AIM To assess magnetic resonance imaging(MRI)and faecal calprotectin to detect endoscopic postoperative recurrence in patients with Crohn's disease(CD).METHODS From two tertiary centers,all patients with CD who un...AIM To assess magnetic resonance imaging(MRI)and faecal calprotectin to detect endoscopic postoperative recurrence in patients with Crohn's disease(CD).METHODS From two tertiary centers,all patients with CD who underwent ileocolonic resection were consecutively and prospectively included.All the patients underwent MRI and endoscopy within the first year after surgery or after the restoration of intestinal continuity[median=6 mo(5.0-9.3)].The stools were collected the day before the colonoscopy to evaluate faecal calprotectin level.Endoscopic postoperative recurrence(POR)was defined as Rutgeerts'index≥i2b.The MRI was analyzed independently by two radiologists blinded from clinical data.RESULTS Apparent diffusion coefficient(ADC)was lower in patients with endoscopic POR compared to those with no recurrence(2.03±0.32 vs 2.27±0.38×10^(-3)mm^2/s,P=0.032).Clermont score(10.4±5.8 vs 7.4±4.5,P=0.038)and relative contrast enhancement(RCE)(129.4%±62.8%vs 76.4%±32.6%,P=0.007)were significantly associated with endoscopic POR contrary to the magnetic resonance index of activity(Ma RIA)(7.3±4.5 vs 4.8±3.7;P=0.15)and MR scoring system(P=0.056).ADC<2.35×10^(-3)mm^2/s[sensitivity=0.85,specificity=0.65,positive predictive value(PPV)=0.85,negative predictive value(NPV)=0.65]and RCE>100%(sensitivity=0.75,specificity=0.81,PPV=0.75,NPV=0.81)were the best cutoff values to identify endoscopic POR.Clermont score>6.4(sensitivity=0.61,specificity=0.82,PPV=0.73,NPV=0.74),Ma RIA>3.76(sensitivity=0.61,specificity=0.82,PPV=0.73,NPV=0.74)and a MR scoring system≥MR1(sensitivity=0.54,specificity=0.82,PPV=0.70,and NPV=0.70)demonstrated interesting performances to detect endoscopic POR.Faecal calprotectin values were significantly higher in patients with endoscopic POR(114±54.5μg/g vs 354.8±432.5μg/g;P=0.0075).Faecal calprotectin>100μg/g demonstrated high performances to detect endoscopic POR(sensitivity=0.67,specificity=0.93,PPV=0.89 and NPV=0.77).CONCLUSION Faecal calprotectin and MRI are two reliable tools to detect endoscopic POR in patients with CD.展开更多
The authors describe a rare case in which blunt abdominal trauma resulted in mesenteric injury with delayed double ischemic ileal stenosis. Abdominal computed tomography demonstrated stenotic ileal loop with mural thi...The authors describe a rare case in which blunt abdominal trauma resulted in mesenteric injury with delayed double ischemic ileal stenosis. Abdominal computed tomography demonstrated stenotic ileal loop with mural thickening. At surgery, a double stenotic bowel loop was found adjacent to a healed defect in the mesentery. Histological examination of the two resected segments showed fibrotic and ischemic lesions within the mesentery. Ischemic intestinal stenosis from mesenteric injury should be considered in the differential diagnosis in patients suffering from intestinal occlusion with a history of blunt abdominal trauma.展开更多
<u>Background:</u><span style="font-family:Verdana;"> Extracorporeal</span><span style="font-family:;" "=""> </span><span style="font-fami...<u>Background:</u><span style="font-family:Verdana;"> Extracorporeal</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">membrane oxygenation is a rescue life support technique used in life threatening</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">conditions of refractory respiratory and/or cardiac distress. Indication for extracorporeal life support in children</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">depends on age and varies from pulmonary to cardiac pathologies. In some cases</span><span style="font-family:Verdana;">,</span><span style="font-family:Verdana;"> it may be used as a bridge to a</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">therapeutic procedure.</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">We described here the management of respiratory failure due to hemoptysis in a child with a Fontan circulation</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">and veno-venous extracorporeal membrane oxygenation which served as a bridge to angio-embolization. Hemoptysis can be a life threatening condition which can lead to hypovolemic shock and impaired alveolar gas</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">exchange. The latter can result in respiratory failure and consequent asphyxia.