1. Ann Dermatol Venereol. 2010 August - September;137(8-9):507-513. Epub 2010 Aug
21.
[Long-term follow-up of the efficacy of methotrexate alone or in combination with
low doses of oral corticosteroids in the treatment of alopecia areata totalis or
universalis.]
[Article in French]
Chartaux E, Joly P.
Clinique dermatologique, CHU de Rouen, université de Rouen, 1, rue de Germont,
76000 Rouen, France.
BACKGROUND: Treatment of severe and chronic forms of alopecia areata (AA) totalis
remains difficult. It has been suggested that methotrexate (MTX) is an
efficacious treatment for AA totalis. The aim of our study was to assess the
long-term safety and efficacy of MTX in patients with chronic severe forms of AA
totalis. PATIENTS AND METHODS: Thirty-three patients (24 women and nine men) with
AA totalis or universalis were included. Mean disease duration was 7.7years and
these patients had not responded to prior standard treatment. The initial weekly
dosage of MTX was 15mg (n=2), 20mg (n=16) or 25mg (n=15). Nineteen patients (58%)
were treated with MTX and low doses of corticosteroids (prednisone 10-20mg/d),
while 14 patients (42%) received MTX alone. The primary end-point was complete
hair regrowth under treatment. RESULTS: Twenty-one patients had total hair
regrowth and 13 patients were considered as treatment failures, with 10 of these
having partial regrowth and three having no regrowth. Complete regrowth was seen
in 12 of 19 patients (63%) on combined treatment and in eight of 14 patients
(57%) on MTX alone. The onset of hair regrowth was noted after a median delay of
3months. At the end of the study, after a median of 30months' follow-up, the
median cumulative dose of MTX was 1.8g (400mg-5.5g). Relapse was observed on
corticosteroid dose reduction or withdrawal in 16 of the 20 patients in whom
total hair regrowth initially occurred. Regrowth after treatment of relapse was
seen in 14 of these 16 patients (87%). Seven patients experienced adverse events
consisting of transient elevated transaminases (n=4), persistent nausea (n=2) and
lymphocytopenia (n=1). CONCLUSION: MTX alone or in combination with low doses of
oral corticosteroids resulted in complete hair regrowth in about half of these
patients presenting AA totalis or universalis. Lasting improvement required
continuous treatment in most cases.
PMID: 20804893 [PubMed - as supplied by publisher]
2. Cell Mol Biol Lett. 2010 Aug 28. [Epub ahead of print]
TRPC expression in mesenchymal stem cells.
Torossian F, Bisson A, Vannier JP, Boyer O, Lamacz M.
IFRMP, Institute for Biomedical Research, Inserm, U905, University of Rouen,
Rouen, France.
Transient receptor potential canonical (TRPC) channels are key players in calcium
homeostasis and various regulatory processes in cell biology. Little is currently
known about the TRPC subfamily members in mesenchymal stem cells (MSC), where
they could play a role in cell proliferation. We report on the presence of TRPC1,
2, 4 and 6 mRNAs in MSC. Western blot and immunofluorescence staining indicate a
membrane and intracellular distribution of TRPC1. Furthermore, the decrease in
the level of TRPC1 protein caused by RNA interference is accompanied by the
downregulation of cell proliferation. These results indicate that MSC express
TRPC1, 2, 4 and 6 mRNA and that TRPC1 may play a role in stem cell proliferation.
PMID: 20803258 [PubMed - as supplied by publisher]
3. Arthritis Care Res (Hoboken). 2010 Aug 25. [Epub ahead of print]
Serum IgA rheumatoid factor and pyridinoline in very-early arthritis are
predictors of erosion(s) at 2 years: A simple model of prediction from the
conservatively treated community-based inception VErA cohort.
Le Loët X, Brazier M, Mejjad O, Boumier P, Daragon A, Gayet A, Pouplin S, Tron F,
Zarnitsky C, Vittecoq O, Ménard JF, Fardellone P.
Rheumatology, Department Inserm Unit 905, Rouen University Hospital, Rouen,
France.
OBJECTIVE.: To identify, in conservatively treated, very-early arthritis
patients, predictors of >/=1 erosion(s) at 2 years and to construct a prediction
model. METHODS.: Community-based adults (n=310) with DMARD- and steroid-naïve
swelling of 2 or more joints persisting >4 weeks and lasting <6 months were
recruited. Erosion status was assessed at 0, 6, 12 and 24 months; evaluations
comprised of clinical criteria (DAS, HAQ), CRP, ESR, autoantibodies, bone and
cartilage markers, hand densitometry; HLA class-II shared epitopes. Patients
meeting ACR rheumatoid arthritis (RA) criteria or with undifferentiated arthritis
(UA) were followed and treated conservatively: one-third of RA and three-fourths
of UA patients received no DMARDs during 2 years; a biologic was given to 1.8% of
the patients during the first year. The main judgment criterion was >/=1
erosion(s) at 2 years. RESULTS.: At 2 years, 219 patients were assessed; 31.3%
with RA and 11.6% with UA had >/=1 erosion(s). Logistic-regression analysis at
that time showed erosion(s) strongly associated with serum IgA-RF and
pyridinoline levels for the 190 patients with no baseline erosions, with the
corresponding ROC curve having an AUC = 0.77 [95% CI: 0.64-0.86]. A prediction
model was constructed with IgA-RF thresholds of 5 and 25 IU/ml and pyridinoline
(10 nM/l); odds ratios ranged from 1, for IgA-RF <5 IU/ml and pyridinoline <10
nM/l to 50.75 for the association of IgA-RF >/=5 IU/ml and pyridinoline >/=10
nM/l. CONCLUSION.: This model, using serum IgA-RF and pyridinoline
concentrations, was able to predict >/=1 erosion(s) at 2 years in very-early
arthritis patients.
