Coexistence of benign phyllodes tumor and invasive ductal carcinoma in distinct breasts: case report

This report describes a rare case of coexistence of benign phyllodes tumor, which measured 9 cm in the right breast, and invasive ductal carcinoma of 6 cm in the left breast, synchronous and independent, in a 66-year-old patient. The patient underwent a bilateral mastectomy due to the size of both lesions. Such situations are rare and usually refer to the occurrence of ductal or lobular carcinoma in situ when associated with malignant phyllodes tumors, and more often in ipsilateral breast or intra-lesional.     

Abnormal renal vasodilation to an amino acid infusion in congestive heart failure: normalization by enalapril

In congestive heart failure (CHF), the neurohormonal mechanisms that cause renal vasoconstriction, particularly those depending on the renin-angiotensin system, could interfere with renal vasodilating mechanisms. To elucidate this issue, we studied the kidney response to an amino acid infusion (known to cause renal vasodilation in healthy individuals) in eight patients with CHF. We found that the amino acid infusion (0.7 mL/kg/h of a 10% solution) elicited no renal hemodynamic response, in marked contrast to healthy subjects. We next hypothesized that the renin-angiotensin system (known to be activated in heart failure) has a role in the lack of response to the amino acid infusion. To test this hypothesis, we repeated the study after two 5-mg doses of enalapril, an inhibitor of the angiotensin-converting enzyme, administered 12 hours apart. After enalapril treatment, the amino acid infusion caused a 45% increase in mean renal blood flow (RBF) from 383 +/- 55 to 557 +/- 51 mL/min at the fifth hour (P < 0.05). This normalization of the renal response to the amino acid infusion occurred without changes in cardiac output or in systemic vascular resistance. Hence, the renal fraction of the cardiac output increased during the amino acid infusion. The recovery of the renal vascular response was not accompanied by an increase in glomerular filtration rate (GFR; filtration fraction decreased), suggesting a predominant efferent arteriole dilatation. Our study shows that, in heart failure, the kidney loses its ability to increase RBF in response to an amino acid load. This lack of renal vascular response can be restored by inhibiting the renin-angiotensin system and is unrelated to changes in systemic hemodynamics.     

Faster pulmonary oxygen uptake kinetics in children vs adults due to enhancements in oxygen delivery and extraction

This study aimed to examine if the faster pulmonary oxygen uptake (VO_2p) phase 2 in children could be explained by increased O ₂ availability or extraction at the muscle level. For that purpose, O ₂ availability and extraction were assessed using deoxyhemoglobin (HHb) estimated by near‐infrared spectroscopy during moderate‐intensity constant load cycling exercise in children and young adults. Eleven prepubertal boys and 12 men volunteered to participate in the study. They performed one maximal graded exercise to determine the power associated with the gas exchange threshold (GET) and four constant load exercises at 90% of GET. VO_2p and HHb were continuously monitored. VO_2p, HHb, and estimated capillary blood flow () kinetics were modelled after a time delay and characterized by the time to achieve 63% of the amplitude (τ) and by mean response time (MRT: time delay + τ), respectively. Mean values of τ for VO_2p (P < 0.001), of MRT for HHb (P < 0.01) and of MRT for (P < 0.001) were significantly shorter in children. Faster VO_2p kinetics have been shown in children; these appear due to both faster O ₂ extraction and delivery kinetics as indicated by faster HHb and kinetics, respectively.     

Application du concept de puissance critique à différentes populations

Aim

The aim of this review was to state the use of critical power concept at different populations and to summarize studies reported data in order to highlight its interest for the aerobic abilities assessement.

Conclusion

The critical power determination is based on times to exhaustion at different exercise intensities. The synthesis of several studies showed that this concept allows to discriminate populations relatively to their aerobic abilities. This is confirmed by its correlation to maximal oxygen uptake and ventilatory threshold in age and fitness different populations.     

肝脏增强CT扫描与MRI在肝癌诊断中的研究价值

目的探讨增强CT扫描与MRI在肝癌诊断中的价值。方法回顾性分析2014年5月至2016年3月在本院进行影像检查并经手术病理确认的60例肝癌患者的临床资料和影像资料,同时对患者癌变部进行归类分析,并通过两种影像检查方法的确诊率来评判两种检查方式的价值。结果60例中,巨块型占总数,结节型占总数54.5%,小肝癌例数占总数30.3%。增强CT对肝癌患者的总检出率为91.2%,MRI对肝癌患者的总检出率为92.3%。两者无明显统计学差异。结论在肝癌的确诊方面,MRI和增强CT扫描均具有较高的精度,可以作进一步推广应用。     

Lisfranc injury: how frequently does it get missed? And how can we improve?

Lisfranc injuries are sometimes easily missed especially if they present in a subtle form. In this study, we have tried to measure the level of accuracy of plain radiographs in detecting this type of injury. We have selected 30 sets of foot radiographs with various diagnoses. Eighteen of them had a Lisfranc type of injury which was confirmed by operative findings or further imaging. These radiographs, together with a small diagnostic questionnaire, were presented to nine senior clinicians. We found that only 11 of the 18 cases (61%) were detected by all the readers. Eight of nine readers (90%) missed one particular case of subtle Lisfranc injury in a diabetic neuropathic foot. One case of a divergent injury was missed by five readers (56%). Another case with a coexistent Frieberg's disease was missed by three readers (33%). The mean accuracy for all injuries was 87% (95% confidence interval (CI) 84.6-89.9%). The mean accuracy level for detection of Lisfranc injury among the whole series was 92% (CI 89-95%). We think that the presence of a strong clinical index of suspicion or the presence of impaired pain sensation, further imaging is a must to avoid missing this type of injury at early presentation, and consequently the long term poor prognosis.     

宫腹腔镜联合手术诊治不孕症150例分析

目的:探讨宫腹腔镜联合手术在诊治不孕症中的应用。方法:对150例不孕症患者行宫腹腔镜联合手术,对不孕症病因进行诊断,同时行治疗。结果:盆腔粘连和输卵管阻塞是不孕症的主要原因。子宫内膜息肉和正常盆腔占次要比例。子宫内膜异位症和多囊卵巢也是主要病因。150例同时行宫腹腔镜输卵管通液和各种疾病的治疗。联合手术后妊娠率为48.8%。结论:腹腔镜联合手术,在一次麻醉下,可以对不孕的原因全面评价和明确诊断,在诊断同时进行治疗,对不孕症的诊断和治疗有重大的意义,值得推广。