Personalized identification of abdominal wall hernia meshes on computed tomography.

An abdominal wall hernia is a protrusion of the intestine through an opening or area of weakness in the abdominal wall. Correct pre-operative identification of abdominal wall hernia meshes could help surgeons adjust the surgical plan to meet the expected difficulty and morbidity of operating through or removing the previous mesh. First, we present herein for the first time the application of image analysis for automated identification of hernia meshes. Second, we discuss the novel development of a new entropy-based image texture feature using geostatistics and indicator kriging. Third, we seek to enhance the hernia mesh identification by combining the new texture feature with the gray-level co-occurrence matrix feature of the image. The two features can characterize complementary information of anatomic details of the abdominal hernia wall and its mesh on computed tomography. Experimental results have demonstrated the effectiveness of the proposed study. The new computational tool has potential for personalized mesh identification which can assist surgeons in the diagnosis and repair of complex abdominal wall hernias.

[Scintigraphy using leukocytes marked with 99m-Tc-HMPAO in Crohn's disease]. / Scintigraphie aux leucocytes marqués par l'HMPAO 99mTc au cours de la maladie de Crohn.

99mTc-HMPAO leukocyte scintigraphy was prospectively studied in 20 patients with Crohn's Disease and was compared with radio-endoscopy and with disease activity index (Crohn's Disease Activity Index, ESR, C-reactive protein). Disease localization as defined by the scan was well correlated with those visualized at endoscopy or radiography (rs = 0.90 - p = 0.0001). A scan score was calculated by evaluating uptake of the tracer in 6 bowel segments with lumbar bone marrow activity, correlation with endoscopic score was strong (rs = 0.96 - p < 0.0001). Scan score was well correlated with the Crohn's Disease Activity Index (rs = 0.63 - p = 0.0026), but no correlation was found between ESR, C-reactive protein and scan score. In four patients with ileal localization, scintigraphy was helpful to separate inflammatory from scared stenosis. Scintigraphy with 99mTc-HMPAO appeared to be useful in evaluation of Crohn's Disease activity, and for the diagnosis of complications as stenosis.

[Study of hepatic drug metabolism. For a rationalization of a new molecular development]. / Etude du métabolisme hépatique des médicaments. Pour une rationalisation du développement des nouvelles molécules.

Interindividual variability of hepatic metabolism of drugs may be responsible for decrease in efficacy, increase in the incidence and severity of adverse effects or drug-interactions. This variability may be due to hepatic drug interaction, specific physio-pathologic condition or genetic polymorphism. Search for variability of hepatic metabolism and the factors determining this variability during the pre-clinical and clinical development of new drug contributes to an individual optimization of treatment during clinical research and after introduction into the market. This strategy results in an improvement of the benefit-risk ratio. The various methodological approaches to the study of hepatic metabolism during the successive phases of drug development and the integration of these studies in the clinical development plan of a new drug are discussed in this paper.

[History of internal medicine]. / Histoire de la médecine interne.

The concept of Internal Medicine was introduced recently and stems from the Internal Pathology which dates back to Antiquity. This concept spread out during the XIXth century with the concomitant progress of clinical science and heurism within a global and humanistic medicine. In France, Internal Medicine was not recognized until 1966. The criteria of eligibility for certification in this specialty were issued in 1970. The Syndicat National des Médecins Spécialistes de Médecine Interne, the Société Nationale Française de Médecine Interne and the diploma of certification in Internal Medicine were respectively created in 1975, 1979, 1984. The field of interest of Internal Medicine is wide and ambiguous. It includes a specific hard core and less specific allocations that encroach on "organ" specialties. French internist practitioners are not numerous and most of them are practising in hospitals. Internal Medicine is highly regarded in Anglo-Saxon countries and in Germany. In the European Community, the future of this medical specialty depends on the success of the harmonization of training programs and the development of medical students exchange. There is currently a controversy about the recognition of Internal Medicine as a full specialty. To bring out this specialty, French internists should benefit from reforms at several levels: university, hospital and French health service contract.

Changes in indocyanine green kinetics after the administration of enalapril to healthy subjects.

Enalapril maleate, an angiotensin converting enzyme inhibitor, is a vasodilator liable to modify regional blood flow. The effects of an oral dose of 40 mg enalapril maleate on indocyanine green (ICG) kinetics were assessed in nine healthy subjects. At 4 h after the administration of the drug, a 35% decrease in ICG clearance was observed (P less than 0.01) associated with a 23% decrease in its volume of distribution (P less than 0.02). The half-life of ICG was not altered significantly by enalapril. These results suggest that the administration of enalapril maleate to healthy subjects may reduce apparent liver plasma flow and plasma volume, as a consequence of the pooling of blood in the hepatosplanchnic area.

Amineptine, a tricyclic antidepressant, inhibits the mitochondrial oxidation of fatty acids and produces microvesicular steatosis of the liver in mice.

Microvesicular steatosis of the liver has been reported in two subjects receiving amineptine (a tricyclic antidepressant metabolized by beta-oxidation of its acyl chain). A similar disease is observed after ingestion of drugs which inhibit hepatic mitochondrial fatty acid beta-oxidation, or in subjects with various inborn defects in this metabolic pathway. We therefore determined the effects of amineptine on the mitochondrial oxidation of fatty acids in mice. In vitro, the formation of beta-oxidation products during incubation of palmitic acid with mouse liver mitochondria and the various cofactors necessary for beta-oxidation was inhibited by 27, 33, 46 and 57% respectively, in the presence of 0.25, 0.5, 1 and 2 mM of amineptine. Inhibition was reversible. Tricarboxylic acid cycle activity, assessed by the in vitro formation of [14C]CO2 from [1-14C]acetyl coenzyme A by mouse liver mitochondria, was inhibited by 22, 23, 47, 54, 60 and 62%, respectively, in the presence of 0.0625, 0.125, 0.25, 0.5, 1 and 2 mM of amineptine. In vivo, administration of amineptine, 0.5 and 0.75 mmol.kg-1, inhibited by 70 and 84%, respectively, the exhalation of [14C] CO2 during the first 3 hr after the administration of a tracer dose of [U-14C]palmitic acid. Administration of amineptine, 0.0625, 0.25, 0.5 or 1 mmol.kg-1, 6 hr before the measurement, increased hepatic triglycerides by 73, 139, 295 and 320%, respectively. After 1 mmol.kg-1, accumulation of hepatic triglycerides was maximum at 24 hr, reaching 5-fold the control value; liver histology at that time showed microvesicular steatosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Aging of schizophrenic patients as seen through the Rorschach test.

The authors have repeated, on the average 29.7 years later, Rorschach test in 11 schizophrenic men and 19 schizophrenic women. This work was carried out in the course of a follow-up study of schizophrenics more than 65 years of age. Analysis of the records showed that the only differences between the first and second examinations were increases in animal and popular responses in old age. The authors have tried to relate these findings to the general trends of schizophrenic development in senescence.