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1.
Ann Intensive Care ; 12(1): 39, 2022 May 08.
Article in English | MEDLINE | ID: mdl-35526199

ABSTRACT

INTRODUCTION: The reports of an early and profound acquired immunodepression syndrome (AIDs) in ICU patients had gained sufficient credence to modify the paradigm of acute inflammation. However, despite several articles published on AIDs and its assessment by monocytic HLA-DR monitoring, several missing informations remained: 1-Which patients' are more prone to benefit from mHLA-DR measurement, 2-Is the nadir or the duration of the low mHLA-DR expression the main parameter to consider? 3-What are the compared performances of leukocytes' count analyses (lymphocyte, monocyte). MATERIAL AND METHOD: We conducted an observational study in a surgical ICU of a French tertiary hospital. A first mHLA-DR measurement (fixed flow cytometry protocol) was performed within the first 3 days following admission and a 2nd, between day 5 and 10. The other collected parameters were: SAPS II and SOFA scores, sex, age, comorbidities, mortality and ICU-acquired infections (IAI). The associations between mHLA-DR and outcomes were tested by adjusted Fine and Gray subdistribution competing risk models. RESULTS: 1053 patients were included in the study, of whom 592 had a 2nd mHLA-DR measurement. In this cohort, 223 patients (37.7%) complicated by IAI. The initial decrement in mHLA-DR was not associated with the later occurrence of IAI, (p = 0.721), however, the persistence of a low mHLA-DR (< 8000 AB/C), measured between day 5 and day 7, was associated with the later occurrence of IAI (p = 0.01). Similarly, a negative slope between the first and the second value was significantly associated with subsequent IAI (p = 0.009). The best performance of selected markers was obtained with the combination of the second mHLA-DR measurement with SAPSII on admission. Persisting lymphopenia and monocytopenia were not associated with later occurrence of IAI. CONCLUSION: Downregulation of mHLA-DR following admission is observed in a vast number of patients whatever the initial motif for admission. IAI mostly occurs among patients with a high severity score on admission suggesting that immune monitoring should be reserved to the most severe patients. The initial downregulation did not preclude the later development of IAI. A decreasing or a persisting low mHLA-DR expression below 8000AB/C within the first 7 days of ICU admission was independently and reliably associated with subsequent IAI among ICU patients with performances superior to leukocyte subsets count alone.

2.
Arch Pediatr ; 29(4): 253-257, 2022 May.
Article in English | MEDLINE | ID: mdl-35351343

ABSTRACT

Neonatal screening for congenital hypothyroidism (CH) is based on the measurement of thyroid-stimulating hormone (TSH) in whole dried blood samples on filter paper in all newborns. The objective of screening for CH is to prevent mental retardation, which is irreversible in the event of a late diagnosis, by setting up prompt treatment (before day 15) with levothyroxine. The threshold value of TSH on filter paper on day 3 is 17 mIU/L in France in the GSP method (GSP, Genetic Screening Processor, Perkin Elmer): It is one of the highest thresholds used in the world. In many countries, the TSH threshold is between 6 and 12 mIU/L. Studies have found that a threshold of > 17 mIU/L may miss as much as 30% of cases of CH, with 30-80% of these being permanent CH. Recent studies suggest that mild CH (currently missed by the French TSH threshold) is associated with cognitive consequences if left untreated. An inverse relationship between TSH at screening (below the current threshold) and cognitive development at preschool or school age has been shown. These studies advocate for the evaluation of a lowering of the threshold of TSH on filter paper in France: (a) to determine the number of CH diagnoses with the new threshold and whether these "new cases" would be transitory or permanent; and (b) to analyze the cost-effectiveness of the strategy.


Subject(s)
Congenital Hypothyroidism , Neonatal Screening , Congenital Hypothyroidism/complications , Congenital Hypothyroidism/diagnosis , France , Humans , Infant, Newborn , Neonatal Screening/methods , Thyrotropin
3.
Clin Nutr ; 41(12): 2918-2923, 2022 12.
Article in English | MEDLINE | ID: mdl-35140034

