[Iodine 131 uptake by a bronchogenic cyst in a patient with differentiated carcinoma of the thyroid gland]. / Fixation à l'iode 131 d'un kyste bronchogénique chez une patiente ayant un carcinome différencié thyroïdien.

BACKGROUND: After thyroidectomy for differentiated thyroid carcinoma, extracervical uptake of iodine 131 is suggestive of metastasic dissemination. False positives can however occur. CASE REPORT: Differentiated thyroid carcinoma was found in a female patient with a non-functional nodule. Two years after subtotal thyroidectomy and an ablative dose of iodine 131, the whole body scan showed abdominal mediastinal uptake with low serum thyroglobulin level. Considering the possibility of tumor recurrence or lymph node metastasis, the mass was excised. The histology diagnosis was mediastinal bronchogenic cyst. DISCUSSION: To date, iodine uptake in a bronchogenic cyst has not been reported among other false-positives previously described. The pathophysiology of this iodine 131 uptake in a bronchogenic cyst is still unknown: the presence of NIS symporter or a protein which can organify iodine in the mucus cells of the cyst remains to be proven.

In situ repair of a secondary aortoappendiceal fistula with a rifampin-bonded Dacron graft.

Secondary aortoenteric fistulas remain challenging diagnostic and therapeutic problems. Although the duodenum is most frequently involved, other intestinal segments are possible sites for fistulization. We report here a case of graft-appendiceal fistula revealed by recurrent gastrointestinal bleeding 11 years after abdominal aortic aneurysm replacement. The preoperative diagnosis was not achieved by endoscopy or imaging assessment. Despite recommended principles of total graft excision and extraanatomic bypass, appendectomy and in situ rifampin-bonded graft reconstruction were performed because of the advanced age and poor arterial runoff. The postoperative course was uneventful and the patient remains well 17 months after operation.

Absorbable Adams-DeWeese caval clip: an experimental study.

Adams-DeWeese caval clips have been shown to be effective in preventing pulmonary embolism. However, the use of Teflon clips constitutes a permanent solution for this transient risk. We tested an absorbable caval clip made of currently available synthetic biodegradable polymers in five female beagle dogs. The polymer used was PLA 96 containing 96% L lactic acid and 4% D lactic acid. After placement through a laparotomy, clips were routinely inspected and samples of the material were collected at regular intervals between 3 and 19 months postoperatively. The characteristics of absorption of PLA 96 in the retroperitoneal space were the same as those previously described in the literature. The clip retained its shape, rigidity, and effectiveness for 7 months. Complete degradation of the clip took between 18 and 19 months. Absorption did not cause a major inflammatory reaction and had no thrombogenic effect. Given the small number of animals studied, these results must be considered preliminary.

[Budd-Chiari's syndrome with caval membranous web treated by liver transplantation]. / Syndrome de Budd-Chiari par membrane cave traité par transplantation hépatique.

In this paper, the case of a 30 year-old Asiatic man with a Budd-Chiari syndrome secondary to a caval membranous web, associated with cirrhosis is presented. After unsuccessful percutaneous dilatation, liver transplantation associated with membranotomy treated the venous obstacle and ensured satisfactory recovery. Orthotopic liver transplantation is the most effective treatment in this setting.

Biometry of the infrarenal inferior vena cava measured by computed tomography. Clinical applications.

In a previous study based upon the cavography of 100 patients, we determined that the average diameter of the infrarenal inferior v. cava (IIVC) was 21.3 mm (range 10-31 mm) at its end [1]. We discuss the value of different methods to measure IIVC, and particularly computed tomography (CT) scans reviewed in our department. It showed that the largest diameter of IIVC was not in a frontal plane and the width observed in a cavography was in fact the projection of a transverse diameter on the film. The real diameter of the IIVC is larger than that showed by cavography. This present study shows the results of measurements of the IIVC obtained from 50 consecutive CT scans. The average transverse diameter is 24.26 mm (range 14-33.3). The average anteroposterior diameter is 13.4 mm (range 5-22) and the average angle alpha between the transverse diameter and the frontal plane is 30 degrees 45' (range 12 degrees-55 degrees). We discuss the different methods of measurement of IIVC and we conclude that at present, CT scan is one of the most reliable methods to measure the real diameter of IIVC.

[Acute hepatic artery thrombosis in pediatric liver transplantation: surgical thrombectomy and in situ fibrinolysis]. / Thromboses aiguës de l'artère hépatique en transplantation hépatique pédiatrique: désobstruction chirurgicale et fibrinolyse in situ.

