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3.
Rev Mal Respir ; 33(5): 383-7, 2016 May.
Artigo em Francês | MEDLINE | ID: mdl-26303098

RESUMO

INTRODUCTION: Schwannomas are a form of rare tumor, arising from neural tissue and representing 2 % of mediastinal tumors. They are usually located in the posterior mediastinum, most often in the paravertebral gutters and typically appended to intercostal nerves. CASE REPORTS: We report two cases of unusual mediastinal schwannomas, appended to the vagus nerve. The schwannoma was located in the subcarinal region in the first case and in the right para-tracheal region in the second case. The lesions were thought to be bronchogenic cysts preoperatively in both cases because of a cystic appearance on preoperative CT scan and endobronchial ultrasonography. A surgical approach was adopted to remove the tumors. Video-assisted thoracoscopy was used in one case and robotic-assisted surgery in the second case, without any complication, allowing for complete resection and to establish a certain pathological diagnosis. CONCLUSION: Despite this location and cystic presentation being unusual, schwannoma should be considered as a possible cause of cystic lesions in the mediastinum. Minimally invasive surgery allows for complete resection and definitive pathological diagnosis.


Assuntos
Neoplasias dos Nervos Cranianos/diagnóstico , Neoplasias do Mediastino/diagnóstico , Neurilemoma/diagnóstico , Doenças do Nervo Vago/diagnóstico , Nervo Vago/patologia , Idoso , Neoplasias dos Nervos Cranianos/patologia , Neoplasias dos Nervos Cranianos/cirurgia , Feminino , Humanos , Masculino , Neoplasias do Mediastino/patologia , Neoplasias do Mediastino/cirurgia , Mediastino/patologia , Mediastino/cirurgia , Pessoa de Meia-Idade , Neurilemoma/patologia , Neurilemoma/cirurgia , Procedimentos Cirúrgicos Robóticos , Nervo Vago/cirurgia , Doenças do Nervo Vago/cirurgia
4.
Cell Death Dis ; 6: e1924, 2015 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-26469972

RESUMO

Tissue-type plasminogen activator (tPA) is a pleiotropic serine protease of the central nervous system (CNS) with reported neurotrophic and neurotoxic functions. Produced and released under its single chain form (sc), the sc-tPA can be cleaved by plasmin or kallikrein in a two chain form, tc-tPA. Although both sc-tPA and tc-tPA display a similar fibrinolytic activity, we postulated here that these two conformations of tPA (sc-tPA and tc-tPA) could differentially control the effects of tPA on neuronal survival. Using primary cultures of mouse cortical neurons, our present study reveals that sc-tPA is the only one capable to promote N-methyl-D-aspartate receptor (NMDAR)-induced calcium influx and subsequent excitotoxicity. In contrast, both sc-tPA and tc-tPA are capable to activate epidermal growth factor receptors (EGFRs), a mechanism mediating the antiapoptotic effects of tPA. Interestingly, we revealed a tPA dependent crosstalk between EGFR and NMDAR in which a tPA-dependent activation of EGFRs leads to downregulation of NMDAR signaling and to subsequent neurotrophic effects.


Assuntos
Receptores ErbB/metabolismo , Receptores de N-Metil-D-Aspartato/metabolismo , Ativador de Plasminogênio Tecidual/fisiologia , Apoptose , Sinalização do Cálcio , Sobrevivência Celular , Feminino , Humanos , Conformação Proteica , Receptor Cross-Talk , Ativador de Plasminogênio Tecidual/química
6.
Rev Mal Respir ; 29(5): 727-30, 2012 May.
Artigo em Francês | MEDLINE | ID: mdl-22682601

RESUMO

INTRODUCTION: Spontaneous regression of an epithelial thymic tumour has been reported but seems extremely rare. Its mechanism is unknown. CASE REPORT: We report two cases of epithelial thymic tumour, either histologically proven or highly suspected on imaging, that regressed spontaneously (partially in one patient and totally in the other). CONCLUSION: Spontaneous regression of an epithelial thymic tumour is very rare but this possibility could lead to clinical and radiological monitoring rather than surgery in selected patients.


