1: Int J Gynecol Pathol. 2009 May 28. [Epub ahead of print]
Oligodendroglioma Arising in an Ovarian Mature Cystic Teratoma.
Opris I, Ducrotoy V, Bossut J, Lamy A, Sabourin JC.
Department of Pathology, (I.O., J.B., A.L., J-C.S.), Rouen University Hospital,
Rouen Obstetrics and Gynecology Department (V.D.), Belvedere Hospital,
Mont-Saint-Aignan, France.
We describe a case of oligodendroglioma arising in an ovarian mature cystic
teratoma associated with a loss of heterozygosity on the long arm of chromosomes
19 and 10. To our knowledge it is the second case reported in the literature at
this site and the first one described in association with a characterized genetic
alteration. The patient was 29 years old and presented with a history of 4 months
of pelvic pain. Ultrasound examination showed a cystic mass arising in the left
adnexa suggesting a teratoma. At laparotomy a cystic ovoid mass was found arising
from the left adnexa, completely replacing the ovary. An ovariectomy was
performed. Macroscopically a multilocular cyst containing hair, sebum, and a
relatively well-defined solid zone of grayish-pink color strongly suggestive of a
cerebral tissue, was observed. Microscopic analyses confirmed the teratomatous
nature of the cyst. The solid area was composed of mature glial tissue in which
was observed a proliferation of monotonous cells with round and homogenous
nuclei, surrounded by a clear halo of cytoplasm ("honeycomb appearance") which
immunohistochemically showed positivity for glial fibrilar acidic protein and for
neurofilament protein. Ki-67 labeling index was about 3%. These findings were
consistent with a low-grade oligodendroglioma arising in a mature ovarian cystic
teratoma. Reverse transcription-polymerase chain reaction analysis showed a
characterized loss of heterozygosity occurring in tumor DNA on chromosomes 10q
and 19q13.
PMID: 19483626 [PubMed - as supplied by publisher]
2: Rheumatology (Oxford). 2009 May 29. [Epub ahead of print]
Can rheumatoid arthritis responsiveness to methotrexate and biologics be
predicted?
Bansard C, Lequerré T, Daveau M, Boyer O, Tron F, Salier JP, Vittecoq O, Le-Loët
X.
Inserm, Unité 905,Institut Fédératif de Recherche Multidisciplinaire sur les
Peptides 23, Institute for Biomedical Research, Faculté de Médecine-Pharmacie,
University of Rouen,Department of Rheumatology, Rouen University Hospital and
Consortium EGERIE, Paris, Rouen, France.
This review briefly recapitulates the existing markers predictive of RA
responsiveness to treatment, focusing on MTX alone or combined with a biologic.
In addition to the demographic and clinical factors, an update is provided of the
predictive biomarkers identified by large-scale gene and protein analyses that
generated new insights into the ability of high-throughput analysis of biological
systems to select new potential indicators. Among the large-scale analysis tools
now available, pharmacogenetics and pharmacogenomics (including transcriptomic
and proteomic approaches) have been shown to provide such new putative biomarkers
of therapeutic responses.
PMID: 19483089 [PubMed - as supplied by publisher]
3: Orthop Traumatol Surg Res. 2009 Jun;95(4 Suppl):41-8. Epub 2009 May 7.
Clinical examination of the foot and the ankle. Data collection and
interpretation of the pathogenic causal sequence of disorders.
Biga N.
Surgery-Rouen University Hospital, University of Rouen, 1, rue de Germont, 76031
Rouen cedex, France. norman.biga@chu-rouen.fr
The clinical examination remains the irreplaceable stage in assessing foot and
the ankle disorders. It comprises a complete inventory of the patient's
complaints and the data obtained from the physical examination. Afterwards, it
should concentrate on establishing consistency between symptoms that can be
disparate, to link them in a logical pathogenic causal pattern to be used in
developing a treatment programme. These correlations are the most often obvious
and only require confirmation with standard X-rays. In the absence of
consistency, and if a diagnosis is difficult to establish, recourse to more
sophisticated investigations (CT scan, MRI or an intra-articular local
anaesthetic test) becomes worthwhile. To achieve maximum value, the physical
examination must be based on prerequisite knowledge of functional anatomy,
admittedly basic but covering all the bone and joint, ligament, muscle, skin and
neurovascular components. All these structures being closely interrelated. This
organization allows for remarkable protection mechanisms and the capacity to
endure considerable cyclic stress. This interdependence can also command chains
of injury difficult to unravel. The examination must thus be methodical and
comprehensive: history taking (ranking of symptoms, evaluation of the patient's
psychological profile); physical examination, standing, on a podoscope, gait
analysis, lying down (trophic disorders, joint range of motion, muscle testing);
standard X-rays, always weight bearing. This discursive organization, essential
in everyday practice, avoids the sequence "symptom --> MRI --> surgical
indication" which is a professional and intellectual deviance; it enables the
development, in terms of advantages against risks, or an appropriate treatment
plan in the best conditions.
PMID: 19427281 [PubMed - in process]
4: Am J Pathol. 2009 May 28. [Epub ahead of print]
Novel Serum Markers of Fibrosis Progression for the Follow-Up of Hepatitis C
Virus-Infected Patients.
Caillot F, Hiron M, Goria O, Gueudin M, Francois A, Scotte M, Daveau M, Salier
JP.
From the Inserm, Unité 905 and Institut Fédératif de Recherches
Multidisciplinaires sur les Peptides,* Faculté de Médecine-Pharmacie, Université
de Rouen, France; the Service d'Hépato-Gastro-Entérologie, Centre Hospitalier
Universitaire, Rouen, France; the Laboratoire de Virologie, Centre Hospitalier
Universitaire, Rouen, France; Département de Pathologie, Centre Hospitalier
Universitaire, Rouen, France; and the Service de Chirurgie Générale et Digestive,
Centre Hospitalier Universitaire, Rouen, France.
