[Rectal leiomyosarcoma. 4 new cases]. / Léiomyosarcome du rectum. Quatre nouvelles observations.

We report four cases of leiomyosarcoma of the rectum suspected by endoscopic ultrasonography. Three patients were treated by local excision and one by abdominoperineal resection. An excision of the mass via a Kraske's approach was used. Leiomyosarcoma confined to the rectum wall can be treated by local excision. Endosonography can provide exact estimation of the lesion and is of great value in selecting the appropriate treatment. The treatment is surgical excision with wide margins. The histological stage and the presence or absence of metastases determine the therapeutic. Two patients in our series underwent radiation therapy. Chemotherapeutic agents including doxorubicin have had beneficial effect on recurrence or survival, only for higher grade sarcomas.

Right nonrecurrent inferior laryngeal nerve and arteria lusoria: the diagnostic and therapeutic implications of an anatomic anomaly. Review of 17 cases.

The authors report 17 cases of a right non-recurrent inferior laryngeal n. (NRILN) observed during 15 years of practice of thyroid and parathyroid surgery. In their last two cases, the existence of an aberrant right subclavian a., constantly associated with NRILN, was confirmed by MRI angiography. On the basis of the literature and their own experience, the authors review the incidence of this double anomaly, its embryologic explanation and its anatomic and surgical importance. They stress the diagnostic factors and the therapeutic implications, very different in children and adults, of a particular vascular anomaly whose outcome is little understood.

[Combination of colorectal tumor and Streptococcus bovis endocarditis. Apropos of 3 cases]. / Association d'une tumeur colo-rectale et d'une endocardite à Streptococcus bovis. A propos de trois observations.

The authors report about 3 cases of bovis endocarditis revealing a colic carcinoma. This morbidity confirms the need for routine digestive investigations in endocarditis due to group D streptococci and eventually a liver disease.

[Comments on emergency treatment of biliary lithiasis in patients over 75 years of age. Apropos of 157 cases]. / Réflexions sur le traitement des urgences de la maladie biliaire lithiasique chez les sujets de plus de 75 ans. A propos de 157 observations.

Surgery remains the ideal emergency treatment for biliary lithiasis in elderly subjects despite perioperative morbidity and mortality. Minimally invasive techniques appear promising but require assessment. The aim of this work was to determine the usefulness of these techniques and evaluate outcome in a series of 157 patients over 75 years of age who were hospitalized in an emergency setting of complicated biliary lithiasis from January 1990 to December 1996. There were 103 women and 54 men, mean age 82 years. The patients' general status was evaluated according to the ASA classification; 66% of the patients were ASA III, IV or V. Diagnoses at admission were acute cholecystitis (n = 71, 45%), angiocholitis (n = 50, 31%) subintrant hepatic colic (n = 17, 10.8%), pancreatitis (n = 10, 6%), isolated jaundice (n = 2), peritonitis (n = 2) and occlusion (n = 5). Within 24 hours of admission, 7 patients underwent emergency surgery, and the 150 others were given medical treatment. Among these 150 patients, cure was considered to have been achieved with medical treatment alone in 41 (subsequent surgery being required in only one 6 months later), semi-emergency was performed in 17, and a minimally invasive procedure was performed in the 92 others (echo-guided percutaneous cholecystostomy in 42, endoscopic sphincterotomy in 50) followed by a subsequent operation in 29. In the 103 patients (65.5%) in this series who did not undergo surgery, mortality was 3.8% and in the 54 patients (34.5%) who did, mortality was 15%, but this rate was only 6.9% when the open procedure followed a minimally invasive technique. Surgical treatment of complicated biliary disease remains the ideal therapy but indications should be carefully weighed in these elderly fragilized subjects. Under surgical observation, abstention from surgery or use of minimally invasive techniques can play an important role in the therapeutic strategy aimed at lowering perioperative mortality.

[Digestive cancers and choroid metastasis. Diagnostic circumstances and prognostic value apropos of 2 cases]. / Cancers digestifs et métastases choroïdiennes. Circonstances du diagnostic et intérêt pronostique à propos de 2 observations.

We report two observations of malignant gastric and pancreatic tumors with choroid metastasis. Clinical course was rapidly and spontaneously unfavorable.

[Leiomyosarcoma of the inferior vena cava. Apropos of a new case]. / Léiomyosarcome de la veine cave inférieure. A propos d'une nouvelle observation.

A leiomyosarcoma was diagnosed in the mid portion of the inter-renal inferior vena cava. Survival was long (6 years) but required 14 reoperations to remove metastases. During the first operation, vascular integrity was reestablished with a cava-cava prosthesis after exeresis of the upstream cava without removal of the left renal vein ostium. The right renal vein was sectioned and directly implanted onto the prosthesis. The pathology report confirmed the diagnosis of leiomyosarcoma with multiple metastases presenting cytonuclear anomalies which worsened with time.