Assuntos
Neoplasias Epiteliais e Glandulares/patologia , Neoplasias do Timo/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica , Neoplasias Epiteliais e Glandulares/diagnóstico por imagem , Radiografia , Remissão Espontânea , Neoplasias do Timo/diagnóstico por imagem
7.
Rev Mal Respir ; 28(5): 672-6, 2011 May.
Artigo em Francês | MEDLINE | ID: mdl-21645840

RESUMO

Congenital bronchial atresia is a rare congenital obliteration of a segmental or lobar bronchus resulting in distension of the corresponding parenchyma. It is seldom diagnosed in the adult. It may lead to infectious complications and, in the long term, to damage to the adjacent lung parenchyma. A surgical resection is necessary and it can be achieved by thoracoscopy. We report a recent series of six patients.


Assuntos
Brônquios/anormalidades , Anormalidades Múltiplas , Adulto , Brônquios/cirurgia , Broncoscopia , Diagnóstico Tardio , Suscetibilidade a Doenças , Feminino , Tórax em Funil , Hemoptise/etiologia , Humanos , Pulmão/anormalidades , Pulmão/cirurgia , Abscesso Pulmonar/complicações , Pessoa de Meia-Idade , Pneumonia/complicações , Pneumotórax/etiologia , Embolia Pulmonar/complicações , Enfisema Pulmonar/complicações , Toracoscopia , Tomografia Computadorizada por Raios X , Adulto Jovem
8.
Biol Lett ; 7(5): 702-5, 2011 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-21508020

RESUMO

A recent study showed that a critically endangered migratory predator species, the Balearic shearwater Puffinus mauretanicus, rapidly expanded northwards in northeast Atlantic waters after the mid-1990s. As a significant positive correlation was found between the long-term changes in the abundance of this seabird and sea temperature around the British Isles, it was hypothesized that the link between the biogeographic shift and temperature occurred through the food web. Here, we test this conjecture and reveal concomitant changes in a regional index of sea temperature, plankton (total calanoid copepod), fish prey (anchovy and sardine) and the Balearic shearwater for the period 1980-2003. All three trophic levels exhibit a significant shift detected between 1994 and 1996. Our findings therefore support the assertion of both a direct and an indirect effect of climate change on the spatial distribution of post-breeding Balearic shearwater through a trophic cascade.


Assuntos
Aves/fisiologia , Mudança Climática , Algoritmos , Animais , Oceano Atlântico , Espécies em Perigo de Extinção , Geografia , Comportamento Predatório
10.
J Radiol ; 90(11 Pt 2): 1801-18, 2009 Nov.
Artigo em Francês | MEDLINE | ID: mdl-19953073

RESUMO

Multidetector row computed tomography (MDCT) is the imaging modality of reference for the diagnosis of bronchiectasis. MDCT may also detect a focal stenosis, a tumor or multiple morphologic abnormalities of the bronchial tree. It may orient the endoscopist towards the abnormal bronchi, and in all cases assess the extent of the bronchial lesions. The CT findings of bronchial abnormalities include anomalies of bronchial division and origin, bronchial stenosis, bronchial wall thickening, lumen dilatation, and mucoid impaction. The main CT features of bronchiectasis are increased bronchoarterial ratio, lack of bronchial tapering, and visibility of peripheral airways. Other bronchial abnormalities include excessive bronchial collapse at expiration, outpouchings and diverticula, dehiscence, fistulas, and calcifications.


Assuntos
Broncopatias/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Idoso , Neoplasias Brônquicas/diagnóstico por imagem , Neoplasias Brônquicas/secundário , Bronquiectasia/diagnóstico por imagem , Calcinose/diagnóstico por imagem , Carcinoma Broncogênico/diagnóstico por imagem , Carcinoma de Células Pequenas/diagnóstico por imagem , Carcinoma de Células Pequenas/imunologia , Diagnóstico Diferencial , Proteínas ELAV/imunologia , Hamartoma/diagnóstico por imagem , Humanos , Masculino
11.
J Radiol ; 87(5): 572-4, 2006 May.
Artigo em Francês | MEDLINE | ID: mdl-16733416

RESUMO

Renal angiomyolipomas are renal hamartomas. They are usually found incidentally, presenting as well-defined echogenic masses on sonography and fat containing tumors on CT and MRI. We report a case of angiomyolipoma with sonographic and CT evidence of extension to the renal vein and inferior vena cava.


