Pancreas serous cystadenoma: typical imaging aspect of a rare tumor

Abdominal ultrasonography performed in a 54-year-old woman suffering from dyspepsia revealed a large pancreatic mass (Fig. A). CT showed an 8 cm rounded shape pancreatic head mass, slightly lobulated, hypodense but of non pure hydric density at its edge (15- 20 UH) with a stellar-shaped calcified center (Fig. B). After iodine injection, multiple thin septa were visible forming multiple small lodges non-exceeding 2 cm diameter. Pancreatic head or body were not atrophic and main pancreatic duct size was < 3 mm

I-CARE, a European Prospective Cohort Study Assessing Safety and Effectiveness of Biologics in Inflammatory Bowel Disease

Background and aims: There is a need to evaluate the benefit-risk ratio of current therapies in inflammatory bowel disease (IBD) patients to provide the best quality of care. The primary objective of I-CARE (IBD Cancer and serious infections in Europe) was to assess prospectively safety concerns in IBD, with specific focus on the risk of cancer/lymphoma and serious infections in patients treated with anti-tumor necrosis factor and other biologic monotherapy as well as in combination with immunomodulators.. Methods: I-CARE was designed as a European prospective longitudinal observational multicenter cohort study to include patients with a diagnosis of Crohn's disease, ulcerative colitis, or IBD unclassified established at least 3 months prior to enrollment. Results: A total of 10,206 patients were enrolled between March 2016 and April 2019, including 6169 (60.4%) patients with Crohn's disease, 3853 (37.8%) with ulcerative colitis, and 184 (1.8%) with a diagnosis of IBD unclassified. Thirty-two percent of patients were receiving azathioprine/thiopurines, 4.6% 6-mercaptopurine, and 3.2% methotrexate at study entry. At inclusion, 47.3% of patients were treated with an anti-tumor necrosis factor agent, 8.8% with vedolizumab, and 3.4% with ustekinumab. Roughly one-quarter of patients (26.8%) underwent prior IBD-related surgery. Sixty-six percent of patients had been previously treated with systemic steroids. Three percent of patients had a medical history of cancer prior to inclusion and 1.1% had a history of colonic, esophageal, or uterine cervix high-grade dysplasia.. Conclusions: I-CARE is an ongoing investigator-initiated observational European prospective cohort study that will provide unique information on the long-term benefits and risks of biological therapies in IBD patients

Editorial: mongersen in Crohn's disease - a new contribution to the beginning of a long-awaited therapeutic revolution?

International audienc

Risk of severe COVID-19 in patients treated with IBD medications: a French nationwide study

International audienceBackground: Recently, the SECURE-IBD study, based on a physician-reported registry, suggested that thiopurines, either alone or combined with anti-TNF, may increase risk of severe COVID-19. Aims: To compare the risk of severe COVID-19 according to IBD medications in a large and unselected population. Methods: Using the French national health data system, the risks of hospitalisation and of death or mechanical ventilation for COVID-19 from 15 February 2020 to 31 August 2020 in IBD patients were compared according to IBD treatment (immunomodulators and biologics), using multivariable Cox models adjusted for socio-demographic characteristics, budesonide/corticosteroids and aminosalicylates use, and comorbidities. Results: Among 268 185 IBD patients, 600 were hospitalised for COVID-19 and 111 of them died or were mechanically ventilated (including 78 deaths). In multivariable analysis, the risk of hospitalisation for COVID-19 did not differ according to IBD treatment category, with adjusted Hazard Ratios (aHR, unexposed patients used as reference) of 0.94 (95%CI: 0.66-1.35) for immunomodulator monotherapy, 1.05 (0.80-1.38) for anti-TNF monotherapy, 0.80 (0.38-1.69) for anti-TNF combination therapy, 1.06 (0.55-2.05) for vedolizumab and 1.25 (0.64-2.43) for ustekinumab. Similarly, the risk of death or mechanical ventilation for COVID-19 did not differ according to IBD treatment. Conclusions: Immunomodulators and biologics prescribed in patients with IBD do not appear to increase the severity of COVID-19 infection

Diffuse vertebral marrow changes at MRI: Multiple myeloma or normal?

Five MRI patterns of marrow involvement (diffuse, focal, combined diffuse and focal, variegated, and normal) are observed in patients with a marrow proliferative disorder including MM. The wide range of marrow involvement patterns in monoclonal plasma cell proliferative disorders mirrors that of their natural histories that can vary from indolent to rapidly lethal. MRI of the axial bone marrow contributes to stage these disorders, but it should not be obtained for disease detection and characterization because of its limited specificity and sensitivity. At MRI, diffuse benign hematopoietic marrow hyperplasia and marrow heterogeneities in elderly patients mimic the diffuse and variegated patterns observed in MM patients. Careful analysis of fat- and fluid-sensitive MR images and quantitative marrow assessment by using MRI and FDG-PET can contribute in differentiating these changes from those associated with neoplastic marrow infiltration, with some residual overlapping findings

Occurrence of inflammatory bowel disease in patients with chronic inflammatory skin diseases: a cohort study

