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Paumier M, Coussement J, Matignon M, Chauvet C, Bouvier N, Poncelet A, Dantal J, Scemla A, Ceunen H, Van Wijngaerden E, Kamar N, van der Beek MT, Wunderink HF, De Greef J, Candon S, Bougnoux ME, Lebeaux D. (1-3)-ß-D-glucan for the diagnosis of Nocardia infection in solid organ transplant recipients. Diagn Microbiol Infect Dis 2024; 108:116184. [PMID: 38241921 DOI: 10.1016/j.diagmicrobio.2024.116184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 01/09/2024] [Accepted: 01/11/2024] [Indexed: 01/21/2024]
Affiliation(s)
- Margot Paumier
- Unité de Parasitologie-Mycologie. AP-HP, Hôpital Necker enfants malades; 149 rue de Sèvres, Paris 75015, France
| | - Julien Coussement
- University of Melbourne, Sir Peter MacCallum Department of Oncology, Melbourne, Australia
| | - Marie Matignon
- Nephrology and Renal Transplantation Department, Groupe Hospitalier Henri-Mondor/Albert-Chenevier, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil 94010, France.; IMRB (Institut Mondor de Recherche Biomédicale), VIC (Virus-Immunité-Cancer), DHU (Département Hospitalo-Universitaire), Université Paris-Est-Créteil (UPEC), INSERM U955, Equipe 21, Créteil 94010, France
| | - Cécile Chauvet
- Service de Transplantation Rénale, Hôpital Edouard HERRIOT, Lyon, France
| | - Nicolas Bouvier
- Service de Néphrologie, Université de Caen - Normandie, Caen, France
| | - Arthur Poncelet
- Department of Infectious Diseases, CUB-Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Jacques Dantal
- ITUN (Institut de Transplantation, d'Urologie et de Néphrologie), CHU Nantes, Nantes, France
| | - Anne Scemla
- Kidney Transplantation Unit, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes Sorbonne Paris Cité, RTRS Centaure, Labex Transplantex, Paris, France
| | - Helga Ceunen
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Eric Van Wijngaerden
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Nassim Kamar
- Department of Nephrology and Organ Transplantation,; Toulouse Rangueil University Hospital, INSERM UMR, Toulouse 1291, France; Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), Paul Sabatier University, Toulouse, France
| | - Martha T van der Beek
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Herman F Wunderink
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Julien De Greef
- Service de Médecine interne et Maladies infectieuses, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Sophie Candon
- CHU de Rouen Normandie, Université de Rouen Normandie, Rouen France
| | - Marie-Elisabeth Bougnoux
- Unité de Parasitologie-Mycologie. AP-HP, Hôpital Necker enfants malades; 149 rue de Sèvres, Paris 75015, France; Institut Pasteur, Université Paris Cité, Fungal Biology and Pathogenicity Unit - INRA USC Mycology Department, Paris 75015, France
| | - David Lebeaux
- Institut Pasteur, Université Paris Cité, CNRS UMR 6047, Genetics of Biofilms Laboratory, Paris 75015, France.; Service de Microbiologie, Unité Mobile d'Infectiologie, AP-HP, Hôpital Européen Georges Pompidou, 20 rue Leblanc, Paris 75015, France..
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Rahnama N, Ghaye B, Kubangumusu L, Pasquet A, Poncelet A, Kefer J, Moniotte S, De Beco G, Pierard S. Partial anomalous pulmonary venous return in adults. Insight into pulmonary hypertension. Archives of Cardiovascular Diseases Supplements 2023. [DOI: 10.1016/j.acvdsp.2022.10.263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Milas S, Poncelet A, Buttafuoco F, Pardo A, Lali SE, Cherifi S. Antibiotic use in patients with Coronavirus disease 2019 (COVID-19): outcomes and associated factors. Acta Clin Belg 2022; 77:579-587. [PMID: 33896399 DOI: 10.1080/17843286.2021.1916300] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 12/14/2022]
Abstract
OBJECTIVES To characterise the factors, outcomes and infections associated with antibiotic use in COVID-19 patients. METHODS Records of patients with RT-PCR-confirmed COVID-19, hospitalized at the CHU Charleroi (Belgium) between 11 March and 3 May 3 2020, were retrospectively reviewed. Factors associated with antibiotic treatment, outcomes and bacterial infections were analysed. RESULTS Among the 164 hospitalized COVID-19 patients (median age 60.5 years [IQR] 46-79), twenty-five (15.2%) were admitted to the ICU. Twenty-six (15.9%) died in the hospital. One hundred (61%) received antibiotic treatment. Combination therapies with macrolides were more common in the early part of the study period (26/67, 38.8%). Twenty-eight patients (17.1%) had a confirmed infection, mostly of the urinary tract (18/28, 64.3%). Only 2 (1.2%) had a documented respiratory coinfection. Six of the 7 ICU infections (85.7%) were superinfections. Gram-negative bacteria were most frequently isolated. In multivariate analysis, six factors were associated with antibiotic use: being hospitalized in the ICU (OR: 4.59; 95% CI 1.07-19.71), age > 65 years (OR: 4.16; 95% CI 1.72-10.05), arrival from a nursing home (OR: 4.59; 95% CI 1.11-19.71), diabetes (OR: 4.35; 95% CI 1.26-14.93), bilateral consolidation on chest CT (OR: 9.92; 95% CI 2.40-41.06) and a C-reactive protein level > 60 mg/L (OR:2.46; 95% CI 1.13-5.37). Antibiotic treatment did not reduce the length of stay or the mortality rate. CONCLUSION Antibiotics have been overused during the COVID-19 pandemic, despite a low rate of coinfections . Integrating the antimicrobial stewardship (AMS) programme into the COVID-19 response is essential.
