[Pseudoaneurysm of the ascending aorta. Rare complication following aortic valve replacement]. / Faux anévrisme de l'aorte ascendante. Complication rare d'une chirurgie valvulaire aortique.

False aneurysm of the ascending aorta has been reported as a rare complication of cardiovascular surgery among which the etiology, the physiopathology and the natural evolution are still badly known. The diagnosis is often fortuitous. The clinical polymorphism of the affection imposes the appeal to the morphological explorations to establish an early diagnosis and determine the adequate therapeutic attitude. This complication of the cardiac surgery is associated with a high mortality in spite of the cardiovascular surgery progress. In this report, we present a case of a pseudoaneurysm of the ascending aorta which was discovered six months after aortic valve replacement for severe aortic stenosis. We discuss in this article the diagnostic and therapeutic aspects of this case.

Rescue extracorporeal circulation as bridge to recovery in fulminant cocaine-induced heart failure.

Cocaine is an increasing cause of admission in the emergency room. The widespread abuse of this drug during the last decade in the USA is now widely emerging in Europe. Because of its various cardio-vascular complications, cocaine is one of the most death-related drugs known at this time. The following report describes the dramatic case of a young man polydrug addict presenting at our institution with life-threatening acute heart failure that developed shortly after his very first cocaine intake. Because of the lack of response to intensive medical treatment, we decided to perform a percutaneous extracorporeal circulation membranous oxygenation (ECMO) that allowed survival and rapid left ventricular function recovery. This report highlights cocaine as a rising trigger of acute heart failure in young people and is, to the best of our knowledge, the first report that illustrates ECMO as an effective hemodynamic support in the course of fulminant cocaine-induced cardiomyopathy.

Brachial, radial, or femoral approach for elective Palmaz-Schatz stent implantation: a randomized comparison.

UNLABELLED: From October 1994 to November 1995, 150 male eligible patients were randomly assigned to Palmaz-Schatz stent implantation through 6 French catheters using the femoral (puncture) (n = 56), radial (puncture) (n = 56), or brachial (cutdown) (n = 38) approach at 6 participating Belgian centers. Acenocoumarol was given for 1 month after stenting. END POINTS: Primary-entry site complications (bleeding, haematoma, transfusion, occlusion, surgery) poststent implantation. Secondary-success rate, stent thrombosis, Q or non Q wave MI, repeat PTCA, CABG, CVA, haemorrage, death. There were no statistically significant differences between the three groups for base line and angiographic patient characteristics, procedural characteristics, in hospital outcome, average hospitalisation time after stenting, events during the month after stenting, or local complications at 1 month follow-up. The only statistically significant difference was the arterial time of the procedure: mean +/- SD (minutes) brachial 31.0 +/- 10.02 *P < 0.001, femoral 42.2 +/- 21.8, radial 55.8 +/- 31.3 **P < 0.0001 (*brachial vs. femoral, **brachial vs. radial). There was a clear trend toward more technical difficulties and more problems with the radial approach. In each group: vascular surgery at entry site: 0%, blood transfusion: 0%. In our study, local complications and length of hospital stay were similar with the three possible approaches, and brachial approach was associated with a shorter arterial time.

Variability and reproducibility of quantitative left ventricular angiography.

To evaluate the reproducibility of left ventricular angiography for the assessment of left ventricular (LV) function and regional wall motion, two ventriculographies were performed in the 30 degrees right anterior oblique (RAO) projection, at 15-minute intervals, in 19 patients undergoing coronary angiography. Heart rate, left ventricular systolic pressure, and end-diastolic pressure were measured 15 minutes after the first angiography returned to the baseline values (71.0 +/- 14.1 vs. 72.2 +/- 15.5 beats/minute, 153.6 +/- 18.0 vs. 152.8 +/- 19.9 mm Hg, 21.7 +/- 8.6 vs. 20.9 +/- 7.3 mm Hg, respectively). Global and regional LV performance was analyzed by two observers with a computer-assisted technique. Intraobserver mean variation of end-diastolic volume and ejection fraction was less than 3% of the control value. Interobserver mean variations for the same parameters were less than 4% of control values. For both observers, there was no significant variation of LV end-diastolic volume and ejection fraction from one study to the other. Under stable hemodynamic conditions, the mean observed variations were, depending on the observer, 5-6% of the control value for LV end-diastolic volume and 5% for ejection fraction. Analysis of segmental wall motion was also highly reproducible. The mean intraobserver variation (% of control value) of wall motion ranged from 4.4% to 9.2%, depending on the sectors studied. The mean interobserver variation, whatever the sector, ranged from 6.9% to 13.5%.(ABSTRACT TRUNCATED AT 250 WORDS)

Colposcopic evaluation of men with genital warts.

