Sigmoid stricture associated with diverticular disease should be an indication for elective surgery with lymph node clearance

BACKGROUND: The literature concerning stricture secondary to diverticulitis is poor. Stricture in this setting should be an indication for surgery because (a) of the potential risk of cancer and (b) morbidity is not increased compared to other indications for colectomy. The goal of this report is to study the post-surgical morbidity and the quality of life in patients after sigmoidectomy for sigmoid stricture associated with diverticular disease. METHOD: This is a monocenter retrospective observational study including patients with a preoperative diagnosis of sigmoid stricture associated with diverticular disease undergoing operation between Jan 1, 2007 and Dec 31, 2013. The GastroIntestinal Quality of Life Index was used to assess patient satisfaction. RESULTS: Sixteen patients were included of which nine were female. Median age was 69.5 (46-84) and the median body mass index was 23.55kg/m(2) (17.2-28.4). Elective sigmoidectomy was performed in all 16 patients. Overall, complications occurred in five patients (31.2%) (4 minor complications and 1 major complication according to the Dindo and Clavien Classification); none resulted in death. Pathology identified two adenocarcinomas (12.5%). The mean GastroIntestinal Quality of Life Index was 122 (67-144) and 10/11 patients were satisfied with their surgical intervention. CONCLUSION: Sigmoid stricture prevents endoscopic exploration of the entire colon and thus it may prove difficult to rule out a malignancy. Surgery does not impair the quality of life since morbidity is similar to other indications for sigmoidectomy. For these reasons, we recommend that stricture associated with diverticular disease should be an indication for sigmoidectomy including lymph node clearance

Early lung ultrasonography predicts the occurrence of acute respiratory distress syndrome in blunt trauma patients

PURPOSE: Extent of lung contusion on initial computed tomography (CT) scan predicts the occurrence of acute respiratory distress syndrome (ARDS) in blunt chest trauma patients. We hypothesized that lung ultrasonography (LUS) on admission could also predict subsequent ARDS. METHODS: Forty-five blunt trauma patients were prospectively studied. Clinical examination, chest radiography, and LUS were performed on arrival at the emergency room. Lung contusion extent was quantified using a LUS score and compared to CT scan measurements. The ability of the LUS score to predict ARDS was tested using the area under the receiver operating characteristic curve (AUC-ROC). The diagnostic accuracy of LUS was compared to that of combined clinical examination and chest radiography for pneumothorax, lung contusion, and hemothorax, with thoracic CT scan as reference. RESULTS: Lung contusion extent assessed by LUS on admission was predictive of the occurrence of ARDS within 72 h (AUC-ROC = 0.78 [95 % CI 0.64-0.92]). The extent of lung contusion on LUS correlated well with CT scan measurements (Spearman\u27s coefficient = 0.82). A LUS score of 6 out of 16 was the best threshold to predict ARDS, with a 58 % [95 % CI 36-77] sensitivity and a 96 % [95 % CI 76-100] specificity. The diagnostic accuracy of LUS was higher than that of combined clinical examination and chest radiography: (AUC-ROC) 0.81 [95 % CI 0.50-1.00] vs. 0.74 [0.48-1.00] (p = 0.24) for pneumothorax, 0.88 [0.76-1.00] vs. 0.69 [0.47-0.92] (p < 0.05) for lung contusion, and 0.84 [0.59-1.00] vs. 0.73 [0.51-0.94] (p < 0.05) for hemothorax. CONCLUSIONS: LUS on admission identifies patients at risk of developing ARDS after blunt trauma. In addition, LUS allows rapid and accurate diagnosis of common traumatic thoracic injuries

Non-monotonic field-dependence of the ZFC magnetization peak in some systems of magnetic nanoparticles

