[Managing the open abdomen with vacuum-assisted closure therapy: retrospective evaluation of 22 patients]. / Prise en charge des abdomens ouverts par la thérapie vacuum-assisted closure (VAC): évaluation rétrospective de 22 malades.

BACKGROUND: The authors reviewed their experience in the management of "open abdomen" using the vacuum-assisted closure device (VAC), in order to assess its morbidity particularly in terms of fistula, and the outcome of abdominal wall integrity. METHODS: Between January 2003 and October 2006, 22 patients required management with an "open abdomen" technique (18 patients were managed with the VAC abdominal dressing device with application of a specific sheet and 4 other patients simply required a dressing with the polyurethane sponge). The mean age was 55 years, and M/F sex ratio was 2.67. Indications were abdominal compartment syndrome in 7 patients, initial "abdominal closure" after trauma in one patient, severe abdominal sepsis in 7 patients, and abdominal wound dehiscence where closure was impossible in 7 patients. RESULTS: There were no enteric fistulae. Two infections were seen--a chronic suppuration which resolved with antibiotic therapy and a deep abscess which was drained with radiologic guidance. Of the 18 cases of "open abdomen" managed with the VAC, 15 were alive. Six (40%) underwent a delayed primary closure at a mean interval of 9 days; the others underwent secondary healing by granulation, and 10 eventually underwent split thickness skin grafting at a mean interval of 50 days. With VAC closure of the "open abdomen", the development of ventral hernia is an anticipated outcome; in four cases, patients underwent abdominal wall reconstruction at an interval of one year. CONCLUSION: Laparostomy or "open abdomen" using the VAC dressing system should be considered an established and well-defined technique which provides temporary abdominal coverage with limited morbidity.

[Thoracic sympathectomy: treatment for hyperhidrosis]. / Sympathectomie thoracique: un traitement de l'hyperhidrose.

Hyperhidrosis is a benign functional anomaly which is highly stressful for the patient. Active management is required. Several medical options are available but are often ineffective. The thoracic sympathic system plays a fundamental role in propagating stimulation of sudoral gland secretion. Endoscopic thoracic sympatecomy thus provides a radical treatment for severe palmar and axillary hyperhidrosis. We describe the technique used in our unit and present results and possible complications. This method has been used by many teams for several Years and despite some differences, most confirm major patient benefit. Phenomena of transferred sudation are frequent by are usually not invalidating. Patients should however be informed of this possibility because the effect is often irreversible.

[Lymph node supraclavicular metastasis of thymic carcinoma: an inaugural and unusual feature of a rare disease]. / Métastase ganglionnaire sus-claviculaire d'un carcinome thymique: présentation inaugurale inhabituelle d'une pathologie rare.

Among the epithelial tumours of the thymus, thymic carcinomas are rare, involving more aggressive locoregional behaviour and a poor prognosis. More than one-third of cases present lymph node metastasis during an evaluation of the extension of a primitive mediastinal tumour of thymic origin. The authors report an unusual case in a 46-year-old woman presenting a metastatic form. The diagnosis of epidermoid thymic carcinoma was based on the histopathological examination of a right supraclavicular lymph node, associated with an anterior radiological mediastinal tumoral syndrome, raising the delicate problem of its diagnosis and treatment.

[Catamenial pneumothorax with diaphragmatic lacerations]. / Brèches diaphragmatiques majeures au cours d'un pneumothorax cataménial.

The authors describe a case of catamenial pneumothorax with diaphragmatic lacerations and partial liver herniation. It's a rare presentation of catamenial pneunmothorax. We analyse the diagnostic and surgical therapeutic.