[Acute cytomegalovirus proctitis in a immunocompetent patient]. / Rectite aiguë à cytomégalovirus chez un patient immunocompétent.

Cases of CMV proctitis are frequently reported in immunocompromised patients. However, some cases of CMV proctitis are linked to a CMV primary infection and to unprotected anal intercourse in immunocompetent patients. The most common symptom is bloody diarrhea (hemorrhagic colitis). The endoscopic exam can present in distincts forms. The diagnostic is based on a set of clinical, biological, endoscopic and histological arguments. The prognosis of the disease is favorable. The treatment is supportive. A research on other sexually transmitted diseases must be conducted.

Des cas de rectite à cytomégalovirus (CMV) sont fréquemment rapportés chez des patients immunodéprimés. Cependant, certains cas de rectite à CMV sont associés à une primo-infection à CMV et des rapports anaux non protégés chez une personne immunocompétente. La diarrhée hémorragique est le symptôme le plus fréquent. La présentation endoscopique est variée. Le diagnostic repose sur un faisceau d'arguments cliniques, biologiques, endoscopiques et histologiques. Le pronostic de l'affection est favorable. Le traitement est simplement supportif. Une recherche d'autres maladies sexuellement transmissibles doit être réalisée.

[Laryngeal metastasis of a colonic adenocarcinoma]. / Le cas clinique du mois. Dissémination métastatique au larynx d'un adénocarcinome colique.

We report the case of a 63 year old man with laryngeal metastasis of a colonic adenocarcinoma recurrent after partial cordectomy by CO2 Laser microlaryngoscopy. This patient was followed for this condition between 2009 and 2010. The rarity of metastatic laryngeal metastases, particularly when the primary tumor is colic, justifies this presentation.

Did the introduction of maize into Europe provide enemy-free space to Ostrinia nubilalis? Parasitism differences between two sibling species of the genus Ostrinia.

We examined whether maize offers enemy-free space (EFS) to its pest Ostrinia nubilalis, and may thereby have contributed to its divergence from the sibling species, Ostrinia scapulalis, feeding mainly on mugwort, when introduced into Europe five centuries ago. We collected Ostrinia larvae on maize (70 populations, 8425 individuals) and mugwort (10 populations, 1184 individuals) and recorded parasitism using both traditional (counting emerging parasitoids) and molecular methods (detection by specific polymerase chain reaction). The main parasitoid was Macrocentrus cingulum (Braconidae). On mugwort, parasitism was twice that on maize, and parasitoid-related mortality was 8 times higher. This suggests that maize affords substantial EFS to Ostrinia feeding on it. The lower Mortality:Infestation ratio in maize suggests that O. nubilalis' immune response might be stronger than that of O. scapulalis. If so, adapting to maize and diverging from O. scapulalis would decrease the impact of parasitism on O. nubilalis at both ecological and evolutionary levels.

Collagenous gastritis : about two paediatric cases and literature review.

BACKGROUND AND STUDY AIMS: Collagenous gastritis is a rare entity divided in two subgroups (paediatric and adult). In the paediatric population, it often causes anaemia and abdominal pain. Therapy remains the most challenging part as no randomized clinical trial exists and long-term outcome is not well established. PATIENTS AND METHODS: We reviewed the 43 paediatric patients with diagnosis of collagenous gastritis reported in Pubmed from 1989 to mid 2019 to analyse clinical and histological response depending on the treatment choice. RESULTS: In 43 patients (M/F ratio 1:2), a clinical response was observed in 85.7% of patients and a histological response in 20.8% of patients. PPI treatment associated with oral iron supplement was the most frequent choice with clinical improvement in 78.5% of patients. Other treatments such as gluten-free diet or corticoids showed relatively good rates of clinical improvement. Histological remission seems difficult to achieve and recurrence of symptoms after treatment interruption was often reported. CONCLUSIONS: Collagenous gastritis in children is mainly characterized by symptoms of anaemia, abdominal pain or diarrhea. Gastroscopy with fundic biopsies helps to confirm diagnosis and treatment with PPI's (associated with oral iron supplement in case of anaemia) seems to be the most efficient choice to achieve clinical and sometimes histological remission. Long-term outcome of these young patients is unknown. A better understanding of the pathogenesis could lead to new medications focusing on this histological remission.

