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Boisseau W, Benomar A, Ducroux C, Fahed R, Smajda S, Diestro JDB, Charbonnier G, Ognard J, Burel J, Ter Schiphorst A, Boulanger M, Nehme A, Boucherit J, Marnat G, Volders D, Holay Q, Forestier G, Bretzner M, Roy D, Vingadassalom S, Elhorany M, Nico L, Jacquin G, Abdalkader M, Guedon A, Seners P, Janot K, Dumas V, Olatunji R, Gazzola S, Milot G, Zehr J, Darsaut TE, Iancu D, Raymond J. The Management of Persistent Distal Occlusions after Mechanical Thrombectomy and Thrombolysis: An Inter- and Intrarater Agreement Study. AJNR Am J Neuroradiol 2024:ajnr.A8149. [PMID: 38388684 DOI: 10.3174/ajnr.a8149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 10/24/2023] [Indexed: 02/24/2024]
Abstract
BACKGROUND AND PURPOSE The best management of patients with persistent distal occlusion after mechanical thrombectomy with or without IV thrombolysis remains unknown. We sought to evaluate the variability and agreement in decision-making for persistent distal occlusions. MATERIALS AND METHODS A portfolio of 60 cases was sent to clinicians with varying backgrounds and experience. Responders were asked whether they considered conservative management or rescue therapy (stent retriever, aspiration, or intra-arterial thrombolytics) a treatment option as well as their willingness to enroll patients in a randomized trial. Agreement was assessed using κ statistics. RESULTS The electronic survey was answered by 31 physicians (8 vascular neurologists and 23 interventional neuroradiologists). Decisions for rescue therapies were more frequent (n = 1116/1860, 60%) than for conservative management (n = 744/1860, 40%; P < .001). Interrater agreement regarding the final management decision was "slight" (κ = 0.12; 95% CI, 0.09-0.14) and did not improve when subgroups of clinicians were studied according to background, experience, and specialty or when cases were grouped according to the level of occlusion. On delayed re-questioning, 23 of 29 respondents (79.3%) disagreed with themselves on at least 20% of cases. Respondents were willing to offer trial participation in 1295 of 1860 (69.6%) cases. CONCLUSIONS Individuals did not agree regarding the best management of patients with persistent distal occlusion after mechanical thrombectomy and IV thrombolysis. There is sufficient uncertainty to justify a dedicated randomized trial.
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Affiliation(s)
- W Boisseau
- From the Department of Interventional Neuroradiology (W.B., S.S.), Fondation Rothschild Hospital, Paris, France
- Department of Radiology (W.B., A.B., D.R, D.I., J.R.), Centre Hospitalier de l'Université de Montréal Montréal, Canada
| | - A Benomar
- Department of Radiology (W.B., A.B., D.R, D.I., J.R.), Centre Hospitalier de l'Université de Montréal Montréal, Canada
| | - C Ducroux
- Department of Neurology (C.D., R.F.), Ottawa Hospital Research Institute & University of Ottawa, Ottawa, Canada
| | - R Fahed
- Department of Neurology (C.D., R.F.), Ottawa Hospital Research Institute & University of Ottawa, Ottawa, Canada
| | - S Smajda
- From the Department of Interventional Neuroradiology (W.B., S.S.), Fondation Rothschild Hospital, Paris, France
| | - J D B Diestro
- Division of Diagnostic and Therapeutic Neuroradiology (J.D.B.D., R.O.), Department of Medical Imaging, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - G Charbonnier
- Interventional Neuroradiology Department (G.C.), Besançon University Hospital, Besançon, France
| | - J Ognard
- Interventional Neuroradiology Department (J.O.), Hôpital de la Cavale Blanche, Brest, Bretagne, France
| | - J Burel
- Department of Radiology (J. Burel), Rouen University Hospital, Rouen, France
| | - A Ter Schiphorst
- Neurology Department (A.T.S.), CHRU Gui de Chauliac, Montpellier, France
| | - M Boulanger
- Department of Neurology (M. Boulanger, A.N.), Caen University Hospital, Caen, France
| | - A Nehme
- Department of Neurology (M. Boulanger, A.N.), Caen University Hospital, Caen, France
| | - J Boucherit
- Department of Radiology (J. Boucherit), Rennes University Hospital, Rennes, France
| | - G Marnat
- Department of Neuroradiology (G. Marnat), University Hospital of Bordeaux, Bordeaux, France
| | - D Volders
- From the Department of Interventional Neuroradiology (W.B., S.S.), Fondation Rothschild Hospital, Paris, France
| | - Q Holay
- Radiology Department (Q.H.), Hôpital d'Instruction des armées Saint-Anne, Toulon, France
| | - G Forestier
- Neuroradiology Department (G.F.), University Hospital of Limoges, Limoges, France
| | - M Bretzner
- Neuroradiology Department (M. Bretzner), CHU Lille, University Lille, Inserm, U1172 Lille Neuroscience & Cognition, F-59000, Lille, France
| | - D Roy
- Department of Radiology (W.B., A.B., D.R, D.I., J.R.), Centre Hospitalier de l'Université de Montréal Montréal, Canada
| | - S Vingadassalom
- Interventional Neuroradiology Department (S.V.), CHRU Marseille, La Timone, France
| | - M Elhorany
