[Sleep apnea syndrome and abdominal aortic aneurysm: Study of the prevalence of sleep apnea syndrome in patients with aneurysm and research of association. Clinical study on 52 patients]. / Syndrome d'apnée du sommeil et anévrisme de l'aorte abdominale : étude de la prévalence du syndrome d'apnée du sommeil chez les patients présentant un anévrisme et recherche d'une association. Étude clinique sur 52 patients.

OBJECTIVES: Prevalence of abdominal aortic aneurysms (AAA) in Europe is between 4.1 % and 8.9 %. The risk of rupture of AAA is related to the evolution of its diameter. The role of sleep apnea (SA) remains still discussed. The objective of this study was to study the prevalence of SA in patients presenting with AAA in comparison with the general population as well as the relation between the AAA diameter and the severity of SA. MATERIALS AND METHODS: Between June 2012 and December 2014, we included all patients referred for surgical treatment of an AAA. All the patients had a preoperative polysomnography and angio-scanner. An apnea/hypopnea index (AHI)>10/h was chosen for the diagnosis of SA. SA prevalence was compared with the prevalence in general population. The patients were also divided into two groups according to the severity of SA: group 1 (no SA and light SAS); group 2 (moderate and severe SA). RESULTS: Fifty-two patients were included. Fifty-six percent of the patients presented SA - prevalence was significantly higher than in the general population (56 vs. 8 %, P<0.001). The distribution of the two groups was: group 1, n=27 patients, group 2, n=25 patients. AAA diameter and BMI were higher in group 2 than in group 1, respectively 61mm vs. 55mm, P=0.03 and 28 vs. 23, P=0.02. CONCLUSION: Prevalence of SA in patients with an AAA seems to be significantly higher than in general population. The growth of the aneurysm seems to be linked to the severity of SA.

[Leg ulcers occurring under tyrosine kinase inhibitor therapy (sunitinib, nilotinib)]. / Ulcères des membres inférieurs développés sous inhibiteurs de tyrosine kinase (sunitinib, nilotinib).

BACKGROUND: Certain anticancer drugs are known to induce leg ulcers, mainly chemotherapy agents such as hydroxyurea. We report 2 cases of leg ulcers in cancer patients treated with the tyrosine kinase inhibitors, sunitinib and nilotinib, and we discuss the role of these treatments in the pathogenesis of leg ulcers. PATIENTS AND METHODS: Case 1. A 62-year-old patient on sunitinib for intrahepatic cholangiocarcinoma developed a lesion on her right foot. The vascular evaluation was negative. After progressive worsening, sunitinib was stopped and healing was observed within a few months. Case 2. A 83-year-old patient had been treated for chronic myeloid leukemia since 2005. Nilotinib was introduced in 2009. Peripheral arterial revascularization was required in May 2013. A few months later, worsening was noted with the onset of ulceration and necrosis of the third toe. Further revascularisation surgery was performed, and nilotinib was suspended and antiplatelets introduced. Healing occurred a few months later. DISCUSSION: Many skin reactions have been described in patients on nilotinib and sunitinib, but few publications report the development of de novo ulcers in patients without risk factors. The pathophysiology of the development of ulcers in patients receiving tyrosine kinase inhibitors is not clear, and probably involves several mechanisms of action. The increasing use of this type of treatment could lead to an upsurge in the incidence of vascular complications. CONCLUSION: We report two cases of leg ulcers developing in patients on tyrosine kinase inhibitors and raise the question of causal implication of these treatments in the pathogenesis of ulcers.

[Outpatient thoracoscopic resection of lung nodules within a fast-track recovery program]. / Résection thoracoscopique ambulatoire de nodules pulmonaires dans le cadre de la réhabilitation précoce.