Assuntos
Angiomiolipoma/diagnóstico , Neoplasias Renais/diagnóstico , Veias Renais , Neoplasias Vasculares/diagnóstico , Veia Cava Inferior , Idoso , Feminino , Humanos
12.
Arch Dis Child Fetal Neonatal Ed ; 89(1): F19-24, 2004 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-14711848

RESUMO

OBJECTIVE: To present the views of a representative sample of neonatal doctors and nurses in 10 European countries on the moral acceptability of active euthanasia and its legal regulation. DESIGN: A total of 142 neonatal intensive care units were recruited by census (in the Netherlands, Sweden, Hungary, and the Baltic countries) or random sampling (in France, Germany, Italy, Spain, and the United Kingdom); 1391 doctors and 3410 nurses completed an anonymous questionnaire (response rates 89% and 86% respectively). MAIN OUTCOME MEASURE: The staff opinion that the law in their country should be changed to allow active euthanasia "more than now". RESULTS: Active euthanasia appeared to be both acceptable and practiced in the Netherlands, France, and to a lesser extent Lithuania, and less acceptable in Sweden, Hungary, Italy, and Spain. More then half (53%) of the doctors in the Netherlands, but only a quarter (24%) in France felt that the law should be changed to allow active euthanasia "more than now". For 40% of French doctors, end of life issues should not be regulated by law. Being male, regular involvement in research, less than six years professional experience, and having ever participated in a decision of active euthanasia were positively associated with an opinion favouring relaxation of legal constraints. Having had children, religiousness, and believing in the absolute value of human life showed a negative association. Nurses were slightly more likely to consider active euthanasia acceptable in selected circumstances, and to feel that the law should be changed to allow it more than now. CONCLUSIONS: Opinions of health professionals vary widely between countries, and, even where neonatal euthanasia is already practiced, do not uniformly support its legalisation.


Assuntos
Atitude Frente a Morte , Eutanásia Ativa/legislação & jurisprudência , Pessoal de Saúde/psicologia , Unidades de Terapia Intensiva Neonatal , Adulto , Comparação Transcultural , Tomada de Decisões , Europa (Continente) , Eutanásia Ativa/ética , Feminino , França , Pesquisas sobre Atenção à Saúde , Humanos , Cooperação Internacional , Masculino , Neonatologia , Países Baixos , Recursos Humanos de Enfermagem Hospitalar/psicologia , Pais/psicologia , Religião , Pesquisa , Fatores Sexuais , Inquéritos e Questionários , Assistência Terminal/psicologia
13.
J Radiol ; 84(4 Pt 2): 484-96; discussion 497-8, 2003 Apr.
Artigo em Francês | MEDLINE | ID: mdl-12844071

RESUMO

Multidetector CT and MRI are the most efficient non invasive techniques in the assessment of pancreatic diseases. As with MRI, multidetector CT has now become an all in one examination using 2 D and 3 D multiplanar reformations with the ability to perform with high accuracy: a) vascular assessment using MIP reconstruction and b) biliary and pancreatic ducts assessment using minIP reconstruction. This review compares and illustrates the respective advantages of MRI and multidetector CT in the assessment of pancreatic diseases.


Assuntos
Imageamento por Ressonância Magnética/métodos , Pancreatopatias/diagnóstico , Tomografia Computadorizada por Raios X/métodos , Doença Aguda , Adenocarcinoma/diagnóstico , Idoso , Colangiocarcinoma/diagnóstico , Doença Crônica , Cistadenocarcinoma Seroso/diagnóstico , Humanos , Imageamento Tridimensional/métodos , Imageamento Tridimensional/normas , Imageamento por Ressonância Magnética/normas , Masculino , Cisto Pancreático/diagnóstico , Pancreatite/diagnóstico , Reprodutibilidade dos Testes , Tomografia Computadorizada por Raios X/normas
14.
Rev Mal Respir ; 19(2 Pt1): 253-6, 2002 Apr.
Artigo em Francês | MEDLINE | ID: mdl-12040327