- Department of Neuroradiology (M.E.), Groupe Hospitalier de Pitié Salpêtrière, Paris, France
- Department of Neurology (M.E.), Tanta University, Tanta, Egypt
| | - L Nico
- Department of Radiology (L.N.), University Hospital of Padova, Padova, Italy
| | - G Jacquin
- Neurovascular Health Program (G.J.), Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
| | - M Abdalkader
- Department of Radiology (M.A.), Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - A Guedon
- Department of Neuroradiology (A.G.), Lariboisière Hospital, Paris, France
| | - P Seners
- Neurology Department (P.S.), Hôpital Fondation A. de Rothschild, Fondation Rothschild Hospital, Paris, France
- Institut de Psychiatrie et Neurosciences de Paris (P.S.), UMR_S1266, INSERM, Université de Paris, Paris, France
| | - K Janot
- Interventional Neuroradiology (K.J.), University Hospital of Tours, Tours, France
| | - V Dumas
- Radiology Department (V.D.), University Hospital of Poitiers, Poitiers, France
| | - R Olatunji
- Division of Diagnostic and Therapeutic Neuroradiology (J.D.B.D., R.O.), Department of Medical Imaging, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - S Gazzola
- From the Department of Interventional Neuroradiology (W.B., S.S.), Fondation Rothschild Hospital, Paris, France
- From the Department of Interventional Neuroradiology (W.B., S.S.), Fondation Rothschild Hospital, Paris, France
| | - G Milot
- Department of Radiology (W.B., A.B., D.R, D.I., J.R.), Centre Hospitalier de l'Université de Montréal Montréal, Canada
- Department of Radiology (W.B., A.B., D.R, D.I., J.R.), Centre Hospitalier de l'Université de Montréal Montréal, Canada
| | - J Zehr
- Department of Neurology (C.D., R.F.), Ottawa Hospital Research Institute & University of Ottawa, Ottawa, Canada
- Department of Neurology (C.D., R.F.), Ottawa Hospital Research Institute & University of Ottawa, Ottawa, Canada
| | - T E Darsaut
- Division of Diagnostic and Therapeutic Neuroradiology (J.D.B.D., R.O.), Department of Medical Imaging, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
- Division of Diagnostic and Therapeutic Neuroradiology (J.D.B.D., R.O.), Department of Medical Imaging, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - D Iancu
- Department of Radiology (W.B., A.B., D.R, D.I., J.R.), Centre Hospitalier de l'Université de Montréal Montréal, Canada
| | - J Raymond
- Department of Radiology (W.B., A.B., D.R, D.I., J.R.), Centre Hospitalier de l'Université de Montréal Montréal, Canada
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Ducroux C, Nehme A, Rioux B, Panzini MA, Fahed R, Gioia LC, Létourneau-Guillon L. NCCT Markers of Intracerebral Hemorrhage Expansion Using Revised Criteria: An External Validation of Their Predictive Accuracy. AJNR Am J Neuroradiol 2023; 44:658-664. [PMID: 37169542 PMCID: PMC10249705 DOI: 10.3174/ajnr.a7871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 04/06/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND AND PURPOSE Several NCCT expansion markers have been proposed to improve the prediction of hematoma expansion. We retrospectively evaluated the predictive accuracy of 9 expansion markers. MATERIALS AND METHODS Patients admitted for intracerebral hemorrhage within 24 hours of last seen well were retrospectively included from April 2016 to April 2020. The primary outcome was revised hematoma expansion, defined as any of a ≥6-mL or ≥33% increase in intracerebral hemorrhage volume, a ≥ 1-mL increase in intraventricular hemorrhage volume, or de novo intraventricular hemorrhage. We assessed the predictive accuracy of expansion markers and determined their association with revised hematoma expansion. RESULTS We included 124 patients, of whom 51 (41%) developed revised hematoma expansion. The sensitivity of each marker for the prediction of revised hematoma expansion ranged from 4% to 78%; the specificity, 37%-97%; the positive likelihood ratio, 0.41-7.16; and the negative likelihood ratio, 0.49-1.06. By means of univariable logistic regressions, 5 markers were significantly associated with revised hematoma expansion: black hole (OR = 8.66; 95% CI, 2.15-58.14; P = .007), hypodensity (OR = 3.18; 95% CI, 1.49-6.93; P = .003), blend (OR = 2.90; 95% CI, 1.08-8.38; P = .04), satellite (OR = 2.84; 95% CI, 1.29-6.61; P = .01), and Barras shape (OR = 2.41, 95% CI; 1.17-5.10; P = .02). In multivariable models, only the black hole marker remained independently associated with revised hematoma expansion (adjusted OR = 5.62; 95% CI, 1.23-40.23; P = .03). CONCLUSIONS No single NCCT expansion marker had both high sensitivity and specificity for the prediction of revised hematoma expansion. Improved image-based analysis is needed to tackle limitations associated with current NCCT-based expansion markers.
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Affiliation(s)
- C Ducroux
- From the Département des Neurosciences (C.D., A.N., B.R., M.-A.P., L.C.G.), Faculté de Médecine
- Département de Médicine (Neurologie) (C.D., A.N., B.R., M.-A.P., L.C.G.)
