Non-invasive evaluation of portal hypertension using shear-wave elastography: analysis of two algorithms combining liver and spleen stiffness in 191 patients with cirrhosis.

BACKGROUND: Two algorithms based on sequential measurements of liver and spleen stiffness using two-dimensional shearwave elastography (2D-SWE) have been recently proposed to estimate clinically significant portal hypertension (hepatic venous pressure gradient [HVPG] ≥10 mm Hg) in patients with cirrhosis, with excellent diagnostic accuracy. AIM: To validate externally these algorithms in a large cohort of patients with cirrhosis. METHODS: One hundred and ninety-one patients with stable cirrhosis (Child-Pugh class A 39%, B 29% and C 31%) who underwent liver and spleen stiffness measurements using 2D-SWE at the time of HVPG measurement were included. Diagnostic accuracy of the 2 algorithms was assessed by calculating sensitivity, specificity, positive and negative predictive values. RESULTS: The first algorithm, using liver stiffness <16.0 kilopascals (kPa) and then spleen stiffness <26.6 kPa, was used to rule-out HVPG ≥10 mm Hg. In our population, its sensitivity and negative predictive value were 95% and 63% respectively. The second algorithm, using liver stiffness >38.0 kPa, or liver stiffness ≤38.0 kPa but spleen stiffness >27.9 kPa, was used to rule-in HVPG ≥10 mm Hg. In our population, its specificity and positive predictive value were 52% and 83% respectively. Restricting the analyses to the 74 patients without any history of decompensation of cirrhosis or to the 65 patients with highly reliable liver stiffness measurement did not improve the results. CONCLUSION: In our population, diagnostic accuracies of non-invasive algorithms based on sequential measurements of liver and spleen stiffness using 2D-SWE were acceptable, but not good enough to replace HVPG measurement or to base clinical decisions.

Lack of clinical or haemodynamic rebound after abrupt interruption of beta-blockers in patients with cirrhosis.

BACKGROUND: Beta-blockers may have to be interrupted in patients with cirrhosis. The concept of a rebound after interruption of beta-blockers is based on an animal study and on isolated case reports of variceal bleeding. AIM: To determine if a rebound occurs in patients with cirrhosis following abrupt interruption of beta-blockers. METHODS: We prospectively included all consecutive patients with cirrhosis undergoing right heart and hepatic vein catheterisation. Four groups were defined: 'no beta-blockers' including patients not receiving beta-blockers; '≤1 day', '2-3 days' and '≥4 days' classified according to the time patients had interrupted beta-blockers before catheterisation. Results were expressed as median (interquartile range). RESULTS: A total of 150 patients were included. Among the 25 patients in the groups '2-3 days' and '≥4 days', median duration of beta-blockers interruption was 4 (3-6) days. No gastrointestinal bleeding occurred during that period, nor during the following month. Hepatic venous pressure gradient was not different among patients in usually treated with beta-blockers. After adjustment, beta-blockers interruption was not associated with hepatic venous pressure gradient. Cardiac index was higher in the '≥4 days' group [4.6 L/min/m(2) (3.5-5.1)] than in the '≤1 day' group [3.4 (2.6-4.0); P = 0.001] or in the '2-3 days' group [3.1 (2.7-3.7); P = 0.007], but not different from the 'no beta-blockers' group. CONCLUSIONS: Abrupt interruption of beta-blockers is associated neither with an apparent increase in the risk of variceal bleeding nor with a haemodynamic rebound. Thus, interruption of beta-blockers in patients with cirrhosis may not require particular dosing or surveillance.

How does heat shock affect the life history traits of adults and progeny of the aphid parasitoid Aphidius avenae (Hymenoptera: Aphidiidae)?

