Advances in laparoscopic surgery.

After a brief account of the origins of laparoscopy and of its development into an interventional technique thanks to technical improvement, the author gives a dynamic state of the art in laparoscopic surgery, beginning with a description of his original classification method for laparoscopic procedures according to their level of use. Before tackling the highly controversial issue of laparoscopic surgery for cancer, he reviews in detail the various operations successfully performed by laparoscopy for the treatment of nonmalignant abdominal disorders and acute syndromes, all the while checking their results against those obtained with their open counterparts. As the various procedures are described, the interest of the laparoscopic approach becomes clearly visible, based on the excellent view of the operative field that allows diagnostic accuracy, thus avoiding unnecessary operations, and precise dissection with minimal damage.

Radiofrequency catheter ablation of common atrial flutter in 200 patients.

Introduction: The purpose of this study was to evaluate the efficacy and safety of radiofrequency (RF) catheter ablation of common atrial flutter and to determine the optimum target sites in a large series of patients. Three different approaches were used to target the ablation site. The first used a combined anatomic and electrophysiologic approach, whereas the second and the third approaches relied primarily on anatomic guidelines to target the critical area in the atrial flutter reentrant circuit located in the low right atrium.

CD30-positive cutaneous large cell lymphomas. A comparative study of clinicopathologic and molecular features of 16 cases.

The authors have analyzed and compared the clinicopathologic and molecular features of 16 cases of large cell cutaneous lymphomas expressing CD30 antigen. Three main clinical groups were defined: (1) a group of localized skin disease (7 cases); (2) a group of multicentric skin disease (5 cases); and (3) a group of concomitant skin and extracutaneous disease. Good prognosis was associated with localized skin disease and no history of lymphoma.

Radiofrequency catheter ablation of common atrial flutter in 80 patients.

Objectives: The purpose of this study was to evaluate the efficacy and safety of radiofrequency catheter ablation of common atrial flutter and to determine the optimal target sites in a large series of patients.

Background: Recent studies report the efficacy of radiofrequency current application in the low right atrial region to interrupt and prevent recurrences of common atrial flutter. However, larger groups of patients are required to confirm the efficacy of this technique and to specify the target sites.

Overview of peripheral blood progenitor cell usage in France.

Peripheral blood progenitor cell (PBPC) transplantation offers a number of advantages over the use of bone marrow (BM) cells. Both the number and percentage of transplants performed with blood cells in France increased dramatically from 1990 to 1992. This report presents an analysis of 573 patients who underwent autologous transplantation of PBPC without BM.

Successful catheter ablation of atrial fibrillation.

Introduction: Catheter ablation of a case of incessant atrial fibrillation was attempted using linear right atrial lesions created by sequential applications of radiofrequency energy.

Methods And Results: A 46-year-old patient had incessant episodes of atrial fibrillation. He had previously undergone successful radiofrequency catheter ablation of a common atrial flutter.

Involvement of a nodofascicular connection in supraventricular tachycardia with VA dissociation.

We present the case of a patient with episodes of supraventricular tachycardia and atrial dissociation that were terminated by either adenosine or verapamil. Involvement of an accessory pathway was shown by ventricular extrastimuli, elicited during His-bundle refractoriness, that interrupted the tachycardia or advanced the next His potential. The tachycardia circuit was demonstrated to be confined to the nodofascicular region based on the exclusion of surrounding tissues.

Laparoscopic cholecystectomy: the state of the art. A report on 700 consecutive cases.

Born in secret in 1987, developed in an atmosphere of skepticism and even hostility throughout 1988, the laparoscopic cholecystectomy triumphed in 1989-90 and caused a veritable revolution in the world of general surgery. The 700 consecutive cases that we report here reflect the spirit of these various periods. From prudently restrictive, our indications widened to include 90% of all patients with gallbladder lithiasis.

Assessing prosthetic heart valve function. Value of Doppler echocardiography and patient/prosthetic valve identity and follow-up card.

Doppler echocardiography is being used increasingly in the follow-up of patients with valvular heart prostheses because it provides unique hemodynamic information about flow through prosthetic valves. A baseline checkup about 3 months after implantation is now recommended. We therefore now supply each patient with an identity and follow-up card for each particular prosthesis.

[Transesophageal echocardiography in infectious endocarditis].

During the past 20 years, TTE has acquired a role of choice in the positive diagnosis as well as in the prognostic evaluation of endocarditis. However, it is a non-histobacteriological technique and is also operator-dependent. If often enables the detection of high risk patients: large vegetations, severe valve damage with major leaks, threatened complications: abscess, fistula, sometimes leading to referral of the patient for emergency surgery when required by hemodynamic conditions (often without recourse to catheterisation) or when infection is uncontrolled despite proper medical treatment.

Unilateral diaphragmatic paralysis: an electrophysiological study.

An electrophysiological study was carried out on four patients with unilateral diaphragmatic paralysis. Whereas neurogenic involvement of the paralysed hemidiaphragm was roughly similar in all cases, neurogenic patterns could be detected in the normally moving contralateral hemidiaphragm in three cases, and the degree of involvement could be correlated with the respiratory state of the patients. EMG also showed that the neuropathic process affected the limb muscles.

[Morphological and functional characteristics of the heart in untreated hypertension].

