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OBJECTIVES: We assessed the effect of invalid responding on factor structure and on scores of schizotypy through the factor analysis of the Schizotypal Personality Questionnaire-Brief (SPQ-B) in a sample of 580 Romanian students using 3 validity items and 5 social desirability items. METHODS: We examined the factor structure of the SPQ-B, we compared the mean SPQ-B scores between reliable and unreliable responders and between high vs. low social desirability responders, and we re-run the factor analysis restricting the sample to the reliable or low social desirability responders. RESULTS: Factor analysis resulted in a 3-factor solution: Cognitive-perceptual, Interpersonal and Disorganized dimensions. Unreliable responders had lower scores of positive, negative and total schizotypy. Subjects with high social desirability scores had lower scores of disorganized schizotypy. Factor analyses in the samples of "good" responders showed minor differences in reliable responders, whereas, after taking into account the effect of social desirability, 2 items correctly loaded on expected dimensions. CONCLUSIONS: Random responding and social desirability could influence scores of schizotypy and factor structure. Simple methods could be used to identify invalid responses. The effect of social desirability could be linked to the phrasing of items.
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Testes Neuropsicológicos , Transtorno da Personalidade Esquizotípica/diagnóstico , Transtorno da Personalidade Esquizotípica/psicologia , Adolescente , Análise Fatorial , Feminino , Humanos , Masculino , Reprodutibilidade dos Testes , Romênia , Caracteres Sexuais , Desejabilidade Social , Fatores Socioeconômicos , Inquéritos e Questionários , Traduções , Adulto JovemRESUMO
INTRODUCTION: The main objective of the study was to explore the factorial structure of the French version of the Schizotypal Personality Questionnaire-Brief (SPQ-B) in a Likert format, in a representative sample of the general population. In addition, differences in the dimensional scores of schizotypy according to gender and age were analyzed. As the study in the general population of schizotypal traits and its determinants has been recently proposed as a way toward the understanding of aetiology and pathophysiology of schizophrenia, consistent self-report tools are crucial to measure psychometric schizotypy. A shorter version of the widely used Schizotypal Personality Questionnaire (SPQ-Brief) has been extensively investigated in different countries, particularly in samples of students or clinical adolescents, and more recently, a few studies used a Likert-type scale format which allows partial endorsement of items and reduces the risk of defensive answers. METHOD: A sample of 233 subjects representative of the adult population from an urban area near Paris (Créteil) was recruited using the "itinerary method". They completed the French version of the SPQ-B with a 5-point Likert-type response format (1=completely disagree; 5=completely agree). We examined the dimensional structure of the French version of the SPQ-B with a Principal Components Analysis (PCA) followed by a promax rotation. Factor selection was based on Eigenvalues over 1.0 (Kaiser's criterion), Cattell's Scree-plot test, and interpretability of the factors. Items with loadings greater than 0.4 were retained for each dimension. The internal consistency estimate of the dimensions was calculated with Cronbach's α. In order to study the influence of age and gender, we carried out a simple linear regression with the subscales as dependent variables. RESULTS: Our sample was composed of 131 women (mean age=52.5±18.2 years) and 102 men (mean age=53±18.1 years). SPQ-B Likert total scores ranged from 22 to 84 points (mean=43.6±13). Factor analysis resulted in a 3-factor solution that explained 47.7% of the variance. Factor 1 (disorganized; 10 items) included items related to "odd behavior", "odd speech", as well as "social anxiety", one item of "constricted affect" and one item of "ideas of reference". Factor 2 (interpersonal; 7 items) included items related to "no close friends", "constricted affect", and three of the items of "suspiciousness". Factor 3 (cognitive-perceptual; 5 items) included items related to "ideas of reference", "magical thinking", "unusual perceptual experiences" and one item of "suspiciousness". Coefficient α for the three subscales and total scale were respectively 0.81, 0.81, 0.77 and 0.88. We found no differences in total schizotypy and the three dimensions scores according to age and sex. CONCLUSION: Factor analysis of the French version of the SPQ-B in a Likert format confirmed the three-factor structure of schizotypy. We found a pure cognitive perceptual dimension including the most representative positive features. As expected, "Suspiciousness" subscale is included in both positive and negative dimensions, but mainly in the negative dimension. Surprisingly, "social anxiety" subscale is included in the disorganized dimension in our analysis. The SPQ-B in a Likert format demonstrated good internal reliability for both total and subscales scores. Unlike previous published results, we did not find any influence of age or gender on schizotypal dimensions.
