[Emergency and repeat dissection of the thoracic aorta. Apropos of 45 surgical cases].
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Biomedical subjects
Publications and source records attributed to J Jourdan.
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The introduction of intracoronary thrombolysis as a treatment for myocardial infarction has led to an increase in the number of very early coronary angiographies carried out in the acute phase of myocardial infarction. These investigations can be performed without excessive risk. In some cases, severe stenosis with significant distal circulatory impairment without evidence of thrombosis is found. In these very early investigations, these findings may represent a "pre-thrombolic" lesion in an evolving myocardial infarction. Six cases of very severe pre-thrombolitic stenosis of the LAD were observed in a series of 67 coronary angiographies performed in the early stages of myocardial infarction. These six cases were selected on strict clinical, ECG and angiographic criteria. One patient was hospitalised with cardiogenic shock. The six patients underwent emergency coronary bypass surgery: average time from admission to coronary angiography was 55 minutes; average time from coronary angiography to surgery was 3 hours. These 6 pre-thrombolic lesions of the LAD were also associated with lesions of the left circumflex and right coronary arteries. There were no operative complications but two patients had stormy immediate postoperative periods. There was no hospital mortality. All patients were reinvestigated at 1 month and all grafts were shown to be patent. The left ventricular ejection fractions improved in 3 cases, remained unchanged in 2 cases, and deteriorated in 1 case (the patient with cardiogenic shock). These results suggest that emergency coronary bypass surgery is a rational treatment of pre-thrombolic coronary stenosis observed at early coronary angiography in patients with evolving myocardial infarction in order to preserve as much myocardial muscle as possible.
Campylobacter coli is known to cause ulcerous enterocolitis, but hepatitis has not yet been reported. A 50-year-old woman without history of liver disease was admitted with diarrhoea, fever, poor general condition, subicterus and enlarged liver. Campylobacter coli was grown in haemoculture, and a specific antibiotic treatment resulted in complete cure. The results of haemoculture, the necrosis and polymorphonuclear infiltrates found in liver biopsies, the return to normal of biochemical tests and liver size under antibiotic therapy and the absence of any other cause of acute or chronic liver disease are strong arguments in favour of the hepatitis being caused by Campylobacter coli in this patient.
Five cases of Brucella melitensis endocarditis are reported. Common features included subacute course, enhanced humoral immunity, and deficient cellular immunity. Appropriate antibiotic therapy led to recovery in all cases. In two patients, valvular replacement was necessary.
Six cases of coarctation of the aorta with aneurysms are reported. The 6 patients have been successfully operated with resection of the aneurysm and replacement of the aorta by a Dacron graft. The different anatomic characteristics are described. The authors emphasize the frequency of other aneurysms upstream of the coarctation, the risk of rupture (2 cases out of 6) and the technical difficulty of the operative procedure in comparison with a common coarctation. Aneurysm formation is a rare but severe sequel of coarctation in the adult and underlines the importance of surgical treatment of this lesion in childhood.
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A 9-month-old male baby was investigated for a massive left-to-right shunt at the arterial level. On right heart catheterization a patent ductus could not be demonstrated but retrograde arterial angiography showed an aorto-pulmonary window. During corrective surgery on cardiac bypass, the left coronary artery was found to arise from the aorto-pulmonary window, this was corrected by dividing the communication distal to the origin of the left coronary artery. On follow-up investigation 6 months after operation the baby was without symptoms and showed a fully functional left coronary artery. To our knowledge this is the first case of such a congenital anomaly to be described.
Delayed unilateral pulmonary embolectomy via the peripheral approach has been performed in 12 patients suffering from chronic pulmonary vascular obstruction after a single or repeated embolisms. Arterial hypoxemia and pulmonary hypertension were present in all cases. Embolectomy was performed several months or years after the initial event. There were 2 early and one late death. The surviving patients are doing well clinically and show definite hemodynamic and angiographic improvement.
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A 55 year old man, hypothyroid from previous thyroidectomy, presented with angina due to tracheal compression by a tumour of the posterior superior mediastinum. The preoperative work-up was negative. An aneurysm of a retrooesophageal subclavian artery was found at exploratory right thoracotomy in January 1977. This was resected and arterial reconstruction with a dacron graft was performed. The long term post operative clinical and angiographic results are satisfactory. The medical literature of this rare condition is reviewed.
A case of probable infective aneurysm complicating isthmic coarctation of the aorta, is reported. On radiology, the aneurysmal mass seemed to have developed in less than two years. However, it was not possible to culture the causative organism. The pre- and postoperative angiographical appearance after one-stage radical surgery of the lesion and its complication are described.
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The authors discuss the present value of rifampicin in the treatment of human brucellosis on the basis of: 1) a bacteriological study of 42 strains of Brucella spp. (MIC's of rifampicin, tetracyclin, doxycyclin, minocyclin and streptomycin; results of doxycyclin-rifampicin and doxycyclin-streptomycin combinations), and 2) a clinical study of 38 cases of brucellosis treated with rifampicin, including 25 acute septicemias and 13 osteo-arthritis. Satisfactory results were observed in 92% of the cases with rifampicin alone, but one cannot state that the benefits are significant.