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Surgical specialization is a logical consequence of the evolution of medicine. On the other hand, overspecialization appears in a more perverse way; out of 39 specialist surgeons polled during the latest A.F.C. meeting, 22 think that overspecialization is not a good thing. This situation gives rise to several reflections: early specialization may lead to poor surgical training and some surgeons may be unable to change to a new specialty; overspecialization is an invitation to medical overconsumption; the "overall" patient management in regions with a poor medical infrastructure may be difficult; finally, the legal consequences are still unknown. Thus the changes brought about by surgical specialization and overspecialization require thinking about the nationwide distribution of health facilities and about our country's surgical policy.

Two hundred and seven patients aged from 37 to 65 years with noninflammatory breast cancer treated by surgery without radiation were studied over a ten year period with a view to forecasting the prognosis on the basis of the immune status and treatment. The immunocompetence or immune status was studied in 121 patients by in vitro and in vivo pre and post-surgical skin tests. The immunostimulation or restoration of the immune status was conducted by the P 40 immunomodulator from the Pasteur Institute: in an experimental study whose results are based on modified Huggins model and take in to account the survival rate and the evaluation of tumor growth; in a subgroup of 86 patients, demonstrating that immunostimulation is effective in low-scores, improves tolerance to chemotherapy and increases the six year survival rate in high risk low-score patients. The results are encouraging enough to propose improving the survival rate in a prospective clinical study of early breast cancer treated by local and regional means using a protocol incorporating an immunostimulation based on the existing immunocompetence with interferon-induced reconversion of the target cells in the hope of specific stimulation.

This case report documents severe autoimmune thrombocytopenia in a 20 yrs. old patient with ulcerative colitis. Diagnosis of idiopathic thrombocytopenic purpura was made on the presence of bound antiplatelet antibodies and on the absence of any other disorder capable of provoking a platelet fall. Colonic lesions were moderate but were resistant to steroids and total parenteral nutrition. Thrombocytopenia resisted to steroids and vincristine and a major fall in the platelet count (less than 10,000/mm3) occurred in two instances. However, platelets rose transiently after high-dose intravenous gamma-globulins. The patient underwent splenectomy, colectomy and ileostomy because of life-threatening colonic hemorrhage. The platelet count rose to normal levels within one week after surgery. Ileorectal anastomosis was subsequently performed. One year later the patient was in good health and his platelet count had returned to normal.

The study of the immune status of breast cancer patients with delayed hypersensitivity skin tests reveals a clear immune deficiency in comparison with a reference patients group. This immunstatus was significantly improved by an immunstimulation with the P40 fraction. The responsive capacity to an immunstimulation appears independant of the lymphnodes involvment, whereas, on the contrary, the initial degree of immune deficiency appears connected. The P40 fraction has an immunstimulant effect comparable with the BCG and has not occasioned any local or general undesirable reaction.

One hundred eighty left colonic single-layer end-on anastomoses performed on 90 rats by microsurgical techniques, using polydioxanone monofilament absorbable sutures, were examined histopathologically and microangiographically at nine different times, from two to 180 days. There was no anastomotic leakage. The vascular state after suturing and the evolution of the neovascularization are described. The neovascularization appeared to follow the same process of evolution as tissue restoration. It began early, was greatest on the seventh day, and diminished thereafter. When granulation tissue was narrow, the anastomoses were barely hypervascular, the neovascularization assured by submucosal plexus. A voluminous granulation tissue was hypervascular, had a slower evolution, and neovascularization was then assured above all by the peritoneal formations adherent to the suture.