ABSTRACT

PURPOSE: Evaluation of CT sarcopenia as a predictor of intensive care hospitalization during SARS-COV2 infection. MATERIALS AND METHODS: Single-center retrospective study of patients admitted to hospital with SARS-COV2 infection. The estimation of muscle mass (skeletal muscle index (SMI)) for sarcopenia, measurement of muscle density for muscle quality and body adiposity, were based on CT views on the T4 and L3 levels measured at admission. Demographic data, percentage of pulmonary parenchymal involvement as well as the orientation of patients during hospitalization and the risk of hospitalization in intensive care were collected. RESULTS: A total of 162 patients hospitalized for SARS-COV2 infection were included (92 men and 70 women, with an average age of 64.6 years and an average BMI of 27.4). The muscle area measured at the level of L3 was significantly associated with the patient's unfavorable evolution (124.4cm2 [97; 147] vs 141.5 cm2 [108; 173]) (p = 0.007), as was a lowered SMI (p < 0.001) and the muscle area measured in T4 (OR = 0.98 [0.97; 0.99]), (p = 0.026). Finally, an abdominal visceral fat area measured at the level of L3 was also associated with a risk of hospitalization in intensive care (249.4cm2 [173; 313] vs 147.5cm2 [93.1; 228] (p < 0.001). CONCLUSION: This study demonstrates that thoracic and abdominal sarcopenia are independently associated with an increased risk of hospitalization in an intensive care unit, suggesting the need to assess sarcopenia on admission during SARS-COV2 infection.


Subject(s)
COVID-19 , Sarcopenia , Male , Humans , Female , Middle Aged , Sarcopenia/complications , RNA, Viral , Retrospective Studies , Tomography, X-Ray Computed , SARS-CoV-2 , Muscle, Skeletal/diagnostic imaging , Muscle, Skeletal/pathology
4.
Intensive Care Med ; 45(8): 1103-1111, 2019 08.
Article in English | MEDLINE | ID: mdl-31292686

ABSTRACT

PURPOSE: We aimed to study the association of body temperature and other admission factors with outcomes of herpes simplex encephalitis (HSE) adult patients requiring ICU admission. METHODS: We conducted a retrospective multicenter study on patients diagnosed with HSE in 47 ICUs in France, between 2007 and 2017. Fever was defined as a body temperature higher or equal to 38.3 °C. Multivariate logistic regression analysis was used to identify factors associated with poor outcome at 90 days, defined by a score of 3-6 (indicating moderate-to-severe disability or death) on the modified Rankin scale. RESULTS: Overall, 259 patients with a score on the Glasgow coma scale of 9 (6-12) and a body temperature of 38.7 (38.1-39.2) °C at admission were studied. At 90 days, 185 (71%) patients had a poor outcome, including 44 (17%) deaths. After adjusting for age, fever (OR = 2.21; 95% CI 1.18-4.16), mechanical ventilation (OR = 2.21; 95% CI 1.21-4.03), and MRI brain lesions > 3 lobes (OR = 3.04; 95% CI 1.35-6.81) were independently associated with poor outcome. By contrast, a direct ICU admission, as compared to initial admission to the hospital wards (i.e., indirect ICU admission), was protective (OR = 0.52; 95% CI 0.28-0.95). Sensitivity analyses performed after adjustment for functional status before admission and reason for ICU admission yielded similar results. CONCLUSIONS: In HSE adult patients requiring ICU admission, several admission factors are associated with an increased risk of poor functional outcome. The identification of potentially modifiable factors, namely, elevated admission body temperature and indirect ICU admission, provides an opportunity for testing further intervention strategies.


Subject(s)
Encephalitis, Herpes Simplex/complications , Physical Functional Performance , Aged , Cohort Studies , Encephalitis, Herpes Simplex/epidemiology , Female , France/epidemiology , Hospitalization/statistics & numerical data , Humans , Intensive Care Units/organization & administration , Intensive Care Units/statistics & numerical data , Male , Middle Aged , Outcome Assessment, Health Care/statistics & numerical data , Retrospective Studies
5.
Intensive Care Med ; 45(9): 1331-1332, 2019 Sep.
Article in English | MEDLINE | ID: mdl-31346675

ABSTRACT

The original article unfortunately contained a mistake. Due to technical problems the study group was not tagged correctly. Please find the correct tagging down below. We apologize for the mistake.

