[Severe hemoptysis in the onco-hematology patient]. / Hémoptysies sévères du patient d'onco-hématologie.

In France, even though it occurs only exceptionally in cases of hemopathy, severe hemoptysis in cancer is the leading cause of hemoptysis. Without adequate treatment, in-hospital mortality exceeds 60%, even reaching 100% at 6 months. The management of severe hemoptysis should be discussed with the oncologist. Aside from situations of threatening hemoptysis, in which bronchoscopy should be performed immediately, CT angiography is an essential means of localizing the bleeding and determining the causes and the vascular mechanisms involved. In more than 90% of cases, hemoptysis is linked to systemic bronchial or non-bronchial hypervascularization, whereas in fewer than 5%, it is associated with pulmonary arterial origin or, exceptionally, with damage to the alveolar-capillary barrier. The most severely ill patients must be treated in intensive care in centers equipped with interventional radiology, thoracic surgery and, ideally, with interventional bronchoscopy. Interventional radiology is the first-line symptomatic treatment. In over 80% of cases, bronchial arteriography with embolization allows immediate control. Emergency surgery should be avoided, as it is associated with significant mortality. Appropriate and adequate care reduces hospital mortality to 30%, enabling patients to benefit from the most recent, survival-prolonging treatments.

[Rapid outpatient diagnostic pathways for lung cancer: Evaluation after one year]. / Parcours de diagnostic rapide du cancer du poumon : évaluation à un an.

INTRODUCTION: The introduction of coordinated care pathways for lung cancer diagnosis and treatment is a complex process. The purpose of the French Cancer Plan 2014-2019 was to improve referral to treatment waiting times in people with suspected malignancy. The aim of this study was to assess a rapid outpatient diagnostic program for lung cancer established in 2016. METHOD: This retrospective study was carried out in the Pulmonology Department at Tenon Hospital, Paris, France between May 2016 and May 2017. RESULTS: During this period, 118 patients (60%) of patients in the pathway were diagnosed with lung cancer. The median waiting time to first consultation (D1) was 4 (2-7) days. The median waiting time between diagnosis and treatment decision (D4) was 4 (0-8) days. The median waiting time to the first treatment (D5) was 10 (4-15) days for chemotherapy and 27 (16-34) days for surgery. The median waiting time between the first abnormal chest X-ray and the first treatment (D6) was 49 days (34-70). CONCLUSION: Referral to treatment waiting times was consistent with international recommendations. Coordinating nurses improved care pathways in lung cancer patients.

Diving into the unknown: identification of antimicrobial resistance hotspots in a tropical urban estuary.

Antimicrobial resistance is widely studied and well-characterized from a clinical perspective. However, considerably less information is available regarding resistance in environmental settings, especially in aquatic habitats. This study presents data regarding the occurrence, distribution and the antimicrobial susceptibility profile of bacteria isolated from Guanabara Bay (GB), a heavily polluted tropical urban estuary and an important tourist attraction in Rio de Janeiro, Brazil. Water samples from sites characterized by growing degrees of pollution were analysed by culture-dependent methods, revealing the presence of multidrug-resistant bacteria and clinically relevant indicators of antimicrobial resistance, such as extended-spectrum beta-lactamases. Isolates were identified by mass spectrometry, which indicated the presence of potential human pathogens such as Aeromonas spp. and Vibrio spp. Bacteria harbouring beta-lactam resistance genes were also detected. Although GB is widely used as a recreational and fishing area, there is a substantial knowledge gap regarding the monitoring of antimicrobial resistance and the risk that exposure to these waters poses to public health. Thus, this study reveals new information that calls for better comprehension of antimicrobial resistance in aquatic environments, especially those used for recreational purposes.

Daily multidisciplinary COVID-19 meeting: Experiences from a French university hospital.

