[Neurogenic appendicitis. A case]. / Appendicite neurogène. Une observation.

Laparoscopic procedures have changed the indications for appendectomy. Routine exeresis should not be performed if a normal organ is observed during an exploratory procedure, but should be in cases with clinical manifestations of right flank pain since neurogenic appendicitis is not rare. We report a recent case observed in a 76-year-old woman. The patient was initially hospitalized for right flank pain with nausea and irregular episodes of diarrhoea. Clinical examination and complementary exploration led to cholecystectomy via subcostal access. On per-operative cholangiography the common bile duct appeared normal. Immediate follow-up was uneventful and the patient was discharged. Twelve days later, the patient complained of the same type of abdominal pain and was hospitalized with a fever at 38 degrees C and shivers. The right flank was very painful at palpation. Echography and computed tomography eliminated a subphrenic abscess or secondary pancreatitis. Pain localized at MacBurney's point 8 days later. Barium study showed a normal colon with the exception of uncomplicated diverticulosis. Subjective pain persisted and appendectomy was decided. Pathological examination revealed neurogenic appendicitis. First described in 1924, neurogenic appendicitis is relatively frequent. Macroscopically, a sclerous fibromyxomatous nodule obliterates the lumen. Microscopically, the central obliterating lesion is composed of hyperplastic nervous tissue in a fibromyxoid matrix, particularly important at the point of the appendix. Clinically neurogenic appendicitis is usually chronic and the appendix appears healthy in situ. Cure is always achieved with resection. Laparoscopic procedures can identify para-appendicular causes of painful abdominal syndromes and sclero-atrophic appendicitis, but in the absence of another explanation exeresis appears to be justified due to the possibility of neurogenic appendicitis.

[Are there limits to conservative treatment of breast cancer?]. / Y a-t-il des limites au traitement conservateur du cancer du sein?

For nearly 40 years, a multidisciplinary team working in a private clinic has used a conservative approach to breast cancer for small tumours, i.e. T1-T2. Treatment is based on tumorectomy and radiotherapy. Good results, comparable to those obtained with mastectomy have been obtained and continue to improve with developments in therapeutic methods. The rate of recurrence remains below 7% and 95% of the women were able to keep their breast without any supplementary danger. There are satisfied.

[Splenosis after splenic rupture: a disease to be recognized]. / La splénose après rupture de rate: une affection à reconnaître.

One case of peritoneal splenosis is reported. The diagnosis was established at surgery in a 17-year-old female patient presenting with dull abdominopelvic pain, who had undergone total splenectomy after a trauma ten years earlier. This autograft of splenic tissue must be known to be acknowledged, especially today, when the conservative treatment advocated for ruptures of the spleen may increase its incidence. The literature reports only about one hundred cases. The treatment only consists in removing the sole symptomatic nodules.

[Madelung's disease and lesions of the extensor tendons. A case report]. / Maladie de Madelung et lésions des tendons extenseurs. A propos d'une observation.

A case of incomplete rupture of the extensor tendon to the little finger is reported in a 64-year-old woman with an idiopathic Madelung's deformity which had been present since adolescence but had given rise to no problems. Surgical treatment by resection of the head of the ulna with fixation of the ulna to the radius gave a satisfactory result. Only two similar case reports of rupture of extensor tendons associated with Madelung's deformity have been published. In spite of its rarity, this complication deserves to be known and possibly prevented by resection of the head of the ulna when it is very prominent. It should be recognized before any loss of extension of the little finger, however slight, develops. Lesions of extensor tendons in contact with an excessive prominence of the head of the ulna are among the best known complications of rheumatoid arthritis. Occasionally, the same type of lesion can be seen in Madelung's deformity.

[Mesenchymatous tumor of the spermatic cord with late recurrence in the retroperitoneal space. Apropos of a case]. / Tumeur mésenchymateuse du cordon spermatique avec récidive tardive dans l'espace rétro-péritonéal. A propos d'une observation.

