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Background Multisite information regarding surgical site infection (SSI) rates for cardiac surgery programmes is not widely available. Ward characteristics that may affect outcomes have not been analysed previously. Aim To determine individual- and ward-level factors associated with SSI occurrence after coronary artery bypass grafting (CABG) and valvular surgery. Methods A dataset from the French national SSI database ISO-RAISIN 2008–2011 was used. Only adult patients were included. A standardized questionnaire was completed for each patient who underwent surgery, and patients with and without SSI were characterized. Patients and ward risk factors for SSI were analysed using a multilevel logistic regression model with SSI as binary outcome (two levels: patient and ward). Results Out of 8569 patients from 39 wards, the SSI rate was 2.2%. Micro-organisms were isolated in 144 patients (74%): 35% coagulase-negative staphylococci (N = 51), 23% Staphylococcus aureus (N = 33), 6% Escherichia coli (N = 8). Higher probability of SSI was associated with the duration of preoperative hospitalization, the duration of follow-up, the duration of surgery >75th percentile and the SSI rate in the surgery ward. The residual heterogeneity between wards (median odds ratio: 1.53) was as relevant as duration of preoperative hospitalization (odds ratio: 1.57). Conclusion Although patient risk factors were more strongly associated with SSI occurrence, this study provided evidence for the existence of a ward-level effect. This should be taken into account when considering possible corrective interventions.

Transferrin receptor density was investigated in human colorectal surgical specimens. Crude membranes were prepared from 23 cancer tumors (adenocarcinoma or malignant villous tumor) and 3 non-cancer tumors (polyadenoma or villous tumor) and 26 adjacent control mucosa. Contrary to non-cancer tumors, Scatchard analysis of 125I-transferrin binding data evidenced higher maximal transferrin binding capacity and lower dissociation constant in cancer tissues (Bmax cancer 1.828+/-0.320 nmol/g, Kd 24.1+/-4.7 nM), as compared to paired control colonic mucosa (Bmax contol 0.851+/-0.182 nmol/g, Kd 30.7+/-7.3 nM), paired t-tests: Bmax p

A total of 100 accidents occurring during laparoscopic surgery between 1969 and 1993 were studied. Fifty-five of the cases concerned gynaecology surgery over a 24 year period. The other 45 concerned digestive surgery over a 5 year period (1989-1993). The surgical risk was not statistically greater compared with open surgery. Overall morbidity was 1%. Overall mortality was 0.5/1000. A more precise statistical analysis was recently reported. The examination of the 100 cases was qualitative rather than quantitative. The study demonstrated an imbalance between age (mean age 38 years) in patients with major pathology initially and the gravity of the induced accidents: 26 deaths for 100 observations. These deaths were related to technology trocar, capnoperitoneum, electrocoagulation. Technical skill, cautiousness, vigilance and humility are qualities the surgeon must have to perform successful operations. The irreversible acceleration of the new surgical technique should not cloud the basic precepts of sound surgical technique.

Among hepatic hemangiomas (the most common solid hepatic tumor in adults), "giant hemangiomas" are those defined by a diameter greater than 4 cm. The natural history of such lesions is unclear, and many surgical procedures have been described. In five women and one man (mean age 49), we successfully used enucleation of the tumor under blood inflow control. This technique was made possible by a cleavage plane between the hepatic parenchyma and the hemangioma. This straightforward and safe procedure required a low rate of transfusion (mean 200 mL/patient) and spared a maximum amount of hepatic tissue.

From 1990 to 1993, programmed surgery was performed in four patients with histologically low grade malignant gastric lymphomas of mucosa-associated lymphoid tissue (MALT) (partial gastrectomy = 1, total gastrectomy = 3). These small cell lymphomas have the B phenotype and are uncommon. The clinical course is usually slow and classically limited to the stomach. As for other gastric lymphomas, there is still a certain amount of discussion as to the best therapeutic choice between surgery, chemotherapy and radiotherapy. Certain elements in the literature can help in managing these low grade gastric lymphomas. Recent publications report on a prospective study on primary lymphomas of the digestive tract, a clinical trial on single drug chemotherapy alone and the relationships between Helicobacter pylori and MALT lymphoma.

Postoperative intraperitoneal adhesions are known to occur after conventional surgery. The prospective study that we have performed in 1992 shows that the frequency of postoperative intraperitoneal adhesions is very high (93% of patients). It is higher than was stated 20 years ago, while so-called "spontaneous" adhesions seem to be decreasing. The histological study of postoperative intraperitoneal adhesions shows a specific evolution in time and a very high frequency of foreign bodies (starch, variably decayed textile fibers) (92%). The very great frequency of such foreign bodies in postoperative intraperitoneal adhesions, logically involving them in the genesis of this condition, may be an argument in favor of the new surgical techniques, especially of celioscopy.

