Laparoscopic thermal ablation of splenic metastases initial experience and present aspects.

UNLABELLED: Splenic metastases develop in less than 1% of all metastatic cancers, and typically occur in a setting of disseminated disease. When isolated splenic metastasis occurs, the patient may be a candidate for aggressive treatment consisting mainly of splenectomy as described in the literature. However, the increased incidence of post-operative morbidity and severe infection after splenectomy are well known. We report a case of splenic metastasis that developed from colorectal cancer and was treated by laparoscopic-guided radiofrequency ablation. We reviewed the few reported cases of splenic metastasis (from colorectal and other primary cancers) treated by thermal ablation using radiofrequency (RF) or microwave (MW) energy sources. DISCUSSION: Many studies have proved that thermal ablation for benign splenic pathology is both feasible and safe with no sacrifice in efficacy. However only a few cases of MW or RF treatment of splenic secondary tumor have been described; no complications have been reported with this treatment in contrast to the 15 to 27% morbidity rate for splenectomy. CONCLUSION: When treatment of splenic metastasis is proposed with curative intent, thermal ablation by RF or by MW seems to be a feasible and safe technique resulting in spleen conservation with a low morbidity rate. Because of these features, thermal ablation seems an ideal treatment modality to obliterate splenic metastasis and may be an indispensable tool in the armamentarium of modern splenic surgery.

[Paraplegia and dissection of the abdominal aorta after closed trauma. Apropos of a case. Current review of the literature (1982-1993)]. / Paraplégie et dissection de l'aorte abdominale après traumatisme fermé. A propos d'un cas. Revue de la littérature récente (1982-1993).

A case of dissection with thrombosis of the subrenal abdominal aorta after blunt trauma led to paraplegia and bilateral ischaemia of the lower limbs in addition to acute abdominal signs. A review of the recent literature (1982-1993) revealed 32 reported cases. The patients were predominantly male and most often victims of an automobile accident (18 cases) or crushing trauma (6 cases). The clinical picture associated diverse degrees of abdominal signs, ischaemia and sensorial-motor impairment of the lower limbs. The diagnosis was established immediately on D0 in only 18 cases, early on days 1 to 7 in 4 cases and was late (day 8 to day 30) in 5 cases or very late (beyond day 30) in 6 cases. The difficulty in immediate diagnosis was related to the absent or incomplete vascular symptomatology or the late onset of the first signs. When a lesion of the aorta was suspected, an arteriography, angioscanner or peroperative exploration led to diagnosis. Neurological signs were frequent (10 cases including 8 with paraplegia) and generally related to ischaemia of the peripheral nerves. They may lead to denate from the diagnosis of vascular lesions. Fractures of the intima (17 cases) was the most frequent aortic lesion which also involved fracture of the media in a number of cases. Dissection was associated in 7 cases and complete or partial thrombosis of the aorta in 7. False aneurysms observed in 6 cases are the usual pathological form in cases of late diagnosis. Nearly all of the lesions were subrenal. Damage to abdominal organs was frequently observed.(ABSTRACT TRUNCATED AT 250 WORDS)

[Acquired multicystic disease of the renal sinus]. / Maladie multikystique acquise du sinus rénal.

A case of multilocular parapelvic cyst in a 62 years old male patient is reported herein. The features and differential diagnosis of this offently incidental disposis are discussed. The specificity of computed tomography eliminates the need for invasive diagnostic procedures.

[Burgeoning form of cancer of the superior biliary bifurcation Nosological, diagnostic and therapeutic aspects. Apropos of a case]. / Cancer du confluent biliaire supérieur à forme bourgeonnante. Particularités nosologiques, diagnostiques et thérapeutiques. A propos d'un cas.

The authors report a case of fungating cholangiocarcinoma of the porta hepatis, revealed by jaundice in a 73-year-old cholecystectomized female. The diagnosis of obstruction of the hepatic duct junction suspected by ultrasonography and computed tomography was confirmed intraoperatively. Disobstruction was followed by laterolateral choledocoduodenostomy. An early recurrence required a second disobstruction with surgical then endoscopic insertion of a drain, with 23 months of satisfactory survival. The discussion is focused on hilar fungating cholangiocarcinoma. The extrahepatic (Klatskin tumor) or intrahepatic origin of these lesions, the circumstances and morphological investigations for the diagnosis are discussed. Particularities of the treatment are mentioned, with emphasis on the possible participation of the endoscopist for choledocho or hepaticoduodenostomy.

[Intravenous leiomyomatosis of the inferior vena cava and the right heart atrium. Apropos of a case and review of the literature]. / Léiomyomatose intra-veineuse cave inférieure et cardiaque droite. A propos d'un cas et revue de la littérature.

The authors report a case of intravenous leiomyomatosis, a rare uterine tumor, extending to the inferior vena cava and to the right atrium. It seems to be the first case described in France. The wrong diagnosis of massive pulmonary embolism and the distance from a cardiac surgery unit led to emergency tumorectomy without cardiopulmonary bypass. A review of the literature studied the 24 cases with cardiac extension already reported, 19 operated and 5 autopsy reports. Right cardiac failure or syncopes are the most frequent clinical signs. Sometimes histologic examination after hysterectomy leads to the diagnosis. Echocardiography diagnoses an intra-atrial mass. Abdominal ultrasonography and phlebocavography show the iliocaval portion of the tumor. Cardiac angiography and computed tomography are also contributive. Surgical treatment except in extreme conditions should be performed by a cardiac surgical team. If the diagnosis of intra-venoux leiomyomatosis has been made preoperatively a one-stage cardiac and abdominal treatment should be preferred. In the other cases, cardiac surgery should be done first, allowing a precise histologic diagnosis and subsequent treatment of the iliocaval and uterine lesions.

