Ultrasonographic guidance for portal vein access during transjugular intrahepatic portosystemic shunt (TIPS) placement.

PURPOSE: The purpose of our study was to retrospectively assess the safety and efficacy of percutaneous real-time ultrasound guidance for portal vein puncture during transjugular intrahepatic portosystemic shunt (TIPS) placement. MATERIALS AND METHODS: Between January 2011 and November 2018, procedure details and outcome were retrospectively analyzed for 224 patients who underwent TIPS placement using real-time ultrasound guidance for portal vein puncture. There were 175 men and 49 women with a mean age of 52.7±10.6 (SD) years (range: 22-82 years). For each procedure, technical success, primary ultrasound guidance success, portosystemic pressure gradient, duration of the intervention, procedural complications, radiation exposure, mortality and morbidity rates at day 30 post-procedure were recorded for data analysis. RESULTS: Technical success rate was 100.0% with a success rate of the primary ultrasound guidance of 97.8% (219/224; 95% CI: 95.8-99.7). Mean duration of the procedure was 86.2±41.7 (SD) min (range: 22.0-267.0min). Mean dose-area product was 62.0±50.2 (SD) Gy.cm2 (range: 3.7-306.5Gy.cm2). Twelve complications (12/224; 5.4%) occurred in ten patients during TIPS procedures including 8 arterial punctures (3.6%) and 4 biliary punctures (1.8%). Four complications (4/224; 1.8%) were clinically significant. Mortality rate at day 30 after the procedure was 9.8% (22/224), without any patient dying from technical complications. CONCLUSION: Real-time ultrasound guidance is a safe technique to assist in the creation of TIPS and may allow for lower radiation exposure.

Renal dysfunction in adults during measles.

BACKGROUND: Many cases of measles in adults were notified during the epidemic in France in 2008. Studying these cases can lead to a better understanding of their potential complications, little data having been reported on renal dysfunction during measles. METHODS: A retrospective study of biologically confirmed measles cases in patients hospitalized for more than 24 hours was carried out in the Nantes Teaching Hospital, between January and December 2011. The renal function was assessed using the modification of diet in renal disease (MDRD) equation. RESULTS: Thirty-eight patients were included, 17 (45%) presented with a clearance below 90 mL/min. One patient presented with acute renal failure, with a clearance at 37 mL/min, and proteinuria at 2.8 g/L. His renal function was restored on day 2. CONCLUSION: Acute renal failure can occur during measles in adults. Serum creatinine should be systematically assessed during the initial medical evaluation.

[Prevalence and description of hyponatremia in internal medicine departments of the France west area. A "one day" multicentric descriptive study]. / Prévalence et description des hyponatrémies dans les services de médecine interne de l'ouest de la France. Une enquête descriptive multicentrique type "jour donné".

PURPOSE: Few data are available on the prevalence and causes of hyponatremia in medical setting and to our knowledge, no recent descriptive study has been performed about hyponatremias in the French Departments of internal medicine. METHOD: A "one day" descriptive multicentric study was performed in the medicine departments of the France West area. A questionnaire was mailed to physicians who had to take part in a annual regional meeting about "hyponatremias", one month later. Hyponatremia was defined by a blood sodium level under the normal value of the local laboratory. Each internist had to precise for all hyponatremias in course at the study day, the exact value, the discovery circumstances, the mechanisms and etiologies, the associated diseases, the course and treatments. RESULTS: Seventy-four hyponatremias were identified. The overall prevalence was 12,1%. The prevalence of severe hyponatremias (under 120 mmol/l) was 1,1%. These latter represented 9,4% of the whole hyponatremias (7/74). Associated symptoms and diseases, the mechanisms, the suspected etiologies, the course and treatments are described in detail. CONCLUSION: This multicentric study reports for the first time the prevalence, the clinical and etiological characteristics of hyponatremias coming from Internal Medecine Departments of the West area from France. The overall prevalence is lower in comparison with values usually reported in hospitalized patients, but the frequency of severe and moderate hyponatremias, the mechanisms and the suspected etiologies are identical to those reported in others countries.

Henoch-Schönlein purpura associated with Toxocara canis infection.

We describe a case of Henoch-Schönlein purpura in the onset of Toxocara canis infection. The diagnosis was made in a 17-year-old boy based on the association of palpable purpura, oligoarthritis, acute abdominal pain, microhematuria, and cutaneous vasculitis. Toxocariasis, suggested by hypereosinophilia and domestic contact with a puppy, was confirmed by anti-Toxocara IgG and IgE and Western blot. Complete spontaneous resolution occurred within a few days. Transient presence of antinuclear antibodies and the absence of larvae in the skin biopsy favor an immunologic parasite induced disorder. A hypersensitivity vasculitis to Toxocara canis is suggested.

Coagulation activation in patients with an inflammatory syndrome: is there a link with acquired protein S deficiency?

The pathogenic mechanisms of thrombosis during inflammatory syndromes are unknown. The aim of our study was to evaluate coagulation activation and fibrinolysis and to study an acquired protein S deficiency in 58 patients with an inflammatory syndrome of neoplastic (16), infectious (24) or systemic (18) origin and in 54 control subjects. The results indicated that coagulation activation, demonstrated by an increase in the prothrombin fragment 1+2, was present in patients with an inflammatory syndrome regardless of its origin. Free protein S, the only functionally active protein, was not reduced even though C4b-binding protein was increased in inflammatory syndromes. Thus, a prothrombotic state was found in inflammatory syndromes but is not explained by an acquired protein S deficiency. All except five patients had normal plasminogen activator inhibitor-1 levels.