[Tripe palms and a hypertrophic osteoarthropathy syndrome revealing a neuroendocrine carcinoma of the lung]. / Pachydermatoglyphie associée à une ostéoarthropathie hypertrophique révélant un carcinome neuroendocrine du poumon.

BACKGROUND: Tripe palms is a rare cutaneous paraneoplastic syndrome, primarily evocative of lung and gastric neoplasia. Association of many paraneoplastic diseases has also been reported. PATIENTS AND METHODS: A 49-year-old man with a history of alcoholism and smoking addiction reported haemoptysis and thoracic pains present for one year. The physical examination showed left lung condensation. The skin examination revealed a thickened yellowish keratoderma with exaggerated skin ridges and digital clubbing. A diagnosis of paraneoplastic tripe palms was made, prompting repetition of the biopsy which ultimately revealed a neuroendocrine carcinoma. Skeletal scintigraphy showed periosteal proliferation with hypertrophic osteoarthropathy. COMMENTS: "Tripe palms" or "osteoarthritic acanthosis" is a paraneoplastic syndrome. It involves an acquired keratoderma taking on a yellow velvety appearance with accentuation of dermatoglyphic lines. Malignancy is discovered in over 90% of individuals with tripe palms. If malignancy is isolated, it mostly involves the lung (53%). Gastric cancer is associated in 77% of cases if the condition is associated with acanthosis nigricans. In approximately one third of cases, the keratoderma may resolve, generally after treatment of the tumour. The association of many paraneoplastic syndromes has also been reported, in particular digital clubbing and hypertrophic osteoarthropathy. At least 90% of cases of hypertrophic osteoarthropathy in adults occur in patients who have or will eventually develop a malignancy. It is characterized by periostosis of long bones, joint pain, and clubbing, and it is often seen on bone scintigraphy during staging of lung carcinoma.

[Multiple tuberculous aortic aneurysms in a child. A case report]. / Multiples anévrismes aortiques d'origine tuberculeuse chez un enfant. A propos d'un cas.

INTRODUCTION: Tuberculous aortic aneurysms are rarely seen. Their major complication is unforeseeable and lethal aneurysmal rupture. We report an exceptional case of multiple tuberculous aortic aneurysms in a child. CASE REPORT: A 13-year-old girl was admitted to our hospital with abdominal pain. She reported a history of fever, night sweats and weight loss. Physical examination showed a pulsatile mass over the umbilicus. Thoracoabdominal angio-NMR revealed multiple pseudoaneurysms of the thoracic and abdominal aorta. The patient underwent elective laparotomy, resection of the abdominal aortic and in situ prosthetic repair with an aortic graft. The postoperative recovery was uneventful. The histopathologic examination of the aortic wall and para-aortic lymph nodes showed evident features of tuberculosis. Antituberculous chemotherapy was initiated. CONCLUSION: Tuberculous aortic aneurysms are rarely seen. Their major complication is rupture. Surgery must not be delayed just like antitubercular therapy.

[Giant aneurysm of the splenic artery. Case report and review of the literature]. / Anévrisme géant de l'artère splénique. A propos d'un cas et revue de la littérature.

INTRODUCTION: Giant splenic artery aneurysm is exceptional. We report a case and review the literature to ascertain the characteristic epidemiological, clinical and therapeutic features of this condition. CASE REPORT: A 62-year-old man was admitted for epigastric pain. Physical examination found an epigastric pulsatile mass. A contrast computed scan of the abdomen revealed a 10-cm thrombosed aneurysm of the splenic artery. An abdominal aortography, including selective celiac angiography, confirmed the presence of a 10-cm aneurysm originating from the medial third of the splenic artery. The patient underwent open surgical repair. The proximal and the distal splenic artery were ligated from within the aneurysm. The postoperative period was uneventful. CONCLUSION: Giant aneurysm of the splenic artery is a rare clinical entity. These aneurysms differ from usual splenic artery aneurysms in several ways involving the predominant gender, localization on the splenic artery, clinical presentation, and treatment.

[False aneurysm of the external iliac artery revealing Behçet's disease]. / Faux anévrysme de l'artère iliaque externe révélant une maladie de Behçet.

Behçet's disease is a vasculitis of unknown etiology. Vascular involvement is rare, but may be inaugural in many cases. We report a case of Behçet's disease revealed by a symptomatic pseudo-aneurysm of the external iliac artery. The symptomatology was non-specific. Ultrasound Doppler and computed tomographic angiography were essential for diagnosis. The pseudo-aneurysm was managed by endovascular treatment. Corticosteroid and immunosuppressant therapy were administrated after surgery.

