Pas de chirurgie sans échographie préalable en cas de thrombose veineuse superficielle clinique : à propos d’un cas d’embolie paradoxale grave

Lower limbs superficial venous thrombosis (LLSVT) is usually considered as common and of a benign prognosis. LLSVT can, however, be responsible for major thromboembolic complications: lower limbs deep vein thrombosis (LLDVT) and pulmonary embolism (PE). We report a case of a LLSVT complicated with a massive bilateral PE and an ischemic cerebral stroke, occurring immediately after a varicose vein surgery. Venous ultrasonography of the lower limbs must be systematically performed in case of LLSVT, in order to evaluate the presence of an associated LLDVT. A rigorous diagnostic and therapeutic approach is the only way to optimize the treatment of this disorder, and to avoid the occurrence of dramatic venous thromboembolic complications.     

Correction de l’hypoxémie d’exercice chez le BPCO : variabilité des réponses, enjeux et problèmes posés dans le cadre de la réhabilitation respiratoire

Aim

To define in chronic obstructive pulmonary disease patients (COPD) moderately hypoxemic in resting conditions, if controlled acute oxygen supplementation was always able to increase exercise tolerance when partial oxygen saturation SpO₂ was corrected.

Results

In hyperoxia, endurance time (T_LIM) was significantly and consistently increased in 14 COPD (+68%) and decreased in seven others (–36%). These two subgroups exhibited no difference in resting values or in their disease severity. COPD with a decreased T_LIM under hyperoxic conditions had an abnormal response to O₂: unchanged cardiac output and ventilation, increased breathing frequency.

Conclusion

This work shows that acute O₂ supplementation responses in COPD are not univocal, either on exercise tolerance or cardio-respiratory variables typically affected by hyperoxia.     

Postpartum cardiomyopathy revealed by acute lower limb ischemia

Peripartum cardiomyopathy is an uncommon disease defined as a dilated cardiomyopathy during puerperium, with left ventricular dysfunction (ejection fraction < 45%) without any other etiology. The etiology of this disease remains uncertain and it can be revealed in a variety of ways. Thrombo-embolic complications may be, although infrequently, the initial manifestation of peripartum cardiomyopathy, which is usually an intracardiac thrombosis. Lower extremity embolism is uncommon. The case reported is about a 39-year-old woman, multiparous, who presented, 40 days after delivery, a global heart failure with atrial fibrillation, revealed by left lower extremity thromboembolism. After echocardiographic and etiologic examinations, the diagnosis was established as peripartum cardiomyopathy. It evolved favourably after 2 months of medical treatment: the symptoms and cardiomegaly decreased, left ventricular systolic function was improved.