Circulating Inhibitor against Factor X: A Rare Cause of Hemorrhagic Diathesis.

Acquired coagulopathies resulting from factor X deficiency are rare and typically associated with amyloidosis or plasma cell dyscrasia. Factor X plays a pivotal role in the coagulation cascade, converting prothrombin into thrombin and facilitating the formation of fibrinogen and thrombus. While its occurrence following common infections is extremely rare, isolated cases have been documented. We present a rare case of bleeding diathesis in a patient with community-acquired pneumonia, where prolonged activated partial thromboplastin time (aPTT) and prothrombin time (PT) led to the diagnosis of an infectious-triggered acquired circulating inhibitor targeting factor X. Prompt treatment with methylprednisolone effectively controlled the inhibitor without recurrence. This case report provides insights into the diagnostic strategies, differential algorithm, and therapeutic approaches for managing this rare coagulopathy.

Synthetic Cathinones in Belgium: Two Case Reports with Different Outcomes Observed in the Emergency Room.

We herein report two cases of cathinone intoxication. The first case is about a drug addict who was admitted to the emergency room after the injection of an unknown compound. He presented with tachycardia, palpitations, mydriasis, dyspnea, dizziness, headache and nausea. After leaving the hospital against medical advice, he returned the next day with police escort, presenting aggressiveness and agitation signs. One month later, he returned one more time for sleeping disorders, hallucinations and anxiety. He was finally transferred for his 21st detoxification treatment. The second case concerns a man who was wandering the streets and tried to escape when police officers called him. He confessed to snorting of N-ethylpentedrone and was admitted with severe agitation including delusion of persecution, tachycardia, mydriasis and fever. Because of renal failure, rhabdomyolysis and metabolic acidosis, he was transferred to the intensive care unit where he manifested worsening of the symptoms, turning into coma. He was intubated for 3 days before a complete resolution of the symptoms. A screening was performed by high-resolution mass spectrometry followed by quantifications made by high-performance liquid chromatography coupled with a diode array detector. In the first case, alpha-pyrrolidinohexiophenone was identified only during the first two admissions. However, as plenty of other psychotropic substances were also found, the cathinone alone could not be held directly responsible for the symptoms. In the second case, more than 2,000 ng/mL of N-ethylpentedrone was found without any decrease in the next 17 h, underlining the long half-life of this compound. Unlike the first case, symptoms could be clearly attributed to the cathinone. In conclusion, cathinones can be found on the Belgian illicit drug market, with various routes of administration and clinical consequences. In these two case reports, some common points were observed initially. However, one patient was finally able to leave the hospital without any treatment, whereas the other would most likely have died without intensive care.

[Post-traumatic ileal branch pseudoaneurysm]. / L'image du mois. Pseudoanévrysme iléal post-traumatique.

Arterial aneurysms of visceral branches are rare, even more if they occur on the superior mesenteric artery and its branches (among which ileal branches). Rupture is its major complication, thus rapid treatment is mandatory. CT angiography is the gold standard for diagnosis and therapeutic planification. Usual treatment is surgical, even though percutaneous embolization can be safely and precisely performed. Use of coils with sandwich technique is preferred.

Les anévrysmes artériels viscéraux sont rares, d'autant plus s'ils se situent au niveau du réseau artériel mésentérique supérieur et de ses branches (dont les artères iléales). Le risque principal est leur rupture, raison pour laquelle une prise en charge rapide est nécessaire. L'angioscanner abdomino-pelvien constitue le gold standard, permettant diagnostic et planification thérapeutique. Le traitement habituel est chirurgical, cependant, la technique percutanée endovasculaire peut être réalisée de façon sûre et efficace. L'utilisation de coils avec embolisation en «sandwich¼ de l'anévrysme est préférée.

[Pulmonary nodules in oncologic patients : always metastasis ?] / L'image du mois : Nodule pulmonaire dans un contexte oncologique : origine métastatique ?