- Neurovascular Health Program (C.D., L.C.G.)
- Department of Medicine (C.D., R.F.), Division of Neurology, The Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada
| | - A Nehme
- From the Département des Neurosciences (C.D., A.N., B.R., M.-A.P., L.C.G.), Faculté de Médecine
- Département de Médicine (Neurologie) (C.D., A.N., B.R., M.-A.P., L.C.G.)
| | - B Rioux
- From the Département des Neurosciences (C.D., A.N., B.R., M.-A.P., L.C.G.), Faculté de Médecine
- Département de Médicine (Neurologie) (C.D., A.N., B.R., M.-A.P., L.C.G.)
- Centre for Clinical Brain Sciences (B.R.), University of Edinburgh, Edinburgh, UK
| | - M-A Panzini
- From the Département des Neurosciences (C.D., A.N., B.R., M.-A.P., L.C.G.), Faculté de Médecine
- Département de Médicine (Neurologie) (C.D., A.N., B.R., M.-A.P., L.C.G.)
| | - R Fahed
- Department of Medicine (C.D., R.F.), Division of Neurology, The Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada
| | - L C Gioia
- From the Département des Neurosciences (C.D., A.N., B.R., M.-A.P., L.C.G.), Faculté de Médecine
- Département de Médicine (Neurologie) (C.D., A.N., B.R., M.-A.P., L.C.G.)
- Neurovascular Health Program (C.D., L.C.G.)
| | - L Létourneau-Guillon
- Département de Radiologie (L.L.-G.), Radio-oncologie et Médecine Nucléaire, Faculté de Médicine, Université de Montréal, Montréal, Quebec, Canada
- Département de Radiologie (L.L.-G.), Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
- Imaging and Engineering Axis (L.L.-G.), Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
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Nehme A, Boulanger M, Aouba A, Pagnoux C, Zuber M, Touzé E, de Boysson H. Diagnostic and therapeutic approach to adult central nervous system vasculitis. Rev Neurol (Paris) 2022; 178:1041-1054. [PMID: 36156251 DOI: 10.1016/j.neurol.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 05/16/2022] [Indexed: 12/14/2022]
Abstract
The clinical manifestations of central nervous system (CNS) vasculitis are highly variable. In the absence of a positive CNS biopsy, CNS vasculitis is particularly suspected when markers of both vascular disease and inflammation are present. To facilitate the clinical and therapeutic approach to this rare condition, CNS vasculitis can be classified according to the size of the involved vessels. Vascular imaging is used to identify medium vessel disease. Small vessel disease can only be diagnosed with a CNS biopsy. Medium vessel vasculitis usually presents with focal neurological signs, while small vessel vasculitis more often leads to cognitive deficits, altered level of consciousness and seizures. Markers of CNS inflammation include cerebrospinal fluid pleocytosis or elevated protein levels, and vessel wall, parenchymal or leptomeningeal enhancement. The broad range of differential diagnoses of CNS vasculitis can be narrowed based on the disease subtype. Common mimickers of medium vessel vasculitis include intracranial atherosclerosis and reversible cerebral vasoconstriction syndrome. The diagnostic workup aims to answer two questions: is the neurological presentation secondary to a vasculitic process, and if so, is the vasculitis primary (i.e., primary angiitis of the CNS) or secondary (e.g., to a systemic vasculitis, connective tissue disorder, infection, malignancy or drug use)? In primary angiitis of the CNS, glucocorticoids and cyclophosphamide are most often used for induction therapy, but rituximab may be an alternative. Based on the available evidence, all patients should receive maintenance immunosuppression. A multidisciplinary approach is necessary to ensure an accurate and timely diagnosis and to improve outcomes for patients with this potentially devastating condition.
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Affiliation(s)
- A Nehme
- Normandie University, Caen, France; Department of Neurology, Caen University Hospital, Caen, France; Inserm UMR-S U1237 PhIND/BB@C, Caen, France.
