[Management of ureteral injuries]. / Prise en charge des lésions urétérales iatrogènes.

Ureteral injury is a rare but potential serious complication that can occur during a variety of general surgical procedures. Knowledge of the course of the ureter is the first step toward preventing ureteral injuries. While some injuries are noticed intraoperatively, most are missed and present later with pain, sepsis, urinary drainage or renal loss. The choice of treatment is based on the location, type and extend of ureteral injury. For injuries recognized during open surgery, when involving the distal 5 cm of the ureter, an antireflux ureterocystostomy such as the Politano-Leadbetter procedure or a vesicopsoas hitch can be performed. For the middle ureter, an ureteroureterostomy is satisfactory and for the proximal ureter, most injuries can be managed by transureteroureterostomy. In complex situations intestinal interposition, autotransplantation or even nephrectomy can be considered. The majority of patients with delayed diagnosed ureteral injuries should be managed by an initial endo-urologic approach.

[Metastatic renal cell carcinoma to the thyroid gland: report of seven cases and review of the literature]. / Les métastases intrathyroïdiennes du cancer du rein à cellules claires: présentation de sept cas et revue de la littérature.

PURPOSE: The aim of this study was to retrospectively report clinical manifestations, type of treatment, survival rate of thyroid metastases from renal carcinoma. PATIENTS AND METHODS: Seven patients were retrospectively collected from files of different Burgundy's hospitals. All renal and thyroid gland specimens were controlled by the anatomopathologist. RESULTS: Tumors occurred in four women and three men (mean age: 66 years). Symptoms were generally a solitary mass. The metastatic tumor to the thyroid gland was the initial presentation of renal carcinoma in one case. In the other cases, patients had documented previous evidence of renal carcinoma as remotely 8.1 years before the thyroid metastases. Thyroglobulin immunohistochemistry was always negative in the foci of metastatic renal carcinoma. All patients had surgical resection of there metastasis. The majority of patients died with disseminated malignancies (mean: 38.1 months after there thyroid resection). Three patients are still alive, one after a complementary pancreatic resection for a secondary pancreatic metastasis and one other with cervical and mediastinal lymph node recurrence. CONCLUSIONS: Surgical treatment of the metastatic disease is suggested, as this may prolonged patient survival.

[Abdominal lavage for peritoneal cancer cell seeding prevention]. / Intérêt des lavages abdominaux pour la prévention de l'ensemencement néoplasique péritonéal.

Spontaneous or iatrogenous peritoneal seeding is responsible for locoregional recurrent cancer or peritoneal carcinomatosis. Few surgeons are used to wash the abdominal cavity to prevent peritoneal seeding. But experimentally, washing is not able to dislodge or destroy tumour cells adherent to the peritoneum or to the surgical wounds. The antitumoral effect of abdominal washing is increased by addition of antiseptics or anti-adherent agents.

[Histological and cytopathological cancer specimens: good practice in operating room]. / Prélèvements anatomopathologiques en cancérologie : règles de bonnes pratiques au bloc opératoire.

Concerning good practice for the management of histological cancer specimen, the main recommendations concern: (1) the quality of transmission in information between professionals; (2) the necessity of fresh, unfractionated, oriented surgical samples; (3) the importance of an appropriate storage condition for samples collected for extemporaneous examination, freezing or cell culture; (4) the quality of the deep freezer at temperatures of -80 degrees C or liquid nitrogen for frozen samples storage; (5) the importance of fixing tissues shortly after sample collection in buffered Formal solution in order to prevent cell lysis.

[Synovial cyst of the hip: a misleading strangulated crural hernia diagnosis]. / Le kyste arthrosynovial de hanche : à ne pas confondre avec une hernie crurale étranglée.

We report a case of crural tumefaction becoming rapidly painful revealing a synovial cyst of the hip. Literature data concerning differential diagnosis, pathogenesis, clinical varieties, diagnosis and treatments of this rare pathology are emphasized.

[Role of microbiopsy in diagnostic and therapeutic approach of mammary suspect microcalcification]. / Place de la microbiopsie dans la prise en charge des microcalcifications mammaires suspectes.

