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1.
Int J Oral Maxillofac Surg ; 52(7): 801-805, 2023 Jul.
Article in English | MEDLINE | ID: mdl-36443143

ABSTRACT

This study was performed to present a single operator's experience of in-office (outside of a hospital setting) outpatient orthognathic surgery over a period of 12 years. A total of 254 surgeries were performed during this period. Average procedure times were comparable with published results from studies of similar material. The mean operating time for bimaxillary surgery (n = 21) was 3 hours and 11 minutes. Regarding single-jaw procedures, the mean operating time for Le Fort I osteotomy (n = 115) was 2 hours and 14 minutes and for bilateral sagittal split osteotomy (n = 118) was 2 hours and 1 minute. All patients were discharged from the office the same day, except one patient who was transported to the hospital after surgery due to an anaesthetic complication. This patient was discharged from the hospital later the same day. In this setting, outpatient orthognathic surgery is both safe and practical when careful attention is given to patient preparation and selection. Emergency phone contact with the surgeon in case of complications is important to avoid unnecessary hospitalization.


Subject(s)
Orthognathic Surgery , Orthognathic Surgical Procedures , Humans , Orthognathic Surgical Procedures/methods , Outpatients , Patient Discharge , Osteotomy, Le Fort/methods
2.
Rev Med Interne ; 42(2): 79-85, 2021 Feb.
Article in French | MEDLINE | ID: mdl-33160706

ABSTRACT

INTRODUCTION: Patients admitted from emergency units represent a large portion of the population in internal medicine departments. The aim of this study is to identify characteristics of patients and organization of these departments. METHODS: Between June 29th and July 26th 2015, voluntary internal medicine departments from the SiFMI group prospectively filled anonymized internet forms to collect data of each patients admitted in their ward from emergency units, during seven consecutive days. RESULTS: Three hundred and sixty-five patients from emergency departments were admitted in 18 internal medicine inpatients departments, totalling 1100 beds and 33,530 annual stays, 56% of them for emergency units inpatients. Mean age was 68 years, 54% were women, mean Charlson score was 2.6 and 44% of the patients took at least three drugs. Main causes of hospitalization were infectious (29%) and neurological (17%) diseases. Mean length of stay was 9.2 days. The medical team was composed by a median value of 4,5 [2,75-6,25] senior full-time equivalents, 86% were internists. Each department except one received residents, two third of them were from general medicine. CONCLUSION: This study highlights a high organizational variability among internal medicine departments and patients, and sets internal medicine as a specialty with a great capacity to achieve an integrative/comprehensive management of patients and to offer a comprehensive basis for physicians in training.


Subject(s)
Emergency Service, Hospital , Internal Medicine , Aged , Cross-Sectional Studies , Female , Hospitalization , Hospitals , Humans
3.
Med Mal Infect ; 50(1): 36-42, 2020 Feb.
Article in English | MEDLINE | ID: mdl-30982671

ABSTRACT

OBJECTIVE: The WHO recommends same-day sputum smear microscopy for the diagnosis of smear-positive tuberculosis (TB) in countries with high TB burden for earlier diagnosis and treatment, a cornerstone to prevent air-borne transmission. We aimed to compare the conventional strategy (sputum collection on three consecutive days) and the same-day strategy (hour h, h+1, h+2) in France, a country with low TB burden. PATIENTS AND METHODS: Over a six-month period, all adult individuals presenting with presumptive smear-positive TB were eligible for the study, registered in https://clinicaltrials.gov/ ID (NCT02961569). Sputum specimens were collected three times the first day, then once on the second day and once on the third day. The concordance between the two strategies regarding smears and cultures were assessed. RESULTS: Of the 131 eligible individuals, 34 were given a TB treatment. Smears from hour h, h+1, h+2, day two and three were negative in 19 of these 34 patients. Positive smears were obtained in 15, 14, 15, 14, and 14 patients at hour h, h+1, h+2, on day two and three, respectively. Concordance regarding smear or culture was good, with Kappa 0.69 and 0.64, respectively. CONCLUSION: The same-day strategy seems to be a good alternative to the conventional strategy.


