[Ambulatory laparoscopic colectomy : First experiences at the CHU of Liège]. / Colectomie cœlioscopique ambulatoire. Premières expériences au CHU de Liège.

CONTEXT: For many years, enhanced recovery programs (ERP) for colorectal surgery have been developed in many hospitals around the world. Recently, our institution took a new step forward in colonic surgery : ambulatory laparoscopic colectomies. METHODS: Our eligibility criteria for our ambulatory colectomy program were defined and our perioperative ERP protocol was adapted to the ambulatory setting. Five patients consented to inclusion in this program. RESULTS: Patients' characteristics were as follows : four women, one male, age : 48 years (range 21-67); surgical indication : cancer in two patients, diverticulitis in two patients, and Crohn disease in one patient. The surgical site was the left colon in four cases and the right colon in one case. Four out of the five patients left the hospital 5-8 h after the end of the surgery. No postoperative complication occurred, no readmission was necessary. DISCUSSION: This article discusses the benefits and risks of ambulatory colectomy. We emphasize that such outpatient management must not be pursued at the expense of the patient's safety and well-being.

Contexte : Depuis de nombreuses années, les programmes de réhabilitation améliorée après chirurgie (RAC) colorectale ont été développés dans de nombreux centres hospitaliers à travers le monde. Récemment, notre institution a franchi une nouvelle étape en chirurgie colique : la réalisation de colectomies coelioscopiques en ambulatoire. Méthodes : Après avoir déterminé nos critères d'inclusion dans le programme de colectomie ambulatoire et adapté notre protocole péri-opératoire de RAC au contexte ambulatoire, nous y avons inclus cinq patients. Résultats : Les caractéristiques des patients étaient les suivantes : quatre femmes et un homme; âge : 48 ans (range 21-67); indications chirurgicales : deux patients pour cancer, deux patients pour diverticulite et un patient pour maladie de Crohn. La colectomie concernait le côlon gauche dans quatre cas et le côlon droit dans un cas. Quatre des cinq patients ont quitté l'hôpital 5-8 h après la fin de l'intervention chirurgicale. Aucune complication postopératoire n'est survenue, aucune réadmission n'a été nécessaire. Discussion : Cet article discute les bénéfices et risques de la colectomie ambulatoire. Nous insistons sur le fait qu'une prise en charge ambulatoire ne doit pas être poursuivie au détriment du bien-être et de la sécurité du patient.

Transient cortical blindness after diagnostic cerebral angiography - A single center report.

Background: Transient cortical blindness (TCB) has been reported as a complication after diagnostic cerebral angiography in 0.3-1% of cases. Our aim was to observe the frequency of TCB after diagnostic cerebral angiography over a period of 11 years using only hypo-osmolar, nonionic contrast agents and following a protocol to reduce both the total volume of injected contrast agent and the number of angiography series obtained. Methods: We retrospectively included all 2431 patients who received diagnostic cerebral angiographies at our institution. Primary outcome measure was the occurrence of TCB after diagnostic cerebral angiography, hypothesizing that the occurrence of TBC depends on the volume of contrast agent and angiography of the vertebrobasilary arteries. Results: Over the analyzed time period of 11 years, we did not observe a single case of TCB following diagnostic cerebral angiography. The median contrast volume used was 100 ml (IQR, 100-200), ranging from 15 ml to 500 ml. In our cohort, 61.5% of patients received a selective catheterization of the vertebrobasilary territory. In 99.8% of angiographies iopamidol was used a contrast agent. Conclusion: Our results indicate that following to certain aspects of the angiography protocol (using the hypoosmolar, non-ionic contrast agent iopamidol and reducing the number of catheterized vessels and angiography series to a diagnostic minimum) the frequency of transient cortical blindness as a complication of diagnostic cerebral angiography considerably can be very low.

Significance of ADC value for detection and characterization of urothelial carcinoma of upper urinary tract using diffusion-weighted MRI.

