Acute mesenteric venous thrombosis: Case for nonoperative management

AbstractObjective: Initial treatment in the management of acute mesenteric vein thrombosis (MVT) is controversial. Some authors have proposed a surgical approach, whereas others have advocated medical therapy (anticoagulation). In this study, we analyzed and compared the results obtained with surgical and medical treatment to determine the best initial management for this disease. Methods: We retrospectively reviewed the records of patients treated for MVT in a secondary care surgical department from January 1987 to December 1999. Before January 1995, our departmental policy was to perform surgery in patients with suspected MVT. Since January 1995, we have preferred a medical approach when achievable. Each patient in this study was assessed for diagnosis, initial management (laparotomy or anticoagulation), morbidity, mortality, duration of hospitalization, the need for secondary operation, portal hypertension, and survival rates. Results: Twenty-six patients were treated, 14 before January 1995 (group 1) and 12 since January 1995 (group 2). Morbidity, mortality, secondary operation, portal hypertension, and 2-year survival rates were 34.6%, 19.2%, 15.3%, 19.2%, and 76.9%, respectively. No statistical difference was observed between the two groups. The mean duration of hospitalization was 51.6 days in group 1 and 23.2 days in group 2 (P <.05). Among the 12 patients treated by means of laparotomy with bowel resection, 10 patients (83%) had mucosal necrosis without transmural necrosis at pathologic study. Conclusion: Nonoperative management for acute MVT is feasible when the initial diagnosis with a computed tomography scan is certain and when the bowel infarction has not led to transmural necrosis and bowel perforation. The morbidity, mortality, and survival rates are similar in cases of surgical and nonoperative management. The length of hospital stay is shorter when patients are treated with a nonoperative approach. A nonoperative approach, when indicated, avoids the resection of macroscopically infarcted small bowel (without transmural necrosis) in cases that are potentially reversible with anticoagulation alone. (J Vasc Surg 2001;34:673-9.

Планування ЗЕД на підприємствах малого та середнього бізнесу

Pheochromocytomas (PCC) and abdominal paragangliomas (PGL) display a highly diverse genetic background and recent gene expression profiling studies have shown that PCC and PGL (together PPGL) alter either kinase signaling pathways or the pseudo-hypoxia response pathway dependent of the genetic composition. Recurrent mutations in the Harvey rat sarcoma viral oncogene homolog (HRAS) have recently been verified in sporadic PPGLs. In order to further establish the HRAS mutation frequency and to characterize the associated expression profiles of HRAS mutated tumors, 156 PPGLs for exon 2 and 3 hotspot mutations in the HRAS gene was screened, and compared with microarray-based gene expression profiles for 93 of the cases. The activating HRAS mutations G13R, Q61R, and Q61K were found in 10/142 PCC (7.0%) and a Q61L mutation was revealed in 1/14 PGL (7.1%). All HRAS mutated cases included in the mRNA expression profiling grouped in Cluster 2, and 21 transcripts were identified as altered when comparing the mutated tumors with 91 HRAS wild-type PPGL. Somatic HRAS mutations were not revealed in cases with known PPGL susceptibility gene mutations and all HRAS mutated cases were benign. The HRAS mutation prevalence of all PPGL published up to date is 5.2% (49/950), and 8.8% (48/548) among cases without a known PPGL susceptibility gene mutation. The findings support a role of HRAS mutations as a somatic driver event in benign PPGL without other known susceptibility gene mutations. HRAS mutated PPGL cluster together with NF1- and RET-mutated tumors associated with activation of kinase-signaling pathways.Funding Agencies|Swedish Cancer Foundation; StratCan; Swedish Research Council; Cancer Research Foundations of Radiumhemmet; Karolinska Institutet; Stockholm County Council</p

18F-FDOPA PET/CT Uptake Parameters Correlate with Catecholamine Secretion in Human Pheochromocytomas

