[Surgical treatment of pulmonary metastases. Apropos of 26 cases]. / Traitement chirurgical des métastases pulmonaires. A propos de vingt-six cas.

Twenty-six patients with known primary tumors were treated surgically for pulmonary metastases between 1951 and 1979. The metastases were diagnosed more often (58% of cases) by routine radiological examinations than because of thoracic symptoms. While diagnosis of the primary tumor and the metastases was simultaneous in three cases, the average lapse of time between the two diagnoses was 5 years and 1 month in the other cases. In four cases, it was 10 years or more. Lung X-rays showed single tumors more often than multiple tumors (12%). Broncho-fibroscopy was usually normal, but a preoperative biopsy showed the metastatic nature of the tumor in 5 cases. Ablation was by lobectomy (42%), pneumonectomy (23%) or atypical resection (27%). The hospital mortality rate was 7.6%. The survival rate at 1, 3 and 5 years (71%, 39%, and 17%) is identical to that of primitive bronchial tumors, and seems to be influenced by certain factors, such as the locus of the primitive tumor (with a particularly bad prognosis for ENT tumors), the lapse of time between the diagnoses of the primary and secondary tumors, the fact that there is one, rather than several, metastases, or that the metastases are monolateral rather than bilateral, and, finally, the limited nature of the exeresis. These factors prompt regular, systematic and prolonged radiological monitoring in search of further pulmonary metastases.

[Metastatic pulmonary echinococcosis secondary to a primary cardiac lesion situated in the interventricular septum. One case successfully treated surgically (author's transl)]. / Echinococcose pulmonaire métastatique, secondaire à une localisation cardiaque primitive située dans le septum interventriculaire. A propos d'un cas opéré avec succès.

The authors report a case of metastatic pulmonary echinococcosis secondary to a primary cardiac lesion. The diagnosis was made on the basis of round pulmonary lesions developing during an episode of cardiac diseases which had been labelled as idiopathic acute pericarditis. The septal site then suspected on the basis of minor conduction disturbances was confirmed by angiography and could be excised under extracorporeal circulation.

[Comparative study of mechanical and manual suture of bronchial stumps in pneumonectomy (author's transl)]. / Suture mécanique et manuelle des moignons bronchiques dans la pneumonectomie. Etude comparative.

The incidence and time of onset of bronchial fistulae were retrospectively studied in 306 patients who underwent pneumonectomy at the Saint-Joseph Hospital, Paris, between 1975 and 1979. The bronchial suture was performed mechanically in 145 cases and manually in 161 cases. Patients in both groups were of comparable age, lung disease, side operated upon, nature of the bronchial division, post-operative course and surgeon's ability. From the results of the study, the authors have endeavoured to determine the advantages of mechanical suture as opposed to manual suture with regard to both operatory technique and quality of results.

[Bronchial myoblastoma with cartilage injury (author's transl)]. / Myoblastome bronchique avec atteinte cartilagineuse.

The authors present a new case of bronchial myoblastoma the particularity of which is the partial destruction of bronchial cartilages. This unusual aggressivity of the tumor facing the toughest bronchial structures does not seem to be an unfavourable prognosis element. Two years after resection, the tumor hasn't recurred.

[A comparative study of "slowly resorbed suture material" in the rat with tracheal sutures (author's transl)]. / Etude comparative du comportement des fils à "résorption lente" chez le rat lors des sutures trachéales.

The authors studied the outcome of polyglycotic acid and braided polyglactine suture material used on the trachea of the rat. The compared them with two non-self-resorbing sutures. 61 rats were operated. The study was on the resistance of the slowly resorbing material over time, as well a macroscopic and histological observations and the tolerance of the 4 materials tested. The merit of this work is to show that these slowly absorbed materials are far from the ideal solution for sutures of the tracheo-bronchial tree and that single-ply nylon suture has remarkable tissue tolerance.

Surgical treatment for a complicated congenital aortic stenosis. The association of a three-level obstruction of the left ventricular outflow tract with mitral incompetence, coarctation of the aorta, and the Wolff-Parkinson-White syndrome.

