An integrated modelling approach to derive the grey water footprint of veterinary antibiotics.

Water pollution by veterinary antibiotics (VAs) resulting from livestock production is associated with severe environmental and human health risks. While upward trends in global animal product consumption signal that these risks might exacerbate toward the future, VA related water pollution is currently insufficiently understood. To increase this understanding, the present research assesses processes influencing VA pollution from VA administration to their discharge into freshwater bodies, using an integrated modelling approach (IMA). For the VAs amoxicillin, doxycycline, oxytetracycline, sulfamethazine, and tetracycline we estimate loads administered to livestock, excretion, degradation during manure storage, fate in soil and transport to surface water. Fate and transport are modelled using the VA transport model (VANTOM), which is fed with estimates from the Pan-European Soil Erosion Risk Assessment (PESERA). The grey water footprint (GWF) is used to indicate the severity of water pollution in volumetric terms by combining VA loads and predicted no effect concentrations. We apply our approach to the German-Dutch Vecht river catchment, which is characterized by high livestock densities. Results show a VA mass load decrease larger than 99% for all substances under investigation, from their administration to surface water emission. Due to metabolization in the body, degradation during manure storage and degradation in soil, VA loads are reduced by 45%, 80% and 90% on average, respectively. While amoxicillin and sulfamethazine dissipate quickly after field application, significant fractions of doxycycline, oxytetracycline and tetracycline accumulate in the soil. The overall Vecht catchment's GWF is estimated at 250,000 m3 yr-1, resulting from doxycycline (81% and 19% contribution from the German and Dutch catchment part respectively). Uncertainty ranges of several orders of magnitude, as well as several remaining limitations to the presented IMA, underscore the importance to further develop and refine the approach.

[Rectal giant inflammatory pseudopolyps : an unusual cause of rectal bleeding]. / Pseudo-polypes inflammatoires géants du rectum : une cause rare de rectorragies.

Giant inflammatory pseudopolyps are begnin lesions that have been described usually in patients with inflammatory bowel disease. Rarely, they have been reported in patient without any colonic disease. We report the case of a 40-old woman, without previous colonic pathology, who presented with rectal giant inflammatory pseudopolyps revealed by rectal bleeding.

Les pseudo-polypes inflammatoires géants sont des tumeurs bénignes du tube digestif. Ils ont principalement été décrits chez les malades atteints de maladie inflammatoire chronique de l'intestin. Exceptionnellement, ils ont été rapportés chez des patients n'ayant aucune pathologie digestive. Nous rapportons l'observation d'une patiente de 40 ans, présentant de multiples pseudo-polypes inflammatoires géants du rectum, en l'absence de toute autre pathologie colorectale, révélés par des rectorragies.

Spontaneous rupture of omental varices: an uncommon cause of hypovolemic shock in cirrhosis.

In cirrhotic patients, esophageal and esophagogastric varices are the most common sites of bleeding, often responsible for hypovolemic shock. Hepatocellular carcinoma, blunt abdominal trauma and postprocedural complications are classical causes of hemoperitoneum in hepatic cirrhosis. Rupture of omental varices is another and rarely reported cause of shock in cirrhosis. We report a case of hypovolemic shock caused by ruptured omental varices. Selective review of literature regarding presentation, diagnosis and management of ruptured intraabdominal varices is also part of presentation.

Relation between severity of liver disease and renal oxygen consumption in patients with cirrhosis.

BACKGROUND: Worsening cirrhosis may lead to increased renal O2 metabolism caused by activation of neurohumoral antinatriuretic substances. AIMS: To evaluate the relation between the severity of liver disease, sodium excretion, and neurohumoral antinatriuretic substances on the one hand and renal O2 metabolism on the other in patients with cirrhosis. METHODS: Renal O2 consumption and haemodynamics as well as plasma concentrations of noradrenaline, renin, and aldosterone were measured. Investigations were performed in 14 patients with Pugh's grade A, 43 with grade B, and 29 with grade C liver disease. RESULTS: Renal O2 consumption significantly increased with the severity of cirrhosis (grade A, 8.9 (1.6); grade B, 15.5 (1.3); grade C, 18.0 (1.5) ml/min/m2). Plasma concentrations of noradrenaline, renin, and aldosterone significantly increased while mean arterial presssure and systemic vascular resistance significantly decreased with the severity of the disease. A significant inverse correlation was found between renal O2 consumption and sodium excretion. A significant direct correlation was found between plasma levels of noradrenaline and aldosterone on the one hand and renal O2 consumption on the other. Renal blood flow and the glomerular filtration rate did not differ significantly between patients with grade C and grade A or B disease. CONCLUSIONS: This study shows for the first time that, in patients with cirrhosis, worsening of the disease is associated with an increase in renal O2 consumption. The results suggest that increased renal O2 consumption is due to renal tubular sodium retention caused by increased levels of neurohumoral antinatriuretic substances. This neurohumoral activation is related to cirrhosis induced vasodilation.

Influence of transjugular intrahepatic portosystemic shunts (TIPS) on tissue oxygenation in patients with cirrhosis.