Exudative lesions of Reinke's space: a terminology proposal.

There has been an ongoing confusion among pathologists in their attempt to accurately identify lesions of Reinke's space. Nodules, polyps and Reinke's edema fall in the same basket and differentiation between them relies largely on the clinical description of the pathologic specimen by the operating surgeon than on their distinct pathologic features. By revising the pertinent literature, the need for an establishment of the aforementioned term still remains and is further stressed out, as confusion among the various pathologic descriptions of these lesions still exists. This is further verified by a study conducted in the Department of Otorhinolaryngology-Head and Neck Surgery of the University Hospital of Louvain at Mont-Godinne, Belgium, involving 323 operative specimens obtained from 200 patients with macroscopic picture. Statistical analysis showed lack of agreement between surgical and histopathologic diagnosis in almost a third of the cases (Cohen's kappa coefficient of 0.683 +/- 0.037, P < 0.001). We, therefore, propose the term "exudative lesions of Reinke's space" to include Reinke's edema, polyps and nodules. These lesions share common histologic features, which are located in the Reinke's space and whose macroscopic appearance is largely dependent upon the presence and duration of certain causative factors.

Study of effects of Bt maize (Zea mays) events on Lepidoptera Ostrinia nubilalis, Sesamia nonagrioidesin southwestern France.

Crops of maize (Zea mays L.) were conducted in southwestern France with GMO (Genetic Modified Organism) vs isogenetic varieties in order to verify the control of European Corn Borer (ECB) Ostrinia nubilalis (Hübner) and the Corn Stalk Borer (CBS) Sesamia nonagrioides (Lefevbre) by GMO in field conditions. The bioassays were carried out in 1998 and 1999 before moratorium, then in 2005. Experiments involved respectively 18, 12 and 19 fields cultivated with Furio/Furio cb (GMO), Cecilia/ Elgina (GMO) and PR33P66/PR33P67 (GMO) varieties. These transgenic events expressed Cry1A(b) protein (Bt maize). Plants were noted for insect infestation assessment (number of larvae in stalks and ears per plant). Statistical tests used t-test on couple of plots. Results showed a significant difference in the density of both ECB and CBS between control and the two transgenic events. The two transgenic events acted differently. The control of the two Bt events on the two pests were differentiated and discussed. These experiments underlined the importance of field evaluation for testing real effects of transgenic events on crop according the environmental context.

Effectiveness of crizotinib in a patient with ALK IHC-positive/FISH-negative metastatic lung adenocarcinoma.

We report a case of crizotinib effectiveness in a heavily pretreated patient with a metastatic NSCLC initially considered IHC-positive and FISH-negative for ALK rearrangement. After repeated analyses of tumor samples, borderline ALK FISH-positivity (18.5% positive cells) was demonstrated.

Geometric differences of the mitral apparatus between ischemic and dilated cardiomyopathy with significant mitral regurgitation: real-time three-dimensional echocardiography study.