Public opinion maintains the myth that ambulatory surgery is a benign operation. Although it may not be the ideal moment for demonstrating exceptional technical skill, there are unpredictable factors and certain limitations. To date, no specific legal concept of medical appraisal applicable to ambulatory surgery has been developed in France. Nevertheless, the nation that the surgeon is required to use all possible means is keenly accentuated because in a very short delay of a few hours the patient no longer is under direct management of the surgeon or his health care team. The aim of this work was to summarize the mandatory techniques for quality care and safety adapted to the lesions and the circumstances and taking into account accepted procedure, the current state of the art and the socio-familial environment. Two specific problems are encountered in the medical appraisal: a) defining whether the complication is inherent to ambulatory surgery, b) deciding how the responsibility could be shared. The possibility of special insurance for demonstrated non-fault surgical risk would be an elegant solution to avoid legal bias and facilitate controlled development of ambulatory surgery units.

Although celioscopic cholecystectomy provides acknowledged advantages, lesions of the common bile duct appear to be more frequent with this technique than with laparotomy. Two cases of annular stenosis of the common bile duct after celioscopic cholecystectomy are presented. Evidence of their ischemic origin is available, and they lead to reflexions on the use of monopolar coagulation. In both cases, the stenosis was repaired surgically, with resection and anastomosis in one case and with a hepaticojejunal anastomosis in the other. Laying an endoprosthesis as used in case 2 seems to be interesting as a temporary solution to prepare for surgery.

After giving the highlights on the few surgical indications of biliary cysts, the authors present a film of the resection of the protruding dome with celioscopy for an 80-mm cyst of the 3rd segment of the liver, in association with cholecystectomy for lithiasis. The simple technique and uncomplicated postoperative period emphasize the merits of this procedure, although this should not lead to inappropriate indications.

An experimental study on 15 piglets allowed defining the technical procedure and controlling the anatomical and functional results of various modes of restoration of the ileocolic tract after resection with a terminolateral tubing including and intracolic ileal sleeve. Coloileal fixation was ensured only by a few seromuscular sutures and adhesion with "Tissucol". The clinical application of this procedure was very satisfactory for 9 recent right colectomies, thus confirming the results previously observed for 33 ileal perforations in Africa. The ileocolic tubing technique is easy, reliable, morbidity-free, and causes no leakage of intestinal fluid, no intestinal ischemia and no stenosis. As it prevents coloileal reflux, this assembly may prevent ileitis after right colectomy. Its valvular effect also contributes in the mechanical regulation of transit. The assembly produces a system that can be compared to the ileocecal valve.

Most hepatic traumas are easily cured, but the series of 135 consecutive hepatic wounds reported in the present paper is unusual in that the patients were specifically recruited from among patients subjected to neurosurgical or spinal operations, 25% of whom sustained severe hepatic injuries (classes IV and V) as a result of the surgery. The postoperative mortality was analyzed according to such potentially predictive factors as severity of the hepatic wound, the concomitant extraabdominal lesions, the initial shock, and the kind of surgical treatment. The statistical comparison of the factors affecting the results was analyzed by the Chi-square test. The postoperative mortality rate was 24.4% (33 deaths). This mortality rate is evidently related to the severity of the hepatic lesions and to the frequent associated lesions. The 14 deaths from benign and moderate hepatic injuries were due to concomitant lesions. Among the 19 deaths from severe lesions, 12 were directly related to the severity of the hepatic injury and 7 to associated wounds. Complications directly related to the hepatic trauma occurred in 39 cases with 16 deaths. In general, conservative surgical treatment can be performed with quite low mortality. Among the patients who require hepatic resection one of two dies of hemorrhage or coagulopathy. Among conservative procedures, perihepatic packing has proved to be efficient and safe. If perioperative cholangiography has excluded any leak from a major bilde duct, septic complications are rare. Therefore, the surgical treatment of hepatic trauma should be as conservative as possible, because this can stop hemorrhage and decrease the risk of coagulopathy. It is better to perform perihepatic packing followed by a second operative on the 2nd day (possible after transfer to a more specialized unit) than to attempt hepatic resection as an emergency procedure, which could be hazardous.

On the basis of 5 personal cases with illustrations and a review of the literature, the authors emphasize the clinicopathological features of peritoneal mesotheliomas, rare primary tumors for which the histological diagnosis is often difficult. The classical evidence by contact with asbestos fibers is obtained in every second case only. The tumor is often associated with a pleural lesion. Ultrasound and CT currently aid in the diagnosis, usually in a context of extensive ascites. The prognosis is poor. For technical reasons, surgical exeresis most often remains partial in the diffuse forms. Chemotherapy is rarely effective.