PURPOSE: To determine the sensibility, the specificity, the positive and negative predictive values of microcalcifications detection by core needle biopsy and intra-operative pathologic examination. MATERIALS AND METHODS: A hundred and one patients (between 1998 and 1999) were investigated in this retrospective study. The initial presentation was breast microcalcifications without palpable tumour. The mean age of patients was 55 (34-79) years. Mammography was performed in 3 standard projections. All suspect microcalcifications were recommended for surgical excision. In the others cases, 5 core biopsies were taken of the lesion. Needle guidance was accomplished by means of either dedicated stereotaxic device or ultrasound equipment. All biopsies were performed with a biopsy device fitted with 14 G needles. The mean follow-up period was 3 years. RESULTS: Clinical or surgical follow-up was available in 101 lesions. Only 4 benign lesions did not have surgery. The 97 remaining were subsequently excised. Pathologic study showed cancer in 38 (39%) lesions, carcinoma in-situ in 14 lesions, and benign disease in 45 lesions. There was 1 false-negative biopsy. The specificity and sensitivity of percutaneous biopsy diagnosis were 73,6 and 93,7% respectively. Intra-operative pathologic diagnoses were concordant in 77% of 30 cases. Discordance occurred in 2 cases of atypical hyperplasia with a single false-negative result for a carcinoma that led to an additional surgical procedure. Positive and negative predictive values of intra-operative pathologic diagnosis were 82 and 100% respectively. CONCLUSION: Needle biopsy findings are accurate and allow definitive therapeutic surgery, including mastectomy.

[Evaluation of povidone abdominal washing for prevention of peritoneal cancer cell seeding: experimental study in the rat]. / Evaluation des lavages par la polyvidone iodée dans la prévention de l'ensemencement néoplasique péritonéal: étude expérimentale chez le rat.

GOAL: The aim of the study was to evaluate the in vitro cytototoxicity of diluted povidone iodine on colon cancer cells and its in vivo antitumoral effect in a model of peritoneal carcinomatosis in the rat. METHODS: Cell cytotoxicity of a povidone iodine diluted solution was assessed, in vitro, on rat colon cancer cells (DHD/K12/PROb) and human colon cancer cells (HT29). The antitumoral effect of diluted povidone iodine washing was measured in BDIX rats after the intraperitoneal inoculation of 10(6) DHD/K12/PROb cells. Results were compared to an abdominal washing within a 9 g/l salinel solution. In one experiment, peritoneal scars and a colocolic anastomosis were performed after the injection of cancer cells. RESULTS: A short 10 min incubation of human and rat colon cancer cells with diluted povidone iodine resulted in a complete cell killing. In animals, a peritoneal washing with 1% diluted povidone iodine completely inhibited the tumor growth in parietal peritoneum. However, development of peritoneal tumor nodules was not inhibited in the omentum, in scarified peritoneum or in intestinal anastomosis. CONCLUSIONS: Despite its high in vitro efficacy, diluted povidone iodine has an incomplete effect in the prevention of peritoneal carcinomatosis, with only a partial inhibition in scarred peritoneum epiploïc area and intestinal anastomosis. In contrary, it procures a complete inhibition of tumor growth in normal peritoneum.

[Preparation for Patey incision in mastectomy: technique demonstration]. / Préparation de l'incision de Patey pour mastectomie: artifice technique.

The authors report a technique of skin resection for mastectomy in order to allow secure, tension free closure using a suture upon the nipple.

Increased cytotoxicity and stability of Lipiodol-pirarubicin emulsion compared to classical doxorubicin-Lipiodol: potential advantage for chemoembolization of unresectable hepatocellular carcinoma.

