[Autologous transfusion and hemoglobin SC disease]. / Transfusion autologue et drépanocytose SC.

Three autologous blood units were transfused during elective orthopaedic surgery in a patient with undiagnosed haemoglobin SC disease. The packed red blood cells had been stored at 4 degrees C on SAG-M under standard conditions for 10 to 31 days. There was no evidence of adverse clinical reactions during the perioperative period. Six months later, a blood unit was collected at the initial step of an exchange transfusion in the same patient. Haemolysis was moderate after a 12-day-storage period and more significant after 32 days. This observation, as some other case reports, suggest that autologous blood transfusion may be considered for haemorrhagic surgery in selected patients with sickle cell disease.

[Liver transplantation in adults: postoperative management and development during the first months]. / Transplantation hépatique chez l'adulte: prise en charge postopératoire et évolution au cours des premiers mois.

Recent improvements in the results of orthotopic liver transplantation (OLT) have made this a well-accepted treatment for patients with severe hepatic failure. Current problems encountered following OLT are discussed. Immediate complications comprise surgical bleeding, primary graft non-function, and graft failure due to hepatic artery occlusion. Secondary complications are frequent. Surgical ones include biliary and vascular (hepatic artery thrombosis most often) problems, as well as intra-abdominal abscesses associated with gastrointestinal perforation, biliary leak, graft ischaemia or an infected haematoma. 40% of patients having undergone OLT will be reoperated on, 2/3 of them within 3 months. Non-surgical complications are mostly pulmonary. The risk of pneumonitis is increased by prolonged mechanical ventilation; it is always potentially disastrous in the immunosuppressed, transplanted patient. Hypertension is also often seen in the early postoperative period; it requires prompt treatment. Early renal impairment after OLT is common, and of better prognosis than late onset renal failure, which is generally associated with shock, graft failure, sepsis or use of nephrotoxic agents. Seizures, usually only one, occur in about 10% of patients; recovery is complete. Encephalopathy with intracranial oedema related to fulminant hepatitis has a worse prognosis, but survival figures are quite encouraging. Three type of rejection are described after OLT: 1) severe accelerated rejection (very rare), 2) acute rejection encountered in about 70% of patients over the first 3 months, and 3) late rejection, which can lead to the vanishing bile duct syndrome (VBDS). Diagnosis of rejection is made by liver biopsy. Prophylactic immunosuppression includes cyclosporin, methylprednisolone and azathioprine. Cyclosporin toxicity and drug interactions are reviewed. Treatment of acute rejection episodes comprises an initial bolus of high doses of corticoid drugs; if there is no response, antilymphocyte globulin or monoclonal antibodies may have to be used. Infection is the main cause of death following OLT. Early infections, mostly intra-abdominal and pulmonary, are bacterial or fungal. Vital (especially CMV) and other opportunistic infections occur generally after the second week. Retransplantation, carried out in 10 to 25% of patients, may be urgent in case of primary graft failure, or hepatic artery thrombosis associated with graft failure, or hepatic artery thrombosis associated with graft failure. Other indications are early graft rejection with severe hepatic dysfunction, chronic rejection with severe VBDS, and recurrence of the initial disease.

Biometry of the infrarenal inferior vena cava measured by computed tomography. Clinical applications.

In a previous study based upon the cavography of 100 patients, we determined that the average diameter of the infrarenal inferior v. cava (IIVC) was 21.3 mm (range 10-31 mm) at its end [1]. We discuss the value of different methods to measure IIVC, and particularly computed tomography (CT) scans reviewed in our department. It showed that the largest diameter of IIVC was not in a frontal plane and the width observed in a cavography was in fact the projection of a transverse diameter on the film. The real diameter of the IIVC is larger than that showed by cavography. This present study shows the results of measurements of the IIVC obtained from 50 consecutive CT scans. The average transverse diameter is 24.26 mm (range 14-33.3). The average anteroposterior diameter is 13.4 mm (range 5-22) and the average angle alpha between the transverse diameter and the frontal plane is 30 degrees 45' (range 12 degrees-55 degrees). We discuss the different methods of measurement of IIVC and we conclude that at present, CT scan is one of the most reliable methods to measure the real diameter of IIVC.