Anomalies de l’équilibre hydrosodé

Water balance control is aimed at normalizing cellular hydration, and sodium balance control at normalizing extracellular volume. Water balance control is based on the regulation of body fluid tonicity, while the control of sodium balance is based on the regulation of effective arterial volume. Disorders of water balance act on cellular hydration: primary disorders induce a proportional change in tonicity; secondary disorders are induced by a change in tonicity or effective arterial volume. Disorders of sodium balance act on extracellular volume: primary disorders of sodium balance induce a change in effective arterial volume; secondary disorders are induced by a change in effective arterial volume. Physical examination of the patient allows assessing the extracellular volume and the severity of the sodium balance disorder. Natremia – that generally reflects tonicity – allows to assess cellular hydration and to determine the type of water balance disorder. In the case of natremia disturbance, the assessment of both the tonicity and the extracellular volume allows the determination of the type of water and/or sodium balance disorder that is necessary for prescribing the adequate therapy.     

Tiefe Hypothermie unter 20° C

Ohne ZusammenfassungMit 28 Textabbildungen     

L’ischémie mésentérique chronique

Chronic mesenteric ischemia concerns patients with obliterant arteriopathy of digestive arteries. Clinical presentation is typical but often unrecognized, so-called mesenteric angor, which is associated with chronic abdominal post prandial pain, alimentary fear, and malnutrition. The evolution of this syndrome is progressive and can lead to fatal acute mesenteric ischemia. Diagnosis of chronic mesenteric ischemia is possible only if two of the three digestive arteries are involved. Because of the lack of digestive abnormalities in the earlier stage of this disease, diagnosis is difficult. The aims of the treatment are to treat symptoms to prevent acute mesenteric ischemia. Two therapeutical options are offered to physicians, surgical or endovascular revascularization.     

Repigmentation d’un vitiligo universalis déclenchée par l’hémodialyse

Vitiligo is an acquired depigmenting disorder. Vitiligo universalis is a rare form responsible for significant aesthetic damage. To date, the exact pathogenesis remains unknown. Its treatment, a real challenge, consists rather in removing the still pigmented areas. We report a case of a patient followed for stable vitiligo universalis from an early age who presented with repigmentation shortly after initiation of hemodialysis.     

Main de l’hémiplégique

The hemiplegic hand is a spastic and paralytic hand due to central neurological lesions. Two completely different types must be distinguished: the hand of the child with cerebral palsy which is the subject of almost all the studies on surgery of the hemiplegic hand, and the hand of the brain damaged adult (after vascular hemiplegia or brain traumatism). In this second type, the indications in a functional aim are very rare, due to the associated cerebral disorders. However, the indications in a hygienic or aesthetic aim are common and make this surgery, which is not very well known and which can greatly improve the global functions of these patients, a winning surgery. The surgical indications are based on a specific clinical study of the hand completed by the use of anaesthetic blocks, electromyographic studies and use of botox. Apart from this lesional study, they must take into consideration general and cognitive conditions. It is thus possible to distinguish two types of hands: the “Potentially Functional Hand” which can recover after treatment its functional possibilities which will never be total but will be useful, and the “Potentially Non Functional Hand” which will remain functionally unusable. The aim of this surgery is to correct muscular disorders between agonist and antagonist and the osteo-articular deformations that they bring about. For this, the nerve can be treated (hyponeurotisation, neurectomy, neuro-surgery) or on the muscle by relaxing the agonist muscles (muscular disinsertion, tendon lengthening…) or by strengthening the action of the antagonist muscles by tendon transfers. The articular stabilisation of the wrist, of the digital chains and of the thumb in a good position can be performed by arthrodesis or tenodesis.     

L’ischémie mésentérique aiguë

Mesenteric ischemia is defined by the anatomical and clinical consequences of a prolonged decrease of splanchnomesenteric perfusion. Mesenteric ischemia is classified not only by following its acute or chronic course, but also by an occlusive or non-occlusive mechanism, and by arterial or veinous vascular involvement. Etiologies of arterial ischemia are emboli from valvulopathy or cardiopathy and thrombosis from pathological arteries. Non occlusive arterial mesenteric ischemia occurs in low-flow states or in patients with vasoconstrictive medications or drugs (cocaine).     

Thrombose d’oxygénateur en l’absence de résistance à l’héparine mais en présence d’une maladie de Vaquez

A 55-year-old male with a history of positive HIV serology and polycythemia vera underwent coronary artery bypass graft surgery with normothermic extracorporeal circulation. Following heparin administration the activated clotting time (ACT) was 633 seconds (Hemocron^® with kaolin). Lower than expected arterial and venous oxygen partial pressures together with high pressure (350 mmHg) in the arterial line upstream of the oxygenator were observed. Because of these signs the oxygenator was changed during the procedure. The outcome was uneventful. Electronic microscopic examination of the oxygenator membrane and thermic exchanger revealed fibrin and platelet deposits. Similar cases are described in the literature during polycythemia vera. Therefore the prevention might be a preoperative treatment with antiplatelet therapy in polycytemia vera.     

Transpiration stimulée afin d’améliorer l’équilibre hydro-sodé chez les patients hémodialysés : à propos d’un cas

Obtaining the desired dry weight in dialysis patients is challenging once residual diuresis has disappeared, considering the trend of increasing dietary salt intake and shortening dialysis time over the last 40 years. We describe the case of a 55-year-old patient of Sudanese origin, who presented excessive interdialytic weight gain and hypertension on maintenance hemodialysis. After failure of conservative measures, a therapy of daily hot water baths of 30 minutes each on non-dialysis days was introduced. All clinical parameters improved, including potassium profile. In this article, we review the history, pathophysiological mechanisms, efficacy and possible side effects of this interesting, somewhat forgotten technique.