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To evaluate post-operative complications and the recurrence rate after repair of large ventral incisional hernia with an open technique using intraperitoneal composite mesh and an associated aponeurotic overlay. This prospective study included a total of 280 patients who underwent repair of large incisional hernia using Parietex(®) composite mesh. The post-operative mortality rate was 0.35%. Six patients (2%) developed subcutaneous surgical site infection without infection of the prosthesis. Six other patients (2%) developed a deep-seated infection; in three cases, the mesh had to be removed. Nine patients (3.2%) developed recurrent incisional hernia. Large ventral incisional hernias can be effectively treated by the intraperitoneal placement of Parietex(®) composite mesh overlaid by an aponeurotic graft; the incidence of complications in this prospective study was very low. Copyright © 2011 Elsevier Masson SAS. All rights reserved.


Fournie A.,Angers University Hospital Center
Journal de Gynecologie Obstetrique et Biologie de la Reproduction | Year: 2012

Placental ischemia is the background of the pathophysiology of preeclampsia. It is mainly - but not exclusively - caused by an immunological conflict between maternal NK cells of the decidua and of the uterine junctional zone, and the HLA-C antigens shared by interstitial trophoblast. The maternal disease is the consequence of the placental ischemia, and is characterized by an inflammatory syndrome with an oxidative stress and an endothelial cell dysfunction. Genetics play an essential part in each of these steps. © 2012 Elsevier Masson SAS. All rights reserved.


Libouban H.,Angers University Hospital Center
Morphologie | Year: 2015

In myeloma, the understanding of the tissular, cellular and molecular mechanisms of the interactions between tumor plasma cells and bone cells have progressed from in vitro and in vivo studies. However none of the known animal models of myeloma reproduce exactly the human form of the disease. There are currently three types of animal models: (1) injection of pristane oil in BALB/c mice leads to intraperitoneal plasmacytomas but without bone marrow colonization and osteolysis; (2) injection of malignant plasma cell lines in immunodeficient mice SCID or NOD/SCID; the use of the SCID-hu or SCID-rab model allows the use of fresh plasma cells obtained from MM patients; (3) injection of allogeneic malignant plasma cells (5T2MM, 5T33) in the C57BL/KalwRij mouse induces bone marrow proliferation and osteolytic lesions. These cells did not grow in vitro and can be propagated by injection of plasma cells isolated from bone marrow of a mouse at end stage of the disease into young recipient mice. The 5TGM1 is a subclone of 5T33MM cells and can grow in vitro. Among the different models, the 5TMM models and SCID-hu/SCID-rab models were extensively used to test pathophysiological hypotheses and to assess anti-osteoclastic, anti-osteoblastic or anti-tumor therapies in myeloma. In the present review, we report the different types of animal models of MM and describe their interests and limitations. © 2015 Elsevier Masson SAS.


Lerolle N.,Angers University Hospital Center
Critical Care | Year: 2012

The previous issue of Critical Care reports new data on renal resistive index in critically ill patients. Although high renal resistive index may indeed be associated with acute kidney injury, the existence of several determinants of this index, of which renal resistance is only one among many, obscures the usefulness of this index in clinical practice. © 2012 BioMed Central Ltd.


Kempf M.,Angers University Hospital Center
Microbial drug resistance (Larchmont, N.Y.) | Year: 2011

Antimicrobial resistance of Streptococcus pneumoniae in France is closely monitored by the pneumococcus surveillance network, founded in 1995, which collects data from regional observatories (Observatoire Régionaux du Pneumocoque [ORP]). In 2007, 23 ORPs analyzed the antibiotic susceptibility of 5,302 isolates of S. pneumoniae recovered in France from cerebrospinal fluid, blood, middle ear fluid, and pleural fluid, as well as from adult respiratory samples. The study showed that 38.2% of the strains were nonsusceptible to penicillin, 19.3% nonsusceptible to amoxicillin, and 10.5% nonsusceptible to cefotaxime. The percentage of pneumococcus nonsusceptible to penicillin varied according to both the sample and the age of the patient (child/adult): blood (27.8%/32.5%), cerebrospinal fluid (33.7%/34.6%), middle ear fluid (60.2%/27.5%), and pleural fluid (50.0%/31.0%). Between 2003 and 2007, the frequency of penicillin resistance in invasive pneumococcal disease gradually decreased from 46.4% to 29.0% in children and from 43.8% to 32.7% in adults. This decrease coincided with the introduction of a seven-valent pneumococcal conjugate vaccine into immunization programs and with a general reduction in levels of antibiotic consumption in France. © Mary Ann Liebert, Inc.