Liver biopsy is considered the gold-standard method for the assessment of liver
fibrosis during follow-up of hepatitis C virus-infected patients, but this
invasive procedure is not devoid of complications. The aim of the present study
was to identify novel non-invasive markers of fibrosis progression. By microarray
analysis, we compared transcript levels in two extreme stages of fibrosis from 16
patients. Informative transcripts were validated by real-time PCR and used for
the assessment of fibrosis in 23 additional patients. Sixteen transcripts were
found to be dysregulated during the fibrogenesis process. Among them, some were
of great interest because their corresponding proteins could be serologically
measured. Thus, the protein levels of inter-alpha inhibitor H1, serpin peptidase
inhibitor clade F member 2, and transthyretin were all significantly different
according to the four Metavir stages of fibrosis. In conclusion, we report here
that dysregulation, at both the transcriptional and protein levels, exists during
the fibrogenesis process. Our description of three novel serum markers and their
potential use as serological tests for the non-invasive diagnosis of liver
fibrosis open new opportunities for better follow-up of hepatitis C
virus-infected patients.
PMID: 19477948 [PubMed - as supplied by publisher]
5: Eur Heart J. 2009 May 28. [Epub ahead of print]
Magnetic resonance diagnosis of cardiac fat-containing tumours in tuberous
sclerosis.
Martin C, Fares J, Vivier PH, Dacher JN.
Department of Radiology, University Hospital of Rouen, 1, rue de Germont, Rouen
76031, France.
PMID: 19477876 [PubMed - as supplied by publisher]
6: Gastroenterol Clin Biol. 2009 May 26. [Epub ahead of print]
Unusual skeletal muscle metastasis from gastric adenocarcinoma.
Tougeron D, Hamidou H, Dujardin F, Maillard C, Di Fiore F, Michel P.
Digestive Oncology Unit, Department of Gastroenterology, Rouen University
Hospital, Northwest Cancéropôle, 1, rue de Germont, Rouen, France.
Patients with gastric adenocarcinoma frequently develop hepatic metastases or
peritoneal carcinosis but involvement of the skeletal muscle is extremely rare.
We report the case of a 71-year-old man with a painful soft tissue mass in the
right shoulder. Two years previously, the patient had been treated for a locally
advanced gastric carcinoma (surgery plus chemoradiotherapy). Surgical exploration
with biopsy showed skeletal muscle metastasis from the gastric adenocarcinoma in
the deltoid muscle. Chemoradiotherapy resulted in complete regression of symptoms
from the metastatic lesion. The patient is alive and free of recurrence in the
deltoid muscle after a follow-up of 13 months. Based on this case study, the
difficulty of diagnosing skeletal muscle metastases, the prognosis and treatment
options are discussed.
PMID: 19477611 [PubMed - as supplied by publisher]
7: Gastroenterol Clin Biol. 2009 May 25. [Epub ahead of print]
Predictive and prognostic factors in patients with an oesophageal carcinoma
treated with chemoradiotherapy: The key role of nutritional parameters.
Duclos A, Di Fiore F, Lecleire S, Michel P.
Digestive Oncology Unit, Hepatogastroenterology Department, Charles Nicolle
Hospital, Rouen University Hospital, 1, rue de Germont, 76031 Rouen cedex,
France.
Publication Types:
LETTER
PMID: 19473797 [PubMed - as supplied by publisher]
8: Joint Bone Spine. 2009 May 20. [Epub ahead of print]
Infliximab induced skin and pulmonary sarcoidosis in a rheumatoid arthritis
patient.
Josse S, Klemmer N, Moreno-Swirc S, Goëb V, Lequerré T, Vittecoq O.
Department of Rheumatology, Rouen University Hospital, 76031 Rouen cedex, France.
Publication Types:
LETTER
PMID: 19464223 [PubMed - as supplied by publisher]
9: Neurogastroenterol Motil. 2009 May 21. [Epub ahead of print]
Irritable bowel syndrome is more frequent in patients hospitalized for ischaemic
colitis: results of a case-control study.
Hervé S, Beaugerie L, Bouhnik Y, Savoye G, Colombel JF, Dyard F,
Hourmand-Ollivier I, Dao T, Vial M, Lerebours E.
Département d'hépatogastroentérologie, Rouen University Hospital, Rouen, France.
Abstract It has been suspected that there is an epidemiological link between
irritable bowel syndrome (IBS) and ischaemic colitis (IC). We performed a
retrospective case-control study to compare the frequency of IBS in patients
hospitalized for IC compared with that of patients with peptic ulcer bleeding.
Cases were patients with a first episode of IC and controls were patients with a
first episode of peptic ulcer bleeding, matched to cases for sex and 10-year
age-class. Diagnosis of IBS was based on medical information extracted from
hospital medical files and a standard self-questionnaire. The association between
IBS and IC was tested using Mc Nemar's paired odds ratio (OR); confidence
interval at 95% (CI 95%) was calculated; Mantel-Haenzel's Chi(2) was applied. A
total of 113 cases and 113 matched controls were studied. There were 37 males and
76 females and the mean age was 69 +/- 15 years in each group. The prevalence of
IBS in cases was 16.9%vs 1.8% in controls. The risk of IBS was 11.05 times higher
among cases than in controls (P < 0.001); CI 95%: (2.45-49.74). A total of 87
pairs with complete data were used for OR calculation. The risk of IBS was 7.5
times higher in cases than in controls (P = 0.002); CI 95%: (1.72-32.80). This
case-control study shows that IBS is more frequent in IC patients than in
controls.
PMID: 19460104 [PubMed - as supplied by publisher]
10: Arch Dermatol. 2009 May;145(5):529-35.
Comment in:
Arch Dermatol. 2009 May;145(5):585-7.
