[Late renal revascularization]. / Revascularisation rénale tardive.

Late renal revascularization could be indicated in totally occluded renal artery with hypertension and or renal insufficiency. Six cases of secondary revascularization after occlusion of renal artery are reported here. In three cases severe renovascular hypertension was the indication for renal revascularization. In three other cases, indication was proposed for renal insufficiency. In four cases, renal revascularization for totally occluded renal artery have been beneficial for the patients. In two cases of terminal renal insufficiency, chronical hemodialysis could be suppressed. In the others two cases, hypertension was clearly improved. The criteria for renal revascularization before and during surgery are discussed here. The kidney length, the cortico-medullary ratio at kidney echography, and the visualization of a nephrography during angiography are the principal criteria before surgery for renal revascularization. The macroscopic aspect of the kidney, the immediate results of renal biopsy and the importance of a blood reflow in the renal artery are the principal criteria during surgery, but must be discussed because there are no definitive criteria. Renal revascularization shall be proposed when totally occluded renal artery is associated with renal insufficiency and/or hypertension, especially when the other side can be affected by the same disease.

[Standard thoracic radiography in recent pneumonectomized patients. Its contribution to the diagnosis of empyema and bronchopleural fistula]. / Le cliché thoracique standard chez le pneumonectomisé récent. Sa contribution dans le diagnostic d'empyème et de fistule broncho-pleurale.

Case reports of 110 patients undergoing pneumonectomy were reviewed to assess value of standard postoperative chest radiography for detection of early complications, consisting mainly of empyema and/or bronchopleural fistula. Most radiologic modifications observed do not represent abnormal findings, although two signs can contribute to the radiologic diagnosis of empyema: the central superimposed air/fluid levels and the secondary mediastinal displacement, but even these signs are inconstant and of late onset. Five signs may be of significance for the diagnosis of bronchopleural fistula: in addition to the two described above there are the rapid fall in principal air/water level, the increase in subcutaneous emphysema and the late onset contralateral alveolar syndrome. The diagnosis of a bronchopleural fistula prior to the development of clinical symptoms was possible in one of two cases.

[Stenosis of hemodialysis grafts. Treatment with a short graft]. / Sténoses des greffons d'hémodialyse. Traitement par courte greffe.

In elective or emergency operations 363 short venous or polytetrafluoroethylene grafts were inserted to correct stenosis of haemodialysis grafts. Such stenoses are located in the upper part of the graft or in the receiving vein in 80% of the cases. After 2 years, 74% of the short grafts were still permeable. This original technique has several advantages: the initial venous approach is respected, the graft can be used immediately for dialysis, and the patient's venous "capital" is spared.

Renal artery emboli: the role of surgical treatment.

Twelve cases of emboli to the renal artery (one of which was recurrent) were reviewed. In seven patients, emboli were unilateral and the opposite kidney was functional. In five patients, emboli were bilateral or occurred in a solitary kidney, leading to anuria. Cardiac rhythm disorders were encountered in eight patients and were responsible for emboli in other areas in three. Arteriography in ten patients demonstrated seven complete truncal occlusions (one bilateral), two incomplete truncal occlusions, and one distal embolus. One patient with a distal embolus was treated by heparin alone with satisfactory results. One patient in poor general condition was treated with intraarterial streptokinase, resulting in incomplete lysis of the clot. The five patients with anuria were operated on: four regained satisfactory renal function whereas the other patient died. In five patients without anuria who were operated upon, renal function returned to normal in four, and one patient required nephrectomy. Surgical treatment is imperative with anuria and is indicated in unilateral emboli with a functional contralateral kidney, especially when there is complete occlusion of the renal trunk. If the embolus is recent, intraarterial fibrinolytic treatment or percutaneous embolectomy can be attempted, but these techniques are not of proven efficacy. Patients with distal emboli or contraindications to operation should be treated by anticoagulant therapy, alone or with local fibrinolytic treatment.