Dramatic improvement in survival after lung transplantation over time: a single center experience.

Lung transplantation (LT) is a recognized procedure for selected patients with end-stage respiratory failure. We performed 123 LT, including 32 single lung, 84 double lung, and 7 heart-lung transplantations in 48 patients with chronic obstructive pulmonary disease (COPD), 13 patients with pulmonary hypertension (PH), 33 with cystic fibrosis (CF), and 29 with interstitial lung disease (ILD) between July 1990 and January 2008. Survival was compared for periods before and after December 2001. The mean age of patients was 44.4 years (range 16-66.5 years); 84 (69%) were men. Before LT, 1 second forced expiratory volume was 28.7% +/- 18.1% and PaCO(2) = 6.3 kPa. Fifty-five patients were on noninvasive ventilation. Cold ischemia time was 320 +/- 91 minutes. Cardiopulmonary bypass (CPB) was used in 77 patients (64%). There were 18 early surgical reinterventions, 8 extracorporeal membrane oxygenations, and 38 bronchial stent insertions among 206 at-risk bronchial sutures. Crude survivals were 69%, 58%, 41%, and 18% at 1, 2, 5, and 10 years, respectively. Comparing before (n = 70 with 15 CF) vs after December 2001 (n = 53 with 17 CF), survivals were 63% vs 78%, 51% vs 71%, and 33% vs 60% at 1, 2, and 5 years, respectively (P = .01) and for CF patients, 52% vs 100%, 52% vs 94%, and 25% vs 94% at 1, 2, and 5 years, respectively (P = .005). There was significant improvement in survival before and after 2001 in 123 LT and particularly among CF patients. Improvement in survival after LT may be related to the sum of numerous changes in our practice since December 2001, including the use of pulmonary rehabilitation pre-LT, extracellular pneumoplegia, statins, macrolides for chronic rejection, monitoring of Epstein-Barr blood load, changes in maintenance immunosuppressants, as well as position movement up the coordinator nurse and learning curve.

Role of glutathione in the detoxification of ferriprotoporphyrin IX in chloroquine resistant Plasmodium berghei.

The reduction in hemozoin content is a well known feature of chloroquine-resistant Plasmodium berghei. Using NK65-derived lines displaying increasing resistance levels, we observed an inverse relationship between the hemozoin content, and the glutathione (GSH) and glutathione S-transferase (GST) levels. Treatment of highly chloroquine-resistant-infected mice with buthionine sulfoximine (BSO), which has previously been shown to partially reverse this chloroquine resistance, led to a significant increase in hemozoin production. In vitro studies on the polymerization of ferriprotoporphirin IX (FPIX) at pH 5.0 showed that GSH partially inhibited beta-hematin synthesis, while GST had a trivial and non specific effect. Furthermore, chloroquine-sensitive parasites invading reticulocytes displayed higher GSH level and GST activity, and reduced hemozoin synthesis and susceptibility to chloroquine. We conclude that, in chloroquine resistant P.berghei, GSH can detoxify hemin within the food vacuole, thus precluding its polymerization and preventing the activity of chloroquine and other quinoline-containing drugs. It is proposed that vacuolar GSH could be ascribed to an erythrocytic origin, since the resistant lines invade reticulocytes, which contain higher levels of GSH and GST than normocytes.

Pharmacodynamics and tolerance of two nadroparin formulations (10,250 and 20,500 anti Xa IU x ml(-1)) delivered for 10 days at therapeutic dose.

