Value of cytoprognostic classification in breast carcinomas.

Two hundred and four cases of breast carcinoma were classified according to cytological features, and these were related to prognosis. A disease free interval of seven years was 95% for patients with grade I, 70% for those with grade II, and 45% for those with grade III tumours. The risk of recurrence was also related to tumour size and the presence or absence of steroid receptors in the tumour. Cytological classification of breast carcinoma based on fine needle aspiration provides valuable information concerning the prognosis of patients, which is relevant to their clinical management.

[An attempt at classification of the vaginal arteries. Functional and surgical implications]. / Essai de systématisation des artères vaginales. Implications fonctionnelles et chirurgicales

It has been possible to attempt to classify the vaginal arteries after studying 10 specimens of total contents of the pelvis removed at autopsy. The classical descriptions are confirmed except for these features: The longitudinal vaginal artery supplies the anterior and inferior part of the vagina and probably also the bladder. The middle haemorrhoidal artery supplies, as far as we can see, mainaly the posterior portion of the vagina. Finally, in a last section, we discuss some surgical and functional implications arising from these deductions.

[The lymphatic drainage of the stomach (author's transl)]. / Le drainage lymphatique de l'estomac.

The authors became interested in the lymphatic drainage of the stomach in order to attempt to determine for each region the type of drainage and the risk of cancer spread. They studied 132 dissections including 97 injections, 210 cases records of gastric carcinoma, 8 lymphographies by ultrafluid Lipiodol and 17 peroperative injections of vital staining. The system of drainage proposed by Rouvière was on the whole confirmed; however, one should emphasise the doubling of the hepatic chain, the existence of long collectors which bypass a relay in the left gastric artery, the importance of the posterior gastric artery which transmits the lymphatics of the splenic chain. Finally, the authors emphasise the existence of 3 longitudinal areas on the stomach where the presence or agsence of valvules in the subserous collectors orients the lymph towards the lesser or greater curvature of the stomach, which easily explains the onset of isolated carcinomatous adenopathy, situated on the curvature opposite the neoplasm.

[Wirsungorrhage by chronic pancreatitis. About one case (author's transl)]. / Wirsungorragie par pancréatite chronique. A propos d'un cas.

Studying a case of wirsungorrhage on a 62 years, alcoholic patient, the authors emphasize the difficulty of diagnosis of this upper digestive hemorrhage and the interest of fibroscopy and arteriography during hemorrhagic period. Pancreatectomy is not always possible and an hemostatic intervention is often indicated in emergency cases.

[The injection of the lymphatic system of the stomach during surgery by vital staining dye: an anatomical or surgical interest? (author's transl)]. / L'injection per-opératoire du système lymphatique de l'estomac par colorant vital. Intérêt anatomique ou intérêt chirurgical? A propos de 20 cas.

The authors present the report of their experience of 20 injections of the lymphatic system of the stomach during surgery by vital staining dye: 19 times by Pontamine sky blue 6 BX, 1 time by patent blue violet. The results of this study are analysed; the anatomical interest is specified. Nevertheless, this technique presents no surgical interest concerning the stomach, in spite of many authors' opinion.

[End-to-side ileo-colonic anastomosis perpendicular to the band (30 cases) (author's transl)]. / Anastomose iléo-colique termino-latérale perpendiculaire à la bandelette (30 observations).

Over the last 3 years, the authors restore intestinal continuity after ileo-colonic removal by end-to-side anastomosis according to Bloch's technic the colonic incision is made perpendicular to the peritoneal band. This type of anastomosis, in view of the mode of distribution of the colonic arterioles does not cause any loss of blood supply as is sometimes the case on the antemesocolic border of the incision when it is made on the band. The first results appear very encouraging as in the first thirty cases there was only one case of breakdown of sutures in the anastomosis. The latter was not due to the technic but to recutting of the ileum in an area with a poor blood supply.

[Our experience with methods of studying the visceral lymphatic vessels]. / Notre expérience des méthodes d'investigation des vaisseaux lymphatiques des viscères.

