Bilateral thrombosis of the internal carotid arteries after a closed trauma. Advantages of magnetic resonance imaging and review of the literature.

Bilateral traumatic dissection of an internal carotid artery (BTDIC) after a closed injury is very rare. We report a case of bilateral thrombosis caused by internal carotid artery dissection due to a closed injury. The 22 cases documented in the literature are also reviewed. Six of the patients (26%) were asymptomatic at the initial examination, but all developed secondary symptoms, during the first 48 hours. Sixteen patients (69%) had associated traumatic lesions. Six patients died during the week after the accident, all of them had initial neurological symptoms. Magnetic resonance imaging (MRI) provided more items of information than angiography, showing a dissection on an occluded artery and a clearer picture of the length of the dissection, directly visualizing the wall hematoma and a residual signal that showed the persistence or arrest of blood flow. Treatment of BTDIC is based on early anticoagulation therapy.

Pericardial effusion and AIDS: benefits of surgical drainage.

OBJECTIVES: During the last few years, AIDS has been the main cause of large pericardial effusions in urban settings. We have therefore had to perform surgical pericardial drainage for diagnostic and/or therapeutic purposes in AIDS patients. This study was designed to establish the diagnostic and therapeutic yield of pericardial drainage for these patients. METHODS: We retrospectively reviewed the data of the 13 AIDS patients with a pericardial effusion, referred to our surgical department between December 1989 and December 1996 for surgical drainage and pericardial biopsy. RESULTS: Cytological studies and searches for bacteria, mycobacteria and parasites were all negative. The histology of the 13 pericardial biopsies disclosed three pericardial locations of a Kaposi's sarcoma (all three patients had a pre-existent extra-cardiac location of this sarcoma) and one pericardial location of an already known immature mediastinal teratoma. In the nine other cases, the lesions were aspecific. Four patients died of multivisceral failure within 30 days of surgery. For the survivors, surgical drainage afforded relief and there were no clinical signs of recurrent effusion. CONCLUSIONS: The cause of pericardial effusion in AIDS is still often unknown, even after pericardial biopsy. Here, aspecific pericarditis was the most common diagnosis. Although the prognosis of such effusion in these patients is known to be poor, surgical drainage provided relief for those who survived the post-operative period.

Incorporation of fibronectin-impregnated vascular prostheses in the pig. Microscope study.

An interface near the endothelial extracellular matrix is necessary to augment and maintain endothelial cell attachment. The use of plasma lectins constitutes one of the present lines of research designed to improve this interface. We studied the incorporation of 2 series of arterial prostheses with a diameter of 4 mm and a mean length of 9 cm. They were implanted in the carotid arteries of adult Europig minipigs. Prostheses were of two types: polytetrafluoro-ethylene (PTFE) and knitted Dacron. Two series of 12 pigs each were used. One was explanted at 3 months and the other at six. Each pig was grafted with one prosthesis impregnated with the plasma components of diluted Fibrogel and one non-impregnated prosthesis which served as control. The explanted prostheses and adjacent parts of the carotid were prepared for light or scanning electron microscopy. Proximal, median and distal segments were cut and embedded in resin. Collagen distribution was revealed by Milligan's trichrome stain, and fibrin distribution by Picro-Mallory staining. Macroscopic examination showed discrete periprosthetic adhesion for impregnated prostheses and complete adhesion for non-impregnated prostheses. Scanning electron microscopy revealed a median endothelial cell coating on impregnated grafts whereas the only endothelial cells on non-impregnated grafts, were perianastomotic. On impregnated grafts, Milligan's trichrome staining revealed an even collagen distribution. The walls of non-impregnated grafts exhibited capillary cell infiltrations with breaches in the outer structures. In impregnated prostheses, the absence of such breaches enabled us to postulate that their incorporation was better than that of the non-impregnated grafts. The minipig model was hard to handle because of the aggressiveness engendered by restricted feeding designed to limit weight increases. In general, however, we may justifiably conclude that in this model, the use of plasma lectins improved prosthetic incorporation.

Distal bypass for limb salvage: comparative study in patients below and above 80 years of age.

Revascularization for chronic lower extremity ischemia in patients of 80 years and older is controversial. To better define operative risk and outcome after peripheral vascular procedures in the elderly, our experience from January 1990 to December 1992 was reviewed. We compared two groups of patients: group I with 26 patients (28 revascularizations) 80 years of age and older (84 +/- 3 years) and group II with 29 patients (32 revascularizations) younger than 80 years (70 +/- 8 year). The two groups were similar with regard to risk factors, surgical indication (rest pain and/or gangrene) and type of graft (in situ vein: 35, reversed vein: 12, PTFE: 13). Fourteen femoro-popliteal bypasses, 17 femoro-tibial bypasses (8 to the anterior tibial artery and 9 to the posterior tibial artery) and 29 femoro-peroneal bypasses were performed. The operative mortality rate was 11.5% in group I and 6.9% in group II. The cumulative life-table survival rate at 24 months was 39.5% in group I and 55% in group II. Primary patency rate at 24 months was 64% in group I and 67% in group II. Secondary patency rate at 24 months was 74.5% in group I and 73% in group II. Limb salvage at 24 months was 80% in group I and 83% in group II. Comparison of the older and younger groups showed no statistically significant difference in mortality rate, graft patency and limb salvage. Operative mortality and graft patency were not different with regard to age of patients.