OBJECTIVES: In March 2020, the World Health Organization declared the coronavirus disease 2019 (COVID-19) a pandemic. In absence of official recommendations, implementing daily multidisciplinary team (MDT) COVID-19 meetings was urgently needed. Our aim was to describe our initial institutional standard operating procedures for implementing these meetings, and their impact on daily practice. METHODS: All consecutive patients who were hospitalized in our institution due to COVID 19, from March 31 to April 15, 2020, were included. Criteria to be presented at MDT meetings were defined as a proven COVID-19 by PCR or strongly suspected on CT scan, requiring hospitalization and treatment not included in the standard of care. Three investigators identified the patients who met the predefined criteria and compared the treatment and outcomes of patients with predefined criteria that were presented during MDT meeting with those not presented during MDT meeting. COVID-19 MDT meeting implementation and adhesion were also assessed by a hospital medical staff survey. RESULTS: In all, 318 patients with confirmed or suspected COVID-19 were examined in our hospital. Of these, 230 (87%) were hospitalized in a COVID-19 unit, 91 (40%) of whom met predefined MDT meeting criteria. Fifty (55%) patients were presented at a MDT meeting versus 41 (45%) were not. Complementary exploration and inclusion in the CorImmuno cohort were higher in MDT meeting group (respectively 35 vs. 15%, P=0.03 and 80 versus 49%, P=0.0007). Prescription of hydrocortisone hemisuccinate was higher in group of patients not presented during MDT meeting (24 vs. 51%, P=0.007). Almost half of the patients fulfilling the inclusion criteria were not presented at MDT meeting, which can be partly explained by technical software issues. CONCLUSIONS: Multidisciplinary COVID-19 meetings helped implementing a single standard of care, avoided using treatments that were untested or currently being tested, and facilitated the inclusion of patients in prospective cohorts and therapeutic trials.

Avaliação morfofuncional do enxerto de túnica albugínea suína na cistoplastia em ratos / Morpho-fuctional evaluation of porcine tunica albuginea as a graft for cystoplasty in rats

O objetivo deste trabalho é avaliar o uso da túnica albugínea suína na cistoplastia em ratos, avaliando funcionalidade, capacidade de reparação do órgão e possibilidades de complicações. Foram selecionados 30 ratos Wistar, machos, de seis meses de idade, divididos em: um grupo teste (TA), em que os animais receberam o enxerto de túnica albugínea suína após a cistectomia parcial e um grupo controle (C), em que os animais sofreram somente a cistectomia parcial. Os animais pertencentes a ambos os grupos foram divididos igualmente em subgrupos de cinco animais cada, que sofreram eutanásia em sete, 28 e 42 dias de pós-operatório. Foi realizada uma análise macroscópica e, posteriormente, uma análise histopatológica da região da ferida cirúrgica. Aos sete e 28 dias, os animais pertencentes ao grupo C e ao grupo TA apresentaram urotelização, regeneração da lâmina própria e da musculatura, porém o grupo TA apresentou menores sinais inflamatórios e maior organização tecidual, principalmente com relação à formação das fibras musculares. Aos 42 dias de pós-operatório, ambos os grupos já apresentavam características histológicas normais. Concluiu-se que o enxerto de túnica albugínea suína obteve sucesso na regeneração da bexiga de ratos, mantendo a funcionalidade do órgão, sem rejeição, e favorecendo a migração celular.(AU)

The aim of this study is to evaluate porcine tunica albuginea as a graft for cystoplasty in rats, regarding bladder function, capacity and possible complications. 30 male Wistar rats with six monthes of age have been selected and separated into two different groups: A test group (TA) in which the animals received a tunica albuginea graft after partial cystectomy and a control group (C) in which partial cystectomy was performed, followed by bladder suture. In each group the animals were euthanized at seven, 28 and 42 days after surgery. Macroscopic and Histological analysis have been performed. At seven and 28 days after surgery the samples from both groups had urothelial lining upon a lamina propria and smooth muscle fibers in regeneration process. However, the TA group showed less inflammatory signs and more organized structure, mainly regarding the smooth muscle formation. At 42 days after surgery all groups showed a bladder wall structure qualitatively identical to the normal tissue. We could conclude that tunica albuginea graft is able to maintain bladder function and support cellular migration without any kind of rejection.(AU)

Neurocisticercosis. Hallazgos radiológicos / Imaging findings in neurocysticercosis

