Rozenberg F.,Hopital Cochin
Virologie | Year: 2014
Herpes simplex encephalitis (HSE) is a rare but severe complication of a frequent and mostly benign infection with herpes simplex virus (HSV). Molecular and cellular determinants of HSE are incompletely understood. The rarity of the disease has suggested an increased susceptibility of some subjects to HSV infection. In a few children with HSE, specific defects of the immune innate response have been identified, which impair the interferon (IFN)-α/β and IFN-λ production of fibroblasts and/or neurons infected with HSV and render these cells more permissive to infection. The mutations affect proteins involved in the pathway of IFN induction by stimulation of the Toll-like Receptor 3 (TLR3). The patients' susceptibility to infection is restricted to HSV central nervous system (CNS) invasion, indicating the specific role of TLR3 in CNS protection against viral infection. The incomplete clinical penetrance suggests that other factors (age, infectious dose) are involved in the development of HSE. Numerous experimental studies have then confirmed the major role of the IFN-TLR3 pathway in limiting access of HSV to and/or viral replication in the CNS. The pathogenesis of adult HSE has not been investigated.
Meunier Y.,Hopital Cochin
Medicine of the Future: Risk Assessment, Elimination or Mitigation, and Action Plans for 28 Diseases and Medical Conditions | Year: 2014
This book outlines risk assessments for 28 diseases and medical conditions including the following aspects: genetics, biochemistry, serology, past medical history, family history, co-morbidities, age, gender, ethnicity, nutrition and lifestyle. Recommendations are made for how to avoid, eliminate or mitigate risks. Preventing measures concerning chemical compound intake, lifestyle and nutrition are proposed. The unique content and approach of the book to chronic disease management make it a state-of-the-art reference work, addressing a missing component of medical care and reflecting the cutting edge of preventive medicine. © Springer International Publishing Switzerland 2014.
Mion G.,Hopital Cochin
The American journal of emergency medicine | Year: 2014
A patient scheduled for a laparoscopic cholecystectomy had an anaphylactic shock during induction of anesthesia. After the injection of vecuronium, an unusual fall of arterial pressure occurred, with bradycardia, enlargement of the QRS complex, then a circulatory arrest. Chest compressions were initiated, while intravenous epinephrine 1 mg was administered. The cardiac rhythm turned into a ventricular fibrillation (VF). Despite continuous chest compressions with repeated boluses of epinephrine and several external electric shocks, the patient remained in VF. Because of obviously β-adrenergic adverse effects, epinephrine was replaced with norepinephrine. Return of spontaneous circulation was observed, with the recovering of sinusal activity. After staying for several weeks in intensive care unit because of multiorgan failure, the patient recovered without sequelae. Blood samples and cutaneous testing confirmed an allergy to vecuronium. This case report of a cardiac anaphylaxis with prolonged cardiac arrest illustrates the dual activity and adverse effects of epinephrine. Although vasoconstriction is mandated during cardiopulmonary resuscitation to provide an acceptable perfusion pressure to organs, β-adrenergic stimulation seems deleterious to the heart. Experimental studies have shown that blocking the β-adrenergic effects of epinephrine attenuates postresuscitation myocardial dysfunction or helps the return of spontaneous circulation after VF. Norepinephrine, a potent α-adrenergic drug nearly devoid of β-adrenergic properties, could be an interesting alternative to epinephrine. It can improve organ perfusion during cardiopulmonary resuscitation and could be more efficient than epinephrine in case of VF.
Gouin F.,Nantes University Hospital Center |
Gouin F.,French Institute of Health and Medical Research |
Dumaine V.,Hopital Cochin
Orthopaedics and Traumatology: Surgery and Research | Year: 2013
Background: Curettage is a well-established treatment modality for giant cell tumors of bone. The purpose of this retrospective study by the French Sarcoma and Bone Tumor Study Groups (GSF-GETO) was to analyze various tumor-specific and surgery-specific factors that could influence the rate of local recurrence. Patients and method: Data was collected from patients with giant cells tumors of the appendicular skeletal who were treated by intralesional curettage. The hazard ratio for tumor recurrence was calculated for the different variables collected and a multifactorial analysis carried out. Results: One hundred and ninety-three surgical procedures were included from nine centers. One hundred and seventy-one (89%) were primary tumors and 22 had been referred after one or more recurrences. The mean follow-up was 6. years and 11. months. The distal femur and proximal tibia were the most common locations: 42.5 and 34.2% of cases, respectively. The bone defect after curettage was filled in 176 cases (91.2%) and left empty in 16 cases. Local adjuvant treatment (phenol, alcohol, cryotherapy or combination treatment) was used in 39 cases (20.2%) and systemic adjuvant treatment used in 24 cases (calcitonin 11 and zoledronic acid 13). Local recurrence occurred in 71 cases (36.8%). Risk factors for local recurrence were an empty defect, a defect filled with autograft, and patients treated before 2005. Multivariate analysis showed that the only risk factors for local recurrence were a surgical procedure before 2005 (odds ratio 3.6 (95% CI: 1.2, 7.9) P=. 0.017) and a bone defect filled with autograft (odds ratio 3.9 [95% CI: 1.3, 11.6] P=. 0.013). Conclusion: Neither tumor-specific nor surgery-specific factors such as adjuvant treatment were found to be as risk factors for local recurrence after curettage of giant cell tumors in the appendicular skeleton. As recently reported, high-quality local curettage is probably the most effective technique to prevent local recurrence. The current study suggests that two factors associated with more recent management of these tumors in France, high-speed burring and centralization to skilled surgical teams, can improve the quality of curettage. Level of evidence: 4, retrospective cohort study. © 2013 Elsevier Masson SAS.
Marsac J.,Hopital Cochin
Bulletin de l'Academie Nationale de Medecine | Year: 2013
Heart rate variability (HRV) is a noninvasive, practical and reproducible measure of autonomic nervous system function. Although the heart is reasonably stable, the time between two beats (R-R) can be very different. HRV is the time variation between two consecutive heartbeats. HRV is believed to correspond to the balance between the sympathic and parasympathic influences on the intrinsic rhythm of the sinoatrial node. HRV is influenced by lifestyle factors, including physical activity, eating habits, sleep pattern, and smoking. In adults, decreased HR V is associated with a higher risk of cardiac events, including death, and is a predictor of hypertension. HRV may also have predictive value for life expectancy and health. HR V changes due to lifestyle factors precede the onset of cardiovascular disorders. Measurement of HRV and its components is of major interest for medical practitioners and public health specialists, in order to predict and evaluate the risk of cardiometabolic events related to lifestyle factors.