[Sternal metastasis from differentiated thyroid carcinoma: what management?]. / Que faut-il faire devant une métastase sternale d'un cancer différencié de la thyroïde?

OBJECTIVE: The aim of this study was to evaluate results of surgical management for sternal metastasis from differentiated thyroid carcinoma. METHODS: A retrospective study has been completed on patients treated in our department for sternal metastasis from differentiated thyroid carcinoma. RESULTS: Among the 235 patients who underwent thyroidectomy for thyroid cancer, seven (3%) had sternal metastasis during follow-up. These sternal metastasis were metachronous with an average delay of 10 years. Treatment corresponded to an excision of the upper half of the sternum including internal parts of the clavicle and the adjacent ribs (four cases), a reduction of the metastatic tumour mass (two cases) and one biopsy with no resection (one case). After sternal excision, reconstruction of the chest wall was obtained with the use of polyester prosthesis covered with pectoral muscle flap. Radioiodine was assigned to all patients as a complementary therapy. With an average follow-up of 58 months, no local or distant recurrence was observed in five patients (71%). Two patients had local and/or distant metastasis. CONCLUSION: Incidence of sternal metastasis is rare but does not preclude a large surgical resection. When possible, an aggressive management (surgical resection and radioiodine therapy) allows more than 70% relapse-free survival at 5 years.

[Desmoid tumors of the abdominal wall: three cases]. / Les tumeurs desmoïdes de la paroi abdominale. A propos de trois cas.

Desmoids tumors are rare. They often develop from the fascia and muscles of the abdominal wall. They are considered as benign, but endowed with local aggressiveness. Treatment is primarily surgical. Complete resection with large safety margins and sometimes complex reconstruction is necessary to reduce the risk of local reccurrence. WE report three cases of histology proven desmoids tumors of the abdominal wall treated between 2000 and 2007. Etiologic factors, diagnosis, surgical management and adjuvant therapy in case of incomplete resection or reccurrence are discussed.

[Thyroid cancer in patients with Grave's Disease]. / Maladie de Basedow et cancers différenciés de la thyroïde.

OBJECTIVE: To evaluate the incidence of thyroid carcinoma in patients operated on for Graves' disease, to identify criteria which may predict malignancy, and to develop a practical approach to determine the extensiveness of thyroidectomy. PATIENTS AND METHODS: Retrospective study of all patients who underwent thyroidectomy for Graves' disease between 1995 and 2005. RESULTS: 547 patients underwent subtotal thyroidectomy for Graves' disease during this period. Post-operative pathology examination revealed six cases of thyroid cancer (1.1%). All six cases had differentiated thyroid carcinoma (papillary carcinoma in 3 cases, follicular carcinoma in 2 cases and papillo-follicular carcinoma in 1 case). The indication for initial thyroidectomy was a palpable thyroid nodule in 3 cases (50%), failure of medical treatment for Grave's disease in 2 cases (33%), and signs of goiter compression in 1 case (17%). Five patients underwent re-operative total thyroidectomy. CONCLUSION: This study shows that while malignancy in Grave's disease is uncommon, the presence of thyroid nodule(s) in patients with Grave's disease may be considered as an indication for radical surgery. The most adequate radical surgery in this situation is to perform a total thyroidectomy.

[Not Available]. / Maladie de Basedow et cancers différenciés de la thyroïde.

