Role of RAPID score and surgery in the management of pleural infection: a single center retrospective study.

Background: The RAPID [Renal (urea level), Age, Pleural fluid purulence, source of Infection and Denutrition (albumin level)] score classifies patients with pleural infection according to mortality risk at 3 months. This study aims to assess the applicability of this score in a thoracic surgery department and to determine the impact of surgery in the management of pleural infection depending on the Rapid score. Methods: In this single center retrospective study, patients managed for pleural infection, from January 1st 2013 to June 30th 2019, were included. The primary endpoint was the probability of survival at 6 months and 12 months depending on the RAPID score. Secondary endpoint was the probability of survival at 6 and 12 months in patients who had surgeries (surgical treatment group) and patients who didn't have surgery (medical treatment group). Results: Seventy-four patients were included, with a median age of 54.5 years. According to the RAPID score, the low-, medium- and high-risk groups had 30, 30 and 14 patients respectively. The probability of survival at 6 and 12 months in the low- and medium-risk groups were both 0.967 [95% confidence index (CI95): 0.905-1] whereas, the probabilities of survival at 6 and 12 months in the high-risk group was significantly lower at 0.571 (CI95: 0.363-0.899) and 0.357 (CI95: 0.177-0.721) respectively (P<0.0001). The probabilities of survival at 6 months and 12 months in the medical treatment group was 0.875 (CI95: 0.786-0.974) and 0.812 (CI95: 0.704-0.931) respectively compared to the surgical treatment group where probabilities of survival at 6 and 12 months were both 0.923 (CI95: 0.826-1) (P=0.26). Conclusions: In our study, patients with pleural infection, classified as high-risk according to the RAPID score, had a lower survival rate compared to low- and medium-risk patients. No difference in survival rate was found between patients classified as low- and medium-risk. In selected patients, surgical management seems to decrease mortality compared to exclusive medical management: this result should be confirmed in larger prospective studies.

Thoraco-abdominal aortic aneurysm rupture secondary to lymphocytic lymphoma.

We present the case of a 60-year old woman with a ruptured thoraco-abdominal aortic aneurysm (TAAA). It was a Type IV TAAA in the Crawford Classification. A mycotic origin was suspected as she had a known history of lymphocytic lymphoma. She underwent thoraco-abdominal aortic replacement with a good surgical result. Histopathological examination revealed destruction of the aortic layers due to inflammatory lymphomatous aortic infiltration. The patient fully recovered.

Excision of a permanent inferior vena cava filter with multiple vena caval perforations.

Perforation of an inferior vena cava filter by one the filter device hooks is a recognized possible complication of this device. We describe a case of surgical excision of a permanent inferior vena cava filter associated with multiple perforations of surrounding structures by each of the 6 hooks of the device. Structures affected include the third lumbar vertebral body, transverse mesocolon, the infrarenal aorta, the duodenum, and the psoas muscle. A thorough understanding of the filter design and adequate preoperative imaging were vital in planning the safe surgical excision of this device.

[In situ arterial allografting for aortoiliac infection]. / Traitement des infections aorto-iliaques par allogreffe artérielle in situ.

From January 2009 to January 2013, we treated 83 patients for aortoiliac infection by resection of all infected material and in situ revascularization with an arterial allograft. Thirteen patients (15.7 %) died during the first month or before discharge. Perioperative mortality was associated with the presence of a visceral fistula: five deaths (27.8%) occurred among the 18 patients with a visceral fistula, and8 (12.3 %) among the 65 without a visceral fistula (p = 0.11). These results confirm those of our previous studies regarding the severity of aortoiliac infection, especially in patients with a visceral fistula, and endorse our in situ allografting strategy.

Diagnosis and surgical treatment of a Takayasu disease on an abdominal aortic dissection.

BACKGROUND: To report the rare diagnosis and the surgical treatment of a young patient presenting a symptomatic dissection of the abdominal aorta revealing a Takayasu's arteritis (TA). METHODS AND RESULTS: A 24-year-old woman developed a painful chronic dissection of the infrarenal aorta associated with a claudication of both lower extremities. As the patient was still symptomatic despite an optimal medical treatment, a surgical revascularization was proposed. An aortobifemoral bypass was performed allowing the removal of infrarenal aorta and the histologic diagnosis of TA. CONCLUSION: Isolated abdominal aortic dissection is an unusual event in TA, and this is the first surgically treated case. Only few reports of aortic dissection in TA have been published so far which are commented in this article.