[Coronary angioplasty under extracorporeal circulation. Technique and experience of the Centre cardiologique du Nord]. / Angioplastie coronaire sous circulation extracorporelle. Technique et expérience du Centre cardiologique du Nord.

Between May 1989 and April 1990, 21 patients, candidates for coronary angioplasty but with major left ventricular dysfunction, underwent the procedure using percutaneous cardiopulmonary support (CPS). All patients had one or more previous infarcts, severe angina, and 19 out of 21 had one or more episodes of cardiac failure. Angioplasty was carried out by the usual method, after establishing a percutaneous femoro-femoral CPS. Twenty-three procedures were performed and 22 successes were recorded without any complications (success = 95% per patient). There were no deaths, infarcts or emergency surgical referrals. Two patients required transfusion. The canulae were removed by compression. The only local complication was one case of deep vein thrombosis. The results of this short series suggest that myocardial revascularisation is possible with an acceptable risk in selected coronary patients with severe left ventricular dysfunction by coronary angioplasty with percutaneous cardiopulmonary support.

[Value of short prophylactic antibiotherapy in thoracic and vascular surgery. Comparative randomized double-blind study of 3 and 8 injections of cefamandole]. / Intérêt d'une antibiothérapie prophylactique de courte durée en chirurgie thoracique et vasculaire. Etude comparative, randomisée, en double aveugle comparant 3 et 8 injections de céfamandole.

The subject of whether an optimal duration of prophylactic antibiotic therapy exists was evaluated by comparing results of short and medium-term treatment in aseptic surgery during a double-blind, randomized, prospective trial in 507 patients undergoing vascular or thoracic operations. Patients were randomly allocated to receive either 3 injections of cefamandole: at induction of anesthesia and after 4 and 10 hours (251 cases) or 8 injections of the same antibiotic: at induction of anesthesia, after 4 hours and then every 6 hours up to 40 hours (256 cases). Evaluation on discharge showed that among the 251 patients receiving 3 injections, 21 (8.33%) were infected while in the group treated with 8 injections (256 cases) 25 (9.8%) were infected. The X2 was 0.25 and there is a lack of statistically significant difference between treatments. Duration of prophylactic antibiotic therapy can be shortened, without loss of efficacy in thoracic or vascular aseptic surgery, to reduce selection of resistant germs and to lower costs.

[Fatal hematemesis due to erosion of a retro-esophageal right subclavian artery by an esophagogastric tube]. / Hématémèse foudroyante due à l'érosion d'une artère sous-clavière droite rétro-oesophagienne par une sonde oeso-gastrique.

A case of fatal haematemesis due to erosion of a retro-oesophageal right subclavian artery by a nasogastric tube is reported. In view of this exceptional but extremely serious complication, no oesophageal tube should be used in patients known to have this abnormal anatomical arrangement. Systematic treatment of aberrant subclavian arteries should perhaps be considered when it can be performed during thoracic surgery.

Hypertensive responses during operation for phaeochromocytoma: a study of plasma catecholamine and haemodynamic changes.

Virtually all patients undergoing resection of a phaeochromocytoma exhibit hypertensive crises at some period perioperatively. In order to study the events associated with hypertensive responses, cardiovascular variables were measured with a Swan-Ganz pulmonary artery catheter and plasma catecholamine levels were determined simultaneously in eight patients during surgery for phaeochromocytoma. Hypertensive responses requiring vasodilator treatment occurred in five patients, i.e. systolic blood pressure (BP) greater than 200 mmHg for more than 1 min. Transient elevation, at least in systolic BP, to greater than 200 mmHg occurred in all patients. Hypertensive responses were identified associated with two circumstances: the first in association with noxious stimuli, i.e. intubation, skin incision, etc., but were not generally accompanied by an elevation in plasma noradrenaline and adrenaline levels; the second occurring during tumour manipulation were more severe and were always accompanied by elevated plasma noradrenaline and adrenaline levels. Transient left ventricular dysfunction, defined by increased pulmonary capillary wedge pressure (PCWP) and decreased cardiac index (CI) secondary to a marked increase in systemic vascular resistance (SVR), was observed in four patients during palpation of the tumour, while one patient exhibited more marked and prolonged ventricular dysfunction. It is concluded that hypertensive responses associated with noxious stimuli may be controlled with deep anaesthesia while those due to tumour manipulation cannot be prevented and are best treated with vasodilators.

[Recent tracheobronchial ruptures caused by closed injuries of the thorax. Diagnosis and complications in 18 cases]. / Ruptures trachéo-bronchiques récentes par traumatisme fermé du thorax. Diagnostic et complications sur 18 cas.

Tracheo-bronchial ruptures are serious complications of thoracic trauma. The authors report their experience of 18 cases: 3 tracheal ruptures, 3 tears in the tracheal or bronchial membrane, 11 unilateral bronchial ruptures and 1 bilateral bronchial rupture. Diagnostic endoscopy was performed immediately in 9 cases, with a delay of 2 to 3 days in 6 cases and with a longer delay (15th, 23rd and 25th days) in 3 cases. The treatment was non-operative in the 3 cases with membranous tears. The other patients were operated by resection of the contused area and end-to-end anastomosis of the ruptured extremities: within 24 hours following the diagnosis in 10 cases, and after a delay in the 5 other cases. The post-operative course was uncomplicated in 13 cases; 1 patient developed a bronchial stenosis requiring pneumonectomy and 4 patients died, including 2 from infective lesions due to delay in the diagnosis.

[The abdomen in multiple-injured patients. Comparative study on 225 multiple-injured patients with and without abdominal lesions. Incidence of abdominal complications]. / L'abdomen du polytraumatisé. Etude comparative portant sur 225 polytraumatisés avec et sans lésions abdominales. Incidence des complications abdominales.

Of 225 patients with multiple injuries and a high lesional score, 100 presented traumatic abdominal lesions. Comparison of the two groups confirmed both the usefulness and validity of a traumatic index and the reliability of abdominal puncture-lavage. Abdominal complications were analyzed. Mortality in all multiple injury cases, with or without abdominal lesions, was identical in this series where emergency surgery was performed only for lesions affecting vital organs, the mean age of patients with abdominal lesion being significantly lower. An attitude to adopt when deciding whether surgery is necessary is proposed.