[Sub-venous iliac lymphatic dissection with celioscopy for the staging of prostatic cancer (16 patients)]. / Curage lymphatique iliaque sous-veineux par coelioscopie pour le bilan des cancers prostatiques (16 patients).

Subvenous external iliac lymph node dissection is an essential element for the staging of prostatic cancer. 7 to 30% of patients with intracapsular prostatic cancer have lymph node metastases despite normal imaging examinations. Laparoscopic surgery allows lymph node dissection through a limited incision. Sixteen patients underwent laparoscopic lymph node dissection (LLND) for prostatic cancer. The mean duration of the operation was 100 +/- 50 minutes (35-180 min: 130 minutes for the first nine operations, then 60 minutes for the last seven operations). One patient died on the second day from a cerebral vascular accident. There was one technical failure (pneumoperitoneum leak), one vascular injury, one ureteric injury, one transient paresis of the obturator nerves and one case of perineal lymphoedema. The mean number of lymph nodes removed in bilateral lymph node dissection was 7.5 +/- 2 (14-20) per patient. Three patients had lymph node metastases. The mean hospital stay related to laparoscopy was 4 +/- 2 days with a median of 2 days. Laparoscopic surgery, like any conventional or innovative surgical technique, requires specific training to become safe and effective. It allows complete histological examination of the lymph nodes removed and planning of prostatectomy, which may be subsequently performed through a perineal approach.

[Vesico-ureteral reimplantation on psoas bladder in lesions of the pelvic ureter. Review of 50 patients]. / Réimplantation urétéro-vésicale sur vessie psoïque dans les lésions de l'uretère pelvien. Revue de 50 patients.

Between 1979 and 1991, the authors performed 50 psoas bladder ureterovesical reimplantations for lesions of the pelvic ureter. 90% of very good results were obtained with this technique at the cost of a low morbidity. This series confirms the influence of previous pelvic radiotherapy on the postoperative complication rate. On the basis of the excellent results in this series, confirmed by those reported in the literature, this technique can be proposed as treatment of choice for lesions of the pelvic ureter when suture-resection or simple reimplantation cannot be performed after failure of endoluminal dilatation in patients with a life expectancy greater than 6 months to one year.

Tracheobronchial necrosis after caustic ingestion.

Between 1968 and 1988, 679 patients were hospitalized for ingestion of caustic substances, and 87 had severe caustic burns of the entire esophagus, together with panparietal necrosis. Twenty-one of them had tracheobronchial necrosis with perforation. Fifteen have not been operated on; six have had operations, with success in four. We describe an original technique for repairing these tracheobronchial perforations with a pulmonary patch.

[Anatomic localization of parathyroid adenomas. Experience of 1200 cases of primary hyperparathyroidism]. / Localizzazione anatomica degli adenomi paratiroidei. Esperienza di 1200 casi di iperparatiroidismo primario.

From 1969 to December 1988 1200 patients were successfully operated on for primary hyperparathyroidism. In 1086 cases the parathyroid lesion was an adenoma and in 252 cases (23.2%) we considered this adenoma in an unusual location. Analysis of the patient's records enables us to describe the operative difficulties for each of those locations, and to assess the value of complementary investigations in the patients whose adenomas are difficult to find.

[Functional analysis of micturition and continence after a Hautmann type enterocystoplasty (27 patients)]. / Analyse fonctionnelle de la miction et de la continence après entérocystoplastie de type Hautmann (27 patients).

Twenty seven patients treated by Hautmann enterocystoplasty completed a detailed questionnaire concerning the quality of their micturition and continence. The mean capacity of the neobladder was 250 cc with a diurnal interval between micturitions of about 3 hours. 79% of patients experienced an urge to micturate. The mean frequency of nocturnal micturition was 1.6. Diurnal continence was perfect in 100% of patients, while nocturnal continence was excellent in 78% of cases and good in 18% of cases, while one patient (4%) suffered from nocturnal incontinence. Hautmann enterocystoplasty is therefore an excellent technique for bladder replacement, ensuring diurnal and nocturnal continence for the great majority of patients.

[Tracheal injury caused by intubation for compressive endothoracic goiter]. / Plaie trachéale à l'intubation pour goître endothoracique compressif.

The tube cannot pass along the marked curve of the trachea, which is displaced by a large goiter extending into the posterior mediastinum. The trachea is perforated in a low thoracic location. Tracheal suture and exeresis of the goiter are performed through sternotomia. This serious accident seems to be exceptional. Can it be predicted?

[Mediastinal exploration for hyperparathyroidism]. / Exploration médiastinale pour hyperparathyroïdie.

Five per cent of parathyroid adenomas are situated in the mediastinum. Many of them are accessible via a cervical incision: virtually all posterior mediastinal adenomas, by dissecting well behind the oesophagus, and most intrathymic adenomas, by cervical exteriorisation of the thymus. Finally, the indications for sternotomy are are: less than 2% of operations for hyperparathyroidism. After describing the technical details, the authors review the indications, the imaging modalities used and the results of their last 20 sternotomies.

[Vicissitudes of the surgery of primary hyperparathyroidism]. / Vicissitudes de la chirurgie de l'hyperparathyroïdie primaire.

The difficult and disappointing cases encountered in patients who were operated upon for hyperparathyroidism between 1960 and 1987 have been studied. Ninety two patients underwent negative cervicotomy. Among the 12 patients who underwent a second operation, 4 were found to have cervical adenomas and in 6 others mediastinal adenomas were discovered by sternotomy. Most of the other cases were diagnostic errors. The present frequency of negative surgical operations is very low: 2 to 3 per cent of the cases; errors of diagnosis are exceptional, and the unusual sites of adenomas are better known. Seventeen patients were reoperated upon for persistent or recurrent hypercalcaemia despite excision of a 1st parathyroid lesion; 3 cancers which had been mistaken for adenomas at the 1st operation; 6 had a 2nd adenoma which had passed unnoticed during an exploration that was probably too limited and as hypercalcaemia persisted all 6 were reoperated upon with success at different intervals; finally, 8 patients had undiagnosed primary hyperplasia (as part of polyadenomatosis in 5 cases). Recurrences were observed, often after a long period, up to 3 to 5 years. Hypercalcaemia was corrected by the 2nd operation in only 5 out of 8 cases. In retrospect, it was found that the pathological examination could not always determine if the lesion was malignant or distinguish between adenoma and glandular hyperplasia.

[Chemotherapy in cancer of the prostate]. / La chimiothérapie dans les cancers de prostate.

The most classical treatment of metastatic prostatic adenocarcinoma is hormone therapy. Most often, chemotherapy is proposed only when the tumor becomes hormonally unresponsive. But evaluation of its efficacy is impaired by the diversity of inclusion criteria used and by the different criteria of response assessment. Results of randomized, comparative studies show that all cytotoxic agents currently available have a similar response rate (about 30 to 40%). Use of combined chemotherapy does not seem to significantly improve these results. Several others ways have been proposed which attempt to improve the efficacy of chemotherapy (androgen stimulation, priming chemotherapy, adjuvant or neo-adjuvant chemotherapy...) but, most probably, progress will come from the discovery of more effective and selective cytotoxic agents, and not from the increase of clinical trials with the same agents.