[Oncocytic tumors of the thyroid. Diagnostic and therapeutic problems. Report of 17 cases and review of the literature]. / Tumeurs oncocytaires de la thyroïde problèmes diagnostiques et thérapeutiques. Rapport de 17 cas et revue de la littérature.

Histopathologic and clinical follow-up data of 17 patients observed 3-104 months (mean: 38 months) after operation for oncocytic tumors of the thyroid gland are presented. Mean patient age was 50 +/- 15 years. Benign and malignant lesions were respectively 13 and 4. Frozen sections were positive for benign and malignant lesions in respectively 7 and 2 cases. Total thyroidectomy was performed in all cases of malignant lesions and in 7 cases of benign lesion, the latter in order to treat high volume adenomas or associated controlateral lesions. No tumor relapse was observed during the follow-up period (data about 16 patients). A review of the literature indicates that thyroid oncocytic adenoma diagnosis can be trusted and that this tumor is not especially prone to a malignant course with the mode of treatment applied. Thus total thyroidectomy should be recommended for: 1) malignant tumors. 2) and for selected benign adenomas depending on the tumor volume or on associated lesions.

[Retroperitoneal perforations of the colon. Apropos of 2 cases]. / Perforations coliques rétropéritonéales. A propos de 2 cas.

The retroperitoneal perforation of the colon is rare and our observations illustrate its two modes of revelation: a retroperitoneal suppuration; it must be traited quickly in order to decrease the mortality. Note that the abscess of the thigh is exceptional. Retroperitoneal perforations during colonoscopy whose treatment (initially medical) become surgical if there is no clinical improvement.

[Reoperations of rectal resection for recurrence after previous resection for rectosigmoid cancer]. / Les réinterventions d'exérèse rectale pour récidive après résection antérieure d'un cancer recto-sigmoïdien.

From June 1986 to December 1992, 16 patients (12 men and 4 women, 63 years-old [36 to 79]) who underwent a prior sphincter-saving resection for colorectal adenocarcinoma were operated on for locoregional recurrence with a surgical resection. Eight patients had a second anterior resection (5 colorectal, 2 coloanal and 1 ileoanal anastomosis), one a resection without anastomosis, and 7 an abdomino-perineal resection. Nine patients received an intraoperative irradiation (10 to 25 Gy). Excisions of surrounding organs were often necessary. Post-operative complications occurred in most of the patients. Excluding 3 post-operative deaths, 9 patients died of disease in a median of 12.9 months after surgery (range: 3 to 32 months). Four patients are still living 5 to 14 months after the second resection. There is little in the surgical literature dealing with these difficult surgical problem of which results are always uncertain. An earlier diagnosis of the recurrence would result in a more satisfactory procedure, but is difficult because of the limited possibilities of detection after surgical treatment and often external irradiation.

[Surgical treatment of secondary hyperparathyroidism in chronic kidney failure. Results of total parathyroidectomy with parathyroid autotransplantation]. / Traitement chirurgical de l'hyperparathyroïdie secondaire des insuffisants rénaux chroniques. Résultats de la parathyroïdectomie totale avec autotransplantation parathyroïdienne.

Between 1978 and 1990, 68 patients, operated on for secondary hyperparathyroidism (HPT), received a forearm intramuscular free autologous parathyroid graft (37 women and 31 men--mean age: 43 +/- 16 years). The transplantation (Wells technique) was performed in the same time as the total parathyroidectomy and the remaining parathyroid material after surgical resection was cryopreserved. The results were evaluated in term of clinical and/or radiological and/or biological response respectively 3 or 5.5 years later, depending of the realisation of a renal transplantation (n = 27) or not. Four patients were lost to follow-up and 4 died post-operatively, including a wrong diagnosis (60 patients evaluated). Mortality rate was 12% (5 cases out of 7 related to chronic renal insufficiency). In 3 patients (5%) the transplanted gland had to be removed because of recurrent HPT (1 graft hyperplasia; 2 wrong diagnosis: 1 cervical gland left over and 1 aluminium intoxication). Second cervicotomy was performed in 3 cases (5%) for remaining cervical parathyroid gland (2 cases) and false-positive Tallium-Technetium scan (1 case). Overall results were good or very good in 51 cases (85%). A review of the literature indicate that subtotal parathyroidectomy in not superior to the Wells technique and the latter remain the landmark technique in the authors' hands in order to treat secondary HPT.

[Cytological study in case of gastric leiomyoblastoma. Review of the literature]. / Examen cytologique en cas de léiomyoblastome gastrique. Revue de la littérature.