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Transtorno da Personalidade Esquizotípica/diagnóstico , Transtorno da Personalidade Esquizotípica/psicologia , Inquéritos e Questionários , Adulto , Afeto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Cognição , Análise Fatorial , Feminino , França , Humanos , Relações Interpessoais , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Fatores Sexuais , População Urbana , Adulto JovemRESUMO
PURPOSE: The standard treatment of T2-T3 rectal adenocarcinoma is radical proctectomy by total mesorectal excision often combined with some neoadjuvant treatment. To reduce morbidity of this surgery, organ preservation strategy using various combination of radiotherapy, chemotherapy and local excision is gaining interest. Some randomized trials have proven the feasibility of such approaches. The OPERA trial demonstrated, for T2 T3<5cm diameter low-middle rectum, that a contact X-ray brachytherapy boost of 90Gy in three fractions over 4 weeks was able to achieve a planned organ preservation in 81% of patients at 3years with 97% success for tumour smaller than 3cm treated with contact X-ray brachytherapy boost first. To try to expand organ preservation to larger tumours we set up a feasibility trial in T2-T3 tumours using total neoadjuvant treatment and a contact X-ray brachytherapy boost. MATERIAL AND METHOD: The trial was approved by the institutional review board of Nice. Inclusion criteria were operable patients, 75years or less, adenocarcinoma of the low-middle rectum staged T2c-T3N0 larger than 3.5cm and less than 6cm in diameter or T2-T3N1 less than 6cm in diameter. Treatment started in all cases with neoadjuvant chemotherapy associating 5-fluoro-uracile, irinotecan and oxaliplatin ('folfirinox' regimen, four to six cycles). In case of good tumour response after four cycles, a contact X-ray brachytherapy boost (delivering 90Gy in three fractions) was given followed by chemoradiotherapy (external beam radiotherapy delivering 50Gy, with concurrent capecitabine). After six cycles if only a partial response (tumour still larger than 3cm) was seen, chemoradiotherapy was given and contact X-ray brachytherapy boost was delivered after that. At the end of this total neoadjuvant treatment a watch and wait strategy was decided in case of clinical complete response or radical proctectomy by total mesorectal excision for partial response. RESULTS: Between July 2019 and October 2022, 14 patients were included; median age was 66years (range: 51-77years), there were nine male and five female, two T2 N1 tumours, seven T3N0, and five T3N1, all were M0. Median tumour diameter was 40mm (range: 11-50mm); three tumours had a circumferential extension greater than 50%. Seven patients received four folfirinox cycles and seven had six cycles. Contact X-ray brachytherapy boost was given during folfirinox chemotherapy before chemoradiotherapy in 11 patients (and after in three). The tolerance was good, with no grade 4-5 toxicity. The main grade 3 early toxicity was in relation with the folfirinox regimen. A clinical complete response was seen in 12 patients at the end of the total neoadjuvant treatment (85%). All these patients are alive and have preserved their rectum with a mean follow-up time of 17.8months (range: 6-48months) and a good bowel function (low anterior rectal resection syndrome score below 30). The main contact X-ray brachytherapy boost toxicity was radiation ulceration in three patients that usually healed within 6 months, sometimes necessitating hyperbaric oxygen. CONCLUSION: The preliminary results of this feasibility study show that early tolerance of these intensive total neoadjuvant treatment is compatible with an acceptable toxicity. The high rate of organ preservation in this intermediate group of T2-T3 tumours is encouraging and is a good argument to start the next randomized TRESOR trial that will aim at achieving a 65% of 3-year survival with organ preservation in this intermediate tumour group.
