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International audience; Introduction: Resistance to thyroid hormone beta (RTHβ) is a rare disease with an autosomal dominant transmission. Diagnosis may be challenging especially in patients with hyper-or hypothyroidism. Case Presentation: A 31-year-old male patient with suppressed thyroid-stimulating hormone (TSH), elevated free thyroxine and free triiodothyronine, along with high thyroid receptor antibodies was diagnosed with Graves' disease. Benzylthiouracil was started. One month later, reduced sensitivity to thyroid hormones was suspected because of persistently high thyroid hormone levels contrasting with high TSH level. Molecular analysis highlighted a 10c.1357C>T p.P453S mutation in the thyroid hormone receptor beta gene (THRB). RTHβ was diagnosed. Several relatives also had RTHβ (the mother, the young son, and 2 out of 3 siblings). Autoimmune hypothyroidism was present in the mother, whereas 2 out of 3 siblings had asymptomatic autoimmunity. Discussion/Conclusion: Both Graves' disease and autoimmune hypothyroidism were described in patients with RTHβ. We show here for the first time that autoimmune hypo-and hyperthyroidism may coexist in kindred with RTHβ. Seven previously published cases of Graves' disease and RTHβ were retrieved and analyzed. Treatments and thyroid hormone level targets are discussed as well as the possible link between RTHβ and autoimmune thyroid diseases.

Compared to traditional composite steel-concrete beams, where the concrete slab is supported by the top flange of a steel profile, in slim floor systems, the beam is integrated into the height of the concrete slab. These configurations are popular due to their cost-effectiveness and fire performance. However, fire design requires advanced calculation models, as Eurocodes do not provide a simplified method for the analysis of these types of beams when exposed to fire. The validation of the numerical models is an important issue for researchers, designers, software developers, and authorities. The European Standard for the fire design of composite steel and concrete structures, EN 1994-1-2, states that advanced calculation models must be validated against experimental test results. The paper presents the validation of a numerical model, for the thermal and mechanical analysis of slim floor beams, using SAFIR software. SAFIR is a special purpose computer program, based on the Finite Element Method, developed for the analysis of structures under elevated temperature conditions. The model is validated against an existing experimental fire test, available in the literature. The temperatures on the cross-section and the vertical beam displacements obtained numerically are reproducing very well the experimental results.

Despite the advanced therapeutic arsenal in Heart Failure (HF), this progressive disease, symptomatic in many clinical aspects and potentially fatal when compared to oncologic diseases, remains a public health issue, involving both the patient, the clinician and also the health system. By the nature of its’ prolonged evolution, HF affects the quality of life more pronounced compared to other chronic diseases [1]...

Introduction Different consequences concerning the cardiac function and structure in patients with renal artery stenosis (RAS) and completely different patterns of activation of the renin-angiotensin-aldosteron system were reported, depending on RAS severity. These changes might have an impact upon the outcomes after renal revascularization. Purpose The study was aimed to analyze the effect of renal stenting upon echocardiographic parameters of cardiac structure and function in the studied population and by comparison between 3 different RAS-profile patients. Methods A total of 78 hypertensive patients diagnosed by renal angiography with significant RAS (>70%) were prospectively enrolled, thus subsequently resulting in 3 groups (34-unilateral RAS, 28-bilateral RAS, 14-RAS in a solitary kidney). Clinical, laboratory and echocardiographic parameters (left ventricular (LV) dimensions, LV mass index (LVMI), relative wall thickness (RWT), type of cardiac geometry, systolic and diastolic function, LV filling pressures) were assessed before renal stenting and 12 months after the procedure. The evolution of renal function was based on the glomerular filtration rate (eGFRCKD-EPI). Blood pressure evolution after revascularization was defined as cured, controlled, improved or stationary. Results Similar baseline characteristics were found for the 3 study groups regarding demographics, cardiovascular risk factors, baseline LV diameters, RWT and LVMI (p>0.05), although higher values of echocardiographic parameters were observed in solitary kidney RAS patients. Only 9.6% of all cases had normal geometry, the majority of the patients presenting concentric hypertrophy (58.9%) of similar proportions in the defined groups. Analyzing variations of echocardiographic parameters before and 12 months after stenting confirmed significant changes in all structural parameters (LV walls dimensions, LVMI, RWT, p0.05). Conclusions The current analysis showed favorable outcomes after renal angioplasty with stent in RAS patients with regard to structural changes of the LV (regression of LVMI, RWT). However, the impact of these beneficial changes did not have the magnitude for producing a significant effect upon cardiac geometry one year after renal revascularization.

