[Results of vascular repairs in trauma of the femoral veins, iliac veins and the inferior vena cava]. / Résultats des réparations vasculaires dans les traumatismes des veines fémorales, des veines iliaques et de la veine cave inférieure.

We examined the records of 12 patients operated for lesions of the inferior vena cava, the iliac vein, or the common femoral vein were examined. The results of venous grafts, treatment of the lesions of the posterior inferior vena cava or the supra hepatic vena cava and the permeability after repair of these large vessels was studied. Treatment included simple suture (n = 9), venous patch (lateral iliac vein, n = 1), and venous autografts (common femoral veins, n = 2). For 3 lesions of the posterior or supra-hepatic inferior vena cava, haemostasis was obtain by double clamping (n = 2) or four-way clamping (n = 1) with right hepatectomy. In 9 cases, the patients were followed-up for a mean of 59 months. Morphologic exploration with phlebography (n = 1) or echo-Doppler examination (n = 7) was performed during the follow-up period. There were no post-operative deaths. There were no functional sequellae affecting the lower limbs. In one case, the echo-Doppler examination revealed repermeabilization of a thrombosed lateral iliac vein after simple suture. Lesion repair of large diameter veins with autografts using the internal jugular or internal saphenous vein gave good results. Haemostais of posterior or supra-hepatic lesions to the inferior vena cava was obtained with clamping. In cases with associated hepatic involvement, haemostasis was controlled with a four-way clamp and trans-hepatic access or digitoclasty. Long-term permeability of venous repair was good.

[Use of a biological glue in partial pulmonary excision surgery. Results of a controlled trial in 50 patients]. / Utilisation d'une colle biologique en chirurgie d'exérèse pulmonaire partielle. Résultats d'un essai contrôlé chez cinquante malades.

A controlled study concerning the surgical use of a fibrin glue was conducted in 50 patients undergoing partial pulmonary excision. In 25 of these patients, chosen at random, hemostasis and aerostasis of the fissural, and/or intersegmentary dissection planes were achieved by electrocoagulation, in the other 25 by the application of fibrin glue. The statistical study did not show any significant difference between the two groups in terms of the surgical indication, the type of excision and the associated surgical procedures (pleurectomy and parietectomy). No significant statistical difference was observed concerning the quality of aerostasis, the post-operative drainage, the persistance of residual collection or faulty reexpansion after removal of the latter, and the necessity for repeated drainage. The same applied to the length of post-operative hospital stay. This study seems to demonstrate that the surgical application of fibrin glue on the fissural and/or intersegmentary dissection planes is feasible but, as compared to electrocoagulation, does not significantly improve the quality of the surgical results for partial pulmonary excision; however its use could reduce the duration of post-operative drainage.

[Computed tomography of the abdomen in 8 cases of pancreatic trauma]. / La tomodensitométrie de l'abdomen dans huit cas de traumatisme pancréatique.

Computed tomography (CT) is an accurate method for detecting pancreatic trauma. There are two pitfalls to its use: the indication of CT and the risk of misinterpretation. The purpose of this study was to evaluate these 2 difficulties. We report our experience and results obtained in 8 patients with pancreatic trauma (7 closed, 1 open). Peritoneal lavage demonstrated an increased amylase level in the fluid in 2 of our patients. Computed tomography was performed as an emergency diagnostic test for 2 patients and secondarily in 6 patients. In 5 patients, the pancreatic injury was considered to be deep with suspicion of a major pancreatic duct lesion and in 3 patients, the lesion was superficial. Six patients had operative confirmation of the CT results. Pancreatic injuries were classified according to Hervé and Arrighis. Four were grade III, 1 grade II, 1 grade I, while CT showed 5 deep injuries and 1 superficial injury in these patients. Two patients with CT signs of superficial injury were not operated. When there is a clinical suspicion and/or a high amylase level in serum, urine or fluid collected from peritoneal lavage, CT must be carried out as part of in the overall strategy of management of isolated pancreatic trauma. We believe that CT is a valuable tool to evaluate the extent of the injury to the pancreatic parenchyma.

[Anatomo-clinical and therapeutic study of esophageal resection for cancer of the thoracic esophagus]. / Etude anatomo-clinique et thérapeutique des résections oesophagiennes pour cancer de l'étage thoracique.

272 cancers of the thoracic esophagus were resected on 664 cases observed from 1975 to 1985 (resection rate: 41 p.c.): 8.1 p.c. were on the upper third, 71.3 p.c. on the middle third, 20.6 p.c. on the lower third of the esophagus. Tumors were classified as stage I (12: 4.5 p.c.), II (40: 15.2 p.c.), III (100: 37.9 p.c.), IV (112: 42.2 p.c.); 8 cases were not classified. Post-operative radiotherapy was administered to 90 patients. Hospital mortality was 50 (18.4 p.c.). Respiratory complications were the main lethal cause. After a post-operative survival of 81.6 p.c., survival at 1 year was 58.3 p.c., at 3 years 23.3 p.c., at 5 years 9.8 p.c. Actuarial survival at 5 years is 11.1 p.c. +/- 3, 17.2 p.c. for T1 and T2, 8 p.c. for T3. No advantage was noted comparing neck or intrathoracic anastomosis. Post-operative irradiation was beneficial. Factors influencing survival are staging, curative or no curative resection and post-operative irradiation for T3 N+. Nodes invasion is more important than invasion of the site of anastomosis. Palliative resections are the majority. They have no more severity than curative resections and give a 10 p.c. 5 years survival. The main effort must bear on a decrease of post-operative pulmonary complications and mortality.