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Le Mans, France

Bruel D.,Center Hospitalier Le Mans | Duez C.,Hopital Louis Mourier | Ebel-Lao S.,Nice University Hospital Center | Garrigue H.,Hopital Cochin
Pharmacien Hospitalier | Year: 2011

The preparation of radiopharmaceutical drugs refers to the assessment of both pharmaceutical drugs and radionuclides preparations regulations. It should avoid microbiological contamination while ensuring staff as well as environmental protection from radioactive exposure. Therefore, in order to warranty sterility of injected doses, the environmental quality, specifically units indoors air quality and surfaces quality must be guaranteed. The aim of this work is to propose guidelines pertaining to environmental quality monitoring in the special field of radiopharmacy. These propositions are based on available guidances, including regulations, treating about methodology to apply for evaluation and control of hospital's environment. Throughout this report, the French College of Radiopharmacy proposals both improve the methodology for control and data analysis (targeted grade of environment, threshold for notification and corrective actions) and ensure follow-up and management of nonconformities. These recommendations represent a model for harmonization of radiopharmacists practices with regards to frequency of environmental quality controls for facilities and equipments in their centralised radiopharmacy units. © 2011 Elsevier Masson SAS. All rights reserved.

Obert L.,Center Hospitalier Of Besancon | Ferrier M.,Center Hospitalier Of Besancon | Jacquot A.,Center Chirurgical lle | Mansat P.,Institut Universitaire de France | And 4 more authors.
Orthopaedics and Traumatology: Surgery and Research | Year: 2013

Introduction: Fractures of the distal humerus in patients over the age of 65 remain a therapeutic challenge. Treatment options include conservative treatment, internal fixation or total elbow arthroplasty. The complications of these different treatment options were evaluated in a multicentre study. Materials and methods: Four hundred and ninety-seven medical records were evaluated. A retrospective study was performed in 410 cases: 34 received conservative treatment, 289 internal fixation and 87 underwent total elbow arthroplasty. A prospective study was performed in 87 cases: 22 received conservative treatment, 53 internal fixation, and 12 underwent total elbow arthroplasty. Patients were evaluated after at least 6 months follow-up. Results: The rate of complications was 30% in the retrospective study and 29% in the prospective study. The rate of complications in the conservative treatment group was 60%, and the main complication was essentially malunion. The rate of complications was 44% in the internal fixation group and included neuropathies, mechanical failure or wound dehiscence. Although complications only developed in 23% of total elbow arthroplasties, they were often more severe than those following other treatments. Discussion: Complications develop in one out of three patients over 65 with distal humerus fractures. Three main types of complications were identified. Neuropathies especially of the ulnar nerve, especially during arthroplasty, must always be identified, the nerve requiring isolation and transposition. Bone complications, due principally to mechanical failure, were found following internal fixation. Despite technical progress, care must be taken not to favor excessive utilization of this treatment option in complex fractures on fragile bone. Although there were relatively fewer complications with total elbow arthroplasty they were more difficult to treat. Ossifications were frequent whatever the surgical option and can jeopardize the functional outcome. Level of evidence: Level IV. © 2013.

AIM : To calculate the prevalence of emmetropia, myopia, hyperopia, and amblyopia. METHOD : Cross sectional, descriptive, populationbased study, studying 212 randomly selected Lebanese patients of Armenian origin, aged from 15 to 45 years, from June 1 st till September 30 th 2003. The patients presenting with no exclusion factors are examined, before and after cycloplegia. Mean keratometry and mean ocular axial length are measured for each eye. RESULTS : 212 patients are examined. Mean age is 33.6 years. Sexe ratio F/M is 1.94. The prevalence of hyperopia, emmetropia and myopia is 14.6%, 51%, and 34.4% before cycloplegia, and 50%, 16.5% and 33.5% after cycloplegia, respectively. 14.9% of patients wearing myopic corrections were not found myopic after cycloplegia. The prevalence of amblyopia is 19.8%. Most of hyperopic patients do not wear eye-glasses (p = 0.00000101), whereas most of the myopic patients wear eyeglasses (p = 0.00000024). CONCLUSION : Prevalence of hyperopia is very high (50%) in this group of Lebanese Armenian population, as well as amblyopia (19.8%). Moreover, 6.7% of myopic patients wearing eyeglasses are not truly myopic.

Some non-small cell lung cancers harbor single mutated oncogenes that, as EGFR mutation or ALK fusion genes, are valid predictors of increased sensitivity to specific inhibitors. Molecular subsets have been recently identified and are potential targets for new therapies. Thus, besides these two mutations, those illustrate the therapeutic relevance of molecular clusters, a lot of genomic alterations, belonging to the proteins of the MAPK family - as BRAF or MEK1 - or to the proteins of the PI3K signaling - as PI3KCA or AKT-have been found in lung tumors. However, because of the molecular complexity of NSCLC, the way from the identification of driver mutations to substantial therapeutic improvements will be certainly long. KRAS mutations are the most commonly mutated oncogenes and are essentially negative predictors of benefit from adjuvant chemotherapy or anti- EGFR therapy; inversely, no direct RAS inhibitors have proven clinically effective. Squamous-cell lung cancer do not benefit from these advances in targeted therapeutics, but the discovery of genome alterations, as amplifications of FGFR1 or mutations of the DDR2 gene, can be the first step for development of distinct molecularly therapeutics. © 2012 Elsevier Masson SAS.

Cavailles A.,Nantes University Hospital Center | Dixmier A.,CHR dOrleans | Goupil F.,Center Hospitalier Le Mans | Gut-Gobert C.,Brest University Hospital Center | And 8 more authors.
European Respiratory Review | Year: 2013

By 2020, chronic obstructive pulmonary disease (COPD) will be the third cause of mortality. Extrapulmonary comorbidities influence the prognosis of patients with COPD. Tobacco smoking is a common risk factor for many comorbidities, including coronary heart disease, heart failure and lung cancer. Comorbidities such as pulmonary artery disease and malnutrition are directly caused by COPD, whereas others, such as systemic venous thromboembolism, anxiety, depression, osteoporosis, obesity, metabolic syndrome, diabetes, sleep disturbance and anaemia, have no evident physiopathological relationship with COPD. The common ground between most of these extrapulmonary manifestations is chronic systemic inflammation. All of these diseases potentiate the morbidity of COPD, leading to increased hospitalisations and healthcare costs. They can frequently cause death, independently of respiratory failure. Comorbidities make the management of COPD difficult and need to be evaluated and treated adequately. © ERS 2013.

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