Severe hepatitis due to percutaneous diclofenac.

Although it is rare, diclofenac, a nonsteroidal antiinflammatory drug, may cause severe liver damage,sometimes with a fatal outcome. We report the first case of a patient who developed severe reversible liver damage after a percutaneous administration of diclofenac.

[Lymphangioma of the mesentery--surgical indication]. / Le lymphangiome du mésentère--l'indication opératoire.

The discovery of a cystic image in the mesentery is a difficult diagnostic and therapeutic problem. We report the case of a 25-year-old female with a mesenteric lymphangioma, which was resected after careful consideration. The complications due to the expansion of this benign tumour are reviewed, and the surgical indications discussed.

Polymyalgia rheumatica as a manifestation of a large hepatic cavernous hemangioma.

A 59-year-old woman presented with polymyalgia rheumatica which was refractory to conventional anti-inflammatory and steroid therapy. A full investigation for an underlying occult malignancy showed only the presence of a giant cavernous hepatic hemangioma. To our knowledge, polymyalgia rheumatica has never been described in association with giant cavernous hepatic hemangioma; resection of the latter lesion resulted in complete and, to this date, definite resolution of rheumatologic complaints in our patient.

[Lesions of hollow organs in closed abdominal trauma--the value of computerized tomography]. / Lésions d'organes creux dans le traumatisme fermé de l'abdomen--la valeur de la tomodensitométrie.

INTRODUCTION: evaluation of the clinical and radiological criteria for laparotomy in intestinal lacerations after a blunt abdominal trauma. Determination of the different radiological signs from the CT scan and the sensitivity of this examination in the diagnosis of intestinal lacerations. DESIGN: retrospective study. MATERIAL AND METHOD: we selected all patients operated for intestinal laceration caused by a blunt abdominal trauma during the period of 1986 to 1995. The clinical and radiological criteria for laparotomy in these patients were determined. Correlation of the radiological signs from the CT-Scan and the surgical findings was used to determine the sensitivity of the CT-scan. We distinguished patients who had an abdominal CT-scan from those patients for which no CT was done.

[Liver transplantation. Preliminary results in the district University Hospital of Geneva]. / La transplantation hépatique. Expérience préliminaire de l'Hôpital cantonal universitaire de Genève.

Between July 1987 and May 1989, 11 liver transplants were performed on 10 patients at the University Hospital of Geneva. Of 15 patients evaluated for elective transplantation, 10 were accepted and put on the waiting list. 5 patients were rejected because of a contraindication or because another treatment seemed preferable. 8 transplantations were eventually performed. Emergency transplantation was considered for 6 patients, but could be performed in only 3. Indications for transplantation were as follows: one hepatocellular carcinoma in a non-cirrhotic patient, 2 post-hepatitis cirrhoses (one B and one non-A-, non-B), 3 primary biliary cirrhoses, one autoimmune cirrhosis, one primary sclerosing cholangitis, one cirrhosis on alpha-1-antitrypsin deficiency, and one fulminant B-Delta hepatitis. Most of these patients had advanced liver disease and a limited life expectancy. 8 of the 10 patients transplanted are nevertheless alive and none is hospitalized at the present time. More than mere survival, however, quality of life regained after transplantation prompts us to consider transplantation early in the progress of the disease. Earlier evaluation of patients would make transplantation feasible soon after the first complication of the disease. This attitude would probably prevent patients from dying while on a waiting list and decrease operative as well as early postoperative risks. Better information and coordination regarding potential donors is necessary in Switzerland to obtain better results in organ transplantation.

Effects of haemorrhage and volume expansion on portal-systemic collateral vascular resistance in conscious portal hypertensive rats.

