[Management of complicated Barrett's esophagus. Observational study carried out in a regional hospital]. / Prise en charge de l'œsophage de Barrett compliqué. Étude observationnelle réalisée dans un centre hospitalier régional.

The incidence of Barrett's esophagus, complication of gastroesophageal reflux disease, is rising in western countries. It is the same for esophageal adenocarcinoma, of which it is the main contributing factor. This retrospective study seeks to report the incidence of these pathologies observed in a regional hospital center and to describe their management. In 5 years, 354 Barrett's esophagus are detected and 34 of them are complicated by high-grade dysplasia or adenocarcinoma. Endoscopic resection is performed in 24 of these patients. The histological analysis of which leads to the conclusion of adenocarcinoma in 20 patients and high-grade dysplasia in the 14 others. The complications of endoscopic and surgical resections are detailed. Their frequency and severity remain low, comparable to data in the literature.

L'incidence de l'œsophage de Barrett, complication du reflux gastro-œsophagien, est en croissance dans les pays occidentaux. Il en est de même de l'adénocarcinome œsophagien dont il est le principal facteur favorisant. Cette étude rétrospective s'attache à rapporter l'incidence de ces pathologies, observées dans un centre hospitalier régional, et à détailler leur prise en charge. En 5 ans, 354 œsophages de Barrett sont détectés et 34 d'entre eux sont compliqués de dysplasie de haut grade ou d'adénocarcinome. Une résection endoscopique est réalisée chez 24 de ces malades. Les analyses histologiques permettent de conclure à un adénocarcinome chez 20 malades et une dysplasie de haut grade chez les 14 restants. Les complications des résections endoscopiques et chirurgicales sont détaillées. Leur fréquence et leur gravité restent faibles, comparables aux données de la littérature.

[Efficacy of macro-clips for perforations and fistulas following endoscopic or surgical procedures. Retrospective analysis of 25 consecutive cases]. / Les macro-clips utilisés dans la suture endoscopique des perforations et fistules compliquant des procédures chirurgicales et endoscopiques Résultats d'une étude monocentrique, rétrospective des 25 premiers cas.

OBJECTIVE: The aim of our retrospective study is to analyse the results of endoscopic macro-clips used for closing intestinal breaches in the real life. Post-endoscopic, spontaneous perforations and surgical fistulas are included. Our results are compared with principal published series. METHODS: Between 2010 and 2015, 25 consecutive patients underwent an endoscopic suture with macro-clips to seal a breach resulting from endoscopic perforation, surgical fistula, invasive medical procedure or spontaneous perforation. RESULTS: The endoscopic efficacy was immediate for all patients whose perforation was of endoscopic aetiology. None of them required surgery. Secondary complementary endoscopic treatment was only used in 6/25 patients. All of them had non-endoscopic aetiology for their perforation. The survival at 1 month was 84 % and at 3 months of 76 %. CONCLUSION: Our results confirm the high efficiency of macro-clips in the treatment of endoscopic breaches in a regional hospital center. The use of macro-clips seems less convincing for the closure of some postoperative fistula. The suture with macro-clips associated with endoscopic and medical treatments allowed to avoid surgical redo in some cases.

Objectifs : Le but de notre étude est d'analyser rétrospectivement les résultats obtenus en utilisant les macro-clips pour réaliser des sutures endoscopiques dans la vie réelle. Les perforations spontanées, postendoscopiques et post-chirurgicales sont incluses. Nos résultats sont comparés à ceux des principales séries publiées. Méthodes : Entre 2010 et 2015, 25 patients consécutifs ont bénéficié d'une suture endoscopique à l'aide de macro-clips utilisés pour fermer des larges brèches transmurales apparues après procédures endoscopiques, procédures chirurgicales ou invasives et, également, lors d'une perforation spontanée. Résultats : La fermeture endoscopique a été immédiate chez tous les patients dont la perforation avait pour origine une procédure endoscopique. Aucun de ces patients n'a requis d'intervention chirurgicale. Un second traitement endoscopique, complémentaire, a été réalisé chez 6/25 patients pour lesquels l'origine de la perforation n'était pas endoscopique. La survie globale à 1 mois était de 84 % et à 3 mois de 76 %. Conclusion : Nos résultats confirment l'efficacité remarquable des macro-clips dans le traitement des perforations endoscopiques rencontrées dans un centre hospitalier régional. Leurs résultats sont moins convaincants lorsqu'ils sont utilisés dans la fermeture des fistules post-chirurgicales. Ces macro-clips, utilisés dans une stratégie associant des traitements médicaux, radiologiques et endoscopiques complémentaires, permettent de réduire le recours à la reprise chirurgicale à de très rares cas.

