[Muscular myxoma. A case of myxoma of the psoas]. / Myxome musculaire. Une observation de myxome du psoas.

Report about one case of rare tumor of the muscles (myxoma of the psoas muscles). Ultrasonographic, tomographic and arteriographic appearance.

Human immunodeficiency virus and infected aneurysm of the abdominal aorta: report of three cases.

Three patients who were seropositive for human immunodeficiency virus underwent surgery for infected aneurysm of the abdominal aorta. Fever and abdominal pain were the principal presenting clinical features. None of the patients had any opportunistic infections or endocarditis. In two cases, a ruptured aneurysm was demonstrated radiographically. In the remaining case, sonograms were diagnostic. The organisms responsible were salmonella, Hemophilus influenzae, and Mycobacterium tuberculosis. In two cases, the infectious origin was evidenced by bacteriologic examination of the aortic wall, which revealed the presence of Salmonella enteritidis and Koch's bacillus. Although Hemophilus influenzae was not found in the aortic wall of the remaining case, the infectious origin of the aneurysm was established because preoperative blood cultures were positive for this pathogen, and pathohistologic examination of the specimen showed destruction associated with leukocyte infiltration of the aneurysmal wall. An in situ prosthetic graft replacement protected by omentum was performed in all three cases. Antibiotic therapy was continued for several weeks. All patients are well with follow-up ranging from 10 to 21 months. Infectious aneurysm associated with human immunodeficiency virus seropositivity results in bacterial infestation of an atheromatous aorta. Infected phenomena are promoted by cellular immunodeficiency. Surgery was justified in these cases because of the immediate threat of rupture.

Innominate artery involvement in type IV Ehlers-Danlos syndrome.

We report two cases of innominate artery involvement in patients with Ehlers-Danlos syndrome. In the first patient, spontaneous dissection of the innominate artery was treated successfully. In the other, the patient died of spontaneous rupture of the innominate artery in the early postoperative course after operation for aneurysm of the celiac artery. Arterial complications occurring in Ehlers-Danlos syndrome are rare but pose difficult diagnostic and therapeutic problems for the vascular surgeon due to arterial wall fragility.

[Doppler ultrasonic evaluation of the embolism-causing potential of carotid artery plaques. Apropos of 113 macroscopic findings]. / Evaluation du potentiel emboligène des plaques carotidiennes par l'écho-Doppler. A propos de 113 confrontations macroscopiques.

Comparison was made between precise descriptions of gross pathology of 113 carotid artery atheromatous plaques (69 symptomatic, 44 asymptomatic) operated upon by thromboendarterectomy and results of ultrasound-Doppler examinations, to determine possible specific ultrasound criteria for precise anatomical lesions. Echographic criteria studied were: ultrasonic structure of plaques; relation of plaque to wall; existence or absence of a solution of continuity; regular or irregular nature of endoluminal border of plaque; and finally the notion of discordance between degree of stenosis as shown by Doppler (D) and ultrasound (E) imaging (E much less than D). Principal results were as follows. Images of the regular, homogeneous highly echogenic plaques (36 cases) corresponded in 69.4% of cases to simple fibrous or calcified plaques with regular endoluminal borders. Irregular heterogeneous plaques (31 cases) were suggestive of irregular, friable and/or ulcerated material in 64.4% of cases. Weakly echogenic plaques (9 cases) suggested mainly thrombus (44.4%) or soft, friable plaques (33.3%). Plaques with solution of continuity do not correspond to a precise lesion but, in contrast, are specific (with weakly echogenic plaques) of the emboligenic character of the plaques (100%). The criterion ultrasound "Doppler was specific for thrombus in 75% of cases. In contrast, the thrombus can also demonstrate very different ultrasound images. Finally, in this study ultrasound-Doppler findings produced 3 false negatives (2.6%). Combined ultrasound-Doppler imaging allows quantitative evaluation and particularly qualitative assessment of carotid artery atheromatous lesions, with sufficiently reliable criteria to detect lesions of high emboligenic potential.

Role of extracellular calcium in the effects of substance P and neurokinin A on guinea pig trachea and human bronchus.