1. In order to study the acute effects of blood volume changes on the vascular resistance of portal-systemic collaterals (collateral vascular resistance), a model of total portal vein occlusion with 100% portal-systemic shunts was developed in the rat. In this model, we determined the haemodynamic effects of haemorrhage (1.8 ml/100 g body weight) or intravenous infusion of a volume expander (1.8 ml/100 g body weight). Cardiac output and regional blood flows were measured by the radioactive microsphere method. 2. Haemorrhage significantly reduced arterial pressure from 108 +/- 4 to 92 +/- 4 mmHg (mean +/- SEM), cardiac output from 56 +/- 4 to 24 +/- 2 ml min-1 100 g-1 body weight, portal pressure from 15.1 +/- 1.5 to 10.0 +/- 1.4 mmHg and portal tributary blood flow from 19.9 +/- 2.3 to 8.3 +/- 1.4 ml/min. Consequently, collateral vascular resistance significantly increased from 6.6 +/- 0.9 x 10(3) to 11.1 +/- 2.0 x 10(3) kPa 1(-1) s. 3. Volume expansion reduced arterial pressure from 98 +/- 3 to 90 +/- 3 mmHg, and significantly increased cardiac output from 43 +/- 3 to 55 +/- 3 ml min-1 100 g-1 body weight, portal pressure from 13.9 +/- 0.7 to 16.5 +/- 0.8 mmHg and portal tributary blood flow from 16.4 +/- 1.3 to 28.2 +/- 3.2 ml/min. Consequently, collateral vascular resistance significantly decreased from 7.0 +/- 0.5 x 10(3) to 4.9 +/- 0.4 x 10(3) kPa l-1 s. 4. This study shows that in rats with portal hypertension, portal-systemic collateral vascular resistance is modified by alterations in blood volume.

[Tissue hypoxia and hepatocellular insufficiency in patients with cirrhosis]. / Hypoxie tissulaire et insuffisance hépatocellulaire chez les malades atteints de cirrhose.

To determine whether tissue hypoxia occurred in cirrhosis, oxygen contents, mixed venous and hepatic venous lactate concentrations as well as systemic hemodynamics were studied in 53 patients with cirrhosis. The influence of liver failure on tissue oxygenation was also studied. Cardiac index and mixed venous and hepatic venous lactate concentrations were significantly higher in patients with cirrhosis than in 20 control subjects. Oxygen consumption, oxygen extraction ratio and mixed venous and hepatic venous carbon dioxide tensions were significantly lower in the former than in the latter. Oxygen transport was not significantly different between the two groups. Cardiac index and oxygen transport were not significantly different between grade A (Pugh's classification) and grade C patients. Mixed venous as well as hepatic venous lactate concentrations were significantly higher while oxygen consumption, oxygen extraction ratio and carbon dioxide tensions were significantly lower in grade C than in grade A patients. We conclude that tissue hypoxia occurs in patients with cirrhosis and hepatic insufficiency. This tissue hypoxia might be due to arteriovenous shunting-related limitation of tissue oxygen extraction.

Reduction of portal pressure by acute administration of furosemide in patients with alcoholic cirrhosis.

In patients with cirrhosis, it has been demonstrated that blood volume and degree of portal hypertension are correlated. Hence, a reduction of blood volume by furosemide could decrease portal pressure and could thereby be useful in the treatment of portal hypertension. Splanchnic and systemic haemodynamics were evaluated before and 1 h after intravenous administration of furosemide (0.75 mg/kg) in 10 patients with cirrhosis. Furosemide significantly increased haemoglobin from 12.4 to 13.0 g/dl and patients passed more than 1 l of urine within the 3 h following furosemide administration. These findings confirm that blood volume decreased after diuretic administration. Cardiac output significantly decreased from 6.6 +/- 2.3 to 5.5 +/- 2.2 l/min, while arterial pressure and heart rate did not change significantly. Furosemide significantly decreased wedged hepatic venous pressure from 31.1 +/- 6.2 to 27.7 +/- 5.2 mmHg, but not free hepatic venous pressure. Accordingly, the hepatic venous pressure gradient significantly decreased from 22.1 +/- 5.4 to 19.5 +/- 4.0 mmHg. Azygos blood flow and hepatic blood flow also significantly decreased from 0.40 +/- 0.17 to 0.31 +/- 0.13 l/min and from 1.49 +/- 0.50 to 0.82 +/- 0.30 l/min, respectively. These results show that diuretic therapy markedly influences splanchnic haemodynamics.

