This clinical controlled study clearly demonstrated the better parenchymal tolerance to IPC over CPC, especially in patients with abnormal liver parenchyma.

Portopulmonary hypertension represents a major risk factor for transplantation; therefore, preoperative detection is crucial. The aims of this study were to determine (1) whether Doppler echocardiography performed at evaluation is a reliable tool for detecting portopulmonary hypertension and (2) the incidence of acquired portopulmonary hypertension profile after evaluation. One hundred sixty-five patients had Doppler echocardiography and right heart catheterization at evaluation over a 9-year period. All patients had a prospective follow-up, and the results of catheterization at evaluation were compared with those obtained at the time of transplantation. Seventeen of 165 patients met the criteria for portopulmonary hypertension on Doppler echocardiography. Portopulmonary hypertension was confirmed by catheterization in 10 patients and ruled out in 7. There were no false negatives for echocardiography. Mean pulmonary artery pressure was significantly higher during the initial phase of transplantation than at evaluation (17.8 ؎ 4.3 vs. 20.3 ؎ 5.5 mm Hg, respectively, P < .0001), and there was no significant correlation between values obtained at these 2 time points. Three patients showed to have acquired portopulmonary hypertension profile while waiting for a graft within time intervals ranging from 2.5 to 5 months. In conclusion, Doppler echocardiography is a highly sensitive tool for detecting portopulmonary hypertension. However, because this technique has a poor positive predictive value, right heart catheterization is recommended for confirming portopulmonary hypertension. In addition, the absence of portopulmonary hypertension at evaluation does not exclude the occasional occurrence of acquired portopulmonary hypertension profile after listing. P ulmonary hypertension associated with portal hypertension, the so-called portopulmonary hypertension, is a rare complication of cirrhosis. When severe, this condition is a major risk factor for transplantation because, in most cases, patients are at best partially responsive to medical therapies. 1 If it is impossible to lower mean pulmonary artery pressure below 40 to 50 mm Hg during transplantation procedure, any significant hemodynamic changes, such as those observed at the time of caval clamping and reperfusion of the graft, may result in irreversible cardiac arrest, especially if right ventricular function is impaired. 2 As a consequence, many authors consider that severe portopulmonary hypertension (i.e., mean pulmonary artery pressure [MPAP] above 40 mm Hg) represents a contraindication for liver transplantation because it would carry an unacceptable mortality rate. 3 Because portopulmonary hypertension is frequently asymptomatic until mean pulmonary pressure exceeds 40 mm Hg, most authors recommend systematic screening at evaluation. Several studies have suggested that Doppler echocardiography, when performed during pretransplantation evaluation, is a useful noninvasive tool to document or exclude portopulmonary hypertension, 4-6 even though this technique ...

Droperidol and ondansetron induced similar clinically relevant QTc interval prolongations. When used in treatment of postoperative nausea and vomiting, a situation where prolongation of the QTc interval seems to occur, the safety of 5-hydroxytryptamine type 3 antagonists may not be superior to that of low-dose droperidol.

Liver resections of up to two segments can be performed by laparoscopy using the same technique as that used during open surgery. However, the benefits observed compared with open surgery appear to be limited.

Support was provided solely from institutional and/or departmental sources. Benoît Plaud and Bertrand Debaene have participated in the clinical development of sugammadex as coinvestigators in two phase III studies funded by Schering-Plough Corporation, Oss, The Netherlands. François Donati and Jean Marty have no conflicts of interest. The figures and tables in this article were prepared by Dimitri Karetnikov, 7 Tennyson Drive,

Aims Out-of-hospital cardiac arrest (OHCA) without return of spontaneous circulation (ROSC) despite conventional resuscitation is common and has poor outcomes. Adding extracorporeal membrane oxygenation (ECMO) to cardiopulmonary resuscitation (extracorporeal-CPR) is increasingly used in an attempt to improve outcomes. Methods and results We analysed a prospective registry of 13 191 OHCAs in the Paris region from May 2011 to January 2018. We compared survival at hospital discharge with and without extracorporeal-CPR and identified factors associated with survival in patients given extracorporeal-CPR. Survival was 8% in 525 patients given extracorporeal-CPR and 9% in 12 666 patients given conventional-CPR (P = 0.91). By adjusted multivariate analysis, extracorporeal-CPR was not associated with hospital survival [odds ratio (OR), 1.3; 95% confidence interval (95% CI), 0.8–2.1; P = 0.24]. By conditional logistic regression with matching on a propensity score (including age, sex, occurrence at home, bystander CPR, initial rhythm, collapse-to-CPR time, duration of resuscitation, and ROSC), similar results were found (OR, 0.8; 95% CI, 0.5–1.3; P = 0.41). In the extracorporeal-CPR group, factors associated with hospital survival were initial shockable rhythm (OR, 3.9; 95% CI, 1.5–10.3; P = 0.005), transient ROSC before ECMO (OR, 2.3; 95% CI, 1.1–4.7; P = 0.03), and prehospital ECMO implantation (OR, 2.9; 95% CI, 1.5–5.9; P = 0.002). Conclusions In a population-based registry, 4% of OHCAs were treated with extracorporeal-CPR, which was not associated with increased hospital survival. Early ECMO implantation may improve outcomes. The initial rhythm and ROSC may help select patients for extracorporeal-CPR.

No abstract

Using phytoplankton pigments as biomarkers, we investigated the relationship between the physical forcing and the resulting biological, ecological and biogeochemical properties of the geostrophic front of the Eastern Alboran Sea. (1) Typical frontal sites present biomass levels averaging 60 mg chl a mm2 (up to 100 mg mm2), whereas the adjacent zones (typical Atlantic and Mediterranean) are characterized by an average integrated chlorophyll biomass of 20 mg chl a rnm2. (2) The phytoplankton biomass at front is diatom-dominated and differs markedly from the adjacent zones (typical Atlantic and Mediterranean), flagellate-and cyanobacteriadominated.Therefore, high biomasses at the front do not result from purely physical accumulation but rather from local production.(3) The chlorophyll and diatom biomasses increase from the left to the right side of the Atlantic jet, which supports the hypothesis of a cross-frontal secondary circulation allowing a diatom bloom development. (4) Using assumptions on the carbon/chlorophyll ratio and growth rates for the different phytoplankton taxa, we evaluated the specific productions: diatoms account for 67% of the production at front and only about 10% at adjacent zones. (5) High concentrations of phaeopigments are only found at frontal stations, which points out the pecularities of the food web at the frontal site, compared to adjacent areas. (6) The observations made during this study give a precise picture of that frontal system: autotrophic new production and exportation are enhanced. The implication of this fro&l system on the carbon budget at a regional scale may be important.