Construction mechanisms and thermal evolution of upper crustal intrusions : the Saint-Jean-du-Doigt bimodal intrusion (Brittany, France)

Understanding the emplacement and growth of intrusive bodies in terms of mechanism, duration, ther¬mal evolution and rates are fundamental aspects of crustal evolution. Recent studies show that many plutons grow in several Ma by in situ accretion of discrete magma pulses, which constitute small-scale magmatic reservoirs. The residence time of magmas, and hence their capacities to interact and differentiate, are con¬trolled by the local thermal environment. The latter is highly dependant on 1) the emplacement depth, 2) the magmas and country rock composition, 3) the country rock thermal conductivity, 4) the rate of magma injection and 5) the geometry of the intrusion. In shallow level plutons, where magmas solidify quickly, evi¬dence for magma mixing and/or differentiation processes is considered by many authors to be inherited from deeper levels. This work shows however that in-situ differentiation and magma interactions occurred within basaltic and felsic sills at shallow depth (0.3 GPa) in the St-Jean-du-Doigt (SJDD) bimodal intrusion, France. This intrusion emplaced ca. 347 Ma ago (IDTIMS U/Pb on zircon) in the Precambrian crust of the Armori- can massif and preserves remarkable sill-like emplacement processes of bimodal mafic-felsic magmas. Field evidence coupled to high precision zircon U-Pb dating document progressive thermal maturation within the incrementally built ioppolith. Early m-thick mafic sills (eastern part) form the roof of the intrusion and are homogeneous and fine-grained with planar contacts with neighboring felsic sills; within a minimal 0.8 Ma time span, the system gets warmer (western part). Sills are emplaced by under-accretion under the old east¬ern part, interact and mingle. A striking feature of this younger, warmer part is in-situ differentiation of the mafic sills in the top 40 cm of the layer, which suggests liquids survival in the shallow crust. Rheological and thermal models were performed in order to determine the parameters required to allow this observed in- situ differentiation-accumulation processes. Strong constraints such as total emplacement durations (ca. 0.8 Ma, TIMS date) and pluton thickness (1.5 Km, gravity model) allow a quantitative estimation of the various parameters required (injection rates, incubation time,...). The results show that in-situ differentiation may be achieved in less than 10 years at such shallow depth, provided that: (1) The differentiating sills are injected beneath consolidated, yet still warm basalt sills, which act as low conductive insulating screens (eastern part formation in the SJDD intrusion). The latter are emplaced in a very short time (800 years) at high injection rate (0.5 m/y) in order to create a "hot zone" in the shallow crust (incubation time). This implies that nearly 1/3 of the pluton (400m) is emplaced by a subsequent and sustained magmatic activity occurring on a short time scale at the very beginning of the system. (2) Once incubation time is achieved, the calculations show that a small hot zone is created at the base of the sill pile, where new injections stay above their solidus T°C and may interact and differentiate. Extraction of differentiated residual liquids might eventually take place and mix with newly injected magma as documented in active syn-emplacement shear-zones within the "warm" part of the pluton. (3) Finally, the model show that in order to maintain a permanent hot zone at shallow level, injection rate must be of 0.03 m/y with injection of 5m thick basaltic sills eveiy 130yr, imply¬ing formation of a 15 km thick pluton. As this thickness is in contradiction with the one calculated for SJDD (1.5 Km) and exceed much the average thickness observed for many shallow level plutons, I infer that there is no permanent hot zone (or magma chambers) at such shallow level. I rather propose formation of small, ephemeral (10-15yr) reservoirs, which represent only small portions of the final size of the pluton. Thermal calculations show that, in the case of SJDD, 5m thick basaltic sills emplaced every 1500 y, allow formation of such ephemeral reservoirs. The latter are formed by several sills, which are in a mushy state and may interact and differentiate during a short time.The mineralogical, chemical and isotopic data presented in this study suggest a signature intermediate be¬tween E-MORB- and arc-like for the SJDD mafic sills and feeder dykes. The mantle source involved produced hydrated magmas and may be astenosphere modified by "arc-type" components, probably related to a sub¬ducting slab. Combined fluid mobile/immobile trace elements and Sr-Nd isotopes suggest that such subduc¬tion components are mainly fluids derived from altered oceanic crust with minor effect from the subducted sediments. Close match between the SJDD compositions and BABB may point to a continental back-arc setting with little crustal contamination. If so, the SjDD intrusion is a major witness of an extensional tectonic regime during the Early-Carboniferous, linked to the subduction of the Rheno-Hercynian Ocean beneath the Variscan terranes. Also of interest is the unusual association of cogenetic (same isotopic compositions) K-feldspar A- type granite and albite-granite. A-type granites may form by magma mixing between the mafic magma and crustal melts. Alternatively, they might derive from the melting of a biotite-bearing quartz-feldspathic crustal protolith triggered by early mafic injections at low crustal levels. Albite-granite may form by plagioclase cu¬mulate remelting issued from A-type magma differentiation.

