[Surgical treatment of stenosis of the renal artery, report of 24 cases operated cases (author's transl)].
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Biomedical subjects
Publications and source records attributed to Y Logeais.
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The authors report a case of bronchoscopy made necessary by severe hemoptysis in a young man with very severe respiratory distress. Bronchoscopy was carried out under excellent conditions thanks to respiratory assistance supplied by partial femoro-femoral extra-corporeal circulation. The interest and limits of this method are discussed.
The association of mitral stenosis with an abnormal pulmonary venous return in the absence of an atrial septal defect, is a rare occurrence, and three cases are reported here. If this diagnosis is suggested by the chest Xray, it is confirmed by haemodynamic investigation, which defines the abnormal pulmonary drainage, guages the size of the left-right shunt, and demonstrates the degree of mitral steonsis. If the defect is poorly tolerated, surgical treatment is required.
Two cases of abnormal venous return from the right lung into the inferior vena cava, or the scimitar syndrome, have been studied. The essential features of this condition are given, emphasis being laid on the haemodynamic findings. Surgical correction of the abnormal pulmonary venous return seems to be a logical solution when the left-right shunt is of significant size.
The authors report 50 by-pass operations followed up for from 6 months to 4 years, which were designed to restore the blood supply via the leg arteries in peripheral arterial disease of the lower limbs. 40 patients were at stages III and IV; acute ischemia required emergency operation in 6 cases. 2 Patients died immediately after operation. 30 by-passes remained permeable. A cure of the trophic disorder and a functional improvement were obtained in 39 patients with only 8 subsequent amputations. In the light of the world literature and their personal experience they discuss the main pronostic factors and the indications for this method which has proved to be a remarkable progress in the treatment of severe arterial disease of the lower limbs.
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The authors report a new case of carotid body tumour operated on, in a 26 year old woman. Recalling the main clinical and histological characteristics of these tumours, they emphasize the importance of pre-operative assessment and the decisive value of arteriography. Modern techniques of surgery of the carotid bodies permit one to face the risk of damage during removal. They re-emphasize the necessity of surgical treatment able to ensure a cure. Finally, emphasizeing the special gravity of advanced tumours (group III), they condemn a conservative attitude and recommended operation as early as possible.
The two-step myocardial infarction is defined by a peculiar course: the initial stage is a temporary rudimentary infarction, the late stage a typical transmural necrosis, separated by a free interval of a variable duration. A coronary arteriography undertaken when the recurrence starts might eventually lead to recommend an emergency operation: two-step myocardial infarction might represent one of the best indications for emergency aorta-to-coronary artyery by-pass operation.
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