Subject(s)
Mycobacterium tuberculosis/isolation & purification , Sputum/microbiology , Tuberculosis, Pulmonary/diagnosis , Tuberculosis, Pulmonary/microbiology , Adult , Aged , Aged, 80 and over , Early Diagnosis , Female , France , Humans , Male , Middle Aged , Prospective Studies , Time Factors , Young Adult
4.
Curr Alzheimer Res ; 16(9): 843-851, 2019.
Article in English | MEDLINE | ID: mdl-31453786

ABSTRACT

BACKGROUND: Growing evidence suggests that pathological processes leading to Alzheimer's disease occurs gradually and begins to develop decades before the earliest clinical symptoms occur. The use of biomarkers has been proposed to detect evidence of preclinical Alzheimer's pathologic change in asymptomatic subjects. Subjective cognitive complaints (SCC) i.e. self-reported cognitive decline with normal cognition have been reported as an indicator of future cognitive decline, however, this condition is unspecific. OBJECTIVE: In the present study we used the regional brain perfusion measured by HMPAO-SPECT as Biomarker of neurodegeneration to compare the regional brain perfusion of patient with subjective cognitive complaints with and without minimal cognitive dysfunction (SCC+ and SCC- respectively) in respect to patients with mild cognitive impairment (MCI). METHODS: We retrospectively examined 736 Patients who referred to our Memory Clinic because of suspected cognitive dysfunction. After exclusion of patients with overt dementia, automated, quantitatively assessed relative cerebral blood flow of 10 forebrain regions (thalamus, parietotemporal, medial temporal, posterior temporal, posterior cingulate gyrus, each region left hemispheric and right hemispheric) and neuropsychological assessment of 64 SCC (32 SCC+; 32 SCC-) and 28 MCI subjects were analysed. RESULTS: .The most relevant differences between groups in cognitive performance concerned verbal memory. Left hemispheric medial temporal region could significantly discriminate between all three groups, with a progressive decrease n perfusion from SCC towards MCI. Area under the curve of left medial temporal region showed a sensitivity of 0,61 and a specificity of 0,78 for discriminating MCI from SCC. CONCLUSION: Automated analysis of HMPAO-SPECT data of MCI and SCC+ patients showed significant perfusion differences in medial temporal region and impaired verbal memory, both of which are known features of Alzheimer's disease. Perfusion patterns and verbal memory performance in SCC+ are more similar to MCI than SCC-. Thus, SPECT analysis could distinguish those subjects whose perfusion pattern resembles that of an MCI from those who do not. In our opinion, this could identify two populations with a different risk of progression to AD, with SCC+ subjects needing further diagnostic examination and repeated follow-up.


Subject(s)
Brain/diagnostic imaging , Cognition Disorders/diagnostic imaging , Tomography, Emission-Computed, Single-Photon , Aged , Brain/metabolism , Cerebrovascular Circulation , Cognition Disorders/metabolism , Diagnosis, Differential , Diagnostic Self Evaluation , Female , Humans , Image Interpretation, Computer-Assisted , Male , Memory , Neuropsychological Tests , Nickel , Oximes , Pattern Recognition, Automated , Radiopharmaceuticals , Retrospective Studies , Titanium
5.
Gait Posture ; 73: 279-285, 2019 09.
Article in English | MEDLINE | ID: mdl-31394371

