[Superior mesenteric vein aneurysm, a rare case]. / Anévrisme de la veine mésentérique supérieure, un cas rare.

We report the case of a 67-year-old man presenting with abdominal pain due to acute thrombosis of an aneurysm of the superior mesenteric vein. It was treated conservatively by a combination of anticoagulation and monitoring by serial imaging after multidisciplinary discussion. With more than one year of follow-up, no aneurysm growth was observed. Mesenteric vein aneurysm is a rare vascular dilatation, which was first described in 1982 and since then 17 cases have been reported. There are congenital and acquired hypotheses regarding their etiology. If asymptomatic, conservative management is recommended. Monitoring is important because of potential complications (thrombosis, portal hypertension, adjacent organs compression and rupture of aneurysm), which may mandate surgical management.

Cet article rapporte un cas rare d'anévrisme thrombosé de la veine mésentérique supérieure chez un homme de 67 ans, diag nostiqué à la suite de douleurs abdominales aspécifiques. Après discussion multidisciplinaire, une anticoagulation et une surveillance par imagerie sont effectuées. Avec plus d'une année de recul, l'anévrisme reste stable. L'anévrisme de la veine mésentérique supérieure est une pathologie exceptionnelle décrite 17 fois dans la littérature depuis 1982. Il existe des hypothèses étiologiques congénitales et acquises. En l'absence de symptôme, un traitement conservateur et une surveillance sont recommandés en raison de complications potentielles (thrombose, hypertension portale, compression d'organes adjacents et rupture d'anévrisme). Une prise en charge chirurgicale est discutée en cas de manifestations cliniques.

Diffusion of small molecules into medaka embryos improved by electroporation.

BACKGROUND: Diffusion of small molecules into fish embryos is essential for many experimental procedures in developmental biology and toxicology. Since we observed a weak uptake of lithium into medaka eggs we started a detailed analysis of its diffusion properties using small fluorescent molecules. RESULTS: Contrary to our expectations, not the rigid outer chorion but instead membrane systems surrounding the embryo/yolk turned out to be the limiting factor for diffusion into medaka eggs. The consequence is a bi-phasic uptake of small molecules first reaching the pervitelline space with a diffusion half-time in the range of a few minutes. This is followed by a slow second phase (half-time in the range of several hours) during which accumulation in the embryo/yolk takes place. Treatment with detergents improved the uptake, but strongly affected the internal distribution of the molecules. Testing electroporation we could establish conditions to overcome the diffusion barrier. Applying this method to lithium chloride we observed anterior truncations in medaka embryos in agreement with its proposed activation of Wnt signalling. CONCLUSIONS: The diffusion of small molecules into medaka embryos is slow, caused by membrane systems underneath the chorion. These results have important implications for pharmacologic/toxicologic techniques like the fish embryo test, which therefore require extended incubation times in order to reach sufficient concentrations in the embryos.

Diagnostic accuracy of point-of-care testing for acute coronary syndromes, heart failure and thromboembolic events in primary care: a cluster-randomised controlled trial.

BACKGROUND: Evidence of the clinical benefit of 3-in-1 point-of-care testing (POCT) for cardiac troponin T (cTnT), N-terminal pro-brain natriuretic peptide (NT-proBNP) and D-dimer in cardiovascular risk stratification at primary care level for diagnosing acute coronary syndromes (ACS), heart failure (HF) and thromboembolic events (TE) is very limited. The aim of this study is to analyse the diagnostic accuracy of POCT in primary care. METHODS: Prospective multicentre controlled trial cluster-randomised to POCT-assisted diagnosis and conventional diagnosis (controls). Men and women presenting in 68 primary care practices in Zurich County (Switzerland) with chest pain or symptoms of dyspnoea or TE were consecutively included after baseline consultation and working diagnosis. A follow-up visit including confirmed diagnosis was performed to determine the accuracy of the working diagnosis, and comparison of working diagnosis accuracy between the two groups. RESULTS: The 218 POCT patients and 151 conventional diagnosis controls were mostly similar in characteristics, symptoms and pre-existing diagnoses, but differed in working diagnosis frequencies. However, the follow-up visit showed no statistical intergroup difference in confirmed diagnosis frequencies. Working diagnoses overall were significantly more correct in the POCT group (75.7% vs 59.6%, p = 0.002), as were the working diagnoses of ACS/HF/TE (69.8% vs 45.2%, p = 0.002). All three biomarker tests showed good sensitivity and specificity. CONCLUSION: POCT confers substantial benefit in primary care by correctly diagnosing significantly more patients. TRIAL REGISTRATION: DRKS: DRKS00000709.