PMID: 20740612 [PubMed - as supplied by publisher]
4. Scand J Work Environ Health. 2010 Aug 25. [Epub ahead of print]
Searching for high-quality articles about intervention studies in occupational
health - what is really missed when using only the Medline database?
Rollin L, Darmoni S, Caillard JF, Gehanno JF.
Service de Médecine du Travail, Rouen University Hospital, 1 rue de Germont,
76000 Rouen, France. -laetitia.rollin@chu-rouen.fr.
OBJECTIVE: Most occupational health physicians access electronic databases to
obtain reliable medical information. Although it is demonstrated that the use of
Medline alone does not ensure comprehensiveness, many experts rely solely on this
database. Our study aimed to discover to what extent the physician who limits
his/her search to Medline misses studies of high quality. METHODS: We constructed
a "gold standard" database of high-quality intervention studies gathering all the
references included in the systematic reviews of the Cochrane Library and indexed
under the topic "occupational health field". We then searched all these
references, one by one, in Medline. RESULTS: Overall, 88.8% [95% confidence
interval (95% CI) 86.1-91.5] of the high quality studies included in our gold
standard database were indexed in Medline. References included in reviews on
psychiatric or psychological topics were significantly less often indexed in
Medline [81.7% (95% CI 75.9-88.5)] than references included in reviews on other
topics [92.2% (95% CI 89.5-95.0)] (P=0.001). CONCLUSION: The recall ratio of
Medline for high-quality intervention studies is close to 90%. For occupational
health practitioners who aim to find reliable answers to their daily practice
questions, searching Medline only is more cost-effective than previously thought.
PMID: 20740265 [PubMed - as supplied by publisher]
5. Sci Transl Med. 2010 Aug 25;2(46):46ra62.
Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS): A Multiorgan
Antiviral T Cell Response.
Picard D, Janela B, Descamps V, D'Incan M, Courville P, Jacquot S, Rogez S,
Mardivirin L, Moins-Teisserenc H, Toubert A, Benichou J, Joly P, Musette P.
INSERM U905, Rouen University Hospital, Rouen 76000, France.
Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe,
drug-induced reaction that involves both the skin and the viscera. Evidence for
reactivation of herpes family viruses has been seen in some DRESS patients. To
understand the immunological components of DRESS and their relationship to viral
reactivation, we prospectively assessed 40 patients exhibiting DRESS in response
to carbamazepine, allopurinol, or sulfamethoxazole. Peripheral blood T
lymphocytes from the patients were evaluated for phenotype, cytokine secretion,
and repertoire of CD4(+) and CD8(+) and for viral reactivation. We found
Epstein-Barr virus (EBV), human herpes virus 6 (HHV-6), or HHV-7 reactivation in
76% of the patients. In all patients, circulating CD8(+) T lymphocytes were
activated, exhibited increased cutaneous homing markers, and secreted large
amounts of tumor necrosis factor-alpha and interferon-gamma. The production of
these cytokines was particularly high in patients with the most severe visceral
involvement. In addition, expanded populations of CD8(+) T lymphocytes sharing
the same T cell receptor repertoire were detected in the blood, skin, liver, and
lungs of patients. Nearly half of these expanded blood CD8(+) T lymphocytes
specifically recognized one of several EBV epitopes. Finally, we found that the
culprit drugs triggered the production of EBV in patients' EBV-transformed B
lymphocytes. Thus, cutaneous and visceral symptoms of DRESS are mediated by
activated CD8(+) T lymphocytes, which are largely directed against herpes viruses
such as EBV.
PMID: 20739682 [PubMed - in process]
6. Rev Stomatol Chir Maxillofac. 2010 Aug 23. [Epub ahead of print]
[Upper aerodigestive tract erythroplakia.]
[Article in French]
Hardy H, Persac S, Péron JM.
Service de chirurgie maxillo-faciale et stomatologie, CHRU Charles-Nicolle, 1,
rue de Germont, 76031 Rouen cedex, France.
Erythroplakia is a red mucosal macule with a chronic evolution. It is diagnosed
after excluding traumatic, vascular, or inflammatory etiologies. Erythroplakia is
rare in the upper aerodigestive tract. It affects middle-aged adults. The main
predisposing factors are those of in situ carcinoma. Lesions are mainly located
on lips or mucosa. Erythroleukoplakia may also occur. Ninety-one percent of
erythroplakia are severe dysplasia, in situ carcinoma, or invasive carcinoma.
Excision and histopathological examination are mandatory.
PMID: 20739037 [PubMed - as supplied by publisher]
7. Mol Imaging Biol. 2010 Aug 25. [Epub ahead of print]
Brain Perfusion in Adult Patients with Acute Myeloblastic Leukemia before and
after Cytosine Arabinoside.
Modzelewski R, Lepretre S, Martinaud O, Hannequin D, Hitzel A, Habert MO, Tilly
H, Vera P.
Department of Nuclear Medicine, Henri Becquerel Centre and Rouen University
Hospital, University of Rouen, Rouen, France, romain.modzelewski@rouen.fnclcc.fr.
