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Russo L, Giboyeaux K, Gilman J, Jordan B, Myers M, Schaeffer A, Urban K, Wong C. Food Insecurity Needs Dietitians: Dietitians F.I.N.D. a Way to Help More During the Covid Pandemic. J Acad Nutr Diet 2022. [DOI: 10.1016/j.jand.2022.06.172] [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: 11/29/2022]
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Hernandez-Montfort J, Sinha S, Thayer K, Whitehead E, Pahuja M, Garan A, Mahr C, Haywood J, Harwani N, Schaeffer A, Kanwar M, Burkhoff D, Kapur N. Clinical Outcomes Associated with Acute Mechanical Circulatory Support Utilization in Heart Failure Related Cardiogenic Shock. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.406] [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: 10/21/2022] Open
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Lau G, Anderson R, Cartwright P, Wallis MC, Schaeffer A, Oottamasathien S, Snow B. Unilateral open extravesical ureteral reimplanation with contralateral dextronomer/hyaluronic acid injection performed as an outpatient therapy. J Pediatr Urol 2018; 14:566.e1-566.e5. [PMID: 30126744 DOI: 10.1016/j.jpurol.2018.07.014] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 07/19/2018] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Historically, patients with unilateral high-grade vesicoureteral reflux (VUR) and contralateral low-grade or resolved VUR have been treated with bilateral intravesical ureteral reimplantation, which requires postoperative admission. If the high-grade VUR side is treated alone, then the contralateral side is at risk of developing recurrent or worsening VUR. Bilateral subureteric injection of dextronomer/hyaluronic acid (DHA) is another option that can be performed as an outpatient therapy, but a single injection is less effective for high-grade VUR. OBJECTIVE The safety and efficacy of an outpatient combination of open extravesical ureteral reimplantation (EVUR) and contralateral DHA injection were investigated. STUDY DESIGN A retrospective review of children who had concomitant EVUR and subureteric injection of DHA between January 2005 and December 2015 was performed. Exclusion criteria were diagnosis other than VUR, repeat procedures, and patients with no follow-up. Patient characteristics, postsurgical complications, and follow-up imaging were evaluated. Febrile urinary tract infection (fUTI) was defined as ≥50,000 Colony Forming Units (CFU) of an organism from clean-catch or catheterized urine and temperature ≥ 101.5 F. Clinical success is defined as no fUTI for 1 year after the initial operation. Univariate analyses were used to identify risk factors for treatment failure. RESULTS A total of 117 patients met inclusion criteria. Mean age at surgery was 6.0 years, and 85% were female. The mean pre-operative grade of VUR was 3.3 on the EVUR side and 0.6 on the contralateral side (42% resolved before treatment). Median follow-up was 12.2 months (interquartile range, 3.1-25.4). Sixteen patients (14%) had documented fUTI within 1 year, with a clinical success rate of 86%. Of these, five had a postoperative imaging showing resolution of VUR, increasing overall success to 91%. Postoperative fUTI was more common in patients with pre-operative bowel and bladder dysfunction (BBD) (P = 0.003), but this was not associated with a higher reoperation rate (P = 0.168). There were 11 total complications, with three grade 3 complications. DISCUSSION This study is the first to report safety and outcomes of EVUR and contralateral DHA injection for patients with high-grade VUR with contralateral low-grade or resolved VUR. It was shown that it is an effective and safe treatment that can be performed as an outpatient therapy. Limitations to this study include the retrospective design and the clinical definition of success that is used in a cohort of patients from across the mountain west region without routine postoperative voiding cystourethrogram. CONCLUSION Extravesical ureteral reimplantation and contralateral DHA injection can safely be performed as an outpatient therapy and are effective in the treatment of higher grade VUR with contralateral low-grade or resolved VUR. Treatment failure is more likely in patients with BBD.
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Affiliation(s)
- G Lau
- University of Utah/Primary Children's Hospital, 100 N Capecchi Dr #2200, Salt Lake City, UT, USA
| | - R Anderson
- University of Utah/Primary Children's Hospital, 100 N Capecchi Dr #2200, Salt Lake City, UT, USA.
| | - P Cartwright
- University of Utah/Primary Children's Hospital, 100 N Capecchi Dr #2200, Salt Lake City, UT, USA
| | - M C Wallis
- University of Utah/Primary Children's Hospital, 100 N Capecchi Dr #2200, Salt Lake City, UT, USA
| | - A Schaeffer
- University of Utah/Primary Children's Hospital, 100 N Capecchi Dr #2200, Salt Lake City, UT, USA
| | - S Oottamasathien
- University of Utah/Primary Children's Hospital, 100 N Capecchi Dr #2200, Salt Lake City, UT, USA
| | - B Snow
- University of Utah/Primary Children's Hospital, 100 N Capecchi Dr #2200, Salt Lake City, UT, USA
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Lionnet F, Gouault-Heilmann M, Azoulay C, Lacorte JM, Schaeffer A. Auto-lmmune Eactor Vlll : G lnhibitor Durably Responsive to lmmunoglobulin: A New Case. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1647344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- F Lionnet
- Department of Internal Medicine Henri Mondor Hospital, 94010 Creteil, France
| | | | - C Azoulay
- Department of Internal Medicine Henri Mondor Hospital, 94010 Creteil, France
| | - J M Lacorte
- Heamostasis Laboratory Henri Mondor Hospital, 94010 Creteil, France
| | - A Schaeffer
- Department of Internal Medicine Henri Mondor Hospital, 94010 Creteil, France
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Affiliation(s)
| | - D Payen
- Hôpital Henri Mondor, Créteil, France
| | - G Contant
- Hôpital Henri Mondor, Créteil, France
| | | | - Y Huet
- Hôpital Henri Mondor, Créteil, France
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Berg K, Blatt B, Lopreiato J, Jung J, Schaeffer A, Heil D, Owens T, Carter-Nolan PL, Berg D, Veloski J, Darby E, Hojat M. Standardized patient assessment of medical student empathy: ethnicity and gender effects in a multi-institutional study. Acad Med 2015; 90:105-11. [PMID: 25558813 DOI: 10.1097/acm.0000000000000529] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
PURPOSE To examine, primarily, the effects of ethnicity and gender, which could introduce bias into scoring, on standardized patient (SP) assessments of medical students and, secondarily, to examine medical students' self-reported empathy for ethnicity and gender effects so as to compare self-perception with the perceptions of SPs. METHOD Participants were 577 students from four medical schools in 2012: 373 (65%) were white, 79 (14%) black/African American, and 125 (22%) Asian/Pacific Islander. These students were assessed by 84 SPs: 62 (74%) were white and 22 (26%) were black/African American. SPs completed the Jefferson Scale of Patient Perceptions of Physician Empathy (JSPPPE) and the Global Ratings of Empathy tool. Students completed the Jefferson Scale of Empathy and two Interpersonal Reactivity Index subscales. The investigators used 2,882 student-SP encounters in their analyses. RESULTS Analyses of SPs' assessments of students' empathy indicated significant interaction effects of gender and ethnicity. Female students, regardless of ethnicity, obtained significantly higher mean JSPPPE scores than men. Female black/African American, female white, and female Asian/Pacific Islander students scored significantly higher on the JSPPPE than their respective male counterparts. Male black/African American students obtained the lowest SP assessment scores of empathy regardless of SP ethnicity. Black/African American students obtained the highest mean scores on self-reported empathy. CONCLUSIONS The significant interaction effects of ethnicity and gender in clinical encounters, plus the inconsistencies observed between SPs' assessments of students' empathy and students' self-reported empathy, raise questions about possible ethnicity and gender biases in the SPs' assessments of medical students' clinical skills.