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Affiliation(s)
- Sandrine Milas
- Department of Internal Medicine and Infectious Diseases, Charleroi University Hospital, Lodelinsart, Belgium
| | - Arthur Poncelet
- Department of Internal Medicine and Infectious Diseases, Charleroi University Hospital, Lodelinsart, Belgium
| | - Fabrizio Buttafuoco
- Department of Internal Medicine and Infectious Diseases, Charleroi University Hospital, Lodelinsart, Belgium
| | - Antonelle Pardo
- Department of Pharmacy, Charleroi University Hospital, Lodelinsart, Belgium
| | - Salah Eddine Lali
- Department of Microbiology Laboratory, Charleroi University Hospital, Lodelinsart, Belgium
| | - Soraya Cherifi
- Department of Internal Medicine and Infectious Diseases, Charleroi University Hospital, Lodelinsart, Belgium
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Poncelet A, Verschelden G, Colard M, Hildebrand M, Hites M, Yin N, Michel C, Grimaldi D, De Wilde V. Worsening of COVID-19 after chemotherapy in patients considered to have recovered from a SARS-CoV-2 infection. Leuk Lymphoma 2021; 63:253-255. [PMID: 34521312 DOI: 10.1080/10428194.2021.1978086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Arthur Poncelet
- Departement of Hematology, CUB-Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Gil Verschelden
- Clinic of Infectious Disease, CUB-Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Martin Colard
- Departement of Hematology, CUB-Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Marc Hildebrand
- Department of Internal Medicine, CUB-Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Maya Hites
- Clinic of Infectious Disease, CUB-Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Nicolas Yin
- Department of Microbiology, Laboratoire hospitalier universitaire de Bruxelles (LHUB-ULB)- Université libre de Bruxelles, Brussels, Belgium
| | - Charlotte Michel
- Department of Microbiology, Laboratoire hospitalier universitaire de Bruxelles (LHUB-ULB)- Université libre de Bruxelles, Brussels, Belgium
| | - David Grimaldi
- Departement of Intensive Care, CUB-Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Virginie De Wilde
- Departement of Hematology, CUB-Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
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Cabaraux P, Poncelet A, Honnorat J, Demeester R, Cherifi S, Manto M. Corrigendum: CSF HIV RNA Escape in Opsoclonus-Myoclonus-Ataxia Syndrome: Case Report and Review of the Literature. Front Neurol 2021; 12:665996. [PMID: 33815265 PMCID: PMC8010907 DOI: 10.3389/fneur.2021.665996] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 02/23/2021] [Indexed: 11/13/2022] Open
Abstract
[This corrects the article DOI: 10.3389/fneur.2020.585527.].
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Affiliation(s)
- Pierre Cabaraux
- Unité des Ataxies Cérébelleuses, Service de Neurologie, Centre Hospitalier Universitaire (CHU)-Charleroi, Charleroi, Belgium
| | - Arthur Poncelet
- Service de Médecine Interne, Centre Hospitalier Universitaire (CHU)-Charleroi, Charleroi, Belgium
| | - Jérome Honnorat
- Centre National de Référence pour les Syndromes Neurologiques Paranéoplasiques, Hospices Civils de Lyon, Synatac Team, NeuroMyoGene Institute, INSERM U1217/CNRS UMR5310, University Claude Bernard Lyon 1, Université de Lyon, Lyon, France
| | - Remy Demeester
- Service de Médecine Interne, Centre Hospitalier Universitaire (CHU)-Charleroi, Charleroi, Belgium
| | - Soraya Cherifi
- Service de Médecine Interne, Centre Hospitalier Universitaire (CHU)-Charleroi, Charleroi, Belgium
| | - Mario Manto
- Unité des Ataxies Cérébelleuses, Service de Neurologie, Centre Hospitalier Universitaire (CHU)-Charleroi, Charleroi, Belgium
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Poncelet A, Ruelle L, Konopnicki D, Miendje Deyi VY, Dauby N. Saccharomyces cerevisiae fungemia: Risk factors, outcome and links with S. boulardii-containing probiotic administration. Infect Dis Now 2020; 51:293-295. [PMID: 33934809 DOI: 10.1016/j.idnow.2020.12.003] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 12/01/2020] [Accepted: 12/04/2020] [Indexed: 02/07/2023]
Abstract
Saccharomyces cerevisiae fungemia: risk factors, outcome and links with S. boulardii-containing probiotic administration. OBJECTIVE The aim of our study was to review cases of S. cerevisiae fungemia along with the corresponding risk factors (including S. boulardii probiotic intake), treatment and outcomes. PATIENTS AND METHODS Retrospective study (2005-2017) of S. cerevisiae fungemia. All the data were extracted from medical files. RESULTS We identified 10 patients with S. cerevisiae fungemia. Mean age was 59.4 years (range 21-88). Four fifths (80%) were on total parenteral or enteral nutrition, 70% had a central venous line, and 30% were admitted in an Intensive Care Unit (ICU). S. boulardii-containing probiotic prescription was identified in 6 subjects. Three patients with no risk factors such as ICU or central venous catheter were 80 years old or more. Mortality rate was 50%. CONCLUSION S. cerevisiae fungemia is a rare but life-threatening infection, associated with intake of probiotics containing S. boulardii. Besides classical risk factors, older age should be a contraindication for these probiotics.