We report a case of complex congenital aortic stenosis with obstruction at all three levels of the left ventricular outflow tract (subaortic, aortic, and supravalvular aortic stenoses) associated with a mitral malformation, coarctation of the aorta, and the Wolff-Parkinson-White syndrome. The subaortic stenosis was corrected by excision and myotomy, and the supravalvular stenosis by a widening prosthetic operation with a Dacron patch extending as far as the aortic ring, at which level a Björk-Shiley No. 17 aortic prosthesis was inserted. The mitral valve was replaced by a Lillehei-Kaster prosthesis. The coarctation of the aorta was not significant and was left alone. Permanent pacing was needed because of peroperative surgical section of the bundle of His. Reviews of the literature and the various techniques used to widen the left ventricular outflow tract are included.

[Treatment of mitral insufficiency by Wooler-Reed annuloplasty. Remote results]. / Traitement de l'insuffisance mitrale par annuloplastie de Wooler-Reed. Résultats lointains.

The outcome of 67 patients operated on between 1963 and 1971 for pure mitral regurgitation due to dilatation of the mitral ring (group I: 25 cases), papillary muscle dysfunction (group II: 11 cases) and valvular and/or subvalvular lesions (group III: 31 cases) was analysed with an average follow up of 9.1 years (range 4 to 12 years). Eleven patients (16 p. 100) died in the late post-operative period (average 4 years). The main cause of death was cardiac failure related to the valvulopathy (8 cases). 11 patients were reoperated (16 p. 100) (on average 5 years after operation). The opeartive findings, besides early technical errors (2 cases), showed deterioration to be less often related to secondary dilatation of the mitral ring (1 case) than to progression of the valvular and subvalvular disease (7 cases). The patients followed up at present have shown symptomatic improvement (39 out of 40 cases) although the cardiothoracic ratio has generally remained unchanged. Average pulmonary capillary and arterial pressures were lower than the preoperative findings in 9 control cardiac catheterisations. Thromboembolism (2.6 p. 100), infection (2.6 p. 100) and haemolysis (0 p. 100) were less frequent than in patients with prosthetic valves. The survival curve is also better in patients having undergone reconstructive surgery. This study showed the best results in the group with pure mitral regurgitation secondary to mitral ring dilatation. The results were less favourable in groups II and III. This surgical technique would seem best reserved for young people, when anticoagulant therapy carries unacceptable risks, and when the following anatomical conditions are respected: pure mitral regurgitation with a normal valvular and subvalvular apparatus.

[Total anomalous pulmonary venous return: apropos of an unusual case]. / Retour veineux pulmonaire anormal total. A propos d'une observation inhabituelle.

A case is reported in which the entire pulmonary venous return was abnormal, being retro-cardiac. Unusual features were the age at which the abnormality was discovered (14 years), and the anatomical type of abnormality of pulmonary venous return. The return effectively emptied into a posterior cavity which was "a diverticulum of the right atrium" which had a wide communication with the "normal" right atrium, which in turn communicated with the left atrium by a highly placed Ostium Secundum. The muscular septum which separated the highly placed auricle of the left atrium and the "diverticulum" was removed, and vertical partitioning allowed a right and left atrial cavity to be reconstituted. The post-operative progress was uneventful.

[Aortic valve replacement. Apropos of a series of 117 patients]. / Remplacement valvulaire aortique. A propos d'une série de 117 patients.

With a series of 117 aortic valve replacements, the authors have examined the results in relation to the method of protecting the myocardium while the aorta is clamped off. There does not appear to be much difference between coronary perfusion and the technique of profound local hypothermia by the perfusion of a chilled solution into the pericardium. Because of this, the authors remain in favour of the latter technique, which provides effective protection of the myocardium during periods of aortic occlusion sufficient for monovalvular replacements. An occlusion time of up to 90 minutes has been achieved without any major problems. Nevertheless, perfusion of the two coronary arteries is sometimes indicated, notably when profound local hypothermia cannot be employed at revision surgery, feeling of the pericardial cavity being neither possible nor desirable.