[An atypical discipline: surgery in bullfighting. Two case reports]. / Une discipline atypique: la chirurgie taurine. A propos de deux observations.

Many bullfighters had been seriously injured, even sometimes killed during the fight in the bullring (around 300 deaths since the beginning of the 20th century). There is no comparison between bullfight's traumas and civil or war traumas, so only specialized medicine doctors and surgeons can be involved for practising. Surgery of bullfighting is a single speciality. The bullfight's surgeon in safekeeping will operate immediately in the bullfight place's infirmary and will aim at reducing the deep effect of horn injury. In this work, authors point out the bullfight pathology's complexity and its surgical treatment by presenting two original cases.

[A detailed examination of injuries to the head and neck caused by bullfighting, and of their surgical treatment; the role of the cervico-facial surgeon]. / Spécificités lésionnelles et chirurgicales des traumatismes de la tête et du cou en tauromachie. Rôle du chirurgien cervico-facial.

Bullfighting (corrida) dates back to the 13th century in France, especially in the Camargue and the South-West, even if this fight between man and wild bull had been described before in other countries. The current modern bullfight, as an artistic interpretation, was codified in Spain during the 18th century into 3 tercios (parts): the tercio of the lance, of the bandillera, and of the muletta, which end with the death of the bull. Celebrated by our Spanish neighbours as a national fiesta, the corrida represents a confrontation between the intelligence of man and the power of the bull. Injuries are the heavy cost of this art paid by each bullfighter. Most of them have been injured seriously, or even gored to death inside the bullring. Goring is a single injury, a mix of wound, burn, contusion and infection. Its treatment calls for an expert, which makes this type of surgery highly specialised. Head and neck trauma represents 16% of the total wounds in bullfighting. Its not very often that this type of injury happens, but each time it is serious. This study is based on 1450 case reports, deals with causes and accident circumstances, together with the type of injuries and their early management in the bullring's infirmary. The seriousness of these wounds would justify a head and neck surgeon being part of the medical staff during the corrida.

[Anatomic pecularities of the inguinal canal in West Indians. Influence on the management of inguinal hernia]. / Particularités anatomiques du canal inguinal chez l'Antillais. Incidences sur la cure de hernie inguinale.

Inguinal and umbilical hernias are much more frequent in the black and half-breed than in the white population. We have observed anatomical differences in the inguinal region between Whites and Blacks. The latter have a vertical, wide subcutaneous ring and a smaller conjoined tendon, and it is hardly possible to reconstruct the fascia of the obliquus externus abdominis anterior to the cord in them. For Black patients, we propose the suture of the conjoined tendon to the crural arch, like in the Bassini procedure, and the suture of the fascia of the obliquus externus to the arch, but in a retrofunicular position. This technique allows, so to speak, duplicating the caudal connection of the conjoined tendon to the arch by means of the extensive suture of 2 tissues of similar nature, ie. the fascia of the obliquus externus and the crural arch.

[Ambulatory thrombectomy of a graft. Transcutaneous clamping]. / Thrombectomie ambulatoire d'un greffon. Clampage transcutané.

Thrombectomy of a graft in ambulatory patients can be performed simply under local anesthesia, avoiding admission to hospital of patients with shunts. The technique is applicable to two types of shunt: arterio-arterial shunts for lower limb arteriopathy and arteriovenous shunts of a dialysis for chronic renal failure. The advantages are twofold: dissection of a subcutaneous graft is avoided and the patient can either immediately reinstitute activity if arteritic or dialysis for renal failure. The method is effective if the thrombus is of accidental origin, failures resulting from proximal or distal stenosis, their evaluation being possible during thrombectomy.

[Controlled fistula of Wirsung's duct]. / La fistule dirigée du canal de Wirsung.

In order to prevent the serious pancreatic fistulae which complicate anastomoses between the pancreatic tail and a jejunal loop after cephalic duodenopancreatectomy, we propose a pancreatic fluid derivation on a temporary drain equivalent to a controlled fistula of Wirsung's duct. This already known technique consists of a punctiform anastomosis on an Escat's supporting drain between the main pancreatic duct and the jejunum. No complication occurs when the drain is removed 12 days later, as shown by a series of 24 cephalic duodeno-pancreatectomies where this technique was used.

[Temporary jejunostomy]. / Les jéjunostomies temporaires.

The different techniques used for temporary jejunostomy are described. They are governed by the presence or absence of utilizable stomach. The advantages and drawbacks of each technique are examined. The simplest and most reliable one is transgastric jejunostomy. Two variants of jejunostomy after total gastrectomy and oesophagectomy are described.

[Success or failure factors in the treatment of insulin-secreting nesidioblastomas]. / De quelques facteurs de succès ou d'échec dans le traitement des nésidioblastomes insulino-secrétants

The authors report 5 cases of insulin- secreting nesidioblastoma which is not an exceptional tumour but may be suspected clinically before being confirmed in the laboratory. Fasting hypoglycemia or hyper-insulinism may be present, leading to arteriography and surgical exploration. The only valid forms of treatment are enucleation of the tumour or pancreatectomy, depending on whether it is situated on the right or on the left. The authors consider removal must be complete, if not, medical treatment should be preferred.

[Radiology of tumours of the region of the ampulla of Vater (author's transl)]. / Radiologie des tumeurs de la région vatérienne

On the basis of 18 personal cases, the authors discuss the different radiological appearances of tumours of the ampulla of Vater region. After a review of the histopathological aspects, they attempt to separate the respective indications for the various endoscopic and radiological studies possible, stressing the importance of duodenoscopy. They give an illustrated classification of the different appearances seen.

[Exploration and removal in focal infections of the liver (apropos of 32 resections in a 4-year period]. / De l'exploration à l'éxérèse dans les affections focalisées du foie. (A propos de 32 resections faites en 4 ans)

The surgeon can no longer be satisfied today, with a diagnosis of focal lesion of the liver. It is also necessary to give the precise localisation of the nodular image compared with the segments and vessels of the gland. The lesional topography is usually determined by coeliac arteriography but, in certain cases, complementary cavography becomes necessary. On knowledge of this hepatic angio-cartography, depends the choice of approach and the nature of the surgical operation, for there are easy methods of approach where, for example, removal may reasonably be attempted and, other segments which are difficult or impossible to approach, e.g. segments VIII and IV posteriorly. The authors report their experience of surgery of the liver between 1971 and April 1974 for 14 abscesses, 15 hydatid cysts, 5 tumours and 9 cases of trauma. They carried out 32 resections, 22 of the right lobe of the liver, 10 of the left lobe. The immediate results are studied in relation to the indications and techniques used.