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COVID-19 has been the center of global attention and concern for the last months. Patients undergoing dialysis and especially those treated at the hospital are likely to be infected, due to their mandatory presence at the hospital several times a week and due to their intrinsic fragility in regard of chronic kidney disease, often an older age, and the presence of many associated comorbidities. Thereby, patients with chonic kidney disease treated by haemodialysis have higher odds of a more severe COVID-19 infection with a high mortality rate. Prevention is thus a high priority for these patients.Au cours des derniers mois, la COVID-19 a été au centre des préoccupations et de l’attention de chacun. Les patients dialysés, et surtout ceux hémodialysés en centre, représentent une population particulièrement à risque de contamination vu la nécessité de se rendre à l’hôpital plusieurs fois par semaine et compte tenu de leur fragilité intrinsèque liée au statut de malade rénal chronique, un âge souvent plus avancé, et de nombreuses comorbidités. Ils ont donc un risque de développer une infection grave et potentiellement mortelle. Dès lors, la stratégie de prévention est d’une importance capitale pour ces patients.

Il trapianto bipolmonare rappresenta il trattamento curativo dei pazienti che presentano un’insufficienza respiratoria allo stadio terminale. I progressi realizzati in questi ultimi anni nella selezione e nella gestione dei donatori, nella conservazione dei trapianti e nel miglioramento dei trattamenti immunosoppressivi e delle complicanze infettive hanno permesso di ottenere un miglioramento costante dei risultati a breve e a lungo termine dei pazienti trapiantati. Le tecniche chirurgiche si sono molto evolute nel corso degli anni per contribuire ai tassi di successo attualmente conseguiti. Dopo gli esordi del trapianto bipolmonare definito «in blocco» introdotto dall’equipe di Toronto e progressivamente abbandonato, noi assistiamo, dagli anni ‘90, allo sviluppo e al perfezionamento del trapianto bipolmonare detto sequenziale. Anche se divenuto relativamente standardizzato, il trapianto bipolmonare rimane un intervento delicato. Un gran numero di punti tecnici concorre alla riuscita dell’operazione e deve essere noto al chirurgo. Questa revisione illustra gli aspetti chirurgici del trapianto bipolmonare sequenziale, includendo degli aspetti storici, i punti fondamentali della gestione anestesiologica, delle vie d’accesso e delle tecniche di espianto e di impianto, il ricorso all’assistenza circolatoria e la gestione postoperatoria immediata. Il testo e illustrato con modelli ed elementi audiovisivi per una perfetta comprensione.

Resume La tumeur cardiaque primitive est une affection rare, avec une frequence entre 0,001 et 0,03 %. Quatre-vingts pour cent sont des tumeurs benignes et, parmi elles, 70 % sont des myxomes. Les autres tumeurs benignes sont les fibroelastomes, rhabdomyomes, fibromes, angiomes et lipomes. Quatre-vingt-quinze pour cent des tumeurs malignes sont des sarcomes, les 5 % restants des lymphomes. Les metastases cardiaques sont plus frequentes que les tumeurs primitives. Le diagnostic est fait par echocardiographie, scanner ou resonance magnetique. La chirurgie est le traitement de choix pour les tumeurs benignes et les sarcomes quand ils sont localises, la chimiotherapie pour les sarcomes avec une extension locale ou a distance. La radiotherapie associee a la chimiotherapie pour les lymphomes. Les tumeurs benignes ont un excellent pronostic. La survie moyenne d’un sarcome est de 11 mois, celle des lymphomes de cinq ans.