The authors describe the fine-needle aspiration cytologic features of leiomyoblastoma. Aspirated tumor cells occur singly, not in clusters. The tumor cells are globular in shape or sometimes have a spindle appearance. The nuclei are round, central or eccentric, with small nucleoli. The cells have well-defined cytoplasmic borders. The cytoplasm is abundant and, to some extent, granular, with sometimes a microvacuolar peripheral pattern. To date five cases of leiomyoblastoma with a cytological study have been published, two of them located to the stomach. A review of the literature is presented.

[An unusual secondary localization of bronchial adenocarcinoma]. / Une localisation secondaire inhabituelle d'un adénocarcinome bronchique.

The authors report a rare case of metastatic carcinoma of the large bowel, secondary to a primary bronchogenic adenocarcinoma. Abdominal pain developed in a 44-year old man 5 months after lobectomy for lung adenocarcinoma. The diagnosis of a large caecal extraluminal mass was established by means of sonography, scanner and laparoscopy. Palliative resection (brain metastases) was performed. Postoperative histological examination revealed the resected tumor to be identical to the lung adenocarcinoma. The patient eventually died 4 months after resection (complication of intracranial hypertension). Diagnosis and therapeutic features of metastatic extra-thoracic lung carcinoma are discussed.

[Evaluation of quality of care in a general surgery department]. / Evaluation de la qualité des soins dans un service de chirurgie générale.

A permanent evaluation of a department's activity and the quality of health care it provides is needed to avoid inappropriate use resulting from a wide range of causes. The activity of a general surgery department treating and average of 1,500 patients per year and performing 1,200 operations was analyzed over the period 1986 to 1992. Post-operative hospital follow-up was noted for each patient and any complications were analyzed on discharge day by the surgeons, the anaesthesiologists and the nursing staff. A year-end sum up was conducted each year by homogeneous groups. Examples are presented: surgery for cancer of the oesophagus (122 cases), surgery for gastro-oesophageal reflux (120 cases), thyroid surgery (1,314 cases from 1988 to 1992). Complications, hospital stay and former pathologies were evaluated in order to determine the indications, prevent complications and evaluate more rapidly the advantages of modifications in techniques. The results were compared between surgeons. This daily evaluation allowed a better analysis than a retrospective study compared with data in the literature. Permanent personal reevaluation was one of the practical consequences of the study considered to be and enriching experience.

[Cystic dystrophy of aberrant pancreatic tissue in the duodenal wall. Diagnostic and therapeutic problems]. / Dystrophie kystique sur pancréas aberrant de la paroi duodénale. Problèmes diagnostiques et thérapeutiques.

The authors report the case of a 28-year-old man with a cystic dystrophy of aberrant pancreatic tissue (C.D.A.P.T.) presenting with a history of major abdominal pain. First diagnosis was chronic pancreatitis because of clinical presentation, alcoholic intoxication, and the results of medical imaging techniques. A vagotomy associated with a gastroenterostomy was performed. Several years later the abdominal pain relapsed and failed to be cure by means of medical treatment. A duodenopancreatectomy was performed. Histology demonstrated the diagnosis of C.D.A.P.T. C.D.A.P.T. is a benign disease of the pancreas, limited to its cephalic portion, without demonstrated pathogenesis. C.D.A.P.T. can be either isolated or associated with a chronic pancreatitis. Clinical diagnosis can be particularly difficult as indicated by a literature review. Abdominal pain is the main symptom. Clinical presentation is rarely related to a complication (stenosis). Endoscopy, sonogram, and CAT scan are three techniques of diagnosis value, but intraluminal-sonography is more efficient. Tumor excision is not recommendable. Treatment of C.D.A.P.T. by duodeno-pancreatectomy (D.P.) is often indicated because of concurrent chronic pancreatitis or suspected pancreatic carcinoma. In case of clinical diagnosis of C.D.A.P.T., fenestration of the cysts under endoscopic control is the only local treatment that can avoid D.P.

[Stomach leiomyoblastoma: contribution of cytology. Apropos of a case]. / Léiomyoblastome gastrique: apport de la cytologie. A propos d'un cas.

The authors report the case of a 51-year-old man with gastric leiomyoblastoma, presenting with a history of gastrointestinal bleeding and hemoperitoneum. CAT scan showed a mass measuring 10 x 10 cm arising from the stomach. At laparotomy the mass extended into the gastrosplenic omentum. A splenopancreatectomy was performed and the mass was excised for biopsy. The cytologic findings suggested a mesenchymal tumor; histology demonstrated the diagnosis of leiomyoblastoma. The postoperative course was uneventful. In the literature there is no evidence that intraperitoneal bledding from these tumors worsens survival. The cytopathologic features of leiomyoblastoma are discussed.