[Catamenial pneumothorax: easy to see, difficult to manage]. / Pneumothorax cataménial : facile à reconnaître, difficile à traiter.

INTRODUCTION: Catamenial pneumothorax (PNO) is a real clinical occurrence. Several cases are reported in the literature as a spontaneous PNO occurring during the catamenial period among women in their thirties. There is no consensus about management and the recurrence rate is very high whatever the initial treatment. PATIENTS AND METHODS: Among 310 cases of spontaneous PNO operated in our institution in 10 years, we identified five cases of catamenial PNO. A retrospective study of these cases was used to study the initial operating data, including the existence of intrathoracic lesions and the choice of technique of pleurodesis. Patient follow-up was clinically and radiologically. Adjuvant hormonal therapies, recurrence of PNO and treatment modalities have been studied. RESULTS: These five patients of average age 37.6 years (37,38) who had 2.6 (2.3) episodes of right catamenial PNO before hospitalization in surgery department. No patient was smoker. Two of them had a known thoracic or pelvic endometriosis. The initial surgery was video assisted thoracic surgery with a parietal pleurectomy and twice a mesh upon the diaphragm. There were no immediate postoperative complications, and the average length of stay was 6.6 days (5.9). Two patients had adjuvant hormonal therapy. All patients had at least one recurrence and three of them had redo surgery. CONCLUSION: The diagnosis of catamenial PNO must be mentioned in any woman who has a spontaneous pneumothorax right in catamenial period. Endometriosis should be systematically sought. A standardized therapeutic approach to establish the role of surgery and the most appropriate technique as well as the appropriateness and duration of peroperative hormonal therapy remains to be defined.

[Recent injuries to the left diaphragm: value of laparoscopy in Africa and Europe]. / Lésions récentes du diaphragme gauche: intérêt de la laparoscopie, en Afrique comme en Europe.

Management of recent diaphragm injury is challenging. The purpose of this report is to describe two patients who presented injuries to the left diaphrgmatic cupola, i.e., rupture due to blunt trauma in Europe and a stab wound in Africa. The value of laparoscopy for diagnosis and treatment are discussed in these contrasting settings.

[Thoracic ballistic traumatisms. Wounding agents and wound ballistic]. / Traumatismes balistiques du thorax. Agents vulnérants et balistique lésionnelle.

The adequate care of thoracic ballistic traumatisms implies a good preliminary knowledge of wounding agents, and of the principles governing lesion-based ballistic, in particular the role played by the meeting with an obstacle which modifies the ballistic behaviour of the projectile, with worsened wounding effects. Authors describe the principal types of involved projectiles and their wound profile applied to the thorax, while stressing the need to treat systematically the wound and not the weapon, and on the importance of the choice of the surgical exploration way of these lesions, which conditions, as from the initial stage, the later choices of the parietal closure and rebuilding methods. The importance of parietal disrepair is therefore an essential decisional factor in the assumption of responsibility and the definition of the therapeutic strategy of these casualties.

The role of videothoracoscopy in management of precordial thoracic penetrating injuries.

OBJECTIVES: To report on the value of diagnostic videothoracoscopy in patients with possible penetrating cardiac wounds. METHODS: Thirteen patients admitted over a 4 year period with hemodynamic stability and a penetrating injury in cardiac proximity had exploratory videothoracoscopy. All data related to those patients were retrospectively reviewed. RESULTS: Eighty-five percent of patients had videothoracoscopy within 8 h of trauma. In most cases (eight of 13), operations were performed on patients in the supine position with the chest slightly rotated. Nine patients had a left hemothorax, five had pulmonary lacerations and five had a bleeding parietal vessel. Pericardial exploration was achieved either by direct vision (nine patients), or by the performance of a pericardial window (four patients). Acute hemopericardium related to a cardiac wound was diagnosed in two patients. Procedures included evacuation of clotted hemothorax (six patients), stapling of pulmonary laceration (four patients), and electrocoagulation of bleeding parietal vessel (four patients). Four patients required conversion to thoracotomy: two for repair of a cardiac wound, one for adequate exposure of the pericardium and one for ligation of a bleeding intercostal artery. The mean operative time was 37+/-23 min. Two patients experienced postoperative complications (coagulopathy, subcutaneous emphysema) and the in-hospital mortality was 0%. The mean hospital stay was 10+/-4 days. CONCLUSIONS: In the hands of an experienced surgeon, videothoracoscopy may represent a valid alternative to subxiphoid pericardial window in patients with hemodynamic stability and a suspected cardiac wound. Videothoracoscopy can rule out a cardiac injury and allows for the performance of associated procedures such as diaphragm assessment/repair, evacuation of clotted hemothorax, hemostasis of parietal vessels or pulmonary laceration and removal of projectiles.

Cardioplegia preserves hypoxic response in isolated coronary arteries but not in isolated hearts.

BACKGROUND: Experiments were designed to determine whether hyperkalemic crystalloid cardioplegic solution alters the hypoxic response of isolated segments of rabbit coronary arteries. METHODS: Coronary arteries were suspended in organ chambers to measure isometric force. We measured the coronary perfusion pressure at a constant flow rate in isolated Langendorff-perfused hearts. Coronary arteries and hearts were preserved in warm (37 degrees C) physiologic solution or in cold (10 degrees C) crystalloid cardioplegic solution. RESULTS: In all groups of coronary arteries, the acetylcholine-induced relaxation before and after preservation was unchanged (n = 7). Hypoxia (15 mm Hg) caused an endothelium-dependent contraction, the amplitude of which did not change after cardioplegia. Conversely, in coronary arteries preserved in physiologic solution, hypoxic contraction amplitude decreased by 67% +/- 17%. In isolated hearts, hypoxic perfusion (15 mm Hg) induced a vasodilation. In all groups, the second hypoxic vasodilation was significantly greater (group 1, first hypoxic perfusion 2.8% +/- 2.8%, second hypoxic perfusion 18.2% +/- 7.1%; group 2, first hypoxic perfusion 6.8% +/- 1.5%, second hypoxic perfusion 29% +/- 9%). CONCLUSIONS: The crystalloid cardioplegic solution did not change the hypoxic response in isolated hearts and preserved the endothelium-dependent hypoxic contraction in coronary arteries.