Surgical treatment of atherosclerotic popliteal aneurysms

peer reviewe

Surgical treatment of atherosclerotic popliteal aneurysms : retrospective study

peer reviewe

Extended Transternal Thymectomy for Myasthenia Gravis

editorial reviewe

Chylothorax and its management

Le chylothorax est une affection rare caracterisée par une fistule entre le canal thoracique et une cavité pleurale. Son évolution spontanée est peu favorable, compliquée en phase aigue par une insuffisance respiratoire, puis, si la cavité pleurale est drainée, par des perturbations hémodynamiques, nutritionnelles et immunologiques. Depuis la première ligature du canal thoracique en 1948, la chirurgie a permis de réduire sensiblement la morbidité et la mortalité des chylothorax. Récemment, l'introduction des techniques de thoracoscopie permet d'entrevoir une nouvelle approche thérapeutique, plus précoce et moins aggressive. Cependant, si le chirurgien thoracique joue un rôle central dans le traitement du chylothorax, il doit également se souvenir qu'il peut provoquer une plaie du canal thoracique ou de ses branches lors de toute chirurgie thoracique, surtout .au cours d'intervention au niveau médiastinal posterieur. La possibilité d' un chylothorax doit donc être évoquée devant tout épanchement anormalement important survenant dans la période postopératoire de ces interventions, surtout si celui-ci prend un aspect lactescent. Après rappel de l'anatomie et de la physiologie de la circulation lymphatique, les auteurs envisagent les différentes étiologies des chylothorax et discutent des modalités de traitement.Chylothorax is an unfrequent pathology defined by fistula between the thoracic duct and one of the pleura. Its spontaneous evolution is worse, with respiratory failure in the acute phase. After a few days of thoracic tube drainage, hemodynamic, nutritional and immunologic disturbances appear. Since the first thoracic duct ligature by Lampson in 1948, surgical approach has obviously reduced the morbidity and mortality of chylothorax. The new development of the thoracoscopic techniques will allow earlier and less aggressive surgical treatment. However, thoracic surgeons must keep in mind that every intrathoracic operation could induce chylothorax, especially in case of posteriror mediastinal surgery. Chylothorax must be evocated if unusually profuse milky pleural effusion complicate this type of procedure. We discribe the anatomy and the physiology of chylous circulation and we discuss the etiologies and the different therapeutic approaches of chylothorax

Extended transsternal thymectomy for myasthenia gravis: a report of 19 consecutive cases.

BACKGROUND: Thymectomy is considered as an effective therapeutic option for patients with myasthenia gravis (MG). This study reports the experience of our centre's investigation into the efficacy and the safety of the procedure and the influence of different pre-operative factors on the surgical outcome. METHODS: A retrospective chart review/interview was made of 19 consecutive patients who underwent extended transsternal thymectomy for MG from 1992 to 2003. The severity of the disease was determined according to the Osserman Classification. Efficacy was measured by determining the change in clinical status, the rate of remission during follow-up, and the reduction in medication requirements after thymectomy. Complete remission (CR) was defined as asymptomatic off medication for 6 months. The CR rate was calculated using the Kaplan-Meyer method. RESULTS: The mean age of the patients at surgery was 34 years (range, 9-63) and 78.9% were female. Mean length of follow up was 86 months (range, 24-163). The overall complication rate was 10.6% (1 episode of atrial fibrillation and a left recurrent laryngeal nerve palsy that resolved after the first postoperative month). There was no operative mortality. The mean hospital stay was 9.4 days (range, 5-23). The crude CR rate was 32% (n = 6). The Kaplan-Meier estimate of CR was 42% at 6 years. Age, gender, duration of symptoms, thymic histology, Osserman stage and the presence of thymoma were not identified as prognostic variables. The average daily dose of Medrol and Mestinon decreased significantly between the pre-operative period and the last follow-up (Medrol, p = 0.0081; Mestinon, p = 0.0013). CONCLUSIONS: Transsternal thymectomy for MG is safe and effective. It benefits patients with MG at all stages. Patients with thymoma are not associated with poorer remission rates. Complete responses are durable, as the CR rate remains stable over time

"A Priori" Resectability of Nsclc Pulmonary Neoplasms in Relation to the New International Classification

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Image of the Month. Spontaneous Hematoma of the Psoas

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Truncal Vagotomy and Pyloroplasty Combined with Valvular Replacement in Patients with Ulcer Disease

peer reviewedIn 1988, 5 patients (3 men and 2 women) with ulcer disease (mean age 56 +/- 8 years) underwent valvular replacement for aortic (No. = 4) or mitral disease (No. = 1). All patients had had gastroduodenal ulcers. Preoperative gastroscopy demonstrated active ulcers (No. = 4) and a healed pyloric ulcer with pyloric stenosis (No. = 1). Despite the presence of ulcers, a non-biologic prosthesis was preferred in each patient because of their young age (No. = 3), chronic atrial fibrillation requiring anticoagulant therapy (No. = 1), and refusal of the eventuality of subsequent reoperation (No. = 1). In each patient, a truncal vagotomy with pyloroplasty was performed simultaneously with the valvular procedures by the same incision. The postoperative courses were uneventful. With a mean follow-up of 15 +/- 3 months, no gastrointestinal bleeding was observed during anticoagulant therapy. With anticoagulant drugs, bleeding may occur with a frequency of 4% per patient treatment-year, half of which are gastrointestinal in origin. Nevertheless, in selected patients with gastroduodenal ulcers, performing a vagotomy-pyloroplasty simultaneously with valvular replacement allows implantation of a non-biologic prosthesis, with greater durability than bioprosthesis