Whether the influx of calcium through voltage-operated channels is involved in the stimulatory effects of substance P and neurokinin A in airways smooth muscle is not yet firmly established. This question was addressed in the present study using guinea pig trachea and human bronchi suspended in normal or calcium-free Krebs solution and tested with inhibitors of calcium channels. In calcium-free Krebs solution, the myotropic effects of substance P (10(-7) M), neurokinin A (3.10(-8) M), acetylcholine (2.10(-5) M), and histamine (2.10(-5) M) were reduced by 27-57%, while those of potassium chloride and tetraethylammonium were practically abolished. Calcium antagonists such as verapamil or nicardipine, when applied at concentrations of 10(-8)-10(-6) M, inhibited the contractions produced by potassium chloride and tetraethylammonium, whereas higher concentrations (10(-5)-10(-4) M) of both inhibitors were needed to reduce the effects of substance P, neurokinin A, acetylcholine, and histamine. In neither preparation did the calcium agonist Bay K 8644 (10(-6) M) modify the effects of neurokinin A, substance P, acetylcholine, or histamine, but it potentiated potassium chloride's effect on human bronchi. We conclude that transmembrane calcium influx through voltage-operated channels plays a minor role in the stimulatory effects of neurokinins in airways smooth muscle.

[Evaluation of the emboligenic potential of carotid plaques. Apropos of 113 echographic and macroscopic comparisons]. / Appréciation du potentiel emboligène des plaques carotidiennes. A propos de 113 confrontations échographiques et macroscopiques.

113 cases of atheromatous plaques in carotid arteries (69 cases where symptoms were present and 44 were asymptomatic) surgically treated by endarterectomy, including an accurate description of gross lesions, were compared to findings obtained with echographic examination to determine if there are specific echographic criteria corresponding to exact anatomical lesions. The echographic criteria selected for this study were the echo-inducing structure of the plaques; the relationship of the plaque with the artery wall (presence of a lesion continuous with the wall); the regular configuration of the endoluminal edge of the plaque or not; and finally, the notion of a discrepancy between the extent of the carotid artery stenosis visualized by ultrasound and that observed with echography (E much less than U). The primary results of this study demonstrate that echo-inducing, uniform and regular (36 cases) atheromatous plaques corresponded to ordinary, fibrous or calcified plaques in 69.4% of cases, with regular endoluminal borders. Irregular and non-uniform plaques (31 cases) suggested irregular, friable and/or ulcerated substance in 64.4% of cases. Poor echo-conducting plaques (9 cases) suggested formation of a thrombus, basically, in 44.4% or of soft and friable plaques (33.3% of cases). Those plaques which were continuous with the wall do not correspond to a precise type of lesion but, rather, are characteristic (with poor echo-conducting plaques) of the embolic nature of the plaques (100%). The criteria echo much less than ultrasound is specific for a thrombus in 75% of cases. On the other hand, the thrombus may also assume very diverse echographic presentations. Finally, three negative echo-ultrasound results were observed in this study.(ABSTRACT TRUNCATED AT 250 WORDS)

Arteriovenous fistulae of the internal iliac vessels.

Seven patients with arteriovenous fistulae of the internal iliac artery are reported. Ages varied from 6 to 50 years (mean 32 years). Cutaneous angiomata , leg oedema and pain was present in 4 cases each, bleeding in 2 cases whilst only one was asymptomatic. Only 1 patient had cardiac insufficiency. In six patients the lesion was a congenital malformation but in one it was posttraumatic. Arteriography both global and selective, intravenous pyelography and cardiac output are routine. Recently, pelvic computerised tomography has been most helpful. Embolization is recommended in all cases with surgery within 24 hours unless the lesion is very extensive and considered to be inoperable. Repeat embolization is used for recurrence or very extensive lesions. Results were good in five patients; in two patients the results were clinically good but control angiograms showed a recurrence.

"Redo" surgery for late aorto-femoral graft occlusive failures.

Experience of late failures of Dacron aortofemoral grafts is presented; about 70 cases observed during the past eight years on whom 105 subsequent operations were performed. One third of these patients were first operated upon by another surgical team. During the same period, 850 patients were submitted to reconstructive surgery of the abdominal aorta and iliac arteries either for atherosclerotic or for aneurysmal disease. It appears that conservative procedures like thrombectomy of the occluded limb are often insufficient, impossible, inappropriate or dangerous, even after restoration of a good deep femoral outflow. On the other hand, aggressive restoration of limbflow is generally necessary, with other various and ingenious direct or indirect reconstructive techniques for restitution of a good inflow and outflow. These techniques are usually successful (85%) and gain time against the major etiology of these late failures viz the development of atherosclerotic disease.