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Affiliation(s)
- Katherine Berg
- Dr. K. Berg is professor of medicine and codirector, University Clinical Skills and Simulation Center, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania. Dr. Blatt is professor of medicine and director, Clinical Learning and Simulation Skills Center, George Washington University School of Medicine, Washington, DC. Dr. Lopreiato is professor of pediatrics and associate dean for simulation education, Uniformed Services University of the Health Sciences, Bethesda, Maryland. Dr. Jung is assistant professor of emergency medicine and associate director, Simulation Center, Johns Hopkins University, Baltimore, Maryland. Ms. Schaeffer is a medical student, Tufts University, Boston, Massachusetts. Mr. Heil is a research assistant, University Clinical Skills and Simulation Center, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania. Ms. Owens is director, Clinical Skills and Simulation Center, Howard University, Washington, DC. Dr. Carter-Nolan is assistant dean for medical education, vice chair for education, and assistant professor, Department of Community and Family Medicine, Howard University, Washington, DC. Dr. D. Berg is G. Fritz Blechschmidt, MD, Professor of Clinical Skills and codirector, University Clinical Skills and Simulation Center, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania. Mr. Veloski is director, Medical Education Research, Center for Research in Medical Education and Health Care, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania. Ms. Darby is standardized patient educator, Uniform Services University of the Health Sciences, Bethesda, Maryland. Dr. Hojat is research professor of psychiatry and human behavior and director, Jefferson Longitudinal Study, Center for Research in Medical Education and Health Care, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
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Riesenberg LA, Berg K, Berg D, Morgan CJ, Davis J, Davis R, Schaeffer A, Hargraves R, Little BW. Resident and attending physician perception of maladaptive response to stress in residents. Med Educ Online 2014; 19:25041. [PMID: 25407054 PMCID: PMC4236638 DOI: 10.3402/meo.v19.25041] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 09/26/2014] [Accepted: 10/14/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND Residency stress has been shown to interfere with resident well-being and patient safety. We developed a survey research study designed to explore factors that may affect perception of a maladaptive response to stress. METHODS A 16-item survey with 12 Likert-type perception items was designed to determine how often respondents agreed or disagreed with statements regarding the resident on the trigger tape. A total of 438 respondents from multiple institutions completed surveys. RESULTS Attending physicians were more likely than residents to agree that the resident on the trigger tape was impaired, p<0.0001; needed to seek professional counseling, p=0.0003; should be removed from the service, p=0.002; was not receiving adequate support from the attending physician, p=0.007; and was a risk to patient safety, p=0.02. Attending physicians were also less likely to agree that the resident was a good role model, p=0.001, and that the resident should be able to resolve these issues herself/himself, p<0.0001. CONCLUSION Our data suggest that resident physicians may not be able to adequately detect maladaptive responses to stress and that attending physicians may be more adept at recognizing this problem. More innovative faculty and resident development workshops should be created to teach and encourage physicians to better observe and detect residents who are displaying maladaptive responses to stress.
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Affiliation(s)
- Lee Ann Riesenberg
- Department of Anesthesiology, The University of Alabama at Birmingham, Birmingham, AL, USA;
| | - Katherine Berg
- Rector Clinical Skills Simulation Center, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Dale Berg
- Rector Clinical Skills Simulation Center, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Charity J Morgan
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Joshua Davis
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Robyn Davis
- Department of Anesthesiology, The University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Robert Hargraves
- Rector Clinical Skills Simulation Center, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
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Riesenberg LA, Berg K, Berg D, Davis J, Schaeffer A, Justice EM, Tinkoff G. The Development of a Validated Checklist for Femoral Venous Catheterization. Am J Med Qual 2013; 29:445-50. [DOI: 10.1177/1062860613503032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | | | - Dale Berg
- Thomas Jefferson University, Philadelphia, PA
| | | | | | | | - Glen Tinkoff
- Thomas Jefferson University, Philadelphia, PA
- Christiana Care Health System, Newark, DE
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Berg K, Riesenberg LA, Berg D, Schaeffer A, Davis J, Justice EM, Tinkoff G, Jasper E. The development of a validated checklist for radial arterial line placement: preliminary results. Am J Med Qual 2013; 29:242-6. [PMID: 23847083 DOI: 10.1177/1062860613492189] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Radial arterial line placement is an invasive procedure that may result in complications. Validated checklists are central to teaching and assessing procedural skills and may result in improved health care quality. The results of the first step of the validation of a radial arterial line placement checklist are described. A comprehensive literature review of articles published on radial arterial line placement did not yield a checklist validated by the Delphi method. A modified Delphi technique, involving a panel of 9 interdisciplinary, interinstitutional experts, was used to develop a radial arterial line placement checklist. The internal consistency coefficient using Cronbach α was .99. Developing a 22-item checklist for teaching and assessing radial arterial line placement is the first step in the validation process. For this checklist to become further validated, it should be implemented and studied in the simulation and clinical environments.
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Riesenberg LA, Berg K, Berg D, Schaeffer A, Mealey K, Davis J, Weber D, King D, Justice EM, Geffe K, Tinkoff G. The Development of a Validated Checklist for Nasogastric Tube Insertion. Am J Med Qual 2013; 28:429-33. [DOI: 10.1177/1062860612474488] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | | | - Dale Berg
- Thomas Jefferson University, Philadelphia, PA
| | | | - Kathleen Mealey
- Loyola University Chicago Stritch School of Medicine, Maywood, IL
| | - Joshua Davis
- University of Delaware, Newark, DE
- Christiana Care Health System, Newark, DE
| | - Danielle Weber
- University of Cincinnati and Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Daniel King
- Ross University School of Medicine, Dominica
| | | | | | - Glen Tinkoff
- Thomas Jefferson University, Philadelphia, PA
- Christiana Care Health System, Newark, DE
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Jasper E, Berg K, Reid M, Gomella P, Weber D, Schaeffer A, Crawford A, Mealey K, Berg D. Disaster preparedness: what training do our interns receive during medical school? Am J Med Qual 2013; 28:407-13. [PMID: 23341470 DOI: 10.1177/1062860612471843] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Disaster preparedness training is a critical component of medical student education. Despite recent natural and man-made disasters, there is no national consensus on a disaster preparedness curriculum. The authors designed a survey to assess prior disaster preparedness training among incoming interns at an academic teaching hospital. In 2010, the authors surveyed incoming interns (n = 130) regarding the number of hours of training in disaster preparedness received during medical school, including formal didactic sessions and simulation, and their level of self-perceived proficiency in disaster management. Survey respondents represented 42 medical schools located in 20 states. Results demonstrated that 47% of interns received formal training in disaster preparedness in medical school; 64% of these training programs included some type of simulation. There is a need to improve the level of disaster preparedness training in medical school. A national curriculum should be developed with aspects that promote knowledge retention.
