Management of adhesive small bowel obstruction: the results of a large retrospective study.

BACKGROUND: Postoperative adhesive small bowel obstruction (SBO) is a frequent cause of hospital admission in a surgical department. Emergency surgery is needed in a majority of patients with bowel ischemia or peritonitis; most adhesive SBO can be managed nonoperatively. Many studies have investigated benefits of using oral water-soluble contrast to manage adhesive SBO. Treatment recommendations are still controversial. METHODS: We conducted an observational retrospective monocentric study to test our protocol of management of SBO using Gastrografin®, enrolling 661 patients from January 2008 to December 2021. An emergency surgery was performed in patients with abdominal tenderness, peritonitis, hemodynamic instability, major acute abdominal pain despite gastric decompression, or CT scan findings of small bowel ischemia. Nonoperative management was proposed to patients who did not need emergency surgery. A gastric decompression with a nasogastric tube was immediately performed in the emergency room for four hours, then the nasogastric tube was clamped and 100 ml of nondiluted oral Gastrografin® was administered. The nasogastric tube remained clamped for eight hours and an abdominal plain radiograph was taken after that period. Emergency surgery was then performed in patients who had persistent abdominal pain, onset of abdominal tenderness or vomiting during the clamping test, or if the abdominal plain radiograph did not show contrast product in the colon or the rectum. In other cases, the nasogastric tube was removed and a progressive refeeding was introduced, starting with liquid diet. RESULTS: Seventy-eight percent of patients with SBO were managed nonoperatively, including 183 (36.0%) who finally required surgery. Delayed surgery showed a complete small bowel obstruction in all patients who failed the conservative treatment, and a small bowel resection was necessary in 19 patients (10.0%): among them, only 5 had intestinal ischemia. CONCLUSIONS: Our protocol is safe, and it is a valuable strategy in order to accelerate the decision-making process for management of adhesive SBO, with a percentage of risk of late small bowel resection for ischemia esteemed at 0.9%.

Link Between Anhedonia and Depression During Early Alcohol Abstinence: Gender Matters.

AIMS: The aim of the present study was to evaluate the relation between anhedonia and depression in alcohol use disorders (AUD) during detoxification: Is trait anhedonia measured at the beginning of detoxification predictive of depressive symptoms observed at the end? Does state anhedonia recover during detoxification as depression does? Gender differences that have been previously observed for depression in AUD were also explored. METHODS: 81 AUD inpatients were tested at T1 (day 1) and T2 (day 14-18) of withdrawal with the trait Physical Anhedonia Scale, the state anhedonia Snaith-Hamilton Pleasure Scale, the Beck depression inventory and the Spielberger State Anxiety Inventory and compared to 34 control participants, matched for age and gender. RESULTS: AUD patients scored significantly higher than controls on depression, anxiety and state and trait anhedonia when they just entered the detoxification unit. Depression, anxiety and state anhedonia decreased between T1 and T2 in AUD patients. In women, state anhedonia at T1 was predictive of depressive symptoms at T2 over and above anxiety and depression at T1. CONCLUSION: In AUD, state anhedonia recovers during detoxification, concurrently to other affective-related symptoms. However, in women, trait anhedonia predicts the level of depression at the end of detoxification, above and beyond anxiety. This finding stresses the importance of addressing anhedonia in the treatment of AUD and emphasizes the need for targeted interventions within clinical settings in this gender. Clinical consequences are discussed.

Growing teratoma syndrome of the ovary presenting with liver metastasis: report of a case.