ELISA testing of anti-desmoglein 1 and 3 antibodies in the management of
pemphigus.
Abasq C, Mouquet H, Gilbert D, Tron F, Grassi V, Musette P, Joly P.
Department of Dermatology, Clinique Dermatologique, Hôpital Charles Nicolle, 1
rue de Germont, 76031 Rouen CEDEX, France.
OBJECTIVE: To assess the predictive value of anti-desmoglein (Dsg) 1 and
anti-Dsg3 antibody (Ab) enzyme-linked immunosorbent assay (ELISA) values for the
occurrence of relapses in pemphigus. DESIGN: Retrospective study. SETTING:
Dermatology departments from 13 university hospitals in France. Patients The
study population comprised 26 patients with typical clinical, histologic, and
immunofluorescence findings of pemphigus, who were followed up over a 17-month
period. MAIN OUTCOME MEASURES: Serial anti-Dsg1 and anti-Dsg3 Ab ELISA values
were recorded during the patients' follow-up examinations and correlated with the
occurrence of skin and/or mucosal relapses. RESULTS: A significant reduction of
anti-Dsg1 (P < .001) and anti-Dsg3 (P < .001) Ab ELISA values was observed in
serum samples from patients with pemphigus foliaceus or pemphigus vulgaris after
the initial treatment. During the long-term follow-up, anti-Dsg1 Ab ELISA values
correlated with the course of skin lesions (P = .03); the 20 U/mL cutoff for the
anti-Dsg1 Ab ELISA value provided a 79% positive and an 84% negative predictive
value for the occurrence of cutaneous relapses. No correlation was observed
between anti-Dsg3 Ab ELISA values and the course of mucosal lesions (P = .13).
Anti-Dsg3 Ab ELISA values higher than the 14-U/mL cutoff were observed in 5 of
the 5 patients with relapse and in 10 of the 13 patients with ongoing mucosal
remission, providing a 100% sensitivity but a poor specificity of 23%. A cutoff
value of 130 U/mL for anti-Dsg3 Abs was calculated based on the receiver
operating characteristics curve and provided an 84% positive and an 81% negative
predictive value. CONCLUSIONS: Anti-Dsg1 Ab ELISA values are more closely
correlated than anti-Dsg3 Ab ELISA values with the course of the disease in
patients with pemphigus vulgaris or pemphigus foliaceus. This should be taken
into account for the management of patients with pemphigus.
PMID: 19451496 [PubMed - in process]
11: Gynecol Obstet Fertil. 2009 May 15. [Epub ahead of print]
[She won't be a mother, nor a surrogate-mother.]
[Article in French]
Marpeau L.
Clinique gynécologique et obstétricale, hôpital Charles-Nicolle, CHU de Rouen, 1,
rue de Germont, 76031 Rouen cedex, France.
Publication Types:
EDITORIAL
PMID: 19447665 [PubMed - as supplied by publisher]
12: Psychiatry Res. 2009 Jun 30;168(1):78-85. Epub 2009 May 17.
The role of coagulation marker fibrin D-dimer in early diagnosis of catatonia.
Haouzir S, Lemoine X, Desbordes M, Follet M, Meunier C, Baarir Z, Allio G, Menard
JF, Briant L, Jouen F, Petit M.
Service Hospitalo-Universitaire de Psychiatrie de Rouen, Centre Hospitalier du
Rouvray, 4 rue Paul Eluard, 76300 Sotteville-lès-Rouen, France.
Catatonia is a common but under-diagnosed neuropsychiatric syndrome characterized
by the occurrence in a single patient of concomitant affective, motor and
behavioral symptoms with a hazardous outcome (called lethal catatonia: LC).
Deaths by thromboembolic disease have been previously reported in LC. A 2-year
prospective study was carried out to examine D-dimer levels, an early and
sensitive coagulation marker, in patients with catatonic disorders. Twenty-five
acute catatonic patients and 50 psychiatric control patients - matched on age,
gender, psychiatric diagnosis, general psychopathology and neuroleptic medication
matched - were investigated and considered in relation to D-dimer blood levels
and other biological variables (serum iron, creatine phosphokinase,
leukocytosis). All catatonic patients had high D-dimer levels and mean levels
were significantly higher in catatonics than in non-catatonic patients,
independently of age, gender, immobility, comorbid diagnosis, general
psychopathology and neuroleptic medication. No significant association was
observed with other biological parameters investigated. These preliminary and
exploratory results suggest that catatonia is associated with early coagulation
activation.
PMID: 19447502 [PubMed - as supplied by publisher]
13: Medicine (Baltimore). 2009 May;88(3):182-92.
Long-term follow-up of aortic involvement in giant cell arteritis: a series of 48
patients.
Marie I, Proux A, Duhaut P, Primard E, Lahaxe L, Girszyn N, Louvel JP, Levesque
H.
FDepartment of Internal Medicine, Rouen University Hospital, Rouen, France.
isabelle.marie@chu-rouen.fr
To date, only a few series have analyzed the long-term outcome of giant cell
arteritis (GCA) patients with aortic involvement, which prompted us to conduct
the current retrospective study. Our aims were to 1) determine the prevalence of
GCA in patients exhibiting nonatherosclerotic aortic involvement (that is,
aortitis, aortic ectasia, and/or aneurysm); and 2) evaluate clinical features and
long-term outcome of GCA patients exhibiting aortitis, aortic ectasia, and/or
aortic aneurysm.From January 1997 to March 2008, 66 consecutive patients in the
Department of Internal Medicine at the University of Rouen medical center
received a diagnosis of nonatheromatous aortic complications (aortitis, aortic
ectasia, and/or aneurysm). In these 66 patients, aortic involvement was related
to GCA (n = 48), Takayasu arteritis (n = 6), relapsing polychondritis (n = 1),
and infection (n = 11).Of the 48 patients with GCA, aortic involvement preceded
the initial GCA diagnosis in 1 patient. Aortic involvement was identified in
association with GCA in 40 patients (83.3%), and developed after the onset of GCA
in the 7 remaining patients (14.6%). Aortic involvement was more often
asymptomatic (77.1%). The aortic helical computed tomography (CT)-scan procedure
principally showed isolated aortitis (circumferential thickening of the aortic
wall >3 mm) in 41 patients (85.4%). In the remaining 7 patients with GCA (14.6%),
aortic helical CT scan demonstrated aortic thoracic ectasia and aortitis (n = 3),
aortic thoracic aneurysm and both thoracic and abdominal aortitis (n = 3), and
both aortic abdominal aneurysm and aortitis (n = 1). All patients were given
steroid therapy at a median daily dose of 1 mg/kg initially.At 6-month follow-up,
34 of 48 patients systematically underwent both thoracic and abdominal CT scan.
