1. Encephale. 2010 Apr;36(2):132-138. Epub 2009 Sep 23.
[Information for patients about hospital infections in psychiatry: An assessment
of healthcare professionals' knowledge, opinion and attitude.]
[Article in French]
Audureau E, Merle V, Kerleau K, Dollois B, Baugé-Rousseau M, Théry S, Tavolacci
MP, Dubreuil N, Thillard D, Gasparin-Grisel S, Mathieu M, Augé C, Czernichow P;
le réseau CoCLINNOR.
Département d'épidémiologie et de santé publique, CHU de Rouen, 1, rue de
Germont, 76031 Rouen cedex, France.
INTRODUCTION: French legislation makes mandatory for healthcare providers the
disclosure of hospital infection (HI) risk and actual occurrence to the patient.
Given the specific diseases encountered in psychiatry, some difficulties may be
expected in practical application of this regulation. OBJECTIVES: The aim of our
study was to describe the knowledge, declared practices and opinions of
healthcare workers (HCW) in psychiatry concerning information for patients about
HI. METHODS: We randomly selected doctors, nurses and head nurses from four
hospitals with psychiatric activity in Normandy. The HCW were asked to
self-complete an anonymous questionnaire, including data describing the
responding HCW and questions aiming at describing his/her knowledge, attitude in
routine daily practice and opinion about information to patients about HI.
RESULTS: One hundred and forty-one HCW were initially selected, of which 114
(80.9%) eventually agreed to complete the questionnaire. Only eight HCW (7.0%)
were considered to have a correct overall knowledge of legal obligations. Main
errors concerned the obligation to inform the patient of the HI risk according to
the medical procedures that are to be performed (43.9% of correct answers) and
the obligation to inform the patient of the HI risk according to his/her medical
condition (46.5%). The obligation to inform the patient of the occurrence of a HI
was largely known (84.2%). HCW usually giving information about the risk of HI to
patients without HI accounted for 5.3%. Main reasons advocated for not informing
patients were a low level risk of HI in psychiatry (80.4%) and the lack of
patients' demand (59.8%). In the case of HI occurrence, the percentage of HCW
routinely informing patients was 13.2%. HCW systematically informing the
patient's family about the occurrence of HI accounted for 9.6%. A large
proportion of HCW supported delivering information to patients about HI (86.0%).
HCW expected from information better approval of prevention programs by the
patients (87.7%) but feared an increased anxiety in patients (75.4%) and a higher
rate of care refusal (48.2%). CONCLUSION: Whereas a very large proportion of HCW
in psychiatry support delivering information to patients about HI, our study
shows HCW's lack of awareness of regulations and lack of declared practices.
Among factors explaining this contrast, a lower perceived HI risk and severity
level are to be mentioned. Training programs focusing on risk and mechanisms of
HI could be offered to professionals in psychiatry. The issue of specific
communication difficulties with psychiatric patients should be addressed as well.
In order to develop information on HI, specific methods suited to those patients
should be developed. Copyright © 2009 L’Encéphale, Paris. Published by Elsevier
Masson SAS. All rights reserved.
PMID: 20434630 [PubMed - as supplied by publisher]
2. Rev Med Interne. 2010 Apr 21. [Epub ahead of print]
[Protein Z, polymorphisms in the protein Z gene and thrombosis.]
[Article in French]
Le Cam-Duchez V, Barbay V, Soria C, Borg JY.
Unité d'hémostase vasculaire, hématologie biologique, hôpital Charles-Nicolle,
CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France; EA3829, groupe de
recherche MERCI, institut hospitalo-universitaire de recherche biomédicale,
université de Rouen, 22, boulevard Gambetta, 76183 Rouen cedex, France.
Protein Z (PZ) is a vitamin K dependent protein acting as the cofactor of the
protein Z dependent inhibitor (ZPI), in the inhibition of activated factor X
bound on the phospholipids. Normal plasma protein Z concentrations have wide
variations among individuals, partly explained by a genetic control. Several
protein Z gene polymorphisms influence plasma concentration, separately and in
combination. The role of PZ in blood coagulation regulation has been demonstrated
in vitro. The responsibility of low PZ level in the occurrence of thrombosis has
been questioned. However, the roles of PZ plasma level and PZ gene polymorphisms
remain debated with conflicting results in arterial, venous, or placental
thrombosis. These discrepancies can be explained by the heterogeneity of
populations chosen as control, by the PZ interindividual variability, by the
small size of the cohorts in mainly retrospective studies and perhaps by the lack
of real important influence of this protein on coagulation. PZ measurement is not
actually considered as a biological marker of thrombophilia. Large prospective
studies remain to be done to investigate its possible role in thrombosis.
