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1.
J Clin Periodontol ; 51(5): 522-535, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38343130

RESUMO

AIM: We investigated whether periodontal measures are cross-sectionally associated with prediabetes and cardiometabolic biomarkers among non-diabetic younger adults. MATERIALS AND METHODS: One thousand seventy-one participants (mean age = 32.2 years [SE = 0.3]; 73% female) from the Oral Infections, Glucose Intolerance and Insulin Resistance Study were enrolled. Full-mouth clinical attachment loss (fm-CAL), probing depth (fm-PD) and bleeding on probing were ascertained. Interproximal CAL (i-CAL) and probing depths (i-PD) served as our primary exposures. Glucose, HbA1c, insulin and insulin resistance (HOMA-IR) outcomes were assessed from fasting blood. Prediabetes was defined per American Diabetes Association guidelines. Prediabetes prevalence ratios (PR [95% CI]) and mean [SE] cardiometabolic biomarkers were regressed on periodontal variables via multivariable robust variance Poisson regression or multivariable linear regression. RESULTS: Prevalence of prediabetes was 12.5%. Fully adjusted prediabetes PR in Tertiles 3 versus 1 of mean i-CAL was 2.42 (1.77, 3.08). Fully adjusted fasting glucose estimates across i-CAL tertiles were 83.29 [0.43], 84.31 [0.37], 86.48 [0.46]; p for trend <.01. Greater percent of sites with i-PD ≥3 mm showed elevated natural-log-HOMA-IR after adjustment (0%-12% of sites = 0.33 [0.03], 13%-26% of sites = 0.39 [0.03], ≥27% of sites = 0.42 [0.03]; p for trend = .04). CONCLUSIONS: i-CAL (vs. fm-CAL) was associated with elevated fasting glucose and prediabetes, whereas i-PD (vs. fm-PD) was associated with insulin resistance. Future studies are needed to examine periodontal disease and incident prediabetes.


Assuntos
Doenças Cardiovasculares , Diabetes Mellitus , Resistência à Insulina , Estado Pré-Diabético , Adulto , Humanos , Feminino , Masculino , Estado Pré-Diabético/epidemiologia , Glucose , Glicemia , Hemoglobinas Glicadas , Diabetes Mellitus/epidemiologia , Biomarcadores
2.
Am J Health Educ ; 54(6): 451-462, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-38486878

RESUMO

Background: Personal Health literacy (PHL) is essential in cardiovascular risk management. Hindrances in PHL can lead to poor cardiovascular outcomes. Purpose: To investigate whether limited PHL is associated with lower likelihoods of i) overall cardiovascular health and ii) individual cardiovascular health components as defined by the American Heart Association's Life Simple (LS7). Methods: Multi-Ethnic Study of Atherosclerosis participants (N=3719; median age[range]: 59[45-84]) completed a PHL questionnaire in 2016-2018. PHL was classified as limited (score ≥10) or adequate (score <10). LS7 components were measured in 2000-2002. Robust Poisson regression was employed to compute prevalence ratios and 95% confidence intervals (PR[95%CI]) of LS7 measures. Results: 14.7% of participants had limited PHL. Limited PHL was associated with lower likelihoods of optimal LS7 (0.69[0.50, 0.95], p=0.02) and average LS7 (0.95[0.88, 1.02], p=0.15) after adjustment. Limited PHL was significantly associated with a 7% lower likelihood of ideal fasting blood glucose level after adjustment (0.93[0.89, 0.98], p<0.01). Discussion: Limited PHL was modestly associated with suboptimal cardiovascular health and elevated blood glucose, independent of income and education. Translation to Health Education Practice: Health educators and providers should equitably address PHL barriers to improve cardiovascular management and quality of care for patients and communities.