PURPOSE: High-dose (HD) cytosine arabinoside (ara-C) is a major treatment in
acute myeloblastic leukemia (AML) that can lead to cerebellar complications,
although electroencephalogram, computed tomography, and magnetic resonance
imaging remain normal. We conducted a prospective study to evaluate brain
perfusion with single-photon emission computed tomography (SPECT) in adult
patients before and after receiving ara-C. PROCEDURES: Forty-three patients were
pre-included, and 20 reached a complete remission. These 20 patients were
definitively included and underwent three technetium-99m
hexamethyl-propylene-amine oxime (HMPAO) SPECT acquisitions with a double-head
camera: SPECT1 at AML diagnosis, SPECT2 after induction (conventional ara-C
dose), and SPECT3 during HD ara-C treatment. All the included patients underwent
six series of neurological and cognitive examinations: N1, N2, and N3 at the time
of SPECT1, SPECT2, and SPECT3, respectively; N4 during HD ara-C treatment; N5 (at
10 days); and N6 during follow-up (at 6 months). Statistical parametric mapping
(SPM2) was used to test perfusion changes. A specific method based on random walk
(RW) was used to analyze diffuse brain perfusion heterogeneity. RESULTS: No
neurological adverse effect was observed, and all neurological and cognitive
examinations remained normal. Between SPECT1 and SPECT2, SPM2 analysis showed a
decrease in cerebral blood flow, i.e., in the cerebellum, in the occipitoparietal
cortex, and in the thalamus. No significant difference was observed between
SPECT2 and SPECT3 or between SPECT1 and SPECT3. RW analysis showed no significant
difference in perfusion heterogeneity between the three SPECTs. CONCLUSIONS:
HMPAO SPECT demonstrated a decrease in thalamus, cerebellar, and
parieto-occipital perfusion after conventional doses of ara-C in AML patients,
although the neurological examinations were normal and the patients had no
neurological adverse effects.
PMID: 20737220 [PubMed - as supplied by publisher]
8. Clin Exp Immunol. 2010 Aug 20. [Epub ahead of print]
Beneficial effects of cathepsin inhibition to prevent chemotherapy-induced
intestinal mucositis.
Alamir I, Boukhettala N, Aziz M, Breuillé D, Déchelotte P, Coëffier M.
ADEN - EA4311, Institute for Biomedical Research and European Institute for
Peptide Research (IFRMP23), Rouen University.
Summary One of the main secondary toxic side effects of anti-mitotic agents used
to treat cancer patients is intestinal mucositis. Previous data showed that
cathepsin D activity, contributing to the proteolytic lysosomal pathway, is
up-regulated during intestinal mucositis in rats. At the same time, cathepsin
inhibition limits intestinal damage in animal models of inflammatory bowel
diseases. The aim of this study was to evaluate the effects of cathepsin
inhibition on methotrexate-induced mucositis in rats. Male Sprague-Dawley rats
received saline solution subcutaneously as the control group or 2.5 mg/kg of
methotrexate for 3 days (D0-D2). From D0 to D3 methotrexate-treated rats also
received intraperitoneal injections of pepstatin A, a specific inhibitor of
cathepsin D or E64, an inhibitor of cathepsins B, H and L, or vehicle. Rats were
euthanized at D4 and jejunal samples were collected. Body weight and food intake
were partially preserved in rats receiving E64 compared with rats receiving
vehicle or pepstatin A. Cathepsin D activity, used as a marker of lysosomal
pathway, was reduced both in E64 and pepstatin-treated rats. However, villus
atrophy and intestinal damage observed in methotrexate-treated rats were restored
in rats receiving E64 but not in rats receiving pepstatin A. The intramucosal
concentration of proinflammatory cytokines, interleukin-1beta and
cytokine-induced neutrophil chemoattractant (CINC)-2, was markedly increased in
methotrexate-treated rats receiving vehicle or pepstatin A but not after E64
treatment. In conclusion, a large broad inhibition of cathepsins could represent
a new potential target to limit the severity of chemotherapy-induced mucositis as
opposed to the inhibition of cathepsin D alone.
PMID: 20731673 [PubMed - as supplied by publisher]
9. J Nutr. 2010 Aug 19. [Epub ahead of print]
An {alpha}-Linolenic Acid-Rich Formula Reduces Oxidative Stress and Inflammation
by Regulating NF-{kappa}B in Rats with TNBS-Induced Colitis.
Hassan A, Ibrahim A, Mbodji K, Coëffier M, Ziegler F, Bounoure F, Chardigny JM,
Skiba M, Savoye G, Déchelotte P, Marion-Letellier R.
Appareil Digestif Environnement Nutrition, Medicine University, I.F.R. 23,
Institute of biomedical research, 22, 76183 Rouen cedex, France.
We have previously shown that alpha-linolenic acid (ALA), a (n-3) PUFA exerts in
vitro antiinflammatory effects in the intestine. In this study, we aimed to
evaluate its effect on inflammatory and oxidative stress in a colitis model.
Colitis was induced in 2 groups at d 0 by intrarectal injection of
2-4-6-trinitrobenzen sulfonic acid (TNBS), whereas the control group received the
vehicle. Rats we fed 450 mgkg(-1)d(-1) of ALA (TNBS+ALA) while the other colitic
group (TNBS) and the control group were fed an isocaloric corn oil formula for 14
d (from d -7 to d 7). RBC fatty acid composition was assessed. Oxidative stress
was studied by measuring urinary 8-isoprostanes (8-IP) and colon glutathione
(GSH) concentration and inducible nitric oxide synthase (iNOS) expression.
Colitis was assessed histologically, by production of proinflammatory mediators,
including cytokines, leukotrienes B(4) (LTB(4)), and cyclooxygenase-2 (COX-2) and
by nuclear factor-kappaB (NF-kappaB) activation. The ALA-rich diet significantly
increased the RBC levels of ALA, eicosapentaenoic acid, and docosapentaenoic acid
(n-3) compared with the TNBS group (P < 0.01 for all). The beneficial effect of
ALA supplementation on oxidative stress was reflected by lower urinary 8-IP
levels (P < 0.05), a normalized colon GSH concentration (P < 0.01), and reduced
colon iNOS expression (P < 0.05) compared with the TNBS group. ALA also protected
against colon inflammation as assessed by lower tumor necrosis factor-alpha
secretion and mRNA level (P < 0.05), reduced NF-kappaB activation (P = 0.01), and
lower colon lipid mediator concentrations such as LTB(4) and COX-2 (P < 0.05)
compared with the TNBS group. These findings show that an ALA-rich formula is
beneficial to TNBS-induced colitic rats via inhibition of oxidative and
inflammatory stress.
