[Malignant pleural mesothelioma: The role of surgery]. / Mésothéliome pleural malin : place de la chirurgie.

INTRODUCTION: Malignant pleural mesothelioma (MPM) is a rare and highly aggressive disease, whose incidence is increasing. Asbestos is the primary causal agent. STATE OF KNOWLEDGE: Knowledge about MPM has evolved. Thoracoscopy is essential for diagnosis of MPM. It allows performing pleural biopsies, to study the extent of the disease and to relieve dyspnea. The pathological diagnosis is also better codified with immunohistochemistry and with analysis by expert of Mesopath group. Curative surgical treatments are pleurectomy decortication and extended pneumonectomy in combination with chemotherapy and/or radiotherapy. Those heavy treatments improve survival in highly selected patients. For the other patients, supportive measures will be considered to reduce pain and dyspnea. PROSPECT: Radical surgical treatment is only offered in therapeutic trials or multimodal treatment. Its place is not formally established. New therapies associated to surgical treatment are being studied. CONCLUSIONS: Surgical management of MPM has to be operated in specialized teams where the survival benefit and quality of life is discussed case by case.

Saxitoxin Exposure Confirmed by Human Urine and Food Analysis.

A case of an elderly female with suspected paralytic shellfish poisoning (PSP) is presented. The patient shared a meal of recreationally-harvested shellfish with her family and soon began to experience nausea and weakness. She was taken to the local emergency department and then transported to a larger hospital in Anchorage where she was admitted to the intensive care unit with respiratory depression and shock. Her condition improved, and she was discharged from the hospital 6 days later. No others who shared the meal reported symptoms of PSP. A clam remaining from the meal was collected and analyzed for paralytic shellfish toxins (PST) by the Alaska Department of Environmental Conservation Environmental Health Laboratory; the clam tested positive for saxitoxin (STX; 277 µg/100 g), neosaxitoxin (NEO; 309 µg/100 g), multiple gonyautoxins (GTX; 576-2490 µg/100 g), decarbamoyl congeners (7.52-11.3 µg/100 g) and C-toxins (10.8-221 µg/100 g) using high-pressure liquid chromatography with post-column oxidation (AOAC Method 2011.02). Urine from the patient was submitted to Centers for Disease Control for analysis of selected PSTs and creatinine. STX (64.0 µg/g-creatinine), NEO (60.0 µg/g-creatinine) and GTX1-4 (492-4780 µg/g-creatinine) were identified in the urine using online solid phase extraction with HPLC and tandem mass spectrometry. This was the first time GTX were identified in urine of a PSP case from Alaska, highlighting the need to include all STX congeners in testing to protect the public's health through a better understand of PST toxicity, monitoring and prevention of exposures.

Computer-based desktop system for surgical videotape editing.

BACKGROUND: The educational role of surgical video presentations should be optimized by linking surgical images to graphic evaluation of indications, techniques, and results. We describe a PC-based video production system for personal editing of surgical tapes, according to the objectives of each presentation. METHODS: The hardware requirement is a personal computer (100 MHz processor, 1-Gb hard disk, 16 Mb RAM) with a PC-to-TV/video transfer card plugged into a slot. Computer-generated numerical data, texts, and graphics are transformed into analog signals displayed on TV/video. A Genlock interface (a special interface card) synchronizes digital and analog signals, to overlay surgical images to electronic illustrations. The presentation is stored as digital information or recorded on a tape. RESULTS: The proliferation of multimedia tools is leading us to adapt presentations to the objectives of lectures and to integrate conceptual analyses with dynamic image-based information. We describe a system that handles both digital and analog signals, production being recorded on a tape. Movies may be managed in a digital environment, with either an "on-line" or "off-line" approach. System requirements are high, but handling a single device optimizes editing without incurring such complexity that management becomes impractical to surgeons. CONCLUSIONS: Our experience suggests that computerized editing allows linking surgical scientific and didactic messages on a single communication medium, either a videotape or a CD-ROM.

[Laparoscopic cholecystectomy: 3 years of experience at a university hospital]. / Colecistectomía laparoscópica: tres años de experiencia en un Hospital Universitario.

We analyse the first 174 patients treated with laparoscopic cholecystectomy (LC) and their follow-up results. Average age was 57 years. Intraoperative cholangiography was not done in anyone. Conversion rate into other forms of intervention was 6.3%. The rate of common bile duct injury has been null. Total morbidity was 6.3%. Two cases of pulmonary embolism and two biliary leakages stand out in the postoperative morbidity. There was no death. After a follow-up period of up to 36 months, only 1 case of residual choledocholithiasis was registered, and it was cured with endoscopy. In this series morbid-mortality figures are low. LC is a safe procedure in the treatment of cholelithiasis, even in older patients.

