[Neurogenic appendicitis. A case]. / Appendicite neurogène. Une observation.

Laparoscopic procedures have changed the indications for appendectomy. Routine exeresis should not be performed if a normal organ is observed during an exploratory procedure, but should be in cases with clinical manifestations of right flank pain since neurogenic appendicitis is not rare. We report a recent case observed in a 76-year-old woman. The patient was initially hospitalized for right flank pain with nausea and irregular episodes of diarrhoea. Clinical examination and complementary exploration led to cholecystectomy via subcostal access. On per-operative cholangiography the common bile duct appeared normal. Immediate follow-up was uneventful and the patient was discharged. Twelve days later, the patient complained of the same type of abdominal pain and was hospitalized with a fever at 38 degrees C and shivers. The right flank was very painful at palpation. Echography and computed tomography eliminated a subphrenic abscess or secondary pancreatitis. Pain localized at MacBurney's point 8 days later. Barium study showed a normal colon with the exception of uncomplicated diverticulosis. Subjective pain persisted and appendectomy was decided. Pathological examination revealed neurogenic appendicitis. First described in 1924, neurogenic appendicitis is relatively frequent. Macroscopically, a sclerous fibromyxomatous nodule obliterates the lumen. Microscopically, the central obliterating lesion is composed of hyperplastic nervous tissue in a fibromyxoid matrix, particularly important at the point of the appendix. Clinically neurogenic appendicitis is usually chronic and the appendix appears healthy in situ. Cure is always achieved with resection. Laparoscopic procedures can identify para-appendicular causes of painful abdominal syndromes and sclero-atrophic appendicitis, but in the absence of another explanation exeresis appears to be justified due to the possibility of neurogenic appendicitis.

[Are there limits to conservative treatment of breast cancer?]. / Y a-t-il des limites au traitement conservateur du cancer du sein?

For nearly 40 years, a multidisciplinary team working in a private clinic has used a conservative approach to breast cancer for small tumours, i.e. T1-T2. Treatment is based on tumorectomy and radiotherapy. Good results, comparable to those obtained with mastectomy have been obtained and continue to improve with developments in therapeutic methods. The rate of recurrence remains below 7% and 95% of the women were able to keep their breast without any supplementary danger. There are satisfied.

[Splenosis after splenic rupture: a disease to be recognized]. / La splénose après rupture de rate: une affection à reconnaître.

One case of peritoneal splenosis is reported. The diagnosis was established at surgery in a 17-year-old female patient presenting with dull abdominopelvic pain, who had undergone total splenectomy after a trauma ten years earlier. This autograft of splenic tissue must be known to be acknowledged, especially today, when the conservative treatment advocated for ruptures of the spleen may increase its incidence. The literature reports only about one hundred cases. The treatment only consists in removing the sole symptomatic nodules.

[Peritoneoectomy in the surgical treatment of advanced ovarian cancer. Stages III and IV]. / La péritonectomie dans le traitement chirurgical des cancers de l'ovaire "dépassés". Stades III et IV.

Extirpation of so-called inoperable "over-run" stages III and IV ovarian cancer is possible. This exeresis is based on the essentially peritoneal extension of the disease and the use of a retroperitoneal dissection plane. The complex operation involves the total abdomen and includes exeresis of all the parietal peritoneum, a right and left colectomy and a posterior pelvectomy. It does not appear mutilating but is sufficiently complex to justify the present technical description. It gives a real efficiency to chemotherapy which follows it.

[Treatment of lateral eventrations by an aponeuroplasty method]. / Cure des éventrations latérales par un procédé de plastie aponévrotique.

Lateral incisional hernias are not uncommon. Aponeuroplasty, which has already given excellent results in the repair of midline incisional hernias, is also suitable for transverse or oblique incisions. No complications have been observed, and the technique has been proved successful in our series of 22 cases.

[Surgery of pilonidal cysts in dorsal decubitus]. / Cure des kystes pilonidaux en décubitus dorsal.

All lesions located in the sacro-coccygeal region can be operated upon in supine position, which requires a lighter general anaesthesia.

Prophylactic use of cefotaxime in colonic and rectal surgery.

Two hundred and seventeen patients, undergoing abdominal colonic and rectal surgery, received after randomization, the following regimen: group A (74 patients): cefotaxime 1 g intravenous at the induction of anaesthesia, the beginning of the resection, 4 and 8 h later; group B (72 patients): cefotaxime in the same regimen associated with ornidazole or metronidazole 0.5 g intravenous at the induction of anaesthesia and 0.5 g intravenous with the last injection of cefotaxime; group C (71 patients):cefotaxime following the same regimen as groups A and B and metronidazole orally 0.5 tds 3 days before surgery. All wounds were assessed daily, until discharge from hospital. Severe sepsis included: septicaemia, peritonitis, intra-abdominal abscess and extra-abdominal infections with death. Non-severe sepsis included all others. All the patients having a history of allergy to beta-lactam antibiotics and those with pre-operative infection were excluded. Mean age of the population was: 64.5 years. Seventy-seven patients had rectal cancer and 82 patients cancer of the colon; Twenty-five patients had inflammatory bowel disease, and in 33 others disease such as polyposis was present. Risk factors of post-operative infection were present in 115 cases (A, 36 patients; B, 37 patients; C, 42 patients). All three groups were very well matched for age, sex, type of intervention and diagnosis. Non-infectious complications appeared in 56 patients. Sepsis developed in 76 patients (A, 27 patients; B, 27 patients; C, 22 patients, no significant difference). Severe sepsis occurred in 14 patients (A, 6 patients; B, 4 patients; C, 4 patients, no significant difference) and in 62 patients non severe sepsis (A, 21 patients; B, 23 patients; C, 18 patients, no significant difference). Post-operative peritonitis was not seen. This study suggests that cefotaxime alone 4 g peri-operatively is useful in prophylaxis during rectal and colonic surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

[Peroperative estimation of the imperviousness of choledochoduodenal anastomoses]. / Appréciation per-opératoire de l'étanchéité des anastomoses cholédoco-duodénales.

Fistulae occurring after choledochoduodenostomy always have severe consequences. The following procedure aimed at checking for leakage is suggested by the authors. After completion of the posterior stage of the operation, a naso-gastric tube is introduced into the common bile duct, exposing the anterior suture; once the anastomosis has been performed, a fluid is injected into the tube by the anaesthetist, thus revealing any leakage. Once the incisions are covered, the naso-gastric tube is simply withdrawn on a few centimetres.

[Post-traumatic disinsertions of the terminal brachial biceps tendon. Surgical technique in five cases (author's transl)]. / Les désinsertions traumatiques du tendon terminal du biceps brachial. Au sujet de cinq observations illustrant une technique chirurgicale.

The many techniques proposed for repair of post-traumatic desinsertions of the terminal brachial biceps tendon well illustrate the therapeutic difficulties encountered when attempting to treat these lesions, none of them being currently unanimously employed. After describing these various operative methods, the authors discuss their technique, as used in five cases, this method allowing restauration of both flexion and supination of the muscle.