Differential transferrin receptor density in human colorectal cancer: A potential probe for diagnosis and therapy.

Transferrin receptor density was investigated in human colorectal surgical specimens. Crude membranes were prepared from 23 cancer tumors (adenocarcinoma or malignant villous tumor) and 3 non-cancer tumors (polyadenoma or villous tumor) and 26 adjacent control mucosa. Contrary to non-cancer tumors, Scatchard analysis of 125I-transferrin binding data evidenced higher maximal transferrin binding capacity and lower dissociation constant in cancer tissues (Bmax cancer 1.828+/-0.320 nmol/g, Kd 24.1+/-4.7 nM), as compared to paired control colonic mucosa (Bmax contol 0.851+/-0.182 nmol/g, Kd 30.7+/-7.3 nM), paired t-tests: Bmax p<0.001, Kd p<0.05). As the cancer/control Bmax ratio was 2.6+/-0.4,transferrin carrier constructs should be proposed for cancer imaging or therapy.

[Risk of laparoscopic surgery. 100 records of complications. A qualitative study]. / Le risque en coeliochirurgie. 100 dossiers d'accidents. Etude qualitative.

A total of 100 accidents occurring during laparoscopic surgery between 1969 and 1993 were studied. Fifty-five of the cases concerned gynaecology surgery over a 24 year period. The other 45 concerned digestive surgery over a 5 year period (1989-1993). The surgical risk was not statistically greater compared with open surgery. Overall morbidity was 1%. Overall mortality was 0.5/1000. A more precise statistical analysis was recently reported. The examination of the 100 cases was qualitative rather than quantitative. The study demonstrated an imbalance between age (mean age 38 years) in patients with major pathology initially and the gravity of the induced accidents: 26 deaths for 100 observations. These deaths were related to technology trocar, capnoperitoneum, electrocoagulation. Technical skill, cautiousness, vigilance and humility are qualities the surgeon must have to perform successful operations. The irreversible acceleration of the new surgical technique should not cloud the basic precepts of sound surgical technique.

Giant cavernous hepatic hemangiomas in adults: enucleation under selective blood inflow control.

Among hepatic hemangiomas (the most common solid hepatic tumor in adults), "giant hemangiomas" are those defined by a diameter greater than 4 cm. The natural history of such lesions is unclear, and many surgical procedures have been described. In five women and one man (mean age 49), we successfully used enucleation of the tumor under blood inflow control. This technique was made possible by a cleavage plane between the hepatic parenchyma and the hemangioma. This straightforward and safe procedure required a low rate of transfusion (mean 200 mL/patient) and spared a maximum amount of hepatic tissue.

[Gastric MALT lymphoma of low-grade malignancy. Apropos of 4 surgically treated cases]. / Les lymphomes gastriques du M.A.L.T. de faible degré de malignité. A propos de 4 cas opérés.

From 1990 to 1993, programmed surgery was performed in four patients with histologically low grade malignant gastric lymphomas of mucosa-associated lymphoid tissue (MALT) (partial gastrectomy = 1, total gastrectomy = 3). These small cell lymphomas have the B phenotype and are uncommon. The clinical course is usually slow and classically limited to the stomach. As for other gastric lymphomas, there is still a certain amount of discussion as to the best therapeutic choice between surgery, chemotherapy and radiotherapy. Certain elements in the literature can help in managing these low grade gastric lymphomas. Recent publications report on a prospective study on primary lymphomas of the digestive tract, a clinical trial on single drug chemotherapy alone and the relationships between Helicobacter pylori and MALT lymphoma.

[Natural history of postoperative intraperitoneal adhesions. Surely, a question of the day]. / Histoire naturelle des adhérences intra-péritonéales post-opératoires. Une question vraiment à l'ordre du jour.

Postoperative intraperitoneal adhesions are known to occur after conventional surgery. The prospective study that we have performed in 1992 shows that the frequency of postoperative intraperitoneal adhesions is very high (93% of patients). It is higher than was stated 20 years ago, while so-called "spontaneous" adhesions seem to be decreasing. The histological study of postoperative intraperitoneal adhesions shows a specific evolution in time and a very high frequency of foreign bodies (starch, variably decayed textile fibers) (92%). The very great frequency of such foreign bodies in postoperative intraperitoneal adhesions, logically involving them in the genesis of this condition, may be an argument in favor of the new surgical techniques, especially of celioscopy.

[Medico-legal implications of ambulatory surgery]. / Implications médico-légales de la chirurgie ambulatoire.

Public opinion maintains the myth that ambulatory surgery is a benign operation. Although it may not be the ideal moment for demonstrating exceptional technical skill, there are unpredictable factors and certain limitations. To date, no specific legal concept of medical appraisal applicable to ambulatory surgery has been developed in France. Nevertheless, the nation that the surgeon is required to use all possible means is keenly accentuated because in a very short delay of a few hours the patient no longer is under direct management of the surgeon or his health care team. The aim of this work was to summarize the mandatory techniques for quality care and safety adapted to the lesions and the circumstances and taking into account accepted procedure, the current state of the art and the socio-familial environment. Two specific problems are encountered in the medical appraisal: a) defining whether the complication is inherent to ambulatory surgery, b) deciding how the responsibility could be shared. The possibility of special insurance for demonstrated non-fault surgical risk would be an elegant solution to avoid legal bias and facilitate controlled development of ambulatory surgery units.

