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Christou N.,Limoges University Hospital Center
Journal of visceral surgery | Year: 2013

The two most common early complications of thyroid surgery are hypocalcemia (20-30%) and recurrent laryngeal nerve injury (5-11%). Bilateral recurrent nerve paralysis resulting in adduction of the vocal cords is a rare life-threatening complication (occurring in less than 0.1% of cases that requires emergency management. Prevention of complications depends on careful operative technique and is enhanced for some teams by the use of specific techniques such as intraoperative neuromonitoring. Postsurgical hypocalcemia is managed by the administration of calcium plus vitamin D for at least 10 days. Recurrent laryngeal nerve paralysis recovers in most cases, and no invasive therapy should be performed for at least six months, except for emergency presentations; laryngeal surgery techniques may offer significant improvement if phonation or respiratory sequelae persist beyond six months, but the results are inconsistent. There should be a systematic strategy for detection of complications after thyroidectomy involving a multidisciplinary approach. Copyright © 2013. Published by Elsevier Masson SAS. Source

Patient-reported outcome measures are being developed for more relevant assessments of pain management. The patient acceptable symptom state (PASS) ("feeling well") and the minimal clinically important improvement (MCII) ("feeling better") have been determined in clinical trials, but not in daily pain management. We carried out a national multicenter cohort study of patients over the age of 50 years with painful knee osteoarthritis (KOA) or hip osteoarthritis (HOA) who had visited their general practitioner and required treatment for more than 7 days. Overall, 2414 patients (50.2% men, mean age 67.3 years, body mass index 27.9 kg/m2, 33.5% with HOA) were enrolled by 1116 general practitioners. After 7 days of treatment, PASS was estimated on a numerical rating scale as 4 at rest and 5 on movement, for both HOA and KOA, above the PASS threshold in clinical trials. In KOA, PASS was more frequently reached in men and younger people with less pain at rest and on movement, and in patients specifically seeking an improvement during sport activities. In HOA, PASS was most frequently reached in patients with low levels of pain at risk and in nonobese patients. MCII was -1 numerical rating scale point after 7 days of usual treatment. This improvement is smaller than that recorded in randomized controlled trials, and was the same for both sites, both at rest and on movement. In conclusion, patient-reported outcome values in daily practice differ from those in clinical trials, and their determinant factors may depend on the site of osteoarthritis. Assessments of the treatment of painful osteoarthritis should be adapted to the characteristics and daily life of the patient, to personalize patient management. © 2012 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved. Source

Jaccard A.,Limoges University Hospital Center | Hermine O.,University of Paris Descartes
Current Opinion in Oncology | Year: 2011

Purpose of Review: Extranodal natural killer (NK)/T-cell lymphoma, nasal-type is a highly aggressive disease more frequent in Asia than in Western countries. There is no consensus treatment. The outcome depends on disease stage. Localized NK/T-cell lymphomas often respond to radiotherapy. In contrast, patients who have extensive disease or who relapse after radiotherapy have a very poor prognosis. Overall, long-term survival in these lymphomas tends to be inferior to that for other aggressive lymphomas. This review focuses on the new management modalities in light of advances in risk stratification, patient monitoring and treatment strategies. Recent Findings: Many parameters have been reported to correlate with prognosis and new staging systems have been elaborated. Detecting Epstein-Barr virus (EBV) in the bone marrow is important for staging and measuring EBV DNA in the serum improved monitoring response to therapy. Radiation modalities have been precised and new strategies combining radiation and chemotherapy have been proposed for patients with localized disease. The particular efficacy of L-asparaginase in this disease has been confirmed and L-asparaginase-based regimens have been studied in prospective trials for patients with refractory, relapsing or disseminated disease with good results. Laboratory studies may point the way toward new therapeutic approaches. Summary: Early-stage disease is treated by involved-field radiotherapy with adjuvant chemotherapy. L-Asparaginase-containing regimens are the mainstay of treatment for advanced or disseminated disease. The role of targeted therapies, autologous and allogeneic haematopoietic stem cell transplantation is yet to be clearly defined. © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Source

