Solid tumors of the liver. Diagnostic and therapeutic problems.

The diagnostic and therapeutic problems involved in 29 cases of isolated hepatic tumors have been presented. In nine cases the hepatoma was discovered during emergency treatment for complications. Selective arteriography was the most accurate method of establishing the etiologic diagnosis. Suprahepatic phlebography indicated the possibilities for surgical treatment. These possibilities are not influenced by the volume of the tumor, but are closely dependent on damage to the suprahepatic vascular system. Effective surgery was performed in 22 cases, of which 14 were excisions.

[Value of angiography in the diagnosis of peripheral nerve tumors]. / Intérêt de l'angiographie dans le diagnostic des tumeurs des nerfs périphériques

In current practice, arteriograpy is already acknowledged, at the present time, as a method of primary importance which cannot be dispensed withfor diagnosis, prognosis and treatment. By opposition, considering pathology of the peripheric nerves, arteriography is often overlooked before chirurgical exploration though it affords the same advantages as in the remaining fields of pathology. Technically our preference goes to selective angiography by direct puncture of humeral or femoral artery. Arteriography will permit:-Visualisation of the location of the tumor close to the major vessels;-Evidence of the exact site of the efferent and afferent pedicles;-Discovery of other localisation. Mostly arteriography helps preoperatively to histological diagnosis. It must be recalled that benign neurinomas often assume a misleading aspect on the tumorography with stagnation of the contrast medium which might suggest malignancy. These benign tumors have three peculiar features: 1. Arteries are observed to stretch out around the lesion but never to narrow. 2. There is no explosive vascularisation ; hypervascularisation appears progressively, is located on the periphery of the lesion, and occupies but a part of the whole area. 3. Veins are not invaded but pushed apart and duly appear in normal timing. This peculiar aspect is quite the opposite of what can be observed in malignant tumors, which are, by far, less frequent.

[Contribution of arteriography to the investigation of peripheral nerve tumours (author's transl)]. / Apport de l'artériographie dans les tumeurs nerveuses tronculaires des membres.

Based on their personal experience of the use of arteriography in 11 patients, the authors describe the angiographic appearances of both benign and malignant peripheral nerve tumours. They emphasise the reasons for errors, and the criteria enabling the precise nature of the lesion to be determined pre-operatively in the majority of cases. Other contributions supplied by angiography are discussed.

[Indications for portacaval anastomoses in portal hypertension due to alcoholic cirrhosis. (Role of anatomo-pathological examination.)]. / Indications des anastomoses porto-caves dans les hypertensions portales par cirrhose éthylique. (Rôle de l'examen anatomo-pathologique.)

The authors report their experience of 134 cases of porta-caval anastomosis for alcoholic cirrhosis. From their experience, they draw up the logical indications for this operation, i.e. in order to ensure better survival than that of patients treated in other ways. They suggest routine study of surgical biopsy, even as an emergency. This biopsy permits them to recognise which cases are liable to be progressive; in severe cases, surgery should not be undertaken. Thanks to this selection, the operative mortality is reduced to that of any other severe operation (6 p. 100) and later survival is improved owing to absence of recurrent hemorrhage.

Sacral intraspinal lipoma associated with congenital iliac anomaly.

2 cases of a peculiar unilateral protuberance near the iliac bone with intraspinal abnormalities are reported. 8 cases have been described in the literature with this characteristic congenital association; they indicate the frequency of an occult spinal dysraphism which must be proved by myelography. In each case, surgical treatment of bone abnormality or of intraspinal lesions, or of both, should be discussed.