Differential transferrin receptor density in human colorectal cancer: A potential probe for diagnosis and therapy.

Transferrin receptor density was investigated in human colorectal surgical specimens. Crude membranes were prepared from 23 cancer tumors (adenocarcinoma or malignant villous tumor) and 3 non-cancer tumors (polyadenoma or villous tumor) and 26 adjacent control mucosa. Contrary to non-cancer tumors, Scatchard analysis of 125I-transferrin binding data evidenced higher maximal transferrin binding capacity and lower dissociation constant in cancer tissues (Bmax cancer 1.828+/-0.320 nmol/g, Kd 24.1+/-4.7 nM), as compared to paired control colonic mucosa (Bmax contol 0.851+/-0.182 nmol/g, Kd 30.7+/-7.3 nM), paired t-tests: Bmax p<0.001, Kd p<0.05). As the cancer/control Bmax ratio was 2.6+/-0.4,transferrin carrier constructs should be proposed for cancer imaging or therapy.

Giant cavernous hepatic hemangiomas in adults: enucleation under selective blood inflow control.

Among hepatic hemangiomas (the most common solid hepatic tumor in adults), "giant hemangiomas" are those defined by a diameter greater than 4 cm. The natural history of such lesions is unclear, and many surgical procedures have been described. In five women and one man (mean age 49), we successfully used enucleation of the tumor under blood inflow control. This technique was made possible by a cleavage plane between the hepatic parenchyma and the hemangioma. This straightforward and safe procedure required a low rate of transfusion (mean 200 mL/patient) and spared a maximum amount of hepatic tissue.

[Current radiologic aspects of surgical technics for resection of cancer of the rectum]. / Aspects radiologiques actuels des techniques chirurgicales de résection pour cancer du rectum.

The aim of this work is to describe the current surgical rectum resection techniques for the treatment of cancer and the corresponding radiological images. The authors emphasize the mechanical, "trans-suture" anastomoses and on the colo anal anastomoses with colic container, which radiologists will have to follow up postoperatively.

[Retroperitoneal gas images following subperitoneal hollow viscus rupture (author's transl)]. / Images de rétropneumopéritoine dans les ruptures d'organes creux sous-péritonéaux.

Three cases of traumatic rupture of a subperitoneal hollow viscus are reported : two duodenal lesions and one rectal wound. Early diagnosis was possible in all three cases by the recognition of retroperitoneal gas on simple radiographs of the abdomen, which was evidenced by images containing air bubbles, which were also fasciculated and fairly fixed. They were unilateral, on the right side, and usually associated with disappearance of the psoas shadow in duodenal injuries. Rectal perforation produces a bilateral distribution of the retroperitoneal gas, which extends to the subperitoneal fat and the posterior extraperitoneal space, according to the amount of effusion.

[New data on the adrenal-post-pituitary system of cancer patients]. / Nouvelles données sur le système surréno-posthypophysaire du cancéreux.

A water loading test was performed in 10 patients with a cancer of the digestive tract without hyponatremia and in 10 controls. A lowering of the CfH2O was observed in the patients during the test, as well as an increase in the cortisol plasmatic rates, while aldosterone rates remained normal. To valid the hypothesis of a hypervasopressinic state in these patients, 15 cancerous patients and 12 controls had a plasmatic ADH dosage, which pointed indicated higher hormonal level in the first group.

[Hemorrhoidectomy by surgical excision with anoplasty by mucocutaneous suture]. / Hémorroïdectomie par excision chirurgicale avec anoplastie par suture muco-cutanée.

The technique suggested here consists of radical excision of the haemorrhoids with preservation of skin flaps which are sutured to the healthy rectal mucosa inside the anus. There is no traction nor sphincteral damage. This simple procedure, derived from the Whitehead's technique, is suitable for large haemorrhoids, notably when they are prolapsed and associated with lesions of the mucosa Resections "as required", with preservation of healthy mucocutaneous bridges, avoids the development of stenosis. Rectal palpation by the patients themselves twice a day from the 8th to the 30th post-operative days is essential. In a series of 150 cases evaluated 5 to 15 years after surgery, 9 out of 10 patients showed evidence of persistent success without functional sequelae.

[Reflections concerning the fixation of the small intestine or of mesentery in the adult (author's transl)]. / Réflexions sur la fixation de l'intestin grêle ou de son mésentère chez l'adulte.

