A new technique for double lung transplantation. "Bilateral single lung" transplantation.

Two techniques are currently practiced to achieve bilateral lung transplantation for the treatment of patients with end-stage pulmonary disease associated with infection: heart-lung transplantation, which is illogical, and double lung transplantation by the Toronto technique, which is difficult and entails tracheal complications. After our short experience with single lung transplantation without any bronchial problems, we have performed three double lung transplantations by a new technique, "bilateral single lung" transplantation. After a sternal bithoracotomy, first one lung was transplanted and then the other, without cardiopulmonary bypass.

[Etomidate modifies hemodynamic response to fentanyl in patients with impaired left ventricular function].

The haemodynamic effects and the side-effects of anaesthesia using high doses of fentanyl were compared in two groups of 12 patients each. All the patients had poor left ventricular function and were scheduled for elective coronary artery bypass graft surgery or valvular replacement. Patients were randomly assigned to either group.

Left lower lobe transplantation during a bilateral single lung transplantation (pulmonary lobe transplantation).

An isolated left lower lobe was used as a left graft, during a bilateral single lung transplantation procedure, in a patient with infected fibrosis. This technique is suitable for patients with small lung volume (especially cystic fibrosis) or asymmetric retraction.

Bilateral single lung transplantation. Complications and results in 14 patients.

Between November 1989 and April 1991, 14 bilateral single lung transplantations (BSLT) were performed at our institution using the technique we have described without omentoplasty and rarely cardiopulmonary bypass. The indications included emphysema (8), cystic fibrosis (3), infected fibrosis (1), alveolar microlithiasis (1) and lymphocytic interstitial pneumonitis (1). Maximum mean pulmonary artery pressure was 53 mmHg and minimal right ventricular ejection fraction was 15%.

[Donor-recipient lung volume matching in double lung transplantation. Value of left lower lobe graft].

For double lung transplantation, lung volume matching is easier comparing the predicted total lung capacities of the donor and recipient and the recipient's true TLC. The major concern in the inability to close the chest when the donor lungs are too large. The technique reported of left lower lobe implantation during bilateral single lung transplantation might be of great value in patients with small lung volume.

[Tennis elbow].

Tennis elbow is most often due to a tendinitis of the extensor carpi radialis brevis, and occasionally of the extensor digitorum. Pain felt at the outer aspect of the elbow, is elicited by grasping. Passive movements are painless, and of full range, excepted for extension, and varus strain tested in slight flexion.

[Traumatic amnesias. Memory disorders consecutive to head injuries].

Traumatic amnesia is a good index predictive of the disablement due sequelae of cranial injuries. The residual memory deficit, correlated with the return to work, mainly affects long-term memory, learning, verbal memory and sensitivity to interferences. The most relevant tests are Rey's 15 words--and particularly their retrieval at 30 minutes--and the verbal fluency test, but the changes in memory observed in the patient's daily life must also be evaluated.

High-dose alfentanil for myocardial revascularization: a hemodynamic and pharmacokinetic study.

It has been suggested that high plasma levels of alfentanil are required in order to control hemodynamic responses to noxious stimuli in patients undergoing myocardial revascularization. The present study was designed to determine the hemodynamic profile in 10 patients and the time course of alfentanil plasma concentrations and pharmacokinetics (7 patients) during and following coronary artery surgery using alfentanil administration based on an overdosage principle. Premedication consisted of lorazepam, 0.

Tremor and idiopathic dystonia.

The clinical and electromyographic characteristics of tremor were studied in 45 patients presenting with various forms of idiopathic dystonia. Dystonic tremor was shown to be postural, localized, and irregular in amplitude and periodicity, absent during muscle relaxation, exacerbated by smooth muscle contraction, and associated frequently with myoclonus. Although it resembles essential tremor, dystonic tremor seems to be a distinct entity: it is more irregular with a broader range of frequencies; it is asymmetric and remains localized; myoclonus is sometimes associated.

[A new technique for double lung transplantation. "The bilateral single lung transplantation". Apropos of ten operations].

The technique of enbloc double lung transplantation described by the Toronto team, with cardiopulmonary bypass, cardioplegia, and tracheal suture is complicated by problems of tracheal anastomosis for its authors. Single lung transplantation has a more straight forward postoperative course and bronchial complications are moderate. We present a new technique of lung transplantation, the "bilateral single lung transplantation".

[Ovarian cysts in women over 50 years of age. A retrospective study from 1979 to 1989 at Foch Medicosurgical Center].

This was a retrospective study for the years 1979 to 1989 involving histological examination of ovarian cysts in women over 50 years who underwent surgery in our Department. A higher incidence of malignant tumours was found (32%), associated with a late diagnosis (70%) diagnosed stage III or IV). There was a higher incidence of fibrothecomas (10%) among benign tumours and functional cysts were only found in non menopausal or recently menopausal women taking hormone replacement therapy.

[Mirizzi's syndrome].

Six cases of Mirizzi syndrome are reported. The syndrome consists of a special anatomical variant of the cystic duct, which has a low opening but runs side-by-side with the common bile duct, associated with entrapment of a gallstone in the cystic duct or the neck of the gallbladder, partial or total obstruction of the hepatic duct by the stone and by inflammatory lesions, and recurrent cholangitis. Clinical signs are non-specific and suggest at first sight an obstructive jaundice.

[Converting enzyme inhibitors in the treatment of arterial hypertension].

Angiotensin converting enzyme inhibitors, in comparison with other antihypertensive agents, offer unquestionable advantages in the treatment of hypertension. They do not alter cerebral blood flow. They improve cardiac function by decreasing postload, by preventing left ventricular hypertrophy and by decreasing myocardial excitability which engenders dysrhythmias.

[Hematomas of the rectus abdominis muscle. 27 cases].

A series of 27 haematomas of the rectus abdominis muscle is reported; 10 occurred under anticoagulants, 6 were spontaneous, 5 followed a trauma, and 6 were consecutive to a surgical procedure. The clinical picture was subacute in 20 cases, with abdominal pain and extensive ecchymosis, acute in 4 cases, and reduced to an abdominal mass in 3 cases. Since 1977, ultrasonography has been of considerable help in the diagnosis, which was found to be accurate in 5 out of the 10 cases seen before its introduction, and in 13 out of the 14 cases where it was used among the 17 cases recorded later.

[Effects of converting enzyme inhibition by enalapril on renal hemodynamics in essential arterial hypertension].

The effects of enalapril, an angiotensin-converting enzyme inhibitor, on renal haemodynamics were studied in 10 patients with moderates essential hypertension and no renal failure. Renal blood flow and glomerular filtration were measured (by I 131-hippuran and I 125-iothalamate clearances respectively), before ("placebo period"), and after 15 days of treatment with enalapril 40 mg/day. The drug clearly had an antihypertensive effect: systolic pressure fell from 169 +/- 4 to 149 +/- 5 mmHg (P less than 0.