[Cardiac surgery without transfusion in 2005]. / Chirurgie cardiaque sans transfusion en 2005. A propos d'une série de 200 témoins de Jehovah opérés.

PURPOSE: Between January 1991 and October 2003, 200 Jehovah Witnesses adult patients underwent elective cardiac surgery. To asses the impact on continuing progress of blood saving protocols and the increasing operative risk of patients proposed to surgery, we have re-assessed our results in this specific population. METHODOLOGY: Files of the first 100 patients operated upon between 1991 and 1998 were reviewed, and compared to the following 100 ones treated between 1998 to today. All patients were scored using the Euroscore model. RESULTS: In the latest series, patients are older (68 vs 51) and 13% underwent an iterative procedure, although there was none in the first series. Three deaths occurred after one month at the beginning of our experience, only one in the latest series. Operative risk factors had distinctly deteriorated, with more redux, and ejection fraction lower than 35%. Major progress to maintain morbi-mortality stability were multifactorial: preoperative erythropoietin in order to reach an haemoglobin minimal value of 14 g/dL, Cornell University protocol, mini-ECC, warm blood cardioplegia, ultra-early extubation. CONCLUSION: Cardiac surgery without transfusion can be realised with an equivalent risk to that of classical surgery, despite an operative risk aggravation, due to the association of recent conservative techniques.

[Migration of an Antheor filter in the pulmonary artery. A case]. / Migration d'un filtre Anthéor dans l'artère pulmonaire. Une observation.

Migration of an Antheor caval filter into the pulmonary artery was observed in a 66-year old male patient referred for multifocal pulmonary embolism in a context of heparin-induced thrombocytopenia. The inferior vena cava was of small diameter (18 mm). The filter was removed under cardio-pulmonary bypass and total heparinization, despite the proven thrombocytopenia. The postoperative period was marked by tamponade which had to be drained. The long-term results were satisfactory. This seems to be the first documented case of Antheor caval filter migration into the cardiac cavities.

[Technical modification of transaxillary resection of the first rib in surgery of thoraco-brachial outlet syndromes]. / Modification technique de la résection de la première côte par voie transaxillaire dans la chirurgie des syndromes de la traversée thoraco-brachiale.

From April 1985 to September 1991, 88 patients were operated for a total of 100 thoracobrachial outlet syndromes. The patients were placed in the dorsal supine position, turned 30 degrees towards the contralateral side. The arm was suspended in slight abduction. The access obtained is identical to that obtained with the classical operation. No direct traction or compression is exerted on the pedicles during retraction and the operation requires a single assistant. The composition, indications and results of our series are similar to those reported in the recent literature. We did not observed any immediate or late neurological complications. We conclude that thoracobrachial outlet syndromes can be treated via an axillary approach using mechanical traction and a single assistant without increasing the risk of neurological complications.

[Return to work after surgical treatment of varicosities of the lower limb]. / Reprise du travail après traitement chirurgical des varices des membres inférieurs.

Factors which the duration of time off work after surgical treatment of venous insufficiency of the legs were studied in 3000 patients undergoing surgery in our institution between 1985 and 1990. Three variables significantly influenced return to work at 2 weeks (RW2w). The first was socio-professional group. All patients in the first was socio-professional group. All patients in the professions and 95 per cent of tradesmen or freelance workers had returned to work after 2 weeks, while 40 per cent of civil servants and 35 per cent of employees in private organisations were still off work. Time spent of work was 23 +/- 10 days in civil servants, 4 +/- 3 days in the professions and 5 +/- 2 days in tradesmen of freelance workers. The second was the type of anesthesia with or without hospitalisation, local or general. The final variable was the physical effort involved in work, the RW2w was 72 par cent in patients in whom such effort was mild or moderate, and 56 per cent in effort was considerable. The second was the type of anesthesia with or without hospitalisation, local or general. The final variable was the physical effort involved in work. The RW2w was 72 percent in patients in whom such effort was mild or moderate, and 56 per cent in effort was considerable. It is concluded that the rapidity of return to work was not as good as could legitimately be expected following an operation with nil mortality and extremely limited morbidity.(ABSTRACT TRUNCATED AT 250 WORDS)

[Early return to work after arterial surgery and strict control of disabled patients]. / Reprise précoce du travail après chirurgie artérielle et contrôle strict des invalides.

