Vasculitis of the bladder: An extremely rare case report

AbstractINTRODUCTIONIsolated vasculitis of the bladder is extremely rare. The main causes of which are auto-immune diseases and occasionally infections. Corticosteroid therapy plays a central role in treatment in the majority of cases.PRESENTATION OF CASEWe report a case of gross hematuria associated with irritative low urinary tract symptoms (LUTS) and an increase of biological parameters of inflammation. Radiologic studies suspected a pelvic tumor process. We performed a cystoscopy with multiple biopsies. The pathological findings of the chips were in favor of a thrombotic nongranulomatous vasculitis of small and medium caliber. In view of these findings, all systemic diseases and inflammatory diseases such as cryoglobulinemia, the anti-phospholipid syndrome, Crohn's disease were eliminated. The symptoms regressed completely under antibiotics and anticoagulants.DISCUSSIONOur treatment options were based on the extent of the acute phase reaction and the pelvic venous thrombosis. A few similar cases have been reported in the literature, particularly a case of isolated necrotizing vasculitis of the bladder involving small vessels with a mild laboratory acute phase reaction which was treated with corticosteroids and cyclophosphamide.CONCLUSIONIt is important to differentiate this rare pathological feature of the bladder from other bladder tumors as the treatment is medical rather than surgical

Multicentric Case-Control Study on Azathioprine Dose and Pharmacokinetics in Early-onset Pediatric Inflammatory Bowel Disease

BACKGROUND: Early-onset inflammatory bowel disease (IBD) is generally aggressive, with a high probability of complications and need of surgery. Despite the introduction of highly effective biological drugs, treatment with azathioprine continues to be important even for early-onset IBD; however, in these patients azathioprine response seems to be reduced. This study evaluated azathioprine doses, metabolite concentrations, and their associations with patients' age in children with IBD treated at 6 tertiary pediatric referral centers. METHODS: Azathioprine doses, metabolites, and clinical effects were assessed after at least 3 months of therapy in 17 early-onset (age 12 and <18 yrs, controls) patients with IBD. Azathioprine dose was titrated on therapeutic efficacy (response and adverse effects). Azathioprine metabolites and thiopurine methyltransferase activity were determined by high-performance liquid chromatography with ultra violet-vis detection (HPLC-UV) methods. RESULTS: Frequency of patients in remission was similar among early-onset and control groups, respectively (82% and 84%, P value = 0.72). Early-onset patients required higher doses of azathioprine (median 2.7 versus 2.0 mg\ub7kg\ub7d, P value = 1.1 7 10). Different doses resulted in comparable azathioprine active thioguanine nucleotide metabolite concentrations (median 263 versus 366 pmol/8 7 10 erythrocytes, P value = 0.41) and methylmercaptopurine nucleotide concentrations (median 1455 versus 1532 pmol/8 7 10 erythrocytes, P value = 0.60). Lower ratios between thioguanine nucleotide metabolites and azathioprine doses were found in early-onset patients (median 98 versus 184 pmol/8 7 10 erythrocytes\ub7mg\ub7kg\ub7d, P value = 0.017). Interestingly, early-onset patients presented also higher thiopurine methyltransferase activity (median 476 versus 350 nmol methylmercaptopurine/mg hemoglobin/h, P-value = 0.046). CONCLUSIONS: This study demonstrated that patients with early-onset IBD present increased inactivating azathioprine metabolism, likely because of elevated activity of the enzyme thiopurine methyltransferase

Metals distribution in colorectal biopsies: New insight on the elemental fingerprint of tumour tissue