[Contribution of real time echotomography to evaluation of cervico-encephalic atheromatous disease]. / Apport de l'échotomographie en temps réel dans le bilan de la maladie athéromateuse cervico-encéphalique.

Real time ultrasonography can now provide fine, easily reproducible images of the carotid arteries and to a lesser degree the vertebral arteries. The method is a simple one but requires an experienced operator. Care should be taken to visualize mainly the zones of predilection of the atheroma (carotid bifurcation and ostia). Even minimal sized atheromatous plaques can be detected, including those that are frequently asymptomatic to the doppler test, and their calcareous, regular, or ulcerated nature can be determined. The limits of the examination are described, demonstrating the need for complementary ultrasound and doppler tests. The two main poles of interest of this vascular imaging are early detection of carotid atheroma and supervision of medical and surgical treatments.

[Myocardial ischemia and carotid surgery. Holter study of 21 severe coronary patients. Preventive effect of intravenous trinitrin]. / Ischémie myocardique et chirurgie carotidienne. Etude par la méthode de Holter chez 21 coronariens sévères. Effet préventif de la trinitrine intraveineuse.

Cervical carotid artery surgery is increasingly being performed in elderly, polyvascular, high risk patients, some of whom have severe coronary artery disease. Is this right? The effects of this almost routine surgical procedure from the technical point of view were analysed with respect to the coronary lesions. 1. A retrospective study of coronary events occurring in the peroperative or immediate postoperative period and at short term was carried out in 367 patients aged over 70 years old (average 73,4 years) undergoing 424 cervical carotid artery procedures with a particularly high coronary risk. 2. A prospective study of ischemic ECG changes occurring in the period between induction of anaesthesia and the 4th postoperative day was performed by Holter monitoring in 21 patients with severe coronary artery disease. The mortality and morbidity observed were very low and could be further reduced by certain anaesthetic and pre-and postoperative techniques. In particular, prophylactic intravenous trinitrin (0,5 to 1,5 gamma kg/min) was most effective in protecting the myocardium in 15 patients with severe angina (classes III and IV of the NYHA classification). The authors conclude that the surgical result depends mainly on the neurological status of the patients, the best results being obtained in asymptomatic patients (stage 0) or those having suffered transient ischemic attacks (stage 1). The global mortality and morbidity rate was less than 2 p. 100 in those groups. On the other hand, long-term survival depends mainly on the severity of the coronary artery disease.

The role of surgery in the treatment of acute phlebitis in the lower members.

UNLABELLED: Most phlebitis responds favorably to medical treatment. Iliofemoral and iliocaval phlebitis, however, involve considerable risk as they may endanger life (pulmonary embolism), limb (ischemic forms) or the functioning of the limb (severe post-phlebitic syndromes). Because of this triple risk it is important to be able to judge when to opt for surgery. Surgical treatment is called for in cases of certain iliofemoral phlebitis developing in spite of medical treatment. Threat of "blue phlebitis" (acute arterial ischemia); threat of severe post-phlebitis syndrome (the thrombosed iliac veins do not easily recover their permeability); threat to life (iliac thromboses producing mortal embolism). These three risks justify emergency phlebography. The aims, means and limitations of surgery. 1. Aim - to maintain the permeability of the femoro-ilio-caval venous axis and to avoid pulmonary embolism. 2. Methods - Thrombectomy is done at the level of the femoral vein using Fogarty's catheter and Esmarch's bandage; this is carried out at an early stage (5 first days). A De W. clamp may be positioned at the level of the vena cava (in case of preexisting pulmonary embolism or incomplete thrombectomy). 3. INDICATIONS: --Phlebitis with ischemia. --Recent severe phlebitis not responding enough to urgent medical treatment particularly in the cases of young patients. --Clamp used in cases of pulmonary embolism or when threats of embolism are visible on the phlebography (floating clots). 4. MATERIALS: --82 patients were operated between 1970-1978. Phlebography showed: 44 iliofemoral phlebites, 11 femoropopliteal phlebites, 27 iliocaval phlebites. --Arterial affection revealed in the cases of 8 patients, four of which had blue phlebitis. --Pulmonary embolism was the symptom showing iliofemoral phlebitis in 7 cases. 5. OPERATIONS: 42 isolated clamps; 40 thrombectomies (in 15 cases completed by a clamp, in 12 cases by arteriovenous fistula; in 10 cases by treatment of an anomaly of the origin of the left common iliac vein. 6. RESULTS: --Two deaths. --In the long term (average interval = 4 years) the results were excellent in 54% of the cases (no oedema), good in 28% (light compression required), and bad in 8%. Conclusion. Certain iliac phlebites can, we believe, be cured by surgery.

