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Donadille B, Janmaat S, Mosbah H, Belalem I, Lamothe S, Nedelcu M, Jannot AS, Christin-Maitre S, Fève B, Vatier C, Vigouroux C. Diagnostic and referral pathways in patients with rare lipodystrophy and insulin-resistance syndromes: key milestones assessed from a national reference center. Orphanet J Rare Dis 2024; 19:177. [PMID: 38678257 PMCID: PMC11056061 DOI: 10.1186/s13023-024-03173-2] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 03/30/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Rare syndromes of lipodystrophy and insulin-resistance display heterogeneous clinical expressions. Their early recognition, diagnosis and management are required to avoid long-term complications. OBJECTIVE We aimed to evaluate the patients' age at referral to our dedicated national reference center in France and their elapsed time from first symptoms to diagnosis and access to specialized care. PATIENTS AND METHODS We analyzed data from patients with rare lipodystrophy and insulin-resistance syndromes referred to the coordinating PRISIS reference center (Adult Endocrine Department, Saint-Antoine Hospital, AP-HP, Paris), prospectively recorded between 2018 and 2023 in the French National Rare Disease Database (BNDMR, Banque Nationale de Données Maladies Rares). RESULTS A cohort of 292 patients was analyzed, including 208 women, with the following diagnosis: Familial Partial LipoDystrophy (FPLD, n = 124, including n = 67 FPLD2/Dunnigan Syndrome); Acquired lipodystrophy syndromes (n = 98, with n = 13 Acquired Generalized Lipodystrophy, AGL); Symmetric cervical adenolipomatosis (n = 27, Launois-Bensaude syndrome, LB), Congenital generalized lipodystrophy (n = 18, CGL) and other rare severe insulin-resistance syndromes (n = 25). The median age at referral was 47.6 years [IQR: 31-60], ranging from 25.2 (CGL) to 62.2 years old (LB). The median age at first symptoms of 27.6 years old [IQR: 16.8-42.0]) and the median diagnostic delay of 6.4 years [IQR: 1.3-19.5] varied among diagnostic groups. The gender-specific expression of lipodystrophy is well-illustrated in the FPLD2 group (91% of women), presenting with first signs at 19.3 years [IQR: 14.4-27.8] with a diagnostic delay of 10.5 years [IQR: 1.8-27.0]. CONCLUSION The national rare disease database provides an important tool for assessment of care pathways in patients with lipodystrophy and rare insulin-resistance syndromes in France. Improving knowledge to reduce diagnostic delay is an important objective of the PRISIS reference center.
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Affiliation(s)
- Bruno Donadille
- Saint-Antoine Hospital, Reference Center for Rare Diseases of Insulin Secretion and Insulin Sensitivity (PRISIS), Department of Endocrinology, Assistance Publique-Hôpitaux de Paris (AP-HP), 184 rue du Faubourg Saint-Antoine, 75012, Paris, France.
| | - Sonja Janmaat
- Saint-Antoine Hospital, Reference Center for Rare Diseases of Insulin Secretion and Insulin Sensitivity (PRISIS), Department of Endocrinology, Assistance Publique-Hôpitaux de Paris (AP-HP), 184 rue du Faubourg Saint-Antoine, 75012, Paris, France
| | - Héléna Mosbah
- Saint-Antoine Hospital, Reference Center for Rare Diseases of Insulin Secretion and Insulin Sensitivity (PRISIS), Department of Endocrinology, Assistance Publique-Hôpitaux de Paris (AP-HP), 184 rue du Faubourg Saint-Antoine, 75012, Paris, France
- Saint-Antoine Research Center, Institute of CardioMetabolism and Nutrition (ICAN), Sorbonne University, Inserm UMR_S 938, Paris, France
| | - Inès Belalem
- Saint-Antoine Hospital, Reference Center for Rare Diseases of Insulin Secretion and Insulin Sensitivity (PRISIS), Department of Endocrinology, Assistance Publique-Hôpitaux de Paris (AP-HP), 184 rue du Faubourg Saint-Antoine, 75012, Paris, France
| | - Sophie Lamothe
- Saint-Antoine Hospital, Reference Center for Rare Diseases of Insulin Secretion and Insulin Sensitivity (PRISIS), Department of Endocrinology, Assistance Publique-Hôpitaux de Paris (AP-HP), 184 rue du Faubourg Saint-Antoine, 75012, Paris, France
| | - Mariana Nedelcu
- Saint-Antoine Hospital, Reference Center for Rare Diseases of Insulin Secretion and Insulin Sensitivity (PRISIS), Department of Endocrinology, Assistance Publique-Hôpitaux de Paris (AP-HP), 184 rue du Faubourg Saint-Antoine, 75012, Paris, France
| | - Anne-Sophie Jannot
- Banque Nationale de Données Maladies Rares, DSN-I&D, APHP, Paris, France
| | - Sophie Christin-Maitre
- Saint-Antoine Hospital, Reference Center for Rare Diseases of Insulin Secretion and Insulin Sensitivity (PRISIS), Department of Endocrinology, Assistance Publique-Hôpitaux de Paris (AP-HP), 184 rue du Faubourg Saint-Antoine, 75012, Paris, France
- Sorbonne Université, Inserm UMR_S 933, Paris, France
| | - Bruno Fève
- Saint-Antoine Hospital, Reference Center for Rare Diseases of Insulin Secretion and Insulin Sensitivity (PRISIS), Department of Endocrinology, Assistance Publique-Hôpitaux de Paris (AP-HP), 184 rue du Faubourg Saint-Antoine, 75012, Paris, France
- Saint-Antoine Research Center, Institute of CardioMetabolism and Nutrition (ICAN), Sorbonne University, Inserm UMR_S 938, Paris, France
| | - Camille Vatier
- Saint-Antoine Hospital, Reference Center for Rare Diseases of Insulin Secretion and Insulin Sensitivity (PRISIS), Department of Endocrinology, Assistance Publique-Hôpitaux de Paris (AP-HP), 184 rue du Faubourg Saint-Antoine, 75012, Paris, France
- Saint-Antoine Research Center, Institute of CardioMetabolism and Nutrition (ICAN), Sorbonne University, Inserm UMR_S 938, Paris, France
| | - Corinne Vigouroux
- Saint-Antoine Hospital, Reference Center for Rare Diseases of Insulin Secretion and Insulin Sensitivity (PRISIS), Department of Endocrinology, Assistance Publique-Hôpitaux de Paris (AP-HP), 184 rue du Faubourg Saint-Antoine, 75012, Paris, France.
