[Pulmonary artery percutaneous angioplasty for extrinsic compression induced by squamous cell carcinoma]. / Angioplastie percutanée d'une artère pulmonaire pour compression extrinsèque par un carcinome épidermoïde.

Pulmonary artery stenting is usually performed in congenital heart diseases and in cases of extrinsic compression due to a mediastinal tumor or fibrosis. We report one clinical case of a 61-year-old man treated by radiation and chemotherapy for T3N1M0 non-small cell lung carcinoma. He complained of disabling dyspnea. Pulmonary scintigraphy showed an absence of perfusion in the left lung. Chest computed tomography revealed a severe stenosis of the left pulmonary artery due to tumoral extrinsic compression. Under general anesthesia, we performed percutaneous angioplasty with self expandable nitinol stent. There was no peroperative complication. Dyspnea decreased immediately despite the natural course of the disease was not altered. Percutaneous stenting of pulmonary artery is safe and a feasible option for tumoral extrinsic compression. It is a palliative treatment but it can improve patient's quality of life.

L'angioplastie percutanée avec stent d'une artère pulmonaire est habituellement réalisée dans des pathologies cardiaques congénitales et en cas de compression extrinsèque par une masse médiastinale ou de la fibrose. Nous rapportons le cas d'un patient de 61 ans, traité par radio- et chimiothérapie pour un cancer pulmonaire non à petites cellules de stade T3N1M0. Le patient se plaignait de dyspnée invalidante. La scintigraphie pulmonaire montrait l'absence de perfusion du poumon gauche. La tomodensitométrie thoracique révélait une sténose sévère de l'artère pulmonaire gauche provoquée par une compression extrinsèque tumorale. Sous anesthésie générale, nous avons réalisé une angioplastie percutanée avec déploiement d'un stent en nitinol auto-expansible. Il n'y a pas eu de complication pendant la procédure. Le symptôme dyspnéique a régressé immédiatement, sans changer l'histoire naturelle de la maladie. L'angioplastie percutanée d'artère pulmonaire est une option faisable et sûre en cas de compression extrinsèque tumorale. C'est un traitement palliatif qui peut améliorer la qualité de vie des patients.

[Endovascular treatment of femoropopliteal arterial occlusive disease]. / Le traitement endovasculaire des lésions artérielles occlusives fémoro-poplitées.

Endovascular treatment established itself last years as the first choice to treat femoropopliteal arterial occlusive disease. It is less invasive than the surgical approach. Endovascular techniques and devices evolution made it efficient. Use of retrograde puncture or re-entry catheters allows to recanalize more complex lesions. Vessel preparation of stenotic or occluded target lesion becomes an integral part of the therapy. Thanks to a lot of multicenter randomized controlled trials, drug eluting balloons took major place in the armamentarium we have, despite strong controversies last months about their safety. Conventional self-expandable stents with or without eluting drug, and vasculo-mimetic stents allow to treat very calcified lesions or dissected lesions through the recanalization procedure. This paper aims to review endovascular technical developments achieved last years to treat femoropopliteal arterial occlusive disease.

Le traitement endovasculaire s'est imposé, ces dernières années, comme le traitement de premier choix des lésions artérielles occlusives fémoro-poplitées. Il est moins invasif que l'approche chirurgicale. L'évolution des techniques endovasculaires et du matériel l'ont rendu efficace. L'utilisation de la ponction rétrograde ou de cathéters de ré-entrée permet de recanaliser des occlusions plus complexes. La préparation du segment artériel sténosé ou occlus fait partie intégrante de la thérapie. Grâce à de nombreuses études prospectives, multicentriques et randomisées, les ballons à élution de drogue ont pris une place importante dans l'arsenal thérapeutique mis à notre disposition, même si leur innocuité a été fort débattue ces derniers mois. Des stents auto-expansibles conventionnels, avec ou sans élution de drogue, et des stents vasculo-mimétiques permettent de traiter des lésions très calcifiées ou disséquées par le processus de recanalisation. Cet article a pour but de revoir les progrès techniques endovasculaires, réalisés ces dernières années, dans le traitement des lésions artérielles occlusives fémoro-poplitées.

[Retroperitoneal cystic lymphangioma treated by sildenafil]. / Lymphangiome kystique rétropéritonéal traité par sildénafil.

Cystic lymphangioma is a rare and benign lymphatic malformation found most often in the first two years of life. Clinical manifestations are diverse and depend on size and site of the lesion. The most frequently affected sites are cervicofacial and axillary areas. The retroperitoneal form is rare. Diagnosis requires imaging but can only be confirmed on the basis of an anatomopathological examination. The treatment of choice is complete surgical removal. However, this is not always feasible due to proximity of vital structures. Some alternative therapies like sclerotic injection and oral drugs like immunosuppressive treatment or sildenafil are described. We report the case of a 62-year-old patient with retroperitoneal cystic lymphangioma successfully treated with sildenafil.

