ABSTRACT
Perivascular epithelioid cell tumors (PEComas) are a family of benign neoplasms characterized by smooth muscle and melanocytic differentiation. Orbital cases are rare. A 9-year-old male presented with a slowly growing orbital mass. Magnetic resonance imaging (MRI) revealed a well-defined orbital mass without intracranial extension. The microscopic appearance of the complete resection specimen showed large nests of epithelioid cells with wide cytoplasm containing melanin pigment and round to oval nuclei with mild cytonuclear atypia and low mitotic activity. Immunohistochemistry was positive for HMB45 and negative for melanA, smooth muscle actin, desmin and S-100 protein. Pangenomic RNA-sequencing identified an in-frame NONO-TFE3 rearrangement, and clustering data showed that the tumor's gene expression profile was grouped with other previously studied PEComas. A diagnosis of orbital pigmented PEComa with uncertain malignant potential associated with a NONO-TFE3 rearrangement was made. There was no recurrence after 1 year of follow-up.
ABSTRACT
While toll-like receptors (TLRs), which mediate innate immunity, are known to play an important role in host defense, recent work suggest their involvement in some integrated behaviors, including anxiety, depressive and cognitive functions. Here, we investigated the potential involvement of the flagellin receptor, TLR5, in anxiety, depression and cognitive behaviors using male TLR5 knock-out (KO) mice. We aobserved a specific low level of basal anxiety in TLR5 KO mice with an alteration of the hypothalamo-pituitary axis (HPA) response to acute restraint stress, illustrated by a decrease of both plasma corticosterone level and c-fos expression in the hypothalamic paraventricular nucleus where TLR5 was expressed, compared to WT littermates. However, depression and cognitive-related behaviors were not different between TLR5 KO and WT mice. Nor there were significant changes in the expression of some cytokines (IL-6, IL-10 and TNF-α) and other TLRs (TLR2, TLR3 and TLR4) in the prefrontal cortex, amygdala and hippocampus of TLR5 KO mice compared to WT mice. Moreover, mRNA expression of BDNF and glucocorticoid receptors in the hippocampus and amygdala, respectively, was not different. Finally, acute intracerebroventricular administration of flagellin, a specific TLR5 agonist, or chronic neomycin treatment did not exhibit a significant main effect, only a significant main effect of genotype was observed between TLR5 KO and WT mice. Together, those findings suggest a previously undescribed and specific role of TLR5 in anxiety and open original prospects in our understanding of the brain-gut axis function.
Subject(s)
Anxiety , Toll-Like Receptor 5 , Animals , Anxiety/genetics , Anxiety Disorders , Corticosterone , Male , Mice , Mice, Knockout , Toll-Like Receptor 5/geneticsABSTRACT
Cixiid planthoppers are considered of major economic importance, as they can transmit phytoplasmas responsible for many plant diseases. While thorougly studied in vineyards, the epidemiology of stolbur phytoplasma, transmitted by Hyalesthes obsoletus Signoret, was rarely investigated on minor crops as lavender, where it leads to 'yellow decline' disease and large economic losses. The objective of this paper is to understand the effect of the local landscape characteristics on the presence and density of H. obsoletus in the 'Plateau de Valensole', southern France. Potential host plants of H. obsoletus were surveyed in three contrasted zones (in terms of crops and disease intensity), by uprooting plants and capturing adults in emergence traps. The localization and potential movements of H. obsoletus from the host plants towards lavandin (infertile hybrid of lavender) were determined using yellow sticky traps. Clary sage plants were found as major hosts of H. obsoletus. Flying insects were also caught in fields of lavandin, although emergence traps and plant uprooting did not confirm this crop as a winter host, i.e., as a reservoir for the insect. Based on one zone, we showed that attractiveness may depend on crop (clary sage or lavandin) and on its age, as well as on the distance to the supposed source field. These results suggest that clary sage could be an important host of H. obsoletus, whose density largely varies between zones. Genetic studies would be required to confirm the role of clary sage in the dissemination of yellow decline of lavandin.
