Isolated clinical syndrome of primary aldosteronism in four patients with adrenocortical carcinoma.

Adrenocortical carcinoma is a rare disorder that can be revealed by an isolated syndrome of mineralocorticoid excess. In a retrospective study of 137 patients referred to our hypertension clinic in the past 10 years for primary aldosteronism, four cases of adrenocortical carcinoma were identified. The clinical presentation of these patients was similar to that of patients with Conn's adenoma, but preoperatively, malignant tumoral primary aldosteronism was suspected because of profound hypokalemia, marked elevation in plasma aldosterone levels, and enlarged size and weight of an heterogenous adrenal tumor with internal calcifications. Malignancy was confirmed by the histologic features. No prognostic criteria could be established and two patients died despite specific surgery, which was performed in all cases. More recent developments in the use of mitotane led to the addition of adrenocorticolytic therapy in the remaining two patients, who are still alive at the time of this report.

Evaluation of slow release nicardipine in essential hypertension by casual and ambulatory blood pressure measurements. Effects of acute versus chronic administration.

We conducted a randomized placebo-controlled double-blind study in 40 hypertensive subjects to assess the antihypertensive effect of a new galenic form of nicardipine administered at a dosage of 50 mg twice daily for 3 weeks. Regardless of whether blood pressure was measured by standard mercury sphygmomanometer, non-ambulatory automatic oscillometry or a Remler ambulatory blood pressure recorder, it dropped by a significantly larger amount in the nicardipine group than in the placebo group. In the control group, a placebo effect was observed with the ambulatory diastolic blood pressure recording, whereas it was not observed with hospital blood pressure measurements, especially when using the serial measurements performed for 30 min by an automatic recorder. The fall in blood pressure measured with the Remler recorder was correlated with the fall measured 10-20 min during one acute intravenous nicardipine perfusion before the trial, although the correlation coefficients do not suggest clinically relevant predictability of nicardipine efficacy at the individual level. The present findings support the need for controlled double-blind trials with careful office blood pressure measurements.

The radial artery for coronary artery bypass grafting: clinical and angiographic results at five years.

OBJECTIVE: The aim of this study was to assess the long-term results of use of the radial artery as a conduit for coronary artery bypass grafting. METHODS: After revival of the technique in 1989, the radial artery was used as a conduit in 910 patients undergoing coronary artery bypass grafting. A complete follow-up was obtained for the first 102 consecutive patients from 4 to 7 years after the operation (mean 5.27 +/- 1.30 years). Fifty-nine percent of the patients were receiving calcium-channel inhibitors. An electrocardiographic stress test was obtained for 51 patients, with no contraindications found. Routine follow-up angiography was performed in 50 cases, including those of all patients with symptoms. Thus 64 radial artery and 48 left internal thoracic artery grafts were followed up from 4 to 7 years after the operation (mean 5.6 +/- 1.40 years). RESULTS: The actuarial survival was 91.6% at 5 years, and the actuarial rate of freedom from angina was 88.7% at 5 years. Four patients underwent percutaneous transluminal angioplasty during the period of follow-up, and there were no reoperations for revision of the bypass. The electrocardiographic stress test showed negative results in 73% of cases, electrocardiographic changes alone in 21%, and clinically positive results in 6%. Angiography showed that the patency rate of the radial artery grafts was 83%. The patency rate of the left internal thoracic artery grafts (n = 47) was 91%. The difference in patency could be related to the implantation sites of the grafts, mainly the circumflex artery (51%) for the radial artery grafts and almost exclusively the left anterior descending artery (94%) for the left internal thoracic artery. CONCLUSION: The use of the radial artery for coronary bypass grafting provides excellent clinical and angiographic results at 5 years. Routine use of the radial artery in combination with the left internal thoracic artery can be recommended.

Revival of the radial artery for coronary artery bypass grafting.

