EUS-guided biliary drainage with electrocautery-enhanced lumen-apposing metal stent placement should replace PTBD after ERCP failure in patients with distal tumoral biliary obstruction: a large real-life study.

AIMS: In cases of malignant distal biliary obstruction, ERCP is the preferred technique for bile duct drainage. In case of failure, the alternative techniques are percutaneous transhepatic biliary drainage (PTBD) and more recently endoscopic ultrasound-guided biliary drainage. A new type of stent called the electrocautery-enhanced lumen-apposing metal stent (EC-LAMS) has been developed to enable the performance of biliary-enteric anastomosis under EUS-guidance in a single step, without prior bile duct puncture or the need for a guidewire. The aim of our study was to compare the real-life efficacies of PTBD and EUS-BD with the EC-LAMS for cases of ERCP failure in patients with malignant biliary obstruction. METHODS: We performed a monocentric retrospective study comparing PTBD and EUS-BD with the use of electrocautery-enhanced lumen-apposing metal stent in the context of a malignant distal biliary obstruction after ERCP failure. RESULTS: 95 patients were included (50 in EUS-BD group and 45 in PTBD group). The main etiology of malignant obstruction was adenocarcinoma of the head of pancreas (85%). There was a significant difference in favor of endoscopic ultrasound-guided biliary drainage using electrocautery-enhanced lumen-apposing metal stent for the following criteria: clinical success: 89.3% vs. 45.5%; p < 0.0001; procedure-related adverse event rate: 2.12% vs. 22.7%; p = 0.003; duration of post-drainage hospitalization: 3.5 vs. 8.2 days; p < 0.0001, overall survival (median survival): 118.2 vs. 42 days; p = 0.012, overall cost of the strategy per patient: 5098 vs. 9363 euros; p < 0.001. CONCLUSION: Our results are in favor of EUS-BD using electrocautery-enhanced lumen-apposing metal stent in case of ERCP failure for a distal tumor biliary obstruction. Operators performing ERCP for distal tumor biliary obstruction must learn this backup procedure because of its superiority over percutaneous transhepatic biliary drainage in terms of clinical success, safety, cost, and overall survival.

Substitution modelling in life cycle assessment of municipal solid waste management.

Life cycle assessment (LCA) is gaining importance worldwide in guiding waste management policies. The capacity of co-products such as recycled materials and recovered energy to avoid primary production of equivalent products largely determines the environmental performance of waste treatment technologies. Estimating the reductions in resource use, emissions, and impacts enabled by this substitution of primary production is often the most influential and controversial factor in quantifying the overall environmental performance of a waste management strategy. This study aims to critically evaluate the modelling of substitution in LCAs of recovered material from municipal solid waste management systems (MSWMS) by answering two questions. First, to what extent is substitution modelling transparently documented in the literature? Second, are the substitution ratios justified to represent physically realistic replacement of one product by another? To address these questions, we performed a systematic analysis of 51 LCA studies on MSWMS published in the peer-reviewed literature. We found that 22% of the substitution ratios are only implicitly expressed. A significant proportion of substitution ratios is not justified (65%), while for the remaining 35%, justifications do not represent physically realistic substitutions. We call for more rigor and transparency, and we propose guidance for the documentation of substitution ratios, with the aim of reaching more credible and robust analyses. For the justification of a substitution ratio to be considered physically realistic, information should notably be provided concerning loss of quality, the function performed by substitutable materials, and the sector of use.

[Non-cirrhotic ascites: pathophysiology, diagnosis and etiology]. / L'ascite non liée à la cirrhose : physiopathologie, diagnostic et étiologies.

Ascites, in 20% of cases, is not linked to liver cirrhosis. The pathophysiology is most often different. The understanding of these pathophysiological mechanisms can lead to etiologic diagnosis. The diagnostic approach is mainly based on the biological study of ascites, especially protein concentration and albumin gradient between serum and ascites. In Western countries, tumors and heart diseases are the predominant causes, while developing countries are mainly concerned by infectious diseases, among which tuberculosis is the leading cause. Other uncommon causes must be recognized, as ascites may be the presenting feature of the disease. Their knowledge will facilitate the therapeutic approach.

[Lead poisoning by fishing sinker ingestion]. / Intoxication par ingestion de plombs de pêche.

INTRODUCTION: Lead colic is a rare cause of abdominal pain. The diagnosis of lead poisoning is most often mentioned in at risk populations (children, psychotic patients). CASE REPORT: We report a 21-year-old man who presented with colicky abdominal pain. Abdominal plain radiograph showed multiple intracolonic metallic bodies. Markedly elevated lead and zinc protoporphyrin serum levels confirmed the diagnosis of lead poisoning. The patient reported that he commonly chewed fishing lead sinker and may sometimes swallow them during the preparation of fishing rod. Clinical outcome was favourable with chelation therapy. CONCLUSION: Lead poisoning following fishing sinker ingestion is very uncommon. Diagnosis may be discussed in the presence of foreign metallic bodies on plain abdominal radiograph and confirmed by high serum level of lead. A prompt treatment with chelation therapy and digestive emptying is usually effective.

