[Primary pulmonary rhabdomyosarcoma: a case report]. / Rhabdomyosarcome pulmonaire primitif: à propos d'une observation.

We report a case of primary pulmonary rhabdomyosarcoma in a 52-year-old woman. The diagnosis was established after radical right pneumonectomy, mainly based on immunohistochemistry and electron microscopy findings. This type of tumor is rare in adults. Its primary origin is suggested when a pulmonary meta-stasis of rhabdomyosarcoma from another site or a component of a mixed tumor are ruled out. The best treatment is surgery. The prognosis is poor.

[Excision of an intracardiac metastasis under chemotherapy]. / Exérèse d'une métastase intra-cardiaque sous chimiothérapie.

An intracardiac malignant lesion was found in a 28-year old male patient following orchidectomy for an advanced germinal tumour of the testicle. Although the patient is under chemotherapy, the neoplastic thrombus will be removed by surgery. Heart metastases are uncommon. When they do occur, they are usually secondary to locoregional extension and limited to the pericardium or myocardium. Endocardial or intracavitary lesions are rare, but can, in certain cases, be removed by surgery.

[Surgery of calcified aortic stenosis in patients aged 70 and over. Immediate results. Apropos of a series of 229 cases]. / Chirurgie du rétrécissement aortique calcifié chez les sujets âgés de 70 ans et plus. Résultats immédiats. A propos d'une série de 229 cas.

229 patients aged 70 or over with aortic stenosis (AS) underwent surgery between January 1972 and July 1983 (21.8% of 814 cases of AS operated on during the same period). The Björk Shiley prosthesis was used at the beginning of the series (115 cases, 50.2%), until bioprostheses became the treatment of choice in this age group. Overall operative mortality in the series was 10.9% (25/229). Analysis shows a very marked reduction in recent years: from 15.6% between 1972 and 1977, to 5.8% in 1982-3. Improvement can be attributed in part to the technical progress in myocardial protection. Patient age is a very significant factor in the prognosis. Progress in surgery, together with that in anaesthetics and intensive care, justifies operation in these elderly and incapacitated patients whose general and neurological condition is well preserved.

[Hepatic insufficiency and nutritional problems after major hepatobiliary surgery]. / Insuffisance hépatique et problèmes nutritionnels après chirurgie majeure hépato-biliaire.

Problems raised by major hepatobiliary surgery affect the total economy of the human body. The liver is implicated in all body metabolism processes and possible problems during partial or total hepatectomy can only be solved by a knowledge of liver physiology. The liver plays a major role in the metabolism of products of digestion, whether these are carbohydrates or amino acids arriving in the portal blood. The most important activity of the liver is the preservation of a constant level of glucose by ensuring a fixed and predictable concentration to extrahepatic tissues. It ensures a very precise control of plasma and tissue flow of amino acids and thus protein synthesis and neoglycogenesis. Synthesis and degradation of non-esterified fatty acids, ketogenesis, cholesterol synthesis and triglyceride production result from the action of the liver on lipid metabolism. Free cholesterol is the precursor of bile acids and steroid hormones, but esterified cholesterol is not synthetized in the liver. Apart from its role in bilirubin metabolism, it has a key role to play in correct functioning of most endocrine systems: many are catabolized in the liver. But one of the most interesting properties of the hepatic tissue, as far as the surgeon is concerned, is liver regeneration, which combines hypertrophy with hyperplasia. This is dependent on age, hepatotrophic factors of portal blood, and extraportal factors. A study of hepatic metabolic processes allows assessment of the consequences of partial hepatectomy. Postoperative hypoglycemia, in the absence of a continuous infusion of glucose, is easily explained by the weakness of hepatic reserves in glycogen. Albumin levels fall during the first 7-10 days after liver resection, but this hypo-albuminemia is often marked by the need to infuse large quantities of frozen fresh plasma to try to avoid lesions of the other specific proteins, which are coagulation factors. Lipid metabolism disorders are of little clinical consequence. Hepatic resection is being alarming when it involves 80 to 90% of the hepatic mass and menaces the life of the patient. The existence of a previous liver alteration worsens the consequences of major hepatobiliary surgery. Indications for hepatic resection must be weighed carefully in patients with cirrhosis, liver regeneration being totally absent after resection. Metabolic consequences of total hepatectomy followed by transplantation are identical in kind to those of partial hepatectomy but are increased in frequency and start during operation. Postoperative surveillance must be strict to avoid marked variations in glycemia with the risk of hypoglycemia, and variations in kaliemia.(ABSTRACT TRUNCATED AT 400 WORDS)

[Anatomic and tomodensitometric study of the levator ani muscle in infants]. / Etude anatomique et tomodensitométrique du muscle élévateur de l'anus chez le nourrisson.

