Timone Hospital

Marseille, France

Timone Hospital

Marseille, France
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Frere C.,Timone Hospital | Frere C.,Aix - Marseille University | Farge D.,Saint Louis Hospital | Farge D.,University of Paris Pantheon Sorbonne
Thrombosis and Haemostasis | Year: 2016

Symptomatic venous thromboembolism (VTE) occurs 4-7 times more frequently in cancer patients as compared to non-cancer patients. A significant number of risk factors, which can be subcategorised as patient-, cancer- or treatment-related, have been shown to influence the risk of VTE during malignancy and further incorporated in risk-assessment models. Safe and efficient thromboprophylaxis regimens allow substantial decreased in VTE rates, since VTE is most often a largely preventable disease, but thromboprophylaxis remains underused in cancer compared to non-cancer patients. If thromboprophylaxis is warranted in cancer patients undergoing surgery or hospitalised for acute medical illness or with a lower mobility in the absence of con- traindications to anticoagulants, its benefit remains controversial in outpatients and may be limited to locally advanced or metastatic pancreatic or lung cancer treated with chemotherapy. The International Initiative on Thrombosis and Cancer-CME free mobile app (ios and an-droid), based on the International Clinical Practice Guidelines (CPG), facilitates their implementation and dissemination of knowledge worldwide so as to improve VTE treatment and prophylaxis in cancer patients. © Schattauer 2016.


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.


Lombardi G.,Veneto Institute of Oncology IOV | Di Stefano A.L.,Groupe Hospitalier Pitie Salpetriere | Di Stefano A.L.,University of Pavia | Farina P.,Veneto Institute of Oncology IOV | And 3 more authors.
Cancer Treatment Reviews | Year: 2014

The frequency of metastatic brain tumors has increased over recent years; the primary tumors most involved are breast cancer, lung cancer, melanoma and renal cell carcinoma. While radiation therapy and surgery remain the mainstay treatment in selected patients, new molecular drugs have been developed for brain metastases. Studies so far report interesting results.This review focuses on systemic cytotoxic drugs and, in particular, on new targeted therapies and their clinically relevant activities in brain metastases from solid tumors in adults. © 2014 Elsevier Ltd.


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.


Abdel M.P.,Mayo Medical School | Parratte S.,Aix - Marseille University | Parratte S.,Timone Hospital | Blanc G.,Aix - Marseille University | And 5 more authors.
Clinical Orthopaedics and Related Research | Year: 2014

Background: Although some clinical reports suggest patient-specific instrumentation in TKA may improve alignment, reduce surgical time, and lower hospital costs, it is unknown whether it improves pain- and function-related outcomes and gait. Questions/purposes: We hypothesized that TKA performed with patient-specific instrumentation would improve patient-reported outcomes measured by validated scoring tools and level gait as ascertained with three-dimensional (3-D) analysis compared with conventional instrumentation 3 months after surgery. Methods: We randomized 40 patients into two groups using either patient-specific instrumentation or conventional instrumentation. Patients were evaluated preoperatively and 3 months after surgery. Assessment tools included subjective functional outcome and quality-of-life (QOL) scores using validated questionnaires (New Knee Society Score© [KSS], Knee Injury and Osteoarthritis Outcome Score [KOOS], and SF-12). In addition, gait analysis was evaluated with a 3-D system during level walking. The study was powered a priori at 90% to detect a difference in walking speed of 0.1 m/second, which was considered a clinically important difference, and in a post hoc analysis at 80% to detect a difference of 10 points in KSS. Results: There were improvements from preoperatively to 3 months postoperatively in functional scores, QOL, and knee kinematic and kinetic gait parameters during level walking. However, there was no difference between the patient-specific instrumentation and conventional instrumentation groups in KSS, KOOS, SF-12, or 3-D gait parameters. Conclusions: Our observations suggest that patient-specific instrumentation does not confer a substantial advantage in early functional or gait outcomes after TKA. It is possible that differences may emerge, and this study does not allow one to predict any additional variances in the intermediate followup period from 6 months to 1 year postoperatively. However, the goals of the study were to investigate the recovery period as early pain and functional outcomes are becoming increasingly important to patients and surgeons. Level of Evidence: Level I, therapeutic study. See the Instructions to Authors for a complete description of levels of evidence. © 2014 The Association of Bone and Joint Surgeons®.


