Esophageal variceal ligation in the secondary prevention of variceal bleeding: Result of long term follow-up

Introduction: Long-term outcome of patients after band ligation have been poorly defined. Therefore, we conducted a long-term follow-up study to delineate the outcome of ligation in patients with portal hypertension in the Hassan II university hospital, Fes, Morocco. Methods: Over 118 months patients treated by endoscopic variceal ligation were received regular follow- up and detailed clinical assessment of at least 24 months.Results: One hundred twenty five patients were followed up for a mean of 31 months (range 12-107 months). Obliteration of the varices was achieved in 89.6 % (N=112) of patients, with 3 +/-1.99 (range 1-8) endoscopy sessions over a period of 14+/-6.8 weeks (range 3-28). The percentage of variceal recurrence during follow-up after ligation was 20.5 % (N=23). Recurrence were observed in a mean of 22 months +/- 7.3 (range 3-48). Bleeding rate from recurrent varices was 30.4 % (7/23). Rebleeding from esophageal ulcers occurred in 5.6 % (7/125) of patients. Portal hypertensive gastropathy before and after eradication of varices was 17.6% (N=22) and 44.6% (N=50) respectively; p< 0.05. Fundal gastric varices was 30.4% (N=38) and 35.7% (N=40) before and after eradication of varices respectively; p> 0.05. The overall mortality was 4 % (N=5).Conclusion: Band ligation was an effective technical approach for variceal obliteration with low rates of variceal recurrence, rebleeding and development of gastric varices. Furthermore, it was associated with frequent development of portal hypertensive gastropathy.Key words: Variceal hemorrhage, endoscopic band ligation, liver cirrhosis, complication of band ligation, esophageal varices, secondary preventio

La différence épidémiologique des hémorragies digestives hautes entre les hommes et les femmes

Introduction: Des différences épidémiologiques, étiologique voire pronostique des hémorragies digestives hautes (HDH) entre les deux sexes opposés ont été cité par différentes études. Méthodes: Nous avons essayé de déceler ces différences à travers une analyse rétrospective nichée sur une étude prospective sur les hémorragies digestives hautes ayant inclus 945 patients.Résultats: Six cents trente-sept patients étaient des hommes (67,4% Vs 32,6%). Un antécédent d’HDH était trouvé chez 24,2% des cas sans différence significative entre les deux sexes. L’âge de survenue de l’hémorragie était plus élevé chez les femmes que chez les hommes : 51,5 ans ± 18,8 Vs 47,8 ans ± 18,3 (p : 0,003). Les étiologies de l’HDH étaient différentes entre les deux sexes. Alors que l’hémorragie liée à l’HTP était la première cause chez la femme (38 % Vs 23,5 % chezl’homme, p<0,0001), c’est la pathologie ulcéreuse qui venait en premier chez l’homme (62 % Vs 36,7 % chez la femme, p <0,0001). Un besointransfusionnel était noté chez 42,4 % des patients de sexe masculin contre 35,4 % des patientes avec un p = 0,03. Le taux de récidive et de décès global étaient de 7,5 % et de 5,7 % des cas respectivement, sans différence significative entre les deux sexes.Conclusion: L’étude trouve un profil épidémiologique, clinique et étiologique différent selon le sexe des patients.Key words: Hémorragie digestive haute, épidémiologie, sexe masculin, sexe féminin, endoscopie, ulcère gastroduodénal, hypertension portal

New electronic orderings observed in cobaltates under the influence of misfit periodicities

We study with ARPES the electronic structure of CoO2 slabs, stacked with rock-salt (RS) layers exhibiting a different (misfit) periodicity. Fermi Surfaces (FS) in phases with different doping and/or periodicities reveal the influence of the RS potential on the electronic structure. We show that these RS potentials are well ordered, even in incommensurate phases, where STM images reveal broad stripes with width as large as 80\AA. The anomalous evolution of the FS area at low dopings is consistent with the localization of a fraction of the electrons. We propose that this is a new form of electronic ordering, induced by the potential of the stacked layers (RS or Na in NaxCoO2) when the FS becomes smaller than the Brillouin Zone of the stacked structure

Tuning a Schottky barrier in a photoexcited topological insulator with transient Dirac cone electron-hole asymmetry

The advent of Dirac materials has made it possible to realize two dimensional gases of relativistic fermions with unprecedented transport properties in condensed matter. Their photoconductive control with ultrafast light pulses is opening new perspectives for the transmission of current and information. Here we show that the interplay of surface and bulk transient carrier dynamics in a photoexcited topological insulator can control an essential parameter for photoconductivity - the balance between excess electrons and holes in the Dirac cone. This can result in a strongly out of equilibrium gas of hot relativistic fermions, characterized by a surprisingly long lifetime of more than 50 ps, and a simultaneous transient shift of chemical potential by as much as 100 meV. The unique properties of this transient Dirac cone make it possible to tune with ultrafast light pulses a relativistic nanoscale Schottky barrier, in a way that is impossible with conventional optoelectronic materials.Comment: Nature Communications, in press (12 pages, 6 figures

