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Le Touquet – Paris-Plage, France

Rossignol M.,Hopital Lariboisiere | Rozenberg A.,Hopital Necker Enfants Maladies
Journal de Gynecologie Obstetrique et Biologie de la Reproduction | Year: 2014

Objectives - To elaborate guidelines for inter-hospital transfer for severe postpartum hemor-rhage.Materials and Methods - Bibliographic search in Medline and Cochrane Database by PubMed.Results - Severe postpartum hemorrhage sometimes needs inter-hospital transfer for arterialembolization or admission in intensive care unit. Validation of this transfer needs multidisci-plinary decision, including obstetricians, anesthesiologist-intensivists of primary and tertiarycenter and prehospital medical team. If bleeding is too important or in case of uncontrol-led hemorrhagic shock, inter-hospital transfer may be dangerous and local surgical hemostasisshould be preferred. In such situation, prehospital medical team should stay on scene forhelp especially in small institutions where medical and paramedical resources are sometimesinsufficient. In case of inter-hospital transportation, organ failure should be controlled andblood transfusion, if needed, should be initiated before. The patient should be transferred toa multidisciplinary center (surgery, anesthesiology and ICU, interventional radiologist, bloodbank).Conclusion -Inter-hospital transfer for severe postpartum hemorrhage is possible under certainconditions including continuation of blood transfusion and organ failure correction. © 2014 Elsevier Masson SAS. All rights reserved.

Duffau H.,Montpellier University | Duffau H.,French Institute of Health and Medical Research | Mandonnet E.,Hopital Lariboisiere
Acta Neurochirurgica | Year: 2013

Diffuse low-grade glioma (DLGG) is a growing pre-cancerous tumor, often diagnosed in patients with no or only mild deficit. Maximal and early surgical resection is currently the first therapeutic option, in order to delay the malignant transformation and thus increase the overall survival. Preserving the quality of life (QoL) is nonetheless another priority. Here, our purpose is to weight the value of the extent of resection versus the neurological worsening that could be voluntarily generated by a radical resection; that is, to study the "onco-functional balance" at the individual level. To this end, we will examine DLGG involving the supplementary motor area and DLGG involving visual pathways. We will consider the benefit-risk ratio of different strategies of resection, according to the brain structures actually invaded and their plastic potential. The aim is to increase both the quantity of life and the time with a normal QoL, on the basis of strong interactions between the tumor course, brain reorganization and multistage surgical approach adapted to each patient over time. To this end, beyond the conceptual and technical issues, the most important point remains the honest and unique relationship between the surgical oncologist and the patient, based on clear and complete information about the behavior of DLGG versus the expected medical and social consequences of a resection over years. In other words, in the era of "evidence-based medicine", it is crucial to not forget "individual-based medicine" by offering tailored resections adapted to each patient. © 2013 Springer-Verlag Wien.

To compare the capabilities of apparent diffusion coefficient (ADC) and normalized ADC using the pancreatic parenchyma as reference organ in the characterization of focal pancreatic lesions. Thirty-six patients with focal pancreatic lesions (malignant, n=18; benign tumors, n=10; focal pancreatitis, n=8) underwent diffusion-weighted MR imaging (DWI) at 1.5-Tesla using 3 b values (b=0, 400, 800 s/mm(2)). Lesion ADC and normalized lesion ADC (defined as the ratio of lesion ADC to apparently normal adjacent pancreas) were compared between lesion types using nonparametric tests. Significant differences in ADC values were found between malignant (1.150 × 10(-3)mm(2)/s) and benign tumors (2.493 × 10(-3)mm(2)/s) (P=0.004) and between benign tumors and mass-forming pancreatitis (1.160 × 10(-3)mm(2)/s) (P=0.0005) but not between malignant tumors and mass-forming pancreatitis (P=0.1092). Using normalized ADC, significant differences were found between malignant tumors (0.933 × 10(-3)mm(2)/s), benign tumors (1.807 × 10(-3)mm(2)/s) and mass-forming pancreatitis (0.839 × 10(-3)mm(2)/s) (P<0.0001). Our preliminary results suggest that normalizing ADC of focal pancreatic lesions with ADC of apparently normal adjacent pancreatic parenchyma provides higher degrees of characterization of focal pancreatic lesions than the conventional ADC does. Copyright © 2013 Éditions françaises de radiologie. Published by Elsevier Masson SAS. All rights reserved.

Duffau H.,Montpellier University | Duffau H.,Montpellier University Hospital Center | Moritz-Gasser S.,Montpellier University Hospital Center | Moritz-Gasser S.,Montpellier University | And 2 more authors.
Brain and Language | Year: 2014

From recent findings provided by brain stimulation mapping during picture naming, we re-examine the neural basis of language. We studied structural-functional relationships by correlating the types of language disturbances generated by stimulation in awake patients, mimicking a transient virtual lesion both at cortical and subcortical levels (white matter and deep grey nuclei), with the anatomical location of the stimulation probe. We propose a hodotopical (delocalized) and dynamic model of language processing, which challenges the traditional modular and serial view. According to this model, following the visual input, the language network is organized in parallel, segregated (even if interconnected) large-scale cortico-subcortical sub-networks underlying semantic, phonological and syntactic processing. Our model offers several advantages (i) it explains double dissociations during stimulation (comprehension versus naming disorders, semantic versus phonemic paraphasias, syntactic versus naming disturbances, plurimodal judgment versus naming disorders); (ii) it takes into account the cortical and subcortical anatomic constraints; (iii) it explains the possible recovery of aphasia following a lesion within the "classical" language areas; (iv) it establishes links with a model executive functions. © 2013 Elsevier Inc.

Bousser M.-G.,Hopital Lariboisiere
Bulletin de l'Academie Nationale de Medecine | Year: 2014

Despite a decrease in stroke mortality, the global burden of stroke is increasing worldwide, hence the importance of improving prevention, acute treatment and rehabilitation. Numerous randomized clinical trials have been performed in the acute treatment of the three main varieties of stroke, namely acute cerebral ischemia, intracerebral hemorrhage and subarachnoid hemorrhage. They have all shown that "time is brain". Stroke, however, is only the tip of the iceberg: MRI studies have shown the frequency of silent ischemic and hemorrhagic lesions contributing to cognitive impairment and eventually to dementia. This again underlines the need for effective prevention strategies to reduce the incidence of stroke.

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