La neurocisticercosis es una parasitosis humana causada por las larvas de la Taenia solium, que es la que con mayor frecuencia afecta el sistema nervioso central. Esta infección es endémica en prácticamente todos los países en vías de desarrollo, pero debido a la globalización y a las migraciones humanas su frecuencia ha aumentado en países desarrollados como los de Europa Occidental. Las manifestaciones clínicas más frecuentes son la epilepsia, signos neurológicos focales e hipertensión intracraneal. Los hallazgos radiológicos dependen del estadio larvario de la Taenia solium, número y localización de los parásitos (parenquimatosa, subaracnoidea e intraventricular), así como de la respuesta inmune del huésped (edema, gliosis, aracnoiditis) y del desarrollo de lesiones secundarias (arteritis, infartos o hidrocefalia). El diagnóstico de esta parasitosis debe establecerse en función de los hallazgos clínicos y radiológicos, especialmente en un contexto epidemiológico adecuado, con apoyo de la serología(AU)

Neurocysticercosis, caused by the larvae of Taenia solium, is the parasitic infection that most commonly involves the central nervous system in humans. Neurocysticercosis is endemic in practically all developing countries, and owing to globalization and immigration it is becoming more common in developed countries like those in western Europe. The most common clinical manifestations are epilepsy, focal neurologic signs, and intracranial hypertension. The imaging findings depend on the larval stage of Taenia solium, on the number and location of the parasites (parenchymal, subarachnoid, or intraventricular), as well as on the host's immune response (edema, gliosis, arachnoiditis) and on the development of secondary lesions (arteritis, infarcts, or hydrocephalus). The diagnosis of this parasitosis must be established on the basis of the clinical and radiological findings, especially in the appropriate epidemiological context, with the help of serological tests(AU)

Supernumerary ring chromosome: an etiology for Pallister-Killian syndrome?

Characterization of marker chromosomes before the introduction of array CGH (aCGH) assays was only based on their banding patterns (G, C, and NOR staining) and fluorescent in situ hybridization techniques. The use of aCGH greatly improves the identification of marker chromosomes in some cases. We describe an atypical case of Pallister-Killian syndrome (PKS) detected at prenatal diagnosis with a very unusual cytogenetic presentation: a supernumerary ring chromosome including two copies of 12p. A similar anomaly described in a postnatal patient suggests ring chromosome as a possible cause of PKS. Extra ring chromosomes might be a more common etiology for PKS than previously thought, given the difficulty in their characterization before the advent of aCGH.

[Imaging findings in neurocysticercosis]. / Neurocisticercosis. Hallazgos radiológicos.

Neurocysticercosis, caused by the larvae of Taenia solium, is the parasitic infection that most commonly involves the central nervous system in humans. Neurocysticercosis is endemic in practically all developing countries, and owing to globalization and immigration it is becoming more common in developed countries like those in western Europe. The most common clinical manifestations are epilepsy, focal neurologic signs, and intracranial hypertension. The imaging findings depend on the larval stage of Taenia solium, on the number and location of the parasites (parenchymal, subarachnoid, or intraventricular), as well as on the host's immune response (edema, gliosis, arachnoiditis) and on the development of secondary lesions (arteritis, infarcts, or hydrocephalus). The diagnosis of this parasitosis must be established on the basis of the clinical and radiological findings, especially in the appropriate epidemiological context, with the help of serological tests.

Hallazgos neurorradiológicos en la fase inicial del desarrollo de astrocitomas corticales de alto grado de malignidad / Neuroimaging findings in the initial phase of development of high grade cortical astrocytomas