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Affiliation(s)
- A Poncelet
- Infectious Diseases Department, Saint-Pierre University Hospital, Université Libre de Bruxelles, rue aux Laines, 105, 1000 Bruxelles, Belgium.
| | - L Ruelle
- Infectious Diseases Department, Saint-Pierre University Hospital, Université Libre de Bruxelles, rue aux Laines, 105, 1000 Bruxelles, Belgium
| | - D Konopnicki
- Infectious Diseases Department, Saint-Pierre University Hospital, Université Libre de Bruxelles, rue aux Laines, 105, 1000 Bruxelles, Belgium
| | - V Y Miendje Deyi
- Microbiology Department, Laboratoire Hospitalier Universitaire de Bruxelles-Universitair Laboratorium Brussel (LHUB-ULB), Brussels, Belgium
| | - N Dauby
- Infectious Diseases Department, Saint-Pierre University Hospital, Université Libre de Bruxelles, rue aux Laines, 105, 1000 Bruxelles, Belgium
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Cabaraux P, Poncelet A, Honnorat J, Demeester R, Cherifi S, Manto M. CSF HIV RNA Escape in Opsoclonus-Myoclonus-Ataxia Syndrome: Case Report and Review of the Literature. Front Neurol 2020; 11:585527. [PMID: 33329331 PMCID: PMC7719769 DOI: 10.3389/fneur.2020.585527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 10/26/2020] [Indexed: 11/22/2022] Open
Abstract
Background: Human immunodeficiency viruses (HIV) infection is associated with a broad range of neurological manifestations, including opsoclonus-myoclonus ataxia syndrome (OMAS) occurring in primary infection, immune reconstitution syndrome or in case of opportunistic co-infection. Case: We report the exceptional case of a 43-year-old female under HIV treatment for 10 years who presented initially with suspected epileptic seizure. Although the clinical picture slightly improved under anti-epileptic treatment, it was rapidly attributed to OMAS. The patient exhibited marked opsoclonus, mild dysarthria, upper limbs intermittent myoclonus, ataxia in 4 limbs, truncal ataxia, and a severe gait ataxia (SARA score: 34). The diagnostic work-up showed radiological and biological signs of central nervous system (CNS) inflammation and cerebral venous sinus thromboses. The HIV viral load was higher in cerebrospinal fluid (CSF) than in the blood (4,560 copies/ml vs. 76 copies/ml). She was treated for 5 days with pulsed corticotherapy. Dolutegravir and anticoagulation administration were initiated. Follow-ups at 2 and 4 months showed a dramatic improvement of clinical neurologic status (SARA score at 4 months: 1), reduction of CNS inflammation and revealed undetectable CSF and serum viral loads. Conclusion: This case underlines the importance of the evaluation of the CSF viral load in HIV patients developing OMAS and suggests CSF HIV RNA escape as a novel cause for OMAS.
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Affiliation(s)
- Pierre Cabaraux
- Unité des Ataxies Cérébelleuses, Service de Neurologie, Centre Hospitalier Universitaire (CHU)-Charleroi, Charleroi, Belgium
- *Correspondence: Pierre Cabaraux
| | - Arthur Poncelet
- Service de Médecine Interne, Centre Hospitalier Universitaire (CHU)-Charleroi, Charleroi, Belgium
| | - Jérome Honnorat
- Centre National de Référence pour les Syndromes Neurologiques Paranéoplasiques, Hospices Civils de Lyon, Synatac Team, NeuroMyoGene Institute, INSERM U1217/CNRS UMR5310, University Claude Bernard Lyon 1, Université de Lyon, Lyon, France
| | - Remy Demeester
- Service de Médecine Interne, Centre Hospitalier Universitaire (CHU)-Charleroi, Charleroi, Belgium
| | - Soraya Cherifi
- Service de Médecine Interne, Centre Hospitalier Universitaire (CHU)-Charleroi, Charleroi, Belgium
| | - Mario Manto
- Unité des Ataxies Cérébelleuses, Service de Neurologie, Centre Hospitalier Universitaire (CHU)-Charleroi, Charleroi, Belgium
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Becker C, Pierard S, Pasquet A, Poncelet A, De Beco G, Momeni M. The value of three-dimensional echocardiography in the evaluation of cor triatrium sinister. J Cardiothorac Vasc Anesth 2019. [DOI: 10.1053/j.jvca.2019.07.090] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Vô C, Carbonez K, De Beco G, Poncelet A, Moniotte S. An unusual cause of right ventricular outflow tract obstruction. Eur Heart J Cardiovasc Imaging 2019; 20:657. [PMID: 30689777 DOI: 10.1093/ehjci/jez005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- C Vô
- Department of Pediatric Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - K Carbonez
- Department of Pediatric Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - G De Beco
- Department of Cardiovascular and Thoracic Surgery, Cliniques Universitaires Saint-Luc, 10 Avenue Hippocrate, Brussels, Belgium
| | - A Poncelet
- Department of Cardiovascular and Thoracic Surgery, Cliniques Universitaires Saint-Luc, 10 Avenue Hippocrate, Brussels, Belgium
| | - S Moniotte
- Department of Pediatric Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
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Forget P, Berlière M, Poncelet A, De Kock M. Effect of clonidine on oncological outcomes after breast and lung cancer surgery. Br J Anaesth 2018; 121:103-104. [PMID: 29935555 DOI: 10.1016/j.bja.2018.04.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 04/02/2018] [Accepted: 04/10/2018] [Indexed: 10/16/2022] Open
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Bouazza F, Poncelet A, Garcia CA, Delatte P, Engelhom JL, Galdon MG, Deleporte A, Hendlisz A, Vanderlinden B, Flamen P, Donckier V. Radioembolisation and portal vein embolization before resection of large hepatocellular carcinoma. World J Gastroenterol 2015; 21:9666-9670. [PMID: 26327775 PMCID: PMC4548128 DOI: 10.3748/wjg.v21.i32.9666] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 02/20/2015] [Accepted: 04/09/2015] [Indexed: 02/06/2023] Open
Abstract
Resectability of hepatocellular carcinoma in patients with chronic liver disease is dramatically limited by the need to preserve sufficient remnant liver in order to avoid postoperative liver insufficiency. Preoperative treatments aimed at downsizing the tumor and promoting hypertrophy of the future remnant liver may improve resectability and reduce operative morbidity. Here we report the case of a patient with a large hepatocellular carcinoma arising from chronic liver disease. Preoperative treatment, including tumor downsizing with transarterial radioembolization and induction of future remnant liver hypertrophy with right portal vein embolization, resulted in a 53% reduction in tumor volume and compensatory hypertrophy in the contralateral liver. The patient subsequently underwent extended right hepatectomy with no postoperative signs of liver decompensation. Pathological examination demonstrated a margin-free resection and major tumor response. This new therapeutic sequence, combining efficient tumor targeting and subsequent portal vein embolization, could improve the feasibility and safety of major liver resection for hepatocellular carcinoma in patients with liver injury.