INTRODUCTION: The objectives of outpatient surgery are to reduce the risks related to the hospitalization, to improve the postoperative recovery and to optimize contact with family physicians. The objective of this work is to present the first unit of outpatient pulmonary surgery and to report the results of the resections of pulmonary nodules in outpatient surgery in the setting of early discharge. METHODS: The indications for the resection of nodules were discussed in a multidisciplinary thoracic oncology meeting. The patients underwent resection of one or more lung nodules by thoracoscopy after verification that they met the anaesthetic and surgical criteria for ambulatory surgery. We analyzed the characteristics of the population, the duration of surgery, the type of resection, the time of the chest drain removal and the postoperative follow-up. RESULTS: Between November 2013 and December 2014, 51 patients underwent sub-lobar pulmonary resections. Among them 7 patients (4 men and 3 women), with an average age of 57.6 years (39-64) and histories of malignant tumor, underwent 7 atypical resections and two segmentectomies in outpatient surgery (3 patients had two resections). The average operating time was 53.75min (30-90). The chest drain was removed before the third hour in 8 cases and on the third day in one case. The average tumor diameter was 10.375mm (6-23). The histology revealed a metastasis of colorectal carcinoma in 4 cases, a metastasis of a renal carcinoma in 1 case, an in situ adenocarcinoma in 1 case and a benign tumor in 3 cases. Neither recurrence nor complication was observed during an average follow-up of 6 months. CONCLUSION: Thanks to a protocol of early mobilisation and discharge included in a well established clinical care pathway, thoracoscopic resection of lung nodules is feasible, with safety in properly selected and prepared patients in outpatient surgery.

[Propionibacterium granulosum bare-metal stent infection after drug-eluting balloon]. / Infection de stent artériel périphérique à Propionibacterium granulosum après angioplastie au ballon actif.

INTRODUCTION: Bare-metal stents are used to treat arterial stenotic lesions. Morbidity and mortality are less important compared with other techniques. Drug-eluting balloons are often used to treat stent stenosis. We reported the case of a bare-metal stent infection after drug-eluting balloon and a review on the subject. MATERIAL AND METHOD: Two weeks after percutaneous transluminal angioplasty with paclitaxel-eluting balloon and a bare-metal stent, our patient presented an infection of the stent. Diagnosis was based on the clinical presentation, positron emission tomography findings and isolation of Propionibacterium granulosum in repeated blood cultures. Adapted antibiotic therapy was given for three months with removal of the surgical bare-stent. Antibiotic therapy was interrupted after a second positron emission tomography. A literature search (PubMed and Cochrane) was performed on the subject. RESULTS: We found 49 cases of peripheral bare-metal stent infection including our patient. This is a rare but serious complication with a high morbidity (25% amputation rate) and mortality (30%). It seems to be underestimated. Treatment is based on surgical ablation of the bare-metal stent and intravenous antibiotics. The role of the paclitaxel-eluting balloon is not clearly established but some authors believe that it can produce a local immunosuppression. CONCLUSION: We report the first case of bare-metal stent infection after paclitaxel-eluting balloon. This complication is rare and difficult to diagnose. Manifestations are often limited to skin signs. Functional and vital prognosis is poor.

[Acute finger ischemia: A retrospective study of 13 patients]. / Ischémie digitale aiguë : étude rétrospective de 13 cas.

BACKGROUND: Acute ischemia of the upper limbs is rare in comparison with ischemia of the lower limbs. The origins of this condition are varied. GOALS: We retrospectively analyzed cases of acute finger ischemia (Raynaud's phenomena was excluded) in a dermatology department between 2008 and 2013 in order to evaluate the etiology and management of this phenomenon. RESULTS: Thirteen cases of finger ischemia were reported. The mean age was 54 years. Active smoking was noted in 11 cases. Ischemia was acute in 9 cases and subacute in 4 cases. The location was unilateral in 10 cases and bilateral in 2. Etiologies were: dysplasia of the palmar arch, antiphospholipid antibody syndrome, frostbite, distal arteritis linked to smoking, paraneoplastic arteritis, Buerger's disease, polyarteritis nodosa, stenosis of the subclavian artery, and 3 cases of embolic origin (ulnar, cardiac, and paraneoplastic aneurysm). In the acute phase, antiplatelets were given in 6 cases, anticoagulants in 10 cases and ilomedin in 6 cases. Sympathectomy was performed in 1 case and amputation in 2 cases. DISCUSSION: This study illustrates the diversity of etiologies of finger ischemia. The etiological test battery should be broad and include immunological and thrombophilia tests, arterial and cardiac investigations, cervical radiography and CT scan (screening for cancer). Close collaboration between dermatologists, hematologists, vascular surgeons and radiologists is essential for the management of these patients.

