Two case reports describing patients having cardiac operations under extra corporeal circulation are presented. At the completion of the operation, a massive hemoptysis occurred in both patients after a Swan-Ganz catheter had perforated the pulmonary artery. A hemostasis lobectomy was then immediately required. The immediate and long term prognosis seems satisfactory. This is an unusual but serious complication. The incidence of this complication varies between 0.06 and 0.2%. The more frequently related risk factors include people over the age of 60, pulmonary artery hypertension, anticoagulant therapy, hypothermia and manipulation of the heart by the surgeon. When this accident occurs, many authors suspect the balloon. An early diagnosis is essential in the case of a major or even a minor hemoptysis, because this complication may be a lethal one as the mortality rate may reach 50%. According to us, the appropriate therapy which would reduce this mortality is a surgical one (hemostasis lobectomy).

The association of Ehlers-Danlos type IV syndrome and acrogeria with renovascular hypertension is reported. Ultrastructural abnormalities observed in our case were different of those associated with acrogeria. We propose that acrogeria associated with Ehlers-Danlos type IV syndrome be a different disease of acrogeria of Gottron. The occurrence of renovascular hypertension in Ehlers-Danlos is unusual.

The association of Ehlers-Danlos type IV syndrome and acrogeria with renovascular hypertension is reported. Ultrastructural abnormalities observed in our case were different of those associated with acrogeria. We propose that acrogeria associated with Ehlers-Danlos type IV syndrome be a different disease of acrogeria of Gottron. The occurrence of renovascular hypertension in Ehlers-Danlos is unusual (J Mal Vasc 1994 ; 19 : pages 323-325).

77 pure iliac aneurysms where detected in a group of 48 patients along a period of 21 years, and represented 12.3% of all patients having aortic, iliac, or aorto-iliac aneurysms. The study group comprised 42 men and 6 women, 48-86 years old (mean 67.8 years). The aneurysm was located on the right side in 51.9%, on left side in 48.1%. The affection of the common iliac arteries (70.1%) was more frequent than it was on the internal iliac arteries (18.2%), or in the external iliac arteries (11.7%). The diameter was from 2 to 10 cms. 44 patients out of 48 (91.6%) where symptomatic, and 15 presented a rupture syndrome (31.3%). 10 patients (20.8%) had a pulsating mass. The etiology was unknown in 8 cases (16.7%); 2 patients had a mycotic aneurysm (4.2%). The remaining 38 patients (79.1%) had an aneurysm of atheromatous origin. 5 arteritic patients (10.4%) did not have any cure for their aneurysm, because it was considered threatening for 4 of them. The fifth patient was not treated because the artery was so calcified that it could not be clamped. A lumbar sympathectomy on the same side of the lesion was realised, in addition to the peripheral surgical act for arteritis. One patient had an endoaneurysmorrhaphy, another had an exclusion by ligature section of the aneurysm. For the remaining 41 patients (83.1%) the aneurysms where flattened, and vascular continuity was re-established by a prosthesis. 7 patients (12%) decreased post-operatively.(ABSTRACT TRUNCATED AT 250 WORDS)

77 pure iliac aneurysms where detected in a group of 48 patients along a period of 21 years, and represented 12,3 % of all patients having aortic, iliac, or aorto-iliac aneurysms. The study group comprised 42 men and 6 women, 48-86 years old (mean 67,8 years). The aneurysm was located on the right side in 51,9 %, on left side in 48,1 %. The affection of the common iliac arteries (70,1 %) was more frequent than it was on the internal iliac arteries (18,2 %), or in the external iliac arteries (11,7 %). The diameter was from 2 to 10 cms. 44 patients out of 48 (91,6 %) where symptomatic, and 15 presented a rupture syndrome (31,3 %). 10 patients (20,8 %) had a pulsating mass. The etiology was unknown in 8 cases (16,7 %); 2 patients had a mycotic aneurysm (4,2 %). The remaining 38 patients (79,1 %) had an aneurysm of atheromatous origin. 5 arteritic patients (10,4 %) did not have any cure for their aneurysm, because it was considered threatening for 4 of them. The fifth patient was not treated because the artery was so calcified that it could not be clamped. A lumbar sympathectomy on the same side of the lesion was realised, in addition to the peripheral surgical act for arteritis. One patient had an endoaneurysmorraphy, another had an exclusion by ligature section of the aneurysm. For the remaining 41 patients (83,1 %) the aneurysms where flatened, and vascular continuity was reestablished by a prosthesis. 7 patients (12 %) deceased postoperativaly. 14 patients (29,2 %) couldn't be followed up. 27 patients (56,2 %) had an average follow up of 38 months, with a permeable arterial reconstruction in 21 cases. And so the pure iliac aneurysms are rare, but of very difficult diagnosis. The major risk is rupture with high mortality. Surgical treatment must be the rule before appearence of this complication. Conclusion Isolated iliac aneurysms are rare compared to aorto-iliac aneurysms, and represent from 0,9 to 1,9 % of aortic aneurysms. The higher frequency in our series (12,3 %) is not explained. Most of the patients where males, mean age 67,8 years, which is a commun rule to all series in the literature. The clinical diagnosis is difficult because of the deeply situated iliac arteries in the pelvis justifying at the least diagnostic doubt complementary tests (ultrasonography, scanner and arteriography). In all the series, the site of predilection on the iliac aneurysm was the commun iliac artery with a hight predominance on the right side. The treatment is surgical in the majority of cases with the interposition of a prosthesis. The post operative mortality is higher compared to aortic aneurysms, perhaps because of a later diagnosis.