Le lymphangiome kystique est une malformation lymphatique rare et bénigne, découverte le plus souvent durant les deux premières années de vie. Les manifestations cliniques sont diverses et dépendent de la taille et de la localisation de la lésion. Les localisations les plus fréquentes sont cervicofaciale et axillaire. La forme rétropéritonéale est rare. Le diagnostic nécessite un bilan d'imagerie, mais ne peut être confirmé que sur base d'un examen anatomopathologique. Le traitement de choix est l'exérèse chirurgicale complète. Toutefois, celle-ci n'est pas toujours réalisable en raison de la proximité de structures vitales. Certains traitements alternatifs comme la sclérothérapie ou l'administration de traitements oraux tels qu'immunosuppresseurs ou sildénafil sont décrits. Nous rapportons le cas d'un patient âgé de 62 ans avec lymphangiome kystique rétropéritonéal traité avec succès par sildénafil.

[The opportunities of the minimally invasive approach for the cardiovascular and thoracic surgery]. / Apport de l'approche moins invasive en chirurgie cardiovasculaire et thoracique.

There is a continuous growth in the incidence of cardiovascular and thoracic diseases, especially related to the increased life expectancy. Moreover, the quality and efficacy of care for these pathologies are progressing constantly. The evolution of surgery prompts us to develop less aggressive (minimally invasive), although technically more complex, treatment or diagnostic techniques. Pathologies, which until now required heavy surgeries, are managed today in a less invasive way and become therefore accessible to patients even if they are older or in a poor general condition. In this article, we present our experience in the development of the minimal invasive procedures in cardiovascular and thoracic surgery.

Les pathologies cardiovasculaires et thoraciques, au sens large, sont de plus en plus fréquentes, vu l'augmentation de l'espérance de vie, mais elles sont aussi de mieux en mieux prises en charge. En effet, l'évolution de la chirurgie nous incite à développer des techniques de traitement ou de diagnostic moins agressives (mini-invasives) quoique techniquement plus complexes. Des pathologies qui nécessitaient, jusqu'à présent, des chirurgies lourdes se prennent en charge, aujourd'hui, de manière moins invasive et deviennent donc accessibles à des patients en moins bon état général ou de plus en plus âgés. Nous présentons ici notre expérience dans le développement de l'approche mini-invasive en chirurgie cardiovasculaire et thoracique.

[Acute mesenteric ischemia]. / L'ischémie mésentérique aiguë.

Acute mesenteric ischemia is a real life-threatening emergency. Mode of presentation is severe abdominal pain with sudden onset. The etiology is most of the time embolus coming from the heart or thrombosis of atherosclerotic vessel wall concerning the superior mesenteric artery. The best investigation is computed tomography with intravenous contrast media injection. Treatment consists of revascularization by open surgery or endovascular approach. Bowel resection may be necessary, as well as delayed second look surgery. This paper aims to review etiologies and therapeutics options for acute mesenteric ischemia.

L'ischémie mésentérique aiguë est une réelle urgence vitale. Elle se manifeste par une douleur abdominale sévère d'apparition brutale. Elle est, le plus souvent, provoquée par une embolie d'origine cardiaque ou une thrombose sur terrain athéroscléreux au niveau de l'artère mésentérique supérieure. Le meilleur examen complémentaire est la tomodensitométrie avec injection intraveineuse de produit de contraste. Le traitement consiste en une revascularisation par chirurgie ouverte ou technique endovasculaire. Une résection intestinale est ensuite parfois nécessaire, ainsi qu'une chirurgie différée de second look. Cet article a pour but de revoir les causes et les possibilités thérapeutiques de l'ischémie mésentérique aiguë.

Treatment of a groin lymphatic fistula with negative pressure wound therapy.

INTRODUCTION: Groin lymphatic fistulas are a troublesome finding after limb revascularization surgery. Its management represents a difficult task for the clinician. REPORT: We report our experience in the treatment of such a condition with negative-pressure wound therapy (NPWT) in a 70-year-old man which benefited from extra-anatomic prosthetic axillofemoral bypass. After a week of treatment, the fistula dried up and closure was obtained with simple suture under local anaesthesia. Follow-up at 9 months showed stable coverage without any sign of leakage. DISCUSSION: This study depicts NPWT as an effective non-invasive treatment in the management of groin lymphocutaneous fistula.

[Ground-glass opacity and mixed pulmonary nodules: a new computed tomography semiology of the pulmonary adenocarcinoma]. / Comment j'explore... les nodules pulmonaires de types verre dépoli et mixte: une nouvelle sémiologie tomodensitométrique de l'adénocarcinome pulmonaire.

