[Appendiceal mucoceles, pseudomyxoma peritonei and appendiceal mucinous neoplasms: update on the contribution of imaging to choice of surgical approach]. / Mucocèles appendiculaires, pseudomyxomes péritonéaux et tumeurs mucosécrétantes du carrefour iléocaecal: apport de l'imagerie dans la stratégie thérapeutique et le choix de la voie d'abord laparoscopique ou classique.

INTRODUCTION: The treatment of pseudomyxoma peritonei (PMPs) and appendiceal mucocele (AM) has changed radically. To assess the contribution of preoperative imaging to the treatment strategy and choice of approach, a surgeon and a radiologist different from the initial radiologist examined the files of all patients treated for PMP or AM in four facilities in one district from January 1, 1996, through December 31, 2008. PATIENTS AND METHODS: The study included 27 patients (20 men and seven women, mean age: 63+/-13 years). Eleven patients had an intact AM, seven synchronous PMP (malignant appendiceal lesion in two of seven), six metachronous PMP (five with peritoneal mucinous carcinomatosis and one with diffuse peritoneal adenomucinosis) and three a ruptured AM but not PMP. The incidence of mucin-secreting tumors observed (27 cases in 12 years in a region of 500 000 inhabitants) corresponds to a prevalence of approximately five cases per year per million inhabitants. Acute clinical pictures (7/27) were significantly more frequent for the malignant forms (5/7) (p<0,02). RESULTS AND DISCUSSION: The overall sensitivity of computed tomography (CT) for all the criteria studied was 93%. The predictive value for AM rupture of visualization of thick calcifications was 100%. On the other hand, rupture never occurred when the CT showed an AM under pressure, with thin walls and septa. The predictive value for PMP of "scalloping" was 100%. The diagnostic accuracy of the initial reading was 25/27 for the imaging overall and 25/25 for the CT. Preoperative visualization of the exact size of the intact AM or of diagnostic information about ruptured AM and PMP helped to select an appropriate approach in 25 of 27 cases.

[Distal tubal microsurgery using the CO2 laser. Experimental study and analysis of a series of 95 cases]. / La microchirurgie tubaire distale au laser CO2. Etude expérimentale et analyse d'une série de 95 cas.

After having used the CO2 laser in gynaecological surgery for 5 years, can we already work out a balance of the effects of laser in this field and especially in tubal microsurgery? An experimental study was carried out on 2 groups of rabbits, the first group being one where artificially created adhesions were freed without any residue thanks to the CO2 laser, and a second group where the uterine cornua could be sutured using pulses of laser and no sutures. 95 microsurgical tubal operations were carried out using the CO2 laser between 1979 and 1983. Adhesiolysis was carried out in 39 patients with 25 intra-uterine and one extra-uterine pregnancies resulting. Fimbrioplasty was carried out in 41 patients with 24 intra-uterine and 2 extra-uterine pregnancies. Salpingostomy was carried out in 15 patients with 5 intra-uterine pregnancies and one extra-uterine pregnancy. A second surgical procedure was carried out in 20 patients with 7 intra-uterine pregnancies and one extra-uterine pregnancy. The CO2 laser makes microsurgical techniques easier and avoids recurrent adhesions, giving rise to a level of pregnancies in the region of 60% after adhesiolysis and fimbrioplasty. This latter term was used for the reconstruction of the ampulla, which had only partially been blocked. On the other hand, when there is a hydrosalpinx with total loss of patency, the laser is no more successful than classical microsurgical techniques.