Diagnostic Value of Blood D-dimer Level in Acute Mesenteric Ischaemia in the Rat: An Experimental Study

ObjectiveThe high mortality rate of mesenteric ischaemia is mainly due to delay in diagnosis. For this reason, it is of great importance to find a specific and rapidly elevating marker. The present study investigated the diagnostic value of blood D-dimer level as a potential marker for acute mesenteric ischaemia in a rat model.MethodsThirty male Wistar albino rats were divided into three groups. Basal D-dimer and L-lactate levels were determined in the non-operative control group (I). In the operated control group (II), the superior mesenteric artery was simply manipulated, while the artery was ligated in Group III. Blood samples were drawn in all groups for D-dimer and L-lactate assays.ResultsBoth Group II (p = 0.016) and Group III (p = 0.001) had significantly higher mean D-dimer levels in the first postoperative hour compared with the basal level in Group I. However, there was no difference between the levels in Groups II and III. The mean level in Group II in the sixth hour had dropped to a statistically insignificant level compared with the basal value, while the mean value in Group III kept rising during this period (p = 0.001). Nevertheless, there was no significant difference between Groups II and III. On the other hand, the mean L-lactate level in the first postoperative hour in Group III was significantly higher than the basal level in Group I (p = 0.003). No significant rises were recorded in Group II in the first and sixth postoperative hours. The difference between Groups II and III in the first hour was significant (p = 0.005). Group III also had significantly higher mean serum L-lactate value in the sixth hour compared with both the basal value in Group I (p = 0.001) and the sixth-hour value in Group II (p = 0.003).ConclusionThese results do not adequately support the use of blood D-dimer level as an independent parameter in the diagnosis of mesenteric ischaemia due to arterial thrombosis. However, this parameter can be used together with other tests in eliminating the possibility of a thromboembolic event

Ultrasound Findings in a Case of Myeloid Sarcoma of the Breast

Myeloid sarcoma is a rare, solid extramedullary tumor originating from immature granulocytic cells or monocytes. Breast involvement without an aleukemic or myeloproliferative disorder is very infrequent. A 21-year-old female patient was admitted with bilateral palpable breast masses for four months. The patient had given birth approximately one year ago. The ultrasonographic examination revealed multiple, oval shaped—some of them with microlubulated margins—hypoechoic, solid masses of which, the largest mass measured 4.5 . 2.5 cm, evaluated as BI-RADS 4. The histopthological examination suggested hematolymphoid neoplasm. In the differential diagnosis of solid breast lesions, myeloid sarcoma should be kept in mind even without hematological findings. Early diagnosis of this tumor is important for the effectiveness of the medical treatment

A case of pityriasis rosea of vidal accompanied by neurofibromatosis type 1:

International audienceLes fondements chrétiens de l'obéissance au pouvoir politique étaient au XVIe siècle à la fois une évidence et un sujet de débat. Dès ses origines, le christianisme avait élaboré des théologies politiques diverses, voire contradictoires, mais le temps des Réformes, reprenant ces thèmes déjà anciens, devait les confronter aux nouveautés que représentaient la déchirure religieuse et le développement d'une monarchie aux exigences croissantes. L'historiographie récente s'est déjà beaucoup intéressée à cette question, mais en privilégiant les moments d'affrontement, où les acteurs définissent les limites de l'obéissance ou du droit à la révolte 1. Dans le royaume de France, ces affrontements atteignent bien sûr leur point culminant pendant les guerres de religion, avec d'étonnants transferts des positions et des arguments entre catholiques et protestants en fonction de la situation politique. Les débats sont nourris par la relative polysémie scripturaire sur le sujet, de l'injonction d'obéir aux puissances temporelles à la possibilité d'une résistance légitime aux pouvoirs contraires à Dieu, en passant par la séparation radicale entre ce que l'on doit rendre à César et à Dieu. Dans un contexte politique incertain, ces prises de position s'insèrent dans des réflexions bien plus larges, qui s'efforcent, chacune à leur manière, de construire un avenir viable pour un royaume en perdition. L'intensité des débats dans la période qui suit la mort de Henri II contraste avec le silence de la période qui précède. Ce silence est certes relatif et certains ont pu s'interroger, surtout à partir des années 1550, sur la nature exacte de l'obéissance due aux pouvoirs constitués, sur son éventuelle absurdité, en tout cas sur ses limites 2. Ces réflexions, parfois capables d'une radicalité étonnante, ne débouchent pas sur un véritable débat public, en tout cas pas sur une contestation organisée et durable de l'obéissance due au roi. De son côté, le pouvoir peut bien promouvoir une image qui exalte l'obéissance, mais ne passe pas obligatoirement de ces représentations, dont le décodage peut s'avérer particulièrement subtil, à une véritable théorisation officielle qui légitimerait le renforcement de l'autorité royale dans la première moitié du XVIe siècle. En ce qui concerne plus précisément les rapports entre obéissance au roi et à Dieu, les règnes de François Ier et de Henri II voient bien sûr les « mal-sentant de la 1 Voir notamment Marie-Madeleine Fragonard et Michel Péronnet (dir.), « Tout pouvoir vient de Dieu… » (St Paul. Rm. XIII, 1). Actes du VIIe colloque Jean Boisset, Montpellier, Sauramps éditions, 1993, et sur la question du tyrannicide Mario Turchetti, Tyrannie et tyrannicide de l'Antiquité à nos jours, Paris, PUF, 2001. 2 C'est évidemment à La Boétie et à son Contr'un, rédigé peut-être vers 1553, que l'on pense. Sur sa signification replacée dans le contexte du règne de Henri II, voir l'analyse d'Arlette Jouanna dans Arlette Jouanna, Philipp