Adrenocortical carcinoma is a rare cancer with a poor but heterogeneous prognosis. These tumours are more frequently encountered in women, sometimes very young and may be diagnosed in women in their child bearing years or already pregnant. Several clinical data have indicated that the secretion and or proliferation of adrenocortical tumors may be affected by the hormonal context of pregnancy. In this review, we will examine the link between ACC and pregnancy in two main aspects. We will first consider the situation of a pregnant woman with a clinical suspicion of adrenocortical carcinoma: which diagnostic procedures will be useful and safe for the foetus? What are the therapeutic options? What is the prognosis if the diagnosis is confirmed? In a second part, we will examine the possible risk of mothering a child in a patient previously treated for an ACC. The data shown here were obtained from studies carried out in a tertiary reference medical centre in Paris (Hopital Cochin) and from the European Network for the Study of Adrenal Tumor (ENS@T) database of adrenocortical carcinoma.

The purpose of this paper is to detect any changes in fatty acid and cholesterol content of goat colostrum in the period of 0-72 hours after kidding. For that purpose, samples of colostrum from 16 goats, belonging to local populations in north-eastern Romania where collected. Samples were preserved by freezing and then subjected to chemical analysis. Preparation of solutions for fatty acids analysis was based on the principle of methylation, by combining alkaline methylation (NaOCH3/MeOH) with acid (BF3/MeOH). For cholesterol we used the principle of fat saponification, using potassium hydroxide, followed by filtration and separation of cholesterol with hexane. Detection of cholesterol and fatty acids content was performed by gas chromatography device. Caprinic acid (C10:0), myristic acid (C14:0), palmitic acid (C16: 0), stearic acid (C18:0) and oleic acid (C18:1) quantified more than 75% of the total fatty acids determined 72 hours after birth. Among short-medium-chain fatty acids, capronic acid (C6:0) was found in highest proportion (average concentration of 5.7% of total fatty acids), but at the same time, presented the most obvious oscillation range from 0 to 72 hours (6.56% at birth, 2.45% and 7.59% from 12 hours to 72 hours), with the differences between mean values being significant (p

Introduction L’hypoparathyroidie est une complication de la chirurgie cervicale, dont le traitement par voie orale permet souvent de corriger la calcemie. Cette correction devient un veritable defi apres une chirurgie bariatrique malabsorptive et pose la question de reversion chirurgicale. Observation Nous rapportons l’observation de deux patientes ayant developpe une hypocalcemie severe et persistante : la premiere suite a une thyroidectomie pour goitre multinodulaire a un an d’un bypass gastrique en Y, la seconde suite a une parathyroidectomie pour hyperparathyroidectomie primaire a deux ans d’une derivation biliopancreatique. La premiere patiente a necessite le maintien, en association aux supplementations orales, d’un traitement par PTH recombinante1-34 (Teriparatide 20 mg × 3/jour) pendant 2 ans. Seule la conversion du bypass en Y en sleeve gastrectomie a permis la normalisation du calcium a un mois postoperatoire et la reduction significative des besoins en Teriparatide. La deuxieme patiente a necessite de multiples perfusions quotidiennes de calcium pendant 14 mois justifiant le demontage du court-circuit intestinal. Ceci a permis le sevrage des injections des le premier mois, au prix cependant d’une reprise ponderale. Conclusion Seulement trois cas de reversions pour hypocalcemie severe sont decrites dans la litterature [1] , [2] . La survenue d’une hypocalcemie severe dans ce contexte s’explique par l’association de plusieurs facteurs : modification du pH gastrique, court-circuit duodenal, defaut d’absorption de la vitamine D et absence de compensation par la PTH. En cas d’hypocalcemie refractaire, la reversion du court-circuit semble etre la seule solution perenne.