PURPOSE: To evaluate utility of diffusion-weighted magnetic resonance imaging (DWI) to detect and predict the histological characteristics of upper urinary tract urothelial carcinomas (UTUCs). MATERIALS AND METHODS: We retrospectively evaluated 20 suspicious lesions from 19 patients. MRI study included conventional sequences and DWI with apparent diffusion coefficient (ADC) maps calculated between b = 0 and b = 1,000. ADC values were measured within two different regions of interest (ROI): a small identical ROI placed in the most restrictive part of the tumour and a larger ROI covering two-thirds of the mass surface. The mean ADC values of the tumours were compared with that of normal renal parenchyma using an unpaired Student's t test. Association between ADC values and histological features was tested using non-parametric tests. RESULTS: Overall, 18 tumours were confirmed histologically as UTUCs. DWI failed to detect two cases of UTUCs (one CIS and one small tumour of 5 mm). There was no statistically significant difference in ADC values measured with the small or large ROI (p = 0.134). The mean ADC value of UTUC was significantly lower than that of the normal renal parenchyma (p < 0.001). No statistical association was found between ADC values and pathological features (location, p = 0.35; grade, p = 0.98; muscle-invasive disease, p = 0.76 and locally advanced stage, p = 0.57). CONCLUSION: DWI may be interesting tool for detecting UTUCs regarding the difference of ADC values between the tumours and surrounding healthy tissues. In regard to low frequency of UTUCs, the association of ADC values and histological characteristics need further investigations in a large prospective multi-institutional study.

Cochlear implant with a non-removable magnet: preliminary research at 3-T MRI.

OBJECTIVE: To perform preliminary tests in vitro and with healthy volunteers to determine the 3-T MRI compatibility of a cochlear implant with a non-removable magnet. METHODS: In the in vitro phase, we tested six implants for temperature changes and internal malfunctioning. We measured the demagnetisation of 65 internal magnets with different tilt angles between the implant's magnetic field (bi) and the main magnetic field (b0). In the in vivo phase, we tested 28 operational implants attached to the scalps of volunteers with the head in three different positions. RESULTS: The study did not find significant temperature changes or electronic malfunction in the implants tested in vitro. We found considerable demagnetisation of the cochlear implant magnets in the in vitro and in vivo testing influenced by the position of the magnet in the main magnetic field. We found that if the bi/b0 angle is <90°, there is no demagnetisation; if the bi/b0 angle is >90°, there is demagnetisation in almost 60 % of the cases. When the angle is around 90°, the risk of demagnetisation is low (6.6 %). CONCLUSION: The preliminary results on cochlear implants with non-removable magnets indicate the need to maintain the contraindication of passage through 3-T MRI. KEY POINTS: • Magnetic resonance imaging can affect cochlear implants and vice versa. • Demagnetisation of cochlear implant correlates with the angle between bi and b0. • The position of the head in the MRI influences the demagnetisation. • Three-Tesla MRI for cochlear implants is still contraindicated. • However some future solutions are discussed.

Coronary-subclavian steal syndrome treated with carotid to subclavian artery by-pass.

Coronary-subclavian steal syndrome is a rare clinical entity, which results from the atherosclerotic disease of the origin of the subclavian artery in patients in which the internal mammary artery was used as a conduit for coronary artery by-pass. This complication causes reversal of the flow in the internal mammary artery and the recurrence of myocardial ischemia. The therapeutic options are angioplasty and stent of the subclavian artery or, in a rare case of occlusion, surgical treatment. This case report describes the use of the carotid to subclavian artery by-pass for the treatment of coronary-subclavian steal syndrome due to the occlusion of the subclavian artery.

Zonal segmentation of prostate using multispectral magnetic resonance images.

PURPOSE: To investigate the performance of a new method of automatic segmentation of prostatic multispectral magnetic resonance images into two zones: the peripheral zone and the central gland. METHODS: The proposed method is based on a modified version of the evidential C-means clustering algorithm. The evidential C-means optimization process was modified to introduce spatial neighborhood information. A priori knowledge of the prostate's zonal morphology was modeled as a geometric criterion and used as an additional data source to enhance the differentiation of the two zones. RESULTS: Thirty-one clinical magnetic resonance imaging series were used to validate the method, and interobserver variability was taken into account in assessing its accuracy. The mean Dice Similarity Coefficient was 89% for the central gland and 80% for the peripheral zone, as validated by a consensus from expert radiologist segmentation. CONCLUSIONS: The method was statistically insensitive to variations in patient age, prostate volume and the presence of tumors, which increases its feasibility in a clinical context.