6.
Arch Pediatr ; 23(8): 840-4, 2016 Aug.
Article in French | MEDLINE | ID: mdl-27345554

ABSTRACT

Medullary thyroid carcinoma (MTC) is a rare cancer during childhood. MTC is sporadic in approximately 80% of cases and hereditary in 20%. When hereditary, it can be associated with other endocrine neoplasias and/or typical nonendocrine diseases, thus configuring the multiple endocrine neoplasia (MEN) syndromes. Children with clinically obvious MTC belong to MEN 2A or 2B families, related to RET mutations. The standard treatment is total thyroidectomy and central neck dissection. However, treatment of advanced MTC has not yet been standardized, even if a new tyrosine kinase inhibitor specific to RET mutation has changed the outcome of such patients. Vandetanib plays a role in the treatment of children with metastatic, locally advanced and nonoperable MTC, with good tolerance. We report the 5-year treatment of an 11-year-old patient, with vandetanib and without thyroid surgery.


Subject(s)
Carcinoma, Neuroendocrine/drug therapy , Lung Neoplasms/drug therapy , Piperidines/therapeutic use , Protein Kinase Inhibitors/therapeutic use , Quinazolines/therapeutic use , Thyroid Neoplasms/drug therapy , Carcinoma, Neuroendocrine/pathology , Carcinoma, Neuroendocrine/secondary , Child , Female , Humans , Lung Neoplasms/diagnostic imaging , Lung Neoplasms/secondary , Multiple Endocrine Neoplasia Type 2b/pathology , Thyroid Neoplasms/pathology
7.
Cancer Radiother ; 20(2): 83-90, 2016 Apr.
Article in French | MEDLINE | ID: mdl-26969244

ABSTRACT

PURPOSE: Retrospectively evaluate the safety, feasibility and efficacy of concomitant chemoradiotherapy after induction chemotherapy by docetaxel, cisplatin and 5-fluoro-uracil for locally advanced head and neck cancers. PATIENTS AND METHODS: Patients' data from three radiotherapy centres in South of France, with locally advanced head and neck cancers, and treated between December 2007 and July 2013 by concomitant chemoradiotherapy, after induction chemotherapy by docetaxel, cisplatin and 5-fluoro-uracil, were analysed. Adverse effects were graduated according to CTCAE v3.0 criteria. Overall survival and disease-free survival were calculated according to Kaplan-Meier method. RESULTS: One hundred and sixty-eight patients, mostly oropharynx (38%) T4 (46%) N2 (54%) tumors, received, after induction chemotherapy by docetaxel, cisplatin and 5-fluoro-uracil, a concomitant chemoradiotherapy with platin or cetuximab, which delivered 66 to 70Gy. Grade 3-4 adverse effects were less frequent in the group of patients who received cisplatin (with or withour 5-fluoro-uracil) at 100mg/m(2) each 21 days compared to cetuximab (radiomucositis: 32.5% vs 61%, P=0.018; radioepithelitis: 13% vs 61 %, P<0.0001). Chemopotentiation was incomplete for 21% of patients without impacting survival. Two years overall survival and disease-free survival were respectively of 81% and 64%. Lymph nodes status and WHO status significantly influenced these survivals (overall survival 84% if N<3 vs 56% if N3, P=0.017 and 85 % if WHO status ≤ 1 vs 50% if WHO status>1, P=0.006; disease-free survival 66% if N<3 vs 47% if N3, P=0.046). CONCLUSION: The association of induction chemotherapy by docetaxel, cisplatin and 5-fluoro-uracil and concomitant chemoradiotherapy shows satisfying results with an acceptable toxicity. The terms of the chemopotentiation and its superiority to a single concomitant chemoradiotherapy treatment still remain to be clarified.


Subject(s)
Chemoradiotherapy , Head and Neck Neoplasms/mortality , Head and Neck Neoplasms/therapy , Adolescent , Adult , Aged , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Cetuximab/therapeutic use , Cisplatin/administration & dosage , Disease-Free Survival , Docetaxel , Female , Fluorouracil/administration & dosage , France/epidemiology , Head and Neck Neoplasms/pathology , Humans , Lymphatic Metastasis , Male , Middle Aged , Radiotherapy Dosage , Retrospective Studies , Taxoids/administration & dosage , Young Adult
8.
West Indian Med J ; 62(1): 35-8, 2013 Jan.
Article in English | MEDLINE | ID: mdl-24171325

