Search

Resume Introduction La realisation d’une arthrodese vertebrale constitue le traitement de reference de nombreuses pathologies rachidiennes. Les techniques mini-invasives pourraient apporter un benefice supplementaire par rapport aux techniques conventionnelles. L’objectif principal de cette etude etait de rapporter les resultats a 1 an d’une serie d’arthrodese lombaire posterieure par technique mini-invasive en termes d’amelioration fonctionnelle, de fusion inter-somatique et de morbidite. Materiel et methodes Entre janvier 2012 et mai 2013, 182 patients pris en charge par une arthrodese lombaire posterieure trans-foraminale (TLIF) mini-invasive etaient inclus dans cette etude prospective multicentrique. L’evaluation clinique etait basee sur les scores d’Oswestry (ODI), le SF-12, le score de Quebec et l’echelle visuelle analogique (EVA) compares en preoperatoire et a 1 an. Les donnees operatoires et de suivi etaient etudiees. L’analyse radiologique etait basee sur des teleradiographies du rachis en totalite en preoperatoire et au dernier recul. La fusion inter-somatique a 1 an etait evaluee par un scanner systematique. Resultats Cent quatre-vingt-deux patients etaient inclus avec un âge moyen de 58,9 ans. La duree operatoire moyenne etait de 101 minutes, le saignement peroperatoire moyen de 143 mL, et l’irradiation moyenne de 247,4 cGy/cm 2 . Le taux de complication postoperatoire etait de 7,7 %. L’ODI, le score de Quebec, le SF-12 et l’EVA etaient tous ameliores de maniere significative a 1 an ( p Discussion L’arthrodese lombaire posterieure par technique mini-invasive permet d’obtenir des resultats fonctionnels et radiologiques satisfaisants a 1 an. L’avantage de cette approche mini-invasive se situe essentiellement dans les 6 premiers mois postoperatoires. L’obtention d’une fusion inter-somatique radiologique n’etait pas correlee aux resultats fonctionnels au dernier recul. Niveau de preuve IV.

Resume Introduction L’arthrodese intervertebrale lombaire a fait la preuve de son efficacite mais sa morbidite augmente avec l’âge. La chirurgie mini-invasive est reputee pour diminuer cette morbidite en etant moins traumatisante sur le plan musculaire, en diminuant le saignement peroperatoire et le temps operatoire. L’objectif principal de cette etude etait de rapporter les resultats a 1 an d’une serie d’arthrodeses lombaires posterieures par technique mini-invasive dans une population de plus de 70 ans, en termes d’amelioration fonctionnelle, de fusion inter-somatique et de morbidite. Patients et methode Entre janvier 2012 et mai 2013, 30 patients d’âge moyen 77 ans pris en charge par arthrodese lombaire posterieure trans-foraminale (TLIF) mini-invasive etaient inclus dans cette etude prospective. Le spondylolisthesis degeneratif representait l’indication principale. L’evaluation clinique etait basee sur les scores d’Oswestry (ODI), le Score de Quebec et l’echelle visuelle analogique (EVA) lombaire et radiculaire compares en preoperatoire et a 1 an. Les donnees operatoires et de suivi etaient egalement etudiees. L’analyse radiologique etait basee sur des teleradiographies du rachis en totalite en preoperatoire et au dernier recul. Enfin la fusion inter-somatique a 1 an etait evaluee par un scanner systematique. Resultats La duree operatoire moyenne etait de 85 minute par niveau, le saignement peroperatoire moyen de 150 mL, l’irradiation de 150 cGy/cm2. Le taux de complications etait de 13 % (3,3 % necessitant une reprise). L’Oswestry, le score de Quebec et l’EVA etaient tous ameliores de maniere significative a 1 an (p Discussion L’etude de notre serie d’arthrodese TLIF mini-invasive chez la personne âgee de plus de 70 ans confirme l’interet de cette technique dans cette tranche d’âge avec des resultats cliniques et radiologiques satisfaisants et un taux de complications faible. Niveau de preuve III.

Pancreatitis are inflammatory diseases of the pancreas and include acute pancreatitis (AP) and chronic pancreatitis (CP). The diagnosis of AP is based on the fulfillment of 2 out of 3 criteria : abdominal pain, hyperlipasemia, signs of AP on imaging. The most frequent etiologies of AP are gallstone(s) and alcohol abuse. The early management of AP includes in all cases, fluid resuscitation, pain control and transient fasting. In biliary AP, endoscopic biliary sphincterotomy should be performed only if associated cholangitis. In infected organized necrosis with clinical deterioration despite conservative treatment, an invasive treatment (step-upapproach by drainage ± necrosectomy) could be proposed. Contrary to AP, the morphological alterations of the pancreatic ducts and parenchyma are irreversible in CP. The clinical presentation of CP is dominated by abdominal pain associated with loss of weight and denutrition. The mechanisms of pain generation in CP are multiple and complex. Endoscopic therapy could be proposed with the aim to relieve a distal ductal obstruction and could provide clinical improvement in about 2/3 of patients. Surgery, either by pancreaticojejunostomy or resection remains indicated for 20 - 25 % of patients. The management of complications from CP (biliary stricture, pseudocyst) is also important as well as the treatment of diabetes and steatorrhea in order to avoid denutrition.Les pancréatites sont des affections inflammatoires du pancréas et comprennent les pancréatites aiguës (PA) et les pancréatites chroniques (PC). Le diagnostic de PA se base sur la présence d’au moins 2 parmi 3 critères : douleur abdominale, élévation de la lipasémie, signes de PA à l’imagerie. Les causes les plus fréquentes de PA sont la lithiase biliaire et l’alcoolisme. La prise en charge précoce d’une PA comprend dans tous les cas une (hyper) hydratation, un contrôle de la douleur et une mise à jeun transitoire du patient. En cas de PA d’étiologie biliaire, une sphinctérotomie biliaire ne doit être réalisée en urgence qu’en cas d’angiocholite associée. En cas de nécrose liquéfiée, surinfectée, associée à une détérioration clinique du patient, malgré un traitement conservateur, un traitement invasif (drainage ± nécrosectomie) peut être proposé. Contrairement à la PA, les altérations morphologiques (au niveau des canaux et du parenchyme pancréatiques) sont irréversibles dans la PC. La symptomatologie clinique de la PC est dominée par la douleur associée à l’amaigrissement et la dénutrition. Les mécanismes de la douleur sont multiples dans la PC. En cas d’obstacle canalaire distal, un traitement endoscopique visant à drainer le canal pancréatique principal permet d’obtenir une amélioration clinique pour environ 2/3 des patients. La chirurgie, soit de dérivation pancréaticojéjunale, soit de résection reste indiquée pour 20 à 25 % des patients. La prise en charge des complications de la PC (sténose biliaire, pseudokyste) est aussi importante ainsi que le contrôle du diabète et de la stéatorrhée.

