Splenic injury: management in the Languedoc-Roussillon region.

GOAL OF STUDY: Treatment of splenic injury is not standardized. We conducted an inventory of splenic injury treatment modalities of splenic injury in the Languedoc-Roussillon region of France. METHODS: A questionnaire was sent by e-mail to 33 surgeons practicing in 10 hospitals in that region. Surgeons were asked: how many cases were treated per year (PMSI databank for the last three years), local resources (resuscitation bay or intensive care unit, availability of CT and interventional radiology), indications (surgery, embolization, nonoperative management [NOM]), prognostic criteria, NOM modalities (duration of bed rest, hospital stay, restriction of physical activity, thromboembolic prophylaxis, and imaging schedule). RESULTS: Thirty-one surgeons replied. An average of 185 patients were treated per year. There was consensus concerning the indication for urgent splenectomy, NOM was practiced in the stable patient (even with diffuse hemoperitoneum) and splenic artery embolization was performed for active bleeding (blush on CT) (for the six centers who have interventional radiology at their disposal). Disparities existed between centers concerning the modalities of NOM excepting imaging monitoring, initial surveillance in resuscitation bay or intensive care and in the therapeutic indications when bleeding persisted. CONCLUSION: Based on the consensus observed in this study and an analysis of the literature, a uniform treatment policy can be proposed.

[Endocrine tumor arising in heterotopic gastric pancreas]. / Tumeur endocrine développée sur pancréas ectopique gastrique.

We report the case of a 49-year-old caucasian woman, in whom an endocrine tumor arising in gastric heterotopic pancreas was diagnosed. The patient was treated surgically with a gastric wedge resection. Heterotopic pancreas is a benign anatomic condition, probably widely underdiagnosed because usually asymptomatic. The malignant transformation of aberrant pancreas is very rare and almost always in adenocarcinoma. The endocrine tumors developed in heterotopic pancreas are exceedingly rare. Of our knowledge, only four cases have been published and only one case in the gastric location similar to this reported case.

[Asymptomatic cystic dilatation of the choledochus in an adult]. / Dilatation kystique asymptomatique du cholédoque chez un adulte.

A congenital choledochal cyst, type Ia according to Todani's classification, was discovered fortuitously in a 54-year old man by abdominal sonography. The patient had no biliary symptoms, and liver tests were normal. Excision of the cyst was performed because of the theoretical risk of cholangiocarcinoma. Recovery was uneventful.

[Mediastinal parathyroid adenomas on a 5th ectopic gland. 2 case reports]. / Les adénomes parathyroïdiens médiastinaux sur 5ème glande ectopique. Deux observations.

Mediastinal parathyroid adenoma located on the 5th ectopic gland is rare. We report here two new cases diagnosed by scintigraphy. In one case the adenoma was found to be located in the mediastinum prior to cervicotomy. The modern imaging methods capable of locating parathyroid adenomas are evaluated.

Influence of age and sun exposure on the biophysical properties of the human skin: an in vivo study.

The physical properties of the skin were measured by using noninvasive methods on 72 people displaying various levels of solar elastosis on the neck. The physical parameters measured were the skin extensibility, the elastic recovery, the skin colour, the skin thickness and the electrical conductance. The correlation between the above parameters, the clinical grades of elastosis and the chronological age of each subject were studied using two different statistical approaches. They both showed that elastotic skin is less elastic, dryer, darker, more erythematous and less yellowish than the nonexposed skin. The similarities and differences between the properties of elastotic skin and purely chronologically aged skin are discussed.

[Last recourse reconstruction of the cervicothoracic esophagus: the free jejunal transplant]. / Reconstruction de dernier recours de l'oesophage cervico-thoracique: autotransplant jejunal libre.

Free intestinal autograft has been recommended for oesophageal reconstruction following total circular pharyngolaryngectomy for cancer. Coloplasty or gastroplasty are commonly used for reconstruction of cervical and thoracic oesophagus. Necrosis of the plasty or anastomotic leakage can occur and may require the resection or reintegration of the pedicled graft into the abdominal cavity. For later reconstruction another pedicled graft may not be feasible and interposition of a free intestinal autograft can be a helpful method. The authors report a case of successful reconstruction of the cervical and thoracic oesophagus by a free ileal autograft, after the initial failure of a right coloplasty in a patient with previous gastrectomy. The free ileal autograft was interposed between the cervical oesophagus and the previous coloplasty repositioned in the lower part of the anterior mediastinum. The vessels of the graft were implanted onto the left common carotid artery and the innominate venous confluent.