ABSTRACT

OBJECTIVES: High perinatal autopsy rates are necessary for institutional management protocols and national policy-making. This study reviews perinatal autopsy rates and factors affecting these rates at the University Hospital of the West Indies. METHOD: All perinatal deaths (stillborn infants > or = 24 weeks gestation or 500 g; early neonatal deaths ie 0-7 days old) at the University Hospital of the West Indies, between January 2002 and December 2008, were reviewed retrospectively, using the annual perinatal audit records. The annual autopsy rates were calculated and the reasons why autopsies were not done examined. RESULTS: The average stillbirth (SB) autopsy rate was 59.6% (range 51.9 - 76.7%), while that for early neonatal deaths (ENDs) was 47.9% (range 34.4 - 63.2), with an overall average perinatal autopsy rate of 54.0% (range 42.2 - 62.2). Autopsies were requested in 79.3% and 51.7% of SBs and ENDs, respectively. Of those requested, 81.7% were done (75.2% stillbirths; 92.5% ENDs). In the ENDs, failure to request an autopsy was predominantly noted in premature infants weighing < 1000 g (75.2% of those not requested). In stillbirths, the reasons for failure to request were largely unknown with failure to gain permission accounting for only 20.3% of these cases. CONCLUSIONS: The average annual perinatal autopsy rate at the University Hospital of the West Indies between 2002 and 2008 was 54.0%. This is below the internationally recommended rate of 75%. Failure to request an autopsy was the most significant factor contributing to this. The reasons for this are not entirely clear and require further study.


Subject(s)
Autopsy/statistics & numerical data , Fetal Diseases/mortality , Infant, Newborn, Diseases/mortality , Cause of Death , Death Certificates , Female , Fetal Diseases/diagnosis , Fetal Mortality , Hospitals, University/statistics & numerical data , Humans , Infant, Newborn , Infant, Newborn, Diseases/diagnosis , Perinatal Mortality , Pregnancy , Retrospective Studies , Stillbirth , West Indies/epidemiology
9.
West Indian med. j ; 62(1): 35-38, Jan. 2013. ilus, tab
Article in English | LILACS | ID: biblio-1045584

ABSTRACT

OBJECTIVES: High perinatal autopsy rates are necessary for institutional management protocols and national policy-making. This study reviews perinatal autopsy rates and factors affecting these rates at the University Hospital of the West Indies. METHOD: All perinatal deaths (stillborn infants > 24 weeks gestation or 500 g; early neonatal deaths ie 0-7 days old) at the University Hospital of the West Indies, between January 2002 and December 2008, were reviewed retrospectively, using the annual perinatal audit records. The annual autopsy rates were calculated and the reasons why autopsies were not done examined. RESULTS: The average stillbirth (SB) autopsy rate was 59.6% (range 51.9 - 76.7%), while that for early neonatal deaths (ENDs) was 47.9% (range 34.4 - 63.2), with an overall average perinatal autopsy rate of 54.0% (range 42.2 - 62.2). Autopsies were requested in 79.3% and 51.7% of SBs and ENDs, respectively. Of those requested, 81.7% were done (75.2% stillbirths; 92.5% ENDs). In the ENDs, failure to request an autopsy was predominantly noted in premature infants weighing < 1000 g (75.2% of those not requested). In stillbirths, the reasons for failure to request were largely unknown with failure to gain permission accounting for only 20.3% of these cases. CONCLUSIONS: The average annual perinatal autopsy rate at the University Hospital of the West Indies between 2002 and 2008 was 54.0%. This is below the internationally recommended rate of 75%. Failure to request an autopsy was the most significant factor contributing to this. The reasons for this are not entirely clear and require further study.


OBJETIVOS: Las altas tasas autopsia perinatal son necesarias para los protocolos institucionales de tratamiento, y el establecimiento de políticas a nivel nacional. Este estudio examina las tasas de autopsia perinatal y los factores que afectan estas tasas, en el Hospital Universitario de West Indies. MÉTODO: Todas las muertes perinatales (mortinatos > 24 semanas de gestación o 500 g; muertes neonatales tempranas, es decir, 0-7 días de nacido) en el Hospital Universitario de West Indies, entre el 2002 de enero y el 2008 de diciembre, fueron sometidas a examen retrospectivo, usando los registros de auditoría perinatales anuales.Las tasas de autopsia anuales fueron calculadas y se analizaron las razones por las que no se hicieron autopsias. RESULTADOS: La tasa de autopsia promedio de mortinatos (MN) fue 59.6% (rango 51.9-76.7%), mientras que la tasa de autopsia promedio de las muertes neonatales tempranas (MNT) fue 47.9% (rango 34.4-63.2), con una tasa promedio general de autopsia perinatal de 54.0% (rango 42.2-62.2). Se requirieron autopsias en 79.3% y 51.7% de los MN y las MNT respectivamente. De las autopsias requeridas, se realizaron 81.7% (75.2% mortinatos; 92.5% MNT). En relación con las MNT, la no solicitud de autopsia se notó predominantemente en infantes prematuros de peso < 1000 g (75.2% de aquéllos no solicitados). Con respecto a los mortinatos, se desconoce en gran medida las razones por las que no se hizo una solicitud, excepto el no haber obtenido permiso, lo cual explica sólo el 20.3% de los casos. CONCLUSIONES: La tasa de autopsia perinatal promedio anual en el Hospital Universitario de West Indies entre 2002 y 2008 fue 54.0%. Esta cifra se halla por debajo de la tasa internacionalmente recomendada de 75%. La no solicitud de una autopsia fue el factor más significativo que contribuyó a ello. Las razones para esto no están completamente claras y requieren estudio posterior.