In pediatric liver transplantation, hepatic artery thrombosis usually leads to graft loss, early due to hepatic necrosis when it occurs during the first week following the transplant procedure, or later due to biliary complications. Liver retransplantation is the usual attitude. However, urgent surgical hepatic arterial thrombectomy to restore the blood flow can be successful when early diagnosis is made with Doppler ultrasound examination and angiography. Four hepatic arterial thrombectomies were performed as an emergency with additional intra-hepatic arterial fibrinolytic treatment, in three children, 1.5, 3 and 5.5 years of age. Mean duration between the first signs of hepatic artery thrombosis and thrombectomy was 16 hours. None of the children had an urgent liver retransplantation. A complete success was obtained in one case, with normal liver function tests and patent hepatic artery on the Doppler ultrasound examination at the present time. In the two other cases, hepatic artery thrombosis recurred, in spite of repeated thrombectomy in one case; following this attempt complications of hepatic artery thrombosis occurred in the two patients: ischemic necrosis of the left lobe (1 case), biliary leak (1 case) and stenosis of the common bile duct (2 cases). A complete success in one case and a partial success in the two others lead us to advocate urgent thrombectomy and in situ fibrinolytic treatment when early diagnosis of hepatic artery thrombosis is made.

Monobloc resection of the upper extremity of the leg for bone tumor with distal vascular reconstruction.

A patient with juxtacortical osteosarcoma of the upper extremity of the left tibia which encased the popliteal neurovascular bundle was treated by monobloc resection of the superior extremity of the tibia and the tibial nerve. The knee joint was replaced by a Guepar prosthetic knee. Arterial and venous continuity was reestablished by a double bypass using the contralateral greater saphenous vein. One year later the patient had good lower limb function and was free of local or general disease. This observation confirms that preservation of lower limb function is possible using reconstruction techniques of bone, nerves, and vessels in sarcoma of the musculoskeletal system.

Intraoperative ultrasonography for location of proximal limit of inferior vena caval thrombosis.

Appropriate surgical management of inferior vena caval thrombosis is dependent on the proximal limit of the thrombus. Cavograms, computed tomography, or magnetic resonance imaging all have their shortcomings in locating this limit. Intraoperative ultrasonography has allowed us to determine the exact proximal limit of vena caval thrombosis in two patients, one with suprarenal thrombosis, the other with infrarenal thrombosis. In the first patient, caval interruption and clearance of the inferior vena cava was greatly enhanced by the use of this method. Intraoperative sonography is useful in the surgical treatment of thrombosis of the inferior vena cava.

[Pathology of the inferior vena cava and liver transplantation]. / Pathologie de la veine cave inférieure et transplantation hépatique.

Pathology of the inferior vena cava is not frequently encountered in the context of liver transplantation. Such a pathology was observed in 7.9% of our recipients, in the pre- intra- and post-operative period. Pre-existing anomalies of the IVC consisted the absence of the retrohepatic vena cava in 7 children with biliary atresia; technical adjustments were quite simple. During the operative period, dissection of the supra-hepatic vena cava was made very difficult in 2 patients with hepatic alveolar echinococcosis complicated by secondary biliary cirrhosis it was necessary to make a trans-diaphragmatic approach to the inferior vena cava. Post-operative inferior vena cava thrombosis occurred in four recipients, in three cases, it was caused by the inadequate size of the graft and major anastomotic discrepancy between the inferior vena cava of donor and recipient and in one case IVC thrombosis occurred in a context of allergy to heparin. Six of the 13 recipients with pathology of inferior vena cava died directly of indirectly because of these problems. Analysis of the causes of this pathology and their possible correction will perhaps allow better results in these patients who undergo liver transplantation.

[Behçet's disease and vascular surgery]. / Maladie de Behçet et chirurgie vasculaire.

The role of vascular surgery in Behçet's disease is limited. It is concerned with the two types of lesion, venous and arterial, usually encountered. Indications for surgery in venous thrombosis did not differ from those in ordinary thrombo-embolic disease. The multicenter study reported divided arterial lesions into three groups: aneurysmal, occlusive or traumatic (arterial puncture) lesions. While surgery offers satisfactory results in the treatment of aneurysmal or traumatic lesions, the treatment of occlusive lesions is disappointing. Surgery is thus indicated only in patients with an aneurysm, bleeding or severe ischemia.