Comparative Risk of Incident Cancer in Patients with Inflammatory Bowel Disease with Prior Non-digestive Malignancy According to Immunomodulator: a Multicentre Cohort Study.

INTRODUCTION: Knowledge about the cancer risk when initiating a biologic in inflammatory bowel disease [IBD] patients with prior malignancy remains scarce, especially for vedolizumab. Our aim was to evaluate the rate of incident cancer in a cohort of IBD patients with prior non-digestive malignancy, according to the subsequent treatment given. METHODS: A multicentre retrospective study included consecutive IBD patients with prior non-digestive malignancy. Inclusion date corresponded to the diagnosis of index malignancy. Patients were categorized into different cohorts according to the first treatment [none, conventional immunosuppressant, anti-TNF, or vedolizumab] to which they were exposed after inclusion and before incident cancer [recurrent or new cancer]. RESULTS: Among the 538 patients {58% female; mean (standard deviation [SD]) age inclusion: 52 [15] years} analyzed, the most frequent malignancy was breast cancer [25%]. The first immunomodulator given after inclusion was a conventional immunosuppressant in 27% of patients, anti-TNF in 21%, or vedolizumab in 9%. With a median (interquartile range [IQR]) follow-up duration of 55 [23-100] months, 100 incident cancers were observed. Crude cancer incidence rates per 1000 person-years were 47.0 for patients receiving no immunomodulator, 36.6 in the anti-TNF cohort, and 33.6 in the vedolizumab cohort [p = 0.23]. Incident-cancer free survival rates were not different between patients receiving anti-TNF and those receiving vedolizumab [p = 0.56]. After adjustment, incidence rates were not different between patients receiving no immunomodulator, anti-TNF, or vedolizumab. CONCLUSIONS: In this large multicentre cohort study, there was no difference of cancer incidence in those IBD patients with prior non-digestive malignancy, treated with vedolizumab or anti-TNF.

[The role of reflectance confocal microscopy in the diagnosis of secondary syphilis of the vulva and anus: A first case report]. / Apport de la microscopie confocale par réflectance dans le diagnostic de syphilides ano-vulvaires, premier cas relaté.

PATIENTS AND METHODS: Herein we report the case of an 18-year-old pregnant patient presenting with plantar and ano-genital lesions of syphilis, pharyngitis, erythematosus and scalynasolabial intertrigo and angular cheilitis. REFLECTANCE CONFOCAL MICROSCOPY: In vivo reflectance confocal microscopy examination (Vivascope 3000®; Caliber Inc, Rochester, NY, USA, distributed in France by Mavig, Munich) of ano-genital lesions enabled us to identify hyper-reflective elongated rods in the papillary dermis suggesting spirochetes. The diagnosis was confirmed by TPHA and VDRL as well as immunohistological examination. COMMENTS: We identified for the first time rod shaped structures in ano-genital lesions of secondary syphilis, regularly alternating hyper-reflective and non-reflective areas corresponding to helix-shaped treponemes visualized by darkfield microscopy, which may not be confused with other cell structures.

Videodermoscopy compared to reflectance confocal microscopy for the diagnosis of scabies.

INTRODUCTION: Reflectance confocal microscopy (RCM) and dermoscopy have recently been suggested for non-invasive diagnosis of scabies. However, there are large studies on diagnostic accuracy for scabies only with dermoscopy at low (10×) and high (100-1000×) magnification. OBJECTIVE: Our study evaluated the diagnostic accuracy, for the diagnosis of scabies, of RCM and videodermoscopy at intermediate (20× and 70×) magnification, which is usually found in commercially available videodermoscopes. METHODS: Patients with a presumptive diagnosis of scabies were prospectively enrolled during 20 months and examined by RCM and videodermoscopy at intermediate magnification. The specificity of RCM was considered 100% because RCM can identify the anatomical details of the parasites. RESULTS: A total of 148 patients were enrolled. Videodermoscopy showed a higher sensitivity for scabies than RCM (95% vs. 92%) and a specificity of 97%. CONCLUSIONS: Videodermoscopy at intermediate magnification, and RCM are both highly accurate for the diagnosis of scabies. If the two devices are available, it would be better to perform videodermoscopy first, that is more sensitive, and then RCM to confirm the diagnosis.

