[Trans-vesical incarceration of a small bowel loop after pelvic trauma]. / Incarcération transvésicale d'une anse grêle lors d'un traumatisme du bassin.

The authors report the case of a patient presenting with small bowel obstruction after a pelvic trauma with associated bladder injury. While urinary bladder and bowel injuries are frequent following this type of trauma, their association is rare. Small bowel obstruction secondary to trans-vesical incarceration of a small bowel loop at the fracture site is exceptional. CT is invaluable for diagnosis.

[Primary hyperparathyroidism revealed by pseudomyopathia]. / Pseudomyopathie révélant une hyperparathyroïdie primitive isolée.

We report the case of an 11-year-old child with delayed development who developed signs of exercise-induced pain in the lower limb muscles after an acute attack of appendicitis. He had difficulty standing up from the sitting position and ascending and descending stairs. The physical examination revealed increased reflex activity in the lower limbs. Initially, blood tests, MRI and EMG were normal. Serum phosphorus and calcium were not assayed. Eight months later, the boy's condition worsened (myopathy gait, hyperlordosis) leading to the possible diagnosis of muscle disease. After muscle biopsy, blood tests revealed hypercalcemia at 3.5 mmol/l (normal 2.2-2.6), hypercalciuria, and hypophosporemia. The diagnosis of primary hyperparathyroidism was confirmed by the abnormal level of parathormone initially (19 ng/ml) and later (156 ng/ml) with hypercalcemia. Medical treatment failed and surgery was performed to remove three and a half parathyroid glands. After removal, blood tests returned to normal in six days and the physical examination in three years. The diagnosis of principal cell hyperplasia was retained at the pathology examination. We found no evidence of hypercalcemia or other endocrinopathy such as multiple endocrine neoplasia (MEN 1 or 2a). Study of the menine gene did not reveal any mutation. Muscle dysfunction suggest possible abnormal phosphocalcium regulation. A normal parathormone level with hypercalcemia reveals inappropriate synthesis and secretion.

[Inferior vena cava injury. X-ray computed tomographic and angiographic aspect]. / Traumatisme de la veine cave inférieure. Aspect tomodensitométrique et angiographique.

We report one case of traumatic rupture of the inferior vena cava. CT was performed during the acute phase and showed retroperitoneal hematoma near the inferior vena cava with extravasation of contrast agent. After stabilization angiography showed pseudo-aneurysmal picture of inferior vena cava.

[Giant cell hepatitis and autoimmune hemolytic anemia: efficacy of splenectomy on hemolysis]. / Hépatite à cellules géantes et anémie hémolytique auto-immune: efficacité de la splénectomie sur l'hémolyse.

BACKGROUND: The previously reported cases of giant cell hepatitis with autoimmune hemolytic anemia were improved by prednisone plus azathioprine. CASE REPORT: A 14-month-old boy suffered from giant cell hepatitis with auto-immune hemolytic anemia and positive direct Coombs test. Prednisone and azathioprine administration improved the liver disease but failed to control hemolysis so that repeated blood transfusions were necessary. Persistance of severe degree of hemolysis required splenectomy that was promptly and definitively effective. Azathioprine and prednisone were pursued for a total duration of five years. Twelve years after the onset of the disease, the child is well without any treatment. CONCLUSION: This is the first reported case of such an association in which poorly controlled auto-immune hemolytic anemia benefited from splenectomy.

[Angiomyolipoma and polycystic kidney secondary to Bourneville's tuberous sclerosis]. / Angiomyolipome et polykystose rénale révélateurs d'une sclérose tubéreuse de Bourneville.

We describe the case of a previously healthy young woman admitted to hospital for abdominal pain and symptoms of shock. The preoperative diagnosis arrived at was polycystic kidney disease associated with ruptured angiomyolipoma. This combined pathology is pathognomonic of tuberous sclerosis; skin signs of the disease were also present in the patient, although undetected till then. The lack of neurological symptoms was an extraordinary finding. Cure is achieved at the cost of nephrectomy.

[Thrombocytopenia induced by heparin. Apropos of 10 cases]. / Thrombocytopénies induites par l'héparine. A propos de 10 cas.

The authors report ten observations of thrombocytopenia induced by heparin complicated with two arterial thrombosis and four deep venous thrombosis. Two deaths and two amputations are to mention. This retrospective study leads to a review of literature: this iatrogenic disease, which frequency is variously estimated, has no relation with the dose and the mode of administration of Heparin. It's mechanism might be immuno-allergic. It's diagnosis depends mainly on the repetition of platelet numerations at the outset period of treatment, and on the rapid and lasting climbing of platelet countings when heparin is stopped. This uncommon and unforeseeable complication indicates to stop Heparin and to start K antivitamin's if necessary.

[Outcome of patients undergoing surgical plication of the inferior vena cava]. / Devenir éloigné des sujets ayant subi un cloisonnement chirurgical de la veine cave inférieure.

In a group of 70 patients, 40 undergoing the insertion of a Mobin-Uddin umbrella and 30 the placing of an Adams-DeWeese clip, the authors noted a 6% recurrent embolism rate within a follow up period of 14 months to 5 years. This was fatal in 1.5% of cases. There was 10.9% recurrent phlebitis and 9.4% sequelae of severe stasis. Mobin-Uddin umbrellas gave the most complications and should be reserved for the worst cases. Indications for the Adams-DeWeese clip can be extended to surgical patients with a thrombo-embolic risk and to dangerous clots visualised by phlebography.

[Treatment of severe acute pancreatitis (30 cases). Respective role of surgery, intensive care and artificial nutrition (author's transl)]. / Traitement des pancréatites aiguës graves. Place respective actuelle de la chirurgie, de la réanimation et de la nutrition artificielle (30 cas).

The authors report on a retrospective study of 30 severe acute pancreatitis. The severity of the illness is documented by operative statement and evolution of the disease = 50 p. cent of mortality. A first group of 10 patients (1972-1975) was treated by primary intensive care and rapid ablative surgery with 10 deaths. A second group of 20 patients (1976-1980) was treated by primary intensive care, artificial nutrition and secondary surgical drainage. Mortality is significantly lower in the second group (5 deaths). It is concluded that all severe acute pancreatitis should be initially managed by intensive metabolic care and respiratory support if necessary. The only indication for primary surgery is a diagnostic doubt with peritonitis or bowell infarction. The authors emphasize the improvement of the prognosis of severe acute pancreatitis related to hemodynamic and respiratory measures and to a better nutritionnal support. Surgery should be secondary on a well prepared patient. Drainage or sequestrectomy support a lower mortality than ablative surgery.