Barthe Je

Obstruction of aortocoronary bypass due to blunt chest trauma

We report the first case in the literature of acute myocardial infarction due to blunt chest trauma in a patient with saphenous vein aortocoronary bypass to the anterior descending coronary artery. Angiograms demonstrated two stumps - aortic and coronary - suggesting that the primary obstruction was at the graft level with subsequent anterior descending occlusion. A large left ventricular aneurysm developed. As his clinical situation was stable, early aneurysmectomy was not done, and the patient is asymptomatic 15 months after the trauma.

Penetrating aortic ulcer: Clinical and angiographic characteristics

Abstract“Penetrating aortic ulcer,” an atherosclerotic lesion with ulceration that penetrates the internal elastic lamina and allows hematoma formation within the aortic wall, is rarely considered in the differential diagnosis of patients with sudden onset of severe chest or back pain. It has been suggested that it is a pathologic process that involves elderly hypertensive patients with severe atherosclerosis and rarely has been observed in the ascending aorta. To determine the characteristics of this process, 11 clinical, 2 hemodynamic, 3 angiographic, and 4 surgical variables were compared between 10 consecutive patients with penetrating aortic ulcers and 20 matched patients with classic acute aortic dissection. Clinical and hemodynamic variables were similar in the two compared groups. In the group of patients with penetrating ulcer, mean age was 58±6 years, previous hypertension was observed in six patients and the penetrating ulcer was located in the ascending aorta in six cases. Compared with patients with aortic dissection, more angiographic projections were necessary to obtain the diagnosis in the group of patients with penetrating ulcer (2.4±0.8 vs 1.7±0.6;p<0.05). In addition, the presence of angiographic aortic valve regurgitation was only observed in the group of patients with acute dissection (60% vs 0%;p<0.01). Severe atherosclerosis was not present angiographically in any patient with penetrating ulcer. In conclusion, penetrating aortic ulcer can also affect middle-age patients without severe atherosclerosis and is frequently observed in the ascending aorta. Its form of presentation and clinical characteristics are similar to classic aortic dissection. The lack of confirmatory evidence of dissection with suggestive clinical history should raise the possibility of penetrating aortic ulcer.

Trombopenia e insuficiencia renal aguda tras tratamiento con estreptocinasa. Papel de los esteroides

La proteinuria es un fenomeno observado con frecuencia tras el tratamiento con estreptocinasa. Se ha sugerido el deposito de inmunocomplejos en el glomerulo renal como mecanismo mas probable. En cambio, la asociacion de plaquetopenia e insuficiencia renal aguda inducida por estreptocinasa es rara. Presentamos un paciente que sufrio un deterioro rapido de la funcion renal y de la cifra de plaquetas tras el tratamiento con estreptocinasa, normalizandose ambos tras la administracion de esteroides. Posteriormente, se comenta la probable patogenia inmunologica del cuadro. Tambien se discute sobre la posible utilidad de los corticoides en el tratamiento y/o profilaxis de cuadros de este tipo.