Eighteen years after its first introduction for coronary artery revascularization, the radial artery (RA) was reinvestigated because of unexpected good long-term results in the early series. Since July 1989, 104 patients underwent myocardial revascularization using 122 RA grafts (18 patients received two grafts). The left internal mammary artery (IMA) was concomitantly used as a pedicled graft in 100 cases and the right IMA in 19 cases; a free IMA graft was used in 29 cases and a saphenous vein graft in 24 cases. A mean of 2.8 grafts per patient were performed. Nine patients underwent associated procedures: carotid endarterectomy (3), aortic valve replacement (3), Bigelow procedure (1), and mitral valve repair (2). The target artery receiving the RA was the circumflex (n = 59), diagonal (n = 29), right coronary (n = 27), and left anterior descending (n = 7). One patient died (0.96%) and 2 had perioperative myocardial infarct. Sternal wound infection was noted in 3 cases of double IMA implantation. No ischemia of the hand was observed. All patients received diltiazem started intraoperatively and continued after discharge. In addition aspirin (100 mg/day) was given at discharge. Early angiographic controls (less than 2 weeks) were obtained in the first 50 consecutive patients and revealed 56 of 56 patent RA grafts, 48 of 48 patent left IMA grafts, 11 of 11 patent right IMA grafts, 14 of 18 patent free IMA grafts, and 8 of 9 patent vein grafts.(ABSTRACT TRUNCATED AT 250 WORDS)

Epithelioid sarcoma of soft tissues: a case of extrarenal renin-secreting tumour.

The case of a young woman presenting with a renin-secreting soft tissue sarcoma is described. The primary extrarenal tumour as well as metastatic disease were associated with severe hypertension and both required surgical treatment. The location of these rare malignant tumours and their association with renin-dependent hypertension is discussed. In cases of this type, reappearance of hypertension suggests tumour recurrence.

New non-ionic contrast: effects on the cardiovascular system.

Contrast media cause a variety of effects on the cardiovascular system both hemodynamic and electrophysiologic in nature. These effects are mainly related to the physico-chemical characteristics of the compounds and are less pronounced with low osmolar nonionic than with ionic contrast media. Nonetheless there is still room for further improvement in the features of the nonionic agents. Iomeprol is a new nonionic contrast medium which, with its low osmolality and toxicity and very low viscosity, proved to be safe and well tolerated during clinical trials in cardioangiography.

[Critical limb ischaemia: endovascular treatment in diabetic patients?]. / Approche interventionnelle des artériopathies périphériques. Existe-t'il des spécificités chez le diabétique?

Endovascular treatment has an increasing role in the treatment of patients with critical limb ischemia, particularly in diabetic patients with a majority of infrapopliteal lesions. The aim of the procedure is to obtain a "straight-line flow to the foot" by treating all the significant stenoses and short occlusions that impair distal vascularization. Stents are indicated when there is a suboptimal results following balloon angioplasty (recoil or dissection). Restenosis rate after primary stenting for long lesion is high. Angioplasty is a safe and effective procedure, allowing limb salvage rate in a majority of the cases with a low mortality and morbidity rate.

[Comparison of ambulatory blood pressure determinations using the Remler and Spacelabs devices]. / Comparaison des mesures tensionnelles ambulatoires des appareils Remler et Spacelabs.

Ambulatory blood pressure recorded with the Spacelabs was compared with both Remler recordings and office blood pressures in 11 normotensive and 13 hypertensive volunteers. Analysis of 324 simultaneous measurements with Remler and Spacelabs showed very high correlation for systolic and for diastolic blood pressure. For systolic blood pressure, measurements with Spacelabs recorder were lower than those with the Remler recorder by a mean of 3.6 +/- 6.5 mmHg, principally in hypertensive subjects. Spacelabs measurements were also lower than Remler measurements for diastolic blood pressure by a mean of 5.3 +/- 6.6 mmHg principally in normotensive subjects. The averages of blood pressure variability (standard deviation as index) recorded by each device were identical. Mean systolic and diastolic blood pressure differed by more than 10 and 5 mmHg respectively between the two devices in 11 and 83% of the subjects. These individual discrepancies were unpredictable. Comparison of Spacelabs records with office blood pressure measured with a standard mercury manometer showed discrepancies of more than 10 mmHg for systolic blood pressure and more than 5 mmHg for diastolic blood pressure in 46 and 42% of the 24 subjects, respectively. These discrepancies could be due, in part, to different methods of blood pressure measurements. These data demonstrate that the Spacelabs apparatus provides records for a group, reasonably close to those obtained with the Remler over a wide range of blood pressure. For the management of hypertension, the advantages--as compared to physician's measurements--of ambulatory blood pressures recorded with indirect methods,need to be weighed, taking into consideration the difference between the ambulatory record and the office blood pressure measured with the same device.