[Annular stenosis of the main bile duct after laparoscopic cholecystectomy]. / Sténose annulaire de la voie biliaire principale après cholécystectomie par coelioscopie.

Although celioscopic cholecystectomy provides acknowledged advantages, lesions of the common bile duct appear to be more frequent with this technique than with laparotomy. Two cases of annular stenosis of the common bile duct after celioscopic cholecystectomy are presented. Evidence of their ischemic origin is available, and they lead to reflexions on the use of monopolar coagulation. In both cases, the stenosis was repaired surgically, with resection and anastomosis in one case and with a hepaticojejunal anastomosis in the other. Laying an endoprosthesis as used in case 2 seems to be interesting as a temporary solution to prepare for surgery.

[Biliary cysts. Resection of the protruding dome using celioscopy]. / Kyste biliare. Résection du dôme saillant par coelioscopie.

After giving the highlights on the few surgical indications of biliary cysts, the authors present a film of the resection of the protruding dome with celioscopy for an 80-mm cyst of the 3rd segment of the liver, in association with cholecystectomy for lithiasis. The simple technique and uncomplicated postoperative period emphasize the merits of this procedure, although this should not lead to inappropriate indications.

Hepatic trauma: experience with 135 consecutive liver injuries (1982-1989) and arguments for conservative surgery.

Most hepatic traumas are easily cured, but the series of 135 consecutive hepatic wounds reported in the present paper is unusual in that the patients were specifically recruited from among patients subjected to neurosurgical or spinal operations, 25% of whom sustained severe hepatic injuries (classes IV and V) as a result of the surgery. The postoperative mortality was analyzed according to such potentially predictive factors as severity of the hepatic wound, the concomitant extraabdominal lesions, the initial shock, and the kind of surgical treatment. The statistical comparison of the factors affecting the results was analyzed by the Chi-square test. The postoperative mortality rate was 24.4% (33 deaths). This mortality rate is evidently related to the severity of the hepatic lesions and to the frequent associated lesions. The 14 deaths from benign and moderate hepatic injuries were due to concomitant lesions. Among the 19 deaths from severe lesions, 12 were directly related to the severity of the hepatic injury and 7 to associated wounds. Complications directly related to the hepatic trauma occurred in 39 cases with 16 deaths. In general, conservative surgical treatment can be performed with quite low mortality. Among the patients who require hepatic resection one of two dies of hemorrhage or coagulopathy. Among conservative procedures, perihepatic packing has proved to be efficient and safe. If perioperative cholangiography has excluded any leak from a major bilde duct, septic complications are rare. Therefore, the surgical treatment of hepatic trauma should be as conservative as possible, because this can stop hemorrhage and decrease the risk of coagulopathy.(ABSTRACT TRUNCATED AT 250 WORDS)

[Reconstruction of the intestinal tract by intracolonic ileal sleeve. An experimental study and 1st clinical cases]. / Rétablissement du circuit intestinal par trompe iléale intracolique. Etude expérimentale et premiers cas cliniques.

An experimental study on 15 piglets allowed defining the technical procedure and controlling the anatomical and functional results of various modes of restoration of the ileocolic tract after resection with a terminolateral tubing including and intracolic ileal sleeve. Coloileal fixation was ensured only by a few seromuscular sutures and adhesion with "Tissucol". The clinical application of this procedure was very satisfactory for 9 recent right colectomies, thus confirming the results previously observed for 33 ileal perforations in Africa. The ileocolic tubing technique is easy, reliable, morbidity-free, and causes no leakage of intestinal fluid, no intestinal ischemia and no stenosis. As it prevents coloileal reflux, this assembly may prevent ileitis after right colectomy. Its valvular effect also contributes in the mechanical regulation of transit. The assembly produces a system that can be compared to the ileocecal valve.

[Peritoneal mesothelioma]. / Mésothéliome péritonéal.

On the basis of 5 personal cases with illustrations and a review of the literature, the authors emphasize the clinicopathological features of peritoneal mesotheliomas, rare primary tumors for which the histological diagnosis is often difficult. The classical evidence by contact with asbestos fibers is obtained in every second case only. The tumor is often associated with a pleural lesion. Ultrasound and CT currently aid in the diagnosis, usually in a context of extensive ascites. The prognosis is poor. For technical reasons, surgical exeresis most often remains partial in the diffuse forms. Chemotherapy is rarely effective.

[Current radiologic aspects of surgical technics for resection of cancer of the rectum]. / Aspects radiologiques actuels des techniques chirurgicales de résection pour cancer du rectum.

The aim of this work is to describe the current surgical rectum resection techniques for the treatment of cancer and the corresponding radiological images. The authors emphasize the mechanical, "trans-suture" anastomoses and on the colo anal anastomoses with colic container, which radiologists will have to follow up postoperatively.