[Development of indications in surgery of coronary revascularization. Current role of mammary-coronary anastomoses]. / Evolution des indications opératoires en chirurgie de revascularisation coronarienne. Place actuelle des anastomoses mammaro-coronariennes.

At a time when the cardio-surgical community has become aware that arterial revascularizations are superior to venous bypasses, GRUNTZIG (24) initiated the now well-known, and highly successful techniques of endoluminal angioplasty (P.T.C.A.) thus leading many teams to explore non-surgical revascularizations. These fast changing events somewhat overshadowed the interest placed in arterial anastomoses in general, and in particular, in mammary-coronary anastomoses. We believe that in 1993, many centres have not used this technique to its fullest and propose to the Académie de Chirurgie a programme of operative indications reinstating mammary-coronary anastomosis to its proper place in the treatment of coronary artery disease.

[Postanoxia encephalopathies]. / Encéphalopathies postanoxiques.

Ischaemic brain damage can follow global cerebral hypoxia, localized cerebral hypoxia and global cerebral anoxia as it occurs after circulatory arrest. The calcium-ion-mediated mechanism is one of the main routes to cerebral deterioration. Barbiturates are restricted for treatment of increased intracranial pressure and seizures. Calcium channel blockers cannot yet be recommended. Therapy remains mainly symptomatic. Hyperglycaemia should be avoided.

[Plasma and tissue concentrations of cefamandole during cardiac surgery]. / Concentrations sériques et tissulaires du céfamandole pendant la chirurgie cardiaque.

This study aimed to determine plasma (CPC) and tissue concentrations of cefamandole during cardiac surgery, so as to compare them with the minimal inhibitory concentration (MIC) for staphylococci (0.25 - 1 microgram.ml-1 for S. aureus; 2 micrograms.ml-1 for S. epidermidis). Cefamandole was given prophylactically to 8 consecutive patients as a single intravenous dose of 60 mg.kg-1. Tissue concentrations were measured in presternal subcutaneous loose tissue and sternal marrow. Average CPC was 233.75 +/- 58 micrograms.ml-1, 15 min after drug administration, 187 +/- 6.4 micrograms.ml-1 at the time of sternotomy, 57.9 +/- 36.5 micrograms.ml-1 10 min after the start of bypass and 36.4 +/- 18.4 micrograms.ml-1 at its end, and 15.5 +/- 5.9 micrograms.ml-1 at the end of the procedure. Sternal subcutaneous tissue and marrow concentrations were respectively 24.4 +/- 13.3 micrograms.g-1 and 31 +/- 5.6 micrograms.g-1 at the time of sternotomy, and 9.4 +/- 5.5 micrograms.g-1 and 9.2 +/- 3.5 micrograms.g-1 at the end of the procedure. Giving a high dose of cefamandole preoperatively appeared to have an effective prophylactic antibiotic action, as the plasma and tissue concentrations were always higher than the MIC for staphylococci.

[Emergency coronary surgery after transluminal coronary angioplasty]. / Chirurgie coronarienne en urgence au décours d'une angioplastie transluminale coronarienne.

Twenty-five patients underwent emergency coronary arterial bypass surgery immediately after attempted percutaneous transluminal coronary angioplasty (PTCA). The average time between the onset of PTCA complication and revascularization was 90 min (30-120 min). The surgical indications, the anaesthesia and the perioperative intensive care were analysed. No acute complication was observed during the anaesthesia. Peroperative findings defined two groups: the first "organic" (coronary arterial dissection and/or occlusive coronary thrombi; n = 15), the second "functional" (coronary arterial spasm; n = 10). The rate of perioperative myocardial infarction was significantly higher in the "organic" group. In this group, at the end of the cardiopulmonary bypass, a higher number of patients required circulatory assistance and/or an antiarrhythmic agent, as well inotropic drugs.

[Histamine liberation in extracorporeal circulation]. / Histaminolibération au cours de la circulation extra-corporelle

Extra-corporeal circulation (E.C.C.) has been held responsible for histamine liberation incidents, essentially by a mechanical cause. In order to prove this, the authors assayed the overall histaminaemia at different times during E.C.C. in 11 patients. The results are discussed in terms of the patients' backgrounds, temperature, hematocrit, blood gases and the acid-base balance, and electrolyte balance. Histaminaemia, corrected depending on the dilution, did not show any significant variation, even in two patients who clinically had anaphylactic manifestations.