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Dupery M, Lescaut V, Lenglet A, Lemoine J, Petit N, Poncelet A, Tranchet E. Des outils pour la prévention des risques professionnels chez les caristes. ARCH MAL PROF ENVIRO 2012. [DOI: 10.1016/j.admp.2012.03.575] [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: 10/28/2022]
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Wanet M, Lee J, Weynand B, de Bast M, Poncelet A, Lacroix V, Coche E, Grégoire V, Geets X. 440 poster A GRADIENT-BASED SEGMENTATION METHOD FOR FDG-PET BASED GTV DELINEATION: CLINICAL VALIDATION IN NSCLC. Radiother Oncol 2011. [DOI: 10.1016/s0167-8140(11)70562-x] [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: 11/26/2022]
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Van Caenegem O, Poncelet A, Vercruysse J, Theunis B, Beauloye C, Baurin G, Adnet PY, Horman S, Bertrand L, Jacquet L. 589 Machine Perfusion Improves Metabolic Preservation of Heart Grafts from Non Heart Beating Donors. J Heart Lung Transplant 2011. [DOI: 10.1016/j.healun.2011.01.601] [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] Open
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Hiemann N, Bara C, Segovia J, Parameshwar J, Simonsen S, Crespo-Leiro M, Eiskjaer H, Vanhaecke J, Arizon J, Poncelet A, Przybylowski P, Frigerio M, Lehmkuhl H, Meyer R. 205 Everolimus Prevents the Quilty Phenomenon – A Risk Factor for Microvasculopathy in Biopsy (RAD B253 Trial). J Heart Lung Transplant 2011. [DOI: 10.1016/j.healun.2011.01.212] [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] Open
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Hiemann N, Bara C, Segovia J, Parameshwar J, Simonsen S, Crespo-Leiro M, Eiskjaer H, Vanhaecke J, Arizon J, Poncelet A, Przybylowski P, Frigerio M, Lehmkuhl H, Meyer R. 76 Everolimus for the Prevention of Microvasculopathy in Biopsy: Final Results from Re-Evaluation of the RAD B253 Trial. J Heart Lung Transplant 2011. [DOI: 10.1016/j.healun.2011.01.083] [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: 11/15/2022] Open
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Hiemann N, Bara C, Segovia J, Simonsen S, Crespo-Leiro M, Eiskjaer H, Vanhaecke J, Poncelet A, Przybylowski P, Frigerio M. 491: Everolimus for the Prevention of Microvasculopathy in Biopsy in Cardiac Transplant Recipients: Preliminary Results from Re-Evaluation of the RAD B253 Trial. J Heart Lung Transplant 2010. [DOI: 10.1016/j.healun.2009.11.507] [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] Open
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Viganò M, Dengler T, Mattei MF, Poncelet A, Vanhaecke J, Vermes E, Kleinloog R, Li Y, Gezahegen Y, Delgado JF. Lower incidence of cytomegalovirus infection with everolimus versus mycophenolate mofetil in de novo cardiac transplant recipients: a randomized, multicenter study. Transpl Infect Dis 2009; 12:23-30. [PMID: 19744284 DOI: 10.1111/j.1399-3062.2009.00448.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Cytomegalovirus (CMV) is a major cause of infectious complications following cardiac transplantation, severely affecting short- and long-term outcomes. A 12-month, multicenter, randomized, open-label study in de novo cardiac transplant patients was undertaken to compare the efficacy, renal function, and safety of everolimus plus reduced cyclosporine versus mycophenolate mofetil (MMF) plus standard cyclosporine (ClinicalTrials.gov NCT00150046). CMV-specific data was prospectively collected on infections, laboratory evidence, CMV syndrome, and CMV disease. In total, 176 patients were randomized (everolimus 92; MMF 84). Use of CMV prophylaxis was similar between groups (everolimus 20.8%; MMF 24.0%). Patients in the everolimus arm had a significantly lower incidence of any CMV event (8.8% versus 32.5% with MMF, P<0.001), CMV infection as an adverse event (4.4% versus 16.9%, P=0.011), laboratory evidence of CMV (antigenemia 7.7% versus 27.7%, P<0.001; polymerase chain reaction assay 2.2% versus 12.0%, P=0.015), and CMV syndrome (1.1% versus 8.4%, P=0.028). In the donor (D)+/recipient (R)+and D-/R+ subgroups, even after adjusting for use of prophylaxis, the CMV event rate remained significantly lower with everolimus than with MMF (P=0.0015 and P=0.0381, respectively). In conclusion, de novo cardiac transplant recipients experienced lower rates of CMV infection, CMV syndrome, or organ involvement on an everolimus-based immunosuppressant regimen compared with MMF.
