[Injuries to abdominal vessels after surgery of disk herniation]. / Traumatismes des vaisseaux abdominaux après chirurgie de la hernie discale.

Four cases of major vascular injury after disc surgery have been treated by the authors. In two instances the symptoms were those of an intra peritoneal haemorrhage after injury to the aorta or to the common iliac artery. These two cases were treated by resection-anastomosis of the vessel. In the two other cases, a fistula developed between the common iliac artery and the inferior vena cava or between the common iliac artery and the common iliac vein. Both lesions were also repaired two days and 10 days after disc surgery. A review of the literature has shown that these lesions are more frequent after surgery at L4-L5 level than at L5-S1 level. They are more frequent after repeated operation. They should be looked for when a fall in blood pressure is noted at the end of the surgical procedure. The published mortality is about 80 p. 100 in vessel division and 10 p. 100 after arterio venus fistula. The earlier the diagnosis is made, the higher is the proportion of healing.

[Peroperative vascular accidents during orthopedic surgery. Apropos of 55 cases]. / Accidents vasculaires per-opératoires de la chirurgie orthopédique. A propos de 55 cas.

The functional or vital prognosis may be affected by the rare vascular accidents resulting from orthopedic operations. During a 10 year period (1970-1980), 55 vascular lesions were observed in 40 patients, and were either arterial (40 cases) or venous (15 cases) in type. Vascular injuries in 9 cases were due to spinal operations (cervical, lumbosacral or herniated disc arthrodesis), in 7 cases to shoulder operations (recurrent dislocation, excision of first rib), in 9 cases to hip surgery (prosthesis, plate and screws, fractured acetabulum), and in 15 cases to operations on the lower limbs (osteosynthesis of femur or tibia, meniscus operations, etc.). Emergency operation was necessary in 18 cases because of a hemorrhagic or ischemic syndrome, all other cases except three requiring secondary surgery for false aneurysms, arteriovenous fistulae, or residual ischemia. Four patients (10%) died, three following hip surgery, and 8 developed complications. The frequency, mechanism, diagnostic and therapy of these lesions are discussed.

[Arterial injuries in civilian practice]. / Les traumatismes artériels en pratique civile.

The authors report their experience of arterial trauma in civilian life in a series of 227 patients (average age 38.2 years) with 233 arterial lesions, treated between 1977 and 1981. Iatrogenic trauma is responsible for 45 p. 100 of cases, the remainder (55 p. 100) being due to road traffic and industrial accidents (29 p. 100), projectiles (16 p. 100) and knife wounds (10 p. 100). 40 p. 100 of patients were seen within 24 h, 30 p. 100 between 24 h and 8 days, and 30 p. 100 over 8 days after the initial trauma. Arteries of the limbs were involved in 61 p. 100 of cases, of the neck in 11 p. 100 of cases and of the trunk in 28 p. 100 of cases. All patients were operated upon, 18 died (7.7 p. 100) and 16 had to undergo amputation (6.8 p. 100). The authors emphasize firstly the serious nature of trauma to the great vessels which is life-threatening and to the popliteal arteries which threatens the functional prognosis, and secondly, the necessity of early diagnosis and treatment.

[Leiomyomas of the esophagus. Report of 20 cases (author's transl)]. / Les leiomyomes de l'aesophage. A propos de 20 observations.

The authors report 20 cases of leiomyoma of the esophagus operated on between 1964 and 1976. The diagnosis depended on the existence of dysphagia without loss of weight, the integrity of the mucosa on endoscopy and the findings of the esophagogram, suggested the true origin of the mediastinal image. Surgical operation usually permits simple enucleation of the leiomyoma. Postoperative mortality was nil. The late postoperative period was uneventful. There was no relapse of the histologically benign leiomyoma.