Plaies du cœur, prise en charge de chirurgie cardiaque ou generale ? J.-P. Avaro, D. Grisoli, V. Gariboldi, A. Piccardo, A. Riberi, F. Kerbaul, D. Metras, F. Collart Objectif : L’objectif du travail etait de definir les modalites de prise en charge chirurgicale des patients victimes de plaies du cœur, en particulier l’orientation des blesses, le diagnostic initial et la technique chirurgicale dans le traitement de ces lesions. Methode : Il s’agissait d’une etude retrospective de patients victimes de plaies de l’aire cardiaque et pris en charge dans un service de chirurgie cardiovasculaire entre 1996 et 2006. Les donnees etudiees etaient le type de lesions, les delais de prise en charge, les donnees cliniques et paracliniques pre-operatoires, la technique chirurgicale et l’utilisation d’une circulation extracorporelle, ainsi que la morbidite et la mortalite. Resultats : Seize patients (12 hommes/4 femmes) d’âge moyen 45,7 ans (18 a 80 ans) ont ete pris en charge pour traumatisme de l’aire cardiaque. Les etiologies etaient soit des plaies penetrantes (n = 9), des traumatismes fermes (n = 2), ou des traumatismes iatrogenes (n = 5). Le delai moyen de prise en charge chirurgicale etait de 63 min (0 a 180 min). Treize patients ont ete operes. Deux ont necessite une procedure sous circulation extracorporelle. La technique de reparation a toujours ete une myoraphie sans geste intracardiaque ou chirurgie coronarienne associee. La morbidite etait de 25 % et la mortalite de 12,5 %. Les complications et les deces sont survenus chez les patients qui ont eu les delais de prise en charge les plus longs. Conclusion : Les blesses victimes de traumatisme de l’aire cardiaque doivent etre orientes vers le centre chirurgical disponible le plus proche, qu’il possede ou non un service de chirurgie cardiaque. L’utilisation d’une circulation extracorporelle, dans le contexte traumatologique, ne semble apporter aucun benefice.

Excessive alcohol intake is one of the leading causes of premature death in Europe and particularly in Belgium. Belgian people are consuming more alcohol per year than the European average. It is well established that excessive alcohol consumption is a significant predictor of the development of hypertension (HTN). Two million adults in Belgium suffer from HTN and this number will increase to three million by 2025.Less than 50% of Belgian people treated for HTN are well-controlled. Alcohol reduction in patients with HTN can significantly lower systolic and diastolic blood pressure. After reviewing the epidemiology of HTN and alcohol disorders in Belgium, this paper will focus on the rationale for alcohol screening and brief intervention in primary care. It will also describe the barriers to alcohol screening, and what could be the benefits of alcohol screening for our healthcare system. The authors believe that early identification through alcohol screening and brief intervention in general practice can help to improve the management of patients with HTN, to reach the targets of the WHO Global Action Plan, i.e., a 25% relative reduction in the risk of premature mortality from cardiovascular diseases, cancer, diabetes or chronic respiratory diseases. They are also convinced that this would allow achieving major healthcare savings.

The surgical treatment of mitral regurgitation has been completely revamped in the last years. The development of reproducible and durable plasty techniques has made mitral valve replacement less and less frequent. The virtual disappearance of rheumatic valve disease in developed countries has made degenerative disease the most frequent etiology of mitral insufficiency. Furthermore the outlook of this pathology has been modified by the early surgical treatment. The following article presents the surgical techniques available today and their indications in the different types of mitral insufficiency.

The follow-up of chronic kidney failure is a long and complex process. The diagnosis of the kidney disease and the level of renal failure have first to be established. A strategy for slowing the evolution of chronic kidney disease has to be build. The blockade of the renin angiotensin system and the control of the cardiovascular risk factors are the main components of this strategy. The evaluation and the treatment of the classical complications of chronic kidney disease should also take place. Correction of anemia, and of phosphocalcic complications need specific therapies. Preparation for dialysis and transplantation have to be taken into account. Such a follow-up deserves a close collaboration between general practitioners and nephrologists.

Mobile ECMO support for remote cardiac or respiratory assistance (MESRCA and MESRRA) allows mobilization of the medical and paramedical team 24/7 in a very large geographical area. Mobility and autonomy require adapted devices. During many years, teams had to deal with non useful equipment. Recently, thanks to interest of medical world and laboratories, many materials especially suitable for this activity are developed. We describe our local experience and solutions we tented to fi nd to deal with material difficulties.

Le CPS (Cardio-Pulmonary System) ou ECMO (Extra-Corporeal Membrane Oxygenator meme si ce terme est plutsot reserve aux assistances veino-veineuses d’oxygenation) est devenue le traitement de choix du choc cardiogenique severe refractaire a un traitement medical optimal. Son implantation est realisable en urgence dans un temps bref, possible meme chez les patients en arret cardio-circulatoire. Elle permet egalement un support ventilatoire associe ou exclusif en cas de Syndrome de Detresse Respiratoire Aigue isole sans defaillance cardiaque.