Compes P.,Timone Hospital | Rakotozanany P.,Timone Hospital | Dufour H.,Timone Hospital | Fuentes S.,Timone Hospital
European Spine Journal | Year: 2015

Purpose: Septic cervical facet joints arthritis is a rare pathology, usually revealed by fever and neck pain. As symptoms may be indolent, a high index of suspicion needs to be maintained. Magnetic resonance imaging (MRI) is effective for early diagnostic, looking for local spread and guiding potential preoperative planning. We present a case exhibiting an uncommon pathology with possible significant morbidity if misdiagnosed. Methods: A 75-year-old woman presented with fever, neck stiffness and torticollis accompanied with altered level of consciousness. Results: The diagnosis was established by computed tomography and MRI, identifying atlantoaxial facet joint destruction with para spinal muscles and epidural abscesses. A surgical treatment consisting in posterior decompression of the spinal canal and atlantoaxial pars articularis fixation known as Harms technique, associated with a targeted antibiotic therapy, succeeded in obtaining favorable clinical course. Conclusion: Atlantoaxial septic arthritis is an under reported and severe infection. Early use of MRI should avoid delayed diagnosis and would guide the practitioner in choosing an appropriate therapy. Early surgical treatment for uncontrolled sepsis is also a critical element of the prognosis. © 2014, Springer-Verlag Berlin Heidelberg.


Donnet A.,Timone Hospital | Daniel C.,Timone Hospital | 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.


Castelain M.,Timone Hospital
European Journal of Dermatology | Year: 2011

Globalisation brings patients more and more into contact with products or food from other cultures or countries. Europeans may be confronted with allergens not yet known in Europe - such as dimethylfumarate - responsible for contact allergy epidemics. Moreover, "lowcost" goods, not always legally imported into Europe, sometimes may lead to European legislation being circumvented and thus bring our patients into contact with components that have been banned from manufacturing processes or strongly regulated, such as nickel in jewelry or telephones, some colouring agents in clothes or preservatives in cosmetics. Disinfection measures for freight containers arriving from other continents into our harbours lead to fumigants and other toxic products contaminating the air and the transported products or goods. Globalisation can not only elicit contact allergy but also airborne contact dermatitis or food allergy. The aim of this paper is not to make an exhaustive review of cutaneous allergic problems elicited by globalisation, but to illustrate this new worldwide problem with a few meaningful examples.


Giacino C.,Timone Hospital | Grandval P.,Timone Hospital | Laugier R.,Timone Hospital
Endoscopy | Year: 2012

Fully covered self-expanding metal stents (FC-SEMSs), which can be removed from the bile duct, have recently been used in the main pancreatic duct (MPD) in chronic pancreatitis. The aim of this study was to investigate the feasibility, safety, and efficacy of FC-SEMSs in painful chronic pancreatitis with refractory pancreatic strictures. The primary endpoints were technical success and procedure-related morbidity. Secondary endpoints were pain relief at the end of follow-up and resolution of the dominant pancreatic stricture at endoscopic retrograde pancreatography. Over 5 months, 10 patients with painful chronic pancreatitis and refractory dominant pancreatic duct strictures were treated with FC-SEMSs. All FC-SEMSs were successfully released and removed, although two stents were embedded in the MPD at their distal end and treated endoscopically without complications. Mild abdominal pain was noted in three patients after stent release. During treatment, pain relief was achieved in nine patients, but one continued to take morphine, because of addiction. Cholestasis developed in two patients and was treated endoscopically; no patient developed acute pancreatitis or pancreatic sepsis. After stent removal, the diameter of the narrowest MPD stricture had increased significantly from 3.5 mm to 5.8 mm. Patients were followed up for a mean of 19.8 months: two patients who continued drinking alcohol presented with mild acute pancreatitis; one patient developed further chronic pancreatic pain; and one had a transient pain episode. At the end of the study, nine patients no longer had chronic pain and no patients had required surgery. Endoscopic treatment of refractory MPD stricture in chronic pancreatitis by placement of an FC-SEMS appears feasible, safe, and potentially effective. © Georg Thieme Verlag KG Stuttgart - New York.


Conte-Devolx B.,Timone hospital | Vialettes B.,Timone hospital
Annales d'Endocrinologie | Year: 2013

Hyperthyroidism due to Graves' disease is autoimmune in origin. The initiation of dysimmunity responsible for the disease is still poorly understood. Numerous population studies show that genetic factors have a major role, but the environment and any kind of stress also contribute to the onset of the disease. There remains the recurring question for medical experts of the accountability of stress in the onset of Graves' disease. To date, it is impossible to establish a direct link between this disease and a specific stress. The relationship can only be hypothetical, indirect and partial. © 2013 Elsevier Masson SAS.

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