Subject(s)
Humans , Female , Infant, Newborn , Autopsy/statistics & numerical data , Hospitals, University/statistics & numerical data , West Indies , Retrospective Studies , Fetal Mortality , Stillbirth , Perinatal Mortality
10.
Diabetologia ; 54(2): 350-9, 2011 Feb.
Article in English | MEDLINE | ID: mdl-20857084

ABSTRACT

AIMS/HYPOTHESIS: Prenatal exposure to excess glucocorticoids associates with low birthweight in rodents, primates and humans and its involvement in programming glucose homeostasis is suspected. Our aim was to further dissect the role of glucocorticoids on beta cell development and function in mice. METHODS: Using the model of maternal general food restriction during the last week of pregnancy, we thoroughly studied in the CD1 mouse-mothers and fetal and adult offspring--the pancreatic, metabolic and molecular consequences of maternal undernutrition associated with excess glucocorticoids. The specific involvement of the glucocorticoid receptor (GR) was studied in mutant fetuses lacking GR in pancreatic precursors or mature beta cells. RESULTS: Maternal general food restriction in the mouse is associated with decreased maternal glucose and increased corticosterone levels. Fetuses from underfed dams had increased corticosterone levels, decreased pancreatic endocrine gene expression but increased exocrine gene expression and a lower beta cell mass. The offspring of these dams had a low birthweight, permanent postnatal growth retardation and, as adults, impaired glucose tolerance, decreased beta cell mass (-50%) and massively reduced islet expression (-80%) of most of the genes involved in beta cell function (e.g. Pdx1, Sur1 [also known as Abcc8], insulin). Moreover, using mutant fetuses lacking GR in pancreatic precursors or beta cells we show that the deleterious effect of undernutrition on fetal beta cell development requires the presence of the GR in pancreatic precursor cells. CONCLUSIONS/INTERPRETATION: These results demonstrate the crucial role of excess fetal glucocorticoids and the importance of GR signalling in progenitor cells to programme beta cell mass and dysfunction.


Subject(s)
Eating/physiology , Glucocorticoids/metabolism , Insulin-Secreting Cells/metabolism , Receptors, Glucocorticoid/metabolism , Animals , Body Composition/physiology , Corticosterone/blood , Female , Fetal Growth Retardation/metabolism , Fetal Growth Retardation/physiopathology , Glucose Tolerance Test , Insulin/metabolism , Islets of Langerhans/metabolism , Male , Mice , Polymerase Chain Reaction , Pregnancy , Receptors, Glucocorticoid/genetics
11.
J Gynecol Obstet Biol Reprod (Paris) ; 40(1): 77-80, 2011 Feb.
Article in French | MEDLINE | ID: mdl-20692777

ABSTRACT

We report the third case of spontaneous monochorionic dizygous pregnancy, discovered on foetal sex discordance. Blood group testing on the female twin revealed a hematopoietic chimera. The mechanism of monochorionic dizygous formation could be the fusion of two independent zygotes at a late morula stage. A single placental mass with vascular anastomosis then develops. Stem cells exchanged during early foetal life can thus lead to chimeras, in similar conditions to stem cell transfusion in adults. Immaturity of the foetal immune system allows cell graft in the other twin's marrow. Assisted reproductive procedures are believed to promote such pregnancies.