UNLABELLED: R. Mssrouri, S. Benamr, A. Essadel, J. Mdaghri, El H. Mohammadine, M.-K. Lahlou, A. Taghy, A. Belmahi, B. Chad Objective: To evaluate the incidence of thyroid carcinoma in patients operated on for Graves' disease, to identify criteria which may predict malignancy, and to develop a practical approach to determine the extensiveness of thyroidectomy. PATIENTS AND METHODS: Retrospective study of all patients who underwent thyroidectomy for Graves' disease between 1995 and 2005. RESULTS: 547 patients underwent subtotal thyroidectomy for Graves' disease during this period. Post-operative pathology examination revealed six cases of thyroid cancer (1.1%). All six cases had differentiated thyroid carcinoma (papillary carcinoma in 3 cases, follicular carcinoma in 2 cases and papillo-follicular carcinoma in 1 case). The indication for initial thyroidectomy was a palpable thyroid nodule in 3 cases (50%), failure of medical treatment for Grave's disease in 2 cases (33%), and signs of goiter compression in 1 case (17%). Five patients underwent re-operative total thyroidectomy. CONCLUSION: This study shows that while malignancy in Grave's disease is uncommon, the presence of thyroid nodule(s) in patients with Grave's disease may be considered as an indication for radical surgery. The most adequate radical surgery in this situation is to perform a total thyroidectomy.

[Splenomegaly and splenic pseudotumor due to tuberculosis: six new cases]. / Splénomégalie et pseudo-tumeur splénique d'origine tuberculeuse: six nouvelles observations.

INTRODUCTION: Splenic tuberculosis is rare. The aim of this study was to remind diagnostic problems in this disease, and to evaluate the value of surgery in its management. MATERIAL AND METHODS: Retrospective study of data of six patients (three male and three female, whose mean age was 50 years) admitted in surgical department from 1980 to 2000 for splenic tuberculosis. RESULTS: In six cases, symptoms were poorly specific; splenomegaly and anemia were constant. In imaging studies, splenomegaly was homogeneous in four cases and heterogeneous in two. Diagnosis of tuberculosis was done without need for splenectomy in four patients. Five patients were operated on: two had diagnostic laparotomy without splenectomy, two underwent diagnostic splenectomy and one had splenectomy indicated for splenic abcess refractory to medical treatment. Four of the five operated patients recovered. The two other patients were lost of follow-up. CONCLUSIONS: In our experience, surgery is useful in diagnosis and treatment of splenic tuberculosis.

[Hibernoma: a rare case of massive weight loss]. / L'hibernome: une cause rare d'amaigrissement massif.

Hibernoma is a rare soft tissue benign tumor composed of cells similar to those of brown fat observed in fetus and hibernating animals. Brown fat has thermogenous properties, by the way of carbohydrates and lipid catabolism, and can be of an important mean in thermoregulation. A massive weight loss is a rarely reported sign in patients with hibernoma. We report herein the case of a 47 man with a history of isolated weight loss, of 16 kg over 4 months. Clinical examination has shown a swelling of the right flank. Surgical resection has been made and histopathological examination has shown hibernoma. The post-operative weight gain confirmed the relationship between hibernoma and weight loss.

[Cicatrix endometriosis of the abdominal wall]. / L'endométriose cicatricielle de la paroi abdominale.

Endometriosis is a rare entity, related after operation on the uterus or uterine tubes or a laparotomy procedures or other extrapelvic procedures, when seeding of endometrial fragments were shed into the peritoneal cavity. We report the case of a menopaused woman with a subcutaneous incisional scar mass that appeared 22 years after a caesarean section. The diagnosis was made by histological examination.

[A rare complication of ileal pouch anal anastomosis: superior mesenteric artery syndrome]. / Une complication rare de l'anastomose iléoanale avec réservoir: le syndrome de la pince mésentérique.

The aim of this study was to report a new case of superior mesenteric artery syndrome following total proctocolectomy and ileal pouch-anal anastomosis for chronic ulcerative colitis. Diagnosis was made following a prolonged gastric stasis and was based on upper gastrointestinal X-ray series. Medical treatment was unefficient and gastro-jejunostomy was performed. The early outcome was good.

[Apropos of a case of gas gangrene of the abdominal wall after cholecystectomy]. / A propos d'une observation de gangrène gazeuse de la paroi abdominale après cholécystectomie.

The authors report a new case of gas gangrene following cholecystectomy with a fatal outcome. Mode of infection and principles of diagnosis and therapy are discussed together with a review of the literature.

[Treatment of cystobiliary fistula of hydatid cyst of the liver. Apropos of 33 cases]. / Traitement de la fistule kysto-biliare du kyste hydatique du foie. A propos de 33 cas.

