Acute mesenteric ischemia is a rare diagnosis with a very high mortality rate. It is often suspected in case of severe abdominal pain, disproportional to the findings of physical examination. The definite diagnosis is confirmed by CT-angiography and surgical exploration, but the measurement of blood L-lactate often takes place during the diagnostic work-up when this pathology is suspected. This review shows that there is no biological marker with sufficient sensitivity and specificity to confirm or rule out acute mesenteric ischemia. L-lactate measurement is easy to perform, but its diagnostic performance is insufficient to avoid a CT-angiography, whatever the pre-test clinical probability of acute mesenteric ischemia. These conclusions are supported by the current recommendations of the World Society of Emergency Surgery.
L'ischémie mésentérique aiguë est un diagnostic rare au taux de mortalité très élevé. Elle est souvent suspectée en cas de douleurs abdominales sévères et disproportionnelles aux résultats de l'examen physique. Le diagnostic définitif s'obtient par angio-CT et exploration chirurgicale, mais le dosage du L-lactate intervient fréquemment lors de la stratégie diagnostique au moment de la suspicion clinique. Cet article met en évidence qu'il n'existe pas de marqueur biologique unique suffisamment sensible et spécifique pour confirmer ou exclure une ischémie mésentérique aiguë. Le dosage du L-lactate est rapide, mais sa performance diagnostique ne permet pas de surseoir à l'angio-CT, et ce quelle que soit la probabilité clinique prétest d'ischémie mésentérique. Ces conclusions sont soutenues par les recommandations des sociétés de chirurgie.
Lactic Acid/blood , Mesenteric Ischemia/blood , Mesenteric Ischemia/diagnosis , Biomarkers/blood , Humans , Sensitivity and Specificity
Isolated congenital vomer agenesis is a very rare and poorly understood condition. In the context of dental work-up by cone-beam computed tomography (CBCT), the explored volume of the facial bones occasionally reveals incidental abnormalities. We report the case of a 13-year old Caucasian female who underwent CBCT for the pre-treatment evaluation of primary failure of tooth eruption affecting the permanent right upper and inferior molars. CBCT depicted a large defect of the postero-inferior part of the nasal septum without associated soft tissue abnormality and without cranio-facial malformation or cleft palate. In the absence of a history of trauma, chronic inflammatory sinonasal disease, neoplasia and drug abuse, a posterior nasal septum defect warrants the diagnosis of vomer agenesis. A discussion of this condition and of salient CBCT features is provided.
INTRODUCTION: Alteplase and tenecteplase are two widely used thrombolytic agents and are both approved for the treatment of acute myocardial infarction. These two molecules have increased fibrin specificity compared with older thrombolytics but distinct pharmacokinetic properties and may differ in terms of risks and benefits. We decided to review the available evidence comparing the safety and efficacy of these two molecules in acute coronary syndrome (ACS) or pulmonary embolism (PE). MATERIAL AND METHODS: To compare the efficacy and safety profile of alteplase and tenecteplase, we systematically searched PubMed, Cochrane and Embase for randomized studies comparing weight-adjusted alteplase to weight-adjusted tenecteplase in patients with ACS or PE. The primary endpoint was the risk of major bleeding, and secondary endpoints were risk of intracranial haemorrhage (ICH), vessel recanalization and 30-day mortality. RESULTS: Three studies including 17,325 patients with ACS were included in a quantitative meta-analysis. No study compared alteplase to tenecteplase in acute PE. Tenecteplase was associated with a statistically significant reduction of the risk of major bleeding compared to alteplase (RR = 0.79; 95% CI: 0.69-0.90, p = 0.0002). The risk of intracranial haemorrhage (RR = 0.96; 95% CI: 0.71-1.31, p = 0.82) and 30-day mortality (RR = 1.02; 95% CI: 0.9-1.15) were similar in patients treated with alteplase or tenecteplase. No difference was observed in the rate of vessel recanalization. CONCLUSIONS: The available evidence suggests that tenecteplase is associated with a reduced risk of major bleeding compared to alteplase in ACS without evidence of reduced efficacy. These results are however mainly dependent on a single study.
