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The objective of this study was to evaluate the adherence to the French Health Authority's 2017 guidelines concerning early-onset sepsis (EOS) in neonates. This 6-month prospective observational study was conducted in 2020 in a tertiary hospital maternity unit. Neonates were classified according to their risk of EOS and the level of appropriate surveillance was analyzed. The risk of EOS was determined for 69.9% of the 1024 included neonates. Of the 123 neonates with a moderate or high risk of EOS, the optimal clinical surveillance was 88%. Even in a tertiary hospital, with training of caregivers, adherence to guidelines was incomplete. Some corrective measures are suggested and should be applied to enhance the adherence.

Resume Introduction Les neoplasies intraepitheliales (NIE) genitales sont des precurseurs de carcinomes epidermoides. Le traitement ideal doit etre efficace, conservateur et bien tolere. Le laser CO2 est un des traitements recommandes, mais son efficacite et sa tolerance n’ont fait l’objet que de peu d’etudes. Patients et methodes Il s’agit d’une etude retrospective monocentrique. Seize patients (8 femmes et 8 hommes) traites par laser CO2 pour une NIE genitale, de haut grade ou differenciee, ont ete inclus. Les marges laterales prises macroscopiquement lors du traitement etaient de 3 a 5 mm. La seance de laser CO2, l’evaluation de la reponse therapeutique et le suivi etaient effectues par un dermatologue du CHU de Caen. Resultats L’âge moyen des patients etait de 68,1 ans et le delai de suivi moyen de 52,7 mois (5 a 130). Les lesions etaient uniques pour 87,5 % des patients. Les taux de recidive des NIE genitales apres traitement par laser CO2 etaient de 58 % pour les femmes et 40 % pour les hommes. Chez plus de 90 % des patients, il n’existait pas d’alteration de la qualite de vie ni de modifications de l’activite sexuelle. Conclusion Quels que soient les traitements recommandes, les recidives des NIE sont frequentes. Le laser CO2 est une option therapeutique conservatrice, efficace et bien toleree. Il permet d’obtenir rapidement une remission clinique mais, comme avec tous les traitements disponibles, un suivi dermatologique au long cours reste necessaire.

OBJECTIVES To describe the clinical and pathological features of canine focal lipogranulomatous lymphangitis, to evaluate its underlying infectious cause and to compare it with human Crohn's disease. METHODS Retrospective review of case records with a histopathological diagnosis of focal lipogranulomatous lymphangitis. Bacterial and fungal colonisation was evaluated using fluorescence in situ hybridisation and histochemical staining, respectively. A comparison with Crohn's disease was performed by a human pathologist. RESULTS Ten dogs were evaluated. The historical complaints were predominantly chronic diarrhoea (10/10) and vomiting (5/10). The biochemical abnormalities included hypoalbuminaemia (6/10) and hypocobalaminaemia (4/6). Abdominal sonography revealed a thickened distal ileum±ileocolic junction. Colonoscopy showed a swollen caecal ostium and oedematous caecum in 7/10 dogs. A stenotic ileo-colic opening prevented endoscopic intubation in all dogs. Histology from the resected lesions revealed granulomatous inflammation involving the muscularis and serosa. Fluorescence in situ hybridization demonstrated invasive bacteria in 2/10 dogs. Post-resection, all dogs received metronidazole and tapering immunosuppressive doses of prednisolone. Remission (median 17 months) was achieved in 8/10 dogs. CLINICAL SIGNIFICANCE Focal lipogranulomatous lymphangitis is a rare and severe form of canine inflammatory bowel disease with preferential localisation to the ileum and the ileocolic junction. An underlying infectious aetiology was not identified.

SummaryIntroduction With the introduction of the Sysmex XN haematology analyser, the white blood cell differentiation channel (WDF) and abnormal cell detection channel (WPC) have been added with algorithms for flagging blasts and abnormal or atypical lymphocytes. Methods In this study, 2011 samples were evaluated on a Sysmex XN2000 analyser and microscopically reviewed using a CellaVision DM96 digital microscope. Results A reference group of apparently healthy blood donors (n = 262) demonstrated in only three samples a positive suspect flag, which could not be confirmed microscopically. Positive WBC suspect flags were demonstrated in 3% of the 2011 samples. From the 55 samples with positive WBC suspect flags, an automatic reflex test was performed within the WPC. The WPC reflex test resulted in 10× Blast?, 15× Abnormal lymph? and 15× Atypical lymph? flags, which could be confirmed microscopically in 33% of these cases. A negative flagging was demonstrated in 15 cases. Microscopic evaluation demonstrated no abnormalities in these 15 cases. However, laboratory technicians also reported the presence of abnormal lymphocytes in 158 samples without an Abnormal lymph? flag. Conclusion In conclusion, the combined use of WDF and WPC resulted in a reduction of approximately 25% of the number blood smears. As a result of the various techniques for light microscopy and haemocytometry, the adequacy of the XN flagging for abnormal and atypical lymphocytes cannot be established with certainty. To improve the quality of the reported results, it is recommended that laboratory technicians incorporate the haemocytometry results and the flagging information in the microscopic slide review.