Hydrogen and oxygen isotope behaviors during variable degrees of upper mantle melting: Example from the basaltic glasses from Macquarie Island

We present measurements of hydrogen and oxygen isotopes in MORB glasses from Macquarie Island (SW. Pacific Ocean) coupled with determination of bulk H2O content by two independent techniques: total dehydration and FTIR. The incompatible trace elements in these glasses vary by a factor of 12 to 17, with K2O varying from 0.1 to 1.7 wt.%; these ranges reflect a variable degree of closed-system mantle melting, estimated from 1 to 15%. Water concentrations determined by the two techniques match well, yielding a range from 0.25 to 1.49 wt.% which correlates positively with all of the measured incompatible trace elements, suggesting that water is un-degassed, and behaves conservatively during mantle melting. Also, the agreement between the FTIR-determined and extracted water contents gives us confidence that the measured isotopic values of hydrogen reflect that of the mantle. Comparison of the range of water content with that of other incompatible trace elements allows estimation of the water partition coefficient in lherzolite, 0.0208 (ranging from 0.017 to 0.023), and the water content in the source, 386 ppm (ranging from 370 to 440 ppm). We observe a fairly narrow range in delta D and delta O-18 values of -75.5 +/- 4.5 parts per thousand and 5.50 +/- 0 .05 parts per thousand respectively, that can be explained by partial melting of normal lherzolitic mantle. The measured delta D and delta O-18 values of Macquarie Island glasses that range from nepheline- to hypersthene-normative, and from MORB to EMORB in composition, are identical to those in average global MORB. The observed lack of variation of delta D and delta O-18 with 1 to 15% degree of mantle melting is consistent with a bulk melting model of delta D and delta O-18 fractionation, in which water is rapidly scavenged into the first partial melt. The narrow ranges of delta D and delta O-18 in normal mantle are mostly due to the buffering effect of clino- and orthopyroxenes in the residual assemblage; additionally, fast ``wet'' diffusion of oxygen and hydrogen isotopes through the melting regions may further smooth isotopic differences. (C) 2012 Elsevier B.V. All rights reserved.

Uroradiological screening for upper and lower urinary tract anomalies in patients with hypospadias: a systematic literature review.

INTRODUCTION: Hypospadias is associated with anomalies of the urinary tract, but the exact prevalence and significance of these anomalies are still controversial. OBJECTIVES: To assess the percentage of patients with hypospadias and associated urological anomalies, either requiring or not requiring medical or surgical attention. MATERIAL AND METHODS: We searched several databases using the following Mesh terms: hypospadias AND urination, ultrasonography, urinary tract/abnormalities, urinary bladder/radiography, ureteral obstruction, hydronephrosis or vesico-ureteral reflux. Type of uroradiological studies performed, type of urological anomalies, medical or surgical interventions, number of patients available, enrolled and undergoing uroradiological studies and number of patients with abnormal uroradiological exams were recorded. RESULTS: We found 24 studies. Four studies included 100% of available patients. In the other ones, the percentage of patients undergoing uroradiological screening varied from 12 to 82%. Frequency of anomalies varied from 0 to 56%. The most common anomalies were kidney position anomalies, vesico-ureteral reflux and hydronephrosis. CONCLUSIONS: The data published about screening patients with hypospadias for associated anomalies of their urinary tract are of poor quality. The clinical significance of the anomalies found is difficult to evaluate. We found no relationship between the severity of the hypospadias and associated anomalies of the upper or lower urinary tract.

