[Transplantation and tumors of the kidney]. / Transplantation et tumeurs du rein.

The authors report the case of a woman who was transplanted with a cadaveric kidney. It was a cyst on the kidney; a biopsy was performed: it was a carcinoma. The transplanted kidney was removed. The second case was a man, transplanted with a cadaveric kidney, with a tumor at the lower pole: a tumorectomy was performed: it was a angiomyolipoma.

The embolic type of popliteal entrapment syndrome.

The authors describe their experience with two patients who presented with clinical extremes of popliteal entrapment syndrome. One patient presented with acute ischemia and the second patient presented with a chronic Buergerian-like syndrome. The common denominator for both of them was embolic phenomena originating at the site of entrapment. Discussion is centered on pathogenesis of the embolic phenomenon, prevalence of distal arterial degradation and its clinical manifestation. The clue for differentiation from true Buerger disease is the angiographic pattern demonstrating apparently healthy distal arterial segments, confirmed by mandatory arterial biopsy. It is emphasized that in cases having acute embolic presentation the primary pathology should be treated concomitantly to revascularization.

[Early graft venous thrombosis after renal transplantation (2 cases)]. / Thrombose veineuse précoce du greffon après transplantation rénale (deux cas).

The authors report two cases of early transplant renal vein thrombosis after kidney transplantation. In the two cases, the graft had to be removed. Many difficulties prevented the diagnosis of this fortunately unusual (0.8% of all transplantations performed) vascular injury.

[Evaluation of surgical renal revascularization in renovascular arterial hypertension. Measurement by 99m Tc DTPA scintigraphy]. / Evaluation de la revascularisation rénale chirurgicale dans l'hypertension artérielle rénovasculaire. Appréciation par la scintigraphie au 99m Tc DTPA.

The effects of surgical renal revascularization on both hypertension and kidney function was assessed in 16 patients with renovascular hypertension (14 unilateral). We have taken a special interest to the split renal function studied with DTPA renogram. The function of the operated kidney was improved in 9 patients and not improved (worsened or unchanged) in 7. Hypertension was cured in 25% and improved in 56% of the patients, without correlation with split renal function outcome.

[Isolated dissection of the renal artery treated by conservative surgery in 3 patients]. / Dissection isolée de l'artère rénale traitée par chirurgie conservatrice chez 3 malades.

We reported 3 cases of male patients with isolated dissecting aneurysm of the renal artery. The clinical presentation included lumbar pain followed by hypertension (malignant in 2 cases) in the next 3 months. These three patients have underwent surgical renal artery repair. At maximal follow-up (4, 5, 11 years after surgery), the blood pressure was normalized in these 3 patients (with one antihypertensive drug in 2) and the renal function remained stable.

Infrageniculate thin-walled PTFE bypass: preliminary study of 53 cases.

Between May 1, 1983 and May 1, 1985, 53 patients whose mean age was 75 years, and who presented with rest pain or ischemic changes had infrageniculate insertion of femoropopliteal or femorotibial thin-walled polytetrafluoroethylene (PTFE-TW) bypasses. Occlusive atherosclerotic disease was present in all patients. Postoperative follow-up ranged from 6 to 30 months. One patient died in the immediate post-operative period whereas 15 others died later during follow-up. There was one case of prosthetic sepsis. No anastomotic aneurysms occurred. Actuarial analysis of overall patency rates in significant population samples showed that 88% and 68% of bypasses were functional at one month and two years, respectively. The overall rate of early amputation was 17%. Overall limb salvage was 67% at 30 months. In patients over 75, 85% of bypasses were patent at one year whereas life expectancy for one year in this same group of patients was 49%. Although this is a preliminary study, results obtained with this new material suggest that an average gain of 20% in patency rates can be expected compared to those recorded with standard PTFE prostheses. The PTFE-TW vascular prosthesis may be the material of first choice for the geriatric patient in order to promote early hospital discharge and return to the home environment. Even though long-term patency rates of venous grafts are better, we believe that the use of PTFE-TW prostheses in elderly patients with limited life expectancy may be preferred.

Supraceliac aorta-to-lower extremity arterial bypass.

From 1979 to 1986, ten patients had a revascularization procedure using the supraceliac portion of the aorta. Six patients had aortofemoral or aortoiliac bypasses and four others had additional procedures for revascularization of the lower extremities or of the visceral arteries. The latter included four renal, three superior mesenteric and three hepatic artery revascularizations. There were no postoperative deaths. One patient with chronic renal failure underwent temporary hemodialysis after the operation. The postoperative course was uneventful in the nine remaining patients. Postoperative arteriograms showed all visceral artery revascularizations to be patent. All patients were symptom-free at follow-up (mean 3.8 years, range 1 month to 7 years). One patient had a successful percutaneous balloon angioplasty for a late anastomotic stenosis in a renal artery. The operative technique is described and the specific indications for the technique are discussed in patients with renal and suprarenal aortic disease.

Radio-anatomic study of the carotid axis with regard to the implantation of microsurgical vascular anastomoses.

The authors report a radio-anatomic study of the carotid axis in the context of the implantation of microsurgical vascular anastomoses. The information derived from 36 dissections and 50 arteriographic studies suggests the preferential use of the superior thyroid, facial and lingual branches. Section and turning-down of the external carotid and direct end-to-side implantation on the common carotid could provide fall-back solutions when the collaterals are slender. Because of anatomic variations and frequent atheromatous lesions, arteriographic study before implantation appears essential.

[Present role of Hartmann's operation. Apropos of 50 cases]. / La place actuelle de l'opération de Hartmann. A propos de 50 cas.

Of 50 Hartmann's operation conducted, 22 (including 19 for sigmoid diverticulitis) were for non-neoplastic lesions. Emergency surgery was necessary for lesions complicated by perforation, abscess, or occlusion in 34 cases, the indications for operation being local and general conditions, where immediate re-establishment of colorectal continuity was not possible, in the other 16 patients. Overall mortality was 22 p. cent, being much higher in cancer cases (32 p. cent) than in those with sigmoiditis (52 p. cent). Postoperative morbidity was marked, and was dominated by parietal complications and those due to the colostomy, and by thromboembolic complications particularly in the sigmoiditis cases. Secondary re-establishment of intestinal continuity was possible in 19 patients (6 cancers and 13 benign lesions) with a single postoperative death. Whereas the employ of Hartmann's operation in cancer would appear to be justified only in urgent complicated cases it is certainly a valid procedure in the acute phase of sigmoid diverticulitis, where its mortality is relatively low. Current mechanical suturing techniques, by facilitating secondary re-establishment of continuity, reduce the classical inconveniences of Hartmann's operation, suggesting its wider use for the emergency treatment of complicated lesions of the colon.