PMID: 20724486 [PubMed - as supplied by publisher]
10. J Fr Ophtalmol. 2010 Aug 17. [Epub ahead of print]
[Cicatricial conjunctivitis.]
[Article in French]
Gueudry J, Vera L, Muraine M.
Service d'ophtalmologie, hôpital Charles-Nicolle, CHU de Rouen, 1, rue de
Germont, 76031 Rouen cedex, France.
Cicatricial conjunctivitis is chronic conjunctivitis with conjunctival fibrosis
and may lead to alterations of conjunctival architecture, which are potentially
sight-threatening. The patient's medical history, physical exam, and laboratory
tests often provide the diagnosis of the underlying disease. Causes of
conjunctival cicatrization are autoimmune diseases such as ocular cicatricial
pemphigoid, thermal and chemical burns, postinfectious conjunctivitis,
Stevens-Johnson syndrome, etc. Medical management varies according to specific
causes and may lead to severe side effects. Furthermore, strategies may be
necessary to restore corneal transparency and normal palpebral architecture.
PMID: 20724027 [PubMed - as supplied by publisher]
11. Arthritis Care Res (Hoboken). 2010 Aug 18. [Epub ahead of print]
Intravenous immunoglobulins for steroid-refractory esophageal involvement related
to polymyositis and dermatomyositis. A series of 73 patients.
Marie I, Menard JF, Hatron PY, Hachulla E, Mouthon L, Tiev K, Ducrotte P, Cherin
P.
Department of Internal medicine, CHU Rouen, Rouen, France.
OBJECTIVES:: To assess long term outcome of esophageal complications in the group
of patients receiving intravenous immunoglobulins (IVIg) for the treatment of
severe steroid-refractory esophageal involvement related to PM/DM. PATIENTS AND
METHODS:: We retrospectively reviewed the medical records of 73 patients (39 PM,
34 DM) with steroid-resistant esophageal involvement. Esophageal involvement was
evaluated by clinical and manometric investigations. RESULTS:: 73 patients with
steroid-refractory esophageal involvement related to PM/DM received IVIg therapy
(2 grams per kilogram, monthly). The median interval between PM/DM diagnosis to
the onset of esophageal complications was 6 months. The most common clinical
manifestations revealing esophageal dysfunction were dysphagia (69.9%), coughing
while eating (61.6%) and gastro-esophageal reflux into pharynx and/or mouth
(34.2%). Twenty-five exhibited life-threatening esophageal complications
requiring exclusive enteral feeding (n=25); 33 patients with esophageal
impairment (45.2%) developed aspiration pneumonia. Sixty patients exhibited
resolution of esophageal clinical manifestations (82.2%), leading to return to
normal oral feeding and ablation of feeding enteral tubes. Four other patients
improved (5.5%), although they still complained of mild dysphagia intermittently.
Because of impaired cricopharyngeal muscle relaxation, another patient
successfully underwent cricopharyngeal myotomy. Eight patients died from
aspiration pneumonia (n=6) and cancer (n=2). Muscle weakness, thoracic myopathy
and aspiration pneumonia were independent predictive factors of IVIg-treated
esophageal complications in PM/DM patients. CONCLUSION:: Our findings indicate
that IVIg should be considered in life-threatening esophageal impairment
complicating steroid-resistant PM/DM. We also suggest that combined therapy of
IVIg and high dose steroids may be the first line therapy in PM/DM patients with
life-threatening esophageal manifestations.
PMID: 20722047 [PubMed - as supplied by publisher]
12. Arch Pediatr. 2010 Aug 16. [Epub ahead of print]
[Evaluation of language at 6 years in children born prematurely without cerebral
palsy: Prospective study of 55 children.]
[Article in French]
Charollais A, Stumpf MH, Beaugrand D, Lemarchand M, Radi S, Pasquet F, Khomsi A,
Marret S.
Service de pédiatrie néonatale et réanimation, centre d'éducation fonctionnelle
de l'enfant, centre de référence pour les troubles des apprentissages, hôpital
universitaire de Rouen, 1, rue de Germont, 76000 Rouen, France; EA 4309 <<
endothélium microvasculaire et lésions cérébrales néonatales >>, institut
hospitalo-universitaire de recherche et d'innovation, faculté de médecine et de
pharmacie, université de Rouen, 37000 Tours, France.
OBJECTIVES: Very premature birth carries a high risk of neurocognitive
disabilities and learning disorders. Acquiring sufficient speech skills is
crucial to good school performance. METHODS: A prospective study was conducted in
2006 to evaluate speech development in 55 children born very prematurely in 2000
at the Rouen Teaching Hospital (Rouen, France), free of cerebral palsy, compared
to 6-year-old born at full term. A computerized speech assessment tool was used
(Bilan Informatisé du Langage Oral, BILO II). RESULTS: In the premature-birth
group, 49 % of 6-year-old had at least 1 score below the 25th percentile on 1 of
the 8 BILO II tests. Significant speech impairments were noted for 2 components
of speech, namely, comprehension and phonology. Oral comprehension scores no
higher than the 10th percentile were obtained by 23 % of prematurely born
children (P<0.02 vs controls). On word repetition tasks used to test phonology,
21 % of prematurely born children obtained scores no higher than the 10th
percentile (P<0.01 vs controls). An evaluation of sensorimotor language
prerequisites (constraints) in 30 of the 55 prematurely born children showed
significant differences with the controls for word memory, visual attention, and
buccofacial praxis. CONCLUSION: The speech development impairments found in
6-year-old born very prematurely suggest a distinctive pattern of
neurodevelopmental dysfunction that is consistent with the motor theory of speech
perception.
