Does the degree of calcification of the celiac trunk and superior mesenteric artery on preoperative computerized tomography predict the risk of anastomotic leak after right colectomy? A single center retrospective study.

Anastomotic leak is a serious complication of colonic surgery. The aim of our study is to evaluate the impact of vascular calcifications of the celiac axis and superior mesenteric artery in patients undergoing elective right colectomy, and particularly their relationship to the risk of anastomotic leak. MATERIALS AND METHODS: We performed a retrospective analysis of preoperative abdominal computerized tomography (CT) scans of patients who underwent right colectomy at the Vendean Departmental Hospital (France) between January 2011 and December 2016. We established a calcification score, which was correlated to the incidence of anastomotic leak and to the patients' American Society of Anesthesiologists (ASA) score. RESULTS: The charts of 250 patients were reviewed. Twenty-three patients had a postoperative anastomotic leak. A stratified analysis revealed that the risk of developing an anastomotic leak was statistically significantly increased in patients whose calcification score was equal to or greater than 3 (P<0.05). In these patients, the risk was increased by a factor of 3.48 [odds ratio: 3.48 (1.45-8.36)]. A second stratified analysis showed that a calcification score of 2 at the level of the celiac axis takeoff was correlated with a statistically significantly increased risk of anastomotic leak (P<0.01). There was a correlation between a calcification score≥3 and an ASA score≥3. CONCLUSION: A calcification score≥3 correlates to an increased risk of anastomotic leak. The analysis of CT findings is simple, easy and reproducible. This calcification score should be confirmed by a prospective study.

Swirl Sign in Intracerebral Hemorrhage.

BACKGROUND: An 80-year-old male (patient A) felt at home and consequently was admitted to the emergency unit. Following the head trauma, he was bleeding on the right frontoparietal area. The patient was found unconscious and the Glasgow Coma Scale was 9/15. An unenhanced CT scan of the brain was performed. A second patient, an 86-year-old male (patient B) was admitted to the intensive care unit with a degrading Glasgow Coma scale from 14/15 to 8/15. A subdural hematoma was diagnosed on a first CT scan. An unenhanced CT scan of the brain was performed to control the hematoma.

Prevalence and spectrum of SDHx mutations in pheochromocytoma and paraganglioma in patients from Belgium: an update.

Since the early 2000s, the prevalence and spectrum of mutations in genes encoding subunits of succinate dehydrogenase (SDHx) were reported in large cohorts of patients with pheochromocytoma (PC) and paraganglioma (PGL) from most Western countries. Unfortunately, in Belgium, no equivalent work was performed thus far. Therefore, the aim of the work was to look for mutations in SDHx genes and genotype-phenotype correlations in patients with PC and/or PGL from Belgium. Screening of the coding parts of SDHx genes and deletion search were performed in all patients with PC and/or PGL referred to the -Cliniques Universitaires Saint-Luc from 05/2003 to 05/2011. Genetic screening was performed in 59 unrelated head and neck (hn)PGLs (8 fami-lial) and 53 PCs (7 extra-adrenal; 3 metastatic). In hnPGLs, 10 different SDHD mutations (3 substitutions, 5 deletions, 2 splice site mutations) were detected in 16 patients, including 7 familial cases and 9 apparently sporadic cases. In the same subset, we found 8 different SDHB mutations (5 substitutions, 1 splice site mutation, 1 deletion, 1 duplication) in 10 patients with sporadic hnPGL without evidence of malignancy. No SDHx mutation was detected in patients harboring PCs and no SDHC mutation whatsoever. In conclusion, in our multicentric database of PC-PGLs from Belgium, (i) the prevalence of SDHx mutations was high in hnPGLs (44% in the whole subset, 37% of apparently sporadic cases); (ii) in sporadic cases, the prevalence of SDHB mutations was high (20%), similar to that of SDHD (18%); and (iii) no SDHx mutation was found in a subset of mostly adrenal, benign PCs.

Percutaneous ethanol injection vs. resection in patients with small single hepatocellular carcinoma: a retrospective case-control study with cost analysis.