- Saint-Antoine Research Center, Institute of CardioMetabolism and Nutrition (ICAN), Sorbonne University, Inserm UMR_S 938, Paris, France.
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Sista F, Carandina S, Andreica A, Zulian V, Pietroletti R, Cappelli S, Balla A, Nedelcu M, Clementi M. Long-term results of laparoscopic gastric sleeve: the importance of follow-up adherence. Eur Rev Med Pharmacol Sci 2022; 26:6691-6699. [PMID: 36196719 DOI: 10.26355/eurrev_202209_29770] [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: 01/19/2023]
Abstract
OBJECTIVE This study was conducted to assess the long-term results of the Laparoscopic Sleeve Gastrectomy (LSG) in patients not compliant with follow-up, and in patients who completed a postoperative follow-up program. PATIENTS AND METHODS The data concerning LSG patients operated from February 2011 to December 2013 were retrospectively reviewed basing on a single center database. The patients with complete long-term follow-up were scheduled in Group A, while patients who failed to attend controls for more than two years were scheduled in Group B. Long-term results (weight loss, comorbidity improvement and late complications) were compared between the two groups. RESULTS The study population consisted of 285 patients. Of these, 101 had a complete follow-up with a mean duration of 71 ± 7.6 months (Group A). The remaining 184 patients (Group B) were not compliant with follow-up and, consequently, the mean duration of follow-up was 5.5 ± 7.3 months (p < 0.00001). A higher number of patients with insufficient weight loss was recorded in Group B with respect to Group A (78 vs. 23; p = 0.001). The number of patients with results below 25% EWL was significantly higher in Group B than in Group A (24 vs. 5; p = 0.04). In the long-term, the rate of patients with symptomatic reflux requiring medical treatment was two-fold higher in Group B than in Group A. CONCLUSIONS The adherence to a long-term follow-up plan after LSG seems to decrease the number of patients experiencing insufficient weight loss and those at risk for developing a gastro-esophageal reflux disease.
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Affiliation(s)
- F Sista
- San Salvatore Hospital, Department of Surgery, L'Aquila, Italy.
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Sista F, Clementi M, Rivkine E, Soprani A, Fiasca F, Cappelli S, Montana L, Nedelcu M, Carandina S. Gastric Bypass after multiple restrictive procedures: Roux-en-Y or One Anastomosis? A retrospective multicentric study. Eur Rev Med Pharmacol Sci 2022; 26:2075-2084. [PMID: 35363357 DOI: 10.26355/eurrev_202203_28355] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE When restrictive surgery fails, conversion to more malabsorptive techniques is frequently proposed. The aim of this study is to evaluate the weight loss figures between Roux-en-Y Gastric Bypass (RYGB) and One Anastomosis Gastric Bypass (OAGB) in patients who have already undergone Multiple Restrictive Procedures (MRP). PATIENTS AND METHODS All patients who underwent conversion of Laparoscopic Sleeve Gastrectomy (LSG) to RYGB or OAGB between 2010 and 2019 were retrospectively analyzed. Only patients who had conversion for Weight Regain (WR) or Insufficient Weight Loss (IWL) after both Laparoscopic Gastric Banding (LGB) and LSG entered the study population. Finally, 44 patients underwent conversion to RYGB, and 24 patients to OAGB. RESULTS Concerning Excess Weight Loss (%EWL) at 3, 6, 12, 24 postoperative months, the results for RYGB were 33.7%, 47.95%, 61.8%, 61.8%, while for OAGB were 38.3%, 51.9%, 63.75%, 79.45%. A significant difference was recorded in favor of OAGB at 3 (p=0.03) and 24 (p=0.046) postoperative months. % EWL at 24 months in the case of IWL was 57.8% for RYGB, while for OAGB was 72.7% (p=0.047). No significant difference was found considering patients with WR (80.9% and 80.5%; p= 0.999). Patients with better results at 24 months after surgery had a significantly longer time between sleeve and bypass than those with a lower % EWL. CONCLUSIONS The results of the present study seem to show that both techniques give good results at 24 months in patients who have undergone MRP. However, OAGB shows overall better results, particularly in patients with IWL.
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Affiliation(s)
- F Sista
- Department of Surgery, Ospedale Civile San Salvatore L'Aquila, UOC di Chirurgia Epato-Bilio-Pancreatica, L'Aquila, Italy.
