Castelain F.,St Jacques Hospital |
Castelain M.,Timone Hospital
European Journal of Dermatology | Year: 2012
Parabens belong to a family of preservatives that are widely used, particularly in the cosmetic, pharmaceutical and food industries. Four esters are commonly used: methyl, ethyl, propyl and butyl parabens. They are either used alone or, for better efficacy, in the form of a mixture. They have been the target of a media smear campaign since 2005. Several studies have failed to formally prove their alleged responsibility in the occurrence of breast cancer. At recommended concentrations, methyl and ethyl parabens have no hormonal effect in humans. Propyl and butyl parabens are still being investigated as regards their effects on fertility in men exposed during early childhood. Parabens are well-known for having weak sensitising properties and for their absence of toxicity whereas new substitution products, not as well-known, may lead to new cases of contact allergy.
Suri R.M.,Mayo Medical School |
Aviernos J.-F.,Timone Hospital |
Dearani J.A.,Mayo Medical School |
Mahoney D.W.,Mayo Medical School |
And 3 more authors.
European Journal of Cardio-thoracic Surgery | Year: 2011
Objective: It is well accepted that patients with severe mitral regurgitation (MR) benefit from mitral valve repair; however, the management of those with less than severe leakage is controversial. Watchful waiting is often advocated and considered safe, but the risk of developing left ventricular (LV) dysfunction under medical management is unknown. Methods: Using a population-based County-wide study database, we analyzed echocardiograms during clinical follow-up and medical management of 204 patients with mitral valve prolapse and less-than-severe MR. LV dysfunction was defined per American Heart Association guidelines as an ejection fraction (EF) <60% or LV end-systolic dimension >40. mm. Results: At index examination, mean age was 57 years and 121 (59%) were women. The mean EF was 62%, and 62 (30%) had evidence of LV dysfunction. MR severity was mild in 121 (59%), mild-moderate in 23 (11%), moderate in 36 (18%) and moderate-severe in 24 (12%). During follow-up (mean 8.6 years), 79 patients (39%) demonstrated progression of MR by at least one grade. Greater degrees of regurgitation at index echocardiogram were associated with greater progression during follow-up (P= 0.0001). After adjusting for age, sex, body surface area (BSA), and baseline regurgitation grade, multivariable modeling revealed that larger LV end-diastolic dimension (odds ratio (OR). = 1.14; P= 0.0018) and greater diastolic septal thickness (OR. = 1.40; P= 0.0211) predicted greater progression of MR with time. From initial diagnosis to follow-up echocardiography, EF declined, while left-heart dimensions and pulmonary arterial pressure increased. Of the 142 patients with normal baseline LV function, 52% developed either worsening MR or de novo LV dysfunction. Importantly, even in the 87 patients with stable regurgitation, 18 (21%) developed new LV dysfunction during follow-up. Fifty-two patients (25%) eventually underwent mitral valve repair. Following surgery, there were significant decreases in EF, LV end-diastolic dimensions and LV mass; while 11 developed de novo LV dysfunction. Conclusions: Over half of patients with chronic persistent, but sub-severe MR due to mitral leaflet prolapse develop LV dysfunction or worsening regurgitation despite optimal medical management. LV deterioration can occur even in the absence of MR progression. These data advocate for the development of detailed guidelines supporting frequent echocardiographic monitoring and the identification of earlier triggers for surgical consideration prior to the development of LV dysfunction in this patient population. © 2010 European Association for Cardio-Thoracic Surgery.
Girard N.J.,Timone Hospital |
Girard N.J.,Aix - Marseille University
Topics in Magnetic Resonance Imaging | Year: 2011
Fetal developmental anomalies consist of central nervous system malformations, brain injury, and tumors. Overlap is often seen especially between malformation and injury because malformation may be genetically determined or related to external causative agent, whereas brain injury may be, on one hand, caused by malformation as with intracranial vascular malformation and, on another, can cause brain malformation when cerebral insult occurs during organogenesis and histogenesis. The goal of this review was not to describe by magnetic resonance imaging (MRI) all fetal developmental anomalies encountered in utero; it is most likely to focus on fetal brain anomalies that either are most commonly seen in fetal tertiary care facility or are extremely challenging for MRI. Consequently, the potential of advanced MR techniques such as proton MR spectroscopy and diffusion tensor imaging is also described especially when a challenge is highlighted. This review is therefore organized in subchapters as follows. The first section gives the place of MRI in prenatal development and cites the standard protocol and the advanced techniques. The rules of fetal brain MRI, the challenge and pitfalls, and the selection of MRI cases follow as 3 subchapters. Also, abnormalities are described as 3 separate subchapters entitled ventriculomegalies (hydrocephalus), malformations, and brain injury. Copyright © 2011 by Lippincott Williams & Wilkins.
