[Primary renal marginal zone B lymphoma]. / L'image du mois. Lymphome B primitif de la zone marginale rénale.

Primary renal marginal zone B lymphoma is extremely rare. The renal involvement by the lymphoma is most often a manifestation of a disseminated disease. We report the case of a 53-year-old patient who presented lower back pain and kidney failure. The renal biopsy showed a marginal zone B lymphoma type MALT and the PET scan showed bilateral renal involvement. A treatment based on rituximab combined with chemotherapy (cyclophosphamide, prednisone and oncovin) was started with good outcome.

Le lymphome B de la zone marginale rénale comme lésion primitive est extrêmement rare car l'atteinte rénale est le plus souvent une manifestation de la maladie disséminée. Nous rapportons le cas d'un patient âgé de 53 ans présentant des lombalgies chroniques avec insuffisance rénale. La biopsie rénale était en faveur d'un lymphome B de la zone marginale type MALT et la tomographie par émission de positons a objectivé une atteinte rénale bilatérale. Un traitement à base de rituximab couplé à une chimiothérapie (cyclophosphamide, prednisone et oncovin) a été démarré avec une bonne évolution.

Falling through the cracks. A thematic evaluation of unmet needs of adult survivors of childhood cancers.

OBJECTIVE: The population of adult survivors of childhood cancers (ASCCs) is growing, resulting in unique long-term challenges. This study explored experiences of perceived unmet ASCC survivorship needs. METHODS: We invited ASCCs to complete surveys sent through the cancer registry. Four open-ended questions allowed participants to write in comments. We analyzed responses to these open-ended questions thematically, employing a process of constant comparison. RESULTS: Our sample included 94 ASCCs who completed open-ended questions (61 female; aged 20-78 years, mean age = 34.47, SD = 11.84, mean = 23.27 years post diagnosis). Identified themes included (1) overlooked experiences of distress; (2) lack of counseling: system, patient, and family barriers; (3) difficulty negotiating future life milestones exacerbated by lack of knowledge; and (4) dissatisfaction with service provision: past and present. Prevalent issues identified by participants included lack of supportive care to address needs, distress due to missed developmental milestones as a result of cancer, lack of knowledge about late-term and long-term effects of cancer treatment, and concern over absence of organized long-term follow-up. CONCLUSIONS: Adult survivors of childhood cancers continue to experience unmet needs during their cancer diagnosis, treatment, and long into survivorship due to the treatment for cancer and ongoing side effects. Solutions could focus on addressing the needs of survivors to bridge system gaps and barriers. Specifically, there is a need to improve psychological interventions and transitions from pediatric to adult-care facilities.

The SAGES Fundamental Use of Surgical Energy program (FUSE): history, development, and purpose.

BACKGROUND: Adverse events due to energy device use in surgical operating rooms are a daily occurrence. These occur at a rate of approximately 1-2 per 1000 operations. Hundreds of operating room fires occur each year in the United States, some causing severe injury and even mortality. The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) therefore created the first comprehensive educational curriculum on the safe use of surgical energy devices, called Fundamental Use of Surgical Energy (FUSE). This paper describes the history, development, and purpose of this important training program for all members of the operating room team. METHODS: The databases of SAGES and the FUSE committee as well as personal photographs and documents of members of the FUSE task force were used to establish a brief history of the FUSE program from its inception to its current status. RESULTS: The authors were able to detail all aspects of the history, development, and national as well as global implementation of the third SAGES Fundamentals Program FUSE. CONCLUSIONS: The written documentation of the making of FUSE is an important contribution to the history and mission of SAGES and allows the reader to understand the idea, concept, realization, and implementation of the only free online educational tool for physicians on energy devices available today. FUSE is the culmination of the SAGES efforts to recognize gaps in patient safety and develop state-of-the-art educational programs to address those gaps. It is the goal of the FUSE task force to ensure that general FUSE implementation becomes multinational, involving as many countries as possible.

Histonedeacetylase 1 mRNA has elevated expression in clinical specimen of bladder cancer.