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Kallali W, Messiaen C, Saïdi R, Lessim S, Viaud M, Dulon J, Nedelcu M, Samara D, Houang M, Donadille B, Courtillot C, de Filippo G, Carel JC, Christin-Maitre S, Touraine P, Netchine I, Polak M, Léger J. Age at diagnosis in patients with chronic congenital endocrine conditions: a regional cohort study from a reference center for rare diseases. Orphanet J Rare Dis 2021; 16:469. [PMID: 34736502 PMCID: PMC8567586 DOI: 10.1186/s13023-021-02099-3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 10/24/2021] [Indexed: 11/10/2022] Open
Abstract
Background For chronic congenital endocrine conditions, age at diagnosis is a key issue with implications for optimal management and psychological concerns. These conditions are associated with an increase in the risk of comorbid conditions, particularly as it concerns growth, pubertal development and fertility potential. Clinical presentation and severity depend on the disorder and the patient’s age, but diagnosis is often late. Objective To evaluate age at diagnosis for the most frequent congenital endocrine diseases affecting growth and/or development. Patients and Methods This observational cohort study included all patients (n = 4379) with well-defined chronic congenital endocrine diseases—non-acquired isolated growth hormone deficiency (IGHD), isolated congenital hypogonadotropic hypogonadism (ICHH), ectopic neurohypophysis (NH), Turner syndrome (TS), McCune-Albright syndrome (MAS), complete androgen insensitivity syndrome (CAIS) and gonadal dysgenesis (GD)—included in the database of a single multisite reference center for rare endocrine growth and developmental disorders, over a period of 14 years. Patients with congenital hypothyroidism and adrenal hyperplasia were excluded as they are generally identified during neonatal screening. Results Median age at diagnosis depended on the disease: first year of life for GD, before the age of five years for ectopic NH and MAS, 8–10 years for IGHD, TS (11% diagnosed antenatally) and CAIS and 17.4 years for ICHH. One third of the patients were diagnosed before the age of five years. Diagnosis occurred in adulthood in 22% of cases for CAIS, 11.6% for TS, 8.8% for GD, 0.8% for ectopic NH, and 0.4% for IGHD. A male predominance (2/3) was observed for IGHD, ectopic NH, ICHH and GD. Conclusion The early recognition of growth/developmental failure during childhood is essential, to reduce time-to-diagnosis and improve outcomes.
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Affiliation(s)
- Wafa Kallali
- Pediatric Endocrinology-Diabetology Department, Reference Center for Growth and Development Endocrine Diseases, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, 48 Bd Sérurier, 75019, Paris, France.
| | - Claude Messiaen
- Banque Nationale de Données Maladies Rares, DSI-I&D, APHP, Paris, France
| | - Roumaisah Saïdi
- Banque Nationale de Données Maladies Rares, DSI-I&D, APHP, Paris, France
| | - Soucounda Lessim
- Pediatric Endocrinology-Diabetology Department, Reference Center for Growth and Development Endocrine Diseases, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, 48 Bd Sérurier, 75019, Paris, France
| | - Magali Viaud
- Pediatric Endocrinology, Gynecology and Diabetology Department, Reference Center for Growth and Development Endocrine Diseases, Necker University Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, 75015, Paris, France
| | - Jerome Dulon
- Endocrinology Department, Reference Center for Growth and Development Endocrine Diseases, La Pitié Salpétrière University Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, 75013, Paris, France
| | - Mariana Nedelcu
- Endocrinology Department, Reference Center for Growth and Development Endocrine Diseases, Saint Antoine University Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, 75012, Paris, France
| | - Dinane Samara
- Pediatric Endocrinology, Gynecology and Diabetology Department, Reference Center for Growth and Development Endocrine Diseases, Necker University Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, 75015, Paris, France
| | - Muriel Houang
- Pediatric Endocrinology Unit, Reference Center for Growth and Development Endocrine Diseases, Trousseau University Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, 75012, Paris, France
| | - Bruno Donadille
- Endocrinology Department, Reference Center for Growth and Development Endocrine Diseases, Saint Antoine University Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, 75012, Paris, France
| | - Carine Courtillot
- Endocrinology Department, Reference Center for Growth and Development Endocrine Diseases, La Pitié Salpétrière University Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, 75013, Paris, France
| | - GianPaolo de Filippo
- Pediatric Endocrinology-Diabetology Department, Reference Center for Growth and Development Endocrine Diseases, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, 48 Bd Sérurier, 75019, Paris, France
| | - Jean-Claude Carel
- Pediatric Endocrinology-Diabetology Department, Reference Center for Growth and Development Endocrine Diseases, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, 48 Bd Sérurier, 75019, Paris, France
| | - Sophie Christin-Maitre
- Endocrinology Department, Reference Center for Growth and Development Endocrine Diseases, Saint Antoine University Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, 75012, Paris, France
| | - Philippe Touraine
- Endocrinology Department, Reference Center for Growth and Development Endocrine Diseases, La Pitié Salpétrière University Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, 75013, Paris, France
| | - Irene Netchine
- Pediatric Endocrinology Unit, Reference Center for Growth and Development Endocrine Diseases, Trousseau University Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, 75012, Paris, France
| | - Michel Polak
- Pediatric Endocrinology, Gynecology and Diabetology Department, Reference Center for Growth and Development Endocrine Diseases, Necker University Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, 75015, Paris, France
