[How I treat... choledocholithiasis by retrograde cholangiopancreatography in a patient with gastric bypass]. / Comment je traite... une lithiase cholédocienne par cholangiographie rétrograde chez un patient avec bypass gastrique.

Performing endoscopic retrograde cholangiopancreatography (ERCP) in bariatric patients with gastric bypass is often challenging. Many techniques have been described. Recently, Endoscopic ultrasound (EUS) - direct transgastric ERCP (EDGE) by using lumen-apposing metal stent (LAMS) has shown efficacy to reach biliary orifice and perform conventional ERCP with good safety profile and low risk of adverse events.

La réalisation d'une cholangiographie rétrograde (CPRE) chez les patients avec un bypass gastrique a longtemps posé des difficultés. Durant les dernières années, quelques techniques ont été développées pour permettre l'extraction de lithiases cholédociennes chez ces patients. Récemment, une nouvelle technique consistant à créer une fistule gastro-gastrique avec la mise en place d'un stent permettant le passage du duodénoscope a montré un excellent taux de réussite, avec un bon profil de sécurité et un faible taux de complications.

[Inflammatory bowel disease and venous thromboembolisms]. / Maladies inflammatoires chroniques de l'intestin et phénomènes thromboemboliques veineux.

Inflammatory Bowel Diseases (IBD) are associated with lots of extra-intestinal complications. Among them, venous and arterial thromboembolisms lead to high rates of morbidity and mortality. They often occur during an IBD flare and seem to be mostly provoked by acquired factors. The prevention mainly resorts to heparin, which is not used enough in spite of its effectiveness. Its indications have recently been upgraded to outpatients. In this review, we describe the epidemiological and ætiological features of these manifestations, as well as their prevention and management. Only venous thromboembolisms are considered.

Les maladies inflammatoires chroniques de l'intestin (MICI) sont associées à de nombreuses complications extra-digestives. Parmi elles, les thromboembolies veineuses et artérielles sont responsables d'une importante morbidité et mortalité. Elles surviennent, majoritairement, durant une phase de poussée de la maladie inflammatoire et semblent principalement médiées par des facteurs acquis. La prévention repose, le plus souvent, sur une prophylaxie héparinique qui reste trop peu utilisée malgré son efficacité. Ses indications ont été récemment élargies aux patients ambulatoires. Nous évoquons, dans cette revue de la littérature, les caractéristiques épidémiologiques et étiologiques de ces manifestations, ainsi que leur prévention et prise en charge. Seuls les phénomènes thromboemboliques veineux sont abordés.

Efficacy of switching to infliximab in patients with Crohn's disease with loss of response to adalimumab.

BACKGROUND AND STUDY AIMS: Anti-TNF monoclonal antibodies are a cornerstone in the treatment of Crohn's disease. Prospective data on switching from the subcutaneous and human adalimumab (ADM) to the intravenous and chimeric infliximab (IFX) are scarce. PATIENTS AND METHODS: In this prospective, observational, multicentre cohort study we included 21 patients with loss of response to ADM despite at least 4 consecutive weekly injections. Clinical response (CDAI drop≥70 points) and remission (CDAI≤150) were assessed after switching from ADM to IFX after 10 weeks, 6 and 12 months. Predictive factors of response/remission, the need for therapy intensification, discontinuation and safety were investigated. RESULTS: Short-term response and remission (10 weeks) were seen in 57% and 48% respectively. Mid- and long-term clinical response and remission were achieved in 40% and 25% after 6 months and in 45% and 20% after 12 months respectively. At 12 months, 81% still were on IFX. IFX therapy intensification was needed in half of the patients at 6 months and three quarter of patients at 12 months. Undetectable ADM trough levels (despite weekly injections) were a predictive factor for short-term response and remission to IFX. About half of the patients with response at week 10 maintained response at 6 and 12 months. CONCLUSIONS: Switching from ADM to IFX can be efficacious in patients with loss of response, in particular in case of undetectable ADM trough levels. The majority of patients however will need IFX therapy intensification during their first year of treatment.

[When diagnostic imaging is misleading: a case of subacute liver failure]. / LE CAS CLINIQUE DU MOIS. Quand l'imagerie nous induit en erreur: à propos d'un cas d'insuffisance hépatique subaiguë.

We report the case of a 67 year old woman presenting with a mixed alteration of liver function tests. Despite normal results of tomodensitometry and positon emission tomography, a liver biopsy was performed due to the development of acute liver failure: it showed a diffuse infiltration of liver sinusoids by a breast adenocarcinoma, unfortunately fatal for the patient. The tumour infiltration was responsible for portal hypertension and hepatic perfusion disorders leading to liver failure.

The transcriptome of the arbuscular mycorrhizal fungus Glomus intraradices (DAOM 197198) reveals functional tradeoffs in an obligate symbiont.

• The arbuscular mycorrhizal symbiosis is arguably the most ecologically important eukaryotic symbiosis, yet it is poorly understood at the molecular level. To provide novel insights into the molecular basis of symbiosis-associated traits, we report the first genome-wide analysis of the transcriptome from Glomus intraradices DAOM 197198. • We generated a set of 25,906 nonredundant virtual transcripts (NRVTs) transcribed in germinated spores, extraradical mycelium and symbiotic roots using Sanger and 454 sequencing. NRVTs were used to construct an oligoarray for investigating gene expression. • We identified transcripts coding for the meiotic recombination machinery, as well as meiosis-specific proteins, suggesting that the lack of a known sexual cycle in G. intraradices is not a result of major deletions of genes essential for sexual reproduction and meiosis. Induced expression of genes encoding membrane transporters and small secreted proteins in intraradical mycelium, together with the lack of expression of hydrolytic enzymes acting on plant cell wall polysaccharides, are all features of G. intraradices that are shared with ectomycorrhizal symbionts and obligate biotrophic pathogens. • Our results illuminate the genetic basis of symbiosis-related traits of the most ancient lineage of plant biotrophs, advancing future research on these agriculturally and ecologically important symbionts.