[Validation of an self-measurement blood pressure device]. / Validation d'un appareil d'automesure tensionnelle.

UNLABELLED: The aim of this study was to test the self-blood pressure (Self-BP) measurement device Copal UA-251 (Philips). This device uses auscultatory method for BP measurement. It was compared to reference methods: intraarterial and Hawksley Random Zero in 38 patients, selected in two groups: group RO (n = 18), compared Copal to Random Zero. 20 simultaneous measurements were recorded, with devices inversion at eleventh BP measurement, in 18 treated or untreated hypertensive patients. Group IA (n = 20) included 20 patients and compared Copal to intra-aortic measurement. Three simultaneous measurements were recorded, before a coronarography was performed, in 20 normo or hypertensive patients. RESULTS: (Table: see text). 1) A significant difference was recorded for SBP evaluated by Copal versus RO and for DBP measured by Copal versus IA. 2) A significant correlation was assessed between the different methods of measurement. 3) Differences between couples of RO-Copal values are not correlated to BP level, neither for SBP (r = 0.07), nor DBP (r = 0.05). Same results occur for IA-Copal values (SBP: r = 0.36, DBP: r = 0.30). 4) No order effect was found; no discrepancy between arms occurred in BP measurement. CONCLUSION: comparing intraaortic measure, Copal is efficient for SBP measurement, but overestimate DBP. Compared to R0, Copal overestimates SBP, but is efficient for DBP measurement. Regarding these results, a self-BP measurement is possible with this device.

[Comparison of 3 methods of blood pressure measurement in obesity]. / Comparaison de trois techniques de mesure de la pression artérielle chez l'obèse.

Arm girth and circumference often leads to difficulties in Blood Pressure (BP) measurement in obese patients. In order to assess the best method of BP measurement, we have compared in a triplicate study, Intra-arterial Pressure (INTRA) to indirect measurements: Mercury Sphygmomanometer (SPH) and oscillometric device Bard Sentron (SEN). SPH and SEN were successively connected to the same cuff (inflatable bladder 14 x 31 cm). Cuff was positioned on contralateral arm to arterial puncture. 19 subjects were studied (18 female); mean age was 51.3 +/- 9 years (extremes: 37-69), mean weight 104 +/- 19 kg (84-147), weight index 40 +/- 4.7 kg/m2 (34-49), and brachial circumference 39 +/- 4 cm (33-47). First out-patient mean blood pressure measurement was 182/104 mmHg (148-264/80-132). Mean SPH BP were 158 +/- 34/91 +/- 3 (98-230, 72-112) and mean INTRA: 171 +/- 37/85 +/- 5 (122-256/56-118). Mean systolic and diastolic differences (S, D, mmHg) were: (Table: see text). 1) SPH systolic BP underestimates HUM systolic BP. 2) Mean SEN measurements are very closed to HUM values. 3) A great intra-individual variability occurs since more than 50 per cent systolic SPH values show discrepancy of more than 10 mmHg for systolic and diastolic HUM BP; the same discrepancies occur for SEN vs HUM. 4) Differences between couples of values (HUM-SEN, HUM-SPH) are not correlated to BP level, neither for systolic nor for diastolic BP. 5) No significant correlation occurs when BP deltas are compared to weight index or arm circumference.(ABSTRACT TRUNCATED AT 250 WORDS)

[Malignant adrenal cortex carcinoma revealed by an isolated picture of primary hyperaldosteronism]. / Corticosurrénalomes malins révélés par un tableau isolé d'hyperaldostéronisme primaire.