Genital intraepithelial neoplasias (IEN) are precursors of squamous cell carcinoma. The ideal treatment must be efficacious, conservative and well-tolerated. CO2 laser is one of the recommended therapies, but its efficacy and safety have not been extensively studied.This was a retrospective single-center study. Sixteen patients (8 women and 8 men) treated with CO2 laser for genital IEN, whether high-grade or differentiated, were included. Surgical lateral margins of 3 to 5mm were taken macroscopically during treatment. The CO2 laser session, assessment of therapeutic response and follow-up were undertaken by a dermatologist at the University Hospital of Caen.The mean patient age was 68.1 years and mean follow-up was 52.7 months (5-130). Lesions were isolated in 87.5% of patients. The recurrence rates of genital intraepithelial neoplasia after CO2 laser treatment were 58% for women and 40% for men. No impact on quality of life or on sexual activity was reported in over 90% of patients.Whatever the treatment recommended for intraepithelial neoplasia, recurrence is frequent. CO2 laser is an effective and well-tolerated conservative therapeutic option. It enables rapid clinical remission, but as with all currently available treatments, long-term dermatologic follow-up remains necessary.

Toxoplasmosis is a potentially serious fetal infection associated with maternal seroconversion of toxoplasmosis during pregnancy. Follow-up and treatment vary between different countries. We present a case of congenital toxoplasmosis with unusual physiopathology and symptomatology. The mother was immunized before the beginning of pregnancy but immunosuppressive treatments for Crohn disease maintained during the pregnancy could explain toxoplasmosis reactivation in the mother and congenital toxoplasmosis. The baby presented reversible B lymphopenia and hypogammaglobulinemia.

OBJECTIVES/HYPOTHESIS: There is limited data linking demographic determinants to clinical outcomes in facial trauma, particularly when comparing regional to national datasets; these are the aims of the present study. STUDY DESIGN: Retrospective chart review. METHODS: A 10-year, retrospective single-institutional chart review was undertaken at Children's Hospital Colorado (CHC) to characterize a pediatric population with facial fractures. A comparative analysis between the CHC and National Trauma Data Bank (NTDB) datasets was also conducted. RESULTS: In the CHC dataset, increased hospital stay was positively predicted by bilateral mandible fracture, skull, intracranial, spine, thoracic, abdominal, and limb injuries. Predictors of increased intensive-care unit (ICU) stay included skull, spine, and limb injuries. The CHC cohort had younger subjects, more females, fewer African Americans, and more Hispanics than the NTDB dataset. They were more likely to be injured by nonviolent activities than by altercations. Divergent facial and associated injuries between the datasets were found. Multivariate models showed longer length of hospital stay for the CHC group (P = .0085), but the NTDB group had higher ICU admission (P = .04) and longer lengths of ICU stay (P = .007). CONCLUSION: The demographic disparities (age, ethnicity, mechanism of injury, and injury type) resulted in divergent injury patterns and likely influenced clinical outcomes. LEVEL OF EVIDENCE: 4. Laryngoscope, 2015. Language: en

International audience; Prompt-gamma emission detection is a promising technique for hadrontherapy monitoring purposes. In this regard, obtaining prompt-gamma yields that can be used to develop monitoring systems based on this principle is of utmost importance since any camera design must cope with the available signal. Herein, a comprehensive study of the data from ten single-slit experiments is presented, five consisting in the irradiation of either PMMA or water targets with lower and higher energy carbon ions, and another five experiments using PMMA targets and proton beams. Analysis techniques such as background subtraction methods, geometrical normalization, and systematic uncertainty estimation were applied to the data in order to obtain absolute prompt-gamma yields in units of prompt-gamma counts per incident ion, unit of field of view, and unit of solid angle. At the entrance of a PMMA target, where the contribution of secondary nuclear reactions is negligible, prompt-gamma counts per incident ion, per millimetre and per steradian equal to (124 ± 0.7stat ± 30sys) × 10−6 for 95 MeV u−1 carbon ions, (79 ± 2stat ± 23sys) × 10−6 for 310 MeV u−1 carbon ions, and (16 ± 0.07stat ± 1sys) × 10−6 for 160 MeV protons were found for prompt gammas with energies higher than 1 MeV. This shows a factor 5 between the yields of two different ions species with the same range in water (160 MeV protons and 310 MeV u−1 carbon ions). The target composition was also found to influence the prompt-gamma yield since, for 300/310 MeV u−1 carbon ions, a 42% greater yield ((112 ± 1stat ± 22sys) × 10−6 counts ion−1 mm−1 sr−1) was obtained with a water target compared to a PMMA one.

Resume Introduction Les conidiobolomycoses (infection fungique a Conidiobolus coronatus) sont des infections rares et potentiellement graves predominant dans les zones tropicales. L’evolution a point de depart rhinosinusien se fait vers l’exteriorisation des lesions sous la forme d’une tumeur sous-cutanee a point de depart medio-facial. Observation Une jeune femme de 19 ans, d’origine burkinabe, presentait une deformation centro-faciale acquise evoluant depuis plusieurs mois associee a une obstruction nasale bilaterale. La patiente ne presentait aucun antecedent medico-chirurgical. L’analyse de la piece operatoire a fait le diagnostic d’infection a C. coronatus. Discussion Le C. coronatus est un champignon siegeant dans les vegetaux en decomposition dans des climats chauds et humides. Pathogene humain potentiel, il se developpe chez des patients immunocompetents exposes presentant des micro-plaies de la muqueuse rhinosinusienne. On retrouve une centaine de cas decrits. Sa prise en charge est specifique. Le diagnostic doit etre evoque devant une tumeur deformante de l’etage moyen de la face.

