[Efficacy of rituximab in lymphomatoid granulomatosis]. / Efficacité du Rituximab au cours d'une granulomatose lymphomatoïde.

INTRODUCTION: Lymphomatoid Granulomatosis is a rare and serious disease, now considered to be a B-cell lymphoma, which is frequently associated with Epstein-Barr virus infection. There is no consensus on treatment, which is usually based on steroid therapy, either alone or combined with cyclophosphamide and combination chemotherapy. CASE REPORT: We report the case of an asymptomatic patient diagnosed after the incidental discovery of bilateral nodular opacities on their chest x-ray. Physical examination and bronchoscopy were normal. The diagnosis of Lymphomatoid Granulomatosis was made on the basis of surgical lung biopsy. Immunohistochemical studies confirmed the B phenotype of the lymphoma with the identification of atypical large CD 20 positive cells. In situ hybridisation confirmed the presence of EBV. In this case the course of the disease was slow. Treatment with anti CD 20 monoclonal antibodies (rituximab) led initially to a reduction in parenchymal abnormalities and mediastinal adenopathy. CONCLUSION: This treatment, recently used in Lymphomatoid Granulomatosis with pulmonary involvement, has shown promising results. Rituximab can be used in combination chemotherapy as standard treatment for aggressive B-cell lymphoma.

[Pulmonary malacoplakia caused by Rhodococcus equi in AIDS: a case report]. / Malacoplasie pulmonaire à Rhodococcus equi au cours du SIDA: à propos d'un cas.

We describe the observation of a right upper lobe consolidation with cavitation produced by Rhodococcus equi in a patient suffering from AIDS. The inefficacy of a prolonged antimicrobial therapy adapted against R. equi led to a right upper lobectomy. The histopathology showed a pseudotumoral mass, with dense infiltration of macrophages containing Michaelis-Gutmann bodies, which was positive for the culture of R. equi. Pulmonary malacoplakia with Rhodococcus equi was diagnosed. This pathology should be evoked when a R. equi pneumonia persists despite a right management of treatment for several months. The features of pneumonia with Rhodococcus equi and of pulmonary malacoplakia are taken from a literature review.

Esophageal perforation during attempted endotracheal intubation.

Perforation of the cervical esophagus in the course of attempted intubation of the trachea is a very rare accident, or at least rarely reported. Over the past 11 years, 12 patients ranging in age from 44 to 72 years were treated in our unit. If suspected, esophageal perforation is easy to diagnose when intubation has been difficult or when the patient complains of dysphagia and neck pain. Subcutaneous cervical emphysema appears early. All the patients who were operated upon early made an uneventful and prompt recovery. In those subjected to delayed operation (more than 12 hours) or nonoperative treatment, the mortality rate was 56 percent and recovery was achieved only after long and difficult treatment.

[Right pneumonectomy for carcinoma with resection of the carena and left tracheo-bronchial anastomosis: 3 cases (author's transl)]. / Pneumonectomie droite pour cancer avec résection de la carène et anastomose trachéo-bronchique gauche. 3 observations.

Extended pneumonectomy for carcinoma is associated with very poor results. However, a tumour which remains limited to the bronchial tree does not perhaps have such a poor prognosis as those which involve neighbouring organs. Valuable survival periods may be obtained after right pneumonectomy with resection of the carena. The authors here report 3 cases, including 2 with survivals of 10 and 8 years respectively.

[Acute hyperparathyroidism, diagnosis and treatment. 10 recent cases]. / L'hyperparathyroïdie aiguë, diagnostic et traitement. A propos de dix observations récentes.

The authors report 10 observations of acute hyperparathyroïdism crisis cases operated without death. They draw their conclusions from their own experience and from published cases. The evolution on the medical treatment is invariably mortal. The logical treatment is surgery. The operation is a true emergency, preceded by a brief but intensive medical treatment which checks dehydratation up and bring the blood calcium level down.

[Early surgical management of severe corrosive burns of the oesophagus (author's transl)]. / Indications opératoires précoces dans les brûlures caustiques graves de l'oesophage.

The authors have treated, as an emergency, 120 adults with corrosive burns. Thet were 22 patients among them checked as severe burns, i. e. who underwent surgical operations. Most of them tried to kill themselves by swallowing great quantities of acid or lye. Subsequently, gastric associated burns were frequent. Critical analysis of these observations, compared with the findings of pathology and in the literature permit one to get through the early management: -- Total fiberendoscopy is a true emergency, but for the patients who actually swallowed a glass or more of strong acid and have to undergo an immediate laparotomy. -- The place ofmajor surgical operations is discussed in relation to further specialist investigations of the appearance of complications. -- The results are assessed in 13 patients who were followed up for a long period.

