A transiting giant planet with a temperature between 250 K and 430 K.

Of the over 400 known exoplanets, there are about 70 planets that transit their central star, a situation that permits the derivation of their basic parameters and facilitates investigations of their atmospheres. Some short-period planets, including the first terrestrial exoplanet (CoRoT-7b), have been discovered using a space mission designed to find smaller and more distant planets than can be seen from the ground. Here we report transit observations of CoRoT-9b, which orbits with a period of 95.274 days on a low eccentricity of 0.11 +/- 0.04 around a solar-like star. Its periastron distance of 0.36 astronomical units is by far the largest of all transiting planets, yielding a 'temperate' photospheric temperature estimated to be between 250 and 430 K. Unlike previously known transiting planets, the present size of CoRoT-9b should not have been affected by tidal heat dissipation processes. Indeed, the planet is found to be well described by standard evolution models with an inferred interior composition consistent with that of Jupiter and Saturn.

Oncologic outcomes, prognostic factor analysis and therapeutic algorithm evaluation of head and neck mucosal melanomas in France.

BACKGROUND: Head and neck mucosal melanoma (HNMM) is aggressive and rare, with a poor prognosis because of its high metastatic potential. The two main subtypes are sinonasal (sinonasal mucosal melanoma [SNMM]) and oral cavity (oral cavity mucosal melanoma [OCMM]). Consensual therapeutic guidelines considering the primary tumour site and tumour-node-metastasis (TNM) stage are not well established. MATERIAL & METHODS: Patients with HNMM from the prospective national French Rare Head and Neck Cancer Expert Network database between 2000 and 2017 were included. Clinical characteristics, treatment modalities, outcomes and prognostic factors were analysed. RESULTS: In total, 314 patients were included. The 5-year overall survival (OS) and progression-free survival (PFS) rates were 49.4% and 24.7%, respectively, in the surgery group; no long-term survivors were observed when surgery was not feasible. Moreover, even after surgery, a high recurrence rate was reported with a median PFS of 22 months. In multivariate analysis, Union for International Cancer Control (UICC) stage and tumour site correlated with PFS and OS. Postoperative radiotherapy (PORT) improved the PFS but not OS in patients with small (T3) SNMM and OCMM tumours. Nodal involvement was more frequent in patients with OCMM (p < 10-4), although, as in SNMM, it was not a significant prognostic predictor. CONCLUSION: Even early HNMM was associated with poor oncologic outcomes due to distant metastases despite surgical resection with clear margins. Lymph node metastases had no impact on the prognosis, suggesting treatment de-escalation in cervical node management. PORT might be useful for local control.

[Hemoglobin targets in anemic patients with chronic kidney disease treated with erythropoietin]. / Erythropoïétine et insuffisance rénale: jusqu'où ne pas aller?

PURPOSE: Erythropoietin is the treatment of the anaemia in chronic kidney disease. A target rate of haemoglobin higher than 11 g/dl was usually proposed, but recent recommendations stated that higher limit of haemoglobin was to be reached, with the aim to improve the quality of life of the patients and to reduce their risks of cardiovascular diseases. These objectives are to be revised, according to the results of recently published clinical trials. CURRENT KNOWLEDGE AND KEY POINTS: Patients treated to reach a high rate of haemoglobin (between 13 and 14,5 g/dl) have an improved quality of life, but a 30% higher mortality rate, compared to patients treated with a lower objective of haemoglobin rate (10-12 g/dl). Hypertension and vascular access thromboses were also more frequent in the patients with the highest haemoglobin rate. Two to three times more erythropoietin was necessary to reach the higher rate of haemoglobin. These results favour a target rate of haemoglobin not higher than 12 g/dl. A polemic followed the results of these clinical trials, mostly in the United States, questioning the way in which the higher limit had been fixed whereas precise data were unavailable. The role of pharmaceutical industry and of for profit dialysis centres was underlined. FUTURE PROSPECTS AND PROJECTS: The next step is now to explain if the excess in cardiovascular morbimortality is related to the haemoglobin rate or to a direct effect of the erythropoietin. Such an understanding is important, the more so as new erythropoiesis-stimulating agents are being developed.

[Management of cytomegalovirus infections in patients treated with immunosuppressive drugs for chronic inflammatory diseases]. / Prise en charge de l'infection à cytomégalovirus symptomatique chez les patients traités par immunosuppresseurs pour une maladie inflammatoire chronique.

