Endovascular repair of aorto-iliac artery injuries after lumbar-spine surgery.

OBJECTIVE: This study aims to describe the endovascular management of abdominal-aortic- or common-iliac-artery injuries after lumbar-spine surgery. METHODS: Patients treated for abdominal-aortic- or common-iliac-artery injuries after lumbar-spine surgery during a 13-year period were identified from an endovascular database, providing prospective information on techniques and outcome. The corresponding patient records and radiographic reports were analysed retrospectively. RESULTS: Seven patients were treated with acute (n = 3) or subacute (n = 4) injuries of the common iliac artery (n = 6) or abdominal aorta (n = 1) after lumbar-spine surgery. Vascular injuries included arterial lacerations (n = 3), arteriovenous fistulas (n = 2) and pseudo-aneurysms (n = 2). The mean age of the patients was 51.7 years (30-60 years), 71.4% were women. These lesions were repaired by transluminal placement of stent grafts: Passager (n = 3), Viabahn (n = 1), Wallgraft (n = 1), Zénith (n = 1) and Advanta V12 (n = 1). Exclusion of the injury was achieved in all cases. Mortality was nil. There were no procedure-related complications. During a median follow-up of 8.7 years (range 0.3-13 years), all stent grafts remained patent. CONCLUSIONS: Sealing of common iliac artery or abdominal aortic lesions as a complication of lumbar-disc surgery with a stent graft is effective and is suggested as an excellent alternative to open surgery for iatrogenic great-vessel injuries, particularly in critical conditions.

[Secreting parathyroid carcinoma. Apropos of a case]. / Carcinome parathyroïdien sécrétant. A propos d'un cas.

Parathyroid carcinoma is rare and hits diagnosis often difficult. A case is reported, remarkable by the age of the patient (17 years), and the main peculiarities of the disease are reviewed: frequency of complete bone syndrome, palpable tumour of the neck, calcemia more than 140 mg/l, occurrence of recurrent palsy; relapsing course, death being dependent on hypercalcemia rather than metastasis; median survival time about five years, non influenced by chemotherapy. Ultrastructural study, previously realized in about thirty cases, is specially evaluated: it seems able to concur on anatomopathologic diagnosis, when assertion of malignancy is difficult.

[Bone metastasis of breast cancer. Apropos of a series of 50 cases]. / Les métastases osseuses du cancer du sein. A propos d'une série de cinquante cas.

Among fifty patients with bone metastases from breast cancer who were hospitalized between 1971 and 1980, 19 were given intermittent chemotherapy including both hormone-therapy (drostanolon propionate and tamoxifen) and a combination of cyclophosphamide, methotrexate, 5 FU, doxorubicin and vincristine (CMFDV). Comparison of these patients with two other groups given either miscellaneous chemotherapy programs (19 cases) or no chemotherapy (12 cases) exhibited the value of the standardized protocol, especially concerning median survival which exceeded three years (versus one year with the two other methods). Cobalt-therapy, chemotherapy and hormone-therapy in bone metastases from breast cancer are reviewed.

[Changes in blood calcium, phosphorus and alkaline phosphatase levels in rheumatoid polyarthritis and other types of inflammatory rheumatism]. / Etude des variations de la calcémie, de la phosphorémie et de la phosphatasémie alcaline au cours de la polyarthrite rhumatoide et d'autres rhumatismes inflammatoires.

Albuminemia, calcemia, phosphoremia and alcaline phosphatasemia were measured in three groups of 52 subjects each : rheumatoid arthrits, inflammatory rheumatisms other than rheumatoid arthritis and lumbarthrosics serving as a reference group. Calcemia and albuminemia were significantly lower in patients suffering from rheumatoid arthritis, whose calcemia corrected in relation to albuminemia is, on the other hand, normal : the increase in corrected calcemia pointed out by Kennedy, was not noted. Corrected calcemia was also normal in ankylosing spondylitis, but it was significantly higher in polymyalgia rheumatica. Phosphoremia was shown to be normal but alkaline phosphatases were higher than normal in the three groups.