[Multiple paragangliomas: about two cases]. / Paragangliomes multiples: à propos de deux cas.

The multiple paragangliomas are rare tumours, with slow evolution, posing diagnostic and therapeutic problems. The carotid and jugulo-tympanic localization are the most frequent, and the aortic localization is very infrequent. The association of two, three and four localization is possible in the multiple forms. These multiple localizations are more frequent in familial forms. Surgical removal is the first intention treatment of these tumours. In the multiple forms, the therapeutic strategy must be adapted to each case: usually, the intervention begins by the carotid localization. We report two cases of chemodectoma with multiple localizations. The first case is a 44 years-old woman, who presented a double localization: carotid (bilateral) and aortic (arch). The second case is a patient with a double aortic localization, carotid and aortic, associated to a tympano-jugular localization. Surgical treatment was performed for all these localization, except for the tympano-jugular localization, treated by embolization. The post-operative periods were uneventful. The first case had adjunctive radiotherapy.

[Cerebral revascularisation in Takayasu's arteritis]. / Revascularisation cérébrale dans la maladie de Takayasu.

SUBJECT: Supraaortic angioplasty is often not feasible in patients with Takayasu's arteritis because of involvement of long segment of arteries. Consequently, the role of surgical treatment in the management of cerebral ischemia is important in this disease. The objective of this work is to specify the indications and surgical techniques in lesions of arteries to the head in this disease and to report our experience. METHODS: Seven patients with cervical arterial lesions due to Takayasu's arteritis were treated by bypass surgery in the department of vascular surgery, Ibn-Sina hospital on one period of 11 years. RESULTS: It is about 6 women and one man of middle age at the time of the diagnosis of 33,8 years. The revealing signs were essentially of neurological and ocular order. Six of our patients were in inflammatory thrust at the time of the diagnosis, and required a medical treatment first to basis of corticosteroids. Bypasses from the ascending aorta to the carotid artery were performed in six cases. In one case, the bypass was performed between the brachiocephalic artery and common carotid artery. A death in relation with a cerebral hemorrhage occurred 2 days after the revascularisation. A clean improvement of the functional signs was noted among 3 patients, whereas the improvement was partial at two other. A secondary thrombosis of the bypass surgery occurred in 3 cases. CONCLUSION: The natural history of Takayasu's arteritis and its evolution is badly known. The operative indications must not rest solely on the only anatomical balance, but based on a bundle of arguments in which, the assessment of the cerebral blood flow would be useful. Cerebral hyperperfusion syndrom constitutes a major risk that can be reduced by staged revascularisations.

[Chronic dissection of the aorta after coronary bypass surgery]. / Dissection aortique chronique après pontages coronaires. Une stratégie chirurgicale difficile.

Dissection of the aorta is a potential complication of all forms of cardiac surgery. It occurs after a variable interval. When observed in the long term, surgery may be complex with greater technical difficulties resulting in increased postoperative morbidity and mortality compared with other types of dissection. These difficulties are all the more marked when the initial surgery is coronary bypass grafting and when the grafts, especially internal mammary artery grafts, remain patent. A surgical strategy has to be elaborated to prevent certain per- and postoperative complications. The authors report the case of a patient who developed a chronic dissection of the aorta 9 months after coronary bypass surgery with patent internal mammary artery grafts. In this situation, a strategy associating anterograde cerebral perfusion before the sternotomy and endovascular control of the internal mammary grafts was proposed.

Effect of pyruvate on glucose metabolism in Clostridium acetobutylicum.

Pyruvate effects on the metabolism of Clostridium acetobutylicum during glucose fermentation were studied. After addition to the culture medium, the pyruvate was rapidly used, provoking several changes in the metabolic pattern of the bacteria. When pyruvate addition occurred early in the fermentation, the glucose utilization decreased and the solventogenic phase was not induced. When pyruvate was added during solventogenesis, glucose consumption was slightly affected and the cells fermented both substrates simultaneously: however, the acidogenic phase started again to the detriment of solvent formation. Usually, during the solvent phase, the cells remetabolized acetic and butyric acids into solvents, but when pyruvate was added, the utilization of acids was stopped and the specific rates of acetate and butyrate formation increased immediately. The acidogenic growth phase was characterized by high levels of acetate and butyrate kinase which dropped during the solvent phase. Addition of pyruvate limited the down shift of these two enzymes and the levels of the activities remained constant during the course of the fermentation. Conversely, the acetoacetate decarboxylase, which is characteristic of the solvent phase, decreased sharply in the presence of pyruvate. The fact that the specific rate of glucose consumption was not decreased by the pyruvate metabolism, a cosubstrate, proves that the phosphoroclastic reaction is not a limiting step. Furthermore, the pyruvate utilization represented a promising approach to obtain useful data on the intracellular compounds implicated in the mechanism for switching from the acidogenic to the solventogenic phase.