</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">When hemoptysis occurs in a patient with a univentricular</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">heart and a Fontan circulation, management of this</span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">clinical situation can be challenging due to the particular physiology of the latter. Total cavopulmonary connection is a palliative surgical repair which constitutes Fontan circulation as a definitive treatment in patients with a univentricular heart. </span><u><span style="font-family:Verdana;">Methods:</span></u><span style="font-family:Verdana;"> Case report description of a 16 year-old boy with a univentricular heart and a Fontan circulation</span></span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">who presented hemoptysis managed with a veno-venous extracorporeal membrane oxygenation (ECMO) as a</span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">bridge to angio-embolization. </span><u><span style="font-family:Verdana;">Results:</span></u><span style="font-family:Verdana;"> Hemoptysis due to diffuse intra-alveolar hemorrhage from collateral circulation was successfully treated</span></span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">in this young patient with pulmonary vascular embolization. This allowed to wean the patient from</span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">extra-corporeal membrane oxygenation. </span><u><span style="font-family:Verdana;">Conclusion:</span></u><span style="font-family:Verdana;"> Veno-venous ECMO can be life-saving as a bridge to angio-embolization for severe hemoptysis in</span></span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">patients with Fontan circulation. The reported case allows to underline that </span><span style="font-family:Verdana;">our multidisciplinary approach in</span></span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">this complex pediatric patient surely</span><span style="font-family:Verdana;"> participated to improve outcome.</span>展开更多
BACKGROUND Anti-epidermal growth factor receptor therapy is associated with skin adverse events not previously reported with conventional chemotherapy.Prophylactic actions are recommended,but routine clinical manageme...BACKGROUND Anti-epidermal growth factor receptor therapy is associated with skin adverse events not previously reported with conventional chemotherapy.Prophylactic actions are recommended,but routine clinical management of these toxicities and their impact on quality of life remain unknown.AIM To assess the dermatological toxicities reported after panitumumab initiation,their impact on the quality of life and the clinical practices for their management.METHODS Patients included in this prospective multicenter observational study were over 18 years of age and began treatment with panitumumab for wild-type KRAS metastatic colorectal cancer.The incidence of dermatological toxicities,clinical practices for their management and impact on quality of life were recorded during a 6-mo follow-up.RESULTS Overall,229 patients(males,57.6%;mean age,66.2 years)were included.At day 15,59.3%of patients had dermatological toxicity;the rate peaked at month 2(74.7%)and decreased at month 6(46.5%).The most frequent dermatological toxicities were rash/acneiform rash,xerosis and skin cracks.At least one preventive treatment was administered to 65.9%of patients(oral antibiotics,84.1%;emollients,75.5%;both,62.9%).The rates of patients who received at least one curative treatment peaked at month 2(63.4%)and decreased at month 6(44.8%).The impact of the dermatological toxicities on quality of life was limited as assessed with Dermatology Life Quality Index scores and inconvenience visual analogic scale score.The rates of topical corticosteroids administration and visits to specialists were low.CONCLUSION The rates of the different skin toxicities peaked at various times and were improved at the end of follow-up.Nevertheless,their clinical management could be optimized with a better adherence to current recommendations.The impact of skin toxicities on patient’s quality of life appeared to be limited.展开更多
