The use of lanreotide in polycystic kidney disease: a single-centre experience.

The secretion of large volumes of fluid into cysts and changes in the structure and mobility of the cilia of the renal tubular epithelium can lead to nephromegaly. This in turn often causes a deterioration of kidney function and arterial hypertension. In recent clinical studies, somatostatin analogues have demonstrated efficacy in isolated polycystic liver disease and, to a lesser extent, in polycystic kidney disease. Since the publication of these clinical studies, several patients have been referred to us for somatostatin analogue treatment. Here, we report our experience with 6 patients who were treated with lanreotide autogel 120 mg every 4 weeks over 6, 12 or 18 months and were longitudinally followed using CT scans without contrast agents, to evaluate the total bilateral kidney volume. We observed a mean decrease in volume of 4%, with mild to moderate side effects.

[Effects of 50 to 60 Hz and of 20 to 50 kHz magnetic fields on the operation of implanted cardiac pacemakers]. / Effets des champs magnétiques de 50 et 60 Hz et de 20 à 50 kHz sur le fonctionnement des cardiostimulateurs implantés.

UNLABELLED: The effect of 50 Hz and 60 Hz (frequencies of current distribution) and 20 kHz to 50 kHz (frequencies of induction cooktop) magnetic interference on implanted pacemakers have been assessed with the present generation of device technology. Sixty patients implanted in 1998 and 1999 with dual chamber pacemakers from 9 different manufacturers were monitored with telemetry while passing through, and standing between a system of two coils. They generated a 50 Hz or a 60 Hz magnetic field at 50 microT. Then, patients used a cooktop at different power. The recordings were made with the standard setting of "medically correct" sensing parameters chosen for the patients. Then pacemakers were reprogrammed to the unipolar mode, with the highest atrial (A) and ventricular (V) sensitivity that did not induce muscular inhibition while moving. Between each exposure (50 Hz, 60 Hz or 20 kHz to 50 kHz), the pacemaker programmation was controlled. At the end of the tests, pacemakers will be reprogrammed with the standard setting. The medical observer being blind to the existence or not of the magnetic field. No pacemaker was influenced by the vicinity of the magnetic field at medically correct settings. At unipolar high sensitivity, no inhibition nor reprogramming was observed. Transient reversion to interference mode was observed in 6 cases, 3 transient acceleration due to atrial detection of the interference, and one T wave detection by the ventricular lead. All were observed with the 60 Hz, and only 3 with the 50 Hz magnetic field. One device (Biotronik) shifted out of its special program (hysteresis research) during the tests with the induction cooktop, but it maintained its standard program, and the event could not be repeated despite further testing. CONCLUSION: Actual pacemakers do not present any electromagnetic interference with 50 Hz and 60 Hz or induction cooktop frequency working. They are insensitive with medically correct settings. Unusual high sensitivity leads only to noise reversion mode, or transient ventricular tracking.

[Multislice computed tomography in clinical practice]. / La tomodensitométrie multibarrette en pratique clinique.

This paper presents our first experience with multislice computed tomography emphasizing our technical protocols. Between November 1999 and October 2000, 8086 multislice computed tomographic examinations were performed. The choice in collimation, pitch, slice width and increment, multiplanar reconstructions and contrast enhancement were adapted to provide high resolution in the Z axis, high speed acquisitions and low exposure to the patient. Filming and archiving parameters are also detailed. Multislice CT provides excellent 3D imaging with high speed acquisitions and lower doses than previously reported with single slice CT.

Magnetic field desensitizes 5-HT(1B) receptor in brain: pharmacological and functional studies.