PMID: 20719486 [PubMed - as supplied by publisher]
13. Int J Lab Hematol. 2010 Aug 16. [Epub ahead of print]
The new haematology analyzer DxH 800: an evaluation of the analytical
performances and leucocyte flags, comparison with the LH 755.
Jean A, Boutet C, Lenormand B, Callat MP, Buchonnet G, Barbay V, Basuyau JP,
Vasse M.
Laboratoire d'Hématologie Biologique and IHU, CHU Charles Nicolle, Rouen, France.
Summary Introduction: The analytical performance and the abnormality messages on
differential (flags) of the new analyzer Beckman Coulter DxH 800 were compared
with those of the LH 755. Methods: First, we evaluated the accuracy of the
results of the DxH 800, in comparison with the LH 755, in 125 samples without
alarm using unflagged sample results on both analyzers. Second, flagged samples
on the LH 755 but not flagged by the DxH 800 were evaluated by flow cytometry for
accuracy of the DxH 800 results. Finally, we evaluated the sensitivity and
specificity of abnormality messages on differential given by the analyzers, in
comparison with manual blood smears. Results: The correlation coefficients (R)
for complete blood count parameters and differential demonstrated that the DxH
800 results were similar to that of LH 755. Excellent correlation coefficients
between DxH 800 and flow cytometry results were found for white blood cell count
(R = 0.985, n = 31), platelet count (R = 0.976, n = 51) and nucleated red blood
cells (R = 0.966, n = 37). The overall performance showed an increased
sensitivity (0.892) and specificity (0.864) of the flags on DxH 800 when compared
to the LH 755 (0.846 and 0.733, respectively). Conclusion: The DxH 800 provides
reliable results and increases laboratory efficiency by reducing working time and
costs associated with the optical validation of the results.
PMID: 20718875 [PubMed - as supplied by publisher]
14. Interact Cardiovasc Thorac Surg. 2010 Aug 17. [Epub ahead of print]
Isolated ventricular septal rupture secondary to blunt trauma.
Hamdan-Challe M, Godin M, Bouchart F, Doguet F.
Rouen University Hospital, Rouen, France.
A ventricular septal rupture (VSR) is a rare complication of blunt chest trauma.
We describe the case of a 25-year-old man who developed a VSR as a result of a
high-speed road accident. The rupture was closed by left ventricular remodeling
and replacement of the diseased myocardium with a Dacron patch. The patch sutures
were reinforced with glue. Redo surgery was necessary at nine months due to patch
detachment and embolization of the glue in the right lower lobe. The patient is
asymptomatic, at 13-month follow-up. Keywords: Trauma; Blunt; Myocardial injury;
Cardiac intervention; Shunts (cardiac); Wound closure.
PMID: 20716555 [PubMed - as supplied by publisher]
15. Interact Cardiovasc Thorac Surg. 2010 Aug 13. [Epub ahead of print]
Place of extracorporeal membrane oxygenation in acute aortic dissection.
Doguet F, Vierne C, Leguillou V, Bessou JP.
Department of Thoracic and Cardiovascular Surgery, Rouen University Hospital,
Rouen, France.
Coronary artery dissection (CAD) is a rare but serious complication of type A
aortic dissection (AD) which may be discovered preoperatively in the presence of
clinical or ECG signs of ischemia, or intraoperatively after dissection of the
coronary ostium. Treatment of CAD consists of surgical repair with glue and, if
necessary, coronary artery bypass graft. No case of AD with CAD complicated by
major arrhythmias treated by assisted circulation has been reported in the
literature. We report the first case of AD with implementation of extracorporeal
membranous oxygenation following cardiotomy with a favorable outcome. Keywords:
Coronary disease; Mechanical circulatory assistance; Great vessels;
Extra-corporeal circulation.
PMID: 20709696 [PubMed - as supplied by publisher]
16. J Visc Surg. 2010 Aug 12. [Epub ahead of print]
Necrotizing fasciitis of the thigh should raise suspicion of a rectal cancer.
Khalil H, Tsilividis B, Schwarz L, Scotté M.
Service de chirurgie digestive, hôpital Charles-Nicolle, CHU de Rouen, 1, rue de
Germont, 76000 Rouen cedex, France.
Perforation of rectal cancer usually occurs intraperitoneally. Extraperitoneal
perforation is rare and usually presents as perineal sepsis, leading to diagnosis
and urgent surgical management plus antibiotic therapy. We report the case of a
patient presenting with a perforated rectal carcinoma which presented as
necrotizing fasciitis of the right thigh.
PMID: 20708997 [PubMed - as supplied by publisher]
17. Eur Urol. 2010 Aug 2. [Epub ahead of print]
Nitric Oxide/Cyclic Guanosine Monophosphate Signalling Mediates an Inhibitory
Action on Sensory Pathways of the Micturition Reflex in the Rat.
Caremel R, Oger-Roussel S, Behr-Roussel D, Grise P, Giuliano FA.
Charles Nicolle Hospital, Department of Urology, Rouen, France.