Since the outbreak of coronavirus disease 2019(COVID-19)in December 2019 in China,various measures have been adopted in order to attenuate the impact of the virus on the population.With regard to spine surgery,French ...Since the outbreak of coronavirus disease 2019(COVID-19)in December 2019 in China,various measures have been adopted in order to attenuate the impact of the virus on the population.With regard to spine surgery,French physicians are devoted to take place in the national plan against COVID-19,the French Spine Surgery Society therefore decided to elaborate specific guidelines for management of spinal disorders during COVID-19 pandemic in order to prioritize management of patients.A three levels stratification was elaborated with Level I:Urgent surgical indications,Level II:Surgical indications associated to a potential loss of chance for the patient and Level III:Non-urgent surgical indications.We also report French experience in a COVID-19 cluster region illustrated by two clinical cases.We hope that the guidelines formulated by the French Spine Surgery Society and the experience of spine surgeons from a cluster region will be helpful in order optimizing the management of patients with urgent spinal conditions during the pandemic.展开更多
Primary ciliary dyskinesia is a rare, genetic disorder resulting of an abnorma l ultrastructural morphology of cilia. Such disease is rarely recognized in neon atal period. We report on a newborn who exhibited unexpla...Primary ciliary dyskinesia is a rare, genetic disorder resulting of an abnorma l ultrastructural morphology of cilia. Such disease is rarely recognized in neon atal period. We report on a newborn who exhibited unexplained respiratory distre ss. The diagnosis of primary ciliary dyskinesia was suggested by the association of bilateral and multiple atelectasis and situs inversus. Diagnosis was confirm ed by three months of age by ultrastructural study of cilia. Primary ciliary dys kinesia is a rare disease. Diagnosis should be considered in unexplained cases o f neonatal respiratory distress, especially when situs inversus totalis and mult iple atelectasis are present. Diagnosis requires ciliary studies that can be per formed in newborn infants.展开更多
Objective:To determine the etiologic factors,circumstances of diagnosis,obstetrical management and complications of face presentation and to value the maternal and foetal prognosis of this presentation. Patients and m...Objective:To determine the etiologic factors,circumstances of diagnosis,obstetrical management and complications of face presentation and to value the maternal and foetal prognosis of this presentation. Patients and methods:Thirty-two cases of face presentation have been observed in the maternity wards of Reims and Troyes over the last 12 years. Results:The incidence of face presentation was 0.7 per 1000 deliveries. Spontaneous vaginal delivery occurredwith mento-anterior presentation 73%of the time and caesarean section was performed in 100%of mento-posterior presentation. There was no increasing rate of foetal or maternal mortality and morbidity with vaginal delivery. Discussion and conclusion:Face presentation is an unusual complication of pregnancy with obstetric factors that predispose the foetus to face presentation. The low foetal and maternal mortality and morbidity substantiate the effectiveness of conservative management in face presentation.展开更多
Acute fatty liver of pregnancy is a rare clinical syndrome of pregnancy that occurs during the third trimester. Clinicians must have a high index of suspicion for this condition when a woman has nausea or vomiting dur...Acute fatty liver of pregnancy is a rare clinical syndrome of pregnancy that occurs during the third trimester. Clinicians must have a high index of suspicion for this condition when a woman has nausea or vomiting during the last trimester. Early diagnosis and prompt delivery improve foetal and maternal prognosis. We report a case of a previously healthy 23- year-old woman who presented an acute fatty liver of pregnancy with intrauterine fetal death. Based on this experience as well as on medical literature, characteristics of this uncommon pathology are discussed.展开更多
Introduction Septic shock remains highly lethal,with a 30-day mortality of approximately 35%.[1]Vascular dysfunction is a key mechanism underlying hemodynamic failure in this context.In addition to microcirculatory ab...Introduction Septic shock remains highly lethal,with a 30-day mortality of approximately 35%.[1]Vascular dysfunction is a key mechanism underlying hemodynamic failure in this context.In addition to microcirculatory abnormalities,[2]vascular dysfunction is characterized by a reduction in vascular tone,which is associated with a diminished responsiveness to vasoconstrictive agents.[3]This leads to arterial hypotension.When severe hypotension impairs the perfusion of vital organs and results in multiorgan failure,even in the presence of normal or elevated cardiac output(CO).展开更多