Staphylococcus aureus nasal and pharyngeal carriage in Senegal.

Nasal and pharyngeal swabs were collected from 132 patients admitted to the Principal Hospital in Dakar (Senegal), in January and February 2012. The prevalence of Staphylococcus aureus carriage was 56.1% (n = 74): 40.2% for pharyngeal samples and 36.4% for nasal samples. None of the isolates was methicillin-resistant. Carriage was independently associated with being female (p <0.01) and large households (≥15 members) (p 0.04). The luk-PV genes encoding Panton-Valentine leukocidin (PVL) were present in 26.2% of the isolates. These data highlight the importance of the oropharynx as a site of colonization, and the high prevalence of PVL-positive isolates in Senegal as compared with industrialized countries.

[Measles in the Nantes Teaching Hospital during the 2008-2009 epidemic]. / Rougeole au CHU de Nantes au cours de l'épidémie 2008-2009.

OBJECTIVE: A recent measles epidemic in France incited us to report and describe measles cases requiring hospitalization, to raise the awareness of health professionals on under-diagnosis and frequent complications of this viral disease. DESIGN: We carried out a retrospective and epidemiologic study of measles cases recorded in the Nantes Teaching Hospital between August 2008 and September 2009. All these cases where confirmed by biological diagnosis and recorded by the Teaching Hospital virological laboratory. RESULTS: Thirteen cases of measles (11 adults and two children) were recorded during the study period. Adults were young (mean age 21.4 years); the oldest was 35 years old. We noted two severe cases with viral pneumonia and hypoxemia and one case with bacterial pneumonia. Two female patients were pregnant; one delivered prematurely, in the acute phase of measles, with no complication for the newborn. Two cases occurred in the nursing staff by documented nosocomial transmission. Sixty-nine percent of the patients were not vaccinated whereas the vaccinal status was not documented for 31%. CONCLUSIONS: These cases underline the potential severity of this infection and the difficulty to diagnose measles at the early phase because of lack of awareness of medical staff. It will be necessary to reinforce prevention messages and promote measles vaccination in children as well as in young people and health workers.

Search for extraterrestrial point sources of neutrinos with AMANDA-II.

We present the results of a search for point sources of high-energy neutrinos in the northern hemisphere using AMANDA-II data collected in the year 2000. Included are flux limits on several active-galactic-nuclei blazars, microquasars, magnetars, and other candidate neutrino sources. A search for excesses above a random background of cosmic-ray-induced atmospheric neutrinos and misreconstructed downgoing cosmic-ray muons reveals no statistically significant neutrino point sources. We show that AMANDA-II has achieved the sensitivity required to probe known TeV gamma-ray sources such as the blazar Markarian 501 in its 1997 flaring state at a level where neutrino and gamma-ray fluxes are equal.

Limits on diffuse fluxes of high energy extraterrestrial neutrinos with the AMANDA-B10 detector.

Data from the AMANDA-B10 detector taken during the austral winter of 1997 have been searched for a diffuse flux of high energy extraterrestrial muon neutrinos. This search yielded no excess events above those expected from background atmospheric neutrinos, leading to upper limits on the extraterrestrial neutrino flux measured at the earth. For an assumed E-2 spectrum, a 90% classical confidence level upper limit has been placed at a level E2Phi(E)=8.4 x 10(-7) cm(-2) s(-1) sr(-1) GeV (for a predominant neutrino energy range 6-1000 TeV), which is the most restrictive bound placed by any neutrino detector. Some specific predicted model spectra are excluded. Interpreting these limits in terms of the flux from a cosmological distributions of sources requires the incorporation of neutrino oscillations, typically weakening the limits by a factor of 2.