BACKGROUND: Overactive bladder can be associated with a hyperexcitability of
bladder afferent C-fibres. Several studies have suggested that nitric oxide (NO)
or its downstream signalling could modulate the micturition reflex (MR) by
reducing the excitability of bladder afferents. OBJECTIVES: To evaluate the role
of the NO/cyclic guanosine monophosphate (cGMP) signalling pathway on the MR in a
model of bladder hyperactivity (BHA) associated with C-fibre activation in the
rat. DESIGN, SETTING, AND PARTICIPANTS: Adult female Sprague Dawley rats were
used. MEASUREMENTS: Cystometry was performed in anaesthetised rats. The effects
of 0.1mg/kg of sodium nitroprusside (SNP), an NO donor; 10mg/kg of 8Br-cGMP, a
cGMP analogue; 3mg/kg of sildenafil and 1mg/kg of vardenafil, two
phosphodiesterase type 5 inhibitors (PDE5-I); 10mg/ml of L-N(G)-nitroarginine
methyl ester (L-NAME), an NO synthase inhibitor; and 1mg/kg of LY-83583, a
guanylate cyclase inhibitor, were investigated on BHA during intravesical
capsaicin (30mumol/l) instillation. All drugs were delivered intravenously except
for L-NAME, which was intravesically administered. RESULTS AND LIMITATIONS: SNP,
8Br-cGMP, and PDE5-I increased the intercontraction interval (ICI), while SNP and
PDE5-I increased the micturition pressure threshold (MPT). L-NAME and LY-83583
decreased MPT, and L-NAME decreased ICI. 8Br-cGMP decreased the maximum
intravesical pressure (MP), contrary to L-NAME and LY-83583. SNP and PDE5-I had
no effect on MP. SNP increased the voided volume (VV). PDE5-I and 8Br-cGMP also
increased VV, although not significantly. In contrast, L-NAME tended to decrease
VV. Although 8Br-cGMP decreased the baseline intravesical pressure, LY-83583
increased it. Neither SNP nor PDE5-I nor L-NAME had any effect on baseline
pressure. CONCLUSIONS: Compounds activating the NO/cGMP pathway inhibited BHA,
whereas compounds inhibiting the NO/cGMP pathway increased it. These results
indicate that the NO/cGMP signalling pathway is involved in the regulation of the
MR, with an action that seems more predominant on the sensory rather on the motor
component of the MR in a rat model of BHA associated with C-fibre afferent
activation.
PMID: 20708839 [PubMed - as supplied by publisher]
18. Presse Med. 2010 Aug 6. [Epub ahead of print]
[Autoimmune blistering skin diseases: Recent advances.]
[Article in French]
Joly P.
Université de Rouen, hôpital Charles-Nicolle, unité Inserm U905, clinique
dermatologique, 76031 Rouen cedex, France.
PMID: 20692800 [PubMed - as supplied by publisher]
19. Ann Fr Anesth Reanim. 2010 Sep;29(9):629-634. Epub 2010 Aug 1.
[Albumin in sepsis.]
[Article in French]
Tamion F.
Service de réanimation médicale, CHU de Rouen, 1, rue de Germont, 76031 Rouen,
France; Inserm U644, institut hospitalo-universitaire de recherche biomédicale,
IFRMP23, université de Rouen, 22, boulevard Gambetta, 76183 Rouen, France.
Human serum albumin is a small (66kD) globular protein representing over 60 % of
the total plasma protein content. It is made up of 585 amino 6 acids and contains
35 cysteine residues forming disulfide bridges that contribute to its overall
tertiary structure. It has a free cysteine-derived thiol group at Cys-34, which
accounts for 80 % of its redox activity. Physiologically, serum albumin exists in
a reduced form with a free thiol contributing to its antioxidant properties. It
is synthesized primarily in the liver and is an acute-phase protein. It is a
multifunctional plasma protein ascribed ligand-binding and transport properties
as well as antioxidants and enzymatic functions. It maintains colloid osmotic
pressure, modulates inflammatory response and may influence oxidative damage.
Hypoalbuminemia is common in the intensive care unit and may be due to decreased
synthesis by the liver and/or to increased losses or increased proteolysis and
clearance. Although albumin was long used to control vascular collapse in
critically ill patients, the evidence suggests that it does not offer a benefit
over crystalloid solutions in vascular collapse. However, human serum albumin is
an important circulating antioxidant and it may be beneficial in critically ill
patients to limit oxidative damage. A number of studies suggest that in specific
groups of hypoalbuminemic critically ill patients, albumin administration may
have beneficial effects on organ function, although the exact mechanisms remain
undefined. Further trials are needed to confirm theses observations and to
clearly demonstrate whether albumin should be administered in critically ill
patients with hypoalbuminemia.
PMID: 20675098 [PubMed - as supplied by publisher]
20. Dis Colon Rectum. 2010 Aug;53(8):1155-60.
Artificial anal sphincter for severe fecal incontinence implanted by a
transvaginal approach: experience with 32 patients treated at one institution.
Michot F, Lefebure B, Bridoux V, Gourcerol G, Kianifard B, Leroi AM, Tuech JJ.
Department of Digestive Surgery, Rouen University Hospital, Rouen, France.
francis.michot@chu-rouen.fr
PURPOSE: Our aim was to evaluate medium-term results of transvaginal implantation
of an artificial anal sphincter in a large series of patients. METHODS: Women
undergoing treatment for severe fecal incontinence at Rouen University Hospital,
Rouen, France, from January 2003 through December 2007 were eligible for the
study if the fecal incontinence had lasted for 6 months and if they had attempted
other therapies without success. All patients received implantation of an
artificial anal sphincter via a transvaginal approach. Incontinence was assessed
with the Cleveland Clinic Florida Fecal Incontinence Scale (Wexner score).
RESULTS: A total of 32 women entered the study. Their median age was 63 (range,
26-79) years. At entry, 20 (63%) had severe destruction and scarring of the
perineum, which was a contraindication for implantation via a perineal approach.
Nine patients (28.1%) had previously undergone implantation of an AAS which had
been removed because of complications, and 5 had had a Pickrell procedure for
anal agenesia. No deaths occurred during the study. The device was removed in a
total of 9 patients (28.1%): in 7 because of septic adverse events within the
first 6 months after the operation, in 1 because of poor function, and in 1 for
psychological reasons despite good functional results. Implantation was
successful in 23 patients (71.9%), and the device remained activated for a mean
follow-up of 41 (range, 18-75) months, with a mean decrease in Cleveland Clinic
incontinence score from 18.4 to 6.8 (P < .0001). None of the patients complained
of dyspareunia. CONCLUSIONS: The transvaginal approach for implantation of an
artificial anal sphincter permits treatment of women with fecal incontinence who
have severe damage and scarring of the anterior perineum. This route provides an
alternative for patients whose only therapeutic option would previously have been
a defunctioning stoma.