The challenge of imaging is to combine resolution and sensitivity in order to gain accuracy in diagnosis.No single modality can provide comprehensive information.Then,the solution is to design probes that are able to ...The challenge of imaging is to combine resolution and sensitivity in order to gain accuracy in diagnosis.No single modality can provide comprehensive information.Then,the solution is to design probes that are able to gather on a single platform the best features of the different imaging modalities.To achieve this objective,we have combined two types of probes,one associated with photoacoustic imaging(PAI)and the other with magnetic resonance imaging(MRI),within polysaccharide-based nanohydrogels.For that,chitosan(CS)which is a cationic polysaccharide was grafted with the photoacoustic probe ZW800-1.The synthesis of the corresponding CS-ZW800 and the purification conditions that allow to overcome ZW800 aggregation on the course of the protocol were carefully analyzed.Nanohydrogels that encapsulated gadolinium chelates as MRI probes were further obtained by ionic gelation between CS-ZW800 and the anionic hyaluronic acid(HA)in the presence of tripolyphosphate(TPP)as an ionogenic cross-linker.The bimodal nanohydrogels were then subjected to MSOT and MRI experiments.Upon excitation at 770 nm the nanoparticles were then able to produce a significant MSOT signal while in MRI at 3T,a significant positive contrast was obtained with low Gd doses.展开更多
Laparoscopic liver resections(LLR)of posterosuperior segments(PS)(7,8,and 4a)are technically challenging.Adequate surgical exposure during parenchymal transection and bleeding control from the deep liver cut surface c...Laparoscopic liver resections(LLR)of posterosuperior segments(PS)(7,8,and 4a)are technically challenging.Adequate surgical exposure during parenchymal transection and bleeding control from the deep liver cut surface can be difficult to achieve.Both the IWATE(1)and IMM(2)LLR scoring systems classify PS segment resections as either advanced/expert level(IWATE)or group 3(IMM),reflecting a high level of technical difficulty.Studies comparing laparoscopy to open surgery for this indication are mainly retrospective and the level of evidence supporting the superiority of laparoscopy remains low.The PS segment subgroup analysis of the OSLO-COMET randomized trial concluded that laparoscopy yielded a shorter hospital stay with no significant differences between open and LLR groups in complications and mortality rates(3).展开更多
Colorectal cancer(CRC)is the third most common cancer worldwide and represents a serious global health issue.During the disease course,up to 50%of patients will develop liver metastases[colorectal liver metastasis(CRL...Colorectal cancer(CRC)is the third most common cancer worldwide and represents a serious global health issue.During the disease course,up to 50%of patients will develop liver metastases[colorectal liver metastasis(CRLM)]with a significant negative impact on survival(1,2).Liver resection(LR),in combination with chemo-and targeted therapies,is the standard curative treatment for CRLM.In selected patients and in specialized centers,the 5-year overall survival(OS)after LR may reach 50%(3,4).展开更多
文摘AIM To assess magnetic resonance imaging(MRI)and faecal calprotectin to detect endoscopic postoperative recurrence in patients with Crohn's disease(CD).METHODS From two tertiary centers,all patients with CD who underwent ileocolonic resection were consecutively and prospectively included.All the patients underwent MRI and endoscopy within the first year after surgery or after the restoration of intestinal continuity[median=6 mo(5.0-9.3)].The stools were collected the day before the colonoscopy to evaluate faecal calprotectin level.Endoscopic postoperative recurrence(POR)was defined as Rutgeerts'index≥i2b.The MRI was analyzed independently by two radiologists blinded from clinical data.RESULTS Apparent diffusion coefficient(ADC)was lower in patients with endoscopic POR compared to those with no recurrence(2.03±0.32 vs 2.27±0.38×10^(-3)mm^2/s,P=0.032).Clermont score(10.4±5.8 vs 7.4±4.5,P=0.038)and relative contrast enhancement(RCE)(129.4%±62.8%vs 76.4%±32.6%,P=0.007)were significantly associated with endoscopic POR contrary to the magnetic resonance index of activity(Ma RIA)(7.3±4.5 vs 4.8±3.7;P=0.15)and MR scoring system(P=0.056).ADC<2.35×10^(-3)mm^2/s[sensitivity=0.85,specificity=0.65,positive predictive value(PPV)=0.85,negative predictive value(NPV)=0.65]and RCE>100%(sensitivity=0.75,specificity=0.81,PPV=0.75,NPV=0.81)were the best cutoff values to identify endoscopic POR.Clermont score>6.4(sensitivity=0.61,specificity=0.82,PPV=0.73,NPV=0.74),Ma RIA>3.76(sensitivity=0.61,specificity=0.82,PPV=0.73,NPV=0.74)and a MR scoring system≥MR1(sensitivity=0.54,specificity=0.82,PPV=0.70,and NPV=0.70)demonstrated interesting performances to detect endoscopic POR.Faecal calprotectin values were significantly higher in patients with endoscopic POR(114±54.5μg/g vs 354.8±432.5μg/g;P=0.0075).Faecal calprotectin>100μg/g demonstrated high performances to detect endoscopic POR(sensitivity=0.67,specificity=0.93,PPV=0.89 and NPV=0.77).CONCLUSION Faecal calprotectin and MRI are two reliable tools to detect endoscopic POR in patients with CD.
