[Cholesterol in serum high density lipoprotein fraction (author's transl)]. / Cholestérol de la fraction lipoprotéine de haute densité.

The risk of atheroma can be assessed and valid epidemiological surveys can be carried out by measuring cholesterol in serum high density lipoprotein fraction (HDL) and calculating the HDL cholesterol: VLDL + LDL ratio. This was done in 39 patients free from surgically confirmed atheromatous lesions and in 51 patients presenting with such lesions. Of the four different techniques used for separation in these patients (ultracentrifugation, precipitation with heparin-Mn2+, precipitation with phosphotungstate-Mg2+ and electrophoresis), precipitation with phosphotungstate-Mg/2+ seems to be the most suitable, since there is no degradation of the HDL fraction as during electrophoresis on polyacrylamide gel, and less floculation of the supernatant after separation. Contrary to ultracentrifugation, which requires sophisticated equipment and good technical skill, the technique is easily carried out.

[Aortic and mitral monovalvular replacements. Comparison of the ball prosthesis of Starr-Edwards (1260-6120) and the tilting disc prosthesis of Bjork-Shiley. Series of 390 patients]. / Remplacements monovalvulaires aortiques et mitraux. Comparaison des prothèses à bille de Starr-Edwards (1260-6120) et à disque basculant de Björk-Shiley. Une série de 390 patients.

The evaluation of short and long term replacement by the Björk-Shiley tilting disc prosthesis (BS) and by the Starr-Edwards ball and cage prosthesis (SE) was carried out on a series of 390 consecutive patients. In mitral replacement, operative mortality rate (SE 5.9 P. 100 - BS 4.8 P. 100), 5 year actuarial survival (SE 79.8 P. 100 +/- 3.8 P. 100 - BS 86.3 P. 100 +/- 9 p. 100) incidence of thromboembolic complications and valvular thrombosis (SE 1.6 P. 100 - BS 1.3 P. 100) as well as the degree of post-operative improvement were virtually identical in both types of prosthesis. Likewise, in aortic valve replacement, operative mortality rate (SE 4 p. 100 - BS 3.2 p. 100), 5 year survival (SE 82 +/- 7.8 P. 100 - BS 86 +/- 3.3 p. 100) incidence of thromboembolic complications (SE 2.2 p. 100 - BS 1.8 p. 100) and the degree of post-operative improvement were not statistically different. However, the incidence of sudden death was statistically smaller with a BS prosthesis than with a SE prosthesis (respectively 1.6 p. 100 and 6.9 p. 100).

[Problems encountered by the anesthetist-intensive care specialist during aorto-coronary bypass surgery]. / Problèmes posés a l'anesthésiste-réanimateur par la chirurgie du pontage aorto-coronaire.

The authors studied a series of 288 patients undergoing surgery for aorto-coronary bypass. The anaesthetic protocol and operative protocol are described and particular emphasis is placed upon the aortic clamp time. Mortality and peri-operative complications are then analysed. The treatment of such complications is based essentially upon vasodilators and where necessary intra-aortic counter-pressure balloon device to provide circulatory assistance.

[Surgical treatment of massive pulmonary embolism. (Reported of 45 successful embolectomies inclusive 10 with Trendelenburg's technic) (author's transl)]. / Chirurgische Behandlung der massiven Lungenembolie. Bericht über 45 erfolgreiche Operationen, hiervon 10 Eingriffe nach Trendelenburg.

45 pulmonary embolectomies have been carried out successfully, 10 by Trendelenburg's procedure, 35 with extracorporeal circulation. The latter method gives satisfactory results (34 survivals out of 36 attempts since 1970) and appears to be the procedure of choice. Any pulmonary trauma should be avoided at operation; embolectomy is done by intra-vascular suction. The hemodynamic status was always abnormal: 5 initial cardiac arrests, 20 cases of severe shock (9 demonstrating cardiac arrest on the operating table) and 11 cases with less severe shock. In 9 cases cyanosis, respiratory distress and signs of acute cor pulmonale were the clinical features of the massive embolus. In 9 patients the operation was performed after an unsuccessful trial of thrombolysis. Preoperative pulmonary angiography could be performed in 30 cases and always showed extensive pulmonary vascular obstruction of 60 to 95 per cent. These data are important for diagnosis and for assessment of the prognosis. Despite of present medical treatment with fibrinolytics, surgery is still advisable in the treatment of massive pulmonary embolism. The indications are moribund patients, those in whom thrombolysis is contraindicated or unsuccessful and those with massive pulmonary obstruction (greater than 60 per cent). In this latter subset thrombolytic therapy carries a high level of mortality.