[Acute cholecystitis and laparoscopic cholecystectomy. Comparison with non-complicated cholelithiasis]. / Colecistitis aguda y colecistectomia laparoscópica. Comparación con la colelitiasis no complicada.

Laparoscopic cholecystectomy has become the treatment of choice for symptomatic cholelithiasis. However, the indication of the laparoscopic approach for acute inflammation of the gallbladder in unclear and further analysis of the results is required. The aim of our study was to compare the results of laparoscopic cholecystectomy after uncomplicated cholelithiasis and after acute cholecystitis. Data from 201 patients who underwent laparoscopic cholecystectomy were collected prospectively. Uncomplicated cholelithiasis was present in 149 patients and 52 individuals had acute cholecystitis. No differences in age, sex distribution or associated diseases were observed between groups. The mean operative time was significantly higher in patients with acute cholecystitis. However, no difference was observed regarding conversion rate (7.3%-7.6%) and morbidity rate (8.7%-9.6%). No mortality has occurred in any group. The average hospital stay after laparoscopic cholecystectomy was greater when acute cholecystitis was present (2.6 days-4.9 days; p < 0.01). But in this case hospitalization was shorter than after elective conversion (8 days; p < 0.001 and p < 0.05). We conclude that patients with acute cholecystitis can undergo laparoscopic cholecystectomy safely, with low morbidity and mortality rates and reduced hospital stay.

National survey on laparoscopic cholecystectomy in Spain. Results of a multiinstitutional study conducted by the Committee for Endoscopic Surgery (Associación Española de Cirujanos).

We present a joint study conducted by the Committee for Endoscopic Surgery in Spain. Sixty-nine surgeons reported 2,342 laparoscopic cholecystectomies (LCs) performed until November 1992. The conversion rate was 5.1%. The overall morbidity was 7.1%. The biliary morbidity was 0.45%: Seven severe bile duct injuries were recognized at laparoscopy (0.28%) and four lesions were postoperatively diagnosed (0.16%). Bile leak unrelated to bile duct lesion occurred in 14 patients (0.7%), leading to five reoperations. The mortality was 0.12% and was unrelated to the laparoscopic approach in two cases. The risk factors for biliary complications were obesity, previous history of jaundice, and previous hospital admissions. Surgeon experience was defined by 50 LCs performed and the overall complication rate presented a statistically significant relation to surgeon experience (P < 0.001).

Pulmonary embolism following laparoscopic cholecystectomy: report of two cases and review of the literature.

Laparoscopic abdominal surgery is considered a low-risk procedure for postoperative thromboembolic disease. We report two cases of pulmonary embolism following laparoscopic cholecystectomy, review the incidence of deep venous thrombosis and pulmonary embolism in laparoscopic cholecystectomy, and suggest a specific prophylactic scheme for patients undergoing laparoscopic cholecystectomy. In spite of the low incidence of postoperative thromboembolic disease following minimally invasive procedures, the risk of pulmonary embolism must not be underestimated and its symptoms must not be underdiagnosed.

[Reoperations of rectal resection for recurrence after previous resection for rectosigmoid cancer]. / Les réinterventions d'exérèse rectale pour récidive après résection antérieure d'un cancer recto-sigmoïdien.

From June 1986 to December 1992, 16 patients (12 men and 4 women, 63 years-old [36 to 79]) who underwent a prior sphincter-saving resection for colorectal adenocarcinoma were operated on for locoregional recurrence with a surgical resection. Eight patients had a second anterior resection (5 colorectal, 2 coloanal and 1 ileoanal anastomosis), one a resection without anastomosis, and 7 an abdomino-perineal resection. Nine patients received an intraoperative irradiation (10 to 25 Gy). Excisions of surrounding organs were often necessary. Post-operative complications occurred in most of the patients. Excluding 3 post-operative deaths, 9 patients died of disease in a median of 12.9 months after surgery (range: 3 to 32 months). Four patients are still living 5 to 14 months after the second resection. There is little in the surgical literature dealing with these difficult surgical problem of which results are always uncertain. An earlier diagnosis of the recurrence would result in a more satisfactory procedure, but is difficult because of the limited possibilities of detection after surgical treatment and often external irradiation.

[Evaluation of quality of care in a general surgery department]. / Evaluation de la qualité des soins dans un service de chirurgie générale.