Venous thromboembolism may be efficiently treated by once-a-day (o.d.) administration of a high dose of low molecular weight heparin (LMWH) instead of administration of the same total dose in two injections a day (b.i.d.). To reduce the volume of the subcutaneous (s.c.) injection, a more concentrated form of the drug is advisable. This study was designed to compare the bioavailability of 2 formulations of nadroparin containing 10,250 and 20,500 anti-Xa IU x ml(-1) respectively. This was an open, randomized, cross-over study where 12 healthy volunteers (age 18-35) were enrolled. They received either 90 anti-Xa IU x kg(-1) b.i.d. of the 10,250 IU preparation (treatment A), or 180 anti-Xa IU x kg(-1) o.d. of the 20,500 IU preparation (treatment B) for 10 days. On day 1, the subjects were sampled between 0 and 12 h (treatment A) or between 0 and 24 h (treatment B). On day 10, they were sampled between 0 and 12 h and between 12 and 24 h (treatment A) or between 0 and 24 h (treatment B). Anti-Xa and anti-IIa activities were determined by specific chromogenic assays. The main result of the study was that the bioavailability of the anti-Xa activity of the 2 nadroparin formulations was equivalent, as shown by the comparison of the AUC(0-12 h) plus AUC(12-24 h) (treatment A) and the AUC(0-24 h) (treatment B), calculated on day 10. This study also allowed a number of interesting observations to be made. 1) Between day 1 and day 10, there was an accumulation of the anti-Xa activity for treatment A but not for treatment B (accumulation factors: 1.6 and 1.1 respectively); 2) On day 10, the AUC(0-12 h) were slightly but significantly lower than the AUC(12-24 h) suggesting a circadian effect for anti-Xa and anti-IIa activities; 3) the clearance of the anti-Xa activity was comparable at the 2-dose regimens, while that of the anti-IIa activity was lower in treatment B than in treatment A, indicating a significant dose effect for the pharmacodynamics of the longer heparin chains; 4) On average, the clearance of the anti-IIa activity was twice as high as that of the anti-Xa activity; 5) For treatment B, significant APTT prolongations were noticed at Tmax (prolongation factor: 1.7 +/- 0.25), in relation with the anti-IIa activity (0.3 +/- 0.1 IU x ml(-1)).

Aging and venous thromboembolism influence the pharmacodynamics of the anti-factor Xa and anti-thrombin activities of a low molecular weight heparin (nadroparin).

Venous thromboembolism may be efficiently treated by one single daily administration of a high dose of low molecular weight heparin (LMWH). The present study investigates if the physiological deterioration of renal function associated with normal aging or the presence of an acute venous thromboembolism influences the pharmacodynamic pattern of the anti-factor Xa and anti-thrombin activities. Three groups of 12 subjects were investigated. The first 2 groups were composed of healthy volunteers differing by age (25 +/- 4 and 65 +/- 3 yrs) and creatinine clearance (114 +/- 15 and 62 +/- 6 ml x min(-1)). The third group was composed of patients hospitalized for deep vein thrombosis, having a mean age of 65 +/- 11 yrs and creatinine clearance of 76 +/- 8 ml x min(-1). Nadroparin was administered subcutaneously once daily at the dose of 180 anti-factor Xa IU.kg(-1) for 6 to 10 days. Serial sampling on day 1 and on the last day of administration (day n) allowed the pharmacodynamic parameters of the anti-factor Xa and anti-thrombin activities to be compared at the beginning and at the end of the treatment. The main findings were the following: (1) After repeated administration, a significant accumulation of the anti-factor Xa activity was observed in the healthy elderly and in the patients but not in the healthy young subjects (accumulation factor: 1.3). There was no evidence of accumulation of anti-thrombin activity; (2) There were significant correlations between the clearance of creatinine and the clearance of the anti-factor Xa activity but not with that of the anti-thrombin activity; (3) In the patients, the clearance of the anti-factor Xa and of the anti-thrombin activities were 1.4 and 2 times higher respectively than those calculated in the healthy elderly; (4) The mean ratio of the of anti-factor Xa and anti-thrombin clearances was close to 2 in the healthy subjects but equal to 5.4 in the patients. These results suggest that the mechanisms involved in the clearance of polysaccharide chains which support the anti-thrombin activity are different from those of the anti-factor Xa activity and that the enhanced binding properties of plasma proteins to unfractionated heparin reported in patients presenting an acute venous thromboembolism also exists for LMWH, predominantly for the anti-thrombin activity.

High-level chloroquine resistance of Plasmodium berghei is associated with multiple drug resistance and loss of reversal by calcium antagonists.

The chloroquine resistance of Plasmodium falciparum is reversed in vitro by numerous compounds, including calcium antagonists, which could enhance the accumulation of the drug in the parasite food vacuole. However, this mechanism of resistance could be insufficient when the resistance level increases. Using in vitro drug trials on strains of Plasmodium berghei displaying various chloroquine-resistance levels, we confirmed previous results obtained in vivo in the chloroquine-resistant strains of P. berghei are cross-resistant to related drugs (amodiaquine, quinine and mefloquine), the resistance levels to these drugs being related to their analogy to chloroquine. Furthermore, we showed that high-level resistant lines were associated with a loss of drug potentiation by verapamil and nicardipine in vivo, but that the reversal rates obtained in vitro are of low significance. We conclude that the parasite is able to escape the activity of these reversing agents.