Objetivos. Describir las características neurorradiológicas de una serie de astrocitomas corticales de alto grado de malignidad en su fase inicial de desarrollo y su patrón de crecimiento durante un corto período de tiempo. Material y métodos. Estudio observacional retrospectivo de los hallazgos neurorradiológicos de 6 pacientes que, tras una primera crisis epiléptica, mostraron lesiones focales corticales supratentoriales que fueron seguidas clínico-radiológicamente durante un corto período de tiempo, tras el cual se estableció el diagnóstico de astrocitoma de alto grado de malignidad, Resultados. En los estudios de resonancia magnética (RM) de todos los pacientes se constató una pequeña lesión cortical hiperintensa en secuencias T2 con realce leve o moderado con la administración de contraste (en 5 de ellos). En los 6 pacientes se llevó a cabo un seguimiento radiológico en los 6 primeros meses tras el examen inicial (media: 79 días), que reveló un marcado crecimiento de las lesiones. Tras esta segunda RM, los pacientes fueron sometidos a cirugía citorreductora, y se estableció el diagnóstico histológico de astrocitomas de alto grado (glioblastoma en 5 pacientes y oligoastrocitoma anaplásico en uno). Conclusión. Los astrocitomas de alto grado de malignidad de origen cortical supratentorial en estadios iniciales pueden presentarse en los estudios neurorradiológicos de forma atípica. La presencia de una lesión cortical con realce leve o moderado tras la administración de contraste en un paciente que ha presentado una primera crisis epiléptica debería incluir en su diagnóstico diferencial los astrocitomas de alto grado de malignidad (AU)

Objectives. To describe the neuroradiological characteristics of a series of high grade cortical astrocytomas in the initial phase of development and their pattern of growth during a short time period. Material and methods. This was a retrospective observational study of the neuroradiological findings in six patients diagnosed with high grade astrocytoma. All presented with a new onset epileptic seizure and focal supratentorial cortical lesions. The diagnosis was established after a short period of clinical and radiological follow-up. Results. Magnetic resonance imaging (MRI) detected a small cortical lesion that was hyperintense in T2-weighted sequences in all six patients. This lesion showed slight or moderate enhancement after the administration of a contrast agent in five patients. All six patients underwent follow-up MRI within six months of the initial MRI examination (mean 79 days). Follow-up MRI showed marked growth of the lesions in all cases, and the histological diagnosis of high grade astrocytoma (glioblastoma in five patients and anaplastic oligoastrocytoma in one) was established after surgical debulking. Conclusion. High grade astrocytomas originating in the supratentorial cortex can have an atypical neuroradiological presentation in the early stages. High grade astrocytoma should be included in the differential diagnosis of a cortical lesion that enhances slightly or moderately after the administration of contrast material in a patient with a new onset epileptic seizure (AU)

Velocidad de expansión de gliomas de alto grado. Respuesta / No disponible

No disponible

Neuroimaging findings in the initial phase of development of high grade cortical astrocytomas.

OBJECTIVES: To describe the neuroradiological characteristics of a series of high grade cortical astrocytomas in the initial phase of development and their pattern of growth during a short time period. MATERIAL AND METHODS: This was a retrospective observational study of the neuroradiological findings in six patients diagnosed with high grade astrocytoma. All presented with a new onset epileptic seizure and focal supratentorial cortical lesions. The diagnosis was established after a short period of clinical and radiological follow-up. RESULTS: Magnetic resonance imaging (MRI) detected a small cortical lesion that was hyperintense in T2-weighted sequences in all six patients. This lesion showed slight or moderate enhancement after the administration of a contrast agent in five patients. All six patients underwent follow-up MRI within six months of the initial MRI examination (mean 79 days). Follow-up MRI showed marked growth of the lesions in all cases, and the histological diagnosis of high grade astrocytoma (glioblastoma in five patients and anaplastic oligoastrocytoma in one) was established after surgical debulking. CONCLUSION: High grade astrocytomas originating in the supratentorial cortex can have an atypical neuroradiological presentation in the early stages. High grade astrocytoma should be included in the differential diagnosis of a cortical lesion that enhances slightly or moderately after the administration of contrast material in a patient with a new onset epileptic seizure.

Changes in individual glucose threshold during military training.

The objective of the present study was to assess any improvement in the IGT (Individual Glucose Threshold) of soldiers during military physical training (MPT). Nine healthy non-athlete recruits (mean weight: 66.3+/-7.9 kg; mean height: 1.77+/-0.05 cm; mean age: 18.4+/-0.5 year) were submitted to incremental ergometric test on a treadmill. The initial speed was 6.0 km.h (-1) followed by increment of 1.0 km.h (-1) every 2 min until the subject became exhausted. Between running stages, a 15 s pause allowed 5 muL of capillary blood sample to be collected from the earlobe for glucose analysis. The IGT was determined by blood glucose concentration ([Gluc]) kinetics considering the exercise intensity corresponding to the lower [Gluc] during the test. The tests were conducted in four steps: before and after exactly 30, 60, and 90 days of training. The results showed that IGT was initially detected at 9.4+/-1.8 km.h (-1) but shifted to 11.4+/-1.9, 11.2+/-2.1 and 11.9+/-1.4 at 30, 60, and 90 days of training, respectively. A significant improvement after 30 and 90 days of training (p<0.05) compared to baseline. We concluded that the IGT shifted to higher exercise intensities after MPT. Future studies examining different training modalities are required to verify our results.