There is no well-defined curative treatment for advanced and unresectable hepatocellular carcinoma. The widely used transarterial chemoembolization (TACE) with a doxorubicin-Lipiodol emulsion has not been shown to improve survival in randomized studies. Further, obstruction of the hepatic artery used in the procedure is badly tolerated in patients with cirrhosis. Drugs with a more rapid penetration into the cancer cells are likely to eliminate the need for obstruction of the hepatic artery. We therefore compared the cytotoxicity of another anthracycline pirarubicin with that of the commonly used doxorubicin. In this report, we show that pirarubicin has a greater in vitro cytotoxic effect than doxorubicin on the HepG2 and Hu-H7 human hepatoma cell lines. Pirarubicin emulsion with Lipiodol is more stable at 37 degrees C than doxorubicin-Lipiodol. Moreover, pirarubicin accumulates at a greater extent in the oil phase, permitting Lipiodol to act as a slow-releasing vector for the anthracycline. Further, amiodarone, a multidrug resistance inhibitor, was shown to decrease the intrinsic resistance of HepG2 and Hu-H7 cells to both anthracyclines, and the presence of polysorbate 80 in the amiodarone preparation increased the stability of the anthracycline-Lipiodol emulsions. We therefore conclude that pirarubicin is a better candidate for TACE than doxorubicin. The rapid and increased cytotoxicity of pirarubicin on hepatoma cancer cells and the stability of the pirarubicin-Lipiodol amiodarone emulsion could avoid the complete obstruction of the hepatic artery by Gelfoam sponges, and provide a better tolerated method of TACE in patients with latent liver insufficiency.

[Intraperitoneal chemo-hyperthermia with "overflow" open abdomen]. / La chimiohyperthermie intrapéritonéale à ventre ouvert et avec "débordement".

The authors report an original procedure of open-abdomen intraperitoneal chemo-hyperthermia. The skin edges are watertightly stapled with a soft "abdominal cavity expander", supported by a Thompson self-retaining retractor positioned over the abdomen. So, the level of the liquid can be widely raised above the level of the skin edges. The anterior wall peritoneum, the wall edges are constantly exposed to the liquid. Large amplitude movements become possible: introduction into the abdomen of two forearms, even two arms, does not induce loss of any liquid. The small bowel, the stomach can be partially exteriorized. It becomes very easy to expose all the peritoneal spaces, to maintain an homogeneous hyperthermia within the abdomen, while using only one inflow drain, and one outflow drain.

Pre-clinical study of the epinephrine-cisplatin association for the treatment of intraperitoneal carcinomatosis.

We have previously shown that intraperitoneal (i.p.) epinephrine enhances tumour penetration and anti-cancer activity of i.p.-administered cisplatin in rats with peritoneal carcinomatosis. Here, we show a direct correlation between the i.p. epinephrine concentration and cisplatin accumulation in rat peritoneal tumour nodules up to a concentration of 5 mg/l. This concentration leads to a maximal 3.7-fold increase of tumour platinum content and a maximal vasoconstriction of the peritoneal and tumour superficial microcirculation when registered by a laser doppler probe. Further, epinephrine half-life was 20.8+/-3.6 min in the peritoneal cavity of two laparotomized pigs. In these animals, epinephrine plasma concentration, heart rate and systolic blood pressure were dependent on the intraperitoneal dose of epinephrine, and life-threatening signs were not observed in either animal. In conclusion, a 5 mg/l concentration of epinephrine could be safely maintained in peritoneal fluid by regular replacement. This concentration is sufficient to maintain a constant vasoconstriction of the peritoneal and tumoral microvascular bed, and enhance the slow diffusion of cisplatin into peritoneal tumour nodules in the course of per-operative intraperitoneal chemotherapy.

[Laënnec, re-inventor of the stethoscope?]. / Laënnec, ré-inventeur du stéthoscope?

According to our common medical culture, some facts are simply unquestionable, for instance Laënnec invented the stethoscope. But was he the first one? On a recent trip to Egypt we visited the temple of Kom Ombo, built prior to the roman period and renowned as a medical care center. Today, the tourist is fascinated by the magnificent hieroglyphics on the well-preserved walls testifying to significant advances in various fields of medicine including ophthalmology and gynecology. We were particularly interested by the basreliefs presenting vivid drawings of some of the first medical instruments. We easily identified curettes, scissors, a balance, forceps for dental extraction, and a surgical saw, but were captivated by two other instruments. The first one looked a lot like what Laënnec invented around 1820. The second one was amazingly similar to the instrument we use everyday, with a distal opening and flexible tubes (woven papyrus?) leading to proximal ear pieces. Our Egyptian guide was formal: the stethoscope was invented in Egypt. The scientific impact of our observations leaves something to be desired, but did make us think about the huge gap between the advancement of medical knowledge in ancient Egypt and Laënnec's (re)-invention. Exposed to a similar gap in history, what would our documents stored on CD and video tapes have to say to future touring doctors?