What is the prognostic significance of acrometastases?

In contrast with bone metastasis, acrometastases are uncommon and are associated with advanced cancer. We report the cases of two patients with atypical lesions of the fingers in a context of cancer, in which biopsies confirmed a metastasis. Patients died rapidly before treatment was initiated. We discuss the characteristics of these atypical metastatic sites, associated with a generally poor prognosis.

Contribution to the understanding of the cycle of the protozoan parasite Marteilia refringens.

The paramyxean parasite Marteilia refringens infects several bivalve species including European flat oysters Ostrea edulis and Mediterranean mussels Mytilus galloprovincialis. Sequence polymorphism allowed definition of three parasite types 'M', 'O' and 'C' preferably detected in oysters, mussels and cockles respectively. Transmission of the infection from infected bivalves to copepods Paracartia grani could be experimentally achieved but assays from copepods to bivalves failed. In order to contribute to the elucidation of the M. refringens life cycle, the dynamics of the infection was investigated in O. edulis, M. galloprovincialis and zooplankton over one year in Diana lagoon, Corsica (France). Flat oysters appeared non-infected while mussels were infected part of the year, showing highest prevalence in summertime. The parasite was detected by PCR in zooplankton particularly after the peak of prevalence in mussels. Several zooplanktonic groups including copepods, Cladocera, Appendicularia, Chaetognatha and Polychaeta appeared PCR positive. However, only the copepod species Paracartia latisetosa showed positive signal by in situ hybridization. Small parasite cells were observed in gonadal tissues of female copepods demonstrating for the first time that a copepod species other than P. grani can be infected with M. refringens. Molecular characterization of the parasite infecting mussels and zooplankton allowed the distinguishing of three Marteilia types in the lagoon.

One Perkinsus species may hide another: characterization of Perkinsus species present in clam production areas of France.

Although clam populations in France are known to be infected with protozoans of the genus Perkinsus, no molecular characterization was previously performed on these parasites. Considering that several members of this genus have been associated with mortalities of molluscs worldwide, a study was undertaken in order to characterize these parasites in France. For that purpose, clams, Ruditapes philippinarum and R. decussatus, collected from different production areas and found to be infected with Perkinsus sp. in thioglycolate culture medium, were selected for PCR-RFLP tests and sequencing. Perkinsus olseni was detected in all the investigated areas and results also suggested the presence of P. chesapeaki in Leucate, a lagoon on the Mediterranean coast and in Bonne Anse in Charente Maritime, on the Atlantic coast. Clonal cultures from both detected species were produced in order to describe and compare in vitro stages. Differences in size between both Perkinsus spp. were noticed especially for schizonts and zoosporangia. Lastly, in situ hybridization tests allowed confirmation of the presence of both species in the same R. decussatus population and even in same clams. This is the first detection of P. chesapeaki in Ruditapes species and outside North America, which questions its introduction into Europe.

[Schwannoma of the vagus nerve: diagnostic strategy and therapeutic approach]. / Schwannome médiastinal bénin du nerf vague: stratégies diagnostique et thérapeutique.

INTRODUCTION: Scwhannomas are uncommon neurogenic tumors of the mediastinum. Most of them are located in the posterior mediastinum usually in the paralateral gutters. We report the case of an uncommon localisation of such a tumour appended to the right vagus nerve in the middle mediastinum. CASE REPORT: The patient was 50 years old and complained of thoracic pain, shortness of breath and dysphagia. CT scanning of thorax and abdomen revealed a heterogeneous mass in the middle mediastinum, which was not visible on plain radiography. Further investigation included transoesophageal ultrasound and PET scan. The diagnosis was confirmed by histopathology after mini video-assisted thoracotomy. The schwannoma was entirely removed without any post-surgical complications. CONCLUSION: We report a novel case of schwannoma arising from the vagus nerve and review the diagnostic strategies. PET scanning has poor sensitivity and specificity and does not therefore contribute to confirm the diagnosis which depends on exploring the mediastimun surgically.

Gastric metastases. An endoscopic series of ten cases.