Atypical haemolytic uraemic syndrome (aHUS) is a rare but life-threatening complement system-related disorder, characterized by renal failure, non-immune haemolytic anaemia and thrombo-cytopenia. We report on a young woman who developed a pancreatitis-induced aHUS following a routine procedure of endoscopic retrograde cholangiopancreatography. The patient was successively treated by 2 plasma exchanges with fresh frozen plasma and eculizumab, a monoclonal antibody designed to block terminal complement activation. The last treatment resulted in the immediate improvement of haemolytic parameters and to the definitive suspension of plasma exchanges. This is likely the first description of the use of a complement inhibitor to treat post-pancreatitis aHUS. We discussed treatment options and concluded that eculizumab could be a beneficial alternative to plasma exchanges in the management of such complications.

Background and aims: Clarification of the position of the European Society of Gastrointestinal Endoscopy (ESGE) regarding the interventional options available for treating patients with chronic pancreatitis. Methods: Systematic literature search to answer explicit key questions with levels of evidence serving to determine recommendation grades. The ESGE funded development of the Guideline. Summary of selected recommendations For treating painful uncomplicated chronic pancreatitis, the ESGE recommends extracorporeal shockwave lithotripsy/endoscopic retrograde cholangiopancreatography as the first-line interventional option. The clinical response should be evaluated at 6 – 8 weeks; if it appears unsatisfactory, the patient’s case should be discussed again in a multidisciplinary team. Surgical options should be considered, in particular in patients with a predicted poor outcome following endoscopic therapy (Recommendation grade B). For treating chronic pancreatitis associated with radiopaque stones ≥ 5 mm that obstruct the main pancreatic duct, the ESGE recommends extracorporeal shockwave lithotripsy as a first step, combined or not with endoscopic extraction of stone fragments depending on the expertise of the center (Recommendation grade B). For treating chronic pancreatitis associated with a dominant stricture of the main pancreatic duct, the ESGE recommends inserting a single 10-Fr plastic stent, with stent exchange planned within 1 year (Recommendation grade C). In patients with ductal strictures persisting after 12 months of single plastic stenting, the ESGE recommends that available options (e. g., endoscopic placement of multiple pancreatic stents, surgery) be discussed in a multidisciplinary team (Recommendation grade D). For treating uncomplicated chronic pancreatic pseudocysts that are within endoscopic reach, the ESGE recommends endoscopic drainage as a first-line therapy (Recommendation grade A). For treating chronic pancreatitis-related biliary strictures, the choice between endoscopic and surgical therapy should rely on local expertise, patient co-morbidities and expected patient compliance with repeat endoscopic procedures (Recommendation grade D). If endoscopy is elected, the ESGE recommends temporary placement of multiple, side-by-side, plastic biliary stents (Recommendation grade A).

Loneliness is particularly prevalent during adolescence, a time also associated with the appearance of psychiatric illnesses. Loneliness has been linked to a number of mental health indicators such as depressive symptoms, self-esteem, anxiety, and perceived stress. During adolescence, the individual undergoes major social and personal transformations through redefining their social network thus making them more susceptible to developing mental health problems. Some studies suggest that the risk of mental health problems arises when an adolescent is repeatedly faced with loneliness. Mental health workers should therefore focus on any given adolescent's inability to establish satisfactory interpersonal relationships as a predictive element of loneliness. Thus, it would seem that the development of loneliness prevention and intervention programs aimed at adolescents who are unable to establish satisfactory interpersonal relationships could be of benefit to many.