INTRODUCTION: For patients with chronic inflammatory disease treated by immunosuppressive agents (for example: rheumatoid arthritis or systemic lupus erythematosus), there are no available guidelines in medical literature on the use of antiviral agents for the management of symptomatic cytomegalovirus (CMV) infection. EXEGESIS: A patient treated by methotrexate for a spondylarthritis presented a CMV infection manifested with persistent fever and pneumonia. CMV pp65 antigenemia was of 120 positive nuclei for 100,000 cells. Treatment with valganciclovir allowed a prompt recovery, while treatment by methotrexate was maintained. CONCLUSION: Symptomatic CMV infection evolution is unpredictable and potentially severe in patients with chronic inflammatory diseases receiving immunosuppressive agents. Although there is no data issued from clinical trials, the observation reported in this article and the publications of similar cases in the medical literature indicate that treatment with valganciclovir seems worth to be used in this context. Stopping immunosuppressive therapy does not seem mandatory.

[Hypokalaemia and paralysis: think about the thyroid]. / Hypokaliémie et paralysie: penser à la thyroïde.

Periodic hypokalemic paralysis can be of genetic origin or secondary to other causes of hypokalaemia. The thyreotoxic hypokalemic periodic paralysis (THPP) usually occurs among asian subjects. It is a diagnostic and therapeutic emergency which may lead to life-threatening complications due to hypokalaemia and muscle weakness. The potassium supplementation is followed by a complete recovery after a few hours. We underlined the interest of thyroid assays in patients having an acute muscular paralysis associated with hypokalaemia.

[Systemic corticosteroid treatment and risk of infectious diseases]. / Corticothérapie systémique et risque infectieux.

PURPOSE: It was shown that corticosteroids alter the inflammatory and immune responses. Many publications report on serious infections occurring in patients receiving corticosteroids or presenting with Cushing's syndrome. This information is synthesized in this article. CURRENT KNOWLEDGE AND KEY POINTS: The demonstration of the infectious risk associated with corticosteroids relies on observational data and on biological plausibility. However, this risk remains difficult to quantify, because of many confusing factors such as the patients' associated conditions and immunosuppressive treatments, and the highly variable dose and duration of the corticosteroid treatment. Taking into account the published data, the screening for a chronic infection seems licit among patients receiving a systemic corticosteroid treatment, in particular for those who will receive more than 10 mg of prednisone per day. FUTURE PROSPECTS: Although no clinical trials of prevention of infections in corticosteroid treated patients has been published, a strategy aiming at minimizing the infectious risk of corticosteroid treated patients is proposed, based on the analysis of the literature presented in this article.

[Is there an evidence-based management of idiopathic retroperitoneal fibrosis?]. / Peut-on proposer une prise en charge de la fibrose rétropéritonéale idiopathique validée par les données de la littérature?

BACKGROUND: Nowadays it is quite easy to diagnose idiopathic retroperitoneal fibrosis (IRF), particularly with the help of medical imaging. However there is no guideline about the treatment. PURPOSE: Looking for data about an evidence-based management. METHODS: Screening of the database Medline. Titles and abstracts of articles published between 01/01/1985 and 31/12/2004 have been read to identify clinical trials and series about more than ten patients. RESULTS: No record of any therapeutic trials has been found. Eight series in total, which included 177 patients, were identified. Two of the patients have been treated by an ureteral desobstruction only (endoscopy or nephrostomy), 45 by surgery (ureterolysis), 65 by corticotherapy and 64 both by surgery and steroids. For 38 patients, immunosuppressive drugs were combined with corticotherapy (azathioprine, cyclophosphamide or D-penicillamine). According to the authors, doses and duration of corticotherapy varied. Median follow-up lasted 56 months. The outcome is satisfactory in 73% for surgery alone, 86% for medical treatment alone and 73% for both. The association between steroids therapy and immunosuppressive drugs is efficient in 97% of the cases. No clear data about side effects was mentioned. DISCUSSION: Treatment of the IRF is still empirical, based on surgery and corticotherapy. There is no guideline about the treatment strategy. Although tamoxifen has been proposed, efficacy evidence is lacking. Prospective multicenter studies will help us to progress in the management of the IRF.

[Use of nitrates in hospitalised elderly patients aged 65 and over]. / Utilisation des dérivés nitrés chez les patients âgés de 65 ans et plus hospitalisés en médecine interne.