3.
J Clin Periodontol ; 49(4): 322-334, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-34905804

RESUMO

AIM: We investigate if periodontal disease is prospectively associated with cerebrovascular and neurodegenerative markers of dementia and Alzheimer's pathology. MATERIALS AND METHODS: N = 1306 participants (Visit 5 mean age = 76.5 [standard deviation = 5.4] years) in the Atherosclerosis Risk in Communities study with completed dental exams at Visit 4 underwent brain magnetic resonance imaging scans at Visit 5 while N = 248 underwent positron emission tomography scans. Participants were classified as edentulous or, among the dentate, by the modified Periodontal Profile Class. Brain volumes were regressed on periodontal status in linear regressions. Cerebrovascular measures and ß-amyloid positivity were regressed on periodontal status in logistic regressions. RESULTS: Periodontal disease was not associated with brain volumes, microhaemorrhages, or elevated ß-amyloid. Compared with periodontally healthy individuals, odds ratios [95% confidence interval] for all-type infarcts were 0.37 [0.20, 0.65] for severe tooth loss and 0.56 [0.31, 0.99] for edentulous participants. CONCLUSIONS: Within the limitations of this study, periodontal disease was not associated with altered brain volumes, microhaemorrhages, or ß-amyloid positivity. Tooth loss was associated with lower odds of cerebral infarcts.


Assuntos
Aterosclerose , Doenças Periodontais , Perda de Dente , Idoso , Peptídeos beta-Amiloides/metabolismo , Aterosclerose/complicações , Aterosclerose/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Encéfalo/metabolismo , Humanos , Neuroimagem , Doenças Periodontais/complicações , Doenças Periodontais/diagnóstico por imagem , Perda de Dente/complicações , Perda de Dente/diagnóstico por imagem
4.
Cureus ; 13(10): e18955, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34815901

RESUMO

We report the case of a 54-year-old male with alcoholic cirrhosis who presented several times to the emergency department (ED) with right upper quadrant abdominal pain. Ten days after his initial presentation, the patient represented with hypotension and anemia. An abdominal CT angiogram identified hemorrhage from an ectopic varix successfully treated with emergent glue embolization of mesenteric, omental, and periumbilical varices. Intraperitoneal bleeding from ectopic varices in cirrhosis patients is a rare, life-threatening condition. Consideration and recognition of ectopic variceal hemorrhage in patients with cirrhosis can facilitate prompt life-saving treatment in a population susceptible to significant morbidity and mortality.

5.
J Clin Endocrinol Metab ; 106(9): e3546-e3558, 2021 08 18.
Artigo em Inglês | MEDLINE | ID: mdl-33982107

RESUMO

PURPOSE: To determine whether periodontal disease is positively associated with incident diabetes across the continuum of body mass levels (BMI) and test the hypothesis that the periodontal risk for incident diabetes is modified by BMI. METHODS: We included 5569 diabetes-free participants from Visit 4 (1996-1998) of the Atherosclerosis Risk in Communities study and followed them until 2018. Periodontal disease status was classified by periodontal profile class (PPC)-Stages , and incident diabetes was based on participant report of physician diagnosis. We estimated the hazard ratios (HR) for diabetes using a competing risk model for each PPC-Stage. We assessed multiplicative interactions between periodontal disease and BMI (as a continuous variable) on risk of diabetes. RESULTS: During a median time of 19.4 years of follow-up, 1348 incident diabetes cases and 1529 deaths occurred. Compared to the "Health/Incidental Disease" stage, participants with PPC "Severe Periodontal Disease" or "Severe Tooth Loss" stage and lower BMI had elevated risk for diabetes adjusting for demographic, smoking, education, and biological variables when accounting for death as a competing risk with HRs of 1.76 (95% CI 1.10-2.80) and 2.11 (95% CI 1.46-3.04), respectively. The interaction between PPC-Stages and BMI was significant (P = 0.01). No significant associations of PPC-Stages with incident diabetes were present when BMI was above 31 kg/m2. CONCLUSION: Periodontal disease was associated with incident diabetes, especially in nonobese participants. Dentists should be aware that periodontal disease is associated with incident diabetes but the association may be modified for patient's at higher BMI levels.


Assuntos
Aterosclerose/epidemiologia , Índice de Massa Corporal , Complicações do Diabetes/epidemiologia , Diabetes Mellitus/epidemiologia , Periodontite/complicações , Periodontite/epidemiologia , Adulto , Idoso , Estudos de Coortes , Etnicidade , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Obesidade/epidemiologia , Modelos de Riscos Proporcionais , Risco , Fatores Socioeconômicos
6.
Basic Clin Androl ; 30: 10, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32685170