Trattamento efficace della lotta contro l’obesita patologica, la chirurgia bariatrica fa ormai parte della chirurgia digestiva. Piu una tecnica e efficace, piu essa puo portare a delle complicanze. Le complicanze dopo il posizionamento di un anello gastrico sono rare, ma il tasso di reinterventi puo raggiungere il 10%: le migrazioni intragastriche dell’anello (1%) possono richiedere una gastrotomia e un anello mal controllato puo provocare una necrosi che richiede una gastrectomia ampia. La fistola digestiva alta rimane la complicanza piu temibile. Dopo un bypass gastrico, la fistola si trova, il piu delle volte, sull’anastomosi gastrodigiunale. Dopo una sleeve gastrectomy (SG), essa interessa l’apice della cucitura. Dopo una derivazione biliopancreatica, si tratta di una fistola duodenoileale con peritonite biliare. Il monitoraggio postoperatorio deve essere rigoroso, in quanto la diagnosi delle complicanze e difficile, con un quadro clinico poco chiaro; e la tachicardia (superiore a 120 battiti/min) che deve far ricercare una fistola e portare a una laparoscopia urgente. Ogni ritardo patito e pregiudizievole per questi pazienti obesi difficili da curare in un’unita di terapia intensiva. Diagnosticata precocemente, la fistola puo essere suturata; piu tardi, la gestione e piu lunga e difficile, con una fistolizzazione diretta o, anche, una gastrectomia ampia. A distanza occorre restare vigili in presenza della comparsa tardiva di un dolore addominale dopo bypass. Essa puo, a volte, imporre una laparoscopia per trattare un’ernia interna chiudendo le brecce mesenteriche.

Resume But de l’etude L’allergie alimentaire est frequente dans la population pediatrique avec souvent des decouvertes de polysensibilisations chez les nourrissons. Notre etude a evalue l’utilisation de la biopuce ISAC® dans le bilan d’allergies alimentaires chez l’enfant. Patients et methode Il s’agit d’une etude observationelle, monocentrique sur une population de 52 enfants allergiques connus ou suspect d’allergie, ou polysensibilises ayant beneficie d’un bilan allergologique standard et d’une recherche d’IgE specifiques par la technique de la biopuce ISAC®. Resultats Parmi les 52 enfants, neuf ont ete explores pour une suspicion d’allergie non documentee, 13 pour un syndrome d’allergie orale, 30 pour des polyallergies ou polysensibilisations. Ce test renforce la presomption d’absence d’allergie chez les enfants explores pour suspicion d’allergie avec un bilan negatif. Il a ete particulierement interessant chez les patients presentant un syndrome d’allergie orale avec la mise en evidence d’une allergie a un composant moleculaire appartenant a une famille particuliere (PR10 ou profilines). Il a egalement ete contributif pour les explorations des polyallergies et des polysensibilisations a l’arachide et aux fruits a coque, en permettant de definir des profils moleculaires et de proposer ou d’eviter des reintroductions alimentaires. Cependant l’utilisation de cette technique amene parfois a la decouverte de sensibilisations asymptomatiques potentiellement graves. Conclusion Ce travail confirme l’utilite de la biopuce ISAC®, en population pediatrique, dans des situations d’allergies alimentaires multiples ou complexes. Ce test ne doit pas etre realise en premiere intention. L’interpretation des resultats necessite leur integration dans l’ensemble de la demarche allergologique, ce qui sous-entend de la part du prescripteur une excellente connaissance de ce domaine.

Resume Objectif Le bilan de depistage du cancer au decours d’une maladie thromboembolique veineuse (MTEV) reste actuellement controverse. Nous avons cherche a caracteriser une population la plus a risque de developper une neoplasie au decours d’un evenement thromboembolique. Methode Nous avons realise une etude retrospective ancillaire cas-temoins, chez des patients ayant presente une MTEV authentifiee, et chez lesquels les cancers ont ete repertories. Nous avons evalue l’association de la presence d’un cancer aux caracteristiques de la MTEV et aux resultats de quatre marqueurs biologiques. Resultats Notre population etait constituee de 142 patients (53 % d’hommes, âge median de 71 ans). A deux ans de la MTEV, 24 patients (17 %) etaient porteurs d’un cancer. Les valeurs des medianes des D-dimeres, des monomeres de fibrine et de la SP-selectine sont significativement plus elevees chez les patients ayant un cancer. La regression logistique a permis d’identifier deux elements permettant de cibler les patients a haut risque de cancer : le caractere bilateral de la thrombose (OR : 4,41, 95 % IC : 1,41–13,78, p = 0,01) et un taux de D-dimeres superieur a 3,8 μg/mL (OR : 3,68, 95 % IC : 1,36–9,94, p = 0,01). Ces deux caracteristiques portent une information additive ; 58 % des patients de notre population ayant ces deux facteurs associes ont un cancer. Conclusion Le caractere bilateral de la thrombose et des D-dimeres superieurs a 3,8 μg/mL sont hautement associes a la pathologie carcinologique. Ce resultat necessite d’etre valide par une etude prospective. Cela permettrait de limiter le depistage a la population la plus a risque.