ABSTRACT

BACKGROUND: In ambulatory stroke survivors, outdoor walking is important for participation, so adapting to heightened levels (e.g. curbs) is essential. This needs precise step regulation and foot positioning and has to be achieved despite impaired balance and motor regulation. RESEARCH QUESTION: How do stroke patients approach and cross elevated surfaces? METHODS: Gait of 12 hemiparetic stroke patients (62.8 ± 10.3 years; Functional Ambulatory Category 3-5) and 13 controls (60.0 ± 12.4 years) was compared using a sensor carpet and 3D motion capturing to collect tempo-spatial parameters and foot trajectories in two conditions: flat walking vs. approaching to and stepping onto an elevated surface (height 15 cm) in a self-selected manner (6 trials each). Tempo-spatial adaptations were normalized to flat walking while trajectory analysis focused on foot clearance and placement. Complementary assessments included the Dynamic-Gait-Index, the Berg-Balance-Test and the Falls Efficacy Scale. RESULTS: Patients showed significantly worse Dynamic-Gait-Indices, less balance and more fear of falling. During the approach phase, patients slowed down, partly accompanied by shorter steps which controls did not. During crossing, no preference for a specific leading leg was detected. Clearance of the leading leg on average was not reduced but patients landed closer to the edge. Still clearance of the paretic leg was less than that of the non-paretic leg and the minimal clearance across all trials suggested an increased tripping risk, most evident for the trailing leg. In particular slower approaching caused difficulties to ensure sufficient leg clearance and to place the foot safely. Independent from that, better balance correlated with safer clearance. SIGNIFICANCE: When managing elevated levels, leading with the paretic leg causes more difficulties to safely clear the legs which is considerably dependent upon speed. Therapists should consider that slow walking may not increase safety while faster gait and aspects of postural control potentially facilitate crossing a curb.


Subject(s)
Adaptation, Physiological , Gait Disorders, Neurologic/physiopathology , Paresis/physiopathology , Stroke/physiopathology , Accidental Falls , Aged , Biomechanical Phenomena , Case-Control Studies , Female , Foot , Gait Analysis , Gait Disorders, Neurologic/etiology , Humans , Male , Middle Aged , Paresis/etiology , Postural Balance/physiology , Spatio-Temporal Analysis , Stroke/complications
7.
Clin Microbiol Infect ; 25(2): 242-247, 2019 Feb.
Article in English | MEDLINE | ID: mdl-29730222

ABSTRACT

OBJECTIVES: Superficial swab sampling of American tegumentary leishmaniasis (ATL) lesions shows higher amounts of Leishmania than those from biopsy. Subcutaneous involvement is also important in ATL, but parasite quantification according to lesion depth has not been evaluated. We aim to present the best depth at which sampling should be performed for molecular exams of ATL. METHODS: Patients with a clinical presentation compatible with ATL were allocated to ATL and control groups. Qualitative and quantitative qPCR assays were performed using SYBR Green and primers amplifying the kDNA minicircle of Leishmania spp. in different skin layers, including the epidermis, the superior dermis, the inferior dermis, and the hypodermis. RESULTS: Fifty-nine patients were included in this study, including 40 who had been diagnosed with ATL and 19 controls. The number of parasites was greater in samples of the epidermis and superior dermis (159.1 × 106, range 4.0-781.7, and 75.4 × 106, range 8.0-244.5, mean Leishmania parasite equivalents per µg of tissue DNA, respectively) than those in samples of the inferior dermis and hypodermis (54.6, range 8.0-256.6, and 16.8 × 106, range 8.0-24.1, mean Leishmania parasite equivalents per µg of tissue DNA, respectively). The best diagnostic accuracy was achieved in the superior dermis (77.9%) and was significantly greater than that in the hypodermis (63.3%; p 0.039). CONCLUSIONS: We conclude that superficial sampling can retrieve a greater quantity of parasites. Future studies of the role of transepidermal elimination as a mechanism of host defence in ATL must be performed as there is a considerable quantity of Leishmania kDNA in the epidermis.


Subject(s)
DNA, Kinetoplast/genetics , Leishmania/genetics , Leishmaniasis, Cutaneous/parasitology , Polymerase Chain Reaction/methods , Skin/parasitology , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged
9.
Phys Rev Lett ; 120(6): 062503, 2018 Feb 09.
Article in English | MEDLINE | ID: mdl-29481255

ABSTRACT

A precision mass investigation of the neutron-rich titanium isotopes ^{51-55}Ti was performed at TRIUMF's Ion Trap for Atomic and Nuclear science (TITAN). The range of the measurements covers the N=32 shell closure, and the overall uncertainties of the ^{52-55}Ti mass values were significantly reduced. Our results conclusively establish the existence of the weak shell effect at N=32, narrowing down the abrupt onset of this shell closure. Our data were compared with state-of-the-art ab initio shell model calculations which, despite very successfully describing where the N=32 shell gap is strong, overpredict its strength and extent in titanium and heavier isotones. These measurements also represent the first scientific results of TITAN using the newly commissioned multiple-reflection time-of-flight mass spectrometer, substantiated by independent measurements from TITAN's Penning trap mass spectrometer.