BK2 but not BK1 receptors mediating contractile response in human umbilical arteries: role of thromboxane A2.

Bradykinin receptors have been divided into B1 and B2 subtypes. The aim of this study on human umbilical arteries was: i) to compare the recognition properties of the mediating contractions of bradykinin receptors; and ii) to assess the possible role of thromboxane A2 in a bradykinin-induced contraction of smooth muscle. Umbilical arteries were dissected and mounted in organ baths for isometric measurement of force. Our results showed that the B1 agonist [Sar1dPhe8desArg9]-bradykinin had no effect on the concentration-response 10(-9)-3 x 10(-5) mM. Cumulative additions of bradykinin (10(-9)-3 x 10(-5) mM) and of the B2 agonist [Hyp3TyrMe8]-bradykinin (10(-9)-3 x 10(-5) mM) produced dose-dependent contractions. Dose response curves to bradykinin (10(-9)-3 x 10(-5) mM) were not significantly altered by the presence of B1 selective antagonist [des-Arg9, Leu8]-bradykinin (10(-5) mM), or by the selective B2 antagonist [Thi(5,8), D-Phe7]-bradykinin (10(-5) mM). However, Hoe 140 D-Arg-[Hyp3, Thi5,D-Tic7, Oic8]-bradykinin, an antagonist of B2 responses, significantly inhibited bradykinin-induced contraction. The responses to bradykinin were unaffected by indomethacin (10(-4) mM), dazoxiben (10(-5) mM) or even by nordihydroguaiaretic acid (10(-5) mM). However, bradykinin contractions were antagonized in a noncompetitive manner by quinacrine (10(-5) mM). These results showed that bradykinin contracts human umbilical arteries essentially through B2 receptors. Moreover, the responses to bradykinin are unlikely to be mediated by the cyclooxygenase/lipooxygenase pathway. The inhibitory effects of quinacrine may be due to a specific or nonspecific effect at a cellular level on smooth muscle contractility, or due to a direct action to block Ca2+ influx at membrane level.

[Induction of Prinzmetal's angina by stopping exercise. Apropos of 3 cases]. / Induction d'un angor de Prinzmetal par arrêt de l'effort. A propos de 3 cas.

Three cases of anginal pain with ST elevation occurring at the end of exercise are reported. In 2 cases, there was a symptom-free interval between exercise, which was well tolerated, and the clinical and electrical changes. The coronary circulation was angiographically normal, although one of the patients had have previous transmural myocardial infarction. Spontaneous coronary spasm was observed during coronary angiography in this patient. The third case was characterised by exclusively spontaneous angina. ST elevation was observed very early in the recovery phase after stress testing. This patient had severe triple vessel disease. Angiospastic manifestations were noted in the immediate postoperative period after myocardial revascularisation surgery. A review of the litterature shows two types of behaviour. In the rare cases of ST elevation after maximal stress testing (7 cases apart from those reported here) the coronary vessels were normal. On the other hand, when ST elevation occurred during exercise and/or followed ST depression, coronary artery disease was demonstrated: significant 52 cases (81%), less than 70%: 12 cases (19%). Overall, these results indicate that when ST elevation is observed in the recovery phase after stress testing, the coronary arteries are angiographically normal (specificity: 0,9).

[Recording of His potentials from surface chest leads using a computer]. / Enregistrement des potentiels hisiens à partir d'électrodes thoraciques de surface à l'aide d'un moyenneur.

Under certain circumstances it is possible to record His potentials using surface chest leads. These potentials have a very low intensity over the thorax, and must be separated from the "background noise" by an averaging technique. The desired activity occurs before the R wave and has a constant relationship to it; the potentials picked up by the chest leads are amplified, coded numerically, and presented to the memory store which accepts only those potentials which precede the R wave. It then summates the successive cycles, using a synchronising signal to ensure that they coincide. All this is carried out with an averager. In the 80 patients studied, a signal which seems very likely to reflect His activity was obtained in slightly more than a third of cases. The findings were correlated in 14 cases with those produced by invasive techniques, and showed that the main source of error was the after-potential of the P wave after a short PR interval--this occurred in one case; in the other 13 cases, the correlation was good. This method needs to be refined before it can be used clinically. It seems unlikely that it will replace the invasive technique which is so important for stimulation tests, and so necessary for studies of dynamic pharmacology.

[Mitral valve prolapse and pectus excavatum. Expressions of connective tissue dystrophy?]. / Prolapsus valvulaire mitral et pectus excavatum. Expressions d'une dystrophie du tissu conjonctif?