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Affiliation(s)
- M Viganò
- Department of Cardiac Surgery, Policlinico S. Matteo - IRCCS Università degli Studi di Pavia, Pavia, Italy
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Astarci P, Lacroix V, Glineur D, Poncelet A, Rubay J, El Khoury G, Noirhomme P, Verhels R. Endovascular treatment of acute aortic isthmic rupture: concerning midterm results. Ann Vasc Surg 2009; 23:634-8. [PMID: 19467828 DOI: 10.1016/j.avsg.2009.03.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2008] [Revised: 03/06/2009] [Accepted: 03/23/2009] [Indexed: 11/28/2022]
Abstract
BACKGROUND We evaluated midterm results of endovascular management of traumatic aortic isthmic ruptures. METHODS Between 2001 and 2008, 10 patients (seven males, mean age 38 years) underwent endovascular treatment of an acute aortic rupture. Eight procedures were emergent, with four cases of hemodynamic instability with Glasgow scores of 3, 5, and 7. Associated traumas were severe brain, liver, and pelvic bone injuries. All procedures were performed with transoesophageal echocardiography monitoring. We used two AneuRx and nine Medtronic Talent or Valiant stent grafts. RESULTS All patients survived their traumatic isthmic rupture. In nine patients, stent-graft deployment was successful. One patient experienced a distal migration needing a laparotomy and deployment of an additional new thoracic stent graft. The mean intensive care unit stay was 48 hr (range 24-168). The mean hospital stay was 11 days (range 8-43). All patients were controlled clinically and by contrast computed tomography (CT) according to the EUROSTAR protocol. There were no endoleaks, stent graft-related complications, or late deaths during a mean follow-up of 49 months. The control CT showed a lack of apposition of the proximal part of the stent graft at the inner curve of the aortic arch in three patients. CONCLUSION The midterm results of endovascular treatment of acute traumatic aortic isthmic rupture are encouraging and compare favorably to the surgical approach. Late follow-up is required to exclude possible stent-graft complications, especially in young patients with angulated aortic arches.
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Affiliation(s)
- P Astarci
- Cardiovascular Surgery Department, Saint-Luc University Hospital, Brussels, Belgium.
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Poncelet A, Gianello P, Vercruysse J, Lecuivre C, Nizet Y. 403: Immunosuppressive or Immunogenic? Culture Medium Strongly Influences the In Vitro Immunomodulatory Properties of Mesenchymal Stem Cells (MSC). J Heart Lung Transplant 2009. [DOI: 10.1016/j.healun.2008.11.410] [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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Vermes E, Almenar L, Viganò M, MacCherini M, Poncelet A, Mattei MF, Dengler T, Delgado J, Vanhaecke J, Hexham M, Mange K. 465: More Adverse Events Leading to Drug Dose Adjustment/Interruption in the Presence of MMF- vs Everolimus-Based Immunosuppression in De Novo Heart Transplant Patients. J Heart Lung Transplant 2008. [DOI: 10.1016/j.healun.2007.11.478] [Citation(s) in RCA: 2] [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: 10/22/2022] Open
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Dengler T, Viganò M, Magelli C, Guillemain R, Varnous S, Gerosa G, Poncelet A, Vanhaecke J, Li Y, Gezahegen Y. 16: Concentration-Controlled Everolimus Versus MMF in De Novo Heart Transplant Patients: Incidence of CMV Infection at 12 Months Post-Transplant in a Randomized Trial. J Heart Lung Transplant 2008. [DOI: 10.1016/j.healun.2007.11.020] [Citation(s) in RCA: 2] [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: 11/16/2022] Open
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Astarci P, Guerit JM, Robert A, Elkhoury G, Noirhomme P, Rubay J, Lacroix V, Poncelet A, Funker JC, Glineur D, Verhelst R. Stump pressure and somatosensory evoked potentials for predicting the use of shunt during carotid surgery. Ann Vasc Surg 2007; 21:312-7. [PMID: 17484967 DOI: 10.1016/j.avsg.2006.07.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [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: 10/19/2005] [Revised: 06/30/2006] [Accepted: 07/06/2006] [Indexed: 11/15/2022]
Abstract
The aim of this study is to compare measurement of stump pressure (SP) and somatosensory evoked potentials (SSEP) made during carotid surgery as criteria upon which to base the decision whether or not to use a shunt. We included 288 patients who underwent for carotid surgery under general anaesthesia. We performed 247 endarterectomies with patch closure (85.7%), 25 carotid transsection with reimplantation (8.7%), and 16 carotid bypasses (5.6%). SSEP monitoring showed no modification in 225/288 patients (78.1%), moderate modification in 32/288 patients (11.1%), and severe modification in 31/288 patients (10.8%). Shunt was used if there was moderate or severe SSEP modification in response to carotid clamping, which represents 63 patients in our series. A shunt was used in 47/288 patients (16.3%). In 16 patients, despite SSEP modifications, the shunt was not used because these SSEP modifications occurred only in the last minutes of the procedure just before off clamping the carotid. The mean SP for all patients was 51 mm Hg. In the shunted patients, the mean SP was 33 mm Hg. Variation of SP was correlated with the SSEP modifications. There was just one perioperative stroke in this series (1/288 = 0.3%). We concluded that the threshold of SP below which shunting is indicated in our study was 44 mm Hg with 81% sensibility and 68% specificity.
