What is the prognostic significance of acrometastases?

In contrast with bone metastasis, acrometastases are uncommon and are associated with advanced cancer. We report the cases of two patients with atypical lesions of the fingers in a context of cancer, in which biopsies confirmed a metastasis. Patients died rapidly before treatment was initiated. We discuss the characteristics of these atypical metastatic sites, associated with a generally poor prognosis.

Contribution to the understanding of the cycle of the protozoan parasite Marteilia refringens.

The paramyxean parasite Marteilia refringens infects several bivalve species including European flat oysters Ostrea edulis and Mediterranean mussels Mytilus galloprovincialis. Sequence polymorphism allowed definition of three parasite types 'M', 'O' and 'C' preferably detected in oysters, mussels and cockles respectively. Transmission of the infection from infected bivalves to copepods Paracartia grani could be experimentally achieved but assays from copepods to bivalves failed. In order to contribute to the elucidation of the M. refringens life cycle, the dynamics of the infection was investigated in O. edulis, M. galloprovincialis and zooplankton over one year in Diana lagoon, Corsica (France). Flat oysters appeared non-infected while mussels were infected part of the year, showing highest prevalence in summertime. The parasite was detected by PCR in zooplankton particularly after the peak of prevalence in mussels. Several zooplanktonic groups including copepods, Cladocera, Appendicularia, Chaetognatha and Polychaeta appeared PCR positive. However, only the copepod species Paracartia latisetosa showed positive signal by in situ hybridization. Small parasite cells were observed in gonadal tissues of female copepods demonstrating for the first time that a copepod species other than P. grani can be infected with M. refringens. Molecular characterization of the parasite infecting mussels and zooplankton allowed the distinguishing of three Marteilia types in the lagoon.

One Perkinsus species may hide another: characterization of Perkinsus species present in clam production areas of France.

Although clam populations in France are known to be infected with protozoans of the genus Perkinsus, no molecular characterization was previously performed on these parasites. Considering that several members of this genus have been associated with mortalities of molluscs worldwide, a study was undertaken in order to characterize these parasites in France. For that purpose, clams, Ruditapes philippinarum and R. decussatus, collected from different production areas and found to be infected with Perkinsus sp. in thioglycolate culture medium, were selected for PCR-RFLP tests and sequencing. Perkinsus olseni was detected in all the investigated areas and results also suggested the presence of P. chesapeaki in Leucate, a lagoon on the Mediterranean coast and in Bonne Anse in Charente Maritime, on the Atlantic coast. Clonal cultures from both detected species were produced in order to describe and compare in vitro stages. Differences in size between both Perkinsus spp. were noticed especially for schizonts and zoosporangia. Lastly, in situ hybridization tests allowed confirmation of the presence of both species in the same R. decussatus population and even in same clams. This is the first detection of P. chesapeaki in Ruditapes species and outside North America, which questions its introduction into Europe.

Detection of Bonamia ostreae and B. exitiosa (Haplosporidia) in Ostrea edulis from the Adriatic Sea (Italy).

The flat oyster Ostrea edulis L. is widespread along the Italian coasts. In particular, the Manfredonia Gulf (Adriatic Sea) represents an important site where natural beds subsist. Previous monitoring conducted in 1990 by light microscopy and ultrastructural studies revealed the presence of Bonamia-like microcell parasites in some flat oysters: following this observation, a new sampling of O. edulis was carried out at this location in 2007. Of 750 oysters collected, 3 showed the presence of uninucleated microcells (2 to 3 microm diameter) free or inside the haemocyte cytoplasm by cytology and histopathology. Molecular analysis confirmed that the microcells in 2 oysters were B. exitiosa, whereas in the third oyster the microcells were B. ostreae. Moreover, molecular studies were carried out to confirm the existence of Bonamia sp. in archived samples, confirming the presence of B. ostreae in the Manfredonia Gulf since 1990.

Gastric metastases. An endoscopic series of ten cases.