[Pulmonary rehabilitation and non-invasive ventilation before lung surgery in very high-risk patients]. / Réhabilitation et VNI avant exérèse pulmonaire chez les patients à haut risque opératoire.

INTRODUCTION: The benefits of a rehabilitation program before surgical lung cancer resection remain to be defined. The purpose of this prospective observational study was to assess the effects of rehabilitation together with the use of noninvasive ventilation (NIV) in patients who were at a high operative risk. METHODS: Between January 2010 and June 2011, 20 consecutive patients (16 males, four females, mean age: 66 years [44-79]) with a clinical N0 non-small cell lung cancer were included. Eligibility criteria were predicted post-operative respiratory function (FEV1, VO2 max) below the guideline thresholds for eligibility for surgical resection and/or associated with severe co-morbidities. The protocol included a cardiorespiratory rehabilitation program and 3 hours of NIV each day. Functional tests were repeated after 3 weeks of therapy. RESULTS: Participants displayed a significant increase in their FEV1 and VO2 max, which allowed surgical resection to go ahead in all patients (lobectomy, n=15; pneumonectomy, n=3; bilobectomy, n=2). The morbidity rate was 20% (acute renal failure, n=2; pneumonia, n=1; haemothorax, n=1). The mortality rate was 5% (myocardial infarction, n=1). Further postoperative rehabilitation allowed a return at home in 19 patients after a mean hospital stay of 11 days. CONCLUSION: Pulmonary rehabilitation associated with a period of preoperative NIV allows surgery to be performed in patients who are not initially eligible for resection. An evaluation of long-term outcomes survival in comparison to non-surgical therapies is necessary.

[Mediastinal bronchial artery aneurysm: treatment with stent-graft]. / Anévrisme médiastinal de l'artère bronchique : traitement par endoprothèse aortique.

Mediastinal bronchial artery aneurysm is rare but potentially life-threatening, and requires prompt treatment to avert rupture with catastrophic results. Inflammatory conditions dominate the aetiologies. Conventional therapies are surgery via thoracotomy and endovascular embolization. We report a case of a giant saccular aneurysm of the bronchial artery described in an 80-year-old man, adjacent to the descending aorta, simulating aortic aneurysm and causing esophageal compression. It was totally excluded with an aortic stent-graft (TX2, Cook) performed through femoral access. Our case is the fourth reported of mediastinal bronchial aneurysm stent-graft exclusion. The analysis of success, complications rate and hospital stay duration favors endovascular grafting comparing with conventional techniques.

[Pseudotumoral lipid pneumopathies. Apropos of six cases]. / Pneumopathies lipidiques pseudo-tumorales. A propos de six observations.

In cases of localised pneumonia due to oil aspiration, the diagnosis may be difficult and is often assessed by thoracotomy. Six cases of lung paraffinoma are reported. The lesion, localised in the lower lobe in five patients out of six, was discovered on screening chest x-rays. In two cases, two lesions were observed in the same patient. All six patients underwent lung resection. Diagnosis was made on histologic examination showing foreign body reactions against oil. Oil aspiration was due to oily nose drops in one patient and to the use of paraffin oil on a tracheostomy in two others. The preoperative diagnosis may be suspected on bronchial lavage CT scan and MRI. When the diagnosis is strongly suspected, thoracotomy can be avoided as in some cases withdrawal of the medication can be followed by progressive resolution of the radiological signs.