RESUMO

SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) metamorphosed our medical practice. In early June 2020, more than 6,400,000 COVID-19 (coronavirus-19 disease) cases were diagnosed across the world and more than 380,000 deaths were linked to COVID-19. Many medical symptoms of COVID-19 were reported. We will focus, here, on potential impacts of COVID-19 on men's andrological health. Our society (French-speaking society of andrology, SALF) also emitted some recommendations in the andrological management of men infected by SARS-CoV-2. First, considering the fever and the potential presence of SARS-CoV2 in semen, SALF recommends waiting for 3 months (duration of one spermatogenesis cycle and epididymal transit) before re-starting ART in the case of men diagnosed COVID-19 positive. Whatever the nature of testosterone and COVID-19 relationships, we recommend an andrological examination, sperm parameters, and hormonal evaluation at the time of the COVID-19 is diagnosed, and several months later. Furthermore, we are concerned by the potential morbid-mortality of the COVID-19, which mainly affects men. This "andrological bias", if proven, must be reduced by specific andrological diagnosis, therapeutic and prophylactic measures. Research in this direction must be substantiated and financially supported over the next few months (years).


Le SRAS-CoV-2 (nouveau coronavirus ou coronavirus numéro 2 responsable du syndrome respiratoire aigu sévère) a métamorphosé notre pratique médicale. Début juin 2020, plus de 6,400,000 cas de COVID-19 (maladie à coronavirus 2019) ont été diagnostiqués dans le monde et plus de 380,000 décès ont été reliés à cette maladie. De nombreux symptômes médicaux de cette infection virale ont été signalés. Nous nous concentrerons, ici, sur les impacts potentiels de COVID-19 sur la santé andrologique des hommes. Notre société (Société d'andrologie de langue Française, SALF) émet ici quelques recommandations dans la prise en charge andrologique des hommes infectés par le SRAS-CoV-2. Tout d'abord, compte tenu de la fièvre et de la présence potentielle du SRAS-CoV2 dans le sperme, la SALF recommande d'attendre 3 mois (durée d'un cycle de spermatogenèse et transit épididymaire) avant de recommencer les techniques d'assistance médicale à la procréation pour les hommes diagnostiqués COVID-19 positifs. Quelle que soit la nature des relations entre la testostérone et l'infection à SARS-CoV-2, nous recommandons un examen andrologique, un examen des paramètres du sperme et une évaluation hormonale au moment du diagnostic de l'infection, ainsi qu'à distance (3­6 mois plus tard). De plus, nous sommes préoccupés par la morbidité et la mortalité potentielles de l'infection COVID-19, qui touche principalement les hommes. Ce "biais andrologique", s'il est. prouvé, doit être réduit par un diagnostic andrologique spécifique et des mesures thérapeutiques et prophylactiques. La recherche dans ce sens doit être étayée et soutenue financièrement au cours des prochains mois (années).

7.
Lasers Surg Med ; 51(4): 363-369, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30575060

RESUMO

BACKGROUND: Femtosecond (fs) Laser Ionisation Mass Spectrometry (fs-LIMS) on colon tissues are described and investigated using ionization/fragmentation processes in details to present a new application in this study. Linear Time of Flight (L-TOF) mass analyzer was utilized to investigate paraffin-embedded human tissue in this study. The effect of fs laser intensity on the spectral characteristics was investigated and interpreted due to mass spectra obtained using 800 nm wavelength with 90 fs pulses at 1 kHz repetition rate. OBJECTIVES: Mass spectra of tissues were recorded from L-TOF system and then analyzed by performing a statistical approach called Principal Component Analysis (PCA). The fs-LIMS method applied is proposed as a new and pioneering technology to analyze tissues using L-TOF system, as a human free fast and reliable intra-operative cancer diagnosis method for guiding surgeon to clean the edges of cancerous tissues to be applied during the surgical operation, for pathological examinations. Fs-LIMS provides some unique diagnosis opportunities to investigate biochemical characteristics of cancerous tissues leading to obtain sensitive, fast, and reliable results. The analysis of tissue is based on distribution of molecular ion (m/z) peaks in low mass region (

Assuntos
Adenocarcinoma/diagnóstico , Colo/patologia , Neoplasias do Colo/diagnóstico , Lasers , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz/métodos , Adenocarcinoma/patologia , Neoplasias do Colo/patologia , Diagnóstico Diferencial , Humanos , Análise de Componente Principal , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz/instrumentação
8.
Opt Lett ; 43(20): 4965-4968, 2018 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-30320795

RESUMO

We present an experimental characterization of the internal oscillations, vibrations, and transients of optical soliton molecules generated in a passively mode-locked thulium-doped fiber laser. We use custom linearly chirped Bragg grating filters to perform real-time spectral measurement of the ultrafast dynamics at wavelengths around 2 µm.

