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Beauchesne P.,Nancy University Hospital Center
Cancers | Year: 2011

Malignant gliomas account for approximately 60% of all primary brain tumors in adults. Prognosis for these patients has not significantly changed in recent years-despite debulking surgery, radiotherapy and cytotoxic chemotherapy-with a median survival of 9-12 months. Virtually no patients are cured of their illness. Malignant gliomas are usually locally invasive tumors, though extra-neural metastases can sometimes occur late in the course of the disease (median of two years). They generally appear after craniotomy although spontaneous metastases have also been reported. The incidence of these metastases from primary intra-cranial malignant gliomas is low; it is estimated at less than 2% of all cases. Extra-neural metastases from gliomas frequently occur late in the course of the disease (median of two years), and generally appear after craniotomy, but spontaneous metastases have also been reported. Malignant glioma metastases usually involve the regional lymph nodes, lungs and pleural cavity, and occasionally the bone and liver. In this review, we present three cases of extra-neural metastasis of malignant gliomas from our department, summarize the main reported cases in literature, and try to understand the mechanisms underlying these systemic metastases. © 2011 by the authors; licensee MDPI, Basel, Switzerland.

Germain A.,Nancy University Hospital Center
Journal of visceral surgery | Year: 2011

Laparoscopic adrenalectomy has become the preferred method for removal of almost all adrenal tumors. An important component in selecting patients for this operation is a thorough understanding of the clinical presentation (mainly hypertension) and diagnostic workup for the full variety of functioning and nonfunctioning adrenal tumors including genetic evaluation when necessary (MEN2, VonHippel-Landau [VHL], type 1 neurofibromatosis [NF1], succinate dehydrogenase mutations [SDH], and MEN1). The indications and contraindications for a laparoscopic approach are discussed with regard to each tumor type. Relevant literature about partial and bilateral adrenalectomy is also summarized. Main areas of controversy are discussed including the size threshold to avoid risk of adrenal capsular effraction and the appropriateness of laparoscopic resection for suspected and known malignancy. This article presents recent data to help the surgeon make well-informed decisions and to optimize the operative approach for a wide variety of adrenal pathologies (secreting vs. non-secreting, benign vs. malignant tumors). Copyright © 2011 Elsevier Masson SAS. All rights reserved.

Loeuille D.,Nancy University Hospital Center | Chary-Valckenaere I.,Nancy University Hospital Center
Osteoporosis International | Year: 2012

In contrast to radiography, magnetic resonance imaging permits visualization of all articular structures affected by osteoarthritis. Many studies have demonstrated its potential to elucidate the pathophysiological phenomena that lead to joint destruction, quantify cartilage damage, and establish risk factors for chondrolysis. Bone marrow lesion is a well-recognized process localized just beneath the subchondral bone that is responsible for clinical symptoms and structural changes not only to bone but also to cartilage. © 2012 International Osteoporosis Foundation and National Osteoporosis Foundation.

The prognostic significance of CD20 expression in B-cell precursor acute lymphoblastic leukemia (BCP-ALL) has been mostly studied in children and yielded conflicting results. In 143 adults with Philadelphia chromosome-negative BCP-ALL treated in the multicentric GRAALL 2003 trial, CD20 positivity over 20% was observed in 32% of patients. While not influencing complete remission achievement, CD20 expression was associated with a higher cumulative incidence of relapse (CIR) at 42 months (P=0.04), independently of the ALL high-risk subset (P=0.025). Notably, the negative impact of CD20 expression on CIR was only observed in patients with a white blood cell count (WBC) over 30x10 9/L (P=0.006), while not in those with a lower WBC. In the former subgroup, this impact translated into lower event-free survival (15% vs. 59% at 42 months, P=0.003). CD20 expression thus appears to be associated with a worse outcome, which reinforces the interest of evaluating rituximab combined to chemotherapy in CD20-positive adult BCP-ALL. ClinicalTrials.gov ID, NCT00222027. ©2010 Ferrata Storti Foundation.

