Multiple primary lung cancers.

Seventy-five cases of multiple primary lung cancers, representing 3.78% of a series of 1980 consecutively resected tumors, were divided into 24 synchronous and 51 metachronous cancers, according to the criteria of Martini and Melamed. They all concerned tobacco-smoking men. The synchronous tumors were symptomatic in 66% of the cases, the metachronous tumors in 37%. Nine synchronous locations were unilateral and 15 were bilateral; 20 metachronous locations were ipsilateral and 31 were contralateral. There were three third metachronous cancers. The resection of both tumours was performed for 15 synchronous cancers and for 19 metachronous cancers, including two third metachronous tumors. There were two deaths related to metachronous cancers. No patient with resected synchronous cancers survived 5 years, while 20% of patients with resected metachronous cancers survived this period. Synchronous cancers appear to represent an advanced stage. Metachronous cancers are often diagnosed too late.

Lympho-epithelial thymomas. A retrospective study of 88 resections.

Of 113 lympho-epithelial thymomas retrospectively studied, 56 were epithelial, 20 lymphocytic, 30 mixed and 7 were undefined forms. There were 88 resections (20 stage I, 47 stage II, 13 stage III and 8 stage IV). There were 69 primary resections (followed by radiotherapy in 54 cases) of which 57 were complete and 12 were incomplete. There were 19 secondary resections after radiotherapy: 10 were complete and 9 were incomplete and 25 patients were not operated upon and were treated by radio- and chemotherapy. After primary resection, the actuarial 5-year survival is 64.07% and the 10-year survival is 50.86%. After a secondary resection, the 5 year-survival is 43.74%. After non-surgical treatment, it is 18.67%. After surgery, the prognostic importance of staging is confirmed as more important than the cellular structure. Myasthenic patients are subject to late accidents. Postoperative radiotherapy seems to be justified, but its effect is not statistically significant when resection is complete. Post-radiotherapy surgery is beneficial only in cases of complete resection. The metastatic evolution of thymomas has been underrated and seems to depend upon the local control of the tumour. The use of chemotherapy remains to be defined.

[Multiple primary cancers of the bronchi]. / Les cancers primitifs multiples des bronches.

Sixty-six cases of multiple primary lung cancers were classified into 18 synchronous cancers and 48 metachronous cancers. They all occurred in tobacco-smoking men. The first group were symptomatic in 66% of cases, the second were symptomatic in 40% of cases. Six synchronous locations were unilateral and 12 were bilateral; 19 metachronous locations were ipsilateral and 29 were contralateral. Two cases had a third metachronous cancer. The resections of both tumours were performed in 11 out of 18 cases of synchronous cancers and 15 out of 48 cases of metachronous cancers. There were 2 deaths related to metachronous cancers. No patient with synchronous cancers survived 5 years after resection. One third of patients survived 5 years after resection of a metachronous cancer. Synchronous cancers represent an advanced stage. Metachronous cancers are diagnosed too late.

[Chest injuries in children. Apropos of 93 cases]. / Les traumatismes du thorax chez l'enfant. A propos de quatre-vingt-trieze observations.

UNLABELLED: Ninety-three cases of thoracic trauma (age ranging from 1.1/2 to 15 years) were observed over a 10 year-period (1980-1990): 86 cases of blunt trauma and 7 cases of perforating injuries. Road accidents were the most prevalent (63 cases) followed by home and sport injuries (9), falls (9), perforating trauma (9) and others. Associated lesions were frequent: skeletal (67), abdominal (19), and head injuries (5)--the latter influence the vital prognosis. Rib fractures were observed in 60% of cases of blunt trauma (86). Pulmonary lesions were as follows: pneumothorax (41), hemothorax (21), and lung contusions (29). In 48 cases, several of these pulmonary lesions were associated. Diagnosis and therapy problems were encountered in 21 cases. Results were as follows: 3 deaths, within 24 hours due to hemorrhage (1 case with aortic lesion). FOLLOW-UP: 85 good results, 5 sequelae, without any clinical consequence--either pleural (2), diaphragmatic (2), or lung (1). The treatment was as follows: none (27), pleural aspiration (2), thoraco-synthesis by drain in other cases for 2 to 9 days. Surgery was necessary in 10 cases, with 2 thoracotomies, 1 orthopedic traction, 1 embolization of iliac artery.

[Lympho-epithelial thymoma. Anatomo-clinical and therapeutic study of 113 cases]. / Les thymomes lympho-épithéliaux. Etude anatomo-clinique et thérapeutique de 113 cas.

One hundred and thirteen cases of lympho-epithelial thymomas were studied retrospectively: 56 were of epithelial type, 20 of lymphocytic type, 30 were mixed and 7 were not defined. Eighty-eight were operated on (20 stages I, 47 stages II, 13 stages III and 8 stages IV). There were 69 primary resections (57 complete and 12 incomplete), followed by radiotherapy in 54 cases and 19 secondary resections after radiotherapy (10 complete and 19 incomplete). Twenty-five patients did not have an operation and were treated with radio- and chemotherapy. After primary resection the actuarial survival at 5 years was 64.07% and at 10 years 50.86%. After a secondary resection it was 43.74% at 5 years. After radiotherapy it was 18.67% at 5 years. In operated cases the prognostic importance of staging was confirmed. The cytological structure was not. In myasthenic cases the secondary respiratory complications worsened the prognosis. Post-operative radiotherapy seems to be justified in all cases, but its effect is not statistically significant when resection was complete. Those operated after radiotherapy only showed a benefit if the resection was complete. The outcome of metastatic disease in TLE has been under-estimated and seems to depend on local control of the tumour. The use of chemotherapy remains to be defined.

[Unusual disclosure of giant Meckel's diverticulum]. / Révélation inhabituelle d'un diverticule géant de Meckel.

At discovery of diabetes mellitus, complementary explorations revealed a superinfection of a giant Meckel's diverticulum. We present this clinical situation in one case and suggest possible nosologies. The epidemiology and clinical approach to Meckel's diverticulum are discussed.