Environmental Protection in the Tomsk Region of the Russian Federation: A Case Study.

/ Implementation of environmental management in Russia is undergoing rapid changes. Federal responsibility rests with the Russian Federation State Committee for Environmental Protection (RFSCEP) and is delegated at regional level to local State Committees for Environmental Protection (SCEPs). This paper focuses on the functioning of the SCEP for Tomsk oblast' (region) in Siberia, which is strongly committed to forging constructive links with regional government, academia, industry, and environmental NGOs. Considerable difficulties exist for SCEPs in Russia, however, and prominent among these are (1) a rigidly vertical civil service structure, with separate organs having responsibility for different natural resources, persisting from Soviet times, which hinders effective intergrated and holistic environmental management; and (2) a lack of open access to environmental information from military and quasi-military sites.

[Adenocarcinoma of the appendix. Apropos of 11 new cases]. / L'adénocarcinome de l'appendice. A propos de onze cas inédits.

The authors review 11 new cases of adenocarcinoma of the appendix and 220 other cases drawn from the literature. In the first series, 6 patients presented with abscess or perforations. The tumor was proximal in 5, distal in 2, medial in 2, and total in 2. It extended to the cecum in 4 cases and to the lymph nodes in two. The clinical picture was one of appendicitis in seven patients, an iliac growth in three and occlusion in one. The diagnosis was made by the surgeon in four cases, and by postoperative histological examination in seven. The authors stress the need to open the appendix at operation, to take frozen sections in the event of any doubts, and systematic postoperative histological examination of operative specimens. Appendectomy is a poor solution, even accompanied by partial cecectomy, the survival rate at five years being only 20 %. It is only licit for a unperforated, proximal mucosal or submucosal tumor. The best solution is immediate or secondary right hemicolectomy, for which the survival rate, of 45 % at five years, is close to that of other forms of colic cancers.

[Subacute cytosteatonecrosis of pancreatic origin. Surgical problem in 5 cases (author's transl)]. / La cytostéatonécrose sous-cutanée d'origine pancréatique. Le problème chirurgical à propos de 5 observations.

The authors report 5 cases of subcutaneous cytosteatonecrosis (Weber-Christian syndrome of pancreatic origin) and review 68 cases in the world literature. The skin, bone joint and general manifestations may appear without any clinical or radiological sign of pancreatitis. The rise in blood and urinary amylase and lipase, the skin lesions, the joint pleural and peritoneal effusions, orient the diagnosis towards the pancreas and suggest a full radiological arteriographic and echotomographic investigation. The pancreatic disease was pancreatitis in 50 cases, cancer in 18 cases. Too long a delay between the initial signs and the diagnosis may lead to early operation even in the absence of pancreatic signs. The cancer may still be limited and removable. The pancreatitis was in 18 cases a false cyst of the head in 2/3rds, whether obvious clinically or not. Operation led to its discovery usually but may miss the lesion which is then only discovered on autopsy. Removal or early by pass operations transform the prognosis which is otherwise fatal. Analysis of these cases illustrates well the problems of indication operative management and efficacy of surgery in a disease still relatively unfamiliar both to physicians and surgeons.

[An original technic of reimplantation of the papilla after accidental disinsertion during gastroduodenectomy for duodenal ulcer]. / Une technique originale de réimplantation de la papille après désinsertion accidentelle au cours d'une gastro-duodénectomie pour ulcère duodénal

During accidental disinsertion of the papilla during surgery of duodenal ulcer, an isolated, pediculated loop of the small intestine was interposed between the head of the pancreas and the second part of the duodenum.