Adrenocortical carcinoma (ACC) is a rare disorder with an estimated incidence of only 0.023 percent of all malignancies. In most cases, Cushing's syndrome and virilization or feminization due to abnormal steroid production by the tumor rapidly lead to the diagnosis. Occasionally, the tumor produces an excessive amount of mineralocorticoids only and ACC can be revealed by an isolated syndrome of primary aldosteronism. Out of 100 cases of tumoral primary aldosteronism studied from 1977 to 1987, we observed 4 ACC and 96 Conn's adenomas (CONN). When primary aldosteronism was diagnosed, ACC and CONN had same clinical features, although hypokalemia in ACC was more profound: 2.2 +/- 0.76 mmol/l (1.4 to 3.2) compared to 2.9 +/- 0.5 (1.6 to 4.2) in CONN. Mean supine plasma aldosterone levels, plasma renin and aldosterone responses to the upright posture or to serum saline infusion, cortisol at 8 a.m. were not different in patients with ACC from those observed in patients with CONN. 24 hours urinary cortisol excretion and 17-ketosteroids excretion were highly increased in three out four patients with ACC. Clinical, biological and hormonal investigations were therefore not sufficient to diagnose malignant tumoral primary aldosteronism. Systematic computed tomographic scanning allowed to differentiate carcinomas from adenomas on the following criteria: ACC showed enlarged tumor size that was always above 30 mm in diameter, whereas the largest CONN measured 20 mm.ACC appeared as an heterogeneous tumor with the presence of internal calcifications in each case of ACC, that were diagnosed both on ultrasound and CT scan, whereas none of the CONN showed any calcification, using the same screening procedure.(ABSTRACT TRUNCATED AT 250 WORDS)

[The decision to treat moderate hypertension: repetition of office visits or ambulatory monitoring of arterial pressure?]. / La décision de traiter l'hypertendu modéré: répétition des consultations ou enregistrement ambulatoire de pression artérielle?

World Health Organization (WHO) recommends antihypertensive therapy for mild to moderate hypertensive patients after 3 or more visits. We tested the hypothesis that an ambulatory blood pressure recording could also help to decide which patient need therapy. Blood pressure was measured in 89 essential, uncomplicated, hypertensive patients (diastolic (DBP): 90-110 mmHg, mean age: 41 +/- 13 years), with a mercury sphygmomanometer at 3 visits and with an ambulatory blood pressure recorder (Spacelabs) during 12 hours. According to WHO recommendations, patients were classified "WHO+" if they need a treatment (n = 44) and "WHO-" if they did not. The mean ambulatory DBP of each subject was compared to the arbitrary limit defined as the mean +2 standard deviations of the ambulatory DBP of a population of normotensive subjects in the same decade and same sex: patients with ambulatory DBP above this limit were defined "AMB+" (n = 27), the others were "AMB-". Ten patients were "WHO- AMB+" and 24 were "WHO+ AMB-". These discordances were independent of age, body weight, duration of hypertension, variability of ambulatory systolic and diastolic blood pressure defined by the standard deviation. By contrast, the difference between the measurements of the simultaneous blood pressure measurements performed with the two methods (mercury sphyngmomanometer and Spacelabs) 2 times by each patient could explain in part these discrepancies. The Spacelabs underestimates DBP measured with the mercury sphyngmomanometer in patients "AMB-" but not in patient "AMB+".(ABSTRACT TRUNCATED AT 250 WORDS)

[Double-blind evaluation of slow-release nicardipine using different methods of blood pressure measurement. Predictive value of the acute response to intravenous nicardipine]. / Evaluation en double insu de la nicardipine à libération différée par différentes méthodes de mesures tensionnelles. Valeur prédictive de la réponse aiguë à la nicardipine intraveineuse.