Primary cardiac tumor is a rare disease, with an incidence ranging from 0.001 to 0.03%. Eighty percent of them are benign tumors, and among them 70% are myxomas, the others are: fibroelastoma, rhabdomyoma, fibroma, angioma and lipoma. Primary malignant tumors of heart are in 95% of cases sarcomas, the remaining 5% are lymphomas. Cardiac's metastases are more frequent than primary tumors. Diagnosis is made by echocardiography TAC and MRI. Whereas surgery is indicated in patients with benign tumors, or localised sarcomas, chemotherapy in those with widespread disease and radiotherapy and chemotherapy in lymphoma. Prognosis is excellent in benign cardiac tumor. Mean survival for sarcomas is 11 months, and lymphoma 5 years.

The purpose of this report is to describe a case involving a 62-year-old Moroccan woman hospitalized for generalized edema that lead to diagnosis of chronic constrictive pericarditis. Diagnosis was confirmed on the basis of pericardial calcification and typical hemodynamic findings. New imaging techniques such as cardiac MRI allow accurate anatomical and physiological assessment in difficult cases. While tuberculosis is rarely involved in industrialized countries, it is a frequent factor in developing countries. The usual treatment consists of pericardectomy in association with standard antituberculosis drugs if association with tuberculosis is established or highly likely.

The World Kidney Day offers a crucial opportunity to the Belgian associations of nephrologists to inform public and medical communities about the global problem of chronic kidney disease (CKD). According to epidemiological data from GNFB/ NBVN registries in our country, cardiovascular diseases and diabetes 2 are responsible for an increasing amount of CKD cases with pejorative evolution to end-stage renal disease requiring cost-effective renal replacement therapies (haemodialysis, peritoneal dialysis or renal transplantation). In these patients, the high level of comorbidities and the late referral to the nephrologists are recognized as enhanced morbidity and mortality factors. These facts underline the need for the nephrologists to stimulate collaboration with general practitioners and specialists from other disciplines in order to set up systematic screening procedures and early follow-up of patients at risk of developing CKD. These procedures should contribute to reduce the progression rate of renal function impairment.

To define modalities of cardiac wound management with a special emphasis on the initial direction of the patient toward a surgical service, rapid diagnosis, and surgical treatment.Sixteen patients with thoracic injury to the region of the heart treated between 1996 and 2006 were evaluated retrospectively. Pre-operative clinical data, echography, and CT results were collected; time elapsed between injury and treatment, type of surgical treatment, use of cardio-pulmonary bypass, morbidity and mortality were evaluated.There were 16 patients (12 men); age ranged from 18 to 80 with an average of 45.7 years. Nine patients had penetrating cardiac wounds, two had blunt trauma, and five suffered iatrogenic trauma. Cardio-pulmonary bypass was used in two cases. The mean time elapsed between trauma and surgical evaluation was 63 minutes (p=0.18). In all cases, surgery consisted of a myorraphy without coronary or valvular repair. Post-operative complications occurred in 4 patients (25%) and resulted in 2 deaths (12.5%). Complication and death were associated with a prolonged interval between injury and surgical management.Patients with cardiac wounds should be transported to the nearest surgical hospital. There are no benefits to cardio-pulmonary bypass in cardiac trauma.

An apico-aortic shunt enables a reduction in the aortic transvalvular pressure gradient. It is recommended for patients with symptomatic severe stenosis when anatomical constraints contra-indicate valvular replacement. The authors report the case of a patient who underwent this uncommon procedure, which was indicated due to previous coronary bypass surgery using both mammary arteries, plus massive calcification of the ascending aorta. Angio-haemodynamic investigation and MRI performed three years and five years respectively following the procedure confirmed its efficiency. An analysis of the few reported series confirms the value of this special procedure.

To review the perioperative anaesthetic management of pulmonary arterial hypertension.Extraction from Pubmed database of French and English articles on the perioperative anaesthetic management of pulmonary hypertension for 9 years.The collected articles were reviewed and selected according their quality and originality. The more recent data were selected.Pulmonary arterial hypertension is classically divided in primary and secondary. Primary pulmonary hypertension (familial and sporadic) is relatively severe and rare. Muscularization of the terminal portion of the pulmonary vascular arterial tree, caused by smooth muscle cell hyperplasia is the first change. Pulmonary arterial hypertension linked with disorders of the respiratory system and hypoxemia or pulmonary venous hypertension including mitral valve disease and chronic left ventricular dysfunction are often associated with high morbidity and mortality. The main consequence of pulmonary hypertension development is the occurrence of right-sided circulatory failure. A better understanding of disease pathophysiology will contribute to the development of new therapies increasing then the prognosis of these patients. The management of primary pulmonary hypertension or secondary pulmonary arterial hypertension is a challenge for the anaesthesiologist because the risk of right ventricular failure is markedly increased.