PMID: 20628279 [PubMed - in process]
21. Hum Mutat. 2010 Aug;31(8):961-5.
Type I hyperprolinemia: genotype/phenotype correlations.
Guilmatre A, Legallic S, Steel G, Willis A, Di Rosa G, Goldenberg A,
Drouin-Garraud V, Guet A, Mignot C, Des Portes V, Valayannopoulos V, Van
Maldergem L, Hoffman JD, Izzi C, Espil-Taris C, Orcesi S, Bonafé L, Le Galloudec
E, Maurey H, Ioos C, Afenjar A, Blanchet P, Echenne B, Roubertie A, Frebourg T,
Valle D, Campion D.
Inserm U614, IHU, 76000 Rouen, France.
Type I hyperprolinemia (HPI) is an autosomal recessive disorder associated with
cognitive and psychiatric troubles, caused by alterations of the Proline
Dehydrogenase gene (PRODH) at 22q11. HPI results from PRODH deletion and/or
missense mutations reducing proline oxidase (POX) activity. The goals of this
study were first to measure in controls the frequency of PRODH variations
described in HPI patients, second to assess the functional effect of PRODH
mutations on POX activity, and finally to establish genotype/enzymatic activity
correlations in a new series of HPI patients. Eight of 14 variants occurred at
polymorphic frequency in 114 controls. POX activity was determined for six novel
mutations and two haplotypes. The c.1331G>A, p.G444D allele has a drastic effect,
whereas the c.23C>T, p.P8L allele and the c.[56C>A; 172G>A], p.[Q19P; A58T]
haplotype result in a moderate decrease in activity. Among the 19 HPI patients,
10 had a predicted residual activity <50%. Eight out of nine subjects with a
predicted residual activity > or = 50% bore at least one c.824C>A, p.T275N
allele, which has no detrimental effect on activity but whose frequency in
controls is only 3%. Our results suggest that PRODH mutations lead to a decreased
POX activity or affect other biological parameters causing hyperprolinemia.
PMID: 20524212 [PubMed - in process]
22. Rev Med Interne. 2010 Aug;31(8):540-4. Epub 2010 May 26.
[Idiopathic inflammatory myopathies with anti-PM-Scl antibodies: case series and
literature review]
[Article in French]
Marie I, Lahaxe L, Tiev K, Duval-Modeste AB, Vittecoq O, Levesque H, Jouen F.
Département de médecine interne, CHU de Rouen, 1, rue de Germont, 76031 Rouen
cedex, France. isabelle.marie@chu-rouen.fr
PURPOSE: The objectives of this study were to evaluate: (1) the prevalence of
anti-PM-Scl antibodies within the framework of antinuclear antibodies detection;
and (2) the clinical features and outcome of patients with isolated
polymyositis/dermatomyositis. METHODS: Nine thousand and sixty-four consecutive
antinuclear testing data allowed us to evaluate anti-PM-Scl antibody prevalence.
Second, we also assessed the characteristics of patients with isolated
dermatomyositis/polymyositis and associated anti-PM-Scl antibody. RESULTS: Over
9064 consecutive antinuclear samples tested for antinuclear antibodies, 3263
(36%) were positive; anti-PM-Scl antibody were positive in nine patients: 0.1% of
all sera, 0.2% of sera positive for antinuclear antibodies, 1.2% of sera positive
for anti-ENA antibodies. Four of the nine patients with anti-PM-Scl antibody had
dermatomyositis (n=3) and polymyositis (n=1). Patients with
dermatomyositis/polymyositis and anti-PM-Scl antibody exhibited severe
complications, as follows: ventilatory insufficiency (n=2) requiring mechanical
ventilation in one case, esophageal involvement requiring enteral feeding (n=1);
also, two of these patients had cancer. CONCLUSION: Our case series suggests that
the presence of anti-PM-Scl antibody is not a favorable prognostic factor in
patients with dermatomyositis/polymyositis. This type of antibody appears to be
associated with lung and esophageal involvement; in addition, anti-PM-Scl
antibody may co-exist with malignancy in PM/DM patients. Taken together, we
suggest that patients with dermatomyositis/polymyositis and anti-PM-Scl antibody
require both initial evaluation for lung/digestive manifestations and cancer and
close surveillance.
PMID: 20510485 [PubMed - in process]
23. Rev Med Interne. 2010 Aug;31(8):558-61. Epub 2010 May 21.
[Acute reactive arthritis after intravesical instillation of bacillus
Calmette-Guérin. Two case reports and literature review]
[Article in French]
Miranda S, Vernet M, Héron F, Vittecoq O, Levesque H, Marie I.
Département de Médecine interne, CHU de Rouen-Boisguillaume, 1, rue de Germont,
76031 Rouen cedex, France.
INTRODUCTION: Intravesical bacillus Calmette-Guérin (BCG) therapy-associated
articular complications are uncommon, occurring in only 0.5 to 1% of the
patients. OBSERVATIONS: We report two patients who were given intravesical BCG
therapy for superficial bladder cancer. Both patients developed polyarthritis and
fever related to intravesical BCG instillation. The outcome of articular
manifestations was favorable after administration of nonsteroidal
anti-inflammatory therapy. CONCLUSION: Intravesical BCG therapy-associated
articular complications should not be overlooked, as they may result in high
morbidity. Nevertheless, the diagnosis of intravesical BCG therapy-related
reactive arthritis should be discussed after excluding infectious arthritis due
to Mycobacterium bovis. Therefore, joint fluid microbiological tests (cultures,
PCR) are required in the patients receiving intravesical BCG who develop
arthritis.
