ABSTRACT
Patients with hepatocellular carcinoma who are on liver transplant waiting list usually require local treatment to limit any risk of tumour growth. Historically percutaneous radiofrequency ablation or transarterial chemoembolization represented the major therapeutic alternatives. Depending on the size, or the topography of the lesion these two techniques may not be feasible. Radiation therapy under stereotactic conditions has recently emerged in the management of localized hepatocellular carcinoma as an alternative to the focused therapies performed to date. We herein report the case of a 43-year-old patient harbouring a complete histological response on explant after liver stereotactic irradiation and discuss its role in the management of hepatocellular carcinoma before liver transplantation.
Subject(s)
Carcinoma, Hepatocellular/radiotherapy , Liver Neoplasms/radiotherapy , Liver Transplantation , Radiosurgery , Adult , Carcinoma, Hepatocellular/surgery , Combined Modality Therapy , Contraindications, Procedure , Dose Fractionation, Radiation , Female , Heparin, Low-Molecular-Weight/therapeutic use , Humans , Liver Neoplasms/surgery , Radiosurgery/methods , Remission Induction , Vena Cava Filters , Vena Cava, Inferior , Venous Thrombosis/complications , Venous Thrombosis/drug therapy , Venous Thrombosis/therapySubject(s)
Niacinamide/analogs & derivatives , Phenylurea Compounds/administration & dosage , Skin Diseases/drug therapy , Skin/pathology , Administration, Topical , Aged , Antineoplastic Agents/administration & dosage , Biopsy , Humans , Male , Middle Aged , Niacinamide/administration & dosage , Receptors, Vascular Endothelial Growth Factor , Skin Diseases/pathology , SorafenibABSTRACT
PURPOSE: The aim of this study is to conduct a forced degradation study on ifosfamide under several stress conditions to investigate the robustness of the developed HPLC method. It also aims to provide further insight into the stability of ifosfamide and its degradation profile using both HPLC and NMR. METHODS: Ifosfamide solutions (20mg/mL; n=15, 20mL) were stressed in triplicate by heating (70°C), under acidic (pH 1 & 4) and alkaline (pH 10 & 12) conditions. Samples were analysed periodically using HPLC and FT-NMR. RESULTS AND DISCUSSION: Ifosfamide was most stable under weakly acidic conditions (pH 4). NMR results suggested that the mechanism of ifosfamide degradation involves the cleavage of the PN bond. For all stress conditions, HPLC was not able to detect ifosfamide degradation products that were detected by NMR. CONCLUSION: These results suggest that the developed HPLC method for ifosfamide did not detect the degradation products shown by NMR. It is possible that degradation products co-elute with ifosfamide, do not elute altogether or are not amenable to the detection method employed. Therefore, investigation of ifosfamide stability requires additional techniques that do not suffer from the aforementioned shortcomings.
Subject(s)
Antineoplastic Agents, Alkylating/chemistry , Chromatography, High Pressure Liquid/methods , Ifosfamide/chemistry , Magnetic Resonance Spectroscopy/methods , Acids , Alkalies , Drug Stability , Hot Temperature , Pharmaceutical Solutions/chemistryABSTRACT
Neurologic disorders, mainly Guillain-Barré syndrome and ParsonageTurner syndrome (PTS), have been described in patients with hepatitis E virus (HEV) infection in industrialized and developing countries. We report a wider range of neurologic disorders in nonimmunocompromised patients with acute HEV infection. Data from 15 French immunocompetent patients with acute HEV infection and neurologic disorders were retrospectively recorded from January 2006 through June 2013. The disorders could be divided into 4 main entities: mononeuritis multiplex, PTS, meningoradiculitis, and acute demyelinating neuropathy. HEV infection was treated with ribavirin in 3 patients (for PTS or mononeuritis multiplex). One patient was treated with corticosteroids (for mononeuropathy multiplex), and 5 others received intravenous immunoglobulin (for PTS, meningoradiculitis, Guillain-Barré syndrome, or Miller Fisher syndrome). We conclude that pleiotropic neurologic disorders are seen in HEV-infected immunocompetent patients. Patients with acute neurologic manifestations and aminotransferase abnormalities should be screened for HEV infection.
