The semi-sewer river: hydraulic backwater effects and combined sewer overflow reverse flows in Central Brussels reduce deoxygenation impact further downstream.

In 2011 and 2012 the dissolved oxygen content in the low-discharge river Zenne was monitored continuously, every 5 minutes, downstream of Brussels city centre, making it possible to document the complex mechanisms by which combined sewer overflow (CSO) spills affect both the hydraulics and the oxygen balance of the hydrosystem. In addition to oxygen demand impacts, proportions of water volumes are such that the oxygen-devoid sewage water discharged from CSOs contributes significantly to the oxygen deficit observed in the river further downstream. It is shown that ensuing unexpected hydraulic behaviour, such as a full river-flow reversal, can explain the dual nature of oxygen sag following major CSO events. At times the semi-sewer river plays the role of an in-stream stormwater tank, effectively attenuating the environmental impacts of Brussels CSOs.

Sonographic detection of multiple Staphylococcus aureus hepatic microabscesses mimicking Candida abscesses.

We report the sonographic, CT, and clinical findings in a patient presenting with clinical sepsis and multiple Staphylococcus aureus hepatic microabscesses. Although contrast-enhanced CT has had a higher sensitivity than sonography in detecting hepatic microabscesses in some studies, this examination was negative in our patient. On sonography, numerous small hypoechoic lesions were present. Some target-like lesions had a striking similarity to Candida albicans microabscesses. The hepatic lesions were believed to be pyogenic liver microabscesses, as several blood cultures were positive for S. aureus. Following prolonged intravenous antibiotic therapy, all the hypoechoic hepatic lesions disappeared, along with the clinical and biochemical signs of sepsis.

Structural heart adaptations in triathletes.

OBJECTIVE: To perform a triathlon in aerobic conditions, a variety of cardiovascular, haemodynamic and metabolic adaptations are required. The heart is the central concern and also the most important limiting factor. In this study we investigate the structural and functional heart adaptations of a group of triathletes. METHODS AND RESULTS: A group of 52 male triathletes was divided into 4 subgroups in function of their athletic results and compared with a control group of 22 healthy, very active but no athletic men. The groups had comparable anthropometric and general physical characteristics. Very significant differences in cardiac structure and cardiac function were observed between the groups. In the triathletes, we registered distinct signs of significantly mixed eccentric and concentric hypertrophy. Unlike the findings in a pathological left ventricular hypertrophy, the diastolic left ventricular function in triathletes was completely normal and even better than in the control group. The late passive diastolic filling period of the triathlete, in particular, seemed to have specific characteristics. The comparison between the subgroups of triathletes shows us that genetic factors probably play an important role in the cardiac adaptations in triathletes. CONCLUSIONS: In our opinion the "athletic heart" in triathletes is not a specific "physiological entity" but is a transitional phase to a dilated hypertrophic cardiomyopathy. Our study yields some arguments for the following proposition: "People are born as elite athletes, with specific characteristics of the left ventricle and with a specifically supernormal diastolic left ventricular function."

Ventricular premature beats in triathletes: still a physiological phenomenon?

UNLABELLED: Sudden death is a tragic fact, unexpectedly arising in all age groups. Ventricular arrhythmias are the main cause. At the end of a maximal exercise test more ventricular premature beats were noted in a group of well trained triathletes compared with a similar control group. The etiology is multifactorial. When these ventricular premature beats are associated with specific structural and functional heart adaptations, echocardiographically and electrocardiographically well-documented, then those 'banal' ventricular premature beats cannot longer be considered as a physiological phenomenon. In these circumstances the involved subject is a candidate for dangerous arrhythmias and 'sudden cardiac death'. PURPOSE: The principal cause of 'Sudden cardiac death' is ventricular arrhythmias. We explore the incidence of ventricular premature beats (VPB) in triathletes, who engage in enforced endurance sports. METHODS: Fifty-two triathletes were compared with twenty-two control subjects with comparable anthropometric parameters in function of structural and functional cardiac adaptations. Maximal exercise tests were conducted on a stationary bicycle and a treadmill. During the last two minutes of each test, the VPB were registered. RESULTS: Statistically significant differences emerged in the cardiac structure and function between the triathletes and the controls. There were signs of cardiac hypertrophy and arguments for a supernormally diastolic left ventricular function in the triathletes. The performance capacity was also significantly higher in the triathletes. The maximal heart rate was significantly higher in the control group. The number of VPB was significantly higher in the triathletes. The increased risk of VPB in the triathlon group is caused by several factors: the degree of cardiac hypertrophy, the increased diastolic reserve, the duration of the exercise, the existence of an aortic insufficiency jet and some specific electrocardiographic findings. CONCLUSIONS: The triathlete has an increased risk of VPB during maximal efforts. We doubt the traditionally accepted view of the physiological nature of those VPB and suspect that the limit of physiological cardiac adaptations to sport efforts is exceeded with the appearance of VPB. The triathlete with VPB and with specific electrocardiographic and echocardiographic findings is a candidate for 'sudden cardiac death'.

