[What etiologic investigations should be done following recurrent pulmonary embolism?]. / Quel bilan étiologique réaliser au décours d'embolies pulmonaires récidivantes?

Recurrence of pulmonary embolism can occur in presence of coagulation disorders or cancer. It can also develop without any of these factors. Coagulation tests should search for abnormalities such as inherited deficiencies of antithrombin, protein C, protein S, factor V mutation, variation of the prothrombin gene, hyperhomocysteinaemia, lupus anticoagulant, antiphospholipid antibodies. Biological examinations for determining the cause of recurrent pulmonary should be associated with a familial enquiry. An aggressive search for an occult cancer in a patient with a recurrent pulmonary embolism is not warranted. An evaluation includes medical history, physical examination, laboratory tests, chest X-ray sufficient to orientate this investigation. Patients should be given long-course oral anticoagulant treatment. However, the optimal duration have still to be determined.

[Evaluation of a test for rapid detection of D-dimers for the exclusion of the diagnosis of venous thrombosis]. / Evaluation d'un test de détection rapide des D-dimères pour l'exclusion du diagnostic de thrombose veineuse.

OBJECTIVES: The SimpliRED whole blood D-dimer assay for exclusion of deep venous thrombosis in symptomatic outpatient appears to be a simple and rapid method; we wanted to confirm its reliability. METHODS: Fifty consecutive outpatients (mean age 57, range 20 to 89) referred to our department between September and December 1996, for clinically suspected deep venous thrombosis (DVT) were included. Hospitalized patients were excluded as well as patients under anticoagulant and pregnant women. DVT was diagnosed with our usual strategy of compression ultrasonography at the levels of the common femoral, the superficial femoral and the popliteal veins including the exploration of sural and saphenous veins. The D-dimer assay was performed, according to the manufacturer recommendation, blindly by a physician unaware of the results of ultrasonography within one hour. RESULTS: Eight of nineteen patients with DVT had a normal D-dimer test result Four had a sural DVT, but four had a proximal DVT. Furthermore four patients with normal D-dimers had superficial venous thrombosis. CONCLUSIONS: Our series does not confirm the high sensitivity and negative predictive value reported previously. To date it is premature to propose this assay as a first line test in the therapeutic management of patients with suspected DVT.

[Distal gangrene and cryoglobulinemia related to hepatitis C virus infection with presence of anticardiolipin antibodies]. / Gangrène distale et cryoglobulinémie liée à l'infection par le virus de l'hépatite C avec présence d'anticorps anticardiolipines.

We report the case of a 63-year old women with toe gangrene, peripheral polyneuropathy, polyarthritis, histologically proven necrotizing vasculitis, in association with type III mixed cryoglobulinemia and hepatitis C virus (HCV) infection. Raised anticardiolipin antibodies (aCL) were found, without beta 2-glycoprotein I. HCV infection is associated with mixed cryoglobulinemia which can cause a vasculitis affecting various organs. The pathogenesis of production and clinical significance of aCL could be associated in this case with HCV infection.