Subject(s)
Acute Disease/mortality , Hepatitis E/complications , Immunocompetence , Nervous System Diseases/etiology , Adult , Aged , Education, Medical, Continuing , Female , Hepatitis E/physiopathology , Humans , Male , Middle Aged , Nervous System Diseases/mortalityABSTRACT
BACKGROUND: In developed countries, hepatitis E is a porcine zoonosis caused by hepatitis E virus (HEV) genotype 3. In developing countries, hepatitis E is mainly caused by genotype 1, and causes increased mortality in patients with pre-existing chronic liver disease (CLD). AIM: To determine the role of HEV in patients with decompensated CLD. METHODS: Prospective HEV testing of 343 patients with decompensated CLD at three UK centres and Toulouse France, with follow-up for 6 months or death. IgG seroprevalence was compared with 911 controls. RESULTS: 11/343 patients (3.2%) had acute hepatitis E infection, and three died. There were no differences in mortality (27% vs. 26%, OR 1.1, 95% CI 0.28-4.1), age (P = 0.9), bilirubin (P = 0.5), alanine aminotransferase (P = 0.06) albumin (P = 0.5) or international normalised ratio (P = 0.6) in patients with and without hepatitis E infection. Five cases were polymerase chain reaction (PCR) positive (genotype 3). Hepatitis E was more common in Toulouse (7.9%) compared to the UK cohort (1.2%, P = 0.003). HEV IgG seroprevalence was higher in Toulouse (OR 17, 95% CI 9.2-30) and Truro (OR 2.5, 95% CI 1.4-4.6) than in Glasgow, but lower in cases, compared to controls (OR 0.59, 95% CI 0.41-0.86). CONCLUSIONS: Hepatitis E occurs in a minority of patients with decompensated chronic liver disease. The mortality is no different to the mortality in patients without hepatitis E infection. The diagnosis can only be established by a combination of serology and PCR, the yield and utility of which vary by geographical location.
Subject(s)
End Stage Liver Disease/virology , Immunoglobulin G/blood , Adult , Alanine Transaminase/blood , Bilirubin/blood , End Stage Liver Disease/epidemiology , Female , France/epidemiology , Genotype , Hepatitis E/diagnosis , Hepatitis E virus/genetics , Humans , Male , Middle Aged , Prospective Studies , Seroepidemiologic Studies , United Kingdom/epidemiologyABSTRACT
Using the international organonymy is mandatory as well for daily clinical practice as for research and teaching our students. The international organonymy, Nomina Anatomica, is in Latin. A rather unsuccessful attempt at using a French version of the international organonymy in clinical practice has been made in France. Eponyms have been systematically contraindicated; the definitions of general anatomy are applied, as well as a systematic Gallicization of the Latin terminology. Despite a stringent observance of these rules, some terms remain inappropriate because they are misleading or inaccurate. Furthermore, using this language used worldwide remains uneasy in daily clinical practice. We had for objective to focus on the main anatomical terms used routinely in oral and maxillofacial surgery, and to justify their use in clinical practice, research, and education.
Subject(s)
Anatomy , Head/anatomy & histology , Oral Surgical Procedures , Surgery, Oral , Terminology as Topic , Anatomy/methods , Anatomy/trends , France , Humans , Language , Neck/anatomy & histology , Oral Surgical Procedures/classification , Surgery, Oral/classification , Surgery, Oral/methods , TranslatingABSTRACT
In industrialized countries, most cases of hepatitis E virus (HEV) infection in humans are autochthonous, mainly through foodborne and zoonotic transmission routes. In Europe, genotype 3 is a cause of acute self-limiting viral hepatitis, but can also be responsible for chronic hepatitis in immunocompromised patients. Ribavirin has been successfully used in the treatment of chronic hepatitis E and in a few cases of severe acute hepatitis E in immunocompetent patients. We report here the case of a 39 year-old man infected with HIV presenting with acute hepatitis E (genotype 3c). Unlike most cases, evolution was severe with a fall of prothrombin time down to 45%. Treatment with ribavirin allowed rapid viral clearance and a gradual normalization of liver function tests.