International audienceBackground: Colorectal cancer is considered to be an environmental disease. In this context, the study of environmental risk factors associated with the presence of chemical elements is important, as well as improving our knowledge of the elemental fingerprint of tumor tissuecompared to non-cancer tissue.Aims: The objective was to evaluate the element distribution in colorectal adenocarcinoma biopsies, adjacent non-tumor tissues, and healthy controls (non-cancer colorectal biopsies including occlusion or ischemic colons).Methods: The study is a case-control study which compared the element distribution in colon biopsies from two groups of patients: with colorectal cancer and without colorectal cancer. Patients with colorectal cancer provided 2 different groups of samples: colorectal cancer biopsies and adjacent non-tumor tissues. 15 metal concentrations (Al, B, Cd, Cr, Cu, Fe, Mg, Mn, Ni, Pb, Se, Si, Ti, V, and Zn) in colorectal biopsies were quantified by using acid digestion procedures and then inductively coupled plasma (ICP) atomic emission spectrometry.Results: A total of 104 patients were included. 76 patients in the colorectal cancer group (i.e. tumor and adjacent non-tumor tissues) and 28 patients in the healthy control group (i.e. noncancer colorectal biopsies). Among the 15 elements analyzed by ICP spectrometry, only boron, chromium, zinc, silicon, and magnesium were found in colorectal tissue at clearly detectable concentrations. Our data indicated that colorectal tumor biopsies have significantly elevated concentrations of magnesium as compared to adjacent non-tumor or healthy tissues. Zinc concentration followed the same trend but differences were not statistically significant. In addition, silicon appears to be more accumulated in colorectal cancer tissue than in healthy non-cancer tissue, while chromium was mostly found in adjacent non-tumor tissue. Conclusion: Magnesium, chromium, zinc and silicon were found in noteworthy concentrations in colorectal tumor. Their potential role in colorectal carcinogenesis should be explored

Oncological digestive surgery using fluorescence

Dans notre travail de thèse, nous nous sommes attachés à répondre à cette question : peut-t-on améliorer la résécabilité tumorale dans le métastases hépatiques et péritonéales du cancer colorectal? Pour cela nous nous sommes appuyés sur deux éléments : la fluorescence du vert d’indocyanine et sa détection par la caméra NIR. Dans un premier temps, après une mise au point en laboratoire, nous avons appliqué cette technique aux résections hépatiques. Nous avons montré que cette technique a un double intérêt : la détection des lésions tumorales et l’amélioration de la marge de résection oncologique. La question encore ouverte est le pourcentage de cellules cancéreuses ou précancéreuses présentent dans cette couronne fluorescente. Dans un deuxième temps nous avons appliqué cette technique dans la carcinose péritonéale. Il s’agit d’une première étude de faisabilité car nous n’avons retrouvé aucune publication sur ce sujet. Nous avons pu montrer des similitudes avec l’étude sur le foie. La fluorescence de l’ICG permet de détecter des tumeurs du péritoine difficilement visibles à l’œil nu grâce à l’intensité et à la qualité de la fluorescence même. Les perspectives sont centrées sur deux axes: l’agent fluorescent, le vert d’indocyanine, et les caméras NIRIn our work of PhD, we endeavored to answer this question: do we can improve tumor resectability in the liver and peritoneal metastases of colorectal cancer? For this, we relied on two elements: the fluorescence of indocyanine green and its detection by NIR camera. Initially, after formal laboratory development, we applied this technique to liver resections. We have shown that this technique has two advantages: the detection of tumor lesions and improving the margin of oncologic resection. The still open question is the percentage of cancerous or precancerous cells present in the fluorescent ring. Secondly, we applied this technique in peritoneal carcinomatosis. This is a first feasibility study because we did not find any publications on this topic. We could show similarities with the study on the liver. The fluorescence from ICG can detect tumors of the peritoneum hardly visible to the naked eye through the intensity and quality of the fluorescence. The outlook is focused on two areas: the fluorescent agent, indocyanine green, and NIR camera

