[Ostial stenosis of the renal arteries: results of surgery]. / Sténose ostiale des artères rénales: résultats de la chirurgie.

Surgery and percutaneous balloon are two contrasting methods for the treatment of renal artery stenosis. Surgical revascularizations offer excellent long term results with a 70% to 90% five year patency rate wherever the location of the lesion on the renal artery. Long term results of transluminal angioplasty are strongly correlated with the anatomo-radiological features of the lesions. From their own experience and after a literature review, the authors conclude that: For lesions located on the trunks of the renal artery, results of surgery and transluminal angioplasty are equivalent. For lesions involving the ostium of the renal artery, the failure rate is high and restenosis are frequent with angioplasty. In that case, surgery is a proper choice which offers better immediate and long term results.

[Acute aortic dissection and peripheral ischemia. Diagnostic and therapeutic problems. Remote control using nuclear magnetic resonance]. / Dissection aortique aiguë et ischémie périphérique. Problèmes diagnostiques et thérapeutiques. Contrôle à distance par résonance magnétique nucléaire.

This study concerns 7 cases of acute aortic dissection associated with visceral and/or lower limb ischemia. Only those cases are included which raised diagnostic and therapeutic problems. Patients were excluded who had purely angiographic involvement of an aortic branch and minor rapidly resolving ischemic syndromes. Five of the 7 patients presented type B (type III or distal) and 2 type A (type I or proximal) dissection. All patients received anti-hypertensor medical treatment. All but one had undergone surgery at least once at the acute stage. Five had been followed up and monitored by magnetic resonance imaging (MRI). One type A and 4 type B dissections were thus reviewed between the 15th month and the 9th year. Diagnostically, aortography was found to be inaccurate twice because of incomplete exploration of the thoracoabdominal aorta. Therapeutically, a case of intraoperative death occurred during replacement of the ascending aorta. Thus, out of the 6 patients who survived the acute stage, 4 are alive and asymptomatic, one has been lost sight of and the other died in year 5 after surgery for chronic dissecting aneurysm of the aortic arch. Among the 5 patients examined by MRI, 4 presented aortic ectasia, chronic dissecting aneurysm of the aortic arch and/or a descending aorta with a diameter between 45 and 65 mm. The patient with subnormal aortic diameter had his ascending aorta replaced (the follow-up period at this writing is only 27 months). Among 3 patients who were examined twice, one showed improvement after a year's interval, with a 5-mm increase in the caliber of the dissected aorta.(ABSTRACT TRUNCATED AT 250 WORDS)

[Can we reduce the number of exploratory thoracotomies using mediastinoscopy?]. / Peut-on réduire le nombre de thoracotomies exploratrices grâce à la médiastinoscopie?

Between 1975 and 1988, 965 cases of bronchogenic carcinoma were submitted to surgery. A cervical mediastinoscopy (CM) was performed in 548 cases (57%). A nodal involvement was found in 35% of these 548 cases, thus 4 patients out of 5 did not undergo thoracotomy. One patient out of 5 underwent a thoracotomy in case of right ipsilateral and intranodal metastasis. Among 803 thoracotomies,-sixty were purely exploratories (7.5%), mainly because of a non resectable tumor. The rate of exploratory thoracotomy (ET) is decreasing (1975-1977 = 15%, less than 5% in recent years) as the rate of CM is increasing (1975-1979: 10-20%, 60-70% in recent years). The study of 60 cases of ET shows that 16 upon 39 performed CM revealed some nodal or mediastinal involvement. Nevertheless, among these 16 patients, the need of thoracotomy was under the pressure of necessity. Twenty-three patients had a negative CM: half of them had a left upper lobe carcinoma. Thus CM was inefficient to establish nodal mediastinal involvement in these cases.