[Pseudoaneurysm of the deep palmar arch due to infective endocarditis]. / Faux anévrisme de l'arcade palmaire profonde et endocardite infectieuse.

The authors report a case of mycotic pseudoaneurysm of the deep palmar arch in a complicated case of Staphylococcus aureus infective endocarditis. They review the literature to discuss the physiopathology, diagnosis and treatment of this rare complication.

[Spontaneous internal carotid artery dissection]. / Dissection spontanée de l'artère carotide interne.

Spontaneous carotid artery dissection is one of the main causes of stroke in young adults. We report two cases occurring after non-traumatic hyperextension of the head. Most of these events result from minor head trauma. Some family history cases would suggest the possibility of an underlying artery wall disorder. The favorable natural history of carotid dissection emphasizes the need for a noninvasive approach for diagnosis. Delayed diagnosis may lead to poor prognosis. Ultrasonography and magnetic resonance angiography are adequate for diagnosis.

Blunt injury to the common iliac artery.

OBJECTIVES AND DESIGN: iliac artery lesion after blunt trauma is uncommon, with only 12 previously reported cases. We report nine patients treated in two French teaching hospitals over a six-year period. Mechanism, symptomatology, treatment and outcome were analysed. MATERIAL AND METHOD: All patients were male with a mean (range) age of 29 (16-43) years. Median delay to operative repair was 15 days. Through an extraperitoneal approach PTFE grafts were used in five cases and autogenous graft in four. RESULTS: Morbidity was 22%. Reoperation was necessary in two cases at a mean follow-up of 48 months, at which time all patients were asymptomatic with normal pulses. CONCLUSION: Clinicians should be alert to the possibility of this injury. An arteriography for Doppler ultrasound should be performed. Treatment is mainly surgical and produces excellent long-term results.

Long-term functional outcome after low anterior resection: comparison of low colorectal anastomosis and colonic J-pouch-anal anastomosis.

OBJECTIVE: The purpose of this study was to compare long-term functional results of two methods of reconstruction after anterior rectal resection for cancer: low colorectal anastomosis and colonic J-pouch-anal anastomosis. SUMMARY BACKGROUND DATA: After anterior resection for mid or low rectal cancer, the decision to perform low colorectal or coloanal anastomosis is made intraoperatively, depending on the distance of the tumor from the anal verge. Functional results of these operations are considered to be similar one to two years after surgery. No study to date has compared long-term functional results after rectal excision followed by either low colorectal anastomosis or colonic J-pouch-anal anastomosis. METHODS: From 1987 to 1992, 173 patients underwent anterior resection for cancer located between 2 to 12 cm from the anal verge. All patients alive without recurrence were contacted by telephone interview for assessment of functional results. There were 47 patients with colonic J-pouch-anal anastomosis and 34 patients with low colorectal anastomosis. Minimum follow-up was three years for all patients (mean, 5 years). RESULTS: The two groups were well matched for gender, age, histologic stage, and use of adjuvant therapies. Patients with colonic J-pouch-anal anastomosis displayed significantly better function in terms of frequency of defecation (1.57+/-1 vs. 2.79+/-1; P=0.001) and presence of irregular transit or stool "clustering" (30 vs. 71 percent; P=0.003). Patients who underwent colonic J-pouch-anal anastomosis were significantly less likely to require constipating agents (4 vs. 21 percent; P=0.03) or need to follow a restricted diet (14 vs. 41 percent; P=0.01). Results concerning the need to defecate again within one hour and disruption of social or professional life as a consequence of surgery showed a tendency in favor of colonic J-pouch-anal anastomosis. CONCLUSION: Colonic J-pouch-anal anastomosis offers superior long-term function compared with low colorectal anastomosis after radical treatment of rectal cancer. Preservation of a short rectal segment followed by a straight colorectal anastomosis does not offer any clinical advantage over colonic J-pouch-anal anastomosis.

Effects of aging on the functional outcome of coloanal anastomosis with colonic J-pouch.