We report a series of ten cases of the clinical, endoscopic and pathological features of gastric metastases. Patients were six women and four men between 54 and 88 years old, with gastric metastases from breast carcinoma (4), lung carcinoma (4) and melanoma (2). Patients underwent an upper gastrointestinal endoscopy for epigastralgia (2), hematemesis (2), dysphagia (1) and anemia (5). On endoscopy, tumors appeared as nodules with a central ulceration (5), an ulceration (4) or simulating linitis plastica (1). Metastases were located in the cardia (2), fundus (5) and antrum (3). Primary tumors had been diagnosed between one day and 20 years before upper endoscopy. Eight patients had multivisceral metastases. The microscopic features of the gastric metastases resembled a primary gastric cancer in eight cases. Thanks to clinical data, the pathologist confirmed the diagnosis of gastric metastases on immunohistochemistry. Nine patients died in the eight-month follow-up period. Gastric metastases are rare, occur at a late stage of the neoplastic disease, and have a poor prognosis. Diagnosis of gastric metastases is difficult because they simulate primary gastric cancer on endoscopy and on microscopic examination. A correct diagnosis is based on good communication between gastroenterologists and pathologists.

Detection of Bonamia ostreae and B. exitiosa (Haplosporidia) in Ostrea edulis from the Adriatic Sea (Italy).

The flat oyster Ostrea edulis L. is widespread along the Italian coasts. In particular, the Manfredonia Gulf (Adriatic Sea) represents an important site where natural beds subsist. Previous monitoring conducted in 1990 by light microscopy and ultrastructural studies revealed the presence of Bonamia-like microcell parasites in some flat oysters: following this observation, a new sampling of O. edulis was carried out at this location in 2007. Of 750 oysters collected, 3 showed the presence of uninucleated microcells (2 to 3 microm diameter) free or inside the haemocyte cytoplasm by cytology and histopathology. Molecular analysis confirmed that the microcells in 2 oysters were B. exitiosa, whereas in the third oyster the microcells were B. ostreae. Moreover, molecular studies were carried out to confirm the existence of Bonamia sp. in archived samples, confirming the presence of B. ostreae in the Manfredonia Gulf since 1990.

Assessment of asymptomatic liver fibrosis in alcoholic patients using fibroscan: prospective comparison with seven non-invasive laboratory tests.

BACKGROUND: Systematic screening for liver fibrosis in heavy-drinking patients is a challenge. Aims To assess Fibroscan for non-invasive diagnosis of asymptomatic liver fibrosis in alcohol abuse patients, to determine diagnostic liver stiffness cut-off values and to compare performance of Fibroscan with seven non-invasive laboratory tests. METHODS: One hundred and three alcoholic patients were studied. Liver fibrosis was staged by METAVIR system. Fibroscan, Fibrotest, Fibrometer, Hepascore, APRI, PGA, PGAA and hyaluronic acid tests were performed. Liver stiffness cut-offs were determined using receiver-operating characteristic (ROC) curves. RESULTS: Liver stiffness was correlated with fibrosis (r = 0.72, P < 0.014), with median at 5.7, 6.3, 8.4, 15 and 47.3 kPa for F0 (n = 8), F1 (n = 18), F2 (n = 24), F3 (n = 20) and F4 (n = 33) stage fibrosis respectively. For Fibroscan, areas under ROC curves (AUROCs) were 0.84 (95% CI: 0.73-0.95) (F > or = 1), 0.91 (0.85-0.98) (F > or = 2), 0.90 (0.82-0.97) (F > or = 3) and 0.92 (0.87-0.98) (F = 4), yielding diagnostic stiffness cut-offs of 5.9 (F > or = 1), 7.8 (F > or = 2), 11 (F > or = 3) and 19.5 (F4) kPa. Sensitivity, specificity, PPV and NPV were 80%, 90.5%, 93% and 70% for F > or = 2, and 85.7%, 84.2%, 68.6% and 87.9% for F = 4. Performance of Fibroscan was higher than seven laboratory tests, for which AUROCs ranged from 0.66 to 0.77 (F > or = 1), from 0.54 to 0.82 (F > or = 2), from 0.43 to 0.88 (F > or = 3) and from 0.56 to 0.89 (F = 4), with significant difference only vs. APRI (P < 0.001) and Hepascore (P = 0.04). Combining Fibroscan with each tests did not improve performance. CONCLUSIONS: Fibroscan is effective to assess liver fibrosis in alcoholic patients. Instant screening of liver fibrosis in heavy drinkers is feasible without liver biopsy.