Coronary surgery represents an increasing economic burden to society. This is aggravated a great deal by the fact that these patients do not return to work and are often placed in permanent postoperative disability. Comparative analysis of return-to-work rates after coronary by-pass, according to the social benefits system, clearly demonstrates the magnitude of the possible savings. Attending physicians, specialists and experts must, therefore, motivate the patients with total disability.

Percutaneous transvenous caval interruption with the "LGM" filter: early results of a multicenter trial.

From September 1985 to December 1986, 100 patients undergoing percutaneous placement of a transvenous "LGM" caval filter were included in a multicenter prospective trial. Peripheral venograms completed by pulmonary arteriography or scintigraphy were obtained for all patients. Eighty-five patients had experienced pulmonary embolism, 59 had iliocaval thrombosis, while 40 had venous thrombosis confined to the lower limbs. In two instances, insertion or passage of the catheter was impossible. Ninety-eight "LGM" filters were placed percutaneously through the internal jugular vein, 82 of which were correctly positioned in the infrarenal inferior vena cava. Eight filters were positioned with a tilt of more than 15 degrees with respect to the vertical axis, five failed to open correctly, and three were incompletely open and tilted. No postoperative deaths were observed; there were two recurrent embolisms, and seven caval thromboses occurred during the year that followed insertion of the filter. The "user-friendliness" and efficacy of this percutaneous filter makes it a treatment of choice in the partial interruption of the inferior vena cava.

Rupture of abdominal aortic aneurysm into the inferior vena cava: a study of seven cases.

The authors report seven cases of abdominal aortic aneurysm rupturing into the inferior vena cava system. Symptoms were protean, but included local clinical manifestations and general findings due to the high-flow arteriovenous fistula. In spite of different types of clinical presentation, the correct preoperative diagnosis was made when a continuous bruit with systolic accentuation was heard over the abdomen. Venous repair consisted of simple closure of the fistula from within the aneurysm in six cases. In one case, treatment required ligation of the right common iliac vein. There were two cases of paraplegia, one before and one after the operation. Two of the seven patients died.

Erectile dysfunction caused by venous leakage: treatment with detachable balloons and coils.

Impotence can be caused by leakage of venous blood from the penis during erection. Of 135 patients studied with erectile dysfunction, 40 had venous leakage, and these patients were classified into three groups according to findings on cavernosograms. Thirty-one patients were treated with implantation of balloons and coils. Twenty-six of these patients now have normal sexual function. The authors believe this technique is simple, safe, and effective for the treatment of impotence caused by venous leakage.

[Aorto-iliocaval fistula caused by rupture of an aneurysm. Apropos of 3 cases]. / Fistule aorto et ilio-cave par rupture d'anévrysme. A propos de trois cas.

Three cases of aorto-iliocaval fistula are reported. Two cases were diagnosed during operation, an emergency laparotomy being indicated by the picture of hemodynamic shock unimproved by intravenous fluids, and without reduction in number of circulating red cells, associated with a painful abdominal aorta aneurysm. Recovery occurred after surgical closure of fistula and grafting of the aneurysm. In one case a caval stenosis required the insertion of a prophylactic subrenal clip. The third case was original in that a paradoxical pulmonary embolus developed in a patient with a primary left iliac aneurysm complicated by phlebitis. The hemodynamic state was such that a first stage operation. allowed insertion of a Greenfield's filter by the jugular route. Arteriography confirmed the diagnosis of a fistula and surgery was successful. Possible clinical manifestations of aortocaval fistula and surgical therapeutic measures are discussed.

