[Remote results of ostial coronaritis surgically treated]

This study comprises 15 patients operated for syphilitic coronary ostial stenosis by Dubost's team between 1959 and 1975. Three operative deaths (20%) were observed. Three other late deaths occured, but only one of his coronary pathology. Of the nine survivors, seven have been reviewed and five have undergone control coronary angiography. The long term results of the 9 survivors, reviewed from 3 1/2 to 11 years after operation, illustrate the difficulties of disobliteration of the right coronary ostium, the necessity of changing the aortic valve systematically when incompetent and the maintenance of the good results obtained by this surgery.

[Differentiation between parathyroid adenoma and hyperplasia. Proof by peroperative Wang floating test (author's transl)]

It is sometimes very difficult during operation to distinguish a normal parathyroid gland from a hyperplasic gland. The Wang test offers a solution, very simply demonstrating a difference in density between two glandular specimens. Normal parathyroid tissue, with its fat-containing cells, floats, in contrast to hypersecreting glands which are poor in lipid elements. This test was performed in 30 patients and led to the recognition of hyperplasia in 2 cases.

Esophageal perforation during attempted endotracheal intubation

Perforation of the cervical esophagus in the course of attempted intubation of the trachea is a very rare accident, or at least rarely reported. Over the past 11 years, 12 patients ranging in age from 44 to 72 years were treated in our unit. If suspected, esophageal perforation is easy to diagnose when intubation has been difficult or when the patient complains of dysphagia and neck pain. Subcutaneous cervical emphysema appears early. All the patients who were operated upon early made an uneventful and prompt recovery. In those subjected to delayed operation (more than 12 hours) or nonoperative treatment, the mortality rate was 56 percent and recovery was achieved only after long and difficult treatment.

[Echocardiographic study of 4 cases of dilatation of the sinus of Valsalva]

Four cases of dilatation of the sinus of Valsalva with or without rupture were studied by echocardiography before surgical correction. In three cases the dilatation affected the right anterior sinus with rupture into the right atrium or ventricle. In the other case dilatation of the right anterior sinus dissecting the interventricular septum was associated with an aneurysm of the left anterior sinus dissecting the free wall of the left ventricle.

[Postoperative haemodynamic evaluation of myocardial protection by physicochemical cardioplegia. Hyperkaliemic, hyperosmolar and acid solution at 4 degrees C (author's transl)]

Myocardial protection by a combination of cardiac hypothermia and chemical cardioplegia (high concentration of K+ and Mg++, hyperosmolarity, acid pH), was studied during 20 valve replacements. Essentially assessed on the basis of repeated measurements of postoperative cardiac output, the results were compared with those obtained previously using local hypothermia only (20 patients) and hypothermic cardioplegia using Ringer Lactate (20 patients). Analysis of haemodynamic data, which thus involved 60 patients, indicated the superiority of physicochemical cardioplegia, and this for clamping periods of up to 2 hours, but also showed the desirability of changes in the protection protocol during the ischaemia phase and during reperfusion which might improve the results.

[Right pneumonectomy for carcinoma with resection of the carena and left tracheo-bronchial anastomosis: 3 cases (author's transl)]

Extended pneumonectomy for carcinoma is associated with very poor results. However, a tumour which remains limited to the bronchial tree does not perhaps have such a poor prognosis as those which involve neighbouring organs. Valuable survival periods may be obtained after right pneumonectomy with resection of the carena. The authors here report 3 cases, including 2 with survivals of 10 and 8 years respectively.

[Surgical treatment of Prinzmetal's syndrome. Report of sixty operated cases (author's transl)]

The results of the surgical treatment of Prinzmetal's angina are reported in this study of 60 patients. The operative mortality is 3,3 percent and the incidence of post-operative infarction is 20 percent. 53 patients were followed over an average period of 2,7 years. The global survival rate is 91 percent at 5 years, the infarction rate is 24 percent. 76 percent of the sublims are asymptomac. The patients can be classified in three group : isolated lesions, multiple lesions and spasms.

Conservative management of the prolapsed mitral valve

Prolapsed leaflet is the result of ruptured chordae, elongated chordae, or ruptured papillary muscle. Various techniques adapted to each of these lesions were developed, and repair of 213 prolapsed mitral valves was performed between 1969 and 1977. There were 109 patients with ruptured chordae treated by quadrangular resection of the prolapsed leaflet; 103 patients with elongated chordae were treated by either a "sliding plasty" of the papillary muscle or a "shortening plasty" of the chordae; and 1 patient with ruptured papillary muscle was treated by reimplantation. The great majority of patients had an associated annular dilatation or deformation requiring the use of a Carpentier ring to remodel the annulus and reinforce the repair. The operative mortality was 4% and the late mortality, 3%. There were 6 reoperations, 3 of which occurred within 1 year. Thromboembolic complications occurred in only 1 patient (0.5%), even though the majority of patients received no anticoagulation treatment. Actuarial curves demonstrated a 91% survival at 8 years.

[Acute hyperparathyroidism, diagnosis and treatment. 10 recent cases]

The authors report 10 observations of acute hyperparathyroïdism crisis cases operated without death. They draw their conclusions from their own experience and from published cases. The evolution on the medical treatment is invariably mortal. The logical treatment is surgery. The operation is a true emergency, preceded by a brief but intensive medical treatment which checks dehydratation up and bring the blood calcium level down.