Pectus excavatum is a common malformation in diseases of elastic tissue (Marfan, Ehlers-Danlos...). When observed apparently alone it may represent a minor form of dystrophy, implying the same risk of a cardiac lesion. Abnormalities of the thoracic skeleton and echocardiographic mitral valve prolapse is a well established association, suggesting a common disorder of connective tissue. However, there is no absolute proof that this is a statistically significant association. Histological connective tissue changes relating these two markers have yet to be found. Clinical and echocardiographic examinations and skin biopsies were performed in 17 patients with pectus excavatum. Mitral valve prolapse was detected in 65% of cases (associated in 1 out of 3 cases with tricuspid valve prolapse). In 53% of cases electron microscopy showed abnormal skin collagen and elastin. Collagen abnormalities were twice as common as those of elastin and could be associated. Mixed changes of thinning of elastin and collagen fibres of irregular calibre were particularly suggestive. Pectus excavatum would therefore seem to be the expression of a minor form of dystrophy of collagen and elastin tissues and a clinical marker of possible mitral valve prolapse.

[Congenital tricuspid insufficiency due to valvular dysplasia. Review of the literature in light of a case in a 40-year-old adult]. / L'insuffisance tricuspidienne congénitale par dysplasie valvulaire. Revue de la littérature à propos d'une observation chez un adulte de 40 ans.

UNLABELLED: Congenital tricuspid incompetence due to valvular dysplasia is a defect involving the leaflets (normally inserted on the ring) the cordae tendinae and papillary muscles of the tricuspid valve. It is a rare condition, usually diagnosed at open heart. A case of congenital tricuspid incompetence in a 40 year old adult is reported. Surgery indicated for resistant heart failure, confirmed the preoperative clinical, echocardiographic and haemodynamic diagnosis. The dysplasia comprised absence of cordae and papillary muscles on two thirds of the anterior leaflet. Valvular replacement with a bioprosthesis was carried out. 31 other reported cases were discovered on review of the literature since 1923. Two main groups of patients were individualised according to their clinical contexts and outcome: --The first group comprises the newborn and infants. Cyanosis, cardiomegaly and right ventricular failure in the neonatal period raised the differential diagnosis of Ebstein's anomaly and Uhl's disease. The outcome was fatal in several days to weeks. Autopsy confirmed the diagnosis. --The second group comprises patients who decompensate during adult life with right ventricular failure and degrees of tricuspid incompetence. The natural outcome with or without medical treatment may be prolonged, one such patient dying at the age of 53. Congenital tricuspid incompetence, diagnosed after elimination of other causes, was confirmed at operation. Complementary investigations: --Cardiac catheterisation showed tricuspid incompetence and its haemodynamic effects. --Echocardiography, in our case, showed dilatation of the right ventricle and pulsed Doppler echocardiography suggested tricuspid incompetence. The inability to record the anterior tricuspid leaflet, an unusual feature considering the right ventricular dilatation, contrasted with perfect definition of the septal leaflet. The absence of echocardiography in the other 31 reported cases does not allow any conclusions to be drawn as to the significances of this sign. --The tricuspid valve dysplasia was precisely defined on pathological examination: a) thickened valve, b) hypoplastic chordae and papillary muscles, c) incomplete separation between the leaflets and ventricular wall, d) focal agenesis of valvular tissues. --An associated pulmonary artery stenosis in the newborn may explain the severity of symptoms in this age group. This hypothesis, based only on pathological studies, cannot be confirmed. TREATMENT: --In the newborn, the rare surgical attempts at repair have all failed. --In the adult, surgery, indicated for heart failure resistant to all medical treatment, is as for other organic tricuspid incompetence, annuloplasty or valve replacement, by mechanical or bioprosthesis. Porcine bioprosthesis, as chosen in the case reported, has been used by some authors for 5-8 years with good results. Nevertheless, the longer-term outcome of this type of prosthesis is not yet known.

[Hemodynamic and angiographic aspects of endomyocardial fibrosis. Apropos of 19 cases]. / Aspects hémodynamiques et angiographiques des fibroses endomyocardiques. A propos de 19 observations.