Otitis media with effusion (OME) occurs when fluid collects in the middle-ear space behind the tympanic membrane (TM). As a result of this effusion, sounds can become attenuated by as much as 30–40 dB, causing a conductive hearing loss (CHL). However, the exact mechanical cause of the hearing loss remains unclear. Possible causes can include altered compliance of the TM, inefficient movement of the ossicular chain, decreased compliance of the oval window-stapes footplate complex, or altered input to the oval and round window due to conduction of sound energy through middle-ear fluid. Here, we studied the contribution of TM motion and umbo velocity to a CHL caused by middle-ear effusion. Using the chinchilla as an animal model, umbo velocity (VU) and cochlear microphonic (CM) responses were measured simultaneously using sinusoidal tone pip stimuli (125 Hz–12 kHz) before and after filling the middle ear with different volumes (0.5–2.0 mL) of silicone oil (viscosity, 3.5 Poise). Concurrent increases in CM thresholds and decreases in umbo velocity were noted after the middle ear was filled with 1.0 mL or more of fluid. Across animals, completely filling the middle ear with fluid caused 20–40-dB increases in CM thresholds and 15–35-dB attenuations in umbo velocity. Clinic-standard 226-Hz tympanometry was insensitive to fluid-associated changes in CM thresholds until virtually the entire middle-ear cavity had been filled (approximately >1.5 mL). The changes in umbo velocity, CM thresholds, and tympanometry due to experimentally induced OME suggest CHL arises primarily as a result of impaired TM mobility and TM-coupled umbo motion plus additional mechanisms within the middle ear.

La cirugia bariatrica es un tratamiento eficaz de la obesidad patologica y forma parte en la actualidad de la cirugia digestiva. Cuanto mas eficaz es una tecnica, mas complicaciones puede provocar. Las complicaciones que se producen despues de la colocacion de una banda gastrica son infrecuentes, pero la tasa de reintervenciones puede alcanzar el 10%: las migraciones intragastricas de la banda (1%) pueden obligar a realizar una gastrotomia, mientras que una banda mal controlada puede causar una necrosis que requiera una gastrectomia amplia. La fistula digestiva alta sigue siendo la complicacion mas temida. Despues de una derivacion gastrica, la localizacion mas frecuente de la fistula es la anastomosis gastroyeyunal. Despues de una gastrectomia vertical (GV), la fistula se produce en la parte superior de la linea de grapas. Despues de una derivacion biliopancreatica, se trata de una fistula duodenoileal con peritonitis biliar. Se debe llevar a cabo una vigilancia postoperatoria exhaustiva, porque el diagnostico de las complicaciones es dificil debido a que el cuadro clinico es poco claro; la taquicardia (superior a 120 lpm) obliga a buscar una fistula y a realizar una laparoscopia urgente. Cualquier retraso es perjudicial en estos pacientes obesos, cuyo tratamiento en la unidad de cuidados intensivos es dificil. Si el diagnostico de la fistula es precoz, se puede suturar, pero si es mas tardio, el tratamiento es mas largo y dificil, con una fistulizacion dirigida e incluso con una gastrectomia amplia. A lo largo del tiempo, hay que mantener la vigilancia ante la aparicion tardia de dolor abdominal tras una derivacion. En ocasiones, puede obligar a realizar una laparoscopia para tratar una hernia interna cerrando las fisuras mesentericas.

Resume L’allergie aux fruits a coque est de plus en plus frequente : elle occupe en France la quatrieme position chez l’enfant jusqu’a 15 ans et represente 15 % des allergies alimentaires de l’adulte. La noisette est le plus souvent en cause dans les reactions. La noix de cajou est responsable des tableaux les plus severes. Un tiers des allergiques aux fruits a coque sont allergiques a plusieurs fruits a coque ou a l’arachide. Les allergies croisees peuvent etre liees a des parentes botaniques (noix de cajou et pistache, noix et noix de pecan), mais aussi exister entre deux familles de fruits a coque eloignees sur le plan taxonomique par le biais des proteines de stockage des graines. Le diagnostic repose sur l’histoire clinique, sur les prick tests aux aliments natifs ou avec les extraits commerciaux, sur le bilan biologique avec dosage des IgE (vis-a-vis de la source et si possible des composants moleculaires), et finalement sur le test de provocation oral. Seul celui-ci permet d’affirmer l’allergie et de definir eventuellement une dose reactogene, permettant de mettre en place, lorsque cela est possible, une induction de tolerance a domicile. Pour les cas les plus severes, certaines equipes proposent des protocoles de desensibilisation, avec de bons resultats pour la noisette.

Renal cell carcinomas associated with Xp11.2 translocations form a new and little known entity of the WHO 2004 classification. An immunohistochemical (IHC) test aiming at demonstrating the nuclear expression of the protein TFE3, product of a gene frequently involved in translocation, has been proposed as a diagnostic tool. The aims of this work were to define our evaluation criteria of the immunohistochemical test with the antibody anti-TFE3 and to describe new cases of renal cell carcinomas with TFE3 translocations. Using immunohistochemistry with antibody anti-TFE3, we retrospectively studied 83 renal cell carcinomas diagnosed at Edouard Herriot Hospital and Biomnis Laboratory, Lyon, between 2003 and 2009. The patients were 50 years old or younger. We detail our experience of the IHC test using the anti-body anti-TFE3 and the interpretation criteria. This work has enabled two new cases of renal cell carcinomas associated with TFE3 translocations to be detailed, confirmed by molecular biology. The TFE3 immunohistochemical test is a useful tool that demands strict interpretation criteria. In our experience, more than 80% of nuclei stained with an intensity of ++ to +++ is necessary to suspect the diagnosis of Xp11 translocation renal cell carcinoma.