Aortic helical CT scan demonstrated complete disappearance of aortitis in 8.8% of
patients, improvement of aortitis in 47.1%, unchanged pattern of aortitis and/or
aortic thoracic ectasia/aneurysm in 41.2%, and deterioration of aortic thoracic
aneurysm in 1 patient (2.9%). At 18-month follow-up, 11 patients systematically
underwent both thoracic and abdominal CT scan. Aortic helical CT scan showed
complete disappearance of aortitis (n = 1), improvement of aortitis (n = 1),
unchanged pattern of aortic thoracic ectasia/aneurysm (n = 2), and deterioration
of aortic thoracic aneurysm (n = 1). At patients' last follow-up, the median
daily dose of prednisone was 7 mg. Steroid therapy could be discontinued in 17
patients (35.4%).The current retrospective study suggests that aortic impairment
may be more prevalent than previously reported. Our findings suggest that
specific inflammatory thickening of the aortic wall is common at the time of GCA
diagnosis, and that aortitis may be the first manifestation of GCA-associated
aortic complications. Whether isolated aortitis leads to vascular wall injury
responsible for late-onset aneurysmal disease remains to be determined. At this
time, we recommend long-term monitoring for aortic aneurysms, especially in
high-risk subjects, although the optimal frequency and imaging modality have not
yet been determined. A yearly screening strategy for thoracic/abdominal aortic
aneurysms has been proposed for patients with GCA, including physical
examination, 2-view chest radiograph, and abdominal ultrasound.
PMID: 19440121 [PubMed - in process]
14: Gastroenterol Clin Biol. 2009 May 8. [Epub ahead of print]
Translocation of an intra-uterine contraceptive device with sigmoid penetration
through an endometriosic nodule.
Vandaele N, Iwanicki-Caron I, Piat M, Hervé S, Ducrotté P.
Department of Gastroenterology, CHU de Rouen, 1, rue de Germont 76000 Rouen,
France.
The intra-uterine device (IUD) is the most common existing reversible
contraception. Uterine perforation occurs in 0.6 to 3.4 per 1000 insertions. We
describe the first report of IUD translocation and subsequent penetration of the
sigmoid through an endometriosic nodule. A 44-year-old gravida 2 para 2 woman
consulted for rectal bleeding and melena. Rectosigmoidoscopy revealed ischemic
colitis secondary to the use of NSAIDs, which explained the bleeding, but also
sigmoid perforation from part of an intra-uterine device. This was discovered by
chance. Perforation had occurred though an endometriosic nodule.
PMID: 19428208 [PubMed - as supplied by publisher]
15: Eur J Anaesthesiol. 2009 May 6. [Epub ahead of print]
Severe vancomycin-induced drug rash with eosinophilia and systemic symptoms
syndrome imitating septic shock.
Boet S, Noblet C, Haas-Hubscher C, Picard D, Musette P, Dureuil B.
aDepartment of Anaesthesiology and Intensive Care, France bDepartment of
Pharmacology, France cDepartment of Dermatology, University Hospital of Rouen,
Rouen, France.
PMID: 19424074 [PubMed - as supplied by publisher]
16: Arch Pediatr. 2009 May 5. [Epub ahead of print]
[Neuromotor outcome at 2 years of age in children born between 27 and 32 GW with
periventricular leukomalacia. Retrospective 11-year study at the Rouen University
Hospital.]
[Article in French]
Gobalakichenane P, Labarre A, Mons F, Galène-Gromez S, Laudenbach V, Marret S; le
Réseau périnatalité de Haute-Normandie.
Service de pédiatrie néonatale et réanimation, CHU de Rouen, 1, rue de Germont,
76031 Rouen cedex, France; EA 4309 endothélium microvasculaire et lésions
cérébrales néonatales, institut hospitalo-universitaire de recherche biomédicale,
université de Rouen, boulevard Gambetta, 76031 Rouen cedex, France.
Publication Types:
LETTER
PMID: 19423304 [PubMed - as supplied by publisher]
17: Presse Med. 2009 May 5. [Epub ahead of print]
[Reliability of a bibliometric tool used in France for hospital founding.]
[Article in French]
Darmoni SJ, Ladner J, Devos P, Gehanno JF.
CISMeF, CHU de Rouen & GCSIS, TIBS, LITIS EA 4108, Université de Rouen, France.
SIGAPS is a bibliometric score that aims at making an inventory, evaluating and
promoting scientific publications of hospitals that perform research. It has
become a major stake in France since it is one of the most important components
of the MERRI (Mission Training, Research, Reference and Innovation) founding of
hospitals. This score is based on the points attributed to the authors of
articles published in journals indexed in Medline, according to the rank of the
authors and the Impact Factor of the journal. OBJECTIVES: to compare the
reliability of the score when applying different way of computing it, and
different weights for the rank or the Impact Factor. MATERIAL AND METHODS: we
computed the scores of all the physicians of a University Hospital, using the
rules that are actually applied at the national level. We then used 4 different
scenarios, with different weight given to the rank of authors or the Impact
Factor. We compared the scores obtained by each author according to the different
scenarios with the Spearman's rank and Pearson's correlation coefficients.