| | - Juliane Léger
- Pediatric Endocrinology-Diabetology Department, Reference Center for Growth and Development Endocrine Diseases, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, 48 Bd Sérurier, 75019, Paris, France
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Donadille B, Tuffet S, Cholet C, Nedelcu M, Bourcigaux N, Iserin L, Monnier-Cholley L, Rousseau A, Christin-Maitre S. Prevalence and progression of aortic dilatation in adult patients with Turner syndrome: a cohort study. Eur J Endocrinol 2020; 183:463-470. [PMID: 32822316 DOI: 10.1530/eje-20-0284] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 03/28/2020] [Accepted: 07/22/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Turner syndrome (TS) is a rare disorder affecting 1/2500 female newborn. Aortic dilatation (AD) and aortic dissection represent a major concern in TS. The aims of our study were to describe the aortic root growth, potential aortic dilatation (AD) risk factors and cardiovascular outcomes in a cohort of patients with TS. METHODS Among 204 adult patients included, 197 were studied using a standardized 1.5 Tesla MRI protocol. AD was defined as an aortic diameter ≥20 mm/m2 at the Valsalva sinuses and/or at the ascending aorta, when indexed to body surface area. RESULTS At baseline, AD was present in 81/197 (41.1%) and 32/197 (16.2%) of patients, at the levels of Valsalva and ascending aorta, respectively. The aortic Valsalva diameter was larger in patients treated for thyroiditis (P < 0.001). Potential risk factors of AD were aging (P < 0.001) and the presence of bicuspid aortic valve (BAV) (P = 0.002). The hazard ratio (HR) of AD occurrence in the presence of BAV was 2.2 (95% CI: 1.33-3.71). After a median follow-up period of 5.1 years (n = 143), AD was present in 58/143 (40.6%) and 25/143 (17.5%) of patients at the levels of Valsalva and ascending aorta, respectively. The median aortic growth of the Valsalva sinuses remained stable. At the ascending aorta, it increased by 0.14 ± 0.61 mm/year. Only one aortic-related death was observed. CONCLUSION AD is common in adult patients with TS. However, our results are rather reassuring, as the median aortic diameters remained stable after 5.1 years and few aortic events were observed.
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Affiliation(s)
- Bruno Donadille
- Endocrinology Department, Saint Antoine Hospital and Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Paris, France
- Centre de Référence des Maladies Endocriniennes Rares de la Croissance et du Développement (CRMERCD), Filière FIRENDO, Endo-ERN id 739527, Paris, France
| | - Sophie Tuffet
- Clinical Research Unit (URC-EST), Saint Antoine Hospital and Functional Unit of Pharmacology, Sorbonne Université, Paris, France
| | - Clement Cholet
- Radiology Department, Saint Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Mariana Nedelcu
- Endocrinology Department, Saint Antoine Hospital and Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Paris, France
- Centre de Référence des Maladies Endocriniennes Rares de la Croissance et du Développement (CRMERCD), Filière FIRENDO, Endo-ERN id 739527, Paris, France
| | - Nathalie Bourcigaux
- Endocrinology Department, Saint Antoine Hospital and Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Paris, France
- Centre de Référence des Maladies Endocriniennes Rares de la Croissance et du Développement (CRMERCD), Filière FIRENDO, Endo-ERN id 739527, Paris, France
| | - Laurence Iserin
- Congenital Heart Disease Unit, Cardiology Department, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Laurence Monnier-Cholley
- Radiology Department, Saint Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Alexandra Rousseau
- Clinical Research Unit (URC-EST), Saint Antoine Hospital and Functional Unit of Pharmacology, Sorbonne Université, Paris, France
| | - Sophie Christin-Maitre
- Endocrinology Department, Saint Antoine Hospital and Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Paris, France
- Centre de Référence des Maladies Endocriniennes Rares de la Croissance et du Développement (CRMERCD), Filière FIRENDO, Endo-ERN id 739527, Paris, France
- Inserm Unit UMR-S933, Paris, France
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Bernard V, Donadille B, Le Poulennec T, Nedelcu M, Martinerie L, Christin-Maitre S. MANAGEMENT OF ENDOCRINE DISEASE: Transition of care for young adult patients with Turner syndrome. Eur J Endocrinol 2019; 180:R1-R7. [PMID: 30793874 DOI: 10.1530/eje-18-0238] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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] [Indexed: 12/13/2022]
Abstract
Turner syndrome (TS), affecting 1/2000 to 1/2500 live born girls, is a chromosomal aberration with a total or partial loss of one of the X chromosomes. The diagnosis can be established from the intra-uterine life to adulthood. TS is a chronic disease with particular morbidity and mortality. The loss to follow-up rate, during transition, between children and adult units, remains a crucial issue. This review focusses on the adolescent and young adult patients with TS. The different goals of TS transition are presented as well as some of the tools available in order to improve this transition. The involvement of the patient’s family, advocacy groups and therapeutic educational programs are discussed. A specificity concerning TS transition, as compared to other chronic diseases, relies on the fact that patients with TS may present a peculiar neurocognitive profile. They are in general more anxious than the general population. Therefore, psychological support should be offered to optimize transition. Data illustrating the beneficial impact of an organised transition of TS, from paediatric units to multidisciplinary adult care systems, within the same reference centre are presented. Further studies are required to evaluate the mid-to-long-term transition of paediatric patients with TS referred to adult units.