The 20-item Toronto Alexithymia Scale (TAS-20) is the most widely used measure of alexithymia in non-clinical or clinical populations. The TAS-20 evaluates three dimensions of the alexithymia construct: the difficulty identifying feelings (DIF), the difficulty describing feelings (DDF) and externally oriented thinking (EOT). The TAS-20 is also used in adolescents or children, and the psychometric properties of the scale have not been systematically evaluated in these populations. Recently several studies have shown systematic age differences in the factor structure and a decrease of the quality of the measurement with age. Notably, low reliability measured by the Cronbach α coefficient has been found for the EOT factor. Taking into account the limitations of the TAS-20 in pre-adult populations the Alexithymia Questionnaire for Children (AQC), an adaptation of the TAS-20, has been proposed by a reformulation of the TAS-20 items (Rieffe et al., 2006). Two studies in healthy children found satisfactory psychometric properties with the three-factor structure demonstrating adequate parameters in the confirmatory factorial analyses (CFA). In the two studies low reliabilities of the EOT factor were reported, and recent studies in adolescents using the TAS-20 found that a two-factor model (DDF, DIF) had a better fit than the original three-factor model. Thus, the aim of the present study was firstly to verify the psychometric properties of the AQC in a sample of adolescents presenting various psychiatric disorders and secondly to test the adequacy of the bi- or tridimensional model of the scale.One hundred and five adolescents (27 males, 78 females) with a mean age of 15.06 years (sd=1.55, range: 12-18 years) were hospitalized in the adolescent psychiatric department of the Erasme Hospital (Bruxelles, Belgium) for various psychiatric disorders. The main diagnoses were: adjustment disorder (n=56, 53.5%), mood or anxiety disorders (n=17, 16.2%), impulse control disorder (n=11, 10.5%). The subjects completed the French version of the AQC. CFA were done testing the adequacy of the three or two-factor structure of the scale. Two indices were considered: the normed χFit indices for the three-factor model were respectively 1.165 and 0.0303 for the normed χThe Alexithymia Questionnaire for Children had satisfactory psychometric properties found in a sample of adolescent psychiatric inpatients. Taking into account firstly the superiority of the two-factor model over the classical three-factor model and secondly the low value of the Cronbach α for the EOT factor, it is proposed to use only the twelve-item scale by excluding the EOT items.

The Munchausen syndrome by proxy (MSBP) was first described in 1977 by the English paediatrician Roy Meadow. The MSBP is an extremely complicated diagnosis because of the difficulty in finding the incriminating evidence of its existence and because of the ethical issue it raises for caregivers. Its implications from a medical, psychological and legal point of view raise difficult questions for any professional confronted to it. In this article we will first present the case of a 16-year-old teenager who had been bedridden in hospital for a year, before an atypical form of MSBP was finally diagnosed, after a stay in a child and adolescent psychiatry unit. We will then discuss this case in light of a literature review on the MSBP.

This paper proposes an original method for accurately measuring the stator leakage reactance of synchronous machines. The approach relies on an experimental equivalence of resulting fluxes between the unsaturated open-circuited and permanent short-circuited tests. This requires the presence of measurement turns in the air gap of the machine. A complete comparison with existing methods (Potier, El-Serafi & Wu, rotor removed test and geometric calculation) is moreover proposed. A critical analysis is performed, and pros and cons of each method are highlighted.

The obliteration of esophageal and/or gastric varices using Histoacryl is highly effective in controlling active bleeding. However, it is not known whether repeated injections are useful for the long-term eradication of esophagogastric varices. The aim of the study was to compare endoscopic Histoacryl obliteration with propranolol in the secondary prevention of esophagogastric variceal bleeding.Between August 1995 and February 1999, 41 patients with a first bleeding from esophageal (n = 31) or gastric (n = 10) varices were included in the study. After primary hemostasis with obliteration using Histoacryl, patients were randomly allocated either to undergo complete Histoacryl obliteration of the remaining varices (group A, n = 21) or to long-term propranolol administration (group B, n = 20), for the prevention of rebleeding.The two groups were well matched for age, sex, etiology of cirrhosis, Child-Pugh score, renal function, and infection at the time of admission. The median follow-up was 31.9 months (4.8 - 74.7) for group A and 23.2 months (3.0 - 70.0) for group B. Initial hemostasis was achieved in 40/41 patients (97 %). No significant difference was observed between groups A and B with regard to the incidence of early rebleeding (during the first 6 weeks; 5/21 and 3/20), bleeding-related deaths by 6 weeks (3/21 and 6/20), long-term rebleeding (11/21 and 5/20), or overall number of deaths (9/21 and 9/20). The incidence of complications was higher in group A (10/21) than group B (2/20) (P0.03).Repeated injections of Histoacryl with the aim of eradicating esophagogastric varices are associated with more complications compared with beta-blocker administration, with similar results in terms of rebleeding rate and survival in the long term.

The high-temperature design codes are presently considering the use of stress reduction factors for designing welded structures submitted to creep. These reduction factors are derived from creep tests which are generally made on small specimens and are not necessarily representative of large-size geometries. These codes are very likely overconservative, consequently uneconomical and need to be improved; an investigation to assess and quantify the supposed size effect is required. This paper presents an experimental and numerical study on creep behavior at 600°C of full-size welded joints taking into account real full-thickness of weldings. The material investigated is the austenitic stainless steel 316L(N) with manual metal arc welds using the 19 Cr 12 Ni 2 Mo electrode grade. The creep laws used in calculations are those obtained from tests using small specimens, but some coefficients of their theoretical formulation have been modified to obtain a better coherence with fullsize specimen data. Between small and large full-size specimens, experimental results show no significant difference in time to rupture, and the same location of fracture, at the center of the weldment, is observed. Finite element simulations performed for full-size welded joints provide rupture times that are consistent with measured values. The calculated percentage of the damaged volume in the weld metal as a function of load levels and of creep-time duration is studied; it shows that the creep-rupture times for high stress loading are determined with higher accuracy than for low stress loading.

