[Bisegmentectomy 7-8: importance of preoperative diagnosis of a right inferior hepatic vein]. / Bisegmentectomie 7-8: intérêt du repérage pré-opératoire d'une veine hépatique inférieure droite (VHID).

The extent of hepatic resection is often determined by the hepatic veins and their relation to the tumor. A need to transect the right hepatic vein at its entry into the vena cava indicates a need to remove the entire right posterior segment. About six cases, the aim of the study was to remind that under certain circumstances the posteroinferior area may be preserved. The circumstances which allow such preservation are the presence of a stout inferior right hepatic vein and the ability to recognize the presence of the vein in the preoperative staging. In patients with possible impaired hepatic function (cirrhosis, chemotherapy), preservation of hepatic parenchyma is an important consideration during resection for hepatic tumors.

[The importance of lymph node dissection in medullary thyroid macrocarcinomas]. / Importance du curage ganglionnaire dans les macrocarcinomes médullaires de la thyroïde.

UNLABELLED: Medullary thyroid carcinoma (MTC) is often regarded as good medium-term forecast. The 5- and 10-years survival rates are, respectively, appraised at 78-85% and 70-78%. These rates take no care, however, of the fact that 50-56% of the patients keep a pathological calcitonine (CT) level giving evidence of an evolutive disease. The treatment is based on the total thyroidectomy and cervical lymphadectomy. This treatment remains often incomplete and the results of reintervention are disappointing. AIM OF THE STUDY: About 48 patients, we wanted to demonstrate the importance of a complete lymph node dissection performed in the neck as soon as possible. PATIENTS AND METHODS: Between 1979 and 2000, 48 patients were treated for macroMTC (size >1 cm). The duration of follow-up was of 1-29 years (mean 9.3 years). The complete (central and lateral) neck dissection was initially made only in 22 cases. The selected criterion to assess the result was the normalization of the basal CT level. RESULTS: The rate of node involvement was 66.6% if the complete lymphadectomies (n = 22), the secondary neck dissections (n = 15), the incomplete (n = 10) and not made lymphadectomies (n = 2) were gathered. In case of primary or secondary complete lymphadectomies, the rate of node involvement was 81%. The 22 primary complete lymphadectomies performed in 13 patients (59%) allowed to normalize the basal CT level and among 17 (77.2%) to decrease this rate over 90%. All the incomplete neck dissection failed in case of positive nodes. CONCLUSION: The frequency of node involvement in macroMTC is about 80%. It does not have a preferential territory and the bilaterality is frequent (28-49%): that justifies a bilateral complete neck dissection. Initial surgical treatment seems essential in regard to the rate of normalization of basal CT level, which is, when a first complete lymphadectomy is done and in case of iterative surgery, respectively 59 and 26.6%. A complete lymphadectomy is still too rarely carried out: 22 times (45.8%) in our own experience and from 14 to 42% in the literature.

Rupture of internal iliac artery aneurysm into the bladder following aortic aneurysm repair.

This report describes a case of ruptured internal iliac artery aneurysm into the bladder after repair of an infrarenal abdominal aortic aneurysm. Aortic repair consisted of resection of the aneurysm followed by prosthetic interposition to reestablish arterial continuity. During the postoperative period, the patient had ischemia of left colon, which was successfully treated by the Hartmann procedure. A right internal iliac artery aneurysm measuring 50 mm in diameter was demonstrated by an abdominal CT scan during the initial hospitalization but was considered stable, since ultrasonography showed no change in diameter at 3 months and 1 year. The patient was lost from follow-up until 3 years later when he was hospitalized after rupture of the right iliac artery aneurysm, then measuring 120 mm in diameter, into the bladder. Surgical repair was undertaken. The procedure involved aortobifemoral bypass with suture of the bladder defect and branches of the internal iliac artery by the endoaneurysmal route. Postoperative recovery was uneventful. Upon reexamination 1 month after discharge from the hospital, the patient was asymptomatic. This rare case confirms the gravity of internal iliac artery aneurysm and the importance of therapeutic management to prevent rupture.

[Outcome in cervical recurrences of papillary or follicular thyroid cancer]. / Devenir des récidives cervicales de cancer papillaire ou vésiculaire de la thyroïde.

The aim of this study was to evaluate the treatment and outcome of patients with local recurrence (LR) of differentiated thyroid carcinoma. This retrospective study concerned patients treated between 1974 and 1990 for papillary or follicular thyroid cancer. Our patients had at least one LR. LR diagnosed within 6 months after thyroidectomy and patients with increased serum thyroglobulin levels were excluded. Thirty one patients (80% female) aged 15 to 84 years had at least one LR. LR was diagnosed 7 to 200 months after thyroidectomy (mean 63.7). There were 25 papillary and 6 follicular cancers. There were 1.5 LR per patient (range 1-6). LR were treated by radioiodine in 21 cases and by surgery in 22 cases. Among the 22 surgically treated patients, 7 had nodal recurrences, 7 had nodes and tumor, 3 had only tumor, 1 had recurrence in the remnant thyroid. After a mean follow-up of 75.8 months, 11 patients had distant metastases, 11 had died from their thyroid carcinoma (7 after metastases). Three of the 7 patients with nodal recurrence died. In one third of cases, LR announced distant metastases. Node recurrence had a poor prognosis.