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Chen X, Schaeffer A, Devarajan K, Liao C, Zhou Y, Slater CM, Vanderveer L, Conroy J, Godwin AK. Abstract P3-08-03: Defects in BRCA1 Contribute to Global Differential Allele-Specific Expression. Cancer Res 2010. [DOI: 10.1158/0008-5472.sabcs10-p3-08-03] [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] [Indexed: 11/16/2022]
Abstract
Abstract
Differential allele-specific expression (DASE) has been shown to contribute to phenotypic variability in humans and more recently to the pathogenesis of cancer. DASE is associated with X-chromosome inactivation and genomic imprinting and is relatively common among non-imprinted autosomal genes. The DASE phenotype can also be transmitted by Mendelian inheritance. We have previously reported that nonsense-mediated mRNA decay (NMD) of mutant BRCA1 as well as other epigenetic mechanisms can lead to DASE of BRCA1 and enhanced susceptibility to breast cancer. BRCA1 has been implicated in many cellular processes including DNA repair, cell-cycle-checkpoint control, protein ubiquitination, and chromatin remodeling. Importantly, cells carrying a deleterious BRCA1 mutation exhibit increased genome instability, therefore, we hypothesize that defects in BRCA1 lead not only to DASE of itself, but increase genome-wide DASE and thus contribute to increased breast cancer susceptibility. To test this hypothesis, we employed a genome-wide ASE assay (Illumina Human Omni1-Quad BeadChip) using primary mammary epithelial cells [3 BRCA1 wild-type vs. 3 BRCA1 mutant carrying (2800delAA, 4154delA and R1751X)]. As shown in Table 1, cells carrying a BRCA1 mutation had significantly more DASE events as compared to wild-type cell (P<10-7). In addition, we identified 351 genes demonstrating DASE that were unique to the BRCA1 mutant cells. The cellular functions of these genes are wideranging, including DNA repair, cell cycle control, lipid metabolism and protein degradation. In summary, this study provides the first evidence that mutant BRCA1 can lead to global DASE, which in turn may contribute to the development of breast cancer in mutation carriers. This work was supported in part by the Eileen Stein-Jacoby Fund and a grant from the Congressionally Directed Medical Research Programs, Department of Defense, W81XWH-08-1-0361 (XC).
Table 1. BRCA1 mutations increase the global DASE in PMECs
t; A DASE event is defined as that the Log-ratio of allele-specific expression level of one gene is more than 1 or less than -1, i.e. the expression level from one allele is at least 50% less than the level of another allele
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P3-08-03.
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Affiliation(s)
- X Chen
- Fox Chase Cancer Center, Philadelphia, PA; Roswell Park Cancer Institute, Buffalo, NY
| | - A Schaeffer
- Fox Chase Cancer Center, Philadelphia, PA; Roswell Park Cancer Institute, Buffalo, NY
| | - K Devarajan
- Fox Chase Cancer Center, Philadelphia, PA; Roswell Park Cancer Institute, Buffalo, NY
| | - C Liao
- Fox Chase Cancer Center, Philadelphia, PA; Roswell Park Cancer Institute, Buffalo, NY
| | - Y Zhou
- Fox Chase Cancer Center, Philadelphia, PA; Roswell Park Cancer Institute, Buffalo, NY
| | - CM Slater
- Fox Chase Cancer Center, Philadelphia, PA; Roswell Park Cancer Institute, Buffalo, NY
| | - L Vanderveer
- Fox Chase Cancer Center, Philadelphia, PA; Roswell Park Cancer Institute, Buffalo, NY
| | - J Conroy
- Fox Chase Cancer Center, Philadelphia, PA; Roswell Park Cancer Institute, Buffalo, NY
| | - AK. Godwin
- Fox Chase Cancer Center, Philadelphia, PA; Roswell Park Cancer Institute, Buffalo, NY
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Aherne N, Herden J, Wood M, Schaeffer A, Hill J, Last A, Fuller C, Welshman R, Shakespeare T. Daily Fiducial Based Tracking of Seminal Vesicle Motion in Image Guided Dose Escalated IMRT: Are We Kidding Ourselves Regarding Seminal Vesicle Coverage? Int J Radiat Oncol Biol Phys 2009. [DOI: 10.1016/j.ijrobp.2009.07.684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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Naber K, Cho Y, Matsumoto T, Schaeffer A. P285 A bacterial lysate (OM-89 UV) for recurrent urinary tract infection a meta-analysis. Int J Antimicrob Agents 2009. [DOI: 10.1016/s0924-8579(09)70504-7] [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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Giesel FL, Mehndiratta A, von Tengg-Kobligk H, Schaeffer A, Teh K, Hoffman E, Kauczor HU, van Beek E, Wild JM. Rapid prototyping raw models on the basis of high resolution computed tomography lung data for respiratory flow dynamics. Acad Radiol 2009; 16:495-8. [PMID: 19268862 DOI: 10.1016/j.acra.2008.10.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2008] [Revised: 10/24/2008] [Accepted: 10/27/2008] [Indexed: 10/21/2022]
Abstract
RATIONALE AND OBJECTIVES Three-dimensional image reconstruction by volume rendering and rapid prototyping has made it possible to visualize anatomic structures in three dimensions for interventional planning and academic research. METHODS Volumetric chest computed tomography was performed on a healthy volunteer. Computed tomographic images of the larger bronchial branches were segmented by an extended three-dimensional region-growing algorithm, converted into a stereolithography file, and used for computer-aided design on a laser sintering machine. The injection of gases for respiratory flow modeling and measurements using magnetic resonance imaging were done on a hollow cast. RESULTS Manufacturing the rapid prototype took about 40 minutes and included the airway tree from trackea to segmental bronchi (fifth generation). The branching of the airways are clearly visible in the (3)He images, and the radial imaging has the potential to elucidate the airway dimensions. CONCLUSION The results for flow patterns in the human bronchial tree using the rapid-prototype model with hyperpolarized helium-3 magnetic resonance imaging show the value of this model for flow phantom studies.