The authors relate their experience on the investigation of the visceral lymphatic vessels. Their experience concerns the lung, the pancreas and essentially the stomach. This work has been carried out as well on the corpse using the technique of Papamiltiades as on the living. On the corps, only descriptive and topographic results may be taken into account; actually, to consider drainage in such a case seems to be a misinterpretation considering absence of lymphatic circulation and the importance of technique on the results. Only confrontation with results in vivo allows an interpretation.

The Kiricuta procedure in reconstructive surgical treatment of the breast.

A series of 50 patients with carcinoma of the breast underwent omental transposition. This palliative procedure is indicated for recurrences after conservative treatment, radiation necrosis and Stage III or IV ulcerated tumors. The operative technique is described in detail. Omentoplasties were performed upon 33 right and 17 left mammary areas. Forty-five right pedicled flaps and only four left areas were used. One patient died on the fourth postoperative day because of massive pulmonary embolus. Local repair was satisfactory in 76 per cent of the patients. Four patients presented with herniation of the abdominal wall at the site of omental tunneling. In three, the treatment consisted of sectioning the vascular pedicle and reinforcing the parietal closure with Dacron (polyester fiber) mesh.

[An usual observation of Bouveret syndrome (author's transl)]. / Une forme particulière de syndrome de Bouveret.

An unusual observation of Bouveret syndrome is reported. It occurred in a male patient, under the usual age for this disorder, with no history of cholelithiasis. Diagnosis was only established during the surgical procedure. There were neither radio-opaque stones nor air in the common biliary duct. Attempts to opacify the fistula failed. Gastro-entero-anastomosis, which is sometimes proposed because of the patient's poor general condition, is often necessary because of the local lesions. This procedure allows to wait until the local condition improves before undertaking the complete cure during the second procedure, with considerably lesser risk.

[Bilateral lobular in situ carcinoma discovered by sub-cutaneous mastectomy (author's transl)]. / Carcinome lobulaire in situ bilatéral découvert par mastectomie sous-cutanée.

The authors relate the observation of a 42 years old woman with antecedents of mastodynia from several years and numerous operations for fibroadenoma. During the follow-up a sub-cutaneous mastectomy is realized owing to the discovery of clustered calcifications on mammographic study, which reveals a bilateral lobular in situ carcinoma. They talk over surgical procedures in this form of carcinoma.

[Analysis of loco-regional control rate, metastatic remission and survival in 178 breast cancer patients treated by radical modified mastectomy and post-operative irradiation (author's transl)]. / L'irradiation post-opératoire dans les cancers du sein. Analyse du contrôle loco-régional, de la rémission métastatique et de la survie, à propos de 178 cas.

178 cases of post-operative irradiation for breast cancer (145 T1, T2, T3 and 33 T4) are analyzed. According to the surgical procedure there are 146 cases of radical modified mastectomy (Patey) and 32 cases of radical mastectomy (Halsted). The axillary status reveals 50% of involved nodes, but radiotherapy has been systematic on chest wall and supra-clavicular, parasternal, axillary lymph nodes areas. Loco-regional failures are only situated on chest wall (3,9%) and in the supraclavicular area (1,7%). The five year actuarial rate of locoregional control is 93% and 98% if we exclude 7 locoregional failures contemporaneous or consecutive to a metastatic evolution. The five year actuarial rate of metastatic remission for patients with negative axillary nodes (N-) is 83% against 55% for N+ (p < 0,001). The five year actuarial survival rate is 92% (N-) and 64% (N+) (p < 0,001). We discuss about indications of selective irradiation of chest wall and parasternal area for patients with negative axillary nodes and also about post-operative immuno-suppression, and chronology of chemotherapy.

[Management of mammillary discharge. Apropos of 38 cases]. / Conduite à tenir devant un écoulement par le mamelon. A propos de 38 cas.

The authors offer a diagnostic approach in cases of mammillary discharge and present a study of 38 cases of spontaneous discharge. The diagnosis is based on clinical findings combined with supplementary examinations, beginning with a cytological examination of the discharges, either bilateral or, in most cases, unilateral. The supplementary investigations are standard: mammography, galactography, with more and more frequent recourse to ultrasonography. If warranted on sufficient grounds, biopsy by sectorectomy is carried out to provide a histological diagnosis. The observed results show epithelial vegetation with (38%) and without (37.5%) atypical cells, the histological interpretation of which is: benign papilloma: 50 percent, diffuse papillomatosis: 17 percent, galactophoric carcinoma: 1 case and galactophoric ectasias: 22 percent. This study is compared to the results of Mouriquand et al [10] on induced discharges, where the frequency of papilloma and papillomatosis is slightly inferior by about 5 percent.