Obesity-Related Metabolic Dysfunction in Dairy Cows and Horses: Comparison to Human Metabolic Syndrome.

Obesity has become a serious health problem with frequent occurrence both in human and animal populations. It is estimated that it may affect over 85% of the human population and 70-80% of horses and cows by 2030. Fat cow syndrome (FCS) is a combination of metabolic, digestive, infectious, and reproductive disorders that affects obese periparturient dairy cows, and occurs most frequently in loose-housing systems, where periparturient and dry cows are fed and managed in one group disregarding the lactation stages. Equine metabolic syndrome (EMS) was named after human metabolic syndrome (MetS) and has insulin dysregulation as a central and consistent feature. It is often associated with obesity, although EMS may occur in a lean phenotype as well. Other inconsistent features of EMS are cardiovascular changes and adipose dysregulation. Laminitis is the main clinical consequence of EMS. MetS holds a 30-years old lead in research and represents a clustering of risk factors that comprise abdominal obesity, dyslipidemia, hypertension, and hyperglycemia (impaired fasting glucose or type 2 diabetes mellitus-T2DM), which are associated with doubled atherosclerotic cardiovascular disease risk, and a 5-fold increased risk for T2DM. The main aim of this review is to provide critical information for better understanding of the underlying mechanisms of obesity-related metabolic dysfunction in animals, especially in cows and horses, in comparison with MetS. Human medicine studies can offer suitable candidate mechanisms to fill the existing gap in the literature, which might be indispensable for owners to tackle FCS, EMS, and their consequences.

Prolonged orbicularis oculi activity: a major factor in apraxia of lid opening.

BACKGROUND: Apraxia of lid opening (ALO) is a nonparalytic inability to open the eyes at will in the absence of visible contraction of the orbicularis oculi (OOc) muscle. OBJECTIVE: To test the hypothesis that sustained activity of the OOc is a major factor in the difficulty in opening the eyes in this condition. METHODS: Lid movement detected in an electromagnetic field and electromyogram activity of the septal and pretarsal portions of the OOc were recorded in 12 healthy control subjects and 12 patients with a clinical diagnosis of ALO. The latencies to onset and to complete eye opening and the time during which eye opening was sustained were measured and analyzed in relation to OOc activity. RESULTS: The lid opening latencies and the lid movement duration were significantly increased in patients compared with control values. An abnormal persistence of OOc activity was present in 10 of the 11 patients with a delay in complete lid opening. The complete lid opening delay showed a strong positive correlation with the time it took to inhibit the OOc activity. This relationship fit the same linear regression in both groups. CONCLUSIONS: Patients with ALO show significant delays in eye opening. An abnormal persistence of OOc activity, detectable electromyographically but not clinically, could be the main factor contributing to the delay in lid opening in these patients.

Prostate MRI: can we do without DCE sequences in 2013?

Multiparametric MRI (mp-MRI) of the prostate currently provides stable and reproducible performances. The usefulness of dynamic contrast-enhanced (DCE) sequences is currently challenged, as they sometimes only confirm what has already been observed on diffusion-weighted imaging (DWI) and require the additional purchase of a contrast agent. Eliminating these sequences may help accelerate the use of MRI in addition to, or in lieu of, prostate biopsies in selected patients. However, many studies show that these sequences can detect lesions invisible on T2-weighted and diffusion-weighted images, better assess cancer extension and aggressiveness, and finally help detecting recurrence after treatment. We present the various applications of dynamic MRI and discuss the possible consequences of its omission from the current protocol.

ProstAtlas: a digital morphologic atlas of the prostate.

Computer-aided medical interventions and medical robotics for prostate cancer have known an increasing interest and research activity. However before the routine deployment of these procedures in clinical practice becomes a reality, in vivo and in silico validations must be undertaken. In this study, we developed a digital morphologic atlas of the prostate. We were interested by the gland, the peripheral zone and the central gland. Starting from an image base collected from 30 selected patients, a mean shape and most important deformations for each structure were deduced using principal component analysis. The usefulness of this atlas was highlighted in two applications: image simulation and physical phantom design.

Detecting prostate cancer with MRI - why and how.

