[Treatment of patients with atherosclerotic carotid stenosis in 1993. Indications and long-term results of surgery]. / Le traitement des patients porteurs de sténoses carotidiennes athéromateuses en 1993. Indications et résultats à long terme de la chirurgie.

Cerebrovascular accidents (CVAs) are the third commonest cause of death in France. Approximately 15% of them are due to stenosis of the extracranial internal carotid. The fact that a third of CVAs are followed by death and another third by major handicaps leads to the need for careful prevention. This has three aspects: 1) Correction of risk factors: hypertension, smoking, hyperglycemia, hyperlipidemia, obesity, alcohol abuse, hematological abnormalities and oral contraception; 2) the prescription of one of two platelet anti-aggregants, the efficacy of which has been proved: acetylsalicylic acid or ticlopidine; 3) surgical elimination of tight carotid stenoses. The following require surgery: 1) more than 70% stenosis following cerebral or ocular TIA or minor CVA; 2) more than 75% stenosis in asymptomatic patients or with episodes of VBI as well as 70% in case of thrombosis of the contralateral internal carotid; 3) following a CVA leaving serious sequelae: tight stenosis when it is reasonable to assume that a further CVA could lead to clinical worsening or to a loss of independence; 4) symptomatic and/or more than 80% restenosis. The decision should be made only after confirmation of the diagnosis and of the degree of stenosis and verification of the absence of any local or systemic contra-indication. The surgical team must have a low cumulative mortality and perioperative CVA rate. These patients require ongoing medical monitoring, particularly from a cardiological standpoint.

[A rare cause of portal vein thrombosis: closed abdominal trauma]. / Une cause rare de thrombose portale: le traumatisme fermé de l'abdomen.

Abdominal trauma is a rare and poorly documented cause of portal vein thrombosis. We report here the case of a patient in whom portal vein thrombosis was diagnosed one month after an abdominal blunt trauma. Post-traumatic origin of thrombosis was confirmed by the negativity of an exhaustive aetiological investigation. Thrombosis involved portal bifurcation and right and left portal veins, but remained asymptomatic. A particularity of this case was that a total regression of the thrombosis was observed under anticoagulation therapy.

Asymptomatic renal-vein thrombosis in adult nephrotic syndrome ultrasonography and urinary fibrin-fibrinogen products: a prospective study.

OBJECTIVES: The diagnosis of renal vein thrombosis (RVT), a frequent complication of adult nephrotic syndrome (NS), is generally made by means of invasive methods, i.e. renal venography, venous time of renal arteriography and, more recently, computed tomography (CT). We undertook a prospective study to evaluate the use of Doppler ultrasonography (DUS) and urinary fibrin-fibrinogen degradation products (FDPU) for the diagnosis of asymptomatic RVT. METHODS: Thirty-one adult NS with non proliferative glomerulonephritis were studied. Reference procedures [(selective renal arteriography (n = 18) and renal vein CT (n = 13)] were performed blindly within a few days (48 hours in 17 patients) of renal vein DUS (search for a lack of venous flow) and measurement of FDPU (5 micrograms/min) (in 24 patients). RESULTS: DUS was not interpretable in one patient and positive in nine. Of these 9 patients, RVT was detected by reference methods in only two (sensitivity: 1, specificity: 0.75; positive predictive value: 0.22; negative predictive value: 1). Increased FDPU was observed in 4 patients, 2 of whom had an RVT (sensitivity: 1, specificity: 0.9; positive predictive value: 0.5; negative predictive value: 1). CONCLUSION: We conclude that DUS and FDPU are helpful for screening of RVT in asymptomatic NS patients; their negativity allow further radiological investigations to be avoided while positive results must be confirmed by reference methods.

Evaluation of Doppler examination for diagnosis of catheter-related deep vein thrombosis.

The accuracy of Doppler examination was evaluated for the diagnosis of catheter-related venous thrombosis in 40 postoperative patients. Deep vein thrombosis was detected by venography in 15 patients and confirmed by the Doppler technique in a double blind study. Only one false-positive and one false-negative result were obtained with the Doppler technique. This technique appears to be valuable for the early diagnosis of catheter-related vein thrombosis, even in asymptomatic patients.