[Plasmacytoma of the head of the pancreas: a rare cause of cholestatic jaundice]. / Plasmocytome de la tête du pancréas: une cause rare d'ictère cholestatique.

A case of plasmacytoma of the head of the pancreas in a 75-year-old woman, revealed by obstructive jaundice, is reported. The tumor, which compressed the main bile duct, appeared to be round on sonographic and endoscopic retrograde cholangiographic investigations. Sonographically guided needle biopsy was performed but led to the erroneous diagnosis of pancreatic adenocarcinoma. Choledochojejunostomy and gastrojejunostomy were then performed but the patient died 10 days after the operation. Pathological examination of the specimens obtained at autopsy showed that the pancreatic tumor (as well as an other osseous lesion) were plasmacytomas with cells containing G immunoglobulins of the lambda type. Despite the failure of needle biopsy to lead to correct diagnosis in this case, the potential value of this method remains unequivocal as reported previously. Indeed, when positive results are obtained by this method in visceral localizations of plasmacytoma, hazardous surgery may be avoided and radiation and/or chemotherapy may be chosen preferentially.

[Primary melanoma of the esophagus]. / Mélanome primitif de l'oesophage.

The authors report 2 cases of primary melanoma of the esophagus, and describes the clinical, endoscopical, radiological and histological features from these exceptional tumors. Prognosis is very poor, despite various therapeutical possibilities.

[Subcardial ulcer and the Nissen technic. Apropos of a case of recovery by partial release of the fundoplication]. / Ulcère sous-cardial et technique de Nissen. A propos d'une observation de Guérison par décomplètement de la fundo-plicature.

Gastric ulcer, an uncommon complication of Nissen technique, is nevertheless reported in all series (between 1 and 5% of cases). The authors report a case occurring after a complete fundoplication associated with a longitudinal stapling of the cardia (Rignault's procedure) which resolved after reoperation and transformation into a posterior hemi-valve. The pathogenesis of post-Nissen gastric ulcer is discussed; the mechanical factor appears to be decisive in the subcardial site. Surgical revision according to various modalities is generally unavoidable.

[Giant esophageal fibrovascular polyp. Apropos of a case]. / Polype fibrovasculaire géant oesophagien. A propos d'une observation.

Fibrovascular polyps, together with eleiomyomas, constitute the great majority of rare benign tumors of the oesophagus. Their size and their frequently high level of attachment sometimes give them a spectacular clinical presentation. The hazards involved in the interpretation of radiological and endoscopic data account for frequent mistakes in their diagnosis. The determination of the pedicle site defines the choice of the surgical approach. A diagnostic error and the choice of an incorrect approach are the two main causes of therapeutic difficulties.

[Value of prolonged epidural analgesia in thoracic surgery]. / Intérêt de l'analgésie péridurale prolongée en chirurgie thoracique.

The use of high thoracic epidurals for post-thoracotomy pain relief in 156 patients is reviewed. Analgesia was maintained with a continuous infusion of a local anaesthetic, bupivacaïne 0.5% 40 ml, mixed with a narcotic, fentanyl 10 ml (perfusion rate between 3 and 7 ml/h). There was successful analgesia in 92%, with efficient ventilation, effective cough, no respiratory distress and only 8 cases of fibroaspiration. Only two significant respiratory complications occurred, due to incorrect management of the peridural route: the analgesic mixture was too concentrated and was injected by bolus instead of by continuous infusion. Other complications occurred, 8 cases of nausea or pruritus, 4 hallucinations, 10 cases of urinary retention lasting more than 24 h, 14 superior limb palsies and 22 Horner's oculopapillary syndrome. All of these complications were minor, easy to manage, and resolved after stopping peridural infusion. In conclusion, peridural analgesia is highly effective and improves the atmosphere in post-thoracotomy wards.

[Spontaneous rupture of the excretory urinary tract in solitary kidney. Apropos of a case report]. / Rupture spontanée de la voie excrétrice urinaire sur rein unique. A propos d'une observation.

The authors report a case of spontaneous rupture of the upper urinary tract in a solitary kidney which resolved towards cure after pyelostomy and evacuation of an encysted urinoma. The rarity of similar cases reported in the literature seems to prove that solitary kidney is not a predisposing condition.