Multiparametric MRI of the prostate is an essential examination for the diagnosis, preoperative evaluation and planning of treatment for prostate cancer. This examination can accurately detect cancer foci in the gland so that the most appropriate management can be offered, reduce the risk of over-treatment and also ensure that certain aggressive lesions or unusual locations, which might affect the prognosis, are not ignored. We present here its main indications, focusing on the techniques for interpreting MRI, its performance and its limitations, as well as the recent European recommendations underlining the need for international harmonisation.

[Treatment of arterio-venous high-flow vascular malformations of the mandible]. / Tratamentul malformatiilor vasculare arterio-venoase de flux înalt ale mandibulei.

Arterio-venous vascular malformations (AVM) rarely occur in craniofacial bones. The most frequent location has been reported in the mandible. The first clinical evidence of the lesions can be a fatal hemorrhage, occurring spontaneously or subsequent to dental therapy. Lack of knowledge about these lesions among specialists dealing with the oral and maxillofacial regions can lead to fatal complications. The study presents the successful multidisciplinary management of two cases of mandibular AVM using embolization, sclerotherapy and bone reconstruction, a major challenge owing to the substantial risk of morbidity, recurrence by recanalization and revascularization, neurologic deficits and mortality. There were no complications over a follow-up period of 12 years.

Transesophageal determination of SNRT and SACT in paroxysmal supraventricular tachyarrhythmias.

The paper tested the hypothesis that supraventricular tachyarrhythmias (SVT) could represent the first clinical manifestation of the sick sinus syndrome (SSS). Absolute sinus node recovery time (SNRT) and sinoatrial conduction time (SACT) were determined through transesophageal approach in 16 patients with paroxysmal SVT, but without bradycardic episodes between crises. The values considered normal were: SNRTa less than or equal to less than or equal to 1500 ms; SNRTc less than or equal to 525 ms; SACT less than or equal to 150 ms. SNRTa, SNRTc and SACT were normal in all subjects (SNRTa: 1077 ms; SNRTc: 400 ms; SACT: 111 ms) and suggest the absence of a notable sinusal disfunction in these patients. We concluded that SVT unassociated with bradycardia do not usually represent a manifestation of SSS. Consequently the administration of sinusal depressant drugs in such patients could be permitted without restrictions.

Sensitivity to augmentin and cephalosporines of some bacterial strains isolated from hospitalized patients.

The study allowed the determination of the degree of antibacterial efficiency of three antimicrobial agents belonging to the betalactamine family namely cefuroxime (IInd generation), ceftazidime (IIIrd generation) and augmentin. Likewise the relationship bacterial species-antibiotic could be established. It was found that the pathogenic staphylococcus strains were very sensitive to cefuroxime (92.1%) and equally sensitive to ceftazidime and augmentin (61.0%). The enterococci were 100% sensitive to augmentin and 100% resistant to both cephalosporines. The enterobacteriaceae presented a higher percentage of sensitive strains to cephalosporines than to augmentin 89.6% of the E. coli strains were sensitive to ceftazidime, 77.9% to cefuroxime and 27.3% to augmentin. Klebsiella was sensitive in 68.2%, 45.14% and 13.6% of the cases to ceftazidime, cefuroxime and respectively augmentin. Proteus presented 64.7% strains sensitive to ceftazidime, 35.3% sensitive to cefuroxime and 29.3% sensitive to augmentin. All the enterobacter strains proved resistant to the three antibiotics studied.

[Fibrinolysis during pregnancy. The pre- and postpartal changes]. / Fibrinoliza în cursul sarcinii. Modificari pre si post partum.

Our previous research as well as data in literature (Yuasas, Ishizawa M.--1992) emphasised increased plasma fibrinolytic activity (PFA) in women during labor. Starting from these data we have tried to observe plasma fibrinolytic activity studied through euglobulin lysis time (ELT) in women during pregnancy and after delivery. We studied 25 healthy pregnant women aged between 18 and 30 years which were tested in the seventh month, during labour and at 48 hours after delivery. Blood samples were taken from the antecubital vein by venous puncture. The study showed an increased PFA (shortened ELT) only during labor; in the seventh month and at 48 hours after delivery ELT had almost the same values.

[The behavior of the fibrinolytic system during long-term orthopedic immobilization]. / Comportamentul sistemului fibrinolitic în imobilizarea ortopedica de durata.

