Eapen M.,Medical College of Wisconsin |
Klein J.P.,Medical College of Wisconsin |
Sanz G.F.,Hospital Universitario La Paz |
Spellman S.,Center for International Blood and Marrow Transplant Research |
And 15 more authors.
The Lancet Oncology | Year: 2011
Background: The importance of matching at the HLA C locus has not been well defined for unrelated umbilical-cord blood transplantation. The selection algorithm for umbilical-cord blood units generally considers intermediate resolution HLA typing at A and B and allele-level typing at DRB1. We aimed to establish the relative importance of additional matching at HLA C. Methods: We used Cox regression to assess retrospectively the effect of donor-recipient HLA matching on outcomes of single umbilical-cord blood transplantations for leukaemia and myelodysplastic syndrome. Our primary endpoint was transplant-related mortality. HLA typing was done with molecular techniques with a minimum of intermediate resolution for HLA A, B, and C, and at the allele-level for DRB1. Findings: The median age of our study population was 10 years (range <1-62) and 552 (69%) of 803 patients were aged 16 years or younger at transplantation. Compared with transplantations matched at HLA A, B, C, and DRB1 (n=69), transplant-related mortality risk was higher after transplantations matched at HLA A, B, and DRB1 and mismatched at HLA C (n=23; HR 3·97, 95% CI 1·27-12·40; p=0·018). Transplant-related mortality risk was also higher after transplantations with a single mismatch at HLA A, B, or DRB1 and mismatched at HLA C (n=234; 1·70, 1·06-2·74; p=0·029) compared with transplantations matched at HLA C with a single mismatch at HLA A, B, or DRB1 (n=127). Assessing the overall effect of HLA disparity on transplant-related mortality, risks were higher with units mismatched at two (n=259; 3·27, 1·42-7·54; p=0·006), three (n=253; 3·34, 1·45-7·71; p=0·005), or four (n=75; 3·51, 1·44-8·58; p=0·006) loci compared with matched units (n=69). Interpretation: Our data suggest that the present strategy for umbilical-cord blood unit selection should be reassessed; matching at HLA C for units that are matched at HLA A, B, or DRB1 or in the presence of a single locus mismatch at HLA A, B, or DRB1 should be included to minimise mortality risks. Funding: National Cancer Institute, National Heart Lung and Blood Institute, National Institute for Allergy and Infectious Diseases, Leukemia and Lymphoma Society, US Department of the Navy, Children's Leukemia Research Association, and INSERM. © 2011 Elsevier Ltd.
Eapen M.,Center for International Blood and Marrow Transplant Research |
Klein J.P.,Center for International Blood and Marrow Transplant Research |
Klein J.P.,Medical College of Wisconsin |
Ruggeri A.,Eurocord |
And 19 more authors.
Blood | Year: 2014
We studied the effect of allele-level matching at human leukocyte antigen (HLA)-A, -B, -C, and -DRB1 in 1568 single umbilical cord blood (UCB) transplantations for hematologic malignancy. The primary end point was nonrelapse mortality (NRM). Only 7% of units were allele matched at HLA-A, -B, -C, and -DRB1; 15% were mismatched at 1, 26% at 2, 30% at 3, 16% at 4, and 5% at 5 alleles. In a subset, allele-level HLA match was assigned using imputation; concordance between HLA-match assignment and outcome correlation was confirmed between the actual and imputed HLA-match groups. Compared with HLA-matched units, neutrophil recovery was lower with mismatches at 3, 4, or 5, but not 1 or 2 alleles.NRM was higher with units mismatched at 1, 2, 3, 4, or 5 alleles compared with HLAmatched units. The observed effects are independent of cell dose and patient age. These data support allele-levelHLAmatching in the selection of single UCB units. (Blood. 2014;123(1):133-140). © 2011 by The American Society of Hematology; all rights reserved.
Roche P.-H.,University Hospital of Marseille |
Troude L.,Service de Neurochirurgie |
Peyriere H.,Service de Neurochirurgie |
Noudel R.,Service de Neurochirurgie
Acta Neurochirurgica | Year: 2014
Background: Meckel's cave (MC) is a meningeal cleft lying in the middle fossa laterally to the cavernous sinus. Tumours that develop inside the MC may require a surgical resection. The authors describe the surgical technique of the intracranial epidural approach to the MC. Methods: Based upon anatomical dissection showing the relevant surgical anatomy, and illustrated by the video of an operated case, the authors detail the surgical procedure. The key point is to shave the floor of the middle fossa and skeletonize the superior orbital fissure, rotundum and ovale foramen in order to delineate the plane of dural elevation and expose the lateral wall of the MC. The rules of exposure and resection of the tumour are then shown. Variations and limitations of the approach are discussed. Conclusion: Conducted in a stepwise manner and following relevant landmarks, the epidural anterolateral approach offers a safe and reliable exposure to the diseases that develop within the MC. © 2013 Springer-Verlag Wien.
PubMed | Neurologists Practice, University Hospital of Nice, University of Strasbourg, University of Nimes and 3 more.