International audienceBackground: 18 F-FDOPA positron emission tomography/ computed tomography (PET/CT) is a sensitive nuclear imaging technology for the diagnosis of pheochromocytomas (PHEO). However, its utility in determining predictive factors for the secretion of catecholamines remains poorly studied. Methods: Thirty-nine histologically confirmed PHEO were included in this retrospective single-center study. Patients underwent 18 F-FDOPA PET/CT before surgery, with an evaluation of several uptake parameters (standardized uptake values [SUV max and SUV mean ] and the metabolic burden [MB] calculated as follows: MB = SUV mean × tumor volume) and measurement of plasma and/or urinary metanephrine (MN), normetanephrine (NM), and chromogranin A. Thirty-five patients were screened for germline mutations in the RET, SDHx, and VHL genes. Once resected, primary cultures of 5 PHEO were used for real-time measurement of catechol-amine release by carbon fiber amperometry. Results: The MB of the PHEO positively correlated with 24-h urinary excre-tion of NM (r = 0.64, p < 0.0001), MN (r = 0.49, p = 0.002), combined MN and NM (r = 0.75, p < 0.0001), and eventually plasma free levels of NM (r = 0.55, p = 0.006). In the mutated patients (3 SDHD, 2 SDHB, 3 NF1, 1 VHL, and 3 RET), a similar correlation was observed between MB and 24-h urinary combined MN and NM (r = 0.86, p = 0.0012). For the first time, we demonstrate a positive correlation between the PHEO-to-liver SUV max ratio and the mean number of secretory granule fusion events of the corresponding PHEO cells revealed by amperometric spikes (p = 0.01). Conclusion: While the 18 F-FDOPA PET/CT MB of PHEO strongly correlates with the concentration of MN, amperometric recordings suggest that 18 F-FDOPA uptake could be enhanced by overactivity of cat-echolamine exocytosis

Long-Term Quality of Life and Pregnancy Outcomes of Differentiated Thyroid Cancer Survivors Treated by Total Thyroidectomy and I 131

Introduction. Differentiated thyroid cancer (DTC) is rare and confers good prognosis. Long-term health related quality of life (HRQoL) and pregnancy outcomes are not well known in subjects treated during adolescence and young adulthood. Methods. Cross-sectional analysis of HRQoL and global self-esteem, using SF-36 and ISP-25 surveys, and of pregnancy outcomes in female survivors of DTC treated by total thyroidectomy and I131 before age of 25 years. Results. Forty-five of 61 patients (74%) responded to the survey. Cumulative I131 activity was ≤3.85 GBq in 18 subjects and >3.85 GBq in 27 subjects. Mean time from diagnosis was 7.6 ± 5.2 years for the group ≤ 3.85 GBq versus 16.9 ± 11.6 years for the group > 3.85 GBq (P<0.05). No significant alteration in long-term HRQoL and global self-esteem was observed. Thirty pregnancies after I131 were noted in patients from the group > 3.85 GBq and 10 in patients from the group ≤ 3.85 GBq. Frequency of miscarriages was of 17% (group > 3.85 GBq) and 10% (group ≤ 3.85 GBq) with 9 and 24 live births, respectively. No congenital malformations or first year mortality was noted. Conclusion. Long-term HRQoL, global self-esteem, and pregnancy outcomes are not affected in young female survivors of DTC

Characteristics of contralateral carcinomas in patients with differentiated thyroid cancer larger than 1 cm

Purpose: Traditionally, total thyroidectomy has been advocated for patients with tumors larger than 1 cm. However, according to the ATA and NCCN guidelines (2015, USA), patients with tumors up to 4 cm are now eligible for lobectomy. A rationale for adhering to total thyroidectomy might be the presence of contralateral carcinomas. The purpose of this study was to describe the characteristics of contralateral carcinomas in patients with differentiated thyroid cancer (DTC) larger than 1 cm. Methods: A retrospective study was performed including patients from 17 centers in 5 countries. Adults diagnosed with DTC stage T1b-T3 N0-1a M0 who all underwent a total thyroidectomy were included. The primary endpoint was the presence of a contralateral carcinoma. Results: A total of 1

Prognosis after surgery for multiple endocrine neoplasia type 1-related pancreatic neuroendocrine tumors: Functionality matters