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Affiliation(s)
- P Astarci
- Department of Cardiovascular Surgery, St. Luc University Hospital, Brussels, Belgium.
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Chiappini B, Absil B, Rubay J, Noirhomme P, Funken JC, Verhelst R, Poncelet A, El Khoury G. Withdrawal. The Ross procedure: clinical and echocardiographic follow-up in 219 consecutive patients. Ann Thorac Surg 2007; 84:712. [PMID: 17650548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
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Dardenne S, Coche E, Weynand B, Poncelet A, Zech F, De Meyer M. High Suspicion of Bacillary Angiomatosis in a Kidney Transplant Recipient: A Difficult Way to Diagnose—Case Report. Transplant Proc 2007; 39:311-3. [PMID: 17275532 DOI: 10.1016/j.transproceed.2006.10.202] [Citation(s) in RCA: 6] [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] [Received: 08/14/2006] [Indexed: 11/18/2022]
Abstract
Bacillary angiomatosis is an infection caused by Bartonella, which has first been described in human immunodeficiency virus (HIV)-infected patients. We report an unusually located lesion, in a totally asymptomatic kidney transplant recipient. The diagnosis was strongly suggested based on the iconography and our histological analysis, but was not confirmed using polymerase chain reaction (PCR) and immunohistochemical studies. We illustrate our difficult way to the diagnosis as well as the course of the disease and our therapeutic strategy.
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Affiliation(s)
- S Dardenne
- Service de Chirurgie et Transplantation Abdominale, Universite Catholique de Louvain, Cliniques Universitaires, Brussels, Belgium.
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Astarci P, Siciliano S, Verhelst R, Lacroix V, Noirhomme P, Rubay J, Poncelet A, Funken JC, Glineur D, El Kourhy G. Intra-operative acute leg ischaemia after free fibula flap harvest for mandible reconstruction. Acta Chir Belg 2006; 106:423-6. [PMID: 17017698 DOI: 10.1080/00015458.2006.11679921] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Osteosarcomas of the cranial bones need a large surgical radical resection. The best option to reconstruct mandible defect after resection is the free fibula flap. In our patient an acute ischaemic leg occurred just after the free fibula flap harvest for mandible reconstruction. The abnormal distribution of the calf arteries leads to catastrophic consequences. The peroneal artery could be the main dominant artery of the leg in a small number of patients. We reported an extremely rare case of "peronea magna", described in less than 0.2% of the global population. A careful pre-operative workup of the calf vessels is required in all the patients who need free fibula flap harvest.
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Affiliation(s)
- P Astarci
- Cardiovascular and Thoracic Surgery Department, Catholic University of Louvain Saint-Luc Hospital, Bruxelles, Belgium.
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Poncelet A, Claus C, Weynand B, Ferdin F, Dodenstein D, Noirhomme P. P-635 Bone marrow micrometastasis is not predictor of long-termsurvival in early stages non small cell lung carcinoma: 5-year results of a prospective study. Lung Cancer 2005. [DOI: 10.1016/s0169-5002(05)81128-6] [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: 10/25/2022]
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El Khoury G, Glineur D, Rubay J, Verhelst R, d'Acoz YD, Poncelet A, Astarci P, Noirhomme P, van Dyck M. Functional classification of aortic root/valve abnormalities and their correlation with etiologies and surgical procedures. Curr Opin Cardiol 2005; 20:115-21. [PMID: 15711197 DOI: 10.1097/01.hco.0000153951.31887.a6] [Citation(s) in RCA: 121] [Impact Index Per Article: 6.4] [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: 11/27/2022]
Abstract
PURPOSE OF REVIEW Patients with aortic root pathology may benefit from 'valve-conservation' surgery although application of this philosophy is limited by a lack of 'standardized' surgical techniques. A functional classification of aortic root and valvular abnormalities has been developed in 260 patients and correlated with the etiology of the pathologic process and the surgical procedure performed. Early outcome was assessed using hospital records and medium-term follow-up by cardiological review. RECENT FINDINGS From January 1995 until March 2001, 260 patients were operated on for aortic root pathology using valve-conserving surgical techniques. Hospital mortality was 2%; intra-operative echocardiography showed residual aortic regurgitation (Grade 1-2) in 11%, none in the remaining patients. Follow-up at a mean of 20 months (87% of patients) showed trivial or Grade 1 aortic regurgitation in 80%. SUMMARY Application of a simple functional classification for aortic root pathology and aortic valve disease allows the logical application of 'valve-conserving' surgical procedures with excellent early and medium-term results.