Bouteille B.,Limoges University Hospital Center
Medecine et Sante Tropicales | Year: 2014

Within the genus Taenia, three species are human parasites: T. solium, T. saginata and a new uncommon species, T. asiatica, described recently in Asia. T. saginata and T. solium live as adult tapeworms in human intestines, where they cause taeniasis. T. saginata is widely present worldwide, in all regions where cattle are bred. T. solium is endemic in many countries where livestock and consumption of pigs are common. Cattle and pigs become infected by ingesting eggs emitted by humans into the environment and serve as the respective intermediate hosts of these helminths and host larval forms, or metacestodes or cysticerci. Cysticerci develop into adult worms in the human intestines after a person has eaten contaminated raw or undercooked meat. In the T. solium, eggs are also human contaminants. Humans, like swine, can develop cysticercosis after ingesting eggs with water or contaminated food, or via dirty hands. The clinical manifestations of cysticercosis are highly variable both in kind and in severity. The period between initial infection and the onset of symptoms can also vary. The clinical expression of cysticercosis is generally dependent on the number, size and location of the cysts, as well as the host immune response to the parasite. The preferred locations are the muscles, subcutaneous tissues, central nervous system (CNS), and eyes. Subcutaneous and muscular forms are often asymptomatic. Severe cysticercosis is due to larvae located in human CNS — neurocysticercosis. The World Health Organization (WHO) lists neurocys-ticercosis as a neglected tropical disease. It estimates that about 50 million people worldwide have neurocysticercosis in the world and that it causes about 50,000 deaths each year. Its most frequent clinical manifestations are seizures, intra-cranial hypertension, neurological deficits, and sometimes psychiatric manifestations. It is also responsible for more than 50% of the cases of late-onset epilepsy in developing countries. The T. solium taeniasis/cysticercosis complex is endemic in many developing countries in sub-Saharan Africa, Latin America, and Asia. Although T. solium had virtually disappeared in developed countries due to industrialization, improved methods of husbandry, and health checks, cysticercosis and neurocysticercosis are diagnosed anew in North America, Europe and Australia due to increased immigration from endemic areas. Cysti-cercosis is considered an eradicable disease. Although theoretically feasible, this concept has been replaced by projects to control and reduce the impact of cysticercosis on human health (through mass treatment of people, veterinary control of pigs, improved farming techniques, and health education). © 2014, John Libbey Eurotext. All rights reserved. Source

Marquet P.,Limoges University Hospital Center
Methods in Molecular Biology | Year: 2012

This chapter reviews recent applications of mass spectrometry to systematic toxicological analysis (STA), where extended lists of compounds of toxicological interest are screened, as well as to the general unknown screening (GUS), where all exogenous compounds present in a sample are tentatively detected and identified, without any preselection. Many recent improvements in sample preparation, chromatographic separation, gas chromatography-mass spectrometry, and above all liquid chromatography-mass spectrometry techniques are described, which are applicable or have been applied to STA and/or GUS, generally with promising results. These improvements come from miniaturization and automation of solid-phase extraction, turbulent-flow or ultrahigh-pressure liquid chromatography, linear ion traps, accurate (e.g., time of flight or orbital trap) mass spectrometry, as well as software refinements to alternate between different ionization modes or automatically interpret the results. It also shows that robust LC-MS/MS techniques already exist for STA or GUS, which are at least as efficient as the traditional techniques used in most toxicology laboratories, such as GC-MS or high-performance liquid chromatography with diode-array detection, as shown by three comparative studies. However, the major drawback of LC-MS/MS in the full-scan mode for STA or GUS is that it still lacks universal reference libraries due to insufficient reproducibility of LC-MS(/MS) mass spectra obtained with different instrument types. © 2012 Springer Science+Business Media, LLC. Source

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