[Von Meyenburg disease found during laparoscopic surgery: report of two cases]. / Maladie des complexes de von Meyenburg (micro-hamartomes biliaires) découverte lors d'une chirurgie laparoscopique: à propos de deux observations.

The authors report two cases of von Meyenburg complexes disease found during laparoscopic surgical procedures. The first patient (41 years old) had multiple gallbladder stones with recurrent hepatic colics. The second patient (45 years old) had gastroesophageal reflux with recurrent peptic esophagitis. In both cases, multiple millimetric and superficial hepatic lesions were found during the exploration of the abdominal cavity. Then, an hepatic biopsy was done because the macroscopic aspect should suspect secondary metastatic lesions. Histological result made the diagnosis of von Meyenburg complexes disease (biliary microhamartomas). It seems to be important to know this anomaly of the ductal plate development and to do a liver biopsy during laparoscopy to affirm the diagnosis and cancel the diagnosis of multiple hepatic metastasis. In fact, this congenital pathology could be associated with increased risk of cholangiocarcinoma of the liver. The modality of radiological monitoring still remains to be defined.

[Aneurysm of the splenic artery arising from the superior mesenteric artery: therapeutic management]. / Anévrisme de l'artère splénique naissant de l'artère mésentérique supérieure: stratégie thérapeutique.

A 36-year-old male patient presented with a 3 cm aneurysm of the proximal splenic artery, which originated from the superior mesenteric artery. A surgical management was decided. Exposure of the superior mesenteric artery by a Kocher manoeuvre allowed a safe control of the proximal superior mesenteric artery and the ligation of the aneurysm. Splenic preservation was possible and the postoperative course was uneventful. The aneurysm localization on an anatomical variation of the splenic artery has modified the therapeutic strategy.

[Superior mesenteric artery syndrome: a case report]. / Syndrome de la pince aortomésentérique : à propos d'un cas.

UNLABELLED: Superior mesenteric artery syndrom is a condition triggered by the compression of the third portion of the duodenum between the superior mesenteric artery and the aorta. OBSERVATIONS: A twenty-one year old woman with a significant past history of neurological disease was referred for bilious vomiting and epigastric pain. The diagnosis of superior mesenteric artery syndrom was established by abdominal CT-scan. A laterolateral duodenojejunostomy was performed by laparotomy. After six months follow-up, this patient was asymptomatic. CONCLUSION: Superior mesenteric artery syndrom can be easily diagnosed by abdominal CT-scan. Diagnosis and management of this infrequent syndrom are reviewed.

[Jejunal perforation by a fish bone diagnosed by CT-Scan: report of two cases]. / Perforation jéjunale par arête de poisson diagnostiquée par la tomodensitométrie abdominale : à propos de deux observations.

The authors relate two cases of peritonitis secondary to jejunal perforation by a fish bone. Clinically, the first patient presented signs and symptoms of acute diverticulitis and the second had signs of duodenal perforation. In both cases, the diagnosis was made by the CT-scan revealing a linear radio-opaque object suggestive of a fish bone perforating the jejunum. At laparotomy of the first case, we found a perforation located above several loops of small bowel densely adhered to the nonabsorbable intra-abdominal mesh. Removal of the fish bone, suture of the jejunal perforation, washing and drainage of the abdominal cavity were performed. The mesh was removed and replaced by a polyglycolic acid mesh. In the second case, jejunal perforation occurred in an unaltered small bowel loop and a short intestinal resection was performed. The postoperative course was uneventful for both patients. These clinical cases allow us to discuss the several fish bone perforation site and our patients precipitating factors.

[Fort Lauderdale congress report: advances in infertility treatment - Florida, 24-26 January 2002]. / Compte rendu du congrès de Fort Lauderdale : progrès dans le domaine du traitement de l'infertilité - Floride, 24-26 janvier 2002.

The goal of the treatment of infertility is to apply therapeutic techniques to patients in a safe manner and at the same time increase the chances for conceiving and delivering healthy babies: basic and clinical research is more and more finalized directed to these goals. The conference "Advances in Infertility Treatment" held in Fort Lauderdale, Florida on January 24-26, 2002 covered many clinical and research aspects of this important therapeutic area. Important discussed issues included the impact of age, lifestyle, and the genetic set-up of patients in the pathogenesis and development of infertility-causing disorders such as male reproductive dysfunction, polycystic ovary syndrome, and ovarian failure. New ovulation induction regimens that may optimize, reduce complications, and lower costs of ovarian stimulation procedures and of assisted reproduction in general were presented. This was the 5th Ferring Pharmaceuticals Conference in the area of reproductive medicine held in Florida.

[When daughter becomes mother]. / Le devenir mère de la fille.

The mother-daughter link is more complex than at first appears. Its influence is in fact so crucial as to be able to determine factors such as access of daughter to fertility and the gender of the children she will bear.

[Duodenal tuberculosis: a difficult diagnosis]. / Tuberculose duodénale: un diagnostic difficile.

