Compression of the median nerve in the proximal forearm by a giant lipoma: A case report

<p>Abstract</p> <p>Background</p> <p>Compression of the median nerve by a tumour in the elbow and forearm region is rare. We present a case of neuropathy of the median nerve secondary to compression by giant lipoma in the proximal forearm.</p> <p>Case presentation</p> <p>A 46-year-old man presented with a six month history of gradually worsening numbness and paresthesia on the palmar aspect of the left thumb and thenar eminence. Clinical examination reveals a hypoaesthesia in the median nerve area of the left index and thumb compared to the contralateral side. Electromyography showed prolonged sensory latency in the distribution of the median nerve corresponding to compression in the region of the pronator teres (pronator syndrome). Radiological investigations were initially reported as normal. Conservative treatment for one month did not result in any improvement. Surgical exploration was performed and a large intermuscular lipoma enveloped the median nerve was found. A complete excision of the tumour was performed. Postoperative revaluation the X-ray of the elbow was seen to demonstrate a well-circumscribed mass in the anterior aspect of the proximal forearm. At follow-up, 14 months after surgery, the patient noted complete return of the sensation and resolution of the paresthesia.</p> <p>Conclusion</p> <p>In case of atypical findings or non frequent localization of nerve compression, clinically interpreted as an idiopathic compression, it is recommended to make a pre-operative complementary Ultrasound or MRI study.</p

« Je crois que vous voulez faire le petit Marat » : les faux Ami du Peuple du fonds Lacassagne

Mémoire du Master 2 Cultures de l\u27écrit et de l\u27image portant sur l\u27étude de faux exemplaires du journal du révolutionnaire, L’Ami du Peuple, du fonds Lacassagne de la Bibliothèque municipale de Lyon

Prevalence of clinically significant liver disease within the general population, as defined by non-invasive markers of liver fibrosis: a systematic review

At present, there is no evidence based pathway to stratify risk of chronic liver disease in a general population setting. Non-invasive tests of liver fibrosis may provide a mechanism for earlier diagnosis. These tests have been extensively validated in the hospital setting but their performance in a general population setting is unclear. We performed a systematic review of non-invasive tests used to stratify patients at risk of clinically significant liver disease in a general population setting and report the prevalence of chronic liver disease as defined by these tests. We systematically searched EMBASE, MEDLINE, Web of Science, reference lists from the original studies and recent conference proceedings. All study designs were considered. Nineteen studies were identified, utilising eleven non-invasive tests. Only transient elastography and Fibrotest were compared against histological end-points. The prevalence of liver fibrosis varied between 0.7% and 25.7%. More focussed stratification for advanced liver fibrosis (0.9%-2%) or cirrhosis (0.1%-1.7%) narrowed estimates of prevalence. Studies targeting patients with liver disease risk factors such as hazardous alcohol use or type 2 diabetes reported higher prevalence of advanced liver fibrosis (0%-27.9%) and cirrhosis (2.4%-4%). Validated non-invasive tests of liver fibrosis consistently detected otherwise unrecognised liver disease in the general population. Studies targeting risk factors found cirrhosis in 2.4 to 4 % of their target populations. Reliance on abnormal liver function tests will miss the majority of patients with significant liver injury. New pathways to stratify chronic liver, using non-invasive markers of liver fibrosis, are needed in the general population setting

Concordance in a World without a Gold Standard: A New Non-Invasive Methodology for Improving Accuracy of Fibrosis Markers

BACKGROUND: Assessing liver fibrosis is traditionally performed by biopsy, an imperfect gold standard. Non-invasive techniques, liver stiffness measurements (LSM) and biomarkers [FibroTest(R) (FT)], are widely used in countries where they are available. The aim was to identify factors associated with LSM accuracy using FT as a non-invasive endpoint and vice versa. METHODS: The proof of concept was taken using the manufacturers recommendations for excluding patients at high risk of false negative/positive. The hypothesis was that the concordance between LSM and FT, would be improved by excluding high-risk patients. Thereafter, the impact of potential variability factors was assessed by the same methods. Liver biopsy and independent endpoints were used to validate the results. RESULTS: Applying manufacturers' recommendations in 2,004 patients increased the strength of concordance between LSM and FT (P<0.00001). Among the 1,338 patients satisfying recommendations, the methodology identified a significant LSM operator effect (P = 0.001) and the following variability factors (all P<0.01), related to LSM: male gender, older age, and NAFLD as a cause of liver disease. Biopsy confirmed in 391 patients these results. CONCLUSION: This study has validated the concept of using the strength of concordance between non-invasive estimates of liver fibrosis for the identification of factors associated with variability and precautions of use