[Incidence and treatment of complications observed after endoscopic mucosal resection of superficial digestive tumours in a regional general hospital]. / Incidence et traitement des complications observées après résections endoscopiques muqueuses des tumeurs digestives superficielles dans un Centre Hospitalier Régional.

Superficial digestive tumours resection by endoscopic mucosal resection and sub-mucosal dissection causes very few complications according to the results obtained in expert centers. This work reports the rate of complications observed in a regional hospital, also comparing the results of their therapeutic management. The first 100 patients treated by endoscopic mucosal resection and sub-mucosal dissection, conducted by conventional techniques, were studied. The usual complications (stenosis, bleeding, perforation) were identified and details of their treatment reported. The overall complication rate was 16 %. Symptomatic stenoses are observed in 4 % of patients. Secondary bleeding occurs in 5 % of cases. Endoscopic management of these complications is effective in all cases, when it is attempted. Perforations complicate 7 % of the procedures. Two patients were assigned to surgery, successfully, the other 5 patients were treated by endoscopic sutures without damage. The complication rates observed in our department are comparable with results reported by the reference western centers. Their endoscopic management is usually successful and rescue surgery is unfrequent.

La résection par mucosectomie et dissection sous-muqueuse des tumeurs digestives superficielles n'entraîne que très peu de complications selon les résultats obtenus dans les centres experts. Ce travail rapporte le taux de complications observé dans un centre hospitalier régional, comparant également les résultats de leur prise en charge. Les 100 premiers patients ayant été traités par mucosectomie et dissection sous-muqueuse, effectuées selon les techniques classiques, ont été étudiés. Les complications habituelles (sténoses, hémorragies et perforations) ont été répertoriées ainsi que les détails de leur traitement. Le taux global de complications est de 16 %. Les sténoses symptomatiques affectent 4 % des patients. Les hémorragies secondaires surviennent dans 5 % des cas. La prise en charge endoscopique de ces complications est efficace dans tous les cas, lorsqu'elle est tentée. Les perforations compliquent 7 % des procédures. Deux patients ont été confiés à la chirurgie, avec succès, les 5 autres patients ont été traités par sutures endoscopiques sans séquelle. Le taux de complications observé dans notre service est comparable aux résultats rapportés par les centres occidentaux de référence. Leur prise en charge endoscopique est régulièrement efficace et le recours à la chirurgie est peu fréquent.

ICAM-1 and VCAM-1 are differentially expressed on blood-retinal barrier cells during experimental autoimmune uveitis.

Adhesion molecules play a central role in leukocyte adhesion to the blood-retinal barrier (BRB) during uveitis. VCAM-1 expression on the BRB has been already described but although structurally similar, ICAM-1 has shown in various autoimmunity models to have distinct role and expression. Here, we induced uveitis in C57Bl/6 mice by adoptive transfer of semi-purified T cells from IRBP1-20-immunized mice. Using Flow cytometry analysis on transferred cells and immunofluorescence staining on retina we have studied the comparative ocular expression of both ICAM-1 and VCAM-1 and their ligands LFA-1 and VLA-4 at the surface of uveitogenic cells. Our results showed that LFA-1 and VLA-4 are expressed on both T and non T cells, VLA-4 sparsely and LFA-1 ubiquitously. Considering retinal expression, ICAM-1 is faintly present and VCAM-1 is absent in naive eyes. Only ICAM-1 is present on infiltrating cells in the retina and vitreous, while only VCAM-1 extends to perivascular glial cells and all along the internal limiting membrane. Finally, ICAM-1 is strongly expressed on the RPE, where VCAM-1 expression is much weaker. VCAM-1 seems most strongly expressed on the internal BRB while ICAM-1 predominates on the external BRB. Those major differences in the expression pattern could represent differential entry pathways for inflammatory cells to penetrate the eye.

[Value of systematic screening for depressive symptoms and Charles-Bonnet syndrome in AMD patients]. / Intérêt du dépistage systématique des affects dépressifs et du syndrome de Charles­Bonnet chez les patients atteints de DMLA.