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Affiliation(s)
- G El Khoury
- Department of Cardiovascular and Thoracic Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
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El Khoury G, Vanoverschelde JL, Glineur D, Poncelet A, Verhelst R, Astarci P, Underwood MJ, Noirhomme P. Repair of aortic valve prolapse: experience with 44 patients*1. Eur J Cardiothorac Surg 2004; 26:628-33. [PMID: 15302061 DOI: 10.1016/j.ejcts.2004.05.027] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2003] [Revised: 04/30/2004] [Accepted: 05/18/2004] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES In regurgitant tricuspid aortic valves, cusp prolapse may be isolated or associated with dilatation of the proximal aorta. Newly appearing cusp prolapse can also appear after an aortic valve sparing operation (AVSO) and be responsible for residual aortic regurgitation. In this report, we describe our experience in repairing prolapsing aortic cusps in 44 patients with aortic regurgitation. METHODS Between 1996 and 2003, 260 patients had aortic valve repair or valve sparing procedures in our department. All patients had peri-operative TEE. Prolapse of one or more of the aortic cusps was identified by TEE and confirmed by careful surgical inspection before and after valve sparing surgery. Forty-four patients with cusp prolapse were identified. Fifteen had an isolated prolapse, with a normal root (group I), 18 had cusp prolapse associated with dilatation of the proximal aorta (group IIa), and 11 had a newly appearing prolapse after AVSO (group IIb). Correction of the prolapsing cusp was achieved by either free edge plication, triangular resection or resuspension with PTFE. This procedure was associated with an aortic annuloplasty in group I, and with AVSO in groups II and III. RESULTS Post-operative TEE showed AR trivial or grade I regurgitation. At a mean of 23 months follow-up, one patient with recurrent regurgitation required an aortic valve replacement with a homograft. All remaining patients were in NYHA class I or II. Echocardiography confirmed the durability of the valve repair. CONCLUSIONS Among the common causes of aortic regurgitation, isolated cusp prolapse is frequent and is amenable to surgical repair with excellent mid-term results. In particular, in patents who are potential candidates for AVSO, identification and correction of an associated prolapse, either pre-existing or secondary to the AVSO procedure, may further extend the indications for this technique, increase its success rates and improve its long-term outcome.
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Affiliation(s)
- G El Khoury
- Department of Cardiovascular and Thoracic Surgery, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, Brussels 1200, Belgium.
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Lengelé B, Poncelet A, Meunier D, Elias B, El Fouly PE, Willemart G, Noirhomme P. [About the rational use of intrathoracic transfers. Anatomical and surgical bases for the selection of twelve different muscular and omental flaps]. ANN CHIR PLAST ESTH 2003; 48:99-114. [PMID: 12801550 DOI: 10.1016/s0294-1260(03)00013-x] [Citation(s) in RCA: 8] [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: 11/23/2022]
Abstract
Because of their rich blood supply and of their original detersive and filling properties, the muscular pedicled flaps harvested from the trunk or the omental flap elevated from the abdomen may be very usefull to treat large defects or major septic problems in pleural, pericardic or mediastinal cavities. We here describe the main principles to be followed in such intrathoracic reconstructions performed in order to control severe mediastinites, aortic prosthetic infections, pleural empyemas and broncho-pleural, tracheo-esophageal or broncho-esophageal fistulas. In all these circumstances, the muscular or omental flaps which are transferred into the chest are selected according to the recipient field and to their respective access to the upper, middle and lower portions of the pleural space or mediastinum. Twelve different flaps so appear available to achieve the adequate reconstruction, filling or coverage of nine distinct topographic sites. Their rational use, based on various anatomical guidelines, allows to prevent or to cure efficiently 90% of the infectious or fistular complications frequently observed in the postoperative course of aggressive, functional or oncological, intrathoracic surgical procedures.
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Affiliation(s)
- B Lengelé
- Service de chirurgie plastique et de microchirurgie reconstructrice (Prof. R. Vanwijck), cliniques universitaires St-Luc, Université Catholique de Louvain, Bruxelles, Belgique.
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Poncelet A, Gianello P. [Autologous stem cell transplantation in addition to cardiomyoplasty in a porcine model of ischemic cardiomyopathy]. Bull Mem Acad R Med Belg 2003; 158:315-20. [PMID: 15025273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Autologuous stem cell transplantation within regional infarcted or ischemic myocardium is currently a focus of experimental research world-wide, and could provide a unique way to ensure myocardial functional recovery. In order to benefit from immediate access to bone marrow stromal cells at the time of myocardial injury, and thus avoid the delay rendered necessary by autologuous harvesting and clonal expansion, the use of allogeneic stem cell could be of major interest. This experimental work is based on a unique mini-swine model in which the histocompatibility antigens are known, and perfectly controlled, through inbreeding and investigate the survival and the induction of an immune tolerance to allogeneic stem cells injected into the infarcted myocardium with the use of transient immunosuppression (12 days).
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Affiliation(s)
- A Poncelet
- Laboratoire de Chimie expérimentale, CHEX, U.C.L
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Kawai T, Poncelet A, Sachs DH, Mauiyyedi S, Boskovic S, Wee SL, Ko DS, Bartholomew A, Kimikawa M, Hong HZ, Abrahamian G, Colvin RB, Cosimi AB. Long-term outcome and alloantibody production in a non-myeloablative regimen for induction of renal allograft tolerance. Transplantation 1999; 68:1767-75. [PMID: 10609955 DOI: 10.1097/00007890-199912150-00022] [Citation(s) in RCA: 147] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Multilineage chimerism and long-term acceptance of renal allografts has been produced in non-human primates conditioned with a nonmyeloablative regimen. Our study was undertaken to evaluate the immunological and pathological status of long-term survivors and to define the role of splenectomy and of the primarily vascularized kidney in the regimen. METHOD Monkeys were treated with the basic regimen, including: total body irradiation, thymic irradiation, antithymocyte globulin, donor bone marrow transplantation, and a 4-week course of cyclosporine after which no further immunosuppression was given. They were divided into four groups according to the timing of kidney transplantation (KTx) and splenectomy as follows; group A (n=13): KTx and splenectomy on the day of donor bone marrow transplantation (day 0); group B (n=3): KTx on day 0 without splenectomy; group C (n=7): splenectomy on day 0 but delayed KTx until 3 to 16 weeks post-donor bone marrow transplantation; group D (n=3): both splenectomy and KTx delayed until day 120 post-donor bone marrow transplantation. RESULTS In group A, 11 of 13 monkeys developed chimerism and 9 monkeys achieved long-term survival of 4 to 70 months without evidence of chronic vascular rejection. Alloantibodies were detected in only one long-term survivor. In contrast, all three monkeys in group B developed alloantibodies and rejected their allografts. In group C, long-term survival without alloantibody production was observed in two of three monkeys that had developed chimerism. In group D, all three recipients were sensitized and rejected the kidney allografts rapidly after transplantation. CONCLUSIONS 1) Production of anti-donor antibody was prevented in most recipients that developed mixed chimerism in the regimens with splenectomy at the time of donor bone marrow transplantation. 2) If splenectomy is not included in the initial conditioning regimen, induction of B cell tolerance is less likely and the result is late onset of alloantibody production and allograft rejection. 3) Immediate transplantation of the kidney at the time of recipient conditioning is not essential for induction of donor specific hyporesponsiveness by bone marrow transplantation.
