Necrotizing enterocolitis after antipsychotic treatment involving clozapine and review of severe digestive complications -- a case report.

A case of necrotizing enterocolitis in a 19-year old man treated for schizophrenic disorder, induced by a drug association involving clozapine and requiring surgical treatment, is presented. To our knowledge only few reports have described the occurrence of this complication with atypical antipsychotics. Evidence for linking this complication to clozapine was reinforced by the absence of any viral or bacterial infection. The authors present a review of similar cases, stress the potential hazards induced by such drug combinations and discuss supposed mechanisms of this enterocolitis.

[Infectious complications after liver transplantation]. / Complications infectieuses après transplantation hépatique.

Infections after liver transplantation are frequent and represent the first cause of mortality. Bacterial and fungal infections are favourized by preoperative clinical status, surgical conditions, degree of immunosuppression, and surgical complications. Perioperative antibiotics and, for patients at risk, antifungal prophylaxis, reduce their indicidence. Viral infections are attributed principally to CMV. Prophylaxis against CMV with immunoglobulins can be suggested for patients at risk. Curative antiviral treatment is always effective.

[Cytomegalovirus infections in patients after liver transplantation: determination of risk groups]. / Infections à cytomégalovirus chez les transplantés hépatiques: détermination de groupes à risque.

The goal of this study was to identify high-risk groups for cytomegalovirus infection after liver transplantation. Sixty-one patients were evaluated. Twenty-five patients (41 percent) had infection. Among the 16 patients who were seronegative for the virus before transplantation, 11 received a liver graft and blood products from seronegative donors and none of them developed infection. All seronegative recipients of a liver from seropositive donors (5/5) developed primary infection. Among the 45 patients seropositive before transplantation, 20 developed a cytomegalovirus infection, whatever the donor serologic status. The incidence of symptomatic reactivation or reinfection was high (14/20), and, for 12/14 of them, associated with early acute rejection. Two high-risk groups of patients, eligible for cytomegalovirus prophylaxis, were identified: seronegative recipients of seropositive donors and seropositive recipients with early acute rejection.

Liver transplantation in patients with a surgical portasystemic shunt.

Of 220 patients undergoing liver transplantation between March 1982 and April 1991, eighteen (8.1 percent) already had a surgical portasystemic shunt. Four patients had a distal splenorenal shunt, six a side-to-side portacaval shunt, three an end-to-side portacaval shunt, and five, a mesocaval shunt. The splanchnic venous system was assessed by Doppler ultrasound examination and angiography before liver transplantation. Perioperative mortality rate was higher but not significantly different from that observed in the population of patients without previous portasystemic shunt (33.3 percent versus 21.7 percent). Liver transplantation was particularly difficult in the six patients with a previous side-to-side portacaval shunt, in which the perioperative mortality rate was high (66.6 percent). Liver transplantation is feasible in patients with a previous portasystemic shunt but carries a higher risk. It is easier when no previous dissection of the hepatic pedicle has been done. Suppression of the shunt after revascularization of the graft must be performed in order to provide optimal venous flow to the hepatic graft.