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Affiliation(s)
- Valérie Bernard
- Service d'Endocrinologie et Maladies de la Reproduction, Centre constitutif du centre de Référence des Maladies Endocriniennes Rares de la Croissance et du Développement (CMERCD), Assistance Publique - Hôpitaux de Paris, Hôpital Saint-Antoine, Paris, France
- Sorbonne Université, F-75012, Paris, France
| | - Bruno Donadille
- Service d'Endocrinologie et Maladies de la Reproduction, Centre constitutif du centre de Référence des Maladies Endocriniennes Rares de la Croissance et du Développement (CMERCD), Assistance Publique - Hôpitaux de Paris, Hôpital Saint-Antoine, Paris, France
| | - Tiphaine Le Poulennec
- Service d'Endocrinologie et Maladies de la Reproduction, Centre constitutif du centre de Référence des Maladies Endocriniennes Rares de la Croissance et du Développement (CMERCD), Assistance Publique - Hôpitaux de Paris, Hôpital Saint-Antoine, Paris, France
- Sorbonne Université, F-75012, Paris, France
| | - Mariana Nedelcu
- Service d'Endocrinologie et Maladies de la Reproduction, Centre constitutif du centre de Référence des Maladies Endocriniennes Rares de la Croissance et du Développement (CMERCD), Assistance Publique - Hôpitaux de Paris, Hôpital Saint-Antoine, Paris, France
| | - Laetitia Martinerie
- Service d'Endocrinologie Pédiatrique, Centre de Référence des Maladies Endocriniennes Rares de la Croissance et du Développement (CRMERCD), Hôpital Robert Debré, Assistance Publique - Hôpitaux de Paris, Paris, France
- INSERM Unit 1145, Le Kremlin-Bicêtre, Paris, FranceINSERM UMR_S933, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Sophie Christin-Maitre
- Service d'Endocrinologie et Maladies de la Reproduction, Centre constitutif du centre de Référence des Maladies Endocriniennes Rares de la Croissance et du Développement (CMERCD), Assistance Publique - Hôpitaux de Paris, Hôpital Saint-Antoine, Paris, France
- Sorbonne Université, F-75012, Paris, France
- Sorbonne Université, F-75012, Paris, France
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7
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Bekkar S, Gronnier C, Renaud F, Duhamel A, Pasquer A, Théreaux J, Gagnière J, Meunier B, Collet D, Mariette C, Dhahri A, Lignier D, Cossé C, Regimbeau JM, Luc G, Cabau M, Jougon J, Badic B, Lozach P, Bail JP, Cappeliez S, El Nakadi I, Lebreton G, Alves A, Flamein R, Pezet D, Pipitone F, Stan-Iuga B, Contival N, Pappalardo E, Coueffe X, Msika S, Mantziari S, Demartines N, Hec F, Vanderbeken M, Tessier W, Briez N, Fredon F, Gainant A, Mathonnet M, Bigourdan JM, Mezoughi S, Ducerf C, Baulieux J, Mabrut JY, Bigourdan JM, Baraket O, Poncet G, Adam M, Vaudoyer D, Jourdan Enfer P, Villeneuve L, Glehen O, Coste T, Fabre JM, Marchal F, Frisoni R, Ayav A, Brunaud L, Bresler L, Cohen C, Aze O, Venissac N, Pop D, Mouroux J, Donici I, Prudhomme M, Felli E, Lisunfui S, Seman M, Godiris Petit G, Karoui M, Tresallet C, Ménégaux F, Vaillant JC, Hannoun L, Malgras B, Lantuas D, Pautrat K, Pocard M, Valleur P, Lefevre JH, Chafai N, Balladur P, Lefrançois M, Parc Y, Paye F, Tiret E, Nedelcu M, Laface L, Perniceni T, Gayet B, Turner K, Filipello A, Porcheron J, Tiffet O, Kamlet N, Chemaly R, Klipfel A, Pessaux P, Brigand C, Rohr S, Carrère N, Da Re C, Dumont F, Goéré D, Elias D, Bertrand C. Multicentre study of neoadjuvant chemotherapy for stage I and II oesophageal cancer. Br J Surg 2016; 103:855-62. [DOI: 10.1002/bjs.10121] [Citation(s) in RCA: 4] [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] [Received: 08/20/2015] [Revised: 11/11/2015] [Accepted: 01/05/2016] [Indexed: 12/28/2022]
Abstract
Abstract
Background
The benefit of neoadjuvant chemotherapy (NCT) for early-stage oesophageal cancer is unknown. The aim of this study was to assess whether NCT improves the outcome of patients with stage I or II disease.
Methods
Data were collected from 30 European centres from 2000 to 2010. Patients who received NCT for stage I or II oesophageal cancer were compared with patients who underwent primary surgery with regard to postoperative morbidity, mortality, and overall and disease-free survival. Propensity score matching was used to adjust for differences in baseline characteristics.
Results
Of 1173 patients recruited (181 NCT, 992 primary surgery), 651 (55·5 per cent) had clinical stage I disease and 522 (44·5 per cent) had stage II disease. Comparisons of the NCT and primary surgery groups in the matched population (181 patients in each group) revealed in-hospital mortality rates of 4·4 and 5·5 per cent respectively (P = 0·660), R0 resection rates of 91·7 and 86·7 per cent (P = 0·338), 5-year overall survival rates of 47·7 and 38·6 per cent (hazard ratio (HR) 0·68, 95 per cent c.i. 0·49 to 0·93; P = 0·016), and 5-year disease-free survival rates of 44·9 and 36·1 per cent (HR 0·68, 0·50 to 0·93; P = 0·017).
Conclusion
NCT was associated with better overall and disease-free survival in patients with stage I or II oesophageal cancer, without increasing postoperative morbidity.