Comparative experimental infection of the copepod Paracartia grani with Marteilia refringens and Marteilia maurini.

Paracartia grani (Copepoda) has been identified as a potential intermediate host in the life cycle of Marteilia refringens, a paramyxean parasite infecting flat oysters. However, no intermediate host has yet been identified for Marteilia maurini that infects mussels. A better understanding of the life cycle of these two Marteilia types would clarify their taxonomic relationship and hypothesized co-specificity. For this purpose, experimental infections of copepods, P. grani, were performed using naturally infected flat oysters and mussels. Infection patterns were different depending whether copepods were infected from oysters or mussels. M. maurini did not proliferate in copepods while M. refringens rapidly proliferated in infected copepods. Previously unrecognized developmental stages of M. refringens were found during this study.

Colorectal carcinoma with potentially resectable metastases: factors associated with the failure of curative schedule.

BACKGROUND: The management of patients with colorectal cancer (CRC) and synchronous liver metastases (SLM) depends on the primitive tumor, resectability of the metastatic disseminations and the patient's comorbid condition(s). Considering all patients with potentially resectable primary CRC and SLM, curative resection (R0) will be possible in some patients, although in others surgery will never be performed. The purpose of our study was to identify factors of failure of the curative schedule in these patients. METHODS: We reviewed the data of patients with CRC and SLM between January 2002 and March 2007. Two groups were defined: group R0 when complete metastatic and primary tumor resection was finally achieved after one and more surgical stages and group R2 when curative resection was not possible at the end of the schedule. Clinical, pathologic and outcome data were retrospectively analyzed as well as preoperative management of SLM (chemotherapy, radiofrequency, portal vein embolization). RESULTS: Forty-five patients were included. Curative resection (group R0) was performed in 31 patients (69%) with 48% undergoing major hepatic resection. Mortality of hepatic resection was 0% although it was 9% for primitive tumor. Portal vein embolization was performed preoperatively in eight patients and radiofrequency ablation in 13. Median follow-up was 21 months. Overall survival was 86% at one year and 39% at three years. Survival in group 1 was 97 and 57% at one and three years respectively. Disease-free survival was 87 and 40% at one and three years. Tumor recurrence was noted in 61% of resected patients. At multivariate analysis, number of hepatic metastases superior than three and complicated initial presentation of primitive tumor were found to be significant and predictors of failure of hepatic resection. CONCLUSION: Aggressive management with curative resection of SLM may enable long-term survival. More than three SLM and complicated initial presentation of primitive tumor are factors predictive of failure of the curative schedule.

[Gallbladder cancer revealed by a jaundice caused by an endobiliary tumor thrombus]. / Cancer de la vésicule biliaire révélé par un ictère dû a un thrombus tumoral endobiliaire.

Main bile duct neoplasic thrombosis is a rare cause of jaundice in case of gallbladder cancer. We report the case of 27-year-old woman in whom the endoluminal biopsy of biliary thrombus confirmed the suspected diagnosis of gallbladder cancer. An initial laparoscopic exploration found a localized peritoneal carcinomatosis. However, in this exceptional situation with an unknown prognostic, a surgical procedure has been performed including hepatectomy IV-V with biliary principal bile duct removal, hepatico-jejunal anastomosis (Roux-en-Y), with complete resection of localized peritoneal carcinomatosis. Post-operative course were uneventful and this patient was asymptomatic under chemotherapy with a six month follow-up.

Application of ammonia intermittent temperature-programmed desorption to evaluate surface acidity of tungsten oxide supported on activated carbon.

