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Aim of the Study: Primary thoracic soft tissue sarcomas (PTSTS) include parietal, pulmonary and mediastinal tumors. Management and prognostic factors of these rare tumors are poorly known. The aim of the study was to report a series of 40 patients with PTSTS, with analysis of their clinico-pathological characteristics, management, and prognostic factors., Design: Data were collected from a prospective database. Survival were analyzed by Kaplan-Meier method and compared with log-rank test. Prognostic factors were identified with a Cox model., Results: The median age was 48 years. The male/female ratio was 15/25. The most common subtype was malignant histiocytofibroma (11 cases). Twenty-one tumors were high-grade sarcomas. The commonest location was chest wall (26 cases). Thirty-two sarcomas were treated surgically, including 22 who had radical resections (free margins). Associated treatments were neoadjuvant (n = 8) or adjuvant (n = 8) chemotherapy, and postoperative radiotherapy (n = 17). The 5-year overall survival was 45%. In univariate analysis, prognostic factors were age (p = 0.05), Karnofsky index (p = 0.008), absence of metastases at initial presentation (p = 0.0003), radical resection (p = 0.043), and adjuvant chemotherapy (p = 0.04). The tumor location had no prognostic value., Conclusions: Management of PTSTS needs a multidisciplinary approach, and is mainly based on radical resection. Prognosis of pulmonary, chest wall and mediastinal sarcomas is similar.

Lumboscopy is an endoscopic surgical technique providing direct visualization of the retroperitoneal space from the kidney hilium to the iliac bifurcation. We report our 10-year experience with this technique used to diagnose masses in the retroperitoneal space. This method is not very invasive and the morbidity is low. The sensitivity is greater than needle biopsy under CT guidance.

The adequate treatment of gastrointestinal tract carcinoma requires accurate preoperative staging. Laparoscopy has been advocated for this purpose. We reviewed the data of 12 patients and the literature to compare the results of laparoscopic staging to those of conventional imaging (ultrasonography-CT scan). Laparoscopy was more sensitive in the diagnosis of peritoneal and lives metastases. It was inadequate for the diagnosis of lymph node metastases. Laparoscopy was especially useful in patients with esophagus, stomach, pancreas and liver cancers. Laparoscopic ultrasonography improved the staging of pancreatic carcinoma and the diagnosis of liver metastases.

The frequency of lung cancers associated with synchronous head and neck malignancies can be evaluated between 1.5 to 2%. The purpose of our work was to determine if complete endoscopic head and neck examination performed under general anesthesia was superior than clinical head and neck examination for the diagnosis of these synchronous additional tumors. From july 1991 to august 1992, we realised a prospective study on 58 consecutive patients suffering from pulmonary removable lung cancers. All the patients had a clinical head and neck examination during the preoperative period. Immediately before thoracotomy a complete endoscopy of head and neck aerian and digestive tract was performed. During this last examination 18 new macroscopical lesions were discovered in 13 patients: benign lesions (n = 17), oral cavity and laryngeal dysplasia (n = 1). The one gingivolingual sulcus carcinoma, already discovered by the clinical examination, was confirmed. This study suggests that complete head and neck endoscopy is not superior than clinical examination for the diagnosis of synchronous malignancies before lung cancers removal.

Laparoscopic cholecystectomy is now the procedure of choice for surgical removal of the gallbladder. Injury to the hepatic pedicle is the most significant complication of this procedure. Four cases of bile duct injury and one case of right hepatic artery injury were reviewed. Two complications arose from excessive use of cautery in the area of bile common duct and right hepatic artery, resulting in one case of biliary necrosis and one case of right hepatic artery pseudoaneurysm. Two injuries were due to classical confusion between the common bile duct and the cystic duct. Another injury was due to partial ligation of the common by a clip on the cystic duct. Two patients required a Roux en Y hepaticojejunostomy, two patients had a common duct repair on a T tube and one patient required emergency ligation of the right hepatic artery and suture of the duodenum. We did not observe any mortality. Morbidity consisted of one case of spontaneously resolving duodenum leakage. In the light of these cases, after having discussed the therapeutic attitudes toward these lesions. The authors suggest practical tips to prevent hepatic pedicle injuries during laparoscopic cholecystectomy.

Iliac retroperitoneoscopy, also called extraperitoneal pelviscopy (EPP), is a form of direct vision endoscopy derived from mediastinoscopy; It allows biopsies of pelvic lymph nodes. In view of the poor accuracy of radiological investigations for pelvic lymph node metastasis (N+) detection, EPP was performed in 210 patients with apparently resectable neoplasms (bladder n = 116, prostate n = 81, cervix n = 12, endometrium n = 1). Among 174 patients without radiologic evidence of metastasis (N-), EPP assessed 47 N+ patients and failed in 1 case, requiring a laparotomy (one N+ patient). Among 36 N+ patients after radiologic examinations, EPP assessed 20 N- patients and failed in 1 case, requiring a laparotomy (one N+ patient). Among 124 N- patients after EPP, a further laparotomy showed 8 N+ cases (false negative). Thus, out of 210 patients, EPP corrected the radiologic findings in 67 cases and drastically modified the therapeutic indications. Considering its absence of contraindications, EPP can be performed more often than laparoscopic pelvic lymphadenectomy techniques. Furthermore, its exploration field is not limited to the interiliac area. Its overall reliability is 95% in staging lymph node involvement of pelvic neoplasms.

In patients with a non small cell bronchogenic carcinoma, the detection on a CT scan of a uni or bilateral adrenal gland mass requires determination of its metastatic nature. CT guided needle biopsy (CTGB) is a minimally invasive method and allowed us to achieve this goal. From August 1986 to October 1992, 30 patients underwent such a biopsy. In 14 cases, a metastasis was diagnosed and in 13 cases the mass was benign. There were 3 false negative results. Two of these were rectified: one by a second CTGB and the other by adrenalectomy. Our results showed that CT scan was unable to discriminate metastasis from benign masses. Magnetic resonance imaging (MRI) was used for 11 patients and seemed to be a more accurate method: allowing detection of a pheochromocytoma and avoiding a CTGB which may have been dangerous, predicting the benign nature of some masses when they were iso-intense in relation to the liver on T2 weighted images. Thus, even with the contribution of MRI, in most cases of bronchogenic carcinomas coexisting with an adrenal gland mass, CTGB appeared essential to determine correct therapy: surgery or medical treatment.

Pregnancy is a circumstance which may trigger, reveal or aggravate venous insufficiency of the legs. This association (venous insufficiency and pregnancy) is characterized by the rapidity of the onset and aggravation of the signs and by the spectacular nature of the regression which can occur after childbirth. The treatments administered during pregnancy are intended to control the symptoms and prevent complications. After childbirth, a phlebological assessment is carried out to evaluate the sequelae and the therapeutic possibilities.