19 cases of endomyocardial fibrosis were studied. Angiocardiography localises the site of fibrosis and seems to be the best diagnostic method. All cases in this series had left ventricular involvement which resulted in changes of the silhouette (square, polylobulated or deformed like the shape of a heart on a playing card) and of the ventricular contour (smooth, lacunar or "doubled"). Ten patients had mitral incompetence. The ejection fraction was normal in 8 patients but significantly reduced in the series as a whole (EF = 0,56, p less than 0,05). 15 patients had right ventricular involvement. Apart from the smooth contour of the anterior wall, the only abnormality in the mild cases, the most suggestive feature was an amputation of the ventricular apex, giving rise to a ventricular appearance of a narrow, akinetic (apart from the infundibular region) tube. The catheter data demonstrated the haemodynamic changes due to the fibrosis. A constrictive syndrome was observed in all the severe poorly tolerated cases. This was not apparent under basal conditions in milder cases. The value of pharmacodynamic testing and endomyocardial biopsy in cases where the diagnosis is uncertain should be stressed. The results of resection of the fibrosis and valvular replacement in severe cases depend to a large extent on the degree of myocardial involvement.

[Rare etiology of hemiplegia with young adult: paradoxical embolism (author's transl)]. / Une étiologie rare de l'hémiplégie chez l'adulte jeune: l'embolie paradoxale.

Paradoxical embolism is due to the passage of an embolic material from the deep veins of the lower extremities or pelvis, into the systemic circulation through an abnormal intracardiac communication. Only the angiographic and hemodynamic diagnosis practised on two young patients with a cerebral embolism, can explain the mechanism. The diagnosis is based on the arterial embolism, the venous thrombosis with or without pulmonary embolism, the abnormal communication favoring right-to-left shunting. The rising of right atrial pressures permits this shunting. This high pressure can result from a pulmonary embolism, a high blood pressue due to an effort, or an embolism that might coil up over the tricuspid valve.

The use of alfentanil (Rapifen) by infusion for surgical procedures of long duration.

The use of alfentanil was studied in 49 patients undergoing surgery with a duration of at least 90 minutes. Induction was performed with droperidol (Dehydrobenzperidol) and etomidate (Hypnomidate), maintenance with nitrous oxide/oxygen 2:1 and alfentanil. Alfentanil was administered as an initial bolus of 2-3 mg depending on the body weight of the patient, immediately followed by a continuous infusion of 0.75 microgram/kg/min. In case a stressful or painful event in surgery caused inadequate analgesia, additional increments of 1 mg of alfentanil were administered. Anesthesia was considered to be good in 90% of the patients. The number of additional increments needed did not increase as the anesthetic procedure progressed in time. In virtually all patients postoperative recovery was fast and not related to the number of increments. It is concluded that alfentanil infusion for longer procedures in combination with nitrous oxide/oxygen provided a good and easy method for maintaining a satisfactory level of analgesia.

[Immunofluorescence reaction of antibodies directed against the intestinal epithelium of Schistosoma mansoni. VI. Immunolocalization of a carbohydrate epitope at different developmental stages]. / Etude par la réaction d'immunofluorescence des anticorps dirigés contre l'épithélium intestinal de Schistosoma mansoni. VI. Immunolocalisation d'un épitope glucidique aux différents stades évolutifs.

In the course of previous works, we described an IgM monoclonal antibody directed to a carbohydrate epitope located on the gut epithelium surface of the Schistosoma mansoni adult worm. We provided evidence that this epitope was present in all stages of the parasite and was particularly abundant in eggs. The current work was performed in order to specify the epitope localisation, at each stage, by immunohistochemical techniques. The epitope appears to be located on the peripheral membranes of the adult worm, while it is produced by the alive miracidium in the eggs located in the tissues and subsequently spread out inside the periovular granuloma. Moreover, in adult worms, the observed structure presents itself as a soluble form in organic solvents; on the other hand, in eggs, the epitope was essentially found made of an hydrosoluble substance. These datas can explain why, in experimentally infected mice, the epitope is mainly determined in urines at the sixth week of infestation, when eggs are settled down in the tissues. Besides, the inhibition of the monoclonal antibody fixation by a pentose which contains the Lewis X antigen, painted out that the carbohydrate structure recognised by the monoclonal antibody could be the Lewis X antigen or a very closed structure.

[Epidemiology of certain endemic parasitic diseases in the town of Guadalupe (Republic of Sao Tome and Principe). II. Other endemic parasitic diseases]. / Epidémiologie de certaines endémies parasitaires dans la ville de Guadalupe (République de Saõ Tomé et Príncipe). II. Autres endémies parasitaires.