Studies on the Mechanisms of Pollen Embryogenesis (II) : Effects of Varied Saccharide Concetrations on the Plantlet Formation in Tobacco Anther Culture

1) 葯培養における花粉起源幼植物体の形成に対する糖類の効果を明らかにするために糖の種類及び濃度を変えた培地でタバコ(Nicotiana tabacum L. cv. Bright Yellow, 2n=48)の葯を培養し, 幼植物体の形成を調査した。すなわち, 幼植物体を形成した葯の全培養葯に対する割合を植物体形成率とし, 1葯から形成された植物体数の平均を葯当り形成植物体数とした。さらにこの両者をかけ合わせた値, すなわち, 培養葯1個から期待される植物体数を葯の植物体生産能力として算定した。2) 蔗糖濃度については1/256Mから1/4Mで植物体の形成がみられ, 0M及び1/2Mでは全く認められなかった。植物体形成率については1/8Mが, 葯当り形成植物体数及び葯の植物体生産能力については1/16Mがそれぞれ最適濃度であった。また, 形成された植物体は低濃度区と高濃度区とでその形態が異なる傾向がみられた。3) ブドウ糖及び果糖についても蔗糖と同様に, 1/64Mから1/4Mまで植物体の形成がみられた。いずれの糖も植物体形成率については1/8Mの濃度が, 葯の植物体生産能力については, 1/16Mの濃度がそれぞれ最適であった。1/2Mではいずれの糖の場合も植物体形成がみられなかったので, 糖類濃度の上限が1/4Mから1/2Mの間にあるものと推察される。ブドウ糖は蔗糖とほぼ同等の効果を示したが, 果糖はやや効果が低く, 有効な濃度範囲も狭かった。 / Anthers of tobacco plants (Nicotiana tabacum L. cv. Bright Yellow, 2n=48) were cultured on agar media containing different kinds of saccharides in varied concentrations to elucidate the effects of saccharides on the plantlet formation. A summary of the results obtained is given in the following. 1) The plantlet formation was found in anther cultures on media with sucrose in concentrations varying from 1/256 to 1/4M, but not in those not only on media containing no sucrose but also on media containing it in 1/2M. The most favorable sucrose concentration was 1/8M for 'anther response', which denotes the occurrence frequency of anthers from which plantlets emerged, and 1/16M for 'expected productivity', which denotes the expected number of plantlets emerging from one anther. Morphological differences were observed between relatively low (1/256M, 1/128M, 1/64M and 1/32M) and high (1/8M and 1/4M) sucrose concentrations. 2) In glucose and fructose, the plantlet formation was found in anther cultures on media with these saccharides in concentrations varying from 1/64 to 1/4M, but not on media containing them in 1/2M. The most favorable concentration was 1/8M for 'anther response' and 1/16M for 'expected productivity'. In their effects on the plantlet formation, glucose was similar to sucrose, but fructose was of lower order and had narrower range of effectiveness than the former two saccharides

Breast carcinoma detection in ex vivo fresh human breast surgical specimens using a fast slide-free confocal microscopy scanner: HIBISCUSS project

Background: New generation ultra-fast fluorescence confocal microscopy allows the ex vivo intraoperative analysis of fresh tissue. The High resolution Imaging for Breast carcInoma detection in ex vivo Specimens after breast Conserving sUrgery by hiStolog Scanner (HIBISCUSS) project aimed to develop an online learning program to recognize the main breast tissue features on ultra-fast fluorescence confocal microscopy images and to evaluate the performance of surgeons and pathologists in diagnosing cancerous and non-cancerous breast tissue in ultra-fast fluorescence confocal microscopy images. Methods: Patients who underwent conservative surgery or mastectomy for breast carcinoma (invasive or in situ lesions) were included. The fresh specimens were stained with a fluorescent dye and imaged using a large field-of-view (20 cm2) ultra-fast fluorescence confocal microscope. Results: One hundred and eighty-one patients were included. The images from 55 patients were annotated to generate learning sheets and images from 126 patients were blindly interpreted by seven surgeons and two pathologists. The time for tissue processing and ultra-fast fluorescence confocal microscopy imaging was between 8 and 10 min. The training program was composed of 110 images divided into nine learning sessions. The final database for blind performance assessment comprised 300 images. The mean duration for one training session and one performance round was 17 and 27 min respectively. The performance of pathologists was almost perfect with 99.6 per cent (standard deviation (s.d.) 5.4 per cent) accuracy. Surgeons' accuracy significantly increased (P = 0.001) from 83 per cent (s.d. 8.4 per cent) in round 1 to 98 per cent (s.d. 4.1 per cent) in round 7 as well as the sensitivity (P = 0.004). Specificity increased without significance from 84 per cent (s.d. 16.7 per cent) in round 1 to 87 per cent (s.d. 16.4 per cent) in round 7 (P = 0.060). Conclusion: Pathologists and surgeons showed a short learning curve in differentiating breast cancer from non-cancerous tissue in ultra-fast fluorescence confocal microscopy images. Performance assessment for both specialties supports ultra-fast fluorescence confocal microscopy evaluation for intraoperative management. Registration number: NCT04976556 (http://www.clinicaltrials.gov)