BACKGROUND: Nitrates are frequently prescribed drugs, although their indications are limited. We studied nitrates' prescription in elderly patients hospitalised in the internal medicine ward of a French teaching hospital. METHODS: Hospitalised patients aged 65 years and more and receiving nitrates in their usual treatment were identified prospectively. A standardised questionnaire was used during a structured medical interview conducted by the same physician for all patients. Informations regarding nitrates' prescription were studied according to the actual recommendations for their use: angina in patients with contraindication to betablockers, acute myocardial infarction and acute pulmonary oedema. RESULTS: Among 256 hospitalised elderly patients, 49 (19% [IC95%: 15-25]) were under nitrates therapy, because of either angina pectoris, heart failure or unknown reason. Cardiologists prescribed nitrates in accordance with guidelines significantly more frequently than non-cardiologists. Transdermal treatment was used in 69% of patients. DISCUSSION: In hospitalised patients aged 65 years and more who are prescribed nitrates in their usual treatment, at least one quarter have no recommended indication for its use. As almost one fifth of patients are receiving nitrates in their usual treatment, the medicoeconomic impact of these useless prescriptions could be significant. Nitrates prescribing can be optimized by following guidelines for their use, and restraining from prescribing the transdermal treatment which is more costly and without evidence-based clinical benefit compared to the oral route.

[Case report: Vasa previa diagnosis and management. How to prevent Benckiser's hemorrhage?]. / Cas clinique : diagnostic et prise en charge d'un vasa praevia. Comment prévenir l'hémorragie de Benckiser ?

Benckiser's haemorrhage is a serious obstetrical complication, following a vasa previa rupture. Incidence of vasa previa is estimated between 1/1150 and 1/5000 pregnancies. This case report illustrates the consequences of a suspected vasa previa rupture. There is no French recommendation of how to treat vasa previa. Different methods of prevention are described and examined thanks to a literature review.

Oral load of tyrosine or L-dopa and plasma levels of free and sulfoconjugated catecholamines in healthy men.

The levels of free and sulfoconjugated catecholamines were measured in the plasma of fasting, recumbent normal subjects before and after an oral load of the catecholamine precursors tyrosine or L-dopa. Basal values of sulfoconjugated catecholamines, measured in plasma samples diluted 1:100 were 7998 +/- 540 pg/ml for dopamine sulfate, 2938 +/- 281 pg/ml for norepinephrine sulfate, and 2958 +/- 288 pg/ml for epinephrine sulfate (n = 37 tests in 15 men); these basal values are higher than those reported previously. Neither free nor sulfoconjugated catecholamine concentrations were changed by a tyrosine load (100 mg/kg) that induced a doubling of the plasma tyrosine level or by a meal low in phenylalanine and tyrosine (but otherwise supplying constituents of normal nourishment) that induced a greater than 50% reduction in the plasma tyrosine concentration. After an oral load of L-dopa (125 mg) the following were observed. (1) An extremely large increase (greater than 100-fold) in dopamine sulfate levels was noted, an increase that was less marked in the same subjects given L-dopa (125 mg) plus the peripheral dopa-decarboxylase inhibitor carbidopa (12.5 mg); as expected, free dopamine concentration also was increased. (2) Neither free nor sulfoconjugated norepinephrine concentrations were altered. (3) Epinephrine sulfate but not free epinephrine concentration was increased (more than ten-fold) after L-dopa ingestion alone; this result was unexpected and has to be confirmed before considering its physiological meaning, if any.

Metabolic adverse reactions to diuretics. Clinical relevance to elderly patients.

There is a wide variety of diuretic-induced metabolic abnormalities of unequal severity. Renal failure can be caused by excessive sodium loss, or by certain drug combinations comprising, for instance, a nonsteroidal anti-inflammatory drug (NSAID) or an ACE inhibitor. Hyponatraemia is uncommon. It is encountered with thiazides, especially among women. A sodium level less than 120 mmol/L may result in neurological complications. Hypokalaemia is frequent and might increase the risk of cardiac arrhythmia. Hyperkalaemia induced by potassium-sparing diuretics is often combined with another contributive cause. Glucidic, lipidic and uric acid abnormalities are common, but their clinical effects are slight. They do not seem to worsen cardiovascular risks among elderly patients. Nevertheless, prescribing diuretics for elderly patients requires special precautions. Reducing the diuretic dose, as is now recommended for treating hypertension, seems to lessen adverse effects, and despite all the adverse reactions just mentioned, it has been proven that diuretics are beneficial in many diseases.