Cancer of the kidney invading the vena cava and heart. Results after 11 years of treatment.

Between October, 1973, and October, 1983, 18 patients with cancer of the kidney or adrenal gland that had invaded the vena cava, and in 11 cases had reached the heart, were operated on by seven surgical teams. The surgical excision in all patients was performed with extracorporeal circulation, circulatory arrest and deep hypothermia. No deaths occurred. If there are no detectable metastases before operation, the 5 year survival rate is 75% as compared to 6 months with medical treatment. This clinical situation is not uncommon, as 3% to 10% of cancers of the kidney invade the inferior vena cava and 40% of them reach the heart. The possibility of curing the cancers with minimal operative risk should prompt a systematic search for venous invasion with any cancer of the kidney.

[Effects of intravenous electrodes of cardiac pacemakers. Clinical and plethysmographic approach]. / Retentissement des électrodes endoveineuses de stimulateurs cardiaques. Approche clinique et pléthysmographique.

The authors study the haemodynamics of the endovenous electrodes of cardiac stimulators (EE) in the light of clinical and plethysmographic investigations. Seven venous thromboses were observed out of 2,000 implantations of stimulators (0.35%). The risk increases with age 7th decade) and the presence of multiple EEs. The comparative plethysmography of a series of 22 normal young subjects and 28 old patients equipped with EEs demonstrates that the deep venous return in the upper limbs of a normal subject is better in a young person and in a dominant limb. In the subject equipped with an EE, distensibility is reduced. Temporary coagulation has its place in the treatment of these phlebites (heparin, followed by calciparin). Surgery to disobstruct or excise EE or fibrinolytics are only required exceptionally.

Choledochoscopy in common bile duct surgery for choledocholithiasis: A must: Eight years experience in 441 consecutive patients.

Between 1975 and 1983, 441 choledochoscopy were performed in a series of 451 consecutive patients undergoing surgical common biliary duct exploration for choledocholithiasis. In 127 patients (27.8%), no stones were found. Forty-five cases (10%) of choledocholithiasis missed by surgical and radiologic exploration methods were found by choledochoscopy. Therefore the retained stone rate decreased from 10 per cent to 2 per cent. Fourteen patients (3%) died at surgery, ten of whom (2%) were over 70. Postoperative biliary tract was drained in 98 patients (8%) using external drainage. Biliary tract patency was checked on the tenth postoperative day by the tube cholangiography. When retained stones were not found, T-tube was removed on the 20th day after surgery. When retained stones were found (11 patients, 2%) an endoscopic papillotomy was performed. Choledochoscopy is a significant addition in biliary surgery. It reduces operative mortality and morbidity, decreases retained stone rate, diminishes indications for biliary anastomosis and sphincterotomy, and is easy to perform without specific training. Its extensive and systematic use is advocated when- ever common bile duct patency has to be surgically demonstrated in choledocholithiasis.

[Role of thrombolytic treatment in thrombosis of valvular prostheses. Apropos of 2 cases and review of the world literature]. / Place du traitement thrombolytique dans les thromboses des prothèses valvulaires. A propos de 2 cas et revue de la littérature mondiale.

The authors report 2 cases of thrombolytic therapy by Urokinase at the dose of 4 500 U/kg/hour, for 24 hours, in patients with thrombosis of a Bjork aortic and Lillehei mitral valve prostheses, and assess the efficacy with a review of the world literature. The first case was a 65 year old woman who received a Bjork No 25 aortic valve prosthesis for aortic regurgitation. Two years later oral anti-vitamin K anticoagulants were replaced by an association of Aspirin-Persantine. She developed acute pulmonary oedema secondary to thrombosis of her valve during the fifth postoperative year. Treatment with Urokinase was successful (4 500 U/kg/hour for 24 hours). The second cases was a 33 year old woman who received a Lillehei No 27 mitral valve prosthesis for mitral regurgitation due to infective endocarditis. Six years later, during a period of apparently ineffective oral anticoagulation, she developed subacute pulmonary oedema due to thrombosis of her prosthesis. Urokinase therapy was successful after 4 hours, but the valve surface area on cardiac catheterisation was decreased and elective reoperation to change the prosthesis was decided upon. Prosthetic valve thrombosis is a serious complication with an operative mortality of 68.6% (35 deaths out of 51 reoperations in the worl literature) whilst the efficacy of thrombolytic therapy would appear to be about 80%. When thrombosis is progressive, the valve has to be changed surgically, but when it is secondary, thrombolytic therapy at least helps the patient survive the acute phase.