Intermittent temperature-programmed desorption of ammonia was used to study the strength and population of surface acid sites of tungsten oxide supported on activated carbon pretreated at 350 and 700 degrees C. Catalysts pretreated at 350 degrees C showed two types of surface acid sites and desorption occurred with free readsorption until a temperature of around 300 degrees C was reached. Pretreatment at 700 degrees C produced three different states of ammonia adsorbed on the catalysts and desorption occurred with free readsorption.

A simple technique to concentrate the protozoan Mikrocytos mackini, causative agent of Denman Island Disease in oysters.

This report describes a simple filtration technique to isolate the parasite Mikrocytos mackini from oyster tissue. The technique is based on successive filtration through filter papers and polycarbonate membrane filters of decreasing mesh using a low vacuum (<8 cm Hg). This technique allows for the recovery of about 1 x 10(8) parasites (microcells) from about 2 g of heavily infected oyster tissue. About 99% of the particulate material in the final preparation consisted of intact M. mackini.

[Epithelioid hemangioendothelioma associated with nodular regenerative hyperplasia]. / Hémangioendothéliome épithélioïde associé à une hyperplasie nodulaire régénérative.

Epithelioid hemangioendothelioma of the liver is a rare neoplasm of vascular origin. We report a case of epithelioid hemangioendothelioma occurring in a patient with nodular regenerative hyperplasia. This association suggests that some hepatic vascular changes might promote the growth of epithelioid hemangioendothelioma.

Alcohol use disorders in French university hospital patients.

The adult patients of the somatic departments of Amiens University Hospital were screened on a randomly selected day by interviewers who examined them using a structured questionnaire regarding lifestyle, with the CAGE questionnaire, and their daily alcohol consumption. The medical histories of all patients were collected. A patient was considered having an alcohol problem if one or more of the following criteria was fulfilled: (1) a CAGE questionnaire score of 2 or more positive answers; (2) an alcohol-related diagnosis. In total, 869 patients fulfilled the entry criteria (377 patients were excluded owing to predefined exclusion criteria). A hundred and sixty-seven patients (19.2%) fulfilled 1 or 2 of the criteria for an alcohol problem. Eighty-eight patients (10.1%) had an alcohol-related discharge diagnosis. The prevalence of patients with a positive CAGE score was 13.5% and was significantly higher among male patients (22.7%) than among female patients (5.5%). The frequency of a higher socioeconomic status or the status of 'living alone' increased significantly with alcohol consumption.

Prevalence of alcohol problems among elderly patients in a university hospital.

AIMS: To assess the prevalence of alcohol abuse and the prevalence of alcohol-related discharge diagnosis in an elderly general hospital population. DESIGN: On a randomly selected day, all patients aged 65 years and over admitted to a university hospital were screened. SETTING: University Hospital of Amiens, France. PARTICIPANTS: All patients aged 65 years and over were approached and requested to take part in the study. They were interviewed using the CAGE questionnaire and with a structured questionnaire regarding life-style, and asked about their usual daily alcohol consumption. The medical history of each patient was taken. In total, 612 patients fulfilled the age criteria, but 205 patients (33.6%) had to be excluded owing to predefined exclusion criteria (e.g. dementia, aphasia, terminal illness ...) and 37 patients (6%) refused to participate. FINDINGS: The data were derived from 370 patients. The median age was 79 years; 54% reported no alcohol consumption; 9% of patients scored positive on the CAGE questionnaire. The prevalence of patients with a CAGE questionnaire positive was significantly higher among male patients (17%) than female patients (2.5%). The prevalence of patients with alcohol-related discharge diagnosis was 7%. The frequency of higher socio-economic status or divorced status increased significantly with alcohol consumption. CONCLUSIONS: There may be a substantial prevalence of alcohol problems in elderly hospital patients. Research is needed to examine how generalized this problem is.

[Percutaneous cholecystostomy. A study of 30 patients]. / Cholécystostomie percutanée. Une étude chez 30 malades.