La chirurgie digestive oncologique aidée par la fluorescence

In our work of PhD, we endeavored to answer this question: do we can improve tumor resectability in the liver and peritoneal metastases of colorectal cancer? For this, we relied on two elements: the fluorescence of indocyanine green and its detection by NIR camera. Initially, after formal laboratory development, we applied this technique to liver resections. We have shown that this technique has two advantages: the detection of tumor lesions and improving the margin of oncologic resection. The still open question is the percentage of cancerous or precancerous cells present in the fluorescent ring. Secondly, we applied this technique in peritoneal carcinomatosis. This is a first feasibility study because we did not find any publications on this topic. We could show similarities with the study on the liver. The fluorescence from ICG can detect tumors of the peritoneum hardly visible to the naked eye through the intensity and quality of the fluorescence. The outlook is focused on two areas: the fluorescent agent, indocyanine green, and NIR camerasDans notre travail de thèse, nous nous sommes attachés à répondre à cette question : peut-t-on améliorer la résécabilité tumorale dans le métastases hépatiques et péritonéales du cancer colorectal? Pour cela nous nous sommes appuyés sur deux éléments : la fluorescence du vert d’indocyanine et sa détection par la caméra NIR. Dans un premier temps, après une mise au point en laboratoire, nous avons appliqué cette technique aux résections hépatiques. Nous avons montré que cette technique a un double intérêt : la détection des lésions tumorales et l’amélioration de la marge de résection oncologique. La question encore ouverte est le pourcentage de cellules cancéreuses ou précancéreuses présentent dans cette couronne fluorescente. Dans un deuxième temps nous avons appliqué cette technique dans la carcinose péritonéale. Il s’agit d’une première étude de faisabilité car nous n’avons retrouvé aucune publication sur ce sujet. Nous avons pu montrer des similitudes avec l’étude sur le foie. La fluorescence de l’ICG permet de détecter des tumeurs du péritoine difficilement visibles à l’œil nu grâce à l’intensité et à la qualité de la fluorescence même. Les perspectives sont centrées sur deux axes: l’agent fluorescent, le vert d’indocyanine, et les caméras NI

Nanoparticules et dépistage du cancer colorectal : application humaine <i>ex-vivo</i>

International audiencePas de résum

Nanoparticules et dépistage du cancer colorectal : application humaine <i>ex-vivo</i>

International audiencePas de résum

A MINIATURIZED FLUORESCENCE IMAGING SYSTEM FOR OPTICAL-GUIDED SURGERY OF HUMAN LIVER METASTASES. A PRELIMINARY CLINICAL STUDY.

International audienceSurgery is the only therapy that offers the possibility of cure for patients with hepatic metastatic diseases from colorectal or neuroendocrine carcinoma. Five-year survival rates after resection of all detectable liver metastases can reach 50%. In contrast, the role of hepatectomy in patients with liver metastases from noncolorectal and nonneuroendocrine carcinoma is not well defined. Scientific literature showed that in highly selected patients, resection of noncolorectal and nonneuroendocrine liver metastases can be done safely with survival similar to colorectal metastases. Therefore, preoperative and intraoperative staging are critical parameters in order to anticipate an optimized resectability and a favorable outcome.Indocyanine green (ICG) is a fluorescent agent approved in the clinic for liver function testing, as well as measurement of cardiac output and retinal angiography. It is a water-soluble, anionic, amphilic tricarbocyanine probe with a hydrodynamic diameter of 1.2 nm; the excitation and emission wavelengths in the presence of serum are 778 and 830 nm, respectively. Fluorescent navigation systems with ICG injection are used to detect sentinel lymph nodes. It has only recently shown real interest for optical-guided surgical oncology. Several studies report now that this technique can be useful for assisted intraoperative resection of otherwise undetectable liver cancers (such as hepatocellular and metastatic carcinomas) in patients who received and intravenous injection of ICG 4 to 7 days before surgery for a routine preoperative liver function test.We developed a new, miniaturized version of the Fluobeam (see www.fluoptics.com), which can be used for intra-operative surgery of cancer. We used this system and ICG in a clinical trial on 2 patients with liver metastasis, in order to demonstrate that ICG can efficiently label the rim of these tumors, when it is injected intravenously or infused ex-vivo on the surgical liver specimen. Furthermore, we discuss the quality of the ICG labeling, and the possibility to anticipate it by performing conventional diffusion-weighted magnetic resonance imaging, X-ray imaging and 18-FDG metabolic imaging of these patients before optical guided surgery