10.
EBioMedicine ; 27: 51-60, 2018 Jan.
Article in English | MEDLINE | ID: mdl-29273355

ABSTRACT

BACKGROUND: We describe a homosexual man who strongly controlled HIV-1 for ten years despite lack of protective genetic background. METHODS: HIV-1 DNA was measured in blood and other tissues. Cell susceptibility was evaluated with various strains. HIV-1-specific (CD4 and CD8 activation markers and immune check points) and NK cells responses were assessed; KIRs haplotypes and HLA alleles were determined. FINDINGS: Two HIV-1 RNA copies/mL of plasma were detected in 2009, using an ultra-sensitive assay. HIV-DNA was detected at 1.1 and 2 copies/106 PBMCs in 2009 and 2015 respectively, at 1.2 copies/106 cells in rectal cells in 2011. WBs showed weak reactivity with antibodies to gp160, p55 and p25 from 2007 to 2014, remaining incomplete in 2017. CD4 T cells were susceptible to various strains including HIVKON, a primary isolate of his own CRF02_AG variant. CD8 T cells showed a strong poly-functional response against HIV-Gag, producing mainly IFN-γ; a robust capacity of antibody-dependant cell cytotoxicity (ADCC) was observed in NK cells. Case patient was group B KIR haplotype. Neutralizing antibodies were not detected. CD4 and CD8 blood T cells showed normal proportions without increased activation markers. Phylogenetic analyses identified the same CRF02_AG variant in his partner. The patient and his partner were heterozygous for the CCR5ΔD32 deletion and shared HLA-B*07, C*07 non-protective alleles. INTERPRETATION: This thorough description of the natural history of an individual controlling HIV-1 in various compartments for ten years despite lack of protective alleles, and of his partner, may have implications for strategies to cure HIV-1 infection.


Subject(s)
Genetic Background , Homosexuality, Male/genetics , Sexual Partners , Adult , HIV Infections/genetics , HIV Infections/immunology , HIV Infections/virology , HIV-1/physiology , Humans , Male , Phylogeny , T-Lymphocytes/immunology
11.
J Thromb Haemost ; 15(3): 429-438, 2017 03.
Article in English | MEDLINE | ID: mdl-28120516

ABSTRACT

Essentials In venous thromboembolism (VTE), it is uncertain if enoxaparin should be given twice or once daily. We compared the 15- and 30-day outcomes in VTE patients on enoxaparin twice vs. once daily. Patients on enoxaparin once daily had fewer major bleeds and deaths than those on twice daily. The rate of VTE recurrences was similar in both subgroups. SUMMARY: Background In patients with acute venous thromboembolism (VTE), it is uncertain whether enoxaparin should be administered twice or once daily. Methods We used the RIETE Registry data to compare the 15- and 30-day rates of VTE recurrence, major bleeding and death between patients receiving enoxaparin twice daily and those receiving it once daily. We used propensity score matching to adjust for confounding variables. Results The study included 4730 patients: 3786 (80%) received enoxaparin twice daily and 944 once daily. During the first 15 days, patients on enoxaparin once daily had a trend towards more VTE recurrences (odds ratio [OR], 1.79; 95% confidence interval [CI], 0.55-5.88), fewer major bleeds (OR, 0.42; 95% CI, 0.17-1.08) and fewer deaths (OR, 0.32; 95% CI, 0.13-0.78) than those on enoxaparin twice daily. At day 30, patients on enoxaparin once daily had more VTE recurrences (OR, 2.5; 95% CI, 1.03-5.88), fewer major bleeds (OR, 0.40; 95% CI, 0.17-0.94) and fewer deaths (OR, 0.58; 95% CI, 0.33-1.00). On propensity analysis, patients on enoxaparin once daily had fewer major bleeds at 15 (hazard ratio [HR], 0.30; 95% CI, 0.10-0.88) and at 30 days (HR, 0.16; 95% CI, 0.04-0.68) and also fewer deaths at 15 (HR, 0.37; 95% CI, 0.14-0.99) and at 30 days (HR, 0.19; 95% CI, 0.07-0.54) than those on enoxaparin twice daily. Conclusions Our findings confirm that enoxaparin prescribed once daily results in fewer major bleeds than enoxaparin twice daily, as suggested in a meta-analysis of controlled clinical trials.