We have performed magnetic measurements on a diluted system of gamma-Fe2O3 nanoparticles (~7nm), and on a ferritin sample. In both cases, the ZFC-peak presents a non-monotonic field dependence, as has already been reported in some experiments,and discussed as a possible evidence of resonant tunneling. Within simple assumptions, we derive expressions for the magnetization obtained in the usual ZFC, FC, TRM procedures. We point out that the ZFC-peak position is extremely sensitive to the width of the particle size distribution, and give some numerical estimates of this effect. We propose to combine the FC magnetization with a modified TRM measurement, a procedure which allows a more direct access to the barrier distribution in a field. The typical barrier values which are obtained with this method show a monotonic decrease for increasing fields, as expected from the simple effect of anisotropy barrier lowering, in contrast with the ZFC results. From our measurements on gamma-Fe2O3 particles, we show that the width of the effective barrier distribution is slightly increasing with the field, an effect which is sufficient for causing the observed initial increase of the ZFC-peak temperatures.Comment: LaTeX file 19 pages, 9 postscript figures. To appear in Phys. Rev. B (tentative schedule: Dec.97

PIONIER: a visitor instrument for the VLTI

PIONIER is a 4-telescope visitor instrument for the VLTI, planned to see its first fringes in 2010. It combines four ATs or four UTs using a pairwise ABCD integrated optics combiner that can also be used in scanning mode. It provides low spectral resolution in H and K band. PIONIER is designed for imaging with a specific emphasis on fast fringe recording to allow closure-phases and visibilities to be precisely measured. In this work we provide the detailed description of the instrument and present its updated status.Comment: Proceedings of SPIE conference Optical and Infrared Interferometry II (Conference 7734) San Diego 201

Milli-arcsecond astrophysics with VSI, the VLTI spectro-imager in the ELT era

Nowadays, compact sources like surfaces of nearby stars, circumstellar environments of stars from early stages to the most evolved ones and surroundings of active galactic nuclei can be investigated at milli-arcsecond scales only with the VLT in its interferometric mode. We propose a spectro-imager, named VSI (VLTI spectro-imager), which is capable to probe these sources both over spatial and spectral scales in the near-infrared domain. This instrument will provide information complementary to what is obtained at the same time with ALMA at different wavelengths and the extreme large telescopes.Comment: 8 pages. To be published in the proceedings of the ESO workshop "Science with the VLT in the ELT Era", held in Garching (Germany) on 8-12 October 2007, A. Moorwood edito

Water-enema multidetector computed tomography for planning surgery

PURPOSE: Water-enema multidetector computed tomography (WE-MDCT) is a technique for the localization and preoperative T- and N-stage assessments of colon cancer. It may be a useful tool for planning surgery. The primary aim of this study was to evaluate the diagnostic accuracy of WE-MDCT for T-staging and its ability to locate tumors for laparoscopy planning. The secondary aim was to assess reading reproducibility and diagnostic accuracy for the preoperative determination of N-stage. METHODS: We performed a study to evaluate preoperative WE-MDCT for surgical planning in patients with symptomatic colon adenocarcinomas who underwent surgery between June 2010 and January 2014. A radiologist and a surgeon read the WE-MDCTs separately. Results were compared with colonoscopy and the surgical specimen. RESULTS: Seventy-one patients (42 men (59.1%); mean age 73.1 years (range 45 to 95)) were included. Seventy-six tumors were assessed. The intraclass correlation coefficient (ICC) for location as determined by surgery and that determined by WE-MDCT was 1, and the ICC for location between colonoscopy and WE-MDCT was 0.85 (95% CI 0.75-0.91). For T-stage determination, sensitivity was 96 and 94% and specificity 83 and 88% for readers 1 and 2, respectively. The T-stage assessment allowed for the programing of surgical access and showed good sensitivity and specificity for the assessment of invasion in adjacent organs. CONCLUSION: WE-MDCT is relatively easy to perform, and its results can be read effectively by radiologists and surgeons. WE-MDCT indicated the location of tumors perfectly and permitted a good determination of their T-stage. The technique is thus pertinent for the planning of laparoscopic surgery for colon cancer

First AMBER/VLTI observations of hot massive stars

AMBER is the first near infrared focal instrument of the VLTI. It combines three telescopes and produces spectrally resolved interferometric measures. This paper discusses some preliminary results of the first scientific observations of AMBER with three Unit Telescopes at medium (1500) and high (12000) spectral resolution. We derive a first set of constraints on the structure of the circumstellar material around the Wolf Rayet Gamma2 Velorum and the LBV Eta Carinae