Stool, blood and urine specimens have been collected from 380 inhabitants of all age groups living in the small town of Guadalupe in May 1992. The seroprevalence of Falciparum malaria (96%), toxoplasmosis (73.3%), have been measured.

[Epidemiology of certain endemic parasitic diseases in the town of Guadalupe (Republic of Sao Tome and Principe) I. Schistosomiasis intercalatum and intestinal worms]. / Epidémiologie de certaines endémies parasitaires dans la ville de Guadalupe (République de Saõ Tomé et Príncipe). I. Schistosomose à S. intercalatum et verminoses intestinales.

Schistosomiasis intercalatum in known to exist in Saõ Tomé since 1988, (Corachan et al.). It is transmitted by Bulinus forskalii, (Brown et al., 1989). Stool, blood and urine specimens have been collected from 380 inhabitants of all age groups living in the small town of Guadalupe close to the Agua Traz river and Agua Polino. The prevalence of schistosomiasis by detection of S. intercalatum eggs in a 10 mg stool thick smear (Kato technique) is 25.5%. An excreted Schistosoma polysaccharide antigen, detected by means of a monoclonal antibody (Ripert et al., 1992), is found in 49.1% of the urine samples. Patients voiding S. intercalatum eggs in stools have been treated with praziquantel (40 mg/kg body weight), as recommended by WHO Expert Committee on Schistosomiasis, but it might be wise to also treat persons excreting antigen in urine. The prevalence of intestinal helminthiasis, ascariasis (73.7%), trichuriasis (73.7%) and necatoriasis have been measured.

[Evaluation of an indirect hemagglutination test for the serodiagnosis of amebiasis]. / Evaluation d'un test d'hémagglutination indirecte amibiase (HAI) pour le serodiagnostic de l'amibiase.

167 sera have been tested to appreciate the value of an indirect hemagglutination test (Amibiase HAI FUMOUZE) comparatively to an agglutination test of sensibilized particles of latex (Bichro latex Amibe Fumouze BLA) Amibiase HAI test comes out as sensitive and specific for the detection of antibodies in patients suffering from visceral amoebiasis. But some antibodies are also detected in patients with an antecedent of amoebiasis, as it is usually the case with some other techniques. A high positivity of the indirect hemagglutination test, and the concordance between the test HAI and the BLA one are in favour of a visceral amoebiasis. While lower rates or discrepancy between the two tests may evoke an hidden infestation in patients coming out or originated from endemic zones.

[Reexpansion pulmonary edema after pneumothorax. Apropos of a case. Review of the literature]. / L'oedème de réexpansion pulmonaire après pneumothorax. A propos d'un cas. Revue de la littérature.

Pulmonary edema after re-expansion of a pneumothorax occurs within a maximum of 3 days of the pneumothorax and manifests by intense clinical signs (cough, abundant foamy expectoration, major cyanosis), marked hypoxia and a "white lung" radiologic image. The outcome was rapidly favorable in the case reported, despite the severity of the initial symptomatology. Currently accepted physiopathologic mechanisms implicate numerous factors in the genesis of edema due to re-expansion. The lesional pulmonary edema can be explained by alteration in alveolar capillary permeability, by the atelectasis, hypoperfusion and stretching during revascularization, and possibly by the action of free radicals. A hemodynamic edema also exists as a consequence of the reduction in pulmonary interstitial pressure. Possible prophylactic measures are discussed, the most appropriate appearing to be very progressive evacuation of the pneumothorax.

[Consumption coagulopathies following peritoneojugular bypass. Prevention by a heparin-antithrombin III combination]. / Les coagulopathies de consommation après dérivations péritonéo-jugulaires. Prévention par l'association héparine-antithrombine III.

Consumption coagulopathy (CIVD) is a frequent complication of peritoneojugular bypass operation. Preventive treatment applied involves low-dose heparin (1.5 mg/kg/d) to maintain an antithrombin III concentration of at least 65%. Results are evaluated in 6 patients treated by 7 bypass operations. A biologic CIVD developed in 2 cases (29%) but no clinical coagulopathy was observed. This incidence is less than that usually reported, a literature review indicating a biologic coagulopathy in 65% of cases, with clinical evidence in 12.5%. Furthermore, patients with spontaneously elevated AT III levels did not develop CIVD while, in contrast, sufficiently high concentrations of AT III could not be maintained in the 2 patients with coagulopathy. These findings suggest the interest of prevention of a CIVD by the use of this procedure.