INTRODUCTION: Age-related macular degeneration (ARMD) is the leading cause of blindness in western countries. Along with decrease in vision, ARMD patients, who are often elderly, carry an increased risk of developing depression and Charles-Bonnet syndrome (CBS). However, these disorders remain under-diagnosed. Detection and treatment could considerably improve their quality of life. The aim of our study is to evaluate the relevance and feasibility of systematic screening for depression and CBS in AMD patients. MATERIALS AND METHOD: Patients with ARMD, who showed up to the ophthalmology department of CHU Brugmann (Brussels, Belgium, Université Libre de Bruxelles) over a 4-week period, were asked to measure their depression score using the Geriatric Depression Scale (GDS-15) and to complete a questionnaire on CBS. RESULTS: In total, 112 patients were recruited. One hundred and six responded to the GDS-15 score; among them 70 patients (66.04%) suffered from depressive symptoms. A multivariate analysis highlighted three risk factors: decreased vision in the better eye (P=0.023), unilateral impairment (P=0.024) and social isolation (P<0.001). One hundred and twelve patients completed the CBS questionnaire, no new diagnoses were made. Six of the 112 patients (5.7%) knew about CBS. CONCLUSION: Screening through the GDS-15 depression score should be performed systematically in all ARMD patients. It is important not to overlook psychosocial factors in those patients. In our study, more than two thirds of patients suffer from unrecognised depressive affects. Early detection and adequate treatment could significantly improve their quality of life and compliance. As far as CBS is concerned, given its low prevalence, objective criteria should be established in order to select the patients who need screening.

Metabolic inhibitors accentuate the anti-tumoral effect of HDAC5 inhibition.

The US FDA approval of broad-spectrum histone deacetylase (HDAC) inhibitors has firmly laid the cancer community to explore HDAC inhibition as a therapeutic approach for cancer treatment. Hitting one HDAC member could yield clinical benefit but this required a complete understanding of the functions of the different HDAC members. Here we explored the consequences of specific HDAC5 inhibition in cancer cells. We demonstrated that HDAC5 inhibition induces an iron-dependent reactive oxygen species (ROS) production, ultimately leading to apoptotic cell death as well as mechanisms of mitochondria quality control (mitophagy and mitobiogenesis). Interestingly, adaptation of HDAC5-depleted cells to oxidative stress passes through reprogramming of metabolic pathways towards glucose and glutamine. Therefore, interference with both glucose and glutamine supply in HDAC5-inhibited cancer cells significantly increases apoptotic cell death and reduces tumour growth in vivo; providing insight into a valuable clinical strategy combining the selective inhibition of HDAC5 with various inhibitors of metabolism as a new therapy to kill cancer cells.

A formal study of lateral magnification and its influence on mammographic imaging sharpness.

Radiographic magnification is often employed in mammography to improve detection of small anatomical details of clinical interest, such as microcalcifications. The image size depends on the conventional magnification factor, on the focal spot size, and on the x-ray angulation. In this paper magnification effects are investigated for an object which lays off the radiation field center, for which there is a "lateral magnification" that makes it possible to obtain a sharper image of the object. This occurs because the true image size (i.e., the shadow) becomes larger as the distance from the beam center to the object increases, while the total blurring (penumbra) which is responsible for the unsharpness remains constant. The statement is valid only in the boundary of the perpendicular axis, which for most mammographic units corresponds to the position where the thickest portion of the breast is placed. Calculations are presented which show that the lateral magnification can be useful for enhancing breast microcalcifications using radiographic magnification.

The need for investigating the optical transfer functions in several field orientations for nonisotropic radiographic systems.

In this paper, it is demonstrated that obtaining OTF's for only two directions, parallel and perpendicular to the x-ray tube axis, is insufficient to completely describe the performance of nonisotropic radiographic systems. By performing experiments with three radiological systems in which slit images were obtained for ten different directions, we confirmed that OTF's vary in a nonlinear fashion for directions that are intermediate to the parallel and perpendicular ones. Moreover, we have also identified for each system a range of field orientations--referred to as "Optimum Region"--where sharper images can be obtained. These experimental results can be accounted for by the transfer functions theory.

Automatic identification of the pectoral muscle in mammograms.