Growing teratoma syndrome (GTS) is a rare condition among patients with non-seminomatous germ cell tumors who present with enlarging metastatic masses during appropriate systemic chemotherapy in the context of normalized serum markers. This is an infrequent event in the progression of testicular tumors, and is even less common in the case of ovarian germ cell tumors. The pathogenesis of GTS is not completely understood and diagnosis can only be made with certainty after complete pathologic examination. Although histologically benign, GTS may present an enveloping growth with aggressive local expansion, which can be related to substantial morbidity and mortality. Surgery is the only recommended treatment and early recognition of this syndrome is essential as it offers hope for curative resection and avoids the use of ineffective chemotherapy. The authors present a brief review of the literature, along with the case report of a 37-year-old woman presenting GTS with liver involvement who was successfully treated by debulking surgery followed by major liver resection. This report demonstrates that complete surgical resection results in excellent disease control. More importantly, it highlights that clinicians need to be aware of the possible development of GTS when monitoring their patients with non-seminomatous germ cell tumors. These patients require coordinated care between oncologist, gynecologists, and general surgeons to obtain the best possible outcomes.

The future of cell therapies and brain repair: Parkinson's disease leads the way.

During the past 40 years brain tissue grafting techniques have been used both to study fundamental neurobiological questions and to treat neurological diseases. Motor symptoms of Parkinson's disease are largely due to degeneration of midbrain dopamine neurones. Because the nigrostriatal pathology is relatively focused anatomically, Parkinson's disease is considered the ideal candidate for brain repair by neural grafting and dopamine neurone transplantation for it has led the way in the neural transplantation research field. In this mini-review, we briefly highlight four important areas of development. First, we describe marked functional benefits up to 18 years after transplantation surgery in patients with Parkinson's disease. This is proof-of-principle that, using optimal techniques and patient selection, grafted dopamine neurones can work in humans and the duration of the benefit exceeds placebo effects associated with surgery. Second, we describe that eventually protein aggregates containing α-synuclein, identical to Lewy bodies, develop inside foetal dopamine neurones transplanted to patients with Parkinson's disease. This gives clues about pathogenetic mechanisms operating in Parkinson's disease, and also raises the question whether neural graft function will eventually decline as the result of the disease process. Third, we describe new emerging sources of transplantable dopamine neurones derived from pluripotent stem cells or reprogrammed adult somatic cells. Fourth, we highlight an important European Union-funded multicentre clinical trial involving transplantation of foetal dopamine neurones in Parkinson's disease. We describe the design of this ongoing trial and how it can impact on the overall future of cell therapy in Parkinson's disease.

A questionnaire survey for the assessment of wild-domestic pig interactions in a context oedema disease outbreaks among wild boars (Sus scrofa) in South-Eastern France.

Pig outdoor farming is gaining popularity and commercial success in the European Union, and its expansion, together with an increasing wild boar population, facilitates interactions between domestic and wild suids. In the Southern French Department of Ardèche, several episodes of mass mortalities due to infection with an enteropathogenic strain of Escherichia coli causing oedema disease (OD) were reported in wild boar populations between 2013 and 2016. In order to investigate a potential link between those events and the frequency of interactions between wild boar and domestic pig, we analyzed regional vegetation and hunting bag data and implemented a semi-structured questionnaire survey among a total of 30 outdoor pig farmers and 30 hunters distributed inside and outside the identified area of OD emergence. One third of interviewed farmers (11/30) had experienced intrusions of wild boars in domestic pig premises during the previous year. Similarly, 23% of interviewed hunters reported interactions between wild boar and feral free-ranging pigs in recent years, and 60% reported the observation of free-ranging pigs with a phenotypic feature of Vietnamese pot-bellied pigs (55%). Our analysis identified that in the OD emergence area, several factors could facilitate the transmission of pathogens between wild and domestic suids including a predominance of forested vegetation, a higher estimated wild boar density, weaker levels of farm biosecurity, a higher level of reported wild boar intrusions in pig farms and several reports of feral pot-bellied pig presence. Although our sample was limited, our study suggested a widespread occurrence of situations facilitating the transmission of pathogens between wild and domestic suids. Similar studies in other rural regions in the European Union are recommended, in order to promote preparedness for the emergence and circulation of shared swine pathogens.

Overview of VEGA Venus Balloon in Situ Meteorological Measurements.