A double anatomic and computed tomographic study of the muscle levator ani has been performed in pediatric patients. In or study, we have used frozen anatomical specimens. The anatomic and computed tomographic sections have been made strictly comparable, every 3 millimeters. These actions provide the normal computed tomographic aspect of the muscle levator ani. This anatomic study may have a direct application in the evaluation of imperforate anus, which is often difficult to diagnose : it allows a more precise determination of the level of the terminal rectal pouch compared to the level of the levator ani.

[Surgical treatment of constrictive pericarditis and life-threatening pericardic effusions (author's transl)]. / Principes du traitement chirurgical des péricardites constrictives et des épanchements péricardiques compressifs.

Total excision of both pericardic sac and epicardium is the basic surgical procedure for chronic constrictive pericarditis. Approach being through a vertical sternotomy. In case of either cardiac injury or poor haemodynamic of either cardiac injury or poor haemodynamic conditions, it is sometimes indicated to get help from an extracorporal circulation with femoro-femoral shunt. Surgery for acute pericarditis may vary according to local and general conditions. As soon as a pericardic effusion, whether or not infected, has occurred, drainage by means of an infraxiphoid incision seems to be a safe method. Where pericardic effusions relapse or densify to a constrictive pericarditis, pericardectomy is to be considered. Total pericardectomy is therefore regarded as the best procedure to prevent further disease.

[Ventricular branches of the circumflex artery of the heart]. / Les branches ventriculaires de l'artère circonflexe du coeur.

Because of the great number of anatomic descriptions, and because of the variability of the nomenclature, the authors realized three studies: anatomical, radiological, and surgical studies of 198 hearts (150 dissections and 148 angiographies). There are 3 groups of collateral branches for the left ventricle: --The lateral branch (existing in 49 per cent of the cases), beginning after a short space with often an intra-myocardial segment, and running obliquely on the pulmonary surface of the left ventricle. --The lateral and inferior branch (existing in 38 per cent of the cases), situated just between the pulmonary and diaphragmatic surface of the ventricle, and perpendicular to the coronary sulcus. --The inferior or posterior branches (existing in 59 per cent of the cases), which are parallel to the inferior (or posterior) interventricular sulcus, on the diaphragmatic surface of the heart.

[Skène's duct cysts report of three cases in neonate (author's transl)]. / Les kystes sous et para-urétraux. Trois observations à révélation néo-natale.

The authors report three cases of para-uretral cyst in neonate. After a short recall of Skène's gland anatomy, their aspects, complications and treatment are discussed. A congenital origin is proposed. A simple punction through a needle was enough to cure these three children.

[Agenesis of the left pericardium. Apropos of 3 anatomo-surgical observations]. / Les agénésies du péricarde gauche. A propos de 3 observations anatomo-chirurgicales.

After a short review of the history and the frequency of this malformation, the authors report three cases of pericardial defect: two cases of partial defect, and a case of complete absence (these three patients have been operated); these observations allow the authors to insist on the difference between the complete absence (often very well tolerated) and the partial defect, which exposes to left atrial appendage's incarceration (and sometimes sudden death). The classification based on the extension of the lesions is then considered, and the usual aspect of each type is described. The embryologic findings can explain the higher frequency of left pericardial defects.

[Nephretic colic in patients with arrhythmia (author's transl)]. / La colique néphrétique de l'arythmique.

The authors relate one case of obstruction by emboly in the renal artery. The diagnosis were too late for conservative surgery. In this case, they insist on the particulary signs of that nephretic colic and they show the diagnosis measures which are able to permit a conservative surgery in urgency.

[Deep femoral artery. Anatomoradiological study]. / L'artère fémorale profonde. Etude anatomo-radiologique.

After a double study (anatomical--50 dissections--and radiological--100 arteriograms) the following points can be stressed: the femoral tripod is only found in 38 per cent of the cases. One or several nutrient arteries of the thigh originate often separately (62% of cases). Their origine is situated highup in a number of cases (at 3 cm below the inguinal ligament). The collateral network develops from each of the arteries forming a complete "profunda femoris system". Two surgical consequences deserve to be underlined: 1. The approach to all the branches is possible by a transverse incision in the fold of the groin. 2. Surgical revascularisation must concern the whole of the "profunda femoris" network.