Feasibility and outcomes of percutaneous thermal ablation of hepatocellular carcinoma in a transplanted allograft.

PURPOSE: To examine the safety, feasibility, and oncologic control following percutaneous image-guided thermal ablation of hepatocellular carcinoma (HCC) in a transplanted allograft. MATERIALS AND METHODS: Retrospective review was performed to identify patients who underwent liver transplantation for HCC and subsequently underwent percutaneous hepatic thermal ablation for recurrent HCC within the allograft between January 1st, 2000-September 1st, 2016. Eleven patients with hepatic allograft HCC underwent twelve percutaneous thermal ablation procedures to treat 16 lesions. Patient, procedural characteristics, and local oncologic efficacy were reviewed. Complications were characterized via the Common Terminology for Clinically Adverse Events nomenclature [CTCAE] v4.03). RESULTS: Eleven transplant recipients underwent treatment of 16 HCC tumors in their allografts during 12 ablation sessions. Mean follow-up time was 25 months (range 2-96 months). Local oncologic control was achieved in 10 of 11 tumors (91%) with imaging follow-up. One patient (8%) with Roux-en-Y biliary reconstruction developed a major complication with hepatic abscess. CONCLUSION: Thermal ablation of recurrent HCC in transplanted allografts can be accomplished safely with acceptable rates of local control for patients with duct-to-duct biliary reconstruction. Due to the high number of patients deemed surgically unresectable, the morbidity of surgical resection, the side effects of targeted therapies, and significant mortality associated with recurrences in the transplanted allograft, patients may benefit from percutaneous thermal ablative treatments. Further study is needed to assess the role of thermal ablation in allograft HCC recurrences as primary therapy or in a multimodality approach with emerging systemic therapies.

A Single-Institution Experience in Percutaneous Image-Guided Biopsy of Malignant Pleural Mesothelioma.

PURPOSE: Mesothelioma has been considered a difficult pathologic diagnosis to achieve via image-guided core needle biopsy. The purpose of this study was to assess the diagnostic sensitivity of percutaneous image-guided biopsy for diagnosis of pleural mesothelioma. MATERIALS AND METHODS: Retrospective review was performed to identify patients with a confirmed diagnosis of pleural mesothelioma and who underwent image-guided needle biopsy between January 1, 2002, and January 1, 2016. Thirty-two patients with pleural mesothelioma were identified and included for analysis in 33 image-guided biopsy procedures. Patient, procedural, and pathologic characteristics were recorded. Complications were characterized via standardized nomenclature [Common Terminology for Clinically Adverse Events (CTCAE)]. RESULTS: Percutaneous image-guided biopsy was associated with an overall sensitivity of 81%. No CTCAE clinically significant complications were observed. No image-guided procedures were complicated by pneumothorax or necessitated chest tube placement. No patients had tumor seeding of the biopsy tract. CONCLUSION: Percutaneous image-guided biopsy can achieve high sensitivity for pathologic diagnosis of pleural mesothelioma with a low procedural complication rate, potentially obviating need for surgical biopsy.

Evaluation of infectious complications following percutaneous liver ablation in patients with bilioenteric anastomoses.

PURPOSE: Prior bilioenteric anastomosis (BEA) has been associated with elevated risk of abscess formation after thermal ablation of hepatic tumors. We assessed the incidence of hepatic abscess after thermal ablation in a BEA cohort treated with extended antibiotic regimens following ablation. MATERIALS AND METHODS: Retrospective review was performed to identify patients with BEA who underwent percutaneous hepatic thermal ablation between January 1, 2003-September 1, 2016. Fifteen patients with BEA underwent 18 percutaneous thermal ablation procedures. Patient and procedural characteristics were reviewed, as well as the antibiotic regiment utilized post ablation. Complications were characterized via standardized nomenclature [Common Terminology for Clinically Adverse Events (CTCAE) v4.03]. RESULTS: Fifteen patients with BEA underwent treatment of 49 liver lesions during 18 ablation sessions. Mean follow-up in these patients was 39 months (range 3-138 months). Two patients (11%) developed hepatic abscesses, both of which occurred within 45 days of the ablation procedure while the patients were still on extended prophylactic antibiotic therapy. No additional CTCAE clinically significant complications were observed. CONCLUSION: Thermal ablation of hepatic tumors can be accomplished safely in patients with BEA. Long-term post-procedural antibiotics may mitigate the risk of hepatic abscess formation. Due to the high number of patients who are deemed surgically unresectable, patients with BEA may have limited alternate treatment modalities and percutaneous hepatic thermal ablative treatments warrant consideration.