Because insects are ectotherms, their physiology, behaviour and fitness are influenced by the ambient temperature. Any changes in environmental temperatures may impact the fitness and life history traits of insects and, thus, affect population dynamics. Here, we experimentally tested the impact of heat shock on the fitness and life history traits of adults of the aphid parasitoid Aphidius avenae and on the later repercussions for their progeny. Our results show that short exposure (1 h) to an elevated temperature (36 degrees C), which is frequently experienced by parasitoids during the summer, resulted in high mortality rates in a parasitoid population and strongly affected the fitness of survivors by drastically reducing reproductive output and triggering a sex-dependent effect on lifespan. Heat stress resulted in greater longevity in surviving females and in shorter longevity in surviving males in comparison with untreated individuals. Viability and the developmental rates of progeny were also affected in a sex-dependent manner. These results underline the ecological importance of the thermal stress response of parasitoid species, not only for survival, but also for maintaining reproductive activities.

Ontogenetic study of three Calliphoridae of forensic importance through cuticular hydrocarbon analysis.

The ontogeny of the cuticular hydrocarbons of three dipterans of importance to forensic entomology, Calliphora vomitoria (Linné), Calliphora vicina (Robineau-Desvoidy) and Protophormia terraenovae (Robineau-Desvoidy) (Diptera: Calliphoridae), was explored using gas chromatography analysis. The stages examined ranged from eggs to 8-day-old adults. Cuticular hydrocarbon profiles revealed that odd linear alkanes dominate in all three species. Short-chain carbon compounds in larvae and post-feeding larvae were seen to evolve to long-chain carbon compounds in pupae and adults. Discriminant analysis of cuticular hydrocarbon profiles showed a clear differentiation among the different stages (larvae, post-feeding larvae, pupae and adults) and within stages, according to the age of individuals. This study concluded that the postmortem interval can be determined from the composition of cuticular waxes in Calliphoridae in forensic situations.

ISSR-PCR: tool for discrimination and genetic structure analysis of Plutella xylostella populations native to different geographical areas.

The diamondback moth (DBM), Plutella xylostella (L.) is considered as the most destructive pest of Brassicaceae crops world-wide. Its migratory capacities and development of insecticide resistance in many populations leads to more difficulties for population management. To control movement of populations and apparitions of resistance carried by resistant migrant individuals, populations must be identified using genetic markers. Here, seven different ISSR markers have been tested as a tool for population discrimination and genetic variations among 19 DBM populations from Canada, USA, Brazil, Martinique Island, France, Romania, Austria, Uzbekistan, Egypt, Benin, South Africa, Réunion Island, Hong Kong, Laos, Japan and four localities in Australia were assessed. Two classification methods were tested and compared: a common method of genetic distance analyses and a novel method based on an advanced statistical method of the Artificial Neural Networks' family, the Self-Organizing Map (SOM). The 188 loci selected revealed a very high variability between populations with a total polymorphism of 100% and a global coefficient of gene differentiation estimated by the Nei's index (Gst) of 0.238. Nevertheless, the largest part of variability was expressed among individuals within populations (AMOVA: 73.71% and mean polymorphism of 94% within populations). Genetic differentiation among the DBM populations did not reflect geographical distances between them. The two classification methods have given excellent results with less than 1.3% of misclassified individuals. The origin of the high genetic differentiation and efficiency of the two classification methods are discussed.

Genetic differentiation among various populations of the diamondback moth, Plutella xylostella (Lepidoptera: Yponomeutidae).

Genetic variation among 14 populations of Plutella xylostella (Linnaeus) from USA (Geneva, New York), Brazil (Brasilia), Japan (Okayama), The Philippines (Caragan de Oyo), Uzbekistan (Tashkent), France (Montpellier), Benin (Cotonou), South Africa (Johannesburg), Réunion Island (Montvert), and five localities in Australia (Adelaide, Brisbane, Mareeba, Melbourne, Sydney) were assessed by analysis of allozyme frequencies at seven polymorphic loci. Most of the populations were not in Hardy-Weinberg equilibrium and had a deficit in heterozygotes. The global differentiation among populations was estimated by the fixation index (Fst) at 0.103 for the 14 populations and at 0.047 when populations from Australia and Japan, which differed most and had a strong genetic structure, were excluded from the analysis. By contrast, the populations from Benin (West Africa) and Brazil (South America) were very similar to each other. Genetic differentiation among the populations was not correlated with geographical distance.

Eruptive lingual papillitis with household transmission: a prospective clinical study.