9.
Ann Cardiol Angeiol (Paris) ; 67(3): 111-118, 2018 Jun.
Artigo em Francês | MEDLINE | ID: mdl-29786509

RESUMO

GOALS: Preeclampsia (PE) is a leading cause of maternal and neonatal morbidity and mortality. Early treatment by aspirin has been shown to significantly reduce PE risk before 37weeks supporting the implementation of first-trimester screening. SUBJECTS AND METHODS: A targeted screening was recently implemented at Toulouse University Hospital for women in their first pregnancy or those with personal or familial history of PE. It uses Fetal Medicine Foundation (FMF) algorithm that combines maternal characteristics, clinical, biophysical and biochemical (PAPP-A, Pregnancy Associated Plasma Protein-A, and PlGF, Placental Growth Factor) data. We describe this first population of pregnant women and compare our results with those of a mini-test that excludes PlGF and biophysical data. RESULTS: Between October 2016 and September 2017, 500women have benefited from this screening. In such targeted population, we identified 3,6 % (n=18) of women at high risk to develop PE before 34weeks and 9,6 % (n=48) of women at high risk to develop PE between 34 and 37weeks. When we recalculated the risk using the mini-test, only 10women (56 %) were identified at high risk of early PE. CONCLUSION: For the first time in France, we report the result of a targeted screening of PE during the first trimester using the FMF algorithm. We describe the screened population and show that it is more efficient than the mini-test.


Assuntos
Pré-Eclâmpsia/diagnóstico , Adulto , Diagnóstico Precoce , Feminino , França , Hospitais Universitários , Humanos , Gravidez , Primeiro Trimestre da Gravidez , Estudos Retrospectivos
10.
Andrology ; 5(4): 783-789, 2017 07.
Artigo em Inglês | MEDLINE | ID: mdl-28544660

RESUMO

In cryptorchid boys, failures in germ cell development have been clearly established. Some studies reported some abnormalities in Sertoli cells morphology but the results regarding their endocrine secretion remain controversial. To compare testicular hormone levels in young boys with and without cryptorchidism, we performed a cross-sectional hospital-based study. From surgery appointment records, we identified a case group of boys with unilateral or bilateral cryptorchidism and a control group undergoing dental care, minor osteoarticular or dermal surgery. Blood samples were withdrawn during the surgical procedure to perform testosterone, inhibin B and anti-müllerian hormone (AMH) immunoassays. We included 27 cryptorchid boys and 27 controls aged of 26.6 vs. 24.2 months, respectively (p = 0.172) far from the post-natal mini-puberty and the corresponding hormonal surges. Age-adjusted AMH and inhibin B levels were significantly lower in cryptorchid than in control boys (AMH: 87 ng/mL vs. 135 ng/mL; p = 0.009, inhibin B: 97 pg/mL vs. 133 pg/mL; p = 0.019, respectively). Moreover, AMH and inhibin B levels were significantly lower in the bilateral cryptorchid subgroup, being 50% lower than in the controls (p = 0.011 and 0.019, respectively) and while both hormones levels were independent in controls, they became strongly correlated in bilateral cryptorchid boys (R² = 0.75, p = 0.001). In addition, testosterone levels were still detectable in some boys, with significantly lower levels in cryptorchid group than in controls. Overall, 2-year-old cryptorchid patients presented a simultaneous and significant drop in AMH and inhibin B levels, suggesting a functional defect of Sertoli cells. This deficiency appeared more pronounced in bilateral cryptorchidism and thus, regarding the pivotal role of Sertoli cells in germ cell development, it may explain the compromised fertility found later in men born with such a malformation.


Assuntos
Hormônio Antimülleriano/sangue , Criptorquidismo/sangue , Inibinas/sangue , Células de Sertoli/metabolismo , Testosterona/sangue , Fatores Etários , Hormônio Antimülleriano/metabolismo , Biomarcadores/sangue , Estudos de Casos e Controles , Pré-Escolar , Estudos Transversais , Criptorquidismo/diagnóstico , Regulação para Baixo , Hospitais Universitários , Humanos , Lactente , Inibinas/metabolismo , Masculino , Testosterona/metabolismo
11.
Ann Cardiol Angeiol (Paris) ; 66(1): 52-54, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28139199

RESUMO

We report the case of a 2-month old infant who experienced recurrent sustained ventricular tachycardia (VT) in a structurally normal heart. Resting electrocardiogram (ECG) showed wide QRS with a complete right bundle branch bloc (RBBB) morphology. There was no family history of syncope or sudden death, but the ECGs of the father and the brother showed incomplete RBBB with negative T waves on V1 lead. This case seems to fit well with the newly defined entity of Brugada-like syndrome with a highly suspected genetic underlying disposition.