We hereby present a case report of a patient with an unusual neoplasic and surgical history. M.V. is a 54-year-old patient who had been operated, two years ago, for intestinal obstruction caused by a sigmoid tumor; a segmental rectal and sigmoid resection (Hartmann's procedure) was then performed. Two other surgical procedures were attempted during the last two years, in another surgical department: a colo-rectal anastomosis and a repair of the parastomal hernia, both failed due to postoperative adhesions syndrome. The patient was hospitalized for peristomal gangrene with necrotizing fasciitis. Emergency action was taken to resolve the parietal gangrene. The postoperative local evolution of the wound was favourable and allowed a skin graft for parietal restoration. An intestinal obstruction occurred 2 months later, caused by an extended metachronous tumor of the splenic flexure. The patient underwent other surgeries including the completion of the left hemicolectomy, total gastrectomy, caudal splenopancreatectomy and left adrenalectomy. The patient has a favourable postoperative evolution after 1 year.We noticed a very severe evolution of the peristomal gangrene and the rapid growth towards intestinal obstruction of the metachronous colonic tumor.

In nucleus–nucleus collisions at high energies a competition between different particle production mechanisms is possible. This competition can be studied assuming that experimental data for a given collision can be described using models based on different given hypotheses . An analysis of the particle production mechanisms based on different thermodynamic assumptions (global equilibrium, local equilibrium or non-equilibrium) is performed using (mainly) experimental data obtained from nucleus–nucleus collisions at 4.5A GeV /c . A competition between these mechanisms is observed in a given collision . Connections with the collision geometry are reported.

In this work some experimental results on particle production in nucleus-nucleus at high energies are discussed in connection with some unusual states in nuclear matter formed in such collisions. Cross-sections, multiplicities, participants, space-time characteristics of the particle sources, cumulative particle production, temperature and densities are taken into account. Some evidences for unusual states in nuclear matter at energies lower than 10AGeV are obtained.

The problem of the nuclear matter jets in nucleus-nucleus collisions at 4.5 A GeV/c is discussed. The global analysis of experimental data, namely the sphericity tensor, is used to evidence such jets. The experimental results are compared with those obtained in the same collisions for hydrodynamic flow and thrust. The experiments have been performed in the frame of the SKM 200 Collaboration from JINR Dubna.

To obtain some experimental information on the possibility of observing interesting phenomena in nucleus - nucleus collisions - correlations, flow, etc - the multiplicity distributions of the particles generated in such collisions are analysed using the moments method. The role of the collision geometry is emphasized. Different calculations are compared with experimental results for negative pion yield in nucleus - nucleus collisions at 4.5A GeV/c. The experimental results are obtained at the Syncrophasotron of JINR Dubna.

We propose two novel methods of determining nonideal Schottky and p‐n junction diodes parameters from I–V plots. The series resistance Rs, saturation current Is, as well as the bias‐dependent ideality factor n(V), can be obtained from two successive I–V measurements—one solely of the diode and the other with an external resistance added in series with the measured diode. Our analysis confirms that the methods produce accurate and reliable results even when the conventional techniques fail, such as when we have strongly varying function n(V) in the presence of series resistance and an experimental noise.