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Schaeffer A. Einfluß von Grenzflächen auf mikrobielle Aktivität. Aktuelle Urol 2008. [DOI: 10.1055/s-2008-1058322] [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: 10/21/2022]
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Abstract
Lactobacillus is a Gram positive bacteria found in the mouth, gastrointestinal and female genital tract. Serious infections due to Lactobacillus are becoming increasingly common. We present a 49-year-old diabetic patient with Lactobacillus septic arthritis. To our knowledge, this is the first reported case. Usually, Lactobacillus is implicated with bacteremia, endocarditis and more rarely pneumonia, meningitis and endovascular infection, and half of the cases are reported in immunocompromised patients. As in our patient, diabetes mellitus is a comorbid condition which has been clearly noted. Our finding suggests that further studies are necessary to establish the significance of Lactobacillus as an etiologic agent of septic arthritis.
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Affiliation(s)
- V Chanet
- Service de Médecine Interne, Boulevard Léon Malfreyt, Hôtel Dieu, Clermont Ferrand 1, France.
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Habibi A, Khellaf M, Bachir D, Schaeffer A, Galactéros F, Godeau B. La séquestration splénique aiguë : une complication rare et grave des syndromes drépanocytaires majeurs de l'adulte. À propos d'un cas. Rev Med Interne 2005; 26:339-42. [PMID: 15820572 DOI: 10.1016/j.revmed.2004.12.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [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: 06/16/2004] [Accepted: 12/13/2004] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Acute splenic sequestration, a well-recognized complication of sickle cell syndromes, is characterized by a sudden decrease in haemoglobin concentration and marked painless splenomegaly. We report a case illustrating the outcome and the treatment options of this complication. CASE REPORT A 45-year old homozygous woman developed acute splenic sequestration with severe anemia. Red blood cells transfusion led to transient improvement but a relapse-required splenectomy. Long-term outcome was favorable. CONCLUSION Acute splenic sequestration is a severe complication mainly observed in children. Despite the severity of this complication, prompt diagnosis and appropriate therapy, and particularly red blood cells transfusions, led to a complete recovery. Splenectomy is required in the more severe form of the disease.
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Affiliation(s)
- A Habibi
- Service de médecine interne 1, unité des maladies génétiques du globule rouge et d'Aphérèse 1, CHU Henri-Mondor, AP-HP, 51, avenue de Lattre-de-Tassigny, 94000 Créteil, France
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Khellaf M, Michel M, Schaeffer A, Bierling P, Godeau B. Intérêt d'un score hémorragique pour la stratégiethérapeutique des patients atteints de purpura thrombopénique immunologique auto-immun. Rev Med Interne 2003. [DOI: 10.1016/s0248-8663(03)80401-0] [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: 11/29/2022]
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Habibi A, Roudot-Thoraval F, Elmur T, Khellaf M, Michel M, Bachir D, Paul M, Schaeffer A, Galactéros F, Godeau B. Intérêt du kétoprofène (Profénid®) au cours de la crisevaso-occlusive drépanocytaire de l'adulte. Résultat d'une étude randomisée en double insu contre placebo. Rev Med Interne 2003. [DOI: 10.1016/s0248-8663(03)80400-9] [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: 11/25/2022]
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Abstract
INTRODUCTION Histiocytic necrotizing lymphadenitis, also called Kikuchi-Fujimoto's disease (KD), usually occurs in young women and is characterized by localized lymphadenitis (mostly cervical) usually associated with fever. Diagnosis relies on histopathological and immunohistochemical analysis of involved lymph node. KD is considered to be the clinical expression of an inadequate immunological reaction, resulting in a self-limited hyperstimulation of the lymphoid tissue, trigerred by an antigenic infectious stimulation. The clinical course is usually benign with a spontaneous remission of symptoms. Recurrence is very rarely observed. KD may be associated with systemic lupus erythematosus, whereas the association with chronic discoid lupus has only been rarely reported. EXEGESIS We report a case of KD recurrence, 9 years after the initial diagnosis, in a young eurasian woman, with a chronic discoid lupus erythematosus. CONCLUSION KD is a benign disease with a spontaneously good outcome. Recurrence may rarely occur many years after the initial diagnosis but needs a new histopathological confirmation. Systemic or even cutaneous lupus erythematosus may be associated with KD. Although unfrequent, this association suggests that both diseases could share a common pathogenesis.
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Affiliation(s)
- S Lecoules
- Service de médecine interne, hôpital Henri-Mondor, 51, avenue du maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France.
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Abstract
PURPOSE Among the locations of venous thrombosis, even if rare, cerebral-vein thrombosis is a severe event with a high mortality rate. No aetiology is found in 20 to 30% of the cases. In recent years, inherited coagulation disorders have been described, as risk factors for venous thrombosis. We report the results of a retrospective study of 27 patients who suffered cerebral-vein thrombosis, in which coagulation abnormalities have been searched for. METHOD The patients were referred to the haemostasis laboratory of the Henri Mondor hospital between august 1982 and June 1988, after a cerebral-vein thrombosis. The predisposing factors, personal and family history of thromboembolism, clinical presentation, thrombosis location, evolution under treatment and long-term outcome, have been noted. Deficiencies in antithrombine, protein C, protein S, the Factor V Leiden and the G20210A prothrombin-gene mutation, the presence of lupus anticoagulant, of anticardiolipin antibodies as well as a hyperhomocysteinaemia have been searched, either at the initial presentation, or a posteriori. RESULTS Fourty-one percent of patients had a coagulation abnormality. The prevalence of the different abnormalities was: inherited deficiency in AT 7.4%, in PC 8%, in PS 12.5%, factor V Leiden mutation 12%, G20210A prothrombin-gene mutation 12%. Two patients had combined defects: AT and PC deficiency in one, F V Leiden and F II G20210A mutations in one. e of the patient had lupus anticoagulant. Three patients had a significant rate of anticardiolipin antibodies. Five patients out of eight displayed a moderate hyperhomocysteinaemia. Nothing (past history, age, predisposing factors) distinguished those patients bearing a coagulation disorder from the others. The venous thromboembolic relapse rate of 15 % (4/27 patients). Three of them had an inherited thrombophilic abnormality. CONCLUSION We recommend an investigation of the haemostasis after every cerebral venous thrombosis.
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Affiliation(s)
- S Rosenstingl
- Service de médecine interne, hôpital Henri-Mondor, 94000 Créteil, France.
