Myiases d’ici et d’ailleurs : pseudo-furonculose et bactériémie à Ignatzschineria larvae [Myases from here and elsewhere : pseudo-furonculosis and Ignatzschineria larvae bacteremia]

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

Le traitement du cancer avancé de l'estomac

L'incidence des cancers gastriques a diminué au cours des vingt dernières années mais elle a augmenté chez les patients de moins de 40 ans et dans les localisations proximales de l'estomac. La gastrectomie combinée à une lymphadénectomie est le seul traitement actuel avec un potentiel curatif. Après chirurgie à visée curative, 70-80% des patients présentent une récidive. Dans ce contexte, une chimiothérapie adjuvante n'est d'aucun bénéfice. La survie à cinq ans des patients atteints de cancer gastrique tous stades confondus est de 15%. De nouvelles approches thérapeutiques sont étudiées actuellement: radiothérapie peropératoire, chimiothérapie préopératoire, immunothérapie, etc. Compte tenu de la sévérité du pronostic du cancer gastrique, il est capital d'apprécier soigneusement le mode de traitement afin d'éviter d'ajouter une morbidité et une mortalité supplémentaires

La laparoscopie a-t-elle modifié l'approche chirurgicale de la maladie de reflux gastro-oesophagien? A propos d'une expérience de 63 cas de maladie de reflux gastro-oesophagien traités par laparoscopie [Has laparoscopy changed the surgical approach in gastroesophageal reflux? Apropos of an experience with 63 cases of gastroesophageal reflux treated by laparoscopy].

INTRODUCTION: Indications for surgery in gastrooesophageal reflux disease (GERD) have decreased significantly since the introduction of proton pump inhibitors. At the same time there has been renewed surgical interest in this disease triggered by the development of laparoscopy. We present our results with laparoscopic treatment of GERD and the change in our surgical approach to the condition during the past few years. METHODS: All patients admitted to the surgical department underwent prior evaluation by a gastroenterologist. Indications for surgery were resistance to medical therapy in 30 cases, recurrence of GERD after cessation of treatment in 25 cases and personal preference of the patient when maintenance therapy was necessary in 6 cases. The data were reviewed and the patients contacted during the first trimester of 1998 to evaluate long-term results. RESULTS: 63 patients were operated on between 1991 and July 1997. Rossetti-Nissen fundoplication was performed routinely until March 1995. Thereafter, the type of antireflux surgery has been chosen according to the preoperative evaluation of the patients, including endoscopy, oesophageal manometry and gastric emptying studies. There was no mortality and, except for one case, only minor morbidity. Four patients required reoperation, two for severe gas bloat syndrome and two for recurrence of GERD. Overall, the long-term follow-up shows that 93 patients are satisfied or very satisfied with their outcome (Visick 1 or 2). 5% of the patients need daily medication for heartburn, 5% complain of occasionally disturbing dysphagia, and 12% of sometimes distressing gas bloat. More patients have gas bloat after the Rossetti-Nissen procedure than after the Nissen or Toupet fundoplications. CONCLUSIONS: The enthusiasm of surgeons for the laparoscopic approach to GERD has prompted renewed interest in the pathophysiology of the disease. Consequently, indications for surgery are better defined, surgical technique is chosen according to the individual patient based on objective preoperative studies and follow-up has improved. In this setting, laparoscopic fundoplication represents an effective treatment for GERD. It is associated with lower postoperative morbidity than open surgery and represents the first choice when surgery is indicated

Chirurgie laparoscopique dans le traitement de la maladie de reflux gastro-oesophagien

Un certain nombre de malades ne sont toujours pas soulagés de manière satisfaisante par le traitement médical de la maladie de de reflux gastro-oesophagien (MR). Ce travail rapport notre expérience de 55 malades ayant bénéficié d'un montage anti-reflux réalisé par laparoscopie entre février 1992 et février 1997. La durée opératoire moyenne a été de 181 minutes, et tend à diminuer. La médiane de s&jour postopératoire a été de 4 jours. Quatre-vingt-neuf pour-cent des malades ont eu un suivi complet de 2 à 62 mois. Nonante-deux pour-cent d'entre eux étaient satisfaits ou très satisfaits du résultat. L'enthousiasme lié au traitement laparoscopique de la MR est justifié. Les résultats dépendent de la maîtrise technique du chirurgien, de sa connaissance de la MR, et de ses capacités à adapter le type de montage anti-reflux en fonction de l'évaluation préopératoire. L'intervention donne alors un résultat prévisible, ce qui incite à la proposer aux malades mal contrôlés médicalement, ou qui préfèrent éviter les contraintes d'un traitement de maintien à long terme

La validation des techniques en chirurgie laparoscopique [Validation of laparoscopic surgical techniques].

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