Innominate artery involvement in type IV Ehlers-Danlos syndrome.

We report two cases of innominate artery involvement in patients with Ehlers-Danlos syndrome. In the first patient, spontaneous dissection of the innominate artery was treated successfully. In the other, the patient died of spontaneous rupture of the innominate artery in the early postoperative course after operation for aneurysm of the celiac artery. Arterial complications occurring in Ehlers-Danlos syndrome are rare but pose difficult diagnostic and therapeutic problems for the vascular surgeon due to arterial wall fragility.

[Doppler ultrasonic evaluation of the embolism-causing potential of carotid artery plaques. Apropos of 113 macroscopic findings]. / Evaluation du potentiel emboligène des plaques carotidiennes par l'écho-Doppler. A propos de 113 confrontations macroscopiques.

Comparison was made between precise descriptions of gross pathology of 113 carotid artery atheromatous plaques (69 symptomatic, 44 asymptomatic) operated upon by thromboendarterectomy and results of ultrasound-Doppler examinations, to determine possible specific ultrasound criteria for precise anatomical lesions. Echographic criteria studied were: ultrasonic structure of plaques; relation of plaque to wall; existence or absence of a solution of continuity; regular or irregular nature of endoluminal border of plaque; and finally the notion of discordance between degree of stenosis as shown by Doppler (D) and ultrasound (E) imaging (E much less than D). Principal results were as follows. Images of the regular, homogeneous highly echogenic plaques (36 cases) corresponded in 69.4% of cases to simple fibrous or calcified plaques with regular endoluminal borders. Irregular heterogeneous plaques (31 cases) were suggestive of irregular, friable and/or ulcerated material in 64.4% of cases. Weakly echogenic plaques (9 cases) suggested mainly thrombus (44.4%) or soft, friable plaques (33.3%). Plaques with solution of continuity do not correspond to a precise lesion but, in contrast, are specific (with weakly echogenic plaques) of the emboligenic character of the plaques (100%). The criterion ultrasound "Doppler was specific for thrombus in 75% of cases. In contrast, the thrombus can also demonstrate very different ultrasound images. Finally, in this study ultrasound-Doppler findings produced 3 false negatives (2.6%). Combined ultrasound-Doppler imaging allows quantitative evaluation and particularly qualitative assessment of carotid artery atheromatous lesions, with sufficiently reliable criteria to detect lesions of high emboligenic potential.

[Evaluation of the emboligenic potential of carotid plaques. Apropos of 113 echographic and macroscopic comparisons]. / Appréciation du potentiel emboligène des plaques carotidiennes. A propos de 113 confrontations échographiques et macroscopiques.

113 cases of atheromatous plaques in carotid arteries (69 cases where symptoms were present and 44 were asymptomatic) surgically treated by endarterectomy, including an accurate description of gross lesions, were compared to findings obtained with echographic examination to determine if there are specific echographic criteria corresponding to exact anatomical lesions. The echographic criteria selected for this study were the echo-inducing structure of the plaques; the relationship of the plaque with the artery wall (presence of a lesion continuous with the wall); the regular configuration of the endoluminal edge of the plaque or not; and finally, the notion of a discrepancy between the extent of the carotid artery stenosis visualized by ultrasound and that observed with echography (E much less than U). The primary results of this study demonstrate that echo-inducing, uniform and regular (36 cases) atheromatous plaques corresponded to ordinary, fibrous or calcified plaques in 69.4% of cases, with regular endoluminal borders. Irregular and non-uniform plaques (31 cases) suggested irregular, friable and/or ulcerated substance in 64.4% of cases. Poor echo-conducting plaques (9 cases) suggested formation of a thrombus, basically, in 44.4% or of soft and friable plaques (33.3% of cases). Those plaques which were continuous with the wall do not correspond to a precise type of lesion but, rather, are characteristic (with poor echo-conducting plaques) of the embolic nature of the plaques (100%). The criteria echo much less than ultrasound is specific for a thrombus in 75% of cases. On the other hand, the thrombus may also assume very diverse echographic presentations. Finally, three negative echo-ultrasound results were observed in this study.(ABSTRACT TRUNCATED AT 250 WORDS)

[Contribution of real time echotomography to evaluation of cervico-encephalic atheromatous disease]. / Apport de l'échotomographie en temps réel dans le bilan de la maladie athéromateuse cervico-encéphalique.