On the basis of their own observations as well as those collected during a round table meeting of the Association Française de Chirurgie, the authors attempt to give an objective review of the value of these operations in relations to the technique used, the operative circumstances and the indications. A detailed analytical study shows that mortality and morbidity have a relatively low prevalence. Long term results are favourable in 73% of cases. The risk of recurrent obstruction is of 5 to 10%. Emphasising contraindications on a so-called "prophylactic basis" and in certain pathological states, the authors conclude that such procedures are valuable in recurrent obstructions and deperitonisations after extensive viscerolysis.

[Early and late results of choledoco-duodenal anastomosis during surgical treatment of biliary lithiasis. Apropos of a series of 62 cases]. / Les suites proches et lointaines de l'anastomose cholédoco-duodénale au cours du traitement chirurgical de la lithiase biliaire. A propos d'une série de 62 observations

The authors report a series of 62 choledoco-duodenal anastomoses carried out during surgical treatment of cholelithiasis and note the indications for this procedure, emphasizing the necessity for a wide common bile duct and a normal duodenum. Apart from complete obstruction of the common bile duct with gall stones, the main indication is organic obstruction of the terminal part and of the sphincter of Oddi. A 2 cm anastomosis is necessary. Duodeno-biliary reflux has no direct consequence in the absence of stenosis of the anastomosis and of pre-existing cholangitis. In the long term, the results are favourable in 95 p. 100 of cases.

[Radiomanometric studies of bile flow during surgery on extrahepatic biliary ducts: effects on postoperative course in 1600 patients after follow-up for more than 5 years (author's transl)]. / La radiomanodébitmétrie per-opératoire: incidences sur la chirurgie des voies biliaires extra-hépatiques pour 1600 opérés depuis plus de t ans.

The use of a simple, rapid, and reliable method for studying the anatomy and physiopathology of the main biliary pathway during operation by means of radiomanometry is described. This procedure enables a rational and precise therapeutic decision to be taken, as shown by comparing the results obtained in 1600 cases after a period of 5 years, with the interpretation of the initial radiomanometric findings and the type of operation performed. The overall rate of error based on the radiomanometric results, and leading to erroneous therapy, was 2 p. cent (0.43 p. cent excessive and 1.57 p. cent insufficient). No complications due to the method were observed. The main points noted were the absence of wounds to the main biliary pathway and of external bile tract fistulae, and a considerable reduction in the number of repeat operations and postcholecystectomy syndromes (1.5 p. cent).

[Truncal vagotomy in the posterior inframediastinal space by abdominal approach with suprahiatal phrenotomy]. / Vagotomie tronculaire dans l'espace infra-médiastinal postérieur par voie abdominale avec phrénotomie sus-hiatale.

A proposed procedure for truncal vagotomy uses an abdominal approach with a short posterior phrenotomy above the hiatal orifice. A gastric emptying operation is obviously combined. The aim is to avoid exposing the abdominal esophagus in case of postoperative symphysis or when it is preferable to avoid altering normal morphology and functioning of the esophago-cardio-tuberosital junction. This procedure can be useful in certain particular cases to perform vagotomy in the posterior infra-mediastinal space.

[Adrenal-posterior pituitary imbalance in digestive cancer patients]. / Les déséquilibres surréno-posthypophysaires chez les cancéreux digestifs.

In a group of 10 patients with a cancer of the digestive tract, some investigations, performed before the surgical intervention, showed the evidence of an adrenal-postpituitary imbalance in favour of the second term. During a water loading, the plasmatic cortisol rates stayed more higher by cancerous subjects than by controls (but not the plasmatic aldosterone rates); nevertheless, the vasopressin secretion rates could be considered as more higher yet in cancerous subjects because the free water clearances were significantly lowered by these patients. Such results have to be put in relation with the opposite effects of vasopressin and corticoids on the cell mitosis, as well as with some therapeutical attempts that end to check this type of endocrine imbalance.

[Four original cases of splenic venous infarction during pancreatic disease (author's transl)]. / Quatre observations inédites d'infarctus veineux splénique au cours des atteintes pancréatiques chroniques.

The authors report 4 cases of splenic complications occurring during chronic pancreatic disease and emphasize the vascular origin of the lesions observed in the spleen whether rupture, pseudo-cysts, hematic cysts, infarction or necrosis. The symptoms in each case seemed identical in their pathogenesis and linked to trunkular or radicular splenic venous thrombosis.

[Traumatic perforation of the rectum below the peritoneum (author's transl)]. / Perforation traumatique du rectum sous-péritonéal.