OBJECTIVE: HDACs are among transcriptional regulatory elements that regulate key features of proliferation and differentiation in all cell types including cancerous. They may also interfere in such stages of cancer development as migration, invasion, multi-drug resistance and angiogenesis. Proven information about HDAC1 role in development of bladder cancer is limited only to cell lines in vitro. The lack of a comprehensive clinical in vivo study led us to evaluate HDAC1 expression in human clinical specimens. METHODS: We analyzed a large group of bladder cancer patients. The presence of hHDAC1 mRNAs were tracked using specific HDAC1 primers in cancer samples and the quantity of HDAC1 transcripts were quantified using real time qPCR method and was compared to those of normal bladder samples from healthy patients. RESULTS: HDAC1 mRNA expression was significantly elevated in Bladder cancer specimens. To our knowledge, this result is the first, showing an elevation in vivo in HDAC1 mRNA levels in clinically cancerous tissue of patients with bladder cancer. CONCLUSIONS: We conclude that hHDAC1 overexpression might be implicated in bladder cancer tumorigenesis and that the over-expressed HDAC1 mRNA might be a potential diagnostic marker and, a target for treatment of bladder cancer using HDACi-drugs in future (Tab. 2, Fig. 2, Ref. 30).

Systematic review of e-learning for surgical training.

BACKGROUND: Internet and software-based platforms (e-learning) have gained popularity as teaching tools in medical education. Despite widespread use, there is limited evidence to support their effectiveness for surgical training. This study sought to evaluate the effectiveness of e-learning as a teaching tool compared with no intervention and other methods of surgical training. METHODS: A systematic literature search of bibliographical databases was performed up to August 2015. Studies were included if they were RCTs assessing the effectiveness of an e-learning platform for teaching any surgical skill, compared with no intervention or another method of training. RESULTS: From 4704 studies screened, 87 were included with 7871 participants enrolled, comprising medical students (52 studies), trainees (51 studies), qualified surgeons (2 studies) and nurses (6 studies). E-learning tools were used for teaching cognitive (71 studies), psychomotor (36 studies) and non-technical (8 studies) skills. Tool features included multimedia (84 studies), interactive learning (60 studies), feedback (27 studies), assessment (26 studies), virtual patients (22 studies), virtual reality environment (11 studies), spaced education (7 studies), community discussions (2 studies) and gaming (2 studies). Overall, e-learning showed either greater or similar effectiveness compared with both no intervention (29 and 4 studies respectively) and non-e-learning interventions (29 and 22 studies respectively). CONCLUSION: Despite significant heterogeneity amongst platforms, e-learning is at least as effective as other methods of training.

4977-bp mitochondrial DNA deletion in infertile patients with varicocele.

Varicocele is the abnormal inflexion and distension of veins of the pampiniform plexus within spermatic cord and is one of the amendable causes of male infertility. It can increase reactive oxygen species (ROS) production in semen and cause oxidative stress. The purpose of this study was to analyse spermatozoa mtDNA 4977-bp deletion in infertile men with varicocele. To detect 4977-bp deletion in spermatozoa mtDNA, semen samples of 60 infertile patients with clinical varicocele and 90 normal men from northern Iran were prepared. After extraction of spermatozoa total DNA, Gap polymerase chain reaction (Gap PCR) was performed. 4977-bp deletion was observed in 81.66% of patients with varicocele, while approximately 15.55% of controls had this deletion. As spermatozoa from patients with varicocele had a high frequency of occurrence of 4977-bp deletion in mtDNA [OR = 24.18, 95% confidence interval (CI) = 10.15-57.57, P < 0.0001], varicocele may induce mtDNA deletion in spermatozoa and cause infertility in north Iranian men. However, to determine the relation between sperm mtDNA 4977-bp deletion and varicocele-induced infertility, larger population-based studies are needed. It is concluded that there is an association between sperm mtDNA 4977-bp deletion and varicocele-induced infertility in the population studied.

Silage effluent management: a review.

Silage effluent is a potent wastewater that can be produced when ensiling crops that have a high moisture content (MC). Silage effluent can cause fish-kills and eutrophication due to its high biochemical oxygen demand (BOD) and nutrient content, respectively. It has a high acidity (pH ≈ 3.5-5) making it corrosive to steel and damaging to concrete, which makes handling, storage and disposal a challenge. Although being recognized as a concentrated wastewater, most research has focused on preventing its production. Despite noted imprecision in effluent production models-and therefore limited ability to predict when effluent will flow-there has been little research aimed at identifying effective reactive management options, such as containment and natural treatment systems. Increasing climate variability and intensifying livestock agriculture are issues that will place a greater importance on developing comprehensive, multi-layered management strategies that include both preventative and reactive measures. This paper reviews important factors governing the production of effluent, approaches to minimize effluent flows as well as treatment and disposal options. The challenges of managing silage effluent are reviewed in the context of its chemical constituents. A multi-faceted approach should be utilized to minimize environmental risks associated with silage effluent. This includes: (i) managing crop moisture content prior to ensiling to reduce effluent production, (ii) ensuring the integrity of silos and effluent storages, and (iii) establishing infrastructure for effluent treatment and disposal. A more thorough investigation of constructed wetlands and vegetated infiltration areas for treating dilute silage effluent is needed. In particular, there should be efforts to improve natural treatment system design criteria by identifying pre-treatment processes and appropriate effluent loading rates. There is also a need for research aimed at understanding the effects of repeated land application of effluent on soil quality and crop yields, as spreading is a common disposal practice.