Subject(s)
Hemiptera , Herbivory , Insect Vectors , Animals , LarvaABSTRACT
The most deadly outbreak of Escherichia coli O104:H4 occurred in Europe in 2011. Here, we evaluated the effects of the retrograde trafficking inhibitor Retro-2(cycl) in a murine model of E. coli O104:H4 infection. Systemic treatment with Retro-2(cycl) significantly reduced body weight loss and improved clinical scores and survival rates for O104:H4-infected mice. The present data established that Retro-2(cycl) contributes to the protection of mice against O104:H4 infection and may represent a novel approach to limit Shiga toxin-producing Escherichia coli (STEC)-induced toxicity.
Subject(s)
Benzamides/pharmacology , Enterohemorrhagic Escherichia coli/drug effects , Escherichia coli Infections/drug therapy , Hemolytic-Uremic Syndrome/drug therapy , Shiga Toxin 2/antagonists & inhibitors , Thiophenes/pharmacology , Animals , Benzamides/therapeutic use , Chlorocebus aethiops , Disease Models, Animal , Disease Outbreaks , Enterohemorrhagic Escherichia coli/genetics , Enterohemorrhagic Escherichia coli/pathogenicity , Escherichia coli Infections/epidemiology , Europe , HeLa Cells , Hemolytic-Uremic Syndrome/prevention & control , Humans , Mice , Mice, Inbred BALB C , Thiophenes/therapeutic use , Vero CellsABSTRACT
Cosmetic eyelid surgery is becoming increasingly popular. It can rejuvenate the patient's appearance with relatively minor side effects. Its risk/benefit ratio is one of the best in facial cosmetic surgery. However, the patient does not always accurately assess the aesthetic appearance of his or her eyelids. This underscores the importance of clinical examination in order to determine the patient's wishes, and then make an accurate diagnosis and potential surgical plan. We currently oppose, in general, surgical techniques involving tissue removal (skin-muscle and/or fat) in favor of those involving tissue repositioning and grafting (autologous fat pearl transposition, obtained by liposuction, and lipostructure). Furthermore, the place of adjuvant therapies to blepharoplasty is steadily increasing. They mainly include surface treatments (peels and lasers), dermal fillers and anti-wrinkle botulinum toxin injections. They are also increasingly used in isolation in novel ways. In all cases, a perfect knowledge of anatomy and relevant skills and experience remain necessary.
Subject(s)
Blepharoplasty/methods , Eyelids/surgery , Surgery, Plastic , Adipose Tissue/surgery , Blepharoplasty/classification , Blepharoplasty/statistics & numerical data , Eyelids/blood supply , Female , Humans , MaleABSTRACT
The direct liquefaction of a biomass composed of a mixture of wastes (straw, wood and grass) was studied using Nickel Raney as catalyst and tetralin as a solvent. Tetralin allows to solubilize green waste from 330°C at relatively low hydrogen pressure, and avoids the recondensation of the intermediate products. The green waste deoxygenation results mainly from a decarboxylation reaction. The addition of Raney Ni in the feed, increases the gas yield due to methane formation, without diminishing the yield in solvolysis oil. The catalyst hydrogenolyses the small molecules present in the light fraction. Moreover, it improves the quality of the oil by increasing the hydrogen transfer between the solvent and the solvolysis oil. As a consequence, the oxygen content decreases and the yield of oil soluble in hexane strongly increases. The catalyst allows to obtain straight long chain alkanes (C(13)-C(26)), which result from the hydrogenation of the extractives compounds of the green waste.
Subject(s)
Biomass , Recycling , Refuse Disposal , Hot Temperature , PressureABSTRACT
This study was a comparison between Ru-catalysts and similar, previously investigated, Pt-catalysts. In this paper, ruthenium catalysts for catalytic wet air oxidation are prepared, characterized and tested. Both catalysts were supported on commercial CeO2 as well as mixed oxide Zr(0.1)(Ce(0.75)Pr(0.25))(0.9)O2. The catalysts were characterized by measuring the oxygen storage capacities (OSC), BET, XRD, FTIR and chemisorption of hydrogen. In addition, the effect of sintering (treatments under H2) was compared with both of the catalysts. The comparison of the results showed that initial intrinsic activity of ruthenium is not significantly influenced by the type of the support, which is contrast to platinum. Furthermore, the particle size of Ru had an important effect on CWAO activity: the higher the particle size, the better the activity. This was different with Pt-catalysts, where the optimal particle size was smaller, having about 15% of metal dispersion.
