Lumbar disk hernia in children. Apropos of 12 cases

Lumbar disc herniation in young adolescent is uncommon. Twelve patients of 13 to 16 years old (4 boys and 8 girls) are reported. Traumatic history is encountered only in 1/3 of cases and any spinal abnormality is noted in this series. The rapidity in clinical course is the main difference compared with the lumbosciatalgia of the adult. The mean interval of time between the beginning of clinical signs and surgery is 5 months and a half. A positive straight leg raising test is always present as well as antalgic pseudo-scoliosis. The radiculalgia without lumbalgia is the essential sign in on fourth of cases. The myelography and C.T. scan revealed lumbar disc herniation 5 times in L4-L5 intervertebral space and 7 times in L5-S1 space. The intervertebral disc is reached by unilateral interlaminal approach. The complete removal of the disc is always difficult as the disc is not dehydrated at this age. The radiculalgia disappears immediately in the postoperative period as well as the lumbalgia. The back pain persist some months following the surgery. Up the date any response is noted but the authors think that some prudence is necessary in the evaluation of the results especially because of the incomplete removal of disc in young patients. The authors think also that well hydrated and simply protruded disc of young adolescent may constitute an excellent indication for chemonucleolysis.     

Massive hemobilia. Review of the literature. Apropos of 2 cases

Two cases of hemobilia are reported; the first caused by a liver biopsy procedure, and the second ensuing an accidental liver laceration. In both cases, arteriography led to diagnosis and the ligature of the right hepatic artery stopped the hemorrhage with complete success. A review of the literature emphasizes the nowadays leading prevalence of iatrogenic hemobilia followed by those resulting from blunt abdominal liver trauma. Diagnostic facilities are reviewed and selective arteriography is stressed as being the more useful technique. From a therapeutical standpoint interventional radiology and surgery are both given their own place.     

Pleomorphic xanthoastrocytoma. Apropos of 3 new cases. Review of the literature]

Three cases of pleomorphic xanthoastrocytomas (P.X.A.), a low grade leptomeningeal glioma are reported. Prominent histological features used for diagnosis were a cellular pleomorphism of G.F.A.P. positive cells, with intracytoplasmic lipidic vacuols. A reticulinic network and mononuclear cells infiltrates have been observed. A weak mitotic activity and lack of necrosis and of endothelial cells proliferation were significant additional features necessary for diagnosis. Our cases were observed during the surgical management of young patients with resistant epilepsy. Neuroradiological examinations showed a tumor superficially located within the temporal or the parietal lobe. This tumor could be calcified and/or cystic. Operative aspects showed a firm and non-encapsulated leptomeningeal tumor with possible various colors. Our patients were seizures-free after surgery even during the follow-up. From the currently reported cases clinical follow-up ranging for 1.5 to 3 years is not sufficient to predict a favorable carcinologic prognosis. P.X.A. is an uncommon tumor and less than 50 cases are reported throughout the literature. This tumor affecting young subjects mainly during the second decade is revealed in the majority of cases (3/4) by epileptic seizures, less frequently by a deficit or by an intracranial hypertension. The great majority of clinical events are observed before 20 years. The functional prognosis is rather good after surgery with a disappearance of epileptic fits in about 50% of the cases. Throughout the literature the prognosis of this tumor seems to be comparable to low-grade astrocytomas. Optimal management of P.X.A. seems to be primary surgical resection with later surgery for residual or recurrent tumor. The role of radiotherapy in the management of P.X.A. is at this time uncertain.     

Retroperitoneal lipomas in children. Apropos of a new case. Review of the literature

Retroperitoneal lipoma is a rare tumor in children and is usually benign. A case in a 29 month old girl is reported together with a review of the 18 previously documented cases. The patients ranged in age from 1 to 8 years. Girls are affected three times as often as boys. The majority had a enlarged abdomen of long duration. Most lipomata were large. However, the tumor was easily removed. There have been no known recurrences following operative resection. A child with such a tumor should be followed until more clinical experience has been acquired. The possibility of these tumors being congenital in children cannot be excluded.     

Retro-costo-xyphoid hernia in adults. Apropos of 3 cases]

Three cases of retrosternal diaphragmatic hernia (Morgagni hernia) are reported. Diagnosis have been made by conventional radiology (Chest X-ray, Upper G-I series) in 2 cases: the third one was found incidentally during a laparotomy. Peritoneography, CT scan, NMR are recommended in the difficult cases. ONe case presented as acute gastric outlet obstruction secondary to an intra-thoracic volvulus of the herniated stomach. Surgical treatment is indicated in all cases of retrosternal diaphragmatic hernia because of the high-risk of complications (gastric volvulus, colonic obstruction). Surgery through an abdominal approach is preferred and post-operative course is benign.     