Subject(s)
Chimerism , Pregnancy Complications , Pregnancy, Multiple , Adult , Female , Humans , Pregnancy
12.
West Indian med. j ; 58(2): 138-141, Mar. 2009. tab
Article in English | LILACS | ID: lil-672457

ABSTRACT

OBJETIVE: Granular cell tumours are uncommon lesions that occur in a wide variety of sites. They are usually benign, but as they are infrequently diagnosed preoperatively, they may be confused clinically with malignant lesions. The objective of this study was to assess the relative frequency and the clinico-pathologic characteristics of granular cell tumours identified at the University Hospital of the West Indies (UHWI) over a 41-year period. METHODS: The archives of surgical pathology reports in the Department of Pathology at the UHWI from 1965 to 2006 were searched for all cases of granular cell tumour. From these records, a number of demographic and other data were recorded and analyzed. RESULTS: One hundred and thirty cases of granular cell tumours were found in 122 patients. Of these, 99 patients were female and 23 male, providing a male: female ratio of 1 to 4.3. The ages ranged from 5 days to 82 years with a mean age (excluding the 2 youngest cases) of 34.4 years. Lesions ranged in size from 0.2 cm to 10 cm in greatest dimension, the average size being 1.85 cm and were found in a diverse array of anatomic locations, the most common being the vulva, breast and tongue. The correct clinical diagnosis was proffered preoperatively in only one case. In contrast, a malignant diagnosis was suggested in 19 cases. CONCLUSIONS: Compared with other studies, there was a notable difference in the distribution of granular cell tumours in this series. In particular, lesions of the tongue accounted for fewer than expected, while lesions of the breast and vulva were considerably increased. The well-recognized female predominance was also substantially higher than in other studies.


OBJETIVO: Los tumores de células granulares son lesiones poco comunes que ocurren en una amplia variedad de lugares. Por lo general son benignos, pero como son raramente diagnosticados preoperativamente, puede confundírseles clínicamente con lesiones malignas. El objetivo de este estudio fue evaluar la frecuencia relativa y las características clínico-patológicas de los tumores de células granulares identificados en el Hospital Universitario de West Indies (HUWI) en un período de 41 años. MÉTODOS: Se investigaron los archivos de los reportes de patologías quirúrgicas en el Departamento de Patología de la UHWI, de 1965 a 2006, en busca de todos los casos de tumores de células granulares. A partir de estos archivos, se registraron y analizaron un número de datos demográficos y de otra índole. RESULTADOS: Se hallaron un total de ciento treinta casos de tumores de células granulares en 122 pacientes. De estos, 99 pacientes era mujeres y 23 hombres, para una proporción varón: hembra de l a 4.3 Las edades estuvieron en un rango de 5 días a 82 años con una edad promedio (excluyendo los dos casos de menos edad) de 34.4 años. El tamaño de las lesiones fluctuó de 0.2 cm a 10 cm como la mayor dimensión, siendo el tamaño promedio 1.85 cm. Estas lesiones se encontraban distribuidas en una variedad de lugares anatómicos, siendo los más comunes la vulva, el pecho y la lengua. El diagnóstico clínico correcto fue presentado preoperativamente sólo en un caso. En contraste con ello, se sugirió un diagnóstico maligno sólo en 19 casos. CONCLUSIONES: En comparación con otros estudios, hubo una notable diferencia en la distribución de los tumores de células granulares en este serie. En particular, las lesiones de la lengua dan cuenta de menos casos de los que se esperaba, mientras que las lesiones del pecho y la vulva presentaban un aumento considerable. El bien reconocido predominio femenino fue sustancialmente más alto que en otros estudios.


Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Middle Aged , Young Adult , Granular Cell Tumor/epidemiology , Granular Cell Tumor/pathology , Breast Neoplasms/epidemiology , Hospitals, University , Tongue Neoplasms/epidemiology , Vulvar Neoplasms/epidemiology , West Indies/epidemiology
13.
West Indian Med J ; 58(2): 138-41, 2009 Mar.
Article in English | MEDLINE | ID: mdl-21866599

