Search

A new case of spontaneous cervico-mediastinal hematoma due to parathyroid adenoma is reported. It is a rare complication of parathyroid adenoma. When mediastinal compression with respiratory distress occurs, endotracheal intubation excludes an intrathoracic vascular injury. Laboratory tests reveal a hyperparathyroid syndrome which may disappear after the acute hemorrhage. Whatever is the outcome of the hyperparathyroid syndrome, surgical treatment is required. As far as possible, it should be performed after the acute hemorrhage.

From January 1 1980 to December 1993, 210 patients underwent exeresis of a cancer of the cardia or the lower third of the oesophagus. There were 193 males and 17 females (mean age 63.5 years, range 18-84). Cancers were in an advanced stage in 56.6% (stage 0, 0.95%; stage 1, 9.04%; stage 3, 43.3%; stage 4, 6.19%). Postoperative morbidity was 21% and hospital mortality was 3.81%. Actuarial survival rate at 1, 3, 5 and 10 years were 64.1%, 23.9%, 17.7% and 12.8% respectively. The advent of the CT scan, better patient selection and improved nutrition management and postoperative care have greatly improved hospital mortality (7 deaths for 118 operations before 1987, i.e. 5.93% and 1 death for 92 operations since 1987, i.e. 1.08%. Creating a circumferential instead of radial phrenotomy and the possibility of raising the anastomosis to upper thorax or in combination with left access and cervicotomy have led to excellent immediate results and confirm our choice in this method.

Between February 1988 and January 1992, 61 patients have undergone bilateral lung transplantations (42 heart-lung and 19 double-lung) in Bordeaux. The underlying diseases were primary or secondary hypertension (20), emphysema (22), or other diseases including cystic fibrosis, pulmonary fibrosis, silicosis, and sarcoidosis (19). Actuarial survival for double-lung and heart-lung transplant recipients was 66% and 72% at 1 year and 57% and 53% at 3 years, respectively. Forty-two patients were still alive 6 months after operation, and we studied their pulmonary function at the short and long term. All parameters except arterial carbon dioxide tension had improved dramatically at 6 months (p < 0.0001). Vital capacity, forced expiratory volume in 1 second, and forced expiratory flow rate between 25% and 75% of vital capacity were at 79% +/- 3%, 92% +/- 5%, and 105% +/- 8% of the predicted values, respectively. Arterial oxygen tension was 88 +/- 3 mm Hg. Nine months after operation, a slight decrease in forced expiratory volume in 1 second and forced expiratory flow rate between 25% and 75% of vital capacity appeared but values remained more than 75% predicted. This was related to the occurrence of obliterative bronchiolitis in 6 patients (14%). At 9 months, flow rates and oxygen tension of these 6 patients were highly different from those of patients free of obliterative bronchiolitis (p < 0.0002 for flow rates and p < 0.01 for oxygen tension). Only 1 patient required retransplantation. The others are living an almost normal life. Our results are discussed in view of the published reports on single-lung transplantation. Short-term results of bilateral lung transplantation are thus excellent and maintained on a long-term basis. Therefore, in our opinion, bilateral lung transplantation is the therapy of choice for pulmonary hypertension and emphysema.

The authors report about one case of splenic site in a polyvisceral involvement by von Recklinghausen's disease. This site was not found in the literature. Since it was impossible to confirm the benignancy of the lesions, the degenerative risks of which are well known, the authors carried out partial gastrectomy and splenectomy.

The author report a case of isolated choriocarcinoma of the lung revealed in a young woman by a tumoral syndrome of the right base with haematoma. The diagnosis of isolated pulmonary choriocarcinoma was based on the lack of previous gynaecological history and tumour, on the singleness of the lung tumour at CT, and on the high initial beta-CGH level (3,300 ng/ml) in the absence of pregnancy. Surgical resection confirmed the diagnosis and lowered the beta-CGH level to 7 ng/ml. The various aetiopathogenic theories put forward and their relations with the prognosis disparity found in the literature are reviewed. The authors compare the prognosis of isolated pulmonary choriocarcinoma in a non-nulliparous woman to that of placental choriocarcinoma.