RESULTS: The score is not significantly affected when no points are given to the
fourth authors and above, when the last author get more points or to change the
points according to the Impact Factor of the journal. CONCLUSION: The different
scenarios do not lead to significant changes for the physicians' scores, and
therefore for the cumulated score of the hospital. Despite the well known limits
of bibliometric indicators, the SIGAPS score appears reliable to compare the
hospitals for founding decisions.
PMID: 19423277 [PubMed - as supplied by publisher]
18: Gastroenterol Clin Biol. 2009 May 5. [Epub ahead of print]
Control of pelvic symptoms in patients with rectal cancer and synchronous
metastases.
Tougeron D, Di Fiore F, Lefebure B, Hamidou H, Tuech JJ, Michot F, Paillot B,
Michel P.
Digestive Oncology Unit, Department of Gastroenterology, Northwest Cancéropôle,
Rouen University Hospital, 1, rue de Germont, 76031 Rouen cedex, France.
OBJECTIVE: The optimal treatment strategy for rectal cancer (RC) with synchronous
metastases remains an issue of debate. The aim of this study was to evaluate the
impact of surgery and radiation on the control of pelvic symptoms in this
setting. METHODS: Consecutive patients with RC and synchronous metastases were
retrospectively assessed and divided into four treatment groups: surgical
resection of rectal tumor (S); radiotherapy with/without chemotherapy followed by
surgery (CRTS); chemoradiotherapy (CRT); and chemotherapy only (CT). Each group
was evaluated in terms of duration of pelvic symptom-free periods (relative to
overall survival). RESULTS: A total of 96 patients were evaluated: S: n=30; CRTS:
n=21; CRT: n=27; and CT: n=18. After treatment, pelvic symptoms persisted in
14.7% patients (S=0%, CRTS=7.1%, CRT=31.8%, CT=25%; P=0.01). The relative pelvic
symptom-free periods were 93.0% in the S group, 83.1% in the CRTS group, 53.0% in
the CRT group and 53.2% in the CT group (P<0.01). On multivariate analysis, only
surgical treatment correlated with a significant relative pelvic symptom-free
period (P<0.01), with an adjusted hazards ratio of 2.80 [95% CI: 1.79-4.39].
CONCLUSION: Our results suggest that rectal resection was the most effective
therapeutic procedure in selected patients with RC and synchronous metastases,
offering the patients the longest pelvic symptom-free periods.
PMID: 19423254 [PubMed - as supplied by publisher]
19: Cornea. 2009 May;28(4):401-7.
In vivo confocal microscopic evaluation of corneal changes in chronic
Stevens-Johnson syndrome and toxic epidermal necrolysis.
Vera LS, Gueudry J, Delcampe A, Roujeau JC, Brasseur G, Muraine M.
Department of Ophthalmology, Charles Nicolle Hospital, University of Rouen,
Rouen, France. lizavera22@yahoo.fr
PURPOSE: To describe corneal changes visible on in vivo confocal microscopy, in
patients with debilitating ocular sequelae because of toxic epidermal necrolysis
(TEN) or Stevens-Johnson syndrome (SJS). PATIENTS AND METHODS: Forty-one eyes of
25 consecutive patients suffering from chronic TEN or SJS were studied using in
vivo confocal microscopy. RESULTS: Severe dry eye syndrome with no associated
limbal stem cell deficiency (25 eyes, 16 patients, 61%) was the most frequent
clinical pattern. Limbal stem cell deficiency was noted in 16 eyes (12 patients,
39%). Three patients had asymmetric disease. Confocal microscopy showed a
consistent change in the superficial epithelial cells in both clinical
presentations. Patients with dry eye syndrome had frequent pathological nerve
damages, and the presence of dendritic cells was prevalent (65%). Inflammatory
cells were observed in a large number in 4 of the 12 patients presenting
neovascularization of the cornea. CONCLUSIONS: The corneas of patients with
chronic ocular sequelae linked to SJS and TEN present a number of abnormalities.
In vivo confocal microscopy is a potentially useful tool for therapeutic
indications and for follow-up of the debilitating chronic ocular problems
associated with these diseases.
Publication Types:
Research Support, Non-U.S. Gov't
PMID: 19411958 [PubMed - in process]
20: Respir Physiol Neurobiol. 2009 May 3. [Epub ahead of print]
Impact of swallowing and ventilation on oropharyngeal cortical representation.
Gallas S, Marie JP, Leroi AM, Verin E.
Department of Physiology, Rouen University Hospital, 1 rue de Germont, 76031
Rouen Cedex, France; EA3234/IFRMP23 Digestive Tract Research Group, Rouen
University, 76031 Rouen Cedex, France.
Our aim was to determine whether ventilation and swallowing tasks can modify
oropharyngeal cortical motor organisation. Mylohyoid motor-evoked potentials
(MEP) induced by non-focal (NF) and focal (F) magnetic stimulations were recorded
in nine healthy volunteers four times, with 1 week between each recording.
Baseline values were evaluated and their reproducibility was assessed 1 week
later. Thereafter, the subjects were asked to perform swallowing and ventilation
tasks in random order 15min per day for 1 week. The NF MEP amplitudes after the
swallowing and ventilation tasks increased after effortful swallows (p<0.001) and
ventilation efforts (p<0.001). The F MEP amplitudes obtained after focal cortical
stimulations increased after effortful swallows (p<0.01) and ventilation efforts
(p<0.05). The cortical magnitude of the oropharyngeal muscle representation
increased after swallowing practice (p<0.01). In conclusion, swallowing and
ventilation tasks modified the motor cortex of oropharyngeal muscles and should
be evaluated for use in rehabilitation strategies.