33 hydatid cysts of the liver, opened into the biliary tract were reviewed. The biliary fistula was located in the biliary tract: 16 cases in the right, 14 cases in the left, 1 case in the common bile duct, and 3 cases in the gallbladder. (One case had fistula in the gallbladder and the anterior sectorial canal). Surgical treatment was conservative in 21 cases: bipolar drainage in 10 cases and cysto-biliary disconnection in 11 cases. The treatment was radical in 12 cases: Pericystectomy in 5 cases and liver resection in 7 cases. One postoperative death was observed following bipolar drainage-Postoperative biliary fistula was seen in 8 cases, 7 among them appeared following bipolar drainage. The present results prove the inadequacy of bipolar drainage that should be avoided in large fistula. Better results were observed with radical methods with low morbidity and no mortality. When radical methods are impossible, cystobiliary disconnection seems to allow efficient treatment of cystobiliary fistula with very good immediate and long-term results.

[Orthotopic transplantation of segmental hepatic graft from living donors in the dog. Technic and results]. / Transplantation orthotopique d'un greffon hépatique segmentaire prélevé sur donneurs vivants chez le chien. Technique et résultats.

The authors describe new technic of non-auxiliary orthotopic transplantation of segmental liver harvested from living dogs. 32 dogs were utilized. In the donor dogs, the left medial and lateral lobes were mibilized. The left portal branch, left hepatic artery, left biliary branch and the left hepatic vein were dissected free. The segmental liver graft was perfused and cooled in-situ through the left portal vein. The recipient dogs underwent two steps total hepatectomy: First the segments I, II, III, IV and V were resected. The segments VI and VII were maintained as well as the right portal vein and the retro-hepatic inferior vena cava order to keep the splanchnic and caval flux and to avoid the spleno-cavo-jugular by-pass. The segmental liver graft was then transplanted in an orthotopic position. Termino-lateral hepatico-caval anastomosis and left porto-portal anastomosis as well as arterial and biliary reconstruction were executed. All the donors survived more than 30 days. Nine recipient dogs died during the first three post-operative days from hemorrhage (3 dogs), fibrinolysis (2 dogs), primary non function of the graft (2 dogs) and hepatic artery thrombosis (1 dog). Seven recipients survived more than 30 days.

[Hepatic hydatic cysts rupturing into the bile ducts. Treatment by cysto-biliary disconnection]. / Kystes hydatiques du foie ouverts dans les voies biliaires. Traitement par déconnexion kysto-biliaire.

Rupture of hydatid cyst of the liver into the biliary tract is a severe and relatively frequent complication, and its treatment is controversial. Cysto-biliary disconnection provides an anatomical disjunction between the residual cavity and the biliary fistula. The operation consists of draining the main biliary tract, the ectocytic cavity and the fistulous tract, using a multiperforated drain which exists through a transparenchymatous channel. This technique has the advantage of avoiding the postoperative bile discharge and shortening the hospitalization time. It seems to give excellent short- and long-term results.

[Cyclosporin, toxicity and efficacy in rejection of liver allografts in the rat]. / Ciclosporine, toxicité et efficacité dans le rejet des allogreffes hépatiques chez le rat.

52 orthotopic liver transplants were performed in DA to lewis rat strain combination, in order to appreciate cyclosporine toxicity, and efficacy at doses of 10 mg/kg day (G II) and 20 mg/kg/day (GIII) compared to liver allografts in DA/lewis rats. The first signs of cyclosporine hepatotoxicity are biological (increased plasma level of bilirubine and transaminase) that were noticed at the dose of 20 mg/kg/day. Histological signs (cells inclusion, hepatocytic necrosis) appeared late and were less constant as well as difficult to assert creatinine plasma level was the best reflect of cyclosporine nephrotoxicity. Renal toxicity was practically constant at the dose of 20 mg/kg/day. In spite of renal and hepatic toxicity, cyclosporin by itself, allows the abolition of the acute rejection of liver allografts in the rat.