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Background In chronic hepatitis C, the European Association for the Study of the Liver and the Asociacion Latinoamericana para el Estudio del Higado recommend performing transient elastography plus a blood test to diagnose significant fibrosis; test concordance confirms the diagnosis. Aim To validate this rule and improve it by combining a blood test, FibroMeter (virus second generation, Echosens, Paris, France) and transient elastography (constitutive tests) into a single combined test, as suggested by the American Association for the Study of Liver Diseases and the Infectious Diseases Society of America. Methods A total of 1199 patients were included in an exploratory set ( HCV, n = 679) or in two validation sets ( HCV ± HIV, HBV, n = 520). Accuracy was mainly evaluated by correct diagnosis rate for severe fibrosis (pathological Metavir F ≥ 3, primary outcome) by classical test scores or a fibrosis classification, reflecting Metavir staging, as a function of test concordance. Results Score accuracy: there were no significant differences between the blood test (75.7%), elastography (79.1%) and the combined test (79.4%) ( P = 0.066); the score accuracy of each test was significantly ( P < 0.001) decreased in discordant vs. concordant tests. Classification accuracy: combined test accuracy (91.7%) was significantly ( P < 0.001) increased vs. the blood test (84.1%) and elastography (88.2%); accuracy of each constitutive test was significantly ( P < 0.001) decreased in discordant vs. concordant tests but not with combined test: 89.0 vs. 92.7% ( P = 0.118). Multivariate analysis for accuracy showed an interaction between concordance and fibrosis level: in the 1% of patients with full classification discordance and severe fibrosis, non-invasive tests were unreliable. The advantage of combined test classification was confirmed in the validation sets. Conclusions The concordance recommendation is validated. A combined test, expressed in classification instead of score, improves this rule and validates the recommendation of a combined test, avoiding 99% of biopsies, and offering precise staging. [ABSTRACT FROM AUTHOR]

Purpose: Portosystemic collateral vessels (PSCV) are a consequence of the portal hypertension that occurs in chronic liver diseases. Their prognosis is strongly marked by the risk of digestive hemorrhage and hepatic encephalopathy. Materials and Methods: CT was performed with a 16-MDCT scanner. Maximum intensity projection and volume rendering were systematically performed on a workstation to analyze PSCV. Results: We describe the PSCV according to their drainage into either the superior or the inferior vena cava. In the superior vena cave group, we found gastric veins, gastric varices, esophageal, and para-esophageal varices. In the inferior vena cava group, the possible PSCV are numerous, with different sub groups: gastro and spleno renal shunts, paraumbilical and abdominal wall veins, retroperitoneal shunts, mesenteric varices, gallbladder varices, and omental collateral vessels. Regarding clinical consequences esophageal and gastric varices are most frequently involved in digestive bleeding; splenorenal shunts often lead to hepatic encephalopathy; the paraumbilical vein is an acceptable derivation pathway for natural decompression of the portal system. Conclusion: Knowledge of precise cartography of PSCV is essential to therapeutic decisions. MDCT is the best way to understand and describe the different types of PSCV. [ABSTRACT FROM AUTHOR]

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Gallbladder duplication is a rare anatomic malformation, which can now be detected by preoperative imaging study. We report a case of a symptomatic duplicated gallbladder, successfully treated by laparoscopic cholecystectomy. This anomaly is important to know for surgeons because of associated anatomical variations of main bile duct and hepatic artery and increased risk of common bile duct injury. [ABSTRACT FROM AUTHOR]

Introduction: Forensic doctors are frequently asked by magistrates when dealing principally with knife wounds, about the depth of the blade which may have penetrated the victim's body. Without the use of imaging, it is often difficult to respond to this question, even in an approximate way. Knowledge of the various distances between organs and the skin wall would allow an assessment to be made of the minimum blade length required to obtain the injuries observed. The objective of this study is thus to determine average distances between the vital organs of the thorax and abdomen, and the skin wall, taking into account the person's body mass index (BMI). Materials and methods: This is a prospective single-center study, carried out over a 2-month period at University Hospital in Angers. A sample of 200 people was studied. The inclusion criteria were as follows: all patients coming to the radiology department and the emergency department for an abdominal, thoracic or thoraco-abdominal scan with injection. The exclusion criteria included patients presenting a large lymphoma, a large abdominal or retroperitoneal tumor, a tumor in one of the organs targeted by our study and patients presenting ascites. The organs focused on were: the pericardium, pleura, aorta, liver, spleen, kidneys, abdominal aorta and femoral arteries. The shortest distance between the organ and the skin wall was noted. Median distances were calculated according to gender, abdominal diameter and BMI. Results: We associated these values to propose an indicative chart which may be used by doctors in connection with their forensic activities. Discussion: The problem of the depth of a wound is frequently exposed to the expert. Without a reliable tool, it is difficult to value and a personal interpretation is often done. Even if, in current days, tomodensitometry is frequently done in vivo or after death, measurement can be difficult because of the local conditions. We classified values according to the different factors of fat repartition (BMI, abdominal diameter, gender). These tables, collectively used, permit evaluation of the distance between wall and thoracic or abdominal vital organs. Conclusion: We suggest an indicative chart designed for forensic doctors in their professional life to help determine the minimum penetration length for a knife, which may wound a vital organ. [ABSTRACT FROM AUTHOR]

