24-hour pH-impedance monitoring on therapy to select patients with refractory reflux symptoms for antireflux surgery. A single center retrospective study.

BACKGROUND: Treatment of gastro-esophageal reflux refractory symptoms is challenging. This monocenter retrospective study assessed the value of preoperative pH-impedance monitoring 'on' therapy to predict functional outcome after laparoscopic fundoplication in patients with refractory reflux symptoms. METHODS: Patients with a preoperative pH-impedance monitoring 'on' proton pump inhibitors (PPIs) twice daily were assessed at least 6 months after a laparoscopic fundoplication for refractory reflux symptoms. Failure of fundoplication was defined by a Visick score > 2. Postoperative symptoms were assessed by the reflux disease questionnaire (RDQ). The pH-impedance parameters analyzed were the number of reflux events (total, acid, non-acid), esophageal acid exposure time, esophageal bolus exposure time, and symptom-reflux association defined by symptom index (SI) >50% and symptom association probability (SAP) >95%. KEY RESULTS: Thirty-three patients (18 female patients, median age 46 years) were assessed after a mean follow-up of 41.3 (range 7-102.2) months. Seven (21.2%) patients were considered as failures. Compared to patients with favorable outcome, these patients were more often 'on' PPI therapy (86% vs 23%, p < 0.05) and had higher RDQ scores in each domain: heartburn (p < 0.05), regurgitation (p < 0.05) and dyspepsia (p < 0.05). A positive SAP was the only pH-impedance parameter statistically associated with successful postoperative outcome (p = 0.004). CONCLUSIONS & INFERENCES: On therapy, a preoperative positive symptom association probability is the only pH-impedance parameter associated with favorable outcome after laparoscopic fundoplication for refractory reflux symptoms. These results should be confirmed by prospective studies.

Hepar lobatum carcinomatosum associated with liver metastases from breast cancer: report of five cases.

BACKGROUNDS AND AIMS: Hepar lobatum carcinomatosum (HLC) is an exceptional acquired hepatic distortion which consists in irregularly lobulated hepatic contours seen in patients with known liver metastases, usually from breast carcinoma. We aimed to describe and analyze five similar cases of HLC resulting from metastatic mammary carcinoma in the liver and associated with rapid hepatic failure. METHODS: Five cases of HLC were investigated. Medical (including blood liver tests), radiological and histological data (2 cases) were collected and retrospectively analyzed. All patients were followed up for metastatic invasive ductal carcinoma of the breast and had a common pattern of treatment with combination of targeted therapies (bevacizumab, AVASTIN) and chemotherapy (paclitaxel, TAXOL). RESULTS: All the patients showed rapid hepatic failure after a mean of 9 courses of bevacizumab/paclitaxel. In all cases, liver imaging revealed liver capsule retraction and an irregular lobular margin. An apparent tumor regression of all liver metastases was showed in two cases. Biopsies were consistent with sinusoidal obstruction syndrome (SOS) and, surprisingly, no tumoral cells were found. CONCLUSION: Although rare, such an unusual pattern of liver metastasis may mimick acute cirrhosis and cause rapid hepatic failure in patients, despite possible apparent tumor regression on imaging. The etiology of this pathology is unclear, and may involve multiple pathogenic factors. Direct or indirect vascular injury plays an important role in the development of HLC.

[Mediastinal sarcoidosis in an oncologic context: role of endoscopic ultrasound-guided fine needle aspiration]. / Sarcoïdose médiastinale dans un contexte oncologique : apport de la ponction aspiration guidée par échoendoscopie.

INTRODUCTION: Sarcoidosis and sarcoid reactions have been previously reported in association with cancer. Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is a minimally invasive test for investigating mediastinal lymph nodes PATIENTS AND METHODS: We conducted a retrospective review of 54 patients undergoing EUS-FNA in a cancer institute for suspected metastatic mediastinal lymph nodes showed by CT-imaging or positron emission tomography (PET). Patients with non-caseating granuloma identified by EUS-FNA were included RESULTS: EUS-FNA identified non-caseating granuloma in seven out of the 54 included patients. Most of them had positive PET. One patient had a prior history of sarcoidosis before the diagnosis of cancer. Another patient developed micrometastasis associated with sarcoid-like reaction. There was no adverse outcome associated with the EUS-FNA procedure CONCLUSIONS: Sarcoidosis must be included in the differential diagnosis of patients with a history of malignancy who develop mediastinal lymphadenopathy. EUS-FNA is a safe and minimally invasive test to obtain tissue diagnosis.

Symptomatic diaphragmatic hernia after pulmonary radiofrequency ablation.

Radiofrequency ablation (RF) is a relatively safe and reliable technique for the treatment of pulmonary metastases that has seen rapidly expanding use. Lesions situated near the diaphragm are difficult to treat by RF due to the risk of thermal injury to the diaphragm. Diaphragmatic perforation with progressive development of a diaphragmatic hernia is a rare but serious complication. Treatment is surgical. We present the first case reported in the literature of intestinal obstruction in a left diaphragmatic hernia that developed following RF treatment of a pulmonary metastasis.

Household transmission of haemolytic uraemic syndrome associated with Escherichia coli O104:H4, south-western France, June 2011.

Following the outbreak of haemolytic uraemic syndrome (HUS) on June 2011 in south-western France, household transmission due to Escherichia coli O104:H4 was suspected for two cases who developed symptoms 9 and 10 days after onset of symptoms of the index case. The analysis of exposures and of the incubation period is in favour of a secondary transmission within the family. Recommendations should be reinforced to prevent person-to-person transmission within households.