During the follow-up of oncologic patients, pulmonary nodules are frequently discovered and pose a challenge to radiologists. Eventhough metastatic origin is often proposed, a thorough imaging protocol including non- and contrast-enhanced computed tomography combined with advanced reconstruction techniques, can be of a great support in proposing alternative diagnosis and adequate complementary treatment. This statement is illustrated by the case of a 60-year-old patient in which a pulmonary nodule diagnosed first as a metastasis, proved to be an aneurysmal pulmonary formation.

La découverte d'un nodule pulmonaire lors d'un suivi oncologique est une situation fréquente et pose un challenge radiologique. Si l'origine métastatique est souvent, et à juste titre, évoquée en première hypothèse, une mise au point plus rigoureuse par examen scannographique (sans et avec injection de produit de contraste) associé à des techniques de reconstruction avancées, peut permettre un diagnostic alternatif et la proposition d'une prise en charge adéquate. Nous illustrons ceci avec le cas d'un patient oncologique de 60 ans chez qui un nodule pulmonaire diagnostiqué en premier lieu comme métastase pulmonaire s'est révélé être une formation anévrismale pulmonaire.

Multiple paternity in a wild population of Armadillidium vulgare: influence of infection with Wolbachia?

Female multiple mating has been extensively studied to understand how nonobvious benefits, generally thought to be of genetic nature, could overcome heavy costs such as an increased risk of infection during mating. However, the impact of infection itself on multiple mating has rarely been addressed. The interaction between the bacterium Wolbachia and its terrestrial crustacean host, Armadillidium vulgare, is a relevant model to investigate this question. In this association, Wolbachia is able to turn genetic males into functional females (i.e. feminization), thereby distorting the sex ratio and decreasing the number of available males at the population scale. Moreover, in A. vulgare, females have been shown to mate multiply under laboratory conditions and males prefer uninfected females over infected ones. Additionally, different Wolbachia strains are known to infect A. vulgare and these strains differ in their transmission rate and virulence. All these elements suggest a potential impact of different Wolbachia strains on multiple mating. To investigate this assumption, we collected gravid females in a wild A. vulgare population harbouring both uninfected females and females infected with one of two different Wolbachia strains (wVulM and wVulC) and performed paternity analyses on the obtained broods using microsatellite markers. We demonstrate that (i) multiple paternity is common in this wild population of A. vulgare, with a mean number of fathers of 4.48 ± 1.24 per brood and (ii) females infected with wVulC produced broods with a lower multiple paternity level compared with females infected with wVulM and uninfected ones. This work improves our knowledge of the impact of infections on reproductive strategies.

Salts of the two-coordinate homoleptic manganese(I) dialkyl anion [Mn{C(SiMe3)3}2](-) with quenched orbital magnetism.

The reduction of Mn{C(SiMe3)3}2 with KC8 in the presence of crown ethers yielded the d(6), Mn(I) salts [K2(18-crown-6)3][Mn{C(SiMe3)3}2]2 and [K(15-crown-5)2][Mn{C(SiMe3)3}2], that have near-linear manganese coordination but almost completely quenched orbital magnetism as a result of 4s-3dz(2) orbital mixing which affords a non-degenerate ground state.

Effects of parasitic sex-ratio distorters on host genetic structure in the Armadillidium vulgare-Wolbachia association.

In the pill bug Armadillidium vulgare (Crustacea, Oniscidea), Wolbachia facilitates its spread through vertical transmission via the eggs by inducing feminization of genetic males. The spread of feminizing Wolbachia within and across populations is therefore expected to influence mitochondrial DNA (mtDNA) genetic structure by hitchhiking. To test this hypothesis, we analysed nuclear and mtDNA genetic structure, and Wolbachia prevalence in 13 populations of the pill bug host. Wolbachia prevalence (ranging from 0% to 100% of sampled females) was highly variable among populations. All three Wolbachia strains previously observed in A. vulgare were present (wVulC, wVulM and wVulP) with wVulC being the most prevalent (nine of 13 populations). The host showed a genetic structure on five microsatellite loci that is compatible with isolation by distance. The strong genetic structure observed on host mtDNA was correlated with Wolbachia prevalence: three mitotypes were in strong linkage disequilibrium with the three strains of Wolbachia. Neutrality tests showed that the mtDNA polymorphism is not neutral, and we thus suggest that this unusual pattern of mtDNA polymorphism found in A. vulgare was due to Wolbachia.