We report a series of ten cases of the clinical, endoscopic and pathological features of gastric metastases. Patients were six women and four men between 54 and 88 years old, with gastric metastases from breast carcinoma (4), lung carcinoma (4) and melanoma (2). Patients underwent an upper gastrointestinal endoscopy for epigastralgia (2), hematemesis (2), dysphagia (1) and anemia (5). On endoscopy, tumors appeared as nodules with a central ulceration (5), an ulceration (4) or simulating linitis plastica (1). Metastases were located in the cardia (2), fundus (5) and antrum (3). Primary tumors had been diagnosed between one day and 20 years before upper endoscopy. Eight patients had multivisceral metastases. The microscopic features of the gastric metastases resembled a primary gastric cancer in eight cases. Thanks to clinical data, the pathologist confirmed the diagnosis of gastric metastases on immunohistochemistry. Nine patients died in the eight-month follow-up period. Gastric metastases are rare, occur at a late stage of the neoplastic disease, and have a poor prognosis. Diagnosis of gastric metastases is difficult because they simulate primary gastric cancer on endoscopy and on microscopic examination. A correct diagnosis is based on good communication between gastroenterologists and pathologists.

Comparative experimental infection of the copepod Paracartia grani with Marteilia refringens and Marteilia maurini.

Paracartia grani (Copepoda) has been identified as a potential intermediate host in the life cycle of Marteilia refringens, a paramyxean parasite infecting flat oysters. However, no intermediate host has yet been identified for Marteilia maurini that infects mussels. A better understanding of the life cycle of these two Marteilia types would clarify their taxonomic relationship and hypothesized co-specificity. For this purpose, experimental infections of copepods, P. grani, were performed using naturally infected flat oysters and mussels. Infection patterns were different depending whether copepods were infected from oysters or mussels. M. maurini did not proliferate in copepods while M. refringens rapidly proliferated in infected copepods. Previously unrecognized developmental stages of M. refringens were found during this study.

Colorectal carcinoma with potentially resectable metastases: factors associated with the failure of curative schedule.

BACKGROUND: The management of patients with colorectal cancer (CRC) and synchronous liver metastases (SLM) depends on the primitive tumor, resectability of the metastatic disseminations and the patient's comorbid condition(s). Considering all patients with potentially resectable primary CRC and SLM, curative resection (R0) will be possible in some patients, although in others surgery will never be performed. The purpose of our study was to identify factors of failure of the curative schedule in these patients. METHODS: We reviewed the data of patients with CRC and SLM between January 2002 and March 2007. Two groups were defined: group R0 when complete metastatic and primary tumor resection was finally achieved after one and more surgical stages and group R2 when curative resection was not possible at the end of the schedule. Clinical, pathologic and outcome data were retrospectively analyzed as well as preoperative management of SLM (chemotherapy, radiofrequency, portal vein embolization). RESULTS: Forty-five patients were included. Curative resection (group R0) was performed in 31 patients (69%) with 48% undergoing major hepatic resection. Mortality of hepatic resection was 0% although it was 9% for primitive tumor. Portal vein embolization was performed preoperatively in eight patients and radiofrequency ablation in 13. Median follow-up was 21 months. Overall survival was 86% at one year and 39% at three years. Survival in group 1 was 97 and 57% at one and three years respectively. Disease-free survival was 87 and 40% at one and three years. Tumor recurrence was noted in 61% of resected patients. At multivariate analysis, number of hepatic metastases superior than three and complicated initial presentation of primitive tumor were found to be significant and predictors of failure of hepatic resection. CONCLUSION: Aggressive management with curative resection of SLM may enable long-term survival. More than three SLM and complicated initial presentation of primitive tumor are factors predictive of failure of the curative schedule.

Fibrotic stricture of the extrapancreatic biliary tract: a new complication of acute pancreatitis. Two cases.

