[Gazeous necrosis of the liver due to hepatic artery thrombosis after liver transplantation]. / Nécrose gazeuse du foie par thrombose de l'artère hépatique après transplantation hépatique.

An emergency liver transplantation was performed in a 22 year-old female for fulminant hepatitis. The donor had had splenectomy with portal vein thrombosis which was diagnosed and removed during portoscopy. Nineteen days later, abdominal pain with shock and hepatic failure occurred. X-rays showed pneumoperitoneum and aeric images in the liver area. Laparotomy disclosed massive liver necrosis with gaz under the Glisson's capsula. The hepatic artery was thrombosed. In spite of emergency retransplantation, the patient died 8 days later, due to systemic aspergillosis. Thrombosis of hepatic artery was particular by the importance of gaz-forming infection, and emphasizes the role of rejection. The discovery of portal thrombosis allows to outline the precautions necessary in case of splenectomized donors. The severeness of aspergillosis is underscored.

Antibiotic levels in bronchial tree and in serum during selective digestive decontamination.

Selective digestive decontamination has been found to prevent pulmonary infections in mechanically ventilated patients. The aims of this study were: 1) to determine whether detectable levels of antibiotics could be found in bronchial tree secretions of patients receiving SDD, and 2) to evaluate antibiotic serum levels. In 15 patients receiving mechanical ventilation and SDD for 10 days or more, tobramycin and amphotericin B levels were determined every 3 days in the following specimens: tracheal aspirates, distal bronchial secretions and blood samples. 82% of tracheal aspirates contained detectable (greater than 0.18 mg/l), tobramycin concentrations; the levels varied widely between patients and large day-to-day variations were observed. Every patient had at least 1 tracheal aspirate with tobramycin level higher than 0.5 mg/l during his course. 40% of distal specimens contained detectable tobramycin levels (10 patients). Serum determinations showed detectable concentration of tobramycin in 50% of the specimens (9 patients). Two patients with renal failure had serum tobramycin levels higher than 2 mg/l. In 13 tracheal aspirates cultures were positive and 15 species were isolated; 13 had a MIC higher than the corresponding tobramycin level in tracheal secretions. We conclude that substantial levels of antibiotics can be found frequently in respiratory tract specimens of patients receiving SDD. Therefore, the usual microbiological criteria used to assess respiratory tract infection may be unreliable in this setting and other criteria may be required. Follow-up of antibiotic serum levels is required, especially in patients with renal failure.

[Post-traumatic pulmonary hematomas. Apropos of 2 cases]. / Hématomes pulmonaires post-traumatiques. A propos de deux observations.

Post-traumatic pulmonary hematoma presents clinically as a hemorrhagic collection within a newly-formed cavity in the lung parenchyma. Its frequency is probably underestimated in view of the importance of the associated lesions. The most frequent clinical sign is hemoptysis. The chest radiograph, as well as the CT scan, shows a clearly defined round image. As a rule, there is a favorable outcome with slow resorption over several weeks, with a restoration of the integrity of the pulmonary parenchyma, which justifies simple observation, with an absence of any therapeutic intervention.

[Does extrinsic asthma exist?]. / L'asthme extrinsèque existe-t-il?

Asthma cannot be triggered exclusively by external causes, even allergy. For it to develop, the subject must have pathological bronchial hyper-reactivity. On the contrary, however, asthma cannot be explained solely by intrinsic causes, metabolic or endocrine. It persists only in those subjects who have bronchial hyper-reactivity. The authors suggest a new definition of asthma, designed to replace the semi-logical definition of Charpin: Asthma is a dyspnoeic bronchospasmodic crisis that is linked with the existence of pathological bronchial hyper-reactivity.

[Failure of chemotherapy and radiotherapy in pulmonary fibrosis caused by paraquat]. / Echec de la chimiothérapie et de la radiothérapie au cours des fibroses pulmonaires dues au paraquat.

A case is reported of severe interstitial paraquat poisoning in a 23 year old man. Initial treatment consisted of gastric lavage, fuller's earth, haemoperfusion on activated charcoal and peritoneal dialysis. On the third day, appeared both renal and early respiratory failure, with hypocapnia and hypoxia. Peritoneal dialysis was kept up to the thirteenth day. Pulmonary function tests showed a restrictive syndrome. Chemotherapy with 1 mg.kg-1.24 h-1 prednisone and 3 mg.kg-1.24 h-1 cyclophosphamide was started on day 4. Radiotherapy (13 Gy) was also given to both lung fields between days 6 and 10. Despite this treatment, respiratory failure worsened, and the patient died at the 28th day, with resistant severe hypoxaemia and pneumothorax on fibrous lungs. Several reports have shown conflicting results with chemotherapy and radiotherapy in the treatment of pulmonary fibrosis due to paraquat poisoning. The failure of such treatment in the case reported showed the need for large prospective clinical trials of the treatment of paraquat poisoning, as well as for urgent preventive measures.