[Worsening of chronic disseminated intravascular coagulation after embolization of the renal artery]. / Aggravation d'une coagulation intravasculaire disséminée chronique après embolisation d'une artère rénale.

A case is reported of a 60 year-old patient with chronic disseminated intravascular coagulation (DIC) which was increased by the therapeutic embolization of a renal tumour. The patient had 2 primary carcinomas (renal and prostatic) with vertebral metastases, severe chronic anaemia (due to haematuria), and chronic DIC, with thrombocytopaenia, soluble complexes, and fibrinogen and fibrin degradation products. Therapeutic embolization of the renal artery was carried out with fragments of dura mater. Although the result was anatomically very satisfactory, the patient's condition worsened, with continuing haematuria, and development of an haematoma in the lumbar fossa. Coagulation factors and antithrombin III (AT III) concentrations decreased, whereas the activated partial thromboplastin, thrombin and reptilase times increased. The patient also suffered from acute renal failure (creatinine: 690 mumol.l-1). Treatment consisted in fluid replacement, red blood cell and platelet transfusions, 150 IU.kg-1.d-1 heparin and 20 IU.kg-1.d-1 AT III. Haematological tests returned to pre-embolization values on the ninth day. The sudden worsening in the patient's condition was probably due to the sudden massive release of tissue thromboplastins related to the renal necrosis induced by the therapeutic embolization. The use of heparin AT III in the management of this patient is discussed.

[Importance of suspended peridural anesthesia in percutaneous nephrolithotomy. Apropos of 112 patients in the urology service of the Regional Hospital Center of Lille]. / Intérêt de l'anesthésie péridurale suspendue dans la néphrolithotomie percutanée. A propos de 112 patients du service des voies urinaires du C.H.R. de Lille.

Epidural anaesthesia has been used for transcutaneous renal surgery. Hemodynamic and respiratory parameters were satisfactory in 88% of the cases (2% of complications, 10% of technical failure). Compared to local anaesthesia associated with sedative analgesia or general anaesthesia, epidural anaesthesia appeared more convenient.