UNLABELLED: AIMS/BACKGROUNDS: The aim of this prospective study was to evaluate the influence of transjugular portosystemic intrahepatic shunts (TIPS) on tissue oxygenation in patients with cirrhosis and refractory ascites. METHODS: Five shunted patients were included in the study. The blood and tissue oxygenation values were analyzed 12 days and 4 months after TIPS procedure. The results were compared with those observed in patients treated by paracentesis. RESULTS: Unlike patients treated by paracentesis, PaO2 values remained unchanged throughout follow-up in shunted patients. After the TIPS procedure, there was a transient increase in systemic O2 transport and O2 uptake and a transient decrease in O2 saturation of hepatic oxyhemoglobin. After 4 months, TIPS resulted in an increase in PCO2 values and bicarbonate concentrations. CONCLUSIONS: The TIPS procedure seems to prevent the decrease in PaO2 observed in patients treated by paracentesis and may improve the respiratory alkalosis of cirrhosis.

[Influence of anemia on hemodynamic changes in patients with cirrhosis]. / Influence de l'anémie sur les modifications hémodynamiques des malades atteints de cirrhose.

OBJECTIVE: The aim of this retrospective study was to evaluate the systemic and splanchnic hemodynamic changes induced by anemia in patients with cirrhosis. METHOD: 148 patients (Child-Pugh A: 46 patients, Child-Pugh B: 64 patients and Child-Pugh C: 38 patients) were included in the study. Anemia was defined by a blood hemoglobin level < 12 g/dL. A systemic and splanchnic hemodynamic study was performed in all patients. RESULTS: A significant elevation of the hepatic venous pressure gradient was observed in Child-Pugh A patients with anemia but not in Child-Pugh B and C patients. In the 2 latter groups, cardiac index was significantly increased and systemic vascular resistance decreased in patients with anemia. CONCLUSION: Anemia may worsen the hemodynamic changes associated with cirrhosis.

Systemic and splanchnic hemodynamic changes in patients with hepatic schistosomiasis.

Although hepatic schistosomiasis is a common cause of portal hypertension, only a few hemodynamic studies, in humans, have been published on this subject. The aim of this study was to determine the systemic and splanchnic hemodynamic changes in hepatic schistosomiasis and to evaluate the influence of liver fibrosis on these changes. A retrospective analysis of a series of 13 patients with hepatic schistosomiasis who had undergone hemodynamic studies was performed. Portal or perisinusoidal fibrosis was present at liver biopsy in 8 patients. The control group included 22 patients with chronic hepatitis and normal hepatic venous pressure gradients. Patients with schistosomiasis exhibited high cardiac index (4.11 +/- 1.15 l.min-1.m-2 vs 2.99 +/- 0.85 l.min-1.m-2; p < 0.05) and low systemic vascular resistance (1039 +/- 316 dyn.s.cm-5 vs 1334 +/- 336 dyn.s.cm-5; p < 0.05). The hepatic venous pressure gradient and hepatic blood flow were normal. Azygos blood flow was markedly increased (0.90 +/- 0.66 l.min-1 vs 0.13 +/- 0.04 l.min-1; p < 0.05). Hemodynamic values were not significantly different between patients with liver fibrosis and those without fibrosis at liver biopsy. In conclusion, patients with hepatic schistosomiasis had a hyperkinetic systemic and splanchnic circulation. In patients with esophageal varices, a normal hepatic venous pressure gradient confirmed presinusoidal portal hypertension. The presence of portal or perisinuoidal fibrosis did not influence hyperdynamic splanchnic state.

Spontaneous exoneration of a colonic lipoma.

Colonic lipoma is a rare tumor. This tumor is usually asymptomatic. We report the case of a patient who complained of abdominal pain. Symptoms disappeared after spontaneous exoneration of a colonic lipoma.

Gamma globulin administration in relapsing Clostridium difficile-induced pseudomembranous colitis with a defective antibody response to toxin A.

A 53-year-old woman suffered six episodes of Clostridium difficile-pseudomembranous colitis. The serological follow-up demonstrated the absence of a rise in IgG and IgA to toxin A. Human pooled gamma globulin was administered during the fifth relapse and raised IgG levels to toxin A. Normal stools reappeared a week later. The role of the antibodies to toxin A and gamma globulin in C. difficile colitis are discussed.

[Thrombus of the right atrium simulating myxoma in primary antiphospholipid syndrome]. / Thrombus de l'oreillette droite simulant un myxome au cours d'un syndrome primaire des antiphospholipides.

Various thrombo-embolic complications have been related to the antiphospholipid syndrome. The authors report the case of a patient with a primary antiphospholipid syndrome associated with a right auricular mass highly suggesting a myxoma by both echocardiography and nuclear magnetic resonance imaging. Meanwhile, the histological examination of the operative specimen showed a well organized and calcified thrombus. Intracardiac thrombus has been rarely reported as a complication of the antiphospholipid syndrome. The preoperative investigations can't differentiate such a thrombus with a myxoma and the diagnosis is usually made postoperatively.

[Circulatory hyperkinesis of cirrhosis: etiopathogenesis, clinical and therapeutic implications]. / Hypercinésie circulatoire de la cirrhose: étiopathogénie, implications cliniques et thérapeutiques.

A mysterious complication of cirrhosis is the progressive development of a hyperdynamic circulatory state characterized by high cardiac output and low peripheral and splanchnic arterial resistance. This particular hemodynamic state plays a major role in the progress of portal hypertension and sodium renal retention observed in cirrhosis. In this review, we try to better define the clinical impact and the etiopathogenic mechanism of the hyperdynamic state of cirrhosis.