[Value of a long duration temporary caval filter in critical thrombo-embolic situations]. / Intérêt d'un filtre cave temporaire de longue durée dans les situations thrombo-emboliques difficiles.

In the event of proximal venous thrombosis with a risk of pulmonary embolism, contraindications to or complications of anticoagulant treatment are not uncommon in surgical or intensive care units. These are worrying but temporary situations and represent a classic indication for partial interruption of the inferior vena cava, for which permanent caval filters are not usually suitable. Temporary filters are an attractive option in this context, as long as they are safe and stable, can be left in place long enough to permit normalization of the thrombosis and anticoagulation problems and can then be removed in all circumstances, whether or not they have trapped a thrombus while in place. Most temporary filters do not meet all these criteria and nor do permanent filters with a removal option. We tested the new Tempofilter II filter with increased stability, which has a smooth geometry and can be implanted for up to 6 weeks, in 13 patients. We selected two documented cases concerning, firstly, a contraindication to anticoagulants and, secondly, recurrent thrombosis in heparin-induced thrombopenia. In both cases, the filter trapped a thrombus and prevented a pulmonary embolism, which would have been poorly tolerated and difficult to treat. The filters were removed without any difficulty after 4 and 6 weeks. We did not observe any complications related to infection or migration. Monitoring is recommended throughout the implantation period, in order to identify any clots trapped in the filter and to monitor their lysis or non-emboligenic fibrous structure, authorising removal of the filter.

Influence of the teleradiology technology (N-ISDN and ATM) on the inter-hospital management of neurosurgical patients.

We set out to assess the influence of a teleradiology network on the relations between a general hospital and a 100 km distant university hospital in the context of neurosurgical emergencies, and compared a commercially available technology, N-ISDN (Narrowband Integrated Service/Digital Network), to an emerging technology, ATM (Asynchronous Transfer Mode). The evaluation was conducted using records of advice request calls and patient transfers. Three phases were considered: without teleradiology, with transfer of digitized images over N-ISDN at 64 kbps, and with an experimental ATM network at 10.5 Mbps with DICOM image transfers and videoconferencing. Additionally, staff meetings over ATM videoconferencing were set up. To assess the ATM service, we used log files and questionnaires, 108 advice requests were studied over a 18 month period. The average transmission time for one examination was 38 s with full DICOM image resolution over ATM, versus 150 s with 10:1 JPEG (Joint Photographic Expert Group) compression over N-ISDN. Up to 50% unnecessary patient transfers were avoided. Advice requests increased fourfold, and non-urgent advice requests increased from 0 to 21%. Despite the experimental configuration of the ATM network, the service gave satisfaction to all the physicians. Videoconferencing was unanimously regarded as a prominent tool to improve the quality of interaction. It was particularly useful for non-urgent cases and distant staff meetings. Teleradiology can improve the relations between hospitals through an increase of urgent and non-urgent advice requests. Asynchronous transfer mode is an efficient way for fast transfer of radiological examinations in DICOM format and for discussing them through high-quality videoconferencing.

[Genetic and environmental factors implicated in recurrent calcium lithiasis]. / Facteurs génétiques et environnementaux impliqués dans la lithiase calcique récidivante.

In this prospective study, we compared the frequency of some genetic and environmental factors possibly implicated in the occurrence of calcium stone disease. A group of 439 patients (258 males and 181 females) with one episode of calcium stone was compared to a group of 191 patients (131 males and 60 females) with recurrent calcium stone disease. Population with stones was also compared to control population (n = 78, 40 males and 38 females) matched to age. Major results were as follow: 1) Family history of urinary calculi was more frequent in patients than in controls (28.4% vs 9%, p < 0.01). No difference was observed between patients with one episode and those with recurrent episodes (27% vs 31%, ns). 2) The recurrence was earlier in female than in male, so that in female with family history of urinary calculi (p < 0.05). 3) Mean plasma levels of 1-25OH2D3 was significantly higher in patients with family history than in controls (60% vs 38%, p < 0.01) 5) Restricted calcium diet (< 400 mg per day) was more often observed in patients than in controls (31% vs 14%, p < 0.05) and the most significant difference was found in patients with recurrent calcium stones.

[Short and long term complications of lithotripsy on renal function]. / Séquelles à court et moyen termes de la lithotripsie sur la fonction rénale.

Today, most stones can be removed by minimally invasive means. Extracorporeal Shock Wave Lithotripsy (ESWL) is the preferred form of treatment for symptomatic upper ureteral and renal calculi less than 2 cm a diameter. The short and long term complications of ESWL are underestimated. Thus, ESWL may cause renal trauma and such trauma may induce later hypertension. In this retrospective study, we reviewed the frequency of deleterious effects of ESWL in 45 patients who had undergone ESWL from January 1988 to September 1989. Short-term complications were macroscopic hematuria (15%), lumbar pain (11%) and peri- or intrarenal hematomas (4.4%). Two years later CT scan was performed in 20 patients. It was normal in 7 (35%). In others, it shown a recurrence of stone in 8 (40%) and a focal scarring in 5 (25%). Only 1 out of 43 patients had developed hypertension.

[Hepatic polycystic disease is not always associated with polycystic kidney: epidemiological data]. / La polykystose hépatique n'est pas toujours associée à la polykystose rénale: données épidémiologiques.

Adult polycystic disease of the liver (APLD) and of the kidney (ADPKD) is considered to represent one entity. In 75 ADPKD kindreds with 259 affected members, ultrasonography and/or CT were performed in 186 (71.8%) from 64 kindreds (85.3%). We demonstrated that ADPKD with or without APLD are two separate phenotypes and suggest genetic heterogeneity of these two entities.