Dilated hypokinetic cardiomyopathy in an acromegalic patient is an uncommon event. Specific hormonal therapy with octreotide (a somatostatin analogue) is now recognized as able to improve cardiac failure. A case of worsening of cardiac function under such a therapy is described in this report. Octreotide was finally discontinued and a cardiac transplantation performed. Soon after surgery, treatment with octreotide was started again and no other adverse reaction was noticed. Furthermore, no deleterious or synergistic interaction between the somatostatin analogue and cyclosporine A was detected. A pharmacological hypothesis is given to explain the inability of octreotide to counteract cardiac failure. The patient died 6 months after surgery probably because of an acute episode of arrhythmia.
During the last 10 years (1975-1985), a total of 18 cases of posttraumatic aneurysm at the level of the thoracic isthmus were operated on. Six of the 18 were women (19-71 years of age) and 12 were men (17-61 years of age). The mean age at the time of injury was, respectively, 22 and 25.8 years and, at the time of operation, 34.5 and 35.5 years. The patients were all involved in a motor vehicle accident, except for 2 (1 falling, 1 crushing). Thirty-nine percent of the patients had no apparent thoracic injury and 89% had associated injuries (bony fractures, craniofacial, visceral and abdominal). Eight of the 18 were asymptomatic at the time of operation, the others had various symptoms (pain, fever, dyspnea, cough, hoarseness, murmur, or hemoptysis). Enlargement of the aortic button was present in every case. Seventeen patients were operated on electively from 4 months to 50 years after the injury. Circumferential rupture was total in 9 patients and partial (2/3 to 9/10) in the others. Complete repair was done by either prosthetic Dacron tube (3), Dacron patch (2), or direct suture (12). Protection by femoro-femoral bypass was used in 3 and simple aortic cross-clamp was used in 14. Mean time of aortic cross-clamp was 36.9 minutes (range, 16-80 min). Among these 17 patients, there was no hospital mortality and no late death. One patient had regressive paraplegia. One patient was submitted to an emergency operation for an intrapulmonary rupture of an infected aneurysm and died in the operating room before completion of the repair.(ABSTRACT TRUNCATED AT 250 WORDS)
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