[Carney's triad: a new case]. / Le syndrome de Carney: un nouveau cas.

Carney's triad is a very unusual syndrome, associating three different tumours on the same patient, a young woman generally: a gastric leiomyoblastoma, a pulmonary chondroma and an extra-adrenal paraganglioma. The authors report through the literature review and a new case of Carney's syndrome associating gastric leiomyoblastoma and extra-adrenal paragangliomas, the different diagnostic and therapeutic criterias.

[Malignant adrenocortical tumour with inferior vena cava invasion]. / Le corticosurrénalome avec envahissement de la veine cave inférieure.

Carcinoma of the adrenal cortex is a rare tumour. The incidence of vena cava involvement may be present in 15 to 20% of patients. The intra caval tumour thrombus can attain the right atrium. Even if some authors consider these lesions as a metastasis, long-term survival can be obtained after radical resection. The surgical tactical depend on the extension of thrombus into the vena cava inferior. The authors report a case with 4 years survival without recurrence after surgical treatment.

[Heller's myotomy without fundoplication: a series of 123 patients]. / L'opération de Heller sans système anti-reflux. A propos de 123 cas.

INTRODUCTION: Surgical treatment of achalasia of lower oesophageal sphincter is Heller's myotomy, usually associated with a fundoplication due to an high risk of postoperative gastro-oesophageal reflux. The value of this fundoplication is discussed. The aim of this study was to evaluate retrospectively the results of Heller's myotomy without fundoplication but performed according to a precise technique preventing postoperative reflux. PATIENTS AND METHODS: Between 1975 and 1999, 123 patients underwent Heller's myotomy without systematic fundoplication. Diagnosis of achalasia was performed clinically and confirmed by investigations: baryum meal, fibroscopy and manometry. Myotomy was performed through an abdominal approach in 117 (95%) patients. Dissection preserved fixity of abdominal oesophagus in all cases, particularly its posterior meso. Myotomy was performed on abdominal oesophagus but not below the cardia. Posterior fundoplication was associated in 2 patients. RESULTS: One patient (0,8%) died from massive aspiration. Morbidity (1,6%) consisted in one peritonitis and one postoperative occlusion. At follow-up (mean = 5 years; range: 1-20), functional results were satisfying (excellent and good) in 112 (92%) patients. Seven patients (6%) developed postoperative reflux, including one who need surgical treatment. Dysphagia persisted in 3 patients (2%) who had to be reoperated. CONCLUSION: Results of this series show that systematic fundoplication is not necessary in Heller's myotomy for achalasia of lower oesophageal sphincter.

[Leiomyoma of the esophagus]. / Léiomyome de l'oesophage.

BACKGROUND: Leiomyoma is a benign tumor rarely occurring in the esophagus. Only 1% of esophageal tumors are leiomyomas. CASE REPORT: A 70-year-old man underwent surgery for an asymptomatic tumor of the thoracic esophagus. The tumor was enucleated via right thoracotomy and histology confirmed the diagnosis of leiomyoma. Outcome was favorable. DISCUSSION: Leiomyomas of the esophagus generally develop from the muscularis and exceptionally from the muscularis mucosae, producing a parietal tumor or a pediculated endoluminal tumor respectively. Surgery is indicated for all cases, with the possible exception of asymptomatic leiomyoma. Encleation can be achieved by videothoracoscopy. Resection of the esophagus can be discussed if enucleation is impossible for giant tumors, or ring tumors at the esogastric junction, or if the mucosae wound cannot be repaired. Endoscopic resection is indicated for pediculated leiomyoma. Malignant transformation is exceptional but an association between esophageal myomatosis and carcinoma of the esophagus is possible. Certain authors thus advocate resection for all cases, even small asymptomatic leiomyomas.

[Adenocarcinoma of the anal glands]. / Adénocarcinome des glandes anales.

The study aim was to report an adenocarcinoma of the anal glands revealed by an anal abscess in a 64-year-old man. Malignant transformation of an anal fistula is discussed in the genesis of this disease. Clinical symptoms are not specific. Abdomino-perineal resection of the rectum is the usual surgical treatment and adjuvant radiation therapy didn't prove its efficiency.

[Inflammatory pseudotumor of the spleen]. / Pseudotumeur inflammatoire de la rate.

Inflammatory pseudotumor of the spleen is a very rare benign lesion of unknown etiology. Splenectomy is recommended to obtain histological diagnosis and to eliminate a malignant tumor.

[Place of super-selective vagotomy in the treatment of perforated duodenal ulcer]. / Place de la vagotomie supra-sélective dans le traitement des ulcères duodénaux perforés.

Thirty-two duodenal ulcer perforations were treated by suture and supraselective vagotomy. Perioperative mortality was nil. The recurrence rate was 6.2% against 17% after elective supraselective vagotomy performed by the same surgeons during the same period. Results of this technique for treatment of perforated duodenal ulcer are compared with those of 28 simple sutures and 32 truncal vagotomies.

[Post-bulbary ulcers]. / Les ulcères post-bulbaires.

Authors report 121 cases of post bulbary ulcers between 1969 and 1987. They precise the frequency of complications in this localisations of the ulcerous disease: Hemorrhage: 38% Stenosis: 39.6% Peritonitis through perforation: 9.09% Anatomical reports of the post bulbary area explain the anatomo-pathological aspects made by the above mentioned complications added the biliodigestive fistula and perforations blocked of a surgical treatment. Considering these elements, the authors show the difficulty of a surgical treatment. They suggest choosing the most simple intervention: Treating the ulcer without approaching the ulceron area; namely; making truncal vagotomy and duodenoplasty, that of Finney being the most adapted in case of haemorrhage. On case of a stenosis, with gastric ditension, exclusion gastrectomy is the adequate intervention. The results are good, except two deaths that occurred by cataclysmic ulcerous haemorrhage.

[Partial and total reconstructions of the esophagus. Report on 140 cases]. / Reconstructions partielles et totales de l'oesophage. Bilan de 140 observations.

This work is based on 140 cases of esophageal reconstructions collected during 17 years from 1970 to 1987. Those interventions were performed for 62 cancerous esophageal lesions, 8 peptic stenosis and 70 caustic stenosis. The immediate and long-term results will be presented. Important points of the reconstructions will be stressed.