Pharmacokinetics of cibenzoline in patients with renal impairment.

Pharmacokinetic values of cibenzoline, a new, investigational, antiarrhythmic drug, were determined in 13 patients with varying degree of renal impairment, creatinine clearance range between 5 and 53 mL/min. Cibenzoline plasma levels were measured after direct intravenous injection of one single 1 mg/kg dose. The apparent volume of distribution of the drug (276 1) was similar to that reported in healthy subjects. Total body clearance decreased with creatinine clearance, and there was a close correlation between cibenzoline renal clearance and creatinine clearance (r = 0.956; P less than 0.001). Plasma elimination half-life was prolonged, with values ranging from 7:4 to 23.6 hours. This study showed that cibenzoline total body clearance correlated with the degree of renal impairment, and it is suggested that in patients with chronic renal failure dosage should be adjusted according to creatinine clearance values.

Clinical significance of tolerant strains of streptococci in adults with infective endocarditis.

OBJECTIVES: To compare the characteristics of patients with endocarditis due to tolerant and non-tolerant Streptococcus strains. PATIENTS AND METHODS: A retrospective nine-year study was conducted in a single tertiary-care hospital. The study included 24 cases of streptococcal endocarditis with known beta-lactam minimal inhibitory and bactericidal concentrations. RESULTS: Ten of the 24 patients concerned were infected with tolerant streptococcal strains, and 14 with non-tolerant strains. Bacterial tolerance was not associated with higher mortality or increased frequency of surgery. Fewer patients infected with tolerant than non-tolerant strains had serum bactericidal titers reaching success-predictive levels, and more of these experienced failure of initial antibiotic treatment and needed longer treatment. CONCLUSIONS: The results of this study strongly suggest that penicillin tolerance of the streptococci responsible for endocarditis has a clinical impact. Consequently, pending a larger prospective study addressing the problem of tolerance, it is clinically relevant to determine the minimal inhibitory and bactericidal penicillin concentrations for all streptococcal isolates causing endocarditis.

Reversible renal failure secondary to severe compensated aortic regurgitation.

Severe renal failure associated with proteinuria occurred in a 21-year patient, who had massive rheumatic aortic regurgitation. There was no sign of congestive heart failure or extra-cellular dehydration. Subacute bacterial endocarditis was ruled out by appropriate laboratory investigations. Prosthetic aortic valve replacement resulted in normalization of the renal function and marked reduction of proteinuria. Renal histology showed severe sclerotic endarteritis involving predominantly the large arteries, and membrano-proliferative-like glomerulopathy without immune deposits. The role of the massive aortic regurgitation in the production of renal failure and histologic alterations is suggested.

[Physiopathology of arterial hypertension in chronic hemodialysis patients]. / Physiopathologie de l'hypertension artérielle des hémodialysés chroniques.

The increase in total body sodium and hyperactivity of the renin-angiotensin system plays a major part in hypertension in patients underdoing chronic dialysis. After sodium depletion most patients become normotensive. Their hypertension seems to be due to sodium overload but it is favoured by insufficient inhibition of renin secretion. Some renin hypertensive, hypersecretion of renin is the main factor in these cases but its effect is aggravated by the sodium overload. Other factors may play a role as suggested by the studies of hypertensive patients after bilateral nephrectomy. However, their roles and mechanisms are unknown at present.

[Endocarditis due to staphylococcus aureus during cardiomyopathy]. / Endocardite à staphylocoque doré au dours d'une cardiomyopathie obstructive.

In a patient suffering from obstructive cardiomyopathy (IHSS), the onset of septicaemia due to staphylococus aureus was accompanied: 1. by the appearance of massive mitral incompetence and of cardiac failure; 2. by a marked reduction in the left intra-ventricular pressure gradient; 3. by acute reversible renal failure (interstitial nephritis); 4. by a glomerulonephritis with immune complexes deposits. After the septicaemia had been treated, replacement of the mitral valve by a disc prosthesis of Lillehei was carried out. Twenty months after the operation, the patient was completely asymptomatic, and catheterisation showed that the left intra-venticular pressure gradient had disappeared, as had the haemodynamic signs of cardiac failure.

