[Pancreatic insulinoma, adenomatosis of the Wirsung's duct and chronic pancreatitis. Apropos of a case]. / Insulinome pancréatique, adénomatose du canal de wirsung et pancréatite chronique. A propos d'un cas.

The clinical investigations carried out in a 58 years woman complaining of malaise led to the discovery of an hypoglycaemia resulting from a secreting pancreatic insulinoma. In addition, a chronic pancreatitis, an endocrine hyperplasia (possible nesidioblastosis) and a villous adenomatosis of the pancreatic duct were diagnosed on two biopsies. The immunohistological tests performed on the insulinoma showed insulin, calcitonin and gastrin labelled cells. Electron microscopy displayed numerous neurosecretory granules. The peritumoral endocrine hyperplasia contained intermingled B, A and D cells respectively labelled by insulin, glucagon and somatostatin. Following the operation, the patient recovered without recurrence of the hypoglycaemia (three year follow-up). Factors which may explain such a rare pathological association are discussed.

[Thoraco-bisternotomy in cardiovascular surgery]. / La thoraco-bi-sternotomie en chirurgie cardio-vasculaire.

Median sternotomy associated with anterior lateral thoracotomy with section of the sternum opposite the gaping intercostal space is a classical, though rarely used, incisional approach. The authors are convinced that it is safe, easy to perform and well tolerated. Their experience in 14 cases without morbidity shows that its alleged problems are more theoretical than real. They recommend this approach for aneurysms of the thoracic aorta and in some cases for access to the atrial area and superior vena cava.