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AIMS: Gene x environment (G×E) interactions, i.e. genetic modulation of the sensitivity to environmental factors and/or environmental control of the gene expression, have not been reliably established regarding aetiology of psychotic disorders. Moreover, recent studies have shown associations between the polygenic risk scores for schizophrenia (PRS-SZ) and some risk factors of psychotic disorders, challenging the traditional gene v. environment dichotomy. In the present article, we studied the role of GxE interaction between psychosocial stressors (childhood trauma, stressful life-events, self-reported discrimination experiences and low social capital) and the PRS-SZ on subclinical psychosis in a population-based sample. METHODS: Data were drawn from the EUropean network of national schizophrenia networks studying Gene-Environment Interactions (EU-GEI) study, in which subjects without psychotic disorders were included in six countries. The sample was restricted to European descendant subjects (n = 706). Subclinical dimensions of psychosis (positive, negative, and depressive) were measured by the Community Assessment of Psychic Experiences (CAPE) scale. Associations between the PRS-SZ and the psychosocial stressors were tested. For each dimension, the interactions between genes and environment were assessed using linear models and comparing explained variances of 'Genetic' models (solely fitted with PRS-SZ), 'Environmental' models (solely fitted with each environmental stressor), 'Independent' models (with PRS-SZ and each environmental factor), and 'Interaction' models (Independent models plus an interaction term between the PRS-SZ and each environmental factor). Likelihood ration tests (LRT) compared the fit of the different models. RESULTS: There were no genes-environment associations. PRS-SZ was associated with positive dimensions (ß = 0.092, R2 = 7.50%), and most psychosocial stressors were associated with all three subclinical psychotic dimensions (except social capital and positive dimension). Concerning the positive dimension, Independent models fitted better than Environmental and Genetic models. No significant GxE interaction was observed for any dimension. CONCLUSIONS: This study in subjects without psychotic disorders suggests that (i) the aetiological continuum hypothesis could concern particularly the positive dimension of subclinical psychosis, (ii) genetic and environmental factors have independent effects on the level of this positive dimension, (iii) and that interactions between genetic and individual environmental factors could not be identified in this sample.
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Transtornos Psicóticos , Esquizofrenia , Interação Gene-Ambiente , Humanos , Transtornos Psicóticos/genética , Transtornos Psicóticos/psicologia , Fatores de Risco , Esquizofrenia/genéticaRESUMO
AIMS: Up to 40% of patients who have received radiation for a pelvic malignancy will develop locoregional recurrence in the previously irradiated volume. Stereotactic body radiotherapy (SBRT) has been used in the oligometastatic setting, and provides an ablative approach ideal for reirradiation. The purpose of this study was to evaluate the outcomes after SBRT reirradiation of extraosseous recurrences in the pelvis. MATERIALS AND METHODS: This single institution retrospective study evaluated patients treated with SBRT reirradiation in the pelvis from January 2011 to February 2018. Patients with more than five oligometastatic lesions, >7 cm in size, and recurrence within the prostate were excluded. RESULTS: In total, 30 patients were treated with SBRT with a median follow-up of 29.4 months. The primary tumour sites were most commonly rectum (30.8%) and prostate (30.8%). The median time interval between irradiation for the primary and SBRT reirradiation was 48 months (3-245). The typical reirradiation treatment was 35 Gy in five fractions, the median gross tumour volume size was 10.2 (0.3-110.5) ml and the most common target was the iliac nodes (40%). There were three (10%) acute grade 3 toxicities and no late grade 3 or more toxicities. At 12/24 months, local relapse-free survival, metastasis-free survival, progression-free survival and overall survival were 67.7%/50.7%, 67%/41.7%, 34.8%/14.9% and 83.2%/62.5%, respectively. On univariate analysis, improved local control was associated with low gross tumour volume (<10 ml) (P = 0.003) and prostate primary (P = 0.02), but was no longer significant on multivariate analysis. The proximity of organ at risk to the target did not significantly correlate with worse toxicity (P = 0.14) or tumour coverage (gross tumour volume: P = 0.8, planning target volume: P = 0.4). CONCLUSION: SBRT pelvic reirradiation in oligometastatic patients is a safe and effective treatment modality. Careful consideration should be taken with larger tumour size, as it may be associated with worse oncological and toxicity outcome.
