Description and evaluation of a simplified technique for replacement of the ascending aorta and proximal arch in degenerative aneurysmal disease.

The distal extension of ascending aorta pathology often requires prosthetic grafting into the proximal arch. In order to perform optimal distal anastomosis, an open technique under a short period of circulatory arrest (CA) was adopted. For this purpose we evaluated prospectively a simplified technique for surgery and perfusion. The aneurysmal aorta was directly cannulated to cool down the patient to 26 degrees C. Under CA and retrograde cerebral perfusion, the diseased aorta and aortic cannulation site were resected. After completion of the distal anastomosis, antegrade rewarming was performed via recannulation of the AAo graft (side branch graft) whilst surgery was proceeded on the root and/or aortic valve. This technique clearly addresses the safety of cannulation into the aneurismal aorta. The issues of cerebral and visceral protection during CA and antegrade reperfusion and rewarming have been analysed prospectively in eight patients operated on over a period of 6 months. Our preliminary results indicate that this technique of arterial cannulation and CA at 26 degrees C for the management of degenerative AAo disease involving the proximal arch appears safe both in terms of cerebral and systemic (visceral, muscular) protection. By this way, the complications related to deep hypothermia and prolonged cardiopulmonary bypass are avoided. This assumption may be only valid for a CA period less than 30 min. This preliminary study is limited by its small size and heterogeneity of the pathologies. However, the simplicity, surgical ease, rapidity and efficacy conveyed by this technique warrant further consideration and evaluation.

[Can the development of prostate cancer be prevented?]. / Peut-on prévenir le développement du cancer prostatique?

Prostate cancer is the most frequent cancer in men living in industrialized countries. Numerous epidemiological and laboratory studies suggest that various hereditary, toxic, hormonal, and dietary factors may be involved in the development and/or progression of prostate cancer lesions. Several large prospective randomized trials for the chemo-prevention of prostate cancer are currently ongoing. In this review, data regarding the implication of dietary factors have been analyzed under the light of recent literature in order to determine whether proven efficient prevention is available today.

[Clinical case of the month. Rapid atrial fibrillation causing ventricular tachycardia and syncope]. / Le cas clinique du mois. Syncope sur passage en tachycardie ventriculaire par accélération d'une fibrillation auriculaire.

We report a rare case of rapid atrial fibrillation triggering an episode of ventricular tachycardia. We review the literature and discuss the potential mechanisms of the ventricular arrhythmia.