This paper is dealing with high power broadband signals (multisines) applied in Stand-Still Frequency Response (SSFR) technique for the measuring and modelling of electrical machine characteristics. The powerful excitation signals used are periodic functions with controllable amplitude spectrum. Their are obtained using a thyristor rectifier as an amplifier. Therefore, the excitation signal (multisine waveform) is superimposed on a DC current. The effects of the DC component and of the excitation signal (multisine amplitude) on estimated parameter values are discussed. The aim of the topic is to show that, even in noise corrupted environment, the multisine (msine) signals applied to SSFR test can deliver coherent synchronous machine parameters, using the frequency domain Gaussian Maximum Likelihood Estimator (MLE) method for identification.

This paper reviews some recent developments in Raman instrumentation. The introduction of the confocal design in most Raman spectrometers represents the latest advance in the field of instruments for Raman spectroscopy. It is the basis of new applications in the field of Raman microprobing and improvements in Raman imaging techniques. The basic principle of confocal microscopy is reviewed and its extension to Raman spectroscopy is discussed in terms of improved depth resolution which results in better background discrimination. A new concept of Raman imaging is also presented which benefits from the confocal system and overcomes most of the limitations of direct imaging techniques. A dual fibre-optic remote analysis scheme is described which has been developed to optimize the collection of the scattered light while minimizing the interference from the optical fibres.

L'effet Raman est a la base du developpement de techniques tres performantes d'analyse moleculaire qualitative ou quantitative complementaires de l'absorption Infrarouge. Apres un bref rappel des principes physiques de la methode, les differents aspects interessant les applications analytiques sont passes en revue. Les principales methodes utilisees pour remedier aux inconvenients dus a la fluorescence sont presentees. L'accent est mis sur les possibilites d'analyse locale non destructive de divers materiaux avec une resolution spatiale de l'ordre du micrometre, soit pour des masses d'echantillon de 10 puissance (-9) a 10 puissance (-12) grammes, ainsi que sur la microscopie confocale, l'imagerie et l'extension au proche Infrarouge.

The diagnosis of schizophrenia at adolescence is still difficult. The premorbid history and past family history can help with the differential diagnosis in this situation. Studies on the future of schizophrenic adolescents show that the disorder has particularly harmful consequences on the individuals' development and psychosocial adaptation. The risk of suicide is present. Comorbid disorders as cannabis abuse are discussed. Paradoxically, there are only few data about a productive therapy. The efficacy of prevention remains to be shown.

La faisabilite du couplage d'une sonde Raman avec une microsonde de Castaing ou un microscope electronique a transmission a ete etudiee des 1986. Dans ce dernier cas, l'epaisseur d'echantillon est tres faible et une serie de tests a ete effectuee sur un materiau modele, le polystyrene, afin de determiner experimentalement la profondeur de champ, ou resolution axiale, d'un microspectrometre Raman a detection multicanale utilise dans les conditions d'eclairement de l'echantillon et de collection de la lumiere diffusee aussi proches que possible de celles correspondant au systeme Raman implante dans le microscope electronique. Les resultats obtenus montrent que la resolution axiale observee est de l'ordre de 2 μm et qu'un spectre Raman non resonnant de bonne qualite est encore obtenu pour une epaisseur d'echantillon de 50 nm et une resolution laterale de 0.7 μm soit 2 × 10−14 g de materiau analyse. Par des traitements numeriques bien connus des signaux, il parait possible d'effectuer des mesures jusqu'a des epaisseurs de 10 nm. The feasibility of coupling a Raman probe with a Castaing electron probe or a transmission electron microscope was pointed out as early as 1986. However, in the latter case, the thickness of the sample is very small. A series of tests was therefore made with the help of a model material, polystyrene, in order to define experimentally the depth of field, or axial resolution, of a Raman microspectrometer equipped with a multi-channel detector. The conditions of sample illumination and solid angle of light collection were kept as close as possible to those in the Raman system implemented in the electron microscope. The results obtained show that the observed axial resolution is of the order of 2 μm and that a good quality non-resonant Raman spectrum is still observed from a sample thickness of 50 nm for a lateral resolution of 0.7 μm (2 × 10−14 g of analysed material). With the use of well known signal treatments, it would be possible to make valuable measurements for sample thicknesses down to 10 nm.

BACKGROUND AND STUDY AIMS: Although it has been proved that pancreatic stenting is effective in the symptomatic management of severe chronic pancreatitis, long-term outcomes after stent removal have not been fully evaluated. PATIENTS AND METHODS: A total of 100 patients (75 men, 25 women; median age 49) with severe chronic pancreatitis and pancreatic duct strictures were successfully treated for pancreatic pain using polyethylene pancreatic stents and were followed up for at least 1 year after stent removal. The stents were exchanged "on demand" (in cases of recurrence of pain) and a definitive stent removal was attempted on the basis of clinical and endoscopic findings. Clinical variables were retrospectively assessed as potential predictors of re-stenting. RESULTS: The etiology of the chronic pancreatitis was alcoholic (77 %), idiopathic (18 %), or hereditary (5 %). Patients were followed up for a median period of 69 months (range 14 - 163 months) after study entry, including a median period of 27 months (range 12 - 126 months) after stent removal. The median duration of pancreatic stenting before stent removal was 23 months (range 2 - 134 months). After attempted definitive stent removal, 30 patients (30 %) required re-stenting within the first year of follow-up, at a median time of 5.5 months after stent removal (range 1 - 12 months), while in 70 patients (70 %) pain control remained adequate during that period. By the end of the follow-up period a total of 38 patients had required re-stenting and four ultimately underwent pancreaticojejunostomy. Pancreas divisum was the only factor significantly associated with a higher risk of re-stenting (P = 0.002). CONCLUSIONS: The majority (70 %) of patients with severe chronic pancreatitis who respond to pancreatic stenting maintain this response after definitive stent removal. However, a significantly higher re-stenting rate was observed in patients with chronic pancreatitis and pancreas divisum.