Assuntos
Síndrome de Brugada/diagnóstico , Eletrocardiografia , Taquicardia Ventricular/diagnóstico , Síndrome de Brugada/genética , Bloqueio de Ramo/diagnóstico , Bloqueio de Ramo/genética , Análise Mutacional de DNA , Diagnóstico Diferencial , Humanos , Lactente , Masculino , Recidiva , Canais de Sódio/genética , Taquicardia Ventricular/genética
12.
Arch Pediatr ; 24(2): 112-117, 2017 Feb.
Artigo em Francês | MEDLINE | ID: mdl-27993443

RESUMO

INTRODUCTION: The persistent ductus arteriosus remains a common congenital pathology. Although percutaneous closure of wide channels using an Amplatzer Duct Occluder is an attractive alternative to the surgical treatment, this prosthesis is not recommended for infants weighing less than 6kg. AIM OF THE STUDY: The objective was to evaluate the efficacy and safety of this prosthesis in low-weight children. PATIENTS AND METHODS: The records of children weighing less than 6kg who underwent closure with the Amplatzer Duct Occluder prosthesis between January 2010 and December 2014 were retrospectively analyzed. RESULTS: Fourteen patients (mean weight: 5.7kg [range: 4.8-6]; mean age: 6.5months [range: 3-12]) were included. The main circumstance for discovery was difficulty in breathing (93% of children). The average angiographic persistent ductus arteriosus diameter was 3.5mm (range: 3-6mm), correlating well with that found on ultrasound (r=0.68). The prosthesis was implanted successfully in 93% of cases. The only failure was explained by the increased risk of aortic subocclusion. The immediate angiographic occlusion rate was 71%. The average duration of the procedure was 46±12min. Three children had a channel C-type on the Krichenko classification. Two complications occurred in two patients: a case of cardiac tamponade drained during the procedure without incident and one case of partial protrusion of the Amplatzer disk into the aortic lumen. C-type (tubular) persistent ductus arteriosus and a ratio of the diameter of the persistent ductus arteriosus/weight greater than 0.95 were significantly associated with intervention failure and/or major complications during the percutaneous closure, while weight of less than 6kg was not retained as a predictor of procedure failure. No late embolization occurred after 11months of median follow-up. During this monitoring, we noted a marked clinical improvement with normalization of pulmonary pressure. CONCLUSION: This study includes the few records reported in the literature assessing the feasibility of percutaneous closure in persistent ductus arteriosus in infants weighing up to 6kg. It confirms the effectiveness of the procedure with a relatively low prevalence of complications.


Assuntos
Angioplastia/métodos , Cateterismo Cardíaco/métodos , Permeabilidade do Canal Arterial/terapia , Recém-Nascido de Baixo Peso , Dispositivo para Oclusão Septal , Angiografia , Angioplastia/efeitos adversos , Cateterismo Cardíaco/efeitos adversos , Tamponamento Cardíaco/etiologia , Tamponamento Cardíaco/terapia , Permeabilidade do Canal Arterial/diagnóstico por imagem , Falha de Equipamento , Feminino , Humanos , Lactente , Recém-Nascido , Masculino
13.
Rev Pneumol Clin ; 72(6): 353-358, 2016 Dec.
Artigo em Francês | MEDLINE | ID: mdl-27789163

RESUMO

Neuroblastoma (NB) is an embryonal tumor of the sympathetic nervous system. It represents the most common malignant extracerebral solid tumor, and the first solid tumor in children aged less than one year. Neuroblastoma is rare in adults. We report the case of a 21-year-old male patient. Diagnosis of neuroblastoma was confirmed by percutanous CT scanner biopsy. Radiological assessment of the extension concluded to a stage IV NB with multifocal bone disease. The patient received chemotherapy based on cisplatin-etoposide (6 cycles) and a mediastinal radiotherapy. The evolution was marked by the progression of bone metastasis and the emergence of a tissular process sheathing the left optic nerve and the terminal portion of the internal carotid artery. Second line chemotherapy was indicated. A thoracic localization of NB is rare. Treatment is not codified and the prognosis is variable.


