[Benign pre-sacral teratoma and vestigial retrorectal cysts in the adult]. / Tératome bénin mature pré-sacré et formations kystiques vestigiales rétro-rectales chez l'adulte.

Benign mature presacral teratomas or dermoid cysts occur rarely in the adult; the incidence is estimated at less than 1/40,000. They are considered to be retrorectal vestigial growths from embryonal rests; they are usually asymptomatic and discovered by chance. However, since they have a 20-30% risk of secondary infection and a 1-12.5% risk of malignant degeneration, they should undergo complete surgical resection. We present a case of presacral dermoid cyst in a young male and summarize the diagnostic and therapeutic management.

[Colorectal cancer discovered during pregnancy]. / Cancer colique découvert pendant la grossesse.

Colorectal carcinoma during pregnancy is very rare. Prognosis is severe because of the advanced stage due to delay in diagnosis and the aggressiveness of this widespread metastatic disease. We report the case of colon metaststic adenocarcinoma during a twin pregnancy with a good outcome. In the light of epidemiology, pathogeny and immunology, the diagnostic challenge for clinicians is distinguishing pregnancy symptoms from the warning signs of colorectal cancer and, we describe recommended medical and surgical management.

[Is laparoscopic surgical practice "factual" (evidence based)? Results of a prospective regional survey]. / La pratique de la chirurgie coelioscopique est-elle "factuelle" (evidence-based)? Résultats d'une enquête prospective régionale.

OBJECTIVE: Evidence-based medicine is a growing paradigm in health care. We conducted a prospective study to determine whether laparoscopic surgery is truly evidence-based in everyday practice. METHODS: A prospective regional survey was performed in 11 French hospitals (one university and 10 district hospitals) to ascertain how general laparoscopic surgery was conducted during the last 3 months of 1997. We also searched the electronic databases for original articles on laparoscopic procedures. The methodology of randomized trials was analyzed and procedures were classed by level of evidence. We assumed that an evidence-based procedure was which had been validated by well-designed randomized controlled or prospective trials giving homogeneous results. RESULTS: One half of the procedures performed had been evaluated by randomized controlled trials. Among the 428 laparoscopic procedures, 334 (78%) were found to be evidence-based (CI 74.1-81.9%). Twelve of the 18 indications for laparoscopy (67%) were evidence based (CI: 62.5%-71.5). There was no difference between university teaching hospitals and general district hospitals. CONCLUSION: Contrary to initial criticisms, the practice of laparoscopic surgery appears to be truly evidence-based in the majority of cases.

[A case of solid tumor of the small omentum (author's transl)]. / A propos d'un cas de tumeur solide du petit épiploon.

With regards to an observation of a solid tumor of the small "epiploon", the authors recall the exceptionnal character of the primitive small tumors of the "mesenterium". Such cases pose a histological problem because, when dealing with the "mesenterium", the various criteria for benignity or malignity are difficult to appraise due to the peculiar tissue structure. A pre-operative-selective "arteriogram" cannot be dispensed with this type of tumor. Outside of the diagnostic possibilities offered, this "arteriogram" will be the basis for the treatment given since the possibilities of removal are limited by the connection between the tumor and the vessels. Furthermore due to the histological difficulties posed by these tumors it is desirable to treat them as potentially malignant material and include the removal, even if limited, of the corresponding digestive segment.

[Instrumental technics of exploration of the mediastinum]. / Les techniques instrumentales d'exploration du médiastin.

Several techniques can be used for the diagnosing of diseases pertaining to the mediastinum. The diagnosis can be made in 78% of cases by mediastinoscopy. When the lesion is situated beyond the reach of mediastinoscopy, needle biopsy and pleuroscopy can be used either alone or associated to mediastinoscopy. The histological diagnosis can be made in almost all cases. But a few precautions are necessary because this technique carries a certain risk for vessels. Therefore preoperative angiography of the superior vena cava or arteriography of the branches of the aortic arch should be performed to help for the diagnosis and ensure its safety.

[Role of surgery in the treatment of deep venous thrombosis of the lower limbs and prevention of pulmonary embolism]. / Place de la chirurgie dans le traitement des thromboses veineuses profondes des membres inférieurs et prévention des embolies pulmonaires.

Besides anticoagulants and thrombolytic drugs, surgery should be included among the therapeutical means to prevent deep phlebitis of the lower limbs. Early phlebography, thoroughly innocuous, is necessary to any coherent therapy. The prevention of pulmonary embolism which can be done by a ligature of the inferior vena cava or by the fitting of an umbrella-shaped filtre, is performed most of the time with a clamp of Adams and de Weese. Its reliability is satisfactory as the percentage of embolic recurrences does not exceed 5%. Early venous thrombectomy prevents in 60 to 80% of cases the post-phlebitic incidents; but its indication must be reserved to young patients.