: The authors report about one case of bacterial endocarditis complicated by fungal aneurysms in a superior mesenteric and a popliteal site. While the diagnosis was easy for the popliteal aneurysm, it was not so for the mesenteric aneurysm. Arteriography must have wide indications. The treatment of such aneurysms must always be medical, but surgical as well. The surgical tactics must be carefully discussed, and the restoration of vascular continuity with autologous venous material through an extra-anatomic course should be preferred.

We report about one case of acute dissection of the infrarenal abdominal aorta associated with a horseshoe kidney. A few points in the history of this 47-year-old patient deserve being underscored: the absence of an "etiological" factor of aortic dissection, the presence of five renal arteries, illustrating the complex vascularity of a horseshoe kidney, the specific surgical problems arising from both a lesion of the aortic junction and a horseshoe kidney. On the basis of the literature, we underline the incidence of dissection of the infrarenal aorta (1 to 3%), that of horseshoe kidney (0.15%) and that of pathology of the aortic junction in patients with a horseshoe kidney, which seems to be accidental.

The authors report about one case of bacterial endocarditis complicated by fungal aneurysms in a superior mesenteric and a popliteal site. While the diagnosis was easy for the popliteal aneurysm, it was not so for the mesenteric aneurysm. Arteriography must have wide indications. The treatment of such aneurysms must always be medical, but surgical as well. The surgical tactics must be carefully discussed, and the restoration of vascular continuity with autologous venous material through an extra-anatomic course should be preferred.

We report about a 66-years-old obese and diabetic female patient, treated with anti-inflammatories for osteoarthritis of the hip and operated for varices of the lower limbs by a bilateral stripping of the internal saphenous veins, who presented with a mortal necrotizing fasciitis during the postoperative period. Necrotizing fasciitis is a severe, infrequent disease jeopardizing the vital prognosis, in which an appropriate and early treatment (medical, using antibiotics, and surgical by extensive debridement) can prevent a fatal outcome. The most often involved germs are streptococci (45%). The association of anaerobic and aerobic germs sometimes causes mixed cellulitis. The vital prognosis is always threatened by postoperative fasciitis. The mortality rate ranges from 50 to 75%, the main causes of death being a septic shock or pulmonary embolism. The functional prognosis of the surviving patients depends on the extent and quality of surgery.

Between 1977 and 1986, 23 patients with pulmonary metastases were operated upon in a thoracic and cardiovascular surgery department, totalling 26 thoracotomies. The time elasped between treatment of the primary tumour and that of the metastasis (single or multiple) ranged from 11 to 89 months. The metastases were discovered on follow-up x-ray films of the chest in 15 cases. All patients underwent preoperative lung function assessment, pulmonary radiotomography or thoracic computerized tomography and bronchial fibroscopy. Surgery consisted of tumorectomy (12 cases), lobectomy (5 cases), pneumonectomy (3 cases), segmentectomy (1 case) and tumorectomy combined with lobectomy (1 case). In 2 patients only exploratory thoracotomy could be performed. The operative mortality was nil. The mean survival counted from the date of the last thoracotomy was 17 months (range 1 to 51 months). The mean absolute survival was 24 months (range 13 and 51 months). The actuarial survival rate was 60 percent at 1 year, 47 percent at 2 years and 26 percent at 3 years. Terminal respiratory failure was the main cause of death. Surgery within a multidisclinary approach of lung cancer must therefore spare as much lunch parenchyma as possible to preserve the patient's future.

Four patients aged over 70 received mechanical circulatory assistance for a period of 2 to 48 hours after myocardial revascularisation surgery. Three patients survived. The simplicity and modest cost of the method encourage the authors to use such assistance whenever necessary. This attitude is shared by other authors.

: A technique for the surgical treatment of bronchial fistulae developed after pneumonectomy is presented. This technique, which resembles that of Abruzzini, consists of resection of the carina followed by tracheo-bronchial suture in a healthy area away from any purulent focus of infection. It is easy to perform and facilitates the treatment of thoracic empyema which is no longer maintained by the fistula.

A technique for the surgical treatment of bronchial fistulae developed after pneumonectomy is presented. This technique, which resembles that of Abruzzini, consists of resection of the carina followed by tracheo-bronchial suture in a healthy area away from any purulent focus of infection. It is easy to perform and facilitates the treatment of thoracic empyema which is no longer maintained by the fistula.