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Sebag F.,Aix - Marseille University | Vaillant-Lombard J.,Aix - Marseille University | Berbis J.,Laboratory of Clinical Epidemiology | Griset V.,Clinical Investigation Center | And 5 more authors.
Journal of Clinical Endocrinology and Metabolism | Year: 2010

Context: Elastography uses ultrasound (US) to assess elasticity. Shear wave elastography (SWE) is anew technique that estimates tissue stiffness in real time and is quantitative and user independent. Objectives: The aim of the study was to assess the efficiency of SWE in predicting malignancy and to compare SWE with US. Design: Ninety-three patients and 39 control subjects were included in the study. Predictive value of SWE was assessed by correlation between elasticity, US parameters, and histology. Elasticity index (EI) was first analyzed alone. Scores have been constructed with echographic parameters, i.e. vascularity, hypoechogenicity, and microcalcifications (Score 1 = US Score), and with the same parameters plus EI (Score 2 = US+SWE Score). For statistical analysis, univariate and multivariate analysis and receiver operating characteristic curves were used. Results: A total of 146 nodules from 93 patients were analyzed. Twenty-nine nodules (19.9%) were malignant. Mean (±SD) EI was 150 ± 95 kPa (range, 30-356) in malignant nodules vs. 36 ± 30 (range, 0-200) kPa in benign nodules (P < 0.001, Student's t test). For a positive predictive value of at least 80%, characteristics of tissue elasticity (cutoff, 65 kPa) were: sensitivity = 85.2%, and specificity = 93.9%. Characteristics of the US Score were: sensitivity = 51.9% [95% confidence interval (CI), 33.1; 70.7], and specificity = 97% (95% CI, 93.6; 1). Characteristics of the US+SWE Score were: sensitivity = 81.5% (95% CI, 66.9; 96.1), and specificity = 97.0% (95% CI, 93.6; 1). Conclusion: Promising results have been obtained with SWE. This technique may be applied to multinodular goiters. Larger prospective studies are needed to confirm these results and to define the respective places of SWE, US, and FNA. Copyright © 2010 by The Endocrine Society. Source


Psimaras D.,French Institute of Health and Medical Research | Carpentier A.F.,University Paris - Sud | Rossi C.,Laboratory of Clinical Epidemiology
Journal of Neurology, Neurosurgery and Psychiatry | Year: 2010

Objective: Paraneoplastic neurological syndromes (PNS) probably result from an immune reaction against antigens shared by the nervous system and tumour cells. To characterise CSF alterations in these syndromes, we studied a large series of paraneoplastic patients. Methods: Using the PNS European database which includes patients diagnosed with PNS in Europe, we reviewed the clinical data of all patients included between 2000 and 2007 for which information on CSF was available. Patients were studied if they met the following inclusions criteria: (1) definite paraneoplastic disease with anti-Hu, anti-Yo, anti-CV2, anti-Ri anti-Ma/Ta and anti-Tr antibodies; (2) clinical information available; and (3) at least one CSF study. Results: 295 patients met the inclusion criteria. Abnormal CSF (pleiocytosis and/or high protein level and/ or oligoclonal bands) was found in 93% of patients. Pleiocytosis, but not hyperproteinorachia, was more frequently seen in patients in whom the CSF study was done early in the evolution. In 24 patients, oligoclonal bands were the only abnormality found in the CSF (10%). Elevated numbers of cells were found in 47% of patients before the third month compared with 28% after the third month (p<0.01). This evolution might suggest a subacute inflammation phase within the nervous system, followed by a non-inflammatory phase. The inflammation profile was similar in all antibody types, cancers or neurological syndromes of the PNS. Surprisingly, anti-Hu patients with high pleiocytosis at the time of diagnostic had a better survival in this study than those without pleiocytosis (572 days vs 365 days; p = 0.05). Conclusion: CSF inflammation is a common finding in PNS patients and can be a helpful tool for diagnosis, especially if this analysis is done within 3 months after neurological onset. Source


McDermott M.M.,50 North Lake Shore Dr | Liu K.,50 North Lake Shore Dr | Criqui M.H.,University of California at San Diego | Tian L.,Stanford University | And 10 more authors.
Circulation: Cardiovascular Imaging | Year: 2011

