Complete myocardial revascularization with bilateral internal thoracic artery T graft.

BACKGROUND: The internal thoracic artery is widely recognized as the ideal graft for coronary artery bypass procedures. However, because of the inadequate length of the conduit, use of bilateral internal thoracic artery grafting was not suitable for complete revascularization. To overcome this limitation, the T graft was introduced in the 1990s. We decided to prospectively assess the safety of this technique. METHODS: One hundred six patients with a mean age of 51.5 years underwent complete revascularization with an internal thoracic artery T graft. Mean left ventricular ejection fraction was 0.60 (range, 0.22 to 0.85). RESULTS: No patient required reexploration for bleeding, and no patient died within 30 days after operation. On the basis of electrocardiographic changes, 3 patients sustained a perioperative myocardial infarction. One patient had a sternal wound infection. Mean follow-up was 35 months (range, 15 to 61 months). The actuarial survival rate was 99% +/- 1% at 5 years. No myocardial infarctions were reported during the follow-up. Seven patients had recurrent angina. Eighty patients (76%) underwent postoperative stress tests, and 90% had negative results. CONCLUSIONS: Complete myocardial revascularization with the T graft is a safe and reliable technique with excellent midterm results.

Leiomyosarcoma of the mesocolon.

Retroperitoneal sarcomas are rare tumours. Although exceptional in the mesocolon, they can yet be considered as a special kind of retroperitoneal tumours. Leiomyosarcoma represents from 25 to 30% in this location. Clinical features are rarely obvious because the symptomatology depends upon displaced or compressed adjacent organs. Most authors agree on using the CT-scanner or MRI as diagnostic tools. However, the diagnosis is made after a histologic examination permitting the establishment of its grade and margins. Only a surgical treatment can offer prolonged survival and this can be improved if there is a low histological grade and total excision. The mesocolic location facilitates a radical removal and may therefore offer a better long-term prognosis.

[Pneumatosis cystoides intestinalis. Diagnostic elements and therapeutic approach]. / La pneumatose kystique intestinale. Eléments diagnostiques et attitudes thérapeutiques.

Pneumatosis cystoides intestinalis is an uncommon condition characterised by multiple gas-filled cysts within the small intestine or colonic wall. Clinical manifestations are unspecific and often found in many other abdominal diseases. To avoid unnecessary laparotomy, radiologic and endoscopic findings are essential to be known. The present case associates symptoms highly suspect of neoplasia like weight loss, rectal mass, bloody stools and tenesmus. Treatment of choice is medical. In the absence of an acute abdomen, surgery is only reserved when it is not responsive to medical treatment.

Left thoracotomy for coronary bypass in a patient with pectus excavatum.

In a patient with pectus excavatum, coronary artery bypass grafting with the internal mammary artery is difficult or even impossible through a median sternotomy. We suggest and describe an anterolateral thoracotomy that, in this particular case, not only allowed taking the internal mammary artery but also provided an excellent exposure of the anterolateral aspect of the heart.

[Intramuscular lipoma of the head and neck. Description of a case and review of the literature]. / Lipomes intramusculaires de la tête et du cou. Description d'un cas et revue de la littérature.

Bénignes intramuscular lipomas of head and neck are rare entity; our case report demonstrate the unusual presentation of this tumor. This complete review of the literature sustains the discussion about the pathogeny, the diagnostic and the treatment of this disease.

Dunbar's syndrome.

The authors report the case of a 70-year-old female patient presenting with nausea, epigastric pain, anorexia and a loss of weight. An aortography showed a compression of the celiac trunk. The patient became asymptomatic and her clinical condition improved after surgical release of the celiac trunk by section of the arcuate ligament of the diaphragm. A preliminary attempt at percutaneous transluminal angioplasty proved unsuccessful.

Variant form of popliteal artery entrapment syndrome.

A forty-six-year-old, non smoker, patient presented with an intermittent claudication of the right calf, clinically compatible with a low popliteal artery obliteration. Arteriography showed an irregular intercondylar popliteal artery and oblitered low popliteal and anterior tibial arteries. Surgical posterior access showed a faulty insertion of the mediate gastrocnemius caput responsible for popliteal artery entrapment syndrome and for aneurysmal dilatation of the popliteal artery above compression. As far as we know, this form of popliteal artery entrapment syndrome has not been published yet.