Image guided navigation system-a new technology for complex endoscopic endonasal surgery.

PURPOSE: Endoscopic endonasal surgery (EES) has become the standard practice in sinonasal and anterior skull base surgery. The purpose of this manuscript is to describe experience using a new technology-the image guided navigation system (IGNS)-in complex cases undergoing EES. The advantages and disadvantages of computer aided surgery are discussed. PATIENTS AND METHODS: A total of 165 endoscopic endonasal procedures were performed between April 2001 and January 2003. IGNS was used in 34 patients in whom it was assumed that the ability to identify surgical sites accurately could be compromised by previous surgery, massive recurrent polyposis, or abnormal anatomy, or when biopsies had to be taken from specific anatomic locations (for example, clivus, wall of sphenoid sinus, orbital apex). The precision of the navigation system, total operating room time, surgeon's satisfaction and confidence, and intraoperative and postoperative complications were recorded. RESULTS: In 33 out of 34 patients the surgical procedure was uneventful. One patient with an atelectatic maxillary sinus developed a minor complication of preseptal orbital haematoma. In 94% the IGNS provided accurate anatomical localisation with less than 2 mm localisation error (1.1-2.0 mm, mean 1.6 mm). In all cases the surgical team felt that the system increased the intraoperative safety factor for the patient. The overall operating room time at the end of the study was 15 minutes longer than when regular EES was used. CONCLUSIONS: IGNS enables a new level of efficiency and safety in EES. Nevertheless, it is not advised for surgeons who are not familiar with regular EES. For the experienced endoscopist, however, IGNS is a valuable new tool in complex procedures.

Observation of high-energy neutrinos using Cerenkov detectors embedded deep in Antarctic ice.

Neutrinos are elementary particles that carry no electric charge and have little mass. As they interact only weakly with other particles, they can penetrate enormous amounts of matter, and therefore have the potential to directly convey astrophysical information from the edge of the Universe and from deep inside the most cataclysmic high-energy regions. The neutrino's great penetrating power, however, also makes this particle difficult to detect. Underground detectors have observed low-energy neutrinos from the Sun and a nearby supernova, as well as neutrinos generated in the Earth's atmosphere. But the very low fluxes of high-energy neutrinos from cosmic sources can be observed only by much larger, expandable detectors in, for example, deep water or ice. Here we report the detection of upwardly propagating atmospheric neutrinos by the ice-based Antarctic muon and neutrino detector array (AMANDA). These results establish a technology with which to build a kilometre-scale neutrino observatory necessary for astrophysical observations.

Seasonal variation in sudden death in the Negev desert region of Israel.

BACKGROUND: Previous studies have documented an increased incidence of cardiac mortality and sudden death during winter months. OBJECTIVES: To evaluate seasonal variation in sudden death in a hot climate such as the desert region of southern Israel. METHODS: We analyzed the files of 243 consecutive patients treated for out-of-hospital sudden death by the Beer Sheva Mobile Intensive Care Unit during 1989-90. Daily, monthly and seasonal incidence of sudden death was correlated with meteorological data, including temperature, heat stress, relative humidity and barometric pressure. RESULTS: The seasonal distribution of sudden death was 23% in spring, 21% in summer, 25% in autumn and 31% in winter (not significant). In patients with known heart disease there were more episodes of sudden death in cold weather (< 15.4 degrees C) than hot (> 34.2 degrees C) (16 vs. 3, P < 0.05). Resuscitation was less successful in cold compared with hot weather (28 vs. 11, P < 0.05). Of patients older than 65 years, 11 sustained sudden death when heat stress was below 12.4 degrees C compared to 2 patients when heat stress was above 27.5 degrees C (P = 0.05). CONCLUSION: Despite the warm desert climate, there were more cases of sudden death in older patients and in those with known heart disease during the winter season and on particularly cold days.

