[Cystic lymphangioma of the abdomen in an adult. Contribution of echography and computed x-ray tomography. Apropos of a case]. / Lymphangiome kystique de l'abdomen chez un adulte. Apport de l'échographie et de la tomodensitométrie. A propos d'un cas.

Authors present a case of cystic lymphangioma of the abdomen in an adult patient. Pre-operative investigations are based on ultrasound and computed tomography since plain films, excretory urograms and barium enema are less helpful. Opportunity of such a diagnosis in adult is not frequent.

[Myocardiopathy and Takayasu's disease. Apropos of a case]. / Myocardiopathie et maladie de Takayasu. A propos d'une observation.

The possibility of cardiac involvement in Takayasu's disease is well known, but this involvement generally appears to be secondary to reno-vascular hypertension or to pulmonary arteritis and, exceptionally, as a result of coronary disease. In the case reported here, the inflammatory myocardial lesion localised to the left ventricle was demonstrated while the patient was still alive. It was responsible for an episode of severe heart failure which finally resolved after 2 years. The inflammatory involvement of the myocardium was associated with laboratory signs of inflammation and with inflammatory arterial lesions. Several haemodynamic investigations were performed to follow the course of the disease. The diagnosis was confirmed by myocardial biopsies and by the pulmonary arterial and renal arterial involvement. A review of the literature revealed that this condition was extremely rare and has only been proven in a few autopsy cases.

[Acute gangrenous acalculous cholecystitis disclosed by postoperative septic shock]. / Cholécystites aiguës gangréneuses alithiasiques révélées par un choc septique postopératoire.

Three cases of acute gangrenous acalculous cholecystitis, revealed by a postoperative septic shock, are reported. Clinical examination was negative and the surgery gave the diagnosis. Infection with biliary stasis and ischaemia accounts for this pathological entity. The very serious prognosis of this condition can only be reversed by cholecystectomy.

[Gastrointestinal haemorrhage due to aorto-intestinal fistula. 3 cases (author's transl)]. / Hémorragies digestives par fistules aorto-intestinales. 3 observations.

Three types of aorto-intestinal fistula may be associated with gastrointestinal bleeding: primary fistulae from an aneurysm, secondary fistulae related to an aorto-prosthetic anastomosis and paraprosthetic fistulae by intraduodenal protrusion of a graft. The prevalence of secondary and paraprosthetic fistulae increases with more widespread vascular surgery. Only if the diagnosis is always borne in mind in a patient with an aneurysm or an aortic prosthesis makes it possible to recognise an aorto-intestinal fistula in time. Upper GI series and endoscopy are more useful in reaching a diagnosis than arteriography but signs must be sought in the third and fourth parts of the duodenum. The lesion may even be missed on surgical exploration, being concealed before separation of the aorta and duodenum. Infection and the underlying general medical condition are factors in the gravity of the operative prognosis. One of our three patients treated surgically was saved by the insertion of an extra-anatomic bypass. The prognosis in paraprosthetic fistulae, the possible precursor stage of a secondary aorto-digestive fistula, is more favourable.

[Primary retroperitoneal tumors in adults]. / Tumeurs rétro-péritonéales primitives de l'adulte.

The authors report a series of eight primitive retro-peritoneal tumors, which were difficult to diagnose because of the late appearance of the symptoms. The intravenous urogram is the only satisfactory fundamental examination, possibly completed with ultrasound, CT scanning, and, if necessary, angiography. Extensive surgery allowed total exeresis in most cases. But histological examination remains difficult. Mesenchymomas, the most frequent, are very often malignant. Two cases of association with other malignant tumors were observed. Adjuvant procedures add little to life expectancy and total surgery is alone likely to be effective.

[Fortuitously discovered gallbladder lithiasis and surgery]. / Lithiase vésiculaire "de rencontre" et chirurgie.

When confronted with the fortuitous discovery of cholelithiasis, a simultaneous operation is advisible in view of the drawbacks of performing a second operation and the risks of postoperative cholecystitis. Analysis of the author's results and those reported in the literature shows only a slightly increased morbidity rate and a similar mortality rate. In high-risk patients, and if the cholecystectomy appears difficult, the removal of the stones followed by a cholecystostomy is less aggressive and faster.

[Myxoma of the left atrium diagnosed by pathological examination of an embolism of the aortic bifurcation (author's transl)]. / Myxome de l'oreillette gauche diagnostiqué par examen anatomique d'un embole de la fourche aortique.

The case reported was a 69-year-old patient with a myxoma of the left atrium presenting as multiple emboli: acute ischaemia of the lower limbs preceded, three months before, by a spontaneously regressive right hemiplegia which, in view of the patient's age, was considered to be a simple manifestation of atherosclerosis. The diagnostic value of the echocardiogram in cases of systemic emboli of undetermined origin is stressed.

[Haemorrhagic necrosis of the digestive tract consecutive to massive digitalis intoxication (author's transl)]. / Nécrose hémorragique du tube digestif au cours d'une intoxication digitalique massive.

A 60-year-old man under digitalis treatment for hypertensive heart tried to commit suicide by absorbing a 15 mg dose of digitoxin. Severe intestinal bleeding occurred 12 hours later, followed by pseudo-occlusive syndrome and ischaemia of the distal lower limbs. On abdominal incision the whole gut was found to be invaded by haemorrhagic necrosis and perforated on three points. The patients subsequently died of peritonitis. The responsibility of digitoxin in these events was demonstrated by the absence of any other cause of ischaemia, such as heart failure, shock, arrhythmia, consumption coagulopathy or use of sympathomimetic drugs. This case shows that the vasoconstrictor effect of digitalis, experimentally demonstrated but clinically controversial, is a reality, and that digitalis compounds are contra-indicated in patients with haemorrhagic necrosis of the digestive tract.