Two cases of fibrotic stricture of the extrapancreatic common bile duct were observed 3 and 5.5 months after severe acute alcoholic pancreatitis. The diagnosis was made by endoscopic retrograde cholangiography in both cases. Although colonic or ureteric stenosis have been reported after acute pancreatitis, this is the first report of extrapancreatic biliary stricture occurring after acute pancreatitis. The strictures could have arisen by either an enzymatic or ischemic mechanism. Outcome was favorable after surgical hepaticojejunostomy.

Prevalence of alcohol problems among elderly patients in a university hospital.

AIMS: To assess the prevalence of alcohol abuse and the prevalence of alcohol-related discharge diagnosis in an elderly general hospital population. DESIGN: On a randomly selected day, all patients aged 65 years and over admitted to a university hospital were screened. SETTING: University Hospital of Amiens, France. PARTICIPANTS: All patients aged 65 years and over were approached and requested to take part in the study. They were interviewed using the CAGE questionnaire and with a structured questionnaire regarding life-style, and asked about their usual daily alcohol consumption. The medical history of each patient was taken. In total, 612 patients fulfilled the age criteria, but 205 patients (33.6%) had to be excluded owing to predefined exclusion criteria (e.g. dementia, aphasia, terminal illness ...) and 37 patients (6%) refused to participate. FINDINGS: The data were derived from 370 patients. The median age was 79 years; 54% reported no alcohol consumption; 9% of patients scored positive on the CAGE questionnaire. The prevalence of patients with a CAGE questionnaire positive was significantly higher among male patients (17%) than female patients (2.5%). The prevalence of patients with alcohol-related discharge diagnosis was 7%. The frequency of higher socio-economic status or divorced status increased significantly with alcohol consumption. CONCLUSIONS: There may be a substantial prevalence of alcohol problems in elderly hospital patients. Research is needed to examine how generalized this problem is.

"Tryptic-like" activity in sera of patients with pancreatitis.

Serum trypsin esterolytic activity was measured in 106 sera from 61 controls and 45 patients with pancreatitis. A trypsin specific synthetic substrate, N-alpha-benzoyl-L-arginine-paranitroanilide, was used. High levels of enzymatically active trypsin were shown to be present in serum of patients with pancreatitis. No difference between the two samples was noticed for the serum concentrations of alpha-1-antitrypsin and alpha-2-macroglobulin (the two main serum trypsin inhibitors). Active trypsin was contained in the high molecular weight fraction of plasma proteins, corresponding to a complex with alpha-2-macroglobulin. The determination of serum typsin activity as a sensitive test for detection of pancreatitis was demonstrated to be statistically significant.

Application of ammonia intermittent temperature-programmed desorption to evaluate surface acidity of tungsten oxide supported on activated carbon.

Intermittent temperature-programmed desorption of ammonia was used to study the strength and population of surface acid sites of tungsten oxide supported on activated carbon pretreated at 350 and 700 degrees C. Catalysts pretreated at 350 degrees C showed two types of surface acid sites and desorption occurred with free readsorption until a temperature of around 300 degrees C was reached. Pretreatment at 700 degrees C produced three different states of ammonia adsorbed on the catalysts and desorption occurred with free readsorption.

A simple technique to concentrate the protozoan Mikrocytos mackini, causative agent of Denman Island Disease in oysters.

This report describes a simple filtration technique to isolate the parasite Mikrocytos mackini from oyster tissue. The technique is based on successive filtration through filter papers and polycarbonate membrane filters of decreasing mesh using a low vacuum (<8 cm Hg). This technique allows for the recovery of about 1 x 10(8) parasites (microcells) from about 2 g of heavily infected oyster tissue. About 99% of the particulate material in the final preparation consisted of intact M. mackini.

[Ambulatory ultrasound-guided puncture in abdominal tumoral pathology. Study of 131 cases]. / Ponction échoguidée ambulatoire en pathologie tumorale abdominale. Etude de 131 cas.