The VEGA balloons made in situ measurements of pressure, temperature, vertical wind velocity, ambient light, frequency of lightning, and cloud particle backscatter. Both balloons encountered highly variable atmospheric conditions, with periods of intense vertical winds occurring sporadically throughout their flights. Downward winds as large as 3.5 meters per second occasionally forced the balloons to descend as much as 2.5 kilometers below their equilibrium float altitudes. Large variations, in pressure, temperature, ambient light level, and cloud particle backscatter (VEGA-1 only) correlated well during these excursions, indicating that these properties were strong functions of altitude in those parts of the middle cloud layer sampled by the balloons.

Determination of Venus Winds by Ground-Based Radio Tracking of the VEGA Balloons.

A global array of 20 radio observatories was used to measure the three-dimensional position and velocity of the two meteorological balloons that were injected into the equatorial region of the Venus atmosphere near Venus midnight by the VEGA spacecraft on 11 and 15 June 1985. Initial analysis of only radial velocities indicates that each balloon was blown westward about 11,500 kilometers (8,000 kilometers on the night side) by zonal winds with a mean speed of about 70 meters per second. Excursions of the data from a model of constant zonal velocity were generally less than 3 meters per second; however, a much larger variation was evident near the end of the flight of the second balloon. Consistent systematic trends in the residuals for both balloons indicate the possibility of a solar-fixed atmospheric feature. Rapid variations in balloon velocity were often detected within a single transmission (330 seconds); however, they may represent not only atmospheric motions but also self-induced aerodynamic motions of the balloon.

The Mobile Analyzer of Radioactive Gases OuTflows (MARGOT): A promising environmental xenon radionuclides detection system.

An ultra-compact and unshielded spectrometer for analysis of atmospheric xenon radionuclides has been developed: the MARGOT system. This system works at ambient temperature and high pressure, and has a 54.3 cm3 inner active volume. Atmospheric xenon radionuclide activities are determined with the electron-photon coincidence technique using both NaI(Tl) detectors and large pixellized Si-PIN detectors. The MARGOT system integrates an enhanced version of the PIPSBox™, Geant4 simulation and first calibration results are discussed.

Introducing the MARGOT prototype: An ultra-compact and mobile gas detection system for nuclear explosion monitoring.

An ultra-compact and unshielded spectrometer for analysis of atmospheric radioxenons has been developed. This system works at ambient temperature and has a 58 cm3 inner active volume. Atmospheric radioxenons activities are determined with electron/photon coincidence technique using both NaI(Tl) detector and large pixellized Si-PIN detector. The performances of the detection system without shielding in terms of Minimal Detectable Activities are below 65 mBq for a 12 h acquisition, for all radioxenons of interest. An enhanced version of the prototype presented here is already under development: the Mobile Analyzer for Radioactive Gases OuTflows (MARGOT) system.

[Colonic lipoma: case report and literature review]. / Lipome colique : cas clinique et revue de la littérature.

Colonic lipoma is a rare benign tumor infrequently met in clinical practice. We report a case of symptomatic lipoma of the ascending colon in a 61-year-old woman. Diagnosis was suspected on CT scan. Colotomy with lipectomy was performed. The diagnosis was confirmed by histological examination. Reviewing the literature and combining with our experience, we discuss the clinical features, diagnosis and treatment of this uncommon disease.

Low-level laboratory measurement of xenon radionuclides: Electron-photon versus photon measurements.

Radioactive xenon (mainly 131mXe, 133Xe, 133mXe and 135Xe) are tracked as markers of nuclear weapons testing. The CEA has developed the PIPSBox, a measurement cell able to detect electrons emitted by xenon nuclides. Combined with an ultra-low background γ spectrometer, electron detection capacities allow reaching minimum detectable activities (MDA) for a 3-day long measurement of about 0.5mBq for the four xenon radionuclides. Compared to a classical measurement cell, MDAs are improved by a factor of 2-4.

SPALAX NG: A breakthrough in radioxenon field measurement.