Effects of butyric and acetic acids on acetone-butanol formation by Clostridium acetobutylicum.

The actions of butyric and acetic acids on acetone-butanol fermentation are investigated. Production of butyric and acetic acids are controlled by the extracellular concentrations of both acids: acetic acid added to the medium inhibits its own formation but has no effect on butyric acid formation, and added butyric acid inhibits its own formation but not that of acetic acid. The ratio of end metabolites depends upon acetic and butyric acid quantities excreted during the fermentation. In contrast to acetic acid, which specifically increases acetone formation, butyric acid increases both acetone and butanol formations. Acetate and butyrate kinase activities were also examined. Both increase at the start of fermentation and decrease when solvents appear in the medium. Coenzyme A transferase activity is weak in the acidogenic phase and markedly increases in the solvent phase. Acetic and butyric acids appear to be co-substrates. On the basis of these results, a mechanism of acetic and butyric acid pathways, coupled to solvent formation by C. acetobutylicum glucose fermentation is proposed.

The role of myoglobin in retarding oxygen depletion in anoxic heart.

The present study explores the role of myoglobin (Mb) in retarding the development of anoxia in the perfused working rat heart. We examine this phenomenon by analyzing the behavior and the kinetics of Mb oxygenation and cytochrome aa3 (cytaa3) redoxation. Absorbance changes, measured at wavelength pairs specific to Mb and cytaa3, show parallelism between the Mb oxygenation status and the redox states of cytaa3. Induction of anoxia leads to early and accelerated Mb deoxygenation whereas cytaa3 reduction marks a slight delay and its rate is twice slower than that of Mb. Then, when Mb is desatured above 50%, the cytaa3 reduction becomes accelerated. With the reoxygenated perfusion following the anoxia, the rate of Mb reoxygenation is twice faster than that of the cytaa3 reoxidation. When the oxygen-binding function of Mb, in situ in the heart, is abolished by treatment with sodium nitrite (NaNO2), the redox kinetics of cytaa3 show significant perturbations. Induction of anoxia leads to a precocious and accelerated reduction of cytaa3, compared to the same anoxic heart before the treatment. At reoxygenation, the reoxidation rate of cytaa3 decreases significantly, compared to that before the treatment. Similarly, in the nitrite treated heart, the phosphocreatine (PCr) level decreases to 60% of the control, whereas the inorganic phosphate (Pi) level increases to 300%. ATP concentration, however, remains constant. We conclude from these results that Mb may support mitochondrial respiration at the critical levels of the myocardial O2 supply.

[Ruptures of the posterior wall of the left ventricle after mitral valve replacement: surgical repair and prevention]. / Les ruptures de la paroi postérieure du ventricule gauche après remplacement valvulaire mitral: réparation chirurgicale et prévention.

We report two cases of type III rupture of the left ventricle posterior wall, situated midway between the mitral annulus and the posterior papillary muscle and occurring in immediate continuations of a mitral valvular replacement. The first case has occurred at the moment of the canulas removal in a 28 years old patient operated for mitral stenosis. The tear was repaired with horizontal mattress sutures through felt strips on the external surface of the heart. The immediate post operative course was marked by bleeding recurrence and cardiac failure which has led to death. In the second case, a 68 years old man was operated for degenerative mitral insufficiency. The rupture has occurred just before closing the chest. The repair was realized successfully by using an intra-ventricular patch. The chordae tendinae removal constitutes a factor predisposing to the left ventricle posterior wall rupture. The repair has to use an intra-ventricular patch. The prevention is based on the preservation of the continuity between the mitral annulus and papillary muscles by preserving the sub-valvular apparatus or by using synthetic chordae.

[Internal carotid aneurysm of dysphasic origin]. / Un anévrisme de l'artère carotide interne d'origine dysplasique.

Extracranial carotid aneurysms are rare, but are of significant clinical interest due to the high risk of cerebral embolism. Despite considerable progress in endovascular techniques, surgical treatment of these aneurysms remains the golden standard. We report the case of a 50-year-old man who presented an aneurysm of the left internal carotid artery measuring 46 × 26 mm. Resection of the aneurysm with interposition of a prosthetic graft was performed. The postoperative course was uneventful. Pathology reported that the aneurysmal sac probably had a dysplastic origin.

[False traumatic aneurysm of the ulnar artery in a teenager]. / Faux anévrysme traumatique de l'artère ulnaire chez un adolescent.