L’objectif de cette etude a l’echelle pilote est d’evaluer de facon qualitative et quantitative les emissions de composes organiques volatils (COV) et d’odeurs generees tout au long du procede de compostage (fermentation, maturation, retournements et criblage), pour deux types de dechets (melange de biodechets, appele BIO, et melange de boues, appele BOU). Ces melanges ont ete soumis a deux conditions d’aeration : limitante (–) et non limitante (+) en oxygene. Deux series de six essais ont ete realisees en silos (160 L) pendant 83 jours : une serie BIO+/BIO- et une serie BOU+/BOU-. Pour chaque essai, un suivi ponctuel de la fraction solide et gazeuse a ete realise.Les silos avec une aeration (+) atteignent en moins de 5 jours des temperatures superieures a 70 °C et leur concentration en oxygene residuel en sortie des silos est superieure a 5% vol. En revanche, la temperature maximale des silos ayant une aeration (–) est inferieure a 55 °C et leur concentration en oxygene residuel est inferieure a 5% vol. pendant 60 jours pour les biodechets et 20 jours pour les boues. Ces resultats confirment la bonne mise en oeuvre des modalites d’aeration (+) et (–), permettant ainsi d’etablir des comparaisons fiables des profils d’emissions de COV et d’odeurs entre dechets et conditions de procede mises en oeuvre.Les resultats de cette etude montrent que : la plupart des COV sont emis pendant les 6 premieres semaines de compostage avec une dimiution des especes de COV et leur quantite au cours du procede; l’emission pour chaque type de dechet est caracterisee par differentes familles de COV : terpenes et cetones pour les biodechets, composes soufres et hydrocarbures aromatiques monocycliques (HAM) pour les boues; l’evolution de la concentration et du flux de COV pendant le compostage est liee au type de dechet et a la strategie d’aeration : les emissions diminuent plus rapidement pour les boues que pour les biodechets et pour les modalites avec une aeration (+) que pour celles ayant une aeration (–); la dynamique d’emission de la concentration d’odeur est similaire a celle des COV, mais la concentration en odeur depend de la nature des COV. En conclusion, les emissions de COV et d’odeurs sont specialement importantes pendant la phase active du compostage, tout particulierement quand l’aeration est limitante. Pour reduire les nuisances du compostage, un des leviers, d’apres cette etude, serait une bonne gestion de l’aeration des et durant la phase de fermentation.

Introduction Verification of hemocytometry equipment deviates significantly from that of clinical chemistry equipment due to the absence of appropriate control material and the need for fresh material. In practice, verification is limited to comparison with the previously used equipment and determination of reproducibilities. Particularly in multicenter settings, harmonization of results is necessary. If the same equipment is used in several laboratory departments, calibration and uniformity are important issues. Methods In this study, seven Sysmex XN hematology modules distributed over three laboratories were evaluated with the same set of samples (n=160). Results Results of each Sysmex XN hematology module were compared with the results of the Sysmex XE-2100 hematology analyzer using linear regression. Although excellent correlation coefficients were obtained, in many cases the criteria for slope and/or intercept were not met. Therefore, the same data were analyzed with Bland-Altman difference plots with three times the specified CV% of the parameter as limits of agreement. At least 90% of the determinations per parameter and per module must comply with those limits of agreement. Almost all parameters on each module fulfilled these criteria, and only RBC and Ht from respectively two and four XN modules had to be recalibrated. Reproducibility of each parameter was determined 10 times in patient samples with low, normal, and high levels. Reproducibility of all parameters was within the specifications of the manufacturer and the biological variability. Conclusion With this straightforward method, all seven Sysmex XN hematology modules demonstrated uniform results, which were identical to those of the previously used Sysmex XE-2100 hematology analyzer, the performance of which was well known.

A seven-year-old West Highland white terrier was presented for chronic vomiting associated with mild regenerative anaemia and hypoalbuminaemia. Further examination showed a giant polypoid cerebriform mass located in the lesser curvature of the stomach. Partial gastrectomy was performed and histology was consistent with hypertrophic gastritis with typical features of Ménétrier's disease. Five years after surgery, the dog was re-examined for recurrence of vomiting episodes. Endoscopy showed ulceration of the lesser curvature of the stomach and histological analysis revealed a poorly differentiated superficial gastric carcinoma surrounded by hypertrophic gastritis. To the authors' knowledge, this is the second time that coexistence of these two types of lesions is reported, suggesting that recurrence of gastritis could be the starting point of the tumoural process.