Forty hypertensive patients (diastolic greater than 95 mmHg) were included after 15 days of a single blind placebo period in a randomized placebo controlled double-blind study to assess the antihypertensive effect of a new galenic form of nicardipine (N) administered 50 mg b.i.d. for 3 weeks. They comprised 27 men and 13 women aged from 27 to 72 years (mean: 53 +/- 10). Blood pressure (BP) was measured in hospital before morning drug intake by an automatic recorder (Sentron) in supine position for 30 minutes (min) and by a mercury sphygmomanometer. Ambulatory BP was assessed by a portable patient activated recorder (Remler 2000). Mercury sphygmomanometer supine BP under N fell from 160 +/- 21/104 +/- 6 mmHg to 151 +/- 14/98 +/- 8 mmHg (n = 20; p less than 0.01/p less than 0.01) whereas BP under placebo (P) was respectively 158 +/- 14/103 +/- 6 mmHg and 156 +/- 20/102 +/- 9 mmHg (NS). Sentron BP under N fell from 158 +/- 17/96 +/- 8 mmHg to 148 +/- 13/90 +/- 7 mmHg (p less than 0.001/p less than 0.01) with no BP change under P (152 +/- 12/93 +/- 7 mmHg to 151 +/- 14/93 +/- 8 mmHg NS). BP recorder every 30 min for 12 hours revealed a decrease under N (160 +/- 18/105 +/- 10 mmHg to 142 +/- 16/94 +/- 10 mmHg; p less than 0.001/p less than 0.001) with a placebo effect in the control group on the diastolic BP (160 +/- 15/103 +/- 7 mmHg to 156 +/- 16/100 +/- 8 mmHg/NS/p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

[Results of the surgical treatment of Conn's adenomas]. / Résultats du traitement chirurgical des adénomes de Conn.

During the last 10 years we operated on 69 Conn's adenomas of which 59 were followed up for a mean period of 16 months (range: 3-96 months). Surgery cured the hypertension (blood pressure less than 140/90) in 47 p. 100 of the patients. Improved blood pressure (systolic: mean = 46 mmHg; range 0-135 mmHg and diastolic: mean = 25 mmHg; range 0-66 mmHg) was noted in another 47 p. 100 of patients whereas no blood pressure change was noted in 3 patients. Biological primary aldosteronism was found post-operatively in 2 of these 3 patients and also in one whose hypertension was improved. In this last patient plus the three unimproved by surgery, small tumours (less than 10 mm) were found and co-existnt multifocal hyperplasia was found in the 2 patients who had had an adrenalectomy. Fifty-one patients were treated pre-operatively by spironolactone (SP) alone (3.2 +/- 1.3 mg/kg) for a mean period of 6.8 weeks (range: 3 to 20 weeks). Only 2 of the 24 patients controlled by SP were not cured by surgery and one of them had persistnt primary aldosteronism. Conversely, 3 of the 27 uncontrolled by SP were cured post-operatively, and these exceptions could be due to the weak dose of SP (n = 2) and an observance problem (n = 1). Patients cured by surgery had shorter duration of hypertension (4.3 +/- 3.0 years vs 10.1 +/- 8.1; p less than 0.01) and lower diastolic pressure (111 +/- 14 mmHg vs 121 +/- 12; p less than 0.01) than uncured patients. No significant difference between these two groups was observed with respect to systolic pressure, age, sex, plasma potassium, plasma renin activity and plasma aldosterone levels.(ABSTRACT TRUNCATED AT 250 WORDS)

[Early angiographic evaluation of coronary bypass using arterial grafts]. / Evaluation angiographique précoce des pontages coronaires par greffons artériels.

The aim of this study was to evaluate the early postoperative angiographic features of arterial coronary bypass grafts in 83 asymptomatic patients referred consecutively from the surgical unit. The patients aged 33 to 78 years (average 62 years) were operated between August 1989 and March 1992 and received only arterial coronary bypass grafts: 209 arteries bypassed (121 internal mammary including 10 sequential grafts, 46 radial, 36 epigastric including 4 sequential grafts and 6 gastroepiploic arterial grafts), an average of 2.4 bypass grafts per patient. Selective angiography of the arterial grafts was performed systematically between the 7th and 15th postoperative days in patients with uncomplicated recoveries. The native coronary arterial network was opacified only when a graft was "non-functional": haemodynamic (> 70%) stenosis or occlusion. 3.8% of pediculated mammary grafts were occluded. On the other hand, 16.6% of free internal mammary grafts were occluded. None of the radial artery grafts were occluded, but 8% were stenotic. Finally, 30% of epigastric and 50% of the gastroepiploic grafts were occluded. These results confirm the good function of in situ mammary artery grafts by suggest that systematic multiple arterial grafts should be used with caution. Radial artery grafts give very encouraging results which require long-term evaluation. Early postoperative evaluation of coronary arterial grafts provides important information and should be considered a routine procedure.

