[Incidence of hyperuricemia in atrioventricular block. Systematic study of 158 cases which required implantation of an isotopic cardiac pacemaker]

This is a study of 158 patients in whom the placement of an isotopic cardiac pacemaker was indicated; this procedure was carried out Broussais Hospital between 1970 and 1975. These patients, whose mean age was 39 (84 males, 47 females, 12 young men and 15 young women) were examined for uricaemia, and the levels compared with the mean for control population. The results were as follows: 91% had uricaemia at a level higher than the controls. Of these, 61% had uricaemia above 70 mg/l in the men and youths of over 15 years of age, and above 60 mg/l in the women and 50 mg/l in the adolescents. The highest uric acid levels were found in adults with post-operative atrio-ventricular block following surgical correction of a congenital cardiac abnormality, and also in children and adolescence with block which appeared to be congenital.

[Disinsertion of the left innominate vein during median vertical sternotomy (author's transl)]

The left innominate vein may be torn during median vertical sternotomy. This tear may in fact be a disinsertion of the venous trunk from the superior vena cava. Repair of this disinsertion is difficult, with a risk of stenosis. It requires the most careful technique, after dissection of the superior vena cava on either side of the tear. It is made much more simple by the use of extracorporeal circulation, which empties and collapses the superior vena cava. Finally, it may be necessary to repair this loss of substance by enlarging it with a fragment of saphenous vein.

[Early surgical management of severe corrosive burns of the oesophagus (author's transl)]

The authors have treated, as an emergency, 120 adults with corrosive burns. Thet were 22 patients among them checked as severe burns, i. e. who underwent surgical operations. Most of them tried to kill themselves by swallowing great quantities of acid or lye. Subsequently, gastric associated burns were frequent. Critical analysis of these observations, compared with the findings of pathology and in the literature permit one to get through the early management: -- Total fiberendoscopy is a true emergency, but for the patients who actually swallowed a glass or more of strong acid and have to undergo an immediate laparotomy. -- The place ofmajor surgical operations is discussed in relation to further specialist investigations of the appearance of complications. -- The results are assessed in 13 patients who were followed up for a long period.

[Caustic burns of the oesophagus in the adult. Histopathological study of 12 cases (author's transl)]

A histopathological study of 12 cases of major caustic burns of the oesophagus serves as a basis for a description of the lesions and to demonstrate the inexorable progression to fibrosis. The lesions are most frequantly diffuse, regardless of the substance responsible. Four morphological stages may be distinguished, superimposed on the clinical picture.

[Remote results of the surgical correction of aortic coarctation. Study of 90 patients operated on 11 to 15 years earlier]

An 11 to 15 year follow up (mean 12.7 years) of 90 patients undergoing surgery for coarctation of the isthmus of the aorta is reported. There were 7 late deaths. Of the survivors 87% were normotensive (B.P. less than or equal to 160/100 mmHg) and 90% were asymptomatic and leading a normal life. Five cases-all with an aortic prosthesis-had to be reoperated for recurrent coarctation. These figures are comparable with those found in the literature. The best long-term results are obtained in patients who have the operation while young (less than 20 years), who have no associated abnormality, and whose coarctation can be treated by resection with direct anastamosis.

[The estimation of parathormone in primary hyperparathyroidism (author's transl)]

In a recent series of 110 cases of primary hyperparathyroidism, estimations of plasma immuno-parathormone (PTH) were carried out in fifty two patients. This estimation proved reliable, making possible the confirmation of the diagnosis. In the absence of renal insufficiency, there was a highly positive relationship between PTH levels and plasma calcium. The relationship between PTH and the weight of the parathyroid tumour was less significant. For technical reasons, this long and difficult estimation cannot be used on a routine basis. However, it is most useful in cases in which other laboratory findings are not typical.

[Tuberculosis and caustic eso-gastric burns. Critical reflections on one case]

The diagnostic problems which may be raised during caustic oesophago-gastric burns and concommittent tuberculosis, of which the symptoms may be masked by the richness of the initial clinical picture are discussed here. The authors emphasise the necessity of prophylactic anti-tuberculous treatment, before any surgery when there is any suggestion of tuberculosis even siabilised.

[Closed-heart mitral commissurotomy. Twenty years after]

In order to find out the long-term results of mitral valvotomy as a closed heart operation, the authors investigated the fate of patients who underwent surgery twenty years ago. In 1955, 148 mitral valvotomies by the closed technique were carried out in the Cardiovascular Department of the Broussais Hospital under the direction of Professor F. D'Allaines. There were 15 operative deaths (10 p. 100) and 12 late deaths of non-cardiac origin; only 55 of the patients could be traced for follow-up. After 20 years, 24 of them had still a good or moderate result, and 34 had a bad result. A study of the various characteristic features of the heart defect before operation, and of the operative findings, has allowed us to determine a certain number of factors which presage good immediate and long-term results. The authors have concluded that, if these factors are present, mitral valvotomy as a close technique, with its advantages of simplicity and economy, remains a perfectly valid operation.

[Valve replacement in case of a partial atrioventricular canal. A propos of 17 cases]

In 17 patients with a partial form of atrioventricular canal, at least one valve was replaced. The mitral valve was the most commonly affected (16 cases), sometimes in association with the tricuspid valve (5 cases) or the aortic valve (1 case); the tricuspid valve alone was replaced in one case. 7 cases were ranked as operative deaths, and the longer term mortality was of 4 cases. The factors leading to this high mortality figure are discussed. The future treatment policy for this condition is discussed.

Surgery for aortic dissection: 53 operated cases with 32 in the acute phase

53 cases of aortic dissections were operated on between 1961 and 1975 in the Service of Cardiovascular Surgery at the Broussais Hospital, Paris (Prof. Ch. Dubost). The present study deals with 32 cases operated on in the acute phase. 31 originated in the ascending aorta and 1 in the descending aorta. Operative mortality was 50% (16/32), 4 patients died immediately following sternotomy. Operation consisted in replacement of the ascending aorta for the majority of type I and II dissections. When aortic insufficiency was present, a simple resuspension procedure was effective in 50% of cases. The authors prefer early operative intervention in type I and II dissections and medical treatment in type III dissections.

[Choice of surgical method in the child or adult (excluding infants) suffering from coarctation of the aorta and severe cardiopathy]

A study of a serie of 45 cases of coarctation of the aorta associated with a severe cardiac lesion or malformation, and treated at a single operative session (18 cases) or in two consecutive stages (27 cases) has produced the following conclusions: --Treatment at a single operation is possible, usually at the cost of two consecutive surgical approaches, thus making the operation rather long. This plan, which has given good results in the 18 cases studied (only one death and no serious complications) should be adopted only for young patients who are well-balanced psychologically, and whose cardiac defect is well-compensated. --Treatment in two stages is a more reasonable course for the remainder of the patients, but it must be decided which lesion to treat first: this could be the coarctation if it is a difficult or poorly tolerated one and if the cardiac defect (especially when an aortic valve lesion) is well compensated. It will be the cardiac lesion if, by contrast, the coarctation is simple and well-tolerated, and the cardiac lesion is severe and decompensated (especially a mitral malformation with shunts and major pulmonary hypertension). Current techniques of open heart surgery allow us to employ extracorporeal circulation easily and safely with the coarctation still in place; this will then be treated later. In every case in which a two-stage treatment plan has been chosen, it should be carried out as a planned procedure so that the second stage of the operation is not put off unduly.