[Use of murine models for the study of obstructive sleep apnea syndrome in Down syndrome]. / Utilisation des modèles murins pour l'étude du syndrome d'apnées obstructives du sommeil dans le syndrome de Down.

Down syndrome (DS), or trisomy 21, is a genetic disorder caused by the presence of an extra copy of chromosome 21, leading to various characteristic physical features as well as developmental and cognitive delays. Obstructive sleep apnea syndrome (OSAS) is a common disorder in both adult and pediatric patients with DS. Several characteristics of DS may contribute to the development or worsening of OSAS. Numerous murine models of DS exist. A number of studies have explored apneas and the risk of upper airway obstruction in these models, but up until now, only in adulthood.

Laparoscopic unroofing of symptomatic kidney cysts. A single center experience.

AIM: This study was aimed to evaluate success and complications of laparoscopic transperitoneal renal cyst unroofing and assess its long-term results at our center. METHODS: From October 2008 till April 2012, 23 patients (14 male and 9 female) with a mean age of 53.6 years (range 32-70), underwent transperitoneal laparoscopic renal cyst unroofing at our center. None of the patients, had history of ipsilateral kidney surgery. Complication and outcomes were evaluated. Symptom resolving and disappearance of the cyst or decreasing its size to less than 1/3 of its primary size in radiographies was considered as success. RESULTS: Unroofing was achieved in 100% of patients. Mean operative time was 36.6 minutes (range 25 to 60) and mean hospital stay was 3 days (range 2 to 8). No open conversions were necessary during procedure but one patient underwent open exploration hours after laparoscopy because of need to complete hemostasis. Symptomatic and radiologic success was achieved in 91.3% of patients, with a mean follow-up of 15 months (range 3 to 24). One patient developed a recurrence. One ureter stricture revealed in follow up period which needed open uretero-ureterostomy. No visceral complication occurred. CONCLUSION: Laparoscopic transperitoneal ureterolithotomy is an effective treatment option for skilled surgeons but care must be taken because complications may occur.

A cross-sectional study of the relationship between serum sexual hormone levels and internal derangement of temporomandibular joint.

Temporomandibular disorders (TMD) are defined as clinical conditions that involve the masticatory muscles, temporomandibular joint (TMJ) or both. The aim of this study was to evaluate serum 17ß-oestradiol and progesterone levels in menstruating women affected by internal derangement of the TMJ. A total of 142 women (mean age 30·2 ± 6·7) who referred to medical diagnostic laboratory of Iranian Academic Centre for Education, Culture and Research (ACECR), Mashhad Branch, were enrolled during 2007 and 2008. Forty-seven individuals had disc displacement with reduction (Group IIa) according to Research Diagnostic Criteria (RDC)/TMD Axis I diagnosis. Radioimmunoassay was used for the detection of serum 17ß-oestradiol and progesterone levels in all 142 subjects. The mean progesterone level was significantly higher in control group (11·6 ± 10·4 ng mL(-1) ) compared to women with TMD (8·4 ± 6·8 ng mL(-1) , P = 0·03). No significant difference was found in two groups regarding 17ß-oestradiol level. Lower progesterone level in women with TMD can suggest the more important role of this hormone in the development of the disorder.

Sensitivity and specificity of serum FSH and testis size in predicting the existence of spermatogenesis in azoospermic infertile men.

The objective of research was to determine the sensitivity, specificity and positive predictive value of serum follicle stimulating hormone and testis size in predicting spermatogenesis in infertile men with azoospermia. In a prospective study, azoospermic men were studied. Serum follicle stimulating hormone measurement and scrotal sac ultrasonography were performed. Bilateral testis biopsy was performed for all of these patients. The sensitivity and specificity of follicle stimulating hormone and testis size were determined to predict the existence of different cellular steps of spermatogenesis. Of eighty infertile men who recruited into the study, 53 patients did not represent any different cellular steps of spermatogenesis, while 27 of them had various steps of such differentiation. Among the 53 patients without cellular steps of spermatogenesis in the biopsy, 41 were predicted to be azoospermic based on their serum follicle stimulating hormone levels (77.3% sensitivity), and of 27 patients with various cellular steps of spermatogenesis in the biopsy, 23 were predicted to have spermatozoa according to the follicle stimulating hormone level (85.2%) specificity. It is suggested that combination of these two indicators can substitute the invasive testis biopsy for predicting the existence of spermatozoa in infertile men with azoospermia.