Infarto del territorio de la arteria cerebral posterior por disección carotídea / Posterior cerebral artery territory infarcts due to carotid dissection

Introducción. Cerca del 20% de los ictus en individuosmenores de 45 años se deben a disección de las arterias cervicocefálicasy ante su sospecha la resonancia magnéticadebe considerarse como el examen de primera elección. Lacirculación fetal posterior es una variante en el desarrolloembriogénico que puede ocasionar un infarto en el territorioposterior ante una disección o estenosis carotídea.Caso clínico. Presentamos el caso de un paciente de51 años con un infarto agudo occipitotemporal izquierdo yevidencia por ecografía dúplex de una oclusión de la arteriacarótida interna y de la arteria cerebral posterior izquierda, asícomo un probable origen carotídeo de la arteria cerebral posterior.La resonancia magnética craneal confirmó los hallazgosy mostró una disección en el segmento distal de la arteria carótidainterna izquierda con presencia de trombo mural.Conclusiones. Los infartos del territorio posterior causadospor disección carotídea espontánea son una entidadrara y se han comunicado pocos casos en la bibliografía.Realizamos una revisión de la bibliografía a este respecto (AU)

Introduction. About 20% of strokes in individualsunder 45 years of age are due to cervicocephalic arterydissection. The magnetic resonance should be the firstoption in the diagnostic process when this etiology issuspected. Posterior fetal circulation is a variant in theembryogenic development that may cause posteriorterritory infarcts in carotid dissections or stenosis Case report. We report the case of a 51 year-old malepatient, with left occipitotemporal acute infarct andocclusion of the internal carotid and left posterior cerebralarteries as well as a probable carotid origin of theposterior cerebral artery. These findings were found inthe duplex doppler sonography and were confirmed inthe cranial magnetic resonance which also showed a dissectionin the distal segment of the left internal carotidartery with a mural clot.Conclusions. Posterior territory strokes due to spontaneouscarotid dissection are rare and there are fewcases reported in the literature. We have reviewed theprevious literature on this topic (AU)

[Posterior cerebral artery territory infarcts due to carotid dissection]. / Infarto del territorio de la arteria cerebral posterior por disección carotídea.

INTRODUCTION: About 20% of strokes in individuals under 45 years of age are due to cervicocephalic artery dissection. The magnetic resonance should be the first option in the diagnostic process when this etiology is suspected. Posterior fetal circulation is a variant in the embryogenic development that may cause posterior territory infarcts in carotid dissections or stenosis. CASE REPORT: We report the case of a 51 year-old male patient, with left occipitotemporal acute infarct and occlusion of the internal carotid and left posterior cerebral arteries as well as a probable carotid origin of the posterior cerebral artery. These findings were found in the duplex doppler sonography and were confirmed in the cranial magnetic resonance which also showed a dissection in the distal segment of the left internal carotid artery with a mural clot. CONCLUSIONS: Posterior territory strokes due to spontaneous carotid dissection are rare and there are few cases reported in the literature. We have reviewed the previous literature on this topic.

Idiopathic inflammatory-demyelinating diseases of the central nervous system.