Lessons-learned from 10 years of noble gas stations operation and dedicated R&D allowed the design of a New Generation of station. In order to produce 60m3 air equivalent Xenon samples every 8h, it implements: (i) larger sampler unit for Xenon extraction (2 compressors and 8 nitrogen membranes), (ii) new noble gas adsorbent (Ag@ZSM5), (iii) hardened components and (iv) new high resolution coincidence low background spectrometer (HPGe/PIPSBox). Station expected radioxenon sensitivity is lower than 0.3mBq/m3.

EEG Dynamics and Neural Generators in Implicit Navigational Image Processing in Adults with ADHD.

In contrast to childhood ADHD that is characterized by inattention, impulsivity and hyperactivity, most adults with ADHD predominantly exhibit inattention. We used a new oddball paradigm using implicit navigational images and analyzed EEG dynamics with swLORETA inverse modeling of the evoked potential generators to study cortical processing in adults with ADHD and age-matched controls. In passive observation, we demonstrated that P350 amplitude, alpha-beta oscillation event-related synchronization (ERS) anticipation, and beta event-related desynchronization (ERD) were significantly smaller in ADHD. In the active condition, P100 duration was reduced and N140 amplitude increased for both deviant and frequent conditions in the ADHD. Alpha ERS and delta-theta ERS were reduced in the ADHD in the deviant condition. The left somatosensory area (BA2) and the right parietal lobe (BA31, BA40) contributed more to the P100 generators in the control than in the ADHD group, while the left frontal lobe (BA10) contributed more to the P100 generators in the ADHD. The left inferior parietal lobe (BA40) contributed more to the N140 generators in the control than the ADHD group while the right posterior cingulate (BA30) contributed more to the N140 generators in the ADHD. These findings reinforce the notion that earlier cortical stages of visual processing are compromised in adult ADHD by inducing the emergence of different even-related potential generators and EEG dynamics in ADHD. Considering that classical approaches for ADHD diagnosis are based on qualitative clinical investigation possibly biased by subjectivity, EEG analysis is another objective tool that might contribute to diagnosis, future neurofeedback or brain stimulation therapies.

Quantifying in situ phenotypic variability in the hydraulic properties of four tree species across their distribution range in Europe.

Many studies have reported that hydraulic properties vary considerably between tree species, but little is known about their intraspecific variation and, therefore, their capacity to adapt to a warmer and drier climate. Here, we quantify phenotypic divergence and clinal variation for embolism resistance, hydraulic conductivity and branch growth, in four tree species, two angiosperms (Betula pendula, Populus tremula) and two conifers (Picea abies, Pinus sylvestris), across their latitudinal distribution in Europe. Growth and hydraulic efficiency varied widely within species and between populations. The variability of embolism resistance was in general weaker than that of growth and hydraulic efficiency, and very low for all species but Populus tremula. In addition, no and weak support for a safety vs. efficiency trade-off was observed for the angiosperm and conifer species, respectively. The limited variability of embolism resistance observed here for all species except Populus tremula, suggests that forest populations will unlikely be able to adapt hydraulically to drier conditions through the evolution of embolism resistance.

[Laparoscopic partial splenectomy using the Harmonic Scalpel. Two case reports]. / Splénectomie partielle par laparoscopie et ultracision. A propos de deux cas.

For the extirpation of a benign splenic cyst, partial splenectomy is an appropriate approach, since there is significant long-term morbidity following total splenectomy. We report two cases of laparoscopic partial splenectomy for benign splenic cyst. The use of the harmonic scalpel along with segmental ligation of the splenic pedicle allowed the completion of these interventions with minimal blood loss.

Ground surface ultralow background spectrometer: Active shielding improvements and coincidence measurements for the Gamma3 spectrometer.

The ultralow background versatile spectrometer GAMMA3 has been optimized with the following shielding improvements: (i) optimized nitrogen injection flux of 300Lh-1, and (ii) cosmic veto configuration with 9 scintillating plates. These improvements allow a reduction of 39% of the normalized integral background count rate down to 2.7±0.2min-1kgGe-1 (40-2500keV energy range). Minimum Detectable Activities when performing direct γ-ray spectrometry or γ-γ coincidence spectrometry are compared.

