Cholecystitis-related cystic artery pseudoaneurysm: Case report

The pseudoaneurysms of the cystic artery (CAP) are very uncommon. They usually develop as a result of an acute cholecystitis or after a cholecystectomy. Among the complications, we can find hemorrhaging, biliary blockage, and haemobilia. Limited understanding of the illness makes managing specific cases difficult. We describe a case of a cystic artery pseudoaneurysm complicating an acute cholecystitis that was successfully treated by transcatheter arterial embolization.

CORE SIM+ SIMULATIONS OF COLIBRI FUEL RODS OSCILLATION EXPERIMENTS AND COMPARISON WITH MEASUREMENTS

At EPFL, the CROCUS reactor has been used to carry out experiments with vibrating fuel rods. The paper presents a first attempt to employ the measured data to validate CORE SIM+, a neutron noise solver developed at Chalmers University of Technology. For this purpose, the original experimental data are processed in order to extract the necessary information. In particular, detector recordings are scrutinized and detrended, and used to estimate CPSDs of detector pairs. These values are then compared with the ones derived from the CORE SIM+ simulations of the experiments. The main trend of the experimental data along with the values for some detectors are successfully reproduced by CORE SIM+. Further work is necessary on both the experimental and computational sides in order to improve the validation process.

ANALYSIS OF THE FIRST COLIBRI FUEL RODS OSCILLATION CAMPAIGN IN THE CROCUS REACTOR FOR THE EUROPEAN PROJECT CORTEX

The Horizon2020 European project CORTEX aims at developing an innovative core monitoring technique that allows detecting anomalies in nuclear reactors, such as excessive vibrations of core internals, flow blockage, or coolant inlet perturbations. The technique will be mainly based on using the fluctuations in neutron flux recorded by in-core and ex-core instrumentation, from which the anomalies will be differentiated depending on their type, location and characteristics. The project will result in a deepened understanding of the physical processes involved, allowing utilities to detect operational problems at a very early stage. In this framework, neutron noise computational methods and models are developed. In parallel, mechanical noise experimental campaigns are carried out in two zero-power reactors: AKR-2 and CROCUS. The aim is to produce high quality neutron noise-specific experimental data for the validation of the models. In CROCUS, the COLIBRI experimental program was developed to investigate experimentally the radiation noise induced by fuel rods vibrations. In this way, the 2018 first CORTEX campaign in CROCUS consisted in experiments with a perturbation induced by a fuel rods oscillator. Eighteen fuel rods located at the periphery of the core fuel lattice were oscillated between ±0.5 mm and ±2.0 mm around their central position at a frequency ranging from 0.1 Hz to 2 Hz. Signals from 11 neutron detectors which were set at positions in-core and ex-core in the water reflector, were recorded. The present article documents the results in noise level of the experimental campaign. Neutron noise levels are compared for several oscillation frequencies and amplitudes, and at the various detector locations concluding to the observation of a spatial dependency of the noise in amplitude.

Paternal age and risk of testicular germ cell tumors: a cohort study of 1,000,000 men

Testicular germ cell tumors (TGCT) are the most frequent cancer among young men, with increasing incidence worldwide. Advanced paternal age has been linked to adverse health outcomes in offspring, but reports on the association of paternal age with TGCT are few and inconsistent. We aimed to examine the relationship of paternal age (PAB) at birth with the risk of TGCT and by histologic type: seminoma and non-seminoma. A population-based cohort of 1,056,058 males, examined at ages 16-19 between the years 1980-2011, was linked to the Israel National Cancer Registry to obtain incident TGCT through 2012. We applied multivariable Cox regression. During 16.5 million person-years of follow-up, 1247 incident cases (604 seminomas and 643 non-seminomas) were detected. Increasing PAB was linearly associated with lower risk of TGCT (HR_{per year}  = 0.983, 95% CI: 0.974-0.993, p = 0.001), after adjustment for year of birth, years of education, height, cryptorchidism history and origin, and also with additional adjustment for maternal age at birth (MAB) (HR_{per year}  = 0.980: 0.965-0.995, p = 0.008). The association was stronger for seminoma (HR_{per year}  = 0.968: 0.946-0.989, p = 0.004) and persisted in a subset adjusted for sibship size (HR_{per year}  = 0.950: 0.917-0.983, p = 0.003). In the fully adjusted model, young PAB (15-24 vs. ≥30) was a risk factor for seminoma (HR = 1.41: 1.07-1.85, p = 0.014). In models adjusted for PAB, MAB was not associated with risk of TGCT. In conclusion, our findings suggest that young paternal age is a risk factor of TGCT, especially seminoma. The findings warrant further investigation into the possible impact of young paternal age on their offsprings' testes.