Idiopathic inflammatory-demyelinating diseases (IIDDs) include a broad spectrum of central nervous system disorders that can usually be differentiated on the basis of clinical, imaging, laboratory and pathological findings. However, there can be a considerable overlap between at least some of these disorders, leading to misdiagnoses or diagnostic uncertainty. The relapsing-remitting and secondary progressive forms of multiple sclerosis (MS) are the most common IIDDs. Other MS phenotypes include those with a progressive course from onset (primary progressive and progressive relapsing) or with a benign course continuing for years after onset (benign MS). Uncommon forms of IIDDs can be classified clinically into: (1) fulminant or acute IIDDs, such as the Marburg variant of MS, Baló's concentric sclerosis, Schilder's disease, and acute disseminated encephalomyelitis; (2) monosymptomatic IIDDs, such as those involving the spinal cord (transverse myelitis), optic nerve (optic neuritis) or brainstem and cerebellum; and (3) IIDDs with a restricted topographical distribution, including Devic's neuromyelitis optica, recurrent optic neuritis and relapsing transverse myelitis. Other forms of IIDD, which are classified clinically and radiologically as pseudotumoral, can have different forms of presentation and clinical courses. Although some of these uncommon IIDDs are variants of MS, others probably correspond to different entities. MR imaging of the brain and spine is the imaging technique of choice for diagnosing these disorders, and together with the clinical and laboratory findings can accurately classify them. Precise classification of these disorders may have relevant prognostic and treatment implications, and might be helpful in distinguishing them from tumoral or infectious lesions, avoiding unnecessary aggressive diagnostic or therapeutic procedures.

[Anatomic study of parapharyneal space]. / Estudio anatómico del espacio parafaríngeo.

The parapharyngeal space is considered the key space of the suprahioid neck, being essential to establish the origin and anatomic relations of the lesions of the profound neck. The descriptions of the fascial limits of the parapharyngeal space are variable in the litterature, reflecting some ambiguity in the manuals of anatomy and surgery. We have done a detailed study of this region, working on 5 cadavers, fixed in a solution of phenol and alcohol, and correlating the disection pieces with a radiologic study. The goal has been to improve our anatomic knowledge of the suprahioid neck, to be able to establish an anatomo-clinic-radiologic correlation of the lesions of this region, to be able to establish an differential diagnosis, predict possible ways of dissemination and facilitate the most proper surgical approach.

Estudio anatómico del espacio parafaríngeo / Anatomic study of parapharyneal space

El espacio parafaríngeo se considera el espacio clave del cuello suprahioideo, siendo esencial para establecer el origen y relaciones anatómicas de las lesiones que asientan en el cuello profundo. Las descripciones de los límites fasciales del espacio parafaríngeo son variables en la literatura, reflejándose cierta ambigüedad en los tratados de anatomía y de cirugía. Hemos realizado un estudio detallado de dicha región trabajando sobre 5 cabezas humanas fijadas en solución de fenol y alcohol, y correlacionando las piezas de disección con un estudio radiológico. El objetivo ha sido aumentar nuestro conocimiento anatómico del cuello suprahioideo para así poder establecer una correlación anátomo-clínico-radiológica de las lesiones que asientan en esta región y poder establecer un diagnóstico diferencial, predecir posibles rutas de diseminación y facilitar su abordaje quirúrgico más adecuado (AU)

Difusión por resonancia magnética en el diagnóstico de abscesos cerebrales / Magnetic resonance diffusion in the diagnosis of cerebral abscesses

No disponible

[Magnetic resonance in the diagnosis and treatment of multiple sclerosis]. / Resonancia magnética en el diagnóstico y manejo de la esclerosis múltiple.

Although the diagnosis of multiple sclerosis is still based on clinical criteria, confirmation by magnetic resonance imaging (MRI) is considered to be essential, thank to its high sensitivity in demonstrating the spatial dissemination of the demyelinating plaques in the brain and spinal cord. Additionally, MRI can establish an approximation of the pathological substrate of the multiple sclerosis plaques and it has proven useful for studying the natural history of the disease and monitoring the effects of new treatments. This capacity of MRI is based on its ability to estimate the degree of demyelination, gliosis, edema, inflammation and axonal damage and to detect diffuse involvement of the normal appearing white matter. The selective identification of the lesions that contribute most to the patient's disability and clinical progression, such as severe demyelination and axonal damage, improves the MRI correlation with the neurological impairment scales. However, a correct application of MRI in the study of multiple sclerosis requires standardization of the techniques and sequences used in the different clinical forms of the disease and of the systems for measuring the lesion load. In this way multiple sclerosis can serve as a true biological marker of the severity of the disease.