[Plea for large excision of the thyroid gland in benign diseases (retrospective study 1986-1996)]. / Plaidoyer pour une exérèse large de la thyroïde dans la pathologie bénigne (étude rétrospective 1986-1996).

According to the literature and the study of 158 patients who have been examined, operated and analysed by the same medicosurgical staff, the authors have found a great frequency of clinical and echographic recurrencies. This frequency has also been found by others teams. The study of the different factors for goitrogenesis, either in multiplication of thyrocytes or tissular differentiation shows the pathogenic polymorphism. For the polynodular lesions, most of them located in the 2 lobes, total thyroidectomy seems to be the only procedure to prevent recurrencies. For the nodular lesions, most of the time unilateral, recurrencies are due to the fact that infracentimetric lesions have not been detected by preoperative ultrasonography and scintigraphy. They are discovered by postoperative ultrasonography and the long time follow-up is not to this date sufficient. The palpation and the peroperative ultrasonographic verification of the remaining lobe seem to be the best attitude to avoid the growth of small undetected lesions.

[Epidermoid cyst of the spleen]. / Kyste épidermoïde splénique.

Epidermoid cysts rarely occur in the spleen and are often found fortuitously. Epidermoid cyst of the spleen is an inclusion of epidermoid elements within a mesodermic structure. Treatment is partial conservative splenectomy followed by ultrasound surveillance.

[Influence of surgical biliary pathology on the diffusion of ceftriaxone in the biliary tract]. / Influence de la pathologie biliaire chirurgicale sur la diffusion de la ceftriaxone dans l'arbre biliaire.

Ceftriaxone is a third generation cephalosporin remarkable for its wide distribution in the biliary tract. The purpose of this study was to determine whether biliary tract pathology, as observed during surgery, had an influence on this distribution. 52 patients about to be operated upon and presenting with a high risk of bile infection received a single 1 or 2 g dose of ceftriaxone administered intravenously over 20 min during the hour that preceded surgery. Samples of blood and of bile from the gallbladder (GB) and the common bile duct (CBD), as well as specimens of the GB wall were taken during the operation. In patients whose GB was normal at laparotomy (apart from stones) ceftriaxone concentrations in bile and GB wall were 10-25 and 2 times respectively higher than in plasma. In patients with a grossly distended but not infected GB (hydrocholecystis) ceftriaxone levels were high in CBD bile but null in GB bile and only one-quarter to one-half of plasma levels in GB wall. In patients with stones in the CBD or inflamed GB wall ceftriaxone levels were high in bile (although lower than in cases with normal GB) and similar to plasma levels in GB wall. When malignant pancreatic lesions were present ceftriaxone concentrations could not be measured in both GB and CBD bile but reached 50% of plasma concentrations in GB wall.(ABSTRACT TRUNCATED AT 250 WORDS)

[Antibiotherapy in biliary surgery. Current status]. / Antibiothérapie en chirurgie biliaire. Etat actuel de la question.

Without antibiotherapy, biliary surgery is often followed by infectious complications, possibly serious, indeed life-threatening. Biliary bacteria do are responsible of these complications; mainly E. Coli, Streptococcus faecalis (whose pathogenicity is disputed) and Klebsiella. Bacteroides fragilis and Pseudomonas aeruginosa are restricted to special circumstances. It is often difficult to presee whether bile is infected: some risk factors were emerged by Keighley but their specificity is not excellent; peroperative Gram staining got various results according to the studies. Some prefer to give a systematic antibiotherapy. Preoperative antibiotic treatment should be as short as possible because it does not sterilize bile, but selects resistant bacteria, which induce postoperative complications. It must mainly be aimed at preventing infectious scattering. Surgery is the main part of the treatment. Antibiotic choice has to take into account clinical picture, bacteria (those probably responsible for and their sensibility) and goal of the treatment (prophylactic or curative). Analysis of failures should allow to improve this choice. But only multicenter studies concerning full selected populations of patients are able to prove superiority of one antibiotic to another.

[Diagnostic value of arteriography in a case of splenomegaly of unknown origin (author's transl)]. / Apport de l'artériographie dans un cas de splénomégalie inexpliquée.

A 32 year-old patient was found to have a tender enlarged spleen with hardly any other signs apart from transient fever and moderate hepatomegaly. Coeliac arteriography was performed to eliminate the possibility of a splenic tumor. The splenic arteriography showed the presence of a great number of lacuna dispersed throughout the parenchyma and measuring 0,5 to 1 cm. Histopathological examination of samples of the spleen, removed by operation, and biopsies of the liver and lymphnodes confirmed the diagnosis of sarcoidosis of the liver, spleen and lymphnodes.