BACKGROUND: Eruptive lingual papillitis with household transmission (ELP) is an acute stomatitis of unknown cause occurring in children, with possible spread to one or several members of the family. OBJECTIVES: To verify clinical features and search for clinical characteristics of ELP. METHODS: A prospective case series, including an analysis of epidemiological and clinical factors, was conducted within private paediatric practices in collaboration with a dermatology department at the University Hospital of Nice, France. RESULTS: Thirty-eight children (21 girls and 17 boys) with clinical criteria of ELP referred from 1 February 2000 to 31 January 2002 were included in the study. Mean age at diagnosis was 3 years and 6 months. Thirty-three children attended day nursery or school. The seasonal distribution of observed cases showed a peak of incidence in spring. The eruption started abruptly. Fever was found in 15 (39%) cases. Difficulties in feeding were observed in all cases; intense salivation in 23 (61%) cases. The glossitis was characterized by inflammatory hypertrophy of the fungiform papillae on the tip and dorsolateral part of the tongue. Enlarged submaxillary or cervical lymph nodes were noted in 16 (42%) cases. Angular cheilitis was observed in four (11%) children. Spontaneous regression of the stomatitis occurred between the second and 15 days of clinical evolution. Mean duration was 7.3 days. Transmission to one or several members of the family was noted in 20 (53%) cases. Recurrence of symptoms was observed in five (13%) children. CONCLUSIONS: This study confirms some clinical characteristics of ELP: localized lesions of the fungiform papillae on the tip and dorsolateral part of the tongue, high frequency of intrafamilial transmission, and possibility of recurrence. This study also showed unsuspected clinical data such as possible occurrence of fever and angular cheilitis. ELP resembles an entity termed 'transient lingual papillitis' or commonly 'lie bumps'. The origin of this eruption remains unknown, but the transmission data could suggest a possible infectious origin.

[Left superior vena cava: a simple diagnosis by transthoracic echocardiography. A case report]. / Veine cave supérieure gauche: un diagnostic simple par échocardiographie transthoracique. A propos d'un cas.

Persistent left superior vena cava is an anomaly of the systemic venous return occurring in 0.5% of the general population. We report the case of a patient with an incidental diagnosis made during a dyspnea while he had chronic pulmonary disease. The diagnosis was suspected by the presence of a markedly dilated coronary sinus and confirmed by a simple contrast injection into the left antecubital vein. Transesophageal echocardiography and magnetic resonance imaging confirmed the existence of 2 superior vena cava with the left superior vena cava draining into the coronary sinus. This congenital anomaly is of minimal hemodynamic significance when isolated. The diagnosis can be useful for placement of central catheters from left superior approach.

[The ilio-femoral approach: an alternative for implanting permanent cardiac pacemakers. Three case reports]. / La voie ilio-fémorale: une alternative pour l'implantation de sondes de stimulation cardiaque définitives. A propos de trois cas.

Permanent endocavitary cardiac pacing is a widely used therapeutic method. The implantation of pacing catheters is usually performed by the supracardiac veins, the epicardial approach being the classical alternative. The ilio-femoral approach is a third possibility. The authors report three cases in which this approach was used. The implantations were performed under general anaesthesia with an abdominal pacemaker. In two cases, atrial and ventricular catheters were implanted. After an average of 19 months' follow-up, no short or long-term complications were observed: displacement or fracture of the pacing catheter, infection, venous thrombosis, threshold elevation. These results show that this is a safe and feasible alternative to implantation by the traditional or epicardial techniques when these approaches cannot be used.

[Hospital management of atrial fibrillation. Epidemiologic data and therapeutic strategy. Report of 100 consecutive patients]. / Prise en charge hospitalière de la fibrillation auriculaire. Données épidémiologiques et stratégie thérapeutique. A propos de 100 patients consécutifs.