文摘The authors describe a rare case in which blunt abdominal trauma resulted in mesenteric injury with delayed double ischemic ileal stenosis. Abdominal computed tomography demonstrated stenotic ileal loop with mural thickening. At surgery, a double stenotic bowel loop was found adjacent to a healed defect in the mesentery. Histological examination of the two resected segments showed fibrotic and ischemic lesions within the mesentery. Ischemic intestinal stenosis from mesenteric injury should be considered in the differential diagnosis in patients suffering from intestinal occlusion with a history of blunt abdominal trauma.
文摘<u>Background:</u><span style="font-family:Verdana;"> Extracorporeal</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">membrane oxygenation is a rescue life support technique used in life threatening</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">conditions of refractory respiratory and/or cardiac distress. Indication for extracorporeal life support in children</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">depends on age and varies from pulmonary to cardiac pathologies. In some cases</span><span style="font-family:Verdana;">,</span><span style="font-family:Verdana;"> it may be used as a bridge to a</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">therapeutic procedure.</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">We described here the management of respiratory failure due to hemoptysis in a child with a Fontan circulation</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">and veno-venous extracorporeal membrane oxygenation which served as a bridge to angio-embolization. Hemoptysis can be a life threatening condition which can lead to hypovolemic shock and impaired alveolar gas</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">exchange. The latter can result in respiratory failure and consequent asphyxia.</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">When hemoptysis occurs in a patient with a univentricular</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">heart and a Fontan circulation, management of this</span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">clinical situation can be challenging due to the particular physiology of the latter. Total cavopulmonary connection is a palliative surgical repair which constitutes Fontan circulation as a definitive treatment in patients with a univentricular heart. </span><u><span style="font-family:Verdana;">Methods:</span></u><span style="font-family:Verdana;"> Case report description of a 16 year-old boy with a univentricular heart and a Fontan circulation</span></span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">who presented hemoptysis managed with a veno-venous extracorporeal membrane oxygenation (ECMO) as a</span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">bridge to angio-embolization. </span><u><span style="font-family:Verdana;">Results:</span></u><span style="font-family:Verdana;"> Hemoptysis due to diffuse intra-alveolar hemorrhage from collateral circulation was successfully treated</span></span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">in this young patient with pulmonary vascular embolization. This allowed to wean the patient from</span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">extra-corporeal membrane oxygenation. </span><u><span style="font-family:Verdana;">Conclusion:</span></u><span style="font-family:Verdana;"> Veno-venous ECMO can be life-saving as a bridge to angio-embolization for severe hemoptysis in</span></span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">patients with Fontan circulation. The reported case allows to underline that </span><span style="font-family:Verdana;">our multidisciplinary approach in</span></span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">this complex pediatric patient surely</span><span style="font-family:Verdana;"> participated to improve outcome.</span>