BACKGROUND: Many low rectal cancers can be treated radically by proctectomy with total mesorectal excision followed by colonic J-pouch anal anastomosis (CPAA). In elderly patients, the fear of poor function might reduce indications for CPAA in favor of abdomino-perineal excision with end stoma. METHODS: Among 198 patients with CPAA operated on for low rectal cancer between 1984 and 1992, 20 patients over 75 years old were alive without recurrence at the time of telephone interview (July 1995). Minimal follow-up was 3 years (mean 8) for all patients. Their functional results were compared with those of 37 younger patients operated consecutively during the last 5 years of the study period. RESULTS: The two groups were well matched for gender, tumor distance from the anal verge, histologic staging, and use of adjuvant radiotherapy. Follow-up was longer in the elderly group than in the young group (96 versus 63 months, respectively). The elderly group had a median of 1 bowel movement per day and the young group a median of 1.5 (P = 0.13). The presence of irregular intestinal transit was reported in 48% of the aged and in 35% of the young group (P = 0.6), but fragmented defecation was less frequent (25% versus 47%, respectively; P = 0.15). Urgency was noted, respectively, in 15% and 22% of elderly and young patients (P = 0.7) and constipation in 40% and 22% (P = 0.2). Incontinence for feces (15%) and for flatus (40%) in elderly were not significantly different from the younger group (14% and 46%, P = 1.0 and P = 0.8, respectively). Laxatives were used in 32% of elderly and 17% of young patients (P = 0.3). CONCLUSION: Functional outcome may be good to excellent in elderly patients after CPAA and compares well with that obtained in younger patients. Constipation, however, may be more frequent in the elderly. Age is not a contraindication for CPAA if the sphincter tone is clinically normal.

[Colorectal cavernous hemangiomatosis treated by total coloproctectomy and ileo-anal anastomosis]. / Angiomatose caverneuse colo-rectale traitée par colo-proctectomie totale et anastomose iléo-anale.

A diffuse cavernous hemangioma of the colon and rectum was made in a 20-year-old man. Treatment consisted of total colectomy with ileorectostomy. A proctectomy was mandatory four years later because of massive rectal bleeding. A sphincter-saving operation was possible and bowel continuity was restored with an ileal "J" pouch-anal anastomosis. Cavernous hemangioma generally affects the rectosigmoid and colo-anal sleeve anastomosis is the treatment of choice. When cavernous hemangioma affects the colon and rectum or when the colon has been removed for an other reason, an ileo-anal anastomosis, although technically difficult, can be performed in order to prevent recurrent bleeding while preserving continence and allowing acceptable bowel function.

[Lesions of the iliac arteries secondary to closed traumas. Apropos of 5 cases]. / Lésions des artères iliaques secondaires à des traumatismes fermés. A propos de 5 cas.

Lesions of the iliac arteries after blunt trauma is uncommon. We observed 5 cases in our unit from 1992 to 1995. This pathology usually is seen in young men and the diagnosis often is made late. A Doppler examination and arteriography should be made in case of clinical doubt. Treatment is exclusively surgical. We present the mechanism of the arterial lesions, the symptomatology caused by the lesions and the therapeutic modalities.

[Carotid injuries. Apropos of 5 cases]. / Plaies des carotides. A propos de 5 cas.

The authors use a series of 5 treated carotid wounds to identify the characteristics of these lesions and their management. The gravity of carotid wounds is due to the risk of hemorrhage as well as that of respiratory distress and secondary neurological deficit. Controversy persists regarding the legitimacy of revascularisation procedures in the presence of neurological lesions and, according to the majority of authors, such an approach is recommended unless the patient is in coma.

[Gunshot wounds of the ureter]. / Les plaies par balle de l'uretère.

Lesions of the ureter caused by penetrating wounds of the abdomen rare a are complication of abdominal gunshot wounds, of which the reported incidence is 2 to 17%. The preoperative diagnosis is difficult and unrecognized initially in every third case. There are no early clinical signs of ureteral lesions. There is often no hematuria. Only IVP can make the preoperative diagnosis possible. As a matter of fact, the diagnosis will often be established by the surgical exploration made during the laparotomy required by the extent of the associated lesions. The ureteral blast contusion is an important cause of secondary necrosis with fistula. The treatment is mainly based on ureteroureterostomy after debridement. The transanasmotic drainage of urine is controversial. Mortality results from associated abdominal lesions and morbidity consists in a risk of secondary nephrectomy.

[Gunshot wounds of the ureter]. / Les plaies par balle de l'uretère.

Lesions of the ureter caused by penetrating wounds of the abdomen rare a are complication of abdominal gunshot wounds, of which the reported incidence is 2 to 17%. The preoperative diagnosis is difficult and unrecognized initially in every third case. There are no early clinical signs of ureteral lesions. There is often no hematuria. Only IVP can male the preoperative diagnosis possible. As a matter of fact, the diagnosis will often be established by the surgical exploration made during the laparotomy required by the extent of the associated lesions. The ureteral blast contusion is an important cause of secondary necrosis with fistula. The treatment is mainly based on ureteroureterostomy after debridement. The transanasmotic drainage of urine is controversial. Mortality results from associated abdominal lesions and morbidity consists in a risk of secondary nephrectomy.