[Peroperative rhabdomyolysis caused by compression of a kidney-bridge. Value of muscular scintigraphy]. / Rhabdomyolyse peropératoire par compression sur un billot lombaire. Intérêt de la scintigraphie musculaire.

A case is reported of acute renal failure occurring after prolonged abdominal aortic bypass surgery in an overweight 69-year-old male patient. Preoperative serum creatinine concentration was normal. Surgery lasted for 6 h, and infrarenal aortic cross-clamping 2 1/2 h. The patient complained of important lumbar pain immediately after the operation. In the same time, oliguria and acute renal failure also developed (creatinine: 464 mumol.l-1; urea: 13 mmol.l-1). Rhabdomyolysis caused by the kidney-bridge was confirmed by the elevated blood creatine phosphokinase levels (16,000 IU.l-1 on the second postoperative day). A 99 m-Technetium methylene-diphosphonate imaging on the 10th postoperative day exhibited diffuse fixation in the paravertebral lumbar and thoracic muscles, extending from Th8 to L3. The acute renal failure regressed completely after haemodialysis.

[Traumatic infarction of the right ventricle caused by coronary dissection]. / Infarctus traumatique du ventricule droit secondaire à une dissection coronaire.

A case is reported of a 47 year-old man who suffered from a right ventricular myocardial infarct which occurred as a result of right coronary arterial dissection after non-penetrating anteroposterior chest compression. The patient was admitted with right heart failure and a central venous pressure of 17 cm H2O. The ST segment in leads V1 to V3 (V2: 7mm) was significantly elevated. Echocardiography showed dilatation of both right atrium and ventricle, with a deviated septum. Emergency cardiac angiography confirmed a hypokinetic right ventricle, with no other abnormal finding. Coronary angiography, performed 24 h after admission, revealed a dissection of the second part of the right coronary artery, with a normal left coronary system which reperfused that part of the right coronary arterial territory located beyond the dissection. The ST segment elevation stopped at the 10th hour. Initially, the patient's condition worsened. Thereafter, he slowly improved under treatment (5.5 micrograms.kg-1.min-1 dobutamine, and fluids so as to maintain a pulmonary wedged pressure of about 15 mmHg). As post-traumatic myocardial infarction is rare, the diagnostic and therapeutic strategies are discussed.