VSI: the VLTI spectro-imager

The VLTI Spectro Imager (VSI) was proposed as a second-generation instrument of the Very Large Telescope Interferometer providing the ESO community with spectrally-resolved, near-infrared images at angular resolutions down to 1.1 milliarcsecond and spectral resolutions up to R=12000. Targets as faint as K=13 will be imaged without requiring a brighter nearby reference object. The unique combination of high-dynamic-range imaging at high angular resolution and high spectral resolution enables a scientific program which serves a broad user community and at the same time provides the opportunity for breakthroughs in many areas of astrophysic including: probing the initial conditions for planet formation in the AU-scale environments of young stars; imaging convective cells and other phenomena on the surfaces of stars; mapping the chemical and physical environments of evolved stars, stellar remnants, and stellar winds; and disentangling the central regions of active galactic nuclei and supermassive black holes. VSI will provide these new capabilities using technologies which have been extensively tested in the past and VSI requires little in terms of new infrastructure on the VLTI. At the same time, VSI will be able to make maximum use of new infrastructure as it becomes available; for example, by combining 4, 6 and eventually 8 telescopes, enabling rapid imaging through the measurement of up to 28 visibilities in every wavelength channel within a few minutes. The current studies are focused on a 4-telescope version with an upgrade to a 6-telescope one. The instrument contains its own fringe tracker and tip-tilt control in order to reduce the constraints on the VLTI infrastructure and maximize the scientific return.Comment: 12 pages, to be published in Proc. SPIE conference 7013 "Optical and Infrared Interferometry", Schoeller, Danchi, and Delplancke, F. (eds.). See also http://vsi.obs.ujf-grenoble.f

Is the number of ideal cardiovascular health metrics in midlife associated with lower risk of cancer? Evidence from 3 European prospective cohorts

BACKGROUND: Primordial prevention may be a relevant strategy for the prevention of cancer. Given the commonality of risk factors and mechanisms between cancer and cardiovascular disease, we examined the associations between the number of ideal cardiovascular health metrics in midlife and incident cancer. METHODS: In 3 European cohorts (NutriNet-Santé and GAZEL, France; Whitehall II, United Kingdom), the number of ideal cardiovascular health metrics was determined at baseline (range 0-7). Follow-up for cancer events was until October 2020 (NutriNet-Santé), March 2017 (Whitehall II) and December 2015 (GAZEL). Cox regression was conducted in each cohort, and results were thereafter pooled using a random-effects model. RESULTS: Data were available on 39 718 participants. A total of 16 237 were from NutriNet-Santé (mean age 51.3 yr; 28% men), 9418 were from Whitehall II (mean age 44.8 yr; 68% men) and 14 063 were from GAZEL (mean age 45.2 yr; 75% men). The median follow-up was 8.1 years in NutriNet-Santé, 29.6 years in Whitehall II and 24.8 years in GAZEL, and yielded a total of 4889 cancer events. A greater number of ideal cardiovascular health metrics was associated with a lower overall cancer risk in each cohort, with an aggregate hazard ratio (HR) per 1 increment in number of ideal metrics of 0.91 (95% confidence interval [CI] 0.88-0.93). This association remained after removal of the smoking metric (aggregate HR per unit increment in number of ideal metrics: 0.94, 95% CI 0.90-0.97), and site-specific analysis demonstrated a significant association with lung cancer. INTERPRETATION: A greater number of ideal cardiovascular health metrics in midlife was associated with lower cancer risk, notably lung cancer. Primordial prevention of cardiovascular risk factors in midlife may be a complementary strategy to prevent the onset of cancer

Gastrostomie Percutanée Radiologique

Gastrostomy is mainly used to provide longterm enteral nutrition. Percutaneous techniques are generally preferred to surgery except for specific cases. Image-guided percutaneous gastrostomy, currently used less than the gastroscopy-guided technique, is a simple, reliable and advantageous technique in managing these frequently debilitated patients. The different aspects of the procedure will be described: indications, contraindications, technique, follow-up, main complications and technical variations