Carotid artery surgery in patients over 70 years of age.

Between 1965 and 1979, 934 patients underwent 1,057 operations for extracranial carotid stenosis at this institute, and over a recent 30-month period 463 patients underwent 511 operations of this type. This number is equal to the total of operations performed during the years 1965-1976. The increase in the frequency of carotid artery surgery has been more marked in patients of over 70 years. The percentage of elderly patients has increased from 17.5% to 27% in the recent period. In the latter group of 511 operations, results were good in 93.17% of cases, while there was a mortality rate of 1.95% (1% of which were directly related to the surgery), in 1.95% the neurologic condition deteriorated and in 3.13% there was no change. In the first period the mortality rate for patients over 70 years of age was 7.69%. In the second it was 3.27% (1.63% of which were due to non-neurologic causes), 4.09% deteriorated, in 2.18% there was no change and good results were obtained in 90.46%.

[Congenital arterio-venous malformations. Long-term therapeutic effects of arterial ligatures. A plea for their abandon in favour of more recent procedures (author's transl)]. / Les malformations artério-veineuses congénitales. Conséquences évolutives et thérapeutiques des ligatures artérielles. Plaidoyer pour leur abandon et solutions actuelles.

It is well known that proximal arterial ligations have no curative effect on arterio-venous malformations, unfortunately however they are still employed. The immediate and late consequences of such ligatures have been studied by analysing 36 out of 142 cases of arterio-venous malformations. These ligatures interfere with ulterior treatment. At present such a treatment relies on a combination of radio-surgical treatment associated with embolization and complete surgical excision of the malformation, whenever it is possible.

[The risk of ligation of the external carotid in the treatment of cervico-facial angiodysplasia. A plea for this technique to be abandoned, and current radiosurgical solutions; based upon 13 cases of ligation amongst 200 angiomas explored (author's transl)]. / Les risques de la ligature de la carotide externe dans le traitement des angiodysplasies cervico-faciales. Plaidoyer pour leur abandon et solutions radio-chirurgicales actuelles. A propos de 13 cas de ligatures parmi 200 angiomes explorés.

After describing the different collateral sytems between the various cervicocephalic arteries, the authors indicate the consequences of ligation of the external carotid. This ligation proves to totally ineffective for distal vascular lesions and severely compromises the possibilities of later treatment.

[Cervico-cephalic vascular malformations. Current treatment protocol. Apropos of 230 cases]. / Les malformations vasculaires cervico-céphaliques. Protocole actuel de traitement. A propos de 230 cas.

In the light of 230 cases of vascular malformations in the cervico-facial region and the scalp treated over a 7 year period, the value of embolization is specified. Embolization permits effective treatment of the complications of these lesions, in particular haemorrhage. The reduction of swelling that can be obtained is always marked, but often incomplete : this is largely due to an associated hypertrophy of the neighbouring nonangiomatous tissues : such hypertrophy most often necessitates plastic surgery in order to obtain complete correction of the local disfigurement. With the introduction of embolization, the scope for surgery has been radically transformed, and one can often now consider a complete eradication of an extensive vascular malformation as well as correction of the associated local tissue dystrophy.

[Splenic trauma complicating translumbar aortography : a report on 2 cases (author's transl)]. / Traumatismes spléniques compliquant l'aortographie translombaire. A propos de 2 cas.

Two very rare cases of splenic trauma following high translumbar aortography are described. Two types of clinical picture are observed : severe intraperitoneal hemorrhage, subcapsular and then intraperitoneal, from rupture of the spleen, and septic peritonitis following rupture of an intra- and perisplenic abscess. The authors review the frequency, mechanism, and prevention of complications following translumbar aortic puncture.