PMID: 19410663 [PubMed - as supplied by publisher]
21: Gen Hosp Psychiatry. 2009 May-Jun;31(3):266-73. Epub 2009 Mar 19.
A comparison of anxiety, depression and quality of life between device shock and
nonshock groups in implantable cardioverter defibrillator recipients.
Jacq F, Foulldrin G, Savouré A, Anselme F, Baguelin-Pinaud A, Cribier A, Thibaut
F.
Department of Psychiatry, INSERM U 614, University Hospital Ch. Nicolle,
University of Medicine, Rouen, France.
BACKGROUND: Using standardized scales, we assessed the point prevalence, the
severity of anxiety and depressive disorders, and the quality of life (QOL) in
implantable cardioverter defibrillator (ICD) recipients who received a device
shock. METHODS: Forty research subjects with device shocks (Group 1) and 25
without shocks (Group 2) were interviewed after ICD implantation using the Mini
International Neuropsychiatric Interview (MINI), the Hospital Anxiety and
Depression Scale (HADS) and the Medical Outcomes Study 36-Item Short Form Health
Survey (SF-36). RESULTS: The point prevalence of anxiety disorders was higher in
Group 1 (37.5%) than in Group 2 (8%) (P=.009). Depressive symptoms scores were
higher in Group 1 (4.75) than in Group 2 (2.24) (P=.04)), but the prevalence of
depressive disorders or the anxiety scores were not significantly different. A
positive correlation was found between the number of shocks and the depressive
symptoms scores (P=.05, r=0.24); there was a negative correlation between the
mental health subscore of the SF-36 and the number of shocks (r=-0.36, P=.003).
The point prevalence of depressive disorders was higher in the group with
congenital cardiac diseases (50%) than in the valvular (8%) and ischemic groups
(23%) (P=.04), and the mental health composite summary score of the SF-36 was
lower in this group (46.34) than in those with valvular and ischemic disease
(56.09 and 52.61, respectively) (P=.03). CONCLUSION: Exposure to shocks may lead
to an increased risk of anxiety and depressive symptoms. Research subjects
receiving a high number of shocks and research subjects with congenital
cardiovascular diseases were at higher risk of depressive symptoms or at higher
risk of poorer psychological aspects of QOL.
PMID: 19410106 [PubMed - in process]
22: Obstet Gynecol. 2009 May;113(5):992-9.
Predictors of failed pelvic arterial embolization for severe postpartum
hemorrhage.
Sentilhes L, Gromez A, Clavier E, Resch B, Verspyck E, Marpeau L.
Department of Obstetrics and Gynecology, Rouen University Hospital, Charles
Nicolle, Rouen, France. loicsentilhes@hotmail.com
OBJECTIVES: To estimate what factors are associated with a failed pelvic arterial
embolization for postpartum hemorrhage and to attempt to estimate efficacy of
pelvic arterial embolization in rare conditions. METHODS: This was a
retrospective cohort study including all consecutive women who underwent pelvic
arterial embolization trial for postpartum hemorrhage between 1994 and 2007 at a
tertiary care center. Pelvic arterial embolization failure was defined as the
requirement for subsequent surgical procedure to control postpartum hemorrhage.
RESULTS: Pelvic arterial embolization was attempted in 0.3% of deliveries by the
same radiologist in 87% of cases. Failures occurred in 11 of 100 cases (11%) and
in 4 of 17 cases (24%) of placenta accreta or percreta. The major complication
rate after pelvic arterial embolization was low (3%). Fifty patients (50%) were
transferred from nine other institutions. Pelvic arterial embolization was
performed in 11 cases (11%) after a failed conservative surgical procedure and in
eight cases (8%) for secondary postpartum hemorrhage, with success rates of 91%
and 88%, respectively. Pelvic arterial embolization demonstrated a patency
throughout one ligated pedicle in 9 of the 11 cases of failed conservative
surgical procedure (82%). Twin pregnancy, chorioamnionitis, operative vaginal
delivery, hospital-to-hospital transfer, nature of embolizing agent and arteries
embolized, failed surgical procedure, secondary postpartum hemorrhage, cause of
postpartum hemorrhage, and more than one pelvic arterial embolization were not
found to be significantly associated with failed pelvic arterial embolization.
CONCLUSION: The only factors significantly associated with failed pelvic arterial
embolization were a higher rate of estimated blood loss (more than 1,500 mL) and
more than 5 transfused red blood cell units. Attempted pelvic arterial
embolization after a failed vessel ligation procedure and for a secondary
postpartum hemorrhage is a good option with high success rates.
PMID: 19384113 [PubMed - indexed for MEDLINE]
23: Gynecol Obstet Fertil. 2009 May;37(5):457-8. Epub 2009 Apr 18.
[Against labor induction after previous cesarean delivery.]
[Article in French]
Ricbourg-Schneider A, Marpeau L.
Service de gynécologie-obstétrique, CHU Charles-Nicolle, 1, rue de Germont, 76000
Rouen, France.
PMID: 19376739 [PubMed - in process]
24: Presse Med. 2009 May;38(5):774-87. Epub 2009 Mar 26.
[Anti-TNF alpha in the treatment of rheumatoid arthritis and ankylosing
spondylitis]
[Article in French]
Lanfant-Weybel K, Lequerré T, Vittecoq O.
Service de rhumatologie, CHU de Rouen-Hôpitaux de Rouen, Inserm 905, F-76031
Rouen Cedex, France.
Rheumatoid arthritis (RA) and ankylosing spondylitis (AS) are, with psoriatic
arthritis, the most frequent rheumatic diseases. A better understanding of
pathophysiology of these diseases had led to the development of new treatments
refered as to biologic agents and, among them, TNF blocking agents have a major
role. The knowledge of these drugs in terms of mechanisms of action, indications
and potentials side effects has to be known to improve the efficacy/tolerance
balance. Although these 3 anti-TNFalpha agents are currently used, new TNF
blocking agents are under evaluation and should increase the number of drugs
available within the next months.
