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Resume Le concept d’Acute-on-Chronic Liver Failure (ACLF) decrit un syndrome associant un contexte aigu sur une maladie hepatique chronique, une inflammation et la presence d’au moins une defaillance d’organe. Ce syndrome est associe a une forte mortalite a court terme (mortalite a 28 jours apres l’admission a l’hopital) de l’ordre de 20–25 % chez les patients ayant une defaillance d’organe a plus de 75 % chez les patients presentant trois defaillances ou plus. Les criteres de defaillance d’organe utilises pour definir l’ACLF sont ceux du CLIF SOFA pour chaque organe etudie (hemodynamique, respiratoire, hepatique, coagulation, renale et neurologique). Les patients cirrhotiques avec ACLF sont classes en grade 1 si presence d’une defaillance d’organe, grade 2 (si 2 defaillances), grade 3 (si 3 defaillances ou plus). L’ACLF est present chez 26 % des patients cirrhotiques hospitalises et 8 % le developpent au cours de leur hospitalisation. Il n’existe pas de traitement specifique efficace pour les patients atteints d’ACLF. Le principal objectif du traitement des patients cirrhotiques avec ACLF est de suppleer a la defaillance d’organe, le temps que le traitement de la cause, du facteur declenchant, soit efficace. Dans les formes les plus severes, ce traitement permet de preparer le patient a la transplantation hepatique (notion de « bridge a la transplantation »). La transplantation hepatique est le traitement ultime car seul traitement curatif de la cirrhose. Sa place a emerge ces dernieres annees dans les formes severes chez les patients presentant au moins une defaillance d’organe. Un des objectifs actuels est de prevenir le developpement de l’ACLF chez les patients les plus a risque et/ou de limiter son evolution vers un tableau de defaillance multiviscerale.

Although diabetic gastroparesis could be responsible for delayed gastric emptying, there is conflicting evidence about the volume of gastric content in diabetic patients after preoperative fasting. We hypothesized that diabetic patients had an increased gastric content before anesthesia induction despite the following of fasting recommendations. We used ultrasound assessment of gastric content to evaluate this risk.This multicenter prospective single-blinded case-control study was conducted in three teaching University hospital in France. Our primary outcome was the comparison of increased gastric content between the two groups and was defined either by a Perlas grade 2 antrum or an antral cross-sectional area (CSA)340 mmEighteen (42.9%) diabetic patients reached the primary outcome versus 28 (22.2%) in the control group (P=0.009). Diabetic patients presented less frequently with an empty stomach. Indeed, ten (23.8%) diabetic patients had a grade 0 antrum versus 71 (56.3%) in the control group (P0.001). Twenty-four (70.6%) diabetic patients had an antral CSA340 mmOur study documents that gastric content is increased among diabetic patients compared to control patients despite following appropriate fasting guidelines.

Purpose To evaluate the impact of the COVID-19 pandemic-related lockdown on management and outcomes of children with acute appendicitis. Methods A retrospective cohort study was conducted, including children treated for acute appendicitis (January 20th–May 11th, 2020). The data regarding the severity of appendicitis and outcome were collected and compared for two time periods, before and after the nationwide lockdown (March 17th, 2020). Results The number of cases of acute appendicitis increased by 77% during the lockdown (n = 39 vs. n = 69, p = 0.03). During the lockdown, children treated for appendicitis were older (11.1 vs. 8.9 years, p = 0.003), and were more likely to live more than 5 km away from our institution (77% vs. 52%, p = 0.017). Less children had previously consulted a general practitioner (15% vs. 33%, p = 0.028), whereas more children were transferred from other hospitals (52% vs. 31%, p = 0.043). There was no difference in terms of length of hospital stay, rate of postoperative intra-abdominal abscess, ER visits, and readmissions between both periods. Three children (4%) were diagnosed with COVID-19 and appendicitis. Conclusions Despite an increase in the number of children with appendicitis managed at our hospital during the COVID-19-related lockdown, management, and outcome remained similar. Although our pediatric center was strongly affected by this pandemic, maintaining our prior practice strategies for acute appendicitis avoided the occurrence of collateral damage for those children.

Background Obstetric anaesthesia has been associated with concern for the inhalation of gastric contents for many years, justifying fasting during labour. However, many anaesthesiologists and obstetricians now allow fluid intake during labour. Objective(s) We hypothesised that allowing oral fluid intake during labour is not associated with increased gastric contents. We used ultrasound assessment of gastric contents to evaluate this hypothesis. Design A randomised, single-blind and intention-to-treat noninferiority trial comparing antral area measured by ultrasound in fasting parturients and in those who were allowed to drink fluid for 90 min after randomisation. Setting Tenon University Hospital, Assistance Publique Hopitaux de Paris, Paris, France. Patients Pregnant women, aged from 18 to 40 years and from week 36 of an uncomplicated singleton gestation, were randomised into a fasting group and a fluid intake group after admission to the delivery room. Of the 184 patients screened, data from 125 were analysed: fasting group (62), fluid intake group (63). Intervention Women in the fluid intake group were allowed to drink up to 400 ml of apple juice for 90 min after randomisation. Main outcome measure We compared the percentage of women with an 'empty stomach' between the two groups: empty stomach was defined as an antral cross-sectional area (CSA) less than 300 mm assessed in a semirecumbent position with a 45-degree head-up tilt. Results At full cervical dilatation an antral CSA less than 300 mm was measured in 76 and 79% of the parturients in the fasting group and the fluid intake groups respectively (P = 0.633). Conclusion The current study reveals that the percentage of pregnant women with an 'empty stomach', defined by an antral CSA less than 300 mm in a semirecumbent position with a 45-degree head-up tilt, was comparable at full cervical dilation among those who remained nil by mouth and those allowed to drink up to 400 ml for 90 min after their randomisation. Trial registration Clinicaltrials.gov identifier: NCT02362815.