The authors report a case of traumatic subperitoneal perforation of the rectum, the diagnosis of which was made by finding a pneumoperitoneum on straight X-rays of the abdomen, and on rectal examination. In these cases the pneumoperitoneum is generally bilateral occupying the posterior pararenal space. The course was favourable under medical treatment.

[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.

[Carcinomas of the transverse colon. A series of 75 cases (author's transl)]. / Les cancers du côlon transverse. Réflexions à propos d'une série de 75 cas.

The authors report a series of 75 cases of carcinoma of the transverse colon, involving equally the right and left halves. They rarely arose from the middle segment (10% of the series). Usually the tumour was very large affecting the serous layer with lymph node invasion. Liver metastases were frequent. 50% of patients were aged over 70 years. Theoretically, wide removal attempting to cure the disease means removing both colonic angles and the areas supplied by both the superior and inferior mesenteric arteries. But fairly often the existence of vascular variations in the transverse mesocolon permits one to restrict the extent of the resection whilst saving the basic principles of radical removal. Furthermore, in 20% the treatment was purely palliative. The operative mortality was high (25%). The five year survival, in the whole series was about 50%.

[Sclerodystrophy of the sphincter of Oddi (author's transl)]. / La sclérodystrophie oddienne.

Among 1,645 biliary operation carried out between 1952 and 1974, the authors count 177 organic stenoses of the Oddi region. They recall the authenticity of chronic odditis, the pathological substratum of which is Oddi sclerodystrophy, a primary and progressive lesion. They emphasise the radiomanodebimetric criteria. The risk of an error of interpretation was 2% in this series. After discussing the etiopathogenesis and the physiopathological consequences of Oddi sclerodystrophy, they discuss the therapeutic choice between sphincterotomy and choledoco-duodenostomy. Temporary gall bladder drainage is only of interest in inflammatory labile manifestations without sclerodystrophy. The interest of diagnosis and initial surgical treatment of the lesion is that the classical post-cholecystectomy syndrome almost disappears.

[Natural history of postoperative intraperitoneal adhesions. Surely, a question of the day]. / Histoire naturelle des adhérences intra-péritonéales post-opératoires. Une question vraiment à l'ordre du jour.

Postoperative intraperitoneal adhesions are known to occur after conventional surgery. The prospective study that we have performed in 1992 shows that the frequency of postoperative intraperitoneal adhesions is very high (93% of patients). It is higher than was stated 20 years ago, while so-called "spontaneous" adhesions seem to be decreasing. The histological study of postoperative intraperitoneal adhesions shows a specific evolution in time and a very high frequency of foreign bodies (starch, variably decayed textile fibers) (92%). The very great frequency of such foreign bodies in postoperative intraperitoneal adhesions, logically involving them in the genesis of this condition, may be an argument in favor of the new surgical techniques, especially of celioscopy.

[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.

[Enteropathy caused by clofazimine]. / Entéropathie à la clofazimine.

A case of Clofazimine enteropathy is reported, diagnosed on the demonstration of red brown birefringent crystals in the small bowel mucosa and submucosa as well as in the mesenteric lymph nodes whereas the clinical and radiological signs appear to be non specific. After the withdrawal of the drug, a clear improvement of the symptoms was achieved only under a gluten free diet. The possibility of such accidents, sometimes lethal, suggests the restriction of clofazimine to leprosy.

[Cystadenoma and cystadenocarcinoma of the pancreas. Apropos of 7 new cases]. / Les cystadénomes et cystadénocarcinomes du pancréas. A propos de 7 nouvelles observations.

Cystadenomas and cystadenocarcinomas of the pancreas are tumours which remain poorly known because of their relative rarity. They are seen essentially in women aged between 40 and 60 and involve the left half of the pancreas more often than the right. The symptomatology remains latent for a fairly long time, which explains the fact that they are most often discovered only at the stage of a palpable tumour. Recent methods of investigation--echotomography and computed tomography--are of very great value in preoperative diagnosis. It is extremely important to draw the distinction within the group of benign cystadenomas between microcystic forms and macrocystic forms or mucinous cystadenomas, the latter having a definite potential for malignant change, possibly explaining the link with certain cystadenocarcinomas. As a result, excision surgery is always preferable, when possible, to bypass surgery, at least in caudal or corporeo-caudal lesions, since excision surgery is usually easy. For cephalic lesions, if excision surgery seems difficult, it may be conceivable, using modern techniques of investigation, to adopt a conservative attitude when there are no features suggestive of potential malignant change.