Activity measurement of a 176Lu sample using coincidence peaks and Monte Carlo simulations.

We present the results of the activity measurement of a sample of the rare isotope 176Lu, obtained by gamma-ray spectrometry through the use of 22 peaks in an energy spectrum acquired with a 300 cc well-type HPGe detector located in the Modane underground facility below the French Alps. Of the above peaks, 17 are coincidence peaks between two or three gamma-rays or X-rays. True coincidence summing corrections were made using our Coincal code. Monte Carlo simulations were carried out for calibration purposes.

Low-level activity measurement of 131Xem, 133Xem, 135Xe and 133Xe in atmospheric air samples using high-resolution dual X-gamma spectrometry.

High-resolution dual X and gamma spectrometry has been optimized to improve the sensitivity in analyzing radioxenon from environmental samples, especially for the metastable isotopes (131Xem and 133Xem). The full-energy peak (FEP) efficiency curve in the 20-700 keV range has been established with a global uncertainty better than +/-3% using a Monte Carlo simulation. The minimum detectable activity concentrations (MDC) achievable at the laboratory for 131Xem, 133Xem, 133Xe and 135Xe are presented and the influence of 133Xe activity on the metastable radioxenon MDCs is evaluated.

Certified reference material for radionuclides in fish flesh sample IAEA-414 (mixed fish from the Irish Sea and North Sea).

A certified reference material (CRM) for radionuclides in fish sample IAEA-414 (mixed fish from the Irish Sea and North Seas) is described and the results of the certification process are presented. Nine radionuclides (40K, 137Cs, 232Th, 234U, 235U, 238U, 238Pu, 239+240Pu and 241Am) were certified for this material. Information on massic activities with 95% confidence intervals is given for six other radionuclides (90Sr, 210Pb(210Po), 226Ra, 239Pu, 240Pu 241Pu). Less frequently reported radionuclides (99Tc, 129I, 228Th, 230Th and 237Np) and information on some activity and mass ratios are also included. The CRM can be used for quality assurance/quality control of the analysis of radionuclides in fish sample, for the development and validation of analytical methods and for training purposes. The material is available from IAEA, Vienna, in 100 g units.

[Minimally invasive esophagectomy: prospective evaluation of laparoscopic gastric mobilization]. / Oesophagectomie mini-invasive: évaluation prospective de la gastrolyse coelioscopique.

OBJECTIVE: Esophagectomy carries high morbidity, mainly due to respiratory complications. In digestive surgery, postoperative outcome is generally improved by minimally invasive surgery. A prospective study was conducted to evaluate feasibility and postoperative outcome of minimally invasive esophagectomy (MIE). METHODS: From July 2001 to June 2004, 20 patients underwent esophagectomy with laparoscopic gastric mobilization (LGM) for squamous cell carcinoma (N=11), adenocarcinoma (N=7), Barrett's esophagus with high-grade dysplasia (N=1), and long peptic stricture (N=1). Tumours (N=19) were located on the cardia (N=5), on the lower third of the oesophagus (N=10), on the median third (N=3), and on the upper third (N=1). Following LGM, transthoracic (N=19) or transhiatal (N=1) oesophagectomy was performed. RESULTS: Complete LGM was achieved in all cases. Mean operative time for LGM was 197+/-48 minutes. In the 19 patients operated for tumours, 18 underwent R0 resection. Eleven patients (55%) developed postoperative complications, mainly (30%) respiratory. Intrathoracic anastomotic leakage occurred in 2 patients, with favourable outcome. Pylorospasm (N=1) was the only intraabdominal complication. One patient died (5%). CONCLUSION: Esophagectomy with LGM is feasible with few specific complications. However, no decrease in morbidity could be observed with this technique. Further studies are required to evaluate if thoracoscopy could improve the postoperative course after LGM and to validate oncologic safety of MIE.