[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.

Tracheobronchopathia osteochondroplastica presenting at the time of a difficult intubation.

Tracheobronchopathia osteochondroplastica (TO) is a rare and usually benign disorder affecting the trachea and occasionally the bronchi. We describe the case of a 46-year-old woman who was discovered to have TO at the time of a difficult intubation. This case was also unusual since the patient had presented no previous symptoms despite the presence of extensive endotracheal and bronchial lesions. The incidence of TO appears to be underestimated in the literature in view of the fact that it is usually benign. However, a more accurate estimate of its true prevalence may become available through the use of bronchoscopy and computerized tomographic scanning.

The Tempofilter: a multicenter study of a new temporary caval filter implantable for up to six weeks.

A multicenter study was conducted to evaluate a new temporary caval filter (Tempofilter) designed to be implanted for up to 6 weeks. A total of 66 patients with a mean age of 51.8 years were enrolled in the study. All had documented high risk of pulmonary embolism: severe deep venous thrombosis in 89.5% of cases and previous symptomatic pulmonary embolism in 65% of cases. Filter placement was performed in association with a surgical or obstetrical procedure in 68.5% of cases. The indication for filter placement was contraindication to or failure of anticoagulant therapy in 85% of the cases. The mean duration of implantation was 29.9 days. Pulmonary embolism was not observed during the implantation period. Partial thrombosis of the filter was observed in 15% of cases due to trapping of clots by the filter. Thrombosis did not hinder filter removal when attempted. Filter-related complications were minor. Filter migration occurred in only 7.5% of cases. Migration never led to complications and did not hinder filter removal. In all cases migration was due to specific, preventable causes. The results of this study show that the Tempofilter is not only safe and easy to use but also effective in preventing pulmonary embolism. A significantly longer maximum implantation time is a major advantage of the Tempofilter over conventional temporary filters. We believe that this filter can be used for temporary protection against the risk of pulmonary embolism particularly in young patients and in a surgical setting.

[Diazepam and ketamine for voluntary interruptions of pregnancy]. / Le diazépam et la kétamine pour les interruptions volontaires de grossesse.

PIP: General anesthesia offers greater comfort for both the abortion patient and the operator. The combination of diazepam and ketamine which is rapidly reversible and offers a moderately deep anesthesia was used in 127 voluntary abortions and 3 therapeutic abortions. Patients ranged in age from 14-40 years and averaged 26, with 58% under 26. Patient weights ranged from 40-82 kg and averaged 56 kg. 43% were primaparas and average parity was 2.5. The average duration of the prenancy was 8.1 weeks. 10 patients were obese, 1 was asthmatic, 1 was a controlled hypertensive, 3 had cardiopathies, and 4 each had hepatitis and meningitis. 1 had treated epilepsy and 2 had serious depressive syndromes. 3 women had previously had voluntary abortions, 9 had had miscarriages, and 1 had had an extrauterine pregnancy. 17% had no fear or anxiety before the procedure, 56% had moderate levels, 28% had significant levels, and 19% had very high levels. 94% of the procedures were done by aspiration and in most cases a preliminary insertion of laminaria was done. The average duration of the procedure was 5 minutes, with extremes of 2 and 25 minutes. Patients were premedicated 1 hour before the procedure with intramuscular injections of 10 mg diazepam and 1/4 mg of atropine. For the induction, a butterfly needle with an antireturn system was used to inject 10 mg of diazepam and 1/4 mg of atropine diluted in 20 ml of distilled water. The patient was placed in the gynecological position and, if necessary, 5 mg of diazepam were added. Between .5-1 mg/kg of ketamine were injected in 10-15 seconds. The same dose was reinjected if the anesthesia was insufficient or the procedure was prolonged. A mixture of 40% oxygen and 60% nitrous oxide was administered if necessary. Patients remained in bed for 6 hours after awakening. 85% of patients received total doses of ketamine of .70mg/kg or less. Average duration of anesthesia was 9.2 minutes, with durations of less than 15 minutes in 94% of cases. On awakening 5% of patients had nausea and vomiting. 16% had minor psychic disturbances or disorientation, 8% had moderate problems with vocalization, and 2% had hallucinatory delirium with agitation. Overall, 20% of patients experienced headaches, 11% nausea, and 9% dizziness. It was concluded that the combination of diazepam .2 mg/kg and ketamine .5-.7 mg/kg provides well tolerated light anesthesia utilizable for outpatient abortions.^ieng