Copyright © 2010 Société nationale française de médecine interne (SNFMI).
Published by Elsevier SAS. All rights reserved.
PMID: 20416992 [PubMed - as supplied by publisher]
3. Pediatr Radiol. 2010 Apr 17. [Epub ahead of print]
Prenatal diagnosis of a nasal glioma.
Grzegorczyk V, Brasseur-Daudruy M, Labadie G, Cellier C, Verspyck E.
Department of Obstetrics and Gynaecology, Rouen University Hospital, Rouen,
France.
Nasal glioma is a rare congenital midline malformation composed of heterotopic
masses of neuroglial tissue. We report a case of fetal nasal glioma diagnosed by
sonography at 22 weeks' gestation as a vascular hypoechoic mass located on the
left nasal bone. Fetal MRI excluded an underlying bone defect. At birth, the
lesion appeared as a reddish mass. Post natal imaging confirmed the
vascularisation within the lesion with an arterial low-flow velocity and a
high-resistance spectrum, consistent with a glioma. The child underwent surgery
at 5 months and final diagnosis was made on pathological examination. Therefore,
a vascular lesion and a clinical aspect mimicking a haemangioma should not be
considered sufficient to reach the final diagnosis.
PMID: 20401478 [PubMed - as supplied by publisher]
4. Ann Cardiol Angeiol (Paris). 2010 Apr;59(2):86-92.
[Endothelial dysfunction: role of vasodilating betablockers in hypertension and
chronic heart failure]
[Article in French]
Thuillez C.
Service de Pharmacologie, Institut de Biologie Clinique, INSERM U644, Université
de Rouen CHU de Rouen, France. christian.thuillez@chu-rouen.fr
<christian.thuillez@chu-rouen.fr>
The beneficial effects of beta blocking drugs in hypertension and heart failure
are well known. However, this class of drugs is pharmacologically heterogeneous.
In contrast to the non vasodilator betablockers like propranolol, atenolol or
metoprolol which, in hypertension do not decrease intima media thinckness both in
arterioles and large arteries, do not decrease arterial rigidity and can induce
diabetes mellitus, the betablockers with vasodilating properties are beneficial
on these parameters. Moreover, in heart failure, they more markedly decrease left
ventricular workload than betablockers without any vascular relaxing effect and
the results of SENIOR with nebivolol could suggest the beneficial role of NO on
left ventricular dysfunction. Finally, the third generation betablockers,
represented by celiprolol, carvedilol and nebivolol, have antioxidant properties
which are probably implicated in their endothelial protective effects and in
their absence of deleterious metabolic effects, effects which are probably of
interest in term of protection of target organs during chronic treatment of
hypertensive patients.
PMID: 20399940 [PubMed - in process]
5. Pediatrics. 2010 May;125(5):e1259-64. Epub 2010 Apr 12.
Bolus methylprednisolone efficacy for uncontrolled exacerbation of cystic
fibrosis in children.
Ghdifan S, Couderc L, Michelet I, Leguillon C, Masseline B, Marguet C.
Department of Pediatrics, CF Reference Centre, Charles Nicolle University
Hospital, 1 Rue de Germont, 76031 Rouen, France. christophe.marguet@chu-rouen.fr.
We present here the clinical course of 4 children with cystic fibrosis,
deltaF508/deltaF508, who were admitted with severe respiratory distress and in
whom no improvement was obtained by intensive antibiotic therapy and systemic
corticosteroids. Chest computed-tomography scans showed hyperinflation and
atelectasis. The severity of these exacerbations was explained neither by visible
mucus plugging nor by allergic bronchopulmonary aspergillosis. We hypothesized
that these clinical features were related to a severe inflammatory process in
small airways. Therefore, a high-dose short course of methylprednisolone (1
g/1.73 m(2) per day for 3 days) was given; all the patients' conditions were
dramatically improved, and the therapy was safe. To our knowledge, this is the
first reported use of bolus methylprednisolone in the treatment of uncontrolled
pulmonary exacerbation in children with cystic fibrosis.
PMID: 20385626 [PubMed - in process]
6. QJM. 2010 Apr 11. [Epub ahead of print]
Follow-up of muscular sarcoidosis using fluorodeoxyglucose positron emission
tomography.