Volcanic debris avalanche deposits of the upper Maronne valley (Cantal Volcano, France): evidence for contrasted formation and transport mechanisms

The deposits of two volcanic debris avalanches (VDA I and II) that occur in the upper Maronne valley, northwest sector of Cantal Volcano, France, were studied to establish their mechanisms of formation, transport and deposition. These two volcanic debris avalanches that clearly differ with regard to their structures, textures and extensions, exemplify the wide spectrum of events associated with large-scale sector collapse. VDA I is voluminous (similar to1 km(3) in the upper Maronne valley) and widespread. The deposits comprise two distinct facies: the block facies that forms the intermediate and upper part of the unit and the mixed facies that crops out essentially at the base of the unit. The block facies consists of more or less brecciated lava, block-and-ash-flow breccia and pumice-flow tuff megablocks set in breccias resulting from block disaggregation. Mixing and differential movements are almost absent in this part of the VDA. The mixed facies consists of breccias rich in fine particles that originate from block disagregation, as well as being picked up from the substratum during movement. Mixing and differential movements are predominant in this zone. Analysis of fractures on lava megablocks suggests that shear stress during the initial sliding is the principal cause of fracture. These data strongly indicate that VDA I is purely gravitational and argue for a model in which the initial sliding mass transforms into a flow due to differential in situ fragmentation caused by the shear stress. VDA II is restricted to low-topography areas. Its volume, in the studied area, is about 0.3 km(3). The deposits consist of brecciated, rounded blocks and megablocks set in a fine-grained matrix composed essentially of volcanic glass. This unit is stratified, with a massive layer that contains all the megablocks at the base and in the intermediate part, and in the upper part a normally graded layer that contains only blocks <1 m in size. The different lithologies present are totally mixed. These observations suggest that VDA II may be of the Bezymianny-type and that it underwent a flow transformation from a turbulent to a stratified flow consisting of a basal hyperconcentrated laminar body overlain by a dilute layer. (C) 2000 Elsevier Science B.V. All rights reserved.

Kidney-sparing surgery for upper tract urothelial cancer.

PURPOSE OF REVIEW: This article reviews and summarizes current knowledge on kidney-sparing surgery (KSS) for upper tract urothelial carcinoma (UTUC). RECENT FINDINGS: Radical nephroureterectomy (RNU) has been central to the treatment of UTUC for decades, but KSS has been applied to a rising number of patients to preserve renal function. Ablation or resection through flexible ureteroscopy or the percutaneous route seems to provide comparable cancer-specific survival and overall survival to RNU, but the risk of local and bladder recurrence remains relatively high. Segmental ureterectomy is used for low-risk unifocal UTUC with recent studies confirming its oncologic safety and equivalence to RNU. Antegrade or retrograde instillation therapy may be considered as adjuvant treatment after conservative surgery, but their efficacy needs to be proven. Intravesical single-dose chemotherapy is likely to become part of the therapy algorithm of UTUC treated by KSS or RNU to lower bladder seeding and recurrence. Postoperative vigilant radiographic and endoscopic surveillance are obligatory because of the high probability of recurrence. SUMMARY: KSS should be regarded as a valid alternative to RNU in case of technically resectable low-risk upper tract urothelial cell carcinoma, even in case of a normal contralateral kidney. Advances in technology and biological and clinical risk estimation will make the management of UTUC more evidence based thereby lowering overtreatment.

The Paleozoic magmatic history of the Maggia and Sambuco nappes, Lower Penninic, Central Lepontine Alps