Background: Duodenal duplication cysts are rare congenital anomalies. Symptomatic cases have classically been treated by surgical resection, which can be complex because of the close proximity of the cysts to the papilla. Objective: To describe a series of 8 patients with symptomatic duodenal duplication cysts who were treated endoscopically, with a special focus on the long-term outcome. Design: Retrospective case series. Setting: Three tertiary-care European academic hospitals. Patients: Fight patients, age 8 to 72 years, were treated endoscopically for symptomatic intraluminal duodenal duplication cysts between 1981 and 2006. Seven patients presented with acute pancreatitis, and one patient presented with jaundice. Intervention: Endoscopic incision and marsupialization of the cysts was performed by using a variety of endoscopic tools (needle-knife and regular sphincterotomes, cystotomes, and polypectomy snares). Main Outcome Measurements: Technical success of endoscopic intervention and long-term clinical recurrence of symptoms. Results: No major complications occurred. All patients remained asymptomatic at a median follow-up of 7.3 years. Limitations: Retrospective study; the small number of patients. Conclusions: The endoscopic treatment of symptomatic intraluminal duodenal duplication cysts is a safe and effective technique, with excellent long-term results. it represents a minimally invasive alternative to surgical resection and might be considered the preferred therapeutic modality for these cases.

Background and study aims Endoscopic pancreatic sphincterotomy is indispensable for many therapeutic endoscopic maneuvers, but is also associated with a higher risk of pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP). In this study, this subgroup of patients was investigated in order to identify risk factors and protective factors. Patients and methods A retrospective chart review identified 572 endoscopic pancreatic sphincterotomies that met the inclusion criteria. Charts were examined for indications, endoscopic technique, and outcomes, including pancreatitis. Results A total of 477 patients underwent 572 endoscopic pancreatic sphincterotomies during a 5-year period. Indications for sphincterotomy included chronic pancreatitis (n = 398), access for tissue sampling (n = 52), acute recurrent pancreatitis (n = 45), transpapillary drainage of a pancreatic pseudocyst (n = 32), precut access to the common bile duct (n = 29), and others (n = 16). Pancreatic duct drainage was performed in 69.1 % of the procedures (nasopancreatic catheter, n = 290, or pancreatic stent placement, n = 105). Post-ERCP pancreatitis occurred in 69 cases (12.1 %) and was severe in 10. The multivariate analysis identified female sex as being associated with a higher risk of pancreatitis, while an elevated C-reactive protein level, pancreatic ductal stones, sphincterotomy at only the major papilla, and pancreatic duct drainage with a nasopancreatic catheter or stent were associated with a lower risk. Conclusions This large series of patients undergoing endoscopic pancreatic sphincterotomy provides further evidence that both patient characteristics and technical factors modify the risk profile for post-ERCP pancreatitis. In addition to providing further definition of which patients are at risk, it also suggests that pancreatic duct drainage is an independently significant protective maneuver.

Background and study aims The presence of pancreas divisum may reduce the severity of acute gallstone pancreatitis (AGP), as stone impaction at the major papilla only affects the ventral pancreas. Patients and methods The severity of AGP was compared retrospectively in patients with and without pancreas divisum. Acute gallstone pancreatitis was defined by clinical, biological, radiological, and endoscopic features. Thirteen patients with AGP and pancreas divisum were identified among those presenting with AGP between 1989 and 2000. Pancreas divisum patients were compared to 39 control individuals with AGP and conjugate pancreas. All patients underwent biliary sphincterotomy. Levels of serum amylases, lipases, C-reactive protein (CRP), and white blood cells (WBC) were compared in patients with AGP and pancreas divisum and in control individuals before sphincterotomy. The severity of pancreatitis was assessed on the basis of CRP, Ranson's score, computed tomography, the need for intensive care and drainage of collections or necrosis, duration of hospitalization, and mortality. Results Patients with AGP and pancreas divisum had a lower severity grade at CT scanning than control individuals ( P = 0.005), a shorter hospitalization period (5 +/- 1.9 vs. 11.6 +/- 1.6 nights; P = 0.032), and lower mortality (none of 13 vs. four of 39; P = 0.048). Serum amylases and lipases, WBC, and Ranson's score tended to be lower in patients with AGP and pancreas divisum, but the difference was not significant in comparison with control individuals. Conclusions Acute gallstone pancreatitis is less severe in patients with pancreas divisum than in those with a conjugate pancreas.

The present paper summarizes the various themes of research which have been developed in the department of medical gastroenterology since it was created in 1977. These include: in pancreatology, the study of chronic pancreatitis pathogenesis, acute pancreatitis pathogenesis and immunomodulation, endoscopic treatment of chronic pancreatitis, the development of new imaging techniques of the bile ducts and the pancreas, as well as the treatment of pancreatic cancer and benign or malignant biliary diseases. in hepatology, the immunomodulation of liver cirrhosis, especially alcoholic liver disease, the modulation of experimental acute and chronic hepatitis, the study of liver ischemia-reperfusion. Clinical hepatology has focused on liver transplantation, prognosis factors of chronic liver disease and treatment of portal hypertension and viral hepatitis. in gut diseases, the treatment of gastro-oesophageal reflux and its complications, the therapeutic endoscopy of the upper and lower GI and the prevention, as well as the treatment, of colon cancer, the pathogenesis and the immunopharmacology of inflammatory bowel diseases and the clinical enteral and parenteral nutrition.