BACKGROUND: This study was conducted to elucidate the geometric differences of the mitral apparatus in patients with significant mitral regurgitation caused by ischemic cardiomyopathy (ICM-MR) and by idiopathic dilated cardiomyopathy (DCM-MR) by use of real-time 3D echocardiography (RT3DE). METHODS AND RESULTS: Twenty-six patients with ICM-MR caused by posterior infarction, 18 patients with DCM-MR, and 8 control subjects were studied. With the 3D software, commissure-commissure plane and 3 perpendicular anteroposterior (AP) planes were generated for imaging the medial, central, and lateral sides of the mitral valve (MV) during mid systole. In 3 AP planes, the angles between the annular plane and each leaflet (anterior, Aalpha; posterior, Palpha) were measured. In ICM-MR, Aalpha measured in the medial and central planes was significantly larger than that in the lateral plane (39+/-5 degrees, 34+/-6 degrees, and 27+/-5 degrees, respectively; P<0.01), whereas Palpha showed no significant difference in any of the 3 AP planes (61+/-7 degrees, 57+/-7 degrees, and 56+/-7 degrees, P>0.05). In DCM-MR, both Aalpha (38+/-8 degrees, 37+/-9 degrees, and 36+/-7 degrees, P>0.05) and Palpha (59+/-6 degrees, 58+/-5 degrees, and 57+/-6 degrees, P>0.05) revealed no significant differences in the 3 planes. CONCLUSIONS: The pattern of MV deformation from the medial to the lateral side was asymmetrical in ICM-MR, whereas it was symmetrical in DCM-MR. RT3DE is a helpful tool for differentiating the geometry of the mitral apparatus between these 2 different types of functional mitral regurgitation.

Glycosaminoglycan profiles of myxomatous mitral leaflets and chordae parallel the severity of mechanical alterations.

OBJECTIVES: This biochemical study compared the extracellular matrix of normal mitral valves and myxomatous mitral valves with either unileaflet prolapse (ULP) or bileaflet prolapse (BLP). BACKGROUND: Myxomatous mitral valves are weaker and more extensible than normal valves, and myxomatous chordae are more mechanically compromised than leaflets. Despite histological evidence that glycosaminoglycans (GAGs) accumulate in myxomatous valves, previous biochemical analyses have not adequately examined the different GAG classes. METHODS: Leaflets and chordae from myxomatous valves (n = 41 ULP, 31 BLP) and normal valves (n = 27) were dried, dissolved, and assayed for deoxyribonucleic acid, collagen, and total GAGs. Specific GAG classes were analyzed with selective enzyme digestions and fluorophore-assisted carbohydrate electrophoresis. RESULTS: Biochemical changes were more pronounced in chordae than in leaflets. Myxomatous leaflets and chordae had 3% to 9% more water content and 30% to 150% higher GAG concentrations than normal. Collagen concentration was slightly elevated in the myxomatous valves. Chordae from ULP had 62% more GAGs than those from BLP, primarily from elevated levels of hyaluronan and chondroitin-6-sulfate. CONCLUSIONS: The GAG classes elevated in the myxomatous chordae are associated with matrix microstructure and elastic fiber deficiencies and may influence the hydration-related "floppy" nature of these tissues. These abnormalities may be related to the reported mechanical weakness of myxomatous chordae. The biochemical differences between ULP and BLP confirm previous mechanical and echocardiographic distinctions.

Surgical ablation of atrial fibrillation with bipolar radiofrequency as the primary modality.

OBJECTIVES: In studying cardiac surgical patients undergoing atrial fibrillation ablation with bipolar radiofrequency, we sought to (1) quantify the time-related prevalence of atrial fibrillation postoperatively and identify its risk factors and (2) determine time-related ablation failure and its risk factors. METHODS: From November 2001 to January 2004, 513 patients underwent atrial fibrillation ablation (bipolar radiofrequency alone or with cryothermy) and other cardiac operations. Rhythm documented on 3495 postoperative electrocardiograms was used to estimate the prevalence of and risk factors for atrial fibrillation across time. Ablation failure was defined as occurrence of atrial fibrillation any time beyond 6 months after operation. RESULTS: Prevalence of postoperative atrial fibrillation peaked at about 1 month, decreased to 13% at 6 months, and gradually increased thereafter. Risk factors associated with increased prevalence varied by time period and included older age ( P = .004) for early occurrence, lesion set in permanent atrial fibrillation ( P = .02) for late occurrence, and larger left atrial diameter ( P = .02) and permanent atrial fibrillation ( P < .0001) for occurrence across the entire time span. Freedom from ablation failure was 72% at 12 months. Risk factors for ablation failure included lesion set in permanent atrial fibrillation ( P = .001), longer duration of atrial fibrillation ( P = .01), and larger left atrial diameter ( P = .03). CONCLUSIONS: Bipolar radiofrequency enables extension of ablation to most cardiac surgical patients with atrial fibrillation. Recurrence is influenced by the type and duration of atrial fibrillation, choice of lesion set in permanent atrial fibrillation, and left atrial size. Early operation, careful choice of lesion set, and left atrial reduction might enhance results.