| | - M Boulanger
- Normandie University, Caen, France; Department of Neurology, Caen University Hospital, Caen, France; Inserm UMR-S U1237 PhIND/BB@C, Caen, France
| | - A Aouba
- Normandie University, Caen, France; Department of Internal Medicine, Caen University Hospital, Caen, France
| | - C Pagnoux
- Vasculitis clinic, Division of Rheumatology, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - M Zuber
- Department of Neurology, Saint-Joseph Hospital, Paris, France; Université Paris Cité, Paris, France
| | - E Touzé
- Normandie University, Caen, France; Department of Neurology, Caen University Hospital, Caen, France; Inserm UMR-S U1237 PhIND/BB@C, Caen, France
| | - H de Boysson
- Normandie University, Caen, France; Department of Internal Medicine, Caen University Hospital, Caen, France
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Nehme A, Lanthier S, Boulanger M, Aouba A, Cacoub P, Jayne D, Makhzoum J, Pagnoux C, Rhéaume M, Samson M, Terrier B, Touzé E, De Boysson H. Diagnostic et prise en charge des vascularites primitives du système nerveux central : évaluation des pratiques par un sondage international. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.10.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Kalaycioglu I, Rioux B, Neves BJ, Nehme A, Touma L, Dansereau B, Veilleux-Carpentier A, Keezer MR. The reliability of risk of bias tools for nonrandomized studies. Ann Epidemiol 2021. [DOI: 10.1016/j.annepidem.2021.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Bergeron D, Nehme A, Berthelet F, Létourneau L, Chaalala C, Bojanowski M. HSA par rupture d’un anévrisme spinal isolé : série de cas, revue de la littérature et possible étio-pathogénie. Neurochirurgie 2020. [DOI: 10.1016/j.neuchi.2020.06.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Ayoub ML, Maalouf G, Bachour F, Barakat A, Cortet B, Legroux-Gérot I, Zunquin G, Theunynck D, Nehme A, El Hage R. DXA-based variables and osteoporotic fractures in Lebanese postmenopausal women. Orthop Traumatol Surg Res 2014; 100:855-8. [PMID: 25459457 DOI: 10.1016/j.otsr.2014.06.023] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Revised: 06/12/2014] [Accepted: 06/23/2014] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The aim of this study was to assess DXA-based variables (bone mineral density, bone mineral apparent density, compressive strength index of the femoral neck and trabecular bone score) in Lebanese postmenopausal women having presented a previous fracture. MATERIALS AND METHODS One thousand Lebanese postmenopausal women between 45 and 89 years participated in this study. The women were recruited by advertisements offering bone mineral density measurements at a reduced cost. Subjects with previous history of radiotherapy or chemotherapy were excluded. Informed written consent was obtained from all the participants. RESULTS Femoral neck compressive strength index (FN CSI) was significantly (P<0.001) associated with the presence of fracture using a simple logistic regression (odds ratio=0.51 [0.385-0.653]). When a multivariate logistic regression analysis was performed with the presence of fracture as a dependent variable and each of age, FN BMD and FN CSI as independent variables, only FN BMD (P=0.005) and FN CSI (P=0.004) were found to be associated with the presence of fracture. CONCLUSION This study suggests that FN CSI is associated with history of osteoporotic fractures in postmenopausal women. The use of FN CSI in clinical practice may help to identify patients with high risk of fracture. LEVEL OF EVIDENCE Epidemiological study, level IV.
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Affiliation(s)
- M-L Ayoub
- Department of Physical Education, Faculty of Arts and Social Sciences, University of Balamand, El-Koura, Lebanon
| | - G Maalouf
- Musculoskeletal Department, Bellevue Medical Center, Faculty of Medicine of Saint-Joseph University, Mansourieh, Lebanon
| | - F Bachour
- Musculoskeletal Department, Bellevue Medical Center, Faculty of Medicine of Saint-Joseph University, Mansourieh, Lebanon
| | - A Barakat
- Musculoskeletal Department, Bellevue Medical Center, Faculty of Medicine of Saint-Joseph University, Mansourieh, Lebanon
| | - B Cortet
- Department of Rheumatology, Roger Salengro Hospital, CHU de Lille, 59037 Lille cedex, France; EA4490, 62327 Boulogne-sur-Mer cedex, France
| | - I Legroux-Gérot
- Department of Rheumatology, Roger Salengro Hospital, CHU de Lille, 59037 Lille cedex, France; EA4490, 62327 Boulogne-sur-Mer cedex, France
| | - G Zunquin
- Départment of STAPS, URePSSS-EA 4110/EA448, ULCO, 59383 Dunkerque cedex 01, France
| | - D Theunynck
- Départment of STAPS, URePSSS-EA 4110/EA448, ULCO, 59383 Dunkerque cedex 01, France
| | - A Nehme
- Department of Orthopedic Surgery and Traumatology, Saint-Georges University Medical Center, University of Balamand, P.O. Box 166378, Achrafieh, 1100 2807 Beirut, Lebanon
| | - R El Hage
- Department of Physical Education, Faculty of Arts and Social Sciences, University of Balamand, El-Koura, Lebanon.
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Fink D, Nebel S, Aebi S, Nehme A, Howell S. Loss of DNA mismatch repair due to knockout of MSH2 or PMS2 results in resistance to cisplatin and carboplatin. Int J Oncol 2012; 11:539-42. [PMID: 21528244 DOI: 10.3892/ijo.11.3.539] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Loss of DNA mismatch repair is a common finding in hereditary nonpolyposis colon cancer as well as in many types of sporadic human tumors. The effect of loss of DNA mismatch repair activity on sensitivity to cisplatin and carboplatin was tested using MSH2 and PMS2 knockout cell lines. The knockout dMsh2 embryonic stem cell line was 2.1-fold more resistant to cisplatin and 1.7-fold more resistant to carboplatin when compared to the isogenic wild-type wt-2 cell line. Likewise, the PMS2(-/-) mouse fibroblasts were 1.9-fold more resistant to cisplatin and 1.5-fold more resistant to carboplatin when compared to the isogenic PMS2(+/+) fibroblasts. These findings demonstrate that loss of mismatch repair due to knockout of either MSH2 or PMS2 results in low-level resistance to cisplatin and carboplatin, drugs that form the same types of adducts in DNA. These data validate results previously obtained using non-isogenic mismatch repair-proficient and -deficient cell lines, and indicate that simple recognition of the cisplatin adduct by the MSH2/MSH6 heterodimer is not sufficient for full detector function, but that PMS2 is also required for the pro-apoptotic signal to be generated from this detector.
