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Traumatic rupture of the aortic isthmus is a rare lesion occurring in patients subjected to violent deceleration. Because of the forces involved, it is frequently associated with concomitant life-threatening injuries. Non-invasive examinations such as CT and transesophageal echocardiography aid greatly in making the diagnosis. Urgent conventional repair is still considered the gold standard technique for cases of isolated rupture, or rupture without severe concomitant lesion where aortic clamping and heparinization will not impair post-operative outcomes. Urgent endovascular repair has been shown to be a feasible and efficient technique which may be proposed as a therapeutic option for patients with multiple trauma instead of delayed classical surgical repair after stabilization. Long-term results of endovascular repair need to be assessed before enlarging the indications of this technique in the emergency setting.

Lung transplantation has been developed over the last fifteen years as a therapeutic option for different forms of advanced-stage lung disease. Idiopathic pulmonary fibrosis is a good indication. For these patients, single lung transplantation is usually preferred, bilateral lung transplantation to a lesser extent. Survival is similar for these two types of transplantation. The post-transplantation survival in patients with pulmonary fibrosis is about 65-70% at one year and 40% at five years. This rate is lower than observed for COPD or cystic fibrosis. If there are no complications, the patient can recover nearly normal lifestyle. Among the different complications, reimplantation edema, infection, rejection, and bronchial complications predominate. Chronic rejection, also called obliterative bronchiolitis syndrome, is a later complication which can be observed in about half of the patients. Improvement in graft survival depends greatly in improvement in prevention and management of complications. Despite such complications, graft survival in fibrosis patients is greater than spontaneous survival on the waiting list; idiopathic fibrosis is associated with the highest mortality on the waiting list. Patients should be referred early for the pre-transplantation work-up because individual prognosis is very difficult to predict.

Unlabelled: THORACIC PAINFUL SYNDROME: Penetrating atherosclerotic aortic ulcers represent a condition in which an atherosclerotic plaque ulcerates and disrupts the internal elastic lamina, allowing intramural hematoma formation into the aortic media. Recently individualized as an entity from all vascular thoracic painful syndromes, they affect preponderantly the elderly patients with a medical hypertensive and atherosclerotic history and with multiple cardiovascular risk factors. The descending thoracic aorta is most frequently involved., Imaging: Computed tomography scanning and magnetic resonance imaging tend to replace aortography in providing an accurate diagnosis of the ulceration and of its parietal extent. Moreover, they allow the discrimination with aortic dissection or with intramural hematoma without intimal rupture which outcome and treatment should differ., Risks: In the absence of complication, progressive aneurysmal dilatation at the level of the ulcer is a rule. Pseudoaneurysms formation, embolization, and acute transmural aortic rupture can however occur and may justify, in selected cases, a preventive or curative surgical treatment. STENT-GRAFTING: Endovascular stent-grafting techniques may appear as a safe and effective less invasive choice in high-risk patients with suitable anatomical conditions.

Lung volume reduction surgery in emphysema has, as an objective, the reduction of dyspnoea and an increase in the exercise tolerance in patients with respiratory insufficiency suffering from diffuse emphysema. In principle the resection of the most diseased areas of emphysema leads to improvement in the mechanical properties of the emphysematous lung and correct pulmonary hyperinflation. The respiratory function benefits both objective and subjective, produced by surgery are real but transitory and inconstant depending in particular on the evolutionary profile of the emphysematous disease. The indications should be further refined and an objective comparison of different surgical techniques has not been achieved. The impact on the quality of life for these patients is unknown.

Primary hyperhidrosis of the upper limbs has an important impact on the subject's social and psycho-affective equilibrium. These patients have two main problems. First physicians are not sufficiently aware of the therapeutic possibilities and secondly the generally poor reputation of surgery in this indication. Transthoracic endoscopic sympathectomy has completely changed the treatment of hyperhidrosis of the upper limbs. It is now considered to be the reference treatment in severe cases. The surgical procedure is simple and allows simultaneous treatment of both sides. There is no mortality and morbidity is extremely low quantitatively and of little consequence qualitatively. The therapeutic protocol is short and immediate and long-term results are excellent in 98 to 100% of the patients.

Aneurysms of the abdominal aorta associated with periaortic fibrosis (AFPA) are a different clinicopathological entity from atheromatous aneurysms and nonspecific inflammatory periaortitis. The physiopathology and diagnostic and therapeutic modalities for these AFPAs are controversial. Over a 12-year period, 23 aneurysms with periaortic fibrosis (4%) confirmed by a histological study were operated at Beaujon hospital. Four patients were operated at the rupture stage, 2 with acute rupture and 2 with contained chronic rupture. Uni- or bilateral ureteral obstruction was noted in 8 patients. The diagnosis was suspected preoperatively in 60% of cases. Surgery confirmed the accuracy of the anatomical information provided preoperatively by the CT examination performed in 9 patients. Debridement and grafting were performed in 22 patients. Three patients with associated ureteral obstruction were treated with ureterolysis during the same operative step at the beginning of our experience. Later on, 3 documented cases of hydronephrosis receded after the isolated debridement and grafting of the aneurysm. Hospital mortality was of 5% in 19 patients operated electively. Two patients died later, after 2 months and after 5 years, and 16 are still alive and without symptoms at present, after and average time lapse of 68 months.(ABSTRACT TRUNCATED AT 250 WORDS)

Despite improvements in the treatment of risk factors for atherosclerosis, the incidence and mortality rate for aneurysms of the abdominal aorta have increased during the past 40 years. The prevalence of these aneurysms is 2.5 percent in unselected populations but reaches 13.5 percent in selected populations. The pathogenesis of aneurysms involves multiple factors and the lesion is progressive, leading to lethal rupture in 25 percent of the cases. In elective surgery of abdominal aortic aneurysms the mortality rate is about 2 percent, as against 60 percent in emergency surgery for rupture. The presence of such aneurysms must be detected primarily in populations at risk, using physical examination and abdominal ultrasonography. If this is done, the ratio of detection costs to benefits of preventive surgery is in favour of a decidedly active approach of this dangerous disease.