Tricuspid valve repair for biopsy-induced regurgitation in a heart transplant recipient.

Tricuspid regurgitation (TR) is a frequent complication after heart transplantation. The etiology of TR is multifactorial, but biopsy-induced flail leaflet is one of the most important mechanisms. A 61-year-old woman underwent heart transplant, but experienced several rejection episodes which required multiple surveillance endomyocardial biopsies. At three months after transplant, she required tricuspid valve repair due to symptomatic severe TR. The anterior leaflet was flail, with rupture of primary and secondary chordae. Valve repair was performed with a triple leaflet edge-to-edge technique. The procedure consisted of suture fixation of the prolapsed anterior leaflet joining to the septal and posterior leaflets, and placement of a 30-mm annuloplasty ring. The patient was uneventfully discharged home on day 7 with trivial TR. At a four-years post-transplant evaluation, she was in NYHA functional class I, with preserved ventricular function and trivial TR. She has been followed closely because of post-transplant coronary artery disease.

In vitro performance of the novel coronary sinus AutoRetroPerfusion Cannula.

Myocardial salvage through coronary sinus intervention has been documented. The AutoRetroPerfusion Cannula is a novel device that is able to perfuse the coronary bed retrogradely through the coronary sinus with arterial blood generated from a peripheral artery with no need for a pump. The cannula consists of a distal end that, once secured in the coronary sinus, opens an umbrella-like membrane to create pressure in the coronary sinus, and at the same time has small channels directed backwards to the right atrium to provide pressure relief. The cannula is introduced from the axillary vein under local anesthesia and the proximal end, which consists of a graft, is anastomosed to the axillary artery to start autoperfusion once the distal end is secured in the coronary sinus and the occluding membrane is open. The AutoRetroPerfusion Cannula was tested in the in vitro mock loop under 50-120 mm Hg of proximal pressure and 50, 100, and 150 ml/min of total flow in the cannula. We were able to achieve the nominal design point of 40-80 mm Hg of distal pressure and 50-150 ml/min of distal flow by adjusting the number, diameter, and length of the small backwards channels.

Biomechanical and echocardiographic characterization of flail mitral leaflet due to myxomatous disease: further evidence for early surgical intervention.

BACKGROUND: Flail mitral leaflet (FML) is a common complication of mitral valve prolapse, often leading to severe mitral regurgitation (MR) and left ventricular dysfunction. In the absence of timely surgical correction, survival is significantly impaired. Early recognition of FML and identification of risk factors is important because early intervention increases the chances of survival. METHODS: We studied 123 patients undergoing mitral valve surgery for severe MR caused by myxomatous disease. Chart review, echocardiography, and tensile testing were performed. RESULTS: Thirty-eight patients had FML, and 85 patients had non-flail mitral leaflet (non-FML). Patients with FML were younger (53.7 +/- 1.8 vs 59.3 +/- 1.4 years, P =.02), had more severe MR (3.89 +/- 0.04 vs 3.76 +/- 0.04, P =.02), were less likely to be in New York Heart Association class III or IV heart failure (5% vs 20%, P =.037), and were less likely to have bileaflet mitral valve prolapse (5% vs 38%, P <.001) than non-FML patients. Valve tissue from patients with FML had less stiff chordae (23.5 +/- 3.6 vs 59.1 +/- 11.7 Mpa, P =.006) that tended to have a lower failure stress (3.8 +/- 0.9 vs 9.6 +/- 2.2 Mpa, P =.07) and had more extensible leaflets (56.4% +/- 7.9% vs 42.9% +/- 2.7% strain, P =.04) compared with that of non-FML patients. CONCLUSIONS: The development of FML may result from intrinsic tissue abnormalities and is associated with a distinct subset of the myxomatous population. Identification of such clinical characteristics in this population and knowledge of an implicit mechanical abnormality of valve tissue may further the argument for early surgical correction.