Despite recent large scale trials, the management of atrial fibrillation remains very variable. The authors report the results of a prospective study of the management of atrial fibrillation in their department. One hundred consecutive patients admitted for atrial fibrillation were included in the study. The epidemiological and clinical data and the results of the therapeutic strategy were recorded prospectively. Three embolic complications occurred before hospital admission. The hospital stay was marked by spontaneous reduction of atrial fibrillation in 14 cases in the 6 hours following admission. The therapeutic strategy was the following: 40 arrhythmias were respected (well tolerated, > 1 year or with a left atrium 60 mm). Oral amiodarone (30 mg/Kg and 15 mg/Kg the next day) was given to 22 patients. Only 9 patients (41%) were converted (average delay of 12 hours). Four patients received intravenous amiodarone, reducing two arrhythmias. Twenty patients were treated by external electrical cardioversion of first intent and 14 after failure of pharmacological reduction. All of these procedures, early (after 48 hours anticoagulation and transoesophageal echocardiography), or late (after 1 month of anticoagulation), restored sinus rhythm without complications, especially embolic. This register showed a relatively low efficacy of oral amiodarone in the reduction of atrial fibrillation and underlines the efficacy and safety of external electrical cardioversion, even when performed early.

[Importance of arthrodesis of the big toe combined with a metatarsal alignment according to Lelièvre in the surgery of the rheumatoid forefoot. Apropos of 70 observations]. / Intérêt de l'arthrodèse du gros orteil associée à un alignement métatarsien selon Lelièvre dans la chirurgie de l'avant pied rhumatoïde. A propos de 70 observations.

PURPOSE OF THE STUDY: The authors reviewed 70 cases of rheumatoid forefoot treated by Lelièvre, lateral metatarsal resection alignment, associated to first metatarsophalangeal joint arthrodesis. MATERIAL: Rheumatoid arthritis evolution was 20 years an average. It involved cortico-dependent polyarthritis in 48 per cent cases. Metatarsalgia were always present. METHODS: Mean follow up was 44 months (minimum 24 months) Results were analyzed according to Gainor. RESULTS: Foot pain disappeared in thirty two cases. Shoe wearing was normal 50 times. Arthrodesis fused 55 times. Lateral toes metatarsophalangeal joint space was satisfactory 28 times. Metatarsal divergence improved, 80 per cent of patients were satisfied in a subjective estimation and 85 per cent using Gainor's criteria. DISCUSSION: First-Metatarsophalangeal joint arthrodesis ensures permanent stability of the first ray and therefore an harmonious support distribution. The dorsal surgical approach allows an early weight bearing in cortico or immuno dependent patients. CONCLUSION: This technique keeps a low morbidity and ensures stable mid term results.

[Aorto-coronary dysplasia and pseudoxanthoma elastica]. / Dysplasie aorto-coronaire et pseudoxanthome élastique. A propos d'un cas.

The authors report the case of a 50 year old man with pseudowanthoma elastica with a history of myocardial infarction and severe aortic regurgitation. Angiography showed multiple coronary artery aneurysms and aneurysmal dilatation of the aortic annulus. The outcome after triple coronary bypass surgery with aortic valve replacement in a valved Bentall conduit was favourable. Pseudoxanthoma elastica is a rare condition in which the prognosis depends on the degree of vascular involvement. In this context, coronary artery aneurysms and aneurysmal dilatation of the aorta are rare complications.

[Primary and recovery transmaxillar buccopharyngectomy in buccopharyngeal cancers]. / La buccopharyngectomie transmaxillaire en première intention et en rattrapage dans les cancers buccopharyngés latéraux.

From january 1976 to december 1986, 78 patients were treated surgically for squamous cell carcinoma of the lateral buccopharyngeal junction without chemotherapy at first. 36 patients were treated by primary surgery with post-operative radiotherapy and 31 patients were treated by recovery surgery. Post-operative course was uncomplicated in 41% of cases (39% in primary surgery, 43% in recovery surgery); in 14% of cases serious local complications were observed (11% in primary surgery, 17% in recovery surgery). Carcinological failures appeared in 46% of cases in primary surgery and in 70% of cases in recovery surgery. Three years and five years actuarial survival rate were 45% and 39% respectively in recovery surgery. Prognostic factors are studied: resection quality, histological metastasis in lymph nodes. The authors emphasize on the best control of the big tumors in primary surgery and on the best results with small ulcerated infiltrant carcinoma.