Evaluate the correlation between psychopathological disorders in type 1 insulin-dependent diabetic (IDD) children and adolescents and the occurrence of micro-angiopathic complications.Two hundred and five IDD children (104 girls and 101 boys with a mean age of 13.4 +/- 3.5 years on inclusion) were longitudinally monitored between 1994 and 2000. Somatic complications were systematically searched for during a yearly control visit to the day hospital. Psychiatric disorders had been assessed initially by self-administered questionnaires filled-in by the children (Spielberger's STAIC-Trait for anxiety, CESD for depression and Child-EAT for eating habits), by the parents (CBCL, CPRS or GHQ-28) or the principle teachers (CTRS) and diagnostic screening of psychopathological disorders every year.More than 140% of the IDD children (n = 86) were diagnosed DSM-IV, with predominant anxiety (n = 41), during the longitudinal evaluation. Positive screening was significantly associated with higher psychopathological scores before inclusion in the study, with children considered more perturbed by the parents, teachers and the children themselves and mothers who considered themselves more perturbed (GHQ-28 mean 5.6 +/- 7.5 vs. 3.5 +/- 4.8; t = 2.211 p = 0.028). These children were less compliant. Disorders were associated with metabolic imbalance, measured by HbA1c, overweight and an excess of micro-angiopathic, particularly retinopathic, complications.Our results show the frequency of mental disorders in IDD children, the importance of the parents' psychopathology and its association with increased somatic risk. The nature of this relationship requires clarification and the incidence of prevention measures targeted on the psychological problems. The interest of associating a paedopsychiatric element in the therapeutic management of these patients and their families is emphasized.

Rare forms of demyelinating disease such as Balò's concentric sclerosis or Schilder's disease may simulate brain tumors, both clinically and on the computed tomography (CT) and magnetic resonance imaging (MRI). Even the histopathological diagnosis after a biopsy is not entirely reliable. We report three cases of pseudotumoral demyelinating disorders having required a stereotaxic biopsy, one of which was erroneously diagnosed as a malignant astrocytoma. We describe MRI especially the intense contrast enhancement with ill-defined margins, and the mild mass effect. We then detail the histopathological processes upon which differential diagnosis with a tumor can be based.

Partial hepatectomy (PH) or total hepatectomy and orthotopic liver transplantation (OLT) may be curative in selected patients treated for hepatocellular carcinoma (HCC). The analysis of clinical series may help in the choice of the more appropriate treatment.During the past 11 years, 40 patients with HCC were treated by PH and 16 patients underwent total hepatectomy and OLT. Selection criteria for transplantation were the liver function and the tumor resectability.The actuarial 1-, 3- and 5-year survival rates were 67%, 34% and 18%, respectively, after PH and 62%, 54% and 54% after OLT. The only prognostic factor after PH was the tumor extension to a single or both lobes. Patients with associated cirrhosis had significantly more post-operative complications, but a comparable long-term survival. The proliferative cell nuclear antigen labeling index (PCNA-LI), evaluated on tumoral tissue in 16 patients, showed that an index30% indicates a better prognosis for HCC developing in non-cirrhotic liver.For patients carefully pre-operatively evaluated, the presence of an associated cirrhosis does not seem to modify the long-term survival after PH, and OLT may offer more than 50% 5-year survival. A PCNA-LI30% appears to be a good prognostic factor in patients without cirrhosis.

Since there are now several ways to treat symptomatic gallstone disease, one is able to select treatment on the basis of the patient's comfort, the practicability, effectiveness, and side effects of the technique, and the relative costs. In order to assess the present status of contact dissolution with methyl tert-butyl ether with regard to these aspects, the present enquiry reports the data of 21 European hospitals. Eight hundred three patients were selected for contact litholysis of cholesterol gallbladder stones using methyl tert-butyl ether. Percutaneous transhepatic puncture of the gallbladder was performed under x-ray or ultrasound guidance. Dissolution rate, side effects, and treatment times of 268 patients from one single center were compared to those of 535 patients from the other 20 centers. Two hundred sixty-four patients were followed for five years to assess stone recurrence. Physicians were asked how they assessed the expenditure of the method, the discomfort to the patients, and the staffing situation. Patients were asked to indicate their acceptance on an analog scale. Puncture was successful in 761 (94.8%) patients. Prophylactic administration of antibiotics was not necessary. Stones were dissolved in 724 (95.1%) patients. In 315 (43.5%) sludge remained in the gallbladder. The most severe complication was bile leakage, which led 12 (1.6%) patients to have elective cholecystectomy. Toxic injuries due to the ether were not reported. Method-related lethality amounted to 0%, 30-day-lethality to 0.4%. Stone recurrence rate was about 40% in solitary stones and about 70% in multiple stones over five years. Patients with multiple stones developed recurrent stones almost twice as often as those with solitary stones. The probability of stone recurrence in patients with sludge in the gallbladder after catheter removal was not statistically significantly different from those without sludge. Seventy to 90% of the centers found the puncture to be simple and not distressing for patients and the relation between expenditure and therapeutic success to be acceptable. The acceptance of contact litholysis by the patients was excellent. Contact litholysis when applied by an experienced team provides real advantages in the treatment of gallstone disease. The method is technically simple, well accepted by the patients, and can be easily applied in community hospitals. Contact litholysis may be of particular value in patients who are not suitable for anesthesia or surgery.

Pancreatic stone formation is characteristic of chronic pancreatitis. Ductal obstruction is a major cause of pain and the principal disabling symptom of the disease. This article briefly reviews the pathophysiology of pancreatic stone formation and describes the current nonsurgical range of therapeutic modalities.