Dictyostelium discoideumandEscherichia coliwere aerobically propagated in mixed continuous culture in a predator-prey relationship, and the effects of temperature and holding times were examined. Oscillations developed in the concentration of glucose, the limiting substrate forE. coli, and in the densities of the two populations, but eventually steady-state populations were reached. The experimental data were analyzed according to the Lotka-Volterra model for prey-predator relationships and by the Monod model for saturation kinetics. A comparison of the adequacy of the two models in describing predation is given.

Mathematical models for simple microbial food chains and food webs in continuous culture are developed and analyzed. A model for competition of two microbial species for a single scarce resource is also presented as a degenerate case of the food web model. Two models for food chains are developed. The first is based on a model of microbial growth (Monod's) that is widely mentioned and used at the present time. The second is based on a generalization of that model that recent experimental results on microbial food chains seem to require. Experimental data for microbial food webs are almost entirely lacking but a tentative model having what are felt to be the right properties is developed and analyzed. The results obtained from these models seem to be consistent in most circumstances with current ecological thinking on community dynamics.

The technique suggested here consists of radical excision of the haemorrhoids with preservation of skin flaps which are sutured to the healthy rectal mucosa inside the anus. There is no traction nor sphincteral damage. This simple procedure, derived from the Whitehead's technique, is suitable for large haemorrhoids, notably when they are prolapsed and associated with lesions of the mucosa Resections "as required", with preservation of healthy mucocutaneous bridges, avoids the development of stenosis. Rectal palpation by the patients themselves twice a day from the 8th to the 30th post-operative days is essential. In a series of 150 cases evaluated 5 to 15 years after surgery, 9 out of 10 patients showed evidence of persistent success without functional sequelae.

The aim of this work is to describe the current surgical rectum resection techniques for the treatment of cancer and the corresponding radiological images. The authors emphasize the mechanical, "trans-suture" anastomoses and on the colo anal anastomoses with colic container, which radiologists will have to follow up postoperatively.

The authors report a series of 75 cases of carcinoma of the transverse colon, involving equally the right and left halves. They rarely arose from the middle segment (10% of the series). Usually the tumour was very large affecting the serous layer with lymph node invasion. Liver metastases were frequent. 50% of patients were aged over 70 years. Theoretically, wide removal attempting to cure the disease means removing both colonic angles and the areas supplied by both the superior and inferior mesenteric arteries. But fairly often the existence of vascular variations in the transverse mesocolon permits one to restrict the extent of the resection whilst saving the basic principles of radical removal. Furthermore, in 20% the treatment was purely palliative. The operative mortality was high (25%). The five year survival, in the whole series was about 50%.

A case of Clofazimine enteropathy is reported, diagnosed on the demonstration of red brown birefringent crystals in the small bowel mucosa and submucosa as well as in the mesenteric lymph nodes whereas the clinical and radiological signs appear to be non specific. After the withdrawal of the drug, a clear improvement of the symptoms was achieved only under a gluten free diet. The possibility of such accidents, sometimes lethal, suggests the restriction of clofazimine to leprosy.

A water loading test was performed in 10 patients with a cancer of the digestive tract without hyponatremia and in 10 controls. A lowering of the CfH2O was observed in the patients during the test, as well as an increase in the cortisol plasmatic rates, while aldosterone rates remained normal. To valid the hypothesis of a hypervasopressinic state in these patients, 15 cancerous patients and 12 controls had a plasmatic ADH dosage, which pointed indicated higher hormonal level in the first group.

On the basis of their own observations as well as those collected during a round table meeting of the Association Française de Chirurgie, the authors attempt to give an objective review of the value of these operations in relations to the technique used, the operative circumstances and the indications. A detailed analytical study shows that mortality and morbidity have a relatively low prevalence. Long term results are favourable in 73% of cases. The risk of recurrent obstruction is of 5 to 10%. Emphasising contraindications on a so-called "prophylactic basis" and in certain pathological states, the authors conclude that such procedures are valuable in recurrent obstructions and deperitonisations after extensive viscerolysis.

By opposition to acute post-operative ischaemic enterocolitis, the authors isolate, with the aid of seven cases, the intestinal lesions which spontaneously occur on the small intestines and on the colon and due to an ischaemic mechanism without thrombosis of the mesenteric vessels. After the description of clinical and anatomical features, they point out the main part of the vascular factor in the genesis of the lesions.

The authors report 4 cases of splenic complications occurring during chronic pancreatic disease and emphasize the vascular origin of the lesions observed in the spleen whether rupture, pseudo-cysts, hematic cysts, infarction or necrosis. The symptoms in each case seemed identical in their pathogenesis and linked to trunkular or radicular splenic venous thrombosis.

