[Study of blood pressure, hemodynamic, ventilatory and metabolic responses to isometric exercise performed during dynamic exercise in health subjects]. / Etude des réponses tensionnelles, hémodynamiques, ventilatoires et métaboliques à l'exercice isométrique réalisé au cours d'un exercice dynamique chez le sujet sain.

The object of this study was to study the blood pressure, haemodynamic, ventilatory and metabolic changes on isometric exercise during a dynamic effort in healthy subjects. Twelve healthy subjects underwent isometric exercise by manual prehension at 40% maximal capacity under these conditions: isolated (A), five minutes after the onset of rectangular dynamic exercise on a cycle at 60% of ventilatory threshold (B) and at the fourth minute of the recovery phase of dynamic exercise (C). The blood pressure, heart rate, stroke volume and cardiac index measured by Doppler echocardiography, systemic arterial resistances, respiratory flow and respiratory rate, were measured before and after each isometric exercise. The results showed blood pressure and heart rate to increase in a similar manner during isometric exercise under all conditions. The cardiac index increased by 29.5% +/- 8.3% (p < 0.01) under condition A and by 38.1% +/- 10% (p < 0.01) under conditions C but did not change significantly under conditions B. On the other hand, the systemic arterial resistances increased by 15.5% +/- 6.5% (p < 0.05) under conditions B, decreased by 8.8% +/- 3.9% (p < 0.05) under conditions C but did not change significantly under conditions A. The respiratory flow increased under all three conditions although the respiratory rate was only increased under conditions B. The authors conclude that, in healthy subjects, the increase in blood pressure during isometric and dynamic exercise is the result of an increase in systemic resistances whereas, during isometric exercise, it is flow-dependant.

[Azygo-portal disconnection by the abdominal route]. / Déconnexion azygo-portale par voie abdominale.

Azygo-portal disconnection by the abdominal route consists of devascularization of the lower oesophagus, cardiac orifice and greater gastric tuberosity by ligation of the varices and section of the oesophagus, combined in every case with truncular vagotomy and gastric bypass. In emergencies the abdominal approach enables the bleeding points to be accurately localized. In the treatment of haemorrhages due to portal hypertension, this technique offers an alternative to porto-caval bypasses when these cannot be performed (thrombosis or portal cavernoma) or when the risk of encephalitis is too high. However, contrary to liver transplantation, it is a palliative technique for cirrhotic patients.

[Azygo-portal disconnection for hemorrhagic cirrhosis. Results and value of abdominal and thoracic approach apropos of 20 cases]. / Déconnexions azygo-portales pour cirrhoses hémorragiques. Résultats et intérêts respectifs des voies abdominale et thoracique à propos de 20 cas.

The authors report about the results of 20 azygoportal deconnections for the treatment of hemorrhagic cirrhosis caused by the rupture of esophageal or cardiotuberosal varices. All patients had an ethylic cirrhosis of Child-Pugh classes A (1), B (15) or C (4). All had a contraindication to calibrated laterolateral portocaval shunting. Azygoportal deconnection was performed with a thoracic approach in 7 cases, using a Bérard eso-clip in 6 cases and a Prioton button in 1. In 13 cases the approach was abdominal, using EEA circular mechanical clamps. In this cases, trunk vagotomy was performed in 12 cases, in association with pyloroplasty in 10 cases and gastroenteroanastomosis in 2 cases. Splenectomy was performed in 3 patients and the ligation of the splenic artery in a 4th patient. Mortality at 2 months is of 30%, the 6 deaths being caused by hepatic insufficiency in 3 cases, heart and esophageal fistula after an eso-clip was laid in 1 case. The two patients with chronic ascites died of hepatic insufficiency. Mortality at 2 months is of 23% for patients operated in an elective period, and 43% for semiergent operations. Twenty-six percent of the Child B patients and 50% of the Child C patients died. The percentage of residual varices is 57% in the surviving patients. Every second patient had complementary sclerosis. All had had azygoportal deconnection with mechanical clamps. Bleeding recurred in 2 patients (16.6%). Survival is 50% at 1 year and 39% at 3 years.

[Calibrated side-to-side portacaval anastomosis in the treatment of bleeding from ruptured esophageal varices. Results in 38 cirrhotic patients]. / L'anastomose porto-cave latéro-latérale calibrée dans le traitement des hémorragies par rupture de varices oesophagiennes. Résultats à propos de 38 patients cirrhotiques.

We report the clinical results of 38 calibrated side-to-side portocaval shunts performed in patients with hemorrhagic liver cirrhosis (alcoholic in 90 percent of cases). The operative mortality (at 2 months) was 10.5 percent. The rate of recurrent bleeding was 2.6 percent; hepatic encephalopathy was encountered in 16 percent (acute encephalopathy: 6.5 percent; chronic encephalopathy: 9.6 percent; this rate decreased to 3.2 percent after anastomotic narrowing). Hepatopedal portal blood flow was maintained in 74.3 percent of cases in the early postoperative period (83.3 percent since the portacaval pressure gradient was maintained at 2/3 of the initial gradient) and disappeared with time in 75 percent of cases. The survival rates at 1 and 4 years were 79.4 percent and 60 percent, respectively, for all patients (94.4 and 83.3 percent for Child A patients) with a normal social activity in 90 percent of cases. Twelve patients developed hepatocellular carcinoma. These clinical results are similar to those observed after selective shunts and suggest that the side-to-side calibrated portacaval shunt is an excellent procedure for the treatment of bleeding esophageal varices in case of failure or contraindication to endoscopic sclerotherapy or in patients with chronic ascites and good liver function.

[Proposal for a polyvalent Simplified Acute Physiology Score of severity in biliary tract surgery]. / Proposition d'un score de gravité polyvalent "SAPS" en chirurgie biliaire.

The SAPS score proposed by Le Gall, was used in 128 patients undergoing biliary surgery between January 1987 and April 1988. The score is based on the laboratory data for the first day. The cumulative post-operative complication rate was established during hospital stay and at one month after discharge. There is a highly significant correlation between the SAPS score, the morbidity and the mean hospital stay. From this study it seems valuable to use this score in surgery reports.

[Trendelenburg's operation using an sternostomy approach for pulmonary embolectomy]. / Opération de Trendelenburg par sternotomie pour embolectomie pulmonaire.

Five cases of extremely serious pulmonary embolism treated by embolectomy without extracorporeal circulation have prompted to recall the Trendelenburg's operation through sternotomy. Rapid, simple and requiring little equipment, this technique is perfectly suited to emergency surgery. Its use should save the lives of several patients who would be condemned to death without surgical operation.