[Lymphangioma of the mesentery--surgical indication]. / Le lymphangiome du mésentère--l'indication opératoire.

The discovery of a cystic image in the mesentery is a difficult diagnostic and therapeutic problem. We report the case of a 25-year-old female with a mesenteric lymphangioma, which was resected after careful consideration. The complications due to the expansion of this benign tumour are reviewed, and the surgical indications discussed.

Spinal tumour due to primary hyperparathyroidism causing sciatica: case report.

We report a unilateral intraspinal cyst-like lesion adjacent to the lamina and facet joint at the L4-L5 level producing sciatica. Histological examination revealed multinucleate giant cells suggesting a brown tumour. Further studies disclosed primary hyperparathyroidism, whose first manifestation was the lumbar nerve root compression. Previous cases of compression of neural structures by spinal brown tumours are reviewed and a radiological differential diagnosis is presented.

Computed tomography of retroperitoneal duodenal rupture in blunt abdominal trauma.

Two cases of retroperitoneal duodenum rupture following an upper abdominal blunt trauma are reported. Computed tomography (CT) demonstrates at best extraintestinal fluid and air in the retroperitoneum, especially if acquisition in right lateral decubitus is possible. Drawbacks of the method are also reviewed.

[Traumatic dissection of the internal carotid artery]. / Traumatische Dissektion der Arteria carotis interna.

Two patients with posttraumatic dissection of the internal carotid artery were referred to the neurosurgical department with secondary neurological deterioration following a minor head injury with concussion. Both developed aphasia and right hemiparesis during the first few hours after the accident; one patient also had right focal seizures. On admission, both were only mildly lethargic, which contrasted with the severity of the focal neurological signs. Early CT scan was normal in both cases, whereas cerebral blood flow (CBF) studies by single photon emission computerized tomography (SPECT) with Tc-HMPAO (Ceretec) showed perfusion defects in the region supplied by the left middle cerebral artery (MCA), correlating with the clinical picture. Doppler sonography disclosed pathologic flow patterns, and carotid angiography demonstrated dissection of the internal carotid artery, in one patient on the left only and in the other bilaterally, with embolic occlusion of a branch of the left MCA in the latter case. Clinical features, pathogenesis, diagnostic workup and possible treatment (medical, as in our two cases, versus surgical) of this rare pathology are briefly reviewed.

[Extreme lateral lumbar disk herniation. Apropos of a series of 25 cases]. / La hernie discale lombaire extrêmement latérale. A propos d'une série de 25 cas.

Twenty-five cases of extreme lateral disc herniation (ELDH) were identified amongst 680 operated lumbar discs (3.7%). Their anatomical, radiological and clinical features are presented. They were found at all levels between L3 and S1. At the L5-S1 level 12 ELDH occurred amongst 253 disc herniations (5%), at the L4-L5 level, 8 ELDH amongst 400 herniations (2%), and at the L3-L4 level, 5 ELDH amongst 21 herniations (24%). No clinical features were encountered which could allow to differentiate between an ELDH and a classical disc herniation of the above level. Twenty-three patients underwent lumbar myelogram. This was normal in 6. In 12 it showed a slight shortening and widening of the above situated nerve root sleeve. The same abnormality can be found with downward migration of a classical herniation of the above situated disc or with a lateral recess stenosis. Twenty-five patients underwent computed tomography (CT.). In 24, the ELDH could be unequivocally identified. Disc material occupied the intervertebral foramen or the extravertebral space just beyond it, replacing the normal fat. In order to identify an ELDH, CT has to be done whenever myelogram is normal or equivocal. If the patient is to be investigated by CT only, slices through the intervertebral foramen and the disc below the clinically suspicious level have to be included. Operation in all cases consisted in total or partial unilateral laminectomy with facetectomy.