Subject(s)
HIV Infections/complications , Hepatitis E/drug therapy , Ribavirin/therapeutic use , Adult , Alanine Transaminase/blood , Bilirubin/blood , CD4 Lymphocyte Count , HIV Infections/virology , Hepatitis Antibodies/blood , Hepatitis E/complications , Hepatitis E/virology , Humans , Immunocompromised Host , Liver Function Tests , Male , Prothrombin Time , RNA, Viral/blood , Viral Load/drug effectsABSTRACT
Primary and metastatic mandibular melanoma are extremely rare. We report the original case of a 55-year-old woman treated 16 years before for a cutaneous melanoma, and now presenting with a huge mandibular amelanotic melanoma. Was it an histologically different mandibular metastasis of the previous cutaneous melanoma, or a metachronous oral amelanotic melanoma?
Subject(s)
Mandibular Neoplasms/secondary , Melanoma, Amelanotic/pathology , Melanoma/secondary , Mouth Neoplasms/pathology , Neoplasms, Second Primary/pathology , Skin Neoplasms/pathology , Female , Humans , Middle Aged , Mouth , Neoplasm InvasivenessABSTRACT
INTRODUCTION: The surgical treatment of mandibular condylar fractures is commonly performed. We had for aim to present the latest trends in the surgical management of condylar fractures in France, between 2005 and 2012. MATERIAL AND METHODS: A survey was performed among the 49 members of the French college of oral and maxillofacial surgeons between January and September 2012, with a questionnaire sent by email. We analyzed the therapeutic management, the surgical indications; the techniques used according to the fracture, and the postoperative treatment protocols. The data was compared to that of a similar study performed in 2005. RESULTS: The overall reply rate was 86%. Low subcondylar fractures were operated on in all institutions (100%), compared to 76% in 2005. The most popular technique was the high submandibular approach with intraoral miniplate fixation osteosynthesis. High subcondylar and diacapitular fractures were operated on in respectively 82% and 35% of the cases compared to 29% and 10% in 2005 with various surgical techniques and postoperative management. DISCUSSION: French maxillofacial surgeons operated on more mandibular condylar fractures in 2012 than in 2005. As observed in 2005, the lower and the more dislocated the fractures were, the more they were operated on. The high submandibular approach has become the most popular approach. The use of miniplates for bone fixation has become common. Diacapitular fractures were usually treated functionally. The postoperative management varied greatly from one team to the other.
Subject(s)
Fracture Fixation, Internal/trends , Mandibular Condyle/surgery , Mandibular Fractures/surgery , Adolescent , Fracture Fixation, Internal/methods , Fracture Fixation, Internal/statistics & numerical data , France/epidemiology , Humans , Length of Stay , Mandibular Fractures/epidemiology , Postoperative Complications/epidemiology , Surveys and QuestionnairesABSTRACT
Hepatitis E virus (HEV) is responsible for major outbreaks of acute hepatitis in developing countries where it was first described as a waterborne disease, transmitted by drinking water contaminated with feces. Attention was focused on HEV in developed countries and its associated diseases in recent years as a result of increasing reports of autochthonous infections. Hepatitis E is the zoonotic cause of these acute infections, and mainly in men over 50 years of age. The clinical manifestations and laboratory abnormalities of hepatitis E infections in immunocompetent patients cannot be distinguished from those caused by other hepatitis viruses. HEV is a major public health concern in immunocompromised patients because their infections can become chronic. The specific etiology of cases of hepatitis E infection can be diagnosed by serological testing and detecting viral RNA. Ribavirin is currently the reference treatment for HEV infections in immunocompromised patients. Several vaccines have proved safe and effective in clinical trials, but none have been approved for use in Europe yet.
