[Thyroid epitheliomas in French Polynesia]. / Les épithéliomas thyroïdiens en Polynésie Française.

The authors reviewed 34 cases of thyroid epithelioma registered in French Polynesia from 1985 to 1990. Annual incidence classifies French Polynesia as a region with low endemicity. The patients were 31 females and 3 males. In 18 cases, carcinoma was discovered within a multiheteronodular goitre (MHNG) and in 16 cases within an isolated nodule. In each of these sub-groups, 4 micropapilliform cancers discovered at the occasion of a histopathological test. The mean age of the patients carrying a noduliferous cancer is 36.5 years and the one of multiheteronodular goitre is 50. No particular risk factor was discovered. Mean age of the disease is 2.8 years as far as noduliferous cancers are concerned, and 8.5 years for multiheteronodular goitre. The anatomical and echographic characters are discussed. What demanded a surgery intervention is reviewed. Mortality during intervention is zero. Morbidity recorded 17% of unilateral recurrent paralysis and 50% of transitory parathyroid insufficiency. Extemporaneous anatomopathological test was contributing in 25% of the cases; definitive test revealed 25 (74%) papilliform cancers (of which 8 micropapilliforms) and 9 vesicular cancers (26%). No canceration anaplasia was discovered. Evolutive stage is precised: 7 local invasions (isthm and/or capsule), 4 bifocal localizations, 8 cancers with adenoid metastasis, 4 with osseous and/or pulmonary metastasis. The way to select a therapy is reported and discussed. Cost evaluation is suggested in order to discuss the possibility to acquire for the Territory an equipment for isotopic exams.

[Rehabilitation of the portal vein. Anatomical, experimental and clinical observations of liver metastases]. / Réhabilitation de la veine porte. A la faveur d'observations anatomiques expérimentales et cliniques de métastases hépatieues.

We have studied the macroscopic anatomy of the portal vein to explain the distribution of metastatic emboli, by the orientation of its branches and its internal flows. Its termination seen under the microscope permits, by knowledge of the portal microcirculation of the lobule, one to localise nidation of these emboli in the hepatic sinus and, to explain their proliferation, without neglecting the dynamic role of the hepatic artery through the numerous arterio-portal anastomoses. The portal blood flow is essential to liver regeration even if arterio-biliary proliferation provides the initial impulsion. Interruption of a portal branch produces hepatic atrophy with resultant metabolic disorders. In this context, a precise physiopathological approach permits one to consider the consequences of metastases and, particularly, porto-lymphatic reflux which explains the topography and onset of new emboli. The study of the portal system is an important factor in the decision to operate widely. A nutrient route, the portal vein is followed by the metastasis, it may be interrupted by ligature to prevent the latter. Finally it is an efficacious route for destruction of macroscopic foci (chemotherapy) or prevention and destruction of infraclinical foci (active non-specific loco-regional immunotherapy).

[Hope for cure of gallbladder cancer. Arguments for a new concept of early stages]. / L'espoir de guérison du cancer de la vésicule biliaire. Arguments pour une conception nouvelle des stades précoces.

The study of 20 personal cases and 254 cases collected by a meeting of surgeons reveals contradictory results from surgical treatment. The peculiar structure of the wall and the bipolar relations with the liver and vessels (especially lymphatics) are the basis for the nosological and therapeutic deductions. Personal observation and a review of the literature show that there is an increasing possibility for cure based on the following classification: --the macroscopic stage described as "early" is in fact already invasive and requires major liver resection and wide lymph node excision; --the early stage is dangerous because the lesion involves the whole thickness of the mucosa. It is only recognizable on histology and it requires extension of the cholecystectomy to include liver and lymph nodes which results in long survivals; --the "in situ" stage, a purely epithelial lesion, is diagnosed on cytology and can be cured with simple cholecystectomy. Prevention of cancer of the gallbladder depends on a broader indication for cholecystectomy (stones, females, older than 55).

[A case of traumatic spondylolisthesis treated by Harrington's method and graft (author's transl)]. / A propos d'un cas de spondylolisthésis traumatique traité par matériel de Harrington et greffe.