Choledochoscopy in surgery for choledocholithiasis. Six year experience in 380 consecutive patients.

Choledochoscopy is a definite advance in biliary surgery as it simplifies the operative procedure and decreases the retained stone rate. Easy to perform without special training, its use is cost-effective. Therefore, we agree with Kappes et al [10] recommendation that routine intraoperative biliary endoscopy be performed in all patients undergoing common bile duct exploration.

[Prospective study of the long-term permeability of the internal saphenous vein and of polytetrafluoroethylene in the lower femoro-popliteal bypass. Results after 5 years in 100 patients]. / Etude prospective de la perméabilité à long terme de la veine saphène interne et du polytétrafluoroéthylène dans les pontages de sauvetage fémoro-poplité bas. Résultats à cinq ans chez 100 malades.

Autogenous saphenous vein (ASV) (50 patients-group I) was compared to polytetrafluoroethylene (PTFE) (50 patients group II), in 100 below-knee femoropopliteal bypass (FPB) procedures performed for limb salvage during à 5 year-period. PTFE was used as an alternative procedure in the absence of a suitable ASV. Each group made of 50 patients was not significantly different from the other. The mean follow up period for patent graft is now 35 months (12-60 months) and the overall life table cumulative patency at 5 years, is 65% in group I and 18% in group II (P less than 0.05) whereas the limb salvage rate (LSR) is 81% with ASV and 26% PTFE (P less than 0.05). No correlation was demonstrated between patency and run-off. The graft described was used in elderly patients most of whom would have had amputation before the introduction of PTFE. Theses results advocate the use of PTFE only in secondary intention and never to shorter operation time.

Partial ileal bypass in type II familial hypercholesterolemia. Eleven-year experience at the Montreal Heart institute.

The National Heart, Lung, and Blood Institute is currently sponsoring a multicenter clinical trial to evaluate the long-term efficacy of partial ileal bypass in the prevention of recurrent myocardial infarction in hypercholesterolemia patients. Thus we felt that a report of our clinical results with this intervention at the Montreal Heart Institute during the last 11 years would be of interest. Twenty patients with type II hyperlipoproteinemia and a mean age of 38 (range 25-54) years underwent partial ileal bypass between March 1971 and April 1978. This intervention was associated with aortocoronary bypass surgery in 11 patients. All patients were followed at regular intervals. The mean survival time was 70.7 (range 1-123) months. Two deaths were observed during follow-up, one from an acute myocardial infarction and the other from ventricular fibrillation, respectively, 1 month and 1 and one-half years after partial ileal bypass. The ileal bypass was undone twice because of gastrointestinal problems including a malabsorption syndrome and repeated episodes of subocclusion. A progressive decrease of the effects of the operation on serum cholesterol was noted, from a 33 per cent reduction at 3 months to 43 per cent at 2 years and 16 per cent at 6 years. Two patients presented an acute myocardial infarction respectively 3 and 4 years after the operation, respectively, and one patient suffered a right-sided hemiplegia at age 30, 12 months after the operation. Of 14 patients with angina pectoris preoperatively (class III in 10), eight remained symptomatic postoperatively (class I and II angina in five).(ABSTRACT TRUNCATED AT 250 WORDS)