[Value of US imaging following mastectomy]. / Intérêt de l'échographie systématique du site de mastectomie.

PURPOSE: To assess the value of US of the mastectomy site at the time of follow-up of the contralateral residual breast. MATERIALS AND METHODS: Over a 5 year period, 251 patients with previous mastectomy underwent 505 unilateral mammographies with US of the mastectomy site. The time delay between imaging and mastectomy ranged between 1-15 years, with a mean of 7.5 years. Lesions at the mastectomy site were classified as follows: BIRADS 2 for a cyst or prominent edema, BIRADS 3 for a lymph node with preserved fatty hilum or mildly echogenic cyst, BIRADS 4 for well-defined hypoechoic lesions, and BIRADS 5 for ill-defined lesions. RESULTS: None of the lesions classified as BIRADS 1, 2 or 3 was malignant. Eleven lesions were classified as BIRADS 4: 3 benign lesions, 7 malignant lesions, and 1 non-verified lesion. No lesion was classified as BIRADS 5. CONCLUSION: Systematic US evaluation of the mastectomy site appears warranted since only 1 of 7 malignant lesions was clinically palpable prior to US whereas all were retrospectively palpable after US.

Adenomyoma of the ampullary region: imaging findings in four patients.

BACKGROUND: We report the imaging features of adenomyoma of the distal common bile duct (CBD) and increase awareness of this rare benign disease. METHODS: Four patients (age range = 66-71 years) with abdominal pain and biliary obstruction had spiral computed tomography (CT) and cholangiography with or without papilla biopsy. Two patients also had endoscopic ultrasound. RESULTS: The CT appearance of adenomyoma was that of a rounded, well-circumscribed, soft tissue mass in the ampullary region, which appeared on cholangiography as a well-defined intraluminal filling defect or caused abrupt and regular stenosis of the CBD. Unfortunately, none of our patients was diagnosed before surgery, and cephalic duodenopancreatectomy was performed in all of them. CONCLUSION: Although imaging findings are not specific, their presence should raise the possibility of a benign tumor. If a proper preoperative diagnosis is made, cephalic duodenopancreatectomy can be avoided.

[Metastatic implants after laparoscopic cholecystectomy in unsuspected gallbladder cancer. A case report and review of the literature]. / Implants métastatiques apres cholécystectomie laparoscopique d'un cancer non suspecté de la vésicule biliaire. Rapport d'un cas et revue de la littérature.

A gallbladder carcinoma, diagnosed preoperatively, is a counter-indication for laparoscopic cholecystectomy. When this cancer is not diagnosed and laparoscopic surgery is undertaken, neoplastic dissemination may occur along the trocars pathways which renders the prognosis even worse. The most probable explanation of the dissemination is a seeding of sloughed cancerous cells onto abdominal wall during exsuflation. The authors report the case of a 36-year-old woman with an adenocarcinoma of the gallbladder discovered after laparoscopic cholecystectomy and who has had rapid intra-abdominal and parietal metastases.

[Unusual metastases of breast cancer]. / Métastases inhabituelles du cancer du sein.

The breast cancer is the common cancer in female. The metastasis may occur any where in the body. The common sites are in the lymph nodes, the bones, the chest, the liver and the brain. Other sites of metastasis have little importance, rarely researched and constitute the objective of this article.

[Spontaneous splenic rupture due to heparin. Report of a case and review of the literature]. / Rupture spontanée de la rate sous héparine. Rapport d'un cas et revue de la littérature.

We describe in this report a case of spontaneous rupture of the spleen in a 68-year-old man on heparin therapy for cerebrovascular disease. This spontaneous splenic rupture is a rare complication of anticoagulant or thrombolytic therapy. Twenty cases were reported in the world medical literature. Only one case was due to heparin. The clinical presentation, which includes mainly abdominal and left shoulder pain with shock, could mimic cardiac diseases and delay or even mask the diagnosis. The mechanism of the rupture is still unknown. It is possible that altered hemostatic mechanisms may aggravate unrecognized micro trauma to provoke a rupture of the spleen. Once the rupture is suspected, the diagnosis can be confirmed with CT scan, or ultrasound. The treatment will be mainly reversal of anticoagulation and splenectomy.

[The place of enucleation in the surgical management of hepatic hemangioma. Report of a case and review of the literature]. / Place de l'énucleation dans le traitement chirurgical de l'hémangiome hépatique. Rapport d'un cas et revue de la littérature.

