Eversion endarterectomy of the internal carotid artery: midterm results of a new technique.

A new eversion endarterectomy technique was used in 65 internal carotid artery reconstructions in 56 patients. The original features of the technique include a complete oblique transection of the internal carotid artery distal to the lesion and eversion endarterectomy through a longitudinal incision of the common carotid and external carotid arteries. The mean age of the patients was 68.2 +/- 7.8 years. Seventy-three percent of the patients had hypertension and 45.5% had coronary heart disease. Fifty-four percent experienced neurologic symptoms (transient in 36%, reversible in 6%, and permanent in 11%). Operations were performed under general anesthesia. An indwelling shunt was inserted whenever routine stump pressure was < 50 mmHg. There were no neurologic complications but one patient died of a compression hematoma of the neck, for a combined mortality and morbidity rate of 1.5%. Arteriograms were obtained from all patients on day 5 and showed complete restoration of normal anatomy in all cases and thrombosis of the external carotid artery in one. During a mean follow-up of 27 +/- 4.7 months no strokes were observed. Follow-up duplex scans showed no hemodynamically significant restenoses. Eversion endarterectomy is a reliable alternative to other reconstruction procedures of the internal carotid artery.

[Surgical treatment of sclerotic arterial diseases of the lower limbs]. / Traitement chirurgical des artériopathies scléreuses des membres inférieurs.

Among arterial reconstruction procedures, thromboendarterectomy has progressively left place to prosthetic grafts for aorto-iliac surgery. At infra-inguinal level, inversed or in situ venous grafts allow distal revascularisations down to the foot. Lumbar sympathectomy keeps some indications. Indications depend upon the level of arterial obstruction, the symptoms, and the operative risk of the patient. At aorto-iliac level surgery provides excellent results; indications for proximal surgery are large; operative risk is the main limiting factor. At infra-inguinal level surgery is well tolerated but permeability rates are not as good as with aorto-iliac surgery; distal surgery is appropriate only is case of critical ischaemia, when everything must be done for limb salvage.

[Visco-elastic substances and endothelial preservation of venous autografts. Preliminary study]. / Substances visco-élastiques et conservation de l'endothélium des autogreffes veineuses. Etude préliminaire.

Twelve rabbit jugular veins were studied in order to determine if viscoelastic substances (1% Sodium Hyaluronate and Collagen IV) allowed a better endothelial preservation than normal saline solution. Veins were stored at 4 degrees C for either one or three hours. Endothelial integrity was analysed by scanning electron microscopy. The best endothelial preservation was obtained with normal saline solution. We conclude that endothelial preservation is not enhanced by viscoelastic substances.

[Reverse endarterectomy of the internal carotid]. / Endartériectomie par retournement de la carotide interne.

We have described an original technique of eversion carotid endarterectomy which has been performed in two series of patients. In the first series the patients were operated on in Angers. They were 65 carotid stenosis in 56 patients with a mean follow-up of 27 months (18-36 months). In the later series, the patients were operated on in Lyon. They were 51 carotid stenosis in 43 patients with a follow-up from 1 to 24 months. The two series were comparable in term of symptoms and grade of stenosis as determined by duplex-scan and arteriography. The technique which has been previously described is safe and presents a lot of advantages over classical endarterectomy or vein graft. We observed no postoperative neurological deficit and no postoperative thrombosis. Two residual stenosis (1.7%) were measured at 30% but they did show any impairment during two years of follow up in the first series. Eversion endarterectomy of internal artery is a safe and deficient alternative to others techniques in the surgical treatment of atherosclerosis stenosis of internal carotid artery.

[Wounding of an iliac artery during celioscopy]. / Plaie d'une artère iliaque au cours d'une coelioscopie.

Vascular accidents during celioscopy are rare but potentially serious. Arterial injuries usually involve the aortic bifurcation and are generally recognized and treated as emergencies. In the present case, a transfixing wound of the right common iliac artery provoked by a trocar during gynecological celioscopy in a 36 year old woman was diagnosed secondarily, the posterior orifice being unrecognized during laparotomy to control hemorrhage. A false iliac artery aneurysm was detected 2 months later when she presented signs of a compressive retroperitoneal hematoma confirmed by arteriography and scan images. The common iliac artery was ligatured through a right retroperitoneal approach with extra-anatomical revascularization by a crossed iliofemoral venous shunt. The postoperative course was uncomplicated apart from a right cruralgia sequela. Immediate circumferential dissection for treatment of aortic bifurcation injuries is recommended, to avoid missing a transfixing wound, and to allow direct restoration usually by simple suture. In contrast, secondary treatment is complex, raises problems of arterial reconstruction, and cannot always prevent functional sequelae.

