No. 203-Rubella in Pregnancy.

Objective: To provide an update on rubella and pregnancy so that health professionals remain aware of the potentially devastating effects on the developing fetus.

Outcomes: Rubella vaccination has been effective in virtually eliminating congenital rubella syndrome in Canada.

Evidence: Medline, PubMed, and Cochrane Database were searched for articles published between 1985 and 2007.

The fetal safety of hydrocortisone-pramoxine (Proctofoam-HC) for the treatment of hemorrhoids in late pregnancy.

Objective: Fetal safety has never been studied for any drug used in the treatment of hemorrhoids. Proctofoam-HC is a combination of a corticosteroid and a local anaesthetic that is proven effective for the treatment of hemorrhoids. The objective of this study was to assess prospectively the fetal safety of third trimester exposure to Proctofoam-HC.

Rubella in pregnancy.

Objective: To provide an update on rubella and pregnancy so that health professionals remain aware of the potentially devastating effects on the developing fetus.

Outcomes: Rubella vaccination has been effective in virtually eliminating congenital rubella syndrome in Canada.

Evidence: Medline, PubMed, and Cochrane Database were searched for articles published between 1985 and 2007.

A randomized trial comparing oral misoprostol with intra-amniotic prostaglandin F2alpha for second trimester terminations.

Objective: To compare the efficacy of oral misoprostol with that of intra-amniotic prostaglandin F2alpha (PGF2alpha) for second trimester pregnancy termination.

Methods: One hundred seventeen women with pregnancies of between 16 and 22 weeks' gestation were randomly assigned after insertion of laminaria to receive either oral misoprostol 400 microg every 4 hours (to a maximum of four doses) or intra-amniotic PGF2alpha 40 mg. The rate of complete abortion within 24 hours was the primary outcome for power analysis.

[Development of circulatory support during 420 aneurysm resections of the descending thoracic aorta].

From July 1974 to January 1996, 420 aneurysms of the descending thoracic aorta were surgically treated at l'Hôpital du Sacré-Coeur de Montréal. Three principles were previously established and rigorously respected: 1) the preservation of distal body perfusion, 2) the briefest aortic cross-clamp time realizable (mean: 29.8 +/- 16 minutes overall, reduced to a mean of 24 +/- 6 minutes for the last 250 cases), 3) keep the aortic resection as short as possible in order to preserve as many intercostal arteries as possible (10 cm or less in 91.

Benign pneumopericardium and tamponade.

A 49-year-old obese female was admitted for acute onset pleuritic chest pain. Previous history was significant for surgical correction of a lower esophageal ring. Echocardiography revealed a pericardial effusion, which resolved with steroids.

Aneurysms of the descending thoracic aorta: three hundred sixty-six consecutive cases resected without paraplegia.

Purpose: The aim of this study was to present a 20-year experience with a single method of passive distal perfusion during descending thoracic aortic aneurysm resection.

Methods: Aortic repair with a Dacron graft interposition was performed for 366 consecutive aneurysms located between the left subclavian artery and the crux of the diaphragm. The extent of aorta resected in 335 patients (91.

Surgical repair of traumatic tricuspid insufficiency: report of three cases.

Traumatic tricuspid insufficiency (TTI) is a rare lesion but is classically encountered as a "steering-wheel injury" in nonbelted car divers. This lesion is often not diagnosed because of its subtle clinical manifestations at first and the presence of associated injuries in multiple trauma. The majority of patients reported were treated with valve replacement but, more recently, successful repair of the native valve has made the latter the treatment of choice.

[Traumatic tricuspid insufficiency with a right-to-left shunt and heart luxation].

Traumatic tricuspid insufficiency (TTI) with a right-to-left shunt through a patent foramen ovale associated with a cardiac herniation was identified in a 39-year-old man with severe hypoxemia. All reported cases of TTI with a right-to-left shunt are reviewed, the technical aspects of repair described and the physiologic mechanisms discussed.