Introduction Le nivolumab et le pembrolizumab sont des anticorps monoclonaux diriges contre le recepteur PD1 ( Programmed Death-1 ). Ils ont transforme le traitement des melanomes metastatiques ou inoperables. Ils sont mieux toleres que les anti-CTLA4. Toutefois, leurs effets sur la thyroide semblent assez frequents mais leur description et leur evolution encore mal connues. Notre objectif etait, dans une serie monocentrique, de decrire l’evolution clinique et biologique de patients presentant une dysthyroidie sous anti-PD1. Materiel et methodes Nous enregistrons prospectivement les cas de melanome avance, leurs traitements et evaluations et avons standardise le suivi des patients recevant un anti-PD1. Nous avons selectionne dans la base tous les melanomes ayant recu anti-PD1 et ayant eu des explorations thyroidiennes mensuelles. Les dossiers ont alors ete analyses retrospectivement. Resultats Trente-deux patients atteints de melanome traites par anti-PD1 (nivolumab : 3 mg/kg/2s ; pembrolizumab : 2 mg/kg/3s) en dehors d’un essai therapeutique entre 19/06/2015 et 28/04/2016 ont eu des dosages thyroidiens systematiques tous les mois. Sept patients (22 %), d’âge moyen 66 ans, ont developpe une dysthyroidie. Entre la 2 e et la 17 e cure, cinq patients ont developpe une thyreotoxicose avec TSH effondree et hormones peripheriques et T4l entre 1,2 et 2,5 N. Les anticorps anti-recepteur de la TSH etaient negatifs dans les 5 cas. Deux de ces patients avaient des anticorps anti-TPO positifs. La scintigraphie, realisee dans un seul cas, etait blanche mais en presence d’une surcharge iodee. L’evolution s’est faite spontanement vers l’hypothyroidie (TSH entre 30 et 80 mUI/ml) en 3 a 6 semaines, sans traitement antithyroidien ni arret de l’immunotherapie. Deux autres patients ont eu une hypothyroidie d’emblee. Le traitement hormonal substitutif a ete debute chez cinq patients, qui ont necessite une dose > 1 μg/kg/jour de levothyroxine pour obtenir l’equilibre. Aucun arret de traitement n’a ete fait en raison de la dysthyroidie. Ces dysthyroidies ne s’accompagnaient pas d’autres toxicites. Discussion La dysthyroidie est une consequence frequente des anti-PD1. Les hyperthyroidies, peu symptomatiques dans cette serie, n’ont necessite ni traitement specifique ni arret de l’immunotherapie. Elles ont evolue vers une hypothyroidie franche, accessible au traitement substitutif. Cette serie sera actualisee. Conclusion Cet effet indesirable est frequent mais assez facile a prendre en charge sans modifier le traitement du melanome.

Introduction L’hyperthyroidie gravidique est une complication frequente et habituellement benigne de la stimulation du recepteur de la TSH par l’hCG. Observation Une femme enceinte de 33 ans est adressee en endocrinologie au terme de 19 semaines d’une 2e grossesse, pour amaigrissement majeur (−23 kg depuis le debut de la grossesse) avec vomissements, tachycardie et fatigue extreme. Un diagnostic de thyrotoxicose gravidique avec hyperemesis gravidarum avait ete porte 3 semaines plus tot devant une T4l a 1,5 fois la limite superieure de la normale, TSH effondree et TRAK negatifs. Devant l’aggravation de la symptomatologie malgre le traitement symptomatique, la patiente nous est adressee en urgence. Outre une tachycardie sinusale (140/min) il existe une atteinte neurologique avec troubles mnesiques, confusion fluctuante, faiblesse des membres inferieurs et ataxie. Devant la forte suspicion de carence en vitamine B1, une substitution IV est debutee en urgence (500 mg × 3/j pendant cinq jours). La tachycardie, les vomissements et les troubles de la marche se corrigent en quelques jours. Les troubles mnesiques persistent partiellement. Le developpement fœtal est normal pour le terme. Le dosage de vitamine B1 avant substitution confirme la carence (36 nmol/L, N : 120–250) et le bilan thyroidien est normal. L’IRM cerebrale est normale mais effectuee tardivement 10 jours apres la mise en place de la substitution en thiamine. Discussion Les signes neurologiques classiques (confusion, ataxie) et un contexte evocateur doivent faire suspecter une encephalopathie de Wernicke et debuter en urgence une substitution parenterale en thiamine a fortes doses afin de diminuer les complications materno-fœtales.

The multiplicity distributions of the negative particles are analysed using the moments method, for obtaining some experimental information on the possibility to observe flow processes and correlation between the particles in nucleus-nucleus collisions. The role of the collision geometry is important. The calculations are compared with experimental results for nucleus-nucleus collisions at (4.5×A) GeV/c obtained at the Synchrophasotron from JINR Dubna.

