Perforated esophageal intervention focus (PERF) study: a multi-center examination of contemporary treatment.

The treatment of esophageal perforation (EP) remains a significant clinical challenge. While a number of investigators have previously documented efficient approaches, these were mostly single-center experiences reported prior to the introduction of newer technologies: specifically endoluminal stents. This study was designed to document contemporary practice in the diagnosis and management of EP at multiple institutions around the world and includes early clinical outcomes. A five-year (2009-2013) multicenter retrospective review of management and outcomes for patients with thoracic or abdominal esophageal perforation was conducted. Demographics, etiology, diagnostic modalities, treatments, subsequent early outcomes as well as morbidity and mortality were captured and analyzed. During the study period, 199 patients from 10 centers in the United States, Canada, and Europe were identified. Mechanisms of perforation included Boerhaave syndrome (60, 30.1%), iatrogenic injury (65, 32.6%), and penetrating trauma (25, 12.6%). Perforation was isolated to the thoracic segment alone in 124 (62.3%), with 62 (31.2%) involving the thoracoabdominal esophagus. Mean perforation length was 2.5 cm. Observation was selected as initial management in 65 (32.7%), with only two failures. Direct operative intervention was initial management in 65 patients (32.6%), while 29 (14.6%) underwent esophageal stent coverage. Compared to operative intervention, esophageal stent patients were significantly more likely to be older (61.3 vs. 48.3 years old, P < 0.001) and have sustained iatrogenic mechanisms of esophageal perforation (48.3% vs.15.4%). Secondary intervention requirement for patients with perforation was 33.7% overall (66). Complications included sepsis (56, 28.1%), pneumonia (34, 17.1%) and multi-organ failure (23, 11.6%). Overall mortality was 15.1% (30). In contemporary practice, diagnostic and management approaches to esophageal perforation vary widely. Despite the introduction of endoluminal strategies, it continues to carry a high risk of mortality, morbidity, and need for secondary intervention. A concerted multi-institutional, prospectively collected database is ideal for further investigation.

Monitoring plaque inflammation in atherosclerotic rabbits with an iron oxide (P904) and (18)F-FDG using a combined PET/MR scanner.

PURPOSE: The aim of this study was to compare the ability of (18)F-FDG PET and iron contrast-enhanced MRI with a novel USPIO (P904) to assess change in plaque inflammation induced by atorvastatin and dietary change in a rabbit model of atherosclerosis using a combined PET/MR scanner. MATERIALS AND METHODS: Atherosclerotic rabbits underwent USPIO-enhanced MRI and (18)F-FDG PET in PET/MR hybrid system at baseline and were then randomly divided into a progression group (high cholesterol diet) and a regression group (chow diet and atorvastatin). Each group was scanned again 6 months after baseline imaging. R2* (i.e. 1/T2*) values were calculated pre/post P904 injection. (18)F-FDG PET data were analyzed by averaging the mean Standard Uptake Value (SUVmean) over the abdominal aorta. The in vivo imaging was then correlated with matched histological sections stained for macrophages. RESULTS: (18)F-FDG PET showed strong FDG uptake in the abdominal aorta and P904 injection revealed an increase in R2* values in the aortic wall at baseline. At 6 months, SUVmean values measured in the regression group showed a significant decrease from baseline (p = 0.015). In comparison, progression group values remained constant (p = 0.681). R2* values showed a similar decreasing trend in the regression group suggesting less USPIO uptake in the aortic wall. Correlations between SUVmean or Change in R2* value and macrophages density (RAM-11 staining) were good (R(2) = 0.778 and 0.707 respectively). CONCLUSION: This experimental study confirms the possibility to combine two functional imaging modalities to assess changes in the inflammation of atherosclerotic plaques. (18)F-FDG-PET seems to be more sensitive than USPIO P904 to detect early changes in plaque inflammation.

[Detection by RT-PCR of the 1st cases of Astrovirus in human stools in Abidjan, Côte d'Ivoire]. / Détection par RT-pCR des premiers cas d'Astrovirus dans les selles humaines à Abidjan, Côte d'Ivoire.

Viral gastroenteritis are a problem of public health because of the high rate of morbidity and mortality, particularly in children. Among the etiologic agents, human Astroviruses are the third agents most often incriminated after Rotaviruses and Caliciviruses. Symptoms of gastroenteritis caused by Astroviruses are generally moderated compared with those observed with Rotaviruses and rarely involve hospitalization. In sub-Saharan Africa, particularly in Côte d'Ivoire, the majority of viral gastroenteritis is attributed to Rotavirus with rates varying from 20 to 26%. No study on the circulation of human Astroviruses has been carried out in Côte d'Ivoire. Our objective was to detect human Astroviruses in the diarrhoeal stools in Abidjan. Seventy-two samples of human diarrhoeal stools were collected in ambulatory patients. This population was made up of 44 patients from 0 to 15 and 28 patients over 15 years old. The concentration of the viral particles of the samples was followed by the extraction of the RNA by the modified method of Boom. The extracted RNA were amplified by RT-PCR by using specific primers targeting a portion of the 3' end of the open reading frame ORF la of the genome of human Astroviruses. The amplified fragment was 192 pb. The genome of human Astroviruses was detected in 3 stools out of the 72 samples. That is a frequency of 4%. Among these 3 stools, 2 came from 4 month and 3 year-old children and the 3rd stool came from a 33 year-old patient. For the first time this survey has pointed out the circulation of human Astroviruses in the Côte d'Ivoire population. This survey also showed that human Astroviruses could be found in children as well as in adults.

[Direct sputa examination limits in tuberculosis active detection in 200 immigrant candidates in United States of America]. / Limites de l'examen direct des expectorations dans le dépistage actif de la tuberculose chez 200 candidats à l'émigration aux Etats-Unis.

The Côte-d'Ivoire Pasteur Institute unit of Tuberculous and Nontuberculous Mycobacteria carried out 600 smears stained by Ziehl-Neelsen in 200 immigrant candidates for the U.S.A. The sputa of 44 of them were put in culture on Lowenstein-Jensen medium. Eight (4%) candidates had active pulmonary tuberculosis among whom 5 had smear negative sputum. The pulmonary tuberculosis active detection performed on target population with accessible and sensitive tool can contribute to strengthen the fight against tuberculosis in endemic areas.