[Transluminal angioplasty in renovascular hypertension with renal insufficiency]. / Angioplastie transluminale dans l'hypertension réno-vasculaire avec insuffisance rénale.

From 1985 to 1986, 71 patients with renovascular hypertension were treated by percutaneous transluminal angioplasty (PTA). Among them, 13 (mean age 67 +/- 7 years) had a hypertension refractory to drug therapy (blood pressure: 194 +/- 33/103 +/- 15 mmHg) associated with an impaired renal function (creatinine clearance: 33 +/- 20 ml/mn). Ten had a stenosis in a solitary functioning kidney and a contralateral renal artery thrombosis. Three had bilateral renovascular stenosis. All patients had severe diffuse atherosclerotic disease, i.e. coronary heart disease (n = 7), carotid artery stenosis (n = 6), abdominal aortic aneurysm (n = 3) or arteritis (n = 5). Among these 13 patients, PTA could not be performed in one patient (failure to catheterize the stenosis) and two immediate renal artery dissections were observed: the first was accompanied by a thrombosis of the renal artery which could be successfully treated in emergency by surgical revascularization. The second occurred in a segmental renal branch and did not require surgery since it did not induced further impairment of renal function. Among the 10 remaining patients, nine PAT were classified as immediate angiographic success. One incomplete result required a second PTA 6 months later. Three important inguinal hematomas were observed and blood transfusion was required in 2. Seven patients have been reevaluated after a follow-up of 3 to 22 months. Restenosis occurred in two patients, 6 and 20 months respectively after PTA. A successful surgical revascularization was performed in these 2 patients.(ABSTRACT TRUNCATED AT 250 WORDS)

[Reference values of ambulatory arterial pressure in activity and during the night. Multicenter study of 394 normotensive subjects at rest]. / Valeurs de référence de la tension artérielle ambulatoire d'activité et de nuit. Etude multicentrique de 394 sujets normotendus au repos.

The blood pressure pattern and variability were assessed in a population of 394 normotensive subjects (OMS) stratified by age (20 to 75 years) and sex. Ambulatory blood pressure measurements were performed with an automatic device (Spacelabs 5200) every 15 min. from 6 a.m. to 12 p.m., and every 30 min. from 0 a.m. to 6 a.m. The analysis was effected during normal daily activities (from 9 a.m. to 7 p.m.) and during night (from 11 p.m. to 7 a.m.). Blood pressure levels were higher in males than females. During daytime and nighttime, diastolic blood pressure rose with age until 59 years while SBP was not affected, except for the females older than 60 years. After this age, diastolic blood pressure decreased. No epidemiological study has provided a measure of the cardiovascular risk related to ambulatory blood pressure, so that we were unable to define true normal values. However, reference population values provided from two statistical methods: limit of the 95th upper confidence interval for the mean of limit of the 90th percentile value for the total data. These blood pressure distributions according to age and sex may allow a better approach to borderline hypertensive patients.

[Iodo-methyl norcholesterol scintigraphy in the localization of primary hyperaldosteronism]. / Apport de la scintigraphie au iodo-méthyl norcholestérol dans la localisation de l'hyperaldostéronisme primaire.