The pectoral muscle represents a predominant density region in most medio-lateral oblique (MLO) views of mammograms; its inclusion can affect the results of intensity-based image processing methods or bias procedures in the detection of breast cancer. Local analysis of the pectoral muscle may be used to identify the presence of abnormal axillary lymph nodes, which may be the only manifestation of occult breast carcinoma. We propose a new method for the identification of the pectoral muscle in MLO mammograms based upon a multiresolution technique using Gabor wavelets. This new method overcomes the limitation of the straight-line representation considered in our initial investigation using the Hough transform. The method starts by convolving a group of Gabor filters, specially designed for enhancing the pectoral muscle edge, with the region of interest containing the pectoral muscle. After computing the magnitude and phase images using a vector-summation procedure, the magnitude value of each pixel is propagated in the direction of the phase. The resulting image is then used to detect the relevant edges. Finally, a post-processing stage is used to find the true pectoral muscle edge. The method was applied to 84 MLO mammograms from the Mini-MIAS (Mammographic Image Analysis Society, London, U.K.) database. Evaluation of the pectoral muscle edge detected in the mammograms was performed based upon the percentage of false-positive (FP) and false-negative (FN) pixels determined by comparison between the numbers of pixels enclosed in the regions delimited by the edges identified by a radiologist and by the proposed method. The average FP and FN rates were, respectively, 0.58% and 5.77%. Furthermore, the results of the Gabor-filter-based method indicated low Hausdorff distances with respect to the hand-drawn pectoral muscle edges, with the mean and standard deviation being 3.84 +/- 1.73 mm over 84 images.

Analysis of asymmetry in mammograms via directional filtering with Gabor wavelets.

This paper presents a procedure for the analysis of left-right (bilateral) asymmetry in mammograms. The procedure is based upon the detection of linear directional components by using a multiresolution representation based upon Gabor wavelets. A particular wavelet scheme with two-dimensional Gabor filters as elementary functions with varying tuning frequency and orientation, specifically designed in order to reduce the redundancy in the wavelet-based representation, is applied to the given image. The filter responses for different scales and orientation are analyzed by using the Karhunen-Loève (KL) transform and Otsu's method of thresholding. The KL transform is applied to select the principal components of the filter responses, preserving only the most relevant directional elements appearing at all scales. The selected principal components, thresholded by using Otsu's method, are used to obtain the magnitude and phase of the directional components of the image. Rose diagrams computed from the phase images and statistical measures computed thereof are used for quantitative and qualitative analysis of the oriented patterns. A total of 80 images from 20 normal cases, 14 asymmetric cases, and six architectural distortion cases from the Mini-MIAS (Mammographic Image Analysis Society, London, U.K.) database were used to evaluate the scheme using the leave-one-out methodology. Average classification accuracy rates of up to 74.4% were achieved.

Priapism in a patient treated with total parenteral nutrition.

Venous thrombosis is a common complication of total parenteral nutrition. We report a case of priapism in a 40-year-old man after administration of total parenteral nutrition for chronic idiopathic intestinal pseudo-obstruction. The patient received glucose, amino acids, and 20% fat emulsion; 12 hours after administration, the patient complained of a persistent, painful penile erection lasting 5 hours. Bilateral corpora cavernosa spongiosum shunts achieved immediate and sustained detumescence, but the patient remained impotent. There was no history of penile or pelvic trauma, hemoglobinopathy, coagulopathy, venous thrombosis, or leukemia. The medical literature describes seven other cases of priapism related to total parenteral nutrition. All of the patients received 20% fat emulsion; two patients developed priapism during the weekly infusion of fat emulsion. Among the multiple factors that can favor thrombosis and therefore priapism during total parenteral nutrition, fat infusion appears to be the most important. Three different mechanisms have been postulated: increase in blood coagulability, effects on red blood cells, and fat embolism. In this patient, platelet function was estimated in vivo by the levels of antiheparin platelet factor 4 and beta-thromboglobulin. These two parameters were both elevated before 20% lipid emulsion and were even higher after the 20% fat-emulsion infusion. Therefore, even if a direct thromboplastic effect is possible, 20% fat emulsion increases platelet activity, which was already high in our patient, and thereby favors priapism.

Study of the value of corrected ejection fraction in the evaluation of left ventricular function in patients with mitral or aortic regurgitation.