OBJECTIVES AND METHODS: Outpatient ultrasound guided liver biopsy is usually reserved for diffuse pathologies. The aim of this study was to assess the feasibility and results of 131 ultrasound guided biopsies of 128 abdominal lesions in 104 patients (69 men and 35 women, mean age: 59). Twenty four cysts were punctured (18 pancreatic cysts, 4 liver cysts and 2 unspecified abdominal cysts) and 104 solid tumors were biopsied (80 liver tumors, 9 pancreatic tumors, 5 portal vein obstructions, 4 unspecified abdominal tumors, 3 stomach tumors and 3 lymphadenopathies). RESULTS: The feasability of outpatient ultrasound guided biopsy was 100%. The etiology of 22 cysts (91.6%) and the histology of 100 solid tumors (96.2%) were determined. No side effects were observed, and all patients left the hospital 6 hours after this procedure. No later hospitalisations were necessary. CONCLUSION: This study suggests that outpatient ultrasound guided needle aspiration or biopsy of liver tumors or other abdominal tumors can be performed. Thus, this procedure could be less expensive and more acceptable, while preserving reliability and safety.

[Puncture of solid tumors of the liver with large caliber needle guided by ultrasonography. Study of 70 punctures]. / Ponction des tumeurs solides du foie à l'aiguille de gros calibre guidée par l'échographie. Etude de 70 ponctions.

Seventy specimens of solid hepatic tumors were obtained for histologic examination with a 18 G (1.2 mm) diameter needle under real-time ultrasound control. Overall sensitivity was 95.6 p. 100 while specificity was 100 p. 100. Distinction between primitive and secondary malignant tumor was possible in 91 p. 100 of cases. Transient hemorrhage at the puncture site occurred in one patient. These results attest to the superiority of guided puncture with a needle of sufficient caliber, thus allowing for correct histologic study. Side effects did not occur more frequently than with fine caliber needles.

[Prognostic factors of hepatocellular carcinoma. Multifactorial analysis of 84 cases]. / Facteurs pronostiques du carcinome hépatocellulaire. Analyse multifactorielle de 84 cas.

To identify prognostic factors taking in account recent advances in diagnosis and treatment, 24 clinical, biological, and morphological factors were evaluated by means of uni- and multivariate analysis in 84 patients with hepatocellular carcinoma diagnosed between 1984 and 1991. Okuda's grading (P < 0.01), creatininemia (P < 0.01), and treatment (P < 0.05) were independent prognostic factors. Des-gamma-carboxyprothrombin reached a significant level (P < 0.05) in a subgroup of 32 recent patients but its prognostic value needs to be confirmed. Further prospective randomized trials comparing surgical and non-surgical treatment should take these factors into account.

[Increased fasting gallbladder volume: a new ultrasonic sign of cirrhosis?]. / L'augmentation du volume vésiculaire à jeun: un nouveau signe échographique de cirrhose?

Ultrasound was used to calculate fasting gallbladder volume in three groups of patients: 90 with cirrhosis (alcoholic in 75 cases), 41 with non cirrhotic liver disease (alcoholic in 14 cases), and 38 controls. Gallbladder volume was evaluated according to sex, age, alcoholism, presence of gallstones, time of diagnosis, and biological tests of hepatocellular function. Mean fasting gallbladder volume was significantly higher in cirrhotic patients (45.89 +/- 32.65 ml, m +/- 1 SD) than in patients with non cirrhotic liver disease (25.31 +/- 14.08 ml) and in control subjects (21.28 +/- 10.30 ml) (P less than 0.001), but there was a great overlap between individual results in each group. No relationship was found between gallbladder volume and all clinical and biological tested parameters, except for decreased prothrombin time (P less than 0.02). Further studies are necessary to consider this ultrasound sign as an useful diagnostic tool in cirrhosis.

[Ultrasound-guided puncture-biopsy of the liver could replace blind puncture-biopsy in diffuse hepatopathies. Retrospective study of 1293 patients]. / La ponction-biopsie hépatique échoguidée pourrait remplacer la ponction-biopsie à l'aveugle dans les hépatopathies diffuses. Une étude rétrospective chez 1,293 patients.

