Long-term outcome of patients treated with double balloon enteroscopy for small bowel vascular lesions.

OBJECTIVES: Early rebleeding rate after endoscopic therapy with double balloon enteroscopy (DBE) of hemorrhagic small bowel vascular lesions (SBVL) varies between 10 and 50%. In recent reports, long-term follow-up of patients have been described but rebleeding risk factors are still not well established. The aim of the current study was to identify long-term treatment success rate and rebleeding risk factors after DBE therapy in a large cohort. METHODS: We conducted a single-center, retrospective cohort study in a large French tertiary-referral center between January 2004 and December 2007. RESULTS: Among 261 patients presenting with obscure gastrointestinal bleeding (OGIB), SBVL was present in 133 patients and was treated successfully in 129 (97%) using mainly argon plasma coagulation. Ninety-eight patients were followed up for a mean period of 22.6±13.9 months (range 1-52). Rebleeding rate was 46% (45/98 patients) at 36 months. On multivariate analysis, the total number of observed lesions (hazard ratio (HR): 1.15, 95% confidence interval (CI): 1.06-1.25, P=0.001) and the presence of a valvular and/or arrhythmic cardiac disease (HR: 2.50, 95% CI: 1.29-4.87, P=0.007) were significantly associated with the risk of rebleeding. Complication rate of therapeutic DBE was 2.3% with no mortality. CONCLUSIONS: Endoscopic therapy using DBE for SBVL in patients with recurrent OGIB allows a long-term remission in more than half of the patients. Independent rebleeding risk factors after a first endoscopic therapy are an increased number of SBVL and an associated valvular/arrhythmic heart disease.

Kinetics of SARS-CoV-2-Neutralising Antibodies of Residents of Long-Term Care Facilities.

INTRODUCTION: Elderly residents of nursing homes (NHs) and long-term care units (LTCUs) have been shown to have a high risk of mortality and morbidity in cases of SARS-CoV-2 infection. The objective of this study was to examine the kinetics of neutralizing antibodies (NAbs) directed against the SARS-CoV-2 virus in residents of the NH and LTCU units of our University Hospital who were identified with positive serology after the first epidemic outbreak. MATERIALS AND METHODS: The participants included were sampled every three months for qualitative serological testing, as well as quantitative testing by neutralization tests using retroviral particles containing the S glycoprotein of SARS-CoV-2. Vaccination using the Comirnaty (Pfizer BNT162b2) vaccine begun before the last serological follow-up. RESULTS: The median NAb titer in June 2020 was 80 [40; 60] versus 40 [40; 160] three months later, showing a statistically significant decline (p < 0.007), but remained stable between the three- and six-month timepoints (p = 0.867). By nine months after vaccination, we observed a significant difference between vaccinated residents known to have positive serology before vaccination (SERO+, Vacc+) and those vaccinated without having previously shown COVID-19 seroconversion (SERO-, Vacc+), the latter group showing similar titers to the SERO+, Vacc- participants (p=0.166). The median antibody titer in SERO+, Vacc+ patients increased 15-fold following vaccination. DISCUSSION: Humoral immunity against SARS-CoV-2 appears to be persistent in elderly institutionalized patients, with a good post-vaccination response by residents who had already shown seroconversion but a notably diminished response by those who were seronegative before vaccination. To evaluate immunity in its entirety and elaborate a sound vaccination strategy, the cellular immune response via T cells specific to SARS-CoV-2 merits analysis, as this response is susceptible to being affected by immunosenescence.

Probing quark-gluon interactions with transverse polarized scattering.

We have extracted QCD matrix elements from our data on doubly polarized inelastic scattering of electrons on nuclei. We find the higher twist matrix element d˜2, which arises strictly from quark-gluon interactions, to be unambiguously nonzero. The data also reveal an isospin dependence of higher twist effects if we assume that the Burkhardt-Cottingham sum rule is valid. The fundamental Bjorken sum rule obtained from the a0 matrix element is satisfied at our low momentum transfer.

Tobacco smoking in crosslinked keratoconus patients.

