The internal cavoatrial derivation for temporary vascular exclusion of the liver in the dog.

Vascular exclusion of the liver by clamping the hepatic pedicle and inserting an internal cavoatrial shunt allows bloodless hepatic surgery to be performed. The internal cavoatrial shunt performed on 30 dogs was studied to define its optimal hemodynamic characteristics. The internal diameter should measure half the caliber of the inferior vena cava and the total surface of the holes allowing blood flow to the shunt must be three times the internal caliber of the shunt. The aortic clamping associated with the clamping of the hepatic pedicle and the insertion of the internal cavoatrial shunt considerably diminishes the arterial blood pressure variations resulting from the splanchnic stasis. Administration of methylprednisolone (30 mg/kg) at the beginning of the experiment also plays a role in preventing alterations in the small intestine.

[Hepatic adenoma and oral contraceptives (author's transl)]. / Adénome hépatique et contraceptifs oraux.

The authors report a new case of hepatic adenoma apparently related to oral contraception continued for more than 9 years with a pill containing mestranol. The clinical presentation suggested an attack of hepatic colic with swollen gall bladder. The preoperative diagnosis of a tumour of segment VI of the liver was made by radiological examination of neighbouring organs. Hepatic arteriography, hepatic radioisotope scan using technetium phytate and echotomography. Surgical removal of segment VI confirmed by histological study showed that it was an adenoma with multiple foci, associated with hepatic involvement. One of the tumours was the site of central included hemorrhage, responsible for the clinical syndrome. In connection with this case the authors review the possible relationship between hepatic adenoma and oral contraception.

[Experimental study of anatomo-pathological and physiopathological manifestations of acute cholecystitis]. / Etude expérimentale des manifestations anatomo-pathologiques et physio-pathologiques des cholécystites aiguës

From their experimental findings in 120 rabbits, the authors conclude that, at first, cholecystitis is usually an aseptic lesion and infection occurs only secondarily. In a large number of cases the initial physiopathological mechanism is that of inflammation which may be due to mechanical causes such as obstruction of the gall bladder siphon and vasomotor phenomena under autonomic control. The histological lesions and course are comparable to those observed in clinical medicine. The interest of this experimental study is to compare the pathology of acute cholecystitis with pancreatitis and Reilly's syndrome and Gregoire and Couvelaire's theory of visceral apoplexy.

[Inflammatory fibroïd polyp (author's transl)]. / Polype fibro-inflammatoire de l'estomac.

Based on the case of a inflammatory fibroid polyp, the authors review the features of this gastric lesion of tumoral appearance, but of inflammatory kind.

[Peptic oesophagitis and carcinoma of the lower third of the oesophagus: report of 7 cases (author's transl)]. / Oesophagite peptique et cancer du tiers inférieur de l'oesophage. A propos de sept observations.

The authors report seven cases of carcinomas of the lower third of the esophagus developed on lesions of peptic esophagitis. These lesions precede the carcinoma. They can be real precancerous states and even in situ carcinomas whose evolution over several years could be proved indeed. They argue about the therapeutical indications in peptic esophagitis considering not only that such a cancerous transformation is always possible but also the fact that a surgical ablation is always serious.

[The gastro-intestinal effects of portal hypertension. Role of highly selective vagotomy. Experimental study in the rat (author's transl)]. / Le retentissement gastro-intestinal de l'hypertension portale. Rôle de la vagotomie suprasélective. Etude expérimentale chez le rat.

Portal hypertension was obtained by portal ligature in the rat by an original procedure. Hemodynamic and pathological studies were performed at the end of the 4th postoperative month. Portal hypertension causes macroscopic and histological lesions in particular in the stomach and small intestine. The lesions observed were superficial desquamation, interstitial oedema, submucosal fibrosis, ulcers, and superficial or total necrosis of the intestine. Splenic fibrosis with congestion of the medullary sinuses is usual. A collateral circulation towards the liver and caval system develops rapidly. We never observed oesophageal varices. The main cause of splanchnic modifications was vascular stasis to which should perhaps be added humoral changes. Highly selective vagotomy does not protect the splanchnic area against lesions induced by portal ligature.

[Retroperitoneal mesenchymomas. Remarks apropos of 19 cases]. / Les mésenchymomes rétro-péritonéaux. Réflexions à propos de 19 observations

The authors report 19 cases and review the literature. They analyse the pathological and clinical characteristics of retro-peritoneal mesenchymoma. The diagnosis of these tumours is facilitated by intravenous urography, barium enema, arteriography and bidimensional echography. Cavography is interesting to determine the venous risk. The unforeseeable course, which is always severe in these tumours, is characterised by the frequency of local relapse. The prognosis is very poor with only one 8 year survival in this series. Surgical removal is the only possible treatment, in spite of difficulty, especially during recurrences.