Résumé : Les corps magmatiques sont des indicateurs essentiels dans toute reconstitution paléogéographique et/ou géodynamique d'un cycle orogénique, en particulier en contexte polycyclique, où la plupart des autres indices ont été oblitérés. Ils sont aisément datables et leurs caractéristiques géochimiques permettent de contraindre leur contexte tectonique de mise en place. Cette approche a été appliquée aux socles pré-mésozoïques des nappes penniques inférieures de Sambuco et de la Maggia, dans les Alpes centrales lepontines. Plusieurs événements magmatiques ont été identifiés dans le socle de Sambuco et datés par la méthode U-Pb sur zircon couplée à la technique LA-ICPMS. La suite calco-alcaline mafique rubanée de Scheggia est datée du Cambrien inférieur à 540-530 Ma ; le métagranite alumineux oeillé de Sasso Nero a un âge de 480-470 Ma, tout comme bien d'autres «older orthogneisses» des socles alpins. Il contient des zircons hérités d'âge panafricain à 630-610 Ma, indicateur d'une affiliation gondwanienne de ces terrains. Le pluton calco-alcalin du Matorello est daté à environ 300-310 Ma, et les filons lamprophyriques qu'il abrite à 300 Ma. La granodiorite de Cocco et le leucogranite de Ruscada, tous deux intrudés dans le socle de la nappe adjacente de la Maggia, ont des âges similaires à celui du Matorello. Ceci ajouté aux similitudes magmatiques observées entre Cocco et Matorello suggère une proximité paléogéographique des deux nappes au Permien-Carbonifère. Or ces dernières sont actuellement considérées appartenir à deux domaines paléogéographiques mésozoïques distincts : helvétique pour Sambuco et briançonnais pour Maggia, séparés par un bassin océanique. Si tel fut le cas, aucun mouvement décrochant ne doit avoir décalé les marges continentales de l'océan, retrouvées en parfaite coïncidence lors de sa fermeture. Le Matorello est un pluton recristallisé en faciès amphibolite et plissé par cinq phases successives de déformation non-coaxiales, qui ont conduit à son renversement complet, attesté par des indicateurs de paléogravité. Il préserve de spectaculaires phénomènes de coexistence liquide de magmas (essaims d'enclaves et Bills composites). Ce pluton était originellement tabulaire, construit par l'accumulation de multiples injections de magma en feuillets d'épaisseur métrique à décamétrique. Suivant le rythme de mise en place, les injections successives ont rapidement cristallisé avec des contours nets et bien définis (Bills composites) ou se sont mélangées avec les précédentes pour former une couche non consolidée de plusieurs dizaines de mètres d'épaisseur (granodiorite principale). Les injections individuelles sont délimitées par de subtils contrastes en granulométrie, proportions modales ou ségrégation de minéraux (schlieren), ou par des phénomènes d'érosion le long des surfaces de contact. Deux couches métriques à contour sinueux consistent en une accumulation compacte d'enclaves mafiques arrondies dans une matrice granodioritique fine. Le granoclassement des enclaves, la présence de figures de charge et de phénomènes érosifs en base de couche, ainsi que des schlieren de biotite entrecroisés évoquent l'injection de coulées de magma chargé d'enclaves et de faible viscosité en régime hydrodynamique turbulent dans un encaissant granodioritique encore largement liquide. La nature hybride des roches implique une chambre magmatique sous-jacente, en cours de différenciation et périodiquement réalimentée. Les magmas sont des liquides mafiques dérivés du manteau et des liquides anatectiques d'origine crustale, comme l'indique la gamme mesurée des rapports isotopiques initiaux du Sr (0.704 à 0.709) et des valeurs epsilon Nd (-2.1 à -4.7). Ces données montrent également que la contribution crustale est dominante, en accord avec les isotopes du plomb. Les phénomènes d'hybridation ont vraisemblablement eu lieu en base de croûte et dans la chambre magmatique sous-jacente au laccolite du Matorello. Les indicateurs de paléogravité du Matorello contribuent accessoirement à la compréhension de l'architecture actuelle de la nappe de Sambuco. Des plis isoclinaux à surface axiale verticale peuvent être mis en évidence par le contact entre les faciès dioritique et granodioritique. L'antiforme dont le Matorello forme le coeur est un synclinal, ce qui le positionne dans le Flanc inverse du grand pli couché que forme la nappe de Sambuco. Par ailleurs, des blocs de gneiss retrouvés dans le wildflysch sommital de la couverture de la nappe d'Antigorio ont été affiliés dans cette étude au pluton du Matorello. Ceci implique que le front de la nappe de Sambuco chevauchait déjà la partie est du bassin d'Antigorio au moment de sa fermeture. Par conséquent, ce n'est qu'en position externe que la nappe du Lebendun chevauche directement la nappe d'Antigorio. Abstract Magmatic bodies are important markers in paleo-geographic or geodynamic reconstructions of orogenic cycles, even more so in the case of polycyclic events where many of the other markers have been overwritten or destroyed. Plutons are relatively easy to date and their geochemical properties help constrain the tectonic context in which they were emplaced. This study focuses on the pre-mesozoic basement in the Sambuco and Maggia lower Penninic nappes located in the central Lepontine domain of the Alps. A number of magmatic events have been identified in the Sambuco basement. These events were dated using LA-ICPMS U/Pb on zircon grains. The mafic calc-alkaline banded Scheggia suite is dated as lower Cambrian, 540-530 Ma. The Al-rich Sasso-Nero lenticular gneiss is 480-470 Ma old (similarly to many older orfhogneisses of the Alpine basement) and contains 630-610 Ma old pan-African inherited zircons that illustrate the Gondwanian origin of these terranes.The calc-alkaline Matorello pluton is dated as 310-300 Ma whereas the lamprophyric bodies it contains are of 300 Ma. The Cocco granodiorite and the Ruscada leucogranite both intrude the basement of the adjacent Maggia nappe and are of similar ages to the Matorello. The ages as well as the geochemical similarities between the Cocco, Rucada and Matorello plutons suggest their paleo-geographic proximity at the Permian-Carboniferous boundary. However, these nappes are currently considered as belonging to two different Mesozoic paleo-geographic domains. Indeed, the Sambuco is considered as Helvetic whereas the Maggia is said to be Briançonnais, both separated by an oceanic basin. If this is the case, then it is essential that nostrike-slip movement has misaligned both continental margins since these coincide perfectly now that the oceanic domain closed. The Matorello pluton was originally a tabular intrusion, built up by the accumulation of multiple, several meter-thick, subhorizontal sheet-like injections of magma. Depending on their emplacement rate, the successive magma injections either