Assuntos
Neoplasias do Mediastino/diagnóstico , Neuroblastoma/diagnóstico , Adulto , Diagnóstico Tardio , Evolução Fatal , Humanos , Achados Incidentais , Masculino , Adulto Jovem
14.
J Arrhythm ; 31(5): 326-7, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26550093

RESUMO

Persistent left superior vena cava (PLSVC) can be incidentally detected during pacemaker implantation from the left pectoral side. Optimal site pacing is technically difficult, and lead stability of the right ventricle (RV) can lead to such a situation. We describe a case of successful single-chamber pacemaker implantation in a 76-year-old woman with a PLSVC and concomitant agenesis of the right-sided superior vena cava, after failed attempts with the conventional procedure. The pacemaker had been working well after 12 months of follow-up.

15.
Lasers Med Sci ; 30(8): 2123-8, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25958172

RESUMO

Yttrium-stabilized tetragonal zirconia polycrystalline (Y-TZP) ceramic is widely used as an all-ceramic core material because of its enhanced mechanical and aesthetic properties. The bond strength of Y-TZP restorations affects long-term success; hence, surface treatment is required on ceramic boundaries. This study evaluated the effect of different laser beam angles on Y-TZP-resin cement shear bond strength (SBS). Forty plates of Y-TZP ceramics were randomly assigned to four groups (n = 10). A femtosecond amplifier laser pulse was applied on Y-TZP surface with different incidence angles (90°, 75°, 60°, 45°). The resin cement was adhered onto the zirconia surfaces. The SBS of each sample was measured using universal testing machine at crosshead speed of 1 mm/min. The SBS was analyzed through one-way analysis of variance (ANOVA)/Tukey tests. The results showed that the degree of laser beam angle affects the SBS of resin cement to Y-TZP. The laser beam was applied to a surface with a 45° angle which resulted in significantly higher SBS (18.2 ± 1.43 MPa) than other groups (at 90° angulation (10.79 ± 1.8 MPa), at 75° (13.48 ± 1.2 MPa) and at 60° (15.85 ± 0.81 MPa); p < 0.001). This study shows that decreasing of the angle between the ceramic surface and the laser beam increased the SBS between the resin cement and the ceramic material, as well as the orifice.


Assuntos
Colagem Dentária , Cimentos Dentários/efeitos da radiação , Lasers , Teste de Materiais , Cimentos de Resina/efeitos da radiação , Zircônio/efeitos da radiação , Microscopia Eletrônica de Varredura , Resistência ao Cisalhamento , Fatores de Tempo , Ítrio/química
16.
Neurochirurgie ; 60(3): 63-140, 2014 Jun.
Artigo em Francês | MEDLINE | ID: mdl-24856008

