[Lung cancer with heart failure--a cardiac and thoracic surgeon's collaboration]. / Prise en charge chirurgicale cardiothoracique d'un cancer bronchique responsable d'une insuffisance cardiaque.

Surgical resection is a validated therapeutic option for selected cases of pulmonary tumors invading the important mediastinal structures (caval vein, atrium, aorta or supra-aortic trunks). Here, we present a patient with a necrosed pulmonary tumor invading the left atrium, causing cardiac insufficiency. A complete surgical resection under extracorporeal circulation was performed by the thoracic and cardiac teams. Admitted in a bed-ridden state, the patient was discharged completely rehabilitated on postoperative day 13. He survived 1 year at home with a good quality of life.

[Vertebral primary hydatid cyst with mediastinal involvement and paraplegia]. / Kyste hydatique vertébral primitif à extension médiastinale postérieure compliquée d'une paraplégie.

INTRODUCTION: The vertebrae are the most common localization of hydatid disease of bone. This can lead to fatal consequences. CASE REPORT: We report the case of a 40-year-old-man, from a rural area, who had symptoms of medullary compression. The diagnosis of primary vertebral hydatid cyst, already suspected on the imaging data, was confirmed. A right posterolateral thoracotomy allowed drainage of the cyst and relief of the medullary compression. Medical treatment with albendazole was continued for 4 months. The postoperative course was uneventful and the symptoms of medullary compression resolved progressively. No recurrence was observed during a follow-up of 24 months. CONCLUSION: Vertebral localization of hydatid disease is the most common and serious skeletal complication. Thoracotomy allows drainage of the cyst and the pleural cavity, and relieves the medullary compression.

Prehospital transport of spinal cord-injured patients in Nigeria.

BACKGROUND: Well-organised and efficient prehospital transport is associated with an improved outcome in trauma patients. In Nigeria there is a paucity of information on prehospital transport of spinal cord-injured patients and its relation to mortality. OBJECTIVE: To determine whether prehospital transportation is a predictor of mortality in spinal cord-injured patients in Nigeria. DESIGN: Prospective cohort study. METHODS: Prehospital transport-related conditions, injury-to-arrival intervals and persons who brought spinal cord-injured patients to the casualty departments at the University of Abuja Teaching Hospital, Gwagwalada, and the National Orthopaedic Hospital, Lagos, were noted. Data were analysed using descriptive statistics, the chi-square test and multiple logistic regressions. MAIN OUTCOME MEASURES: Mortality within 6 weeks of admission. Results. During the review period, 168 patients with spinal cord injury presented to the casualty departments. Most presented 24 hours or more after the injury (67.9%) and were brought to casualty by their relatives (58.3%). Saloon cars were the most common mode of transportation (54.2%), most patients (55.4%) lying on their back during transfer. The majority of the patients (75%) had been taken to at least one other hospital before arriving at our casualty departments. The mortality rate was 16.7%. Multivariate analysis after adjusting for age, gender and means of transportation revealed that age (odds ratio (OR) 63.41, 95% confidence interval (CI) 9.24 - 43.53), a crouched position during transfer (OR 23.52, 95% CI 7.26 - 74.53), presentation after 24 hours (OR 5.48, 95% CI 3.20 - 16.42) and multiple hospital presentations (OR 7.94, 95% CI 1.89 - 33.43) were associated with death within 6 weeks of admission. CONCLUSION: Well-organised and efficient prehospital transport would reduce mortality in spinal cord-injured patients. Providing information on prehospital transport would also reduce mortality.

[Bilateral popliteal artery complications of multiple hereditary exostosis]. / Complications vasculaires poplitées bilatérales d'une exostose héréditaire multiple.

The osseous exostose is a rare benign tumor of the bone from which the vascular complications can be of venous or arterial order, are translated in various boards. We report the case of a young adult who presents a forgery aneurysm of the right popliteal artery with the popliteal artery booby-trapped to the left. The patient benefited from surgical treatment with good clinical and radiological evolution.

[Surgery of 56 patients having a partial atrioventricular septal defect]. / Chirurgie du canal atrioventriculaire partiel : résultats à court et à moyen terme à propos de 56 patients opérés.

Between January 1991 and December 2006, 56 patients having a partial atrioventricular septal defect (AVSD) were operated. The purpose of this retrospective study is to analyze the immediate and long-term results of the surgery by granting of the importance to two main problems which are the disturbances of the rhythm and the conduction and the residual mitral regurgitation (MR). The mean age of our patients is of 10 and a half years with a net feminine ascendancy. Ninety-three percent of the patients were in regular sinus rhythm. No case of complete atrioventricular block (AVB) was noted. The MR was of grade I in 28.5% of the cases, grade II in 60% of the cases and grade III and IV in 7.5% of the cases. The MR was mild in 4% of the cases. The correction was made under cardiopulmonary bypass (CPB) and consisted of a suture of the mitral cleft in most of the cases with lock of the ostium primum by a patch of pericardium. The perioperative mortality was 1,8% of the cases. The disturbances of the rhythm and the conduction were noted in 34% of the cases. All the patients were controlled with a mean follow-up of six years and seven months. The secondary mortality was nil. The MR, at mid-term follow-up, was mild in 78% of the cases. The partial AVSD is a congenital heart disease, the spontaneous evolution of which can be burdened by complications, notably the disturbances of the rhythm and the conduction, as well as the heart failure. This justifies a premature surgical repair.