solidified rapidly with sharp and rather well-defined boundaries (like the composite sills) or mingled with previous injections generating a thick molten layer up to several tens to hundred meters thick, like in the main granodioritic facies. These coalesced injections are hardly distinguishable, however subtle contrasts in granulometry, mineral modal proportions or mineral sorting (cross-bedded biotite-rich schlieren), as well as erosional features and/or crystal entrapment along contact surfaces allow to distinguish between the different injections. Two exceptional meter-thick layers display sinuous boundaries with the host granodiorite and consist of a densely packed accumulation of mafic enclaves in a granodioritic matrix. Gravitational sorting of the enclaves with load cast features at the base of the layers and sinuous biotite schlieren point to injection of low viscosity turbulent composite magma flows in the still largely molten granodiorite host. The hybrid nature of these rocks implies the existence of á periodically replenished and differentiated underlying magma chamber. Magmas are mafic liquids derived from the mantle and anatectic liquids of crustal origin, as shown by the (87Sr/86Sr), and epsilon Nd values (0.704-0.709 and -2.1 to -4.7 respectively. These data show that the crustal contribution is important, as confirmed by the Pb isotopes. The hybridisation processes seem to have occurred in the lower crust in magma chambers underlying the Matorello laccolith. The paleo-gravity markers in the Matorello help understand the architecture of the Sambuco nappe. Isoclinal folds with a vertical axial plane can be seen at the contact between dioritic and granodioritic facies. The antiform structure of which the Matorello is the heart is in fact a syncline. This places it in the inverse flanc of the large recumbent fold that constitutes the Sambuco nappe. The gneiss blocs found in the summital wildflysh cover of the Antigorio nappe have been linked to the Matorello pluton. This means that the front of the Sambuco nappe already overlapped the Antigorio basin when it closed. This implies that the Lebendun nappe can only overlap the Antigorio nappe in it's external position. Résumé grand public La chaîne alpine est la conséquence de la collision tertiaire entre deux masses continentales, l'Europe au nord et la péninsule apulienne africaine au sud, originellement séparées par l'océan mésozoïque téthysien. Cette collision a fermé un espace large de plusieurs centaines de km avec pour résultat l'écaillage de la croûte terrestre en unités tectoniques de dimensions variables, qui se sont empilées, imbriquées, éventuellement replissées en nappes de géométrie complexe. Cet amoncellement de 40 km d'épaisseur a vu sa température et sa pression lithostatique internes augmenter jusqu'à des valeurs de l'ordre de 680 °C et 6000 bars, induisant une recristallisation métamorphique des roches. L'un des objectifs de la géologie alpine est de reconstituer la géographie de la région aux temps mésozoïques de l'océan téthysien, en d'autres termes, de replacer chacune des unités tectoniques identifiées au sein de l'empilement alpin dans sa position originelle. Le défi est de taille et peut être comparé à celui de la reconstitution d'un vaste puzzle, dont certaines pièces seraient endommagées au niveau de leur contour ou leurs couleurs (métamorphisme), dissimulées par d'autres (enfouissement), voire tombées de la table de jeu (subduction, échappement latéral). Plusieurs approches ont été mises en oeuvre au cours du siècle écoulé. On citera en particulier la stratigraphie, la tectonique et le paléomagnétisme. Dans ce travail, nous avons essentiellement utilisé des techniques de datation isotopique absolue des roches (U/Pb sur zircon) qui, sur la base des connaissances acquises par l'ensemble des autres disciplines géologiques, nous ont permis de mieux contraindre ta paléogéographie mésozoïque du domaine «pennique inférieur » des Alpes centrales lépontines. Et au-delà? Nous savons tous que la disposition des continents à la surface de la Terre évolue constamment. Il est donc tentant d'essayer de remonter plus loin encore dans le temps et de reconstituer la physionomie de la marge sud européenne, tout au moins certains éléments de son histoire, au cours de l'ère paléozoïque. Les traces de ces événements très anciens sont naturellement ténues et dans ce contexte, les techniques de datation mentionnées ci-dessus deviennent les outils les plus performants. Ainsi, des datations u/Pb sur zircon nous ont permis de recenser plusieurs intrusions magmatiques, attribuées à quatre événements orogéniques anté-alpins. Des âges néoprotérozoïques (630-610 millions d'années ou Ma), cambrien inférieur (540-530 Ma), ordovicien inférieur (480-470 Ma) et carbonifère supérieur-permien inférieur (310-285 Ma) ont été obtenus dans le socle de la nappe de Sambuco. Des âges similaires à 300 Ma ont été obtenus dans la nappe voisine de la Maggia, qui permettent de relier ces deux unités. Aujourd'hui côte à côte, ces deux nappes devaient également se trouver proches l'une de l'autre il y a 300 Ma, lors de l'extension post-varisque. Les structures magmatiques spectaculaires préservées dans le pluton du Matorello (300 Ma) contraignent la géométrie actuelle de la nappe de Sambuco dans laquelle l'intrusion s'est mise en place. La forme originelle du pluton, aujourd'hui retourné et replissé plusieurs fois, s'avère être tabulaire, faite d'intrusions de faible épaisseur (1-300 m) s'étalant en forme de disque (30m à 2 km de diamètre). Les injections successives de magma se sont accumulées sous un toit dioritique précoce; elles sont issues, par le refais de fractures, d'une chambre magmatique plus profonde, périodiquement réalimentée par des magmas calco-alcalins d'origine mantellique contaminés parla croûte continentale profonde (εNd = -2.1 à -4.7). Des accumulations d'enclaves magmatiques arrondies et granoclassées dans des paléo-chenaux à fond érosif témoignent de conditions de mise en place hydrodynamiques à haute énergie. Ces enclaves sont emmenées de la chambre magmatique sous-jacente à la faveur d'épisodes de fracturation hydraulique liés à l'injection de magmas matelliques chauds dans des liquides différenciés riches en eau. Cette hypothèse est étayée par l'existence de filons composites. Une paléohorizontale a pu être déduite au sein du pluton, indiquant que cette partie de la nappe de Sambuco est verticalisée et isoclinalement replissée par la déformation alpine. Finalement, des blocs érodés du socle Sambuco ont été retrouvés dans le wildflysch sommital de la couverture sédimentaire mésozoïque de la nappe d'Antigorio sous-jacente. Ceci suggère que les blocs ont été fournis parle front de la nappe de Sambuco en train de chevaucher sur la nappe d'Antigorio au moment de la fermeture du bassin sédimentaire de cette dernière.