Background-The clinical significance of magnetic resonance-imaged plaque characteristics in the superficial femoral artery (SFA) is not well established. We studied associations of the ankle-brachial index (ABI) and leg symptoms with MRI-measured plaque area and percent lumen area in the SFA in participants with and without lower-extremity peripheral arterial disease (PAD). Methods and Results-Four hundred twenty-seven participants (393 with PAD) underwent plaque imaging of the first 30 mm of the SFA. Twelve 2.5-mm cross-sectional images of the SFA were obtained. Outcomes were normalized plaque area, adjusted for artery size (0 to 1 scale, 1=greatest plaque), and lumen area, expressed as a percent of the total artery area. Adjusting for age, sex, race, smoking, statins, cholesterol, and other covariates, lower ABI values were associated with higher normalized mean plaque area (ABI <0.50:0.79; ABI 0.50 to 0.69:0.73; ABI 0.70 to 0.89:0.65; ABI 0.90 to 0.99:0.62; ABI 1.00 to 1.09:0.48; ABI 1.10 to 1.30:0.47 (P trend <0.001)) and smaller mean percent lumen area (P trend <0.001). Compared with PAD participants with intermittent claudication, asymptomatic PAD participants had lower normalized mean plaque area (0.72 versus 0.65, P=0.005) and larger mean percent lumen area (0.30 versus 0.36, P=0.01), adjusting for the ABI and other confounders. Conclusions-Lower ABI values are associated with greater MRI-measured plaque burden and smaller lumen area in the first 30 mm of the SFA. Compared with PAD participants with claudication, asymptomatic PAD participants have smaller plaque area and larger lumen area in the SFA. © 2011 American Heart Association, Inc. Source


Miranda L.H.M.,Oswaldo Cruz Foundation | Santiago M.A.,Laboratory of Diagnostic Technology | Schubach T.M.P.,Oswaldo Cruz Foundation | Morgado F.N.,Oswaldo Cruz Institute IOC | And 4 more authors.
Medical Mycology | Year: 2016

Sporotrichosis is a subcutaneous mycosis with worldwide distribution, especially in tropical and subtropical areas. Zoonotic transmission is described with cats being the main animal species involved. The occurrence of severe feline sporotrichosis with high fungal levels demonstrates the susceptibility of cats to this disease and the importance of studying its pathogenesis. This study describes the leukocytes profile in blood of cats with sporotrichosis by flow cytometry and its correlation with histopathology and fungal load. The cats with sporotrichosis were separated into groups L1, L2, and L3 (lesions at one, two, and three or more noncontiguous skin locations, respectively) and were classified as good, fair, or poor general conditions. The highest percentage of CD4+ cells was associated to L1 (P = .04) and to good general condition (P = .03). The percentage of CD8+ cells was greater in L2 and L3 (P = .01). CD8low expression occurred in 20 animals with sporotrichosis, mainly in L3 (P = .01) and was not observed in healthy controls. This expression was related to macrophage granulomas (P = .01) and predominated in cases with high fungal load. Altogether, the results indicated that control over feline sporotrichosis, with maintenance of a good general condition, fixed lesions, well-organized response and lower fungal load, is associated with increased CD4+ cells percentages. In contrast, a poor general condition, disseminated lesions and high fungal load were related to increased CD8+ cell percentages and increased expression of CD8low. As conclusion these results point to an important role of the CD4:CD8 balance in determining the clinical outcome in feline sporotrichosis. © The Author 2015. Source


Vitolo U.,Hematology | Barosi G.,Laboratory of Clinical Epidemiology | Fanti S.,SantOrsola Malpighi Hospital | Gianni A.M.,University of Milan | And 4 more authors.
American Journal of Hematology | Year: 2010

90-Yttrium-ibritumomab-tiuxetan is approved for treatment of rituximab-relapsed/refractory CD20+ follicular B-cell lymphoma and as consolidation therapy in untreated follicular lymphoma. Recommendations on the use of 90-yttrium-ibritumomab tiuxetan were issued in a consensus conference, sponsored by the Italian Society of Hematology and the Italian Association of Nuclear Medicine. Current concepts and scientific evidence on the use of 90-yttrium-ibritumomab-tiuxetan were evaluated by a panel of seven experts. The following key recommendations were issued. The most important exclusion criteria are: bone marrow infiltration by lymphoma cells and platelet count or neutrophil count lower than 100 × 109/L or 1.5 × 10 9/L. The most relevant indication for 90Y-ibritumomab- tiuxetan is as a single agent or following debulking chemotherapy for relapsed/refractory follicular lymphoma. 90Y-ibritumomab tiuxetan as a single agent is effective in improving the quality and duration of the response in follicular lymphoma after primary chemotherapy or immunochemotherapy. 90Y-ibritumomab-tiuxetan as a single agent has activity in relapsed/refractory mantle cell lymphoma and DLBCL, but the responses are of short duration. Its use after first line chemoimmunotherapy as consolidation therapy appears promising, particularly in elderly patients. The addition of 90Y-ibritumomab-tiuxetan to high-dose chemotherapy, such as BEAM, is feasible and may be recommended for patients with high-risk relapsed/refractory lymphoma. Subsequent lines of therapy can be successfully used in patients who relapse after radioimmunotherapy. © 2009 Wiley-Liss, Inc. Source

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