[Cancer at confluence of the superior bile ducts with proliferating form. Nosologic, diagnostic and therapeutic aspects. Apropos of a case]. / Cancer du confluent biliaire supérieur à forme bourgeonnante. Particularités nosologiques, diagnostiques et thérapeutiques. A propos d'un cas.

The authors report a case of fungating cholangiocarcinoma of the porta hepatis, revealed by jaundice in a 73-year- old cholecystectomized female. The diagnosis of obstruction of the hepatic duct junction suspected by ultrasonography and computed tomography was confirmed intraoperatively. Disobstruction was followed by laterolateral choledocoduodenostomy. An early recurrence required a second disobstruction with surgical then endoscopic insertion of a drain, with 23 months of satisfactory survival. The discussion is focused on hilar fungating cholangiocarcinoma. The extrahepatic (Klatskin tumor) or intrahepatic origin of these lesions, the circumstances and morphological investigations for the diagnosis are discussed. Particularities of the treatment are mentioned, with emphasis on the possible participation of the endoscopist for choledocho or hepaticoduodenostomy.

[Mesenteric carcinoid tumor presenting as an intra-abdominal abscess]. / Tumeur carcinoïde mésentérique se présentant comme un abcès intra-abdominal.

The authors describe a case of mesentery primitive carcinoid tumor presenting as an abdominal abscess. The clinical findings and the physiopathological mechanisms are discussed.

[Adenocarcinoma of the kidney of a pseudocystic form. Apropos of a case]. / Adénocarcinome du rein de forme pseudo-kystique. A propos d'une observation.

Sometimes, the adenocarcinoma of the kidney appears like a particular cystic mass. In rare cases, as the one described, pre-operative diagnosis can be difficult despite the association of imaging techniques like sonography and CT, and requires necessarily a guided biopsy.

[Pseudocystic kidney adenocarcinoma. Apropos of a case]. / Adénocarcinome du rein de forme pseudo-kystique. A propos d'une observation.

Sometimes, the adenocarcinoma of the kidney appears like a particular cystic mass. In rare cases, as the one described, pre-operative diagnosis can be difficult despite the association of imaging techniques like sonography and CT, and requires necessarily a guided biopsy.

[Retroperitoneal rhabdomyosarcoma revealed by acute kidney failure in children. Report of a case]. / Rhabdomyosarcome rétropéritonéal chez un enfant révélé par une insuffisance rénale aiguë. A propos d'un cas.

Retroperitoneal sarcomas are rare tumors representing 0.1% to 0.2% of all malignant tumors. They are usually revealed by an abdominal mass (33%), possibly associated with pain (41%). Edema of the lower limbs is reported in 10% of cases. Acute renal failure with anuria by bilateral ureteral compression, associated with invasion of the inferior vena cava has not been previously reported.

[Mesenteric cystic lymphangioma in children. Report of a case manifested by anemia]. / Les lymphangiomes kystiques mésentériques chez l'enfant. A propos d'un cas révélé par une anémie.

A case of mesenteric cystic lymphangioma revealed by hypochromic anemia and abdominal pain, secondary to an intracystic hemorrhage is reported in a 4-year old child. Etiology, pathology, diagnosis, treatment and prognosis of mesenteric lymphangioma in children are reviewed.

[Mesenteric cystic lymphangioma in children. Apropos of a case revealed by anemia]. / Les lymphangiomes kystiques mésentériques chez l'enfant. A propos d'un cas révélé par une anémie.

A case of mesenteric cystic lymphangioma revealed by hypochromic anemia and abdominal pain, secondary to an intracystic hemorrhage is reported in a 4-year old child. Etiology, pathology, diagnosis, treatment and prognosis of mesenteric lymphangioma in children are reviewed.

[Renal parenchymal malakoplakia. A case report]. / Malakoplakie parenchymateuse rénale. A propos d'une observation.

A case of renal parenchymal malakoplakia, with tumoral appearance is reported here. The clinical, pathological, and imaging (including US, CT and arteriography) findings of this unusual site of the disease, whose diagnosis requires necessarily a biopsy, are presented.

[Hypothenar aneurysm of the ulnar artery. Apropos of a case treated by excision and anastomosis]. / Anévrysme hypothénarien de l'artère cubitale. A propos d'un cas traité par résection-anastomose.

A case of aneurysm of the ulnar artery, located in the region of the hypothenar eminence is reported. This true traumatic aneurysm had a reconstructive treatment, considering the arterial anatomy of the patient's hand. A resection followed by an end to end anastomosis has been done with a good post-operative result at two years and a half. The unusualness of this pathology, the predominance of its traumatic and occupational etiology are emphasized. True and false traumatic aneurysms are described. The diagnosis of aneurysm is primarily clinical. Arteriography is interesting in the preoperative check-up. Reconstructive surgery is now preferred.