Multi organ assessment of compensated cirrhosis patients using quantitative magnetic resonance imaging

Background and Aims: Advancing liver disease results in deleterious changes in a number of critical organs. The ability to measure structure, blood flow and tissue perfusion within multiple organs in a single scan has implications for determining the balance of benefit versus harm for therapies. Our aim was to establish the feasibility of Magnetic Resonance Imaging to assess changes in compensated cirrhosis (CC), and relate this to disease severity and future liver related outcomes (LROs). Methods: 60 CC patients, 40 healthy volunteers and 7 decompensated cirrhotics were recruited. In a single scan session, MRI measures comprised phase-contrast MRI vessel blood flow, arterial spin labelling tissue perfusion, T1 longitudinal relaxation time and volume assessment of liver, spleen and kidneys, heart rate and cardiac index. We explore MRI parameters with disease severity and differences in baseline MRI parameters in those 11 (18%) of CC patients who had future LROs. Results: In the liver compositional changes were reflected by increased T1 in progressive disease (p<0.001) and an increase in liver volume in CC (p=0.006), with associated progressive reduction in liver (p < 0.001) and splenic (p<0.001) perfusion. A significant reduction in renal cortex T1 and increase in cardiac index and superior mesenteric arterial (SMA) blood flow was seen with increasing disease severity. Baseline liver T1 (p=0.01) and perfusion (p< 0.01), and renal cortex T1 (p<0.01) were significantly different in CC patients who subsequently developed negative LROs. Conclusions: MRI allows the contemporaneous assessment of organs in liver cirrhosis in a single scan without the requirement of contrast agent. MRI parameters of liver T1, renal T1, hepatic and splenic perfusion, and SMA blood flow were related to risk of LROs

The deployment of the telemedicine to answer the stakes in meet the challenges of the 21th century: Examples of experiments in Picardy

International audienceCurrently, we are seeing a considerable organizational change of the health system and the practices of professionals that causes a number of concerns about access to care. In the face of these uncertainties and questions, telemedicine - a medical practice using information and communication technologies - appears to be an essential way to guarantee access to care for all by responding, in part, to the territorial inequalities as evidenced by a number of local examples in Picardie. However, in order to permit an efficient deployment of telemedicine on a large scale, all the obstacles must be removed: responsibility, financing of the telemedicine activity, e-inclusion and accessibility... so as to avoid exacerbating the territorial inequalities of health. (C) 2019 Published by Elsevier Masson SAS on behalf of Academie Nationale De Medecine

Gastrointestinal: Ano-popliteal fistula in Crohn's disease

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Non-granular laterally spreading tumors: potential superficial cancers that artificial intelligence does not easily detect

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What are the predictive factors of caecal perforation in patients with obstructing distal colon cancer?

International audienceAimIn the presence of large bowel obstruction, the choice of treatment is determined by the patient's general status, the tumour characteristics and the perceived risk of caecal perforation. This study was designed to evaluate the predictive factors of impending caecal perforation, and also investigated the use of caecal volumetry. MethodFrom January 2011 to June 2016, patients with obstructive distal colon cancer undergoing emergency laparotomy, for whom a pretreatment CT scan was available, were included in this retrospective, case-control, two-centre study. Two patient groups were defined: patients with and without impending caecal perforation. The primary end-point of the study was a determination of predictive factors for caecal perforation. ResultsA total of 72 patients (45 men, 62.5%) were included. Univariate analysis revealed that the presence of pericaecal fluid (P9cm (P=0.002) and a caecal diameter at the ileocaecal junction >7.5cm (P=0.001) were associated with impending caecal perforation. In multivariate analysis, only caecal volume >400cm(3) (P=0.001) was correlated with the risk of impending caecal perforation. ConclusionCaecal volumetry is an easy and useful tool to predict impending caecal perforation in patients with large bowel obstruction