Search

Abstract: The authors report a case of hydatid cyst of the pancreas in a 29-year-old man. Biology and computed tomography contributed to the preoperative diagnosis. The intervention consisted in a left pancreatectomy with spleen ablation. In the light of this case and the literature review, the authors discuss diagnostic issues raised by hydatid cyst of the pancreas. [Copyright &y& Elsevier]

Surgeons, like other doctors, practice their profession within a framework of contractual liability defined by statute in 1936. This established that the doctor was subject to a contractual obligation to provide appropriate and diligent care. Care and technical acts should conform to those which would have been provided by a prudent doctor within the standards of knowledge and practice of his field; care which deviates from this standard would be considered medical error or fault. This standard of care is referred to as "sound professional conduct". However, while not calling this basic principle into question, civil jurisdictions have progressively held surgeons liable whenever injury has occurred following surgical acts, without considering whether care deviates from sound professional conduct. Since 2000, judges have begun to attribute a requirement for absolute safety of results in cases where the surgeon had injured an organ unrelated to the planned operation. However it seems that the rare judgments given on this topic in the last 2-3 years have become less frequent. The creation of a compensation regime for medical accidents, via the law dated March 4, 2002, has contributed to this evolution. It is to be hoped that the flaws described in this system do not encourage jurisdictions to reconsider previous case law decisions.

Introduction: To correlate findings at high-resolution MR and endoscopic US (EUS) for preoperative loco-regional staging of rectal carcinoma., Patients and Methods: Fifty-two patients with rectal carcinoma underwent high-resolution MR imaging. Only 43 of these patients underwent EUS due to technical limitations and stenosing carcinomas. Morphological imaging features and TNM staging were evaluated for both imaging modalities. The degree of correlation and accuracy were calculated for both., Results: The correlation between MR and EUS was good for tumor length and thickness (r=0.7 and 0.61) for for nodal (N) staging (k=0.53). Correlation was good for T1 and T2 stages (k=0.51) and T3 stage (k=0.43) and very poor for stage 4 (k= -0.09), because no T4 lesion was detected at EUS. 81.8% of patients where T stage was over-estimated on MRI and 100% of patients where T stage was over-estimated on EUS had received preoperative radiation therapy. Therefore, results should be interpreted with caution. The predictive evaluation of tumor resectability (absence of perirectal fascia invasion) with a circumferential margin on MR> or =5 mm was 93%., Conclusion: Correlation between MR and EUS was moderate for T staging, because of limitations of EUS for large tumors. Results confirm that high-resolution MRI is useful for loco-regional staging of rectal carcinoma, especially for large tumors. EUS should be limited to the valuation of superficial tumors of the rectum.

The basic principle of radiofrequency ablation is that the deposit of electromagnetic energy in a tumor causes heat ("cooks the tumor") and thereby destroys it. In the liver, this ablation may be performed percutaneously (by needles) or surgically (laparotomy, laparoscopy). Guidance by an imaging technique is necessary: ultrasound, CT or magnetic resonance imaging. The principal hepatic indications are hepatocellular carcinoma and hepatic metastases smaller than <5 cm. There is no associated mortality and only slight morbidity, due principally to hemorrhage, infection or stenosis of the bile ducts. Results show a 5-year survival rate of 40% for hepatocellular carcinoma and 22% for metastases.

Introduction: Echinococcus granulosus, responsible for hydatidosis, most often lodges in the liver and lungs, but is found in other organs of the body in 10% of cases., Case: A painless, left cervical tumefaction suddenly developed in a 28-year-old Portuguese man. After thyroid lobectomy with isthmusectomy, the pathology findings led to the diagnosis of hydatidosis., Discussion: The thyroid is a rare location for a hydatid cyst. Diagnosis can be difficult and fine-needle aspiration cytology is not usually helpful. Treatment requires surgical excision, and administration of benzimidazole derivatives to prevent recurrence.

Purpose of the Study: To assess clinical, therapeutic and diagnostic findings of strangulated obturator hernias., Patients and Method: Retrospective study of 17 patients (16 women, 1 man; average age: 81.7 years), all treated in the same service, for strangulated obturator hernia. The studied criteria were: clinical characteristics (general status, obstruction, sign of Romberg-Howship), morphologic exams, mean delay for surgical treatment, and occurrence of postoperative complications., Results: The clinical examination revealed small bowel obstruction in 94% of the patients (n = 16) and incomplete obstruction in 1 patient; 23.5% of the patients presented a sign of Romberg-Howship. A major slimming was observed in 82% of the cases. A computed tomography, performed in 3 patients, showed the presence of air in the under-pubic channel. Preoperative diagnosis of obturator hernia was suspected in 23.5% of the cases. Surgical treatment was performed after a mean delay of 5.3 d. The mortality and morbidity rates were respectively 35 and 18%., Conclusion: Due to the low specificity of clinical examination, preoperative diagnosis of obturator hernia remains difficult. Computed tomography can be of great help for the diagnosis. Any therapeutic delay increasing mortality rate, surgery is mandatory in case of small bowel obstruction in order to make the diagnosis and the treatment of such rare pathology.