[Lichtenstein's "tension-free" operation for inguinal hernia under local anesthesia]. / Opération "tension-free" de Lichtenstein pour hernie inguinale sous anesthésie locale.

Lichtenstein's technique for surgical cure of primary inguinal hernia using local anaesthesia is described. Since 1984, 3250 primary hernia operations were performed at the Lichtenstein Hernia Institute. There were 4 recurrences due to technical errors which are described. This tension-free technique is a reliable, simple and effective procedure. Patients return to normal activity within 2 to 14 days. Studies one 22300 operations performed by several surgeons produced similar results for post-operative recurrence and complications.

[Shouldice's operation: can results in a general surgical unit be the same as those in a highly specialized surgical unit?]. / L'opération de Shouldice: peut-on avoir dans un service de chirurgie générale les mêmes résultats que dans un service super-spécialisé?

In the course of 5 years 1803 groin hernia operations have been carried out, 1640 of them Shouldice operations, in a General Surgery Service. Post operation follow up of patients operated with Shouldice technique has shown 0.72% recurrence in patients checked for over a year, and 2.13% complications. Correct applications of this technique gives the same results as those in specialized centres.

Plasma and tissue CEA and TPA markers in operable breast cancer. Preliminary results.

CEA and TPA were studied in sera and in histologic specimens of 200 patients with benign (77) or malignant (123) breast pathology. The frequency and expression of the two markers was different in benign and in cancer tissues. Histologic positivity and high levels of circulating markers were observed more frequently in cancer patients than in patients with benign disease. Tissue positivity for the two tumor markers did not always correlate with elevated levels of circulating markers. Positive CEA and TPA incidence was higher in tissue samples than in serum samples. In the breast cancer group, among 33 patients with histologic positivity for CEA, only 5 cases had circulating CEA levels higher than 5 ng/ml; among 91 patients with histologic positivity for TPA, only 45 cases showed circulating levels for TPA higher than 95 U/l. These findings confirm that tumor size, secretory characteristics and vascular supply are factors affecting the achievement of high circulating marker levels. Combined marker measurement in serum and tissues can provide more information about the presence of a given tumor marker. A limited evaluation of the prognostic meaning of the study of combined CEA and TPA in sera and in tissues was carried out during the follow-up of 60 evaluable patients. Only 5 patients had cancer relapses in the first 12 months from surgery; in 2 of 5 patients TPA was positive initially and at the time of recurrence, in serum as well as in tissues. Circulating CEA gave negative findings in all relapsed patients; 2 of them showed weak positivity only in the histologic staining at the time of presentation.

Fatal hepatic vascular toxicity of DTIC. Is it really a rare event?

A fatal massive hepatic necrosis with widespread thrombotic occlusion of the small hepatic veins developed in two of 68 patients treated with DTIC for advanced melanoma in a randomized study. Thirteen similar reactions, in patients treated with single-agent DTIC, are reported in the literature. Several clinical and pathologic features distinguish this DTIC toxicity from Budd-Chiari syndrome and veno-occlusive disease (both well-known types of possibly drug-related hepatic vascular disease) and make it a distinctive syndrome. We were impressed by the repeated occurrence of this complication in a relatively small set of patients, in contrast with the rarity of the literature reports. We suggest that this dramatic complication could occur more frequently than commonly thought. Therefore, caution should be used with DTIC, particularly in curable patients.