[Post-transfusion purpura: and cause of severe postoperative thrombopenia]. / Purpura post-transfusionnel: une cause de thrombopénie postopératoire grave.

A 59-year-old woman developed an acute and severe thrombocytopenia (platelet count below 10.10(9).L-1) with active bleeding, 6 days after a massive transfusion for intraoperative haemorrhagic shock. The diagnosis of post-transfusion purpura (PTP) was confirmed by the presence of an allo-antibody directed against HPA-1a platelet antigen. The patient and her daughter had a rare HPA-1b platelet phenotype, but also belonged to the HLA DR3 phenotype, frequently associated with PTP. This case shows the therapeutic difficulties of postoperative PTP. Despite active bleeding, this syndrome requires the discontinuation of transfusions of incompatible platelets. Transfusion of phenotyped platelets is often inefficient. Red cell concentrates must be platelet and plasma free. Immunomodulating therapy can shorten the time course. Preventive measures, particularly autologous transfusions, are necessary for subsequent haemorrhagic surgery or parturition.

[Early diagnosis of traumatic extra-pericardial luxation of the heart. Value of tomodensitometry. Apropos of a case]. / Diagnostic précoce de la luxation extrapéricardique du coeur d'origine traumatique. Intérêt de la tomodensitométrie. A propos d'un cas.

Heart luxation is a rare complication of chest trauma. The rupture of pericardium must be diagnosed as soon as possible, particularly before prolonged orthopaedic surgery for multitrauma, as a cardiac arrest may occur during anaesthesia. This report underlines the difficulties of diagnosis in a 40-year-old patient with head trauma, chest trauma and multiple fractures. The diagnosis was suspected on unstable blood pressure and left lung atelectasis. The computed tomography showed herniation of the left ventricle. Emergency thoracotomy showed the left rupture of pericardium with complete left heart dislocation. Orthopaedic operation was carried out three days later. Computed tomography in multitrauma patients, seems to be decisive for early diagnosis of heart luxation. Emergency thoracotomy is essential.

[Peroperative rhabdomyolysis caused by compression of a kidney-bridge. Value of muscular scintigraphy]. / Rhabdomyolyse peropératoire par compression sur un billot lombaire. Intérêt de la scintigraphie musculaire.

A case is reported of acute renal failure occurring after prolonged abdominal aortic bypass surgery in an overweight 69-year-old male patient. Preoperative serum creatinine concentration was normal. Surgery lasted for 6 h, and infrarenal aortic cross-clamping 2 1/2 h. The patient complained of important lumbar pain immediately after the operation. In the same time, oliguria and acute renal failure also developed (creatinine: 464 mumol.l-1; urea: 13 mmol.l-1). Rhabdomyolysis caused by the kidney-bridge was confirmed by the elevated blood creatine phosphokinase levels (16,000 IU.l-1 on the second postoperative day). A 99 m-Technetium methylene-diphosphonate imaging on the 10th postoperative day exhibited diffuse fixation in the paravertebral lumbar and thoracic muscles, extending from Th8 to L3. The acute renal failure regressed completely after haemodialysis.

[Repeated convulsions after abrupt benzodiazepine withdrawal]. / Convulsions itératives après sevrage brutal en benzodiazépines.

Benzodiazepines are widely used and well-known for their safety; serious complications may, nevertheless, occur in the particular case of an abrupt withdrawal, which is quite common after general anaesthesia. The case reported emphasizes the seriousness of the syndrome : after vascular surgery the patient presented with repeated epileptic seizures and a short lasting cardiac arrest. The patient used to absorb large quantities of benzodiazepines, without medical prescription. The convulsions stopped after the benzodiazepine had been taken again. The exact mechanism of the withdrawal syndrome remains hypothetical. There are numerous risk factors which increase the probability and seriousness of the withdrawal symptoms. The prevention of withdrawal accidents depends on the physician, and especially the anesthetist, knowing the patient's drug intake. This shows yet again the importance of the preanaesthetic visit.

[Anti-arrhythmia effects of magnesium salts. 4 cases]. / Effets antiarythmiques des sels de magnésium. Quatre observations.

Known since 1935, the antiarrhythmic effects of magnesium salts are periodically forgotten. They are illustrated here by 4 cases with entirely different clinical and biological features. Of unquestionable therapeutic value was the use of magnesium for the treatment of 2 episodes of severe ventricular extrasystoles with "torsades de pointe". These antiarrhythmic properties are observed whether blood magnesium levels are normal or low and cannot therefore be ascribed to correction of magnesium deficiency. Experimental data are in favour of interferences with transcellular ion flows. Magnesium is thought to ensure normal potassium gradient and also to reactivate the fast sodium channel inhibited by hypokalaemia. Above all, the magnesium ion appears to act as a calcium inhibitor, which would explain its antiarrhythmic properties irrespective of the state of magnesium body stores.

[Single dose of thiopental or fentanyl. Hemodynamic effects after treatment by an anti-hypertensive drug: guanoxabenz (author's transl)]. / Effets hémodynamiques d'une injection unique de thiopental ou de fentanyl après le traitement par un anti-hypertenseur: le guanoxabenz.

The hemodynamic effects of a single dose of fentanyl (4 micrograms/kg) and of thiopental (5 mg/kg) were studied on cranial trauma patients who have hypertension and who are ventilated at constant volume and frequency. At first the results were collected without an hypertensive treatment, in the second time the same results were collected after the injection of an anti-hypertensive drug (guanoxabenz 70 micrograms/kg). The results showed that in two series the modification in the measured parameters was not statistically significant; the used drugs produced little change in the hemodynamic profile: a) Even with insignificant, we noted that the injection of fentanyl after an anti-hypertensive drug caused a smaller change in the blood pressure and cardiac index then was seen in untreated subjects. b) With thiopental treated subjects, the arterial pressure is not decreased because of the increased systemic resistances, at the same time changes in cardiac index are essentially identical whether or not the subject was treated with guanoxabenz. The results therefore tend to show that the anti-hypertensive treatment can be continued without any interruption by a surgical operation.