[Stroke : don't forget the aorta!] / AVC : n'oubliez pas l'aorte !

We are presenting a particular case of stroke occurring in a 45-years old woman.

Nous présentons un cas particulier d'accident vasculaire cérébral survenu chez une patiente de 45 ans.

Surgical repair for aortic valve fibro-elastoma: a case report.

Valvular cardiac tumours are rare but account for a high prevalence of stroke or sudden death. We report a case of an incidental finding on echocardiographic screening of a 65-year-old man. He was admitted to the emergency department for an episode of sinus bradycardia due to B-blocker overdose. Diagnosis of fibro-elastoma was rapidly suspected and the patient underwent surgery in order to prevent embolization. Epidemiology, diagnosis and treatment are discussed.

Complete myocardial revascularization with bilateral internal thoracic artery T graft.

BACKGROUND: The internal thoracic artery is widely recognized as the ideal graft for coronary artery bypass procedures. However, because of the inadequate length of the conduit, use of bilateral internal thoracic artery grafting was not suitable for complete revascularization. To overcome this limitation, the T graft was introduced in the 1990s. We decided to prospectively assess the safety of this technique. METHODS: One hundred six patients with a mean age of 51.5 years underwent complete revascularization with an internal thoracic artery T graft. Mean left ventricular ejection fraction was 0.60 (range, 0.22 to 0.85). RESULTS: No patient required reexploration for bleeding, and no patient died within 30 days after operation. On the basis of electrocardiographic changes, 3 patients sustained a perioperative myocardial infarction. One patient had a sternal wound infection. Mean follow-up was 35 months (range, 15 to 61 months). The actuarial survival rate was 99% +/- 1% at 5 years. No myocardial infarctions were reported during the follow-up. Seven patients had recurrent angina. Eighty patients (76%) underwent postoperative stress tests, and 90% had negative results. CONCLUSIONS: Complete myocardial revascularization with the T graft is a safe and reliable technique with excellent midterm results.

Emergency endovascular treatment of an acute traumatic rupture of the thoracic aorta complicated by a distal low-flow syndrome.

We report the case of a patient who suffered major trauma following a motorcycle accident that resulted in multiple fractures, bilateral hemopneumothorax, pulmonary contusions, and an isthmic rupture of the aorta with a pseudoaneurysm compressing the descending aorta. This compression was responsible for distal hypotension and low flow, leading to acute renal insufficiency and massive rhabdomyolysis. Due to the critical clinical status of the patient, which prevented any type of open thoracic surgery, endovascular treatment was performed. An initial stent-graft permitted alleviation of the compression and the re-establishment of normal hemodynamic conditions, but its low position did not allow sufficient coverage of the rupture. A second stent-graft permitted total exclusion of the pseudoaneurysm while preserving the patency of the left subclavian artery.

Deep femoral artery aneurysm rupture. A case report.

Primary "atherosclerotic" aneurysms of the profunda femoris are rare. Although they commonly present with rapid enlargement or rupture, only 8 ruptured cases have been found in the literature. We report a new case where the preoperative diagnosis was established by Duplex ultrasonography. Angiography was made for surgical management. Simple ligation was effective. Pathogenesis, clinical presentation, radio-graphic findings and surgical treatment are discussed.

Vertebral artery dissection. Case report.

Vertebral artery dissection is an uncommon but important cause of posterior stroke in young and middle aged adults. We report a case with a long term fluctuating ischemic symptoms due to bilateral spontaneous dissection. Etiology and treatment are discussed.

Combined therapeutic approach for extraorbital sebaceous carcinoma in a Torre's syndrome.

Extraocular sebaceous carcinomas are extremely uncommon neoplasms. More exceptional is their association with an internal malignancy as first described separately by Torre and Muir in 1967. We report the first use of combined adjuvant radio- and chemotherapy in a sebaceous carcinoma of the anal margin in a Torre's syndrome. An interesting partial response was attained before the patient died from general debility. The therapeutic approach is discussed.

[A new complication of cystic neoplasms of the pancreas: cysto-duodenal fistula]. / Nouvelle complication des néoplasies kystiques du pancréas: la fistule cysto-duodénale.

Pancreatic cystadenomas and cystadenocarcinomas are rare tumors. Their uncommon complications are usually due to compression of adjacent structures or to pancreatic and bile duct fistulas. Authors report the 1st case of duodenal fistula formation and discuss the reported complications.

[Peroperative localization of insuloma using staged portal vein insulin assay. Apropos of a case]. / Localisation peropératoire de l'insulinome par dosage étagé de l'insuline portale. A propos d'un cas.

The diagnosis of insulinoma is easily done now but, in many cases, it is still difficult to locate it without the use of invasive procedures. With selective angiography and percutaneous transhepatic catheterization of the portal vein however, failure is reduced to about 4%. We report a case of a double localisation of insulinoma, revealed by an intraoperative catheterization of the splenic vein. The advantages of this method are discussed.

Effort rupture of the diaphragm.

Effort rupture of the diaphragm is rare and accounts for only 1% of all diaphragmatic injuries. A 23 year old patient with bilateral rupture that followed sudden movement is described.

[Solitary diverticulum of the cecum: apropos of 2 cases]. / Diverticulite solitaire du caecum: à propos de 2 cas.

Diverticulitis of the cecum and ascending colon represent 1.5% of colonic diverticulitis. The preoperative diagnosis is made in 0 to 23% of cases. Two typically misdiagnosed cases are reported. A review of the literature reveals that CT Scan is useful when atypical pain is present in the right lower quadrant. If diagnosed preoperatively, the uncomplicated caecal diverticulitis can be managed conservatively.