Optimization and scale-up of a fluid bed tangential spray rotogranulation process.

The production of pellets in the pharmaceutical industry generally involves multi-step processing: (1) mixing, (2) wet granulation, (3) spheronization and (4) drying. While extrusion-spheronization processes have been popular because of their simplicity, fluid-bed rotogranulation (FBRG) is now being considered as an alternative, since it offers the advantages of combining the different steps into one processing unit, thus reducing processing time and material handling. This work aimed at the development of a FBRG process for the production of pellets in a 4.5-l Glatt GCPG1 tangential spray rotoprocessor and its optimization using factorial design. The factors considered were: (1) rotor disc velocity, (2) gap air pressure, (3) air flow rate, (4) binder spray rate and (5) atomization pressure. The pellets were characterized for their physical properties by measuring size distribution, roundness and flow properties. The results indicated that: pellet mean particle size is negatively affected by air flow rate and rotor plate speed, while binder spray rate has a positive effect on size; pellet flow properties are enhanced by operating with increased air flow rate and worsened with increased binder spray rate. Multiple regression analysis enabled the identification of an optimal operating window for production of acceptable pellets. Scale-up of these operating conditions was tested in a 30-l Glatt GPCG15 FBRG.

A high-rate perfusion bioreactor for plant cells.

A perfusion bioreactor allowing continuous extraction of secondary metabolites was designed and challenged for Eschscholtzia californica plant cell suspensions. Four sedimentation columns mounted inside a 2.5-L bioreactor separated single cells and cell aggregates from the culture medium. Cells were elicited with chitin at day 4 and the liquid medium free of cells and debris was then continuously pumped to the extraction columns containing fluidized XAD-7 resins, and then recirculated back to the cell suspension. A medium upward velocity corresponding to cell sedimentation velocity maintained a stable cell/medium separation front in the columns for sedimented cell volume (SCV) of 90% (70% packed cell volume, PCV). Two perfusion bioreactor cultures of 10 and 14 days were performed. A maximum dilution rate of 20.4/day was reached from day 4 to day 6, and was then reduced to 5/day at day 9 for 55% SCV. Control cultures were performed without and with free extraction resins into the cell suspension. Perfusion cultures showed similar specific growth rates of 0.24 +/- 0.04/day before and after elicitation. However, production level in the perfusion cultures was similar to that from the culture without resins with a maximum of 2.06 micromole/gDW total alkaloids, with 1.54 micromole/gDW in the resins. Cultures with free resins resulted in 30.94 micromole/gDW with 28.4 +/- 8.8 micromole/gDW in the resins. Difference in the cells nutritional state from elicitation was identified as a major cause in the production reduction. However, pathway to chelilutine was favored in the continuous extraction culture.

In situ extraction strategy affects benzophenanthridine alkaloid production fluxes in suspension cultures of Eschscholtzia californica.

The effect of contact between cells and extractive phase on secondary metabolite production was investigated in two-phase suspension cultures of Eschscholtzia californica. A system was designed to extract benzophenanthridine alkaloids from the cell culture, without contact between XAD-7 resins and the cells: only medium was recirculated through a column packed with the extractive phase. This strategy was compared to the classic method of addition of resins directly into the cell suspension. Removal of the product directly from the medium enabled important increases in production of alkaloids, namely a 20-fold increase in sanguinarine production and a 10-fold increase in chelerythrine, with high recovery in the resin. The recirculation strategy greatly simplified the production process since the resins are easily recovered from the cell culture and enable harvest of product without termination of culture. However, due to limited flow rate, the recirculation strategy was slightly less effective than direct addition of resins into the cell suspension. In addition to enabling increased production, removal of secondary metabolites from the medium changed metabolic flux distribution, testifying to a complex control mechanism of production.

Equifrequency surfaces in a two-dimensional GaN-based photonic crystal.

We established the angular conditions that maintain the quasi-phase matching conditions for enhanced second-harmonic generation. To do that, we investigated the equifrequency surfaces of the resonant Bloch modes of a two-dimensional periodic, hole-array photonic crystal etched into a GaN/sapphire epitaxial structure. The equifrequency surfaces exhibit remarkable shapes, in contrast to the simpler surfaces of a one-dimensional structure. The observed anisotropy agrees well with the surfaces calculated by a scattering matrix method. The equifrequency surfaces at fundamental and second-harmonic frequencies provide the values of polar and azimuthal angles that maintain quasi-phase matching conditions for enhanced second-harmonic generation over an extended tuning range. The predicted values for quasi phase-matching conditions show that frequency tuning for the two-dimensional case covers an about two times larger fractional bandwidth relative to the one-dimensional case.