PURPOSE: The aim of this study was to evaluate the possibly protective link of smoking in keratoconic patients treated with accelerated cross-linking. METHODS: A telephone survey was conducted among 80 KC patients treated by accelerated cross-linking (A-CXL). The questions focused on general history, possible atopy and smoking habits. Results were compared to those of the general population by indirect standardization by age and sex according to the French national INPES survey. RESULTS: Sixty-two patients with KC were analyzed. The mean age at diagnosis was 22 years (SD 5). The mean age at which A-CXL was performed was 23 years (SD 6). Daily smokers represented 19 %, occasional smokers 8 %, ex-smokers 21 % and non-smokers 52 %. The mean age at which the patients began smoking was 17 (SD 2) years. Ex-smokers quit at a mean age of 24 (SD 4) years. The observed rates and expected rates of daily smokers were 19 % and 39 % respectively at the time of the survey (P=0.01), 24 % and 35 % at the time of the A-CXL treatment (P=0.10) and 31 % and 35 % at the time of diagnosis (P=0.58). The decrease in the rate of observed daily smokers over time was significant (P=0.02). DISCUSSION: Our data does not appear to suggest a significant protective effect of smoking on the occurrence of KC. It shows a lesser proportion of smokers in KC patients after A-CXL, but this difference did not exist at the time of KC diagnosis.

Parkinson's disease with camptocormia.

BACKGROUND: Camptocormia is defined as an abnormal flexion of the trunk that appears when standing or walking and disappears in the supine position. The origin of the disorder is unknown, but it is usually attributed either to a primary or a secondary paravertebral muscle myopathy or a motor neurone disorder. Camptocormia is also observed in a minority of patients with parkinsonism. OBJECTIVE: To characterise the clinical and electrophysiological features of camptocormia and parkinsonian symptoms in patients with Parkinson's disease and camptocormia compared with patients with Parkinson's disease without camptocormia. METHODS: Patients with parkinsonism and camptocormia (excluding patients with multiple system atrophy) prospectively underwent a multidisciplinary clinical (neurological, neuropsychological, psychological, rheumatological) and neurophysiological (electromyogram, ocular movement recording) examination and were compared with age-matched patients with Parkinson's disease without camptocormia. RESULTS: The camptocormia developed after 8.5 (SD 5.3) years of parkinsonism, responded poorly to levodopa treatment (20%) and displayed features consistent with axial dystonia. Patients with camptocormia were characterised by prominent levodopa-unresponsive axial symptoms (ie, axial rigidity, gait disorder and postural instability), along with a tendency for greater error in the antisaccade paradigm. CONCLUSION: We suggest that (1) the salient features of parkinsonism observed in patients with camptocormia are likely to represent a specific form of Parkinson's disease and camptocormia is an axial dystonia and (2) both camptocormia and parkinsonism in these patients might result from additional, non-dopaminergic neuronal dysfunction in the basal ganglia.

Long-term efficacy of combination therapy with interferon-alpha 2b and ribavirin for severe chronic hepatitis C in HIV-infected patients.

BACKGROUND: We have assessed the long-term efficacy and safety of a combination therapy of interferon alpha-2b (IFN) and ribavirin (RBV) for the treatment of severe chronic hepatitis C in co-infected HIV-seropositive patients in an open prospective study. METHODS: Fifty-one patients were treated for 12 months. Mean baseline CD4 cell count, alanine aminotransferase and aspartate aminotransferase were 412 +/- 232 x 106/l, 113 +/- 75 IU/l and 111 +/- 84 IU/l respectively. The mean Knodell score was 11.5 +/- 2.1 with 28 patients (55%) exhibiting histological evidence of active cirrhosis. RESULTS: Fifteen (29%) patients discontinued the treatment prematurely because of adverse events. An end of treatment response (ETR) as defined by the lack of detectable hepatitis C virus (HCV) RNA in plasma at the end of treatment was achieved in 15 patients (29%). A sustained virological response (SVR), defined by the lack of detectable HCV RNA in plasma 6 months after completion of combination therapy, was achieved in 11 patients (21%). The HCV genotype 3a was associated with ETR and SVR (P = 0.002 and P = 0.003, respectively). HCV viraemia at baseline was lower in patients who achieved SVR and ETR than in those who did not (6.7 +/- 7.8 versus 24 +/- 26.7 x 10(6) genome equivalents/ml, P = 0.03 and 14.3 +/- 28.7 versus 22.5 +/- 23, P = 0.05, respectively). CONCLUSION: Our results indicate that combination therapy with IFN and RBV is effective in approximately 20% of co-infected patients with severe liver disease.

Efficacy and safety of combination therapy with interferon-alpha2b and ribavirin for chronic hepatitis C in HIV-infected patients.