Prognostic factors and indications for surgical treatment of acute aortic dissections: a report based on 191 observations.

A total of 191 acute aortic dissections were examined to define prognostic factors for surgical intervention. Overall survival rate reached 40% in the 94 patients operated upon and 8% in the 97 patients not operated upon. Among the 122 patients with involved ascending aorta, survival rate was 2% in the 42 nonoperated patients versus 42% in 80 patients undergoing surgery. Since 1977, overall survival rate has reached 60% in the surgical group (21 of 35 patients) and 20% in the nonsurgical group (5 of 25 patients). Factors that showed a significant correlation with postoperative death include: persistent shock; persistent anuria; persistent neurologic deficit; diffuse intravascular coagulation; and involvement of either the celiac trunk, superior mesenteric artery, or both renal arteries at angiography. With the exception of those patients exhibiting any of these high-risk factors, emergency surgical treatment is recommended for all dissections that involve the ascending aorta.

The French Poison Control Center's computer system. Part II: Utilization of the French Poison Control Center data bank in the Marseilles Poison Control Center.

The system used in the Marseilles Poison Control Center is discussed. Input of data on a daily basis and uses of these data for emergency (evaluation of a toxic situation) or for non-emergency (statistics, toxicity files) work is reviewed.

Life expectancy following spinal cord injury: a ten-years survey in the Rhône-Alpes Region, France, 1969-1980.

A ten years survey of 848 patients having sustained traumatic spinal cord injury between 1969 and 1979 was conducted in the Rhône-Alpes Region, France. All patients had been referred to the spinal cord injury unit, Hôpital Henry Gabrielle. 48 deaths were recorded: 36 patients admitted early to the Unit, and 12 patients injured before 1969 but followed-up in the Unit. The deceased patients were older and more frequently male and tetraplegic than the rest of the group. In 75 per cent of the deceased patients, the survival time was less than 1/5 of the theoretical life expectancy. In 59 per cent, it was less than 1/10. Twenty tetraplegics died of respiratory complications. Three patients committed suicide, the rest died of urinary complications. The results appear to determine a secondary period with high mortality rate, after the initial high mortality of these patients. About one year post-injury, the life expectancy in our series appears to tend towards the values observed in the French population.

[Prognosis following mitral valve replacement with the Starr-Edwards 6120 prosthesis]. / Facteurs pronostiques après remplacement valvulaire mitral par la prothèse de Starr-Edwards modèle 6120.

Between 1970-78, 302 mitral valve replacements with the SE 6120 prosthesis were performed, with an average postoperative follow-up of 50,7 months, using the 3 M size (206 cases) and 2 M (96 cases with small left ventricles). Early postoperative mortality was 5,6%, late postoperative mortality: 17,2%, the 5 year actuarial survival rate: 77,4% and the 9 year survival rate 71,8% (early mortality included). There was no significant difference in survival after mono- (143 cases) and polyvalvular replacement (159 cases); only a voluminous left atrium (p less than 0,05) and left atrial thrombosis (p less than 0,01) were statistically significant prognostic factors of global mortality. Late haemorrhage due to anticoagulant therapy (3%) (0,6 per 100 patient years). The most common complication was systemic embolism (3,7 per 100 patient years). Actuarial studies showed that 86,6% at 5 years and 80,1% at 9 years, escaped this complication. Statistically the favorising roles of permanent atrial fibrillation (p less than 0,05), the size of the left atrium (p less than 0,02) of isolated demonstrated. 90,4% of the survivors were clinically improved: the functional result was better when that 86,6% at 5 years and 80,1% at 9 years, escaped this complication. Statistically the favorising roles of permanent atrial fibrillation (p less than 0,05), the size of the left atrium (p less than 0,02) of isolated demonstrated. 90,4% of the survivors were clinically improved: the functional result was better when that 86,6% at 5 years and 80,1% at 9 years, escaped this complication. Statistically the favorising roles of permanent atrial fibrillation (p less than 0,05), the size of the left atrium (p less than 0,02) of isolated demonstrated. 90,4% of the survivors were clinically improved: the functional result was better when the valve replacement was not a reoperation (p less than 0,02), when the patient was not in functional Class IV (p less than 0,01), in permanent excessively dilated (p less than 0,01) and in patients without severe tricuspid regurgitation (p less than 0,01). There was no significant difference in global mortality, the percentage of embolic events and the quality of the functional postoperative result between patients with the 3 M and those with the 2 M SE 6120 prosthesis.