Recently a new computed tomography semiology of the pulmonary adenocarcinoma was highlighted. Studies on ground-glass nodule and on mixed nodule showed the relation between these radiological images and the different anatomopathological forms of lung adenocarcinoma. Ground-glass opacity can correspond to precancerous lesions and morphological characteristics of nodules are correlated with the prognosis. The presence of spiculation, pleural retraction and air bronchogram is significantly more important in neoplasic lesions. The presence or the apparition of a solid component inside the nodule or the presence of indentation is highly suggestive of adenocarcinoma. A lesion smaller than 20 mm and persistant after 1 month must be, either followed up, or removed by a limited surgical resection. Lesions larger than 20 mm or associated with a solid component must be treated by conventional surgery.

[Surgical treatment of chest wall tumors]. / Chirurgie des tumeurs de la paroi thoracique.

The observation of a primary chest wall desmoid tumor discovered incidentally in a young patient is an opportunity to review the nosology, diagnosis and treatment of this uncommon pathology. Surgical intervention should aim at resecting completely the lesion with sufficient margins. Subsequent reconstruction of the bony thorax uses synthetic materials and muscle or myocutaneous flaps.

Infected abdominal aortic aneurysm treated by in situ replacement with cryopreserved arterial homograft.

Infected abdominal aortic aneurysms are uncommon but not rare (1-3% of all abdominal aortic aneurysms). This life-threatening disease can lead to rapid uncontrolled sepsis and/or aortic rupture. We report one case that underlines two notions. Firstly computed tomography is effective to detect early stages of the pathology providing complete depiction of the anatomical abnormalities. Secondly infected aortic aneurysm can be successfully treated by antibiotherapy and in situ replacement with cryopreserved arterial homograft.

Intra-arterial thrombolysis of thrombosed popliteal artery aneurysm. A series of six cases.

AIM OF THE STUDY: To evaluate the role of perioperative, catheter-guided fibrinolysis in the management of thrombosed popliteal artery aneurysms. MATERIAL: From 1990 to 2005, six patients suffering subacute limb ischemia, secondary to thrombosis of a popliteal artery aneurysm, benefited selective intra-arterial fibrinolysis, followed by subsequent aneurysm exclusion and bypass grafting. This represents ten percent of all popliteal aneurysms operated on in that time period and 28% of all thrombosed popliteal artery aneurysms. RESULTS: The lytic procedure was successful in all cases, restituting patency in two (n = 3), one (n = 2) or all (n = 1) crural arteries. The venous bypass graft remained patent in all but one patient. In one patient, the graft occluded at 10 months without limb loss. This outcome compares more favorable than the result obtained with emergent surgery alone for thrombosed popliteal artery aneurysms with profound limb ischemia (eight patients, of whom one required amputation at day 5 and one lost his limb at nine months following graft thrombosis). CONCLUSION: Preoperative intra-arterial lytic therapy, in the setting of subacute limb ischemia caused by thrombosis of a popliteal artery aneurysm, can be considered as safe and effective.

Cardiac surgery in octogenarians; peri-operative outcome and long-term results.

AIMS: Because the elderly are increasingly referred for operation, we reviewed the results of cardiac surgery in patients of 80 years or older. METHODS AND RESULTS: Records of 182 consecutive octogenarians who had had cardiac operations between 1992 and 1998 were reviewed. Follow-up was 100% complete. Seventy patients had coronary grafting (CABG), 70 aortic valve replacement, 30 aortic valve replacement+CABG, and 12 mitral valve repair/replacement. Rates of hospital death, stroke, and prolonged stay (>14 days) were as follows: CABG: 7 (10%), 2 (2.8%) and 41 (58%); aortic valve replacement: 6 (8.5%), 2 (2.8%) and 32 (45.7%); aortic valve replacement+CABG: 8 (26.5%), 1 (3.8%) and 14 (46.6%); mitral valve repair/replacement: 3 (25%), 1 (8.3%) and 5 (41.6%). Multivariate predictors (P<0.05) of hospital death were New York Heart Association functional class, urgent procedure, prolonged cardiopulmonary bypass time, and, after aortic valve replacement, previous percutaneous aortic valvuloplasty. Ascending aortic atheromatous disease was predictive of stroke, while pre-operative myocardial infarction was predictive of prolonged hospital stay. Actuarial 5-year survival was as follows: CABG, 65.8+/-8.8%; aortic valve replacement, 63.6+/-7.1%; aortic valve replacement+CABG, 62.4+/-6.8%; mitral valve repair/replacement, 57.1+/-5.6%; and total, 63.0+/-5.6%. Multivariate predictors of late death were pre-operative myocardial infarction, and urgent procedure. Ninety percent of long-term survivors were in New York Heart Association class I or II, and 87% believed having a heart operation after age 80 years was a good choice. CONCLUSION: Cardiac operations are successful in most octogenarians with increased hospital mortality, and longer hospital stay. Long-term survival and quality of life are good.