[A clinical investigation of Bentall's operation for annuloaortic ectasia in the elderly].

Although Bentall's operation has become a routine procedure for annuloaortic ectasia (AAE), few reports on its effects on operative mortality in elderly patients have been published. The results of Bentall's operation for AAE on 4 elderly patients were reviewed. There were two males and two females in the series. The ages ranged 71 to 77 years with an average of 73. The etiology of aneurysms was syphilitic in three and arteriosclerotic in one patients. All patients had AAE, aortic regurgitation and ascending aortic aneurysms. Of all these patients, 1 had a subacute Type A dissecting aneurysm, 1 had a proximal arch aneurysm and 1 had an aortic arch aneurysm plus a sacciform descending aortic aneurysm. All patients had composite graft replacement with coronary reimplantation. Three patients received the concomitant operative procedures including aortic arch replacement and CABG to right coronary artery with saphenous vein graft. All patients survived operation. Postoperative CTR and NYHA classification showed remarkable improvement and serious complications were not found in spite of old age. In the late postoperative period, all patients were alive and well from 4 to 6 years after operation. Bentall's operation can be performed in elderly patients with AAE.

[Syphilitic thoracic aortic aneurysm with destruction of vertebral body, producing numbness of lower extremities and paraplegia].

Numbness and paraplegia are uncommon complaints in patient with thoracic aortic aneurysm (TAA). The patient was a 64-year-old man. He suffered numbness and gait disturbance (paraplegia). The blood examination showed no positive findings except a Wassermann was positive. Roentgen examination of the chest showed two abnormal shadows like tumors. The CT and MRI revealed destruction of the vertebral bodies and TAAs adjacent to the spinal cord. After the graft replacement was performed, numbness and paraplegia disappeared. This suggests that in our patient the TAAs destruct the vertebral body and produce pressure on the spinal cord, causing numbness and paraplegia. We experienced a rare case of the syphilitic TAA producing bone destruction, numbness and paraplegia.

Meningovascular syphilis after 'appropriate' treatment of primary syphilis.

Meningovascular syphilis developed in a patient two years after the treatment of primary syphilis with a single intramuscular injection of 2.4 million units of penicillin G benzathine as recommended by the Centers for Disease Control. Although it could not be established with certainty whether this infection represented a reinfection or a treatment failure, the case emphasizes the necessity for serologic follow-up examination in all patients treated for primary syphilis.

[Inflammatory lesions of the aorta and its branches, Introduction and etiological aspects (excluding Takayasu's disease)(author's transl)]. / Atteinte inflammatoire de l'aorte et de ses branches. Introduction et aspects étiologiques (Takayasu exclu).

Acquired lesions of the aorta are not confined to atherosclerosis alone, and diagnostic, etiological, pathogenic, and therapeutic problems may be raised when confronted with less frequent infective or inflammatory processes. Syphilitic aortitis was for a long time considered to be the only infective lesion involving the aorta, but bacterial (mycotic) aneurysms were now known to exist. Many pathogenic agents may be involved: staphylococcus, Salmonella, pneumococcus, Proteus, Klebsiella, Brucella, more rarely KB, Rickettsia, or nematodes. Inflammatory causes have been recognized more recently, epidemiological and histological studies confirming their presence and the multiple etiologies involved: Horton's disease, rheumatic disorders, connective tissue diseases.