Relationships between dairy slurry total solids, gas emissions, and surface crusts.

Livestock slurry storages are sources of methane (CH4), nitrous oxide (NO2), and ammonia (NH3) emissions. Total solids (TS) content is an indicator of substrate availability for CH4 and N2O production and NH3 emissions and is related to crust formation, which can affect these gas emissions. The effect of TS on these emissions from pilot-scale slurry storages was quantified from 20 May through 16 Nov. 2010 in Nova Scotia, Canada. Emissions from six dairy slurries with TS ranging from 0.3 to 9.5% were continuously measured using flow-through steady-state chambers. Methane emissions modeled using the USEPA methodology were compared with measured data focusing on emissions when empty storages were filled, and retention times were >30 d with undegraded volatile solids (VS) remaining in the system considered available for CH4 production (VS carry-over). Surface crusts formed on all the slurries. Only the slurries with TS of 3.2 and 5.8% were covered completely for ∼3 mo. Nitrous oxide contributed <5% of total greenhouse gas emissions for all TS levels. Ammonia and CH4 emissions increased linearly with TS despite variable crusting, suggesting substrate availability for gas production was more important than crust formation in regulating emissions over long-term storage. Modeled CH4 emissions were substantially higher than measured data in the first month, and accounting for this could improve overall model performance. Carried-over VS were a CH4 source in months 2 through 6. The results of this study suggest that substrate availability regulates emissions over long-term storage and that modifying the USEPA model to better describe carbon cycling is warranted.

Vector ecology and susceptibility in a malaria-endemic focus in southern Islamic Republic of Iran.

This study aimed to carry out a malaria situation analysis, species composition and susceptibility levels of the main malaria vector, Anopheles stephensi, to different insecticides in Bashagard. A longitudinal survey was conducted in 2 randomly selected villages in Bashagard. Malaria vectors were sampled by dipping method for the larvae and hand catch, night-biting catch, total catch, and shelter pit collection for the adults. Standard WHO susceptibility tests were used for a variety of insecticides on F1 progeny of An. stephensi reared from wild-caught females. In total, 693 adult anopheline mosquitoes and 839 third and fourth-instar larvae were collected and identified. They comprised 7 species; the most abundant adult and larvae anopheline mosquito was An. dthali (40.7% and 30.5% respectively). An. culicifacies (24.2%) and An. stephensi (16.7%) were the next most common species for adult mosquitoes. An. stephensi was fully susceptible to malathion and pyrethroid insecticides but resistant to DDT and tolerant to dieldrin.

Jejunal intussusception on jejunostomy tube: A rare cause of occlusion in adults.

INTRODUCTION: Acute intestinal intussusception (AI) in adults secondary to jejunostomy is a rare complication and a surgical emergency requiring early diagnosis and treatment. PRESENTATION OF CASE: We report the case of a 44-year-old patient, without medical history, who presented dysphagia after caustic ingestion. The patient underwent a Witzel feeding jejunostomy. The evolution was marked by the installation of abdominal distension with vomiting and alteration of the general state, the diagnosis of an intussusception in the jejunostomy tube was made in the abdominal CT scan, which required a surgical intervention, and reduction of intussusception, with simple after effects. DISCUSSION: Acute intestinal intussusception (IIA) secondary to jejunostomy tube placement is a rare abdominal emergency. It manifests with signs of upper gastrointestinal obstruction. Diagnosis is based on abdominal imaging by ultrasound or CT scan. Treatment is most often surgical (Chavrier et al., 1992) [1]. CONCLUSION: We present a very rare example of acute intestinal intussusception in adults, complicating jejunostomy, with non-specific clinical signs, which needed an early radiological diagnosis for adequate management.

Knowledge, attitudes and practices regarding malaria control in an endemic area of southern Iran.