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Affiliation(s)
- D Fink
- UNIV CALIF SAN DIEGO,CTR CANC,LA JOLLA,CA 92093
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Nehme A, Trousdale R, Tannous Z, Maalouf G, Puget J, Telmont N. Developmental dysplasia of the hip: is acetabular retroversion a crucial factor? Orthop Traumatol Surg Res 2009; 95:511-9. [PMID: 19837022 DOI: 10.1016/j.otsr.2009.06.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2009] [Accepted: 06/29/2009] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The objective of this study was to investigate a possible relation between congenital hip dysplasia and acetabular retroversion and to explore the eventual influence of the latter in the surgical decision for periacetabular osteotomy. MATERIALS AND METHODS We assessed the classical morphological characteristics of both hips, with an additional newly described retroversion index. The study was conducted in 174 patients with uni- or bilateral congenital hip dysplasia having undergone unilateral (153 patients) or bilateral (21 patients) periacetabular osteotomy when respectively one or both dysplastic hips remained symptomatic. RESULTS In the group of operated hips (195 hips in total), 53% of the acetabuli were anteverted, 42% retroverted, and 5% neutral orientations. The group of nonoperated hips (153 hips) included 24% normal hips, 22% hips with normal coverage but retroverted, 35% dysplastic hips with anteverted or neutral orientation, and 19% dysplastic retroverted hips. Comparing the two hips in the subgroup of patients in whom the operated and nonoperated sides were both dysplastic failed to demonstrate statistically significant difference in the mean retroversion index. However, all the other variables measured were significantly different; with the operated side more dysplastic. Comparing the two hips in the other subgroups showed that acetabular retroversion was nearly always bilateral and symmetrical, even in presence of unilateral congenital dysplasia. DISCUSSION Our data suggest that the presence of acetabular retroversion is probably independent of the congenital hip dysplasia and that this abnormality seems at best a secondary factor in the appearance of dysplastic hip symptoms. LEVEL OF EVIDENCE Level IV, retrospective diagnostic study.
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Affiliation(s)
- A Nehme
- Department of Orthopedic Surgery and Traumatology, Saint Georges Hospital, PO Box 166378, 11002807 Achrafieh, Beyrouth, Lebanon.
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Maalouf G, Maalouf NM, Schaaf N, Zebaze RM, Nehme A, Tannous Z, Wehbe J, Adib G, Gannagé-Yared MH, Seeman E. The spinal curvature irregularity index independently identifies vertebral fractures. Osteoporos Int 2007; 18:279-83. [PMID: 17021944 DOI: 10.1007/s00198-006-0235-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2006] [Accepted: 09/06/2006] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The spinal curvature irregularity index (SCII) is a quantitative measure of the irregularity of the spinal curvature. We evaluated the predictive ability of SCII to identify subjects with vertebral fractures (VF). METHODS Vertebral heights were measured by quantitative vertebral morphometry in 461 Lebanese women 20-89 years of age and VFs were ascertained by the grade 1 Eastell method. SCII scores were log-transformed and expressed as Z-SCII, the number of standard deviations above or below the mean ln(SCII) of young patients without VF. Univariate and multivariate binary logistic regression models were used to identify clinical predictors of VF. RESULTS Women with a higher SCII were more likely to have prevalent VF. A higher SCII was associated with a greater prevalence of VF within each category of femoral neck BMD (normal, osteopenia, osteoporosis). In univariate analysis, predictors of VF included Z-SCII (odds ratio, OR: 2.21, 95% CI: 1.80-2.71) and femoral neck T-score (OR: 1.35, 95% CI: 1.12-1.63). In multivariate analysis, predictors of VF were: Z-SCII (OR: 1.54, 95% CI: 1.02-2.32), femoral neck T-score (OR: 1.41, 95% CI: 1.11-1.78) and age(3) (OR: 1.40, 95% CI 1.10-1.82). At a cutoff SCII of 9.5%, the sensitivity and specificity of SCII for VF were 71 and 64% respectively, and higher SCII cutoffs identified VFs with greater specificity. CONCLUSION The SCII is a robust, simple and independent indicator of the presence of VFs.
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Affiliation(s)
- G Maalouf
- Department of Orthopaedics, St George Hospital, P.O. Box 166378, Achrafieh-Beirut 11002807, Lebanon
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Nehme A, Chaminade B, Chiron P, Fabie F, Tricoire JL, Puget J. Réduction et vissage percutanés des fractures thalamiques du calcaneus sous contrôle arthroscopique et fluoroscopique. ACTA ACUST UNITED AC 2004; 90:256-64. [PMID: 15211275 DOI: 10.1016/s0035-1040(04)70102-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
We describe a new technique for reduction and percutaneous osteosynthesis of displaced posterior facet fractures of the calcaneus which appears to overcome the problems encountered with other percutaneous methods described for this type of surgery. The method relies on the use of traction which allows automatic reduction of the greater tubersosity. The patient is installed on an orthopedic traction table. Pin traction provides anatomic reduction of the posterior articular surface and restitution of Böhler's angle under fluoroscopic and arthroscopic control. We used this technique in thirteen patients with fifteen displaced posterior facet fractures of the calcaneum. Mean patient age was 50.4 Years. Mean follow-up was twenty Months. We did not have any cutaneous or infectious complications in this short series. In the majority of the cases, the overall functional and physical results were excellent or good. The mean Böhler's angle was 27 degrees, corresponding to 83% correction compared with the healthy side. These preliminary results are encouraging. We were able to restitute calcaneum anatomy, shorten hospital stay, and avoid all skin complications. Indications for this percutaneous technique could be widened. It is a valid alternative to open treatment of posterior facet fractures of the calcaneum.