Two cases of catamenial pneumothorax are reported, a rare condition characterized by its sudden occurrence in a female patient between the ages of 30 and 40 years, always at the onset of the menstrual cycle. Its exact origin is unknown, but the frequent co-existence of endometriosis and a defect in the diaphragm suggests that endometriosis may be important in the etiology both of the pneumothorax and the diaphragmatic lesion. Pelvic endometriosis was present in both our patients, one of whom also had diaphragmatic endometriosis. The treatment of the pneumothorax in both our cases consisted of pleural decortication with excellent results so far.

The small intestine is a frequent site for metastases of cutaneous or ocular melanoma. When the latter are absent, the diagnosis of primary intestinal melanoma can be proposed. Primary malignant melanoma of the small intestine arises from melanoblastic cells of the neural crests, which migrate to the distal ileum through the omphalomesenteric canal. Incomplete regression of the later leads to persistence of Meckel's diverticulum. We report herein a case of malignant melanoma of the small intestine without evidence of a cutaneous and/or ocular origin. Based on its location in the distal ileum, we propose that this tumor be classified as a primary malignant melanoma of the small intestine.

Airway complications remain a major problem after lung transplantation. There is no standardised method of assessment of airway healing. We propose a classification of airway healing based on the anastomotic appearances at endoscopy 15 days postoperatively. The system appears to correlate well with the subsequent development of anastomotic sequelae and can be used to assess the effectiveness of therapeutic modalities designed to reduce airway complications.

We report one new case inflammatory pseudotumor of the appendix. The inflammatory pseudotumor of the appendix is one of these benign tumors of the ileocecal junction that mimic neoplasia and can be treated by appendicectomy.

Three cases of solid and papillary epithelial neoplasm of the pancreas are presented. These tumors occur more commonly in young patients with a predilection for young black females. They have a good prognosis allowing conservative surgery. The histological study of the specimens strongly suggests an endocrine tumor but all histological and immunocytochemical endocrine stains are negative. The ultrastructural study of these tumors has revealed the existence of borderline forms between these tumors and endocrine tumors.

We report a case of a leiomyosarcoma arising in a Meckel's diverticulum in a man of 90 years, with multiple ileal diverticulosis. The clinical picture was similar to acute appendicitis and diagnosis was not made until resection of an abdominal mass with histological appearance of leiomyosarcoma. 59 cases of leiomyosarcoma of Meckel's diverticulum have previously been reported in the literature. No case until now has been reported in a patient of Caribbean origin neither in association with ileal diverticulosis. Although rare, leiomyosarcoma is the commonest sarcoma of Meckel's diverticulum, and with full resection of the tumor the prognosis is very good.

Inguinal and umbilical hernias are much more frequent in the black and half-breed than in the white population. We have observed anatomical differences in the inguinal region between Whites and Blacks. The latter have a vertical, wide subcutaneous ring and a smaller conjoined tendon, and it is hardly possible to reconstruct the fascia of the obliquus externus abdominis anterior to the cord in them. For Black patients, we propose the suture of the conjoined tendon to the crural arch, like in the Bassini procedure, and the suture of the fascia of the obliquus externus to the arch, but in a retrofunicular position. This technique allows, so to speak, duplicating the caudal connection of the conjoined tendon to the arch by means of the extensive suture of 2 tissues of similar nature, ie. the fascia of the obliquus externus and the crural arch.

Results of 334 appendectomies carried out through the umbilical orifice are reviewed. Failures of treatment and complications of the method are reported while emphasizing that only 4 major complications occurred. When compared with the classical incision of right iliac fossa this procedure does not appear to provoke more risks and presents obvious esthetic advantages.

If endometriosis is particularly well known by Gynecologists, ureteral complications of this disease are very rare. We have had the occasion to observe four cases of ureteral stenosis by extrinsic compression of a pelvic endometriosis, and about these four cases, we have reviewed one hundred and fifty six cases in literature. We have emphasize that the fibrosis provoked by endometriosis can look like a neoplastic lesion, and get involved in very heavy therapeutic gestures. We insist on the fact that every endometriosis discovered should be on surgery of kidneys and ureters.