Evaluation of left ventricular function in the presence of valvular regurgitation is still a clinical problem because ejection phase indices including ejection fraction are heavily dependent on preload and afterload and cannot be regarded as reliable indices of contractility in diseases associated with altered loading conditions. The authors attempted to evaluate the usefulness of the new index-corrected ejection fraction in the evaluation of left ventricular (LV) function in patients with chronic mitral (MR) or aortic regurgitation (AR). The study included 21 patients with chronic severe MR (11 patients) and AR (10 patients) with a mean age of 18 years. All patients underwent valve replacement or repair. Echo Doppler study was performed preoperatively and postoperatively and included measurement of the following LV parameters: end-diastolic dimension (EDD), end-diastolic volume (EDV), end-systolic dimension (ESD), end-systolic volume (ESV), ejection fraction (EF), systolic blood pressure/end-systolic dimension (SBP/ESD); also mitral and aortic stroke volume were calculated cross-sectional area (CSA) x time velocity integral TVI. Corrected ejection fraction (EFc) was derived from the following equation: EFc = [EF + square root of (ASV x MSV) / EDV] / 2. The mean preoperative EFc did not change significantly after surgical correction of mitral or aortic regurgitation. Preoperative EFc did not show significant difference compared with postoperative EF in the two groups. Preoperative EFc correlated significantly with other preoperative and postoperative indices of LV function. Postoperative EFc showed very close correlation with other postoperative parameters. Thus, using the new index-corrected ejection fraction in the assessment of LV function in patients with mitral or aortic regurgitation has several advantages: Noninvasive, independent of loading changes, helpful in predicting the immediate postoperative clinical course, and a reliable index for evaluation of LV systolic function preoperatively and postoperatively.

Identification of the breast boundary in mammograms using active contour models.

A method for the identification of the breast boundary in mammograms is presented. The method can be used in the preprocessing stage of a system for computer-aided diagnosis (CAD) of breast cancer and also in the reduction of image file size in picture archiving and communication system applications. The method started with modification of the contrast of the original image. A binarisation procedure was then applied to the image, and the chain-code algorithm was used to find an approximate breast contour. Finally, the identification of the true breast boundary was performed by using the approximate contour as the input to an active contour model algorithm specially tailored for this purpose. After demarcation of the breast boundary, all artifacts outside the breast region were eliminated. The method was applied to 84 medio-lateral oblique mammograms from the Mini-MIAS database. Evaluation of the detected breast boundary was performed based upon the percentage of false-positive and false-negative pixels determined by a quantitative comparison between the contours identified by a radiologist and those identified by the proposed method. The average false positive and false negative rates were 0.41% and 0.58%, respectively. The two radiologists who evaluated the results considered the segmentation results to be acceptable for CAD purposes.

Segmentation of the fibro-glandular disc in mammograms using Gaussian mixture modelling.

The paper presents a technique for the segmentation of the fibro-glandular disc in mammograms based upon a statistical model of breast density. The density function of the model was represented by a mixture of up to four weighted Gaussians, each one corresponding to a specific density class in the breast. The parameters of the model and the number of tissue classes in the breast were determined using the expectation-maximisation algorithm and the minimum description length method. Grey-level statistics of the pectoral muscle were used to determine the tissue categories that are likely to represent the fibro-glandular disc. The method was applied to 84 medio-lateral oblique mammograms from the Mini-MIAS database. The results of the segmented fibro-glandular disc were assessed by a radiologist using the original and the segmented images, with reference to a ranking table categorising the results of segmentation as: 1: excellent; 2: good; 3: average; 4: poor; and 5: complete failure. Of the 84 cases analysed, 64.3% were rated as excellent, 16.7% were rated as good, 10.7% were rated as average, and 4.7% were rated as poor; only 3.6% of the cases were rated as a complete failure with regard to segmentation of the fibro-glandular disc.

[Activity of ticarcillin combined with different concentrations of clavulanic acid on 137 Gram-negative bacilli resistant to ticarcillin]. / Activité de la ticarcilline associée à différentes concentrations d'acide clavulanique sur 137 bacilles Gram négatif résistant à la ticarcilline.

The MIC of ticarcillin exclusively or joined with 3 concentrations of clavulanic acid: (2, 4 and 8 mg/l) was determined by agar dilution in relation to 137 bacilli resistant to ticarcillin (MIC greater than or equal to 256 mg/l) detected between 1985 and 1986 in the Bellevue Hospital in Saint-Etienne. We could study 26 Escherichia coli, 30 Klebsiella, 28 Enterobacter, 36 Serratia and 17 Pseudomonas aeruginosa. The concentration of 2 mg/l of clavulanic acid allows to lower the MIC of ticarcillin over the very large majority of strains of Escherichia coli and Klebsiella resistant to ticarcillin. In those conditions, ticarcillin becomes more active than piperacillin over those species. The concentration of 4 and 8 mg/l of clavulanic acid doesn't bring any real advantage to those bacilli. Moreover the concentrations of 2, 4 and 8 mg/l slightly change the MIC of ticarcillin on the strains of Serratia, Enterobacter and Pseudomonas aeruginosa.