[Cell-free DNA fraction: Can it be used to evaluate the risk of obstetrical issues?] / L'ADN fœtal libre circulant : un outil d'évaluation du risque de survenue de complications obstétricales ?

OBJECTIVE: The aim of the study was to evaluate if fetal cell-free DNA (cfDNA) fraction circulating in maternal blood at the beginning of the second trimester is associated with obstetrical complications. METHODS: This is a retrospective unicentric study conducted at the hospital of Poissy Saint Germain between the 1st January 2015, and the 31st. December 2016, Each woman who had a genetic counseling in order to realize a non-invasive prenatal test (NIPT) was included. Only singleton pregnancies with a documented-issue were analysed. The primary criteria was a composite criteria, defined as the occurrence of preeclampsia, in utero fetal growth, or a spontaneous preterm delivery. A descriptive analyse was first conducted, secondly completed by a sub-group one: "high fetal fraction" (>90th percentile) group, "low fetal-fraction" group (<10th percentile) and "medium fetal-fraction" (control group) group. RESULTS: A total of 417 women had a cfDNA test, which was performed at a mean gestational age of 17.1 weeks of gestation. A total of 17% of pregnancies met the primary criteria. Among them, there were 8 (1.9%) pre-eclampsia, 49 (11.8%) intra-uterine growth restriction and 14 (3.4%) preterm births. There was no significant difference for the occurrence of the primary criteria (P>0.99) and of each obstetrical complication between each group. CONCLUSION: Fetal cf-DNA fraction measured at the beginning of the second trimester is not associated with common obstetrical complications.

[Diagnostic efficiency of histological and simple microbiological tests for Helicobacter pylori detection in a community hospital]. / Rendement diagnostique de l'histologie et des tests bactériologiques simples pour le dépistage d'Helicobacter pylori dans un centre hospitalier intercommunal.

The objective of this study was to compare histology and microbiology (direct method, urease test, culture) for the detection of Helicobacter pylori in antral biopsies. Thirty-six patients, aged between 18 and 82, with a peptic ulcer (active or not), or gastritis or duodenitis were studied. Eighteen patients (50%) had a positive culture, 17 (47%) had a positive urease test, 16 (41%) had positive direct microbiology and 15 (42%) had positive histology. Correlation between histology and culture was 84%. This study confirms the good sensitivity of histology and the urease test for the detection of Helicobacter pylori. Combination of both methods could optimise detection of the organism.

Small intestinal stricture complicating superior mesenteric vein thrombosis. A study of three cases.

Mesenteric vein thrombosis associated with intestinal stricture, as a consequence of intestinal ischaemia, has only been mentioned twice in published works. The clinical, biological, and morphological aspects as well as the treatment of this morbid association were studied in three patients. In all, a two stage clinical course (initial acute abdominal pain and fever, followed by chronic intestinal obstruction), corresponding to the sequence thrombosis/stricture, was found. x Ray studies showed a regularly contoured intestinal stricture. Surgical resection was required in all three cases for stricture, associated in one case with mesenteric infarction. Anticoagulation treatment was used to preclude recurrence. Increased clinical awareness could lead to the diagnosis of intestinal stricture secondary to mesenteric vein thrombosis more often and at an earlier stage. Treatment consists of evaluation of predisposing features, intestinal resection when necessary, and anticoagulation therapy, as indicated.

[Benign mucus-secreting tumors of the appendix. Six cases]. / Tumeurs mucosécrétantes bénignes de l'appendice. Six observations.

The authors report six cases of mucus-secreting tumor of the vermicular appendix, in four women and two men (mean age 59 years). All were benign. Pain in the right lower quadrant was the initial sign in 4 cases, while the mucus-secreting tumor was an incidental finding in the other two cases. A mass was palpated in the right lower quadrant in one case. A barium enema was performed in four cases and showed an extrinsic compression of the caecal base in one case, and of the right colon in another case. Four appendectomies, one associated with removal of the adjacent caecal tissues and two right colectomies were performed. Analysis of these six cases and a review of the literature allow us to recall the histologic classification of these tumors, which determines the prognosis and to emphasize the sonographic and CT scan findings which might lead to earlier preoperative diagnosis in the future. Management depends upon the circumstances under which the tumor is discovered, the local anatomy, and the type of tumor. Appendectomy is the treatment most often performed. Faced with a tumor of the appendix, without histologic proof or when the local anatomic conditions increase the risk of opening an abscess, right colectomy is recommended.