The reported case is characterized by the original tumor site as well as by the recurrence site; by the slowly evolutive nature of the lesion over nine years from the time of surgical tumor excision to relapse; and by histological variations raising a nosological problem. Our clinical, anatomopathological and therapeutical observations are based on the characteristics of the case as well as published data. We only traced 5 cases in the literature of spermatic cord tumors with retroperitoneal localization. The progressive histologic polymorphism of these tumors compels us to raise the question of the very nature of this neoplasm: liposarcoma or malignant mesenchymoma. The potential clinical and histologic outcome of mesenchymal tumors of the spermatic cord cause us to propose direct orchidectomy and surveillance of the retroperitoneal space throughout the evolution of the process, even far off into the future.

[Peritoneoectomy in the surgical treatment of advanced ovarian cancer. Stages III and IV]. / La péritonectomie dans le traitement chirurgical des cancers de l'ovaire "dépassés". Stades III et IV.

Extirpation of so-called inoperable "over-run" stages III and IV ovarian cancer is possible. This exeresis is based on the essentially peritoneal extension of the disease and the use of a retroperitoneal dissection plane. The complex operation involves the total abdomen and includes exeresis of all the parietal peritoneum, a right and left colectomy and a posterior pelvectomy. It does not appear mutilating but is sufficiently complex to justify the present technical description. It gives a real efficiency to chemotherapy which follows it.

[Treatment of lateral eventrations by an aponeuroplasty method]. / Cure des éventrations latérales par un procédé de plastie aponévrotique.

Lateral incisional hernias are not uncommon. Aponeuroplasty, which has already given excellent results in the repair of midline incisional hernias, is also suitable for transverse or oblique incisions. No complications have been observed, and the technique has been proved successful in our series of 22 cases.

Conservation treatment of early breast cancer: long term results and complications.

Results of radiation therapy following breast-conserving surgery were analyzed for 410 patients with clinical Stage I-II mammary carcinoma having a minimum and median follow-up time of 5 years and 11 years, respectively. Crude survival rates were 82.2% at 5 years, 62.5% at 10 years, and 45.4% at 15 years. Local-regional recurrence was observed in 9.7% of patients. Seventy-five percent of these recurrences could be controlled locally by further treatment. Both local recurrences and metastatic deaths were more frequent in patients in clinical Stage II and in patients 40 years of age or younger. The cosmetic result was judged good to excellent in 77% of patients, with unacceptable results in 6.7%. The majority of poor results were seen in patients receiving 60 Gy or more to the entire breast. Arm edema occurred in 25% of patients having had axillary dissection, and in 3.4% of patients without axillary surgery. Edema was confined mainly to patients having had axillary doses of 60 Gy or more, and was never disabling. This study demonstrates that excellent long-term results are obtainable with breast-conserving techniques in early breast cancer. Satisfactory cosmetic results and a very low complication rate can be expected if extensive axillary surgery is avoided in conjunction with axillary radiation, and if the radiation dose applied to large treatment volumes is restricted to 50 Gy.

[Surgery of pilonidal cysts in dorsal decubitus]. / Cure des kystes pilonidaux en décubitus dorsal.

All lesions located in the sacro-coccygeal region can be operated upon in supine position, which requires a lighter general anaesthesia.

[Peroperative estimation of the imperviousness of choledochoduodenal anastomoses]. / Appréciation per-opératoire de l'étanchéité des anastomoses cholédoco-duodénales.

Fistulae occurring after choledochoduodenostomy always have severe consequences. The following procedure aimed at checking for leakage is suggested by the authors. After completion of the posterior stage of the operation, a naso-gastric tube is introduced into the common bile duct, exposing the anterior suture; once the anastomosis has been performed, a fluid is injected into the tube by the anaesthetist, thus revealing any leakage. Once the incisions are covered, the naso-gastric tube is simply withdrawn on a few centimetres.