[Hypermetabolic multifocal steatohepatitis: a rare case of [18F]FDG PET/CT false positive mimicking a metastatic carcinomatosis]. / Stéatohépatite multifocale hypermétabolique : un cas rare de faux positif au [18F]FDG PET/CT mimant une carcinomatose métastatique.

Fatty liver disease is a common condition that rarely occurs on a multifocal mode. In this form, the differential diagnosis with hepatic carcinomatosis is not obvious, especially when a neoplastic condition coexists. Radiologically, MRI can almost systematically differentiate these two entities. However, concerning metabolic imaging with [18F]FDG PET/CT it is important to keep in mind that a multifocal hepatic steatosis may appear hypermetabolic in rare cases. By mimicking a typical presentation of metastatic carcinomatosis, it may lead to a false positive result. Here we report the case of a 73-year-old woman with a recent diagnosis of colorectal cancer. As part of the initial assessment, a MRI of the liver is performed and shows multiple lesions described as multifocal steatosis. A [18F]FDG PET/CT subsequently describes the same liver lesions but assimilates them to colorectal metastatic carcinomatosis. Due to this mismatch between the two different imaging modalities, several biopsies of the liver lesions are performed, first echoguided (two different lesions) then surgically (removal of a third lesion). The pathological analysis of the specimens fails to highlight any malignant lesion and the diagnosis of multifocal steatohepatitis is made.

La stéatose hépatique est une pathologie fréquente. Dans de rares cas, elle peut se présenter sous forme de lésions multifocales. Le diagnostic différentiel avec une carcinomatose hépatique n'est alors pas toujours évident, surtout lorsque coexiste un contexte néoplasique. Radiologiquement, l'IRM permet presque systématiquement de faire la différence entre ces deux entités. Concernant l'imagerie métabolique au [18F]FDG PET/CT, il est important de garder à l'esprit que les plages de stéatose hépatique multifocales peuvent apparaître hypermétaboliques dans de rares cas. Mimant en tout point une présentation typique de carcinomatose métastatique, elles peuvent mener à un résultat faussement positif. Nous rapportons ici le cas d'une patiente de 73 ans chez qui un diagnostic de cancer colorectal vient d'être posé. Lors du bilan d'extension initial, une IRM hépatique met en évidence de multiples lésions décrites comme des plages de stéatose multifocale. Un [18F]FDG PET/CT réalisé parallèlement interprète ces mêmes lésions comme une carcinomatose métastatique du cancer colorectal. Face à cette discordance entre les deux modalités d'imagerie, des biopsies hépatiques, d'abord échoguidées à deux reprises, puis une biopsie-exérèse chirurgicale, sont réalisées. In fine, l'anatomopathologie ne retrouve aucune cellule néoplasique et le diagnostic de stéatohépatite multifocale hypermétabolique est retenu.

Oocyst shedding patterns of Eimeria species and their association with management and performance at ten rose veal starter farms in the Netherlands.

Coccidiosis at rose veal starter farms is often diagnosed however, this was the first study performed considering this topic on this type of rearing unit. The objective of this study was to identify Eimeria species faecal shedding patterns at ten Dutch rose veal starter farms during rearing. Further objectives were to investigate associations with (gut) health, production and management decisions. Faecal samples from twelve randomly selected calves per farm were collected weekly during 9 consecutive weeks. Thereafter samples were pooled in a predetermined composition of six. These calves were clinically evaluated every sample visit and weighed at the first and last visit. Laboratory tests included a flotation test of the samples. If this yielded Eimeria oocysts, both oocysts per gram feces (OPG) and species differentiation were established using a modified McMaster method. Management parameters and technical herd results were identified after finalizing the study period using a questionnaire. Studied patterns in oocyst shedding included the pool's cumulated OPG, maximum OPG level and the number of sample days (SD) that OPG exceeded a confirmed level. Statistical analysis included univariate and multivariate analysis. Associated (p < 0.10) OPG patterns considering rumen fill, faecal consistency and average daily weight gain (ADG) were tested using a model with herd included as random effect. RESULTS: on all ten farms E. alabamensis, E.bovis and E. zuernii besides non-pathogenic species were identified, often as mixed infections. Peak OPG occurred predominately at SD 21 and 28 (E. alabamensis and E. bovis), and at SD 42 (E. zuernii). In 16 pools, OPG levels ≥500 for E. bovis or E. zuernii, were found. Significant correlation (p < 0.0001) showed between the log10 OPG of pathogenic Eimeria and of all Eimeria species. Multivariate analysis showed significant correlation between cumulative faecal consistency scores and cumulative log10 OPG of pathogenic Eimeria species (ß = 0.16; p = 0.008). Pools exceeding 750 OPG for E. bovis showed 93 g lower ADG and pools experiencing ≥2 SD with >1000 OPG for E. alabamensis 141 g lower ADG. From the questionnaire we identified lower cumulated OPG of all Eimeria species except for E. bovis at farms where the units were cleaned before arrival of the calves. CONCLUSION: As a rule, on Dutch rose veal starter farms, mixed Eimeria infections occur, but shedding patterns differ between farms. Clinical and growth performance is related to OPG patterns found. Cleaning units before arrival of calves lowers oocyst shedding during the rearing period.