[Coronary bypass surgery. Results after 5 years : mortality - morbidity]. / La chirurgie de pontage coronarien. Résultats après 5 ans : mortalité - morbidité.

The improvement in the expectation and quality of life of patients undergoing coronary bypass surgery has been studied in the short term but there are relatively few studies with follow-up periods of over five years. The results in 239 patients operated on between 1970 and 1976 are presented. The preoperative data was obtained from a computerised filing system; studies were made at 3 months, at an average of 60 months, and in 78 patients with follow-up exceeding 5 years. Actuarial survival rates were calculated. The operative mortality was 9 patients (3,7%); late mortality was 21 patients (9,2%). Most deaths were due to cardiac causes. The following factors did not appear to be associated with a poor prognosis: sex, the number of cardiovascular risk factors, the number of bypass grafts; however, age and poor left ventricular function as identified by ECG (p less than 0,01), the presence of clinical cardiac failure (p less than 0,001) and by angiography (p less than 0,001) were associated with a poor prognosis. The long-term functional results were interesting: 67% patients followed up to 5 years and 56% patients followed up for over 5 years had no angina. Myocardial infarction occurred in 16,7% of patients at 5 years. Preexisting left ventricular failure which affected the operative and immediate postoperative results was also found secondarily in 9% of patients at 5 years. In the long term, the annual mortality rate seemed to be less in patients with triple vessel disease after myocardial revascularisation. The annual mortality rate of patients with left anterior descending disease alone did not seem to be improved when compared with medically treated patients until after the third year. Once again, the extent of myocardial disease was shown to be the essential prognostic factor whatever the coronary profile of the patient. In this study patients with severe angina or unstable angina who had been treated medically before surgery had the same results as those treated surgically by first intention; this fact is an argument in favour of initial medical management in all forms of angina.

[Stenosis of the left main coronary artery. Results of aorto-coronary by-pass in 67 patients (author's transl)]. / Sténose du tronc coronaire gauche: résultats des pontages aorto-coronaires chez 67 malades.

Between 1970 and 1978 sixty-seven patients with > 50% stenosis of the left main coronary artery underwent aorto-coronary by-pass operation. The mean follow-up period was 54.7 months. Early and late post-operative mortality rates amounted to 3% and 9.2% respectively. Severe global alteration of left cineventriculography was the primary factor of survival (p < 0.01). The actuarial survival rates were 90.3% at 5 years and 84.5% at 9 years. All survivors had control ECGs. Late myocardial necrosis was rare (0.6 per 100 patient-years). 60.3% of the patients remained free from angina. Deterioration of the results mainly occured during the first 2 years but continued at a slower pace beyond the 8th year. Recurrence of angina was significantly less frequent in patients with isolated left main stenosis (p < 0.05) and when local conditions were not unfavourable to derivative surgery (p. < 0.01). On the other hand, the patient's age, sex, type of angina, history of previous infarction, number of risk factors and number of by-passes (the latter excluding possibly incomplete revascularisation) has no influence on the functional prognosis. Thirty-two patients had control, usually routine coronary arteriography 13.7 months on average after surgery. Overall patency was found in 85.9% and abnormal grafts in 16.7% of the cases. The main benefits of aorto-coronary by-pass, therefore, were a reduction in the spontaneous mortality rate of patients with left main coronary disease and a pronounced functional improvement.