Role of rhinovirus load in the upper respiratory tract and severity of symptoms in lung transplant recipients.

BACKGROUND: Rhinovirus is the most common cause of respiratory viral infections and leads to frequent respiratory symptoms in lung transplant recipients. However, it remains unknown whether the rhinovirus load correlates with the severity of symptoms. OBJECTIVES: This study aimed to better characterize the pathogenesis of rhinoviral infection and the way in which viral load correlates with symptoms. STUDY DESIGN: We assessed rhinovirus load in positive upper respiratory specimens of patients enrolled prospectively in a cohort of 116 lung transplant recipients. Rhinovirus load was quantified according to a validated in-house, real-time, reverse transcription polymerase chain reaction in pooled nasopharyngeal and pharyngeal swabs. Symptoms were recorded in a standardised case report form completed at each screening/routine follow-up visit, or during any emergency visit occurring during the 3-year study. RESULTS: Rhinovirus infections were very frequent, including in asymptomatic patients not seeking a specific medical consultation. Rhinovirus load ranged between 4.1 and 8.3 log copies/ml according to the type of visit and clinical presentation. Patients with highest symptom scores tended to have higher viral loads, particularly those presenting systemic symptoms. When considering symptoms individually, rhinovirus load was significantly higher in the presence of symptoms such as sore throat, fever, sputum production, cough, and fatigue. There was no association between tacrolimus levels and rhinovirus load. CONCLUSIONS: Rhinovirus infections are very frequent in lung transplant recipients and rhinoviral load in the upper respiratory tract is relatively high even in asymptomatic patients. Patients with the highest symptom scores tend to have a higher rhinovirus load.

