[Pseudo-Still disease and deep neoplasm]. / Pseudomaladie de Still et néoplasie profonde.

Some rare observations with the diagnosis of Still's disease in adults reveal a different diagnosis: a paraneoplasic syndrome related to a non differentiated bronchitic carcinoma. The term "paraneoplasic pseudo Still's disease" can be considered. However we have to add a syndrome of intestinal dysfunction with characteristics of pseudoblockage with an imprecise mechanism.

[Thoracic tumors after treatment for Hodgkin disease]. / Tumeurs thoraciques après traitement de la maladie de Hodgkin.

Twenty-one patients were admitted to the surgical unit for management of an intra-thoracic mass following treatment of Hodgkin's disease (HD). They consisted of 14 males and 7 females, with a mean age of 34 years (range: 17-62). Seven had recurrent HD, 14 had a non-Hodgkin solid tumour. HD recurrences were treated with repeated chemotherapy with 4 prolonged survivals including 1 relapse (40 to 84 months follow-up). Non-Hodgkin tumours were 13 lung carcinomas, which were resected in 4 cases, with only 1 prolonged survival (54 months) and malignant schwannoma. HD recurrences are observed equally in both young males and females and are subsequent to a mediastinal location of the disease, after an average 3.2 years. They are located on the borders or irradiation fields. Repeated chemotherapy is effective. Carcinomas more often appear in males, at an older age, in a favorable clinical context, after an average 10.2 years. Their prognosis is very poor. Irradiation and chemotherapy contribute to their development. Long-term risks of HD treatment must be considered.

Pulmonary sequestration treated by video-assisted thoracoscopic resection.

An undiagnosed pulmonary sequestration showed abnormal vessels at video-assisted thoracoscopy. Mediastinal or lung masses which are situated at the base of the thorax must be dissected with great caution because of the possible existence of vascular malformations.

[Axillo-axillary access in hemodialysis]. / L'abord axillo-axillaire en hémodialyse.

Axillo-axillary angio-access can be an alternative device (bovine graft or synthetic graft) for dialysis patients among whom upper arm peripheral veins are impracticable or previous fistulas are thrombose. This procedure was used in seven dialysis patient (length of dialysis: 52.2 +/- 40.6 months) among whom forty one angio access were done. Except one immediate failure, these access were patent until, either the death of patients or the achievement of a cadaveric renal graft. The clinical and hemodynamic tolerance were perfect.

[The lung in brain death. Anatomo-biological correlations for pulmonary transplantation]. / Le poumon des sujets en état de mort cérébrale. Corrélations anatomo-biologiques en vue de la transplantation pulmonaire.

Histopathological studies of the lung conducted during multiple organ procurement from 25 subjects in a state of brain death showed that 19 of them had lung lesions pre-existent to coma, viz. alveolitis and lung invasion by dusts increasing with the subject's age. Alveolar or interstitial emphysema and subpleural bullae caused by mechanical ventilation were present in 19 cases; signs of bronchial inertia were found in 6 cases and established superinfection in 3 cases. Finally, 17 subjects showed interstitial and vascular alterations induced by oedema and shock which were related to the time spent in intensive care units, to the cause of the coma and to the quantity and quality of intravenous received while in intensive care unit. There were histological correlations between these various factors, but precise criteria concerning the functional prognosis of the transplant could not be defined. However, this study seemed to confirm the need for a new approach to the intensive care of brain-dead subjects during lung procurement: the time elapsed before procurement should be shortened, the amount of medicinal solutions administered should be reduced, Ringer lactate and packed cells should be used in preference to albumin derivatives, and arterial blood pressure, rather than diuresis, should be maintained.

[Congenital cysts of the esophageal wall with a respiratory type mucosa]. / Kystes congénitaux de la paroi oesophagienne à revêtement muqueux de type respiratoire.

Eight patients with congenital esophageal cysts are described. They presented with respiratory or gastrointestinal symptoms or an abnormal mediastinal profile on a standard chest film. All cysts were contained in the middle or inferior portions of the thoracic esophagus. They were excised in a submucosal plane. Their coat was composed of a ciliated, respiratory type epithelium. In the embryo and after separation of the tracheal diverticulum, the esophagus is lined with ciliated cells which are able cover a "cystic duplication", which is surrounded by an esophageal muscular coat or can be "included" in a common mesenchyma, which explains the possible presence of bronchial elements in the wall of an esophageal cyst. In this eventuality the cyst may be defined as being "bronchogenic".

[Surgical treatment of chronic pancreatitis. Retrospective study of 221 cases]. / Traitement chirurgical de la pancréatite chronique. Etude rétrospective de 221 cas.

221 patients have been operated for chronic pancreatitis, secondary to alcoholic intoxication in 92% of cases. Surgery was performed for a complication of the disease (69%), for intractable pain (30%), or for a false diagnostic of cancer; 265 operations were done, among which 41% of resections, 18.5% of internal derivations, and 14.3% of external derivations. Post-operative morbidity was 23.4% and hospital mortality was 6.4%. Late mortality was 35.5%, pancreatitis being responsible for more than half of those deaths during the first three post-operative years. Iterative surgery was necessary in 37 cases. The risk of diabetes was multiplied by 3.2 after resection. Results were good in 50% of cases after 5 years. An important factor was the arrest of alcoholic intoxication. There was no significant difference between resection and derivation. Internal drainage should be preferred when possible. Surgery must be reserved to grave or invalidating complications of chronic pancreatitis.