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Recidiva Local de Neoplasia , Neoplasias Pélvicas , Neoplasias da Próstata , Radiocirurgia/métodos , Reirradiação/métodos , Neoplasias Retais , Idoso , Feminino , Humanos , Masculino , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/radioterapia , Neoplasias Pélvicas/patologia , Neoplasias Pélvicas/radioterapia , Neoplasias da Próstata/patologia , Neoplasias da Próstata/radioterapia , Neoplasias Retais/patologia , Neoplasias Retais/radioterapia , Análise de Sobrevida , Resultado do Tratamento , Carga TumoralRESUMO
Splenic artery aneurysms are now diagnosed more frequently thanks to the increase and improvement in different imaging techniques. In case of rupture they are potentially life threatening and thus in certain cases may require appropriate preventive treatment. This treatment should be offered to patients with suspected pseudoaneurysms, with an aneurysm larger than 20mm in diameter, or which is progressing. The development of interventional endovascular radiology has provided new therapeutic options for the management of aneurysms, by excluding the sac from the arterial circulation with coil embolisation or with a covered stent. The success rate of these treatments is between 75 and 100% with significantly less morbidity and mortality than with surgical techniques.
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Aneurisma/diagnóstico , Aneurisma/terapia , Angiografia , Embolização Terapêutica/métodos , Artéria Esplênica , Tomografia Computadorizada por Raios X , Ultrassonografia , Embolização Terapêutica/efeitos adversos , Humanos , Resultado do TratamentoRESUMO
The pancreas is an organ that normally does not contain gas. The purpose of this article is to reaffirm the value of CT to detect gas in abnormal locations and illustrate the different causes of gas collections in the pancreatic bed. Abscesses and infected pseudocysts are the most frequent causes of gas in the pancreatic bed followed by malignant and inflammatory fistulae. Iatrogenic etiologies should be considered along with the rare emphysematous pancreatitis associated with very poor prognosis. All of these entities shows multiple imaging findings, including the presence of gas in the pancreatic bed.
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Ar , Pancreatopatias/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
PURPOSE: To determine the usefulness of two classification systems for pelvic prolapse on MRI. MATERIALS AND METHODS: Prospective study of 30 patients with symptoms of pelvic prolapse performed in a single center. All patients underwent clinical evaluation followed by dynamic pelvic MRI within 15 days. All MR examinations were reviewed by three readers using both classification systems based on different anatomical landmarks. The first used the pubococcygeal line and the second used the midpubic line. RESULTS: For prolapse detection, the correlation between clinical examination and MRI was good to very good, ranging between 74 and 89%. For prolapse staging, the correlation was poor to moderate. Inter-observer agreement was good to very good (kappa between 0.67 and 0.95). It was slightly better at the mid stage, with both systems (kappa between 0.83 and 0.97). Comparison of the inter-observer agreement between both MRI classification systems showed better results for the system using the pubococcygeal line (p<0.005). CONCLUSION: The classification system based on the pubococcygeal line appeared more reliable and simple for th eevaluation of pelvic prolapse on MRI.
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Imageamento por Ressonância Magnética , Prolapso de Órgão Pélvico/classificação , Prolapso de Órgão Pélvico/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Método Duplo-Cego , Feminino , Humanos , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
BACKGROUND: Childhood trauma (CT) and cannabis use are both environmental and modifier risk factors for schizophrenia. However, little is known about how they interact in schizophrenia. We examined the main effect of each of these two environmental factors on the clinical expression of the disease using a large set of variables, and we tested whether and how cannabis and CT interact to influence the course and the presentation of the illness. METHODS: A sample of 366 patients who met the DSM-IV-TR criteria for schizophrenia was recruited through the FACE-SCZ (Fondamental Advanced Centre of Expertise - Schizophrenia) network. Patients completed a large standardized clinical evaluation including Structured Clinical Interview for DSM Disorders-I (SCID-I), Positive and Negative Symptoms Scale (PANSS), Columbia-Suicide Severity Rating Scale (C-SSRS), Global Assessment of Functioning (GAF), Short-Quality of Life-18 (S-QoL-18), and Medication Adherence Rating Scale (MARS). We assessed CT with the Childhood Trauma Questionnaire and cannabis status with SCID-I. RESULTS: CT significantly predicted the number of hospitalizations, GAF, and S-QoL-18 scores, as well as the PANSS total, positive, excitement, and emotional distress scores. Cannabis use disorders significantly predicted age of onset, and MARS. There was no significant interaction between CT and cannabis use disorders. However, we found evidence of a correlation between these two risk factors. CONCLUSIONS: CT and cannabis both have differential deleterious effects on clinical and functional outcomes in patients with schizophrenia. Our results highlight the need to systematically assess the presence of these risk factors and adopt suitable therapeutic interventions.