ACE inhibitors and ARA are for the nephrologist two completely unique classes of antihypertensive agents as they offer the opportunity to control microalbuminuria, proteinuria and slow the progression of renal diseases. These properties have mainly been studied in type 1 and type 2 diabetics but can be extended to a wide range of renal diseases. The renal effects of the two classes of compounds differ but the clinical significance of these differences remains to be ascertained.

To review the perioperative anaesthetic management of ventricular assist devices.Extraction from Pubmed database of french and english articles on the perioperative anaesthetic management of ventricular assist devices for 15 years.The collected articles were reviewed and selected according to their quality and originality. The more recent data were selected.Cardiac transplantation is an effective treatment for patients in end stage cardiac failure, but the average waiting time of 17 months, associated with the lack of organs (357 out of 832 candidates were transplanted in 1996) results in a high number of deaths in patients awaiting transplantation. The appearance in the 1980's, of the first ventricular assist device (VAD) provided a new possibility for the management of patients with end-stage cardiac failure awaiting transplantation ("bridge to transplant"). The perioperative anaesthetic management of these patients is complex. End stage cardiac failure, poorly responsive to pharmacological interventions, results rapidly in secondary organ dysfunctions. VADs produce a rapid improvement in haemodynamic, renal, hepatic and neuro-endocrine functions over a 2 months period, allowing transplantation to take place under optimal conditions. However VADs are not without complications (1 year mortality of 20%), of which the major are: infections (40%), perioperative haemorrhage (30%) and thrombo-embolic sequelae (30%). A best knowledge of pathophysiology of these complications is necessary to an optimal management of patients with ventricular assist devices.

We report the case of a young patient native of the Ivory Coast who suffered from homozygous hemoglobin C disease. He presented with the usual findings of this hemoglobinopathy: a moderate hemolytic anemia and a massive, painful and even disabling splenomegaly. Pain completely disappeared following splenectomy. However, postoperative course was complicated by portal venous thrombosis, which was medically treated. No deficiency of natural coagulation inhibitors could be demonstrated, so splenectomy was the only factor predisposing to thrombosis. We consider that in only very few cases of hemoglobin C disease, splenectomy (preceded by prophylactic antipneumococcic vaccine) may be indicated from pain and risk of spontaneous splenic rupture.

The surgical treatment of mitral regurgitation has been completely revamped in the last years. The development of reproducible and durable plasty techniques has made mitral valve replacement less and less frequent. The virtual disappearance of rheumatic valve disease in developed countries has made degenerative disease the most frequent etiology of mitral insufficiency. Furthermore the outlook of this pathology has been modified by the early surgical treatment. The following article presents the surgical techniques available today and their indications in the different types of mitral insufficiency.

We report the case of a female patient of 76 years old admitted to our hospital for a pre-operative assessment of a symptomatic mitral regurgitation (MR) whose transthoracic echocardiography revealed only a trivial regurgitation. The occurrence during hospital stay of an acute pulmonary edema contemporary to the occurrence of a huge MR permitted to suspect the diagnosis of a paroxystic ischemic MR. Angiographic and hemodynamic evaluation revealed only a non-significant atheromateous plaque located in the distal LAD. The infusion of Methylergometrine triggered a severe spasm at the site of that plaque, associated with a huge MR visualized by TTE with restricted movements of both leaflets, responsible for an acute pulmonary edema occurring on the table of the catheterization laboratory. Recovery was quickly obtained after intravenous injection of Nitroglycerin, which removed the spasm and valvular regurgitation. The diagnosis of paroxystic ischemic mitral regurgitation was confirmed and a treatment based on high dosage of calcium-blocker was decided. After a follow-up of more than one year, the patient remains asymptomatic and the regurgitation has never occurred.

