[Giant pulmonary artery aneurysms. Case report and proposal of management algorithm]. / Anévrysmes géants de l'artère pulmonaire : cas clinique et proposition d'un algorithme de diagnostic et de prise en charge.

Pulmonary artery aneurysm is a rare and multiform pathology related to multiple etiologies and therefore different pathophysiological mechanisms. Delineating homogenous sub-groups is a pre-requisite to refine medico-surgical management. The case of a giant PAA without pulmonary hypertension but associated to a dysplastic pulmonary valve is reported. This association could be in some instances the result of a congenital anomaly in the development of both the pulmonary valve and the root creating the conditions for further development of a pulmonary artery aneurysm. Whilst minor forms are usually asymptomatic, they can lead to lethal complications in huge sizes and are frequently associated via pulmonary valve insufficiency to right ventricular dysfunction. This specific association is discussed and a diagnostic algorithm for nosologic classification and management is proposed.

L'anévrysme de l'artère pulmonaire est une pathologie rare, qui répond à de multiples étiologies et autant de physiopathologies différentes. L'identification de sous-groupes constituant des entités cliniques homogènes est un prérequis pour préciser la prise en charge médico-chirurgicale optimale. Nous rapportons un cas d'anévrysme géant de l'artère pulmonaire principale, sans hypertension artérielle pulmonaire, mais associé à une dysplasie/dysfonction de la valve pulmonaire. Cette association pourrait être, dans certains cas, congénitale et liée à une anomalie de la morphogénèse de la valve et de la racine pulmonaire, association qui crée les conditions pour le développement d'un anévrysme. Asymptomatiques dans les formes mineures, les anévrysmes pulmonaires peuvent être causes de symptômes ou de complications gravissimes dans les formes très développées et entraînent souvent, par insuffisance pulmonaire, une dysfonction ventriculaire droite. Nous suggérons une classification claire de cette pathologie mal connue et, sur base de la littérature et de notre expérience personnelle, nous proposons un algorithme de prise en charge médico-chirurgicale.

Late Fate of Cryopreserved Arterial Allografts.

OBJECTIVE: Initial enthusiasm for use of cryopreserved arterial allografts was subsequently tempered by suboptimal long-term outcome. Thrombosis, anastomotic pseudo-aneurysm, allograft disruption, aneurysmal degeneration, recurrent intestinal fistulization, and persistent infection are commonly reported in series with long-term follow-up. The authors reviewed their experience over the past 15 years with the use of cryopreserved arterial allografts as a vascular substitute for vascular prosthetic infection or for primary arterial infection, to investigate allograft-related complications. MATERIAL AND METHODS: A retrospective analysis of prospectively collected data was conducted for 103 cryopreserved arterial allografts inserted in 96 patients between July 2000 and July 2015. There were 78 patients with infected vascular prosthesis (IVP), nine patients with an aorto-enteric fistula (AEF), and nine patients with primary arterial infection (PAI). RESULTS: The in-hospital mortality was eight out of 78 (9%) IVP patients, three out of nine AEF patients, and zero out of nine PAI patients. Median follow-up was 49 months. Allograft-related re-interventions were necessary in 29% of the patients with IVP and four of the patients with AEF, but none of the patients with PAI. Five-year survival for the IVP, AEF, and PAI patients was 53%, 44%, and 90%, respectively. CONCLUSION: This series highlights some shortcomings of cryopreserved arterial allografts in the long term, including suboptimal outcome-results and shortage of material. The authors discuss the allograft-related complications and suggest some tricks to minimize their risk.

[Rectal prolapse revealing a tumor: The role of abdominal ultrasound]. / Prolapsus rectal révélant une tumeur : intérêt de l'échographie abdominale, à propos de 3 cas.

Rectal prolapse is rare in children and usually benign. However, there are various diseases that can be associated with it, such as cystic fibrosis or other causes of increased abdominal pressure. Here, we review the various underlying conditions that pediatricians or pediatric gastroenterologists should consider in the case of rectal prolapse. We report on three cases of children with a rectal prolapse and intra-abdominal tumors. Current recommendations and practice do not include a systematic check via abdominal imaging in cases of rectal prolapse. However, in some situations, imaging is indicated to detect a possible expansive process. Thus, in the presence of recurrent prolapse or of associated urinary or neurological signs, imaging is justified so as to allow for an early diagnosis and treatment of these neoplasms. Given its lack of radiation exposure and good sensitivity in children, ultrasound imaging is the first choice.