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In 17 Belgian surgical centers, 324 operations have been performed for acute cholecystitis in patients 80 years of age or older. In this group of patients: 1. The incidence of acute cholecystitis is hardly higher in women than in men. 2. The patients were operated within 24 hours of admission in 38% of cases. The main bile duct was surgically explored in 1/3 of patients. Cholecystostomy or simple drainage were used in 1/10 of cases only. 3. Operative mortality was 19%. It was higher for patients operated as emergencies than for delayed operations and higher also when the cholecystectomy was associated with an exploration of the bile duct. The ideal treatment for such patients should thus be a cholecystectomy with an endoscopic sphincterotomy.

The different methods used to select the future surgeons are discussed. In order to improve the Belgian system, the authors suggest the creation of a selection board who would reexamine each candidate having accomplished three years of training.

Two hundred and ninety patients operated for breast cancer underwent systematic resection of internal mammery chain. Block resection of this lymphatic drainage is performed without opening the thorax by a personal technique. We have shown these nodes can be involved whatever the site of the primitive tumor. Involvement depends on the local and regional extent of the tumor. Result of frozen section examinations of the mammary chains, internal and external, makes it possible to control and complete the clinical examination. We have thus formed a homogeneous series in which conservative treatment was applied with maximal chances of success.

We have analysed 2.649 observations of cancer of the breast in order to study factors influencing the prognosis. We have found a definitive relationship between the extend of the primary tumor, the condition of the regional lymph nodes and the presence or absence of metastases. A careful clinical examination remains of the utmost importance to assess the characteristics of tumor and nodes. This associated with systematic search for bone and pulmonary metastases, are the basic elements of a sound prognosis. The systematic removal of the internal and external mammary node chains in the surgical cases are indispensable to complete the clinical data. So defined the stage of the disease at the time of the first treatment is by far the most important factor in assessing the prognosis. Concerning the treatment, we have obtained better results with surgery associated with radiotherapy than with surgery alone. Therefore in early cases, that is to say cancer confined to the breast, we feel justified to apply conservative surgery associated with radiotherapy.

Tumorectomy and irradiation for small cancer of the breast. Tumorectomy followed by breast irradiation and a single course of chemotherapy is the most accurate treatment for small cancer of the breast. The 5 and 10 years survival are 92.5% and 85% respectively: this demonstrates the efficacy of the conservative treatment in the control of most of the small breast cancer provided a strict selection of the cases was done. Patients who develop local recurrence have the same life expectancy than the other cases when they are soon treated by mastectomy.