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Affiliation(s)
- A Nehme
- Service de Chirurgie Orthopédique et Traumatologique, Hôpital de Rangueil, 1, avenue Poulhès, 31403 Toulouse Cedex 3.
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12
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Nehme A, Tricoire JL, Giordano G, Rouge D, Chiron P, Puget J. Coracoclavicular joints. Reflections upon incidence, pathophysiology and etiology of the different forms. Surg Radiol Anat 2004; 26:33-8. [PMID: 14574466 DOI: 10.1007/s00276-003-0178-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2003] [Accepted: 07/12/2003] [Indexed: 10/26/2022]
Abstract
Since the first description of the coracoclavicular joint in 1861, many papers have been published reporting its occurrence, anatomical description, and geographical distribution. However, there are as yet no published articles with a convincing explanation for the rather variable forms of this variant. In this study, we investigated the occurrence of the coracoclavicular joint in the current and medieval population of Toulouse city and propose, through biometric measures, an explanation for the different forms of this anatomical variant. A total of 2192 chest X-rays taken for various conditions at a receiving hospital and 392 specimens (784 scapulae and an equal number of clavicles) of the L'Isle-Jourdain Series were examined with this aim. When present in the osteologic collection, the sizes of the articular conoid process as well as the height of the corresponding coracoid and acromial processes were noted. A coracoclavicular joint was noted in 0.82% and in 1.78% of the individuals examined in the radiological and osteologic series, respectively. The conoid process varied in size and correlated with the disposition of each correspondent coracoacromial arch. Osteoarthritis was noted in some of these joints when there was discordance between the conoid process size and the architecture of the correspondent coracoacromial arch, suggesting impingement. Our findings support a genetic origin for this variant, and suggest that its occurrence is also probably influenced by environmental factors. Osteoarthritis of this joint may be responsible for shoulder pain.
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Affiliation(s)
- A Nehme
- Department of Orthopedic Surgery and Traumatology, Rangueil University Hospital, Avenue du Professeur Jean Poulhès, 31054 Toulouse Cedex 4, France.
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13
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Nehme A, Maalouf G, Tricoire JL, Giordano G, Chiron P, Puget J. [Effect of alendronate on periprosthetic bone loss after cemented primary total hip arthroplasty: a prospective randomized study]. Rev Chir Orthop Reparatrice Appar Mot 2003; 89:593-8. [PMID: 14699304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
PURPOSE OF THE STUDY Bone remodeling and osteolysis around total hip prostheses, with its inevitable corollary, prosthesis loosening, remains a difficult problem in orthopedic surgery. Alendronate (bisphosphonate) has proven its efficacy for the treatment of osteoporosis of the lumbar spine and femoral neck. A few in vitro studies have pointed out its inhibiting effect on particle-induced osteolysis. In vivo, one study has demonstrated its usefulness in preventing osteolysis around non-cemented total hip arthroplasties (THA). The purpose of this work was to study the efficacy of this agent for the prevention of changes in peri-prosthetic bone mineral density (BMD) after primary THA. MATERIAL AND METHODS The study series included 38 patients with degenerative hip disease who underwent THA. The patients were randomized in double-blind fashion to two treatment arms: 10 alendronate and 600 mg calcium per day for 2 years (20 patients) or placebo and 600 mg calcium per day for 2 years (18 patients). Conventional x-rays and x-ray biphotonic absorptiometry (DPX) was performed on day four postop and at 3, 6, 12, and 24 months postop. The periprosthetic zones described by Grüen were used for analysis. RESULTS DPX demonstrated a significant reduction in BMD in all patients included in the study. The bone loss was the same in both groups during the early postoperative period reaching maximum loss at 3 months. Differences were observed after this time. In the placebo group, bone loss reached a plateau at 6 months then BMD started to increase progressively, reaching 12.7% bone loss at 2 years follow-up (p<0.002). In the alendronate group, there was no plateau, BMD increased continuously starting from three months and reached 6.857% bone loss at 2 years (p<0.003). DISCUSSION Administration of alendronate led to a significant reduction in peri-prosthetic bone loss at 2 years follow-up. These results are the first to our knowledge demonstrating the beneficial effect in vivo of alendronate on bone behavior around cemented THAs. CONCLUSION This beneficial effect observed in vivo should be confirmed in further studies including a larger number of patients and longer follow-up. The action of alendronate could facilitate and even retard revision surgery by preserving bone stock.