Anatomic, clinical, and therapeutic features of acute cardiac rupture. Successful surgical management fourteen hours after myocardial infarction.

A 62-year-old man sustained an acute myocardial infarction complicated on the thirteen hour by left ventricular rupture and acute periocardial tamponade. Echocardiography confirmed the suspicion of intrapericardial fluid, and immediate pericardiocentesis improved the hemodynamic state for a period sufficient to permit preparation for operation. Resection of ruptured and necrotic anteroapical left ventricular myocardium with primary reconstruction was successfully accomplished with the aid of temporary extracorporeal circulation. The patient has remained well for 1 year after the operation. Anatomic, clinical, and therapeutic features of acute cardiac rupture are discussed.

[A treatable condition: parietal rupture of the heart during the acute phase of myocardial infarct. Apropos of a further case treated successfully with surgery]. / Une affection curable : la rupture pariétale du coeur à la phase aiguë de l'infarctus du myocarde. A propos d'un nouveau cas opéré avec succès.

A man aged 62 had an unexpected anterior myocardial infarction, complicated during the thirteenth hour after onset by parietal rupture and consequent acute tamponnade. The diagnosis was confirmed by echocardiography and then by pericardial puncture which allowed enough time for an operation to be undertaken under extra-corporeal circulation. The infarct was resected together with the weakened area of rupture, and the quality of the patient's life has been maintained at an excellent level after one year.

[Traumatic rupture of the descending aorta. A report of 21 operated cases (author's transl)]. / Die traumatischen Rupturen des Isthmus der Aorta anhand von 21 operierten Fällen.

From 1965 to December 1976, 21 traumatic ruptures of the descending thoracic aorta have been operated; the last 13 cases have been managed in 1975 and 1976. The lesions consisted in 15 recent ruptures (R.R.) and 6 chronic aneurysma (C.A.). Associated injuries were the rule and 6 patients underwent exploratory laparotomy prior to thoracotomy. Surgical repair was consistently due by use of an extracorporeal by-pass (20 times), and resulted in 12 end-to-end aortic sutures (11 R.R., 1 C.A.) and in 9 reconstruction by means of a tubular dacron graft (5 C.A., and 4 R.R.). 4 patients died. 16 of the 17 survivals are healthy and active. Paraplegia developed in one patient.

[Massive pulmonary embolism Apropos of 26 embolectomies with definitive survival, 10 of them by Trendelenburg's operation]. / L'embolie pulmonaire massive. A propos de 26 embolectomies avec survie définitive, dont 10 par opération de Trendelenburg.

The authors report 26 pulmonary embolectomies carried out successfully, 10 of them having been Trendelenberg procedures and 16 having been carried out under extracorporeal circulation. The latter method gives better results, and appears to be the procedure of choice. The haemodynamics before operation were always abnormal, and there were 4 cardiac arrests, 11 cases of severe shock, and 6 cases with less severe hypotension. In the other cases, cyanosis, respiratory distress and signs of acute cor pulmonale were the clinical features of the massive embolus. It was possible to carry out arteriography in 14 cases, and this showed extensive pulmonary vascular obstruction in between 70 and 90%. In 4 cases this procedure was followed by an exacerbation, and extremely urgent treatment became neccessary. This examination is important for diagnosis and for assessment of the prognosis. It seems clear to the authors that surgery has a certain place, alongside medical fibrinolysis of a severe prognosis. It seems clear to the authors that surgery has a certain place, alongside medical fibrinolysis of a severe pulmonary embolus. The essential indications for surgery are moribund patients, those in whom fibrinolysis is contraindicated or unsuccessful, and those with massive obstruction of the pulmonary arterial tree.

[Post infarction septal perforation. Is the early operation benefical?]. / Perforation septale post-infarctus. L'intervention très précoce est-elle bénéfique

A case is reported of a ruptured septum in a man of 74 which was operated on after 48 hours; the authors recall the development of ideas on the surgical treatment, and also the advantages which may be expected from counterpressure from an intra-aortic balloon. If this is not available, it seems to them that the operation must be carried out even more swiftly, within the first few hours, if damage to the myocardium and the consequences of prolonged shock, are to be avoided.