Background Most dermatological conditions can be evaluated using validate clinical scores, no such tool is available for irritant contact dermatitis (ICD). Objective To create and validate a grid-based ICD severity score. Methods Three dermatologists developed the SCOre de REparation de l’EPIderme (SCOREPI) grid. Two studies were conducted to validate the SCOREPI. A cross-sectional study assessed the intra- and inter-observer error associated with using the SCOREPI. Each investigator received 15 min of training on proper use of the SCOREPI. A computer displayed a series of 20 photos of ICD, each of which were repeated three times in a randomized order. The prospective study assessed the correlation between SCOREPI with the severity of clinical symptoms as well as the sensitivity of the score to changes in ICD in response to topical treatment. Results The SCOREPI took an average of 35 ± 5 s to be completed and was characterized by an excellent intra-observer and moderate inter-observer reproducibility (intra-class correlation coefficient = 0.93 and 0.74, respectively). Significant divergence was observed between the physicians’ assessment of estimated surface (P = 0.04), the presence of erythema (P

Accidental foreign body ingestion by children is not exceptional and occurs in most cases in children less than 5 years old. The impact is not well known. We present the case of a 31-month-old boy affected by peritonitis caused by several bowel perforations after swallowing three magnets at different times. A single foreign body magnetic ingestion does not often cause trouble, but if the ingestions are spaced out, then consequential complications can occur. This is why, in case of stomachaches in a child less than 3 years or a child with behavior problems, it is important to perform standard abdominal X-ray examination.

Resume Introduction Le syndrome d’apnees du sommeil (SAS) a une prevalence allant de 40 a 80 % chez les acromegales. L’objectif de notre etude est de preciser les caracteristiques du SAS et de l’acromegalie dans cette population ainsi que les comorbidites de ces patients. Methodes Il s’agit d’une etude retrospective, monocentrique sur une cohorte de 106 patients acromegales dont 55 ont beneficie d’un enregistrement polygraphique ventilatoire a la recherche d’un SAS, avec un releve des comorbidites. Resultats Parmi les patients explores, 42 ont un syndrome d’apnees du sommeil avec une majorite de SAS severe. Dans cette population, le risque de developper un SAS est plus eleve lorsqu’on est hypertendu ou diabetique et que l’acromegalie est ancienne. Dans cette etude, le controle de l’acromegalie n’est pas un facteur de risque. Les patients avec un SAS severe sont plus âges (64 ans) que ceux n’ayant pas de SAS (47 ans) (p = 0,01). Conclusion La prevalence du SAS est vingt fois plus elevee chez les acromegales que dans la population generale, d’autant plus si les patients sont diabetiques, hypertendus, âges et que l’acromegalie est ancienne. Devant une telle prevalence, un depistage systematique pourrait etre propose dans cette population.

Transient elastography (TE) is a noninvasive technique to evaluate liver fibrosis. We compared the performance of TE with liver biopsy (LB) in patients with human immunodeficiency virus (HIV) and hepatitis B virus (HBV) coinfection. Patients prospectively underwent TE and LB. The diagnosis accuracy of TE was calculated using receiver operating characteristic (ROC) curves for different stages of fibrosis, and optimal cut-off values were defined. A sequential algorithm combining TE with biochemical score (Fibrotest) is proposed. Fifty-seven patients had both TE and LB (median time: 3 days) and two with proven cirrhosis, only TE. Forty-six (78%) were under antiretroviral therapy with anti-HBV drugs in 98%, and 19 (32%) had elevated alanine aminotransferase (ALT). A significant correlation was observed between liver stiffness measurement (LSM) and METAVIR fibrosis stages (P < 0.0001). Patients with elevated ALT tended to have higher LSM than those with normal ALT. The areas under the ROC curves were 0.85 for significant fibrosis (≥ F2), 0.92 for advanced fibrosis (≥ F3) and 0.96 for cirrhosis. Using a cut-off of 5.9 kPa for F ≥ 2 and 7.6 kPa for F ≥ 3, the diagnosis accuracy was 83% and 86%, respectively. With an algorithm combining TE and Fibrotest, 97% of patients were well classified for significant fibrosis. Using this algorithm, the need for LB can be reduced by 67%. In HIV/HBV-coinfected patients, most of them with normal ALT under antiretroviral treatment including HBV active drugs, TE was proficient in discriminating moderate to severe fibrosis from minimal liver disease.

Monte Carlo simulations based on the Geant4 toolkit (version 9.1) were performed to study the emission of secondary prompt-gamma rays produced by nuclear reactions during carbon ion-beam therapy. These simulations were performed along with an experimental program and instrumentation developments which aim at designing a prompt-gamma ray device for real-time control of hadrontherapy. The objective of the present study is twofold: firstly, to present the features of the prompt-gamma radiation in the case of carbon ion irradiation; secondly, to simulate the experimental setup and to compare measured and simulated counting rates corresponding to four different experiments. For each experiment, we found that simulations overestimate prompt-gamma ray detection yields by a factor of 12. Uncertainties in fragmentation cross sections and binary cascade model cannot explain such discrepancies. The so-called “photon evaporation” model is therefore questionable and its modification is currently in progress.

Oui, l’anneau reste une option valable en chirurgie bariatrique de premiere intention, mais attention a bien en cibler les bonnes indications ! Il est en effet convaincant a present de restreindre l’usage de l’anneau a certaines d’entre elles et d’evoluer vers d’autres techniques lorsque la connaissance de l’histoire du patient permet d’anticiper un meilleur resultat.

