Splenogonadal fusion: a case report.

Splenogonodal fusion is a rare congenital abnormality. We present the case of a continuous splenogonadal fusion diagnosed in the course of a laparoscopy for left non-palpable testis in a 1-year-old boy. This case illustrates that even though testicular salvage is the recommended approach, various anatomical features might preclude conservation.

Primary stenting for the acute treatment of carotid artery dissection.

OBJECTIVES: To review and evaluate our experience with carotid artery stenting in the acute treatment of carotid artery dissection (CAD). PATIENTS AND METHODS: Reviewing the charts of our hospital between 2000 and 2001, we found two consecutive patients who benefited from primary stenting for the acute treatment of spontaneous extracranial internal CAD. RESULTS: Primary stenting of the internal carotid artery was successful in both cases without any post-operative complications. Clinical and US duplex scan follow-up confirmed the absence of neurological symptoms and the patency of the internal carotid artery with complete disappearance of the dissection at 36 and 42 months after the procedure, respectively. CONCLUSION: Despite the small number of patients, primary stenting for acute CAD seems to be safe and effective.

Emphysematous cholecystitis.

Emphysematous cholecystitis is a relatively rare variant of acute cholecystitis with infection by gas-producing organisms. Diagnosis involves the demonstration of gas within the lumen or wall of the gallbladder by ultrasound or CT scan. In contrast to acute cholecystitis, emphysematous cholecystitis occurs more commonly in elderly and diabetic patients, and is frequently associated with perforation and death. We report here a case of a 75-year old man who developed emphysematous cholecystitis.

Cholecystitis associated with heterotopic pancreas.

Heterotopic pancreas is a rare developmental anomaly usually reported as an incidental finding. We describe a 1 cm diameter gallbladder heterotopic pancreas identified at pathological study. The patient, a 23-year-old woman, was suffering from cholecystitis. She underwent cholecystectomy with an uneventful course.

Mirizzi syndrome with a double biliary fistula.

Mirizzi syndrome is a partial obstruction of the biliary tree caused by a stone impacted in the cystic duct, with or without development of a cholecystobiliary fistula. Clinical signs are non-specific and suggest at first an obstructive jaundice. We describe a patient with a type I Mirizzi syndrome with a cholecystocolic and a cholecysto-internal biliary fistula. The diagnosis was suggested by ultrasonography and tomodensitometry, and confirmed by endoscopic retrograde cholangiopancreatography. A partial cholecystectomy with a Roux-en-Y hepaticojejunostomy reconstruction was performed. A review of the literature covering its clinical presentation, diagnosis and surgical treatment is presented.

[Acute acalculous cholecystitis: apropos of 6 cases]. / Cholécystites aiguës alithiasiques: à propos de 6 cas.

Authors relate their experience of six cases of acute acalculous cholecystitis (4 postoperative, 2 posttraumatic and postoperative). Five cases were correctly diagnosed preoperatively and another case was operated on the basis of a high index of suspicion. Acute acalculous cholecystitis is often misdiagnosed and its frequency is probably higher than suspected. Associated diseases, the natural history of the disease as well as delayed diagnosis explain its poor prognosis. The diagnosis of acute acalculous cholecystitis should be routinely ruled out in high risk patients (polyoperated, polytraumatised) in order to improve the mortality rate. Ultrasonography and biliary scintigraphy are useful for the diagnosis in high risk patients. Emergency cholecystectomy is still the best long term treatment.

[The esophageal axis in the preoperative evaluation of the operability of cancer of the thoracic esophagus]. / L'axe oesophagien dans l'évaluation préopératoire de l'opérabilité des cancers de l'oesophage thoracique.

The length and the esophageal axis, studied by barium swallow, were examined in 30 patients with carcinoma of the thoracic esophagus. All these patients underwent later esophageal resection. An histologic examination was performed in all cases and a correlation was established between these preoperative and postoperative parameters. We have noticed that the presence of abnormalities in the esophageal axis allowed us to predict that the cancer infiltrated markedly through the adventitia in 85.7% of cases. If a resection is performed in these cases, it cannot be a curative resection. On the opposite, when the axis showed no abnormality, 81.2% of the cancers were confined to the wall, permitting then a curative resection. Tumor length did not seem to be an adequate parameter on establishing the depth of infiltration in the esophageal wall. Finally there was no correlation between lymph node metastasis and depth of invasion.

The dangers of oesophageal intubation in the management of corrosive strictures of the oesophagus. Case reports.

Two patients with established corrosive strictures of the oesophagus managed by oesophageal intubation are reported. In both patients intubation of the oesophagus led to serious complications necessitating major oesophageal surgery.