Shoulder function after latissimus dorsi transfer in breast reconstruction.

BACKGROUND/AIMS: Latissimus dorsi (LD) transfer in the case of breast reconstruction remains frequently used because this muscle provides a good size source of tissue in reconstructive surgery. Given that, the consequences of the LD removal on shoulder function and the actual loss of maximal strength developed must be investigated. METHODS: Twenty women (50 ± 7.5 years old) were evaluated before surgery, 3 and 6 months after an unilateral transfer of a pedicle flap of LD muscle used for breast reconstruction. Women performed a bilateral shoulder isokinetic assessment [for the internal rotators (IRs) and external rotators and for the abductor and adductor (ADD) muscles] allowing the establishment of bilateral muscular deficit status and the study of agonist/antagonist muscle ratios. The algofunctional and clinical status of the shoulders was analysed by the means of Constant score and specific shoulder clinical tests. The women did not perform any specific strengthening of muscle shoulder after surgery. RESULTS: The isokinetic assessment showed a muscle weakness 3 and 6 months after LD transfer, mainly on the ADDs (33 ± 9% at 6 months) and on the IRs (16 ± 11% at 6 months). The Constant score significantly decreased after surgery on the operated shoulder. Women with a Constant score impairment showed pain during specific shoulder clinical tests. We also found a correlation between Constant score impairment and internal rotators weakness or rotator muscle imbalance. CONCLUSION: Given those results, we could advocate a specific shoulder strengthening after LD transfer, focused mainly on the IRs and ADDs.

Discovery, characterization and validation of single nucleotide polymorphisms within 206 bovine genes that may be considered as candidate genes for beef production and quality.

A large number of putative single nucleotide polymorphisms (SNPs) have been identified from the bovine genome-sequencing project. However, few of these have been validated and many will turn out to be sequencing artefacts or have low minor allele frequencies. In addition, there is little information available on SNPs within coding regions, which are likely to be responsible for phenotypic variation. Therefore, additional SNP discovery is necessary to identify and validate polymorphisms both in specific genes and genome-wide. Sequence-tagged sites within 286 genes were resequenced from a panel of animals representing a wide range of European cattle breeds. For 80 genes, no polymorphisms were identified, and 672 putative SNPs were identified within 206 genes. Fifteen European cattle breeds (436 individuals plus available parents) were genotyped with these putative SNPs, and 389 SNPs were confirmed to have minor allele frequencies above 10%. The genes containing SNPs were localized on chromosomes by radiation hybrid mapping and on the bovine genome sequence by Blast. Flanking microsatellite loci were identified, to facilitate the alignment of the genes containing the SNPs in relation to mapped quantitative trait loci. Of the 672 putative SNPs discovered in this work, only 11 were found among the validated SNPs and 100 were found among the approximately 2.3 million putative SNPs currently in dbSNP. The genes studied in this work could be considered as candidates for traits associated with beef production and the SNPs reported will help to assess the role of the genes in the genetic control of muscle development and meat quality. The allele frequency data presented allows the general utility of the SNPs to be assessed.

[Sensibility of the abdomen after high superior tension abdominoplasty]. / Sensibilité de la paroi abdominale après abdominoplastie haute tension.