Publication Types:
English Abstract
PMID: 19327945 [PubMed - indexed for MEDLINE]
25: Crit Care Med. 2009 May;37(5):1724-8.
Toll-like receptors 4 contribute to endothelial injury and inflammation in
hemorrhagic shock in mice.
Benhamou Y, Favre J, Musette P, Renet S, Thuillez C, Richard V, Tamion F.
Inserm U644, Institute for Biomedical Research and IFRMP 23, Rouen University
Medical School, Rouen, France.
OBJECTIVE: Hemorrhagic shock followed by resuscitation (HS/R) promotes organ
injury by priming cells of the innate immune system for inflammatory response.
Toll-like receptors (TLRs) play an important role in signal transduction in
shock/resuscitation conditions. Because proinflammatory mediators are a critical
event in mesenteric endothelial injury induced by HS/R, we assessed the role of
TLR4 or TLR2 in this setting. DESIGN: Laboratory investigation. SETTING: Research
laboratory at Rouen University Medical School. SUBJECTS: Male wild-type,
TLR4(-/-) and TLR2(-/-) mice with the same C57BL/6 background. INTERVENTIONS:
Mice were submitted to 30 minutes hemorrhagic shock followed by 1 hour
resuscitation, after which mesenteric endothelial dysfunction, microvascular
injury, and TNF[alpha] production were assessed. MEASUREMENTS AND MAIN RESULTS:
HS/R markedly decreased nitric oxide-mediated mesenteric relaxations induced by
acetylcholine, assessed ex vivo on a myograph. By contrast, in TLR4-deficient
mice, HS/R did not impair the nitric oxide-mediated responses to acetylcholine.
No protection was observed in TLR2-deficient mice. TLR4-deficient mice also
displayed a significant reduction in fluid resuscitation and TNF[alpha] systemic
production. CONCLUSIONS: TLR4 contributes to mesenteric endothelial dysfunction
after hemorrhagic shock. This early TLR4-induced vascular injury may be an
important trigger of the systemic inflammatory response occurring in this
disease.
Publication Types:
Comparative Study
Research Support, Non-U.S. Gov't
PMID: 19325486 [PubMed - indexed for MEDLINE]
26: Arch Pediatr. 2009 May;16(5):409-16. Epub 2009 Mar 25.
[Diagnosis of congenital heart disease in a nonselected population in Upper
Normandy: Retrospective study between 2003 and 2007.]
[Article in French]
Durand I, David N, Blaysat G, Marguet C.
Département de pédiatrie, CHU de Rouen, université de Rouen, 76031 Rouen cedex,
France.
Routine prenatal ultrasound screening for the detection of possible cardiopathy
has existed in Upper Normandy since 1987, including the continuous training of
obstetric ultrasonographers. We evaluated the profitability and the expected
benefit of prenatal detection in a nonselected population in this region.
METHODS: A retrospective study was undertaken from October 2003 to September 2007
in the cardiopediatric units of Upper Normandy. All fetuses and infants with a
diagnosed major cardiac defect were classified into 3 groups: no possibility of
anatomic surgical repair (group 1), risk of early decompensation (group 2), and
anatomic surgical repair possible but without early decompensation (group 3).
Prenatal and postnatal mortality and morbidity were reported. RESULTS: One
hundred and sixty-five major congenital heart defects were detected prenatally
and 68 postnatally. The prenatal detection rate was 71% (93, 53, and 77% for
groups 1, 2, and 3, respectively; p<0.0001). The rate of pregnancy termination
was 92, 17, and 45%, respectively. The mortality rate tended to be higher in the
undiagnosed group of urgent neonatal heart cases (10.6% vs 4.4%). The prenatal
prevalence of abnormal karyotype was 21% and was 11.5% for congenital
malformation syndrome. CONCLUSION: Prenatal detection of major cardiac defects
has continued to attain high success in Upper Normandy. However, 50% of urgent
neonatal heart cases often remain undiagnosed, and therefore the neonatologist
must treat this patient population with particular care. Prenatal diagnosis can
reduce preoperative mortality and morbidity of cardiopathy with a risk of early
decompensation with specific neonatal intensive care.
Publication Types:
English Abstract
PMID: 19324538 [PubMed - in process]
27: Joint Bone Spine. 2009 May;76(3):293-5. Epub 2009 Mar 16.
Atypical forms of syphilis: two cases.
Avenel G, Goëb V, Abboud P, Ait-Abdesselam T, Vittecoq O.
Service de Rhumatologie, CHU-Hôpitaux de Rouen, & Inserm, U905, IFRMP23, Institut
de Biologie Clinique, Rouen, France. avenel_gilles@hotmail.fr
Syphilis is a sexually transmitted disease caused by the spirochete Treponema
pallidum. A chancre usually develops initially. Organ involvement and
neurological complications may occur, sometimes several years after the initial
exposure. We managed two patients with syphilis responsible for joint or
neurological manifestations, diagnosed in 2008. One patient presented with
oligoarthritis involving the knees and right elbow, coinciding with a
maculopapular and pustular eruption. In the other patient, meningoradiculitis
involving the T8, T9, and T10 metameres prompted a test for Lyme disease, which
was weakly positive, leading to evaluation for false-positivity due to a
cross-reaction. Neither patient was infected with the HIV.
PMID: 19289298 [PubMed - in process]
28: Rev Med Interne. 2009 May;30(5):430-3. Epub 2009 Mar 9.
[A double-faced myocarditis: Whipple's disease or sarcoidosis?]
[Article in French]
Benhamou Y, Lachkar S, Cailleux N, Bauer F, Bernet J, Marie I, Lévesque H.