Teaching laparoscopic cholecystectomy: do beginners adversely affect the outcome of the operation?

OBJECTIVE

To evaluate the safety of elective laparoscopic cholecystectomy (LC) as a supervised teaching procedure.

DESIGN

Prospectively documented series, retrospective analysis.

SETTING

University teaching hospital, Austria.

SUBJECTS

581 consecutive patients who underwent elective LC for symptomatic cholelithiasis between January 1993 and December 1997.

INTERVENTIONS

LC were allocated to three groups: the first (n = 91) were done by supervised beginners (who had done fewer than 11 LC), the second (n = 249) by supervised trainees who had a little experience (they had done more than 10 but fewer than 51 LC), and the third group (n = 241) who were experienced surgeons (they had done more than 50 LC).

MAIN OUTCOME MEASURES

Minor and major complications, conversion and reoperation rate, length of operation and postoperative hospital stay.

RESULTS

The minor intraoperative complication rates were 36/91 (40%), 115/249 (46%) and 49/241 (20%), respectively (p < 0.001 when experienced surgeons were compared with the 2 trainees' groups). There were no significant differences between the three groups regarding major complications (1/91, 4/249 and 4/241), conversions (5/91, 21/249, and 17/241) and reoperation rate (1/91, 3/249 and 3/241), median (range) length of operation 82 (24-159), 84 (25-249) and 82 (21-234) minutes and hospital stay 4 (3-19), 4 (3-11) and 4 (2-15) days.

CONCLUSION

Elective LC for symptomatic cholelithiasis done by trainees under supervision does not increase surgical morbidity.

Effect of multiple-dose activated charcoal on the clearance of high-dose intravenous aspirin in a porcine model

STUDY OBJECTIVE

To study the effect of multiple-dose activated charcoal (MDAC) on salicylate clearance in pigs given high-dose i.v. aspirin.

DESIGN

In a crossover design, six fasted pigs received 300 mg/kg i.v. aspirin followed by no treatment or MDAC (1 g/kg hourly for 6 doses by gastrostomy). Serum salicylate samples were obtained every 30 minutes for 6 hours.

RESULTS

The mean peak salicylate concentrations were 47.4 +/- 6.2 mg/dL and 48.4 +/- 3.9 mg/dL (P = .74), and the areas under the time-serum salicylate concentration curve over 6 hours were 171,000 +/- 24,000 mg.minute/L and 188,000 +/- 18,000 mg.minute/L for the control and treatment arms, respectively (P = .22). This study had a 90% power to detect a 30% difference between arms.

CONCLUSION

MDAC does not enhance the clearance of salicylate after administration of high-dose i.v. aspirin.

Comparison of anti-HBe-positive and HBe-antigen-positive chronic hepatitis B in France. French Multicentre Group

Two groups of patients with HBV DNA-positive chronic active hepatitis B, from 20 French hospitals, separated according to HBe status, were prospectively subjected to a comparative analysis of various epidemiological, clinical, biochemical, serologic and histologic features. There were 61 patients with anti-HBe and 215 patients with HBeAg. At diagnosis, 25 variables were compared between the two groups. Some of the patients were followed up for 1 year. Anti-HBe chronic hepatitis B occurred with a prevalence of 22.1%. In the anti-HBe-chronic hepatitis B group, the patients were older, and more often of Southern European origin; the source of infection was more frequently unknown, hepatitis B markers were more frequently observed within the family, and the estimated duration of liver disease was longer. Serum HBV DNA levels were lower in the anti-HBe-positive group. No difference was observed in ALT levels at diagnosis and during follow up in the patients studied. Cirrhosis was more frequent in the anti-HBe-positive group. There was no difference in histological activity score between the two groups. These results suggest that anti-HBe-positive, chronic active hepatitis B is not rare in France, and that the higher occurrence of cirrhosis in this group may be related to a longer duration of the disease.