OBJECTIVES: To evaluate the efficacy and safety of a combination therapy of interferon-alpha2b (IFN) and ribavirin for the treatment of chronic hepatitis C in HIV-seropositive patients. DESIGN: Open prospective trial. METHODS: Twenty patients co-infected with hepatitis C virus (HCV) and HIV, with a mean CD4 cell count of 350 +/- 153 x 10(6)/l were treated with IFN (3 MU three times per week) in combination with ribavirin (500 mg or 600 mg twice a day) for 6 months. Tolerance and efficacy were monitored at weeks 12 (month 3) and 24 (month 6). The primary endpoint was a complete virological response, as defined by the lack of detectable HCV RNA in serum. RESULTS: Baseline values of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were 121 +/- 72 IU/l and 75 +/- 67 IU/l, respectively. The total Knodell score was 10.4 +/- 2.4, with nine patients showing histological evidence of active cirrhosis (45%). All patients exhibited circulating HCV RNA. The treatment was well tolerated, with no impact on the course of HIV infection. After 6 months of combination therapy with IFN and ribavirin, 10 patients (50%) exhibited no further detectable HCV RNA viraemia, seven of whom achieved undetectable viraemia at month 3. Levels of ALT and AST decreased after 6 months of treatment from a mean of 121 +/- 72 to 51 +/- 40 IU/l and from a mean of 129 +/- 58 IU/l to 68 +/- 61 IU/l, respectively (P < 0.0002 and P < 0.0001). CONCLUSION: Our results indicate that combination therapy with IFN and ribavirin is effective in 50% of cases in clearing serum HCV RNA and may thus provide effective means of therapy in HIV-HCV-coinfected patients as initial treatment or in patients who have previously failed IFN monotherapy.

Single-step reverse transcription-polymerase chain reaction for hepatitis C virus RNA with DNA enzyme immunoassay hybridization.

A single reverse transcription-polymerase chain reaction (SRT-PCR) for HCV RNA detection, confirmed by hybridization of amplified products with biotinylated probes using DNA enzyme immunoassay (DEIA), was compared to nested-PCR (N-PCR) on 20 sera from patients with chronic (n = 18) or acute (n = 2) hepatitis. Results obtained by SRT-PCR confirmed by DEIA and by N-PCR identical. All but one of the patients with chronic hepatitis and positive HCV serology as well as the patients with acute hepatitis had detectable HCV RNA in serum; all patients with chronic hepatitis and indeterminate HCV serology and all controls (n = 5) were negative by the two PCR methods. Both SRT-PCR and N-PCR remained positive after 7 x 10(-2) and 5 x 10(-4) dilutions of two HCV RNA-positive sera. The threshold of detection for SRT-PCR was 15 RNA copies per assay, as assessed by testing serial dilutions of an in vitro synthesized 5'-NCR HCV RNA transcript. SRT-PCR confirmed by DEIA for HCV RNA appears to be as sensitive and specific as N-PCR. Furthermore, it is easier to perform, with less of contamination, is less time-consuming, requires fewer enzymes, and it permits semi-quantification of PCR products.

Blood viscosity and sensorineural hearing loss.

Two groups of 33 subjects each, one experimental and one control, matched one-to-one for age and occupation, were chosen from a large number of subjects who were covered by special insurance for annual medical control at our hospital. The periodical checkups included cardiovascular, nervous, and renal systems, as well as vision and hearing. In addition routine blood tests, including whole blood viscosity, were also performed. The experimental group consisted of subjects in whom a bilateral, slight, and unexplained sensorineural loss of hearing was detected in the routine audiological testing, without any known reason. In the control group, the routine hearing tests demonstrated normal hearing. The differences between the two groups were statistically significant in pure-tone threshold level and in speech discrimination score, when the test was performed at a -5dB signal-to-noise ratio. The results of the vestibular tests were normal in both groups. Hematocrit and whole blood viscosity were slightly but significantly higher in the experimental group if compared with the control group. The number of subjects with abnormal whole blood viscosity results was higher in the experimental group. The whole blood viscosity as the etiological factor responsible for the hearing deterioration is described.

[Spontaneous pneumoperitoneum in scleroderma]. / Pneumopéritoine spontané au cours de la sclérodermie.

A spontaneous and asymptomatic pneumoperitoneum was observed in two women presenting with pseudoileus resulting from severe gastrointestinal involvement in progressive systemic sclerosis. In the first case, pneumoperitoneum was associated with pneumatosis cystoides intestinalis and remained unchanged during 3 years. As obstruction resisted to medical management, surgery was performed; however at laparotomy neither perforation nor obstruction of the bowel could be found; the patient died during the postoperative course. In the second case, pneumoperitoneum disappeared after medical management of low-grade intestinal ileus but the patient died 6 months later because of cardiac failure. Autopsy revealed major distention of the bowel but failed to show any signs of perforation. These findings show that, in progressive systemic sclerosis, pneumoperitoneum can occur in the absence of digestive perforation and that surgery is not required. However this complication seems to carry a very poor prognosis.