Unlabelled: To better define the different forms of hypertensive heart disease, we performed 2D guided M mode echo recording of the left ventricle (LV) and Doppler assessment of LV filling in 118 newly recognised (less than 1 year) and untreated hypertensive patients (mean age +/- SD: 49 +/- 10 years, 80 males, 38 females). All recordings were read "blindly". 86 patients underwent also 24 hours BP monitoring during daily routine.

Effects of perindopril on left ventricular hypertrophy, coronary blood flow, and mechanical properties of cardiac muscle in renovascular hypertensive rats.

We studied the effects of perindopril on left ventricular hypertrophy, systemic and coronary hemodynamics, and mechanical cardiac performance in renovascular hypertensive rats (Goldblatt, two-kidneys, one-clip). Systemic and coronary hemodynamics, before and after carbochrome infusion, were assessed by radioactive microspheres injection via an atrial catheter in conscious rats. Mechanical performance was measured on isolated papillary muscle from the same animal.

Interruption of professional and home activity after laparoscopic cholecystectomy among French and American patients.

With a laparoscopic approach, patients can undergo cholecystectomy with a shorter hospitalization, minimal pain, and quicker recovery. It has not been demonstrated, however, that patients actually return to work after laparoscopic cholecystectomy faster than the traditional 4- to 6-week absence from work after a standard open procedure. A survey of 104 French and 84 American patients undergoing laparoscopic cholecystectomy revealed that postoperative discomfort was completely resolved in 2 weeks in 73% of French and 93% of American patients.

Laparoscopic cholecystectomy using intracorporeal lithotripsy.

Over a 13-month period (November 1988 to December 1989), we performed our first 104 laparoscopic cholecystectomies using an intracorporeal ultrasonic lithotripsy technique. The procedure in three of these patients was converted to an open operation because of hemorrhage with unexpected findings of cirrhosis in two patients and dense subhepatic adhesions in a third. Endoscopic retrograde cholangiopancreatography was successfully used in three other patients in whom common bile duct stones were identified.

[Value and limitations of transthoracic Doppler echocardiography in the diagnosis of thromboses of mechanical valve prosthesis. Report of 19 cases].

The diagnosis of thrombosis of a valvular prosthesis is difficult especially in cases of partial thrombosis. The authors report 19 cases of partial thrombosis of mainly (16 cases) mechanical valve prostheses confirmed by radioscopy and treated either by reoperation or fibrinolysis. Mitral Valve Prostheses: 14 cases (6 Björk, 7 SJM, 1 Carbomedics).

[Study of infectious endocarditis using Doppler echocardiography].

Infective endocarditis is still a common and serious disease. Echocardiography is an essential complementary investigation in this condition. Its value in the diagnosis of valvular vegetations has become more accurate since the introduction of two-dimensional and transesophageal echocardiography.

Left ventricular mass changes with nicardipine therapy in essential hypertension.

Eighteen hypertensive patients (13 males, 5 females; age 48 +/- 13; diastolic blood pressure greater than 95 mmHg), either previously untreated or who had been off treatment for more than 3 months, underwent M-mode echocardiography before (DO) and after (D90) 3 months of nicardipine therapy (60-90 mg/day). All echocardiograms were read blind, and left ventricular mass (LVM) was calculated (Devereaux's formula). Blood pressure was significantly reduced after 3 months from 167 +/- 15/102 +/- 8 mmHg on DO to 152 +/- 16/92 +/- mmHg on D90 (p less than 0.

Relationship between left ventricular mass and noninvasive monitoring of blood pressure.

We studied the relationship between left ventricular mass index (LVMI) and blood pressure (BP) monitored during 24 hours in 35 normotensive and 58 hypertensive patients with no treatment for more than three months. We found a close correlation between LVMI and the average daytime systolic BP (r = 0.68).

ACE inhibitors in mild to moderate hypertension: comparison of lisinopril and captopril administered once daily. French Cooperative Study Group.

A double-blind, parallel-group, multicentre study was carried out to compare the effects of once-daily treatment with lisinopril 20 mg and captopril 50 mg in 304 patients with mild to moderate hypertension. Following a 2-week placebo run-in period, patients with a lying DBP between 95 and 115 mmHg were randomised to either active treatment for 10 weeks. BP measurements were made approximately 24 h after the previous dose of either drug.

Left ventricular mass in normotensive subjects. Importance of blood pressure response to activity.

Recent works have shown the importance of blood pressure (BP) response to exercise or to daily activity as determinants of hypertensive cardiac hypertrophy. We have tested the relationship between BP and left ventricular (LV) mass in 23 normotensive young adults (mean age 25 +/- 5) with normotensive parents. Blood pressure was measured at rest, at the end of maximal exercise test, and during 24-hour ambulatory monitoring during daily routine.

[Current aspects of Ebstein's disease].

Ebstein's disease is a rare affection which is more and more frequently discovered since the advent of sonocardiography. As a matter of fact, except in the loud but less frequent neonatal forms, Ebstein's disease appears, most of the time, in the first three decades of life under various, misleading forms. The diagnosis is, today, greatly facilitated by bi-dimensional sonocardiography.

[Should nocturnal arterial pressure be monitored in treated hypertensive patients?].

Ambulatory blood pressure monitorings for diagnosis purpose in non treated hypertensive patients are often performed only during day time for two reasons. First, target organ responses to hypertension, and mainly left ventricular hypertrophy, are more closely related to activity than to rest BP. Second, these automatic devices are frequently not well tolerated during sleep because of their noise during inflation of the cuff.