The gastric plasmacytoma represents a rarely encountered, so that, the diagnosis criteria, the medical attitude and the evolution of this disease are less coded. It is known the fact that this tumours, extramedullary plasmacytomas with gastric localization, develop in soft submucous tissue, therefore it's very difficult or even impossible preoperative diagnosis through an upper endoscopy including biopsy. We present the case of a 54 years old patient, with no significant pathological personal record, that was admitted in our Clinic for having melenic dark stools which have repeated within a 6 months period prior to this hospitalisation. Repeated gastric mucosal samples taken in another medical unit shown normal aspects, contrary to all imaging testing (e.g. ultrasonography, upper endoscopy and barium swallow) which revealed a tumor mass of considerable extent at the level of the gastric corpus. First-line therapy was gastric resection followed by radiotherapy, because it is well known that the tumour is highly radiosensitive. The patient's postoperative course was satisfactory, showing no signs or recurrence 6 months after surgery at upper endoscopy and CT-scan.

Introduction Pour promouvoir l'activite physique dans la prise en charge du diabete de type 2, le service de diabetologie du groupe hospitalier Paris Saint-Joseph a mis en place deux ateliers realises chaque semaine dans l'unite d'hospitalisation de semaine. Une evaluation a 3 mois des modifications comportementales des patients est realisee a l'aide questionnaire. Patients et methodes Sont proposes chaque semaine – une reunion de groupe le mardi apres-midi, atelier theorique avec animation a l'aide d'un jeu de cartes cree dans le service, qui sensibilise sur les freins concernant l'activite – le pret d'un podometre du mardi au vendredi a tous les volontaires, qui mesure le nombre de pas realises chaque jour et les incite a marcher. Le nombre de pas quotidien est note sur les feuilles de glycemie, comme les constantes a surveiller – apres selection des patients sans contre-indication, une activite marche le mercredi pendant 30 a 40 minutes avec controle des glycemies capillaires avant et apres. 35 patients diabetiques de type 2 volontaires consecutifs ont ete colliges sur une periode de 1 mois et ont repondu a un questionnaire lors de l'hospitalisation et 3 mois apres (sondage telephonique). Le score IPAQ ( International Physical Activity Questionnaire ) a ete utilise pour ces recueils qui identifient 3 niveaux d'activite: bas, moyen eleve. Resultats Sur les 35 patients, l'activite initiale est basse pour 14 patients, moderee pour 13 et elevee pour 8 selon le score. Apres 3 mois les chiffres s'elevent respectivement a 9, 13 et 13 montrant une amelioration globale du niveau d'activite. Conclusion La realisation pratique d'ateliers d'activite physique est possible dans la plupart de nos environnements hospitaliers. L'impact de cette activite peut etre facilement evalue a l'aide de scores valides tels que le score IPAQ. Dans cette enquete declarative, les resultats attestent de la progression du score, d'une amelioration des performances de marche. Dans le cadre d'un programme d'education therapeutique, cette evaluation permet de prouver la pertinence de cette action au moins a court terme. L'evaluation a plus long terme reste a faire. Declaration d’interet Les auteurs declarent ne pas avoir d'interet direct ou indirect (financier ou en nature) avec un organisme prive, industriel ou commercial en relation avec le sujet presente.

Objectif L'effet du Ramadan sur l'equilibre glycemique des patients diabetiques de type 2 reste incertain neanmoins l'utilisation recente du CGMS (Glucose Continuous Monitoring System) semble montrer une variabilite glycemique accrue. Nous avons cherche a analyser avec le CGMS l'impact de l'education therapeutique sur cette variabilite. Patients et methodes Cette etude pilote randomisee a inclus des diabetiques de type 2 non insulino-traites, ayant decide de jeuner pendant le Ramadan 2014, repartis en 2 groupes. Une seance d'education specifique au Ramadan avec un medecin, une infirmiere d'education et une dieteticienne a ete realisee la semaine precedant le Ramadan pour les patients du groupe interventionnel (A), ceux du groupe controle (B) n'ayant recu que les conseils de leur diabetologue habituel. Aucun traitement medicamenteux n'a ete modifie. Un CGMS sur 5 jours a ete realise pour chacun des patients pendant le jeune avec le systeme Freestyle Navigator 2. Resultats Sur 22 patients randomises, 16 (7 du groupe A et 9 du groupe B) ont realise un enregistrement analysable. Les HbA1c etaient de 6,8 % vs 7,3 % ( p = 0,244). Les patients etaient traites par Metformine (6/7 vs 9/9 patients, p = 0,896), sulfamides hypoglycemiants (4/7 vs 6/9, p = 0,696) ou inhibiteurs de la DPP4 (3/7 vs 2/9, p = 0,377) respectivement dans les groupes A et B. La glycemie moyenne differait peu entre les deux groupes (112 vs 117mg/dl, p = 0,791). Toutefois la variabilite glycemique semblait moins importante dans le groupe A que dans le B: l'ecart type des glycemies etait de 23 vs 33mg/dl ( p = 0,204), leur amplitude sur le nycthemere de 149 vs 168mg/dl ( p = 0,244) et l'augmentation de la glycemie a la rupture de jeune de 105 vs 162mg/dl ( p = 0,057) respectivement. Conclusion Malgre le faible effectif, ces tendances laissent supposer un impact benefique de l'education therapeutique sur la variabilite glycemique pendant le Ramadan. Declaration d’interet Les auteurs declarent avoir un interet avec un organisme prive, industriel ou commercial en relation avec le sujet presente. Laboratoire Abbott pour le pret de systeme CGMS et le dont de capteurs.