A proposed procedure for truncal vagotomy uses an abdominal approach with a short posterior phrenotomy above the hiatal orifice. A gastric emptying operation is obviously combined. The aim is to avoid exposing the abdominal esophagus in case of postoperative symphysis or when it is preferable to avoid altering normal morphology and functioning of the esophago-cardio-tuberosital junction. This procedure can be useful in certain particular cases to perform vagotomy in the posterior infra-mediastinal space.

Three cases of traumatic rupture of a subperitoneal hollow viscus are reported : two duodenal lesions and one rectal wound. Early diagnosis was possible in all three cases by the recognition of retroperitoneal gas on simple radiographs of the abdomen, which was evidenced by images containing air bubbles, which were also fasciculated and fairly fixed. They were unilateral, on the right side, and usually associated with disappearance of the psoas shadow in duodenal injuries. Rectal perforation produces a bilateral distribution of the retroperitoneal gas, which extends to the subperitoneal fat and the posterior extraperitoneal space, according to the amount of effusion.

The authors report a series of 62 choledoco-duodenal anastomoses carried out during surgical treatment of cholelithiasis and note the indications for this procedure, emphasizing the necessity for a wide common bile duct and a normal duodenum. Apart from complete obstruction of the common bile duct with gall stones, the main indication is organic obstruction of the terminal part and of the sphincter of Oddi. A 2 cm anastomosis is necessary. Duodeno-biliary reflux has no direct consequence in the absence of stenosis of the anastomosis and of pre-existing cholangitis. In the long term, the results are favourable in 95 p. 100 of cases.

Cystadenomas and cystadenocarcinomas of the pancreas are tumours which remain poorly known because of their relative rarity. They are seen essentially in women aged between 40 and 60 and involve the left half of the pancreas more often than the right. The symptomatology remains latent for a fairly long time, which explains the fact that they are most often discovered only at the stage of a palpable tumour. Recent methods of investigation--echotomography and computed tomography--are of very great value in preoperative diagnosis. It is extremely important to draw the distinction within the group of benign cystadenomas between microcystic forms and macrocystic forms or mucinous cystadenomas, the latter having a definite potential for malignant change, possibly explaining the link with certain cystadenocarcinomas. As a result, excision surgery is always preferable, when possible, to bypass surgery, at least in caudal or corporeo-caudal lesions, since excision surgery is usually easy. For cephalic lesions, if excision surgery seems difficult, it may be conceivable, using modern techniques of investigation, to adopt a conservative attitude when there are no features suggestive of potential malignant change.

The authors report 62 cases of operated diverticular sigmoiditis, note the indications for surgery and the method adopted. Apart from acute complications comparison of the clinical, laboratory and radiological data permit one to decide on a cold operation for prophylactic purposes. For acute generalised or localised peritonitis, the authors remove the lesions straight away when local and general conditions permit it. They emphasis the severity of the complications and the dealy with which these patients are still too often admitted on a surgical unit, which explins the persistently poor prognosis in spite of present conditions of resuscitation.

Among 1,645 biliary operation carried out between 1952 and 1974, the authors count 177 organic stenoses of the Oddi region. They recall the authenticity of chronic odditis, the pathological substratum of which is Oddi sclerodystrophy, a primary and progressive lesion. They emphasise the radiomanodebimetric criteria. The risk of an error of interpretation was 2% in this series. After discussing the etiopathogenesis and the physiopathological consequences of Oddi sclerodystrophy, they discuss the therapeutic choice between sphincterotomy and choledoco-duodenostomy. Temporary gall bladder drainage is only of interest in inflammatory labile manifestations without sclerodystrophy. The interest of diagnosis and initial surgical treatment of the lesion is that the classical post-cholecystectomy syndrome almost disappears.

The use of a simple, rapid, and reliable method for studying the anatomy and physiopathology of the main biliary pathway during operation by means of radiomanometry is described. This procedure enables a rational and precise therapeutic decision to be taken, as shown by comparing the results obtained in 1600 cases after a period of 5 years, with the interpretation of the initial radiomanometric findings and the type of operation performed. The overall rate of error based on the radiomanometric results, and leading to erroneous therapy, was 2 p. cent (0.43 p. cent excessive and 1.57 p. cent insufficient). No complications due to the method were observed. The main points noted were the absence of wounds to the main biliary pathway and of external bile tract fistulae, and a considerable reduction in the number of repeat operations and postcholecystectomy syndromes (1.5 p. cent).

Based on the case of a inflammatory fibroid polyp, the authors review the features of this gastric lesion of tumoral appearance, but of inflammatory kind.