Severe chronic pancreatitis (CP) is characterized by the formation of intraductal stones that may or may not be associated with stricture [1]. The resultant outflow obstruction can lead to pain via a mechanism of increased pancreatic ductal pressure [2] and to secondary obstructive CP if the duct obstruction remains for a long time. The consequences of parenchymal atrophy are steatorrhea and diabetes. Malnutrition is the result of decreased eating due to pain combined with exocrine and endocrine insufficiency.

To compare the efficacy and safety of two enzyme-containing preparations, Pancrease HL (Cilag) containing 25,000 units of lipase per capsule and Creon (Triosol) with 8000 units of lipase per capsule, in patients with chronic pancreatitis and exocrine insufficiency.The study is a monocentric open crossover prospective study including 25 patients entered from March 1993 to May 1994.Chronic pancreatitis was alcohol-related in 23 patients, previous surgery was performed in 9, 16 had diabetes and all had steatorrhoea (fat balance10g/24h).Patients were investigated during four periods of 2 weeks, each one corresponding to a new treatment regimen: Pancrease HL, 3 capsules/day or Creon, 9 capsules/day, with or without omeprazole 20 mg/day. Stools were collected on the last 3 days at the end of each period when the patients were on a standard diet with a fixed daily intake of 100 g fat/day.Faecal fat, protein and energy excretion did not differ when both preparations were compared at roughly pharmaceutically equivalent doses. No significant improvement in fat and protein absorption was observed when omeprazole was taken with the pancreatic enzymes. However, omeprazole treatment was associated with a marked decrease in the fat-protein content ratio, suggesting an improvement in the fat digestive process but a decrease in the efficiency of protein digestion. Drug safety was comparable in the four groups of treatment.Pancrease HL with high lipase activity provides effective pancreatic enzyme replacement therapy in patients with chronic pancreatitis at an appreciably lower number of capsules per day than with standard preparations.

A nonlinear model associated with the mean-field approximation leads to the existence of solitary waves for fluids near the critical point. The model is based on the second gradient theory and yields a Landau-Ginzburg-type behavior. Above the critical temperature, solitary waves can only be supersonic with respect to the isothermal acoustic speed. Below the critical temperature, all values of the solitary wave velocities are acceptable.

Chronic hereditary pancreatitis is a rare disease accounting for 0.9% of chronic pancreatitis cases. Onset is at an earlier age than chronic alcoholic pancreatitis, often with recurrent painful episodes in childhood. We report the occurrence of hereditary pancreatitis in 3 members of a family over 3 generations.

Mammalian cells respond to various kinds of stress by altering their normal patterns of protein synthesis and dramatically increasing amino acid incorporation into a series of specific polypeptides called “heat shock” or “stress” proteins (Hickey and Weber, 1982; Landry et al., 1982a; Welch, 1993) that seem to transiently protect the cell against further stress (Landry et al., 1982b).

The indications of endoscopic management for chronic pancreatitis are strictly related to the classification of severe types and to the particular anatomy of the ducts: 1. Impacted or distal calculi: endoscopic pancreatic sphincterotomy (EPS) alone followed by ESWL when extraction fails. 2. Stone(s) and stricture: EPS, ESWL, NPC, and then 10F plastic stenting. 3. Relapsing strictures (with upwards dilatation) after 6 to 12 months stenting: silicone covered self expanding stent in a trial, versus surgical pancreaticojejunostomy. 4. Paraduodenal cyst bulging into the duodenum: ECD. 5. Jaundice and/or cholestasis due to stricture of the intrapancreatic CBD: 10F single or multiple plastic stent for calibration during 3 months. For relapsing cholestasis and stricture, 30F metal mesh stent versus surgical hepaticojejunostomy. The indications of endoscopic management for chronic pancreatitis are specific and require complete imaging and functional check up (ERCP, CT scanner, endosonography, pancreatic function tests). The technique is quite difficult and requires definition fluoroscopy, appropriate devices and experienced team. On this condition, the complication rate is very low and usually medically controlled. Treatment does not compromise any further surgery. Endoscopy allows to avoid or to postpone surgery which indication will become better defined and selected in the future.

Endoscopic varix ligation is a new promising endoscopic method which compete with endoscopic sclerotherapy both during acute bleeding and the chronic setting where the aim is to obliterate varices as soon as possible with minimal side effects.

Pancreas divisum (PD), a congenital anatomic variant consisting of a separate pancreatic ductal system, is diagnosed in nearly 10% of patients for whom a successful pancreatogram was obtained. The relationship between PD and pancreatic disease is discussed since 1976. Some authors, reporting a higher incidence of pancreatitis in patients having two separate pancreatic ducts, proposed the concept of relative outflow obstruction of pancreatic juice through the accessory papilla. Based on the literature data and on our own experience, this review asserts that there is no definite evidence for PD being associated with a significantly risk of idiopathic pancreatitis. Discrepancies between epidemiological series could be explained by selection biases leading to an apparent association of PD and pancreatitis. An objective assessment of accessory papilla stenosis in patients with PD is not clearly available to give consistent results. Although controversies persist with regard to the actual abnormality of PD and the presence of stenosis into the accessory papilla, several endoscopic and/or surgical procedures have been proposed in an attempt to correct what is thought to be a stenosis of the orifice of the dorsal duct. More than 300 patients have been treated until now with variable and unpredictable results, these treatments are not devoid of complications. We conclude that PD should be considered as a frequent coincidental anatomic variant having no clinical significance in the great majority of patients and not requiring systematic further therapy.