[Plasma catecholamines, free and conjugated, in the hemodialyzed chronic renal failure patient]. / Catécholamines plasmatiques, libres et conjuguées, chez l'insuffisant rénal chronique hémodialysé.

Free, sulfo and glucuro-conjugated catecholamines (dopamine, noradrenaline and adrenaline) were measured to study their metabolism in 35 non-selected patients with chronic renal failure, and under hemodialysis for various periods of time. Our data demonstrate a statistically significant increase of free dopamine, and free noradrenaline concentration in these patients, while that of free adrenaline was not different from controls. However a careful scrutiny of 35 individual data suggests that sub-groups of patients with either high normal or low plasma free noradrenaline concentration could exist; this likely heterogeneity could be a good explanation for conflicting conclusions provided by previous reports. Suspecting that conjugated catecholamines might be altered in these patients, plasma sulfo and glucuro-conjugated amines were measured. We have found a predictable and highly significant increase of sulfo-conjugated catecholamines; glucuroconjugated dopamine and noradrenaline were unchanged, while glucuroconjugated adrenaline was significantly increased. The physiological meaning, if any, of these new observations on conjugated catecholamines cannot be assessed at the moment.

[Inflammatory fibroid polyps of the colon]. / Polypes fibro-inflammatoires du côlon.

Inflammatory fibroid polyp is an uncommon lesion involving the stomach, the small bowel and occasionally the colon. Inflammatory fibroid polyp is a large polypoid lesion arising from the submucosa. It has no malignant potential although extensive infiltration may occur. The main histological characteristics are diffuse inflammatory infiltrate with eosinophils and highly vascularized fibrocytic stroma. Immunohistochemistry is always positive for vimentine and negative for S 100 and desmin. We report four cases of inflammatory fibroid polyps, 3 of which mimicked carcinoma of the colon. Exploratory laparotomy and histopathological examination of the resected specimen were necessary to confirm definitive diagnosis. In the last case, diagnosis was established by histological examination of an endoscopically-removed colonic polyp.

[Diffuse recto-colic malacoplakia: association with cryptogenic colitis and remission following long-term antibiotic therapy]. / Malakoplakie recto-colique diffuse: association à une colite cryptogénétique et rémission après antibiothérapie prolongée.

Diffuse digestive malakoplakia appears exceptional. A case of rectocolic malakoplakia with multiple localisations is reported in a 22 year old man presenting with inflammatory bowel disease. The most prominent clinical features were deterioration of his general condition, fever, and rectal bleeding, with fistula. Endoscopy revealed pseudotumoral masses and multiple colorectal ulcerations. Diagnosis was based on histological examination of colorectal biopsies. Clinical and histological remission was obtained after colonic diversion associated with broad spectrum antibiotherapy. These findings raise the problem of the possible association between inflammatory bowel disease and malakoplakia. They also confirm that, as previously reported, favourable outcome in digestive malakoplakia is possible.

[Modifications of hemorheologic parameters in the course of hemodialysis in chronic renal insufficiency]. / Modifications de paramètres hémorhéologiques au cours de l'hémodialyse chez l'insuffisant rénal chronique.

The influence of haemodialysis (HD) was assessed in 72 patients, undergoing a thrice weekly routine HD for chronic renal failure (CRF). Some of them received human recombinant erythropoietin (Eprex). Measurements were performed before and after the HD session: the erythrocyte aggregation (EA) was carried out by a laser backscattering technique with determination of the aggregation time (AT) and of the dissociation thresholds. Plasma viscosity (PV) was evaluated in an automatic capillary viscometer. Fibrinogen (Fg) levels, haematological features (blood cell count), serum proteins, creatinine, and some other biochemical parameters, were also determined. Anaemia was a common feature. Our results compared to those of a control group, confirmed the erythrocyte hyperaggregation before HD which increased during HD. PV also elevated before HD, further increased after HD; the same finding was observed for Fg. Some of these results might be related to the haemoconcentration. Significant correlations were noted between AT and PV, AT and Fg with closer correlations after HD, suggesting a strong cohesion of RBC aggregates, which enhanced during HD. Correlations were highly significant between relative variations of AT and relative variations of PV, Fg, proteins and body weight, before and after HD. Special attention was given to the group of patients under long term treatment with Eprex compared to non-treated dialysed patients: no significant difference was found between both groups. Our results are in agreement with a blood and plasma viscosity syndrome due to increased EA and with a tendency, to thrombosis reported in those patients.