[Lockdown and their effects on hospital emergency department attendance]. / Face à la COVID-19. Effets du confinement sur les admissions dans un service hospitalier d'urgences.

In order to limit the spread of the COVID-19 infection, the Belgian authorities established a lockdown from the 18th of March to the 3rd of May 2020. To our knowledge, an analysis of the effect of the lockdown on the Emergency Department attendance by patients with non-urgent pathologies has not been realized yet. We reviewed the files of patients who presented to the Emergency Department of the Brugmann Hospital in Bruxelles during the lockdown period with affections that were evaluated at 4-5 according to the Manchester Triage System (MTS). We then calculated the proportion of these passages with respect to the total passages to the Emergency Department, and subsequently compared the results with the data referring to the same period in the previous year (from 18/03/2019 to 03/05/2019). The results show a clear decrease in the Emergency Department attendance by patients with non-urgent affections during the 2020 lockdown period.

Afin de limiter la dissémination de la COVID-19, un confinement a été instauré par les autorités Belges du 18 mars au 3 mai 2020. Les conséquences du confinement sur le nombre d'admissions aux Urgences, en général, et sur les différents types d'urgences, en particulier, n'ont pas, à notre connaissance, été étudiées. Nous avons revu les dossiers des patients qui se sont présentés au Service des Urgences de l'Hôpital Brugmann à Bruxelles pendant cette période, et qui ont été triés 4 ou 5 selon le «Manchester Triage System¼ (MTS). On a ensuite comparé la proportion de ces passages au nombre total d'inscriptions. Ces données ont ensuite été confrontées à la même période, mais sur l'année 2019 (du 18/03/2019 au 03/05/2019). Durant le confinement, nous avons observé une nette diminution des passages de patients avec des pathologies moins urgentes.

Penetrating atherosclerotic ulcer of the descending thoracic aorta: treatment by endovascular stent-graft.

PURPOSE: To present four cases of penetrating ulcer of the descending thoracic aorta treated by transfemoral insertion of an endoluminal stent-graft. METHODS: Four patients with penetrating aortic ulcers were reviewed. Three cases were complicated by rupture, false aneurysm, or retrograde dissection. All patients were treated by endovascular stent-graft and were followed by helical computed tomography (CT). RESULTS: Endovascular stent-graft deployment was successful in all patients. However, in one case we observed a perigraft leak that spontaneously disappeared within the first month, and two interventions were needed for another patient. Following treatment, one episode of transient spinal ischemia was observed. The 30-day survival rate was 100%, but one patient died from pneumonia with cardiac failure 34 days after the procedure. In one patient, helical CT performed at 3 months showed a false aneurysm independent of the first ulcer. This patient refused any further treatment and suddenly died at home (unknown cause) after a 6-month follow-up period. CONCLUSION: Transluminal placement of endovascular stent-grafts for treatment of penetrating ulcers of the descending thoracic aorta appears to be a possible alternative to classical surgery. After treatment, follow-up by CT is essential to detect possible complications of the disease.

Occluding aortic endoluminal stent graft combined with extra-anatomic axillofemoral bypass as alternative management of abdominal aortic aneurysms for patients at high risk with complex anatomic features: a preliminary report.

PURPOSE: To describe an exclusion endoluminal technique for management of abdominal aortic aneurysms among high-risk patients with complex anatomic features. METHODS: From January 1995 to December 1996, among 143 patients with infrarenal abdominal aortic aneurysm treated by means of endograft placement, 9 (6.3%) had complex aortic or aortoiliac morphologic features. For these patients, the endograft was delivered through a femoral cutdown in an occluding aortoiliac configuration. The contralateral iliac artery was occluded with an iliac endograft. Axillofemoral bypass grafting was performed. Computed tomographic scans were obtained regularly. RESULTS: There was 1 postoperative death of severe arrhythmia. All aneurysms were found to be affected by thrombosis on immediately postoperative computed tomographic scans, except in 1 patient with a proximal leak, which was managed successfully with angiographic embolization. The mean follow-up time was 12 months. Aortic aneurysm diameter decreased from 2 mm at 6 months (2 patients) to 6 mm at 12 months (6 patients). All axillofemoral bypass grafts are patent. CONCLUSIONS: Placement of an occluding endograft associated with axillofemoral bypass grafting is a good alternative for patients at high risk with complex anatomic features. Longer-term follow-up study is needed to evaluate this endoluminal technique.