[Kaposi's sarcoma complicating long-term corticotherapy for severe asthma]. / Sarcome de Kaposi compliquant une corticothérapie au long cours pour asthme sévère.

Kaposi's sarcoma frequently develops in patients with immune deficiency which may be drug-induced (corticosteroids, immunodepressants). We report a case of Kaposi's sarcoma in a 75-year old man who had been taking oral prednisone continually for 7 years as treatment of severe asthma. Data from the literature clearly show that corticosteroid therapy may trigger the development of Kaposi's sarcoma in patients who usually possess several other pathogenetic factors of that disease, such as pre-existing immune deficiency, environmental (viruses) or genetic factors. In some cases, withdrawing corticosteroids may result in complete remission of the cutaneous lesions.

[Congenital mesoblastic nephroma in the adult]. / Le néphrome mésoblastique congénital de l'adulte.

Congenital mesoblastic nephroma is a benign neoplasm of the kidney which is usually diagnosed during the first three months of life. We report herein a case of mesoblastic nephroma in a 69 year-old man. At this age, diagnosis can only be made by histopathologic examination of the operative specimen. This was the case for our patient and the five other cases reported in the literature. Histogenesis of mesoblastic nephroma is open to debate: mesenchymal origin for some authors, tumor of the blastema for most of the others.

[Nephrotic syndrome with minimal glomerular lesions, sensitive to corticoids, disclosing a chordoid sarcoma]. / Syndrome néphrotique à lésions glomérulaires minimes corticosensible révélateur d'un sarcome chordoïde.

A 65 year old woman had a minimal changes nephrotic syndrome (MCNS) with steroid-induced remission. An underlying malignancy was discovered at the time of relapse of proteinuria: it was a retroperitoneal chordoid sarcoma. Even though the tumor could not be excised, complete remission was again observed with corticosteroids. There was no second relapse when prednisone was discontinued and during the seven months before the patient died. This is a new unusual case of MCNS associated with carcinoma. The response of nephrotic syndrome steroid therapy is further suggestive evidence that deficiency in T-cell function may be involved.

[Gastric eosinophilic granuloma : value of endoscopic polypectomy. Apropos of 2 cases]. / Le granulome éosinophile gastrique : intérêt de la polypectomie endoscopique. A propos de deux observations.

Two ulcerated, sessile, gastric eosinophilic granulomas, measuring 5 and 10 mm in diameter, were diagnosed by endoscopic polypectomy (accurate prior forceps biopsy had not established accurate diagnosis). The patients, aged 76 and 74 years, had anemia and epigastric pain respectively. None of the usual etiologies (parasitic, chemical, traumatic and ulcerous) were found. Survival, clinical symptoms and location were similar to data reported in the literature, which are briefly reviewed. The value of endoscopic polypectomy is emphasized. With this procedure, pedunculated forms can be treated and sessile forms diagnosed, thus avoiding a useless gastrectomy and its hazards in these elderly patients.

[Perforated appendix associated with inflammatory ileo-coecal pseudotumour (malacoplakia) (author's transl)]. / Perforation appendiculaire associée à une pseudo-tumeur inflammatoire malacoplasique.

The authors report one case of perforated appendix associated with an inflammatory ileo-coecal pseudotumour due to malacoplakia. Right hemicolectomy resulted in uneventful and complete recovery. This case, together with a survey of available published data, enables the authors to briefly review the pathological, pathogenic and therapeutic aspects of this rare, if not exceptional, localisation of malacoplakia.

[Renal malacoplakia. Report of two cases and review of the literature (author's transl)]. / Malacoplakie rénale. A propos de deux observations, revue de la littérature.

The authors present a study of 38 cases of renal malacoplakia, two of which are personal. The clinical roentgenological and pathological data of such a histologically defined disease are reviewed. Nosological and physiopathological recollection is necessary before discussing management.