ABSTRACT

OBJECTIVE: Granular cell tumours are uncommon lesions that occur in a wide variety of sites. They are usually benign, but as they are infrequently diagnosed preoperatively, they may be confused clinically with malignant lesions. The objective of this study was to assess the relative frequency and the clinicopathologic characteristics of granular cell tumours identified at the University Hospital of the West Indies (UHWI) over a 41-year period. METHODS: The archives of surgical pathology reports in the Department of Pathology at the UHWI from 1965 to 2006 were searched for all cases of granular cell tumour. From these records, a number of demographic and other data were recorded and analyzed. RESULTS: One hundred and thirty cases of granular cell tumours were found in 122 patients. Of these, 99patients were female and 23 male, providing a male:female ratio of l to 4.3. The ages ranged from 5 days to 82 years with a mean age (excluding the 2 youngest cases) of 34.4 years. Lesions ranged in size from 0.2 cm to 10 cm in greatest dimension, the average size being 1.85 cm and were found in a diverse array of anatomic locations, the most common being the vulva, breast and tongue. The correct clinical diagnosis was proffered preoperatively in only one case. In contrast, a malignant diagnosis was suggested in 19 cases. CONCLUSIONS: Compared with other studies, there was a notable difference in the distribution of granular cell tumours in this series. In particular lesions of the tongue accounted for fewer than expected, while lesions of the breast and vulva were considerably increased. The well-recognized female predominance was also substantially higher than in other studies.


Subject(s)
Granular Cell Tumor/epidemiology , Granular Cell Tumor/pathology , Adolescent , Adult , Aged , Aged, 80 and over , Breast Neoplasms/epidemiology , Child , Child, Preschool , Female , Hospitals, University , Humans , Infant , Infant, Newborn , Male , Middle Aged , Tongue Neoplasms/epidemiology , Vulvar Neoplasms/epidemiology , West Indies/epidemiology , Young Adult
14.
Clin Endocrinol (Oxf) ; 66(6): 838-43, 2007 Jun.
Article in English | MEDLINE | ID: mdl-17437509

ABSTRACT

OBJECTIVE: Paediatric Cushing's disease is frequently associated with abnormal puberty. We addressed the hypothesis that prepubertal patients show excessive virilization and pubertal patients show suppression of LH and FSH secretion. DESIGN AND MEASUREMENTS: Serum androstenedione (A4), dehydroepiandrosterone sulphate (DHEAS), testosterone (T), and sex hormone binding globulin (SHBG) were determined at diagnosis and converted to standard deviation scores. LH, FSH concentrations were also determined. Severity of CD was assessed from the sleeping midnight cortisol concentration. Puberty was staged and excessive virilization defined as advance in pubic hair stage for breast stage or testicular volume (TV). PATIENTS: Twenty-seven CD patients (17 male, 10 female), median age 13.4 years (range 5.9-17.8) were studied. RESULTS: In the CD group as a whole, A4, DHEAS, T standard deviation scores (SDS) values were normal. SHBG SDS values (n = 19) were low (median -1.93, -4.32-0.86) correlating with BMI (r = -0.49). A4, DHEAS, T, SHBG, LH and FSH did not correlate with midnight cortisol, but A4 and T SDS correlated with ACTH at 09.00 h (both r = 0.51). Thirteen patients (11 male, 2 female) had excessive virilization with increased A4 (P = 0.033), DHEAS (P = 0.008), testosterone (P = 0.033) and decreased SHBG (P = 0.004) compared with subjects without excessive virilization. Pubertal boys (TV > or = 4 ml) (n = 7) and girls (breasts > or = stage 2) (n = 8) had low median LH and FSH. Boys had an LH concentration of 1.2 mU/l (0.3-3.5), FSH, 0.9 mU/l (0.2-6.4) and median T SDS, -1.95 (-3.8-4.65), while girls had an LH concentration of 1 mU/l (0.3-7.4). CONCLUSIONS: Many patients had abnormal puberty and excessive virilization associated with increased adrenal androgens and decreased SHBG. Pubertal patients had low LH and FSH suggesting impaired pituitary-gonadal axis function.


Subject(s)
Androgens/blood , Gonadotropins, Pituitary/blood , Pituitary ACTH Hypersecretion/complications , Puberty, Precocious/etiology , Sex Hormone-Binding Globulin/analysis , Adolescent , Adrenocorticotropic Hormone/blood , Androstenedione/blood , Case-Control Studies , Child , Child, Preschool , Female , Follicle Stimulating Hormone/blood , Humans , Hydrocortisone/blood , Luteinizing Hormone/blood , Male , Pituitary ACTH Hypersecretion/blood , Puberty, Precocious/blood , Statistics, Nonparametric , Testosterone/blood , Virilism/blood , Virilism/etiology
17.
Arch Pediatr ; 9(11): 1153-5, 2002 Nov.
Article in French | MEDLINE | ID: mdl-12503506

ABSTRACT

UNLABELLED: In children, viral meningitis is usually caused by Enteroviruses. Herpes simplex viruses (HSV) are known to be a cause of meningo-encephalitis. HSV-2 has been reported to cause recurrent meningitis (Mollaret's meningitis) in adults. CASE REPORT: We report the case of a three-year-old girl with HSV-1 meningitis, whose evolution with treatment by aciclovir was good. CONCLUSION: HSV-1 has rarely been reported as a cause of isolated aseptic meningitis in children. Primary phase of herpes simplex virus infection is not usually associated with neurologic complications.


