N. Morel

Traumatic rupture of the abdominal aorta after spinal fracture from low fall

Fig. 1. Contrast-enhanced MDCT scan revealing traumatic aortic rupture. A 38-year-old patient was admitted in our Emergency Department after a 2-m high fall. The patient denied any loss of consciousness, but complained of back pain. Physical examination revealed a heart rate of 90, a blood pressure of 120/89, symmetric on both arms, localized spine pain on T12 and L1 without motor or sensory deficit, extremity pulses were palpable. A multidetector computed tomogragraphic (MDCT) scan demonstrated a mediastinal haematoma, a thoracic extrapleural haematoma, a fracture of T12 vertebral body and a periaortic haematoma. A contrastenhanced MDCT scan of chest and abdomen revealed a traumatic rupture of the abdominal aorta (Fig. 1). Haemoglobin was initially 12.5 g/dl and all other laboratory values were normal. After consultation of vascular and orthopaedic surgical staff, the patient was admitted in surgical intensive care unit and planned for delayed transluminally placed aortic stented graft repair. On the third day, he needed intubation for an acute respiratory failure. A new MDCT scan was performed and found a major extrapleural haematoma, and a bilateral pleural effusion. The aortic tear and the peri-aortic haematoma were unchanged. Haemoglobin fell to 7 g/dl, which was related to the rise of the extrapleural haematoma and the patient received blood transfusion. Two chest tubes were placed, collecting 600 ml left and 1100 ml right. On the fifth day, the patient presented a septic shock associated with acute respiratory distress syndrome treated with fluid replacement, norepinephrine and association of levofloxacin and piperacillin-tazobactam. Apyrexia was obtained after 48 h and the ratio of arterial oxygen tension to the fraction of inspired oxygen (PaO2/FiO2) rose to 280.

Elevated levels of shed membrane microparticles with procoagulant potential in the peripheral circulating blood of patients with subarachnoid haemorrhage: A-792

Elevated levels of shed membrane microparticles with procoagulant potential in the peripheral circulating blood of patients with subarachnoid haemorrhage M. Biais1, N. Morel2, O. Morel3, L. Petit1, B. Julliac2, A. Lelias1,2, F. Sztark1, Ph. Dabadie2 1DAR I, Hôpital Pellegrin, Bordeaux, France; 2Département des Urgences, Hôpital Pellegrin, Bordeaux, France; 3Fédération de Cardiologie des Hôpitaux Universitaires de Stras Background and Goal of Study: Microparticles (MP) are fragments released from the plasma membrane of most stimulated or apoptotic cells. MP have procoagulant and pro-inflammatory properties. We hypothesized that elevated levels of procoagulant MP could circulate in the peripheral blood of patients who recently underwent subarachnoid haemorrhage (SAH). Materials and Methods: Consecutive patients admitted with SAH were prospectively enrolled. Demographic (age, sex) and neurological (GSW, Hunt-Hess, WFNS and Fisher scores) factors were recorded at admission. The Glasgow Outcome Scale (GOS) at 3 months was evaluated. We isolated the circulating MP by capture with annexine V and determined their procoagulant potential with a prothrombinase assay, at the day of the enrolment (D0) and five days later (D5). The cellular origin of MP was determined by antigenic capture with specific antibodies. As control, circulating MP were measured in 67 healthy patients. Results were expressed as median [Min;Max]. Statistical analysis was performed using Student’s t test and Mann and Whitney test as appropriate. P 0.05 was considered significant. Results and Discussions: We included 16 patients with recent SAH. The mean age was 55 years. The median of the WFNS score was 1 and the median of GCS was 15. The complications were 2 rebleeding, 3 symptomatic vasospasms and 8 acute hydrocephalus (AH). MP levels were significantly higher in SAH group (8.4[2.1–24.7] nMPhtSer Eq) compared with control group (1.57[0.14–9.1] nMPhtSer Eq), P 0.001. Released MP in patients with recent SAH had platelet origin. MP levels decreased significantly between D0 and D5 in patients without rebleeding (P 0.01), and increased in patients with rebleeding. MP were significantly increased in patients with lower Fisher score (P 0.01), lower AH incidence (P 0.05) and better clinical outcome evaluated by GOS (P 0.05). Conclusion: High levels of procoagulant platelet MP are present in circulating blood of patients with recent SAH and are associated with a lower bleeding, a decrease of AH incidence and with a good clinical outcome. Reference: 1 Zwall RF, Schroit AJ. Blood 1997; 89(4):1121–32.