Subject(s)
Acetic Acid/chemistry , Cerium , Platinum , Ruthenium , Air , Catalysis , Oxidation-Reduction , Oxides , Particle SizeABSTRACT
NFAT1 and NFAT5 act as pro-invasive and pro-migratory transcription factors in breast carcinoma, contributing to the formation of metastases. We report that NFAT3 is specifically expressed in estrogen receptor alpha positive (ERA+) breast cancer cells. We show that NFAT3 inhibits by itself the invasion capacity of ERA+ breast cancer cells and needs to cooperate with ERA to inhibit their migration. Conversely, NFAT3 downregulation results in actin reorganization associated with increased migration and invasion capabilities. NFAT3 signaling reduces migration through inhibition of Lipocalin 2 (LCN2) gene expression. Collectively, our study unravels an earlier unknown NFAT3/LCN2 axis that critically controls motility in breast cancer.
Subject(s)
Acute-Phase Proteins/genetics , Breast Neoplasms/pathology , Cell Movement , Lipocalins/genetics , NFATC Transcription Factors/metabolism , Proto-Oncogene Proteins/genetics , Actins/metabolism , Acute-Phase Proteins/deficiency , Breast Neoplasms/genetics , Breast Neoplasms/metabolism , Cell Line, Tumor , Estrogen Receptor alpha/metabolism , Gene Expression Regulation, Neoplastic , Humans , Lipocalin-2 , NFATC Transcription Factors/genetics , Neoplasm Invasiveness , Protein Binding , Proto-Oncogene Proteins/deficiencyABSTRACT
OBJECTIVES: We report in the present study the role of endothelin (ET-1) and ET-1 receptors in the sustained hypoxia-induced systemic hypertension. METHODS: Wistar rats were randomly assigned to live continuously in hypobaric hypoxia (CH rats) or normoxia (N rats). At the end of hypoxic stress exposure (5 weeks at 450 mm Hg), measurements of mean systemic arterial pressure were done. The effects of ET-1 in the presence or not of the endothelium and/or of specific ET-A inhibitors (BQ-123) or ET-B inhibitors (BQ-788), have been investigated in an isolated model of rat thoracic aorta. Finally, plasmatic ET-1 concentrations have been determined by assay procedure. RESULTS: Following five weeks of chronic hypoxic stress, CH rats presented a significant increase of mean systemic arterial pressure (N: 129.1+/-6.8 mm Hg vs CH: 152.5+/-3.4 mm Hg; P<0.05). Despite of this hypoxia-induced hypertension, ET-1 plasmatic concentration was not different between N and CH rats. Finally, CH rats presented a reduce response to ET-1 when compared to N rats. This phenomenon seems to be associated to the ET-A vascular smooth muscle cell receptors, since difference between N and CH rats was still present in endothelium denuded aortic rings in the presence or not of the specific ET-B inhibitors (BQ-788). In addition, in the presence of the specific ET-A inhibitor (BQ-123) response to ET-1 was abolished in N and CH rats to the same extent (N:-98%; CH:-99%). CONCLUSION: This work clearly suggests that, following long term exposure to hypoxia, ET-1 and ET-1 receptors are not involved in the persistence of systemic hypertension in a rat model, and that chronic exposure to severe hypoxic stress was associated with a downregulation of the ET-A receptors response to ET-1.