[Childhood obesity and early food experiences]. / L'obésité infantile et les expériences alimentaires précoces.

Authors insist on the role of early food experiences in the constitution of young child obesity. Obesity often appears precociously within the first two years of life. In many cases, it results from inappropriate feeding behaviors, behaviors of overfeeding deteriorating the mechanisms of energy regulation of the child. The prevention requires a work on the early baby/environment interactions.

[Specificity of function of a psychiatric unit in a general hospital (author's transl)]. / Spécificité de fonction d'une unité psychiatrique d'hôpital général.

The recent creation of a psychiatric unit in the hospital Broussais gives rise to reflection on what, according to the authors, could constitute the originality of such a treatment unit. It should not be used to satisfy all the requests for psychiatric care within the hospital itself, nor act in parallel with the specialized psychiatric departments established as such in psychiatric or general hospitals. The presence, however, of a group of psychiatrists working as a team in a general hospital, and having several beds for their own autonomous use, should enable the first approach to be made, under the best conditions, to pathological disorders produced by psychological disturbances which are not immediately recognized by the patient: somatic manifestations of anxiety or depression, psychosomatic disorders, behavioural problems such as alcoholism, or even suicide attempts. This clinical function cannot be dissociated from the daily therapeutic approach of the health team or from the conception of medical psychology training based on the true needs of general practitioners. It is also the starting point for a close collaboration with physicians and basic scientists in the field of medical research.

[Current concepts of hospitalization in pediatric psychiatry]. / Conceptions actuelles de l'hospitalisation en pédopsychiatrie.

Although it remains valuable for evaluating the patient and planning pharmacotherapy, hospitalization in a psychiatric department is no longer restricted to these purposes. Hospitalization enables separation of the child or adolescent from his usual environment during periods of acute conflict. It is aimed at modifying and overcoming the conflicts between family members which are underlying in the child's or parent's request for support. Hospitalization can become an essential part of the child's treatment if it is carefully planned and harmonized with the other curative and preventive methods.

[Adolescence and family therapy]. / Adolescence et thérapie familiale.

The authors have tried to describe the different levels of understanding or "rationales" of the adolescence crisis: individual rationale of the adolescent going through a period of psychic disruption, individual rationale of the parents who must face the "parental crisis", and rationale of the family system whose relational organization must be changed. In adolescents, symptoms often occur as a result of the confrontation of these different, contradictory rationales. The point at issue is to find out whether the main obstacles to change are at the individual level or in the family system. The authors give some guidelines for selecting the most appropriate therapy and for determining the value of familial therapy in adolescence.

Facial responsiveness to odours in normal and pervasively developmentally disordered children.

The facial responsiveness of 10 mutic children with pervasive developmental disorder (PDD) and 10 normal (N) children matched for sex and chronological age were covertly videotaped while presented with a set of odours contrasted in hedonic valence. Hedonic ratings of the stimuli were obtained both from the group of N subjects and a panel of adults. Two methods were used to measure facial responses in the same subjects. The first method consisted in an analysis of facial movements with the Facial Action Coding System. Results show that PDD and N subjects displayed distinct action units in response to unpleasant odours. PDD subjects typically displayed muscular actions indexing negative experience, while N subjects showed more smiles. With the second method, odour-elicited facial behaviour was rated by a panel of observers, who were asked to judge whether the subjects were exposed a pleasant, neutral or unpleasant smell. The facial responses to unpleasant odours were classified more accurately in PDD than in N subjects. These findings suggest a functional ability to sense the hedonics attached to odours, but a deficit of socialization of hedonic facial displays in developmentally disordered subjects.