Subject(s)
Enoxaparin/administration & dosage , Venous Thromboembolism/drug therapy , Acute Disease , Aged , Anticoagulants/administration & dosage , Drug Administration Schedule , Europe , Female , Hemorrhage , Humans , Male , Middle Aged , Recurrence , Registries , Retrospective Studies , Risk Factors , Treatment Outcome , Venous Thrombosis/drug therapy
12.
Rev Med Interne ; 38(4): 269-273, 2017 Apr.
Article in French | MEDLINE | ID: mdl-27363932

ABSTRACT

INTRODUCTION: We report an unusual observation of central nervous system (CNS) lymphoma in a 60-year-old woman with systemic lupus erythematosus and fatal outcome. OBSERVATION: The patient had systemic erythematosus lupus for 7 years, treated with mycophenolate mofetil and developed lymphocytic meningitis in 2015 associated to the presence of EBV in the cerebrospinal fluid and a necrotic vermis' lesion. Diagnosis of large B-cell lymphoma was histologically confirmed from stereotaxic biopsy, shortly before she died from neurological complications. CONCLUSION: Even though the current association is unusual, lymphocytic meningitis with hypoglycorrachia in patients with systemic lupus erythematosus may reveal CNS lymphoma and diagnosis confirmation requires stereotaxic biopsy in order not to delay specific therapeutic management.


Subject(s)
Central Nervous System Neoplasms/diagnosis , Lupus Erythematosus, Systemic/diagnosis , Lymphoma/diagnosis , Meningitis/diagnosis , Central Nervous System Neoplasms/complications , Diagnosis, Differential , Fatal Outcome , Female , Humans , Leukemic Infiltration/complications , Lupus Erythematosus, Systemic/complications , Lymphoma/complications , Meningitis/etiology , Middle Aged
13.
Pharmacol Res ; 118: 82-92, 2017 04.
Article in English | MEDLINE | ID: mdl-27693910

ABSTRACT

An interaction of drug with food, herbs, and dietary supplements is usually the consequence of a physical, chemical or physiologic relationship between a drug and a product consumed as food, nutritional supplement or over-the-counter medicinal plant. The current educational review aims at reminding to the prescribing physicians that the most clinically relevant drug-food interactions may not be strictly limited to those with grapefruit juice and with the Saint John's Wort herbal extract and may be responsible for changes in drug plasma concentrations, which in turn decrease efficacy or led to sometimes life-threatening toxicity. Common situations handled in clinical practice such as aging, concomitant medications, transplant recipients, patients with cancer, malnutrition, HIV infection and those receiving enteral or parenteral feeding may be at increased risk of drug-food or drug-herb interactions. Medications with narrow therapeutic index or potential life-threatening toxicity, e.g., the non-steroidal anti-inflammatory drugs, opioid analgesics, cardiovascular medications, warfarin, anticancer drugs and immunosuppressants may be at risk of significant drug-food interactions to occur. Despite the fact that considerable effort has been achieved to increase patient' and doctor's information and ability to anticipate their occurrence and consequences in clinical practice, a thorough and detailed health history and dietary recall are essential for identifying potential problems in order to optimize patient prescriptions and drug dosing on an individual basis as well as to increase the treatment risk/benefit ratio.