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Genty I, Michel M, Hermine O, Schaeffer A, Godeau B, Rochant H. [Characteristics of autoimmune hemolytic anemia in adults: retrospective analysis of 83 cases]. Rev Med Interne 2002; 23:901-9. [PMID: 12481390 DOI: 10.1016/s0248-8663(02)00688-4] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.1] [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: 12/25/2022]
Abstract
PURPOSE To describe the main characteristics and outcome of adult's acquired immune hemolytic anemias (AIHA). To analyse the relevance of the complementary tests performed for the search of an underlying disease. METHODS Retrospective (1980-2000) monocentric study. INCLUSION CRITERIA age above 16, AIHA defined by an hemoglobin level below 12 g/dl in men and 11 g/dl in women, with hemolysis and/or a positive direct Coombs test and/or the presence of cold agglutinins (threshold 1/500) and/or in the absence of any other cause. RESULTS Eighty three patients included (56 women and 27 men), with a mean age of 56 years (+/- 22) at AIHA onset including: 72 patients (87%) with warm antibody AIHA and 11 (13%) with cold agglutinin disease. The mean follow-up was 48 months (median 22 months). Among the 72 patients with warm antibody AIHA, the specificity of autoantibodies was: IgG + complement (43%), IgG (32%) or complement alone (25%); cold agglutinins (titre from 1/60 to 1/512) were detected in 15 (20%) of the patients. Antinuclear antibodies were detected (threshold: 1/80) in 33% of the cases. Hypogammaglobulinemia on serum protein electrophoresis (SPE) was significantively associated with the presence of an underlying non-Hogkin lymphoma (NHL). The CT-scan of the the chest and abdomen which was performed in 50% of the patients, showed abnormalities other than a spleen enlargement in 25% of the cases. The medullar biopsy (MB) was abnormal in 7 of 26 cases (27%) but lead by itself to the diagnosis of NHL in a single case. Thrirty seven (51%) of warm antibody AIHA cases were finally considered to be "secondary" to an underlying disease namely: NHLs (n = 14), Hogkin's disease (n = 1) connective tissue disease (CTD) (n = 14), drug-induced AIHA (n = 3), miscellaneous (n = 5). In 6 out of 14 cases (43%) of NHL's associated AIHA, the onset of AIHA precedes the NHL from 22 to 66 months. The response rates to different therapeutic regimens did not significatively differ when "secondary" and "idiopathic" AIHA were compared. Overall, 13 patients (15.6%) died mainly from infectious complications (n = 5) or an underlying NHL (n = 5). CONCLUSIONS In more than half of the cases AIHA are associated with an underlying disease and AIHA may precede the onset of a NHL for a long period. In the absence of a clinically apparent underlying disorder, testing for the presence of antinuclear antibodies, a SPE and a CT-scan must be systematic. Conversely, if no abnormalities are found, the relevance of a systematic MB at AIHA onset seems very low.
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Affiliation(s)
- I Genty
- Service de médecine interne, hôpital Henri-Mondor, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France
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Genty I, Michel M, Godeau B, Schaeffer A, Rochant H. Caractéristiques des anémies hémolytiques auto-immunes de l'adulte : analyse rétrospective à partir d'une série de 83 patients. Rev Med Interne 2001. [DOI: 10.1016/s0248-8663(01)83353-1] [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: 10/27/2022]
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Abstract
INTRODUCTION Sickle cell disease is an inherited disease characterized by the presence of an abnormal haemoglobin. It is the most prevalent genetic disease at birth in the Ile-de-France area. Internists are involved in the management of acute complications, particularly acute vaso-occlusive crisis. CURRENT KNOWLEDGE AND KEY POINTS Sickle cell disease can be complicated by acute vaso-occlusive crisis, chronic visceral involvement related to the ischaemic process, and infectious complications. In adults, acute vaso-occlusive crisis is the major clinical problem prompting admission to the hospital and the main cause of death. It mainly manifests by osteoarticular pain but other clinical complications can be observed such as acute chest syndrome, priapism, ischaemic or haemorrhagic stroke, abdominal pain and acute multivisceral failure. The treatment of acute vaso-occlusive crisis is symptomatic. Simple transfusion or partial exchange transfusion is required in the more severe form of vaso-occlusive crisis. FUTURE PROSPECTS AND PROJECTS The management of adult patients with sickle cell disease must be based on a multidisciplinary approach. At the present time, more than 50% of patients survive beyond the fifth decade. This better and longer life in developed countries has resulted from basic investigations and symptomatic treatments.
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Affiliation(s)
- B Godeau
- Service de médecine interne, hôpital Henri-Mondor, 51, avenue de-Lattre-de-Tassigny, 94010 Créteil, France.
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Ronald AR, Nicolle LE, Stamm E, Krieger J, Warren J, Schaeffer A, Naber KG, Hooton TM, Johnson J, Chambers S, Andriole V. Urinary tract infection in adults: research priorities and strategies. Int J Antimicrob Agents 2001; 17:343-8. [PMID: 11295419 DOI: 10.1016/s0924-8579(01)00303-x] [Citation(s) in RCA: 105] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Waning interest in urinary tract infection (UTI) research has limited clinical advances during the past two decades. Although care has improved for some specific UTI syndromes, there is limited evidence for most of the decisions made each day in the management of these infections. Additional clinical research is necessary to improve UTI prevention and care strategies.
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Affiliation(s)
- A R Ronald
- St. Boniface General Hospital University of Manitoba, Section of Infectious Diseases, Winnipeg, Man, Canada R2H 2A6.
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Abstract
INTRODUCTION The liver and central nervous system are the usual targets of Wilson's disease, an inherited disorder of copper metabolism. Severe hemolytic anemia is an unusual complication of Wilson's disease. EXEGESIS We report two cases of Wilson's disease revealed by acute intravascular hemolytic anemia associated with liver failure. Blood smear analysis showed stippled red cells in one case; hemolytic anemia improved within a few weeks in both patients but progressive liver failure required transplantation in the other. Hemolysis probably results from the toxic effect of free serum copper on erythrocyte membrane. CONCLUSION Diagnosis of Wilson's disease must be considered in case of acute hemolytic anemia associated with liver failure in young adults.
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Affiliation(s)
- M Michel
- Service de médecine interne, hôpital Henri-Mondor, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France.
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Schaeffer A, Bronner R, Benveniste P, Schaller H. The ratio of campesterol to sitosterol that modulates growth in Arabidopsis is controlled by STEROL METHYLTRANSFERASE 2;1. Plant J 2001; 25:605-15. [PMID: 11319028 DOI: 10.1046/j.1365-313x.2001.00994.x] [Citation(s) in RCA: 100] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
The Arabidopsis genome contains three distinct genes encoding sterol-C24-methyltransferases (SMTs) involved in sterol biosynthesis. The expression of one of them, STEROL METHYLTRANSFERASE 2;1, was modulated in 35S:SMT2;1 Arabidopsis in order to study its physiological function. Plants overexpressing the transgene accumulate sitosterol, a 24-ethylsterol which is thought to be the typical plant membrane reinforcer, at the expense of campesterol. These plants displayed a reduced stature and growth that could be restored by brassinosteroid treatment. Plants showing co-suppression of SMT2;1 were characterized by a predominant 24-methylsterol biosynthetic pathway leading to a high campesterol content and a depletion in sitosterol. Pleiotropic effects on development such as reduced growth, increased branching, and low fertility of high-campesterol plants were not modified by exogenous brassinosteroids, indicating specific sterol requirements to promote normal development. Thus SMT2;1 has a crucial role in balancing the ratio of campesterol to sitosterol in order to fit both growth requirements and membrane integrity.