For real-time monitoring of the longitudinal position of the Bragg-peak during an ion therapy treatment, a novel non-invasive technique has been recently proposed that exploits the detection of prompt gamma-rays issued from nuclear fragmentation. Two series of experiments have been performed at the GANIL and GSI facilities with 95 and 305 MeV/u (12)C(6+) ion beams stopped in PMMA and water phantoms. In both experiments, a clear correlation was obtained between the carbon ion range and the prompt photon profile. Additionally, an extensive study has been performed to investigate whether a prompt neutron component may be correlated with the carbon ion range. No such correlation was found. The present paper demonstrates that a collimated set-up can be used to detect single photons by means of time-of-flight measurements, at those high energies typical for ion therapy. Moreover, the applicability of the technique both at cyclotron and at synchrotron facilities is shown. It is concluded that the detected photon count rates provide sufficiently high statistics to allow real-time control of the longitudinal position of the Bragg-peak under clinical conditions.

This study reports the results in 34 dogs with protein-losing enteropathy (PLE). Rottweilers and Yorkshire Terriers were overrepresented. Most obvious clinical signs and laboratory findings were diarrhea (91 %), weight loss (74 %), anorexia (56 %), lethargy (51 %), ascites (18 %), ascites without gastrointestinal signs (9 %), hypoalbuminemia (

En la actualidad, el tratamiento de la obesidad es la cirugia cuando esta afeccion compromete el pronostico vital. El fundamento de las tecnicas usadas consiste en crear un mecanismo de restriccion gastrica o de malabsorcion intestinal. La derivacion gastrica tiene la ventaja de asociar ambos mecanismos y es mas eficaz que las tecnicas restrictivas como el anillo y es menos peligrosa que las tecnicas de malabsorcion, como la derivacion biliopancreatica. La derivacion gastrica asocia la realizacion de una pequena bolsa gastrica con el ascenso de un asa de intestino delgado situado a 1,5 m en direccion distal del angulo de Treitz que se une a la bolsa gastrica mediante una anastomosis gastroyeyunal. Las secreciones biliares y pancreaticas llegan al asa alimentaria por una enteroenterostomia situada en el pie del asa. La anastomosis gastroyeyunal puede realizarse manualmente o mediante una grapadora lineal o circular. La creacion en primer lugar del asa en «omega» permite transformarla despues en una disposicion en «Y». Tambien se puede optar por la simple derivacion en «omega», que solo requiere una unica anastomosis gastroyeyunal y reduce las complicaciones, a la vez que mantiene la misma eficacia. Las anastomosis circulares son totalmente mecanicas, por lo que se pueden reproducir con mas facilidad, aunque conllevan un riesgo infeccioso y de estenosis mayor. Recientemente se ha publicado que, despues de una derivacion gastrica en un paciente diabetico de tipo 2, la glucemia en ayunas se normaliza enseguida, antes incluso que la perdida de peso, lo que abre de este modo el camino a una verdadera «cirugia metabolica».

Il trattamento dell’obesita, quando essa comprometta la prognosi quoad vitam, e attualmente di competenza chirurgica. Le tecniche intervengono configurando sia con meccanismo di restrizione gastrica, sia una condizione di malassorbimento intestinale. Il bypass gastrico ha il vantaggio di associare questi due meccanismi essendo piu efficace delle tecniche restrittive come l’anello e meno pericoloso delle tecniche malassorbitive quali la derivazione biliopancreatica. Il bypass gastrico associa la confezione di una piccola tasca gastrica alla risalita di un’ansa del tenue situata 1,5 cm a valle dell’angolo di Treitz e collegata alla tasca gastrica con un’anastomosi gastrodigiunale. Le secrezioni biliari e pancreatiche raggiungono l’ansa alimentare mediante un’enteroenterostomia a piede d’ansa. L’anastomosi gastrodigiunale puo essere confezionata manualmente o mediante suturatrice automatica lineare o circolare. Se si esegue dapprima un montaggio a «omega», lo si potra poi convertire in ansa a Y. Si puo anche optare per un semplice bypass a «omega» che prevede solo un’anastomosi gastrodigiunale e riduce le complicanze garantendo la medesima efficacia. Le anastomosi circolari sono interamente meccaniche e quindi piu facilmente riproducibili, ma comportano un rischio infettivo e di stenosi maggiore. E stato di recente pubblicato come dopo un bypass gastrico in paziente diabetico di tipo II, la glicemia a digiuno si sia normalizzata molto rapidamente prima ancora della perdita di peso, aprendo quindi la possibilita di una vera e propria «chirurgia metabolica».

The purpose of this clinical trial was to determine in routine practice and in comparison with liver biopsy the limitations of two blood tests, Actitest and Fibrotest, for the evaluation of hepatic activity and fibrosis in patients with chronic hepatitis C.Routine blood tests, Actitest and Fibrotest, and liver biopsy were performed in 96 patients with chronic hepatitis C attending routine outpatient clinics. Receiver operating characteristics (ROC) curves were used to assess the diagnostic value of the biochemical tests in comparison with the METAVIR classification.The study population was predominantly male (63.5%) with a mean age of 48 years; 83.3% of the patients had genotype 1 hepatitis C virus infection. Treatment status was naive (62.5%), nonresponders (17.7%), relapsers (7.3%), or unknown (12.5%). The comparison of F0-F2 versus F3-F4 estimated the negative predictive value at 92% and the positive predictive value at 52% for a cut-off of 0.455. Discrepancies in activity score were more frequently due to a higher score of the biochemical test compared to biopsy (18 cases out of 19). Discrepancies for fibrosis were observed in 18 patients with a higher score for biochemical test in eight and a higher score for liver biopsy in 10 cases. A significant increase of gamma-glutamyl-transferase (GGT) (p=0.0001) and alanine aminotransferase (ALT) (p0.0001) was observed in case of biochemical test overestimation of activity, and a significant increase of alpha2-macroglobulin (p=0.006) and GGT (p=0.018) in case of biochemical test overestimation of fibrosis.This prospective study confirms the good diagnostic value of biochemical tests for necrotico-inflammatory activity and fibrosis as compared with the histological analysis of liver biopsy. Clinicians must interpret Actitest and Fibrotest results with caution in patients with a significant elevation of ALT, and/or GGT and/or alpha2-macroglobulin which could overestimate hepatic injury.