[Evaluation of dermatomes in the hind paw of the rat using retrograde axonal transport]. / Evaluation des dermatomes de la patte postérieure du rat par méthode de transport axonal rétrograde.

UV light fluorescent tracers (True Blue and Fast Blue) are placed in contact with sensitive receptors after dermabrasion. The abraded surfaces are limited to two hemidorsal areas and two hemi plantar areas on the animals' foot. A five days survival is allowed to enable the axonal retrograde transport of the tracers, then the animals are sacrificed and perfused with an intracardiac injection of 10% formaldehyde in phosphate buffer at 7.4 pH. The lumbar spinal ganglions are immediately dissected out, examined as a whole with a Leitz Dialux fluorescence microscope, then frozen and cut with a cryotome. The results of this analysis show that: i-only ipsilateral dorsal root ganglions are labeled by blue dye. ii-the number of fluorescent cells varies between 20 to 60 per ganglion. iii-a map of the distribution of the dermatomes on the rat hind foot can be deducted from the study of the labelled ganglions. They spread from L2 to L5 from the cranial to the caudal part, and from the medial to the lateral side of the rat foot, on both dorsal and plantar areas.

[Cytoprognosis in the pretherapeutic assessment of carcinoma of the breast. 192 cases. (author's transl)]. / "Cyto-pronostic" préthérapeutique du cancer du sein. 192 observations.

A cytologic grading method of fine needle aspiration smears has been applied to 192 cases of breast carcinoma. Grade I defines well differenciated carcinoma, grade II pleioporphic tumor cells, grade III anaplastic carcinoma. Special attention was given to the unfavorable forms of tumors (grade III). The cytologic grading was correlated with the NMT clinical classification, with the notion of acute exacerbation and with axillary nodes involvement. The correlation of grading with the clinical course of the disease was evaluated after a twelve months follow up. In 4% of patients classified in grade I, 8% of grade II and 58% of grade III, metastases, local recurrence or death had occurred within one year. The contribution of grading to the identification of fast growing tumors is discussed.

Prophylactic use of cefotaxime in colonic and rectal surgery.

Two hundred and seventeen patients, undergoing abdominal colonic and rectal surgery, received after randomization, the following regimen: group A (74 patients): cefotaxime 1 g intravenous at the induction of anaesthesia, the beginning of the resection, 4 and 8 h later; group B (72 patients): cefotaxime in the same regimen associated with ornidazole or metronidazole 0.5 g intravenous at the induction of anaesthesia and 0.5 g intravenous with the last injection of cefotaxime; group C (71 patients):cefotaxime following the same regimen as groups A and B and metronidazole orally 0.5 tds 3 days before surgery. All wounds were assessed daily, until discharge from hospital. Severe sepsis included: septicaemia, peritonitis, intra-abdominal abscess and extra-abdominal infections with death. Non-severe sepsis included all others. All the patients having a history of allergy to beta-lactam antibiotics and those with pre-operative infection were excluded. Mean age of the population was: 64.5 years. Seventy-seven patients had rectal cancer and 82 patients cancer of the colon; Twenty-five patients had inflammatory bowel disease, and in 33 others disease such as polyposis was present. Risk factors of post-operative infection were present in 115 cases (A, 36 patients; B, 37 patients; C, 42 patients). All three groups were very well matched for age, sex, type of intervention and diagnosis. Non-infectious complications appeared in 56 patients. Sepsis developed in 76 patients (A, 27 patients; B, 27 patients; C, 22 patients, no significant difference). Severe sepsis occurred in 14 patients (A, 6 patients; B, 4 patients; C, 4 patients, no significant difference) and in 62 patients non severe sepsis (A, 21 patients; B, 23 patients; C, 18 patients, no significant difference). Post-operative peritonitis was not seen. This study suggests that cefotaxime alone 4 g peri-operatively is useful in prophylaxis during rectal and colonic surgery.(ABSTRACT TRUNCATED AT 250 WORDS)