Cardiac and pericardial fistulae associated with esophageal or gastric neoplasms: a literature review

Pericardial and cardiac fistulae secondary to esophageal or gastric tumors are considered exceptional. They have never been the object of a literature review. We reviewed the medical literature between 1881 and 2001, searching for all published cases of pericardial or cardiac fistulae developed from esophageal and gastric tumors or favored by the applied therapy to these tumors. The cases of metastasization, tumor spread, and neoplasic pericardial effusion without fistula were excluded. Fifty patients were identified, with one original case. More than half the cases (56%) occurred in the last 25 years. Substernal pain is the main symptom. The majority of patients present at least one condition favoring fistula formation. The auscultation of a water-wheel murmur may suggest a pneumopericardium and therefore a pericardial fistula, as does a purulent pericarditis. Arrhythmias, signs of ischemia, and hematemesis point toward a ventricular fistula. Neurological and hemostasis disorders may be suspect of an atrial lesion. Diagnosis should be made by the association of a scanner and a transit. Prognosis is bad: 76% of the patients die in the first month. Pericardial or cardiac fistulae are part of the differential diagnosis of thoracic pain in patients with esophageal or gastric tumors and in patients who were treated for these pathologies. The diagnosis must be as quick as possible. An operation (patients with a good prognosis) or the placement of a stent (patients with a bad prognosis) is the only chance of survival

La camaraderie, ou La courte échelle : comédie en 5 actes et en prose / par M. E. Scribe,...

Collection : France dramatique illustrée ; 16e livraison

Acquisitions thérapeutiques en médecine ambulatoire en 2011 [2011 findings from literature on general internal ambulatory medicine].

In 2011 several articles seemed significant for the practice of general medicine. Diagnosis of hypertension needs several measurements and may need 24-hour ambulatory blood pressure monitoring. Glycosylated hemoglobin is a reliable tool to diagnose diabetes mellitus. The ABCD2 score with neurological imaging help the triage of transient ischemic attacks. Pulmonary embolism can be treated as outpatient for low risk patients. Gluten-free diet may be tried in irritable bowel syndrome. Nitrofurantoin is a reasonable alternative for simple urinary tract infection in women, but antibiotics are not needed after drainage of an uncomplicated skin abscess. Subclinical thyroid dysfunction is a risk factor of osteoporosis in older men. Sequential use of MMSE and ACE scores is a promising approach to assess medical decision-making capacity.

Epibulbar osseous choristomaa clinicopathological case series and review of the literature

Background:¦Choristomas are benign, congenital tumours composed of normal tissue in an¦abnormal location. Osseous choristomas represent the rarest form of epibulbar choristomas,¦with now 65 cases reported in the literature. We did a retrospective clinicopathological study¦of all patients with epibulbar osseous choristoma observed at our institution since 1982 and¦updated the last review of the literature.¦History and Signs:¦Three Caucasian male patients, aged between 3 months and 11 years,¦were identified. All osseous choristomas were located under the superotemporal bulbar¦conjunctiva of the right eye.¦Therapy and Outcome:¦All lesions were managed with surgical excision. Histopathology¦revealed the presence of lamellar bone in all cases, one of which was associated with a¦dermolipoma.¦Conclusions:¦We report a small rare case series of 3 epibulbar osseous choristomas and did a¦review of the literature. In one patient, the osteoma was associated with a dermolipoma,¦corresponding to the fourth reported complex choristoma of this type, in an otherwise normal¦eye, in the literature.

Maladies inflammatoires cryptogéniques de l'intestin de novo après transplantation hépatique: rapport de quatre nouveaux cas et revue de la littérature [De novo inflammatory bowel diseases after liver transplantation: description of four new cases and a review of the literature]

Inflammatory bowel diseases are a result of an aberrant mucosal immune response to gut microflora. Several groups have reported newly diagnosed inflammatory bowel diseases following solid organ transplantation and subsequent immunosuppressive therapy. We describe four cases of newly diagnosed inflammatory bowel diseases following liver transplantation in a pool of 120 transplanted patients. These patients had no prior history of inflammatory bowel diseases or primary sclerosing cholangitis and were immunosuppressed. Two patients were transplanted for a hepatitis C related cirrhosis, one for alcoholic cirrhosis and one patient for autoimmune cirrhosis. Three patients were diagnosed with ulcerative colitis and one with Crohn's disease. These four patients were on a cyclosporin monotherapy when their inflammatory bowel diseases were diagnosed. These data suggest that cyclosporin monotherapy following solid organ transplantation does not prevent development of inflammatory bowel diseases.

Recommendations for the use of ultrasound in rheumatoid arthritis: literature review and SONAR score experience.

Ultrasound (US) has become a useful tool in the detection of early disease, differential diagnosis, guidance of treatment decisions and treatment monitoring of rheumatoid arthritis (RA). In 2008, the Swiss Sonography in Arthritis and Rheumatism (SONAR) group was established to promote the use of US in inflammatory arthritis in clinical practice. A scoring system was developed and taught to a large number of Swiss rheumatologists who already contributed to the Swiss Clinical Quality Management (SCQM) database, a national patient register. This paper intends to give a Swiss consensus about best clinical practice recommendations for the use of US in RA on the basis of the current literature knowledge and experience with the Swiss SONAR score. Literature research was performed to collect data on current evidence. The results were discussed among specialists of the Swiss university centres and private practice, following a structured procedure. Musculoskelatal US was found to be very helpful in establishing the diagnosis and monitoring the evolution of RA, and to be a reliable tool if used by experienced examiners. It influences treatment decisions such as continuing, intensifying or stepping down therapy. The definite modalities of integrating US into the diagnosis and monitoring of RA treatments will be defined within a few years. There are, however, strong arguments to use US findings as of today in daily clinical care. Some practical recommendations about the use of US in RA, focusing on the diagnosis and the use of the SONAR score, are proposed.

Supervised injection services : what has been demonstrated? A systematic literature review

BACKGROUND: Supervised injection services (SISs) have been developed to promote safer drug injection practices, enhance health-related behaviors among people who inject drugs (PWID), and connect PWID with external health and social services. Nevertheless, SISs have also been accused of fostering drug use and drug trafficking. AIMS: To systematically collect and synthesize the currently available evidence regarding SIS-induced benefits and harm. METHODS: A systematic review was performed via the PubMed, Web of Science, and ScienceDirect databases using the keyword algorithm [("supervised" or "safer") and ("injection" or "injecting" or "shooting" or "consumption") and ("facility" or "facilities" or "room" or "gallery" or "centre" or "site")]. RESULTS: Seventy-five relevant articles were found. All studies converged to find that SISs were efficacious in attracting the most marginalized PWID, promoting safer injection conditions, enhancing access to primary health care, and reducing the overdose frequency. SISs were not found to increase drug injecting, drug trafficking or crime in the surrounding environments. SISs were found to be associated with reduced levels of public drug injections and dropped syringes. Of the articles, 85% originated from Vancouver or Sydney. CONCLUSION: SISs have largely fulfilled their initial objectives without enhancing drug use or drug trafficking. Almost all of the studies found in this review were performed in Canada or Australia, whereas the majority of SISs are located in Europe. The implementation of new SISs in places with high rates of injection drug use and associated harms appears to be supported by evidence.