[Caustic burns of the oesophagus in the adult. Histopathological study of 12 cases (author's transl)]. / Brûlures caustiques oesogastriques de l'adulte. Etude anatomo-pathologique de 12 observations.

A histopathological study of 12 cases of major caustic burns of the oesophagus serves as a basis for a description of the lesions and to demonstrate the inexorable progression to fibrosis. The lesions are most frequantly diffuse, regardless of the substance responsible. Four morphological stages may be distinguished, superimposed on the clinical picture.

[Tuberculosis and caustic eso-gastric burns. Critical reflections on one case]. / Tuberculose et brûlures caustiques oeso-gastriques. Réflexions critiques à propos d'une observation.

The diagnostic problems which may be raised during caustic oesophago-gastric burns and concommittent tuberculosis, of which the symptoms may be masked by the richness of the initial clinical picture are discussed here. The authors emphasise the necessity of prophylactic anti-tuberculous treatment, before any surgery when there is any suggestion of tuberculosis even siabilised.

[Perforations of the cervical esophagus in attempted tracheal intubation. A report of 12 cases]. / Les perforations de l'oesophage cervical par tentative d'intubation trachéale (12 observations).

The authors underline the factors favouring perforation of the oesophagus during intubation in the light of 12 personal cases: difficulty in intubation, use of an introducer, inexperienced operator. Such a perforation may result in mediastinitis and should be treated early with massive polyvalent antibiotics and a surgical suture left at rest for approximately one week.

[Profile of surgical tumors of the mediatinum. Apropos of a series of 742 operated patients]. / Profil des tumeurs chirurgicales du médiastin. A propos d'une sérle de 742 opérés

The authors seek to draw statistical conclusions on the basis of 742 surgically treated mediastinal tumours. Tumours of the thymus were the most common (20%). They were followed by tumours of the thyroid, neurogenic tumours, haematosarcomas and mediastinal cysts - all with an occurrence rate of around 12 to 15%. From a histological standpoint, 34.5% of the tumours were malignant or "potentially malignant". After a topographical study of these tumours, the authors discuss the possibilities of surgical treatment, the latter being great even in the case of malignant lesions.

[Large esophagogastric caustic burns in the adult]. / Les grandes brûlures caustiques oeso-gastriques de l'adulte

The authors treated, as an emergency, severe caustic burns in adults. They present 13 cases and discuss four deaths. Critical analysis of these observations,compared with the findings of pathology and in the literature, permit one to consider the therapeutic indications. The place of often major surgical operations is discussed in relation to further specialist investigations or the appearance of complications. The results are assessed in 8 patients who were followed up for a long period.

[Surgical treatment of pulmonary metastases from rectocolic cancers. Apropos of 21 cases]. / Traitement chirurgical des métastases pulmonaires des cancers recto-coliques. A propos de 21 observations

The authors report 21 cases of pulmonary metastases from operated cases of rectal and colonic carcinoma. Half the patients were aged between 60 and 70 years. In all cases except one the primary tumour was known and treated surgically before the metastasis occurred. The authors emphasize the necessity of radiological supervision of the chest after operation and recall that neither chemotherapy nor radiotherapy should be undertaken without prior histological confirmation. It is possible to remove the metastases by surgery but a high percentage require pneumonectomy i.e. it is necessary to take the same precautions before operation as for primary carcinoma of the bronchus. The operative mortality was nil, and the five year survival rate 18 p. 100.

[Benign esophagotracheobronchial fistulas in adults]. / Les fistules oesotrachéobronchiques bénignes de l'adulte

Oeso-tracheal-bronchial fistulas are rare in adults and their precise etiology is often difficult to determine, apart from the traumatic causes. Their diagnosis, based on symptoms, is confirmed by tracheal, bronchial and esophageal endoscopy, esophageal opacification and esophageal cineradiography. Treatment should permit one to avoid progressive pulmonary deterioration. Fatal accidents of bronchial inudation are rare but have been observed, especially in tracheotomised subjects. Surgical cure is possible and should be carried out under conditions of security which are defined here. In cases of irreversible pulmonary damage, one should carry out during the same stage, resection of part of the lung. Whereas the prognosis of fistulas after tracheotomy or intubation is always reserved, that of primary fistulas is good, providing the surgical cure is carried out early.