Bronchial artery aneurysm disguised as a leiomyoma of the esophagus.

Bronchial artery aneurysm (BAA) is a rare entity with potentially fatal hemorrhagic complications. It is usually diagnosed using a computed tomography scan or angiography in emergency situations (clinical picture of aortic dissection or massive hemoptysis). We report a case of bronchial artery aneurysm where dysphagia was the predominant symptom.

Interest of PS100 assay when (99m)Tc sestamibi scintigraphy failed to identify lymph node metastases of melanoma.

The study evaluated the contribution of serum PS100 assay to the detection of lymph node metastases during the follow-up of patients previously treated for a malignant melanoma, in addition to (99m)Tc sestamibi (MIBI) scintigraphy and investigation for gene MDR1, in order to detect chemoresistance phenomena. The study included 37 patients with a clinically questionable lymph node around basin lymphatic areas of the previously surgically-treated malignant melanoma. The sensitivity and specificity of PS100 assay were 91% and 86.

Invasive thymoma: a clinical study of 23 cases.

Background: Invasive thymoma is a rare mediastinal tumor. Clinicopathological characteristics that influence survival of patients with this tumor are under debate. Treatment is based on tumor resection.

[Detection of lymphatic metastasis from malignant melanoma after identification of the sentinel node by preoperative lymphoscintigraphy and intraoperative radioisotopic detection].

Objectives: The aim of this study was to evaluate the detection of the first lymph node draining the primary tumour site, using a radioisotopic mapping alone and to determine whether a preoperative lymphoscintigraphy using technetium sulfur colloid and a hand-held gamma detecting probe could improve the detection of the sentinel lymph node (SLN) in melanoma.

Patients And Method: From January to December 1998, 36 patients with a cutaneous melanoma larger than 0.75 mm, stage I TNM were included in this prospective study.

[Bilateral post-traumatic adrenal hemorrhage. Report of a case with acute adrenal insufficiency].

Bilateral adrenal haemorrhage of traumatic origin is rarely observed or possibly missed in severely multi-traumatised patients. It can lead to a potentially fatal adrenal shock. Its emergency diagnosis is made by imaging techniques, usually by CT-scan.

[Results of laparoscopic hernioplasty. A study of 401 cases in 318 patients].

Study Aim: The aim of this retrospective study was to report a series of laparoscopic hernioplasty performed in two surgical centers, and to evaluate the results with a mean follow-up of 31 months.

Patients And Methods: From January 1992 to January 1997, 318 patients with 401 inguinal hernias were operated on through laparoscopy by six senior surgeons and six junior surgeons. There were 302 men and 16 women (mean age: 53 years).

[What place for endoscopic sphincterotomy in treatment of acute pancreatitis?].

Study Aim: A prospective study was undertaken in order to evaluate the effects of endoscopic sphincterotomy on the evolution of biliary and idiopathic acute pancreatitis.

Patients And Methods: Among 320 patients with acute pancreatitis observed from 1986 to 1996, 118 were excluded from the study for etiological reasons and 137 were included for an endoscopic sphincterotomy within 72 hours from their admission. There were nine technical failures and 128 endoscopic sphincterotomies were performed.

The relationship between MIB-1 proliferation index and outcome in pancreatic neuroendocrine tumors.

The expression of the cell-cycle-associated Ki-67 antigen by MIB-1 monoclonal antibody was retrospectively assessed in 35 surgically resected neuroendocrine tumor specimens of the pancreas embedded in paraffin. The MIB-1 proliferation index was correlated with the classification of the neuroendocrine tumors of the pancreas proposed by Klöppel et al. Four prognostic factors showed a significant correlation with MIB-1: local invasion, metastases, tumor differentiation, and production of insulin.

[Colonic pseudo-obstruction caused by digestive amyloidosis in a chronic hemodialyzed patient. Apropos of a case].

A case of intestinal pseudo-obstruction by amyloidosis, occurring after 20 years of dialysis in a 72-year-old woman is reported. Although acute intestinal complications of intestinal amyloidosis, such as ischemia, colonic obstruction or haemorrhage are well known, colonic pseudo-obstruction is more unusual. It gradually results in, it carries out an intestinal obstruction with colonic and gastric distension.

[Treatment of large abdominal eventrations with an intraperitoneal stapled plate. Apropos of a series of 27 patients].

