Marseille University Hospital Center

Marseille, France

Marseille University Hospital Center

Marseille, France
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Faure Conter C.,Marseille University Hospital Center
Journal of Pediatric Hematology/Oncology | Year: 2017

BACKGROUND:: Germ cell tumors with somatic malignant transformation (GCT with SMT) are rare in children and poorly described. Data are missing to determine if therapies should target the GCT, the SMT compound, or both simultaneously. PATIENTS AND METHODS:: A retrospective national study was conducted in the Société Française des cancers de l’Enfant (SFCE) Centers. Medical records from patients aged 0 to 18 years diagnosed with GCT with SMT between 2000 and 2015 were analyzed. Any stages and primary sites were considered as well as synchronous and metachronous cases. RESULTS:: Fifteen patients were identified. Thirteen patients had synchronous GCT with SMT. In the latter cases, primaries were ovary (5), mediastinum (3), pineal gland (3), sacrococcyx (1), and parametrium (1). SMT histologies were central primitive neuroectodermal tumor (5), embryonal rhabdomyosarcomas (3) or thyroid papillary adenocarcinoma, leukemia, poorly differentiated carcinoma, mixed sarcomas, and miscellaneous histology (1 case each). Chemotherapy was targeted against the GCT (3), the SMT (6), or both components (3). The last patient received surgery exclusively. Partial or complete response to chemotherapy was observed in 5/10 assessable cases: 2/3 patients treated with GCT-dedicated chemotherapy, 3/6 patients treated with SMT-dedicated therapy, and 0/1 treated with combined therapy. In addition, 2 patients with mediastinal GCT primary had metachronous SMT, with acute myeloid leukemia and thyroid papillary adenocarcinoma, 8 months and 8 years, respectively, after the diagnoses of GCT. Two patients (1 synchronous and 1 metachronous) were cured with surgery exclusively. At the end of follow-up, 6 patients died of their disease including all 4 with postsurgical macroscopic residue. CONCLUSIONS:: GCT with SMT constitutes a very rare entity in children and adolescents. Surgical removal of the tumor is the cornerstone of the treatment and might be sufficient in selected cases. In the remaining cases, the best management is still unknown and should take into account both components and their respective chemosensitivity. Long-term surveillance is advised for patient with unresected teratoma as late transformation can occur. Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

Cason N.,Marseille University Hospital Center | Schon D.,Marseille University Hospital Center
Neuropsychologia | Year: 2012

While natural speech does not possess the same degree of temporal regularity found in music, there is recent evidence to suggest that temporal regularity enhances speech processing. The aim of this experiment was to examine whether speech processing would be enhanced by the prior presentation of a rhythmical prime. We recorded electrophysiological (EEG) and behavioural (reaction time) data while participants listened to nonsense words preceded by a simple rhythm. Results showed that speech processing was enhanced by the temporal expectations generated by the prime. Interestingly, beat and metrical structure of the prime had an effect on different ERP components elicited by the following word (N100, P300). These results indicate that using a musical-like rhythmic prime matched to the prosodic features of speech enhances phonological processing of spoken words and thus reveal a cross-domain effect of musical rhythm on the processing of speech rhythm. © 2012 Elsevier Ltd.

Adams D.,Marseille University Hospital Center
Current Opinion in Neurology | Year: 2017

PURPOSE OF REVIEW: Transthyretin familial amyloid polyneuropathy is the most disabling hereditary polyneuropathy of adult onset because of a point mutation of transthyretin gene. This review updates our knowledge about natural history of the disease, phenotypes, diagnosis tools for small and large fibers involvement, expertʼs consensus for both symptomatic and asymptomatic follow-up, and treatmentʼs research. RECENT FINDINGS: Access to TTR gene sequencing permit diagnosis and first reports of the disease in nonendemic countries (EU countries, United States, China, India). Most studies showed a more severe natural history of the neuropathy in nonendemic countries. First European consensus for management has been established. New long-term results allow selection of best candidates for liver transplantation based on phenotype and cardiac involvement. Multimodal evaluation of small fiber neuropathy and resonance magnetic neurography are under development. New results are available for long-term effect of tafamidis in late-onset patients. TTR gene silencing drugs are subject to phase 3 clinical trials. SUMMARY: New methods for the evaluation of the disease are being developed. The TTR gene silencing strategy will be available by the end of 2017. Copyright © 2017 Wolters Kluwer Health, Inc. All rights resereved.

