Chest CT Characteristics are Strongly Predictive of Mortality in Patients with COVID-19 Pneumonia: A Multicentric Cohort Study.

RATIONALE AND OBJECTIVES: The novel coronavirus (COVID-19) has presented a significant and urgent threat to global health and there has been a need to identify prognostic factors in COVID-19 patients. The aim of this study was to determine whether chest computed tomography (CT) characteristics had any prognostic value in patients with COVID-19. MATERIALS AND METHODS: A retrospective analysis of COVID-19 patients who underwent a chest CT-scan was performed in four medical centers. The prognostic value of chest CT results was assessed using a multivariable survival analysis with the Cox model. The characteristics included in the model were the degree of lung involvement, ground glass opacities, nodular consolidations, linear consolidations, a peripheral topography, a predominantly inferior lung involvement, pleural effusion, and crazy paving. The model was also adjusted on age, sex, and the center in which the patient was hospitalized. The primary endpoint was 30-day in-hospital mortality. A second model used a composite endpoint of admission to an intensive care unit or 30-day in-hospital mortality. RESULTS: A total of 515 patients with available follow-up information were included. Advanced age, a degree of pulmonary involvement ≥50% (Hazard Ratio 2.25 [95% CI: 1.378-3.671], p = 0.001), nodular consolidations and pleural effusions were associated with lower 30-day in-hospital survival rates. An exploratory subgroup analysis showed a 60.6% mortality rate in patients over 75 with ≥50% lung involvement on a CT-scan. CONCLUSION: Chest CT findings such as the percentage of pulmonary involvement ≥50%, pleural effusion and nodular consolidation were strongly associated with 30-day mortality in COVID-19 patients. CT examinations are essential for the assessment of severe COVID-19 patients and their results must be considered when making care management decisions.

[Muscular metastases from renal cell carcinoma]. / Métastases musculaires des carcinomes à cellules rénales.

Renal cell carcinoma can metastasize to several locations but rarely in muscles. However, this possibility must never be overlooked because muscle metastases may occur a very long time after the initial nephrectomy. So the post-operative follow-up, according to the recommendations, with thoraco-abdomino-pelvic imaging (computed tomography or nuclear magnetic resonance) allowing to detect metastases, including muscle metastases in the trunk, does not have to neglect the metastases located in the members. This search is based upon a thorough clinical examination, completed by targeted imaging in case of symptoms and/or palpable mass.

[Ophthalmic manifestations in Wegener's granulomatosis. Review of literature about an observation]. / Manifestations ophtalmologiques de la granulomatose de Wegener. Revue de la littérature à propos d'une observation.

Wegener's granulomatosis mainly affects the upper respiratory tract, the lungs and the kidneys but many other organs and tissues may be affected, as well including any eye structures. Ocular and orbital structures involvement is frequently encountered, sometimes inaugural, with or without obvious systemic manifestations, sometimes leading to visual loss. The most frequent ophthalmic lesions are inflammatory orbital disease, (necrotising) scleritis with or without keratopathy, episcleritis, conjunctivitis and even conjunctival ulcer, nasolacrimal ducts obstruction, uveitis, retinal vasculitis and even central retinal vascular occlusion, optic neuritis. These ocular lesions result either from extensive granulomatous inflammation or from focal vasculitis. These complications need to be recognized as soon as possible so that an early diagnosis may allow the appropriate treatment meant to keep both visual and even general prognosis.

[A rare cause of peripheral edema: exudative lymphocytic gastritis induced hypoprotidemia]. / Une cause rare d'oedèmes: l'hypoprotidémie de la gastrite lymphocytaire exsudative.

Diagnosis of edema secondary to hypoprotidemia but without nutritional, renal, hepatic or cardiac cause, must consider exudative digestive disease, of which the lymphocytic gastritis, as the authors report here a new observation diagnosed in a 73 year-old woman. Gastroscopy reveals varioliform gastritis and biopsy demonstrates diffuse infiltration of the gastric epithelium by lymphocytes, making of it a real histopathologic entity among the gastropathies. Etiology and pathogeny remain still unknown but proton pump gastric inhibitors are an effective treatment.