RESUMO

PURPOSES: To review in the literature, all the epidemiological, clinical, radiological, histological and therapeutic data regarding chordomas as well as various notochordal entities: ecchordosis physaliphora, intradural and intraparenchymatous chordomas, benign notochordal cell tumors, parachordomas and extra-axial chordomas. To identify different types of chordomas, including familial forms, associations with tuberous sclerosis, Ollier's disease and Maffucci's syndrome, forms with metastasis and seeding. To assess the recent data regarding molecular biology and progress in targeted therapy. To compare the different types of radiotherapy, especially protontherapy and their therapeutic effects. To review the largest series of chordomas in their different localizations (skull base, sacrum and mobile spine) from the literature. MATERIALS: The series of 136 chordomas treated and followed up over 20 years (1972-2012) in the department of neurosurgery at Lariboisière hospital is reviewed. It includes: 58 chordomas of the skull base, 47 of the craniocervical junction, 23 of the cervical spine and 8 from the lombosacral region. Similarly, 31 chordomas in children (less than 18 years of age), observed in the departments of neurosurgery of les Enfants-Malades and Lariboisière hospitals, are presented. They were observed between 1976 and 2010 and were located intracranially (n=22 including 13 with cervical extension), 4 at the craniocervical junction level and 5 in the cervical spine. METHODS: In the entire Lariboisière series and in the different groups of localization, different parameters were analyzed: the delay of diagnosis, of follow-up, of occurrence of metastasis, recurrence and death, the number of primary patients and patients referred to us after progression or recurrence and the number of deaths, recurrences and metastases. The influence of the quality of resection (total, subtotal and partial) on the prognosis is also presented. Kaplan-Meier actuarial curves of overall survival and disease free survival were performed in the entire series, including the different groups of localization based on the following 4 parameters: age, primary and secondary patients, quality of resection and protontherapy. In the pediatric series, a similar analysis was carried-out but was limited by the small number of patients in the subgroups. RESULTS: In the Lariboisière series, the mean delay of diagnosis is 10 months and the mean follow-up is 80 months in each group. The delay before recurrence, metastasis and death is always better for the skull base chordomas and worse for those of the craniocervical junction, which have similar results to those of the cervical spine. Similar figures were observed as regards the number of deaths, metastases and recurrences. Quality of resection is the major factor of prognosis with 20.5 % of deaths and 28 % of recurrences after total resection as compared to 52.5 % and 47.5 % after subtotal resection. This is still more obvious in the group of skull base chordomas. Adding protontherapy to a total resection can still improve the results but there is no change after subtotal resection. The actuarial curve of overall survival shows a clear cut in the slope with some chordomas having a fast evolution towards recurrence and death in less than 4 years and others having a long survival of sometimes more than 20 years. Also, age has no influence on the prognosis. In primary patients, disease free survival is better than in secondary patients but not in overall survival. Protontherapy only improves the overall survival in the entire series and in the skull base group. Total resection improves both the overall and disease free survival in each group. Finally, the adjunct of protontherapy after total resection is clearly demonstrated. In the pediatric series, the median follow-up is 5.7 years. Overall survival and disease free survival are respectively 63 % and 54.3 %. Factors of prognosis are the histological type (atypical forms), localization (worse for the cervical spine and better for the clivus) and again it will depend on the quality of resection. CONCLUSIONS: Many different pathologies derived from the notochord can be observed: some are remnants, some may be precursors of chordomas and some have similar features but are probably not genuine chordomas. To-day, immuno-histological studies should permit to differentiate them from real chordomas. Improving knowledge of molecular biology raises hopes for complementary treatments but to date the quality of surgical resection is still the main factor of prognosis. Complementary protontherapy seems useful, especially in skull base chordomas, which have better overall results than those of the craniocervical junction and of the cervical spine. However, we are still lacking an intrinsic marker of evolution to differentiate the slow growing chordomas with an indolent evolution from aggressive types leading rapidly to recurrence and death on which more aggressive treatments should be applied.


Assuntos
Cordoma/mortalidade , Cordoma/cirurgia , Recidiva Local de Neoplasia/cirurgia , Neoplasias da Base do Crânio/mortalidade , Neoplasias da Base do Crânio/cirurgia , Terapia Combinada , Seguimentos , Humanos , Resultado do Tratamento
17.
Bull Soc Pathol Exot ; 106(3): 184-7, 2013 Aug.
Artigo em Francês | MEDLINE | ID: mdl-23702585

RESUMO

The aim of this study is to estimate the prevalence of Toxoplasma gondii infection in 527 sheep from 4 governorates of Tunisia by Elisa (350 animals) and PCR (177 animals). The seroprevalence in sheep was estimated to be 1.8% (N = 166) in the governorate of Siliana (North Tunisia) and 19% (N = 184) in the governorate of Kasserine (Central Tunisia) with a commercial Elisa kit. T. gondii DNA was extracted from the apex of the heart in 25.5% (N = 106) of sheep from the Sidi-Bouzid governorate (Central Tunisia) and 12.7% (N = 71) from the Ben-Arous governorate (North Tunisia). There was no statistically significant difference between different age categories' prevalence within each locality. Our results indicate that T. gondii infection is frequent in Tunisian sheep. The implementation of a national control programme against toxoplasmosis should not neglect sheep as a frequently infected intermediate host.