文摘BACKGROUND Anti-epidermal growth factor receptor therapy is associated with skin adverse events not previously reported with conventional chemotherapy.Prophylactic actions are recommended,but routine clinical management of these toxicities and their impact on quality of life remain unknown.AIM To assess the dermatological toxicities reported after panitumumab initiation,their impact on the quality of life and the clinical practices for their management.METHODS Patients included in this prospective multicenter observational study were over 18 years of age and began treatment with panitumumab for wild-type KRAS metastatic colorectal cancer.The incidence of dermatological toxicities,clinical practices for their management and impact on quality of life were recorded during a 6-mo follow-up.RESULTS Overall,229 patients(males,57.6%;mean age,66.2 years)were included.At day 15,59.3%of patients had dermatological toxicity;the rate peaked at month 2(74.7%)and decreased at month 6(46.5%).The most frequent dermatological toxicities were rash/acneiform rash,xerosis and skin cracks.At least one preventive treatment was administered to 65.9%of patients(oral antibiotics,84.1%;emollients,75.5%;both,62.9%).The rates of patients who received at least one curative treatment peaked at month 2(63.4%)and decreased at month 6(44.8%).The impact of the dermatological toxicities on quality of life was limited as assessed with Dermatology Life Quality Index scores and inconvenience visual analogic scale score.The rates of topical corticosteroids administration and visits to specialists were low.CONCLUSION The rates of the different skin toxicities peaked at various times and were improved at the end of follow-up.Nevertheless,their clinical management could be optimized with a better adherence to current recommendations.The impact of skin toxicities on patient’s quality of life appeared to be limited.
文摘Since the outbreak of coronavirus disease 2019(COVID-19)in December 2019 in China,various measures have been adopted in order to attenuate the impact of the virus on the population.With regard to spine surgery,French physicians are devoted to take place in the national plan against COVID-19,the French Spine Surgery Society therefore decided to elaborate specific guidelines for management of spinal disorders during COVID-19 pandemic in order to prioritize management of patients.A three levels stratification was elaborated with Level I:Urgent surgical indications,Level II:Surgical indications associated to a potential loss of chance for the patient and Level III:Non-urgent surgical indications.We also report French experience in a COVID-19 cluster region illustrated by two clinical cases.We hope that the guidelines formulated by the French Spine Surgery Society and the experience of spine surgeons from a cluster region will be helpful in order optimizing the management of patients with urgent spinal conditions during the pandemic.
文摘Primary ciliary dyskinesia is a rare, genetic disorder resulting of an abnorma l ultrastructural morphology of cilia. Such disease is rarely recognized in neon atal period. We report on a newborn who exhibited unexplained respiratory distre ss. The diagnosis of primary ciliary dyskinesia was suggested by the association of bilateral and multiple atelectasis and situs inversus. Diagnosis was confirm ed by three months of age by ultrastructural study of cilia. Primary ciliary dys kinesia is a rare disease. Diagnosis should be considered in unexplained cases o f neonatal respiratory distress, especially when situs inversus totalis and mult iple atelectasis are present. Diagnosis requires ciliary studies that can be per formed in newborn infants.
文摘Objective:To determine the etiologic factors,circumstances of diagnosis,obstetrical management and complications of face presentation and to value the maternal and foetal prognosis of this presentation. Patients and methods:Thirty-two cases of face presentation have been observed in the maternity wards of Reims and Troyes over the last 12 years. Results:The incidence of face presentation was 0.7 per 1000 deliveries. Spontaneous vaginal delivery occurredwith mento-anterior presentation 73%of the time and caesarean section was performed in 100%of mento-posterior presentation. There was no increasing rate of foetal or maternal mortality and morbidity with vaginal delivery. Discussion and conclusion:Face presentation is an unusual complication of pregnancy with obstetric factors that predispose the foetus to face presentation. The low foetal and maternal mortality and morbidity substantiate the effectiveness of conservative management in face presentation.
