[Aneurysms in Takayasu disease]. / Anévrysmes au cours de la maladie de Takayasu.

Takayashu's inflammatory panarteritis essentially results in stenotic lesions of the supra aortic axes and the collateral vessels of the abdominal aorta. Fusiform, segmental post-stenotic dilatation is commonly observed. Three particular types of aneurysms are described, each illustrated by a case report: --aneurysm of the ascending aorta causing severe aortic regurgitation by dilatation of the aortic ring: the diagnosis of Takayashu's disease was made in a young West Indian female on the evidence of associated aortic lesions and calcification of the descending thoracic aorta. The patient underwent replacement of the ascending aorta and aortic valve replacement. This form is very rare, although mild aortic regurgitation in Takayashu's disease has been reported in about ten cases by different workers; --large saccular aortic aneurysm. This lesion of the descending thoracic aorta with parietal calcification and without intrasaccular thrombosis was associated with a long, irregular stenosis of the paroxismal segment of the aorta, giving rise to signs of coarctation, and with multiple stenoses of the supra-aortic axes in a 31 year old Algerian. Surgical cure was realised by occluding the orifice in order to avoid replacing the aorta at the origin of the main medullary arteries. An ascending aorta-abdominal aorta bypass was performed at the same time, together with correction of the stenoses of the supra-aortic vessels. A few similar cases of large succular aneurysms of the thoracic or abdominal aorta or of the large collateral vessels have previously been described; --pseudo-aneurysm due to arterial rupture and formation of a large hematoma. A 20 year old Algerian presented with a polylobulated saccular aneurysm of the superficial femoral artery in the femoral triangle. Several stenotic lesions typical of Takayashu's disease (including a particularly rare stenosis of the contra lateral superficial femoral artery) were associated. At surgery, the lesion was found to be a pseudo-aneurysm with no true arterial wall on histological examination. The role of an infective endarteritis is discussed and excluded. This type of lesion does not appear to have been previously reported. These three varieties of aneurysm were the presenting signs of Takayashu's disease in the cases reported.

[Spontaneous pneumopericardium. Apropos of a case report]. / Les pneumo-péricardes spontanés. A propos d'une observation.

A patient operated for carcinoma of the bladder complicated by infection by anaerobic organisms developed pneumopericardium. Spontaneous pneumopericardium may or may not follow effraction of the pericardium. The following causes have been described: fistula with a tuberculous cavernoma, parenchymatous or pleural infection, carcinoma of the bronchus; oesophageal or gastro-pericardial fistulae arising from carcinoma or ulceration of the stomach or oesophagus; rupture of a mediastinal, hepatic or subphrenic abscess and, exceptionally, pericarditis complicated by fistulisation to the tracheo-bronchial tree. Pneumopericardium without effraction is caused by in situ gas production, a complication of pericarditis caused by anaerobic organisms; this may be a primary or a metastatic infection. Idiopathic pneumopericardium is included in this variety whilst "alveolar rupture" is usually considered in the group of pneumopericardial fistulae: air under pressure passes from the mediastinum into the pericardium by microscopic dissection (bronchitis, asthma, obstructive laryngitis, childbirth). The outcome and prognosis depends on the cause and type of effusion: pneumopericardium rarely contains air alone; serous fluid, blood or pus, are usually associated.

[Localizations of Takayasu's disease (author's transl)]. / Les localisations de la maladie de Takayasu.

Localizations of Takayasu's disease are described and discussed in relation to 10 cases. The affection causes panaortitis which produces stenosis, or less often dilatation, of the thoracic and/or abdominal aorta, and stenosis of occlusion of the arteries arising from the aorta. Lesions of the aortic arch and superior aortic branches, mainly subclavian and carotid, are the most frequently observed form of the disease, but coronary stenosis and aortic incompetence are sometimes noted. Lesions in the descending thoraco-abdominal aorta are frequently present, and stenosis and occlusion of the renal arteries are usually associated with the abdominal aortitis. Stenosis of the terminal aorta and iliofemoral axes is a more rare occurrence. The association of lesions in the aortic arch and its branches, and the descending aorta and its branches, was found in about 2/3rds of cases. Pulmonary arteries are affected in about half the cases according to recent reports.