[Treatment of renal cancer extending supradiaphragmatically with fibrinolytics following surgery under extracorporeal circulation, hypothermia and circulatory arrest]. / Traitement d'un cancer du rein avec extension supra-diaphragmatique par fibrinolytiques puis chirurgie sous circulation extra-corporelle, hypothermie et arrêt circulatoire.

The authors report a case of right renal carcinoma with a supradiaphragmatic vena cava thrombus. The patient presented to the emergency ward with a severe pulmonary embolus managed by fibrinolytic treatment. After alcohol embolization of the tumor, the patient underwent a right radical nephrectomy with cavectomy. A large tumor extending to the heart was removed by cardiopulmonary bypass combined with hypothermia and cardiac arrest. The immediate postoperative course was satisfactory. Eighteen months later, a CT scan revealed a suprarenal growth. A cytological study was performed on a specimen obtained by percutaneous fine needle aspiration under CT guidance and revealed local a recurrence of the renal cell carcinoma. This was removed without any problems. Two years later, no pulmonary metastases have been noted despite, the fibrinolytic therapy.

[Angiomyolipoma of the kidney. Attempt at a therapeutic codification]. / L'angiomyolipome du rein. Essai de codification thérapeutique.

On the basis of the analysis of five original and of 181 previously published observations since 1975: the histological, histogenetic, evolutive and epidemiologic patterns of renal angiomyolipoma are exposed; the symptoms at presentation and the clinical manifestations are analysed; some morbid associations of this affection are considered and, particularly, its particular relationship with the tuberous sclerosis is debated; the diagnosis of these angiomyolipomas is studied with special regard to the role of modern radiologic explorations; finally, is propounded a therapeutic codification, which relies mainly on surgery.

[Transdiaphragmatic approach to the supraceliac aorta. Surgical anatomy and operative technic]. / L'abord trans-diaphragmatique de l'aorte sus-coeliaque. Anatomie chirurgicale et technique opératoire.

The surgical anatomy and the practical modalities of the trans-peritoneal-diaphragmatic approach of the low thoracic aorta have been studied on the basis of 40 consecutive dissections. The trans-diaphragmatic approach of the supra-celiac aorta can be performed: either through a restrictive way, by dissociation of the muscular fibers of the posterior angle of the oesophagal hiatus, thus allowing the access to a mean 30 mm long part of supra-celiac aorta, large enough to perform a complete aortic clamping; either through an extensive way, by medial sagittal section, in front of the aorta of the muscular fibers of the posterior angle of the oesophagal hiatus and of the arcate ligament, thus permetting this exposure of a longer aortic part (60 mm on a average) and the realization of more important aortic procedures. These may be performed with a lateral aortic clamp, on account of the large diameter of the aorta at this level (30 mm on an average).

[Hemolymphangioma of the pancreas]. / Les hémo-lymphangiomes du pancréas.

The authors report a case of hemo-lymphangioma from the body and the tail of the pancreas. Through a review of the literature, the histological, histogenetical and clinical features of this disease are recalled and the diagnostic and therapeutic modalities are considered. These are benign tumors and their treatment must be surgical and radical. Two operative attitudes are possible: the tumoral enucleation and the partial pancreatectomies.

[Indications of the trans-diaphragmatic approach to the supra-celiac aorta]. / Indications de l'abord trans-diaphragmatique de l'aorte sus-coeliaque.

The trans-diaphragmatic approach of the supra-celiac aorta can be performed in two different ways, according to the indications of this approach: The approach through a restrictive way, by simple dissociation of the muscular fibers of the posterior angle of the oesophagal hiatus allows an high and fast aortic clamping, especially helpful when a serious sub-diaphragmatic bleeding is encountered. It can also be used at the time of reintervention on the sub-renal aorta, in case of juxta-renal aortic thrombosis or in case of abdominal aortic aneurysm involving renal arteries. The approach through an extensive way, by saggital section of the muscular fibers of the posterior angle of the oesophagal hiatus and of the arcate ligament increases considerably the length of the exposed aortic segment and allows the implant of a by-pass graft on the lower thoracic aorta; this graft can be used to revascularize the underlying aortic step; it can also be used to shunt a lesion of the thoracic aorta.

[Massive digestive hemorrhage caused by aorto-esophageal fistula]. / Les hémorragies digestives massives par fistule aorto-oesophagienne.

A very rare diagnosis before a terminal hemorrhagic accident, aorto-esophageal fistula (FAO) is almost always fatal. Three cases of this exceptional lesion are reported. The first patient died within a few minutes of admission from a cataclysmic hematemesis. This 52 year old man had a recurring adenocarcinoma of the cardia that had been treated by laser. A "premonitory hematemesis" of bright red blood had occurred eight hours before admission. In the two other cases the problem arose with an "open abdomen" in exsanguinated patients operated upon as emergencies for massive hematemesis. In both cases, an intra-esophageal balloon catheter and controlled hypotension allowed performance of a left thoracotomy and aortic clamping. One patient had a cancer of middle third of esophagus that had perforated into the descending aorta. A resection-graft of the aortic isthmus and a retrosternal gastric esophagoplasty was successfully carried out at the time of exploration. The other patient had an FAO in the aortic isthmus region probably due to a foreign body. Operation involved an esophagectomy with cervical esophagotomy and gastrotomy combined with a resection-graft of aortic isthmus using a Dacron prosthesis. This patient died on the 21st postoperative day from rupture of the brachiocephalic trunk over a tracheotomy tube. In both of these patients a "premonitory hematemesis" with dysphagia had preceded the severe hemorrhagic accident. Successful treatment is rarely obtained with such lesions, since difficulties in ensuring rapid hemostasis in exsanguinated patients operated upon usually without diagnosis and for massive hemorrhage only, are associated with the risks of aortic repair surgery in a hemorrhagic field and with a mediastinum infected from the esophageal wound.(ABSTRACT TRUNCATED AT 250 WORDS)

Bladder reconstruction with ileum after cystoprostatectomy for bladder cancer: analysis of the micturition and continence of 44 consecutive patients.

From October, 1987, to August, 1990, 47 patients underwent an ileal low pressure bladder replacement using the Hautmann procedure after radical cystoprostatectomy for bladder cancer. The qualities of micturition and continence were evaluated from a questionnaire mailed to the patients and by urodynamic examinations in 44 consecutive patients over a follow-up period of more than 3 (mean 10.7) months. The 44 patients (100%) were perfectly dry during the daytime and voided every 4 (2-6) h with a micturitional volume of 357 (200-500) ml. Forty-two of the 44 patients had no residual urine. Thirty-three of the 44 patients (75%) were perfectly dry at night with a voiding frequency of 1.5 (0-3). Seven of the 44 patients (16%) were occasionally incontinent (spotting less than 2/week). Four of the 44 patients (9%) had night incontinence and used as external device. Only two patients showed high pressure waves of greater than 50 cm H2O. The maximum urethral pressure was 59.07 +/- 13.6 (30-80) cm H2O. The maximum flow rate was 17.2 +/- 9.7 (4.5-35) ml/sec. The different factors responsible for the new micturitional balance were discussed. With its very good functional results and its ease of performance, the ileal neobladder is, for us, the procedure of choice for bladder reconstruction after cystectomy.

[Treatment of urinary tract infections by dibekacin]. / Traitement des infections urinaries par la dibékacine.

In this cooperative trial, 181 patients with various urinary tract infections were treated by dibekacin, a new hemi-synthetic aminoglycoside. Clinical and bacteriological results confirm the efficacy of dibekacin in this indication. Local and systemic tolerance, and thus renal and cochleo-vestibular, were very satisfactory.