Type: | Journal: Multiple sclerosis and related disorders | Year: 2016
Early manifestations of Multiple Sclerosis (MS) can be atypical and misleading, and several case report studies have highlighted that MS onset sometimes takes the form of a psychotic or manic episode.All neurologists belonging to the French Multiple Sclerosis Observatory network were contacted by email and were asked to find patients with MS who presented with a history of psychiatric episode(s) near MS onset.Seventeen patients were selected that met the criteria of presenting with psychotic or manic symptoms either before the diagnosis of MS (N=8), or at the time of the first neurological episode or shortly after (N=9). Patients with a history of a psychiatric episode occurring before the first neurological episode were diagnosed on average 7 years later than patients with either a first neurological or a mixed (both neurological and psychiatric) episode. However, psychiatric symptoms in the first group and the first neurological symptoms of MS in the second group occurred at a similar age.Based on this multiple case study, we question whether past psychotic or manic episode should be considered equivalent to a first manifestation of MS.
Rusinaru D.,University Hospital Amiens |
Tribouilloy C.,University Hospital Amiens |
Grigioni F.,University of Bologna |
Avierinos J.F.,University Hospital of Marseille |
And 12 more authors.
Circulation: Cardiovascular Imaging | Year: 2011
Background-Left atrium (LA) enlargement is common in organic mitral regurgitation (MR) and is an emerging prognostic indicator. However, outcome implications of LA enlargement have not been analyzed in the context of routine clinical practice and in a multicenter study. Methods and Results-The Mitral Regurgitation International DAtabase (MIDA) registry enrolls patients with organic MR due to flail leaflets, diagnosed in routine clinical practice, in 5 US and European centers. We investigated the relation between LA diameter and mortality under medical treatment and after mitral surgery in 788 patients in sinus rhythm (64±12 years; median LA, 48 [43 to 52] mm). LA diameter was independently associated with survival after diagnosis (hazard ratio, 1.08 [1.04 to 1.12] per 1 mm increment). Compared with patients with LA<55 mm, those with LA ≥55 mm had lower 8-year overall survival (P<0.001). LA ≥55 mm independently predicted overall mortality (hazard ratio, 3.67 [1.95 to 6.88]) and cardiac mortality (hazard ratio, 3.74 [1.72 to 8.13]) under medical treatment. The association of LA ≥55 mm and mortality was consistent in subgroups. Similar excess mortality associated with LA ≥55 mm was observed in asymptomatic and symptomatic patients (P for interaction, 0.77). In patients who underwent mitral surgery, LA ≥55 mm had no impact on postoperative outcome (P<0.20). Mitral surgery was associated with greater survival benefit in patients with LA ≥55 mm compared with LA <55 mm (P for interaction, 0.008). Conclusions-In MR caused by flail leaflets, LA diameter ≥55 mm is associated with increased mortality under medical treatment, independent of the presence of symptoms or left ventricular dysfunction. © 2011 American Heart Association, Inc.
PubMed | University Hospital of Lille, University Hospital of Toulouse, University of Lorraine, University of Paris Descartes and 3 more.
Type: | Journal: Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc | Year: 2017
Behjati et al recently described recurrent mutations of H3F3 genes in giant cell tumors of the bone and chondroblastomas. Both these entities belong to the spectrum of giant cell-rich bone lesions, often presenting a diagnostic challenge for the pathologist. Our aim was to investigate the value of searching for H3F3 mutations in the diagnosis of giant cell tumors of the bone and giant cell-rich chondroblastomas. Two hundred eighty-one bone lesion samples, including 170 giant cell tumors of the bone, 26 chondroblastomas and 85 other giant cell-rich and/or epiphyseal tumors, were analyzed. Mutation status was determined using first high resolution melting screening and then mutation profiling pyrosequencing. Mutational status was compared with clinical data and, for giant cell tumors of the bone, with p63 immunostaining status. As histone methylation changes have been reported in association with H3F3 mutations, the methylation status of lysine 37 was investigated. H3F3A and H3F3B were found in 85% of giant cell tumors of the bone and 88% of chondroblastomas. In addition to the major G35W mutation, we found two rare H3F3A mutations: one G35R and one G35V. Among the other tumors studied, we only found H3F3A gene mutations in two cases of dedifferentiated chondrosarcoma mimicking giant cell tumor of the bone. A H3F3B mutation was also observed in one case of dedifferentiated chondroblastoma. P63 expression in giant cell tumors of the bone seems to be associated with H3F3 gene mutations (P=0.004). H3F3 mutations did not correlate with clinical data, outcome or methylation changes in Lysin 37. In conclusion, H3F3 mutations are sensitive and specific markers of giant cell tumors of the bone and chondroblastomas. High resolution melting and pyrosequencing procedures are high-performance tools in this context. Determination of H3F3 mutation will allow reclassification of some entities belonging to the spectrum of giant cell-rich lesions.Modern Pathology advance online publication, 6 January 2017; doi:10.1038/modpathol.2016.212.
Natale C.,Aix - Marseille University |
Natale C.,University Hospital of Marseille |
D'Journo X.B.,Aix - Marseille University |
D'Journo X.B.,University Hospital of Marseille |
And 4 more authors.