Left atrial myxoma associated with systemic AA amyloidosis.

A 76-year-old woman presenting with generalized amyloidosis of the AA-type protein was found to have a left atrial myxoma. Retrospective estimation of the concentration of SAA protein, a serum precursor of AA amyloid, before and after surgical removal of the myxoma, showed that the SAA protein had disappeared after the operation. A common manifestation of myxoma is the development of a severe inflammatory syndrome that sometimes simulates rheumatic fever or bacterial endocarditis. However, to our knowledge, it has never been described in association with amyloidosis. We suggest that atrial myxoma should be added the list of neoplastic and inflammatory diseases predisposing to AA amyloidosis.

Increase of neurophysin II serum levels in chronic alcoholic patients: relationship with alcohol consumption and alcoholism blood markers during withdrawal therapy.

Neurophysin II (hNpII) but not hNpI serum levels were higher than normal (greater than 2.85 ng/ml) in 9 of 20 patients admitted to the metabolic ward for alcohol withdrawal therapy; a normalization was observed within the first week of alcohol withdrawal. The higher levels of hNpII were felt to reflect alcohol impregnation for the following reasons: 1) on admission, levels of most of the alcoholism blood markers were higher in the group of patients with high hNpII levels than in the group with normal hNpII levels; 2) hNpII levels were correlated with most of the alcoholism blood markers, mainly gamma-glutamyl transpeptidase (r = 0.63, P less than 0.001) in the 20 patients of the study; 3) patients with high hNpII levels admitted to greater alcohol and less anxiolytic drug intake immediately before admission. The physiopathological meaning and hypothetical psychological consequence of this hNpII increase remain to be defined.

Whole body and regional retention of 99mTc-labeled pyrophosphate at 24 hours: physiological basis of the method for assessing the metabolism of bone in disease.

The retention of 99mTc-labeled pyrophosphate (PPi) at 24 h was measured in 235 patients, 119 of whom had a normal bone metabolism. The mean retention in the group of normal subjects is 52% of the injected dose. Reproducibility of the measurement in a given person is 5.5% coefficient of variation (CV). The value depends strongly on sex (higher in males) and age (higher with increasing age, especially in cortical bone). Retention increases slowly with the decrease in glomerular filtration rate (GFR) between 50 and 120 ml/min; it rises very rapidly with values below 50 ml/min. The slowing down of the GFR with age does not account for the increase in PPi retention with age. When expressed as a percentage of the expected value for sex and age, retention is frequently low in osteoporosis (P less than .001), more so when urinary hydroxyproline is low; it is normal or high in osteomalacia, and in some cases rises after vitamin D treatment is started; it is high in hyperparathyroidism (P less than .01). The PPi retention is correlated with bone calcium accretion rate, alkaline phosphatase level, and above all, the urinary hydroxyproline level. The lower the bone mineralization (Ca/hydroxyproline ratio in biopsy), the higher the retention value. We conclude that the PPi retention is an index of bone metabolism when GFR is higher than 50 ml/min. It allows for classification of metabolic bone diseases according to the bone turnover rate. It has the advantage over the usual biologic examinations in that it affords better observation of highly localized bone disorders and can be used in combination with a morphologic record, the bone scintigraphy.

Osteogenesis imperfecta associated with multiple myeloma.

In a case of osteogenesis imperfecta with multiple fractures already from childhood, myelomatosis was diagnosed at the age of 52 years because of a serum M-component (IgG, lambda), Bence Jones proteinuria, myeloma cells in the bone marrow, and osteolytic skeletal lesions. She died 10 months later. A partial postmortem examination of a larger bone lesion confirmed the diagnosis.

[Bone histology and 25-OH vitamin D plasma levels in alcoholics without cirrhosis (author's transl)]. / Etude histologique de la minéralisation osseuse et taux de 25-hydroxycholecalciférol dans l'éthylisme chronique.

Bone mineralization is impaired in alcoholic non cirrhotics admitted to hospital for withdrawal. The defect is more marked in women than in men. Low 25-OH vitamin D plasma values may be observed in these patients and seem to be related to malnutrition. The degree of bone demineralization is not statistically correlated to 25-OH vitamin D plasma level.