Hepatic hemangioma is the most frequent benign tumor of the liver. It is often asymptomatic. If surgery is needed the best method will be enucleation of the hemangioma. We report a case of enucleation of a cavernous hepatic hemangioma with review of the literature.

[Aneurysm of the hepatic artery treated by embolization]. / Anévrisme de l'artère hépatique traité par embolisation.

The hepatic artery aneurysm represent 16 to 20% of visceral artery aneurysms. The man of 40 years of age is often affected. This aneurysm is often asymptomatic. The rupture menace its evolution and justify the treatment. Echo-doppler-color constitute a non invasive exam of choice for diagnosis. Embolisation has a more extent indications. A case is reported of an aneurysm of the hepatic artery treated with embolisation with review of the literature.

[Prevention of postoperative wound dehiscence. Comparative study of polyglactin 910 mesh and total reinforced extraperitoneal sutures]. / Prévention de l'éviscération post-opératoire. Etude comparative du treillis de polyglactine 910 et de points totaux extrapéritonéaux appuyés.

Postoperative wound dehiscence is a serious complication. Various surgical procedures have been proposed to prevent it but only few studies have compared their effectiveness. The authors report a retrospective study on 292 high risk patients operated between 1980 and 1988. These patients were divided in two groups according to the methods of abdominal wall support: 226 patients (group I) with total reinforced extraperitoneal sutures and 66 (group II) with a polyglactin 910 mesh. Preoperative risk factors, surgical pathology and the incisions performed were similar in the two groups. Only two parameters were different: the number of previous operations and emergency surgery which were more frequent in group II (p less than 0.05). Fourteen patients in group I developed postoperative wound dehiscence and none in group II (p = 0.02). Nine of these patients were reoperated with a mortality of 28.5%. The frequency of the other complications was similar in the two groups. Polyglactin 910 mesh was more effective than total reinforced extraperitoneal sutures in the prevention of post operative wound dehiscence justifying its use in high risk patients.

[Cavernous hemangioma of the liver associated with angiosarcoma: malignant transformation?]. / Hémangiome caverneux du foie associé à un angiosarcome: transformation maligne?

Angiosarcoma of the liver is a rare tumor. Its treatment is usually regarded as unsuccessful and its prognosis extremely poor. The authors report the case of a solitary and encapsulated hepatic tumor characterized by the association of a cavernous hemangioma surrounded by an angiosarcoma. The hypothesis of an eventual malignant transformation of cavernous hemangiomas of the liver is raised.

[Pulmonary metastasis with left intra-atrial extension of liposarcoma. Apropos of a case]. / Métastase pulmonaire avec extension intra-auriculaire gauche d'un liposarcome. A propos d'un cas.

The direct extension of a neoplastic thrombus of the pulmonary veins into the left atrium is extremely rare. The authors report the case of a pulmonary metastasis from a liposarcoma of the thigh extending into the pulmonary veins and prolapsing into the left atrium. The patient was successfully treated by tumorectomy under cardiopulmonary bypass then by left upper lobectomy.

[Reoperation in severe hepatic trauma. 30 cases]. / Les réinterventions dans les traumatismes graves du foie. Trente cas.

From 1978 to 1987, thirty patients were secondarily referred to Saint-Antoine Hospital for the treatment of their hepatic trauma. Seventeen were referred because of a postoperative complication (group I) and thirteen after peri-hepatic packing (group II). In group I, transfer was decided because of hemorrhage (8 patients), sepsis (6 patients) and haemobilia (3 patients). The lesions observed in this group (hemoperitoneum, hepatic sequestrum, intrahepatic hematoma, choleperitoneum and subphrenic abscess) were often related to an incomplete assessment of hepatic damage due to an inadequate exploration and the absence of operative cholangiography. In group II, peri-hepatic packing was effective in eleven patients. The overall mortality was 16.6% (17.6% in group I and 15.4% in group II). Postoperative complications occurred in 50% of the patients (64.6% in group I and 30.7% in group II). Good exposure of the liver, operative cholangiography and, in selected cases, a direct approach to the lacerated liver with suture ligation of severed blood vessels and bile ducts are mandatory for the complete exploration and the treatment of severe hepatic trauma. Peri-hepatic packing and the transfer of the patient to a specialized center is a reliable method when the injury cannot be treated locally.