Lagier J.-C.,Aix - Marseille University | Lagier J.-C.,Marseille University Hospital Center
Clinical Microbiology and Infection | Year: 2014

Recurrent Clostridium difficile infections constitute an important medical concern. Evidence has been provided showing that faecal microbiota transplantation is a more efficient treatment than antibiotics. Serious side effects are unusual, and acceptability is not an obstacle. Nevertheless, protocols are heterogeneous with respect to the selection of donors and the methodology used for the faecal transplantation. Regulations by both the Food and Drug Administration and the French authorities consider stool samples to be drugs, and suggest strict supervision in clinical trials. Donor screening by questionnaire or by blood and stool analysis, which is essential in eliminating pathogens or viruses before transplantation, is similar in different countries, with a few exceptions. The traceability of the faecal transplant and long-term follow-up of the patients in clinical trials are issues that may be difficult to organize. The use of frozen microbiota facilitates transplantation, and the nasogastric route seems to be at least as effective as other invasive methods and avoids the risk of anaesthesia. Synthetic microbiota is an approach that selects a mixture of bacteria, thereby eliminating the risk of transmissible disease; however, this approach is not yet evidence-based. The use of pills, which is currently being tested in clinical trials, will certainly be the starting point for the extensive use and wide industrialization of faecal microbiota transplantation. © 2014 European Society of Clinical Microbiology and Infectious Diseases.

Nicoli F.,Marseille University Hospital Center | Lafaye De Micheaux P.,University of Montréal | Girard N.,Marseille University Hospital Center
American Journal of Neuroradiology | Year: 2013

BACKGROUND AND PURPOSE: Recent studies highlight the role of CC in preserving ischemic penumbra. Some authors suggested the quality of CC could also impact recanalization. The purpose of this study is to test this hypothesis in patients who were treated with IV thrombolysis for MCA-M1 occlusion. MATERIALS AND METHODS: A normalized index derived from Tmax maps (MR-PWI) was defined to quantify the CC deficit (nCCD) in 64 patients with stroke who underwent IV thrombolysis. Correlations between nCCD and parameters that may be altered by CC quality were tested (baseline NIHSS, volume of diffusion abnormalities, modified Rankin Scale at 3 months). The correlation between baseline nCCD and MCA-M1 recanalization rate at 24 hours was tested. RESULTS: The nCCD is significantly correlated with NIHSS and with lesional volume (Pearson correlation test, positive correlations, respectively, 0.40, 0.57; P=.00089, P=8.7e-07). The nCCD also has a significant predictive value on the full recanalization at 24 hours that decreases as TTT increases (logistic regression, P = .021). Furthermore, among patients who were treated within 3 hours, nCCD and recanalization are significantly correlated (correlation ratio test, eta2 = 0.23, P = .0023): Patients who did not achieve full recanalization have significantly higher nCCD than fully recanalized patients (Mann-Whitney U test, P = .007). In addition, the probability of full recanalization decreases as the nCCD increases (P=.021). nCCD (OR 0.988, 95% CI 0.977-0.999, P=.042) and full recanalization at 24 hours (OR 4.539, 95% CI 1.252-16.456, P = .021) are independent predictors of functional independence at 3 months. CONCLUSIONS: The nCCD index is a predictor of full MCA-M1 recanalization in patients treated with IV thrombolysis.

Hartung O.,Marseille University Hospital Center
Perspectives in Vascular Surgery and Endovascular Therapy | Year: 2011

Venous obstructive lesions represent a therapeutic challenge. Postthrombotic lesions are the most complex and very prone to rethrombosis. Technical success can be achieved in more than 85% of the cases (100% when recanalization with thrombolysis is not needed) with a low rate of periprocedural complications and no mortality. The overall rate of thrombotic events after stenting is around 5%. Patency rates depend on multiple criteria, including the need for thrombolysis and the involvement of the common femoral vein and of the inferior vena cava. Primary, assisted-primary, and secondary patency rates were 67%, 89%, and 93%, respectively, at 6 years in the study by Neglén and 66%, 70%, and 77%, respectively, in the intention-to-treat European multicentric study, at 5 and 10 years. Stenting is a minimally invasive and safe technique with good long-term clinical results and patency rates. It represents the method of choice for the treatment of postthrombotic iliofemoral venous obstructions. © The Author(s) 2011.