Iran is in the malaria pre-elimination stage. In this situation community based strategies are important for malaria control. In order to intensify elimination activities we need to have a better understanding of the knowledge, attitudes and practices (KAP) of malaria prevention in the community. We carried out a KAP study in one malaria endemic district in southern Iran in 2009 using a structured questionnaire. Five villages with indigenous malaria cases during the previous year and a high potential for anopheline mosquito breeding were selected. All the households in each village were visited and the head of the household or other responsible adult was interviewed. Data were analyzed using SPSS 11.5. A total of 494 respondents from the five villages participated. More than 33% of people in the study area were living in sheds with poor facilities. The illiteracy level of the studied population was high (44.2%) and significantly affected the knowledge and practices of the respondents about malaria control (p<0.05). Descriptive analysis showed significant differences between sex, job and history of malaria infection of the respondents and their knowledge and practices about malaria control (p<0.05). Knowledge of the respondents about the route of transmission in malaria was good; 72.1% knew mosquitoes were the vector. Most people knew at least one symptom of the disease. The practices of respondents were 59.5% for bednet use and 9.3% for screening windows. The knowledge, attitudes and practices of respondents in this survey about malaria control were good in some cases, but in general needed to be improved with educational programs.

Treatment of vitiligo: advantages and disadvantages, indications for use and outcomes.

Topical coticosteroids perform better than placebo and topical PUVAsol in repigmenting vitiliginous skin. Topical corticosteroids compare in efficacy to topical calcineurin inhibitors, but produce greater adverse events. Calcineurin inhibitors are more effective in twice daily dosing and may be used on facial areas and in children. Vitamin D analogues are not as effective as topical corticosteroids as monotherapy, but can increase effectiveness of topical steroids in combination therapy. There are no randomized trials examining pseudocatalase monotherapy. With the advent of NB-UVB, oral PUVA is less used in the treatment of generalized vitiligo. Topical PUVA may be effectively used for the treatment of localized vitiligo. NB-UVB has less side effects and can be used in children. Excimer is also as effective as NB-UVB and may be used in the treatment of localized vitiligo. NB-UVB and excimer combination therapies show some greater effectiveness in repigmentation in vitiligo. All patient undergoing surgical repigmentation therapies, including split-thickness skin grafting, autologous epidermal non-cultured grafts, suction blistering and punch grafting require careful patient selection. Those that have localized, stable vitiligo refractory to other treatments are good surgical candidates. Split thickness skin grafting has the best cosmetic results, with the least side effects. However, scarring of donor and recipient sites is common to split thickness skin grafting. Depigmenting treatments include MBEH, 4-MP, and the Q-switched ruby laser. MBEH and 4-MP may have similar efficacy, but MBEH has a greater side effect profile than 4-MP. Also, visible depigmentation occurs sooner with MBEH as compared with 4-MP, despite both of them requiring long treatment periods. Relapse with both treatments may occur. The Q-switched ruby laser does seem to have the advantage of inducing depigmentation more quickly, but with more discomfort.

[Ultrasound imaging of Dupuytren's contracture]. / Apport de l'échographie dans la maladie de Dupuytren.

Dupuytren's contracture is characterized by two underlying lesions, nodules and cords. These involve the palmar fascia at the distal palmar crease, especially at the level of the third and fourth rays with progressive disabling finger contracture. The superficial palmar aponeurosis appears as a thin echogenic lamellar structure overlying the flexor tendons. The demonstration of hypoechoic bands adhering to the marging of the flexor tendons and deep surface of the dermis appears to be pathognomonic of the disease. Compared to tendons, early nodules are hypoechoic and typically hypervascular whereas older nodules are iso- to hyperechoic, without hypervascular Doppler signal. Ultrasound can sometimes demonstrate arterial encasement by fibrous or scarring tissue. Ultrasound therefore is very useful for the differential diagnosis of pathologies involving the palmar surface of the hand, for the early detection of Dupuytren's contracture, and for the detection of complication, especially vascular. These data may have an impact on management.

[Ultrasound evaluation of the greater occipital nerve]. / Démonstration échographique du nerf grand occipital.

PURPOSE: To demonstrate the appearance of the greater occipital nerve on ultrasound. MATERIALS AND METHODS: The greater occipital nerve was evaluated in 21 patients (9 males-12 females; mean age=52 years, range: 20-71; mean weight=74.5kg, range: 50-125) at the time of carotid duplex ultrasound. All examinations were preformed by the same sonographer using a single ultrasound unit. The anatomical landmark used to locate the nerve was the inferior obliquus capitis muscle. MRI and CT images were available in two cases and anatomical cadaver sections were also available. RESULTS: The greater occipital nerve could be identified at the level of the inferior obliquus capitis muscle in 90.47% (19/21) of cases, even in obese patients. In three slender patients (14.38%), the nerve could be identified at the level of the trapezius aponeurosis and next to the V3 segment of the vertebral artery. The mean anteroposterior diameter of the nerve at the level of the inferior obliquus capitis muscle was 1.65mm (range: 1.14mm-2.8mm). CONCLUSION: The greater occipital nerve could be detected at the level of its first genu by ultrasound in 90% of patients, even in obese patients.