Glioblastomas are considered to be one of the most radio resistant tumors. Despite new therapies, the prognosis of this disease remains dismal. Also, the mechanisms of radiation resistance in mammalian cells are more complex than once believed. Experimental studies have indicated that some human cell lines are sensitive to low radiation doses of <1 Gy. This phenomenon has been termed low-dose hyper-radio-sensitivity (HRS), and is more apparent in radio resistant cell lines, such as glioblastoma cells. Sensitivity may result from the inability of low dose radiation to efficiently induce repair mechanisms, whereas higher doses cause enough damage to trigger repair responses for radio resistance. In vitro studies have demonstrated this phenomenon using various human malignant glioma cell lines: (1) daily repeated irradiation of cells with low doses compared to irradiation using a single biologically equivalent dose resulted in significantly higher cell killing; (2) experiments conducted on glioma xenografts demonstrated that repeated irradiation with low doses was more effective for inhibiting tumor growth than a single dose. In order to confirm and validate these promising studies on HRS, a few phase II trials were developed. For translating the experimental observations into the clinic, ultra fractionation protocols (with three daily doses) were tested in glioblastoma patients. Tolerance and toxicity were the primary endpoints, with overall survival as a secondary endpoint. These protocols were initiated before concomitant radio chemotherapy became the standard of care. For these trials, patients with an unfavorable clinical prognostic factor of newly unresectable GBM were included. When comparing the results of these trials with international literature using multivariate analysis for both progression free survival and overall survival, ultra fractionated irradiation showed superiority over radiotherapy alone. In addition, it was found to be equivalent to treatment using radiotherapy and temozolomide. Therefore, ultra fractionated protocols may prolong survival of glioblastoma patients. In this review, we describe the main experimental data regarding low-dose hypersensitivity as well as the findings of clinical trials that have investigated this new radiotherapy regimen. © 2013 by the authors; licensee MDPI, Basel, Switzerland.

Nancy University Hospital Center | Date: 2013-09-27

The present invention relates to methods and pharmaceutical compositions for the treatment of cardiovascular fibrosis. In particular, the present invention relates to an inhibitor of Neutrophil Gelatinase-Associated Lipocalin (NGAL) activity or expression for use in a method for treating or preventing cardiovascular fibrosis in a subject in need thereof.

French Institute of Health, Medical Research, University of Lorraine and Nancy University Hospital Center | Date: 2013-01-02

The present invention relates to methods and kits for detecting diastolic dysfunction in subjects without clinical signs of heart failure.

French Institute of Health, Medical Research, University of Lorraine and Nancy University Hospital Center | Date: 2012-10-22

The present invention relates to methods and kits for detecting cardiac remodeling in subjects without clinical signs of heart failure. The present invention also relates to methods and pharmaceutical compositions for the prevention and the treatment of cardiac remodeling.

University of Lorraine, French Institute of Health, Medical Research and Nancy University Hospital Center | Date: 2012-06-15

Method for monitoring the evolution of heart failure in a patient comprising determining in vitro a physiological human parameter in a patient, comprising the steps consisting of: i) measuring values of two or more human parameters (P^(1), P^(2), . . . , P^(N)) at time t1 wherein one or more of the human parameters (P^(1)_(t1), P^(2)_(t2), . . . P^(N)_(t1)) is obtained from a human physiological fluid sample, ii) measuring values of the same two or more parameters (P^(1)_(t2), P^(2)_(t2), . . . P^(N)_(t2)) at time t2 different from time t1, and iii) determining the physiological human parameter wherein the physiological human parameter is a plasma volume variation V between time t2 and time t1 from the values (P^(1)_(t1), P^(2)_(t1), P^(N)_(t1), P^(1)_(t2), P^(2)_(t2), . . . P^(N)_(t2)) obtained at times t1 and t2, and devices for implementing said method.

Yang K.,Nancy University Hospital Center
Annals of Surgery | Year: 2016

OBJECTIVE:: This study evaluated the effectiveness of using a video recording and replaying system in robotic surgical training. SUMMARY BACKGROUND DATA:: Robotic surgical videos are reviewed to accelerate the acquisition of robotic surgical skills. However, few professional recording and replaying systems have been used during robotic surgical training. The effectiveness of these professional video systems should be investigated and validated. METHODS:: A randomized study was conducted to analyze the performance of 60 participants, who were unfamiliar with surgical robotics, in a robotic simulator. Participants were enrolled in 2 groups to perform 2 exercises on a Mimic dV-Trainer. One group was trained with the new protocol based on a recording and replaying system (controller of events on simulator and robot) and the other group was trained with the conventional method. The overall scores were automatically evaluated by the simulator. The number of additional requests for reviewing the videos or watching the trainerʼs demonstration and the learning curves based on the overall scores were compared between the 2 groups. RESULTS:: The group trained with controller of events on simulator and robot presented a significantly improved learning curve in both exercises (P < 0.001) with more additional requests (P < 0.001) in comparison with the group trained with the conventional method. CONCLUSIONS:: In robotic skills training, the use of a recording and replay system is beneficial and more efficient than the conventional training method. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.

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