Real time ultrasonography can now provide fine, easily reproducible images of the carotid arteries and to a lesser degree the vertebral arteries. The method is a simple one but requires an experienced operator. Care should be taken to visualize mainly the zones of predilection of the atheroma (carotid bifurcation and ostia). Even minimal sized atheromatous plaques can be detected, including those that are frequently asymptomatic to the doppler test, and their calcareous, regular, or ulcerated nature can be determined. The limits of the examination are described, demonstrating the need for complementary ultrasound and doppler tests. The two main poles of interest of this vascular imaging are early detection of carotid atheroma and supervision of medical and surgical treatments.

[Value of mediastinoscopy and mediastinotomy in exploration of the mediastinum (author's transl)]. / Valeur de l'exploration du médiastin par médiastinoscopie et médiastinotomie.

The value of the information provided by mediastinoscopy or cervical mediastinotomy was evaluated in 150 cases by means of tests measuring diagnostic efficiency with calculated agreement coefficient. An accurate histological diagnosis was made in 100 out of 116 mediastinal syndromes (adenopathy, mediastinal or paramediastinal tumors). In cases with negative results exploratory surgery is required. The operability of bronchial carcinoma was assessed in 34 cases selected for their location and radiological extension. A negative mediastinoscopy makes it very unlikely that an inoperable cancer will be found. In bronchial carcinoma, mediastinoscopy is recommended whenever the risk attending excision of a tumor with lymph node involvement is to be weighed against the high operative risk in a debilitated patient. The usefulness of these exploratory procedures is enhanced by anterior mediastinotomy in cases with anterior tumor and in some left-sided bronchial cancers.

[Penetrating thoracic and abdominothoracic wounds. Results of treatment in 221 cases (author's transl)]. / Plaies thoraciques et plaies thoraco-abdominales. Etude de 221 plaies récentes.

Overall mortality after treatment of 221 thoracic or abdominothoracic wounds was 5 p. cent in a recent series, mortality from bullet wounds being the double of that from other weapons. Isolated thoracic wounds without cardiac lesions have a good prognosis, whereas mortality after heart or abdominothoracic wounds remains high (12.5 p. and 14 p. cent respectively). Apart from those with severe hepatic injuries or wounds of the suprahepatic veins, most of the injured patients that died were in cardiac arrest on arrival. Different therapeutic attitudes are necessary for pure thoracic wounds and those involving the abdominothoracic region. It is essential to gain as much time as possible at all stages, particularly during transport of the injured and when deciding the course of treatment, to avoid losing patients with curable lesions.

Hemophilia A in a phenotypic female with normal male karyotype associated with a low factor XII level.

Hemophilia A was detected in a 40-year-old black Gabonese female prior to thoracic surgery for empyema. The diagnosis of mild hemophilia A was supported by the findings of low factor VIII coagulant activity (VIII:C 4%), normal levels of factors VIII related antigen (VIIIR:Ag) and VIII von Willebrand (VIIIR:WF), without detectable circulating anticoagulant. Neither the patient nor her immediate relatives had past histories of abnormal bleeding. The physical features were phenotypically female with developed breasts, pubic hair and normal external genitalia: however, she had primary amenorrhea, a blind vagina with no uterus and her karyotype was 46,XY. These findings are consistent with the diagnosis of testicular feminization thereby explaining the apparent contradiction between the phenotype and the known six-linked inheritance of hemophilia A. In addition to factor VIII deficiency a low level of factor XII (20%) was detected although it cannot be concluded whether the patient is truly factor XII deficient or whether she represents a low variant of the normal distribution.