[Are pancreatic cystadenocarcinomas degenerated mucinous cystadenomas? French Association of Surgery]. / Les cystadénocarcinomes pancréatiques sont-ils des cystadénomes mucineux dégénérés? Association française de chirurgie.

OBJECTIVES OF THE STUDY: To define arguments in agreement or disagreement with the generally accepted theory of transformation from benign mucinous cystadenoma (MC) to malignant cystadenocarcinoma (CC) of the pancreas. METHODS: A review of the literature since 1978 was conducted together with a comparative analysis of a multicentre retrospective study of the different mucinous cystic tumours of the pancreas: 150 MC, 79 CC and 55 intraductal papillary mucinous tumours of the pancrease (TIPMP). Multiple epidemiological and clinicopathological data were compared between MC and CC: mean age at diagnosis, sex distribution, association with diabetes or concurrent cancer, tumour location and size, type of pancreatic main duct communication, pancreatic fibrosis and serum CA 19-9 levels. The analysis concerned also histopathological features of resected cystadenocarcinomas (n = 58). RESULTS: Two features suggested malignant transformation of mucinous cystadenomas: older mean age at diagnosis of CC and histological characteristics revealing areas of benign-appearing epithelium associated with areas of invasive carcinoma in 55% of cases. Conversely, two statistically significant discordant features were observed: a higher proportion of men (40% for CC vs 13% for MC) and a more frequent location in the head of the pancreas (49% vs 27%). The other differences were not in contradiction with the malignant transformation of MC: associated diabetes mellitus, increasing serum CA 19-9 levels and chromosomal aberrations were more frequent in CC. TIPMP were predominant in men (67%), and more common in the head of the pancreas (67%). CONCLUSION: The risk of malignant transformation of MC should not be questioned despite sex distribution and location differences between MC and CC. These differences may be due to inaccurate designation of intraductal mucinous carcinomas as communicating CC or of CC as pancreatic mucinous adenocarcinomas.

Differential responsiveness to contractile agents of isolated smooth muscle cells from human colons as a function of age and inflammation.

To study the involvement of age and inflammation in motor colonic activity in man, contractile responses to CCK, carbachol, and KCl of isolated colonic smooth muscle cells (SMC) from normal and inflamed human colons were evaluated; the incidence of sex and smoking on contraction was also analyzed. Contractile responses to the three agonists were significantly lower in tissues with a low degree of inflammation than in tissues with high level of inflammation or normal tissues. This reduction in cell responsiveness appears to be nonspecific and nonreceptor mediated. A positive correlation of the contractile responses to the three stimulants with the age of patients was observed. In contrast, no association was found between sex, smoking, and cell contraction. In conclusion, contractions of SMC due to CCK, carbachol, and KCl were significantly modified during life; inflammation of the colon led to a loss of SMC responsiveness.

[Excision of the duodenojejunal angle for tumor. From simple excision to locoregional excision]. / Résection de l'angle duodéno-jéjunal pour tumeur. De l'exérèse simple à l'exérèse loco-régionale.

Locoregional extensions are often observed in tumors of the duodenojejunal angle, either because of their anatomic situation or in cases diagnosed late. Endoscopic and radiographic explorations (basically abdominal CT scan) are indicated to search determine the degree of extensions to neighboring organs and vessels. Colic and mesocolic involvement are at the limit of preoperative explorations. Based on 4 observations of increasing complexity, we describe our operative strategy allowing tumor exeresis in a single block. Extension to the superior mesenteric artery is the main contraindication for exeresis.

Spontaneous dissection of the celiac artery.

We describe a case of intestinal angina caused by spontaneous dissection of the celiac artery and thrombosis of the superior mesenteric artery. Spontaneous dissection of a visceral artery is an uncommon occurrence that is usually diagnosed after fatal hemorrhage or ischemia. The underlying mechanism is unclear but the frequent association with multiple arterial lesions suggests general arterial disease. In symptomatic forms, surgical reconstruction is mandatory, to treat the lesion and allow definitive histological diagnosis.

[Intestinal endosalpingiosis. Apropos of 2 cases]. / L'endosalpingiose intestinale. A propos de 2 observations.

Intestinal endosalpingiosis (ES) involving colon or small bowel is a rare, misleading disease. Two different aspects must be distinguished:--serosal involvement, more or less disseminated: this form is asymptomatic or associated with ascites leading to the diagnosis of peritoneal pseudo-carcinomatosis; in this form of typical or atypical endosalpingiosis of florid type, no malignancy is found on histology;--parietal involvement, leading to stenosis or intestinal perforation with enterocutaneous fistula: this malignant form of endosalpingiosis is similar to primary papillary peritoneal carcinoma or stage III ovarian carcinoma. These two forms of ES are studied on 2 cases illustrating the overlap between typical benign ES, proliferating ES and malignant ES.

[Organization of emergency pediatric surgery at the University Hospital in Nantes]. / Organisation des urgences chirurgicales pédiatriques au C.H.U. de Nantes.

A special emergency ward for paediatric patients was established at the University Hospital in Nantes on November 7, 1990. Both medical and surgical patients less than 15 years, 3 months of age are admitted. The initial organization of the ward (facilities personnel, on call duty) are described for the emergency paediatric surgery unit. The activity of the unit over a 4 month period (from June to September 1992) was retrospectively examined. During this period, 4,438 children were referred to the emergency ward and 2,905 (64.8%) involved a surgical pathology. The epidemiological characteristics of the patients (age, geographic origin, day and hour of admission), the causal pathology, the examinations and procedures performed, and outcome (length of stay in the ward long-term outcome) were studied. Based on these results, the authors analyzed the factors leading to dysfunction and proposed improvements in the organization of this emergency ward.

[Post-stress acute hemorrhagic ulcers of the cecum. Apropos of 3 cases]. / Ulcères aigus hémorragiques post-agressifs du caecum. A propos de trois cas.

Three cases of acute ulcers of the cecum causing massive bleeding with hemodynamic impact are reported. These three cases involve young subjects (28, 31 and 51 years old). Bleeding occurs after an aggression (post-traumatic context in 2 cases, postoperative in 1 case). For these three patients, the angiographic location of arterial bleeding allows elective colic exeresis without rebleeding. From a pathogenetic point of view, the most likely hypothesis seems to be that of ischemic lesions following an aggression.