[Anorexia nervosa in boys: a fact]. / L'anorexie mentale chez le garçon: une réalité.

Adolescent anorexia nervosa is characterised by its relationship to pubertal conflicts. The authors report two cases showing that this syndrome is not confined to girls. In boys, it usually results in delayed puberty. The diagnostic criteria are detailed. The concept of pathological process, causing stereotyped syndrome, is distinguished from the notion of psychological organisation which gives rise to wide individual variation. The pathological outcome is considered in the context of pubertal dynamics, marked by the reemergence of the oedipus conflict and the rearrangement of the patients identificatory systems, and also in the continuity of the particular libidinal behaviour, characterised by important points of fixation of the oral pulsion. The role of the family group in the initiation and maintenance of the anorectic behaviour is also discussed.

The affinities of procolipase and colipase for interfaces are regulated by lipids.

It has been suggested that at physiological pH, the trypsin-catalyzed activation of the lipase cofactor, procolipase, to colipase has no consequence for intestinal lipolysis and serves primarily to release the N-terminal pentapeptide, enterostatin, a satiety factor (Larsson, A., and C. Erlanson-Albertsson 1991. The effect of pancreatic procolipase and colipase on pancreatic lipase activation. Biochim. Biophys. Acta 1083:283-288). This hypothesis was tested by measuring the adsorption of [14C]colipase to monolayers of 1-stearoyl-2-oleoyl-sn-3-glycerophosphocholine and 13, 16-cis, cis-docosadienoic acid in the presence and absence of procolipase. With saturating [14C]colipase in the subphase, the surface excess of [14C]colipase is 29% higher than that of procolipase, indicating that colipase packs more tightly in the interface. With [14C]colipase-procolipase mixtures, the proteins compete equally for occupancy of the argon-buffer interface. However, if a monolayer of either or both lipids is present, [14C]colipase dominates the adsorption process, even if bile salt is present in the subphase. If [14C]colipase and procolipase are premixed for > 12 h at pH approximately 8, this dominance is partial. If they are not premixed, procolipase is essentially excluded from the interface, even if procolipase is added before [14C]colipase. These results suggest that the tryptic cleavage of the N-terminal pentapeptide of procolipase may be of physiological consequence in the intestine.

Pyrimethamine-sulfadoxine treatment of congenital toxoplasmosis: follow-up of 78 cases between 1980 and 1997. Reims Toxoplasmosis Group.

UNLABELLED: The purpose of this study was to determine the clinical and immunological outcome of 78 children with congenital toxoplasmosis treated with the pyrimethamine-sulfadoxine combination between 1980 and 1997. METHODS: Children were divided into 3 groups according to the initial duration of treatment (always including folinic acid, 5 mg/week by mouth), as follows: pyrimethamine (1.25 mg/kg every 15 d) + sulfadoxine (25 mg/kg every 15 d) for 12 months (Group 1, 47 children), or for 24 months, with or without prenatal therapy (respectively, Group 2, 19 children, and Group 3, 12 children). RESULTS: Chorioretinitis occurred in 23% of these 78 children. Four children had unilateral blindness, 1 had mild epileptic fits and 1 had psychomotor retardation. The lowest rate of sequelae were in Groups 2 and 3. Immunological rebounds, generally without clinical repercussions, occurred frequently (90% of cases on average) during, or more often after therapy, regardless of the treatment duration. Treatment was always well tolerated. CONCLUSIONS: Our current treatment strategy for congenital toxoplasmosis consists of a 24-month course of pyrimethamine-sulfadoxine (Fansidar) combined with folinic acid (Lederfoline). If the prenatal diagnosis is positive, we also prescribe this treatment to the mother until delivery. This combination offers satisfactory compliance, adequate serum concentrations, and good preventive efficacy.