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Affiliation(s)
- A Schaeffer
- Institut de Biologie Moléculaire des Plantes du CNRS, Département Biosynthèse et Fonctions des Isoprénoïdes, Institut de Botanique, 28 rue Goethe, 67083 Strasbourg, France
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Baltenweck-Guyot R, Trendel JM, Albrecht P, Schaeffer A. Glycosides and phenylpropanoid glycerol in vitis vinifera cv. Gewurztraminer wine. J Agric Food Chem 2000; 48:6178-6182. [PMID: 11141277 DOI: 10.1021/jf0002600] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Eight glycosides and a phenylpropanoid glycerol were isolated from Vitis vinifera cv. Gewurztraminer wine, and their structures were elucidated by MS and NMR spectroscopies. cis-1-(5-Ethenyl-5-methyltetrahydrofuran-2-yl)-1-methylethyl O-beta-D-apiofuranosyl-(1-->6)-O-beta-D-glucopyranoside, (E)-3,6, 9-trihydroxymegastigm-7-ene 9-O-beta-D-glucopyranoside, 2-phenylethyl O-beta-D-apiofuranosyl-(1-->6)-O-beta-D-glucopyranoside, and 2-[4-(3-hydroxypropyl)-2-methoxyphenoxy]propane-1,3-diol are reported for the first time as wine components.
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Affiliation(s)
- R Baltenweck-Guyot
- Laboratoire de Chimie Organique des Substances Naturelles, UMR 7509 CNRS/Universite Louis Pasteur, Institut de Chimie, 1 rue Blaise Pascal, 67000 Strasbourg, Francece
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Umiel T, Prilutskaya M, Nguyen NH, Moss TJ, Schaeffer A, Burgess J, Griffith M, Mills B. Breast tumor contamination of peripheral blood stem cell harvests: increased sensitivity of detection using immunomagnetic enrichment. J Hematother Stem Cell Res 2000; 9:895-904. [PMID: 11177603 DOI: 10.1089/152581600750062345] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Contaminating tumor cells in peripheral blood stem cell (PBSC) grafts infused for hematopoietic rescue after high-dose chemotherapy could potentially contribute to relapse in BrCa patients. To date the prevalence of PBSC contamination in BrCa patients, as determined by standard immuno-cytochemistry (ICC) assays, has generally been found to be relatively low. However, assay sensitivity may have an important impact on the ability to detect contamination. In this investigation a novel and highly sensitive BrCa cell assay using immunomagnetic enrichment with a panel of antiBrCa monoclonal antibodies (MAbs) and detection by ICC has been characterized. The immunomagnetic enrichment with ICC detection (IE-ICC) assay was directly compared with standard ICC in ability to detect BrCa contamination of PBSC specimens from patients with high-risk stage II/III and metastatic disease. The sensitivity of the IE-ICC assay was approximately 50-fold greater than that of standard ICC. As determined by standard ICC assay, BrCa cells were present in 1/14 patients (7%) and 2/26 (8%) specimens. In contrast, with IE-ICC assay the proportions of positive findings in patients (12/14, 86%) and specimens (19/26, 73%) were significantly higher (p = 0.001 and p < 0.0005, respectively). These preliminary findings suggest that the prevalence of PBSC contamination may be substantially higher than previously appreciated. Consequently, measures to reduce tumor contamination in the graft may have the potential to improve patient outcomes. Higher sensitivity assays such as the IE-ICC assay may play an important role in assessing the risks associated with tumor contamination and the effectiveness of tumor-purging approaches such as positive selection of CD34+ cells and in monitoring patient response to therapy.
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Affiliation(s)
- T Umiel
- IMPATH/BIS Laboratories, Reseda, CA 91335, USA
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Michel M, Fifi A, Bachir D, Schaeffer A, Godeau B, Galacteros F, Arfi S. Drépanocytose et connectivites : étude rétrospective sur 16 patients. Rev Med Interne 2000. [DOI: 10.1016/s0248-8663(00)90079-1] [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: 10/18/2022]
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Niault M, Roudot-Thoraval F, Habibi A, Bachir D, Schaeffer A, Galactéros F, Godeau B. Il faut penser au diagnostic de syndrome drṕanocytaire majeur chez l'adulte. À propos d'une série de 108 patients ayant eu un diagnostic tardif. Rev Med Interne 2000. [DOI: 10.1016/s0248-8663(00)90012-2] [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: 11/16/2022]
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Perronne V, Roberts-Harwood M, Bachir D, Roudot-Thoraval F, Delord J, Thuret I, Schaeffer A, Davies S, Galactéros F, Godeau B. Étude multicentrique européenne des circonstances de décès chez des adultes atteints de syndrome drépanocytaire majeur. Rev Med Interne 2000. [DOI: 10.1016/s0248-8663(00)90013-4] [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: 10/18/2022]
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Lee K, Godeau B, Bachir D, Roudot-Thoraval F, Bernaudin F, Gane P, Schaeffer A, Cartron J, Galactéros F, Bierling P. La gravité des syndromes drépanocytaires majeurs est-elle atténuée en cas de déficit en molécules d'adhésion CD36 (glycoprotéine IV) ? Résultats d'une étude cas-témoins. Rev Med Interne 2000. [DOI: 10.1016/s0248-8663(00)90014-6] [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: 10/18/2022]
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Kolesnikov-Gauthier H, Borie MF, Maitre B, Rosso J, Schaeffer A, Meignan M. Unusual case of diagnosis of pigeon breeder's hypersensitivity pneumonitis with ventilation-perfusion lung scan. Clin Nucl Med 2000; 25:421-3. [PMID: 10836687 DOI: 10.1097/00003072-200006000-00005] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The authors describe a patient thought to have pulmonary embolism. Results of a perfusion scan were normal, but Tc-99m DTPA aerosol ventilation lung scan showed, in successive views, decreased activity of the deposited aerosol. The lung Tc-99m DTPA clearance was measured and was markedly increased. This suggested possible hypersensitivity pneumonitis, which was later confirmed as pigeon breeder's disease. The decreased activity observed on the DTPA ventilation scan must be directed toward increased lung clearance and its measurement.
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Michel M, Zeller V, Noel V, Godeau B, Schaeffer A. Une rétention aiguë d’urine qui tourne mal. Rev Med Interne 2000. [DOI: 10.1016/s0248-8663(00)89281-4] [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: 11/24/2022]
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Abstract
Higher plant cells contain a mixture of 24-desmethyl, 24-methyl(ene), and 24-ethyl(idene) sterols in given proportions according to species but also to cell type. As a first step to investigate the function of such sterol compositions in the physiology of a plant, we have illustrated in the present work the coexistence of two distinct (S)-adenosyl-L-methionine sterol-C24-methyltransferases (SMT) in transgenic Nicotiana tabacum L. Indeed, modulation of the expression of the tobacco gene SMT1-1, which encodes a cycloartenol-C24-methyltransferase, results in variations of the proportion of cycloartenol and a concomitant effect on the proportion of 24-ethyl sterols. Overexpression in tobacco of the Arabidopsis thaliana (L.) Heynh. gene SMT2-1 which encodes a 24-methylene lophenol-C24(1)-methyltransferase, results in a dramatic modification of the ratio of 24-methyl cholesterol to sitosterol associated with a reduced growth, a topic discussed in the present work.