[Heart-skin syndrome and cardiac myxoma: presentation of a case and clinical experience of 17 years].

Between 1971 and 1988, cardiac myxoma was identified in 13 (0.003%) of 4000 patients who underwent open-heart surgery at the hôpital du Sacré-Coeur in Montreal. One patient with multiple right atrial tumours also had abnormal cutaneous pigmentation compatible with the recently identified syndrome of "Carney's complex.

Small-volume resuscitation.

Small-volume resuscitation with hypertonic saline is an attractive modality but is still at an early stage of experimental and clinical investigation. Aggressive resuscitation from traumatic, hypovolemic shock could be facilitated during the prehospital phase, but hypotension remains a physiological and beneficial compensatory mechanism to minimize active bleeding until definitive care is provided. Despite encouraging results, the author concludes that, at present, hypertonic saline cannot be considered a truly "magic potion" for resuscitation of the trauma patient.

Intrapericardial trauma: surgical experience.

From 1975 to 1987, 19 patients (pts) were operated on for a traumatic lesion of the heart or of the ascending aorta. There were 15 males and four females with a mean age of 42 years. Twelve lesions (Group I) were penetrating and seven (Group II) blunt.

Surgery of the descending thoracic aorta: spinal cord protection with the Gott shunt.

From July, 1974, to July, 1987, surgical treatment of descending thoracic aortic aneurysms was performed in 173 patients at l'Hôpital du Sacré-Coeur de Montréal. The cause of the aneurysms was arteriosclerosis or medial degeneration in 83 patients, trauma in 50, dissection in 34, and a congenital malformation in 6. A single method of external shunting provided distal perfusion in all patients in the series.

Penetrating chest trauma: a 20-year experience.

From 1965 to 1985, 76 patients were admitted to Sacré-Coeur Hospital, Montreal, with a diagnosis of penetrating chest trauma (PCT). The majority were under the age of 30 years and almost two thirds suffered gunshot wounds. Sixty-seven (88.

Surgical treatment of bronchogenic carcinoma: the importance of staging in evaluating late survival.

From 1971 to 1980, 1292 patients with lung cancer were admitted to the Hôpital du Sacré-Coeur de Montréal. This diagnosis represented 0.5% of admissions in 1971 and 1.

Acute and chronic traumatic aneurysms of the descending thoracic aorta: a 10-year experience with a single method of aortic shunting.

A 10-year experience in the surgical treatment of traumatic aneurysms of the descending thoracic aorta is reviewed. This series included 40 patients equally divided into two groups. Group I comprised 20 acute ruptures and group II, 20 chronic traumatic aneurysms, all situated at the aortic isthmus.

Acute dissection of the descending thoracic aorta: repair in an unusual case.

Acute tamponade, although a rare manifestation of a descending thoracic aneurysm, was the dominant clinical feature of a classic type III dissecting aneurysm (arising distal to the left subclavian artery) in a 52-year-old man. High-quality aortography confirmed the diagnosis, ruling out any anomaly of the ascending aorta and the aortic arch. Surgical treatment was carried out 24 hours after the initial episode without cardiopulmonary bypass.

Staged resection of a life-threatening aneurysm of the descending thoracic aorta and a coexisting aneurysm of the ascending aorta.

The authors report the successful staged resection of a descending thoracic aortic aneurysm and a coexisting ascending aortic aneurysm. The main challenge was to provide optimal proximal aortic decompression to prevent rupture of the ascending aorta during the distal repair. During the period of aortic arch cross-clamping, organ protection was achieved with a Gott shunt inserted proximally in the aortic arch and distally in the left common femoral artery.

Major mediastinal vascular injuries.

Surgical repair was carried out in 37 patients who had rupture of the thoracic aorta or major branches. The survival rate was 90% (33 of 37). Three deaths occurred in the acute phase, giving a survival rate of 87% (19 of 22).