Predictive factors of stroke in patients undergoing coronary bypass grafting: statins are protective.

BACKGROUND: Despite major improvement in surgical techniques and intensive care management, stroke remains one of the most devastating complications of coronary artery bypass grafting (CABG). We aimed to determine factors predicting the occurrence of stroke during CABG. A special interest was focused on preoperative therapies. METHODS: We prospectively enrolled 810 consecutive candidates for CABG alone in a specific database, including all pre- and perioperative data (history, clinical, therapeutic, cardiac catheterization, surgical and intensive care data). Univariate tests and then multiple logistic regression analysis were used to determine independent predictive factors. RESULTS: During the first postoperative month, stroke occurred in 11 cases and transient ischemic attack (TIA) in 4 additive cases (cumulative rate: 1.85%). After the multivariate analysis, the following factors remained significant (p<0.05) in the predictive model, with corresponding odds ratios between brackets: redo cardiac surgery (7.45), unstable cardiac status (4.74), past history of cerebrovascular disease (4.14), past history of peripheral arterial disease (3.55), whereas the presence of preoperative statins was protective (0.24, 95% IC: 0.07-0.78). The addition of perioperative data (aortic calcification, postoperative arrhythmia, on/off-pump surgery) did not change the final predictive model. CONCLUSION: To our knowledge, this is the first real-world observational report highlighting the interest of statins for the prevention of stroke in the very special situation of CABG. Even though according to randomized trials coronary patients have a benefit from these drugs, a special level of interest should be directed towards those presenting the above-mentioned risk factors.     

Mechanical circulatory assistance after coronary surgery in patients over 70 years of age

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.     

Necrotizing fasciitis: a medical and surgical emergency. Apropos of a case]

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.     

Imaging aspects of sphenoid during development

To show the different steps of ossification and pneumatization of the sphenoid bone in children in order to emphasize normal anatomic variations. CT scanners and MRI studies of children up to 15 year old performed for various craniofacial conditions, without suspected involvement on cranial growth, are presented. The normal process of the ossification, of the closure of the synchondroses and of the pneumatization is demonstrated. Some examples of congenital abnormalities are also shown. The knowledge of these normal steps and variations is essential, in order to properly evaluate traumatic or congenital situations, but is also helpful for the diagnosis of bone dysplasias and bone marrow diseases (tumor or hematologic disorders).     

Cannonball pulmonary hamartochondroma. Apropos of a case--review of the literature]

Chondroid hamartomas disseminated in both lung fields were discovered in a 76 year old man presenting with recurrent haemoptysis. In view of this metastatic cannonball appearance and the negative investigations, exploratory thoracotomy was performed, revealing the correct diagnosis. Although classical, this form of hamartoma is rare and warrants a case report.     

Bacterial endocarditis complicated by popliteal and mesenteric aneurysms]

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.     

Mésothéliome malin primitif du péritoine

Introduction

Peritoneal mesothelioma is a rare disease. Its diagnosis is difficult. It is based on immunohistochemical study. Its symptoms are non specific. Treatment suffers from the lack of standard therapy. Prognosis remains moderate especially with the trials cytoreductive surgery associated with intraperitoneal chemotherapy. We report the case of a patient followed at the medical oncology department of the university hospital Hassan II of Fez.

Patient and observation

A 54 years-old patient had a progressive increase in abdominal volume evolving in a context of deterioration of general condition, clinical and radiological examination found an ascitis with peritoneal thickening, and the diagnosis of primary malignant mesothelioma of the peritoneum was confirmed by immunohistochemical study.

Conclusion

Malignant peritoneal mesothelioma is a rare tumor, which suffer from the lack of a standard treatment hence the need of a multidisciplinary approach and the inclusion of patients in clinical trials.