BACKGROUND: Percutaneous ethanol injection and hepatic resection are the most widely used curative therapeutic options for patients with compensated liver disease and small hepatocellular carcinoma. AIM: To compare percutaneous ethanol injection and hepatic resection in a selected group of consecutive French patients with a single hepatocellular carcinoma, smaller than or equal to 50 mm, in terms of survival, recurrence rate of malignancy and direct costs. METHODS: The analysis of two contemporary cohorts of Child-Pugh A or B patients with a single hepatocellular carcinoma of < or = 50 mm treated by percutaneous ethanol injection (n=55) or hepatic resection (n=50). RESULTS: Long-term survival was not significantly different between the two groups when the size of hepatocellular carcinoma was less than 30 mm. However, the survival of patients with hepatocellular carcinoma larger than 30 mm was higher after hepatic resection than after percutaneous ethanol injection (P=0.044). The cumulative direct costs were significantly higher in patients treated by hepatic resection than in those treated by percutaneous ethanol injection regardless of the tumour size. The calculated costs per month of survival in patients treated with percutaneous ethanol injection and hepatic resection were 999 vs. 3865 euros, respectively (P < 0.001). CONCLUSIONS: Percutaneous ethanol injection is more cost effective than hepatic resection in patients with a single hepatocellular carcinoma smaller than 30 mm. However, in patients with a larger tumour, long-term survival is higher after hepatic resection.

Fluorogenic derivatization of peptides with naphthalene-2,3-dicarboxaldehyde/cyanide: optimization of yield and application in the determination of leucine-enkephalin spiked human plasma samples.

Initial attempts to derivatize the alpha-amino site of several tripeptides with naphthalene-2,3-dicarboxaldehyde/cyanide (NDA/CN) resulted in poor yields of the expected N-substituted 1-cyanobenz[f]isoindole (CBI) products. Examination of the CBI-formation mechanism, in conjunction with knowledge of the general structure-reactivity properties of the tripeptides, led to the recognition of a competing non-productive reaction pathway. Through the use of model reactions and the isolation and structural elucidation of a predicted side-product the viability of the competing pathway was confirmed. From an understanding of the key features of both the productive and non-productive reaction pathways, a rational approach for the optimization of CBI-derivative yield was proposed and confirmed experimentally. This information led, in turn, to the development of HPLC methodology suitable for the determination of leu-enkephalin spiked into human plasma; fluorescence detection was used in conjunction with leu-enkephalin amide as the internal standard. The method enabled leu-enkephalin to be determined at a concentration of 0.31 nmol ml-1 with an error of less than 4% for 25 pmol injected.

Liquid chromatographic determination of ivermectin in animal plasma with trifluoroacetic anhydride and N-methylimidazole as the derivatization reagent.

Ivermectin is a potent anthelmintic agent which was detected at low concentrations in cattle plasma by LC after conversion to a fluorescent derivative. This was accomplished by reaction with acetic anhydride (AA) and pyridine for 24 h at 100 degrees C or with AA and N-methylimidazole (NMIM) for 1 h at 95 degrees C. Substituting trifluoroacetic anhydride (TFAA) for AA reduced the reaction time to less than 30 s at 25 degrees C, yielding an intensely fluorescent derivative with substantially fewer reagent by-products. The need for further sample preparation after derivatization with TFAA-NMIM was thereby eliminated, and detection limits of less than 20 pg ml-1 ivermectin could be achieved with 1 ml of plasma by a considerably simpler analytical procedure.

Chemical derivatization as a strategy to enhance detectability of agents used in cancer management.

The bioanalysis of drugs used in the management of cancer is often complicated by the lack of selectivity and sensitivity. Chemical derivatization of these drugs prior to their chromatographic analysis represents a viable strategy to improve chromatographic resolution and to enhance detectability. This review provides examples of how this approach can meet these objectives. Derivatization of racemic cyclophosphamide with a chiral acylating agent, following hydroxyalkylation to introduce a reactive centre into the molecule, provides the basis for its stereospecific analysis. The analysis of dianhydrogalactitol is described, in which diethyldithiocarbamate is used as a nucleophilic derivatizing agent that improves chromatographic behaviour and analytical sensitivity. The final example that is described is the design and preparation of improved fluorogenic reagents (o-phthalaldehyde analogues) for the derivatization of peptides and application of these reagents to the trace analysis of leu-enkephalin in plasma.