[Ureteral risk of aorto-iliac surgery. Apropos of a case report of bilateral lesion of the ureters]. / Le risque urétéral de la chirurgie aorto-iliaque. A propos d'une observation de lésion bilatérale des uretères.

The authors report a case of bilateral uretero-hydronephrosis following aorto-bifemoral prosthesis for termino-aortic aneurysm due, on one side, to stenosis of incorrect repair of an operative injury to the ureter and, on the other side, to a syndrome of ureteric compression due to its retroprosthetic course, which is the central feature of this aetiological, pathophysiological and therapeutic discussion. Although the objective of treatment is to preserve the kidney, the risk of treatment is dominated by the threat to the future of the vascular prosthesis. The usual technical problem can be summarised by the question: should one cut the ureter or the prosthesis? and it would appear that a urinary problem does not necessarily imply a urological solution.

[Renocutaneous fistula: report of a chronic inguinal fistula]. / Fistules rénocutanées: à propos d'un cas de fistule chronique inguinale.

The authors report a new case of isolated spontaneous nephrocutaneous fistula revealed by a persisting draining sinus in the left groin. Their present causative factors are identified. The computed tomography and magnetic resonance imaging actually may resolve the diagnostic dilemma and are helpful in the surgical treatment.

[Urological surgical effect of the repair of inguinal hernia using bilateral subperitoneal prosthetic mesh]. / Incidences urologiques chirurgicales des cures de hernies inguinales par voile prothétique sous-péritonéal bilatéralisé.

In view of the increasing frequency of using subperitoneal bilateral prosthesis for inguinal hernia repairs, urologists should be aware of the genitourinary implications of this procedure: risk of infection due to potentially septic procedures on bladder or prostate, postoperative genitourinary complications, interval before subsequent trans-prosthetic surgical incision, operative tactical outcomes of subperitoneal pelvic fibrosis.

[Subperitoneal rupture of the bladder due to pelvic fractures. Apropos of 3 cases]. / Les ruptures sous-péritonéales de vessie sur fracas du bassin. A propos de trois observations.

Three different approaches to the diagnostic and therapeutic management of bladder trauma were adopted in 3 patients. Haematuria was discovered on bladder catheterization. Emergency cystography remains the best diagnostic examination. CT has the same limitations as intravenous urography. There are two schools of thought concerning the treatment of the bladder lesion: surgical repair and healing by simple drainage. The indications depend on the size of the rupture and the severity of haematuria: intravesical clots and the need for continuous irrigation constitute contraindications to simple drainage. Emergency surgery must be combined with treatment of the bone lesions. Apart from external fixation, posterior osteosynthesis, when possible, is also indicated in unstable fractures.

[Orchidectomy in testicular cancer. Variant techniques and tactics]. / Les orchidectomies dans le cancer du testicule. Variantes techniques et tactiques.

Exploratory orchidotomy, generally leading to orchidectomy, is the first procedure performed whenever testicular cancer is suspected. The techniques and indications for wide orchidectomy have advanced since the time of Chevassu: radical orchidectomy with lymph node dissection via an inguinoiliolumbar incision is no longer performed, value of wide orchidectomy associated with radiotherapy or chemotherapy, place of enucleations in the case of solitary testis or synchronous bilateral lesions, and deferred orchidectomy after chemotherapy. The various techniques are reviewed and their indications are discussed.

[Late diagnosis of the avulsion of the pyelo-ureteral junction treated by ureterocalicostomy]. / Diagnostic tardif d'avulsion de la jonction pyélo-urétérale traitée par urétérocalicostomie.

The authors report an exceptional case of delayed diagnosis of avulsion of the ureteropelvic junction in a 27-year-old man. Organization of the urohaematoma prevented ureteropelvic anastomosis and the kidney could only be preserved by performing ureterocalicostomy. This technique, generally used for tuberculous retracted renal pelvis, or failure of pyelotomy or ureteropelvic junction repair in horseshoe kidneys or kidneys with retracted renal pelvis, allowed renal preservation in this case.

[Triage of the injured in military surgery and in exceptional situations]. / Le triage des blessés en chirurgie de guerre et en situation d'exception.