The authors report the observation of lead poisoning in a young Moroccan woman, which was caused by prolonged use of a khol made of lead sulphide. Khol is a black eye make-up used since Ancient Egypt. Clinically, this poisoning presented with abdominal crampoid pain, encephalopathy (manifested as anxiety and irritability), a Burtonian gingival border and microcytic sideropenic anaemia. Emergency chelate treatment permitted to improve clinical state and to decrease blood levels (initial blood concentration: 490 micrograms/dl; concentration six weeks after treatment: 49 micrograms/dl). The interest of such a case is recognizing, in French speaking regions, of a public health problem, largely ignored, although real, considering the high lead concentrations found in a majority of kohls available in Brussels and this very old cultural practice among Muslim populations.

Argonne has developed a series of automated protocols to generate bacterial expression clones by using a robotic system designed to be used in procedures associated with molecular biology. The system provides plate storage, temperature control from 4 to 37 C at various locations, and Biomek and Multimek pipetting stations. The automated system consists of a robot that transports sources from the active station on the automation system. Protocols for the automated generation of bacterial expression clones can be grouped into three categories (Figure 1). Fragment generation protocols are initiated on day one of the expression cloning procedure and encompass those protocols involved in generating purified coding region (PCR).

The study aim was to analyze the results of reoperations for structural degeneration of bioprostheses, and to define a high-risk population for reoperative procedures.A series of 524 consecutive patients who had undergone a first reoperative replacement for a failed bioprosthesis between 1978 and 1998 was reviewed retrospectively. The reoperative procedure comprised 363 single valve replacements, and 161 multiple valve replacements. During the original procedure, 648 bioprostheses had been implanted in the mitral (n = 403), aortic (n = 220) and tricuspid (n = 25) positions.The mean interval between the original procedure and reoperation was 8.8 +/- 3.3 years. Tissue valve failure was revealed by recurrence of cardiac insufficiency in 70% of cases. The overall early mortality rate was 8%, but early mortality rates for elective single mitral and aortic reoperative valve replacements were only 3.9% and 4%, respectively. Early mortality following reoperation for single and multiple valve replacement was 6.0% and 12.4% respectively (p = 0.02). Other significant multivariable predictors for early mortality were old age (p = 0.003), NYHA functional class (p = 0.007), presence of ascites (p = 0.02) and reoperation performed before 1988 (p = 0.013).The risk of reoperation for structural degeneration of bioprostheses is acceptable for elective single reoperative valve replacement as opposed to multiple reoperative valve replacement. This may limit the use of bioprostheses during the original procedure when multiple valve replacement is required.

Serious discrepancies between glycemia measurements obtained with an Accutrend Sensor (Boehringer Mannheim GmbH, Mannheim, Germany) type analyzer (based on a glucose dehydrogenase enzymatic reaction) and measurements obtained in the laboratory by a reference method (hexokinase) have been found in an insulin-requiring, diabetic, continuous ambulatory peritoneal dialysis (CAPD) patient treated with icodextrin 7.5% (Extraneal; Baxter Healthcare SA, Castlebar, Ireland), a new osmotic agent for peritoneal dialysis. We therefore investigated the respective role of the Analyzer and of the glucose polymer in this hitherto undescribed problem.Glycemia was measured simultaneously on venous blood using a reference laboratory technique, and on capillary blood using the Accutrend Sensor glucose analyzer in three groups of CAPD patients: 6 patients on Extraneal for at least 1 week, 6 patients receiving their first Extraneal exchange, and 8 patients never exposed to Extraneal. In the first group of patients, glycemia was also measured with another analyzer (Glucocard; Menarini Diagnostics, Firenze, Italy) using a different enzymatic reaction (glucose oxidase). In a separate study, whole blood of a normal subject was spiked with concentrated solutions of glucose and icodextrin and some of its metabolites (maltose, maltotriose, maltopentaose). Once again, comparative measurements of glycemia were performed with the Accutrend Sensor, with two other kits using a glucose dehydrogenase enzyme reaction, and with the hexokinase reference method.In 6 CAPD patients treated with once-daily exchanges with Extraneal for a minimum of 7 consecutive days, we confirmed overestimation of glycemia by the Accutrend Sensor of 65 +/- 26 mg/dL compared to reference values (p0.01), and of 69 +/- 25 mg/dL (p0.001) compared to measurements obtained with the Glucocard monitor. In 6 other CAPD patients studied at the end of one single icodextrin exchange, overestimation of 61 +/- 11 mg/dL was already present (p0.001). On the other hand, in 8 CAPD patients never treated with icodextrin, there was no discrepancy between the Accutrend Sensor readings and reference values. The measurements in spiked blood confirmed that only the Accutrend Sensor overestimates glycemia in the presence of maltose and glucose polymers. The overestimation decreased as the molecular size of the saccharides added to blood increased. There was no overestimation when other kits using a dehydrogenase enzyme were tested.The overestimation observed is probably related to the presence of oligosaccharides (mainly maltose), derivatives of glucose polymers present in Extraneal and absorbed via the peritoneal route, in the blood of patients treated with icodextrin. The glucose dehydrogenase characterizing the Accutrend Sensor, an enzyme of the pyrroloquinolinequinone class, very likely reacts with the free reducing group of the glucose molecule located at the end of each saccharide chain. This would not be the case for the Glucocard monitor using glucose oxidase, for other kits using glucose dehydrogenase, and for the reference method based on hexokinase. The Accutrend Sensor type of analyzers are therefore not suitable for regular monitoring of glycemia in diabetic PD patients treated with icodextrin.

