In a prospective study, the authors have determined the prevalence of phospholipid antibodies and/or lupus anticoagulant in 135 patients with veinous or arterial thrombosis, acute brain syndrome or systemic diseases.

In a prospective study, the authors have determined the prevalence of phospholipid antibodies and/or lupus anticoagulant in 135 patients with veinous or arterial thrombosis, acute brain syndrome or systemic diseases.

Respiratory alkalosis, produced by mechanical ventilation, has been identified as a cause of hypoxemia, which improves when PaCO2 is normalized or increased. Moreover, moderate hypercapnia has been suggested for the treatment of acute respiratory failure (ARF) by the results observed in experimental animals. To correct the situation of hyperventilation one option therapeutic is the addition of dead space (VD). Whereas pulmonary disease that impairs the lung s capability to oxygenate the arterial blood can be evaluated with the utilization of oxygen tension-based indices such as: F(A-a)02, PaO2/PA02, Pa02/FiO2, and Respiratory Index R.I.= P(A-a)O2/PaO2, or oxygen content-based indices such as: Estimated Shunt (Est Bunt). To determine the effects of hypo, normo and hypercapnia on the variations in arterial oxygenation and their indices in critical patients with acute respiratory failure (ARF) receiving mechanical ventilation. 15 ARF patients, prospective and randomized, intubated and mechanically ventilated, were studied within the first 48 hours of evolution. Three stages warp delimited: I) 30 min after the beginning of anaesthesia; II) 30 min after adding 30 cm of dead space (VD); III) 30 min after replacing the previous VD with VD of 60 cm. Ventilation parameters and FiO2 were kept stable. Stage I was characterized by respiratory alkalosis and stage II by normal acid-base balance with an increase in Pa02 (p<0.01) and a decrease in intrapulmonary shunt (Qsp/et) (p<0.001); the indices alveolar to arterial oxygen tension gradient EP(A-a)02], respiratory index (R.I.) and estimated shunt (Est Shunt) also decreased significantly, whereas arterial to alveolar oxygen tension ratio (Pa02/FA02) and arterial oxygen tension to inspired oxygen fraction ratio (Pa02/FiO2) increased significantly. In stage III there was pure hypercapnic acidosis, with decreases in PA02 (p<0.001), P14-a1O2 (p<O.01) and R.I. (p<0.05), while Pa02, Qsp/Qt, Est Shunt, Pa02/PAO2 and Pa02/FiO2 remained stable with respect to the previous situation. Conclupion. It is suggested that " qualitativeli" changes or/and "extra-alveolar" modifications due to localo' regional pulmonary perfusion are responsible for the observed variations. The indices P(A-a)02 and R.I. do not allow us to differentiate the causes of arterial h.ypcxemia in the presence of hypercapnia. P419

The initial management of multiple trauma must achieve a triple aim: performing the actions required by a vital emergency, preventing as well as possible the complications associated with the initial lesions, and, most importantly, bringing the injured person into hospital in the best possible conditions for emergency surgery. Achieving these aims requires a perfect coordination of medical and nonmedical rescue. A rough initial categorization is important to decide whether additional medical staff is desirable, choose the type of transport planned (by ambulance, helicopter...) as well as the department or hospital due to receive the patient. Four actions must be accomplished, most often jointly, all of them contributing to the quality of treatment: 1. picking up/freeing/immobilizing the injured person, 2. controlling the hypovolemic collapse and the traumatic shock, 3. dealing with the associated distresses, 4. suppressing pain. The techniques used to pick up, free and immobilize the injured person require a close co-operation with the rescuing staff (stretcher bearers, fire department, first-aid workers). The hypovolemic shock is treated by volume replacement, mainly with colloids. Local hemostasis may sometimes be necessary. Anti-shock trousers should be widely used in cases of multiple trauma. Dealing with the associated distresses gives priority to ventilation. The indications of ventilatory support must be very wide whenever coma or signs of respiratory distress are noted, more so with an associated shock. The indications of aspiration of a gaseous or fluid pleural effusion must also be discussed. Maximal suppression of pain must be kept in mind throughout all these operations.(ABSTRACT TRUNCATED AT 250 WORDS)

Hemorheological parameters must be taken into account for a better knowledge of venous flow properties. The postcapillary venules are the region of lowest shear rates and therefore the region of highest whole blood viscosity. Red cell aggregation plays a major role in blood viscosity, especially at low shear rate. This microrheological parameter can be increased in pathological circumstances, including a low capillary flow, venular insufficiency, elevated hematocrit, high levels of acute phase proteins. At the level of the capillaries, microcirculatory stasis leads to a low oxygen supply and consequently to poor metabolic state lowering local ATP levels. As a result, both platelet and white blood cell functions are compromised. Hemorheological studies have shown that both deep venous thrombosis and chronic venous insufficiency are associated with high blood viscosity mainly due to an increased red cell aggregation. This hemorheological vicious circle--stasis promoting hyperviscosity leading to further stasis--could be broken up by therapeutic intervention including hemodilution, fibrinolytic drugs or other specific agents.