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Adultos Sobreviventes de Eventos Adversos na Infância , Abuso de Maconha/complicações , Abuso de Maconha/psicologia , Transtornos Psicóticos/complicações , Esquizofrenia/complicações , Adulto , Adultos Sobreviventes de Eventos Adversos na Infância/psicologia , Idade de Início , Feminino , Humanos , Masculino , Escalas de Graduação Psiquiátrica , Transtornos Psicóticos/psicologia , Psicologia do Esquizofrênico , Estresse Psicológico/complicaçõesRESUMO
Local tumor recurrence after thermal ablation of hepatocellular carcinoma (HCC) can impact on overall survival and are very closely linked to partial treatment of the primary lesion or to potential microvascular invasion or satellite micronodules located close to the main lesion. The diagnosis of these liver metastases close to the primary lesion on CT and MRI is difficult and their incidence, number and spread throughout the liver correlates with diameter of primary tumor. Tumor diameter is currently the key factor to predict whether or not thermal ablation of HCC will be complete or not. It has now been shown for monopolar radiofrequency ablation that this therapy alone is sufficient to effectively treat single HCCs<3cm in diameter provided that liver micrometastases are not present. If the HCC is>3cm in size, multifocal or in the case of tumor recurrence, overall survival and recurrence-free survival results are better if monopolar radiofrequency ablation is combined with hepatic trans-arterial chemoembolization. The timing of this combination of treatments probably influences its effectiveness on tumor and tolerability and remains to be assessed.
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Carcinoma Hepatocelular/terapia , Ablação por Cateter , Quimioembolização Terapêutica , Neoplasias Hepáticas/terapia , Algoritmos , Animais , Quimioembolização Terapêutica/métodos , Artéria Hepática , HumanosRESUMO
Post-abortum hemorrhage is a common clinical situation and etiological diagnosis has to be made early to avoid further complications such as persistent bleeding, infection or adhesions that may compromise fertility. Retained products of conception are the most common cause of bleeding. The diagnosis is based on endovaginal color doppler ultrasound showing a thickened and hypervascular endometrial echo-complex extending partly to the myometrium. The main differential diagnosis is uterine arteriovenous malformation, mostly iatrogenic. Diagnosis is based on the presence of myometrial confluent cystic lesions filled with turbulent and high velocity arterial flow on endovaginal color doppler ultrasound. The distinction between these two etiologies of post-abortion bleeding is mandatory because of totally different treatment: typically medical and/or surgical in case of retained products of conception and by selective arterial embolization in case of vascular malformation.
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Aborto Induzido/efeitos adversos , Aborto Espontâneo , Diagnóstico por Imagem/métodos , Metrorragia/diagnóstico por imagem , Aborto Induzido/estatística & dados numéricos , Aborto Espontâneo/diagnóstico por imagem , Aborto Espontâneo/etiologia , Malformações Arteriovenosas/complicações , Malformações Arteriovenosas/diagnóstico por imagem , Diagnóstico Diferencial , Feminino , Humanos , Metrorragia/etiologia , Valor Preditivo dos Testes , Gravidez , Tomografia Computadorizada por Raios X , Ultrassonografia Doppler em Cores , Anormalidades Urogenitais/complicações , Anormalidades Urogenitais/diagnóstico por imagem , Útero/anormalidades , Útero/diagnóstico por imagemRESUMO
We studied hemocompatibility of various blood tubings with C3a anaphylatoxin measurement and comparative electron scanning microscopy. The following tubing materials were tested: polyvinylchloride (PVC) plasticised with phthalate (PVC), pvc plasticised with phthalate coextruded with polyurethane (PIV), and two phthalate-free lines: pvc plasticised with trimellitate coextruded with polyurethane (TRI) and pvc plasticised with LT 360 (LTP). Results of C3a generation rate showed a significant activation by all blood tubings, with a reduced rate with PIV when compared to all others. Electron scanning microscopy showed marked alterations of PIV surface on tubings stored for 6 months. Protein deposits on internal surfaces after dialysis were similar whatever tubing material was tested, but adhesive cell number was greater with TRI when compared to PVC and LTP. Hemocompatibility is unchanged with phthalate-free tubings when compared to phthalate plasticised ones. In contrast with phthalate plasticised PVC there is no beneficial effect of polyurethane coextrusion with trimellitate plasticised PVC in regard to C3a generation.