BACKGROUND: Several studies linked various chronic inflammatory skin diseases (CISDs) with inflammatory bowel disease (IBD) in a range of data sources with mixed conclusions. OBJECTIVE: We compared the incidence of IBD-ulcerative colitis (UC) and Crohn\u27s disease (CD)- in patients with a CISD versus similar persons without a CISD. METHODS: In this cohort study using nationwide, longitudinal, commercial insurance claims data from the US, we identified adults and children who were seen by a dermatologist between 2004-2020, and diagnosed with either psoriasis, atopic dermatitis, alopecia areata, vitiligo, or hidradenitis suppurativa. Comparator patients were identified through risk-set sampling; they were eligible if they were seen by a dermatologist at least twice and not diagnosed with a CISD. Patient follow-up lasted until either IBD diagnosis, death, disenrollment, or end of data stream, whichever came first. IBD events, ulcerative colitis (UC) or Crohn\u27s (CD), were identified via validated algorithms-hospitalization or diagnosis with endoscopic confirmation. Incidence rates were computed before and after adjustment via propensity-score (PS) decile stratification to account for IBD risk factors. Hazard ratios (HR) and 95% confidence intervals were estimated to compare the incidence of IBD in CISD versus non-CISD. RESULTS: We identified patients with atopic dermatitis (n=123,614), psoriasis (n=83,049), alopecia areata (n=18,135), vitiligo (n=9,003) or hidradenitis suppurativa (n=6,806), and comparator patients without a CISD (n=2,376,120). During a median follow-up time of 718 days, and after applying PS adjustment for IBD risk factors, we observed increased risk of both UC (HR =2.30; 1.61-3.28) and CD (HR =2.70; 1.69-4.32) in patients with hidradenitis suppurativa, an increased risk of CD (HR =1.23; 1.03-1.46) but not UC (HR =1.01; 0.89-1.14) in psoriasis, and no increased risk of IBD in atopic dermatitis (HR =1.02; 0.92-1.12, HR =1.08; 0.94-1.23), alopecia areata (HR =1.18; 0.89-1.56, HR =1.26; 0.86-1.86) or vitiligo (HR =1.14; 0.77-1.68, HR =1.45; 0.87-2.41). CONCLUSIONS: IBD was increased in patients with hidradenitis suppurativa. Crohn\u27s disease alone was increased in patients with psoriasis. Neither ulcerative colitis nor Crohn\u27s disease was increased in patients with atopic dermatitis, alopecia areata or vitiligo

Apport des bases médico-administratives en épidémiologie et santé publique des maladies infectieuses

International audienceBackgroundThe public health burden resulting from infectious diseases requires efforts in surveillance and evaluation of health care. The use of administrative health databases (AHD) and in particular the French national health insurance database (SNIIRAM) is an opportunity to improve knowledge in this field. The SNIIRAM data network (REDSIAM) workshop dedicated to infectious diseases conducted a narrative literature review of studies using French AHD. From the results, benefits and limits of these new tools in the field of infectious diseases are presented.MethodsPublications identified by the members of the workgroup were collected using an analytical framework that documented the pathology of interest, the aim of the study, the goal of the developed algorithm, the kind of data, the study period, and the presence of an evaluation or a discussion of the performance of the performed algorithm.ResultsFifty-five articles were identified. A majority focused on the field of vaccination coverage and joint infections. Excluding vaccine coverage field, the aim of 28 studies was epidemiological surveillance. Twenty-six studies used hospital databases exclusively, 18 used ambulatory databases exclusively and 4 used both. Validation or discussion of the performed algorithm was present in 18 studies.ConclusionsThe literature review confirmed the interest of the French AHD in the infectious diseases field. The AHD are additional tools of the existing surveillance systems and their use will probably be more frequent in the coming years given their advantage and reliability. However, incoming users need to be assisted. Thus, the workgroup will contribute to a reasonable use of AHD and support future developments.Position du problèmeCompte tenu des enjeux liés à leur poids en santé publique, les maladies infectieuses nécessitent des efforts de surveillance et d’évaluation de leur prise en charge. L’utilisation des bases de données médico-administratives (BDMA) et notamment du Système national d’information inter-régimes de l’Assurance maladie (Sniiram) constitue une opportunité d’améliorer les connaissances dans ce domaine. Le groupe de travail du Réseau données Sniiram (REDSIAM) dédié aux maladies infectieuses (GT infectieux) a réalisé une revue narrative de la littérature des travaux se basant sur des BDMA française, et montre l’intérêt et les limites de ces nouveaux outils dans le champ des maladies infectieuses.MéthodesLes publications renseignées par les membres du GT infectieux ont été colligées en utilisant une grille d’analyse documentant la pathologie étudiée, l’objectif de l’étude, l’utilisation d’un algorithme, le type de données utilisées, la période d’étude et la présence d’une évaluation ou discussion de la performance des algorithmes.RésultatsAu total, 55 publications ont été identifiées. La couverture vaccinale et les infections ostéoarticulaires étaient les sujets les plus étudiés. Hors champ vaccinal, 28 études avaient pour objectif la surveillance épidémiologique d’une pathologie infectieuse ; 26 études ont utilisé exclusivement les bases de données hospitalières, 18 uniquement les bases de données de soins ambulatoires et 4 les deux types de bases de données. Pour 18 études, les performances de l’algorithme ont été validées ou discutées.ConclusionLa synthèse menée par le GT infectieux a permis de confirmer l’intérêt des BDMA françaises dans l’étude des maladies infectieuses. Les BDMA constituent un outil complémentaire des systèmes existants dans le domaine des maladies infectieuses et leur utilisation devrait être croissante dans les prochaines années compte tenu de leur avantage et de leur fiabilité. Un travail sera néanmoins nécessaire pour accompagner les utilisateurs. Le GT infectieux aura alors toute sa place pour contribuer à une utilisation raisonnée des BDMA et accompagner les évolutions à venir