Subject(s)
Citrus paradisi , Food-Drug Interactions , Fruit and Vegetable Juices , Herb-Drug Interactions , Hypericum , Cytochrome P-450 CYP3A Inhibitors/pharmacology , Dietary Supplements , Humans , Liver-Specific Organic Anion Transporter 1/antagonists & inhibitors , Micronutrients/administration & dosage , Pharmacovigilance , Warfarin/pharmacology
14.
Dis Esophagus ; 30(2): 1-5, 2017 02 01.
Article in English | MEDLINE | ID: mdl-27766725

ABSTRACT

The aim of this study was to determine the outcome of salvage definitive chemoradiation (dCRT) for a locoregional recurrence after any prior curative treatment outside previously irradiated areas. Thirty-nine patients treated between January 2005 and December 2014 were reviewed for locoregional recurrent esophageal cancer outside previously irradiated areas. All patients received salvage treatment with external beam radiotherapy (50.4 Gy in 28 fractions) combined with weekly concurrent paclitaxel and carboplatin. The median follow-up period was 15 months (range 1.7-120). The median overall survival (OS) for all patients after salvage dCRT was 22 months (95% CI 6.2-37.6). The 1-, 3-, and 5-year OS was 72%, 31%, and 28%, respectively. Median survival after salvage dCRT for a regional lymph node recurrence was 33 months (95% CI 5.8-60.3) versus 14 months (95% CI 6.8-21.6) for a recurrence at the anastomosis (P = 0.022, logrank). Median OS was 35 months for the squamous cell carcinoma group and 19 months for the adenocarcinoma group (P = 0.67). Sixteen of 39 patients developed a locoregional recurrence after salvaged dCRT. The median locoregional recurrence-free survival (LRFS) was 24 months. The 1-, 3-, and 5-year LRFS was 79%, 36%, and 36%, respectively. Median disease-free survival (DFS) was 15 months. The 1-, 3-, and 5-year DFS was 66%, 27%, and 27%, respectively. Of 16 patients, 8 (50%) with a primary failure at the site of the anastomosis developed a local recurrence after salvaged dCRT compared to 7 of 22 patients (32%) with a primary recurrence in a lymph node. Definitive chemoradiation is a feasible and effective treatment for locoregional recurrent esophageal cancer outside a previously irradiated area, and should be given with a curative intent. This holds true for recurrence of both squamous cell carcinoma and adenocarcinoma. Lymph node recurrences have a markedly better prognosis than recurrences at the site of the anastomosis.


Subject(s)
Chemoradiotherapy/methods , Esophageal Neoplasms/therapy , Esophagus/surgery , Neoplasm Recurrence, Local/therapy , Salvage Therapy/methods , Adenocarcinoma/pathology , Adenocarcinoma/therapy , Adult , Aged , Aged, 80 and over , Anastomosis, Surgical/adverse effects , Anastomosis, Surgical/methods , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Carboplatin/administration & dosage , Carcinoma, Squamous Cell/pathology , Carcinoma, Squamous Cell/therapy , Disease-Free Survival , Esophageal Neoplasms/pathology , Esophagus/pathology , Feasibility Studies , Female , Follow-Up Studies , Humans , Lymph Nodes/pathology , Male , Middle Aged , Neoplasm Recurrence, Local/pathology , Paclitaxel/administration & dosage , Prognosis , Retrospective Studies , Treatment Outcome , Young Adult
15.
Int J Oral Maxillofac Surg ; 45(11): 1452-1458, 2016 Nov.
Article in English | MEDLINE | ID: mdl-27364368

ABSTRACT

The Obwegeser and Dal Pont modification of the bilateral sagittal split osteotomy (BSSO) is a well-established procedure in orthognathic surgery. The purpose of this retrospective study was to analyze the actual fracture patterns achieved with BSSO by Obwegeser and Dal Pont modification using postoperative cone beam computed tomography (CBCT) datasets from 100 patients. A total of 200 split osteotomies were assessed, which could be categorized into nine different split patterns. Only one of the observed split fractures (0.5%) followed exactly the fracture line described by Obwegeser and Dal Pont, whereas 40% followed the fracture line according to the Hunsuck and Epker modification and 13.5% were seen as unfavourable splits mainly running over the buccal plate. A significant correlation was found between unfavourable buccal splits and both horizontal osteotomies reaching the buccal surface at the dorsal ramus (P=0.001) and a vertical caudal bone cut end at the corpus with a buccal position (P<0.001). These results show that a complete antero-posterior horizontal osteotomy at the mandibular ramus does not lead to the intended fracture pattern, which rebuts the argument of a greater amount of bony overlap using the Obwegeser and Dal Pont modification.