We compared pressure and volume-controlled ventilation (PCV and VCV) in morbidly obese patients undergoing laparoscopic gastric banding surgery.Thirty-six patients, BMI35 kg m(-2), no major obstructive or restrictive respiratory disorder, and Pa(CO(2))6.0 kPa, were randomized to receive either VCV or PCV during the surgery. Ventilation settings followed two distinct algorithms aiming to maintain end-tidal CO(2) (E'(CO(2))) between 4.40 and 4.66 kPa and plateau pressure (P(plateau)) as low as possible. Primary outcome variable was peroperative P(plateau). Secondary outcomes were Pa(O(2)) (Fi(O(2)) at 0.6 in each group) and Pa(CO(2)) during surgery and 2 h after extubation. Pressure, flow, and volume time curves were recorded.There were no significant differences in patient characteristics and co-morbidity in the two groups. Mean pH, Pa(O(2)), Sa(O(2)), and the Pa(O(2))/Fi(O(2)) ratio were higher in the PCV group, whereas Pa(CO(2)) and the E'(CO(2))-Pa(CO(2)) gradient were lower (all P0.05). Ventilation variables, including plateau and mean airway pressures, anaesthesia-related variables, and postoperative cardiovascular variables, blood gases, and morphine requirements after the operation were similar.The changes in oxygenation can only be explained by an improvement in the lungs ventilation/perfusion ratio. The decelerating inspiratory flow used in PCV generates higher instantaneous flow peaks and may allow a better alveolar recruitment. PCV improves oxygenation without any side-effects.

Les facteurs predictifs de succes de l’anneau gastrique ont ete analyses dans l’enquete de la Caisse nationale d’assurance maladie des travailleurs salaries (CNAM-TS) qui a porte sur les 1 238 patients ayant beneficie d’une chirurgie bariatrique en France en decembre 2002 et janvier 2003, soit la pose d’un anneau gastrique dans 87,5 % des cas. Une evaluation a ete faite systematiquement par les medecins-conseils avec un recul d’un et deux ans. L’âge (< 40 ans), l’indice de masse corporelle (IMC) initial (< 40 kg/m2), la reprise ou l’augmentation de l’activite physique, le changement dans les habitudes alimentaires et le volume d’activite de l’equipe chirurgicale (plus de six operations en deux mois) sont les parametres qui sont significativement lies a une perte d’exces de poids superieure ou egale a 50 %.

Detection and localization of Hepatitis C Virus (HCV) in liver tissue is useful for diagnostic purposes as well as to elucidate the mechanisms by which the virus participates in hepatocarcinogenesis. However, so far, a sensitive method for HCV detection at the cellular level is lacking. We describe here the application of a novel antibody, D4.12.9, developed against serum-derived HCV RNA-positive particles, for the detection of E2 proteins by immunohistochemistry in fixed, archived specimens including liver biopsies of HCV-infected patients and surgical specimens of hepatocellular carcinoma. We demonstrate that D4.12.9 is a powerful tool for sensitive and specific detection of HCV, independently of viral genotype. This approach has applications to diagnosis as well as exploratory pathological studies.

To describe the clinical and pathological features of canine focal lipogranulomatous lymphangitis, to evaluate its underlying infectious cause and to compare it with human Crohn's disease.Retrospective review of case records with a histopathological diagnosis of focal lipogranulomatous lymphangitis. Bacterial and fungal colonisation was evaluated using fluorescence in situ hybridisation and histochemical staining, respectively. A comparison with Crohn's disease was performed by a human pathologist.Ten dogs were evaluated. The historical complaints were predominantly chronic diarrhoea (10/10) and vomiting (5/10). The biochemical abnormalities included hypoalbuminaemia (6/10) and hypocobalaminaemia (4/6). Abdominal sonography revealed a thickened distal ileum±ileocolic junction. Colonoscopy showed a swollen caecal ostium and oedematous caecum in 7/10 dogs. A stenotic ileo-colic opening prevented endoscopic intubation in all dogs. Histology from the resected lesions revealed granulomatous inflammation involving the muscularis and serosa. Fluorescence in situ hybridization demonstrated invasive bacteria in 2/10 dogs. Post-resection, all dogs received metronidazole and tapering immunosuppressive doses of prednisolone. Remission (median 17 months) was achieved in 8/10 dogs.Focal lipogranulomatous lymphangitis is a rare and severe form of canine inflammatory bowel disease with preferential localisation to the ileum and the ileocolic junction. An underlying infectious aetiology was not identified.