文摘Acute fatty liver of pregnancy is a rare clinical syndrome of pregnancy that occurs during the third trimester. Clinicians must have a high index of suspicion for this condition when a woman has nausea or vomiting during the last trimester. Early diagnosis and prompt delivery improve foetal and maternal prognosis. We report a case of a previously healthy 23- year-old woman who presented an acute fatty liver of pregnancy with intrauterine fetal death. Based on this experience as well as on medical literature, characteristics of this uncommon pathology are discussed.
文摘Introduction Septic shock remains highly lethal,with a 30-day mortality of approximately 35%.[1]Vascular dysfunction is a key mechanism underlying hemodynamic failure in this context.In addition to microcirculatory abnormalities,[2]vascular dysfunction is characterized by a reduction in vascular tone,which is associated with a diminished responsiveness to vasoconstrictive agents.[3]This leads to arterial hypotension.When severe hypotension impairs the perfusion of vital organs and results in multiorgan failure,even in the presence of normal or elevated cardiac output(CO).
基金funding from Universitéde Reims Champagne-Ardenne and Universitéde Mons(Camille Gosée PhD fellowship)the“Programme de cooperation transfrontalière Interreg France-Wallonie-Vlaanderen”for its support through the“Nanocardio”project,the PHC Brancusi program(project no.43465WA)+2 种基金Nano’Mat and PlAneT platforms(supported by the European Regional Development Fund and the Region Champagne Ardenne)The CMMI and its bioprofiling platform would like to thank the European Regional Development Fund and the Walloon Region for their financial supportsupport of UEFISCDI within project no.81TE/2022(PN-IIIP1-1_1-TE-2021-1375-trans-NANO-BIO)。
文摘The challenge of imaging is to combine resolution and sensitivity in order to gain accuracy in diagnosis.No single modality can provide comprehensive information.Then,the solution is to design probes that are able to gather on a single platform the best features of the different imaging modalities.To achieve this objective,we have combined two types of probes,one associated with photoacoustic imaging(PAI)and the other with magnetic resonance imaging(MRI),within polysaccharide-based nanohydrogels.For that,chitosan(CS)which is a cationic polysaccharide was grafted with the photoacoustic probe ZW800-1.The synthesis of the corresponding CS-ZW800 and the purification conditions that allow to overcome ZW800 aggregation on the course of the protocol were carefully analyzed.Nanohydrogels that encapsulated gadolinium chelates as MRI probes were further obtained by ionic gelation between CS-ZW800 and the anionic hyaluronic acid(HA)in the presence of tripolyphosphate(TPP)as an ionogenic cross-linker.The bimodal nanohydrogels were then subjected to MSOT and MRI experiments.Upon excitation at 770 nm the nanoparticles were then able to produce a significant MSOT signal while in MRI at 3T,a significant positive contrast was obtained with low Gd doses.
文摘Laparoscopic liver resections(LLR)of posterosuperior segments(PS)(7,8,and 4a)are technically challenging.Adequate surgical exposure during parenchymal transection and bleeding control from the deep liver cut surface can be difficult to achieve.Both the IWATE(1)and IMM(2)LLR scoring systems classify PS segment resections as either advanced/expert level(IWATE)or group 3(IMM),reflecting a high level of technical difficulty.Studies comparing laparoscopy to open surgery for this indication are mainly retrospective and the level of evidence supporting the superiority of laparoscopy remains low.The PS segment subgroup analysis of the OSLO-COMET randomized trial concluded that laparoscopy yielded a shorter hospital stay with no significant differences between open and LLR groups in complications and mortality rates(3).
文摘Colorectal cancer(CRC)is the third most common cancer worldwide and represents a serious global health issue.During the disease course,up to 50%of patients will develop liver metastases[colorectal liver metastasis(CRLM)]with a significant negative impact on survival(1,2).Liver resection(LR),in combination with chemo-and targeted therapies,is the standard curative treatment for CRLM.In selected patients and in specialized centers,the 5-year overall survival(OS)after LR may reach 50%(3,4).
