Screening for precancerous anal lesions linked to human papillomaviruses: French recommendations for clinical practice.

In France, about 2000 new cases of anal cancer are diagnosed annually. Squamous cell carcinoma is the most common histological type, mostly occurring secondary to persistent HPV16 infection. Invasive cancer is preceded by precancerous lesions. In addition to patients with a personal history of precancerous lesions and anal cancer, three groups are at very high risk of anal cancer: (i) men who have sex with men and are living with HIV, (ii) women with a history of high-grade squamous intraepithelial lesions (HSILs) or vulvar HPV cancer, and (iii) women who received a solid organ transplant more than 10 years ago. The purpose of screening is to detect HSILs so that they can be treated, thereby reducing the risk of progression to cancer. All patients with symptoms should undergo a proctological examination including standard anoscopy. For asymptomatic patients at risk, an initial HPV16 test makes it possible to target patients at risk of HSILs likely to progress to cancer. Anal cytology is a sensitive test for HSIL detection. Its sensitivity is greater than 80% and exceeds that of proctological examination with standard anoscopy. It is indicated in the event of a positive HPV16 test. In the presence of cytological abnormalities and/or lesions and a suspicion of dysplasia on clinical examination, high-resolution anoscopy is indicated. Performance is superior to that of proctological examination with standard anoscopy. However, this technique is not widely available, which limits its use. If high-resolution anoscopy is not possible, screening by a standard proctological examination is an alternative. There is a need to develop high-resolution anoscopy and triage tests and to evaluate screening strategies.

French multicentre prospective evaluation of radiofrequency ablation in the management of haemorrhoidal disease.

PURPOSE: The aim of this study was to evaluate the efficacy and safety of radiofrequency ablation (RFA) in the management of haemorrhoidal disease with 1 year's follow-up. METHOD: This prospective multicentre study assessed RFA (Rafaelo©) in outpatients with grade II-III haemorrhoids. RFA was performed in the operating room under locoregional or general anaesthesia. Primary endpoint was the evolution of a quality-of-life score adapted to the haemorrhoid pathology (HEMO-FISS-QoL) 3 months after surgery. Secondary endpoints were evolution of symptoms (prolapsus, bleeding, pain, itching, anal discomfort), complications, postoperative pain and medical leave. RESULTS: A total of 129 patients (69% men, median age 49 years) were operated on in 16 French centres. Median HEMO-FISS-QoL score dropped significantly from 17.4/100 to 0/100 (p < 0.0001) at 3 months. At 3 months, the rate of patients reporting bleeding (21% vs. 84%, p < 0.001), prolapse (34% vs. 91.3%, p < 0.001) and anal discomfort (0/10 vs. 5/10, p < 0.0001) decreased significantly. Median medical leave was 4 days [1-14]. Postoperative pain was 4/10, 1/10, 0/10 and 0/10 at weeks 1, 2, 3 and 4. Seven patients (5.4%) were reoperated on by haemorrhoidectomy for relapse, and three for complications. Reported complications were haemorrhage (3), dysuria (3), abscess (2), anal fissure (1), external haemorrhoidal thrombosis (10), pain requiring morphine (11). Degree of satisfaction was high (+ 5 at 3 months on a - 5/+ 5 scale). CONCLUSION: RFA is associated with an improvement in quality of life and symptoms with a good safety profile. As expected for minimally invasive surgery, postoperative pain is minor with short medical leave. CLINICAL TRIAL REGISTRATION AND DATE: Clinical trial NCT04229784 (18/01/2020).

Multiwatt-power highly-coherent compact single-frequency tunable vertical-external-cavity-surface-emitting-semiconductor-laser.