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Affiliation(s)
- S Bekkar
- Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, Lille, France
| | - C Gronnier
- Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, Lille, France
- North of France University, Lille, France
- Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche S1172, Team 5 ‘Mucins, epithelial differentiation and carcinogenesis’, Jean-Pierre Aubert Research Centre, Lille, France
| | - F Renaud
- Department of Pathology, Lille University Hospital, Lille, France
| | - A Duhamel
- Department of Biostatistics, Lille University Hospital, Lille, France
- Site de Recherche Intégré en Cancérologie OncoLille, Lille, France
| | - A Pasquer
- Department of Digestive Surgery, Edouard Herriot University Hospital, Lyon, France
| | - J Théreaux
- Cavale Blanche University Hospital, Brest, France
| | - J Gagnière
- Estaing University Hospital, Clermont-Ferrand, France
| | - B Meunier
- Pontchaillou University Hospital, Rennes, France
| | - D Collet
- Haut-Levêque University Hospital, Bordeaux, France
| | - C Mariette
- Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, Lille, France
- North of France University, Lille, France
- Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche S1172, Team 5 ‘Mucins, epithelial differentiation and carcinogenesis’, Jean-Pierre Aubert Research Centre, Lille, France
- Site de Recherche Intégré en Cancérologie OncoLille, Lille, France
| | - A Dhahri
- Department of Digestive Surgery, Amiens Unievrsity Hospital, Amiens, France
| | - D Lignier
- Department of Digestive Surgery, Amiens Unievrsity Hospital, Amiens, France
| | - C Cossé
- Department of Digestive Surgery, Amiens Unievrsity Hospital, Amiens, France
| | - J-M Regimbeau
- Department of Digestive Surgery, Amiens Unievrsity Hospital, Amiens, France
| | - G Luc
- Department of Digestive Surgery, Pessac University Hospital, Bordeaux, France
| | - M Cabau
- Department of Thoracic Surgery, Pessac University Hospital, Bordeaux, France
| | - J Jougon
- Department of Thoracic Surgery, Pessac University Hospital, Bordeaux, France
| | - B Badic
- Department of Digestive Surgery, Cavale Blanche University Hospital, Brest, France
| | - P Lozach
- Department of Digestive Surgery, Cavale Blanche University Hospital, Brest, France
| | - J P Bail
- Department of Digestive Surgery, Cavale Blanche University Hospital, Brest, France
| | - S Cappeliez
- Department of Digestive Surgery, Brussel ULB Erasme Bordet University, Brussels, Belgium
| | - I El Nakadi
- Department of Digestive Surgery, Brussel ULB Erasme Bordet University, Brussels, Belgium
| | - G Lebreton
- Department of Digestive Surgery, Caen University Hospital, Caen, France
| | - A Alves
- Department of Digestive Surgery, Caen University Hospital, Caen, France
| | - R Flamein
- Department of Digestive Surgery, Estaing University Hospital, Clermont-Ferrand, France
| | - D Pezet
- Department of Digestive Surgery, Estaing University Hospital, Clermont-Ferrand, France
| | - F Pipitone
- Department of Digestive Surgery, Louis Mourier University Hospital, Colombes, France
| | - B Stan-Iuga
- Department of Digestive Surgery, Louis Mourier University Hospital, Colombes, France
| | - N Contival
- Department of Digestive Surgery, Louis Mourier University Hospital, Colombes, France
| | - E Pappalardo
- Department of Digestive Surgery, Louis Mourier University Hospital, Colombes, France
| | - X Coueffe
- Department of Digestive Surgery, Louis Mourier University Hospital, Colombes, France
| | - S Msika
- Department of Digestive Surgery, Louis Mourier University Hospital, Colombes, France
| | - S Mantziari
- Department of Digestive Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - N Demartines
- Department of Digestive Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - F Hec
- Department of Digestive Surgery, Caude Huriez University Hospital, Lille, France
| | - M Vanderbeken
- Department of Digestive Surgery, Caude Huriez University Hospital, Lille, France
| | - W Tessier
- Department of Digestive Surgery, Caude Huriez University Hospital, Lille, France
| | - N Briez
- Department of Digestive Surgery, Caude Huriez University Hospital, Lille, France
| | - F Fredon
- Department of Digestive Surgery, Limoges University Hospital, Limoges, France
| | - A Gainant
- Department of Digestive Surgery, Limoges University Hospital, Limoges, France
| | - M Mathonnet
- Department of Digestive Surgery, Limoges University Hospital, Limoges, France
| | - J M Bigourdan
- Department of Digestive Surgery, Croix Rousse University Hospital, Lyon, France
| | - S Mezoughi
- Department of Digestive Surgery, Croix Rousse University Hospital, Lyon, France
| | - C Ducerf
- Department of Digestive Surgery, Croix Rousse University Hospital, Lyon, France
| | - J Baulieux
- Department of Digestive Surgery, Croix Rousse University Hospital, Lyon, France
| | - J-Y Mabrut
- Department of Digestive Surgery, Croix Rousse University Hospital, Lyon, France
| | - J M Bigourdan
- Department of Digestive Surgery, Croix Rousse University Hospital, Lyon, France
| | - O Baraket
- Department of Digestive Surgery, Edouard Herriot University Hospital, Lyon, France
| | - G Poncet
- Department of Digestive Surgery, Edouard Herriot University Hospital, Lyon, France
| | - M Adam
- Department of Digestive Surgery, Edouard Herriot University Hospital, Lyon, France
| | - D Vaudoyer
- Department of Digestive Surgery, Lyon Sud University Hospital, Lyon, France
| | - P Jourdan Enfer
- Department of Digestive Surgery, Lyon Sud University Hospital, Lyon, France
| | - L Villeneuve
- Department of Digestive Surgery, Lyon Sud University Hospital, Lyon, France
| | - O Glehen