Clinical, echocardiographic, and biomechanical differences in mitral valve prolapse affecting one or both leaflets.

Mitral valve prolapse (MVP) is the most common cause of severe mitral regurgitation necessitating surgical correction. Unileaflet prolapse (ULP), usually involving the posterior leaflet, is more common than bileaflet prolapse (BLP), which is more difficult to repair. Little is known about clinical, echocardiographic, and biomechanical differences between ULP and BLP. In this study, biomechanical testing was performed on mitral valve leaflets and chordae obtained at operation for severe mitral regurgitation. Preoperative clinical characteristics and echocardiographic measurements were obtained on surgical patients (ULP = 88, BLP = 37). Men outnumbered women by a factor of 4:1 in ULP, and by 3:1 in BLP. Patients with BLP were younger (53.2 +/- 1.7 vs 59.5 +/- 1.1 years) than those with ULP, and this difference was greater in women (48.9 +/- 2.5 vs 62.9 +/- 2.2 years). BLP patients were less likely to be hypertensive, and more likely to undergo valve replacement rather than repair. Echocardiography showed that BLP leaflets were longer and thicker than ULP leaflets. The severity of mitral regurgitation was similar in both groups, although ULP patients had a much higher incidence of flail leaflets (45% vs 5% in BLP). Mechanical strength of chordae was greater in BLP than in ULP, although leaflet strength was similar. The increased chordal strength in BLP may be responsible for less flail. In patients with MVP and severe mitral regurgitation requiring surgery, ULP and BLP are distinct entities with substantial differences in the population affected, in echocardiographic manifestations including prevalence of flail, in chordal mechanics, and in the likelihood of surgical repair.

Vacuum-assisted venous return reduces blood usage.

OBJECTIVE: To determine whether vacuum-assisted venous return has clinical advantages over conventional gravity drainage apart from allowing the use of smaller cannulas and shorter tubing. METHODS: A total of 150 valve operations were performed at our institution between February and July 1999 using vacuum-assisted venous return with small venous cannulas connected to short tubing. These were compared with (1) 83 valve operations performed between April 1997 and January 1998 using the initial version of vacuum-assisted venous return, and (2) 124 valve operations performed between January and April of 1997 using conventional gravity drainage. Priming volume, hematocrit value, red blood cell usage, and total blood product usage were compared multivariably. These comparisons were covariate and propensity adjusted for dissimilarities between the groups and confirmed by propensity-matched pairs analysis. RESULTS: Priming volume was 1.4 +/- 0.4 L for small-cannula vacuum-assisted venous return, 1.7 +/- 0.4 L for initial vacuum-assisted venous return, and 2.0 +/- 0.4 L for gravity drainage (P <.0001). Smaller priming resulted in higher hematocrit values both at the beginning of cardiopulmonary bypass (27% +/- 5% compared with 26% +/- 4% and 25% +/- 4%, respectively, P <.0001) and at the end (30% +/- 4% compared with 28% +/- 4% and 27% +/- 4%, respectively, P <.0001). Red cell transfusions were used in 17% of the patients having small-cannula vacuum-assisted venous return, 27% of the initial patients having vacuum-assisted venous return, and 37% of the patients having gravity drainage (P =.001); total blood product usage was 19%, 27%, and 39%, respectively (P =.002). Although ministernotomy also was associated with reduced blood product usage (P <.004), propensity matching on type of sternotomy confirmed the association of vacuum-assisted venous return with lowered blood product usage. CONCLUSIONS: Vacuum-assisted venous return results in (1) higher hematocrit values during cardiopulmonary bypass and (2) decreased red cell and total blood product usage.