[Hepatitis caused by quinidine. Study of a case and review of the literature]. / Hépatite due à la quinidine. Etude d'un cas et revue de la littérature.

The authors report the case of a 63 year-old woman who developed high-grade fever with chills, nausea, diarrhea, severe pain in the right hypochondrium, and jaundice after one month's treatment with 300 mg of hydroquinidine hydrochloride daily. Serum bilirubin and aminotransferases were slightly increased, while alkaline phosphatases and gamma-glutamyl-transpeptidase serum activities were markedly raised. Histological examination of a liver specimen obtained by the transvenous route showed numerous epithelioid granulomas with giant cell formation and eosinophils in hepatic lobules and portal tracts. Symptoms disappeared three days after withdrawal of the drug, but hepatomegaly and a mild increase in serum gamma-glutamyl-transpeptidase persisted more than eighteen months. Quinidine-induced hepatitis is almost always associated with fever, and, in one-third of the cases, with a pseudo-cholangitis picture. Extrahepatic hypersensitivity manifestations are often present. Histological examination of the liver shows granulomatous or cytolytic hepatitis. Withdrawal of the drug is rapidly followed by a favorable outcome; readministration causes immediate relapse; progression to chronic liver disease has never been reported previously.

[Should thalidomide be rehabilitated?]. / Faut-il réhabiliter la thalidomide?

Thalidomide (alpha-N-phtalimido-glutarimide) was withdrawn from sale in 1961 since it was held responsible for the birth of hundreds of phocomelus children. Despite this teratogenic potential, thalidomide remains a useful tool in the treatment of erythema nodosum leprosum, as well as in discoid lupus erythematosus when antimalarial drugs are ineffective or contraindicated. In addition, good results have been reported in several diseases such as actinic prurigo, polymorphous light eruption, Behçet syndrome, Weber-Christian disease, prurigo nodularis, pyoderma gangrenosum and ulcerative colitis. The mechanism of action is under debate but it is likely that thalidomide has immunomodulating properties by controlling T-suppressor lymphocytes, and anti-inflammatory effects, particularly an inhibition of neutrophil chemotaxis. Several attempts at synthesis of effective thalidomide derivatives devoid of teratogenic effects are ongoing.

[Ecology of a focus of cutaneous leishmaniasis in the Thiès region (Senegal, West Africa). Epidemiologic and clinical characteristics of the human disease]. / Ecologie d'un foyer de leishmaniose cutanée dans la région de Thiès (Sénégal, Afrique de l'Ouest). 2. Particularités épidémiologiques et cliniques de la maladie humaine.

During their epidemiological survey of a cutaneous leishmaniasis focus, the authors study the epidemiological and clinical aspects of 60 proven human cases observed in the studied area (Thies region). The disease can occur at any age but is more frequently seen in the preadolescent (10-15 years), adolescent (15-20 years) and adult (20-40 years) age classes. During the year, 76.5% of the lesions appear between july and the end of november. The spontaneous evolution of the disease seems to have a one year duration. Less than to lesions are observed in the majority of the cases (91.5%). The lesions are mainly located on upper and/or lower limbs and are generally of humid ulcerated type, often covered by a deep scar; a lymphatic nodular dissemination from a lesion occurs in 25% of the cases.

[Leprosy tests: diagnostic problems (apropos of 2 cases)]. / Les réactions lépreses: problèmes de diagnostic (à propos de deux observations).

Two cases of reactional leprosy leading to wrong diagnosis are reported. The first one concerns a reversal reaction predominantly neuritic, initially taken for polyarthritis. The second one concerns an erythema nodosum leprosum with extensive cutaneous necrosis (Lucio's phenomenon or ulcerative lazarine leprosy). Main aspects and mechanisms of leprosy reactional states are reviewed. It is emphasized that errors or delays in diagnosis are often caused by failing to recognize cutaneous or neuritic symptoms.

[Red grain mycetomas (A. pelletieri). Apropos of 20 new cases in Dakar]. / Note sur les mycétomes à grains rouges (A. pelletieri) (à propos de 20 nouveaux cas Dakarois).

20 cases of mycetoma A. pelletieri coming from Sénégal are reported. This series confirms the peculiar localisation, extension and severity of this type of mycetoma: 14 cases located outside the foot (buttock, perineum, scrotum, inguinocrural area, abdominal and chest wall); frequency of lymph node involvement; importance of superficial extension; surgical possibilities overreached in more than 1/3 of the cases. Effectiveness of sulfa-methoxy-trimethoprime in the medical management is outlined.