Subject(s)
Aorta, Thoracic/physiology , Hypertension/etiology , Hypoxia/complications , Muscle, Smooth, Vascular/physiology , Receptor, Endothelin A/physiology , Receptor, Endothelin B/physiology , Vasoconstriction , Animals , Endothelin-1/blood , In Vitro Techniques , Male , Oligopeptides/pharmacology , Peptides, Cyclic/pharmacology , Piperidines/pharmacology , Rats , Rats, WistarABSTRACT
1. beta(3)-Adrenoceptors (AR) have been reported to be present in numerous species, where they mediate multiple responses. 2. The aim of the present study was to determine whether beta(3)-AR are present in intact rat heart and the functional implications of beta(3)-AR stimulation. The response to the cardiac beta(3)-AR-selective agonist BRL37344 was expressed as the percentage of values measured at baseline. 3. BRL37344 induced dose-dependent negative inotropic effects at concentrations ranging from 10(-11) to 10(-7) mol/L. BRL37344 (10(-8) mol/L) induced a decrease of left ventricular developed pressure (LVDP) from 127 +/- 5 to 89 +/- 16 mmHg (69 +/- 15%; P < 0.01) and +dP/dt from 2594 +/- 59 to 1885 +/- 50 mmHg/s (72 +/- 8%; P < 0.01). Moreover, a significant reduction of -dP/dt from 2176 +/- 42 to 1458 +/- 43 mmHg/s (67 +/- 8%; P < 0.01) was observed. The BRL37344 dose-response curves were not altered by nadolol (10(-5) mol/L), a potent beta(1)- and beta(2)-AR antagonist, but were completely suppressed by the addition of SR59230A (10(-5) mol/L), a potent beta(3)-AR antagonist. 4. The present study provides functional evidence for the presence of beta(3)-AR in rat hearts and shows, for the first time, that a highly specific beta(3)-AR antagonist can block the attenuation of LVDP caused by the specific beta(3)-AR agonist BRL37344 in rat beating hearts.
Subject(s)
Heart/physiology , Myocardium/metabolism , Receptors, Adrenergic, beta-3/drug effects , Receptors, Adrenergic, beta-3/metabolism , Ventricular Function, Left , Adrenergic beta-Agonists/pharmacology , Adrenergic beta-Antagonists/pharmacology , Animals , Dose-Response Relationship, Drug , Ethanolamines/pharmacology , Heart/drug effects , In Vitro Techniques , Male , Myocardial Contraction , Propanolamines/pharmacology , Rats , Rats, Wistar , Ventricular Function, Left/drug effects , Ventricular PressureABSTRACT
Physical training induces cardiovascular autonomic nervous system regulation adaptations, which could result from beta adrenergic receptor (AR) modifications. Among them, beta(3 )AR alterations have been recently reported but their functional effect remained to discuss. To explain the beta(3) AR gene expression in relation to function, we simultaneously studied the left ventricle (LV) beta(3) AR mRNA and protein levels and the myocardial functional effects of a beta(3) AR agonist following physical training. Forty rats were assigned to either a control (C; N = 20) or a trained (T; N = 20) group. The treadmill running protocol was performed for 8 weeks. Histological measurements on LV slices were quantified. The beta(3) AR mRNA abundance was studied with RT-PCR and beta(3) AR protein density with Western-Blot analysis. Myocardial functional effects of a beta(3) AR agonist, BRL37344 (10(-8) M), were studied in Langendorff-perfused hearts. Histological data confirmed the adapted patterns of the physiological cardiac hypertrophy observed in T (P < 0.01), with a significant increase in arteries density (P < 0.01) and an unchanged collagen concentration. The beta(3) AR protein density was increased in T (154 +/- 38% in T vs. 100 +/- 24% in C; P < 0.05), but no change was noted concerning the beta(3) AR mRNA level. After BRL37344 perfusion LVDP, +dP/dT and -dP/dT, in C (P < 0.01), and only +dP/dT in T (P < 0.05) were decreased. Moreover, all LV hemodynamic parameters were more altered after BRL37344 in C than in T (P < 0.01).Thus, in this physiological model of cardiac hypertrophy, an increase of beta(3) AR density without beta(3) AR mRNA alteration was observed. Classical negative myocardial lusitropic and inotropic effects induced by a specific agonist of beta(3) AR were diminished in trained rats.