Subject(s)
Cone-Beam Computed Tomography , Mandible/diagnostic imaging , Mandible/surgery , Osteotomy, Sagittal Split Ramus/methods , Adult , Female , Humans , Male , Osteotomy/methods , Osteotomy, Sagittal Split Ramus/adverse effects , Osteotomy, Sagittal Split Ramus/statistics & numerical data , Retrospective Studies , Young Adult
17.
J Neurol ; 263(9): 1819-27, 2016 Sep.
Article in English | MEDLINE | ID: mdl-27334906

ABSTRACT

Postural instability is a frequent symptom of patients with idiopathic normal pressure hydrocephalus (iNPH), and might be due to the misperception of body verticality. The objective of this study was to assess the usefulness of the subjective body vertical (SBV) as a potential tool for diagnosing iNPH. Twenty patients with iNPH underwent tests of SBV in the pitch and roll planes before and after cerebrospinal fluid (CSF) drainage. Ten patients with other central gait disorders served as controls and also underwent tests for SBV. Before CSF drainage, patients with iNPH showed an impaired verticality perception in the pitch plane with a significant backward deviation of the SBV as compared to the control group (iNPH: mean ± SD -3.7 ± 3.6°; control group: -0.8 ± 2.2°; t value = -2.30, p t-test = 0.03). After CSF drainage, the SBV of the iNPH patients normalized for the pitch plane (-0.9 ± 1.9°). There was a correlation between the backward deviation of the SBV and the ventricular enlargement of the frontal horns (Evan's index; r = -0.52; p Pearson = 0.02). An even stronger correlation was found with the enlargement of the third ventricle (Thalamus index; r = -0.64; p Pearson = 0.002). The new and clinically relevant finding of this study is that verticality perception of patients with iNPH is primarily impaired the pitch plane, and it improves after CSF drainage. This disturbance in pitch might be due to a bilateral central vestibular dysfunction of the thalamus. Determination of the SBV in pitch promises to increase diagnostic accuracy in the cases of suspected iNPH.


Subject(s)
Hydrocephalus, Normal Pressure/diagnosis , Neurologic Examination/methods , Perception , Postural Balance , Proprioception , Accidental Falls , Aged , Biomechanical Phenomena , Cerebrospinal Fluid Shunts , Drainage , Female , Gait Disorders, Neurologic/diagnosis , Humans , Hydrocephalus, Normal Pressure/diagnostic imaging , Hydrocephalus, Normal Pressure/therapy , Male , Neuropsychological Tests , Severity of Illness Index , Third Ventricle/diagnostic imaging
18.
Klin Padiatr ; 228(6-07): 325-331, 2016 Nov.
Article in German | MEDLINE | ID: mdl-27171924

ABSTRACT

Background: In Germany some 2 000 children and adolescent are diagnosed with cancer every year. Curing rates are increasing and therewith also the number of survivors is growing. Survivors frequently suffer from long-term effects of the disease and its treatment, but long-term follow-up care shows deficits. Method: The Network for oncological advisory service (NOF) started in 11/2013, researching and building up a network of available support in Lower Saxony. A telephone hotline was installed in 01/2014 in order to advice survivors on their problems. At the same time, an interview study on survivors needs was conducted throughout Germany. Results: In the first 2 years, the NOF gave advice to 79 patients. Whilst enquiries of medical or psychological nature were transferred to the cooperation partner, requests on psychosocial and social legal issues are being deled by the NOF due to lack of appropriate partners. The evaluation of 25 interviews shows key issues in long-term after-care: (1) transition from acute therapy to everyday life, (2) problems due to pediatric cancer and therapy, (3) patients perception of own disposition, (4) social reactions towards survivors, (5) structure of long-term follow-up care, (6) information flow. Conclusion: Many survivors suffer from long-term effects of cancer and treatment. The lack of available contact person and being in limbo between cured and simultaneously affected by the cancer treatment and chronic diseases is perceived as being problematic. This translates to various requirements on a patient-oriented long-term care, mainly in the psychosocial field.