[Acquired systemo-pulmonary fistula after pleurectomy responsible for a continuous thoracic murmur]. / Fistule systémo-pulmonaire acquise après pleurectomie responsable d'un souffle thoracique continu.

Systemo-pulmonary fistulae are rare. The case of a 27 year-old man, hospitalized for exploration of a continuous thoracic murmur, is reported. A right pleurectomy had been performed 2 years previously because of a recurrent spontaneous pneumothorax, and no murmur was present at that time. Angiography showed a systemo-pulmonary fistula with the right internal mammary artery and branches of the right axillary artery as afferent vessels, and the right pulmonary arteries and veins as efferent vessels. Blood gases measurements demonstrated a left-right shunt. The acquired nature of the fistula was suspected because of the history of right pleurectomy and the acquired nature of the murmur. There was no indication for surgery because of the complexity of the fistula and the absence of symptoms.

[Evaluation of vascular surgery with digital subtraction angiography. A study of 127 patients]. / Evaluation de la chirurgie vasculaire par angiographie numérisée. Etude de 127 patients.

We have performed digital subtraction angiography (DSA) on 127 patients treated by vascular surgery. This technique was easily and safely performed in outpatients, without any complication. Our experience indicates that DSA is accurate for post operative evaluation in 96% of cases. In digestive arterial surgery, some examinations (3.3%) are insufficient. Distal run off is usually well seen, everywhere, except in kidneys. There is a good correlation between angiographic results and clinical status. However, significant abnormalities were discovered in 5% of cases without any clinical signs. Digital intravenous angiography is a safe and mildly invasive procedure for postoperative evaluation of vascular surgery.

[Adventitial cyst of the aorta]. / Kyste adventitiel de l'aorte.

The authors report a case of adventitial cyst of the abdominal aorta. This would seem to be the first time that a cyst has been reported in the literature with this localization. A 54 year old female patient was treated surgically for a suspected aneurysm of the abdominal aorta. Her antecedents included syphilis treated with bismuth. The condition began with a lumbago with no clearly defined etiology. An abdominal X-ray without preparation visualized a calcified abdominal tumor in a retroperitoneal position, apparently attached to the aorta. Arteriography showed that the tumor was excluded from the circulation. Surgical exploration of the aorta demonstrated a cystic tumor, which was resected. A review of the literature concerning the pathology of arterial cysts shows no previous cases of aortic cyst. On the other hand, references to identical anomalies of the iliac, femoral, popliteal and radial arteries provide grounds for discussion of the etiology of this aortic disease. The macroscopic data and histological studies suggest a phenomenon of cystic degeneration rather than a constitutional anomaly of the artery, or, in this particular case, an anomaly connected with syphilitic lesions.

[Treatment of an aneurysm of the abdominal aorta above a transplanted kidney. Renal protection by inert subclavian-femoral bypass]. / Cure d'un anévrysme de l'aorte abdominale en amont d'un rein transplanté. Protection rénale par un shunt inerte sous-clavio-fémoral.

Opening and grafting of an aneurysm of the abdominal aorta located between and below the renal arteries were carried out in a 44-year old patient with a transplanted kidney in right hypogastric position. Renal ischaemia during clamping of the aorta was prevented by means of an inert bypass between the right subclavian and femoral arteries. The patient's renal function remained normal. The different techniques available to protect renal transplants are compared.

[Radiological picture and surveillance of nontraumatic aortic dissections of the descending aorta]. / Bilan radiologique et surveillance des dissections aortiques de l'aorte descendante.

A retrospective study of 32 cases of acute dissecting aneurysms of the aorta forms the basis for further discussions on the role of arteriography. This is the only examination enabling full visceral investigation in type B dissecting aneurysms (affecting the descending aorta only) treated medically. The possible need for revascularization surgery will depend upon the results of this investigation, the type of arterial lesions affecting the visceral branches being determined by assessment of visibility of arteries in relation to the true and false lumen.