Subject(s)
Cardiomegaly/metabolism , Cardiomegaly/physiopathology , Myocardium/metabolism , Myocardium/pathology , Physical Conditioning, Animal , Receptors, Adrenergic, beta-3/genetics , Receptors, Adrenergic, beta-3/metabolism , Animals , Ethanolamines/pharmacology , Gene Expression Regulation/drug effects , Heart Ventricles/drug effects , Heart Ventricles/physiopathology , Male , RNA, Messenger/genetics , RNA, Messenger/metabolism , Rats , Rats, Wistar , Reproducibility of ResultsABSTRACT
BACKGROUND AND STUDY AIMS: The prevalence of esophageal squamous-cell carcinoma in high-risk patients and the advantages of systematic Lugol staining during esophagoscopy have not yet been evaluated in a large prospective study. In this study we aimed to assess the prevalence of this type of tumor in high-risk patients, to examine the role of Lugol staining in endoscopic screening for esophageal squamous-cell carcinoma, and to establish whether it is possible to identify a particularly high-risk group which would benefit from systematic screening. PATIENTS AND METHODS: A prospective study was undertaken in 62 endoscopy centers. A total of 1095 patients were enrolled, none of whom had any esophageal symptoms. These patients had presented with either a past history of or a recent head and neck or tracheobronchial squamous-cell carcinoma (group 1), with alcoholic chronic pancreatitis (group 2), with alcoholic cirrhosis (group 3), or were alcohol and tobacco addicts (group 4). The patients underwent a meticulous endoscopic examination of the esophagus, followed by Lugol staining. RESULTS: The prevalence of esophageal squamous-cell carcinoma was 3.2 %. The group 1 patients showed the highest prevalence of carcinoma (5.3 %) and the highest prevalence of dysplasia (4.5 %). Of the 35 carcinomas detected in the 1095 patients, seven (20 %) were early lesions, and 20 % were only detected after Lugol staining (P = 0.02). High-grade dysplasia was only observed in group 1 patients and two-thirds of these lesions were only diagnosed after Lugol staining. The overall prevalence of low-grade dysplasia was 2.4 %, and 77 % of these were detected only after Lugol staining (P < 0.001). CONCLUSIONS: Lugol dye staining increases the sensitivity of esophageal endoscopy for the detection of high-grade dysplasia and cancer. The prevalence of dysplasia and cancer reached 9.9 % in group 1, and we therefore believe that an endoscopic screening program could be justified for patients with head and neck or tracheobronchial cancer.
Subject(s)
Carcinoma, Squamous Cell/diagnosis , Esophageal Neoplasms/diagnosis , Esophagoscopy , Adult , Aged , Aged, 80 and over , Biopsy, Needle , Carcinoma, Squamous Cell/pathology , Coloring Agents/administration & dosage , Esophageal Neoplasms/pathology , Female , Humans , Iodides/administration & dosage , Male , Middle Aged , Precancerous Conditions/diagnosis , Precancerous Conditions/pathology , Risk Factors , Sensitivity and Specificity , Staining and LabelingABSTRACT
We present results that were obtained with a newly developed fluorometer, the 'PhytoSensor'. They are based on multi-wavelength excitation of chlorophyll fluorescence to detect the phytoplankton biomass and to identify main taxons (among cyanobacteria, green and brown microalgae). A method to evaluate the photosynthetic potential of the phytoplankton was established. Attention was focused on the measurement of the cyanobacterial biomass. A modelling to distinguish between the two spectral groups (blue and red) of cyanobacteria as a function of their pigments and physiological status is proposed. The main innovation of the device results in the recording of the fluorescence induction kinetics of the phytoplankton to confirm and refine the evaluation of the taxonomic composition. The PhytoSensor abilities were compared with pigment analysis, commercial fluorometers, particle and microscopic counting and identification. The PhytoSensor has been used with success to monitor the dynamics of phytoplankton in drinking-water supply reservoirs in Southeast Asia.
