1991, 208 patients have been operated on by 14 operators flanked by 2 teachers.

Small bowel protection with "STEP". Silastic tissue expander prosthesis.

This is a case report of a patient presenting with rectal carcinoma and Crohn's disease. Adjuvant treatment was considered to be mandatory on the basis of local extension. Therefore a Silastic Tissue Expander Prosthesis (STEP), connected with a subcutaneously located self-sealing valve system, was introduced surgically to push small bowel up out of the treatment portals.

Squamous cell carcinoma of the lung in a nonsmoking, nonirradiated patient with juvenile laryngotracheal papillomatosis. Evidence of human papillomavirus-11 DNA in both carcinoma and papillomas.

Malignant transformation of laryngeal juvenile papillomatosis most often occurs in patients with previous radiation therapy or smoking histories. We report the case of a 35-year-old, nonsmoking, nonirradiated man who developed squamous cell carcinoma of the lung with a 33-year history of laryngotracheal juvenile papillomatosis. Postmortem examination showed pulmonary cavitating papillomatosis and chest wall, vertebrae, and peribronchial lymph node involvement by tumor.

[Radiation protection of the small intestine in the lesser pelvis using an inflatable silicon prosthesis].

The combination of radiotherapy and surgery plays a major role in treating pelvic cancer. However, this technique is chiefly limited by the radiosensitivity of the small bowel following postoperative radiotherapy. In this situation the small bowel is not protected because of its lack of mobility.

[Therapeutic choice in primary costal tumors].

Primary rib tumors constitute a rare entity and have only seldom been studied separately. In a retrospective study based on 21 cases, with the help of the literature, we try to specify the specific problems encountered with rib tumors and the therapeutic consequences that follow. Our series comprises 10 benign tumors, 3 malignant tumors and 8 cartilaginous tumors.

[Dieulafoy's simple stomach ulcer: apropos of 5 cases].

Dieulafoy's ulcer is a probably congenital arterial malformation which may produce severe upper gastrointestinal haemorrhage. It represents about 1% of all cases of acute upper gastrointestinal haemorrhage (3/249 in our department during 1989). We report 5 cases in whom haemostatic endoscopic treatment was successful and propose therefore that this therapy should be the initial treatment of choice.

[Invasive adenocarcinoma of the stomach: prognostic factors and surgical technics].

Between 1976 and 1987, 183 patients with an invasive adenocarcinoma of the stomach were treated in the Department of Surgery of the CHUV in Lausanne. This study allows us to conclude: 1. The localisation, age, sex and the association with atrophic gastritis have no prognostic significance.

Diagnosis and treatment of malignant oddian tumors.

Between 1959 and 1987 we operated on 18 patients for malignant oddian tumor. Eleven had a Whipple resection, 3 a bilio-enteric anastomosis, 4 a local excision with or without bilio-enteric anastomosis. The overall operative mortality was 11% and the median survival was 13.

[Synchronous hepatic metastases of colorectal adenocarcinoma: what is the course? Apropos of 36 cases].

The discovery of synchronous hepatic metastases from colorectal cancer poses a tactical problem ticklish to resolve. What are favourable circumstances for curative excision of hepatic metastases? When and how to operate them? To try to respond, we analysed a collective of 36 patients between 10. 1.

[Pseudocyst and pancreatitis. Which factors are predictive of development?].

Pseudocysts complicating the evolution of pancreatitis are being recognized with increasing frequency at the subclinical stage. The authors' retrospective study covering 55 cases of pseudocyst brings out 5 criteria for prediction of the evolution of the disease, which should facilitate decision-making with regard to therapy.