Marie I, Lahaxe L, Vera P, Edet-Samson A.
Department of Internal Medicine, CHU Rouen 76031 Rouen Cedex, France and
Department of Nuclear Medicine, CHU Rouen, 76031 Rouen Cedex, France
isabelle.marie@chu-rouen.fr.
PMID: 20385567 [PubMed - as supplied by publisher]
7. Diab Vasc Dis Res. 2010 Apr;7(2):158-66. Epub 2010 Feb 22.
Early stage detection of conduit artery endothelial dysfunction in patients with
type 1 diabetes.
Bellien J, Costentin A, Dutheil-Maillochaud B, Iacob M, Kuhn JM, Thuillez C,
Joannides R.
University of Rouen, Rouen cedex, France.
Flow-mediated dilatation evaluation using hand skin heating may possibly be more
accurate than post-ischaemic hyperaemia to detect conduit artery endothelial
dysfunction in type 1 diabetes. We measured in 24 type 1 diabetic patients (n=16
without microangiopathy) and 24 healthy matched subjects radial artery diameter
(echotracking), blood flow and mean wall shear stress during heating and
post-ischaemic hyperaemia. Compared with controls, flow-mediated dilatation was
lower in diabetic patients during post-ischaemic hyperaemia and heating. However,
in the subgroup of uncomplicated patients, a decreased flow-mediated dilatation
was only apparent during heating (17.1+/-1.6% vs. 24.3+/-0.7%, p<0.05) but not
during post-ischaemic hyperaemia (10.1+/-1.1% vs. 10.5+/-0.6%, NS). This was
confirmed by the lower slope of the diameter-mean wall shear stress relationship
in these patients in the absence of modification in endothelium-independent
dilatation. We conclude that hand skin heating permits the early detection of
conduit artery endothelial dysfunction in type 1 diabetic patients with normal
response to post-ischaemic hyperaemia. This procedure could be useful to
investigate the prognostic role of vascular dysfunction and the impact of
vasculoprotective treatments in this patient population.
PMID: 20382780 [PubMed - in process]
8. Rev Med Interne. 2010 Apr 6. [Epub ahead of print]
[Non tuberculous anti-TNF associated opportunistic infections.]
[Article in French]
Marie I, Guglielmino E.
Département de médecine interne, CHU de Rouen, 1, rue de Germont, 76031 Rouen
cedex, France.
Anti-TNFalpha agents have revolutionized the treatment of patients with
rheumatoid arthritis, spondylarthropathies and Crohn's disease. However, their
use is associated with an increased risk of infections. Pyogenic infections
(involving the lungs, skin and urinary tract) and tuberculosis are the more
commonly observed infectious complications in patients receiving anti-TNFalpha
agents. However, opportunistic infections have been increasingly reported in
anti-TNFalpha-treated patients, and include non tuberculous mycobacteria, fungi
(Pneumocystis jiroveci, Candida sp, Aspergillus, Cryptococcus, Histoplasma),
opportunistic bacterial (Nocardia), parasitic (Leishmania) and viral (e.g.
Cytomegalovirus, human herpes virus 8 [HHV 8]) infections. These infectious
complications usually occur within the first months of therapy and are important
causes of morbidity and mortality in anti-TNFalpha-treated patients. It is
recommended to rule out infections, especially latent or active tuberculosis,
before the initiation of anti-TNFalpha therapy. However, it is necessary to
follow-up closely these patients to detect the possible occurrence of
opportunistic infections. Copyright © 2010 Société nationale française de
médecine interne (SNFMI). Published by Elsevier SAS. All rights reserved.
PMID: 20381217 [PubMed - as supplied by publisher]
9. Hum Reprod. 2010 Apr 8. [Epub ahead of print]
Direct proportional relationship between endometrioma size and ovarian parenchyma
inadvertently removed during cystectomy, and its implication on the management of
enlarged endometriomas.
Roman H, Tarta O, Pura I, Opris I, Bourdel N, Marpeau L, Sabourin JC.
Department of Gynaecology and Obstetrics, and Groupe de recherche EA 4308
'Spermatogenesis and Male Gamete Quality', Rouen University Hospital, 76031
Rouen, France.
