[Medical treatment in peripheral arterial disease: a professional practice study in 262 patients]. / Traitement médical de l'artériopathie oblitérante des membres inférieurs: étude de pratique professionnelle chez 262 patients.

PURPOSE: Antiplatelet agents (APA), statins and angiotensin converting enzyme inhibitors (ACEI) are effective to reduce the risk of cardio-vascular events in patients with peripheral arterial disease (PAD). Few data are available on the actual prescription of these drugs in outpatients and on the effect of hospital care on the level of prescription. METHODS: Retrospective study of patients hospitalized with a confirmed diagnosis of PAD over a one-year period. Comparison of medical treatments on admission and on discharge. RESULTS: 262 patients were included. Mean age was 73 +/- 11 years, and 29% of the patients were women. APA were present in 64% on admission and in 83% when discharged (P < 0.0001). A statin was present in 29% on admission and in 38% when discharged (P = 0.001). ACEI were present in 27% on admission and in 32% when discharged (P= 0.02). A vasodilator was present in 47% on admission and 52% when discharged (P = 0.1). 35% of the patients had isolated PAD. Compared to the patients with associated clinical coronary or cerebro-vascular disease, they were less frequently discharged on statins (respectively 26 and 45%, p = 0.003) and on ACEI (respectively 23 et 38%, P = 0.016) whereas APA were equally prescribed (respectively 82 and 84%, P= 0.7). CONCLUSION: APA were prescribed to a majority of outpatients and the level of prescription was further improved when patients were discharged from the hospital. Statins and ACEI were insufficiently prescribed. On the other hand, vasodilator therapy remained still largely prescribed, despite the lack of any strong effect on morbidity and survival.

[Portal vein aneurysm]. / Anévrisme de la veine porte.

In a 72-year-old female patient suffering from non specific and vague abdominal pain, an aneurysm of the portal vein was discovered. In the absence of complication, and because the risk of operation appeared too high, the decision was to abstain from surgery. With more than 3 years of regular follow-up, the patient was free of symptoms, and the portal vein aneurysm was unchanged. Sixty cases including this one are reviewed.

[Coronary surgery in patients aged 70 years and older. 65 cases]. / Chirurgie coronaire chez le sujet âgé de 70 ans et plus. 65 cas.

Out of 428 patients operated upon for coronary disease between December 1984 and November 1989, sixty-five (15.18 percent) were 70 to 80 years' old. All were suffering from a more or less invalidating stage II, III or IV angina. Coronary arteriography showed severe lesions of two or three main vessels (24.6 and 60 percent respectively). Each patient underwent 2.06 bypasses on average. Perioperative mortality was 7.7 percent, and late mortality 1.53 percent. The postoperative myocardial infarction rate was 4.61 percent, and 83 percent of these patients became asymptomatic. There was no deterioration. These satisfactory results are the consequences of numerous technical advances in cardiovascular surgery, anaesthesia and intensive care. As more and more elderly patients undergo coronary surgery, the desire of other elderly patients to be operated upon and their comfort after coronary surgery, the desire of other elderly patients to be operated upon and their comfort after coronary bypass are two additional reasons to opt for surgery. In spite of new vascular recanalization techniques, coronary surgery remains of considerable value. Close cooperation between surgical and medical teams should clarify the respective indications for coronary angioplasty and direct coronary bypass, thereby making these two procedures complementary and no longer competitive.