Popliteal artery thrombosis complicating posterior tibial exostosis in a 35-year-old male.

Chronic popliteal artery thrombosis complicating tibial exostosis has never been described as far as we know. Here, we report the case of a 35-year-old male patient complaining of intermittent claudication over the previous 4 months, without history of trauma or hereditary multiple exostoses. Clinical examination found no popliteal or distal pulses. The diagnosis was confirmed based on CT angiography showing distinct blockage of the contrast product over an exostosis on the posterior side of the proximal tibia. Treatment consisted of removing the exostosis and then bypassing the popliteal artery with a reversed autogenous venous graft.

Adaptive responses to the stress induced by hyperthermia or hydrogen peroxide in human fibroblasts.

Perturbation of oxidant/antioxidant cellular balance, induced by cellular metabolism and by exogenous sources, causes deleterious effects to proteins, lipids, and nucleic acids, leading to a condition named "oxidative stress" that is involved in several diseases, such as cancer, ischemia-reperfusion injury, and neurodegenerative disorders. Among the exogenous agents, both H(2)O(2) and hyperthermia have been implicated in oxidative stress promotion linked with the activation of apoptotic or necrotic mechanisms of cell death. The goal of this work was to better understand the involvement of some stress-related proteins in adaptive responses mounted by human fibroblasts versus the oxidative stress differently induced by 42 degrees C hyperthermia or H(2)O(2.) The research was developed, switching off inducible nitric oxide synthase (iNOS) expression through antisense oligonucleotide transfection by studying the possible coregulation in the expression of HSP32 (also named HO-1), HSP70, and iNOS and their involvement in the induction of DNA damage. Several biochemical parameters, such as cell viability (MTT assay), cell membrane integrity (lactate dehydrogenase release), reactive oxygen species formation, glutathione levels, immunocytochemistry analysis of iNOS, HSP70, and HO-1 levels, genomic DNA fragmentation (HALO/COMET assay), and transmembrane mitochondrial potential (deltaPsi) were examined. Cells were collected immediately at the end of the stress-inducing treatment. The results, confirming the pleiotropic function of i-NOS, indicate that: (i). HO-1/HSP32, HSP70, and iNOS are finely tuned in their expression to contribute all together, in human fibroblasts, in ameliorating the resistance to oxidative stress damage; (ii). ROS exposure, at least in hyperthermia, in human fibroblasts contributes to growth arrest more than to apoptosis activation; and (iii). mitochondrial dysfunction, in presence of iNOS inhibition seems to be clearly involved in apoptotic cell death of human fibroblasts after H(2)O(2) treatment, but not after hyperthermia.

[Nephrotic syndrome revealing malignant thymoma]. / Syndrome néphrotique révélant un thymome malin.

BACKGROUND: A well-established manifestation of neoplastic disease, nephrotic syndrome is infrequently associated with thymoma. Only 18 cases have been reported in the literature. CASE REPORTS: A 65-year-old man and a 60-year-old woman were seen for nephrotic syndrome. Minimal change renal disease was observed in the first patient whose nephrotic syndrome was steroid resistant. The second patient had membranous glomerulopathy and pure red cell aplasia. In both cases, nephrotic syndrome revealed thymoma. DISCUSSION: The histological lesions in 17 of the 18 biopsied cases reported in the literature were minimal change in 10, focal segmental glomerulonephritis in 4, proliferative glomerulonephritis in 2, and membranous glomerulopathy in only one. The outcome of the nephrotic syndrome was dependent on the success of the thymoma treatment. Some patients responded to steroid and immunosuppressive agents. Pure red cell aplasia is uncommon and prognosis is poor. It can be successfully treated with cyclosporin A as in our second case.

[Surgical treatment of right-sided infective endocarditis]. / Traitement chirurgical des endocardites bactériennes du coeur droit.

Between 1980 and 1989, 8 patients (5 men, 3 women; mean age 30 years) were operated upon in our department of right-sided infective endocarditis. Six patients were heroin addicts and among these 3 were HIV positive and 2 had confirmed AIDS. The most frequently encountered microorganisms (6 cases) were staphylococci. It was decided to operate because of persistent infection and haemodynamic deterioration. The infection involved the pulmonary valve in only 1 of the 8 patients. Surgery was performed during the acute phase in 5 patients and was conservative in 6 patients, consisting of excision of the vegetations or valvulectomy combined or not with valvuloplasty. A high mortality rate (3/8 cases) was observed only among patients operated upon in the acute phase. This may be due to the underlying immunodeficiency and poor haemodynamic state of these patients. Among survivors, the long-term results were excellent, with no recurrent endocarditis and no death, and with only one subsequent operation, 4 years after the first one, for residual tricuspic valve regurgitation. This study shows that patients with right-sided infective endocarditis should be operated upon outside the acute phase of the disease and as soon as complications appear, and that surgery should preferably be conservative.

[Approaching the posterior wall of the aortic arch. Temporary division of the innominate artery]. / Abord de la face postérieure de la crosse aortique. Section temporaire du tronc artériel brachiocéphalique.

Two cases of wound affecting the posterior wall of the aortic arch are reported. One wound occurred during mediastinoscopy, the other was caused by a bullet. During surgery under extracorporeal circulation, the approach and repair of the wounds was greatly facilitated by temporary division of the innominate artery: the ascending and horizontal portions of the aorta could be tilted to the left, giving a very satisfactory access to the posterior wall of the arch. The innominate artery was easily repaired, without neurological complications. The authors insist on the convenience of this technique to approach not only the aortic arch but also various mediastinal organs, such as the tracheal bifurcation, the right branch of the pulmonary artery and the roof of the left atrium.

[Atypical heart transplantation. Technical considerations. Apropos of a case]. / Transplantations cardiaques atypiques. Réflexions techniques. A propos d'un cas.

A heterotopic heart transplantation was performed on a patient placed on circulatory assistance with a Biomedicus pump for ten days using a heart taken from a donor with situs inversus. In relation to this case, the authors describe the technical procedures allowing transplantation of a heart obtained from a donor with situs inversus into a heterotopic position and an orthotopic position or a normal heart in a recipient with situs inversus. Lastly, in the case of complex cardiac malformations with preservation of the lungs, they present the procedures allowing heart transplantation in cases of situs incertus, anomalies of venous return and transposition of the great vessels.