Application d'un protocole de prise en charge hémodynamique périopératoire pour la transplantation hépatique

AIX-MARSEILLE2-BU Méd/Odontol. (130552103) / SudocSudocFranceF

Two-Dimensional-Strain Echocardiography in Intensive Care Unit Patients: ă A Prospective, Observational Study

International audiencePurpose. Two-dimensional-strain echocardiography (2D-strain) is a ă promising technique for the early detection of myocardial dysfunction. ă Our study was aimed to assess its feasibility in the intensive care unit ă (ICU). Our secondary goal was to determine if 2D-strain could predict ă the patient's outcome. ă Methods. Conventional echocardiography and 2D-strain were performed on ă 64 consecutive patients admitted to our ICU. Using 2D-strain, the ă longitudinal deformation of the left ventricle was assessed. Feasibility ă of 2D-strain, diagnosis performance, and 28-day mortality prediction ă were determined. ă Results. 2D-strain measurements could be performed in 77% of our ă patients. All 2D-strain variables related to ventricular performance ă were significantly impaired in the patients who died compared with those ă who survived. Strain global medium was the only independent ă echocardiographic variable predictor of 28-day mortality rate (odds ă ratio 0.60; 95% confidence interval 0.43-0.80, p = 0.002). ă Conclusions. 2D-strain measurement is feasible in ICU patients, enabling ă identifying early left ventricle dysfunction. Strain global medium is an ă independent predictor of 28-day mortality. (C) 2016 Wiley Periodicals, ă Inc

Peri-operative risk factors of chronic kidney disease after liver transplantation

International audienc

The white test for intraoperative screening of bile leakage: a potential trigger factor for acute pancreatitis after liver resection—a case series

International audienceAcute pancreatitis after liver resection is a rare but serious complication, and few cases have been described in the literature. Extended lymphadenectomy, and long ischemia due to the Pringle maneuver could be responsible of post-liver resection acute pancreatitis, but the exact causes of AP after hepatectomy remain unclear. Cases presentation We report here three cases of AP after hepatectomy and we strongly hypothesize that this is due to the bile leakage white test. 502 hepatectomy were performed at our center and 3 patients (0.6%) experienced acute pancreatitis after LR and all of these three patients underwent the white test at the end of the liver resection. None underwent additionally lymphadenectomy to the liver resection. All patient had a white-test during the liver surgery. We identified distal implantation of the cystic duct in these three patients as a potential cause for acute pancreatitis. Conclusion The white test is useful for detection of bile leakage after liver resection, but we do not recommend a systematic use after LR, because severe acute pancreatitis can be lethal for the patient, especially in case of distal cystic implantation which may facilitate reflux in the main pancreatic duct