Endovascular treatment of iliac aneurysms with covered stents.

The purpose of this retrospective, single-institution study was to analyze the results of endovascular treatment of iliac aneurysm using covered stents. Since January 1, 1996, a total of 34 iliac aneurysms have been treated with covered endovascular stents. The series included 9 isolated aneurysms, 29 aneurysms following repair of aortic aneurysm, and 3 false anastomotic aneurysms. The mean diameter of aneurysm was 42 mm (range, 21 to 120 mm). The aneurysm was either symptomatic or complicated in 11 cases. Three procedures were carried out under emergency conditions after acute rupture. Stent deployment was successful in 33 cases (technical success rate, 97.6%). Exclusion of the aneurysm was obtained in all cases with one (n = 26) or two overlapping (n = 7) covered stents. Mean procedure duration was 45 min (range, 25 to 75 min). The internal iliac artery was patent in 28 cases, but patency was preserved in only 4 cases. In the remaining 24 cases the internal iliac artery was excluded either preoperatively by embolization using Gianturco coils (n = 15) or intraoperatively by placement of the stent (n = 9). Endovascular treatment of iliac aneurysm with covered stents achieves good short- and middle-term results but usually requires exclusion of the internal iliac artery.

Rapidly invading sebaceous carcinoma of the external auditory canal.

A very rare case of a sebaceous carcinoma of the external auditory canal with basal cell differentiation is presented. Fewer than 400 cases affecting any part of the body have so far been reported and of that only seven cases have been known to involve the external auditory canal. The clinical features, pathology and treatment are described and the relevant literature has been reviewed.

[Popliteal venous aneurysms]. / Anévrismes veineux poplités.

Popliteal venous aneurysms are uncommon. We reviewed 101 cases reported in the literature and our series of 11 operated cases to study the nosology and therapeutic indications. In our series, there were 7 cases of unique dystrophic aneurysms, 4 cases involving locoregional angiodysplasia: 3 cases with venous hemodynamics and 1 case with arteriovenous flow. Pulmonary embolism developed in 2 cases. Ultrasonography provided the diagnosis. A sacciform aneurysm was found in 10 cases and a fusiform aneurysm in 1 case. Venous repair was performed in all cases: 9 endoaneurysmal sutures, 1 interposition of the medial gastrocnemius vein, and 1 PTFE graft. Permeability was confirmed in all cases with no recurrent embolism. These cases and the histological correlations describe the nosology of dysplastic venous aneurysms which should be distinguished from dystrophic ectasia of incompetent veins which is not associated with pulmonary embolism. Indeed, pulmonary embolism is the most common complication revealing venous aneurysms (table I). Doppler ultrasonography can provide early diagnosis before such complications develop. Surgery is required for emergency cure in case of pulmonary embolism and is warranted for preventive cure, generally by endoaneurysmorraphic repair allowing venous permeability without the risk of iterative embolism.

[Abdominal aortic aneurysms associated with visceral artery stenoses]. / Anévrisme de l'aorte abdominale et sténose associée d'une artère viscérale.

During a 6-year period six patients had combined revascularizations for an abdominal aortic aneurysm and a high-grade (> 80%) stenosis of either the superior mesenteric artery (N = 14) and/or a renal artery (N = 60 including 6 bilateral revascularizations). Revascularizations of a visceral artery were done more often with a bypass graft (N = 61) than by endarterectomy (N = 6), reimplantation (N = 4) or endovascular technique (N = 3). Fifty patients had concomitant repair of the aorta and of the visceral artery, and ten had a staged repair, favored in-high risk patients and in cases of multiple visceral artery revascularizations. Four patients (7.5%) died (2 myocardial infarctions and 2 multisystem organ failure) and twelve (20%) had a non-fatal complication in the postoperative period. Survival was 91% at one year and 81% at 5 years. Our experience emphasizes the option of a staged approach in these high-risk patients, with the availability of extra-anatomic reconstruction, and the limited value of endovascular revascularization of the visceral arteries.

An unusual foreign body in the post-nasal space: a case report.

We report a case of a 13-year-old boy who inserted a 5 cm nail into his nose. X-ray showed it in the post-nasal space and it was removed through the mouth.

Actinomycosis of the posterior triangle: a case report and review of the literature.

Actinomycosis presents acutely as an abscess, or as a chronic lesion mimicking malignancy, tuberculosis, or aspergillosis. Most disease involves the mouth and its immediate site of lymphatic drainage, the anterior triangle of the neck. We present a case of actinomycosis at the apex of the posterior triangle, suspected of being a malignancy, and discuss the importance of being aware of this as a cause of neck lumps. The diagnosis is usually made late because of the difficulties in culturing the organism, or in identifying characteristic 'sulphur granules' in pus or biopsy specimens. For these reasons, the disease is underdiagnosed. When acute or chronic neck lesions prove difficult to diagnose, microscopy and prolonged anaerobic culture of pus and biopsy specimens should be performed in addition in Ziehl-Neelsen staining, tuberculosis and fungal cultures. The tests should be repeated if negative. Specific treatment requires prolonged courses of antibiotics, despite adequate surgical excision, to prevent relapse.