Subject(s)
Chlorophyll/analysis , Cyanobacteria/metabolism , Environmental Monitoring/methods , Phytoplankton/chemistry , Asia , Azo Compounds , Cyanobacteria/chemistry , Environmental Monitoring/instrumentation , Eosine Yellowish-(YS) , Fluorescence , Kinetics , Methyl Green , Photochemistry , Time Factors , Water SupplyABSTRACT
AIMS: Computed tomography (CT) is the reference technique for evaluating response to chemotherapy. The potential helpfulness of tumour markers is debated. MATERIALS AND METHODS: From March 1997 to January 1999, 91 consecutive patients receiving chemotherapy for metastatic colorectal carcinoma underwent whole-body spiral CT, estimates of anti-carcinoembryonic antigen (CEA) and CA19-9 every 8 weeks. RESULTS: CEA and CA19-9 levels were above normal in 78 (85.7%) and 61 (67.5%) patients, respectively. Tumour response evaluation according to the RECIST criteria was obtained at 8-week evaluation in 83 (91%) patients. The positive predictive values (PPV) for response of a decrease of the marker levels were 53.8 for CEA and 41.7 for CA19-9 using a 30% decrease threshold, and 60/52.2, respectively, using a 50% decrease threshold. Meaningful PPV values (> 90%) for progression of an increase of the marker levels were only obtained using the 200% increase threshold for CEA alone or a combination of CEA and CA 19-9. A 100% CEA increase between baseline and the 8-week evaluation was correlated to overall survival (P = 0.0023). The need for a radiological confirmation of tumour progression could be avoided by the systematic dosage of tumour markers at baseline and after 8 weeks of treatment only in a sub-population of 13% of the patients with a 200% increase of CEA or CA 19-9 at 8 weeks. CONCLUSIONS: CEA, CA 19-9, or both should be used with caution for tumour response evaluation to chemotherapy in addition to CT in metastatic colorectal carcinoma.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Biomarkers, Tumor/analysis , CA-19-9 Antigen/analysis , Carcinoembryonic Antigen/analysis , Colorectal Neoplasms/drug therapy , Colorectal Neoplasms/pathology , Aged , Disease Progression , Female , Humans , Male , Middle Aged , Predictive Value of Tests , Sensitivity and Specificity , Survival Analysis , Tomography, Spiral Computed , Treatment OutcomeABSTRACT
We report the case of a 10-year-old child who presented a severely deformed upper limb due to post-traumatic partial proximal epiphysiodesis of the humerus. The goal of treatment was to correct the severe angular deformity, prevent recurrence, and lengthen the humerus 6 cm. We used the De Bastiani callotasis method with osteotomy of the humeral shaft and unilateral external fixation (Orthofix LRS). The bony deformations were corrected progressively. Angular correction induced a geometric lengthening sufficient to match the length of the healthy limb. Lengthening index was 22.7 days/cm. The functional and esthetic results were remarkable. Complementary epiphysiodesis of the proximal physis successfully prevented recurrent deformation.
Subject(s)
Bone Diseases/complications , Bone Lengthening/methods , Humerus/abnormalities , Humerus/surgery , Osteotomy/methods , Anthropometry , Child , External Fixators , Humans , Male , Treatment OutcomeABSTRACT
Cyclospora cayetanensis is a pathogenic agent originating from the intertropical zone. It causes diarrhoeal diseases in local populations as well as in travellers visiting these zones. In the first part of this work, an epidemiological study on drinking water supply (reservoirs and consumers' taps) was conducted in Hanoi over 12 months; samples were daily collected and have revealed the presence of Cyclospora cayetanensis oocysts during the whole year in tanks and only during monsoon season. Molecular methods were used for species identification. In the second part, we tried to investigate different water sources in Hanoi city in order to detect Cyclospora cayetanensis environmental contamination: groundwaters, surface waters collected in lakes and rivers and also waters from treatment plants. Our results show that none Cyclospora cayetanensis oocyst was found in the groundwaters and in the desinfected finished waters after treatment. In contrast, in rivers and lakes samples, the level of positivity reached about 63.6% with significant differences between the districts regarding the rates of oocysts recovery: only 24% positive specimens in Hoan Kiem district, whilst respectively 80.4%, 78.3% and 65% positive samples in Hai Ba Trung, Dong Da and Ba Dinh districts. The results of this study seem to confirm that environmental water is contaminated by Cyclospora cayetanensis oocysts and points out the importance of water as a significant source of human transmission. It is quite obvious that observation could be probably extended to the other endemic areas.