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Affiliation(s)
- T Kawai
- Department of Surgery, Harvard Medical School at Massachusetts General Hospital, Boston 02114, USA
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Abstract
Paget's disease of bone is associated with involvement of the central and peripheral nervous system. The brain, spinal cord, cauda equina, spinal roots, and cranial nerves can be affected in Paget's disease due to their anatomic relationship to bone. Neurologic syndromes are uncommon but include headache, dementia, brain stem and cerebellar dysfunction, cranial neuropathies, myelopathy, cauda equina syndrome, and radiculopathies. The central complications result from pagetic involvement of the skull. Expansion of diseased bone can result in compression of cranial nerves as they exit their bony foramina. Softening of the skull leads to basilar invagination with compression of the brain stem, cerebellum, and lower cranial nerves. Brain stem compression can cause hydrocephalus. Rarely, there is direct compression of the brain from acute epidural hematoma or hypertrophy of the calvarium. Myelopathy, cauda equina syndrome, and radiculopathies most commonly result from hypertrophy of the spine with direct compression. Spinal stenosis can also result from ossification of extradural structures or pathologic fractures. Ischemia from vascular compression or a steal syndrome has also been described. Neurologic complications rarely occur due to sarcomatous transformation of pagetic bone. Magnetic resonance imaging (MRI), computerized tomography (CT)-myelography, and bone X-rays are helpful to localize the lesion and direct therapy. Treatment options include surgical decompression, ventricular shunt placement, and medical management with calcitonin and/or the bisphosphonates. The selection of treatment will vary depending upon the rate of progression and the severity of the neurologic deficit.
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Affiliation(s)
- A Poncelet
- Department of Neurology, University of California-San Francisco, San Francisco, California 94143, USA
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Abstract
A randomized double-blinded study was performed on 20 normal volunteers to evaluate 2 different techniques of single-injection digital anesthesia. Single-injection transthecal digital block technique was used to anesthetize 1 index finger and single-injection subcutaneous technique to block the other index finger. Pain and light touch were evaluated and sensory nerve-conduction studies were performed on both index fingers. These data were obtained prior to the nerve blocks and then at 10-minute intervals until recovery from the anesthesia. The method of anesthesia was found to have no effect on the distribution, onset, and duration of anesthesia. Median and radial nerve sensory nerve action potential amplitude reductions following digital anesthesia were also not influenced by the technique of anesthesia. Single-injection subcutaneous block was found to be easier to administer and to produce less pain during and 24 hours after injection than did the single-injection transthecal technique.
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Affiliation(s)
- C K Low
- Department of Orthopaedic Surgery, University of California, San Francisco, USA
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Abstract
Since 1966, we have performed 41 renal transplants from unrelated living donors (ULD), 39 of which were "emotionally related". All donor-recipient pairs included in the present series were AB0-compatible. Recipients included 37 with primary and 4 with secondary transplants; 2 of the latter were diabetics. We compared these results to those of 41 recipients of cadaver donor kidneys matched for age, sex, immunosuppressive regimen, rank, and year of transplant, focusing our attention on the subgroups of patients under cyclosporin A (CyA) therapy (n = 24). We found that ULD transplantation was as successful as cadaver transplantation with good HLA matching: at 3 years, graft survival rates were 81% in ULD versus 86% in the control group under CyA. Moreover, grafts from ULD functioned more rapidly (no post-transplant dialysis and 70% of the patients with serum creatinine below 2 mg/dl within 3 days post-transplant). Graft tolerance was equivalent in both groups (50% of the patients experienced no rejection). We conclude that despite poor HLA matching, ULD transplantation with CyA as the basic immunosuppressive agent offers good results: benefiting from the quality of living donor kidney grafts, it helps to alleviate the persistent shortage of cadaver donors.
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Affiliation(s)
- J P Squifflet
- Department of Renal and Pancreas Transplantation, University of Louvain Medical School, Cliniques UCL Saint-Luc, Brussels, Belgium
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Abstract
Eight rats were trained to use their left paw to rapidly press the right lever of an operant chamber once and the left lever twice to obtain a food reward. Between-levers interresponse times and same lever interresponse times were measured daily for several weeks before and after bilateral removal of frontal motor/sensory cortex. This surgery resulted in a permanent deficit in most rats' ability to rapidly alternate between levers, but resulted in only a temporary deficit in their ability to rapidly press the same lever. Sham surgery and removal of hindlimb motor cortex had little immediate effect on interresponse times. The data demonstrate that sequential motor behavior tested in the between-levers tasks is chronically affected by cortical lesions, but the speed of the same repetitive movement tested in the same lever task is not. Measuring the time to rapidly alternate between two different levers, therefore, provides a quantitative method for measuring acute and chronic forelimb motor deficits due to motor cortex injury in rats which could be applied to any mammal.
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