[Influence of ascites on splanchnic and systemic hemodynamics in patients with alcoholic cirrhosis]. / Influence de l'ascite sur l'hémodynamique splanchnique et systémique chez les malades atteints de cirrhose alcoolique.

The effect of ascites on splanchnic and systemic hemodynamics was retrospectively studied in 256 patients with alcoholic cirrhosis. The patients were divided into 3 classes: no ascites, moderate ascites, and large ascites. They were also classed into 3 groups according to a modified Pugh classification (ascites was not taken into account). In patients without ascites, cardiac output was positively related to the severity of liver disease. This result was not found in patients with large ascites. Similarly, in patients with no or moderate ascites, the degree of portal hypertension estimated by the hepatic venous pressure gradient was associated with liver failure. In patients with large ascites, hepatic venous pressure gradient was higher than in patients without ascites but this relation was observed only in patients without liver failure. These results show that ascites reduces the relation between cardiac output and liver failure and increases the degree of portal hypertension but not cardiac output.

Fatal liver failure due to disulfiram.

We present the case of a 30-year-old man with disulfiram-induced hepatitis complicated by fatal liver failure. The disease followed a protracted course with an interval of 25 days between the onset of jaundice and the onset of encephalopathy. In this patient, the severity of the liver disease might have been due to reingestion of disulfiram shortly after the onset of jaundice.

[Sudden death outside the hospital: evaluation of the activities of an intensive care mobile unit in Geneva]. / Mort subite extra-hospitalière: évaluation de l'activité de l'unité mobile de soins intensifs de Genève.

A prospective study on the treatment of out-of-hospital cardiac arrest by a mobile intensive care unit was conducted in Geneva for 1 year. 76 attempts at cardiopulmonary resuscitation (CPR) were made: 25 patients were admitted to the intensive care unit (33%) and 13 lived to be discharged from hospital (17%). Age, initial arrhythmia and duration of cardiopulmonary arrest (CPA) were important factors in determining the initial success of CPR. Long-term survival was associated with CPA of less than 4 minutes duration, with bystander-initiated CPR and with CPR lasting less than 30 minutes. Better education of the public and more direct access to the system should make it possible to treat more patients in more favourable conditions and improve overall results. A more determined effort to educate the public in CPR would also improve the prognosis in out-of-hospital cardiac arrest.

[Deep accidental hypothermia without cardiorespiratory arrest]. / Hypothermie profonde accidentelle sans arrêt cardio-respiratoire.

A case is reported of profound accidental hypothermia with spontaneous cardiac activity in a patient presenting several risk factors. The rewarming from 23.5 degrees C to 36.5 degrees C by partial cardio-pulmonary bypass was carried out without complications and in particular without cardiac arrythmia. As far as we are aware this is the twelfth case of profound accidental hypothermia reported in the literature in which rewarming was carried out by this method and the fourth case not involving cardiac arrest. Rapid rewarming by partial cardio-pulmonary bypass could be useful in patients with profound accidental hypothermia without cardiac arrest, the most serious complication being, precisely, cardiac arrest during rewarming.

[Pseudo-Conn's syndrome due to intoxication with nonalcoholic pastis]. / Pseudo-syndrome de Conn par intoxication au pastis sans alcool.

A case is reported in a patient who presented with hypertension and quadriparesis, both due to ingestion of a new beverage, non-alcoholic pastis (an anise-based aperitif), containing glycyrrhizinic acid. Consumers, especially if they are ex-alcoholics, diabetics or hypertensives, may develop potentially serious effects from hypermineralocorticism.