Indications and benefits of simultaneous endoluminal balloon angioplasty and open surgery during elective lower limb revascularization.

Combined balloon angioplasty and conventional revascularization are occasionally performed but some points are still controversial: which patients are eligible for this associated procedure?; should the procedures be performed simultaneously or successively?; and in case of simultaneous procedure, which one should be performed first? To answer these questions, the notes of 64 patients consecutively submitted to this procedure at the Henri Mondor hospital were reviewed. Arterial dilatation was performed on the iliac artery, superficial femoral artery, popliteal artery or tibioperoneal trunk in 31, 26, four and four patients, respectively. Reasons for simultaneous procedures were multiple occlusive lesions in 67% of patients and inflow improvement in 14%. The others reasons included iliac obstruction in poor risk patients, unilateral failure of planned bilateral iliac balloon angioplasty, outflow improvement, local contraindication to arterial approach, shortness of vein graft, clamp injury during open surgery and inadequate patient position for both procedures. Complications were rare. One patient died of recurrent sepsis of the femoro-femoral bypass. The 5-year limb salvage rate was 91%. In this study, simultaneous procedures were associated with three advantages: the risk of septic complications associated with graft implantations in a previously punctured site was decreased, anticoagulant and/or antiplatelet therapy did not need to be modified before the second procedure, hospital length of stay and cost appeared to be lower. On a simultaneous procedure, it is recommended that the balloon angioplasty be performed after the conventional procedure in order to avoid clamping a recently dilated artery when performing the bypass.     

Review and update of involuntary facial movement disorders presenting in the ophthalmological setting

We review the existing literature on the involuntary facial movement disorders—benign essential blepharospasm, apraxia of eyelid opening, hemifacial spasm, and aberrant facial nerve regeneration. The etiology of idiopathic blepharospasm, a disorder of the central nervous system, and hemifacial spasm, a condition involving the facial nerve of the peripheral nervous system, is markedly different. We discuss established methods of managing patients and highlight new approaches.     

Effect of persistent pulmonary hypertension on brain oxygenation in asphyxiated term newborns treated with hypothermia

Objective: To better understand the impact of persistent pulmonary hypertension (PPHN) on brain oxygenation in term asphyxiated newborns treated with hypothermia.

Methods: The regional cerebral oxygenation saturation (rSO₂) measured by near-infrared spectroscopy was compared to pre/post-ductal oxygen saturation and mean arterial blood pressure in three term asphyxiated newborns with documented PPHN during their first 4 days of life while they were being treated with hypothermia.

Results: The cerebral oxygen saturation remained relatively stable when oxygen saturation was more than 92% and when there was no difference between pre- and post-ductal oxygen saturations. Episodes of desaturations with a difference between pre- and post-ductal saturations, as well as episodes of hypotension, caused a significant decrease in rSO₂ in these newborns.

Conclusion: This case series demonstrates that PPHN has a profound impact on brain oxygenation in term asphyxiated newborns treated with hypothermia during the first days of life after birth. PPHN may represent an additional risk factor for brain injury in these newborns during the first days of life.     

Development of the action observation network during early adolescence: a longitudinal study

Adolescence places high demands on inter-personal interactions and, hence, on the extraction and processing of social cues. Here we assess longitudinally the development of brain activity within a network implicated in social cognition--the action observation network. We performed activation likelihood estimation meta-analyses to define regions of interest based upon the mature action observation network of adults. Using functional magnetic resonance imaging, we then examined developmental trajectories of functional brain activity within these brain regions. Using this approach, we reveal quadratic trajectories within a fronto-parietal network previously shown to demonstrate correlated morphological development.     

Aorto-bifemoral bypass. Evaluation of Milliknit prosthesis]

Since there is no consensus as to the choice of an optimal prosthesis for aortobifemoral bypass, we have retrospectively evaluated the outcome with 162 Milliknit prostheses laid in cases of obliterating atherosclerosis. Such prostheses were preferentially used when the distal anastomosis were to be located on the deep femoral arteries. Intraoperatively, we noted the absence of fraying and the easy manipulation, owing to the flexibility and thinness of the wall, which are similar to those of the deep femoral artery: however, the blood loss before achieving complete tightness was greater than with most other knitted prostheses, and in 7.4% of the operated patients, defribination on clamp removal caused an additional bleeding averaging 1 litre. There was no graft sepsis during the postoperative period, may be because of the excellent healing of this prosthesis. One prosthesis only presented with excess dilatation accounting for thrombosis. The average length of follow-up was 3.6 years, the primary actuarial patency at 1, 5 and 10 years respectively was 98.7, 93.9 and 92.8%. Secondary patency at the same times was 99, 97.5 and 95.9%. These patency rates are among the best published in the literature. As a conclusion, this prosthesis is perfectly appropriate when the shunts must be located on thin femoral arteries, but a reduction of the intraoperative blood loss through an impregnation process would be desirable.     

Acute and chronic dissections of the abdominal aorta: clinical features and treatment

We report seven cases of dissection of the abdominal aorta. Three patients had acute back pain, whereas four patients had more chronic courses. In six cases, as a result of the palpation of a pulsatile abdominal mass, clinical diagnosis was an atheromatous aneurysm. Angiography and CT scanning demonstrated a dissected abdominal aorta and a normal thoracic aorta. Six patients with an infrarenal dissection were treated by replacement of the aorta with a Dacron prothesis, and one patient with an suprarenal dissection was treated conservatively. With a mean follow-up of 3 years, all patients were alive and free of symptoms. These results favor graft replacement in case of infrarenal aortic dissection and more selective surgical indications in suprarenal aortic dissection.