- Department of Digestive Surgery, Lyon Sud University Hospital, Lyon, France
| | - T Coste
- Department of Digestive Surgery, Montpellier, France
| | - J-M Fabre
- Department of Digestive Surgery, Montpellier, France
| | - F Marchal
- Department of Digestive Surgery, Institut de Cancérologie de Lorraine, Nancy, France
| | - R Frisoni
- Department of Digestive Surgery, Nancy University Hospital, Nancy, France
| | - A Ayav
- Department of Digestive Surgery, Nancy University Hospital, Nancy, France
| | - L Brunaud
- Department of Digestive Surgery, Nancy University Hospital, Nancy, France
| | - L Bresler
- Department of Digestive Surgery, Nancy University Hospital, Nancy, France
| | - C Cohen
- Department of Thoracic Surgery, Nice University Hospital, Nice, France
| | - O Aze
- Department of Thoracic Surgery, Nice University Hospital, Nice, France
| | - N Venissac
- Department of Thoracic Surgery, Nice University Hospital, Nice, France
| | - D Pop
- Department of Thoracic Surgery, Nice University Hospital, Nice, France
| | - J Mouroux
- Department of Thoracic Surgery, Nice University Hospital, Nice, France
| | - I Donici
- Department of Digestive Surgery, Nîmes University Hospital, Nîmes, France
| | - M Prudhomme
- Department of Digestive Surgery, Nîmes University Hospital, Nîmes, France
| | - E Felli
- Department of Digestive Surgery, Pitié-Salpétrière University Hospital, Paris, France
| | - S Lisunfui
- Department of Digestive Surgery, Pitié-Salpétrière University Hospital, Paris, France
| | - M Seman
- Department of Digestive Surgery, Pitié-Salpétrière University Hospital, Paris, France
| | - G Godiris Petit
- Department of Digestive Surgery, Pitié-Salpétrière University Hospital, Paris, France
| | - M Karoui
- Department of Digestive Surgery, Pitié-Salpétrière University Hospital, Paris, France
| | - C Tresallet
- Department of Digestive Surgery, Pitié-Salpétrière University Hospital, Paris, France
| | - F Ménégaux
- Department of Digestive Surgery, Pitié-Salpétrière University Hospital, Paris, France
| | - J-C Vaillant
- Department of Digestive Surgery, Pitié-Salpétrière University Hospital, Paris, France
| | - L Hannoun
- Department of Digestive Surgery, Pitié-Salpétrière University Hospital, Paris, France
| | - B Malgras
- Department of Digestive Surgery, Lariboisière University Hospital, Paris, France
| | - D Lantuas
- Department of Digestive Surgery, Lariboisière University Hospital, Paris, France
| | - K Pautrat
- Department of Digestive Surgery, Lariboisière University Hospital, Paris, France
| | - M Pocard
- Department of Digestive Surgery, Lariboisière University Hospital, Paris, France
| | - P Valleur
- Department of Digestive Surgery, Lariboisière University Hospital, Paris, France
| | - J H Lefevre
- Department of Digestive Surgery, Saint-Antoine University Hospital, Paris, France
| | - N Chafai
- Department of Digestive Surgery, Saint-Antoine University Hospital, Paris, France
| | - P Balladur
- Department of Digestive Surgery, Saint-Antoine University Hospital, Paris, France
| | - M Lefrançois
- Department of Digestive Surgery, Saint-Antoine University Hospital, Paris, France
| | - Y Parc
- Department of Digestive Surgery, Saint-Antoine University Hospital, Paris, France
| | - F Paye
- Department of Digestive Surgery, Saint-Antoine University Hospital, Paris, France
| | - E Tiret
- Department of Digestive Surgery, Saint-Antoine University Hospital, Paris, France
| | - M Nedelcu
- Department of Digestive Surgery, Institut Mutualiste Montsouris, Paris, France
| | - L Laface
- Department of Digestive Surgery, Institut Mutualiste Montsouris, Paris, France
| | - T Perniceni
- Department of Digestive Surgery, Institut Mutualiste Montsouris, Paris, France
| | - B Gayet
- Department of Digestive Surgery, Institut Mutualiste Montsouris, Paris, France
| | - K Turner
- Department of Digestive Surgery, Rennes, France
| | - A Filipello
- Department of Digestive Surgery, Saint-Etienne University Hospital, Saint-Etienne, France
| | - J Porcheron
- Department of Digestive Surgery, Saint-Etienne University Hospital, Saint-Etienne, France
| | - O Tiffet
- Department of Digestive Surgery, Saint-Etienne University Hospital, Saint-Etienne, France
| | - N Kamlet
- Department of Digestive Surgery, Strasbourg University Hospital, Strasbourg, France
| | - R Chemaly
- Department of Digestive Surgery, Strasbourg University Hospital, Strasbourg, France
| | - A Klipfel
- Department of Digestive Surgery, Strasbourg University Hospital, Strasbourg, France
| | - P Pessaux
- Department of Digestive Surgery, Strasbourg University Hospital, Strasbourg, France
| | - C Brigand
- Department of Digestive Surgery, Strasbourg University Hospital, Strasbourg, France
| | - S Rohr
- Department of Digestive Surgery, Strasbourg University Hospital, Strasbourg, France
| | - N Carrère
- Department of Digestive Surgery, Toulouse University Hospital, Toulouse, France
| | - C Da Re
- Department of Digestive Surgery, Institut Gustave-Roussy, Villejuif, France
| | - F Dumont
- Department of Digestive Surgery, Institut Gustave-Roussy, Villejuif, France
| | - D Goéré
- Department of Digestive Surgery, Institut Gustave-Roussy, Villejuif, France
| | - D Elias
- Department of Digestive Surgery, Institut Gustave-Roussy, Villejuif, France
| | - C Bertrand
- Mont-Godinne University Hospital, Yvoir, Belgium
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8