PMID: 20494494 [PubMed - in process]
24. Atherosclerosis. 2010 Aug;211(2):486-91. Epub 2010 Apr 13.
Hypertrophic remodeling and increased arterial stiffness in patients with
intracranial aneurysms.
Maltete D, Bellien J, Cabrejo L, Iacob M, Proust F, Mihout B, Thuillez C,
Guegan-Massardier E, Joannides R.
Department of Neurology, CHU-Hopitaux de Rouen & Institut National de la Sante et
de la Recherche Medicale (INSERM) U644, Institut Federatif de Recherche
Multidisciplinaire sur les Peptides (IFRMP) 23, Institute for Biomedical
Research, University of Rouen, France.
OBJECTIVE: Because an underlying arteriopathy might contribute to the development
of intracranial aneurysms (IAs), we assessed the elastic properties of proximal
conduit arteries in patients with IA. METHODS: In 27 patients with previous
ruptured IA and 27 control subjects matched for age, gender and BMI, we
determined arterial pressure, internal diameter, intima-media thickness (IMT),
circumferential wall stress (CWS) and elastic modulus (wall stiffness) in common
carotid arteries using applanation tonometry and echotracking. Moreover, carotid
augmentation index (AIx, arterial wave reflections) and carotid-to-femoral pulse
wave velocity (PWV, aortic stiffness) were assessed. RESULTS: Compared with
controls, patients with IA exhibited higher brachial and carotid systolic and
diastolic blood pressures, with similar brachial but higher carotid artery pulse
pressure (35 + or - 6mm Hg vs. 41 + or - 8mm Hg, P=0.014). Moreover, patients
have higher PWV (7.8 + or - 1.2ms(-1) vs. 8.3 + or - 1.1ms(-1), P=0.048) and AIx
(15.8 + or - 10.8% vs. 21.1 + or - 8.5%, P<0.001) which contributes to increase
carotid blood pressures. Furthermore, carotid IMT was higher in patients (546 +
or - 64 microm vs. 642 + or - 70 microm, P<0.001) without difference in diameter
suggesting an adaptive hypertrophy. However, patients display a lower CWS (61.6 +
or - 9.2 kPa vs. 56.9 + or - 10.3 kPa, P=0.007) and no correlation between IMT
and pulse pressure (r=0.152, P=NS) in contrast to controls (r=0.539, P<0.001)
showing the contribution of a pressure-independent process. Finally, despite this
lesser CWS, elastic modulus was increased in patients (310 + or - 105 kPa vs. 383
+ or - 174 kPa, P=0.026). CONCLUSION: This study demonstrates that patients with
IA display a particular carotid artery phenotype with an exaggerated hypertrophic
remodeling and altered elastic properties. Thus, a systemic arteriopathy might
contribute, together with the arterial wall fatiguing effect of the increased
pulsatile stress, to the pathogenesis of IA.
PMID: 20452592 [PubMed - in process]
25. Rev Med Interne. 2010 Aug;31(8):551-7. Epub 2010 Apr 22.
[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, EA3829, groupe de recherche MERCI, institut hospitalo-universitaire
de recherche biomédicale, université de Rouen, 22, boulevard Gambetta, 76183
Rouen cedex, France. veronique.le-cam-duchez@chu-rouen.fr
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.
PMID: 20416992 [PubMed - in process]
26. Dig Dis Sci. 2010 Aug;55(8):2172-81. Epub 2009 Nov 13.
A diet containing whey protein, glutamine, and TGFbeta modulates gut protein
metabolism during chemotherapy-induced mucositis in rats.
Boukhettala N, Ibrahim A, Claeyssens S, Faure M, Le Pessot F, Vuichoud J,
Lavoinne A, Breuillé D, Déchelotte P, Coëffier M.
ADEN EA4311 Institute for Biomedical Research and European Institute for Peptide
Research (IFRMP23), Rouen University, Rouen, France.
BACKGROUND: Mucositis, a common side effect of chemotherapy, is characterized by
compromised digestive function, barrier integrity and immune competence. AIMS:
Our aim was to evaluate the impact of a specifically designed diet Clinutren
Protect (CP), which contains whey proteins, TGFbeta-rich casein, and free
glutamine, on mucositis in rats. METHODS: Mucositis was induced by three
consecutive injections (day 0, day 1, day 2) of methotrexate (2.5 mg/kg). Rats
had free access to CP or placebo diets from days -7 to 9. In the placebo diet,
whey proteins and TGFbeta-rich casein were replaced by TGFbeta-free casein and
glutamine by alanine. Intestinal parameters were assessed at day 3 and 9. Values,
expressed as mean +/- SEM, were compared using two-way ANOVA. RESULTS: At day 3,
villus height was markedly decreased in the placebo (296 +/- 11 microm) and CP
groups (360 +/- 10 microm) compared with controls (464 +/- 27 microm), but more
markedly in the placebo as compared to CP group. The intestinal damage score was
also reduced in the CP compared with the placebo group. Glutathione content
increased in the CP compared with the placebo group (2.2 +/- 0.2 vs. 1.7 +/- 0.2
micromol/g tissue). Gut protein metabolism was more affected in the placebo than
in the CP group. The fractional synthesis rate was decreased in the placebo group
(93.8 +/- 4.9%/day) compared with controls (121.5 +/- 12.1, P < 0.05), but not in
the CP group (106.0 +/- 13.1). In addition, at day 9, rats exhibited improved
body weight and food intake recovery in the CP compared to the placebo group.
CONCLUSIONS: Clinutren Protect feeding reduces intestinal injury in the acute
phase of methotrexate-induced mucositis in rats and improves recovery.
PMID: 19911274 [PubMed - indexed for MEDLINE]
