[Laparoscopic treatment of gastroesophageal reflux by the modified Toupet technique. Preliminary results apropos of 55 cases]. / Cure laparoscopique de reflux gastro-oesophagien selon la technique de Toupet modifiée. Résultats préliminaires à propos de 55 cas.

Between October 1992 and July 1994, 55 patients with gastrooesophagal reflux disease underwent laparoscopic 270 degrees posterior fundoplication. The technique used was exactly the same as for the conventional approach. There were no deaths but there were 2 peroperative complications requiring conversions to laparotomy: one oesophagal perforation and one pleural perforation. The mean operative time was 150 min, ranging from 90 to 240 min. The mean hospital stay was 2.5 days, ranging from 1 to 14 days. One patient had to be operated on the 15th postoperative day because of a dysphagia secondary to an oesophagal motility disorder. One other patient underwent a laparoscopic treatment of a bowel obstruction on 30th postoperative day. None patient had dysphagia for more than 1 month after laparoscopy. The mean postoperative follow-up was 10 months with a good clinical result in 90% of the patients at 6 months. Four of our 15 first patients complained of recurrence of reflux symptoms. These preliminary results indicate that laparoscopic Toupet procedure can be performed safely and with similar results as for the open approach if the surgeon is well trained.

[Synergic effect of Dextran 70 at 32% and an antibiotic in the prevention of peritoneal adhesions. Experimental study in rats]. / Effet synergique du Dextran 70 à 32% et d'un antibiotique dans la prévention des adhérences péritonéales. Etude expérimentale chez le rat.

In an experimental study we evaluate the anti-adherential effect of four different solutions: physiological serum, Chloramphenicol, Dextran 70 (32%) and the association of these last two solutions. Synergic effect is shown when using an antibiotic (Chloramphenicol) with a non-bactericid solution (Dextran). Comparing our results with current literature, we are confident on the efficacity of similar association concerning other solutions than Dextran 70 (32%).

[Diagnosis of local recurrence after conservative treatment of breast cancer. A comparative study of a series of 50 cases]. / Diagnostic des récidives locales après traitement conservateur du cancer du sein. Etude comparée d'une série de 50 cas.

In order to determine the diagnostic features of recurrences after conservative treatment of breast cancer, 100 files have been studied. Fifty cases of glandular recurrence have been analysed and compared to 50 control cases of same stage, age and follow-up, without recurrence. In 58% of cases, the diagnosis was established during the course of a visit requested by the patient. In 84% of the cases the recurrence was found to be within the tumorectomy zone. The significant glandular pains, mammary density and deformation, nipple retractions and the radiological evidence of microcalcifications and irregular opacities seem to be strongly indicative of recurrence. The simultaneous clinical and radiological expression of recurrence was not noted in more than 52% of cases.

[Pre-peritoneal inguinal hernioplasty using Rhodergon's prosthesis. Study of a series of 282 hernia operations]. / Hernioplastie inguinale pré-péritonéale par prothèse de Rhodergon. Etude d'une série de 282 hernies.

282 acquired inguinal hernias in 183 adult patients were treated between 1974 and 1986 by means of a pre-peritoneal prosthesis. Posterior herniorrhaphy with reconstruction of the internal inguinal ring was associated with this procedure from 1981 onwards. 75% of the patients were reviewed with a mean follow-up of 58 months. Analysis of the results demonstrated a significant correlation between recurrences and the use of a single midline prosthesis for bilateral hernias and parietalisation of the spermatic cord and between septic complications and the use of a silicone-coated velvet prothesis, which subsequently had to be abandoned. Age, sex, obesity, type of hernia and a history of herniorrhaphy did not have any influence on the results. In group of 150 hernias treated with a single, lateralised Rhodergon prosthesis with a transprosthetic cord and reconstruction of the internal inguinal ring, the recurrence rate was 1.3% (2 cases) and the deep infection rate was 0.6% (1 case). Apart from early recurrences due to technical errors, the long-term efficacy of this technique appears to be permanent.

Tubal desterilization through exclusive laparoscopy.

The first case of tubal desterilization after Yoon rings through exclusive laparoscopy is reported. Yoon ring tubal segment excision was performed with CO2 laser and coelioscopic scissors, after mesosalpinx haemostasis by ornithine--vasopressin infiltration. Tubal anastomosis was managed with biological glue on an intraluminal guide which was pulled out after 48 h. Follow-up hysterosalpingography 3 months later showed perfect tubal patency. This case proves that complete tubal reversal by exclusive coelioscopy is possible. At present, this procedure is restricted to only one tube during coelioscopic evaluation, preserving, in case of failure, the chance of microsurgery either on the contralateral tube or even on the previously operated one. The advantages of such a technique are those of coeliosurgery: no laparotomy, shortened hospitalization and minimal post-operative adhesions. Since this first case, others have been performed. It is still too early to appreciate the results in terms of intrauterine pregnancy.

[Paradoxical effects of tamoxifen on the woman's uterus. Apropos of 7 cases of myoma that appeared while under anti-estrogen treatment]. / Effets paradoxaux du tamoxifène sur l'utérus de la femme. A propos de sept cas de myomes apparus sous traitement anti-estrogénique.

This study concerns the effects of anti-oestrogens which from now on are an integral part of back-up treatment for cancer of the breast. Seven cases where fibroids led to the need for laparotomy occurred in menopausal women who had been treated with tamoxifen. This has led us to discuss the paradoxical effect of this molecule, which is said to be anti-oestrogenic. This ambivalence is confirmed by studying the literature. These cases raise two questions which we try to answer: 1. Is the action of tamoxifen really anti-oestrogenic? 2. What management should be carried out to lessen the likelihood of tamoxifen treatment leading to laparotomy?

[Primary angiosarcoma of the spleen. Apropos of a new case]. / Angiosarcome primitif de la rate. A propos d'un nouveau cas.

The authors report a new case of primary angiosarcoma of the spleen and, after a review of the literature, they discuss its clinical, diagnostic and therapeutic problems. Primary angiosarcoma of the spleen is a very rare tumor. The diagnosis should be suspected in the case of a patient with splenomegaly and unexplained anemia, with no evidence of lymphoma, leukemia or myelofibrosis. In 30% of cases, the tumor presents in the form of spontaneous rupture of the spleen. The prognosis is very poor, as it is a highly malignant tumor, even more so in the presence of early metastases with or without spontaneous rupture of the organ. Splenectomy prior to rupture could increase the survival. Patients with or without metastatic disease may be treated by combination chemotherapy, which still remains empirical and palliative.