Human cytomegalovirus induced pseudotumor of upper gastrointestinal tract mucosa: Effects of long-term chronic disease?

Human cytomegalovirus-induced lesions resembling malignancies have been described in the gastrointestinal tract and include ulcerated or exophytic large masses. The aim of this study was to review the cases registered in the databases of two academic hospitals and formulate a hypothesis concerning the pathogenic mechanisms responsible for cytomegalovirus-induced pseudotumor development. All the diagnoses of human cytomegalovirus infections of the upper gastrointestinal tract recorded from 1991 to 2013 were reviewed. Cases of mucosal alterations misdiagnosed endoscopically as malignancies were selected. Large ulcers occurring in the stomach (three cases) and an irregular exophytic mass at the gastro-jejunal anastomosis were misdiagnosed endoscopically as malignancies (4 cases out of 53). Histologically, all lesions reflected hyperplastic mucosal changes with a prevalence of epithelial and stroma infected cells, without signs of cell atypia. The hypothesis presented is that the development of human cytomegalovirus-induced pseudotumors may be the morphological expression of chronic mucosa damage underlying long-term infection.

Hémorragie par le canal de Wirsung: forme rare d'hémorragie digestive haute. A propos d'une observation [Hemorrhage through Wirsung's duct: rare form of upper gastrointestinal hemorrhage. A case report].

The case of a 41-year-old alcoholic patient who presented with massive upper gastrointestinal bleeding is reported. The diagnosis was established rapidly by endoscopy which revealed bleeding through the papilla of Vater. Selective angiography of the superior mesenteric artery opacified the pancreatic duct as well as the duodenum. CT scan showed signs of chronic pancreatitis. Because of the recurrence of bleeding and shock, an urgent operation was necessary and a Whipple procedure was performed. Recovery was complete. The clinical presentation, the etiology, the diagnostic modalities and the treatment of this particular condition are discussed. Usually, hemorrhage through the pancreatic duct presents as repeated episodes of upper gastrointestinal bleeding with no source found at endoscopy. The presence of chronic pancreatitis or of epigastric pain during bleeding should suggest the diagnosis. Upper gastrointestinal endoscopy and angiography are the principal diagnostic tools. Definitive treatment requires surgery, and resection in most of the cases.

Diagnosis and Management of Upper Tract Urothelial Carcinoma.

While UTUC is relatively uncommon, it has an aggressive natural history and poor prognosis, which has not substantially improved over the past two decades. Nevertheless, continued research has led to the discovery of risk factors improving the prevention and early detection of UTUC. Although RNU remains the standard treatment for localized invasive UTUC, nephron-sparing surgery for selected patients has made considerable progress in the recent years. The stagnation in the prognosis of UTUC over the past two decades highlights the necessity for incorporating multimodal approaches including refinements in systemic chemotherapy and radiotherapy to attain better outcomes for patients with UTUC.