Introduction Un objectif important de la prise en charge du diabete gestationnel est d’assurer une prevention primaire du diabete de type 2, en agissant apres l’accouchement sur ses facteurs de risque : surcharge ponderale, sedentarite, desequilibre alimentaire. Les patientes venant tres rarement en consultation du post-partum, nous avons cherche a ameliorer leur motivation. Patients et methodes Nous colligeons le nombre de femmes prises en charge annuellement pour un diabete gestationnel, ainsi que le nombre revenant en consultation du post-partum. Le calcul d’un pourcentage glissant permet d’evaluer le taux de retour. Resultats En 2008, les efforts educatifs portaient sur la conduite a tenir durant la grossesse : le taux de retour etait proche de 0 %. En 2009, la necessite de consulter en post-partum etait rappelee sur les documents : le taux de retour s’elevait a 12 %. En 2010, une prise en charge en ateliers a ete organisee avec rappel oral, visuel et ecrit du suivi apres l’accouchement. Les objectifs de la consultation du post-partum etaient detailles : s’assurer de la normalisation des chiffres glycemiques et surtout eviter la recurrence du diabete. Le taux de retour etait de 27 % en 2010, de 34 % en 2011 et de 60 % courant 2012. En 2012, un rappel a ete ajoute lors de l’envoi systematique de notre questionnaire informatise du post-partum. Son effet n’a pas encore pu etre evalue. Conclusion Une information repetee des patientes quant a l’interet pour leur sante d’une consultation diabetologique du post-partum apres un diabete gestationnel, passant par plusieurs canaux de communication, a permis une amelioration drastique de la situation en quatre annees : quasiment aucune patiente ne consultait l’equipe diabetologique apres son accouchement, alors que notre taux de retour atteint actuellement 60 %.

Introduction L’opportunite d’une prise en charge preventive du diabete de type 2 apres un diabete gestationnel est souvent manquee, peu de femmes revenant en consultation diabetologique : nous avons cherche a determiner leur profil, pour mieux cibler notre prise en charge. Patients et methodes Au cours de six mois consecutifs, les donnees des femmes revenant en consultation du postpartum (PP, n = 37) ont ete comparees a celles obtenues par notre questionnaire d’evaluation du postpartum apres tout diabete gestationnel (DG, n = 128). Resultats Les donnees des PP vs DG sont les suivantes : âge moyen identique, classes sociales toutes representees, insulinotherapie 61 % vs 55 %, poids de naissance 3,1 vs 3,2 kg, macrosomie 0 % vs 7 %, hypoglycemies neonatales 5 % vs 14 %. Par ailleurs, parmi les PP, 36 % des femmes en surcharge ponderale avaient maigri a 6 mois par rapport a la situation precedant leur grossesse et 36 % avaient deja rejoint leur IMC anterieur a la grossesse vs 27 % des femmes qui avaient un poids pregestationnel normal. Conclusion Les femmes revenant en consultation de prevention du diabete de type 2 apres un diabete gestationnel ne different pas de l’ensemble des patientes, hormis par une frequence moindre de macrosomie et d’hypoglycemies neonatales : l’hypothese qu’un vecu plus difficile du diabete de grossesse inciterait les patientes a consulter en postpartum semble infirmee. Plus de la moitie cependant ont eu un diabete gestationnel precoce des le 1 er trimestre de grossesse, mais sans element comparatif. Une autre explication serait celle d’une structure psychologique differente chez des femmes proactives, investies dans leur sante : cette hypothese est soutenue par la tres bonne evolution ponderale de ces patientes apres l’accouchement.