Background: Metastasized pancreatic neuroendocrine tumors are the leading cause of death in patients with multiple endocrine neoplasia type 1. Aside from tumor size, prognostic factors of pancreatic neuroendocrine tumors are largely unknown. The present study aimed to assess whether the prognosis of patients with resected multiple endocrine neoplasia type 1-related nonfunctioning pancreatic neuroendocrine tumors differs from those with resected multiple endocrine neoplasia type 1-related insulinomas and assessed factors associated with prognosis. Methods: Patients who underwent resection of a multiple endocrine neoplasia type 1-related pancreatic neuroendocrine tumors between 1990 and 2016 were identified in 2 databases: the DutchMEN Study Group and the International MEN1 Insulinoma Study Group databases. Cox regression was performed to compare liver metastases-free survival of patients with a nonfunctioning pancreatic neuroendocrine tumors versus those with an insulinoma and to identify factors associated with liver metastases-free survival. Results: Out of 153 patients with multiple endocrine neoplasia type 1, 61 underwent resection for a nonfunctioning pancreatic neuroendocrine tumor and 92 for an insulinoma. Of the patients with resected lymph nodes, 56% (18/32) of nonfunctioning pancreatic neuroendocrine tumors had lymph node metastases compared to 10% (4/41) of insulinomas (P = .001). Estimated 10-year liver metastases-free survival was 63% (95% confidence interval 42%–76%) for nonfunctioning pancreatic neuroendocrine tumors and 87% (72%–91%) for insulinomas. After adjustment for size, World Health Organization tumor grade, and age, nonfunctioning pancreatic neuroendocrine tumors had an increased risk for liver metastases or death (hazard ratio 3.04 [1.47–6.30]). In pancreatic neuroendocrine tumors ≥2 cm, nonfunctioning pancreatic neuroendocrine tumors (2.99 [1.22–7.33]) and World Health Organization grade 2 (2.95 [1.02–8.50]) were associated with liver metastases-free survival. Conclusion: Patients with resected multiple endocrine neoplasia type 1-related nonfunctioning pancreatic neuroendocrine tumors had a significantly lower liver metastases-free survival than patients with insulinomas. Postoperative counseling and follow-up regimens should be tumor type specific and at least consider size and World Health Organization grade

Characteristics of contralateral carcinomas in patients with differentiated thyroid cancer larger than 1 cm

textabstractPurpose: Traditionally, total thyroidectomy has been advocated for patients with tumors larger than 1 cm. However, according to the ATA and NCCN guidelines (2015, USA), patients with tumors up to 4 cm are now eligible for lobectomy. A rationale for adhering to total thyroidectomy might be the presence of contralateral carcinomas. The purpose of this study was to describe the characteristics of contralateral carcinomas in patients with differentiated thyroid cancer (DTC) larger than 1 cm. Methods: A retrospective study was performed including patients from 17 centers in 5 countries. Adults diagnosed with DTC stage T1b-T3 N0-1a M0 who all underwent a total thyroidectomy were included. The primary endpoint was the presence of a contralateral carcinoma. Results: A total of 1313 patients were included, of whom 426 (32 %) had a contralateral carcinoma. The contralateral carcinomas consisted of 288 (67 %) papillary thyroid carcinomas (PTC), 124 (30 %) follicular variant of a papillary thyroid carcinoma (FvPTC), 5 (1 %) follicular thyroid carcinomas (FTC), and 3 (1 %) Hürthle cell carcinomas (HTC). Ipsilateral multifocality was strongly associated with the presence of contralateral carcinomas (OR 2.62). Of all contralateral carcinomas, 82 % were ≤10 mm and of those 99 % were PTC or FvPTC. Even if the primary tumor was a FTC or HTC, the contralateral carcinoma was (Fv)PTC in 92 % of cases. Conclusions: This international multicenter study performed on patients with DTC larger than 1 cm shows that contralateral carcinomas occur in one third of patients and, independently of primary tumor subtype, predominantly consist of microPTC

