Interleukin-1 receptor antagonist for refractory anti-MDA5 clinically amyopathic dermatomyopathy.

Autoantibodies targeting the melanoma-differentiation-associated gene-5 (MDA5)-encoded ribonucleic acid helicase are associated with clinically amyopathic dermatomyopathy (CADM). Marked systemic inflammation, skin ulcers and severe interstitial lung disease seem frequent. DM treatment consists of immunosuppressants and/or intravenous immunoglobulins, but evidence-based knowledge is lacking. Anakinra (an interleukin-1 receptor antagonist (IL-1RA)) use in this setting has never been reported. Herein, we report on a case of anakinra dramatic and rapid efficacy against general and extramuscular (e.g. calcinosis, arthritis, skin ulcers) in a patient with severe and refractory CADM. Unfortunately, short-term follow-up prevented efficacy evaluation against interstitial lung disease. IL-1RA could be a promising treatment for refractory CADM.

Primary duodenal tuberculosis: a case report.

Gastroduodenal tuberculosis (TB) is a rare condition and is often associated with pulmonary TB. We report the case of a primary duodenal TB in an immunocompetent patient without evidence of pulmonary TB. Diagnosis of this disease is difficult and is often confused with chronic peptic ulcer disease. Literature data concerning this challenging diagnosis are analysed.

Torsion of the gallbladder: two case reports.

Torsion of the gallbladder is a rare disease. It is simply defined as a rotation of the gallbladder on its mesentery along the axis of the cystic duct and cystic artery. The aetiology is unknown. However, several factors are postulated as playing causative roles. The disease symptoms mimic acute cholecystisis. The current value of radiological imaging is limited, but clinically, volvulus of the gallbladder is an acute surgical situation. It may be treated and diagnosed by a laparoscopic approach.

Gastroduodenal artery pseudo-aneurysm after cholecystectomy.

We report the case of a 69-year-old man presenting with rupture of a pseudo-aneurysm of the gastroduodenal artery into the duodenum eight days after open cholecystectomy for acute cholecystitis. The surgical approach to a ruptured visceral artery pseudo-aneurysm is technically difficult and hazardous. The operative mortality rate reaches 16 to 50%, mainly dependent on the anatomic location of the visceral artery pseudo-aneurysm. This report describes a case in which bleeding from a pseudo-aneurysm of the gastroduodenal artery was successfully treated by embolisation using metal coils.

Lesser curvature Roux-en-Y gastric bypass as an alternative procedure to failed vertical banded gastroplasty: surgical technique and short-term results.

PURPOSE: The incidence of revisional surgery for failed vertical banded gastroplasty has increased markedly over the last years. Conversion to gastric bypass is considered as a good alternative with satisfactory long term weight loss without further revisional surgery. Nevertheless, significant morbidity and mortality is still associated with this procedure. New technical aspects make it safer and more effective. The aim of the work is to expose a surgical bypass technique to attempt to reduce morbidity. PATIENTS AND METHODS: Thirty patients have undergone conversions from failed vertical banded gastroplasty to a lesser curvature Roux-en-Y Gastric Bypass. Surgical technique is described in detail and early complications and initial weight loss were analyzed (mean follow-up: 12 months). RESULTS: The key points of the operation were the small vertical pouch, the complete transection of the distal bypassed stomach, the interposition of a jejunal limb between the two gastric shares and the latero-lateral gastrojejunal anastomosis without proximal ring interposition. For the entire series, we noticed one major complication, an acute pancreatitis causing anastomotic fistula and four mild complications, one bleeding on the excluded stomach, one bronchopneumonia, one pleural effusion and one wound dehiscence. The percentage of excess weight loss attained 56.1% at one year follow-up. CONCLUSIONS: There have been tremendous improvements in the safety of gastric bypass over the years. One year follow-up indicates that our surgical bypass procedure is secure with a low complication rate.

[Antibiotics in pregnancy: importance of rational utilization]. / Antibiothérapie en maternité: importance d'une utilisation rationnelle.

It is now clear that antibiotic treatment in the antenatal period significantly does prolong pregnancy during conservative management of preterm premature rupture of membranes and reduces neonatal infectious diseases as well as neonatal-related morbidities. In the same way, prophylactic intrapartum antibiotherapy reduces the incidence of early-onset group B Streptococcus-induced sepsis. Nevertheless, on the other hand, antibiotics in the perinatal period are associated with an increase of neonatal sepsis by organisms resistant to maternally administered antibiotics. In addition, antibiotic treatment in this period of time is emerging as one of the possible sources of the dramatic increase in atopic disorders in infants and children owing to the interference with the normal process of intestinal microbial colonization. So, guidelines for using antibiotics in the perinatal period can be said as one of the major priority in public health. Antibiotics have therefore to be rightly choosen and must be used in a rational manner. Local microbial epidemiology, period of infection onset, clinical evaluation, all together allow the physician to use antibiotics, always in association, according to the "well-thought-out wager". In addition, the pharmacodynamic/pharmacokinetic relationship of each drug has to be known, in order to increase efficacy, decrease toxicity and reduce microbial resistance. It is especially mandatory in neonatology where the differences in drug distribution and drug elimination are of great concern, as compared to children and adults. The aim of this paper is to point out such very important aspects using antibiotics in the perinatal period.

Chemical signals involved in spacing behavior of breeding female bank voles (Clethrionomys glareolus Schreber 1780, Microtidae, Rodentia).

In order to study the mechanism involved in the seasonal territoriality of breeding bank voles, the social behavior and scent marking of paired females were observed throughout a reproductive cycle. Initially unfamiliar females were kept in large laboratory pens provided with individual burrows. After a brief period of hostility, females behaved in a friendly manner towards each other, sharing the same nest even in the presence of a male and until the middle of pregnancy. They scarcely marked with urine. Continuous olfactory assessment appeared to play an important role in maintaining the friendly interactions. In late pregnant and lactating females, on the contrary, the odor of a familiar female triggered aggressiveness and scent marking with urine and probably with flank glands. These reactions may be interpreted as spacing behavior. Moreover, the interaction between females may inhibit reproduction in one of them. These results are discussed in relation with the available ecological data.

[Gallbladder volvulus : report on three cases and review of the literature (author's transl)]. / Volvulus de la vésicule biliaire. Revue de la littérature à propos de trois observations personnelles.

Gallbladder volvulus is an extremely rare disorder. Three cases have been treated recently in the Surgical Department of the Faculty of Medicine, Liège. The clinical picture is that of an acute abdomen requiring urgent surgery, diagnosis usually being made during the operation. Treatment is fairly simple : cholecystectomy, which no problem of dissection ro of instrumental exploration of the bile duct, the volvulus being normally free from stones. Prognosis for the volvulus and the gallbladder is a function of the general condition and the rapidity of operation, and is currently generally good.