Sorting casualties is universally accepted as the best means of coordinating a large number of patients with war injuries. Sorting means classifying casualties by characteristic medical and health features according to three types of criteria: diagnosis: gravity of the injury; prognosis: predictable survival; and logistic: evaluation of demand for care and possibilities for evaluation. The sorting process may be systematic or selective. The rules applied in different war situations or in civilian catastrophies vary according to the emergency care system which is called in (French Army, NATO, International Red Cross, GNO). The current role of the intensive care physician as a sorter is underlined. More than a doctrine, surgical sorting is a concept of action to be understood.

[Urogenital injuries caused by projectiles. Data on recent conflicts and the North-American civilian experience]. / Plaies génito-urinaires par projectiles. Données des conflits récents et de l'expérience civile nord-américaine.

The study of medical series from Vietnam and Lebanon, the analysis of US Army medical organization during recent UNO-IRAK conflict, the major technical contribution of North-American civilian publications should lead to draw correct organizational and technical management principles concerning genito urinary wounds, a for a long time misunderstood or neglected chapter of abdominal wounds.

[Parietal problems in thoracic injuries by gunshot]. / Les problèmes pariétaux dans les plaies du thorax par projectiles.

Injury to the thorax is usually studied to determine management strategy, point of thorax drainage, indications for early surgery, and particular visceral injuries. We examine problems related to abdominal wall injuries in projectile trauma of the thorax based on the characteristics of the projectile, and the anatomic, pathologic, clinical and therapeutic features.

[Traumatic rupture of 3 lobes of the right lung without any parietal lesion. A peculiar entity]. / Rupture traumatique des 3 lobes pulmonaires droits sans lésion pariétale. Une entité particulière.

Following a case of traumatic rupture of the 3 lobes of the right lung without any parietal lesion, the authors found three similar cases in the literature. However, uni or bilobar rupture was more frequently described. The pathological mechanisms are considered. The treatment of these lesions, in contrast to pulmonary laceration due to fractured ribs, most often requires limited parenchymal excision.

[Pseudo-neoplastic aspects of thoracic actinomycosis]. / Aspects pseudo-néoplasiques de l'actinomycose thoracique.

Pulmonary actinomycosis, a rare bacterial disease, is characterized by focal suppuration and an expansile fibrogranulomatous process that has a pseudotumoral evolution. On radioclinical examinations, it often mimicks an advanced or even inextractable primary bronchial tumor, thus leading to extensive surgery or even to give up the treatment. The effectiveness of antibiotic therapy leads the authors to discuss the role and limitations of surgery.

[Malignant adrenocortical tumor as a part of Wermer's syndrome. Apropos of a case]. / Corticosurrénalome malin dans le cadre d'un syndrome de Wermer. A propos d'une observation.

The authors report a case of malignant adrenal carcinoma associated with nodular adrenal hyperplasia as part of Wermer (N.E.M.I.) type pathological polyendocrinopathy syndrome. They stress the prognostic importance of the glandular degeneration and the type of adrenal involvement in these "multiple endocrine neoplasia".

[Subxiphoid pericardiostomy and pericardioscopy. Value and indications apropos of a series of 25 cases]. / Péricardotomie et péricardoscopie sous-xiphoïdiennes. Intérêt et indications à propos d'une série de 25 cas.

An experience of 25 subxiphoid pericardial windows with pericardioscopy in eleven cases is reviewed and presented. The operative indications in pericardial effusions result from hemodynamic compromise or from the need for etiologic criteria. Validated in its technical simplicity, its safety, its etiologic findings, its efficacy on immediate and delayed no recurrence of pericardial effusion, the low rate of late constrictive changes, this operative procedure is worth listing in the therapeutic know-how of a general surgeon. Indications in patients with suspected traumatic pericardial tamponade by chest wound are related.

[Laterosternal mediastinoscopy. Technic and indications. Apropos of 23 cases]. / La médiastinoscopie latéro-sternale. Technique et indications. A propos de 23 observations.

Parasternal (or anterior) mediastinostomy--a thoracic diagnosis surgery--is a simple, safe and rapid procedure which can be used either to gain access to the anterior or superior mediastinum and to the pulmonary pedicles ("hiloscopy" for exploration and biopsy, or to perform a wide lung biopsy without true thoracotomy.