Introduction La maladie de Rendu-Osler (MRO) ou télangiectasie hémorragique héréditaire est une pathologie autosomique dominante à l’origine de multiples complications, notamment hémorragiques, pouvant être responsables d’une anémie. Nous avons voulu rechercher la prévalence de l’anémie et les facteurs associés à celle-ci. Patients et méthodes Étaient inclus tous les patients suivis au sein du centre de compétences de notre CHU entre janvier 2012 et juillet 2017 pour une MRO, confirmée génétiquement et/ou par les critères de Curaçao. L’anémie était définie par la présence d’une hémoglobine inférieure à 12,5 g/dL pour les femmes et inférieure à 13,5 g/dL pour les hommes. L’association aux variables suivantes a été étudiée : sexe, type de mutation génétique, âge au diagnostic, âge à l’inclusion, présence d’épistaxis récidivantes, âge de début, ancienneté et fréquence des épistaxis, numération plaquettaire, ferritinémie, présence de saignements digestifs ou gynécologiques, présence de malformation artério-veineuse et leur localisation (pulmonaire, hépatique, digestive, cérébrales, spinales, télangiectasies), survenue de complication (AVC, évènement thromboembolique veineux, HTAP, hyperdébit cardiaque, insuffisance cardiaque à débit élevé, hypertension portale, cholestase, abcès cérébraux, migraines), prise d’un traitement anticoagulant ou antiagrégant, la réalisation de sclérothérapie endonasale, présence d’une supplémentation martiale per os ou intraveineuse. Résultats Quatre-vingt-deux patients dont 54 femmes (65,9 %), d’âge médian de 50,66 [14–92] ont été inclus. Quarante-six patients (65,7 %) avaient une mutation du gène ALK1 et dix-huit (25,7 %) une mutation du gène de l’endogline. La prévalence de l’anémie était de 53,7 %. Les patients anémiés étaient plus âgés ( p < 0,0001), avaient un diagnostic plus tardif ( p = 0,011) et avaient plus souvent des épistaxis récidivantes ( p = 0,04) et plus anciennes ( p = 0,01). Il n’était pas retrouvé de différence selon l’âge de début des épistaxis ou selon la mutation. Les patients avec une anémie présentaient plus souvent des saignements digestifs ( p = 0,024), une malformation artério-veineuse hépatique ( p = 0,044) et un hyperdébit cardiaque ( p = 0,031). La ferritinémie était diminuée en moyenne de 42 μg/L dans le groupe anémie ( p = 0,008 ; IC95 % [−73 à −11]). Ils bénéficiaient plus souvent d’une supplémentation martiale per os ( p = 0,004) ou IV ( p < 0,0001), d’un traitement anticoagulant ou antiagrégant ( p = 0,035) et d’une sclérothérapie endonasale ( p = 0,003). Discussion Il existe un biais important pour l’association retrouvée entre présence d’anémie et hyperdébit cardiaque au cours de la MRO, en effet l’estimation du débit cardiaque à l’échographie cardiaque est fonction de la fréquence cardiaque qui est fréquemment augmentée à l’occasion d’une anémie. De ce fait, un hyperdébit cardiaque peut être mis en évidence à l’occasion d’une anémie, de façon indépendante à la MRO. L’association entre anémie et la présence d’épistaxis récidivantes était attendue, mais pas l’association avec la présence de malformation artério-veineuse hépatique. Cela pourrait suggérer une corrélation entre l’évolution de l’angiomatose au niveau de la microcirculation (télangiectasies nasales) et de la macrocirculation. La méthodologie de notre étude ne permet cependant pas de conclure et encourage à la réalisation d’autres études pour avancer dans la compréhension des mécanismes physiopathologiques dans la MRO. Conclusion L’anémie concerne près d’un patient MRO sur deux et est plus fréquente avec l’âge et en présence de malformations artério-veineuses hépatiques. Ce travail souligne l’importance du dépistage et du suivi de l’anémie dans cette population. Un dépistage et un traitement précoce de la maladie pourraient améliorer de façon significative la qualité de vie des patients. [ABSTRACT FROM AUTHOR]