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Affiliation(s)
- A Nehme
- Service de Chirurgie Orthopédique et Traumatologique, Hôpital de Rangueil, 1, avenue Poulhès, 31403 Toulouse 3.
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14
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Wehbe J, Cortbaoui C, Chidiac RM, Nehme A, Melki R, Bedran F, Atallah P, Cooper C, Hadji P, Maalouf G. Age-associated changes in quantitative ultrasonometry (QUS) of the os calcis in Lebanese women-assessment of a Lebanese reference population. J Musculoskelet Neuronal Interact 2003; 3:232-9. [PMID: 15758346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
OBJECTIVE This study was aimed to assess age changes in quantitative ultrasonometry (QUS) in a large sample of Lebanese women to determine a Lebanese reference population. DESIGN Cross-sectional study. SUBJECTS AND METHODS Broadband ultrasound attenuation (BUA) and speed of sound (SOS) and the stiffness index (SI) of the os calcaneus was measured in 4,320 women with a mean age of 52.5 years (age range 20 to 79 years) using three identical Achilles Express (GE/Lunar) and one Achilles Plus (GE/Lunar) ultrasonometry devices. Women were randomly selected and asked to participate in a nationwide screening program using the media, conferences, telephone calls etc. Measurements were performed at Red Cross centers located all over the country. No inclusion or exclusion criteria were used. RESULTS There was an overall decline of 19.2% for BUA, 3.1% for SOS and 30.3% for SI between late adolescence and old age. In premenopausal women, BUA decreased only slightly by 3%, while postmenopausal women showed a significant decline of 16.2%. In contrast, SOS continuously decreased from the age of 42; there was a decline of 0.8% from adolescence to the menopause; postmenopausal women showed a larger decline of 2.4%. The SI of premenopausal women decreased by 6%, while postmenopausal women showed a significantly larger decline of 24.3%. SI value for the female Lebanese young adult reference is 8% lower than that of the American and European women (92 SI units compared to 100). At the age of 42, SI value for the Lebanese women is 10.4% lower than the American women and 7.5% lower than the European women (86 SI units compared to 96 and 93, respectively). At the age of 75, SI values for the Lebanese women is 4.4% lower than the American women and the European women (65 SI units compared to 68). The decline in stiffness index for the Lebanese women between age 20 and 75 years is about 30.3% compared to 32% for the American or European reference curves. The rate of decrease for the Lebanese women was 0.2 SI units per year for the premenopausal period, and 0.7 SI units per year for the postmenopausal period. CONCLUSION The age-related female, Lebanese reference curve was significantly different from the American and the European reference curves used by the manufacturer. Therefore, the use of our standardized reference data instead of the proposed US or European database reduces the risk of overestimating osteoporosis in the Lebanese population. The impact of our results on the prevalence of osteoporotic fracture in Lebanon has to be evaluated later on.
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Affiliation(s)
- J Wehbe
- Saint George Hospital, Balamand University, Beirut, Lebanon
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15
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Maalouf N, Wehbe J, Nehme A, Najem P, Chidiac R, Eid J, Attalah P, Adib G, Maalouf G. Osteoporosis: combination therapy for better or worse. J Musculoskelet Neuronal Interact 2003; 3:141-7. [PMID: 15758354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Osteoporosis is a condition that is associated with an increased susceptibility for fractures. In the past few years, several drugs have become available that can reduce the incidence of fractures in patients with osteoporosis. Since these drugs work through different cellular mechanisms, combining agents of different classes may have an additive or multiplicative effect on fracture risk reduction. Combination treatments that have been evaluated in clinical trials include bisphosphonates with estrogen, raloxifene or PTH/ bisphosphonates and PTH/ estrogen. In general, these trials have shown increases in bone mineral density over that observed with each agent alone. However, whether anti-fracture efficacy is improved, or worsened remains to be established. This article reviews the combination treatments that have been evaluated in clinical trials, with a discussion of the potential benefits and risks that those treatments entail. Integrating safety and cost issues will eventually determine whether those combinations will become the standard of care.
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Affiliation(s)
- N Maalouf
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
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16
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Nehme A, Kany J, Sales-De-Gauzy J, Charlet JP, Dautel G, Cahuzac JP. Obstetrical brachial plexus palsy. Prediction of outcome in upper root injuries. J Hand Surg Br 2002; 27:9-12. [PMID: 11895338 DOI: 10.1054/jhsb.2001.0655] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Thirty obstetrical brachial plexus palsies involving the upper roots were retrospectively reviewed. There were 20 C5-C6 palsies and ten C5-C6-C7 palsies in which recovery of C7 occurred by the end of the first month. Recovery of elbow flexion at 3 months, C7 involvement and high birthweight were the best early predictors of outcome, but all were unreliable when used separately. In combination, recovery of elbow flexion and birthweight predicted the final outcome reasonably satisfactorily, particularly when elbow flexion at 9 months, and not 3 months was considered (risk of error = 13%). Brachial plexus reconstruction may therefore be justified when there was initial C7 involvement associated with increased birthweight and poor elbow flexion at 6-9 months.
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Affiliation(s)
- A Nehme
- Department of Paediatric Orthopaedic Surgery, Hospital des Enfants, Toulouse, France.