BACKGROUND The aim of this study was to estimate whether or not the size of an
endometrioma is related to the thickness of the ovarian parenchyma inadvertently
excised along with the cyst wall. METHODS We performed a retrospective study
including 35 women who had undergone endometrioma cystectomy, using an ovarian
tissue sparing procedure. In total 38 specimens were studied by three
pathologists as three women presented bilateral localizations, and all cyst
diameters measured at least 30 mm. For each endometrioma, serial sections were
performed, and on each section four different sites were randomly chosen to
measure the thickness of glandular epithelium and stroma, of subjacent fibrosis,
depending on the cyst, and of the ovarian parenchyma removed with the cyst. The
diameter of the ovary was measured preoperatively either by MRI or ultrasound,
and the area of the internal wall was then calculated. The relationships between
the mean thickness of ovarian parenchyma removed and the variables were estimated
and a multiple regression model identified independent predictors for ovarian
parenchyma thickness. RESULTS Adjacent ovarian tissue was found in 37 cases
(97%). The mean thickness of ovarian tissue removed was 1173 +/- 711 microm and
that of the cyst wall was 851 +/- 499 microm. The thickness of the ovarian
parenchyma removed presented a direct proportional relationship with cyst
diameter (P = 0.015), and consequently with cyst wall area (P = 0.032). This
relationship with cyst diameter was independent after adjustment on other
variables (P = 0.032). CONCLUSION Endometrioma cystectomy even though performed
with an accurate surgical technique leads to significant ovarian tissue removal,
the thickness of which increases proportionally with cyst diameter.
PMID: 20378613 [PubMed - as supplied by publisher]
10. Acta Neuropathol. 2010 Apr 8. [Epub ahead of print]
Human lissencephaly with cerebellar hypoplasia due to mutations in TUBA1A:
expansion of the foetal neuropathological phenotype.
Lecourtois M, Poirier K, Friocourt G, Jaglin X, Goldenberg A, Saugier-Veber P,
Chelly J, Laquerrière A.
Faculty of Medicine, INSERM, U614, IFRMP23, Rouen Institute for Medical Research
and Innovation, University of Rouen, Rouen, France.
Neuronal migration disorders account for a substantial number of cortical
malformations, the most severe forms being represented by lissencephalies.
Classical lissencephaly has been shown to result from mutations in LIS1
(PAFAH1B1; MIM#601545), DCX (Doublecortin; MIM#300121), ARX (Aristaless-related
homeobox gene; MIM#300382), RELN (Reelin; MIM#600514) and VLDLR (Very low density
lipoprotein receptor; MIM#224050). More recently, de novo missense mutations in
the alpha-tubulin 1a gene (TUBA1A) located on chromosome 12q13.12, have also been
associated with more or less severe defects of cortical development, resulting in
complete agyria in the most severe cases of lissencephaly. We report here the
cerebral lesions in a 36 weeks' gestation female foetus with a novel de novo
missense mutation in the TUBA1A gene, presenting the most severe antenatal
phenotype reported so far. Using routine immunohistochemistry and confocal
microscopy, we show evidence for defects in axonal transport in addition to
defects in neuronal migration and differentiation, giving new insights to the
pathophysiology of this form of lissencephaly.
PMID: 20376468 [PubMed - as supplied by publisher]
11. J Am Soc Echocardiogr. 2010 Apr;23(4):370-6.
Immediate and long-term echocardiographic findings after transcatheter aortic
valve implantation for the treatment of aortic stenosis: the
Cribier-Edwards/Edwards-Sapien valve experience.
Bauer F, Lemercier M, Zajarias A, Tron C, Eltchaninoff H, Cribier A.
Division of Cardiology, Rouen University Hospital, Rouen, France.
fabrice.bauer@chu-rouen.fr
Comment in:
J Am Soc Echocardiogr. 2010 Apr;23(4):377-9.