We demonstrate high power (2.1W) low noise single frequency operation of a tunable compact verical-external-cavity surface-emitting- laser exhibiting a high beam quality. We took advantage of thermal lens-based stability to develop a short (3-10 mm) plano-plano external cavity without any intracavity filter. The semiconductor structure emitting at 1microm is optically pumped by a 8W commercial 808 nm multimode diode laser at large incidence angle. For heat management purpose the GaAs-based VECSEL membrane was bonded on a SiC substrate. We measured a low divergence quasi-circular TEM00 beam (M2 = 1.2) close to diffraction limit, with a linear light polarization (>30 dB).We simulated the steady state laser beam of this unstable cavity using Fresnel diffraction. The side mode suppression ratio is > 45 dB. The free running laser linewidth is 37 kHz limited by pump induced thermal fluctuations. Thanks to this high-Q external cavity approach, the frequency noise is low and the dynamics is in the relaxation-oscillation-free regime, exhibiting low intensity noise (< 0.1%), with a cutoff frequency approximately 41MHz above which the shot noise level is reached. The key parameters limiting the laser power and coherence are studied. This design/properties can be extended to other wavelengths.

High power single-frequency continuously-tunable compact extended-cavity semiconductor laser.

We demonstrate high power high efficiency (0:3 W) low noise single frequency operation of a compact extended-cavity surface-emitting-semiconductor-laser exhibiting a continuous tunability over 0:84 THz with high beam quality. We took advantage of thermal lens-based stability to develop a short (< 3 mm) plano-plano external cavity without any intracavity filter. The structure is optically pumped by a 1 W commercial 830 nm multimode diode laser. No heat management was required. We measured a low divergence circular TEM(00) beam at the diffraction limit (M(2) < 1:05) with a linear light polarization (> 37 dB). The side mode suppression ratio is 60 dB. The free running laser linewidth is 850 kHz limited by pump induced thermal fluctuations. Thanks to this high-Q external cavity approach, the frequency noise is low and the dynamics is in the relaxation-oscillation-free regime, exhibiting a low intensity noise, with a cutoff frequency approximately 250 MHz above which the shot noise level is reached. We show that pump properties define the cavity design and laser coherence.

Sudden death from pericardial tamponade. Unusual complication of nonbacterial thrombotic endocarditis.

A ruptured myocardial infarct secondary to total coronary occlusion by a fragment of nonbacterial thrombotic endocarditis produced sudden, unexpected death in a nearly asymptomatic 82-year-old man who harbored two malignant neoplasms.

Metastasis of bronchogenic carcinoma to the skin involved by melanoma.

In a 52-year-old man, a cutaneous malignant melanoma developed concurrently with an adenocarcinoma of the right lung. The latter disseminated widely, and autopsy disclosed that it had also metastasized to the dermal tissue involved with the melanoma. Because it was not a metastasis into the substance of the melanoma, it was classified as an unusual type of "collision tumor" rather than a "cancer-to-cancer" metastasis.

Spurious pseudomembranous enteritis in strongyloidiasis.

A fatal case of Strongyloidiasis, unsuspected until postmortem microscopy, is presented. At autopsy, the gross changes in the small bowel of the patient suggested pseudomembranous enteritis. The "membrane" consisted of inspissated barium sulphate from a gastrointestinal series 2 wk before death, nematodes, and proteinaceous material. We believe these findings to be unique. It is possible that bowel hypomotility, known to occur in Strongyloidiasis, favored retention and inspissation of barium sulphate, thus starting a vicious cycle favoring further stasis with increased susceptibility to burrowing worms and augmented auto-infection.

Strongyloidiasis. When to suspect the wily nematode.

Strongyloidiasis is a tenacious soil-transmitted nematode infestation endemic in the south-eastern United States. Thirty-three cases were diagnosed in a series of 1,290 stool examinations in 971 patients at Veterans Administration Medical Center, Mountain Home, Tennessee. Most patients had a concurrent major illness, such as chronic lung disease, serious bacterial infection, or cancer. A minority presented with gastrointestinal symptoms alone. Skin rash was uncommon. Eosinophilia, IgE elevation, and skin anergy were common. Atypical presentations included severe proctitis, colitis, and exacerbation of inflammatory bowel disease. In a patient with the hyperinfection syndrome, the diagnosis was made only at autopsy. Since strongyloidiasis seems to present like an opportunistic illness, all physicians, not just those in endemic areas, should consider its presence in the appropriate setting.

Cavernous hemangioma of the neck simulating thyroglossal cyst.

A rare case of cavernous hemangioma simulating a thyroglossal duct cyst was reported. It is recommended that these be treated by total excision, including hyoid bone, to prevent recurrence.