OBJECTIVE AND METHODS: The treatment of acute cholecystitis or angiocholitis is often difficult in elderly or very ill patients. The aim of this retrospective study was to assess the efficacy and the results of ultrasound guided percutaneous cholecystostomy in patients with acute cholecystitis or biliary tract obstruction and anesthetic or surgical contraindications. RESULTS: Thirty patients (25-93 years, 16 men and 14 women) were included in this study. Ultrasound guided percutaneous cholecystostomy was successful on the septic syndrome in 27 patients; endoscopic sphincterotomy was performed in 6 patients after clinical improvement. A failure of the procedure on sepsis was observed in 3 patients: cholecystectomy was performed after cardiac improvement in one patient, and 2 patients died. Two other patients died of extradigestive diseases. No serious complication related to cholecystostomy was observed. CONCLUSION: Ultrasound guided percutaneous cholecystostomy is a safe and simple procedure. It can be done at bedside and has low morbidity and mortality. It can be considered as a definitive treatment, or a temporary one with secondary surgical or endoscopic management.

Hepatic nodules as single organ involvement in an adult with Langerhans cell granulomatosis. A case report.

Liver involvement manifesting as hepatomegaly in Langerhans cell granulomatosis (LCG) is well known, but the definitive diagnosis is generally possible because other organs are involved. We report a 41-year-old white man who presented with cholestasis and liver nodules as an isolated hepatic LCG. The diagnosis of LCG was suspected based on routine histopathologic examination; the diagnosis became definitive 4 years later when Birbeck granules were found in the liver, an uncommon occurrence in this organ. This is an unusual presentation of a benign form of this disease and one of the first that reported Birbeck granules in the liver.

Cirrhosis: a new, but expected cause of biliary sludge.

BACKGROUND/AIMS: Biliary sludge is increasingly recognized as a natural stage in gallstone formation. Logically, cirrhosis, a well-documented cause of black pigment cholelithiasis, should be another condition predisposing to the development of sludge. The aim of this study was to assess the prevalence of biliary sludge in an unselected population and to test the hypothesis that cirrhosis could be one of the causes of sludge. METHODS: We reviewed the clinical findings and ultrasonograms of 2138 patients, hospitalized or not, consecutively seen in our department between January 1993 and December 1994. Sonograms showing biliary sludge mixed with stones were excluded. Three hundred and eighty-eight of the 2138 were cirrhotic patients. RESULTS: The overall prevalence of biliary sludge was 4%. Sludge was found in 44 of 388 (11%) of the cirrhotic patients (alcoholism, n = 39; chronic viral B hepatitis, n = 3; hemochromatosis, n = 1; and cryptogenic, n = 1), compared with 42 of 1750 (2%) noncirrhotic patients (p < 0.000001). Thirteen cirrhotic patients received intravenous alimentation for 2 to 17 days, 8 were given somatostatin for variceal bleeding, and 7 have previously had 1 to 5 sessions of endoscopic sclerotherapy of esophageal varices with polidocanol. CONCLUSIONS: This study convincingly demonstrates that cirrhosis must be added to the growing list of conditions associated with biliary sludge.

[Ambulatory ultrasound-guided puncture in abdominal tumoral pathology. Study of 131 cases]. / Ponction échoguidée ambulatoire en pathologie tumorale abdominale. Etude de 131 cas.

OBJECTIVES AND METHODS: Outpatient ultrasound guided liver biopsy is usually reserved for diffuse pathologies. The aim of this study was to assess the feasibility and results of 131 ultrasound guided biopsies of 128 abdominal lesions in 104 patients (69 men and 35 women, mean age: 59). Twenty four cysts were punctured (18 pancreatic cysts, 4 liver cysts and 2 unspecified abdominal cysts) and 104 solid tumors were biopsied (80 liver tumors, 9 pancreatic tumors, 5 portal vein obstructions, 4 unspecified abdominal tumors, 3 stomach tumors and 3 lymphadenopathies). RESULTS: The feasability of outpatient ultrasound guided biopsy was 100%. The etiology of 22 cysts (91.6%) and the histology of 100 solid tumors (96.2%) were determined. No side effects were observed, and all patients left the hospital 6 hours after this procedure. No later hospitalisations were necessary. CONCLUSION: This study suggests that outpatient ultrasound guided needle aspiration or biopsy of liver tumors or other abdominal tumors can be performed. Thus, this procedure could be less expensive and more acceptable, while preserving reliability and safety.