[Prolapse of neovagina after anterior pelvic exenteration for urethral cancer]. / Prolapsus du néo-vagin après pelvectomie antérieure pour cancer de l'urèthre.

The authors report the case of a patient undergoing anterior pelvic exenteration for cancer of the urethra with sigmoid colon urinary diversion and vaginal reconstruction using a colonic segment. The postoperative course was marked by prolapse of the neovagina requiring reoperation via a transvaginal approach. The modalities of this prolapse repair are described and the various possibilities for urinary diversion and vaginal reconstruction after pelvic exenteration in women are then discussed.

[Noninvasive evaluation of aortocoronary bypass graft patency with tomodensitometry and exercise myocardial scintigraphy]. / Evaluation atraumatique de la perméabilité des pontages aorto-coronariens par la tomodensitométrie et la scintigraphie myocardique à l'effort.

The control of the patency of aortocoronary bypass grafts necessitates further coronary angiography, an invasive investigation which is difficult to perform routinely because over 60 p. cent of operated patients are asymptomatic. Non-invasive methods have been proposed for this task, including computerised axial tomography (CAT) and exercise Thallium 201 myocardial scintigraphy (EMS). The aim of this study was to assess the relative value of CAT and EMS, alone and in association, in comparison with coronary angiography. Thirty six patients (35 men, 1 woman) with a mean age of 54 years were studied. These patients had a total of 59 bypass grafts inserted an average of 23 months before investigation (20 single, 10 double, 5 triple and 1 quadruple bypass grafts). CAT scanning was performed the day before coronary angiography. Sections of the thorax 7 mm thick were recorded after intravenous injection of contrast medium. A patent graft was identified as an opacity increasing after the injection of contrast on one of the aortic walls. During coronary angiography a graft was declared to be patent when it was opacified selectively or during aortography, and when the grafted coronary artery was seen to be revascularised. The quality of the distal coronary bed was also evaluated (implantation of the graft, distal and collateral vessels). Twenty three patients (with a total of 36 grafts) also underwent EMS on the same day as CAT scanning. Normal fixation in the revascularised territory was taken as evidence of a patent graft. --Coronary angiography showed that 44/59 grafts were patent at 24 months. --CAT scanning was unable to evaluate 12/59 grafts. Thoracic metallic clips created stratified artifacts and analysis of the section was impossible (20 p. cent of CAT investigations were non-contributive); of the interpretable investigations, 40/47 grafts were correctly assessed (85 p. cent): 30/32 patent grafts and 10/15 occluded grafts. --The results of EMS were less reliable; 23/36 grafts correctly assessed (64 p. cent), 18/27 patent grafts and 5/9 occluded grafts. However, EMS provides complementary information to that provided by CAT scanning, especially with respect to the distal coronary bed. When the two methods were used together, 15/15 good surgical results (patent grafts with good distal vascularisation) and 6/8 poor results (patent grafts but poor distal vascularisation), were identified. We conclude that these two atraumatic methods, CAT scanning and EMS, which may be performed on out-patients, are valuable for the routine assessment of the patency of coronary bypass grafts. Coronary angiography could therefore be reserved for those patients in whom further surgery is being considered.

[Haemodynamic and coronary effects of Risordan injection in patients with coronary disease (author's transl)]. / Effets hémodynamiques et coronariens du dinitrate d'isosorbide injectable chez l'insuffisant coronarien.

Nitro-compounds exert a preventive action on myocardial ischaemia through their peripheral effects (reduction of left ventricular preload) and their effects on the coronary system (increase of collateral flow and imprevement in the endocardium: epicardium perfusion ratio). The haemodynamic, coronary and metabolic effects of Risordan i.v. infusions (5 mg/h) in acute myocardial ischaemia induced by rapid atrial stimulation (RAS) were investigated in 15 male patients with angiographic or ECG signs of non-perfusion of the coronary network. Coronary sinus blood flow was measured by the thermodilution method. The values measured or calculated were: heart rate (HR), cardiac index (CI), aortic pressure (PAo), pulmonary capillary pressure (PCP), right atrial pressure (RAP), systemic arterial resistance (SAR), double product (DP), coronary blood flow (QCcor), total coronary resistance (TCR), O2 arterio venous difference (DAVO2), myocardial O2 consumption (MVO2) and myocardial lactate extraction (K %). RAS produced a significant increase of PAo, CI, DP, MVO2 and QCcor, with inversion of K % (-3.3%) indicatif anaerobic metabolism by myocardial ischaemia. Risordan produced significant diminution of PAo and CI with subsequent increase of HR; there was little increase of DP, MVO2 and QCcor and little change n myocardial metabolism (K % = 14 %). Risordan corrected the myocardial ischaemia induced by RAS, with decrease of PAo, PCP, RAP, CI, DP and QCcor, K % became positive (+ 11.5 % vs -3.3 % during RAS) suggesting a decrease in myocardial ischaemia.

[Use of isosorbide dinitrate (Risordan) injection in left ventricular failure following acute myocardial infarction (author's transl)]. / Utilisation de l'isosorbide dinitrate injectable dans l'insuffisance ventriculaire gauche de la phase aiguë de l'infarctus du myocarde.

Haemodynamic and echocardiographic studies of isosorbide dinitrate were conducted in 12 patients (8 men and 4 women) with left ventricular failure consecutive to recent myocardial infarction. The groups: group I received 5 mg/h and group II 10 mg/h Risordan intravenously. After one hour treatment, group I patients showed a significant fall in both PAP (from 32.3 +/- 5.3 to 26.7 +/- 6.9 mmHg; p less than 0.01) and PCP (from 21.8 +/- 4.7 to 17.3 +/- 7.7 mmHg; p less than 0.05). These haemodynamic changes were amplified after a second hour of treatment: PAP fell to 24 +/- 7.9 mmHg (p less than 0.01) and PCP to 14.2 +/- 4.4 mmHg (p less than 0.001). RAP decreased from 7.2 +/- 5.1 to 3.5 +/- 5 (p less than 0.05). There were no changes in heart rate, systemic arterial pressure, peripheral resistance, cardiac index, forward stroke work nor, on echocardiography, in ventricular diameters, shortening fraction and VCF. After one hour treatment, group II patients showed a fall in PAP (from 30.5 +/- 4.7 to 21.7 +/- 3.5 mmHg; p less than 0.01), PCP (from 21.7 +/- 4.8 to 14.8 +/- 4.9 mmHg: p less than 0.001) and RAP (from 10.3 +/- 2.9 to 7.2 +/- 2; p less than 0.01). The systolic diameter of the left ventricle was reduced from 66.3 +/- 10.6 to 64.3 +/- 11.3 (p less than 0.01). After 4 hours, improvement in PAP and PCP was maintained; the other values remained stable. The effectiveness of Risordan i.v. in left ventricular failure consecutive to acute myocardial infarction is due to reduction of filling pressures in the left ventricule. With the 10 mg/h dose, as opposed to the 5 mg/h dose, the systemic arterial pressure and the double and triple products tend to be reduced, which suggests greater effectiveness.