Enhancing pyrene mineralization in contaminated soil by the addition of humic acids or composted contaminated soil.

The addition of composted PAH-contaminated soil to PAH-contaminated soil spiked with 14C-labeled pyrene resulted in rapid mineralization of pyrene (more than 57% after 21 days compared with 3.4% in un-amended soil). The addition of the humic acid fraction of the composted soil also increased the mineralization potential of the soil significantly, but to a lesser extent (37.5% mineralization after 106 days compared with 20.6% in unamended soil). Increasing the humic acid concentration increased mineralization up to a maximum of more than three times the unamended rate, after which the rate of pyrene mineralization decreased, possibly due to inhibitory pH or concentrations of salts. The amendment of PAH-contaminated soil with materials containing humic acids or humic acid extracts is suggested as a method of bioremediation.

The design and use of aerated microcosms in mineralization studies.

The need for aeration of microcosms during mineralization of 14C-labeled compounds in high oxygen demand environments was assessed using active compost-soil mixtures as the model system. Rapid mineralization of 14C-hexadecane occurred in continuously aerated microcosms while no mineralization occurred in unaerated microcosms. Daily flushing with air also yielded no mineralization. Mineralization of 14C-glucose was much less dependent on aeration. The alkaline solution volume and number of CO2 traps required for continuous aeration were calculated and tested experimentally.

[Magnetic resonance imaging of tibial periostitis]. / Imagerie par résonance magnétique de la périostite tibiale.

Tibial periostitis frequently occurs in athletes. We present our experience with MRI in a series of 7 patients (11 legs) with this condition. The clinical presentation and scintigraphic scanning suggested the diagnosis. MRI exploration of 11 legs demonstrated a high band-like juxta-osseous signal enhancement of SE and IR T2 weighted sequences in 6 cases, a signal enhancement after i.v. contrast administration in 4. Tibial periostitis is a clinical diagnosis and MRI and scintigraphic findings can be used to assure the differential diagnosis in difficult cases with stress fracture. MRI can visualize juxta-osseous edematous and inflammatory reactions and an increased signal would appear to be characteristic when the band-like image is fixed to the periosteum.

[Unilateral adrenal hematoma in adults. Contribution of MRI in follow-up]. / Hématome surrénalien unilatéral de l'adulte. Apport de l'IRM dans le suivi évolutif.

We describe a case of unilateral and spontaneous adrenal hematoma. Initial and follow up MRI examinations showed serial modifications typical of hematoma and allowed to exclude a preexisting non hyperfunctioning tumor. MRI findings modified the therapeutic attitude, a voiding surgery.

[Parathyroid adenoma as an ectopic carotid mass. Apropos of a case]. / Adénome parathyroídien en position carotidienne ectopique. A propos d'un cas.

Authors report a case of parathyroid adenoma as lateral palpable cervical mass, with serious hypercalcemia. MRI and ultrasound investigations were performed preoperatively. No other pathological parathyroid gland was found. Surgical treatment did not include the exploration of the four parathyroid glands. Long term follow-up is necessary.

[Pneumatosis cystoides intestinalis. Apropos of a case]. / La pneumatose kystique intestinale. A propos d'un cas.

Pneumatosis cystoides intestinalis is most frequently characterised by the presence of gaseous cysts, in the intra-parietal, subserous or sub-mucous zones of the colon. This complaint, with symptoms of non specific colic and the cause of chronic pain, generally progresses favourably but can be responsible for surgical complications. Characteristic signs are detected on an plain abdominal X-ray and by colonoscopy. The diagnosis can be established by CT or by ultrasonography but needs carefully trained operators. CT remains the most successful technique for the initial diagnosis and subsequent follow-up. Ultrasonography can also be used for follow-up. As the lesions regress rapidly, the diagnosis must established rapidly, otherwise the disorder might easily be incorrectly diagnosed.

Inflammatory reactions induced by various calcium pyrophosphate crystals.

Various inflammatory reactions can be induced by different crystals responsible for various arthropathies. The aim of this work was to study modifications induced in the rat, locally and at distance, by intrapleural injection of 3 forms of pyrophosphate crystals (CaPP dihydrated monoclinic (M), CaPP dihydrated triclinic (T) and CaPP anhydrous (beta]. The data presented here show that the structure of irritants plays a decisive role in the kinetics of inflammatory reactions from a local and systemic point of view.