Extracorporeal lung support for tracheoesophageal fistula surgical repair with free flap.

Tracheoesophageal fistula results in persistent leakage of saliva into the trachea, prevents oral feeding, and predisposes to aspiration pneumonia. Large fistula closure may require a free flap to cover the defect. When the defect involves the tracheal area between the neck and the mediastinum, a tubeless field for optimal exposure can be advantageous. This article reports the use of veno-venous extracorporeal lung support, a known safe and efficient technique to support the patient's respiratory function, for this purpose. The typical veno-venous extracorporeal lung support setting includes a femoro-jugular bypass. The patient cases reported here had characteristics that precluded the use of the jugular vein, such as neck radiation dermatitis, previous radical neck dissection, and poor accessibility. Therefore a more rarely described femoro-femoral approach was used. The cases of three patients with persistent tracheoesophageal fistula who had free flap surgeries (two bi-paddled radial forearm free flap and one latissimus dorsi muscle free flap) assisted by femoro-femoral veno-venous extracorporeal lung support are reported.

[Multiple primary intraductal tumors of Wirsung's duct: demonstration of a relation between benign and malignant tumors]. / Tumeurs intra-canalaires primitives multiples du canal de Wirsung: démonstration d'une filiation entre tumeurs bénignes et malignes.

A case of multiple villous and, more rarely, tubulovillous adenomas of the main pancreatic duct, associated with a diffuse infiltrating adenocarcinoma of the pancreas in which evidence for a link between these lesions is supported by histopathologic features, is reported in a 53 year old patient. Clinical presentation included abdominal pain, weight loss and chronic diarrhea with steatorrhea related to pancreatic insufficiency. Retrograde endoscopic pancreatography showed a complete stenosis of the main pancreatic duct located 3 mm beyond the ampulla of Vater. CT scan showed an heterogeneous cephalic pancreatic tumor with extensive enlargement of the main pancreatic duct. After total pancreatectomy, recovery was maintained (follow-up 18 months). By analogy to colorectal tumors, a new pathologic classification of these rare neoplasms may be proposed.

[Intrathoracic and retroperitoneal plasmacytomas in multiple IgA myeloma]. / Plasmocytomes intrathoraciques et rétropéritonéal au cours d'un myélome multiple à IgA.

A case of multiple myeloma of bone with retroperitoneal extension is reported and results of ultrasound and computed tomography imaging in this affection discussed. The tumoral mass can be evaluated with precision due to the reliability of CT scan imaging in the diagnosis of bony lesions and a positive diagnosis made and follow up reviews of changes in extra-osseous myelomatous masses conducted by combined ultrasound and CT scan imaging.

[Extradural hematoma after the surgical treatment of kyphosis]. / Hématome extra-dural après traitement chirurgical des cyphoses.

Two patients developed paraplegia during the course of surgical reduction and fixation of kyphosis: one of congenital origin and the other related to Marfan's disease. Myelography with contrast showed an extramedullary hematoma, treated surgically.

[Suprascapular and axillary subcutaneous emphysema after perforation of a pharyngolaryngeal cancer]. / Emphysème sous-cutané sus-scapulaire et axillaire après perforation d'un cancer pharyngo-laryngé.

A case is reported of a laryngeal cancer recurrence that had invaded and then eroded the pharynx. The fistula produced was the cause of a thrombophlebitis of upper limb, and subcutaneous emphysema limited to the right shoulder region due to radiosclerosis of soft tissues of neck.

[The intrathoracic rib. A study in x-ray computed tomography]. / Côte intra-thoracique. Etude en tomodensitométrie.

CT scan imaging of an intrathoracic rib demonstrated a cartilaginous component beyond the distal extremity of the bony structure.

[Contribution of radiology in the study of ileal reservoirs anastomosed to the anal canal]. / Apport de la radiologie dans l'étude des réservoirs iléaux anastomosés au canal anal.

Confection of an ileal reservoir anastomosed to anal canal is a seductive issue after total coloproctectomy. In this prospective study, early complications, mainly anastomotic fistulae, were effectively detected by routine enemas with water soluble media. These complications affected 14% of patients. Preliminary results of functional exploration of reservoirs by defecography showed that continence muscle barriers were apparently unaltered by the operation, that the content of reservoirs in J was satisfactory and that difficulties in exoneration frequently met with in reservoirs in S were due to architectural anomalies of these ileal pouches rather than a disturbance in pelvic muscles play. Radiologic analysis can establish perfection of surgical mounting and guide possible recovery operations.

[Value of cytopuncture associated with microbiopsy in solid masses in the pancreas. Preliminary study]. / Intérêt de la cytoponction associée à la micro-biopsie dans les masses solides du pancréas. Etude préliminaire.

Efficacy of fine needle puncture and microbiopsy technics was compared in 19 patients with a solid pancreatic mass. Results showed sensitivity and global accuracy of 71 and 72% respectively for cytology, 92 and 82% for microbiopsy and 100 and 94% for their combined use. Global accuracy and negative predictive values reached 100% when repeat samples were collected because of insufficient material. No false positives were noted and no complications in this preliminary series.