Our previous experimental studies on rats motionless for 7 to 60 days in special devices limiting their movements revealed a significantly increased activity of the fibrinolytic system (Groza, Artino) due to the "detention stress" rather then to the immobilization. Starting from these studies we have tried to observe the behaviour of the fibrinolytic system during long-term orthopedic immobilization (7-28 days) on patients having different injuries of the lower limb and submitted to orthopedic therapy (with or without osteosynthesis) to which an anticoagulant preventive treatment was added (heparin or low-molecular-weight substitutes such as Clivarine, Fraxiparine). We studied on 23 patients (11 male and 12 female) motionless for 14, 21, 28 days the plasma fibrinolytic activity (PFA) through euglobulin lysis time (ELT). Clinical investigation revealed that PFA did not change significantly during long-term orthopedic immobilization regardless of the duration of immobilization (14,21,28 days). Rosenfeld et al. (1994) described in healthy volunteers on bedrest for 36 hours an increase of PFA beginning at 24 hours of immobilization, this variation being capable of preventing stasis effects. Our results suggest that preventive anticoagulant therapy properly given during immobilization prevents thromboembolic events.

[The effect of continuous illumination and an inverse rhythm (light-darkness) on fibrinolysis]. / Efectul iluminarii continue si a ritmului inversat (lumina-întuneric) asupra fibrinolizei.

The studies of chronobiology on biological phenomena revealed the existence of a human internal mechanism ("biological clock") which controls biological events according to each function of the body. Most of the programmed and genetically fixed rhythms can be changed and synchronized by external factors. Starting from these data and from our previous studies which emphasised an intradian rhythm of the proteolytic blood coagulation and fibrinolytic systems we observed the behaviour of the fibrinolytic system in modified environmental conditions (continuous illumination and inversed day-night rhythm). Our experiments were performed on 180 Wistar rats both male and female, submitted to continuous illumination and inversed rhythm for 1, 3 and 5 weeks. We studied plasma fibrinolytic activity (PFA) through euglobulin lysis time (ELT) at three different moments of the day: 8:30, 18:30 and 8:30 the next day. The study revealed intradian variations of PFA regardless of the type and time of submission. Thus: continuous illumination for 1, 3, 5 weeks determined a decrease of PFA (prolonged ELT) during the second part of the day, less important at 5 weeks. Inversed day-night rhythm for 1 and 3 weeks determined the same intradian behaviour of PFA but less important than continuous illumination. PFA variations in our experimental conditions suggest an alteration of its biological rhythm.

Prodromal angina reduces infarcted mass less in interventionally reperfused than in thrombolysed myocardial infarction.

UNLABELLED: There is a lot of evidence that angina during the 24-48 h before a reperfused myocardial infarction improves the evolution of the patients. However, there are studies that failed to demonstrate this protective effect of preinfarction angina in an interventional reperfusion setting. OBJECTIVE: To compare the effect of preinfarction angina (PIA) on inhospital evolution of thrombolysis vs. interventionally reperfused acute myocardial infarction (AMI). MATERIAL AND METHOD: There were prospectively studied 133 consecutive AMI patients, eligible for reperfusion (thrombolysis or interventional). History of PIA under 48 hours was obtained. Evolution of AMI was evaluated considering the following end-points: the ratio between the number of ECG leads with final pathologic Q wave and the number of leads with initial ST elevation, CK-MB values, separate and composite incidence of death, heart failure, shock and incidence of serious arrhythmia (sustained VT or ventricular fibrillation). RESULTS: ECG ratio was lower in patients with PIA (0.511 +/- 0.281 vs. 0.646 +/- 0.274, p=0.02) in thrombolysed patients, but it was higher in interventionally reperfused patients (0.740 +/- 0.418 vs. 0.554 +/- 0.295 p=0.11). CK-MB values were lowered by PIA in thrombolysed AMI (122 +/- 74 vs. 190 +/- 89, p=0.0003), but they were not in the interventional group. Clinical end-points were slightly less frequent in patients with PIA, in both reperfusion groups, but not statistically significant. Major arrhythmia occurred less frequently in interventionally reperfused patients with PIA (9.5% vs. 31.6%, p=0.12). CONCLUSION: Preinfarction angina under 48 hours significantly reduces infarcted mass (measured by ECG and enzymes) in thrombolysed patients, but not in the interventional group. However, PIA reduced arrhythmic end-point in interventional setting.