Département de médecine interne, CHU de Rouen-Bois-Guillaume, 76031 Rouen cedex,
France. ygal.benhamou@chu-rouen.fr
INTRODUCTION: Whipple's disease is a systemic infection that may mimic
sarcoidosis in its initial presentation. The heart involvement is not uncommon
and consists generally in an endocarditis. Myocarditis is less common and is
usually accompanied by impairment of heart conduction. CASE REPORT: We report a
56-year-old man with Whipple's disease associated with a myocarditis, initially
diagnosed as having a sarcoidosis with cardiac injury. The contribution of the
histology and molecular biology on intestinal sampling made it possible to
rectify the diagnosis. CONCLUSION: The diagnosis of Whipple's disease should be
considered in the presence of a systemic granulomatosis with or without heart
involvement. Early diagnosis is important because of effectiveness of antibiotic
therapy.
Publication Types:
English Abstract
PMID: 19269718 [PubMed - in process]
29: Rheumatology (Oxford). 2009 May;48(5):475-82. Epub 2009 Mar 3.
Infection and vasculitis.
Belizna CC, Hamidou MA, Levesque H, Guillevin L, Shoenfeld Y.
Internal Medicine Department, CHU Rouen, Rouen, France.
cristina.belizna@wanadoo.fr
Vasculitis may be associated with infection, immunization or anti-microbial
drugs. Infections are responsible for a number of different types of vasculitis.
Conversely, patients with vasculitis may develop infections, which sometimes
mimic relapse. The aim of this review is to summarize the various aspects of the
inter-relationship between vasculitis and infection, and the physiopathological
mechanisms involved, in light of our current knowledge from animal models.
Currently, a causal relationship between infection and vasculitis has only been
established in a few instances and many mechanisms remain hypothetical. This
inter-relationship is further assessed from the point of view of clinical
presentation and therapeutic options, based on case reports and prospective
observational data.
PMID: 19258377 [PubMed - in process]
30: Eur J Neurol. 2009 May;16(5):595-601. Epub 2009 Feb 19.
Anatomy of executive deficit following ruptured anterior communicating artery
aneurysm.
Martinaud O, Perin B, Gérardin E, Proust F, Bioux S, Gars DL, Hannequin D,
Godefroy O.
Department of Neurology, Rouen University Hospital, Rouen, France.
olivier.martinaud@chu-rouen.fr
BACKGROUND AND PURPOSE: To evaluate behavioral and cognitive deficits following
anterior communicating artery aneurysm rupture and determine critical lesion
locations. METHODS: We investigated 74 patients with standardized cognitive tests
and behavioral inventory. Two examiners rated MRI signal abnormalities in 51
predetermined regions of interest. Classification tree analysis was used to
select regions associated with each cognitive deficit. RESULTS: Eleven patients
presented behavioral executive deficits and 10 had cognitive executive deficit.
Their presence depended on left hemisphere lesions only: (i) ventral striatum
lesion was associated with behavioral executive deficit (P = 0.04), reduction of
activities (P = 0.01), and hyperactivity (P = 0.02); (ii) superior frontal gyrus
lesion, with cognitive executive deficit (P = 0.01), action initiation deficit (P
= 0.02), and rule deduction deficit (P = 0.02); (iii) anterior half of centrum
semiovale lesion, with Stroop inhibition deficit (P = 0.02); (iv) medial superior
and middle frontal gyri lesions, with task coordination deficit (P = 0.01); and
(v) middle frontal gyrus lesion, with words generation deficit (P = 0.02).
CONCLUSION: This study supports that (i) cognitive executive deficits depend
mostly on lateral prefrontal lesions, (ii) with locations varying according to
executive process, and (iii) behavioral executive deficits are mainly due to left
ventral striatum lesion in post-aneurysmal damage.
PMID: 19236465 [PubMed - in process]
31: Eur Respir J. 2009 May;33(5):974-85. Epub 2009 Feb 12.
Human in vivo fluorescence microimaging of the alveolar ducts and sacs during
bronchoscopy.
Thiberville L, Salaün M, Lachkar S, Dominique S, Moreno-Swirc S, Vever-Bizet C,
Bourg-Heckly G.
Clinique Pneumologique, Hôpital Charles Nicolle, CHU de Rouen, Rouen Cedex,
France. Luc.Thiberville@univ-rouen.fr
The aim of the present study was to assess fibred confocal fluorescence
microscopy (FCFM) as a tool for imaging the alveolar respiratory system in vivo
during bronchoscopy. A 488-nm excitation wavelength FCFM device was used in 41
healthy subjects including 17 active smokers. After topical anaesthesia, the
1.4-mm miniprobe was introduced into the bronchoscope working channel and
advanced distally to the alveoli. Morphometric and cellular analyses were
performed on selected frames harbouring a minimal compression effect. In vivo
acinar microimaging was obtained from each lung segment except for the apical and
posterior segments of both upper lobes. Reproducible patterns, corresponding to
the elastic framework of the axial and peripheral interstitial systems, were
recorded from 192 separate acini. The mean+/-sd thickness of the acinar elastic
fibres was 10+/-2.7 microm. Alveolar mouth diameters (mean+/-sd 278+/-53 microm)
were normally distributed but appeared smaller in the right upper lobe and right
medial basal segment. Lobular microvessels (median diameter 90 microm) were
equally distributed throughout the lungs. Alveolar macrophages were not
detectable in nonsmokers, whereas a specific tobacco-tar-induced fluorescence was
observed in smoking subjects, providing fine details of the alveolar walls and
macrophages. A strong correlation was found between the number of cigarettes
smoked per day and the amount of large and mobile macrophages observed in vivo,
as well as with the intensity of the macrophage alveolitis. Fibred confocal
fluorescence microscopy enables accurate exploration of the peripheral lung in
vivo in both smokers and nonsmokers.
Publication Types:
Research Support, Non-U.S. Gov't
PMID: 19213792 [PubMed - in process]