BACKGROUND: The role of transcatheter aortic valve implantation in the treatment
of calcific aortic stenosis is evolving. Immediate and long-term
echocardiographic findings are poorly reported. METHODS: Eighty-eight patients in
whom surgical aortic valve replacement was contraindicated were studied before
and 1 and 7 days, 1 month, and 1 and 2 years after the transcatheter procedure by
echocardiography for hemodynamic. Transaortic pressure gradient, permeability
index, and aortic valve area were measured, and aortic regurgitation was
estimated from a multiparametric approach. A subset group of 36 patients (23-mm
valve, n = 18; 26-mm valve, n = 18) with optimal ultrasound window were
investigated for valve geometry at 7 days. We measured the sphericity index
(anteroposterior to sagittal diameter ratio) and the angulation of the prosthesis
with the ascending aorta. RESULTS: By analysis of variance, transaortic pressure
gradient significantly decreased and aortic valve area increased after the
procedure (P < .0001 and P < .0001 respectively). Aortic regurgitation severity
tended to decline at follow-up (P = .20) and was unaffected by valve size (P =
.35). Leaks were paraprosthetic in 77% of cases, intraprosthetic in 6% of cases,
and both in 17% of cases. Overall, the sphericity index was 1.03 +/- 0.07 and the
angulation was 2.9 +/- 1.1 degrees. CONCLUSION: Echocardiography aids in the
demonstration of appropriate prosthesis function and positioning after
transcatheter aortic valve implantation. Copyright 2010 American Society of
Echocardiography. Published by Mosby, Inc. All rights reserved.
PMID: 20362925 [PubMed - in process]
12. Rev Stomatol Chir Maxillofac. 2010 Apr;111(2):105-7. Epub 2010 Mar 27.
[Polymorphous low-grade adenocarcinoma of the maxilla simulating an odontogenic
cyst]
[Article in French]
Geha H, Boland FX, Francois A, Tardif A, Peron JM.
Service de chirurgie maxillofaciale et stomatologie, CHU de Rouen, 1, rue de
Germont, 76000 Rouen, France. chirface@free.fr <chirface@free.fr>
INTRODUCTION: In 1990, the WHO classified Polymorphous Low Grade Adenocarcinoma
as a low-grade malignant tumor of the minor salivary glands. This tumor often
originates from the hard or soft palate minor salivary glands. We report the
first case revealed as an infected maxillary odontogenic cyst around an impacted
tooth. CASE REPORT: A 50-year-old female presented 20 months ago with a bulging,
painful oral mass in the right superior vestibule. The diagnosis was infected
odontogenic cyst associated with an impacted canine tooth. A course of oral
antibiotics was given and cyst enucleation and tooth extraction were performed 6
days later. Ameloblastoma was suggested on macroscopic findings; nevertheless,
the pathologic end diagnosis was Polymorphic Low-Grade Adenocarcinoma of minor
salivary gland origin. After negative carcinological screening, wide surgical
resection was performed. Postoperative external radiotherapy was applied to the
operated area as well as to cervical lymph node areas. DISCUSSION: Most of the
565 published cases concern a palatine location. Even though wide surgical
resection is sufficient, external radiotherapy may be used on a case-by-case
basis.
PMID: 20347466 [PubMed - in process]
13. J Nutr. 2010 Apr;140(4):799-805. Epub 2010 Feb 24.
A diet containing whey protein, free glutamine, and transforming growth
factor-beta ameliorates nutritional outcome and intestinal mucositis during
repeated chemotherapeutic challenges in rats.
Boukhettala N, Ibrahim A, Aziz M, Vuichoud J, Saudan KY, Blum S, Déchelotte P,
Breuillé D, Coëffier M.
Nutrition Unit, Rouen University Hospital, Rouen, France.
Anticancer chemotherapy often induces side effects such as mucositis. Recent data
suggest that a diet, Clinutren Protect (CP), containing whey proteins, glutamine,
and transforming growth factor-beta (TGFbeta)-rich casein limits intestinal
mucositis and improves recovery after a single methotrexate (MTX) challenge in
rats. Chemotherapy consists of alternating periods of treatment and rest. Thus,
our study evaluated the effects of CP on nutritional outcome and intestinal
mucositis in rats receiving repeated chemotherapeutic challenges. Thirty-six
Sprague-Dawley rats received 3 cycles of MTX at 8-d intervals. Rats had free
access to CP or control diet (Co) from 7 d before the first MTX injection until
the end of the experiment at d 27. In Co, whey proteins and TGFbeta-rich casein
were replaced by TGFbeta-free casein. L-Glutamine was replaced by L-alanine. Body
composition was assessed by dual energy X-ray absorptiometry. Before MTX
challenges, food intake and body weight were similar in both groups but became
higher during MTX challenges in CP (P < 0.05). Fat mass decreased similarly in
both groups. In contrast, the decrease of fat free mass between d -1 and d 27 was
less pronounced in the CP group (-9.5 g) than in the Co group (-57.2 g) (P <
0.05). The intestinal damage score was lower in the CP group (0.6 +/- 0.3 vs. 2.1
+/- 0.6; P < 0.05). Fecal IgA increased over time in the CP group (P < 0.05) but
not in the Co group. A diet containing whey proteins, glutamine, and TGFbeta
improves nutritional outcome by limiting the reduction of fat free mass and
reduces intestinal mucositis during repeated chemotherapeutic challenges in rats.