INTRODUCTION: Patients who undergo an abdominoplasty frequently complain about the loss of sensibility of the abdominal wall. In this study, we analyze this sensibility after the high tension abdominoplasty. PATIENTS AND METHODS: This is a prospective study of 23 females operated between July 2003 and January 2005. The abdominoplasty technique used in our study combines extensive liposuccion, limited undermining centered on the linea alba and traction sutures. The sensibilty tests are carried out preoperatively, as well as at 3 and 6 months postoperatively. The three components of the skin sensibility -tactile, algesic and thermic- are evaluated in four differents areas of the abdomen. RESULTS: In the lateral areas of the abdomen (liposucted only), the thermoalgesic sensibility is diminished at 3 months and completely recovers at 6 months. At 3 months postoperatively, the tactile sensibility is even better than the preoperative one and continues to improve by 6 months. The postoperative hypogastric area is widely undermined during surgery. In this area, the three types of sensibility are heavily altered at 3 months and only partially recover at 6 months. The undermining of the postoperative epigastric area is limited. In this zone, the postoperative thermoalgesic sensibility is diminished at 3 months, but completely recovers at 6 months. At 3 months, the tactile sensibility is less than the preoperative one, but it improves with time to even exceed the preoperative values at 6 months. CONCLUSION: The high tension abdominoplasty only needs a limited undermining and largely preserves the innervation of the abdominal flap. Only the hypogastric area, largely undermined, presents a sensitivity loss. These results are better than those previously reported in the literature.

[Detection of colonization by Streptococcus agalactiae: prospective study comparing real-time gene amplification with a new chromogenic medium Strepto B ID]. / Détection de la colonisation par Streptococcus agalactiae: étude prospective comparant l'amplification génique en temps réel à un nouveau milieu chromogène Strepto B ID.

We carried out a prospective study including 554 vaginal swabs simultaneously tested for antenatal screening of Group B Streptococcus (GBS or Streptococcus agalactiae) using culture on the chromogenic medium Strepto B ID (Biomérieux, Marcy l'Etoile, France) and real time gene amplification on LightCycler (Roche Applied Science). We centrifuge the swabs with "SETS" device and separate centrifugates in 2 parts: one for the culture and the other one for molecular biology. First half of the centrifugate is inoculated onto Todd-Hewitt broth enriched with antibiotics. This broth is incubated to 35 degrees C during 24 hours and then subcultured on a Strepto B ID medium. This last one is incubated during 24 hours to 35 degrees C in capnophilic conditions before interpretation. DNA extraction for molecular biology is simply obtained by heating the microtubes to 95 degrees C in a water bath. The cfb gene is amplified, allowing a specific gene amplification of GBS even within a polymorphic flora. The concordance between both methods is 94.8%. The sensitivity and negative predictive values obtained are respectively 88.0 and 97.4% for real time PCR and 83.0 and 96.4% for culture on Strepto B ID. Both methods are thus concordant, with equal sensitivity and valid for detection of GBS colonization in pregnant women. However real time gene amplification allows reducing turn around time since molecular biology process (extraction+amplification) does not exceed 1 hour.

Cadmium, lead and endometriosis.

OBJECTIVES: Cadmium (Cd) and lead (Pb) have been demonstrated to exert endocrine disrupting activities. Their possible role in endometriosis, an oestrogen-dependent disease, is unknown. METHODS: We compared cadmium urinary excretion (CdU) and blood concentration of cadmium (CdB) and lead (PbB) in 119 patients with peritoneal endometriosis and/or deep endometriotic (adenomyotic) nodules of the rectovaginal septum and 25 controls. RESULTS: The mean levels of cadmium in urine and blood did not differ among the groups. Women suffering from endometriotic diseases showed lower levels of PbB than controls. CONCLUSIONS: These data do not support a role for cadmium in the onset or the growth of endometriotic diseases but suggest a possible relationship with lead.

[How I treat...fibroproliferative scars]. / Comment je traite...les cicatrices fibroprolifératives.

Following a skin injury like burn, surgery or a trauma, fibroproliferatives scars are responsible of cosmetic, psychologic and symptomatic disorders. Keloids are benign and occur secondary to an imbalance between the synthesis of extracellular matrix and its degradation. There is a lot of therapeutic modalities available. Despite this, recurrence and sometimes increasing lesions are the major complications. Surgery with adjuvant therapy like steroids injections, radiotherapy, silicone materials seems today the best therapeutic choice. A best physiopatholgy's comprehension is at the base of new treatments, but their efficacity still need to be demonstrate in larger studies.

Liposuction: review of the techniques, innovations and applications.