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Materiais Biocompatíveis , Plastificantes , Diálise Renal/instrumentação , Anafilatoxinas/análise , Complemento C3a/análise , Feminino , Humanos , Masculino , Microscopia Eletrônica de Varredura , Pessoa de Meia-Idade , Ácidos Ftálicos , Poliuretanos , Cloreto de PolivinilaRESUMO
Catalysing the liberation of kinins, vasodilator and sodium duiretic substances, renal and urinary kallikreins are identical. The urinary excretion of kallikrein may be evaluated by various methods, biological, radioisotopic or enzymatic, giving comparable results. Specific radioimmunoassay of urinary kallikrein in man and the rat have been recently published. Details are given of a rapid and convenient enzyme method.
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Calicreínas/urina , Animais , Bioensaio , Cães , Esterases/análise , Humanos , Calicreínas/isolamento & purificação , Cinética , Métodos , Radioimunoensaio/métodosRESUMO
When rats are submitted to diets with variable sodium, concentration, one may observe a significant increase in the excretion of urinary kallikrein and in the kallikrein activity of the renal tissue in animals in chronic sodium depletion. During experimental renovascular hypertension induced in the rat by stenosis of the renal artery, one may note a significant rise in the excretion of urinary kallikrein; no change in this excretion is observed when the stenosis is associated with nephrectomy on the opposite side. It is possible to consider interrelations between the renin-angiotensin-aldosterone system and the kallikrein-kinin system.
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Hipertensão Renal/enzimologia , Hipertensão Renovascular/enzimologia , Calicreínas/metabolismo , Rim/enzimologia , Sódio/metabolismo , Animais , Transporte Biológico Ativo , Hipertensão Renovascular/induzido quimicamente , Calicreínas/urina , Masculino , Ratos , Sódio/urinaRESUMO
Difficult problems may arise and place the surgeon in an uncomfortable position in cases where neither pre-operative investigations nor palpation of the pancreas have enabled pancreatic insulinomas to be localized. However, 3 examinations performed during the operation should help solve these problems, as shown by the case presented here. These examinations are insulin assays in the peripancreatic venous blood, blood glucose measurements under constant rate glucose infusion, and intra-operative ultrasonography. Pre-operative radioimmunological assays of insulin have been used for about 10 years, but owing to technical advances and shortening of the incubation time these assays can now be performed during surgery and, above all, with immediate results. Blood glucose measurements are good pointers, and this method has long been used in this type of surgery. Intra-operative ultrasonography has recently been introduced; it is very effective in diagnosing endocrine tumours of the pancreas, since the images it provides are quite characteristic. These 3 examinations combined should be used to localize pancreatic insulinomas; they may replace most of the pre-operative examinations that are still carried out.
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Adenoma de Células das Ilhotas Pancreáticas/diagnóstico , Insulinoma/diagnóstico , Neoplasias Pancreáticas/diagnóstico , Idoso , Glicemia/análise , Feminino , Humanos , Insulinoma/cirurgia , Período Intraoperatório , Neoplasias Pancreáticas/cirurgia , Radioimunoensaio , UltrassonografiaRESUMO
A peripherally inserted central catheter (PICC) is a central venous access mostly used in France in the adult population, whereas it is only rarely used in the pediatric population. The main objective of this study was to analyze a cohort of children treated with PICCs inserted under radiological guidance. We conducted a single-center study in the Radiology department of Nice University Hospital and the Lenval Foundation Children's Hospital. During a 43-month period between November 2008 and June 2012, a total of 67 catheter placement attempts were performed in 57 pediatric patients aged from 7 months to 18 years. We achieved 95.5% technical success with a median procedure duration of 17min. Only 6% of the PICC placements required light intravenous sedation; all the others were performed using a combination of local anesthesia, EMLA cream, and equimolar mixture of oxygen and nitrous oxide (EMONO). Subjective scale analysis of pain during catheter insertion showed a median score of 2.1. Catheter life ranged from 1 to 210 days (median, 38.3 days) with the treatment fully completed in 75% of the cases. The overall complication rate was 18.7% (4.9 per 1000 catheter-days), largely dominated by mechanical complications (9.4%) such as accidental removal (6.2%) or catheter obstruction (3.1%). Infectious complications occurred in 7.8% of the patients. The duration of catheterization and the use of tape to secure the catheter significantly affected the occurrence of complications. Peripheral insertion of central catheters was highly feasible in infants and children. It is a simple, safe, and effective alternative to intravenous central devices in the pediatric population. The occurrence of complications, typically mechanical, must be reduced and prevented by strict management of this type of central line by the nursing team.