Subject(s)
Aftercare/organization & administration , Consultants , Hotlines/organization & administration , Interdisciplinary Communication , Intersectoral Collaboration , Long-Term Care/organization & administration , Patient Care Team/organization & administration , Referral and Consultation/organization & administration , Adolescent , Adult , Child , Evaluation Studies as Topic , Follow-Up Studies , Germany , Health Services Needs and Demand/organization & administration , Humans , Interview, Psychological , Patient Satisfaction , Pilot Projects , Survivors , Transitional Care/organization & administration , Young Adult
19.
HIV Med ; 17(7): 550-6, 2016 08.
Article in English | MEDLINE | ID: mdl-27186847

ABSTRACT

OBJECTIVES: HIV-infected individuals are at increased risk of incident fractures. Evaluation of trabecular bone micro-architecture is an important tool to assess bone strength, but its use has not yet been reported in middle-aged HIV-infected male individuals. The aim of the study was to compare bone micro-architecture between HIV-infected and HIV-uninfected men. METHODS: In this cross-sectional study, 53 HIV-infected male individuals with a mean (± standard deviation) age of 49 ± 9 years who had been receiving antiretroviral therapy including tenofovir disoproxil fumarate (DF) for at least 60 months were compared with 50 HIV-uninfected male controls, matched for age and ethnic origin. We studied the volumetric bone density and micro-architecture of the radius and tibia using high-resolution peripheral quantitative computed tomography (HR-p QCT). RESULTS: Volumetric trabecular bone density was 17% lower in the tibia (P < 10(-4) ) and 16% lower in the radius (P < 10(-3) ) in HIV-infected patients compared with controls. By contrast, the cortical bone density was normal at both sites. The tibial trabecular micro-architecture differed markedly between patients and controls: bone volume/total volume (BV/TV) and trabecular number were each 13% lower (P < 10(-4) for both). Trabecular separation and inhomogeneity of the network were 18% and 24% higher in HIV-infected patients than in controls, respectively. The radial BV/TV and trabecular thickness were each 13% lower (P < 10(-3) and 10(-2) , respectively). Cortical thickness was not different between the two groups. CONCLUSIONS: The findings of lower volumetric trabecular bone density and disrupted trabecular micro-architectural parameters in middle-aged male HIV-infected treated patients help to explain bone frailty in these patients.


Subject(s)
Anti-Retroviral Agents/therapeutic use , Bone Diseases/pathology , Cancellous Bone/pathology , HIV Infections/complications , HIV Infections/drug therapy , Adult , Bone Density , Bone Diseases/diagnostic imaging , Cross-Sectional Studies , Humans , Male , Middle Aged , Radius/pathology , Tenofovir/therapeutic use , Tibia/pathology , Tomography, X-Ray Computed
20.
Neotrop Entomol ; 45(4): 351-6, 2016 Aug.
Article in English | MEDLINE | ID: mdl-26868654

ABSTRACT

Proeulia triquetra Obraztsov (Lepidoptera: Tortricidae) is an occasional pest in fruit orchards in central-southern Chile. In order to develop species-specific lures for detection and monitoring of this species, we identified the female-produced sex pheromone. (Z)-11-Tetradecenyl acetate (Z11-14:OAc), (E)-9-dodecenyl acetate (E9-12:OAc), and (E)-11-Tetradecenyl acetate (E11-14:OAc) were identified as biologically active compounds present in female pheromone glands by solvent extraction of the gland and analysis of the extracts by gas chromatography-electroantennographic detection and gas chromatography-mass spectrometry. In field tests, lures baited with synthetic Z11-14:OAc and E9-12:OAc in a 10:1 ratio were highly attractive to males of the species.


Subject(s)
Fatty Acids, Monounsaturated/chemistry , Lepidoptera , Sex Attractants , Animals , Chile , Fatty Acids, Monounsaturated/pharmacology , Female , Male , Moths
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