[Intraoperative radiotherapy. Preliminary results]. / La radiothérapie per-opératoire. Résultats préliminaires.

We report a series of 40 patients treated by intraoperative radiotherapy between 1988 and 1992 (18 primary tumors, 13 local recurrences and 9 nodal extensions). The doses delivered were 15 Gy to 25 Gy, completed by external radiotherapy (15 to 45 Gy) in 13 cases. The local tumor control rate was 61% for initial therapy in primary tumors (70% for adenocarcinoma of the stomach) and 80.9% after complete en bloc surgery. The local control rate after palliative surgery for local recurrences is 38% and 33% for nodal extension. Two patients died (5%) during the postoperative period. We observed 2 hemorrhages and 3 cases of stone-free cholecystitis. The value of this approach must be confirmed in rigorous indications in comparison with surgery alone in controlled and randomised clinical trials.

[Bacteriologic monitoring of bronchial secretions in surgical intensive care]. / Surveillance bactériologique des sécrétions bronchiques des patients hospitalisés en réanimation chirurgicale.

Quantitative bacteriologic monitoring of bronchial secretions obtained by protected distal catheterism was performed in 60 critically ill patients under mechanical ventilation. A number of factors which have significant bearing on bacterial growth in the respiratory tract were demonstrated. A statistical correlation was found between aspiration pneumonia and presence of Enterobacteriaceae, as well as between hospital-acquired pneumonia and recovery of opportunistic pathogens. S. aureus was especially prevalent in patients under corticosteroids. Aminoglycoside treatments increased the frequency of Acinetobacter infections, whereas prevalence of S. aureus and P. aeruginosa appeared unrelated to the use of any specific antibiotic. The value of bacteriology on protected distal catheter bronchoscopy specimens is to allow accurate diagnosis of lower respiratory tract infections and provide guidelines for the choice of appropriate antibiotics.