[Angioscopy in peripheral vascular diseases]. / L'angioscopie en pathologie vasculaire périphérique.

Angioscopy is a useful investigation in patients referred for vascular surgery. The material has been improved over the last few years to make available angioscopes with external diameters ranging from 0.55 to 3.2 mm. The angioscopes are either rigid, composed of two groups of fibre optics (image and light transmission) or orientable and more complex. Both systems may carry operating channels. The angioscopy may be performed peroperatively or percutaneously. Other essential equipment includes catheter guides, balloon catheters, counterpulsation balloons or perfusion pumps. This investigation is used for diagnostic evaluation but when used peroperatively it may also help guide therapeutic intervention. Angioscopy is complementary to ultrasonic and radiological methods of vessel imaging.

[Immunization against synthetic LHRH used therapeutically in prolonged administration]. / Immunisation contre la LHRH de synthèse utilisée à titre thérapeutique en administration prolongée

PIP: The authors documented 1 case of immunization against synthetic luteinizing hormone-releasing hormone (LH-RH) among 4 patients treated for 2-7 months whose serum antibodies had been measured before and after treatment. The patient was a 26-year-old man with hypogonadotropic hypogonadism, given 500 mcg LH-RH 2-3 times daily for 120 days. Within the 1st month, he developed male hair distribution, erections, increased testicular volume, and elevated follicle stimulating hormone, LH, and testosterone rose from .3-2.7 ng/ml. Over the next 2 months, however, these results regressed to initial values. His LH-RH antibody level was expressed as 6% on Day 110 of treatment. The other 3 patients had no LH-RH binding before or after treatment. They were a 24-year-old woman with hypothalamic amenorrhea, a 27-year-old man with oligospermia, and a 29-year-old man with hypogonadism.^ieng

[Male hypogonadotrophic hypogonadism: successful treatment of infertility with HMG + HCG (author's transl)]. / Hypogonadisme hypogonadotrope masculin: succès du traitement de la stérilité par H.M.G. + H.C.G

Ten typical cases of male eunuchoidism (two with anosmia) are reported. After administration of clomifene citrate to five patients there was no change in blood levels of gonadotrophins in four cases; in the fifth, a small and transitory increase of LH was noted. The intravenous injection of LHRH (100 mcg) to five patients induced an increase of serum LH in all cases and serum FSH in three cases. The initial site of the dysfunction is possibly hypothalamic with secondary gonadotrophic pituitary insufficiency. Among six patients desiring paternity, prolonged treatment (for 36 to 98 weeks), with HCG(1700-7000 I.U. weekly) + HMG (450-825 I.U. FSG weekly) resulted in the appearance of spermatozoa in the seminal fluid in five cases and a pregnancy was obtained in four cases. Methods of treatment are discussed.

[Male hypogonadotropic hypogonadism. Success of treatment of sterility with HMG plus HCG]. / Hypogonadisme hypogonadotrope masculin. Succès du traitement de la stérilité par HMG + HCG

Ten typical cases of male eunuchoidism (two with anosmia) are reported. After administration of clomifene citrate to five patients, there is no change in blood levels of gonadotrophins in four cases; in the fifth, a small and transitory increase of LH is noted. The intravenous injection of LHRH (100 mug) to five patients induces an increase of serum LH in all cases and serum FSH in three cases. The initial site of the dysfunction is possibly hypothalamic with secondary gonadotrophic pituitary insufficiency. Among six patients anxious for paternity, prolonged treatment (for 36 to 98 weeks), with HCG (250-1 000 I.U. daily) +HMG (65-120 I.U. FSH daily) results in appearance of spermatozoa in the seminal fluid in five cases and a pregnancy was obtained in four cases. Comments are done upon methods of treatment.

[Ovarian hyperstimulation syndrome. Notes on the physiopathology and treatment apropos of 3 cases]. / Syndrome d'hyperstimulation ovarienne commentaires sur la physiopathologie et le traitement, à propos de 3 observations

Hyperstimulation appeared in one case on the 10th 11th day after ovulation, allowing by its presence the very precocious diagnosis of successful fecondation. The study of blood coagulation revealed that hypercoagulability was mainly related to hyperactivity of the thrombocytes and of the coagulation proteins. The pathogenesis of the syndrome is discussed. Increase in the permeability of the capillary vessels and hypovolemia seem to be responsible for the main accidents. Unfortunately as we have no real mean of decreasing the permeability of the capillary vessels, the treatment can be directed only against hypovolemia and its results. The infusion of macromolecular fluids, the restriction of sodium and water intake, together with the prescription of spironolactone have been successfully employed in those three cases.