Snow on Arctic Sea Ice in a Warming Climate as Simulated in CESM.

Earth system models are valuable tools for understanding how the Arctic snow-ice system and the feedbacks therein may respond to a warming climate. In this analysis, we investigate snow on Arctic sea ice to better understand how snow conditions may change under different forcing scenarios. First, we use in situ, airborne, and satellite observations to assess the realism of the Community Earth System Model (CESM) in simulating snow on Arctic sea ice. CESM versions one and two are evaluated, with V1 being the Large Ensemble experiment (CESM1-LE) and V2 being configured with low- and high-top atmospheric components. The assessment shows CESM2 underestimates snow depth and produces overly uniform snow distributions, whereas CESM1-LE produces a highly variable, excessively-thick snow cover. Observations indicate that snow in CESM2 accumulates too slowly in autumn, too quickly in winter-spring, and melts too soon and rapidly in late spring. The 1950-2050 trends in annual mean snow depths are markedly smaller in CESM2 (-0.8 cm decade-1) than in CESM1-LE (-3.6 cm decade-1) due to CESM2 having less snow overall. A perennial, thick sea-ice cover, cool summers, and excessive summer snowfall facilitate a thicker, longer-lasting snow cover in CESM1-LE. Under the SSP5-8.5 forcing scenario, CESM2 shows that, compared to present-day, snow on Arctic sea ice will: (1) undergo enhanced, earlier spring melt, (2) accumulate less in summer-autumn, (3) sublimate more, and (4) facilitate marginally more snow-ice formation. CESM2 also reveals that summers with snow-free ice can occur ∼30-60 years before an ice-free central Arctic, which may promote faster sea-ice melt.

[First case of pithomycotoxicosis (facial eczema) in the Netherlands]. / Pithomycotoxicosis of facial eczema bij het rund voor de eerste maal aangetoond in Nederland. Zonnebrand als koppelprobleem op rundveebedryjven.

Between mid September and the beginning of November 2005, the Animal Health Service (AHS) received thirteen reports offarms on which several animals showed severe symptoms of solar eczema. Blood chemistry showed very high levels of GOT/AST and GGT indicative of severe liver damage. Farm visits to eight farms showed that the animals--previous to the start of the symptoms--had been grazing 24 hours/day and received no additional feed. Ingestion of poisonous plants or medications was considered unlikely to have caused the liver damage, and liver fluke infections were present on only two farms. Microscopic examination of specimens of grass revealed the presence of spores of Pithomyces chartarum in samples taken from six of nine farms. This fungus produces the mycotoxin sporidesmin, which causes severe liver damage and pithomycotoxicosis (facial eczema). This article is the first to describe Pithomyces chartarum in cattle in mainland Europe. Further research on the distribution and re-occurrence of Pithomyces chartarum infection and sporidesmin survival in grass silage is recommended.

Levamisole adds granulocyte toxicity to 5FU-based chemotherapies in adjuvant treatment of Dukes B-C colorectal cancer. A preliminary report.