Assuntos
Doenças dos Ovinos/epidemiologia , Toxoplasmose Animal/epidemiologia , Animais , Anticorpos Antiprotozoários/análise , Feminino , Masculino , Prevalência , Ovinos , Doenças dos Ovinos/sangue , Toxoplasma/imunologia , Toxoplasmose Animal/sangue , Tunísia/epidemiologia
18.
J Fr Ophtalmol ; 36(2): 117-23, 2013 Feb.
Artigo em Francês | MEDLINE | ID: mdl-22989988

RESUMO

PURPOSE: The aim of this study was to analyze the indications and the effect of permanently maintaining silicone oil in the treatment of certain cases of vitreoretinal pathology. PATIENTS AND METHODS: Twenty-seven cases seen from January 2002 to December 2008 were retrospectively studied. Silicone oil was kept in the eyes for more than 2years. The surgical file was analyzed in all cases. The evaluation criteria were ocular pressure, emulsification, cataract, corneal dystrophy, and the functional response of the retina and optic nerve. Ultrasound echography (12 MHz), magnetic resonance imaging, and electrophysiological explorations (visual evoked potential and electroretinography) were performed. RESULTS: Twenty-seven eyes of 27 patients were included in this study. The main reasons for maintaining long-term silicone oil are recurrent vitreous hemorrhage, retinal detachment with severe proliferative vitreoretinopathy, and penetrating injury. The patients were distributed into two groups: group 1 included patients with both functional and anatomic failure, group 2 patients had achieved ambulatory vision. Follow-up ranged from 27 to 72months. Cataract incidence was approximately 91% in group 2. Emulsification was noted without high pressure in 50% of the cases in group 1. High pressure averaged 31.8% in group 2. Keratopathy was observed in 9% of the cases in group 2. Intraorbital migration of silicone oil was found in one case. The visual field was improved in 77% of the cases in group 2. CONCLUSION: This study provided interesting insights into certain clinical situations in which silicone oil has to be maintained permanently. The complications stem not only from the presence of silicone oil, but also from the preoperative status of the eye and the vitreoretinal surgery.


Assuntos
Oftalmopatias/terapia , Óleos de Silicone/uso terapêutico , Adolescente , Adulto , Idoso , Oftalmopatias/epidemiologia , Oftalmopatias/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Descolamento Retiniano/epidemiologia , Descolamento Retiniano/cirurgia , Estudos Retrospectivos , Óleos de Silicone/efeitos adversos , Fatores de Tempo , Vitrectomia/reabilitação , Vitreorretinopatia Proliferativa/epidemiologia , Vitreorretinopatia Proliferativa/cirurgia , Adulto Jovem
19.
J Med Entomol ; 49(6): 1507-9, 2012 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-23270183

RESUMO

In total, 656 sand flies were collected in June 2008 from Louata, a locality of Sefrou province, Morocco. Testing was conducted for the presence of phlebovirus by nested reverse transcriptase polymerase chain reaction and sequencing. We detected Toscana virus in four pools of male Phlebotomus perniciosus. This virus belongs to the genotype B previously recognized in France and Spain. This is the first time that Toscana virus has been detected in Morocco.


Assuntos
Phlebotomus/virologia , RNA Viral/isolamento & purificação , Vírus da Febre do Flebótomo Napolitano/isolamento & purificação , Animais , Feminino , Masculino , Marrocos
20.
J Food Prot ; 75(10): 1859-61, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23043838

RESUMO

The aim of this study was to investigate the hygiene performance of a camel (Camelus dromedarius) slaughtering process as carried out with the traditional method in the Sahrawi refugee camps located in southwestern Algeria. The camel slaughtering process in this region differs significantly from that carried out in commercial abattoirs. Slaughtering is performed outdoors in desert areas, and dehiding of the carcass is approached via the dorsoventral route rather than the classic ventrodorsal route. Samples were taken from 10 camel carcasses from three different areas: the hide, the carcass meat immediately after dehiding, and the meat after final cutting. Enterobacteriaceae counts (EC) were enumerated employing conventional laboratory techniques. Carcass meat samples resulted in EC below the detection limit more frequently if the hide samples from the same carcass had also EC counts below the detection limit. Because of the low number of trials, the calculation of statistical significance of the results was not possible. Further experimental research is needed in order to validate the results presented in this study. The comparison of the microbiological hygiene performance between dorsal dehiding and traditional ventral dehiding of slaughtered animals could serve to validate the hypothesis of the potential positive impact of the dorsal dehiding method in carcass meat hygiene.


Assuntos
Camelus , Enterobacteriaceae/isolamento & purificação , Eutanásia Animal/métodos , Contaminação de Alimentos/análise , Manipulação de Alimentos/métodos , Carne/microbiologia , Matadouros , Argélia , Animais , Camelus/microbiologia , Contagem de Colônia Microbiana , Contaminação de Alimentos/prevenção & controle , Humanos , Higiene , Carne/normas , Medição de Risco
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