A close association between human herpesvirus-8 (HHV-8) and Kaposi's sarcoma (KS) has been shown in transplant recipients, but donor-to-recipient transmission of HHV-8 is uncommon. Herein we report a case of a heart transplant recipient who had a fatal visceral KS in association with HHV-8 seroconversion at 18 months after transplantation with a donor having positive serology discovered after transplantation.

The authors report two cases of anterior mitral valve myxoma. This is an exceedingly rare localisation and these cases add to the other 8 previously reported cases. Intracardiac tumours and valvular endocarditis may be detected non-invasively by echocardiography but the precise diagnosis may be extremely difficult: mitral valve myxoma is an exceptionally rare condition. Treatment was surgical in both reported cases.

We used an alternative technique for regional citrate anticoagulation (citrate 0.48 Mol; bicarbonate containing dialysate with Ca 1.75 Mmol) in three patients at chronic risk of bleeding and for a mean follow-up period of ten months. No bleeding recurrence was observed nor any complication related to citrate. Hemoglobin and hematocrit rose without transfusions. Serum bicarbonate increased during the first four months of treatment. No significant change was observed in serum calcium nor serum sodium concentration.

The discovery of new classes of antihypertensive drugs has changed the therapy of essential arterial hypertension. New combinations of antihypertensive drugs are also possible. The aim of the present work is to give practical guidelines for the prescription of an association of antihypertensive drugs and to present a review of the current literature on the efficacy and safety of these therapeutic combinations.

A protein complex (PC) composed of the MRP8 and MRP14 proteins has previously been shown to be a specific inhibitor of casein kinase I and II. This PC is expressed during the late stages of terminal differentiation induced in human promyelocytic HL-60 leukemia cells by 1 alpha,25-dihydroxyvitamin D3 and in human monocytic THP-1 leukemia cells by phorbol 12-myristate 13-acetate. This expression is associated with terminal cell differentiation because incubation of HL-60 cells with an agent or condition that causes suppression of growth but not induction of differentiation does not result in expression of the PC. At concentrations of 5-15 nM, the purified PC inhibited the growth of HL-60 cells and THP-1 cells, as well as other cell types belonging to different cell lineages. This growth inhibition was preceded by a reduction in [32P]phosphate incorporation and, at the higher PC concentrations, was associated with a reduction in [3H]thymidine, [3H]uridine, and [32S]methionine incorporation. The specific expression pattern and growth-inhibitory character of the PC suggests that the complex may have a role in suppressing cell growth during monomyelocytic terminal differentiation induced by specific chemical stimuli and during physiological and pathological events associated with monomyelocytic cell functions.

Les auteurs rapportent une etude de correlation entre la pression portale et la pression intra-variqueuse chez 30 patients cirrhotiques avec hypertension portale. Les mesures ont ete effectuees par ponction directe per-endoscopique des varices et au cours d’une angiographie sus-hepatique. Une correlation positive est observee entre la pression dans les varices et la pression sinusoidale corrigee, ð l’exception des patients etudies au decours d’une hemorragie digestive sur rupture de varices. Ils mettent egalement en evidence un gradient de pression au long des colonnes variqueuses. Ils discutent les resultats obtenus sur base de la selection des patients et de criteres non retenus dans leur serie pour tenter de definir la relation hypertension portale - risque hemorragique sur rupture de varice.