Subject(s)
Cyclospora/isolation & purification , Water/parasitology , Cyclosporiasis/transmission , Humans , Vietnam , Water SupplySubject(s)
Colonoscopy/methods , Diverticulum, Colon/complications , Gastrointestinal Hemorrhage/etiology , Gastrointestinal Hemorrhage/therapy , Hemostasis, Endoscopic/methods , Rectal Diseases/etiology , Rectal Diseases/therapy , Aged , Colectomy , Epinephrine/therapeutic use , Female , Humans , Male , Middle Aged , Treatment Outcome , Vasoconstrictor Agents/therapeutic useABSTRACT
BACKGROUND AND STUDY AIMS: Little is known of the long-term outcome in patients with gastrointestinal bleeding of obscure origin, who undergo investigation by means of push enteroscopy. The aim of this study was to assess the rate of recurrent bleeding and its predictive factors in patients with gastrointestinal bleeding of obscure origin, after exploration by push enteroscopy. PATIENTS AND METHODS: 105 patients with gastrointestinal bleeding of obscure origin (iron-deficiency anemia: n = 56; overt bleeding: n = 49) underwent exploration by push enteroscopy from December 1994 to December 1998. They were classified into three groups according to enteroscopy findings: no lesion found (group A; 56 patients), arteriovenous malformations (group B; 18 patients), and other gastrointestinal lesions (group C; 31 patients). Actuarial rates of rebleeding during follow-up were calculated and factors associated with rebleeding were assessed by means of univariate and multivariate analysis. RESULTS: Follow-up data were obtained for 101 patients (96 %). The mean follow-up was 29 months (6 - 54 months). The 2-year actuarial rate of rebleeding was 31 % in the overall population, and 27.6 %, 56 % and 24 % in groups A, B, and C, respectively (P = 0.13). The number of previous bleeding episodes and the number of packed red cell units transfused were two independent factors predictive of recurrent bleeding. The modality of recurrent bleeding (anemia or overt bleeding) was similar to that of the initial episode in 94 % of cases. In group A, a gastrointestinal lesion was found after rebleeding in one of the 12 patients with iron-deficiency anemia, and in four of the five patients with overt bleeding. CONCLUSION: Recurrent bleeding occurs in about one-third of patients who undergo investigation by push enteroscopy for gastrointestinal bleeding of obscure origin, with a trend towards more frequent rebleeding in patients with arteriovenous malformations. Frequent previous bleeding episodes and transfusion requirements are predictive of recurrent bleeding.
Subject(s)
Endoscopy, Gastrointestinal , Gastrointestinal Hemorrhage/etiology , Gastrointestinal Hemorrhage/pathology , Adolescent , Adult , Aged , Aged, 80 and over , Female , Follow-Up Studies , Gastrointestinal Hemorrhage/surgery , Humans , Male , Middle Aged , Predictive Value of Tests , Prognosis , Recurrence , Retrospective Studies , Time FactorsABSTRACT
A 26-year-old man was involved in a car crash then he presented an isolated trauma of the hand. We found out a dorsal dislocation of the second carpometacarpal joint with trapezoid fracture and a Rolando fracture. In emergency, closed reduction with percutaneous wires to stabilize, was performed. In the same time, the Rolando fracture was treated by internal fixation (plate). In a second time, after computerized tomography of the carpus, the trapezoid was reduced through a dorsal incision and held with two Kirschner-wires. At last follow-up one year after injury, the result was good. All movements of the wrist and fingers were full and pain free. Thumb index pinch and grasp were approximately 80% those of the uninjured hand. The mechanisms of injury, anatomic factors and management of seventy-one cases of similar trauma (included at least a dislocation of the second carpometacarpal joint) were reviewed in the literature.