[Implantable direct intravenous access: technic, complications, outcome. Apropos of 237 cases]. / Accès direct implantable en intra-veineux: technique, complications, devenir. A propos de 237 cas.

From june 1983 to december 1987, 441 direct accesses were implanted, 237 intravenous, 51 intraperitoneal and 153 intra-arterial. The surgical procedure, the indications, the post-operatory and later complications and the issue of the direct intravenous accesses implanted by the same surgical team are presented. 237 direct access implants were placed intravenously in 228 patients. There are many indications for implanting direct access: absence of a superficial venous network, continuous chemotherapy, preservation of the superficial venous network, thrombosis of the hepatic artery after, inoperable hepatic metastasis (jaundice). Direct venous access was implanted for many pathologies essentially for breast cancer (120 cases), large bowel cancer (36 cases). Surgical procedure for direct intravenous access is easy with catheter's control with fluoroscopy monitoring. Only rarely did any later complication occur when using the direct intravenous access (12 cases) representing 5% of all complications. Certain precautions should be taken to reduce the number of complications. Prophylactic antibiotic therapy, surgical procedure for implanting the direct access excision of excess fatty subcutaneous tissue, minutious skin disinfection, heparinization, avoid using the chamber for blood sampling, use intra-arterial direct access. Direct access is used either for sequential chemotherapy or for continuous protocols which vary in length.

[Vascular malformations of the digestive tract: a cause of severe digestive hemorrhage. Apropos of 2 cases]. / Les malformations vasculaires du tube digestif: une cause d'hémorragie digestive grave. A propos de deux cas.

We report on two cases of angiodysplasia of the digestive tract complicated by serious acute bleeding. The preoperative diagnoses were made by angiography. One case concerned a voluminous jejunal lesion which was macroscopically visible; the other concerned a punctiform lesion detected only by angiography and not found on the pathology specimen. The authors insist on the potential gravity of these angiodysplastic lesions, the necessity to perform an emergency celio-mesenteric angiogram when confronted with a serious digestive tract hemorrhage non-explained by conventional methods of exploration when they can be performed.

[Pheochromocytomas: diagnosis, anesthesia and treatment. Apropos of 17 recent cases]. / Phéochromocytomes: diagnostic, anesthésie et traitement. A propos de dix-sept observations récentes.

This article summarizes 5 years of systematic observation of 17 patients presenting with benign pheochromocytoma. The diagnosis was based on clinical and biological findings which were consistently positive. The topographical diagnosis was based on CT scans, and a combination of intravenous urograms and nephrotomography. The preoperative preparations were made with labetalol, and the anesthetic used was narconeuroleptanalgesic. The hemodynamic study was carried out with a Swann-Ganz catheter, which proved indispensable in the surveillance of the patient at operation. The surgical procedure is best performed with transperitoneal subcostal incisions, which the authors prefer. Morbidity was negligible, and mortality, zero.

[Malignant adrenal cortex tumors responsible for primary hyperaldosteronism and biological hypercorticism. Remarks apropos of 2 surgically-treated cases]. / Corticosurrénalomes malins responsables d'un hyperaldostéronisme primaire et d'un hypercorticisme biologique. Réflexions à propos de 2 cas opérés.

Two cases of malignant adrenal cortex tumors revealed by primary hyperaldosteronism with hypertension, and associated with a biological hypercortisonism, are reported. Diagnosis of this very rare affection depends on the finding of marked biological hyperaldosteronism associated with a large adrenal tumor. The outcome appears to be rapidly fatal for tumors exceeding 5 cm in diameter and associated with lymph node invasion. This raises the problem of the utility of surgery in these cases, operative intervention apparently accelerating progression of the lesion. In practice, however, a laparotomy is always justifiable, the most rational biopsy being excision of the tumor.

[Treatment of rectocolic and gastric adenocarcinomas with 5-fluorouracil associated with high doses of folinic acid. Results of an experimental study]. / Traitement des adénocarcinomes recto-coliques et gastriques par le 5-fluorouracile associé a des fortes doses d'acide folinique. Résultats d'une étude pilote.

We report the results of a therapeutic trial in patients with rectocolic and gastric metastatic adenocarcinomas. This trial is based on experimental evidence that an excess of reduced intracellular folic acid increases the cytotoxicity of fluoropyrimidines. The treatment consists of 5-fluorouracile (5-FU) (370 to 400 mg/m2/24 h) and folinic acid in high doses (200 mg/m2: 24 h) given simultaneously for 5 consecutive days; the interval between courses is 21 days. Thirty patients with measurable rectocolic adenocarcinomas were evaluated. They were divided into two groups: 16 patients had had no previous chemotherapy and 14 had not responded to chemotherapy with 5-FU alone or associated with other cytostatic drugs. Response rates were 56% in the first group and 21% in the second. Five patients with measurable gastric adenocarcinomas were also evaluated; none had received previous chemotherapy. A partial response was recorded in three of these patients. Toxicity of the therapeutic regimen was acceptable. Stomatitis was the most common toxic side-effect. In patients with severe adverse side-effects recurrence was efficiently prevented by decreasing the daily dose of 5-FU to 30 mg/m2 during subsequent courses. We conclude that in the tumors studied folinic acid in high doses can improve the antitumoral effect of 5-FU and induce a response to this agent in some rectocolic tumors which were previously resistant.

[Removal of wasted endocavitary pacemaker electrodes by the epigastric route without cardiopulmonary bypass (author's transl)]. / Ablation des sondes endocavitaires perdues par voie épigastrique sans circulation extra-corporelle.

Wasted, embedded and infected endocavitary pacemaker electrodes responsible for severe septicaemia were removed on three occasions, using an original technique. The heart was approached through a subxyphoid or epigastric incision, and the right ventricule was entered through a short opening in its diaphragmatic surface. The cardiac incision was comprised within a U-shaped suture resting on two teflon felter strips. This technique does not require cardiopulmonary bypass.

[True traumatic aneurysm of the proximal part of the brachial artery without osteo-articular lesions : a rare condition. A case report (author's transl)]. / Anévrysme traumatique vrai de l'artère humérale haute sans lésion ostéo-articulaire : une lésion rare. A propos d'un cas.

True isolated traumatic aneurysms are very rarely observed, and have to be differentiated from false aneurysms. They correspond to unrecognized arterial contusions following closed shoulder injuries. The presence of a large hematoma in the axillohumeral region, associated with an early ecchymosis, should suggest the possibility of an arterial lesion, and arteriography should be conducted. Difficulty in diagnosing the lesion clinically arises from the particular location of such lesions and the richness of the brachial and axillary artery collaterals. This latter fact explains why an ischemic syndrome is rarely observed. Treatment of true traumatic aneurysms is always surgical.