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Cotirlet A, Nedelcu M, Popa E, Anghel R, Rau S, Motoc I, Tincu E. Single incision laparoscopic cholecystectomy. Chirurgia (Bucur) 2014; 109:769-773. [PMID: 25560499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND As surgeons embrace the concept of increasingly less invasive surgery, techniques using only a single small incision have begun to gain traction. Multiple case series managed by a single-incision laparoscopic cholecystectomy (SILC) have been published. The objective of this study is to describe the short-term outcomes of SILC in our institution. METHODS A retrospective review was done for 51 patients who underwent SILC between 2009-2012. The operative time, surgical technique, conversion rate, and postoperative complications were reported. RESULTS SILC was performed for 51 patients, all women, with a mean age of 35.6 years (range=19-62). Their body mass index(BMI) ranged from 16.8-35.6 kg m2 with a mean of 20.4. Twelve patients (23.52 %) had acute cholecystitis. The mean operating time was 58.6 minutes (range=45-95 min). Incidents were encountered in 6 patients (11.76%) and were related to intraoperative bleeding. There was a single conversion to the standard laparoscopic procedure (1.9%) and in 5 cases an accessory needle grasp was used (9.8%). Two patients (3.9%)presented postoperative complications (wound infections) and the mean hospital stay was 1.6 days. CONCLUSIONS SILC is feasible and provides a promising alternative to natural orifice transluminal endoscopic surgery for scarless laparoscopic cholecystectomy. However, routine application of this novel technique requires an evaluation of its safety and cost effectiveness in larger studies.
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9
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Noel P, Nedelcu M, Gagner M. SPIDER® sleeve gastrectomy – a new concept in single-trocar bariatric surgery: Initial experience and technical details. J Visc Surg 2014; 151:91-6. [DOI: 10.1016/j.jviscsurg.2014.01.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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10
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Abstract
Laparoscopic sleeve gastrectomy (LSG) has become one of the most common bariatric procedures. Even so, the gastric leak remains the most feared complication with a difficult, non-standardized treatment. The purpose of this study was to assess the feasibility of a new classification of leakage after LSG used in Montpellier University Hospital. We have studied the correlations between radiological findings and therapeutic outcome for the 20 gastric leaks. The presence of a leak was evaluated according to the day of appearance, the symptomatology, the location, severity on the CT scan, and the management. From May 2010 to September 2012, we prospectively collected data from 20 patients diagnosed with gastric leak after LSG. There were 16 women and 4 men with a mean age of 34 years old (range 21-52 years old). The fistula was diagnosed at postoperative day 28.1 days (range 3-77 days). Patients were grouped by the new classification in: 11-type I, 6-type II, 3-type III fistula, and 0-type IV. The visualization of leakage was observed for five cases (25 %). The initial surgical drainage was performed for 11 cases and the conservative treatment was preferred in 9 cases. Three cases necessitated a delayed surgical drainage after 1 week of conservative treatment. The surgical drainage was performed by laparoscopy in 12 cases and by laparotomy in 2 cases. The new CT scan classification of gastric leak could serve as a working basis for a consensus on the therapeutic management of this dreaded complication.
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Affiliation(s)
- M Nedelcu
- Department of Surgery, Saint Eloi Hospital-CHRU Montpellier, 80 Av. Augustin Fliche, 34295 Cedex 5 Montpellier, France.
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11
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Minea L, Rodica Maricela A, Gruia I, Bacinschi X, Isacu I, Tarlea A, Nedelcu M. Romanian experimental research on boron neutron capture therapy (BNCT) in liver tumors. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e21111] [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: 11/20/2022] Open
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12
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Rodica Maricela A, Minea L, Bacinschi X, Isacu I, Tarlea A, Nedelcu M. Cisplatin-based radiochemotherapy in elderly patients with cervical cancer. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e15550] [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: 11/20/2022] Open
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13
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Puscasiu L, Szabo B, Capalna M, Stolnicu S, Andrei S, Marginean C, Nedelcu M. O911 Markers of inflammation in the placenta and fetal membranes - A potential pathway to preterm birth. Int J Gynaecol Obstet 2009. [DOI: 10.1016/s0020-7292(09)61284-4] [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: 10/20/2022]
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14
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15
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Tîrnoveanu G, Negulescu I, Georgescu MI, Nedelcu M, Petrulias C. [The common arterial trunk. Presentation of a case with particular morpho-pathological aspects]. Rev Pediatr Obstet Ginecol Pediatr 1987; 36:173-7. [PMID: 3112909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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16
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Vereanu I, Pătraşcu T, Firescu D, Nedelcu M, Juvara I. [Splenectomy in diseases other than primary diseases of the spleen]. Rev Chir Oncol Radiol O R L Oftalmol Stomatol Chir 1987; 36:49-56. [PMID: 2955456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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