RESUMO

Gemcitabine is a therapeutic agent that has been recently employed in the treatment of various cancers. Pulmonary toxicity has rarely been described. We report a case of a patient treated with Gemcitabine who developed acute respiratory symptoms related to a hypersensitivity pneumonia. Despite a severe clinical and radiological presentation, the outcome was favorable with corticosteroid treatment. In the event of respiratory symptoms in patients receiving Gemcitabine further investigations (chest X-ray, thorax CT-scan, bronchoalveolar lavage) are indicated. In view of the severity of pulmonary toxicity that can be caused by Gemcitabine, re-introduction of treatment is not recommended. We compare our case with other published cases of Gemcitabine-induced pulmonary toxicity.


Assuntos
Antimetabólitos Antineoplásicos/efeitos adversos , Desoxicitidina/análogos & derivados , Desoxicitidina/efeitos adversos , Hipersensibilidade Respiratória/induzido quimicamente , Insuficiência Respiratória/induzido quimicamente , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Humanos , Masculino , Gencitabina
16.
J Radiol ; 82(12 Pt 1): 1699-709, 2001 Dec.
Artigo em Francês | MEDLINE | ID: mdl-11917635

RESUMO

US and CT have both become major tools in imaging of the anterior abdominal wall. The goal of this pictorial review is to illustrate the respective roles of US and CT in the evaluation of normal and abnormal anterior abdominal wall.


Assuntos
Músculos Abdominais/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Hérnia/diagnóstico , Humanos , Ultrassonografia
17.
JAMA ; 284(19): 2451-9, 2000 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-11074774

RESUMO

CONTEXT: The ethical issues surrounding end-of-life decision making for infants with adverse prognoses are controversial. Little empirical evidence is available on the attitudes and values that underlie such decisions in different countries and cultures. OBJECTIVE: To explore the variability of neonatal physicians' attitudes among 10 European countries and the relationship between such attitudes and self-reported practice of end-of-life decisions. DESIGN AND SETTING: Survey conducted during 1996-1997 in 10 European countries (France, Germany, Italy, the Netherlands, Spain, Sweden, the United Kingdom, Estonia, Hungary, and Lithuania). PARTICIPANTS: A total of 1391 physicians (response rate, 89%) regularly employed in 142 neonatal intensive care units (NICUs). MAIN OUTCOME MEASURES: Scores on an attitude scale, which measured views regarding absolute value of life (score of 0) vs value of quality of life (score of 10); self-report of having ever set limits to intensive neonatal interventions in cases of poor neurological prognosis. RESULTS: Physicians more likely to agree with statements consistent with preserving life at any cost were from Hungary (mean attitude scores, 5.2 [95% confidence interval ¿CI¿, 4.9-5.5]), Estonia (4.9 [95% CI, 4.3-5.5]), Lithuania (5.5 [95% CI, 4.8-6.1]), and Italy (5.7 [95% CI, 5.3-6.0]), while physicians more likely to agree with the idea that quality of life must be taken into account were from the United Kingdom (attitude scores, 7.4 [95% CI, 7.1-7.7]), the Netherlands (7. 3 [95% CI, 7.1-7.5]), and Sweden (6.8 [95% CI, 6.4-7.3]). Other factors associated with having a pro-quality-of-life view were being female, having had no children, being Protestant or having no religious background, considering religion as not important, and working in an NICU with a high number of very low-birth-weight newborns. Physicians with scores reflecting a more quality-of-life view were more likely to report that in their practice, they had set limits to intensive interventions in cases of poor neurological prognosis, with an adjusted odds ratio of 1.5 (95% CI, 1.3-1.7) per unit change in attitude score. CONCLUSIONS: In our study, physicians' likelihood of reporting setting limits to intensive neonatal interventions in cases of poor neurological prognosis is related to their attitudes. After adjusting for potential confounders, country remained the most important predictor of physicians' attitudes and practices. JAMA. 2000;284:2451-2459.