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17
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Saliba I, Moukheiber A, Wanna G, Moukarzel N, Nehme A, Mansour S. Hearing preservation mastoidectomy in otogenic meningitis secondary to an enlarged vestibular aqueduct. Case report. J Med Liban 2000; 48:327-32. [PMID: 12489589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
In pyogenic meningitis resulting from a life-threatening ear infection, mastoidectomy is performed as part of the management of the disorder. A dilemma arises when the active ear is the only hearing ear. An active unsafe ear can lead to sensorineural hearing loss whereas ear surgery carries the risk of inner ear damage. We present the case of a 40-year-old woman admitted for severe purulent meningitis and sub-coma secondary to a left mastoiditis with mixed hearing loss on the left side and complete deafness on the right side. The study of this case shows that the intracranial complication was secondary to an abnormally enlarged left vestibular aqueduct. Because of the failure to control meningitis with medical treatment using highly specific antibiotherapy for two weeks, we proceeded with a left side mastoidectomy and closure of the external aperture of the vestibular aqueduct with a muscle graft. This surgery saved the patient's life, cured the meningitis and brought a recovery of a near normal hearing to the only hearing ear. Although demonstrating a rare etiology of intracranial complication, this case confirms that mastoidectomy, even on the only hearing ear, has to be done as early as possible to remove the source of infection, to prevent further intracranial complication, to arrest the progress of the ear disease and preserve or even recover almost normal hearing.
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Affiliation(s)
- I Saliba
- Otolaryngology Section, Lebanese University, Beirut
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18
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Starzec AB, Spanakis E, Nehme A, Salle V, Veber N, Mainguene C, Planchon P, Valette A, Prevost G, Israel L. Proliferative responses of epithelial cells to 8-bromo-cyclic AMP and to a phorbol ester change during breast pathogenesis. J Cell Physiol 1994; 161:31-8. [PMID: 7929605 DOI: 10.1002/jcp.1041610105] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
We have explored the relationship of changes in proliferative responses of human mammary epithelial cells to a phorbol ester (TPA) and to 8-Br-cAMP, which modulate the activities of protein kinases A and C (PKA and PKC), with breast tumour progression. Treatment with TPA had no effect on nontumorigenic cell lines established from human fibrocystic biopsies and apparently normal tissue around a tumour. In contrast, TPA strongly inhibited the proliferation of numerous human tumorigenic breast cell lines. Treatment with 8-Br-cAMP decreased the proliferation of all studied nontumorigenic and tumorigenic cell lines. We have also studied the effect of TPA and 8-Br-cAMP on growth of epithelial cells in short-term culture obtained from surgical human mammary biopsies with different states of breast disease. Both drugs enhanced growth of normal breast cells but had no significant effects on cells from biopsies with benign breast disease. In contrast, all examined cultures from breast cancer biopsies were strongly inhibited by 8-Br-cAMP. Otherwise, TPA had an inhibitory effect only in the case of invasive ductal carcinoma of grade III. Malignant Ha-ras-transformation of nontumorigenic TPA-insensitive breast HBL-100 cells induced an inhibitory effect of TPA. In addition, a TPA-insensitive MCF7 clone was much less tumorigenic in athymic mice than the parental strain shown to be inhibited by TPA. These data suggest that the two intracellular transduction pathways change at different stages of breast pathogenesis. Alterations in the PKA pathway are early events and are probably important to cell immortalization but do not necessarily lead to malignant development. In contrast, changes in PKC pathway are rather later events associated with advanced malignant transformation.
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Affiliation(s)
- A B Starzec
- Institut d'Oncologie Cellulaire et Moléculaire Humaine, Université Paris-Nord, Bobigny, France
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19
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Nehme A, Julia AM, Jozan S, Chevreau C, Bugat R, Canal P. Modulation of cisplatin cytotoxicity by human recombinant interferon-gamma in human ovarian cancer cell lines. Eur J Cancer 1994; 30A:520-5. [PMID: 8018412 DOI: 10.1016/0959-8049(94)90430-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Cytotoxic interactions between recombinant human interferon-gamma (IFN gamma) and cisplatin have been studied in six ovarian cell lines (IGROV1, NIHOVCAR3, SKOV3, OVCCR1, 2008 and its cisplatin resident variant 2008/C13*). Studies were performed using a cell survival assay. Results were assessed using median effect analysis. Synergy between these two drugs was observed in cell lines sensitive to IFN gamma, whatever their relative sensitivity or resistance to cisplatin, suggesting that IFN gamma enhances the cytotoxic activity of cisplatin. This interaction is not due to an increase in platinum accumulation in cells. This combination of drugs should be evaluated against human ovarian cancer xenografts in nude mice before its use in clinical practice.
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Affiliation(s)
- A Nehme
- Groupe de Pharmacologie Clinique et Expérimentale des Médicaments Anticancéreux Centre Claudius Regaud, Toulouse, France
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20
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Huot LA, Nehme A. [Radiotherapy following surgery of the larynx]. J Otolaryngol 1976; 5:421-4. [PMID: 994280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
A method of radiotherapy following total or partial surgery of the larynx is described. Criteria for the selection of patients and a technique of treatment are suggested. The results from 1966 to 1971 are reported.
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