Complication rare de la coloscopie chez un patient sous anticoagulant: hemopéritoine par rupture d’un hématome sous capsulaire de la rate, cas clinique

La coloscopie à visée diagnostique et/ou thérapeutique est un examen invasif fréquemment pratiquée de nos jours. La perforation colique et l'hémorragie digestive en sont les principales complications. La survenue d'un  hémopéritoine par rupture d'un hématome sous-capsulaire splénique est une complication extrêmement rare et potentiellement mortelle de la coloscopie. Un traumatisme splénique minime passé inaperçu et la prised'anticoagulant en sont des facteurs favorisants. Nous présentons le cas d'une rupture d'un hématome sous-capsulaire de la rate après une coloscopie, survenue chez un patient de 70 ans porteur d'une valve mitrale mécanique sous acénocoumarol à dose hypocaogulante. La nécessité d'obtention d'une anti coagulation rapidement efficace et l'instabilité hémodynamique avaient justifiée la réalisation d'une splénectomie. L'évolution était favorable. A travers cette observation clinique nous discutons les mécanismes et les modalités de prise en charge devant cette complication

Ultrafast surface carrier dynamics in the topological insulator Bi2Te3

We discuss the ultrafast evolution of the surface electronic structure of the topological insulator Bi$_2$Te$_3$ following a femtosecond laser excitation. Using time and angle resolved photoelectron spectroscopy, we provide a direct real-time visualisation of the transient carrier population of both the surface states and the bulk conduction band. We find that the thermalization of the surface states is initially determined by interband scattering from the bulk conduction band, lasting for about 0.5 ps; subsequently, few ps are necessary for the Dirac cone non-equilibrium electrons to recover a Fermi-Dirac distribution, while their relaxation extends over more than 10 ps. The surface sensitivity of our measurements makes it possible to estimate the range of the bulk-surface interband scattering channel, indicating that the process is effective over a distance of 5 nm or less. This establishes a correlation between the nanoscale thickness of the bulk charge reservoir and the evolution of the ultrafast carrier dynamics in the surface Dirac cone

Topological phase diagram and saddle point singularity in a tunable topological crystalline insulator

We report the evolution of the surface electronic structure and surface material properties of a topological crystalline insulator (TCI) Pb1-xSnxSe as a function of various material parameters including composition x, temperature T and crystal structure. Our spectroscopic data demonstrate the electronic groundstate condition for the saddle point singularity, the tunability of surface chemical potential, and the surface states' response to circularly polarized light. Our results show that each material parameter can tune the system between trivial and topological phase in a distinct way unlike as seen in Bi2Se3 and related compounds, leading to a rich and unique topological phase diagram. Our systematic studies of the TCI Pb1-xSnxSe are valuable materials guide to realize new topological phenomena.Comment: 10 pages, 7 figures. Expanded version of arXiv:1403.156

Ultrafast Atomic Diffusion Inducing a Reversible (2√3×2√3)R30°↔(√3×√3)R30° Transition on Sn/Si(111)∶B

Dynamical phase transitions are a challenge to identify experimentally and describe theoretically. Here, we study a new reconstruction of Sn on silicon and observe a reversible transition where the surface unit cell divides its area by a factor of 4 at 250 °C. This phase transition is explained by the 24-fold degeneracy of the ground state and a novel diffusive mechanism, where four Sn atoms arranged in a snakelike cluster wiggle at the surface exploring collectively the different quantum mechanical ground states.This work was supported by the French Agence Nationale de la Recherche (ANR) under Contract SurMott, No. NT-09-618999, and by Spanish Ministerio de Economía y Competitividad, Project No. MAT2014-59966-R

Experimental study of the incoherent spectral weight in the photoemission spectra of the misfit cobaltate [Bi2Ba2O4][CoO2]2

Previous ARPES experiments in NaxCoO2 reported both a strongly renormalized bandwidth near the Fermi level and moderately renormalized Fermi velocities, leaving it unclear whether the correlations are weak or strong and how they could be quantified. We explain why this situation occurs and solve the problem by extracting clearly the coherent and incoherent parts of the band crossing the Fermi level. We show that one can use their relative weight to estimate self-consistently the quasiparticle weight Z, which turns out to be very small Z=0.15 +/- 0.05. We suggest this method could be a reliable way to study the evolution of correlations in cobaltates and for comparison with other strongly correlated systems