Assuntos
Atitude Frente a Morte , Tomada de Decisões , Neonatologia , Cuidados Paliativos , Padrões de Prática Médica , Assistência Terminal , Adulto , Coleta de Dados , Ética Médica , Europa (Continente) , Análise Fatorial , Feminino , Humanos , Recém-Nascido , Doenças do Recém-Nascido/terapia , Internacionalidade , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Prognóstico , Qualidade de Vida
18.
J Pediatr ; 137(5): 608-16, 2000 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-11060524

RESUMO

OBJECTIVE: To compare treatment choices of neonatal physicians and nurses in 11 European countries for a hypothetical case of extreme prematurity (24 weeks' gestational age, birth weight of 560 g, Apgar score of 1 at 1 minute). STUDY DESIGN: An anonymous, self-administered questionnaire was completed by 1401 physicians (response rate, 89%) and 3425 nurses (response rate, 86%) from a large, representative sample of 143 European neonatal intensive care units. Italy, Spain, France, Germany, the Netherlands, Luxembourg, Great Britain, Sweden, Hungary, Estonia, and Lithuania participated. RESULTS: Most physicians in every country but the Netherlands would resuscitate this baby and start intensive care. On subsequent deterioration of clinical conditions caused by a severe intraventricular hemorrhage, attitudes diverge: most neonatologists in Germany, Italy, Estonia, and Hungary would favor continuation of intensive care, whereas in the other countries some form of limitation of treatment would be the preferred choice. Parental wishes appear to play a role especially in Great Britain and the Netherlands. Nurses are more prone than doctors to withhold resuscitation in the delivery room and to ask parental opinion regarding subsequent treatment choices. CONCLUSION: An extremely premature infant is regarded as viable by most physicians, whereas after deterioration of the clinical conditions decision-making patterns vary according to country. These findings have implications for the ethical debate surrounding treatment of infants of borderline viability and for the interpretation and comparison of international statistics.


Assuntos
Tomada de Decisões , Ética Médica , Doenças do Prematuro/terapia , Terapia Intensiva Neonatal , Padrões de Prática Médica , Ressuscitação , Adulto , Atitude , Europa (Continente) , Feminino , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Pessoa de Meia-Idade , Enfermeiras e Enfermeiros/psicologia , Médicos/psicologia , Ressuscitação/psicologia , Inquéritos e Questionários
20.
Lancet ; 355(9221): 2112-8, 2000 Jun 17.
Artigo em Inglês | MEDLINE | ID: mdl-10902625

RESUMO

BACKGROUND: The ethical issue of foregoing life-sustaining treatment for newborn infants at high risk of death or severe disability is extensively debated, but there is little information on how physicians in different countries actually confront this issue to reach end-of-life decisions. The EURONIC project aimed to investigate practices as reported by physicians themselves. METHODS: The study recruited a large, representative sample of 122 neonatal intensive-care units (NICUs) by census (in Luxembourg, the Netherlands, and Sweden) or stratified random sampling (in France, Germany, the UK, Italy, and Spain) with an overall response rate of 86%. Physicians' practices of end-of-life decision-making were investigated through an anonymous, self-administered questionnaire. 1235 completed questionnaires were returned (response rate 89%). FINDINGS: In all countries, most physicians reported having been involved at least once in setting limits to intensive care because of incurable conditions (61-96%); smaller proportions reported such involvement because of a baby's poor neurological prognosis (46-90%). Practices such as continuation of current treatment without intensification and withholding of emergency manoeuvres were widespread, but withdrawal of mechanical ventilation was reported by variable proportions (28-90%). Only in France (73%) and the Netherlands (47%) was the administration of drugs with the aim of ending life reported with substantial frequency. Age, length of professional experience, and the importance of religion in the physician's life affected the likelihood of reporting of non-treatment decisions. INTERPRETATION: A vast majority of neonatologists in European NICUs have been involved in end-of-life limitation of treatments, but type of decision-making varies among countries. Culture-related and other country-specific factors are more relevant than characteristics of individual physicians or units in explaining such variability.


Assuntos
Atitude do Pessoal de Saúde , Tomada de Decisões , Ética Médica , Eutanásia Passiva/psicologia , Unidades de Terapia Intensiva Neonatal , Papel do Médico , Adulto , Europa (Continente) , Feminino , Humanos , Recém-Nascido , Modelos Logísticos , Masculino , Respiração Artificial , Inquéritos e Questionários
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