Colonic transit time after spinal cord injury.

Colonic transit time (CTT) was measured with abdominal radiographs using Chaussade's technique in 30 spinal cord injured patients (ASIA A and B) following ingestion of 20 radiomarkers per day for three days. A significant increase in total CTT (p = 0.0001) and segmental CTT of the right colon (p = 0.0004) and of the left colon (p = 0.0001) was shown. While using on the average only 2.3 films of the abdomen per patient, we obtained results comparable with other radiologic techniques which use radiomarkers to measure CTT. The clinical relevance of these results is not clear and their correlation with intestinal symptoms remains to be investigated.

Palliative surgery in tetralogy of Fallot.

Because much controversy surrounds the palliative surgical treatment of young children with tetralogy of Fallot the authors review their experience over 13 years with two procedures--the Blalock-Taussig operation and the Waterston shunt. Blalock shunts were performed 195 times in 172 patients; 147 had a single Blalock anastomosis which carried them through the critical period and allowed for later correction of the tetralogy. Thrombosis of the Blalock anastomosis occurred in two patients in the early postoperative period. In 23 patients a second shunt was necessary after the first Blalock shunt became inadequate in spite of being patent. The age of the children ranged from 2 weeks to 9 years, 74% being operated upon under the age of 2 years. There were four early deaths (2%) and five late deaths (2.5%) in this group. Of the last 91 consecutive patients operated upon between Sept. 1, 1972 and June 30, 1980 none have died. Between September 1968 and June 1980, 14 patients with tetralogy of Fallot underwent a Waterston shunt. Their ages ranged from 2 days to 4 years. Six patients were younger than 35 days at the time of operation. There were two operative deaths in this group. The Waterston shunt carries a high risk and is reserved for the occasional patient who needs palliation during the first weeks of life and in whom the anatomy of the subclavian artery does not favour a good Blalock-Taussig shunt. The Blalock-Taussig operation is preferred because it is safe and gives good sustained clinical results. The mortality was much lower than previously reported. The growth of the pulmonary arteries was good in most patients. The Blalock shunt did not increase the pulmonary resistance and it did not influence the operative mortality.

[Aneurysm of the ductus arteriosus. Apropos of case operated on with success]. / Anévrysme du canal artériel. A propos d'un cas opéré avec succès.

A 6 week old baby was operated on successfully for removal of an aneurysm of the ductus arteriosus. The aneurysm, absent at the age of 12 days, developed progressively during the closure of the ductus. The only suggestive symptom was a haemoptysis. The radiological appearances were characteristic. The authors discuss the physiopathology, clinical presentation and radiological appearances of this lesion.

[Congenital peripheral pulmonary stenosis. Presentation of 16 cases and review of the literature]. / Les sténoses pulmonaires périphériques congénitales: Présentation de 16 observations et revue de la littérature.

Sixteen cases of peripheral pulmonary stenosis have been studied clinically and by cardiac catheterization. Diagnosis has been proved in all cases by manometric measurements and/or cineangiocardiography. All patients except two were below 2 years of age. Ten cases were of type I, i.e. the stenosis was localized to the pulmonary trunk or its main branches. Six patients were of type III, i.e. they had diffuse stenosis of the pulmonary arterial tree. The physical findings, which in many cases are typical and include the presence of a systolic murmur over both lung fields, should alert the physician to the diagnosis at the bedside. At cardiac catheterization the configuration of the pressure tracing in the main pulmonary artery is typical, showing an abrupt rise and fall of the systolic wave followed by a low situated dicrotic notch. There is no doubt that in the past many cases of peripheral pulmonary stenosis have been wrongly diagnosed as "essential pulmonary hypertension".