Subject(s)
Hepatitis E virus/physiology , Hepatitis E/epidemiology , Animals , Antibodies, Viral/blood , Antiviral Agents/therapeutic use , Developing Countries , Feces/virology , Female , Genome, Viral , Hepatitis E/diagnosis , Hepatitis E/prevention & control , Hepatitis E/therapy , Hepatitis E/transmission , Hepatitis E/veterinary , Hepatitis E/virology , Hepatitis E virus/classification , Hepatitis E virus/genetics , Hepatitis, Viral, Animal/epidemiology , Hepatitis, Viral, Animal/transmission , Hepatitis, Viral, Animal/virology , Humans , Immunocompromised Host , Immunoglobulin M/blood , Liver Transplantation , Male , Pregnancy , Pregnancy Complications, Infectious/epidemiology , Pregnancy Complications, Infectious/virology , RNA, Viral/genetics , Swine , Swine Diseases/epidemiology , Swine Diseases/transmission , Swine Diseases/virology , Transfusion Reaction , Viral Hepatitis Vaccines , Water Microbiology , Water Pollution , ZoonosesABSTRACT
Acute pancreatitis is a sudden swelling and inflammation of the pancreas. The two most common causes are alcohol use and biliary stones. Drug-induced acute pancreatitis are rare (1.4-2%). In this present study, we present a case of recurrent acute pancreatitis induced by a specific magnetic-resonance-imaging (MRI) contrast agent called gadobenate dimeglumine.
Subject(s)
Gadolinium/adverse effects , Meglumine/analogs & derivatives , Organometallic Compounds/adverse effects , Pancreatitis/chemically induced , Acute Disease , Female , Humans , Meglumine/adverse effects , Middle Aged , RecurrenceABSTRACT
In European countries, epidemiology of hepatitis E virus (HEV) infection is not well known. Although, seroprevalence of HEV Immunoglobulin G reached a few percent in European women, no acute hepatitis E during pregnancy has been described so far. Here, we report a case of an autochthonous HEV genotype 3 infection in a 41-years-old pregnant woman living in a non-endemic country. The acute hepatitis had a spontaneous good outcome for the mother and the child. In non-endemic areas where Hepatitis E infections are emerging, unexplained cytolysis, whatever its level, in a pregnant woman could be investigated for HEV, using biological molecular and serology tools.
Subject(s)
Hepatitis E virus/isolation & purification , Hepatitis E/diagnosis , Pregnancy Complications, Infectious/diagnosis , RNA, Viral/genetics , Adult , Female , France , Genotype , Hepatitis E virus/classification , Hepatitis E virus/genetics , Humans , Infant , Infant, Newborn , Pregnancy , Treatment OutcomeABSTRACT
OBJECTIVE: Cranioplasty is an everyday concern in neurosurgery, especially in decompressive craniectomy cases. Our surgical team uses custom-made hydroxyapatite implants for large and/or complex defects. PATIENTS AND METHOD: Eight patients had a custom-made prosthesis. Each of them has been reviewed by an independent observer. Each patient described his feeling of satisfaction, using a questionnaire, graduated from "A" (really satisfied) to "D" (unsatisfied). Each of them also underwent a CT-scan (helicoidal acquisition, 0.6mm thick for multiplanar reconstruction) to evaluate qualitatively the ossification graduated from "0" (no ossification) to "5" (continuous ossification). Maximal under-prosthetic bone thickness, intra-prosthetic calcic density were also reported. RESULTS: Supervision delay was 43.7 months [6-99 months], average defect surface was 85.5 cm(2) [27.6-137.6 cm(2)], the craniectomy etiologies were intracranial hypertension (seven patients) and calvarial invasion (one patient). Implant tolerance was reparted in "A" score (50%) and "B" score (50%). Concerning ossification, six patients (75%) had a score of "2" or less and two patients had a score of "3" or "4". DISCUSSION: Hydroxyapatite custom-made implants for cranioplasty appear to be ideal for good aesthetic and tolerance results, but their ossification is hardly analyzed due to the prosthesis density higher than the bone's density. This is why we recommend them for children and in cases of complex defects such as pterion location.