[Acute primary ischemic enteritis and colitis. Clinico-pathological and physio-pathological findings]. / Entérites et colites ischémiques aiguës primitives. Faits anatomo-cliniques et physio-pathologiques.

By opposition to acute post-operative ischaemic enterocolitis, the authors isolate, with the aid of seven cases, the intestinal lesions which spontaneously occur on the small intestines and on the colon and due to an ischaemic mechanism without thrombosis of the mesenteric vessels. After the description of clinical and anatomical features, they point out the main part of the vascular factor in the genesis of the lesions.

[The Vaugirard hospital: radio-anatomo-clinical confrontations (author's transl)]. / L'hospital de Vaugirard: les confrontations radio-anatomo-cliniques.

Since its foundation in the beginning of this century, the Vaugirard hospital of which the origin is briefly recalled, found its way towards digestive surgery and gastroenterology. This induced the creation, 35 years ago, of the Vaugirard Radio-anatomo-clinical Confrontations, only dedicated to digestive pathology.

[Intestinal complications during the use of oral contraceptives]. / Les accidents intestinaux au cours de l'emploi des contraceptifs oraux.

PIP: The only intestinal complications of oral contraception, besides occasional diarrhea, are ischemic colitis, intestinal infarction, and acute ulcerative colitis. Ischemic colitis, the most common of the 3, is usually localized in the left colon, is due to intravascular coagulation, and resolves on stopping the pill. Intestinal infarction is rare but sometimes fatal, and usually occurs after thrombosis of the superior mesenteric artery. Acute ulcerative colitis is often severe but clears up on stopping the pill, although the etiologic role of the pill is in dispute. 1 case of severe Crohn's disease in a pill user was observed. This disorder is known to occur in pregnancy, but has not previously been associated with oral contraception.^ieng

[Anatomical lesions of the liver and oral contraceptives (author's transl)]. / Les lésions anatomiques du foie au cours de la contraception orale.

Based on two cases, the authors recall the anatomical lesions of the liver occurring at times in women using oral contraceptives: jaundice, benign tumors, vascular lesions; and they emphasize more particularly the vascular lesions and their relation with oral contraceptives.

PIP: The authors describe 2 observations of anatomical lesions of the liver related to the use of oral contraceptives. They remind of the different forms of lesions of the liver observed in women using oral contraceptives: jaundice (although this form has become relatively rare), benign liver tumors and vascular lesions. Some hepatic alterations provoked by oral contraceptives are very similar to lesions observed during pregnancy. Experiments performed on animals have shown the influence of sex hormones in hepatic tumors: a prolonged administration of high doses of extrogens increases the carcinogenic action of acetylaminofluoren in the female while the occurence of tumors is not increased in males treated in the same fashion. In males as well as females, testosterone has a stimulating effect on the development of hepatic tumors. It is concluded that clinicians should be aware of the hepatic risks carried by oral contraception.

[Headaches during oral contraception. A selective study concerning 159 observations].

PIP: Headaches experienced by 159 women during use of oral contraceptives for at least 1 year are characterized as migraine or tension headaches, and whether the headaches were related to dose or type of pill is examined. The 159 women accounted for 15% of a total of 1061 pill users: well-defined syndromes such as pituitary adenoma were eliminated. 47 of these women had headaches before, 31 of them worsened, and in 6 improved. Of 115 women with migraine, diagnosed by having at least 2 of 5 criteria for the disorder, 82 developed them during oral contraception. 12 of the 20 women with tension headaches had never had them before. 8 (5%) of the headaches were of indeterminate origin. In 50% headaches occurred during menses, or in 13% they were aggravated then. In 11 women the condition was improved by lowering progestagen dose. Generally migraines appeared or worsened within the 1st year of pill use, while tension headaches usually developed later. Younger women tolerated the pill better. 42 women stopped the pill because of headaches.^ieng

[Colonic cancer and diverticulitis of the large intestine]. / Cancer colique et diverticulite du gros intestin

The authors report 17 cases of colonic carcinoma associated with diverticulitis. They differentiate between carcinomas arising above and below the diverticular area and emphasise the coexistence of both diseases on the same segment of colon. The diagnosis may be made in two different circumstances depending on whether the association presents as diverticulosis or as diverticulitis with complications. Careful examination of the barium enema whenever possible is the basic factor in diagnosis. The operation is rendered more difficult by inflammatory phenomena or suppuration of the sigmoiditis and the prognosis is aggravated by cancer.

[Lymphatic peritonitis occurring 8 days after right colectomy for Crohn's disease]. / La péritonite lymphatique au 8e jour après colectomie droite pour maladie de Crohn

The authors have observed on two occasions, a diffuse peritoneal syndrome in the post-operative period after right hemi-colectomy for Crohn's disease, and interpret, in the absence of complications at the level of the anastomosis, as peritonitis due to septic lymphorrhea. According to them, it does not seem that this syndrome has the same significance as that described following appendicectomy in children.