A permanent evaluation of a department's activity and the quality of health care it provides is needed to avoid inappropriate use resulting from a wide range of causes. The activity of a general surgery department treating and average of 1,500 patients per year and performing 1,200 operations was analyzed over the period 1986 to 1992. Post-operative hospital follow-up was noted for each patient and any complications were analyzed on discharge day by the surgeons, the anaesthesiologists and the nursing staff. A year-end sum up was conducted each year by homogeneous groups. Examples are presented: surgery for cancer of the oesophagus (122 cases), surgery for gastro-oesophageal reflux (120 cases), thyroid surgery (1,314 cases from 1988 to 1992). Complications, hospital stay and former pathologies were evaluated in order to determine the indications, prevent complications and evaluate more rapidly the advantages of modifications in techniques. The results were compared between surgeons. This daily evaluation allowed a better analysis than a retrospective study compared with data in the literature. Permanent personal reevaluation was one of the practical consequences of the study considered to be and enriching experience.

[Fatal hydatid pulmonary embolism during hepatectomy for hydatid cyst. Apropos of a case]. / Embolie pulmonaire hydatique mortelle lors d'une hépatectectomie pour kyste hydatique. Rapport d'un cas.

Liver Hydatid cysts located close to the inferior vena cava and the sus-hepatic veins are known for their risk of rupture inside these veins. The authors report the case of a patient who died from massive pulmonary embolism during the surgical treatment (hepatectomy) of liver hydatid cysts. Diagnosis and treatment of these fistula are reviewed.

[Genetic determinism of the female sex inversion accompanying the crossing of two subspecies of Idotea balthica (Pallas). I.--Results on albafusca, bilineata and uniformis phenotypes]. / Déterminisme génétique de l'inversion du sexe femelle accompagnant le croisement de deux sous-espèces d'Idotea balthica (Pallas). I.--Résultats concernant les phénotypes albafusca, bilineata et uniformis.

A reversal of sexual phenotype resulting in the appearance of neo-males and neo-females occurs in the populations of two marine subspecies of Idotea balthica. Sex inversions are rare in I. b. basteri but more frequent in I. b. tricuspidata. By crossing these two subspecies, the rate of neo-males (ti) was considerably increased, allowing us to study the determination of sex inversion. The I. b. tricuspidata used in this study came from the offspring (27 p. 100 neo-males) of one gravid albafusca female (A1) collected in La Rochelle (LR); these offspring had been studied for five generations. The I. b. basteri came from offspring of females collected in Marseille (M), Racou (eastern Pyrenees) and Tunis. The chi 2 or Mann-Whitney test was used to compare the results of the different crosses. The female Idotea balthica is heterogametic (WZ); the male is homogametic (ZZ). The loci of the genes which determine the colored phenotypes, albafusca (A) and bilineata (B), are situated on the W heterochromosome. The fundamental phenotype, uniformis (U), is the wild type, according to classical genetics. The males used were either ZZ and uniformis or WZ (neo-males) and albafusca. 1) Ten crosses: female A basteri (M) X male U tricuspidata (LR) gave a variety of offsprings (chi 2 = 56 - d.f. = 9), two having an A1-like ti and the other eight no or very few neo-males. 2) Backcrosses (from CRF2 to CRF5) between hybrid females and U La Rochelle males: in CRF2, the ti increased significantly and in CRF3, CRF4 and CRF5 it reached the ti of the A1 lineage. 3) In the female F1 X male UM backcrosses, the ti was nearly zero, thus being comparable with the basteri lineage of Marseille. 4) When female ALR X male UM of some lineages was crossed, the expressivity of the phenotype A was reduced (from A to U) only in neo-males. The penetrance of gene A did not vary significantly in seven crosses from F1 to CRF2. 5) The crossing of male male ULR with female female basteri B or U from various populations showed that only some B and U females were likely to favor sex inversion in their daughters; the resulting ti was ten times higher with A females. These results led to the following conclusions: --crosses 1, 2 and 3 showed that reinforcement of the tricuspidata genotype of La Rochelle, by means of a regular addition of mainly autosomal genes, induced an increase in the ti, whereas reinforcement of the basteri genotype induced a decrease in that rate. The results supported the hypothesis of a polyfactorial determination of sex involving autosomal, or partly sex-linked, factors acting as inhibitors of the major female gene(s); --crosses 4 showed that the reduction of gene A expressivity was always associated with the sex inversion of genetic hybrid females; that process also seemed to be controlled by some autosomal or partly sex-linked recessive genes, different from those of the preceding complex and acting as inhibitors of the major female-determining factor(s) situated on the W heterochromosome...