Subject(s)
Acyclovir/therapeutic use , Antiviral Agents/therapeutic use , Herpesviridae Infections/drug therapy , Herpesvirus 1, Human/pathogenicity , Meningitis, Viral/drug therapy , Adolescent , Female , Herpesviridae Infections/pathology , Humans , Meningitis, Viral/pathology , Treatment Outcome
18.
Ann Chir Plast Esthet ; 45(1): 62-8, 2000 Feb.
Article in French | MEDLINE | ID: mdl-10783514

ABSTRACT

The cutaneous sequelae left by mammaplasties have always constituted a major problem as well for the patients as for the surgeons. Since the turn of the century and the birth of modern mammary corrections, surgeons have tried to reduce these scars, while avoiding the impairment of the vascularisation of the mammary gland, the nipple-areola complex and the skin. L. Dartigues proposed, in 1924, the use of a single subareolar vertical scar for the correction of limited mammary ptosis. F. Lötsch introduced, in 1923, the rudiments of the future vertical mammaplasty by associating a peri-areolar scar to the single vertical subareolar scar. In 1971, C. Lassus, who had become interested and had been using Lötsch's technique since 1964, abandoned the technique for a while, but returned to these basic technique of Lötsch which he modified over the years and made it applicable in 1980 to ptosed and most hypertrophied breasts. This article is also concerned with the historic evolution of the scars left by mammary corrections and with the mastopexy procedures.


Subject(s)
Cicatrix/history , Mammaplasty/history , Surgery, Plastic/history , Cicatrix/etiology , France , History, 19th Century , History, 20th Century , Humans , Mammaplasty/adverse effects , Mammaplasty/methods , Periodicals as Topic/history
19.
Ann Chir Plast Esthet ; 43(2): 169-74, 1998 Apr.
Article in French | MEDLINE | ID: mdl-9768083

ABSTRACT

When going through the biography and bibliography of M. Virenque, one realizes that he was an outstanding maxillo-facial surgeon, who developed his knowledge mainly during the two world wars 1914-1918 and 1939-1945 and gave exceptional care to soldiers with severe face and skull injuries, the so-called "Gueules Cassées". Nevertheless, he did not disregard the importance of aesthetic surgery born between the two wars. Due to his large experience in maxillo-facial surgery and his broad knowledge of the anatomy of the face, he occupies a special place among the forerunners of facelifts by stressing on the importance of plication of the deep aponeurotic layers of the face, thus allowing the elaboration of a modified approach to the problems of the aging face.


Subject(s)
Facial Injuries , Rhytidoplasty , Facial Bones/injuries , Facial Bones/surgery , Facial Injuries/surgery , France , History, 20th Century , Humans , Military Medicine , Rhytidoplasty/methods , Warfare , Wounds, Gunshot/surgery
20.
West Indian med. j ; 47(suppl. 2): 48, Apr. 1998.
Article in English | MedCarib | ID: med-1837

ABSTRACT

This is a study of the prevalence of malnutrition in Dominican children aged 0-5 years, and factors influencing it. Health and other statistical data were compiled and analyzed for the period 1984-1995. A study was also conducted among thirty mothers whose children were attending child health clinics in 1997 to assess their beliefs about nutrition and their feeding practices. Results from the statistical data show there has been a marked decline in under-nutrition (from 5.0 percent to 1.0 percent) over the period and a rise in obesity from (3.4 percent to 9.9 percent). The survey done among mothers showed a 45 percent obesity rate and no case of malnutrition was found. Factors found in association with this trend are: increased employment, reduced fertility rate, increased maternal age, decreased household size, improved immunization coverage and higher levels of education. Childhood obesity is replacing under-nutrition as a public health problem in Dominica.(AU)


Subject(s)
Child, Preschool , Humans , Infant , Obesity/epidemiology , Child Nutrition , Socioeconomic Factors , Food and Nutritional Surveillance
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