Most aneurysms of hand arteries are traumatic. It is a generally rare unrecognized pathology. Complications are serious (embolism and thromboses of interdigital arteries). Two main causes can be recalled: acute trauma, with development of a false aneurysm; repeated microtrauma (hand hammer syndrome), with occurrence of an arterial dysplasic aneurysm. The diagnosis is based on the presence of a pulsatile mass, with finger dysesthesia, unilateral Raynaud's phenomenon. It is confirmed by duplex Doppler. Arteriography is necessary but can be replaced by an angio-MR. We report a case of false traumatic aneurysm of the ulnar artery in a teenager. This case illustrates this rare condition and opens discussion on therapeutic options.

[Rupture of a popliteal artery pseudo-aneurysm revealing a tibial osteochondroma: case report and review of the literature]. / Rupture d'un faux anévrisme de l'artère poplitée révélant une exostose du tibia : à propos d'un cas et revue de littérature.

Osteochondroma constitutes the most frequent bone tumor. It is exceptionally responsible for vascular complications from which pseudo-aneurysms constitute the most frequent entity. We report the case of a 20-year-old patient who presented with acute pain of the left knee following a sports' accident. Vascular ultrasonography showed the rupture of a false aneurysm of the popliteal artery. An arteriography confirmed the diagnosis by showing contrast leakage at the level of the below-knee popliteal artery projecting over an osteochondroma. Surgery was undertaken to close the aneurysm an insert a venous graft. The procedure was completed by excision of the bone tumor. Vascular complications of osteochondroma are rare but should be considered in young patients with a false aneurysm of the popliteal artery. Surgery is required for the treatment of false aneurysms on exostosis.

External jugular vein aneurysm: a rare cause of neck swelling. A report of three patients.

Venous aneurysms are a relatively rare pathology, far less common than arterial aneurysms. Unrelated to either age or gender, they can affect any vein, including cervical, thoracic, visceral, and lower limb veins. Aneurysmal dilatations in cervical veins are rare due to low pressure in the vena cava system; they can involve any vein but most frequently are observed on the internal and external jugular veins. This report of three patients highlights some of the specific diagnostic and therapeutic features of this pathology.

[Acute lower limb ischemia revealing acute leukemia. Case report and review of the literature]. / Ischémie aiguë du membre inférieur révélant une leucémie aiguë. A propos d'un cas et revue de la littérature.

Large vessel thrombosis is a very rare clinical presentation of acute leukemia which is usually revealed by hemorrhagic complications or thrombosis of small vessels. We present here the case of a patient with previously undiagnosed acute myeloid leukemia who was referred to our hospital with symptoms of acute ischemia of the left lower limb. Occlusion of the left popliteal artery due to a leucostasis was noted and successfully treated with emergency surgical thromboembolectomy and chemotherapy.

[Vascular type of Ehlers-Danlos syndrome: a rare cause of spontaneous pseudo-aneurysms]. / Syndrome d'Ehlers-Danlos de type vasculaire : une cause rare de faux-anévrismes artériels spontanés.

We report a case of a 20-year-old-man who was admitted to our hospital through the emergency room for a swelling of the right thigh, which had appeared spontaneously without fever. The physical exam was highly suggestive of a vascular mass. The arterial CT scan of the right lower limb revealed a pseudo-aneurysm of a branch of the deep right femoral artery. The diagnosis of vascular type of Ehlers Danlos syndrome was established on clinical criteria. The successful management was surgical by the excision of the pseudoaneurysm and the ligation of the feeding branch that supplied the pseudoaneurysm. The postsurgical follow-up was uneventful and the clinical course was smooth with no further complications.

[Left atrial myxoma: a rare cause of acute occlusion of the aorta. Case report and review of the literature]. / Myxome de l'oreillette gauche : une cause rare d'occlusion aiguë de l'aorte. A propos d'un cas et revue de la littérature.

We present an observation of a 42-year-old patient admitted in urgency for lower limbs weakness followed by paralysis. At physical examination the lower limbs were cold. Pulses of the lower limbs could not be palpated. Color Duplex ultrasonography revealing an embolus occluding both the infrarenal aorta and bilateral iliac arteries. The aortoiliac embolus was removed by balloon endarterectomy through the femoral arteries with evacuation of a transparent, gelatinous embolus followed by extensive fasciotomies. Two-dimensional echocardiography showed a mass in the left atrium. Pathological examination of the material embolic confirmed the diagnosis of the cardiac myxoma. The clinical course was marked by the development of a syndrome of revascularization; death occurred the fourth day of hospitalization. This case highlights the need for pre- and perioperative measures to be taken to overcome hyperkalemia and acute renal failure when revascularizing acute, massive, prolonged ischemia of the lower body.