Intradural spinal metastasis from visceral neoplasms. Apropos of 4 cases. Review of the literature

Four patients were referred during the last year for treatment of an intradural metastasis. Primary sites were a bronchogenic carcinoma (one case), a prostatic carcinoma (one case) and in the two other cases the primary tumor was not found. In all cases Noot pain had lasted 1 to 5 months, despite CT examination during this painful period. Except in case n.4, diagnosis was not established until the onset of myelopathy. Surgical removal was complete in one case and subtotal in the three other cases, with complete postoperative relief of the pain in all cases and significative improvement of neurological status. The authors emphasize the importance of root pain as an early sign in these patients as well as the difficulty in establishing diagnosis. They discuss the different pathogenic mechanisms and the methods of treatment.     

Gastric ruptures caused by diving accidents. Apropos of 2 cases. Review of the literature

Underwater diving was responsible for gastric rupture in two cases seen personally and five cases of total gastric rupture reported in the literature. The various possible mechanisms for onset of this rupture are envisaged, the diagnosis of this rare accident being established from the existence of a large pneumoperitoneum. Emergency laparotomy allows suture of wound and ensures recovery.     

Cancer of the anus arising within condylomata acuminata. Apropos of 2 cases. Review of the literature

Two cases of squamous carcinoma of the anus developing from condylomata acuminata are reported. The general characteristics of condylomata acuminata are reviewed: viral etiology due to HPV virus, histological appearance and role in the the genesis of certain cancers. The association of condylomata acuminata and cancer of the anus is more particularly studied in a review of the literature: etiology, anatomoclinical aspects, treatment and current state of knowledge concerning the oncogenic role of HPV virus at this site.     

Trophoblastic tumor of placental location or trophoblastic pseudotumor. Apropos of 2 cases. Review of the literature

Two cases of trophoblastic tumor of placental site are reported, less than 30 such lesions being listed in the published literature. Identification of this tumor from among other trophoblastic lesions is facilitated by immunohistochemical and electron microscopy technics, and demonstration of histoprognostic and biologic criteria improves assessment of evolutory potential of this type of tumor and allows adaptation of therapy. Treatment at the localized stage requires early diagnosis and wide surgical excision, results of chemotherapy in metastatic forms being, inversely than with choriocarcinoma, very deceiving.     

One-stage treatment of neoplastic occlusions of the left colon. Apropos of 3 cases. Review of the literature

The authors report of 3 news of subtotal colectomy with immediate anastomosis in the treatment of neoplastic occlusion of the left colon. They review all the cases (153) actually published. The advantages of this technic are: treatment of the occlusion and of the cancer in one stage; quicker social rehabilitation (14.8 days) useful overall in patients whom survival is short, lower mortality rate (10.45%) lower morbidity rate (25.6%) and quite none sequellae.     

Intracerebellar schwannoma. Apropos of a case. Review of the literature

Intracranial schwannoma represents 8% of all primary brain tumors. It usually develops from the Schwann cells of a cranial nerve. Hemispheric intraparenchymal localisations are quite rare; 15 cases have been reported (3, 5, 12, 10, 14, 15, 18, 19, 23, 26, 28, 29) including one intraventricular localization (8). Intracerebellar localization is even by more exceptional. In 1977, one case was reported by Komminoth (16). Since then only one other case has been published in 1987 by Sarkar (25). In this paper, we report a third case.     

Spiegelian hernia. Apropos of a series of 31 cases]

31 cases of spiegelian hernias are reported. It is one of the world biggest statistics of this affection. The patients were divided in 18 women and 13 men, with an average of 45 years old. The hernia was located on the right side of the abdomen in 16 cases and on the left side in 13 cases. In two cases, the affection was bilateral. In 14 cases, there was an incarceration. No strangulation was observed. The rare forms can be divided in massive form, tumoral, crawling (in the old man), spread (in the infant and the woman). The spiegelian hernia can be associated with one or more other kinds of hernias. 27 patients underwent an operation. In all the cases, an direct approach was used. There was no post operative complications. We want to emphazise the high frequence of this affection in Gabon, and the fact that most of the cases have been observed within the same area, in the south of the country. A study researching predictive factors could be interesting to be realised in this area.