Liposuction is currently the most frequently performed aesthetic operation in the world. Despite its wide-spread popularity, it should nevertheless be stated that it is not trivial surgery, not always benign and not as safe as intimated in the glossy office brochures. Since the initial description of liposuction, numerous changes have taken place. Today, surgical indications are well defined and the liposuction procedure is well codified. However, several surgeons and manufacturers have developed new equipment and techniques. We propose to survey all the techniques showing the real place of each of them. Their advantages and disadvantages will be discussed. The various techniques dealt with are: the wetting solution techniques, standard liposuction or Suction-Assisted Lipoplasty (SAL), internal Ultrasound-Assisted Liposuction (iUAL), VASSER assisted liposuction, external Ultrasound-Assisted Liposuction (eUAL), Laser-Assisted Liposuction (LAL), Power-Assisted Liposuction (PAL) and Vibroliposuction (VL). On the basis of this review of the literature and of our clinical experience, we conclude that VL is the safest, most effective and precise surgery that can be used in any of the modern indications for liposuction. We concluded that VL seems to have all the advantages and none of the disadvantages associated with iUAL.

[Mondor's disease: a complication after breast surgery]. / La maladie de Mondor: une complication de la chirurgie mammaire.

Mondor's disease is a rare but not uncommon complication of breast surgery. This problem is commonly described as the thrombophlebitis of the superficial thoracoabdominal veins. Symptoms combine painful contracture occurring in the sub-mammary region and/or in the axillary region, rising during arm abduction. The contracture located in the axillary region usually join the epitrochlea. Based on a serie of 8 patients, the fascial hypothesis is developed. All the patients were treated by LPG and myo-fascial techiques with a complete relief of pain in 10 days.

Phylogeography of the threatened crayfish (genus Austropotamobius) in Italy: implications for its taxonomy and conservation.

A nucleotide sequence analysis of a portion of the mitochondrial large ribosomal subunit was performed to define the phylogeography of the threatened crayfish Austropotamobius (Decapoda; Astacidae) in Italy. We collected 61 specimens from 31 localities across the Italian peninsula. For the phylogenetic inference, we combined the 61 Austropotamobius spp sequences obtained from this study with 18 sequences deposited in GenBank and corresponding to Italian, French, Irish, Swiss, and Slovenian locations. Among the analysed sequences, 34 distinct haplotypes were detected. Our results confirmed the presence of both A. pallipes and A. italicus in the Italian peninsula and the existence within the latter species of a strong intraspecific genetic variation, due to the occurrence of four subspecies with a well-defined geographic distribution. From a conservation viewpoint, Italy, with its high haplotype variability, may be considered a 'hot spot' for the genetic diversity of the European native crayfish Austropotamobius. We suggest that re-introduction programs should be conducted with extreme caution in Italy, since not only the two Austropotamobius species but also the four A. italicus subspecies are genetically and taxonomically separate units and require independent conservation plans.

Dual inhibition of 5-lipoxygenase/cyclooxygenase by a reconstituted homeopathic remedy; possible explanation for clinical efficacy and favourable gastrointestinal tolerability.

OBJECTIVE: In order to elucidate potential anti-inflammatory activities of Zeel comp. N and its constituents, the inhibition of the synthesis of Leukotriene B4 (LTB4) and Prostaglandin (PGE2) by 5-lipoxygenase (5-LOX) and cyclo-oxygenase 1 and 2 (COX 1 and 2) respectively were examined in vitro. MATERIALS: Human HL-60 cells, differentiated for 6-8 days with DMSO (1.2% v/v) were used for the 5-LOX assay. The COX activity assays were carried out with purified enzymes, COX 1 (ram seminal vesicles), COX 2 (sheep placenta) and with human THP-1 cells, differentiated for 24 h with PMA (50 nM). METHODS: LTB4 and PGE2 production in the 5-LOX and COX assays respectively were determined by enzyme linked immunoassays. RESULTS: A reconstituted Zeel comp. N combination as well as its constituent mother tinctures of Arnica montana, Sanguinaria canadensis and Rhus toxicodendron (Toxicodendron quercifolium) showed distinct inhibitory effects on the production of LTB4 by 5-LOX (IC50 values of 10, 20, 2 and 5 microg/ml respectively) and on the synthesis of PGE2 by COX 1 (IC50 values of 50, 80, 40 and 20 microg/ml respectively) and COX 2 enzymes (IC50 values of 60, 110, 50 and 20 microg/ml respectively). The mother tincture of Solanum dulcamara inhibited the production of PGE2 by COX 1 (IC50 40 microg/ml) and COX 2 (IC50 150 microg/ml) but not production of leukotriene LTB4 by 5-LOX. CONCLUSIONS: The observed dual inhibition of both LOX- and COX-metabolic pathways may offer an explanation for the reported clinical efficacy and the favorable gastrointestinal tolerability of the original remedy Zeel comp. N.