In the case of breast cancer with no clinical signs, radiological signs are the decisive factors to indicate surgery, histological studies or treatment. Foci of microcalcifications currently are the feature to identify as a rule. However, they reveal canalicular carcinoma in only 1 case out of 3. We propose a radiological technique allowing the selection of the microcalcifications to be operated by means of the digitization of a mammographic film and of a software-controlled morphometric analysis. 10,000 microcalcifications have been studied in this way. The most reliable of the 12 parameters that were distinguished is compacity. 100 files were studied with conventional mammography and a morphometric and histological analysis. Any microcalcification less compact than 0.35 is highly suspicious, since this parameter is the only one having a significant difference, with a confidence interval of 95%. The patients are now selected in this way. Differences in the age of the lesions, multiple foci and sometimes lesions with multiple centers lead us to automatically propose the exeresis of the gland, followed by immediate reconstruction of its shape and volume. According to a retrospective study we carried out on 111 subclinical intracanalicular carcinomas after a 5 to 20-year time interval, recurrence is observe in only 4.5% of all cases.

The tumor-host relationship is an essential factor in the onset, development, and recovery from malignancies. A basic consideration in the treatment of cancer patients must therefore be to understand this relationship and attempt to modify it in order to favor the host. We here discuss the results of a study of the immunologic status of 91 breast cancer patients. The use of a battery of tests with five subcutaneous hypersensitivity antigens allowed us to detect some differences in the immunological profiles of patients with or without lymph node involvement. The effect of an immunostimulant fraction prepared from Corynebacterium granulosum, P40 is also analyzed. This fraction significantly modifies tumoral recurrence in DMBA-induced mammary cancers in the Sprague Dawley rat, causes regression of mammary permeation nodules following in situ injection and modifies the cutaneous reactions of one-half of the anergic breast cancer patients although regular re-challenge is still necessary.

Frozen section histological study of all cold nodules requiring total extracapsular lobectomy is absolutely essential during surgery. Whilst total thyroidectomy for intracapsular carcinomas is most often proposed in extracapsular carcinomas, the authors deliberately leave a small part of the gland in contact with the parathyroids. The need for recurrent laryngeal lymph node dissection is accepted, as is the principle of jugulo-carotid dissection.

A rare complication of Nissen's operation is described on the basis of four cases. Appearing secondarily, its Clinical signs are hyperperistaltic diarrhea, without bacterial infection and a fall or levelling of the weight curve. Its constant features are:--acceleration of intestinal transit and principally of gastric evacuation;--a characteristic modification of glucose absorption and of the curve of the oral glucose tolerance test compared with the normal intravenous glucose tolerance test. Overload of dissacharides in the intestine and hypervagotony could explain the symptomatology, which responds with difficulty and sometimes only partially to a diet excluding rapidly absorbed surgars. This complication supervenes often in babies operated on at less than six months, and is an indication for post ponement of operation.

It is proposed that proteins can bind with relatively low-affinity and specificity to multiple sites, defined as sequence motifs, on polynucleotide chains, and that such binding can collectively be turned into high-affinity, high-specificity binding through cooperative effects, especially when the sequence motifs recur periodically. The selection of individual nucleotides has in general been thought to be the condition of the existence and conservation of function in most of the noncoding sequences. This condition seems unnecessary. Calculations are presented as a step in the direction of giving credibility to a model of stable gene repression.

This is a retrospective study including 102 cases records of female patients presenting with epithelial carcinoma of the ovary. Survival, as in the other series, depended upon the stage of the cancer at the time of diagnosis, mean survival rates being 77.1, 57.7, 26.6 and 19.3 for stages I, II, III and IV respectively. However, most of all, survival was related to the quantity of remanent tumoral tissue following the initial laparotomy. The 5-year survival rates were 84%, 42% and 10% when there was no residual tumor, when the latter measured less than 2 cm, and more than 2 cm, respectively. In contradistinction to what is generally found in such studies, the diagnosis here was established at earlier stages, since 53% of the cases of interest were female patients with stage I or II carcinoma. The chief argument, therefore, is based on the methods of early diagnosis and, judging from what is generally admitted in literature, on the place of extended surgery.

1. It was shown that dissolved CO(2) and not HCO(3) (-) or H(2)CO(3) is the primary substrate for reductive carboxylation with 6-phosphogluconate dehydrogenase from sheep liver. 2. The equilibrium constant of the reaction was measured in solutions of various ionic strengths and at several temperatures, and the free energy and heat of reaction were determined.