An atypical esthesioneuroblastoma of the inferior nasal cavity and maxillary sinus: Report of a case

Esthesioneuroblastoma is a rare malignant tumor of the nasal cavity that originates from the olfactory epithelium. In this paper a very rare clinical presentation of this tumor is described. The tumor originated from the maxillary sinus and alveolar process, and was independent of the olfactory region. The patient was a 14-year-old girl presenting with facial swelling and nasal obstruction. Paranasal computed tomography showed a mass filling the right nasal cavity, infiltrating the alveolar process, eroding the anterior wall of the maxilla and invading the subcutaneous tissues of the cheek. Fine-needle aspiration and incisional biopsies identified an esthesioneuroblastoma. After neoadjuvant chemotherapy, we performed a right subtotal and left inferior maxillectomy and reconstructed the maxillary defect with a permanent obturator. At 2 years' follow-up the patient is free of recurrence

Arthritis and osteomyelitis due to Aspergillus fumigatus: a 17 years old boy with chronic granulomatous disease.

BACKGROUND: Invasive Aspergillus infections are frequently seen in immunocompromised patients but arthritis is a rare complication of Aspergillus infections in the absence of immune suppressive therapy, trauma or surgical intervention. CASE PRESENTATION: A 17 years old male patient with arthritis and patellar osteomyelitis of the left knee whose further investigations revealed chronic granulomatous disease as the underlying disease is followed. Aspergillus fumigatus was isolated from the synovial fluid and the tissue samples cultures. He was treated with Amphotericin B deoxicolate 0.7 mg/kg/day. Also surgical debridement was performed our patient. Amphotericin B nephrotoxicity developed and the therapy switched to itraconazole 400 mg/day. Itraconazole therapy were discontinued at the 6th month. He can perform all the activities of daily living including. CONCLUSION: We think that, chronic granulomatous disease should be investigated in patients who have aspergillar arthritis and osteomyelitis

Inter-observer Agreement in Laryngeal Pre-neoplastic Lesions

In this series, laryngeal preneoplastic lesions were evaluated by the classifications of the World Health Organization (WHOC), Ljubljana (LC) and squamous intraepithelial neoplasia (SINC) by multiple observers. The inter-observer agreement (IA) by WHOC for laryngeal lesions had been previously evaluated, but to the best of our knowledge, there are no data for LC and SINC. H&E stained slides from 42 laryngeal biopsies were evaluated by fourteen participants according to WHOC and LC, and SINC was additionally applied by 6. The results were analyzed statistically. The diagnoses which were favored by most participants for each case, according to WHOC, were as follows: squamous cell hyperplasia (n = 5; 12%), mild dysplasia (n = 11; 26.2%), moderate dysplasia (n = 12; 28.6%), severe dysplasia (n = 7; 16.7%), carcinoma in situ (n = 5; 12%), and invasive squamous cell carcinoma (n = 2; 4.8%). There was a significant difference between the participants for all three classifications; some participants gave lower or higher scores than the others. The mean correlation coefficients (MCC) of the participants were higher for WHOC compared to LC (0.55 ± 0.15 and 0.48 ± 0.14, respectively). The mean linear-weighted kappa (wKappa) values of participants were not significantly different (0.42 ± 0.10, 0.41 ± 0.12 and 0.37 ± 0.07 for WHOC, LC and SINC, respectively). The kappa values in this series are in agreement with those in previous literature for WHOC, and the similar results obtained for LC and SINC are novel findings. Although the MCC of WHOC was higher, as the wkappa was not significantly different, the findings in this series are not in favor of any of the classifications for better IA for pre-neoplastic laryngeal lesions. © 2010 Humana