UNLABELLED: The aim of the study was to investigate the accuracy of iodomethyl norcholesterol, a new adrenal isotopic scanning agent, in the strategy of aldosteronism localization. Among 1499 patients examined in the clinic in 1987, 49 presented with primary aldosteronism. Nine were explored by adrenal scintigraphy (SCI). Mean age was 50 +/- 10 ans, blood pressure was 188 +/- 26/110 +/- 17 mmHg. Initial serum kalemia was 3.2 +/- 0.4 mMol/l, urinary potassium 67 +/- 39 mMol/d; standing plasma active renin was 9.9 +/- 5.0 pg/ml (20 less than N less than 50), supine plasma aldosterone was 316 +/- 200 pg/ml (50 less than N less than 150) and aldosterone excretion rate was 49 +/- 27 microgr/day (N less than 17). Adrenal CT-scan correctly predicted unilateral adenoma in 7 patients (size from 5 to 15 mm). CT-scan was negative twice. Adrenal vein aldosterone sampling and phlebography confirmed adenoma in the 8th patient. 7 patients underwent surgery, with pathological confirmation of the diagnosis. The diagnosis of adrenal hyperplasia (AH) was made in the 9th patient. (table; see text) When compared to CT-scan, SCI is unuseful if a tumor (greater than or equal to 10 mm) is detected on CT-scan (2 SCI false-negative/5 CT-scan tumors). At the opposite, when CT-scan is negative, SCI localizes 2 tumors in 4 patients (2 adenomas). CONCLUSION: SCI should not be used as first step diagnosis procedure in the localization of primary aldosteronism.

[Use of the radial artery for coronary artery bypass. A new experience after 20 years]. / Utilisation de l'artère radiale pour les pontages coronaires. Nouvelle expérience 20 ans après.

Twenty years after its first introduction by A. Carpentier, the use of the radial artery (RA) for coronary bypass was reinvestigated because of unexpected good long term results in some patients. Since July 1989, 158 patients (pts) underwent myocardial revascularization using 189 RA grafts (31 pts received 2 grafts). The left internal mammary artery (LIMA) was concomitantly used as a pedicled graft in 151 cases and the right internal mammary artery (RIMA) in 31 cases, a free IMA graft was used in 29 cases and a saphenous vein graft in 40 cases. A mean of 2.8 graft/pt was performed. The target artery receiving the RA was: circumflex (n = 93), diagonal (n = 39), right coronary (n = 47) and LAD (n = 10). Two patients died (1.3%) and three presented a perioperative myocardial infarct (2.5%). Sternal wound infection was noted in three cases of double IMA implant. No ischemia of the hand was observed. All patients received diltiazem started intraoperatively and continued after discharge. In addition, aspirin (100 mg/day) was given at discharge. Early angiographic controls (< 3 weeks) were obtained in the first 60 consecutive patients and revealed: 73/73 patent RA grafts, 58/58 patent LIMA grafts, 16/16 patent RIMA grafts, 15/19 patent free IMA grafts and 10/11 patent vein grafts. Six patients presented a localized narrowing of the RA conduit unrelated to the anastomotic lines (spasm). Late angiographic control (6 to 24 months) was obtained after a mean follow-up of 11 months in 37 patients: 42/46 RA grafts were patent (91.3%) and free of spasm and 4 were occluded.(ABSTRACT TRUNCATED AT 250 WORDS)

[Ostial stenosis of the renal arteries: treatment by angioplasty]. / Sténoses ostiales des artéres rénales: traitement par angioplastie.

In a series of 50 patients (22 females, 28 males); 52 ostial renal artery stenoses were treated by transluminal balloon angioplasty. The mean age of patients was 66 years (range 36-81); mean arterial pressures were 181 mmHg for the systolic pressure and 87 mmHg for the diastolic pressure. The mean level of serum creatinine was 179 mumol/l +/- 128. An immediate success was obtained in 86.5% (residual stenosis of 26%). There were 7.6% of immediate failures and 13.5% of residual stenosis above 50%. Mortality within 1 month was observed in 2 patients. Morbidity included one aortic dissection and 5 cholesterol embolisms. After a mean follow-up of 10 months, 78% of the series were controlled: 66.6% exhibited a residual stenosis below 50%, 25.9% had restenosis and 7.4% had an occlusion of the renal artery. Since patients with ostial renal artery stenosis constitute a high surgical risk group, transluminal balloon angioplasty might be considered as an acceptable and safe alternative treatment.