It was previously suggested that exposure to magnetic fields (MFs) could generate dysfunction of the CNS. The physiological manifestations described lead us to postulate that these symptoms might be related to a dysfunction of the serotonergic system and particularly of the 5-HT(1B) receptors. Accordingly, MFs could modify the conformation of these receptors altering their functional activities. In rat brain membrane preparations, we showed that the affinity constant of 5-HT for 5-HT(1B) receptors was modified under exposure to MFs since K(d) varied from 4.7+/-0.5 to 12+/-3 nM in control and exposed (2.5 mT) membranes, respectively. This effect was intensity-dependent (the sigmoidal dose-response curve was characterized by an EI(50) of 662+/-69 microT and a maximal increase of 321+/-13% of the control K(d)), reversible, temperature-dependent and specific to the 5-HT(1B) receptors. Similar results have also been obtained with the human 5-HT(1B) receptors. In parallel assays, the functional activity of 5-HT(1B) receptors was investigated. The capacity of a 5-HT(1B) agonist to inhibit the cAMP production was reduced by 37% (53.7+/-3.5% to 33.7+/-4.1%) following exposure to MFs and the cellular activity of the receptors (inhibition of the synaptosomal release of 5-HT) also was markedly reduced (66.5+/-3.2% to 28.5+/-4.2%). These results clearly show that in in vitro assays, MF specifically interacts with 5-HT(1B) receptors, inducing structural changes of the protein that result in a functional desensitization of the receptors. Thus, in vivo, exposure to MFs may lead to physiological changes, particularly in the field of mood disorders where the 5-HT system is strongly involved.

[Spiral computed tomography of the renal arteries]. / CT spiralé des artères reénales.

With the recent advent of spiral or helical CT, the ability to acquire large volume of imaging has become possible. Fast scanning of both kidneys, the aorta and the renal vessels can be accomplished during one breathhold. Early reports of CT angiography in the evaluation of renal artery stenosis indicated a sensitivity of 92% utilizing the MIP projection method and 59% utilizing the shaded surface display method. Specificity for both method was approximately 82%. More recent articles reports for hemodynamically relevant renal artery stenosis a sensitivity/sensibility of 96/99%. The introduction of a new multidetector CT technology will probably increase those results and the indication of CT angiography.

[A unusual cause of acute pancreatitis: obstruction of the afferent loop after gastrectomy according to Bilroth II. Apropos of a case and review of the literature]. / Une cause rare de pancréatite aiguë: l'occlusion de l'anse afférente après gastrectomie de type Bilroth II. A propos d'un cas et revue de la littérature.

We report a case of afferent loop obstruction after Bilroth II gastrojejunostomy presenting as acute pancreatitis. This form of presentation is extremely rare; to our knowledge, only 19 cases of acute pancreatitis secondary to afferent loop occlusion in patients with prior Bilroth II gastrojejunostomy have been previously reported in the literature. Obstruction can be caused by kinking, internal herniation, adhesive bands or recurrence of gastric ulcer or cancer. Because conservative management is invariably fatal, diagnosis and surgical treatment must be performed as soon as possible. CT Scan is now considered to be the imaging method of choice for the diagnosis. A case report and review of the literature are presented.

[Agenesis of the right lobe of the liver. Apropos of a case]. / Agénésie du lobe droit du foie. A propos d'un cas.

The authors report a case of agenesis of the right lobe of the liver, only thirty two cases of which have been reported in the literature since 1870. The differential diagnosis consists of advanced cirrhosis, portal hypertension, neoplastic infiltration of the porta hepatis, gallstones or surgical resection. Agenesis is due to arrest of hepatic development during foetal life. It is generally symptomatic, but may sometimes present in the form of biliary type pain in the right hypochondrium or portal hypertension and may be associated with other anomalies (retrohepatic gallbladder, common bile duct cyst, aplasia of part of the diaphragm, intrathoracic kidney).

Acutely symptomatic benign mediastinal cysts.

Usually, cystic mediastinal masses are considered as benign. However, the size of the cyst is of importance, chiefly in a closed space such as the superior mediastinum. Rarely a dramatic symptomatology may develop though this was the case in the two patients we describe, who were admitted in the department. In the first case (a parathyroid cyst), the symptoms were due to a thrombosis of the left innominate vein, and in the second case (a thyroid cyst), the severity was dominated by a dramatic compression of the trachea and the vessels. The contribution of computed tomography is nowadays undisputed. It enables the diagnosis of the cystic nature before surgery. The diagnosis can easily be confirmed by percutaneous drainage.