[Human pentastomiasis: clinical, radiological and x-ray computed tomographic study of a case]. / Pentastomose humaine: étude clinique, radiologique et tomodensitométrique d'un cas.

A case of abdominal pentastomiasis in a 38-year-old Congolese man is reported. This parasitic disease has been described in Central Africa and South East Asia. The patient presented with unexplained permanent abdominal pain. The peritoneal and hepatic localisations of the parasite were recognized on plain abdominal film and documented by ultrasonography and CT scan studies. At laparoscopy multiples adherences were found, in spite of the fact that no previous abdominal surgery had been performed. These findings suggest a possible correlation between the clinical manifestations and the anatomic lesions in this disease which is usually considered to be asymptomatic.

["Dysphagia lusoria". Physiopathological discussion apropos of a clinical case]. / "Dysphagia lusoria". Discussion physio-pathologique à propos d'un cas clinique.

We report the observation of a patient suffering from dysphagia lusoria, a dysphagia caused by an anomalous form of the right subclavian artery. The diagnosis was confirmed by aortic arch angiography and cine-oesophagogram. Oesophageal manometric study revealed segmental hypoperistalsis and anti-peristalsis. Dysphagia disappeared with cisapride. This observation suggests that dysphagia lusoria is caused by oesophageal motility disorders and not by vascular compression.

[Ultrastructural markers in LAV-HTLV III virus infection: study of the rectal mucosa in 16 patients]. / Marqueurs ultrastructuraux au cours de l'infection par le virus LAV-HTLV III: étude de la muqueuse rectale chez 16 patients.

Ultrastructural study of rectal mucosa was performed in 6 patients with AIDS related complex (ARC) and in 10 patients with AIDS. There were 16 men (mean age: 39.1 years): 8 homosexuals, 3 Haitians, 2 Africans and 3 IV drug abusers, all having significant titers of LAV antibodies. Two types of ultrastructural markers were observed: tubuloreticular structures (TRS) were found in endothelial cells, lymphocytes and macrophages in 1/6 ARC patients and 10/10 AIDS patients. TRS have already been described in various pathological situations and seem to be related to alpha-interferon, test tube and ring shaped forms (TRF) were observed in lymphocytes and macrophages in 0/6 ARC patients and 6/10 AIDS patients. TRF have been rarely reported previously. The 6 AIDS patients with TRF were 4 homosexuals and 2 Haitians. In two of three of these patients in whom repeated ultrastructural studies were performed, the same markers were found. All AIDS patients with TRF died within a mean time of ten months after the diagnosis had been established, whereas 1/4 AIDS patients without TRF died within seven months and the three others survived for more than 14 months. These data suggest that the association of TRS and TRF in the rectal mucosa could be specific of AIDS. In LAV/HTLV III retro-virus infection, this association is an aggravating factor.

[Prospective comparison of ultrasound endoscopy and computed tomography in the assessment of locoregional invasiveness of malignant ampullar and pancreatic tumors verified surgically]. / Comparaison prospective de l'échoendoscopie et de la tomodensitométrie dans le bilan d'extension loco-régionale de tumeurs malignes ampullaires et pancréatiques vérifiées chirurgicalement.

OBJECTIVE: To compare, in a prospective study, results of endoscopic ultrasonography and computed tomography in staging of pancreatic and ampullary carcinoma tumours, assessed surgically. METHOD: From January 1990 to May 1993, 37 patients with pancreatic tumours had per-operative endoscopic ultrasonography and computed tomography. All patients underwent surgery and surgical and histological staging were performed. RESULTS: All the tumours were visualized by endoscopic ultrasonography, and 92% were correctly localized; 63% of the tumours were visualized by computed tomography. In lymph node involvement diagnosis (23 patients), endoscopic ultrasonography. In major portal vessel involvement diagnosis (14 patients), endoscopic ultrasonography sensitivity and specificity were respectively 71.4% and 95.65%, and 21.4% and 100% for computed tomography. In a vessel-by-vessel analysis, endoscopic ultrasonography was superior to computed tomography for veinous involvement diagnosis (sensitivity: 68.4% vs 26.3%), and the results were similar for arterial involvement diagnosis (sensitivity: 55.5% vs 66.6%). CONCLUSION: Endoscopic ultrasonography is more accurate than computed tomography in detection of metastatic lymph nodes and portal involvement, and their results are similar in detection of arterial involvement.