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Cateterismo Venoso Central , Cateterismo Periférico , Adolescente , Anestesia Local , Anestésicos Combinados/uso terapêutico , Anestésicos Locais/uso terapêutico , Infecções Relacionadas a Cateter/epidemiologia , Criança , Pré-Escolar , Estudos de Coortes , Sedação Consciente , Feminino , Humanos , Lactente , Lidocaína/uso terapêutico , Combinação Lidocaína e Prilocaína , Masculino , Dor/prevenção & controle , Medição da Dor , Prilocaína/uso terapêuticoRESUMO
Immune response to a pandemic influenza A 2009 (H1N1) virus infection can influence the way a second unrelated pathogen is handled by the host. We report here a case of pandemic flu with marked CD4 T-cell lymphopenia complicated by a possible Pneumocystis jirovecii pneumonia in an HIV-infected patient.
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Infecções Oportunistas Relacionadas com a AIDS/complicações , Infecções por HIV/complicações , Vírus da Influenza A Subtipo H1N1 , Influenza Humana/complicações , Pandemias , Pneumocystis carinii/isolamento & purificação , Pneumonia por Pneumocystis/complicações , Pneumonia por Pneumocystis/diagnóstico , Feminino , França , Humanos , Pessoa de Meia-IdadeRESUMO
The recent application of endovascular treatment techniques to venous pathologies has meant that new therapeutic solutions can be offered to patients suffering from post-thrombotic syndrome. This often-underestimated condition frequently complicates cases of deep vein thrombosis, whether treated or not, leading to a chronic and disabling set of clinical symptoms (oedema, claudication, pain, venous ulcers, etc.) due to the combination of the pathophysiological phenomena of obstructions and reflux. These clinical signs see only minimal improvement when managed with the classic medical treatment, venotonic agents, and venous compression. We report the cases of two patients suffering with chronic post-thrombotic venous obstruction of the lower limbs in whom endovascular treatment brought clear and long-lasting clinical improvement.
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Procedimentos Endovasculares , Síndrome Pós-Trombótica/cirurgia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
PURPOSE: To assess the technical success, clinical success and complications after 1 month of percutaneous biliary drainage with the placement of several metallic endoprostheses in complex hilar liver tumours. MATERIALS AND METHODS: This is a retrospective study, on a homogenous target population of 68 consecutive patients, who underwent multiple percutaneous biliary drainage for complex hilar tumour (Bismuth type II, III and IV) between August 1998 and August 2010. Patients benefiting from previous endoscopic drainage were excluded from the study. The clinical data, biological data, imaging and interventional radiology procedures were studied. RESULTS: The rate of success of the technique was 98.5% and the clinical rate of success was 84% after 1 week and 93% after 1 month. The rate of minor and major complications was 25 and 13% respectively. CONCLUSION: Multiple percutaneous biliary drainage in complex hilar tumour is a safe and effective first intention procedure.
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Colangiocarcinoma/cirurgia , Neoplasias Hepáticas/cirurgia , Stents , Adulto , Idoso , Idoso de 80 Anos ou mais , Ductos Biliares Intra-Hepáticos , Drenagem/instrumentação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
MRI has emerged for several years as the imaging examination of second-line indications in the majority of female pelvic imaging, after ultrasonography. Recent technical advances have allowed the widespread use of new MRI sequences, allowing a morphological and functional analysis of the pelvic organs. Diffusion weighted-imaging has a definite interest for the detection, characterization and staging of uterine and adnexal lesions. Dynamic contrast-enhanced imaging is an essential tool for characterizing adnexal lesions and to optimize the staging of uterine cancers. The 3D morphological imaging allows multiplanar reconstructions and is particularly useful in mapping fibroids, uterine malformations and in endometriosis.