Purpose: Erythropoietin currently used as a hemopoietic agent, has remarkable hemostatic activity which can be lifesaving in diffuse, uncontrollable bleeding processes. Following is an example case report: Case presentation: 47 y/o male was admitted with massive GI bleeding and a Hemoglobin (Hg) of 6.7 mg/dl requiring transfusion of 26U Packed Red Blood Cells {PRBC) and 9U of Fresh Frozen Plasma (FFP). The work up revealed a large cell lymphoma infiltrating the mesenteric lymph nodes, the retroperitoneum and the spleen. The small intestine was diffusely infiltrated and bleeding. A portion of the small intestine was resected in an attempt to stop the bleeding; still, the bleeding continued and the Hg could not be raised above 7.8. Erythropoietin 20,000U was administered subcutaneously on day 9 to help correct the anemia. An additional 40,000U were administered on day 14 and 21. Three days after the 2nd dose of Erythropoietin the bowel movement did not appear grossly bloody, the Hg stabilized, and chemotherapy could be administered. After discharge with a follow up of 10 months his Hg stabilized at 12–12.5 mg/dl without any bleeding or transfusion. Discussion: Erythropoietin has been shown to shorten the bleeding time in chronic renal failure patients on hemodialysis by improving the platelet/subendotelial cell interaction and by raising the platelet count. An enhanced platelet aggregation in response to Ristocetin was noted in Erythropoietin treated uremic patients. This effect was correlated with a rise in platelet Serotonin. Erythropoietin also has been found to have a procoagulant effect in uremic patients by decreasing the protein C, protein S, antithrombin III level. These observations offer an explanation for the clinically observed hemostatic effect of Erythropoietin. Conclusion: This and other cases have shown that Erythropoietin is a potent hemostatic factor in anemic patients with diffuse uncontrollable bleeding processes, where large amounts of transfused PRBC can barely keep up with the losses and hemostatic procedures can either not be done or failed. As more experience accumulates Erythropoietin may start a second life as a hemostatic factor. Figure Figure

Using the former results and analyzing the quantitative discrepancies between the experimental data and present theories concerning the projectile fragmentation process we propose an improvement on Goldhaber formula. We want therefore to sustain the idea that the projectile fragmentation process is not as fast as it was supposed to be from the very beginning. The process would be governed by the distribution of nucleon momenta in the projectile shortly after the collision occurred. We used in our analysis protons from the ${}^{4}\mathrm{He}$ fragmentation when colliding ${}^{7}\mathrm{Li}$ target at 4.5 $\mathrm{GeV}/c$ per nucleon incident momentum, protons detected by the 2 m streamer chamber from SKM 200 spectrometer as well as ${}^{40}\mathrm{Ar} {(E}_{\mathrm{inc}}=213\mathrm{ }\mathrm{M}\mathrm{e}\mathrm{V}/\mathrm{n}\mathrm{u}\mathrm{c}\mathrm{l}\mathrm{e}\mathrm{o}\mathrm{n}{)+}^{12}\mathrm{C}$ data used in previous papers. Our purpose was to demonstrate that in order to proceed in analyzing the projectile fragmentation process at intermediate and high energies one has to take into account the dependence of ${\ensuremath{\sigma}}_{0}$ on the apparent temperature of projectile nucleus soon after the collision took place. The generalized Bertsch correction for all light up to medium projectile nuclei and fragments is used and the total number of spatial correlations between identical nucleons (in the same state of spin and isospin) having anticorrelated momenta is evaluated. Considering all those criteria as well as the projectile excitation hypothesis, apparent temperature values reasonably close to the separation energies of the considered fragments per number of fragments were found.