Subject(s)
Intracranial Hypertension/surgery , Ossification, Heterotopic/physiopathology , Patient Satisfaction , Prostheses and Implants , Skull/surgery , Craniotomy/adverse effects , Durapatite , Humans , Neurosurgical Procedures , Prosthesis Implantation , Plastic Surgery Procedures , Skull/injuries , Surveys and Questionnaires , Tomography, X-Ray ComputedABSTRACT
INTRODUCTION: The indication of the buccal mucosal graft for urethroplasty has evolved over recent years. The ease of its harvesting, availability, and immunohistological properties, as well as its satisfactory results, has made the buccal mucosal graft the current procedure of choice. We report a case of use of a buccal mucosal graft to treat an urethral stricture correction. CASE REPORT: A 48-year-old man underwent a buccal mucosal graft for post-infectious urethral stricture correction. An inner right cheek graft of 50 × 30 mm was harvested and inserted into place after complete excision of the stricture. Postoperative evolution was satisfactory with no pain at the 5th day, resumption of normal diet at the 12th day, a significant improvement of peak flow rate at the 21st day. Follow-up examination at the 7th week revealed a mouth opening to 40 mm with complete healing. DISCUSSION: Buccal mucosal graft has currently the highest success rate compared to other surgical techniques as full thickness skin graft from hair or graft of bladder mucosa. Its harvesting can be single or multiple, however care must be taken as regards Stenon's duct and to the labial commissure. The complications of the donor site are infrequent and can be characterized by numbness and limited mouth opening. Tissues that contain immunohistological properties, which are similar to those of the urothelium, buccal mucosal graft, have become the gold standard for this type of correction.
Subject(s)
Mouth Mucosa/transplantation , Surgical Flaps/surgery , Urethral Stricture/surgery , Follow-Up Studies , Humans , Male , Middle Aged , Postoperative Complications/diagnostic imaging , Tissue and Organ Harvesting/methods , Urethral Stricture/diagnostic imaging , Urography , Wound Healing/physiologyABSTRACT
Focal infection of oral origin means that an oral infectious focus may have widespread effects. This concept remains controversial since it is difficult to prove the oral origin of germs responsible for an extra-oral infection. Experiments on animal models and clinical studies suggested several physiopathological mechanisms: bacteremia, toxinic and immunological mechanisms. Various operations induce the passage of bacterial flora (transcytosis) and its toxins into the bloodstream: oral care, chewing, or tooth brushing. Bacteremia is worsened by poor oral hygiene or an infection. The germs are usually destroyed by the host's reticuloendothelial system in a few minutes, but the presence of a valvular disease or a weak immune system favors focal infection. Besides infectious endocarditis, this may concern cardiovascular diseases, lung infections, prematurity and hypotrophy, diabetes, prosthetic infections, cerebral abscesses, etc. This update is based on literature review, selected according to its high level of scientific proof, as well as on a selected choice of consensus conferences. The current recommendation is to limit antibiotic prophylaxis to the high bacteremia risk procedures and to patients highly at risk of developing a focal infection.
Subject(s)
Focal Infection/complications , Mouth Diseases/complications , Stomatognathic Diseases/complications , Animals , Antibiotic Prophylaxis/methods , Bacteremia/prevention & control , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/etiology , Cardiovascular Diseases/prevention & control , Endocarditis, Bacterial/prevention & control , Focal Infection/diagnosis , Focal Infection/epidemiology , Focal Infection/therapy , Humans , Mouth Diseases/diagnosis , Mouth Diseases/epidemiology , Mouth Diseases/therapy , Oral Hygiene/adverse effects , Prosthesis-Related Infections/complications , Prosthesis-Related Infections/diagnosis , Prosthesis-Related Infections/therapy , Stomatognathic Diseases/diagnosis , Stomatognathic Diseases/epidemiology , Stomatognathic Diseases/therapyABSTRACT
INTRODUCTION: It is mandatory to know the anatomic path of the mandibular nerve and its intra-mandibular connections for numerous odontology, stomatology, and maxillofacial surgical procedures. We present a computed tomography study of the mandibular nerve intra-mandibular path. PATIENTS AND METHOD: The computed tomography of 14 mandibles was performed (vestibulo-lingual cross-section) and four landmarks were defined behind the mental foramen. At each landmark, we measured the distance between the alveolar canal and the two cortical layers in the vestibulo-lingual plane, and the distance between the alveolar canal and the alveolar crest, and the inferior border of the mandible in the vertical plane. RESULTS: In the vestibulo-lingual plane, the mandibular nerve is located close to the vestibular cortical layer, then to the lingual cortical before it exits. In the crestal plane, it is located at the superior third of the inferior border of the mandible. DISCUSSION: In spite of anatomical variability, there is a globally common path which means that the utmost caution should be taken by performing systematic imaging before undertaking any surgery close to the nerve.