Colposcopy, which is the examination of the female genital tract that generally is performed after the application of acetic acid, has been an effective tool in the diagnosis of genital warts (condyloma acuminatum) in women for years. With the help of colposcopy, both microscopic and flat warts that cannot be visualized with traditional, noncolposcopic methods can be seen and, hence, treated. Recently, studies reported in the gynecologic and urologic literature have evaluated the usefulness of colposcopy in male patients. We present a patient whose genital warts were recalcitrant to treatment. When examined with colposcopy he was noted to have multiple additional areas of involvement. In view of the neoplastic potential of the human papillomavirus, the ease with which it is transmitted sexually, and the difficulty in discerning certain kinds of warts without colposcopy, we believe colposcopic examination should be routine in all men with genital warts and in those whose sexual partners have tested positive for human papillomavirus.

Five year clinical experience with the Copper 7 intrauterine device.

The clinical observation of 1547 patients who had a Copper 7 IUD inserted in a municipal hospital in New York City during the period August 1, 1974 to July 31, 1979, is presented. Despite the extreme mobility of this lower socio-economic population, complete followup was possible for 79% of the insertions. The demographic characteristics of the patients are presented, as well as the number of events and closures for the first segment of use and for all segments. The events are analyzed by patient's age, gravidity, parity and duration of use. Net annual rates for accidental pregnancies, expulsions and removals, as well as continuation rates are presented for the first 3 years of use. Net cumulative rates for the same events are presented for the 5 years of the study.

Massive ovarian edema: review of world literature and report of two cases.

The subject of massive edema of the ovary is reviewed in detail. Two new cases are reported. One is the first case of massive ovarian edema to occur during pregnancy. In addition, all cases from the world literature since the original description in 1969 are reviewed. Background information, clinical signs and symptoms, laparotomy findings, and pathology from all 22 cases are reviewed. Etiology and management are discussed.

Actinomyces in the endometrium of IUD users.

The colonization of the female genital tract with Actinomyces is closely related to the presence of an IUD in the uterine cavity. This was confirmed in the present study, which shows an Actinomyces frequency of over 3% in users of IUDs, while non-users were free from the opportunistic invader. This frequency was higher with certain types of devices than with others. None of the patients with positive results had pelvic symptoms, but cases of serious infections have been reported in the literature. The length of IUD usage appears to be directly related to the incidence of this colonization. The possible pathogenesis of pelvic actinomycosis is presented; the clinical significance of asymptomatic colonization is discussed.

PIP: This study confirmed that the colonization of the female genital tract with Actinomyces is closely related to the presence of an IUD in situ. Actinomyces was identified in 24 of 763 women who had had an IUD removed, an incidence of 3.14%. No controls showed this microorganism on biopsy. The average age and parity of Actinomyces bearers were 31 and 2, respectively, with a period of IUD use ranging from 24-122 months. 13 of the patients were using Lippes loop, 6 a Copper 7, 3 a Dalkon Shield, 1 a Silverman M, and 1 a Majzlin Spring. These figures represent a positive finding in 3.36% of Lippes loop users, in 1.81% of Copper 7 users, and 10.71% of Dalkon Shield users. None of the patients with positive bacterial cultures had pelvic symptoms in this study. It was concluded that the material of which the device is made is unimportant compared with the amount of tissue injury and length of use of the device in predisposing to the development of this colonization/infection.

Recognizing malignancy in intrauterine contraceptive device users.

PIP: A 43 year old woman, gravida 2, with a Lippes Loop IUD for 4 years presented herself at the family planning clinic of the New York Medical College in New York City complaining of intermittent spotting for 4 months. In her 2 previous clinic visits, clinic staff assured her that this bleeding was a result of the IUD. Upon examination during her 3rd visit for the same complaint, however, the physician noted an enlarged uterus with an irregular contour. The loop was removed and sent for a pathologic examination which showed a grade 1 adenocarcinoma of the endometrium. After confirming the diagnosis with a fractional curettage, the patient had a total abdominal hysterectomy with bilateral salpingo-oophorectomy. As of April 1980 there was no evidence of recurrence. Another woman, a 24 year old, gravida 4, had been followed by the same clinic for 3 months. On her 1st visit a health professional inserted a Copper 7 IUD, even though the health professional noted a cervical erosion. In addition, her Pap smear was not satisfactory. She missed her next appointment, but did attend the clinic 3 months later because of irregular bleeding. Staff removed the IUD and then reevaluated her. Due to the friability and abnormal appearance of her cervix, she had a colposcopy and the physician noted abnormal vessels in a large lesion, compatible with invasive cancer of the cervix. A biopsy and a laparotomy confirmed the physician's preliminary diagnosis. She was treated with radiotherapy, but her condition deteriorated quickly. Immunotherapy was unsuccessful, and she died 1 year after the initial diagnosis. Although abnormal bleeding in IUD users is common, health professionals must always consider the possibility of malignancy.^ieng

Transverse vaginal septum.

Transverse vaginal septum, perhaps the most common congenital anomaly of the vagina, is nonetheless an unusual finding. A case report and its management and theories concerning the embryology of the vagina are presented. The varying presentations of imperforate versus perforate transverse septa are reviewed, as well as diagnostic tools and treatment modalities. Surgical excision of the septum is advocated.