Pouget-Baudry Y.,Angers University Hospital Center
Journal of visceral surgery | Year: 2010

The Alvarado score is a validated test in clinical adult surgery practice which can be helpful in the diagnosis of acute appendicitis. This study aimed to assess the reliability and the reproducibility of this score for patients presenting in the emergency room with acute right lower quadrant abdominal pain. A prospective monocenter study included all adults who presented in the emergency room with right lower quadrant abdominal pain. The score was calculated by assessing six symptoms and two laboratory values weighted by coefficients. The diagnosis of acute appendicitis was confirmed by the histological examination of the resected appendix. Three groups of patients with high, low, and intermediate scores were defined as described in the literature. Of the 233 patients studied, 174 underwent surgery: three had a normal appendix on histological exam. The statistical analysis of the results showed that a score lower than 4 was significantly associated with the absence of acute appendicitis while a score higher than 6 was significantly associated with acute appendicitis which required surgical care. But a score between 4 and 6 was not discriminant. The Alvarado score is a reliable, cheap and reproducible tool for the diagnosis of acute appendicitis in the emergency room; if the score is higher than 6 or lower than 4, there is no need for complementary exams. Patients with a score between 4 and 6, require serial reassessment of physical findings and score over 24 hours and/or complementary diagnostic exam such as ultrasound or CT scan. Copyright (c) 2010 Elsevier Masson SAS. All rights reserved.


Gascoin G.,Angers University Hospital Center
Journal de Gynecologie Obstetrique et Biologie de la Reproduction | Year: 2015

To describe early complications and management of newborns during the firstmonth of life.Methods.-This systematic evidence review is based on PubMed search, Cochrane library andexperts recommendations.Results.-There is no optimal time for maternity discharge for low risk newborn in regard of theliterature. It depends more on the organisation of the post-discharge follow-up (professionalconsensus). Extreme hyperbilirubinemia expose to neonatal mortality and severe neurodeve-lopmental impairment for survivors (evidence level: 1). Neonatal hyperbilirubinemia occursin almost all newborns and may be benign if its progression is monitored (transcutaneousbilirubinometer, capillar or venous bilirubin level) at least 24 hours after any early discharge(professional consensus). Asymptomatic newborns with high risks of neonatal sepsis have to beclosely monitored during the first 48 hours of life (professional consensus). Clinical assessment(heart murmure and femoral pulse) at least 24 hours after any early discharge and at any clini-cal examination almost up to 1 month after birth is recommended to detect possible congenitalheart disease (professional consensus). Serial clinical examination of the hips by a trained cli-nician in the periodic health examination of all infants until they are walking independentlyis recommended (professional consensus). Neonatal screening blood tests are recommendedbetween 60 and 84 hours of life in every newborns, can be advanced between 48 and 60 hoursif necessary but never before 48 hours of life (professional consensus). Neonatal screening ofdeafness is recommended in every newborns and has to be assessed before maternity discharge(professional consensus). All these data have to be reported in the newborn personal medicalfile (professional consensus).Conclusion.-Early discharge has to be prepared during the prenatal period in order to ensurecare continuity at home and to avoid any severe neonatal outcome. © 2015 Elsevier Masson SAS.


Venara A.,Angers University Hospital Center
Journal of visceral surgery | Year: 2012

The mild pancreatic tumors are more and more treated by central pancreatectomy (CP) in alternative with the widened pancreatectomies. Indeed, their morbidity is lesser but they are however burdened by a rate of important postoperative fistulas. The purpose of our study is to compare pancreatico-jejunal anastomosis and pancreatico-gastric anastomosis. This work was realized in a bicentric retrospective way. Twenty-five CP were included and classified according to two groups according to the pancreatic anastomosis (group 1 for pancreatico-jejunal anastomosis and group 2 for the pancreatico-gastric anastomosis). CP was realized according to a protocol standardized in both centers and the complications were classified according to the classification of Clavien and Dindo and the fistulas according to the classification of Bassi. Both groups were comparable. The duration operating and the blood losses were equivalent in both groups. There was a significant difference (P=0,014) as regards the rate of fistula. The pancreatico-gastric anastomosis complicated more often of a low-grade fistula. However, in both groups, the treatment was mainly medical. Our results were comparable with those found in the literature and confirmed the advantages of the CP with regard to the cephalic duodeno-pancreatectomy (DPC) or to the distal pancreatectomy (DP). However, in the literature, a meta-analysis did not report difference between both types of anastomosis but this one concerned only the DPC. This work showed a less important incidence of low-grade fistula after pancreatico-jejunal anastomosis in the fall of a PM. This result should be confirmed by a later study on a more important sample of PM. Copyright © 2012 Elsevier Masson SAS. All rights reserved.


Avenel-Audran M.,Angers University Hospital Center
European Journal of Dermatology | Year: 2010

Like any cosmetic or any product repeatedly applied on the skin, sunscreen products may sensitize their users and cause an allergic reaction. Finding the responsible allergen implies good knowledge of what a sunscreen product is, what are the potential allergens it contains and the manifestations they may cause.


Le Page S.,Angers University Hospital Center | Prunier F.,Angers University Hospital Center
Journal of Cardiology | Year: 2015

Remote ischemic conditioning (RIC) constitutes a promising method in which a tissue or organ is exposed to intermittent ischemia/reperfusion periods enabling it to provide protection to a distant target organ. RIC has been tested in various clinical settings through its simple application by means of intermittent inflation of a blood pressure cuff placed on a limb, primarily evaluating its potential abilities to decrease myocardial injury biomarkers. Its use on other organs, such as the kidneys or brain, has recently been a topic of research. To date, no study has yet been powerful enough to reach a conclusion on the potential benefit of RIC on clinical outcomes. The future role of RIC in the clinical arena could be clarified by the large phase III trials currently underway targeting major outcomes as primary endpoints. © 2015 Japanese College of Cardiology.

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