[Training of foreign physicians in France. Analysis and suggestions]. / La formation en France des médecins étrangers. Analyse et suggestions.

The training of foreign physicians in France raises difficult problems unsolved so far but new measures are being studied. The critical analysis of the current situation can help find out solutions which provide a better answer to current needs both for students wishing to follow a complete training in France and for those, already M. D. willing to come here to get a specialisation course. "DIS" have been suppressed but, getting access to the position of "intern" through the competitive examination even tailor-made may not be the best solution. The background in the home country, the opinions of university supervisors must be determining factors. For specialists already graduated requiring upper level further training it is necessary to improve information and circulation of applications. The success of expected reforms implies awarding a specific budget and modifying in-depth the conditions of choice of training positions.

[Foreign physicians practicing in France (problems posed by the application of the law of July 13, 1972)]. / L'exercice en France des médecins étrangers (problèmes posés par l'application de la loi du 13 juillet 1972).

The 13 July 1972 law defined a procedure which applies to physicians wishing to practise in France but who don't meet the double requirement: having the French nationality (or being a citizen of a member state of the European Union) and holding the national diploma of Doctor of Medicine (or a diploma of the European Community). The Minister, in agreement with a commission in charge of examining the applications one by one, determines each year the number of authorizations to be possibly granted. The applications mainly come from physicians of the Mediterranean area who came to France to follow a specialized training and who, sometimes, have been practising in French hospitals for many years. Many of them have acquired french nationality. Since 1986, the Commission has been facing difficult problems due to a regularly increasing number of applications, meanwhile the number of authorizations, at least until 1991, has been going down on account of restricted intake. The "stock control" cannot be considers without parallel measures, especially for the recruitment of hospital practitioners. A deep legislative reshuffle should also be considered.

[The caudal lobe of the liver. Anatomical study. Surgical applications]. / Le lobe caudé du foie. Etude anatomique. Applications chirurgicales.

The caudal lobe of liver is an independent sector astride the right and left liver regions. It is formed of two parts, right and left, distinguished exteriorly by the caudal and papillary processes, and can now be explored (ultrasound and CT imaging) allowing its surgical removal (tumoral lesion of the superior biliary confluent).

[Wirsung's duct hemorrhage in chronic pancreatitis. Report of 4 cases and study of the literature]. / Wirsungorragies des pancréatites chroniques. Rapport de 4 observations et étude de la littérature.

Hemorrhage from Wirsung's canal complicated chronic pancreatitis in 4 patients. Excision (2 cephalic and 1 corporeocaudal) in 3 cases provided successful results, the 4th patient dying from intraperitoneal rupture of the false cyst responsible for the hemorrhage, during recurrence of the latter after simple ligature. A literature review indicated pancreatic disease, mainly chronic, as the cause in 76.5% of the 64 cases documented. Diagnosis is difficult from clinical findings, and is dependent mainly on results of endoscopy and particularly retrograde catheterization of the papilla, while arteriography is essential for confirmation of the diagnosis and the site of the lesion, and for assisting choice of therapy. When a chronic pancreatitis exists, the only logical attitude is selective excision, mortality being minimal (5%). Embolization could be a valid method for ensuring hemostasis temporarily to allow delayed radical surgery.

[Complications of appendicitis and appendectomies. Apropos of 106 cases]. / Complications des appendicites et appendicectomies. A propos de 106 cas.

Analysis of 106 case-reports of patients developing complications after appendicectomy provided data on factors predisposing to these sequelae (general condition, initial appendicitis) and their severity (26 deaths equivalent to 24,5 p. cent). Complications were exclusively medical in 22 patients (12 deaths), or surgical in 48 cases (no deaths), and were multiple and/or mixed surgical sequelae in 36 patients (14 deaths). The severity of these medical and surgical complications is emphasized and their appropriate treatment proposed. Statistical analysis of findings in patients with several complications enabled definition of risk factors: peritonitis, septic shock, renal or respiratory insufficiency, age over 50 years, and previous history of disease. Analysis of these risk factors, whether multiple or associated with other complications, can be used for numerical rating of prognosis in these patients.

[Meckel's diverticulum. Is it necessary to search for it? Is it necessary to remove it? Apropos of 116 cases]. / Le diverticule de Meckel. Faut-il le rechercher? Faut-il l'enlever? A propos de 116 observations.

Of 116 Meckel's diverticula operated upon over a period of 13 years, 35 had provoked severe disorders and 80 p. cent of the cases concerned patients under 30 years of age. Occlusions represented half of the lesions involved, perforations, hemorrhages, and diverticulitis being less frequently involved. Mucosal heterotopia was a relatively frequent finding: 13 p. cent of cases, and was often the origin of hemorrhagic accidents. Asymptomatic diverticula can be potentially pathologic, as 2 carcinoid tumors and 2 cases of gastric heterotopia were discovered during routine examinations, suggesting that prophylactic excision of apparently healthy diverticula should be performed in young subjects.