PMID: 20181781 [PubMed - indexed for MEDLINE]
14. Rev Med Interne. 2010 Apr;31(4):315-7. Epub 2010 Feb 18.
[Diffuse angioedema]
[Article in French]
Leblanc C, Lahaxe L, Girszyn N, Levesque H, Marie I.
Département de médecine interne, CHU de Rouen, Rouen cedex, France.
PMID: 20167401 [PubMed - in process]
15. Rev Med Interne. 2010 Apr;31(4):255-61. Epub 2010 Feb 11.
[Infectious aortic aneurysms. A case series of 10 patients]
[Article in French]
Miranda S, Janvresse A, Plissonnier D, Lévesque H, Marie I.
Département de médecine interne, CHU de Rouen-Boisguillaume, 76031 Rouen cedex,
France.
PURPOSE: Infectious aortic aneurysms are rare, being responsible of less than 3%
of aortic aneurysms. In this study, we report the clinical characteristics and
the outcome of patients presenting with infectious aortic aneurysms in an
internal medicine unit. METHODS: Diagnosis of infection-related aortic aneurysm
was obtained using: computed tomographic scan; and blood cultures, cultures and
molecular biology testing of aortic wall and intra-aneurismal thrombus. RESULTS:
The 10 consecutive patients included in this study consisted in eight men and two
women with a mean age of 61.7 years. Patients presented with fever (n=9),
asthenia (n=2), abdominal (n=4) or chest pain (n=1), lumbar pain (n=3). Computed
tomographic scan showed aneurysm involving both thoracic and abdominal aorta
(n=1), abdominal (n=8) or thoracic aorta (n=1). Isolated microorganisms were:
positive Gram cocci (70%) and negative Gram bacilli (30%). All patients underwent
both medical and surgical therapy. Outcome was favorable in nine patients; the
remaining patient died from aneurismal aortic rupture. CONCLUSION: Clinical
manifestations revealing infectious aortic aneurysms are variable, including
aneurysm rupture as well as atypical abdominal pain with inflammatory syndrome.
These latter presentations are more common in patients, who are hospitalized in
internal medicine. Our study underlines that this clinical pattern should not be
ignored, in order to avoid both diagnostic and therapeutic delay that could lead
to life-threatening complications and poor prognosis. Copyright 2010 Société
nationale française de médecine interne (SNFMI). Published by Elsevier SAS. All
rights reserved.
PMID: 20153092 [PubMed - in process]
16. J Nucl Cardiol. 2010 Apr;17(2):197-206. Epub 2010 Feb 12.
Diagnostic and prognostic value of myocardial perfusion gated SPECT in orthotopic
heart transplant recipients.
Manrique A, Bernard M, Hitzel A, Bubenheim M, Tron C, Agostini D, Cribier A, Véra
P, Bessou JP, Redonnet M.
Department of Nuclear Medicine, Rouen University Hospital, Henri Becquerel
Center, Rouen, France. manrique@cyceron.fr
Comment in:
J Nucl Cardiol. 2010 Apr;17(2):172-4.
BACKGROUND: Cardiac allograft vasculopathy (CAV) limits long-term survival after
heart transplantation. Diagnostic and prognostic value of gated single photon
emission computed tomography (gated SPECT) has not been documented in this
setting. METHODS AND RESULTS: We identified 110 consecutive heart transplant
recipients (with transplantation >18 months) who underwent stress-rest gated
SPECT and coronary angiography within 1 month, and were clinically monitored in a
single heart transplantation center. Visual scoring of perfusion and wall motion
images used a 16-segment model. Left ventricular function was automatically
calculated. Coronary angiography was normal in 64 patients (58%) and abnormal in
46 (any CAV, 42%), of whom 19 had severe stenoses. Sensitivity and negative
predictive (NPV) value were .63 and .75 for identification of any CAV, and .84
and .96 for severe CAV. Cox regression analysis showed that independent
predictors of cardiac death and retransplantation were the presence of any
angiographic CAV lesions (RR = 8.816, P = .043) and a stress perfusion defect >3
segments (RR = 5.607, P = .0053). A stress perfusion defect >3 segments predicted
the need for late coronary revascularization >2 months (RR = 6.11, P = .0002).