Letters| December 10 2008 Hemorrhagic Colitis with Streptococcus pyogenes Preceding Hemolytic Uremic Syndrome during Early Pregnancy Subject Area: Nephrology P.E. Bollaert; P.E. Bollaert aService de Réanimation, Hôpital Central, and Search for other works by this author on: This Site PubMed Google Scholar P. Bauer; P. Bauer aService de Réanimation, Hôpital Central, and Search for other works by this author on: This Site PubMed Google Scholar P. Judlin; P. Judlin bMaternité Régionale, Nancy, France Search for other works by this author on: This Site PubMed Google Scholar M.C. Laprevote-Heully; M.C. Laprevote-Heully aService de Réanimation, Hôpital Central, and Search for other works by this author on: This Site PubMed Google Scholar H. Lambert; H. Lambert aService de Réanimation, Hôpital Central, and Search for other works by this author on: This Site PubMed Google Scholar A. Larcan A. Larcan aService de Réanimation, Hôpital Central, and Search for other works by this author on: This Site PubMed Google Scholar Nephron (1989) 52 (1): 103–104. https://doi.org/10.1159/000185598 Article history Published Online: December 10 2008 Content Tools Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn Email Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation P.E. Bollaert, P. Bauer, P. Judlin, M.C. Laprevote-Heully, H. Lambert, A. Larcan; Hemorrhagic Colitis with Streptococcus pyogenes Preceding Hemolytic Uremic Syndrome during Early Pregnancy. Nephron 1 January 1989; 52 (1): 103–104. https://doi.org/10.1159/000185598 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll JournalsNephron Search Advanced Search Article PDF first page preview Close Modal This content is only available via PDF. 1989Copyright / Drug Dosage / DisclaimerCopyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements. You do not currently have access to this content.

One case of uremic-haemolytic syndrome associated with an ectopic pregnancy is reported. The main signs are, from the clinical standpoint, a diffuse haemorrhagic syndrome and, from the biological standpoint, a haemolytic anemia, renal failure and thrombopenia. This pathology, exceptionally associated with an early pregnancy, required an intensive resuscitation with blood transfusion, hemodialysis and plasma exchanges. From a surgical standpoint, two procedures were necessary following salpingectomy, to drain intraperitoneal and sub-aponeurotic blood collections. The course, thereafter, was uneventful.

Heparin induced thrombocytopenia is characterized by often dramatic evolution of thrombotic arterial and venous complications. These occurred or are worsened in curative or preventive heparin therapy and the treatment remains delicate. The authors report 32 observations of thrombocytopenia complicated with thromboembolic events; seven deaths are to mention. The tests of platelet aggregation with standard heparin and platelets poor patient's plasma confirm the diagnosis in 28 cases of 30 very early studied and in 2 cases around the 6th day only after the stop of standard heparin. The choice of anticoagulant therapy is carried out the negative tests of platelet aggregation with low molecular weight heparin (L.M.W.H.) (CY 216, CY 222 Choay, PK 10109 Pharmuka). In L.M.W. heparin therapy, clinical and biological improvement is obtained in 26 cases of 30 treated cases. In three cases, the rapid climbing of platelet countings is not present although negative tests of platelet aggregation with selected L.M.W.H. In one case, after a initial climbing of platelet countings, the thrombocytopenia recurs rapidly with L.M.W. heparin after a operation. The immediate or secondary passage with K-antivitamins, platelet antiaggregant stabilized medium and long term's evolution.

Deux observations de thrombopénie sévère associée à des manifestations thrombo-emboliques aiguës au cours d'un traitement par le polysulfate de pentosane, substance héparinoïde de bas poids moléculaire, sont rapportées. In vitro, le plasma des malades agrège les plaquettes d'un témoin en présence du médicament. L'interruption du polysulfate de pentosane est suivie d'une correction rapide du déficit plaquettaire. L'hypothèse d'un mécanisme immuno-allergique identique à celui des thrombopénies thrombogéniques à l'héparine est retenue. Ce phénomène paraît pouvoir être rencontré avec tous les glycosaminoglycanes polysulfatés. La gravité extrême de ces accidents devrait justifier la surveillance de la numération plaquettaire au cours de tout traitement par le polysulfate de pentosane.

Deux syndromes de détresse respiratoire aiguë de l'adulte (SDRA) ont été observés dans une série de 26 cas d'intoxications aiguës par colchicine. Le SDRA est apparu entre la 24e et la 72e heure et s'est intégré dans le cadre d'une atteinte multiviscérale où dominaient hyperthermie et coagulopathie de consommation. Les résultats des explorations hémodynamiques ont été les suivants : état hypercinétique avec hypertension artérielle pulmonaire modérée de type précapillaire ou pression pulmonaire normale. L'évolution a été fatale dans un cas; l'examen anatomopathologique a alors retrouvé un œdème pulmonaire interstitiel et alvéolaire, avec alvéolite hémorragique et macrophagique et présence de membranes hyalines. La physiopathologie du SDRA survenant au cours des intoxications par la colchicine apparaît loin d'être univoque, faisant intervenir aussi bien des facteurs infectieux que l'existence d'un état de choc ou d'une coagulopathie de consommation. Le rôle toxique direct de la colchicine par inhibition de la production de surfactant ou altération directe des microtubules des pneumocytes a été incriminé. Enfin la responsabilité de la colchicine dans la production d'agrégats leucocytaires reste à démontrer.