BACKGROUND: The polymorphous clinical presentation of tuberculosis located in the duodenum may mislead diagnosis. CASE REPORT: A 69-year-old man had duodenal stenosis associated with calculous common bile duct obstruction. Crohn's disease was initially diagnosed and the patient was treated with corticosteroids. Two months later, the diagnosis was rectified when pulmonary tuberculosis developed. DISCUSSION: This case emphasizes the lack of specific clinical, radiological, endoscopic and histological signs of duodenal tuberculosis.

[Diagnostic and therapeutic approach to plasma cell granuloma of the lung. Apropos of a case of favourable course under antibiotics]. / Approche diagnostique et thérapeutique du granulome plasmocytaire du poumon. A propos d'un cas d'évolution favorable sous antibiotiques.

Plasma cell granulomas are more often solitary benign tumoral lesions, which need early surgery both for diagnostic and therapeutic reasons. The authors report a case of multiple plasma cell granuloma, diagnosed on biopsies obtained by thoracoscopy, and with a good response to a long-term antibiotic treatment. A review of the literature shows that this behaviour may represent an interesting alternative to systematical surgery in some cases.

[Successive cancers of the colon and rectum]. / Cancers successifs du côlon et du rectum.

The incidence of successive cancers of the colon and rectum varies from 1.4% to 5.1%. Among 350 malignant colorectal tumours operated in our unit, there were 7 cases of successive cancers (2%). The mean interval between the discovery of the first and second cancer was 4.9 years with a range of 1 to 10 years, 3 cases before 2 years and 4 cases after 5 years. The diagnosis of the second cancer was made by coloscopy in 4 cases and was revealed by rectal bleeding in 4. CAE level was unchanged in all 7 patients and was not contributive to diagnosis. At diagnosis of the first cancer there were 5 intraparietal tumours including 2 with lymph node dissemination. At diagnosis of the second cancer, there were 5 cases of intraparietal tumours with 1 lymph node extension. An association with benign polyps was observed in 2 of the 7 cases at the first diagnosis and in 4 of the 7 at the second. Prophylaxy requires complete work-up with total coloscopy at the diagnosis of the first cancer. Segmentary colectomy is sufficient in patients over 65, but we prefer total colectomy in patients under 65.

[Acute obstruction of the esophagus by mucilage followed by perforation. Apropos of a case]. / Obstruction aiguë de l'oesophage par mucilage suivie de perforation. A propos d'un cas.

The authors report an iatrogenic case of lower esophageal perforation which occurred after a Heimlich procedure performed for a acute drug-induced oesophageal obstruction (mucilage). Esophageal repair, drainage and Nissen procedure to prevent gastro-esophageal reflux were successfully performed via an abdominal approach.

[Triple association: extramembranous glomerulonephritis, renal adenocarcinoma and splenic hamartoma. Apropos of a case]. / Triple association: glomérulonéphrite extramembraneuse, adénocarcinome rénal et hamartome splénique. A propos d'un cas.

We report the case of a 36 year old woman who presented a renal cell carcinoma, associated to a membranous nephropathy as a paraneoplastic syndrome. The concomitant association with a splenic hamartoma was probably fortuitous. Five years after nephrectomy, the patient was asymptomatic and her proteinuria was very low. We studied in the literature 93 cases which reported a such association between cancer, nephrotic syndrome and membranous nephropathy. Carcinoma of the lung and adenocarcinoma of the gastrointestinal tract are the most frequently implicated. This association can occur at every age and more often in men (75%) than in women. The survival is directly linked to the evolution of the cancer. Proteinuria and membranous nephropathy can totally disappear after surgical resection of the carcinoma. The glomerular injury is mediated by immune complexes composed at least in part of tumour associated antigens. The development of several types of glomerular injury in patients with carcinoma have been described but membranous glomerulonephritis is the most commonly observed.

Results of splenectomy for idiopathic thrombocytopenic purpura. Review of 72 cases.

Seventy-two patients underwent splenectomy for idiopathic thrombocytopenic purpura between 1979 and 1990. Mean age at splenectomy was 36.4 years (range 11-73). Indications for splenectomy were corticodependence in 21 cases and resistance to steroids in 44 cases. Thirty-five patients had platelet kinetic studies by 51Cr alloplatelets; 22 of them had splenic sequestration. Hematologic results were evaluated on discharge, at 3 months and in the long term (median follow-up 5.4 years). We had no mortality, morbidity was seen in 7% of the cases. None of the patients suffered from secondary infectious complications. 89% had good results on discharge (> 120 x 10(9)/l), 72.6% at 3 months and 90% on long-term follow-up. Factors associated with good response to splenectomy included a high postoperative platelet count (more than 120 x 10(9)/l on discharge), younger age at the time of surgery, preoperative corticodependence and predominantly splenic sequestration.

[Diverticulosis and Crohn's disease of the sigmoid]. / Diverticulose et maladie de Crohn sigmoïdienne.

Crohn's disease and diverticulitis of the sigmoid may be combined in old patients, this association could lead to difficulties in diagnosis and treatment. Three cases of Crohn's colitis associated with diverticula, two females and one male, aged between 66 and 80 years are reported by the authors. In a review of the literature, some clinical, radiological and endoscopic findings may suggest the diagnosis, which guides subsequent treatment. A high morbidity is observed after surgery. In our series, sigmoidectomy cured both Crohn's colitis and diverticulitis.