Origin and colonization history of the white-clawed crayfish, Austropotamobius pallipes, in Ireland.

The presence of the white-clawed crayfish Austropotamobius pallipes complex in Ireland is suspected to be a result of human translocations. Two hypotheses have been formulated about the origin of the crayfish: from British populations or from western French populations. In order to resolve this question, nine Irish crayfish populations (a total of 124 individuals) were sampled along a south-north cline and investigated by combining two molecular markers: mtDNA and RAPDs. The mtDNA marker, analysed by RFLP on the entire molecule, showed an absence of polymorphism within and among Irish populations. The RFLP haplotype found in Irish populations was only recorded in western French populations and was different from those found in English populations. This result may be explained by a human introduction of crayfish to Ireland from western French populations. RAPD analysis showed a clinal reduction of genetic variability within Irish populations from south to north, associated with an increase in their genetic differentiation. A stepwise model of translocation from the south to the north of Ireland is proposed and discussed.

Population genetic structure of the endangered freshwater crayfish Austropotamobius pallipes, assessed using RAPD markers.

Random amplified polymorphic DNA (RAPD) analysis was performed to characterize the genetic diversity of Austropotamobius pallipes, a threatened freshwater crayfish native to Europe. Four decamer primers which generated six unambiguous polymorphic bands were used to analyse crayfish from 21 populations sampled in the major part of its range. Genetic diversity within populations of A. pallipes, estimated by Shannon's diversity index, ranged from 0 to 0.446 with a mean of 0.159. A UPGMA dendrogram constructed from pairwise PhiST values between populations, revealed three clusters corresponding to populations sampled in the southern, northwestern and eastern part of its range. AMOVA analysis revealed a high genetic structure of A. pallipes populations PhiST=0.814, with 73.11% of the genetic variation distributed between these clusters. It suggests a historical geographical separation of these groups into three refugial areas, probably in the Rhine, Mediterranean and Atlantic basins during recent glaciations. The close genetic relationships between English and western French populations are in accordance with a natural postglacial origin of English populations from individuals having survived in an Atlantic refugium. However, the present results suggest that the Irish stock originated from a human translocation of individuals from an Atlantic refugium.

Drastic bottlenecks in the endangered crayfish species Austropotamobius pallipes in Spain and implications for its colonization history.

Variation in mitochondrial DNA (mtDNA) was surveyed, using restriction endonucleases, in the white-clawed crayfish, Austropotamobius pallipes lusitanicus, from 14 populations sampled in Spain. Four additional samples from France (1), Slovenia (1) and Italy (2) were also analysed. Among the 11 haplotypes listed, only one was detected from the 154 animals sampled from Spanish populations. This haplotype was also recorded in the Fosso di Ferfereta population (Italy). Estimates of nucleotide sequence divergence among haplotypes ranged from 0.45% to 17.4%. Interpopulational genetic relationships showed that Spanish populations were closely related to those of Fosso di Ferfereta with a small genetic distance (0.0003) found between them. AMOVA revealed that most of the genetic variance (71.97%) was attributed to variation between European regions. These results are in accordance with a drastic bottleneck event during the history of the Spanish populations. Four suggestions, based on human introduction, selection and recent or ancient historical events are discussed in relation to the lack of genetic variation in the Spanish crayfish stock.