[Collagenous colitis: a new case of exudative enteropathy]. / La colite collagène: une nouvelle cause d'entéropathie exsudative.

Collagenous colitis with intestinal protein loss was discovered in a sixty-six year-old female who presented with recurrent and prolonged diarrhea associated with hypoprotidemia, hypoalbuminemia, and increased clearance of alpha-1-antitrypsin. Histologic lesions of collagenous colitis were found during each episode of diarrhea. Biological and histological examinations were normal during the remission phases. Intestinal protein loss appeared to be due to collagenous colitis because of the parallel course of the clinical, biological and histological signs, and because no other cause had been discovered. The possibility of protein exudation, probably secondary to the extent of the epithelial detachment, could be an additional argument for the inflammatory etiology of collagenous colitis.

[A new hereditary cause of portal vein thrombosis: the abnormal resistance to activated protein C by the Arg 506-->Gln mutation of the gene of factor V]. / Une nouvelle cause héréditaire de thrombose portale: la résistance anormale à la protéine C activée par mutation Arg506-->Gln du gène du facteur V.

We report 2 cases of portal vein thrombosis associated with a single point mutation in the factor V gene that replaces arginine in residue 506 with glutamine. This mutation induces abnormal resistance to anticoagulant activity of activated protein C and increases the risk of deep vein thrombosis. Both patients had a personal and familial history of deep vein thrombosis. Intraabdominal neoplasia or infection, myeloproliferative disorder, antiphospholipid syndrome, paroxysmal nocturnal hemoglobinuria and coagulation inhibitor deficiency (antithrombin, proteins C and S) were excluded by exhaustive investigation. However, an abnormal resistance to activated protein C was found, and DNA analysis showed the factor V Arg506 to Gln mutation in both cases. Anticoagulant treatment was begun. A study of family history made in one case, showed the same genetic disease in one of the relatives. Resistance to activated protein C with factor V gene mutation should be investigated in patients with portal vein thrombosis. A study of family history, and anticoagulant treatment are justified for symptomatic patients.

[Contribution of the family in the care of the chronically ill aged]. / Der Beitrag der Familie bei der Pflege chronischkranker Betagter.

As part of the Swiss National Research Programm No. 8 (Economy and Efficacy of the Swiss Health System), we evaluated the participation of relatives in the care of institutionalized, chronically ill elderly parents. 323 patients were selected at random. Of 473 relatives and friends it was possible to interview 343. Men below the age of 80 were, cared for significantly more often at home in comparison to women. Care was in most instances provided by closely related women, usually from the next generation (daughters and daughters-in-law). In this group a majority participated in nursing care for institutionalized elderly relatives. Only close relatives appear to be willing to carry the burden of nursing care over a long period of time, whereas friends, neighbours, and distantly related family members are not. Economic problems arise mainly for men, less so for women. The latter are surprisingly often already involved in caring for an additional handicapped or elderly family member.

[Care of elderly chronically ill patients at home]. / Die pflege betagter langzeitkranker zu hause.

In a survey of 261 chronically ill elderly 43 are found to be supported at home by family members. In comparison to institutionalised patients significantly more men are nursed at home. Members of lower socioeconomic groups are overrepresented in the home care group. Only close family members (spouse and daughter) contribute in significant numbers to home care. In addition formal support is necessary in the majority of patients (periodic hospitalisation in more than 50%). In the present situation, only a minority (mainly married men) is cared for at home.

[The care of elderly patients by their relatives]. / Pflege von betagten Patienten durch ihre Angehörigen.

New concepts are needed for the still increasing number of geriatric patients who require long term institutional care and for the often difficult situation of caregiving relatives. We investigated the possibility to integrate relatives of institutionalized patients in the nursing care. 323 geriatric patients were randomly selected and the relatives contacted. Only four (1%) had no relatives or friends. Of 86% of the patients it was possible to interview 343 relatives or close friends. Of those 147 (43%) were favorably disposed towards a cooperation in the care with the ward staff. Persons willing to cooperate were characterized by female sex, middle class status, good health, not too demanding jobs, and close contacts prior to institutionalization of their next of kin. In a second part 29 of 196 relatives were willing to take part in a pilot project. Unfortunately, for technical reasons only five patients could be hospitalized on the experimental ward in the given time. The practical experience demonstrated that relatives can cooperate on a part time basis with the nursing staff in the care of institutionalized geriatric patients. It is estimated that probably 12% of the geriatric patients in institutions have relatives willing and capable to take part in the nursing or other activities on the ward. Smaller nursing facilities appear more suitable than large geriatric clinics for this type of cooperation.