41 patients (pilot study-I) and 50 patients (multicenter study II) were randomized to receive as systemic chemotherapy for 6 courses with 5 FU alone (A) [440 (I)-450 (II) mg/m2 IV bolus, 5/21 days] or folinic acid followed by 5 FU (B) (respectively 200 and 370 mg/m2 IV bolus, 5/21 days). In the multicenter trial, oral levamisole at the dose of 150 mg/day (3/14 days) was added to chemotherapy for one year. Ten patients in study I and 19 patients in study II also received a post-operative course of intra-portal chemotherapy. Toxicity was evaluated respectively on 232 (I) and 276 (II) courses. Clinical limiting toxicities were stomatitis and diarrhea. In protocol II, a significant enhancement of grades 3-4 granulocyte toxicity was seen (17.3% of courses in II vs only 3.4% in I; p < 0.001). This was especially recorded in the group treated with 5-FU alone (26% of courses in A vs 11% in B; p < 0.001). Levamisole was therefore stopped in 12 cases (10 cases in A; 2 cases in B).

Determination of humoral immunoglobulins M and G directed against mycobacterial antigen 60 failed to diagnose primary tuberculosis and mycobacterial adenitis in children.

The serodiagnosis of primary tuberculosis (TB) and mycobacterial adenitis in children was tried using the Anda-Tb tests (Anda Biologicals, France) that measure immunoglobulins (Ig) M and G directed against mycobacterial antigen 60 (A60) by enzyme-linked immunosorbent assay. The 188 cases studied included 81 healthy or mycobacteria-unrelated diseased children with no reaction to tuberculin skin test (STN); 9 recent BCG vaccination (BCG); 35 asymptomatic (AsTB), 29 symptomatic (STB) primary TB and 11 adenitis caused by atypical mycobacteria from the group avium-intracellulare-scrofulaceum (MAIS) tested before treatment; and 23 past primary TB tested at different times after completion of specific treatment (past TB). The individual IgM and IgG levels largely overlapped whatever the clinical status of the children. Setting the normal upper limit at the 95th percentile of the STN values, which by definition gives 95% specificity, the highest IgM sensitivity was found in past TB (35%), AsTB showing 23%, STB 17%, and MAIS 18% sensitivity. IgG sensitivity was also the highest in past TB (26%) and was equal to 6, 14, and 9% in AsTB, STB, and MAIS, respectively. Positive and negative predictive values and the test efficiency (63 and 62% for IgM and IgG, respectively) were far too low. Combining positivity for IgM and/or IgG did not improve the results. In our study, the anti-A60 IgM and IgG measurements using the Anda-Tb tests in primary TB and mycobacterial adenitis in children did not prove of any diagnostic help.

Urticaria pigmentosa--response to topical steroids.

A case of adult-onset urticaria pigmentosa is presented, in which the eruption cleared following the application of potent topical corticosteroids. Remission could be maintained by intermittent topical treatment. Topical steroids would appear to provide a simple, cheap and effective alternative to standard therapies.

Interleukin-2 and soluble interleukin-2 receptor levels in children with active pulmonary tuberculosis and atypical mycobacterial adenitis.

Interleukin-2 (IL-2) level was measured in sera and in supernatants of Purified Protein Derivatives of Tuberculin (PPD) stimulated peripheral blood mononuclear cells (PBMC) cultures from children with active primary pulmonary tuberculosis (TB), or adenitis caused by mycobacteria of the group Mycobacterium avium, intracellulare, scrofulaceum (MAIS). The control groups included BCG vaccinated children (BCG) and children with negative skin test to PPD (NST). High mean IL-2 level was exclusively found in sera of mild TB patients (MTB), and not in sera of MAIS infected or BCG vaccinated children. The IL-2 level increased even more in MTB during treatment. In severe TB (STB) the IL-2 level was not elevated before treatment, but increased also during treatment. IL-2 production in supernatants of PPD stimulated PBMC cultures was increased in MTB as well as in MAIS and BCG subjects. Further, soluble IL-2 receptor (sIL-2R) levels were measured in the different groups of children. With the exception of the STB group, there was otherwise no significant increase of the receptor in the sera levels between groups. During treatment the sIL-2R levels decreased in MTB as well as in STB. A slight but non significant augmentation was found in the supernatants of PBMC cultures stimulated with PPD. This work suggests, along with other referable studies, that IL-2 and sIL-2R levels are inversely modulated by the disease. Indeed, the IL-2 seems to increase in MTB comparatively to NST children, and in treated TB comparatively to non treated TB children. On the other hand, the sIL-2R level was found to decrease in TB under treatment.(ABSTRACT TRUNCATED AT 250 WORDS)