OBJECTIVES: The aim of this retrospective study was to compare the efficiency and complications of percutaneous hepatic biopsy either guided by ultrasonography in the left lobe, or blindly by the intercostal route in the right lobe, in the diagnosis of diffuse liver diseases. PATIENTS AND METHODS: Liver biopsy was performed in 1,293 patients for 5 years. In group 1 (289 patients, including 140 out-patients), liver biopsy was guided by ultrasound. In group 2, blind intercostal liver biopsy was performed in 1,004 patients. Patients were observed for 6 hours after biopsy in both groups. RESULTS: The failure rate of liver biopsy was significantly lower in group 1 (1.7%) than in group 2 (9.25%, P < 0.01). The prevalence of the histological lesions was similar in both groups. No related-biopsy death occurred. Complications were more serious after blind biopsy (1 acute pancreatitis with a hematoma of the liver, 1 bile leakage around the gallbladder, 1 hemoperitonitis, 1 large intrahepatic hematoma), than after guided biopsy (1 small hematoma of the liver, 1 acute biliary pain on the 10th day). CONCLUSION: Hepatic biopsy guided by ultrasonography could replace blind biopsy in the diagnosis of diffuse liver diseases.

[Endoscopic treatment of a pancreatic-pleural fistula. Apropos of a case]. / Traitement endoscopique d'une fistule pancréatico-pleurale. A propos d'un cas.

Pancreaticopleural fistula is a rare complication of pancreatic diseases. It results from communication between a pancreatic duct and the pleural space, either directly, or through a pseudocyst. The treatment is medical or surgical. We report a case of pancreaticopleural fistula occurring in a man suffering from chronic pancreatitis, and treated by endoscopy.

[Portal thrombosis and liver cirrhosis. Value of ultrasound-guided puncture-biopsy of the thrombus]. / Thrombose portale et cirrhose. Intérêt de la ponction-biopsie échoguidée du thrombus.

OBJECTIVES AND METHODS: Portal vein thrombosis which occurs in the course of cirrhosis, associated or not with hepatocellular carcinoma, can be either cruoric or neoplastic. The aim of this study was to assess the feasibility and the results of ultrasound guided biopsy of portal vein thrombosis in 21 patients with cirrhosis (20 men and 1 woman; mean age 66 +/- 9 years), who were hospitalized between May 1989 and November 1993. Ultrasound guided biopsies of the cirrhotic liver, of the portal vein thrombosis and, when present, of a hepatic nodular lesion were performed. The diagnosis of hepatocellular carcinoma was made if the histological examination of the hepatic and portal biopsy samples were positive or if serum concentrations of alpha-fetoprotein were higher than 500 IU/mL. RESULTS: All portal vein thrombosis biopsies were successfully performed. No side-effects were observed. Before ultrasound guided biopsy of the portal thrombosis, diagnosis of hepatocellular carcinoma was made in 15 cases, and diagnosis of cirrhosis in 6 cases. After histological examination of the portal sample, hepatocellular carcinoma was diagnosed in 19 cases and cirrhosis in 2 cases. Thus, in 19% of cases, ultrasound guided biopsy of the portal thrombus provided a definitive diagnosis. CONCLUSION: Ultrasound guided biopsy of the portal vein thrombosis must be performed before liver transplantation for cirrhosis or hepatocellular carcinoma to exclude the presence of a vascular neoplastic extension.

[Immunoblastic lymphoma of the ileocecal region in chronic lymphoid leukemia. Richter's syndrome localized in the intestine and disclosed by ascites]. / Lymphome immunoblastique de la région iléo-caecale au cours d'une leucémie lymphoïde chronique. Syndrome de Richter localisé à l'intestin et révélé par une ascite.

The authors report the case of a patient with chronic lymphocytic leukemia well controlled during five years, and then complicated with immunoblastic lymphoma of the ileo-caecal area. The tumor was revealed by a protein-rich peritoneal effusion containing numerous large undifferentiated lymphoid cells. Only five cases of Richter's syndrome, apparently localized to the digestive tract, have been published to date.