Treatment of 27 large abdominal eventrations by intra-peritoneal prothesis fixed by staples is reported. Only one recurrence (3.5%) in the post-operative period, the good results observed, absence of grave complication, and great simplicity of this procedure lead the authors to recommend the use of intraperitoneal prosthesis in the treatment of post-operative eventration with major loss of parietal substance.

[An unusual complication of perforated sigmoid diverticulitis: gas in the portal vein with miliary liver abscesses].

A patient presented with gas in the portal vein and miliary liver abscesses due to perforation of a sigmoid diverticulitis abscess. The outcome was favorable after surgical treatment. Gas in the portal vein, a sign of extreme seriousness, is generally the result of intestinal necrosis from ileo-mesenteric artery infarction, responsible for more than 75% of deaths.

[Postoperative respiratory function and cholecystectomy by laparoscopic approach].

Open cholecystectomy is associated with characteristic changes in pulmonary function showing a restrictive pattern. Laparoscopic cholecystectomy without opening of the peritoneal cavity could be an alternative in reducing postoperative respiratory dysfunction. Having given their informed consent, 13 healthy ASA1 patients (age: 41 +/- 18 yrs) undergoing laparoscopic cholecystectomy were enrolled in this study, in order to assess their postoperative pulmonary function tests (forced vital capacity [FRC], forced expiratory volume [FEV1], functional residual capacity [FRC]) before operation (T0) and 4 h (T4), 24 h (T24), 48 h (T48) after surgery.

[Endoluminal protection of colorectal anastomosis by Coloshield. Apropos of 14 cases].

Ideal exeresis with immediate anastomosis protected by an endoluminal shield (Coloshield) was performed in a series of 14 patients with left colic lesions for which the classical treatment would have been exeresis without anastomosis. No post-operative anastomotic fistulas were observed; one case of secondary stenosis of the anastomosis was treated successfully by endoscopic dilatation. The results of this series suggest that this technique is a reliable method of internal intestinal by-pass which offers real progress by allowing left colon exeresis with immediate anastomosis even in case with unfavourable local conditions.

Surgical management of chronic pancreatitis on the continent of Europe.

Surgical management of chronic pancreatitis remains a difficult problem. On the continent of Europe, the main etiology of the disease is alcoholism; thus, alcohol withdrawal is mandatory before surgical treatment. Left splanchnicectomy is no longer used.

[Primary adenocarcinoma of the ileostomy after total proctocolectomy for ulcerative colitis].

A 61-year-old man developed primary adenocarcinoma with skin invasion, at the ileostomy site 33 years after a proctocolectomy for ulcerative colitis. A total of eleven patients with ileostomy adenocarcinoma have been reported in the literature. Ten patients were treated surgically for ulcerative colitis and the other for adenomatous polyposis coli.

[Tubular grafts of the inferior vena cava for portacaval shunts. Principle, technic and preliminary clinical results].

A technique for performance of portocaval shunt operations using tubular inferior vena cava grafts is proposed. The aim of this method is to avoid prosthetic or venous interposition with their risk of thrombosis. It is based on results of cadaver experimental studies and a clinical case.

[Difficult diagnosis of a rapidly developing post-traumatic tumor of the thymus region. Encysted hematoma or intracystic hemorrhage?].

We report a case of rapidly developing (subacute) post-traumatic mediastinal haematoma which initially suggested a malignant tumour of the thymus region. The lesion, discovered on the basis of non-specific signal symptoms 2 months after a mild chest injury, consisted of a voluminous tumour of the thymus region associated with pericardial effusion. At angiography, the mass proved to be extravascular.

Radio-anatomic study of the carotid axis with regard to the implantation of microsurgical vascular anastomoses.

The authors report a radio-anatomic study of the carotid axis in the context of the implantation of microsurgical vascular anastomoses. The information derived from 36 dissections and 50 arteriographic studies suggests the preferential use of the superior thyroid, facial and lingual branches. Section and turning-down of the external carotid and direct end-to-side implantation on the common carotid could provide fall-back solutions when the collaterals are slender.

[Marion's calibrated latero-lateral portacaval anastomosis: a truncular shunt maintaining hepatopetal portal blood flow?].

The authors report the hemodynamic study of 22 cases of calibrated side-to-side portacaval shunts performed in patients with liver cirrhosis. In all patients, hepatopetal portal blood flow was present before the operation. According to the data obtained by scintiangiography and angiography, hepatopetal portal flow was maintained in 70 p.