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Amputation of the rectum by a purely perineal route, the Lisfranc procedure, has been progressively replaced by abdominoperineal methods. In the AFC survey made in 1987, a Lisfranc was used only 26 times in 5,274 patients in the survey. We performed a Lisfranc 8 times from 1980 to 1993 in patients over 80 years of age or with an ASA score equal to or above 3. There was one death due to multiple-organ failure 70 days after the operation. Overall mean survival was 17.8 months and reached 24 months for those who did not have metastasis as the time of the amputation. Quality of life was assessed as good. Two patients had a local recurrence 1 and 3 years after the operation. We thus suggest that amputation of the rectum using the Lisfranc procedure can be used for certain patients in which simple colostomy (with no effect on the rectal syndrome), radiotherapy (variable and limited response), chemotherapy and other palliative procedures (electro-coagulation, laser cryosurgery) would not be indicated. Whenever tumour exeresis appears to be possible, we suggest that this method is the best palliative procedure to propose in elderly patients with several organic disorders and for cancers of the lower third of the rectum. The procedure should not however be attempted in patients with advanced stage cancer and a survival time estimated at less than 6 months.

A case of gastric hyperplastic polyposis is reported in a 48-year old woman, with iron deficiency anemia. An hyperplastic gastric polyposis was discovered. This patient had been operated 17 years previously for a large adenomatous polyp of the caecum. Her son had also several adenomatous polyps of the right colon. A gastrectomy was performed. Hyperplastic gastric polyposis is very rare, and is quite always associated with colorectal adenomas. The relationship between gastric hyperplastic polyposis and intestinal polyposis is not quite clear.

Two cases of disinsertion of the papilla following closed trauma to the abdomen were treated by suction of the papilla by a Y loop associated with temporary pyloric exclusion, gastroenterostomy and a feeding jejunostomy. The postoperative course was uneventful in the two patients. This technique is therefore indicated for associated pancreatic lesions which do not require cephalic duodenopancreatectomy.

The technique of Hill's posterior cardiopexy is based on precise anatomical criteria. Hill's "strips" actually correspond to the peri-oesophageal connective tissue described by Boutelier. The operation consists of closing the oesophageal hiatus and attaching the "strips" to the preaortic fascia. We prefer to perform the operation via a left subcostal incision without intraoperative manometry and we complete the procedure by fixing the fundus of the stomach to the left side of the oesophagus.

Injuries to the duodenum are rare and their treatment is controversial. We have wanted to assess the results of treatment in 9 cases of duodenal trauma operated successively. 6 patients were operated at once because of associated lesions producing a state of shock. The other 3 had isolate lesions and were all operated after a waiting time. 5 patients had a simple suture after excision of the margins of the wound. 2 underwent controlled fistulization on a Pezzer probe associated to a feeding jejunostomy. In 2 cases, papillar disinsertion was treated by cupping the papilla with an ascended loop and by temporary pyloric exclusion. No patient died after surgery, and no duodenal fistula was noted. In case of controlled fistulization, the scar was obtained within 21 days. We think that duodenal wounds examined early can readily be sutured if there is no loss of substance. When the duodenal wound is isolate, the delay in treatment leads us to prefer controlled fistulization associated to feeding jejunostomy.

In the present study, we try to discuss the results of the "en bloc" surgical resection of the extensive cancer of the colon which infiltrates one or more of the neighboring organs. Data from 41 patients who underwent this kind of operation from 1970 to 1988 were reviewed. The localisation, currently seen of this cancer, was the sigmoid colon and the number of the infiltrated neighboring organs varied from 1 to 3. The small intestine and the urinary tract were the most frequently infiltrated organs. The classification of Dukes was used: 14 cases were on stage B and 27 on stage C. The operative mortality was 9.7% and the morbidity was 38%. The survival rate at 5 years was calculated with the Kaplan-Meier method. It was 48% with a significant difference between stage B (91%) and stage C (25%). These results were similar to those of the authors found in the literature in the past ten years. They justify these extended resections.

Transverse parorchidium is characterized by the presence of two testes in the same bursa, and may be associated with persistent Müllerian vestige in the spermatic cord of the normally situated testis. Persistence of Müllerian vestige is related to inadequate production of anti-Müllerian hormone by the embryonal testis. Transverse parorchidium is caused by the emergence of both deferent ducts into the Müllerian vestige. Diagnosis is evoked by the presence of an empty bursa associated with an abnormally hard spermatic cord contralaterally. This syndrome should be known of surgeons, as ablation of the Müllerian vestige consecutive to surgical management of a hernia or ectopic testis may lead to the sectioning of the deferent ducts.

Therapy by Taylor's method was attempted in 61 of 96 patients with perforated ulcer of duodenal cap. Treatment was effective in 50 cases (more than 50%) and morbidity and mortality were low. Most operated cases were recipients of simple treatment for the perforation, more rarely combined with therapy for the ulcer disease. Postoperative mortality was very high (24% of patients operated upon) but appeared to be related mainly to associated risk factors. Only 8 of the patients treated by Taylor's method required recovery surgery, while this was necessary in 4 patients operated upon initially and given simple treatment for the perforation. These findings suggest efficacy of Taylor's method for treatment of perforated duodenal ulcer, avoiding operation or allowing treatment of the ulcer disease once the acute episode has passed.

Postoperative variations in the different parameters of humoral and cellular immunity were studied in 18 adult patients in general surgery. Levels of immunoglobulins G (igG) fell and those of immunoglobulins M (igM) increased significantly. Lymphocytic proliferation under the influence of PHA showed a significant fall. Neither polynuclear function nor total complement activity were modified. Patients in whom the postoperative course was complicated by sepsis differed from the others by a lower activity of the lymphocyte transformation test and by a higher level of igG and igM on the day prior to surgery. In addition, deficiency in the lymphoblastic transformation test increased during the postoperative period, there was a further fall in IgG and IgM increased less in these patients than in those in whom the postoperative course was uncomplicated.

The authors report a case of mesothelial cyst of the diaphragm, discovered on ultrasonography performed for pain in the right hypochondrium and treated by simple surgical excision. Based on a review of the literature, they define the topographical, histological and therapeutic aspects of these lesions, which are now recognised more frequently due to the progress in medical imaging.

Two instruments, one of Russian origin, using very fine Tantale clips, permit one to carry out easily mechanical suture during operations on the digestive tract. These two instruments may be associated. The suture obtained is very safe, whether inversing or eversing. This method of suture seems to be particularly applicable to oesophageal and colonic anastomoses.