Digital arteritis and bleomycin. Apropos of a case

A 47-year-old patient developed severe digital arteritis after complementary bleomycin treatment following surgery for esophageal cancer. Arteriography images showed extrinsic stenosis of the digital arteries, results of other investigations suggesting development of a sclerodermic process due to bleomycin. Ischemic lesions regressed after thoracic sympathectomy. Similar cases have been well documented but cases of associated cancer and digital ischemia lacking iatrogenic features have also been reported. The pathogenic role of bleomycin appears to be established in the present case, but the possibility of the digital ischemia developing within the framework of a paraneoplasic syndrome is discussed.     

Fibrous hyperplasia in femoro-popliteal bypasses using treated human umbilical veins

The authors report two clinical cases of the failure due to fibrous hyperplasia of processed human umbilical vein (HUV) grafts employed as femoro-popliteal bypasses. Failure occurred after 19 months implantation at the proximal anastomosis for one graft and after 10 months at the distal anastomosis for the other. Fibrous hyperplasia was the principal cause of reoperation. The lightly vascularized, more or less compacted fibrin involved, adhering loosely to the HUV, remains thrombogenic at the blood-contacting surface. Superposed onto this phenomenon which is widespread in laboratory animals but uncommon in humans, are the usual causes of failure: delamination of the HUV wall, lipid uptake and bacterial colonization.     

Extracorporeal life support following out-of-hospital refractory cardiac arrest

Introduction  

Extracorporeal life support (ECLS) has recently shown encouraging results in the resuscitation of in-hospital (IH) refractory cardiac arrest. We assessed the use of ECLS following out-of-hospital (OH) refractory cardiac arrest.     

Deep venous thromboses in the aged patient. Clinical and therapeutic aspects

This paper looks at the question of whether the age of a patient has any bearing on the thrombolytic treatment of post-thrombotic syndrome in the lower limbs. Our study shows that elderly patients respond just as well to thrombolysis as young patients.     

Tracheal intubation in patients with cervical spine injuries using a fiber optic laryngoscope]

Eleven patients, with a cervical spine injury and scheduled for elective cervical spine fusion at least 48 h after their initial trauma, were intubated using a new fiberoptic laryngoscope (Bullard). This technique uses either a semi-rigid guide independent of the laryngoscope blade, or a rigid one attached to the blade. The cervical spine was immobilized with either a collar or a halo. General anaesthesia was carried out with thiopentone, fentanyl and vecuronium bromide. Orotracheal intubation was successful at the first attempts in 10 out of the 11 patients. No mobilization of the cervical spine occurred. In the first six patients, the semi-rigid guide was used, and the rigid one in the remaining five. The anaesthetist who carried out the intubations was always the same. Using the rigid guide was easier than the semi-rigid one. This is confirmed by the time required, 44 +/- 22 sec for the rigid guide, and 97 +/- 92 sec for the semi-rigid one. In the patient in whom this technique failed at the first attempt, endotracheal intubation was carried out by the nasal route and controlled by the fiberoptic laryngoscope. This technique enables a rapid and easy orotracheal intubation in trauma patients with an immobilized cervical spine, but careful training is necessary.