[Giant cell aortitis complicated by AA amyloidosis diagnosed with imaging techniques: Report of a case]. / Aortite à cellules géantes compliquée d'amylose AA diagnostiquée grâce aux examens d'imagerie : à propos d'un cas.

INTRODUCTION: AA amyloidosis is a common but severe complication of many chronic inflammatory processes of infectious, autoimmune, or neoplastic origin. It frequently leads to renal damage, often presenting as a nephrotic syndrome. Giant cell arteritis is a common inflammatory arteritis in elderly people, but rarely complicated by AA amyloidosis. CASE REPORT: We report an 87-year-old female who presented with a nephrotic syndrome and a chronic inflammation, in whom the kidney biopsy showed secondary amyloidosis. Etiological investigations concluded an amyloidosis related to giant cell pan-aortitis, whereas there were no typical clinical signs for this diagnosis. Outcome was rapidly unfavourable despite the treatment. CONCLUSION: In case of chronic inflammation of unknown origin in elderly patients, aortitis complicating a giant cell arteritis should be looked for with imaging techniques, as clinical diagnosis of this presentation is difficult, whereas delayed diagnosis exposes to severe or fatal issues.

[Acute arterial thrombosis in a context of hyperhomocysteinemia: Case report and literature review]. / Thrombose artérielle aiguë dans un contexte d'hyperhomocystéinémie : à propos d'un cas et revue de la littérature.

INTRODUCTION: Hyperhomocysteinemia is a biological marker that could be identified in the venous thrombotic events and rarely during acute arterial thrombotic events. The consequences can be serious. Effective diagnostic strategy is needed to optimize the management. CASE REPORT: Following bariatric surgery, a 40-year-old patient was admitted with an acute encephalopathy associated with peripheral lower limb arterial ischemia. The diagnostic work-up identified a major hyperhomocysteinemia whose causes were several. Surgical treatment and anticoagulation was associated with vitamins and trace elements supplementation. Correcting deficiencies allowed delirium and hyperhomocysteinemia improvement. Once treatment established, the patient did not present a recurrent thrombotic episode. CONCLUSION: Major hyperhomocysteinemia seems to be associated with an increased risk of acute arterial thrombosis. This marker might be considered in nutritional deficiency situations with appropriate support on the vascular, metabolic and nutrition level.

Transluminal angioplasty for recurrent stenosis after carotid endarterectomy. Prognostic factors and indications.

Over a 15-month period ending in July 1992, 9 patients (7 male, 2 female; mean age 67 years) with recurrent stenosis of the internal carotid artery underwent transluminal angioplasty (TLA). The mean interval between endarterectomy and treatment of recurrent stenosis was 45 months (range: 9 to 84 months). All patients were symptomatic except one with extensive bilateral carotid dysplasia. Three patients had recurrence proximal to the endarterectomized segment (Group I); in one of these patients the narrowing was extensive. The other 6 patients (Group II) demonstrated stenoses distally. In one of these latter patients, the narrowing developed in a vein bypass. Balloon dilation was performed by the surgical route in 3 patients and percutaneously in the other 6. Perioperative transcranial Doppler (TCD) monitoring was employed in all procedures. Postoperative treatment consisted of oral Ticlopicine. In Group I (proximal recurrence), immediate complications included one case of reversible spasm and two dissections that led to acute thrombosis treated by emergency bypass and to sylvian artery embolism complicated by transient hemiplegia. In Group II (distal disease), dissection was not encountered, and only one case of transient neurologic manifestations due to cerebral edema following reperfusion was observed. Mean follow-up has been 18 months (range: 9 to 24 months). All patients are presently asymptomatic. In Group II, 2 patients presented with secondary recurrence at 6 months and were treated again by angioplasty. In one of these cases, a Palmaz stent was placed to prevent restenosis by elastic recoil.(ABSTRACT TRUNCATED AT 250 WORDS)

[Primary surgical resection of tumors of the anterior mediastinum]. / Exérèse chirurgicale première des tumeurs du médiastin antérieur.

Seventy-two anterior mediastinal tumors were operated upon between 1981 and 1991. This accounted for 2% of the 3579 thoracotomies performed during the same period (excluding cardiac surgery). With the exception of Hodgkin's disease, lymphomas and metastases diagnosed either by anterior mediastinoscopy or at thoracotomy, other tumors were treated by the widest possible excision followed by adjuvant treatment in case of incomplete excision. These tumors included 16 metastatic carcinomas and 55 affecting the thymus-including 27 malignant thymomas and 15 benign tumors of the thymus including 2 carcinoids, 6 cases of Hodgkin's disease involving the thymus, 5 non-seminomatous germinal tumors, one differentiated neuro-endocrine carcinoma, 1 thymus lymphoma and 1 seminoma. The approach was via sternotomy in 32 cases and thoracotomy in the other 40. Excision was deemed complete in 45 cases, incomplete in 25 cases and impossible in 2 cases. Extension of surgical excision involved various adjacent organs: the lung in 10 cases and the pericardium in 5. Involvement of the phrenic nerves was found in 25 cases, the aorta in 1, the pulmonary artery in 1 and the vena cava or its afferent vessels in 33 cases. Seven PTFE venous bypasses were performed. Operative mortality was nil. One patient died on the 8th day of undefined causes. Mean tumour survival in metastatic thymomas was nevertheless 19 months. Survival in malignant thymomas was related to the stage of progression of the tumour. When complete excision was possible, survival was 89% with a mean follow-up of 57 months.(ABSTRACT TRUNCATED AT 250 WORDS)

Rupture of the external iliac artery during balloon angioplasty: endovascular treatment using a covered stent.

PURPOSE: To report the emergent endovascular management of an external iliac artery (EIA) rupture after standard guidewire recanalization and balloon angioplasty. METHOD AND RESULTS: A 54-year-old diabetic male presented with an occlusion of the EIA associated with severe stenotic lesions of the femoral bifurcation. Guidewire recanalization of the lumen was followed by balloon angioplasty, but evidence of EIA rupture was detected on the intraoperative arteriogram. Temporary homeostasis was achieved using the angioplasty balloon, and a Cragg EndoPro System 1 stent-graft was inserted transluminally to repair the injury. At 18 months poststenting, routine color Doppler confirmed continued patency of the vessel repair. CONCLUSIONS: While rupture of the EIA during angioplasty usually demands open surgical correction, an endovascular procedure can provide a fast, efficient, and less aggressive method of treating this serious complication.