CONCLUSIONS: We conclude that perfusion gated SPECT is a useful noninvasive
screening test and may be proposed to help identify heart transplant recipients
with a high risk of poor clinical outcome. A normal gated SPECT was associated
with a low risk of cardiac hard event and might alleviate the need for coronary
angiography.
PMID: 20151240 [PubMed - in process]
17. Hum Reprod. 2010 Apr;25(4):890-9. Epub 2010 Jan 26.
Delayed functional outcomes associated with surgical management of deep
rectovaginal endometriosis with rectal involvement: giving patients an informed
choice.
Roman H, Loisel C, Resch B, Tuech JJ, Hochain P, Leroi AM, Marpeau L.
Department of Gynecology and Obstetrics, Rouen University Hospital, Rouen,
France. horace.roman@gmail.com
BACKGROUND: The aim of this study was to compare delayed functional digestive and
urinary outcomes following two different surgical procedures used in the
management of rectal endometriosis. METHODS: Women who had undergone surgical
management of rectal endometriosis with at least 1 year of post-operative
follow-up were included in a retrospective study. Post-operative symptoms were
evaluated using specific questionnaires which focused on pelvic pain and
functional outcomes. RESULTS: There were 41 women who underwent surgical
treatment of symptomatic rectal endometriosis. Post-operative follow-up was
completed over 26 +/- 13 months (range 12-53). Colorectal segmental resection was
performed in 25 women (61%) and nodule excision in 16 (39%). An increase in the
number of daily stools > or =3 was observed in 13 (52%) and 3 (19%) patients
managed, respectively, by segmental resection and nodule excision (P = 0.02).
Severe constipation (<1 stool/5 days) was recorded in three women having
undergone segmental resection. The probabilities of being free of dysmenorrhea,
dyspareunia and non-cyclic pain at 24 months in women managed by segmental
resection and nodule excision were, respectively, 80% (95% CI: 55-92%), 65% (95%
CI: 42-81%), 43% (95% CI: 23-62%) and 62% (95% CI: 34-81%), 81% (95% CI: 52-94),
69% (95% CI: 40-86%). When pain recurrences occurred, a significantly lower
post-operative score for pain was observed in both groups. No significant
difference in pain improvement was found between surgical procedures. CONCLUSION:
Colorectal segmental resection appears to be associated with several unpleasant
functional symptoms when compared with nodule excision. Information about
functional outcomes should be provided to patients managed for rectal
endometriosis, and should be considered when deciding on the most appropriate
treatment of this disease.
PMID: 20106836 [PubMed - in process]
18. J Fr Ophtalmol. 2010 Apr;33(4):296. Epub 2010 Jan 21.
[Bilateral torpedo maculopathy]
[Article in French]
Richez F, Gueudry J, Brasseur G, Muraine M.
Service d'Ophtalmologie, CHU Charles Nicolle, 1, rue de Germont, 76031 Rouen
Cedex. frichez@hotmail.com
PMID: 20096477 [PubMed - in process]
19. Rev Neurol (Paris). 2010 Apr;166(4):428-432. Epub 2009 Dec 5.
[Argyrophilic grain disease: Synergistic component of dementia?]
[Article in French]
Wallon D, Sommervogel C, Laquerrière A, Martinaud O, Lecourtois M, Hannequin D.
Service de neurologie, université de Rouen, CHU Charles-Nicolle, 1, rue de
Germont, 76031 Rouen cedex, France.
INTRODUCTION: Argyrophilic grain disease (AGD) is one cause of neurodegenerative
dementia with a variable clinical spectrum. A neuropathology study is required
for diagnosis. CASE REPORT: We report the case of a 68-year-old patient
presenting with cognitive decline associating with frontal dysfunction and
parkinsonism. Death occurred two years after onset. The neuropathology study
revealed a status criblosus in the basal ganglia, neurofibrillary tangles and
AGD. DISCUSSION: We suggest that AGD could explain the atypical course of this
dementia considering the fast cognitive decline, the clinical expression and the
topography of the lesions. CONCLUSION: This case illustrates the possible
synergistic deleterious effect of this pathology on other causes of dementia.
Copyright © 2009 Elsevier Masson SAS. All rights reserved.
PMID: 19963233 [PubMed - as supplied by publisher]
