[Complications of abdominal hysterectomy for benign gynecologic lesions. Apropos of 1,000 cases]. / Complications de l'hystérectomie abdominale pour lésions gynécologiques bénignes. A propos de 1 000 cas.

The authors present a retrospective study of 1,000 total abdominal hysterectomies performed between 1969 and 1975, and they report the main complications. Early complications are dominated by: rare thrombo-embolic accidents (2.2%) since the advent of prophylactic heparin therapy; infectious complications, dominated by the abscess of the abdominal wall and asymptomatic urinary infections, and for which simple measures prevent resorting to prophylactic antibiotherapy. The role of the hysterectomy seems minimal in the occurrence of a prolapse or a stress-related urinary incontinence: prolapses after hysterectomy (1.4%) seem more related to tissue aging than to the procedure which modifies very little the supporting system of the pelvis. A post-operative urinary incontinence is, most of the time, the result of an incomplete pre-operative work-up: failure to recognize a potential stress-related incontinence, or an incontinence secondary to an unstable bladder. Prolapse and incontinence must always be treated independently. In the psychological and sexual repercussion, age, ovariectomy and the distress related to the procedure, involving the heart of womanhood, seem to be the most important factors.

[Surgical technic for the excision of subclinical radiologic anomalies of the breast]. / Technique chirurgicale pour l'exérèse des anomalies radiologiques infracliniques du sein.

Routine mammography screening can detect radiologically evident but subclinical breast anomalies. Insofar as these anomalies can correspond to carcinoma, either in situ or invasive, surgeons are increasingly forced to operate on non-palpable breast lesions. A regulated and strict surgical technic is necessary to ensure exeresis of a radiologically detected focus, while avoiding sufficient adjacent healthy parenchyma and thus reducing the esthetic prejudice to a minimum. Technical artifices are described to assist compliance with these imperatives. First, the periareolar incision is chosen, as a principle, for its cosmetic qualities. Insofar as it provides an often limited approach it can be extended radially. The latter is concealed during closure without major alteration to the areola. Second, the radiating exeresis assists detection and is safer. It also provides glandular reconstruction of good esthetic quality and facilitates follow up surveillance.

Influence of the timing of physiotherapy upon the lymphatic complications of axillary dissection for breast cancer.

A prospective randomized study was carried out to discover the influence of the timing of shoulder physiotherapy after-axillary dissection for breast cancer upon the incidence and duration of lymphatic fluid production and seroma after these operations. Sixty-eight patients underwent a modified radical mastectomy, 31 were submitted to early physiotherapy and 37 to delayed physiotherapy after removal of the suction drainage. In 32 patients this surgery was conservative of the breast; in 16 the physiotherapy was early and in 16 delayed. The shoulder was left free when the physiotherapy was delayed. The mean volume of lymphatic fluid produced after these 100 axillary dissections was 437 cc (range: 50 to 800 cc) with a mean duration of 6.3 days (range: 2 to 11 days). There was a linear relation between the volume and the duration of the lymphatic fluid production. This volume was significantly higher in radical mastectomy than in conservative procedures (486 cc vs 333 cc - p less than 0.02). There was no significant difference in the production of lymphatic fluid with early or delayed physiotherapy, whatever the group of patients: radical or conservative surgery - age - number of excised lymph nodes - lymph node involvement. Five seromas occurred in patients with delayed physiotherapy. Delaying physiotherapy after axillary dissection for breast cancer does not seem to reduce the incidence of lymphatic complication, but the use of a conservative procedure rather than a modified radical mastectomy seems to be able to do so.

[Injuries of the thoracic duct during neck surgery]. / Plaies opératoires du canal thoracique au cou.

Although rarely published, operative injuries to thoracic duct in neck are by no means exceptional, and can occur during all types of surgery to lower cervical and supraclavicular regions. A case is reported and used as a basis for an analysis of diagnostic means and therapeutic possibilities of injuries detected during operation or those developing manifestations at a later stage. In the case reported, long-term medical treatment resulted in arrest of lymphorrhea within 37 days.

[Value of lumbo-aortic curettage in stage I and IIA tubal cancers]. / Intérêt du curage lombo-aortique dans les cancers tubaires stades I et IIA.

Results of a 7-year follow-up review of a patient with intratubal cancer and lumbo-aortic glands invasion are reported. The highly lympholytic character of these tumors and the existence of elective lumbo-aortic lymph node metastases suggest that surgery should include routine bilateral lumbo-aortic curettage in tubal cancer, particularly stages I and IIA. As well as providing improved assessment of degree of extension of the disease it can also avoid the frequently poorly tolerated abdominopelvic radiotherapy.

[Surgical treatment of recurrence of uterine cervix cancer]. / Traitement chirurgical des récidives du cancer du col utérin.

Surgery for recurrence of malpighian epithelioma of uterine cervix was performed in 14 patients, exenteration being necessary in 10 cases (5 anterior, 4 total and 1 posterior). Possibilities of surgical excision of recurrences are limited (10 to 20% of cases) and should not be considered except after a careful general, local and regional investigation including, if necessary, and exploratory laparotomy. This recovery surgery must be preceded by high-dose irradiation. This partly explains the high incidence of exenterations, with the need for cutaneous bypass of urine and/or fecal matter, but also the high prevalence of postoperative complications and mortality. Long-term results are deceiving and a 5-year survival rate of 20% appears to be maximum obtainable. However, this surgery remains the only solution capable of providing the patients with a chance, and it very often relieves them of the painful course of a pelvic tumor.

[Value of double "J" ureteral stents in cancerology]. / Intérêt des sondes urétérales double "J" en cancérologie.

Self-retaining silicone ureteral stents are used for prolonged urinary drainage in situ. Thanks to the exceptional patient tolerance, they appear to be the best indwelling catheters for the treatment of ureteral obstruction due to cancer. Eighteen catheters were placed in sixteen patients. Endoscopic insertion was carried out in 8 patients (9 catheters were inserted; one patient requiring bilateral catheterisation). An operative procedure was necessary in the remaining 8 cases: in 4 cases a simple ureteral dissection was necessary, whereas ureterostomy had to be carried out in the 5 remaining cases. During the treatment, the patient tolerance was excellent. Mean survival time, after catheterisation was 5,5 months and one patient had a functional catheter for 15 months. Obstruction of the catheter was observed in 3 cases but ureterostomy was avoided in 7 cases and 8 kidneys were protected in 6 cases. The palliative use of the double J catheter when no other treatment is possible for malignant ureteral obstruction precludes the need for ureterostomy. These catheters can be used for strategic curative treatment if nephrotoxic drugs are required to treat obstructive tumors of the ureters. Bladder disease is a contra-indication to the use of these catheters although their insertion is rarely impossible. In cases of acute obstruction, it is better to prepare the pathway with a traditional catheter, which is easier to manage, it is always possible to insert a double J catheter after some time has elapsed.

[Cystic abdomino-mediastinal lymphangioma. Apropos of a case. Review of the literature]. / Lymphangiome kystique abdomino-médiastinal. A propos d'un cas. Revue de la littérature.

A further case of cystic lymphangioma is reported, characteristic features being the multiple abdominal and thoracic localizations of the lesions. Apart form splenic sites, it is rare to detect lesions in the mesogastric and mediastinal regions, particularly as propagation of abdominal lymphangioma towards the mediastinum is an exceptional occurrence. A literature review provides data on the various regions in which cysts have been reported in the body, and the diagnostic problems they raise.