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Affiliation(s)
- A Schaeffer
- Institute de Biologie Moléculaire des Plantes, Département Biosynthèse et Fonctions des Isoprenoïdes, Institut de Botanique, Strasbourg, France
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Godeau B, Caulier MT, Decuypere L, Rose C, Schaeffer A, Bierling P. Intravenous immunoglobulin for adults with autoimmune thrombocytopenic purpura: results of a randomized trial comparing 0.5 and 1 g/kg b.w. Br J Haematol 1999; 107:716-9. [PMID: 10606875 DOI: 10.1046/j.1365-2141.1999.01766.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.0] [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: 11/20/2022]
Abstract
Since the first reports demonstrating the ability of a total dose of 2 g/kg body weight (b.w.) of intravenous immunoglobulin (IVIg) to increase the platelet count in patients with autoimmune thrombocytopenic purpura (AITP), the optimal dose has remained controversial. We report the results of a randomized study which compared two low doses of IVIg (0.5 g/kg b.w., group A, n = 19, and 1 g/kg b.w., group B, n = 18) in 37 adults with AITP and platelet count <50 x 109/l, in preparation for surgery or in a situation with a risk of bleeding. On day 4 the proportion of responses, defined by a platelet count > 80 x 109/l and at least twice the initial platelet count, was significantly higher in the group receiving 1 g/kg b.w. (12/18 in group B versus 4/19 in group A, P = 0.005). All but one of the day 4 responders had already responded on day 3. The daily changes in the platelet count from the beginning of IVIg treatment were larger in group B, with a significant difference relative to group A on day 3 (92 x 109/l in group B versus 50 x 109/l in group A, P = 0.03) and on day 4 (106 x 109/l in group B versus 55 x 109/l in group A, P = 0.03). Patients who had not responded by day 4 subsequently received 1.5 g IVIg/kg b.w. (group A) or 1 g IVIg/kg b.w. (group B). A response was observed in 11/13 initial non-responders in group A, and in 2/6 initial non-responders in group B. Finally, on day 8, the proportion of responders was 78% (29/37) in the entire group and was similar in the two subgroups. In conclusion, (1) initial treatment with 1 g/kg b.w. of IVIg appeared to be more effective than 0.5 g/kg b.w. in adults with AITP; (2) infusion of a low dose of IVIg did not jeopardize the efficacy of IVIg reinfusion; (3) some adults who did not respond to 1 g IVIg/kg b.w. responded to a higher dose.
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Affiliation(s)
- B Godeau
- Laboratoire d'Immunologie Leuco-plaquettaire, Service de Médecine Interne 1, Hôpital Henri Mondor, Créteil, France
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Roudot-Thoraval F, Montagne O, Schaeffer A, Dubreuil-Lemaire ML, Hachard D, Durand-Zaleski I. Costs and benefits of measures to prevent needlestick injuries in a university hospital. Infect Control Hosp Epidemiol 1999; 20:614-7. [PMID: 10501260 DOI: 10.1086/501681] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.2] [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: 11/03/2022]
Abstract
OBJECTIVE To document the costs and the benefits (both in terms of costs averted and of injuries averted) of education sessions and replacement of phlebotomy devices to ensure that needle recapping did not take place. DESIGN The percentage of recapped needles and the rate of needlestick injuries were evaluated in 1990 and 1997, from a survey of transparent rigid containers in the wards and at the bedside and from a prospective register of all injuries in the workplace. Costs were computed from the viewpoint of the hospital. Positive costs were those of education and purchase of safer phlebotomy devices; negative costs were the prophylactic treatments and follow-up averted by the reduction in injuries. SETTING A 1,050-bed tertiary-care university hospital in the Paris region. RESULTS Between the two periods, the proportion of needles seen in the containers that had been recapped was reduced from 10% to 2%. In 1990, 127 needlestick (12.7/100,000 needles) and 52 recapping injuries were reported versus 62 (6.4/100,000 needles) and 22 in 1996 and 1997. When the rates were related to the actual number of patients, the reduction was 76 injuries per year. The total cost of information and preventive measures was $325,927 per year. The cost-effectiveness was $4,000 per injury prevented. CONCLUSION Although preventive measures taken to ensure reduction of needlestick injuries appear to have been effective (75% reduction in recapping and 50% reduction in injuries), the cost of the safety program was high.
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Ruivard M, Caulier MT, Vantelon JM, Tournilhac O, Schaeffer A, Godeau B, Bierling P. The response to high-dose intravenous immunoglobulin or steroids is not predictive of outcome after splenectomy in adults with autoimmune thrombocytopenic purpura. Br J Haematol 1999; 105:1130-2. [PMID: 10554833 DOI: 10.1046/j.1365-2141.1999.01464.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [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: 12/12/2022]
Abstract
The response to high-dose intravenous immunoglobulin (IVIg) was recently reported to be predictive of outcome after splenectomy in patients with autoimmune thrombocytopenic purpura (AITP). We analysed the records of 75 adults with chronic AITP who received IVIg and subsequently underwent splenectomy. There was no significant difference in the response rate to splenectomy according to whether or not patients had responded to IVIg (81% v 67%, P = 0.36). Age, the time from diagnosis to splenectomy, and the response to steroids were also not significantly associated with outcome after splenectomy. These results indicate that the response to IVIg or steroids is not predictive of the efficacy of splenectomy.
