[Chronic saphenous venous access: an interesting alternative in the case of vena cava superior syndrome]. / Chronischer venöser Zugang uber die Vena saphena. Eine interessante Alternative im Falle des Vena-cava-superior-Syndroms.

An easy venous access improves the quality of life of patients who need prolonged intravenous therapy. In the case of vena cava superior syndrome the classic access in the jugular or subclavian vein can be difficult or even impossible. We report on seven implantations of Port-a-Cath in the inferior vena cava for patients presenting contra-indications to classic venous access to the vena cava superior (five cases of vena cava superior compression syndrome, one tracheostomy and one extended tumor of thoracic wall). We describe the operative technique and we analyze the indications, the results and the complications of this rarely used technique.

[Anterior resection of the rectum by double stapling. Retrospective study of 100 consecutively operated patients]. / La résection antérieure du rectum par double agrafage. Analyse rétrospective de 100 patients opérés consécutivement.

The double stapling technique for anterior resection of the rectum since its first description in 1980 has greatly facilitated the anastomosis of the low rectum. Few people use it also for high anastomosis of the rectum, the majority preferring hand-suture. We used this technique for 100 consecutive anterior resections of the rectum performed between August 1990 and November 1992. 51 patients had diverticulitis, 46 had carcinoma of the rectosigmoid colon, 2 had complications after pelvic irradiation and one had Crohn's disease. Surgical complications occurred in 22 patients. They include 8 patients with anastomotic leak (4 severe and 4 minor), all operated for carcinoma. Mortality was 3%. Our experience shows that this technique can be safely performed in a teaching hospital with many surgeons. It was a safe technique for high anastomosis. Surgical complication rate was higher in patients with recurrence of carcinoma and in patients previously irradiated.

The value of colonoscopic surveillance following a diagnosis of colorectal cancer or adenomatous polyp.

Conventional follow-up of patients with colonic neoplasia will at best only identify symptomatic lesions and those visible with a sigmoidoscope, and will therefore fail to identify new malignant lesions in time for effective treatment. In 1980 we began a prospective study of the efficacy and feasibility of replacing conventional outpatient follow-up with annual colonoscopic surveillance. One hundred and fifty-eight patients, attending one surgeon, have been entered: 74 patients who had a curative resection for colorectal carcinoma and 84 patients who had endoscopic or local resection of an adenoma. In the carcinoma group (mean follow-up 4.3 years, range 1-21), 40 of 237 colonoscopies were positive (17%) in 27 patients (36%). Forty-eight polyps were removed endoscopically and two asymptomatic recurrent carcinomas identified. In the adenomatous polyp group (mean follow-up 4 years, range 1-11), 40 of 252 colonoscopies were positive (16%) in 29 patients (34%). Fifty polyps were removed endoscopically, including two which had become malignant. All patients were also screened by Haemoccult stool testing, in the hope that it would identify these lesions and allow the frequency of colonoscopy to be reduced. Unfortunately, Haemoccult testing failed to identify many lesions, including one carcinoma and one malignant polyp. Our experience suggests that colonoscopic follow-up of all patients with colonic neoplasia attending one surgeon is a feasible exercise which can and should replace outpatient appointments for clinical examination.