Adventitial cystic disease of the popliteal artery communicating with the knee joint. A case report.

We describe the case of a patient with adventitial cystic disease of the popliteal artery in which a direct anatomic communication between the cysts and the nearby knee joint was demonstrated by magnetic resonance imaging and confirmed by surgery. This unusual observation could shed some light on the much debated question of the cause, the pathogenesis, and the management of the affection. Moreover, it emphasizes the importance and the role of magnetic resonance imaging in the diagnosis of adventitial cystic disease of the popliteal artery.

[Treatment of abdominal aortic aneurysm by application of a Corvita endoprosthesis. Medium-term results of a feasibility study]. / Traitement de l'anévrisme de l'aorte abdominale par application d'une endoprothèse Corvita. Résultats à moyen terme d'une étude de faisabilité.

Despite improvements in surgical techniques, progress in anesthesia and hemodynamic control, the risk of fatal outcome in the standard surgical technique for aneurysms of the abdominal aorta remains at about 5 to 6% due to associated coronary and pulmonary lesions. Surgical access to the aneurysm may also be hindered in patients with a past history of multiple abdominal operations. In collaboration with the Corvita company, we developed a modular endoprosthesis for endoluminal treatment of AAA and report the results of a feasibility study.

[Surgical treatment of cardiopathies in the elderly]. / Traitement chirurgical des cardiopathies du sujet âgé.

We have reviewed hospital mortality and morbidity with cardiac surgery under cardiopulmonary bypass in patients over 75 years, operated during a 5 years period. It is at the expense of a sometimes difficult selection process in favour of patients with a potentially curable cardiac disease as their only problem, and despite substantially increased mortality and morbidity, that the operated elderly can have excellent probability to normalise both life expectancy and quality of life.

Total anomalous pulmonary venous connection. Results of a small consecutive series.

The surgical experience in 13 infants with total anomalous pulmonary venous connection (TAPVC) between 1987 and 1991 is reviewed. The age vary from 2 days to 35 months with a weight at intervention from 2.130 kg to 5.400 kg. The types of TAPVC were supracardiac in 4 patients, cardiac in 4, and infracardiac in 5. Seven patients (54%) were operated on in emergency. Cardiopulmonary bypass consisted of profound hypothermia and total circulatory arrest in 8 patients (60%) and continuous hypothermic bypass with low flow for the remaining 5 patients (40%). There was no operative death. The follow-up ranges from 21 to 58 months, mean 40 months. There was one reoperation. All the patients were asymptomatic and the height growth percentile is less than 5% in 20%, and the weight growth percentile is less than 5% in 30%. The early repair of infants born with TAPVC can be done with low morbidity with a good prospect on medium term follow-up.

[One-stage subtotal colectomy in the emergency treatment of occlusive left colonic neoplasms]. / La colectomie subtotale en un temps dans le traitement en urgence des néoplasies coliques gauches occlusives.

The authors present a series of 17 emergency subtotal colectomies as treatment of malignant occlusions of the left colon. They insist on the advantages of this operation as well as for the short term results (morbidity, mortality) and for the rare functional disease (diarrhea).

[Jejunal perforation indicating the metastatic extension of a bronchial neoplasm]. / Perforation jéjunale traduisant l'extension métastatique d'une néoplasie bronchique.

After curative pneumonectomy for bronchogenic carcinoma, the first sign of generalization was a peritonitis secondary to the perforation of a jejunal metastasis. The authors review the frequency and etiology of this type of intestinal metastasis as well as the mechanism of perforation.