European Journal of Cardio-thoracic Surgery | Year: 2012
Spontaneous pneumomediastinum (SP) is defined as the presence of free air in mediastinal space without any apparent cause. This rare entity is most likely to occur in young males often related to an episode of vomiting, asthma or sustained physical activity. SP usually resolves spontaneously in few days of treatment based on rest and analgesia. Complications are extremely rare. Its recurrence has been poorly reported but seems exceptional. We present a case of recurrent SP occurring in a 21-year-old male with a mental deficiency. The recurrence occurred after a free-interval of 12 months. We proposed a literature review. © The Author 2011. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
Cuisset T.,University Hospital of Marseille |
Cuisset T.,Aix - Marseille University |
Cayla G.,University of Nimes
Minerva Medica | Year: 2010
Antiplatelet therapy is a cornerstone of coronary artery disease treatment and prevention. Aspirin and clopidogrel has emerged as the gold standard combination for patients receiving coronary stent and/or suffering from acute coronary syndrome. Despite their efficacy, recurrent events still occur and resistance to antiplatelet drugs might be one of the responsible factors. Aspirin and clopidogrel resistance are emerging entities primarily defined in biological studies by inability of the drug to achieve expected antiplatelet effect based on platelet function tests. Mechanisms of this variability of response remain complex and partially unknown. Moreover, clinical papers linked this biological entity with worse clinical outcomes, and therefore, tailored therapy based on platelet tests has been proposed. Mean while, new antiplatelet drugs will soon change the field while achieving homogeneous degree of platelet inhibition. The present review aims to summarize biological and clinical data about resistance to antiplatelet therapy, and try to estimate how much this might change our prescription in daily clinical practice.
Posterior fossa volume increase after surgery for Chiari malformation Type I: A quantitative assessment using magnetic resonance imaging and correlations with the treatment response - Clinical article
Noudel R.,University of Reims |
Gomis P.,University of Reims |
Sotoares G.,Roger Salengro Hospital |
Bazin A.,University of Reims |
And 4 more authors.
Journal of Neurosurgery | Year: 2011
Object. The aim of this paper was to measure the posterior fossa (PF) volume increase resulting from a given-sized occipital craniectomy in Chiari malformation Type I surgery and to analyze its correlations with the PF size and the treatment response, with the perspective of tailoring the amount of bone removal to the patient-specific PF dimensions. Methods. Between January 2005 and June 2006, 11 adult patients with symptomatic Chiari malformation Type I underwent a standardized PF decompression. A prospective evaluation with clinical examination, functional grading, and MR imaging measurement protocols was performed pre- and postoperatively. A method is reported for the measurement of PF volume (PFV) after surgery. The degree of PFV increase was compared with the preoperative size of the PF and with the clinical outcome. Results. All 11 patients improved postoperatively, with complete and partial recovery in 4 and 7 patients, respectively. No postoperative complication occurred after a mean follow-up period of 45 months. The mean relative increase in PFV accounted for 10% (range 1.5%-19.7%) of the initial PFV; the increase was greater in cases in which the PF was small (r = -0.52, p = 0.09) and the basiocciput was short (r = -0.37, p = 0.2). A statistically significant positive correlation was found between the degree of PFV increase and the treatment response (p = 0.014); complete recovery was observed with a PFV increase of 15% and partial recovery with an increase of 7%. Conclusions. The treatment response is significantly influenced by the degree of PFV increase, which is dependent on the size of the PF and the extent of the craniectomy, suggesting that the optimal patient-specific PFV increase could be predicted on the basis of preoperative MR imaging and enhancing the perspective that the craniectomy size could be tailored to the individual PFV.
Zieleskiewicz L.,University Hospital of Marseille |
Lagier D.,University Hospital of Marseille |
Contargyris C.,University Hospital of Marseille |
Bourgoin A.,University Hospital of Marseille |
And 3 more authors.
Anaesthesia | Year: 2013
Lung ultrasonography is a standard tool in the intensive care unit and in emergency medicine, but has not been described in the particular setting of the labour ward. During pregnancy, acute respiratory failure and pulmonary oedema are not uncommon life-threatening events. We present two case reports outlining the potential of lung ultrasonography in parturients. In case 1, lung ultrasonography allowed early diagnosis and treatment of acute dyspnoea in a parturient admitted for suspected asthma exacerbation. Lung ultrasonography revealed a 'B-pattern' of vertical lines radiating into the lung tissue, indicating severe pulmonary oedema complicating previously undiagnosed pre-eclampsia. In case 2, a pre-eclamptic patient was managed with combined transthoracic echocardiography and lung ultrasonography. The accuracy of lung ultrasonography in detecting interstitial oedema at a pre-clinical stage allowed adequate fluid resuscitation in this patient who had a high risk of alveolar pulmonary oedema. We believe that these cases strongly support the prospective validation of lung ultrasound for management of lung disorders in pregnant women. © Anaesthesia © 2012 The Association of Anaesthetists of Great Britain and Ireland.