This exceptional case of traumatic spondylolisthesis recalls the interest of rapid treatment, and the great interest of Harrington's material both for contention and reduction. Finally the authors emphasise the necissity of completing the procedure by an intersomatic graft by the anterior route.

[Orthotopic liver graft with aortic clamping. Experimental study in dogs (author's transl)]. / La greffe orthotopique du foie sous clampage aortique. Etude expérimentale chez le chien.

Orthotopic liver transplants were conducted in 15 dogs, with aortic clamping during the anhepatic time of the operation and without venous shunting. Aortic clamping lasted for between 30 and 42 minutes. Immunosuppressant treatment was not given. Eight dogs died within 2 hours after the operation, 5 from haemorrhage and 3 accidentally. Seven animals survived for between 6 hours and 11 days: 3 died within 24 hours from haemorrhage, 2 from hepatic failure between the 2nd and 3rd day. One animal died on the 7th day from an acute intestinal invagination, the dog surviving for the longest period eventually dying after rejection of the transplant. These results demonstrate, as in other reported series, that the most frequent cause of death is the haemorrhagic diathesis, probably as a result of poor graft conservation. Dogs tolerate the supracoeliac aorta clamp both from the renal and intestinal points of view ; spinal cord tolerance to the ischaemia is less evident as paraplegia of the hindquarters was noted in one animal in the group. Aortic clamping considerably reduces operative time, as it avoids the need to construct a mesentericocaval anastomosis and a femorojugular shunt. It also avoids splanchnic blood sequestration and the risk of reducing cardia filling during clamping of the inferior vena cava.

[Study and prevention of contact lens-related microbial keratitis with a standardized questionnaire]. / Utilité d'un questionnaire standardisé dans la prise en charge et l'étude épidémiologique des kératites infectieuses sous lentilles de contact.

INTRODUCTION: microbial keratitis is a significant health concern for the one million wearers of contact lenses and their ophthalmologists, with some potentially modifiable risk factors. The number of risk factors for contact lens-related microbial keratitis has been described, but many of them still remain assumed or unknown. PATIENTS AND METHODS: a multicenter prospective case-control study was conducted in 12 French university hospitals (Besançon, Bordeaux, Dijon, Fort-de-France, Grenoble, Limoges, Lyon, Nancy, Nantes, Paris, Marseille and Strasbourg) beginning in July 2007 on contact lens wearers presenting with microbial keratitis and on healthy contact lens wearers. Patients and healthy wearers were interviewed using a 51-item anonymous standardized questionnaire to determine subject demographics and contact lens wear history. RESULTS: two hundred and fifty-six patients with microbial keratitis were included. One hundred and thirteen healthy contact lenses wearers were surveyed. Cosmetic contact lens wear highly increased the relative risk (RR) of microbial keratitis (RR, 16.5). Time since the last visit to an ophthalmologist longer than 1 year (RR, 3.4) or prescription by someone other than an ophthalmologist (RR, 7.6) also increased the risk of microbial keratitis. Education on lens care and handling was deficient (hand washing: RR, 2.2; rub and rinse: RR, 2.7). DISCUSSION: a standardized questionnaire is a powerful tool to determine risk factors for contact lens-related microbial keratitis, but also to analyze individual mistakes in contact lenses use and care.

[Hepatic metastases of colonic and rectal carcinoma: surgical treatment (author's transl)]. / Métastases hépatiques des cancers colo-rectaux: traitement chirurgical.

Statistical results show a marked improvement in survival after surgical treatment of hepatic metastases. The possibilities of surgery are evaluated after precise analysis of the lesions seen at the time of excision and not at autopsy. The data from assessment which indicate that surgery will be successful are described and discussed. Surgical techniques consist above all of resection: metastasectomy, segmentectomy, hemihepatectomy and hepatectomy followed by transplant. Other methods are palliative. Certain resections themselves appear to be palliative and the ideal is to carry out adequate resection at the outset, adapted to the size and site of the lesions. However the possibilities of surgery form part of an overall programme: -- complete removal of the primary carcinoma in order to avoid any local recurrence, -- wide eradication of metastatic lesions, -- préventive treatment against further development of possible subclinical lesions by post-surgical chemotherapy and subsequent immunotherapy.