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Affiliation(s)
- M Ruivard
- Service de Médecine Interne, Hôpital Henri Mondor, Créteil, France
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Simon J, Dhote R, Papo T, Sailler L, André M, Dupond J, Laroche C, Piette A, Arlaud J, Labussière A, Baty V, Desveaux A, Schaeffer A, Piette U, Boissonnas A, Christoforov B. Syndromes hémophagocytaires au cours des maladies systémiques. Résultats d'une enquête nationale. À propos de 24 cas. Rev Med Interne 1999. [DOI: 10.1016/s0248-8663(99)80216-1] [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: 10/18/2022]
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Fourestié V, Tognet E, Roudot-Thoraval F, Sillet C, Schaeffer A. La leucocytose est-elle indicative d'infection bactérienne aiguë chez les patients admis dans les services des urgences ? Rev Med Interne 1999. [DOI: 10.1016/s0248-8663(99)80212-4] [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: 10/17/2022]
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Nickel JC, Alexander R, Anderson R, Krieger J, Moon T, Neal D, Schaeffer A, Shoskes D. Prostatitis unplugged? Prostatic massage revisited. Tech Urol 1999; 5:1-7. [PMID: 10374787] [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: 02/12/2023]
Abstract
Repetitive prostatic massage is not a new tool in the urologists' armatarium. Once the most popular therapeutic maneuver used to treat prostatitis, it was abandoned as primary therapy almost 3 decades ago. Based on experience reported outside North America and anecdotal experiences of some patients and their physicians, it may be making a comeback. Unfortunately, there are almost no prospective data that would substantiate a claim as to its effectiveness. This article discusses the historic aspects of prostatic massage, suggests possible mechanisms of action, and describes the opinions of North American urologists who are associated with academic clinical research centers and are universally acknowledged as experts in the diagnosis and treatment of prostatitis. At this time, the science of prostatic massage must rely on anecdotal experiences, small, uncontrolled studies, and perhaps somewhat biased opinions of the major thought leaders in the field of chronic prostatitis/chronic pelvic pain syndrome.
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Affiliation(s)
- J C Nickel
- Department of Urology, Queen's University, Kingston, Ontario, Canada
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Godeau B, Brun-Buisson C, Roudot-Thoraval F, Ruivard M, Durègne L, Lefort Y, Blot F, Habibi A, Schaeffer A, Bachir D, Galactéros F. Évolution et facteurs pronostiques des adultes atteints d’un syndrome drépanocytaire majeur lors de leur admission en réanimation. Rev Med Interne 1999. [DOI: 10.1016/s0248-8663(00)87629-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Chariot P, Drogou I, de Lacroix-Szmania I, Eliezer-Vanerot MC, Chazaud B, Lombès A, Schaeffer A, Zafrani ES. Zidovudine-induced mitochondrial disorder with massive liver steatosis, myopathy, lactic acidosis, and mitochondrial DNA depletion. J Hepatol 1999; 30:156-60. [PMID: 9927163 DOI: 10.1016/s0168-8278(99)80020-8] [Citation(s) in RCA: 187] [Impact Index Per Article: 7.5] [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] [Indexed: 12/04/2022]
Abstract
Zidovudine is known to be responsible for a mitochondrial myopathy with ragged-red fibres and mitochondrial DNA depletion in muscle. Lactic acidosis alone or associated with hepatic abnormalities has also been reported. A single report mentioned the concomitant occurrence of muscular and hepatic disturbances and lactic acidosis in a patient receiving zidovudine, but muscle and liver tissues were not studied. A 57-year-old man with AIDS, who had been treated with zidovudine for 3 years, developed fatigue and weight loss. Serum creatine kinase and hepatic enzyme levels were high. Lactic acidosis was present. Liver biopsy showed diffuse macrovacuolar and microvacuolar steatosis. After withdrawal of zidovudine, creatine kinase, aspartate aminotransferase, and alanine aminotransferase levels normalised within 5 days, and lactacidaemia decreased. Acidosis persisted. The patient became confused and febrile and died 8 days after detection of high blood lactic acid. A muscle sample obtained at autopsy showed mitochondrial abnormalities with ragged-red fibres and lipid droplet accumulation. Southern blot analysis showed depletion of mitochondrial DNA, affecting skeletal muscle and liver tissue. No depletion was found in myocardium and kidney. This case emphasises that zidovudine treatment can induce mitochondrial multisystem disease, as revealed in our case by myopathy, liver steatosis and lactic acidosis.
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Affiliation(s)
- P Chariot
- Department of Pathology, Hôpital Henri Mondor, Groupe d'Etudes et de Recherches sur le Muscle et le Nerf (EA 2347, Université Paris XII), Faculté de Médecine, Créteil, France
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Jubault V, De Lacroix-Szmania I, Zittoun J, Jouault H, Lesprit P, Godeau B, Schaeffer A. [Hemolysis and schizocytosis, malabsorption and the "folate trap": unusual semiological peculiarities associated with vitamin B12 deficiency]. Rev Med Interne 1998; 19:921-3. [PMID: 9887461 DOI: 10.1016/s0248-8663(99)80066-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [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: 11/17/2022]
Abstract
INTRODUCTION Hemolysis and red cell fragmentation accompanying vitamin B12 deficiency may misdirect the diagnosis. Signs of malabsorption and abnormalities related to folic acid metabolism characterized by discrepancies between folic acid normal serum levels and erythrocytic folic acid levels may also exist. EXEGESIS We report the occurrence of hemolysis and red cell fragmentation mimicking microangiopathic hemolytic anemia, malabsorption and folic acid deficiency in the course of vitamin B12 deficiency. Appropriate replacement therapy corrected all abnormalities. CONCLUSION An association between hemolysis, malabsorption and folic acid deficiency should lead physicians to search for signs of vitamin B12 deficiency.
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Affiliation(s)
- V Jubault
- Service de médecine interne I, hôpital Henri-Mondor, Créteil, France
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Bastuji-Garin S, Schaeffer A, Wolkenstein P, Godeau B, Carville C, Durand-Zaleski I, Meignan M. Pulmonary embolism; lung scanning interpretation: about words. Chest 1998; 114:1551-5. [PMID: 9872187 DOI: 10.1378/chest.114.6.1551] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [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: 11/01/2022] Open
Abstract
OBJECTIVE To assess clinicians' agreement on how they interpret lung scan reports with regard to the diagnosis of pulmonary embolism. DESIGN In this prospective study, nuclear medicine physicians provided two types of reports for each lung scan: a routine descriptive report and a short form with a standardized conclusion on the likelihood of pulmonary embolism: "high probability," "no conclusion," and "diagnosis excluded." Three independent blinded senior clinicians reviewed all routine reports and chose one of the following conclusions: "high probability," "no conclusion," or "diagnosis excluded." SETTING An acute care teaching hospital near Paris. SUBJECTS Eighty-two lung scans were studied. MAIN OUTCOME MEASUREMENTS Inter-clinician agreement and agreement between clinicians' conclusions and the nuclear medicine physicians' standardized reports were analyzed using the kappa index. RESULTS The distribution of the clinicians' conclusions from routine reports strongly differed (p < 0.001). Agreement among the three clinicians was observed in 40.2% of the routine reports, and the inter-clinician agreement was poor to moderate (kappa range, 0.28 to 0.52). A complete agreement among the three clinicians and the nuclear medicine physicians' standardized conclusions was observed for 32.9% of the reports. The agreement between each clinician and the standardized conclusions was also poor to moderate (kappa range, 0.32 to 0.55). CONCLUSION Reading the same routine reports, clinicians reached different conclusions. Furthermore these differed greatly from the nuclear medicine physicians' standardized conclusions. These results support the notion that physicians should be given standardized reports.
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Affiliation(s)
- S Bastuji-Garin
- Department of Public Health, Université Paris XII, Hôpital Henri-Mondor, Créteil, France.
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