Direct targeting of risk factors significantly increases the detection of liver cirrhosis in primary care: a cross-sectional diagnostic study utilising transient elastography

OBJECTIVES: To assess the feasibility of a novel diagnostic algorithm targeting patients with risk factors for chronic liver disease in a community setting. DESIGN: Prospective cross-sectional study. SETTING: Two primary care practices (adult patient population 10 479) in Nottingham, UK. PARTICIPANTS: Adult patients (aged 18 years or over) fulfilling one or more selected risk factors for developing chronic liver disease: (1) hazardous alcohol use, (2) type 2 diabetes or (3) persistently elevated alanine aminotransferase (ALT) liver function enzyme with negative serology. INTERVENTIONS: A serial biomarker algorithm, using a simple blood-based marker (aspartate aminotransferase:ALT ratio for hazardous alcohol users, BARD score for other risk groups) and subsequently liver stiffness measurement using transient elastography (TE). MAIN OUTCOME MEASURES: Diagnosis of clinically significant liver disease (defined as liver stiffness ≥8 kPa); definitive diagnosis of liver cirrhosis. RESULTS: We identified 920 patients with the defined risk factors of whom 504 patients agreed to undergo investigation. A normal blood biomarker was found in 62 patients (12.3%) who required no further investigation. Subsequently, 378 patients agreed to undergo TE, of whom 98 (26.8% of valid scans) had elevated liver stiffness. Importantly, 71/98 (72.4%) patients with elevated liver stiffness had normal liver enzymes and would be missed by traditional investigation algorithms. We identified 11 new patients with definite cirrhosis, representing a 140% increase in the number of diagnosed cases in this population. CONCLUSIONS: A non-invasive liver investigation algorithm based in a community setting is feasible to implement. Targeting risk factors using a non-invasive biomarker approach identified a substantial number of patients with previously undetected cirrhosis. TRIAL REGISTRATION NUMBER: The diagnostic algorithm utilised for this study can be found on clinicaltrials.gov (NCT02037867), and is part of a continuing longitudinal cohort study

Obesity and type 2 diabetes are important risk factors underlying previously undiagnosed cirrhosis in general practice: a cross-sectional study using Transient Elastography

Background: Rising cirrhosis incidence and mortality in the United Kingdom has been attributed predominantly to excess alcohol consumption. However, metabolic risk factors such as type 2 diabetes and obesity may also be important. Aim: To screen at-risk individuals in general practice for undetected cirrhosis using transient elastography and study the risk factors underlying these cases. Methods: The study was undertaken in 4 general practices (adult patient population 20,868) between February 2012 and September 2014. Patients with defined risk factors for chronic liver disease (hazardous alcohol use and/or type 2 diabetes) were identified from the General Practice electronic records and invited for transient elastography. Elevated liver stiffness was defined as ≥8 kilopascals. Cirrhosis was confirmed by established histological, radiological and biochemical methods. Results: 2,368 patients were invited for transient elastography and 899/919 who attended (97.8%) had valid measurements. Of these 230 patients had elevated liver stiffness (25.6%) and 27 had cirrhosis (2.9%). Risk factors for new cirrhosis diagnoses were obesity and/or type 2 diabetes in 16 patients (59.3%), alcohol alone in 3 (11.1%) and both alcohol and obesity and/or diabetes in 8 (29.6%). Presence of cirrhosis was significantly increased in obese patients with type 2 diabetes or hazardous alcohol use compared to non-obese (odds ratio 9.4 (95% CI 2.2-40.9) and 5.6 (95% CI 1.6-19.7) respectively). Conclusions: The number of new cases of cirrhosis diagnosed clearly demonstrates that existing estimates of prevalence are likely to be gross underestimates. Obesity was an important risk factor for cirrhosis within both alcohol users and diabetics