Donnet A.,Headache Center |
Daniel C.,Headache Center |
Milandre L.,Timone Hospital |
Berbis J.,University Hospital |
Auquier P.,University Hospital
Journal of Neurology | Year: 2012
The goal of this study was to describe specifically the clinical characteristics of migraine with aura in patients over the age of 50. During 1 year, three neurologists working in a tertiary headache center included all patients aged 50 years and over presenting migraine with aura in a prospective registry. Fifty-seven patients with migraine with aura aged 50 years and over were interviewed using a standardized questionnaire during a consultation. Auras were visual for all the patients, paresthesic for 16 patients, and aphasic for 16. One patient had a sporadic hemiplegic migraine. The headache followed the aura in a large majority of patients and fulfilled the International Headache Society criteria for migraine headache for 38 patients. Typical aura without headache was described in 26 patients and was the only expression of the disease for five patients. Two groups can be defined: in the first one, migraine with aura began before 50 years (39 patients). Thirty-one patients had typical aura with migraine headache and 15 complained of typical aura without headache. The second group (18 patients) included patients who developed migraine with aura over 50 for the first time. Among them, patients may have typical aura with migraine headache (seven patients), typical aura with non-migraine headache (eight patients) and/or typical aura without headache (11 patients). Late-life onset transient visual phenomena are not rare. These symptoms may occur for the first time after 50, in the absence of headache. When migraine with aura began after 50 years, headache has more often the characteristics of typical aura with nonmigraine headache, or migraine may have the presentation of typical migraine without headache. © Springer-Verlag 2012.
Cowen D.,Timone Hospital |
Gross E.,Timone Hospital |
Rouannet P.,Center Val dAurelle |
Teissier E.,Center Azureen Of Cancerologie |
And 6 more authors.
Breast Cancer Research and Treatment | Year: 2010
The objective is to prospectively determine the factors responsible for reconstruction failure and capsular contracture in mastectomized breast cancer patients who underwent immediate two-stage breast reconstruction with a tissue expander and implant, followed by radiotherapy. This is a multicenter, prospective, non-randomized study. Between February 1998 and September 2006, we prospectively examined 141 consecutive patients, each of which received an implant after mastectomy, followed by chest wall radiotherapy at 46-50 Gy in 23-25 fractions. Radiotherapy was delivered during immediate post-mastectomy reconstruction. Patients were evaluated by both a radiation oncologist and a surgeon 24-36 months after treatment. The median follow-up duration was 37 months. According to Baker's classification, capsular contracture was grade 0, 1, or 2 in 67.5% of cases; it was grade 3 or 4 in 32.5% of cases. In total, 32 breast reconstruction failures required surgery. In univariate analysis, the following factors were associated with Baker grade 3 and 4 capsular contraction: adjuvant hormone therapy (P = 0.02), the surgeon (P = 0.04), and smoking (P = 0.05). Only one factor was significant in multivariate analysis: the surgeon (P = 0.009). Three factors were associated with immediate post-mastectomy breast reconstruction failure in multiple logistic regression analysis: T3 or T4 tumors (P = 0.0005), smoking (P = 0.001), and pN+ axillary status (P = 0.004). Patients with none, 1, 2, or all 3 factors have a probability of failure equal to 7, 15.7, 48.3, and 100%, respectively (P = 3.6 x 10-6). The model accurately predicts 80% of failures. Mastectomy, immediate reconstruction (expander followed by implant), and radiotherapy should be considered when conservative surgery is contraindicated. Three factors may be used to select patients likely to benefit from this technique with a low failure rate. © Springer Science+Business Media, LLC. 2009.