Cautela J.,Marseille University Hospital Center
Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology | Year: 2013

Whole body imaging with (18)F-fluorodeoxyglucose positron-emission tomography/computed tomography (FDG PET/CT) has proven useful in various infectious diseases. The purpose of this pilot study was to assess the diagnostic yield of FDG PET/CT in patients with cardiac implantable electronic device (CIED) infection. A total of 21 patients with CIED infection were prospectively included. Diagnosis of CIED infection was made in accordance with current criteria. It was classified in three categories, i.e. superficial skin infection, pocket site infection, or cardiac device-related infective endocarditis (CDRIE). All patients underwent FDG PET/CT. Scans were interpreted blindly, i.e. without prior knowledge of diagnosis, by experienced nuclear medicine physicians. The accuracy of FDG PET/CT was assessed for each diagnostic category. Findings demonstrated superficial skin infection in 1 patient, pocket site infection in 15, and CDRIE in 13 (definite: 7; possible: 6). In patients with pocket site infection, the sensitivity and specificity of FDG PET/CT were 86.7% [59.5-98.3, 95% confidence interval (CI)] and 100% [42.1-100, 95% CI]. The only patient with superficial skin infection was accurately identified by FDG PET/CT. The sensitivity and specificity of FDG PET/CT in patients with CDRIE were 30.8% [9.1-61.4, 95% CI] and 62.5% [24.5-91.5, 95% CI]. Most false-negative results occurred in patients who had undergone previous antimicrobial treatment. This study indicates that FDG PET/CT is highly accurate for the diagnosis of skin and pocket CIED infection but low for infective endocarditis. This suggests that the reliability of FDG PET/CT findings in management decision making varies according to the type of CIED infection.

Borentain P.,Marseille University Hospital Center
Clinics and research in hepatology and gastroenterology | Year: 2011

Sorafenib is a multikinase inhibitor currently used in the palliative treatment of advanced hepatocellular carcinoma. In patients with small hepatocellular carcinoma, sorafenib could be suggested as neoadjuvant therapy to control tumor growth during waiting time for liver transplantation. However, up to now, safety of liver transplantation in patients undergoing sorafenib treatment is not known. Herein, we report a case of successful liver transplantation in a patient treated by sorafenib for hepatocellular carcinoma. In this patient, liver transplantation was performed safely and histological examination of explanted liver evidenced complete necrosis of the largest tumor nodule. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

Colson P.,Marseille University Hospital Center
Euro surveillance : bulletin européen sur les maladies transmissibles = European communicable disease bulletin | Year: 2013

Real-time systematic monitoring of the number of infections diagnosed in our clinical microbiology laboratory in Marseille recently drew attention to the fact that the incidence of gonorrhoea was 10-fold greater from September through December 2012 than during same months of previous years. We also found an increase in the annual incidence of syphilis and human immunodeficiency virus seroconversion. Our system allowed timely identification of an increase in sexually-transmitted infections in Marseille for the whole year of 2012.

Bruder N.,Marseille University Hospital Center | Rabinstein A.,Mayo Medical School
Neurocritical Care | Year: 2011

Cardiopulmonary complications after aneurysmal subarachnoid hemorrhage negatively affect overall morbidity and mortality. An electronic literature search was performed for English-language articles focused on cardiopulmonary complications with subarachnoid hemorrhage published through October 2010. A total of 278 citations were identified, including 72 clinical studies. In most cases, study quality was low or very low. Cardiac injury, evidenced by an elevation in troponin levels, is reported in about one-third of patients after aneurysmal subarachnoid hemorrhage. Arrhythmias also occur in about one-third of patients after subarachnoid hemorrhage. The incidence of pulmonary complications, especially neurogenic pulmonary edema, is more difficult to establish from available literature. Cardiopulmonary complications have been linked to worsened clinical outcome, suggesting a role for cardiac monitoring and interventions. © Springer Science+Business Media, LLC 2011.

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