We report our current management of variceal bleeding with endoscopic sclerotherapy. We emphasize the importance of resuscitation and of recording at time zero and within the first 72 hours clinical and laboratory indicators, as these influence the management of these patients. Primary sclerotherapy using Histoacryl for active bleeding and Ethoxysclerol for recent bleeding should be performed as soon as the patient is stable hemodynamically. As we have identified factors related to the severity of hemorrhage and of liver failure degree which can predict early failure of sclerotherapy, patients presenting with these findings should be, in the future, referred quickly toward alternative therapies among which non-surgical intrahepatic shunt appears a promising modality.

A consensus is growing among units that have an experience in both endoscopic and percutaneous stenting techniques that the endoscopic approach of malignant biliary strictures is more comfortable for the patient and provides less complications. This article describes endoscopic biliary drainage in different malignant stenosis of the bile ducts and delineates the respective indications of percutaneous and endoscopic techniques together with the possible combination of these two methods in selected cases. It also tackles the question of the medical surgical approach of the patients, which might, thanks to a better selection, reduce the morbidity and mortality associated with surgery. The indications of biliary stenting in benign strictures, namely post operative or chronic pancreatitis associated biliary stenoses, are also discussed. Recently, new materials became available for endoscopic and percutaneous biliary drainage, and particularly metallic self expanding stents which might provide a better palliation among these patients. If these stents fulfill their promise on longer follow-up, they may replace the conventional stenting devices.

The success of a defined management policy op peptic ulcer haemorrhage which incorporates endoscopic therapeutic intervention depends on the early identification of a high risk group of patients and a high risk group of ulcers. The high risk group of patients consists of those likely to experience further bleeding on the basis of clinical prognostic indicators: shock and severe anaemia on admission and the pattern of bleeding; or tolerate rebleeding and emergency surgery poorly: patients over 60 years and those with associated disease. UGI endoscopy should be performed early (within 6-12 hours) in this group in order to identify the bleeding point and provide prognostic information regarding the risk of further haemorrhage. Peptic ulcers with major stigmata of recent bleeding (spurting or non-bleeding visible vessel) have high risk of rebleeding, the risk is even greater when major stigmata of recent haemorrhage (SRH) are associated with shock on admission. Patients with such ulcers should be monitored intensively and receive endoscopic haemostatic treatment in order to terminate active haemorrhage or prevent rebleeding thereby avoiding the need for emergency surgery with its attendant morbidity and mortality. Patients with ulcers with minor or no SRH have a very low risk of rebleeding and don't require intensive monitoring or endoscopic treatment and can be discharged from hospital early. Ulcers which cannot be completely characterized have an intermediate risk of rebleeding and should be managed as high risk lesions. Secondary to the anatomy of the visible vessel any haemostatic endoscopic treatment should be applied around, but avoiding, the sentinel clot. Well-designed randomized controlled trials of endoscopic haemostatic treatment of peptic ulcer haemorrhage in which stratification of risk was based on the SRH, have demonstrated for non-bleeding vessel a significant reduction in rebleeding and in emergency surgery, for spurting bleeding benefit was found only for the rebleeding risk. No advantage was demonstrated in each group of patients in term of mortality. Such studies also demonstrate the superiority of the Nd:YAG laser over the Argon laser. Perforation is a rare complication of Nd:YAG laser photocoagulation (less than 1%). Precipitation or aggravation of arterial haemorrhage during treatment of a visible vessel, as a result of a direct hit, is a more frequent complication (0-29%). Further laser treatment is successful in terminating 75% of these induced bleeds, the remainder requiring surgery. Preinjection of the ulcer with adrenaline does not appear to prevent this complication.(ABSTRACT TRUNCATED AT 400 WORDS)

Objectifs pedagogiques Decrire la technique adequate en imagerie par resonance magnetique (IRM) dans l’etude des pancreatites chroniques chez l’enfant. Illustrer l’utilisation de l'IRM dans le diagnostic et le suivi des pancreatites chroniques chez l’enfant a partir d’une revue iconographique de 13 patients observes entre mai 1995 et fevrier 2009. Preciser la place de l’IRM dans la prise en charge des pancreatites chroniques chez l’enfant. Messages a retenir Les pancreatites chroniques sont rares chez l’enfant mais non exceptionnelles representant pres d’un quart des pancreatites de l’enfant. Ces dernieres annees ont vu un engouement croissant pour l’IRM dans l’etude des pathologies pancreatiques pediatriques, permettant une analyse optimale du parenchyme et des canaux bilio-pancreatiques.

Raman microprobing techniques, pioneered nearly 20 years ago, have demonstrated their potential in a large variety of application domains. From the origin up to now, a fruitflul collaboration was established between our laboratory at CNRS-University of Lille - and the industrial team of engineers and scientists brought together by E. DA SILVA at DILOR. A series of innovative progresses, inventions and developments was undoubtedly the consequence of this close cooperation, resulting from a careful analysis of the requirements of spectroscopists and analysts in fundamental or applied research, together with a critical appreciation of the various approaches offered by new technologies.The choice of dispersion, resolution and spectral coverage of conventional optical spectrometers are physically limited by the design parameters (i.e. grating groove spacing, diffraction angle, focal length and detector array dimensions). However, it would be often desirable, in order to select the best compromise of Resonance Raman and fluorescence background, to first examine quickly at low dispersion the whole spectrum from near UV to near IR, in the next step to cover at once the full vibrational range 0-3500 cm-1 with the choosen exciting radiation for a rapid survey of an unknown specimen, and finally to focus the spectral analysis in a narrow spectral domain at high resolution. Such a procedure is often not feasible with a single instrument.