Autochthonous liver cystic hydatid: Past or actual French shepherd's disease?

Autochthonous hydatidosis in France and western Europa are uncommon since the beginning of the 21st century. We report here an authentic indigenous cystic echinococcosis case in a French shepherd. The risk of remerging pathology should not be neglected and measures to interrupt parasite transmission are still relevant.

Early mortality attributable to PICC-lines in 4 public hospitals of Marseille from 2010 to 2016 (Revised V3).

INTRODUCTION: Peripherally inserted central catheters (PICC-line) are devices inserted through peripheral venous access. In our institution, this technology has been rapidly adopted by physicians in their routine practice. Bacteremia on catheters remains an important public health issue in France. However, the mortality attributable to bacteremia on PICC-line remains poorly evaluated in France and in the literature in general. We report in our study an exhaustive inventory of bacteremia on PICC-line and their 30 days mortality, over a 7 years period. MATERIAL AND METHODS: From January 2010 to December 2016, we retrospectively matched PICC-line registers of the radiology department, blood culture records of the microbiology laboratory and medical records from the Hospital Information Systems. RESULTS: The 11,334 hospital stays during which a PICC-line was inserted were included over a period of 7 years. Among them, 258 episodes of PICC-line-associated bacteremia were recorded, resulting in a prevalence of 2.27%. Hematology units: 20/324 (6.17%), oncology units: 55/1375 (4%) and hepato-gastro-enterology units: 42/1142 (3.66%) had the highest prevalence of PICC-line related bacteremia. The correlation analysis, when adjusted by exposure and year, shows that the unit profile explains 72% of the variability in the rate of bacteremia with a P = .023. Early bacteremia, occurring within 21 days of insertion, represented 75% of cases. The crude death ratio at 30 days, among patients PICC-line associated bacteremia was 57/11 334 (0.50%). The overall 30-day mortality of patients with PICC-line with and without bacteremia was 1369/11334 (12.07%). On day 30, mortality of patients with bacteremia associated PICC-line was 57/258 or 22.09% of cases, compared to a mortality rate of 1311/11076, or 11.83% in the control group (P < .05, RR 2.066 [1.54-2.75]). Kaplan-Meier survival analysis revealed a statistically significant excess mortality between patients with PICC-line associated bacteremia and PICC-line carriers without bacteremia (P < .0007, hazard ratio 1.89 [1307-2709]). CONCLUSION: Patients with PICC-line associated bacteremia have a significant excess mortality. The implementation of a PICC-line should remain the last resort after a careful assessment of the benefit/risk ratio by a senior doctor.

In utero embolization for placental chorioangioma and neonatal multifocal hemangiomatosis.

Placental chorioangioma is a limited non trophoblastic vascular tumour that may causes fetal complications as well as post-natal ones. We reported in here the first case of an in utero embolization of chorioangioma diagnosed at 22 W G with a post-natal diagnosis of neonatal multifocal hemangioma with a good outcome. The chorioangioma was embolized using GLUBRAN 2 ® (cyanolacrylate) a biologic surgical glue at 26 W G. Premature rupture of membrane occurred at 28 W G. A cesarean section at 32 W G was performed for retro placental hematoma. The neonate was 1400 g healthy girl with an anemia (hemoglobin 9.7 g/dl). After one month of life, the child met a neonatal multifocal hemangioma (skin and liver were involved) with superficial erosion of skin hemangiomas that required post-natal transfusions. We propose a literature review related to the various technics of in utero treatment of placental chorioangioma and the links with neonatal multifocal hemangiomatosis as well. The girl is now 7 year old and has a normal neurodevelopmental outcome.

Outcomes of Pulmonary Artery Embolization and Stent Graft Placement for the Treatment of Hemoptysis Caused by Lung Tumors.

PURPOSE: To evaluate the safety and efficacy of endovascular management of pulmonary artery lesions caused by lung tumors. MATERIALS AND METHODS: Nineteen patients (15 men, 4 women; average age: 60.3 years, range, 51-86 years) treated for massive or recurrent hemoptysis with transarterial pulmonary artery embolization between 2010 and 2016 were included in this multicenter, retrospective study. Inclusion criteria were: patients with lung cancer and at least 1 episode of hemoptysis with a pulmonary artery lesion detected by computed tomography (CT) angiography or after failed bronchial artery embolization. No patient undergoing pulmonary embolization for a lung tumor was excluded. Technical success, clinical success, and complications were recorded. The survival curve was estimated using the Kaplan-Meier method RESULTS: Mean follow-up was 188.1 days (range, 0-1440 days). Primary and assisted technical success rates were 73.7% (14/19) and 84.2% (16/19), respectively. Two patients died during the procedure due to massive hemoptysis and cardiac arrest, and 1 patient was treated with surgery. All patients with technical success achieved clinical success without further bleeding. No complications were noted, and no pulmonary infarction was detected on CT scan during follow-up. Survival rates after embolization at 1 and 3 months were 67% (95% confidence interval [CI]: 40%-90%) and 46% (95% CI: 23%-80%), respectively, with 36.8% (n = 7) of the patients still alive at the end of the study. CONCLUSIONS: Embolization is an effective and safe treatment of lung tumors with pulmonary arterial bleeding.

Portal Vein Stent Placement in Five Patients with Chronic Portal Vein Thrombosis Prior to Pancreatic Surgery.

Five patients with pancreatic tumors and chronic portal vein (PV) thrombosis underwent PV stent placement before surgery. The patients either had resectable tumors or locally advanced tumors with stable, partial, or complete response to neoadjuvant therapy. PV stent placement removed periportal collaterals in all cases, with no complications, in a mean time of 150 minutes. Patients received a daily dose of subcutaneous low-molecular-weight heparin until 12 hours before surgery, and low-molecular-weight heparin was resumed for 30 days after surgery. Surgery was performed 1 day to 3 months after PV stent placement, with no complications related to periportal collaterals.

Temporal bone fracture under lateral impact: biomechanical and macroscopic evaluation.

This work was conducted to study biomechanical properties and macroscopic analysis of petrous fracture by lateral impact. Seven embalmed intact human cadaver heads were tested to failure using an electrohydraulic testing device. Dynamic loading was done at 2 m/s on temporal region with maximal deflection to 12 mm. Anthropometric and pathological data were determined by pretest and posttest computed tomography images, macroscopic evaluation, and anatomical dissection. Biomechanical data were obtained. Results indicated the head to have nonlinear structural response. The overall mean values of failure forces, deflections, stiffness, occipital, and frontal peak acceleration were 7.1 kN (±1.1), 9.1 mm (±1.8), 1.3 kN/mm (±0.4), 90.5 g (±22.5), and 65.4 g (±16), respectively. The seven lateral impacts caused fractures, temporal fractures in six cases. We observed very strong homogeneity for the biomechanical and pathological results between different trials in our study and between data from various experiments and our study. No statistical correlation was found between anthropometric, biomechanical, and pathological data. These data will assist in the development and validation of finite element models of head injury.