[Splenic abscess. A new diagnostic and therapeutic approach. Apropos of 7 cases]. / Abcès spléniques. Nouvelle approche diagnostique et thérapeutique. A propos de 7 observations.

Anomalies in seven patients with splenic abscess were invariably observed on ultrasound imaging despite absent or misleading clinical symptomatology splenomegaly was detected in only 3 cases. The abscess was multiple in 6 cases with perisplenic extension in 2 patients. Splenectomy was performed in only 2 cases. In one patient, diagnostic and therapeutic fine needle puncture of spleen was performed. Comparison with CT scan imaging is presented with respect to 3 patients. Ultrasound imaging can suggest a diagnosis of intrasplenic abscess and fine needle puncture is not contraindicated.

[Inhalation of metallic mercury. Radiological aspect. Apropos of 2 cases]. / Inhalation de mercure métal. Aspect radiologique. A propos de 2 observations.

Two patients were treated for lesions due to inhalation of mercury, one accidental and the other a suicidal attempt. The pulmonary image showed the mercury fragmented into numerous particles of very enhanced density. In one patient these particles were in the right basal pyramid while in the other they were disseminated throughout the lung fields. The immediate outcome was favorable in both cases.

[Diffuse multiple villous adenoma of Wirsung's canal. Neoplastic transformation. Value of x-ray computed tomography]. / Adénomes villeux multiples, diffus du canal de Wirsung. Transformation carcinomateuse. Intérêt de la tomodensitométrie.

Results of CT scan imaging in a patient with diffuse, multiple villous adenomas of Wirsung's canal showed intracanalar budding. The diffuse nature of the villous lesion of Wirsung's canal and the juxtaposition of pure adenomatous lesions, dysplastic lesions and malignant papillomas make this an exceptional if not unique observation in the literature.

[Hypertension in malignant tumors of the adrenal cortex. A review of clinical, biological and hormonal features]. / L'hypertension artérielle dans les corticosurrénalomes malins. Révision de son expression clinique, biologique et hormonale.

Hypertension may be a prominent and sometimes the dominant expression of tumours of the adrenal cortex as demonstrated in a personal series of 9 cases and in comparable series in the literature. It is therefore important, despite their relatively low incidence, to recognise adrenal cortical tumours as the cause of hypertension. The present study was undertaken to show that this diagnosis is relatively easy. The simplest indicators are:--the change in body electrolytes with hypokalaemia and hyper-kaliuria is practically constant and should prompt a hormonal investigation to demonstrate increases adrenal secretion of mineralocorticoids;--there is also a high incidence, despite the variable profiles of plasma and urinary corticosteroids, of paradoxical lowering of plasma aldosterone in parallel with normal or low PRA which does not react to orthostatism. These two preliminary investigations are the prelude and invitation to the measurement of other mineralocorticoids, especially desoxycorticosterone secondary to a relative block of 11-betahydroxylation from what other in vivo and in vitro studies have shown. Repeated monitoring of the preceding investigations is important for the post-operative follow-up and diagnosis of recurrences or metastases.

[Value of hormonal markers in the detection and therapeutic surveillance of malignant adrenal cortical carcinoma]. / Intérêt des marqueurs hormonaux dans le dépistage et la surveillance thérapeutique des corticosurrénalomes malins.

The value of hormonal markers in the diagnosis and early and late surveillance of adrenocortical carcinoma was assessed in a series of 10 cases and from a review of the literature. Although hormonal investigation with measurement of precursors, performed whenever there is the least clinical suspicion of ACC, is of certain diagnostic value, the possibilities of postoperative controls have not yet been fully exploited: the results are difficult to interpret because of possible interference due to the secretion of the controlateral adrenal; plasma renin activity is rarely assessed in the late postoperative period. A general strategy of investigation and surveillance is proposed.

Pelvic cancers: staging of 139 cases with lymphography and fine-needle aspiration biopsy.

One hundred thirty-nine patients with pelvic cancers (101 bladder carcinomas, 27 prostatic carcinomas, and 11 testicular tumors) considered for radical surgery were studied with lymphography and percutaneous fine-needle aspiration (FNA) biopsy, and the results were correlated with lymphadenectomy. Adequate material for FNA was obtained in 97%, 88%, and 100% of the bladder, prostatic, and testicular tumors, respectively. For bladder carcinoma, the global accuracy was 58% for lymphography and 93% for FNA; the high false-negative rate for lymphography (48%) was lowered to 25% with FNA, providing that the obturator nodes were punctured. For prostatic carcinomas, it was not possible to evaluate the true-positive rate because the patients with positive FNA results did not under-go surgery. For testicular tumors, lymphography and FNA had almost the same global accuracy (73% and 75%), but FNA had a better specificity (100%) than lymphography (86%). FNA had no false-positive results, which means that positive biopsy results obviate radical surgery; when FNA results are negative a lymphadenectomy should be performed. With its mild morbidity, FNA has a role in the preoperative staging of pelvic carcinomas.