Déterminants nutritionnels et génétiques de l'homocystéine et méthylation de l'ADN : modèles expérimentaux et implications en pathologie

DNA methylation is an essential mechanism for epigenetic control of genes expression and for maintenance of genome integrity. Determinant of methionine synthase and DNA hypomethylation are not clear. Low blood folate, is the main determinant of hyperhomocysteinemia, while low vitamin B12 affects methionone synthase activity and DNA hypomethylation. Vitamin B12 affects methionine synthase expression by a non -transcriptional mechanism different from a prospective effect on MTR proteolysis. Nutritional determinants of DNA hypomethylation also have a variable effect on liver carcinogenesis. Choline/methionine and/or folate deficient diets are responsible for an incidence of 20% to 50% of hepatocarcinoma decrease and is estimated to < 5%. The use of histone decetylase inhibitors (Trichostatin A) induces an increase of mRNA of genes that are involved in iodine captation by thyroïd cancer cells. This could be used in clinical trials. Genetic deteminants of hyperhomocysteinemia and hypomethylation are involved in Alzheimer's disease severity and in the pathophysiologie of Down syndrome and neural tube defects.La méthylation de l'ADN est considéreée comme étant un mécanisme fondamental du contrôle épigénétique de l'expression des gènes et de la maintenance de l'intégrité du génome. Les déterminants de la méthionine synthase et de l'hypométhylation de l'ADN sont peu connus. La présence de taux faibles de folates plasmatiques est un déterminant de l'hyperhomocystéinémiealors que la présence de taux faible en vitamine B12 est un facteur déterminant de l'activité méthionine synthase et de l'hypométhylation globale chez le rat F344. La vitamine B12 affecte l'expression de méthionine synthase par un mécanisme non-transcriptionnel différent d'un effet protecteur sur la prothéolyse de méthionine synthase. Les déterminants nutritionnels de l'hypométhylation de l'ADN ont aussi un effet variable sur la carcinogénèse hépatique. Les carences alimentaires en choline méthionine et/ou folates sont responsables de l'incidence de 20% à 50% d'hépatocarcinomes après 12 à 24 mois de survie chez le rat. L'ajout à ce régime d'une carence en vitamine B12 diminue l'incidence des hépatocarcinomes à < 5%. L'acétylation des histones induit une activation transcriptionnelle. L'utilisation d'un inhibiteur des histones déacetylases (Trichostatine A) permet d'induire l'augmentation de l'ARNm de gènes intervenant dans la captation d'iode par les cellules de cancers thyroïdiens. Cette modification de l'expression de gènes pourrait être utilisée en pratique clinique. Les déterminants génétiques (polymorphismes) de l'hyperhomocystéinémie et de l'hypo méthylation sont impliqués dans l'incidence et la sévérité de la maladie d'Alzheimer, dans la physiopathologie de la trisomie 21 et des malformations du tube neural

L'étang de Landes: de sa création au classement en réserve naturelle

Préface de M. le Président du Conseil Général de la Creuse J.-P. LozachInternational audienceSi maintes monographies de lac existent, il n'en est pas de même pour des ouvrages traitant d'un seul étang de manière approfondie et selon des thèmes variés. Pour tenter de participer au comblement de cette lacune, nous avons choisi d'étudier l'étang de Landes et d'en valoriser les premiers résultats dans cette publication. Ce site a notamment retenu toute notre attention de par son rang de plus grand étang limousin et de par son grand intérêt en terme de richesse et de diversité naturelles. Mais, cet ouvrage se pique d'aborder une grande variété de thèmes du moment qu'ils touchent au fonctionnement de l'étang et de son environnement proche. Cependant, en tant que géographes, les deux auteurs n'ont pas la prétention de se substituer à des spécialistes en archéologie, en biologie ou encore en chimie... Nos compétences s'emploient plutôt à localiser, spatialiser, cartographier, synthétiser les phénomènes. Près de trois ans furent nécessaires à l'écriture de ce livre, pendant lesquels nous continuâmes de procéder à de nouvelles mesures inédites sur le terrain, d'analyser les données et de traiter les informations