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Early discontinuation of combination antibiotic therapy in severe community-acquired pneumonia: a retrospective cohort study. BMC Infect Dis 2023; 23:611. [PMID: 37723456 PMCID: PMC10506273 DOI: 10.1186/s12879-023-08493-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 07/28/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Severe community-acquired pneumonia (SCAP) is commonly treated with an empiric combination therapy, including a macrolide, or a quinolone and a β-lactam. However, the risk of Legionella pneumonia may lead to a prolonged combination therapy even after negative urinary antigen tests (UAT). METHODS We conducted a retrospective cohort study in a French intensive care unit (ICU) over 6 years and included all the patients admitted with documented SCAP. All patients received an empirical combination therapy with a β-lactam plus a macrolide or quinolone, and a Legionella UAT was performed. Macrolide or quinolone were discontinued when the UAT was confirmed negative. We examined the clinical and epidemiological features of SCAP and analysed the independent factors associated with ICU mortality. RESULTS Among the 856 patients with documented SCAP, 26 patients had atypical pneumonia: 18 Legionella pneumophila (LP) serogroup 1, 3 Mycoplasma pneumonia (MP), and 5 Chlamydia psittaci (CP). UAT diagnosed 16 (89%) Legionella pneumonia and PCR confirmed the diagnosis for the other atypical pneumonia. No atypical pneumonia was found by culture only. Type of pathogen was not associated with a higher ICU mortality in the multivariate analysis. CONCLUSION Legionella pneumophila UAT proved to be highly effective in detecting the majority of cases, with only a negligible percentage of patients being missed, but is not sufficient to diagnose atypical pneumonia, and culture did not provide any supplementary information. These results suggest that the discontinuation of macrolides or quinolones may be a safe option when Legionella UAT is negative in countries with a low incidence of Legionella pneumonia.
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Bacterial and fungal infections: a frequent and deadly complication among critically ill acute liver failure patients. Infect Dis (Lond) 2023:1-10. [PMID: 37211670 DOI: 10.1080/23744235.2023.2213326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/03/2023] [Accepted: 05/07/2023] [Indexed: 05/23/2023] Open
Abstract
BACKGROUND Acute liver failure (ALF) is a rare but life-threatening condition mostly requiring intensive care unit (ICU) admission. ALF induces immune disorders and may promote infection acquisition. However, the clinical spectrum and impact on patients' prognosis remain poorly explored. METHODS We conducted a retrospective single-centre study on patients admitted for ALF to the ICU of a referral University Hospital from 2000 to 2021. Baseline characteristics and outcomes according to the presence of infection until day 28 were analysed. Risk factors for infection were determined using logistic regression. The impact of infection on 28-day survival was assessed using the proportional hazard Cox model. RESULTS Of the 194 patients enrolled, 79 (40.7%) underwent infection: community-acquired, hospital-acquired before ICU and ICU-acquired before/without and after transplant in 26, 23, 23 and 14 patients, respectively. Most infections were pneumonia (41.4%) and bloodstream infection (38.8%). Of a total of 130 microorganisms identified, 55 were Gram-negative bacilli (42.3%), 48 Gram-positive cocci (36.9%) and 21 were fungi (16.2%). Obesity (OR 3.77 [95% CI 1.18-14.40]; p = .03) and initial mechanical ventilation (OR 2.26 [95% CI 1.25-4.12]; p = .007) were independent factors associated with overall infection. SAPSII > 37 (OR 3.67 [95% CI 1.82-7.76], p < .001) and paracetamol aetiology (OR 2.10 [95% CI 1.06-4.22], p = .03) were independently associated with infection at admission to ICU. On the opposite, paracetamol aetiology was associated with lower risk of ICU-acquired infection (OR 0.37 [95% CI 0.16-0.81], p = .02). Patients with any type of infection had lower day 28 survival rates (57% versus 73%; HR 1.65 [1.01-2.68], p = .04). The presence of infection at ICU admission (p = .04), but not ICU-acquired infection, was associated with decreased survival. CONCLUSIONS The prevalence of infection is high in ALF patients which is associated with a higher risk of death. Further studies assessing the use of early antimicrobial therapy are needed.
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Impact of Arterial CO 2 Retention in Patients With Moderate or Severe ARDS. Respir Care 2023; 68:582-591. [PMID: 36977590 PMCID: PMC10171350 DOI: 10.4187/respcare.10507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
BACKGROUND Lung-protective ventilation (reduced tidal volume and limited plateau pressure) may lead to CO2 retention. Data about the impact of hypercapnia in patients with ARDS are scarce and conflicting. METHODS We performed a non-interventional cohort study with subjects with ARDS admitted from 2006 to 2021 and with PaO2 /FIO2 ≤ 150 mm Hg. We examined the association between severe hypercapnia (PaCO2 ≥ 50 mm Hg) on the first 5 days after the diagnosis of ARDS and death in ICU for 930 subjects. All the subjects received lung-protective ventilation. RESULTS Severe hypercapnia was noted in 552 subjects (59%) on the first day of ARDS (day 1); 323/930 (34.7%) died in the ICU. Severe hypercapnia on day 1 was associated with mortality in the unadjusted (odds ratio 1.54, 95% CI 1.16-1.63; P = .003) and adjusted (odds ratio 1.47, 95% CI 1.08-2.43; P = .004) models. In the Bayesian analysis, the posterior probability that severe hypercapnia was associated with ICU death was > 90% in 4 different priors, including a septic prior for this association. Sustained severe hypercapnia on day 5, defined as severe hypercapnia present from day 1 to day 5, was noted in 93 subjects (12%). After propensity score matching, severe hypercapnia on day 5 remained associated with ICU mortality (odds ratio 1.73, 95% CI 1.02-2.97; P = .047). CONCLUSIONS Severe hypercapnia was associated with mortality in subjects with ARDS who received lung-protective ventilation. Our results deserve further evaluation of the strategies and treatments that aim to control CO2 retention.
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Moderate to severe ARDS: COVID-19 patients compared to influenza patients for ventilator parameters and mortality. ERJ Open Res 2023; 9:00554-2022. [PMID: 37041986 PMCID: PMC9885245 DOI: 10.1183/23120541.00554-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 12/21/2022] [Indexed: 01/27/2023] Open
Abstract
BackgroundThis study aimed to compare ventilatory parameters recorded the first days of ARDS, and mortality at day 60 between COVID-19 and influenza ARDS patients with PaO2/FiO2≤150 mmHg.MethodsWe compared 244 COVID-19 ARDS patients with 106 influenza ARDS patients. Driving pressure (DP), respiratory system compliance (CRs), ventilator ratio (VR), corrected minute ventilation (VEcorr), and surrogate of mechanical power [index=(4×DP)+respiratory rate] were calculated from day1 to day 5 of ARDS. A propensity score analysis and a principal component analysis (PCA) were performed.ResultsOn day 1 of ARDS, COVID-19 patients had significantly higher PaO2/FiO2ratio (median [IQR], 97 mmHg [79–129]versus83 [62.2–114]), p=0.001), and lower DP (13 cmH20 [11–16.0]versus14 [12.0–16.7], p=0.01), VR (2.08 [1.73–2.49versus2.52 [1.97–3.03], p<0.001), VEcorr (12.7 L·mn−1[10.2–14.9]versus14.9 [11.6–18.6], p<0.001), index (80 [70–89]versus84 [75–94], p=0.004). PCA demonstrated an important overlap of ventilatory parameters recorded on day 1 between the two groups. From day 1 to day 5 repeated values of PaO2/FiO2ratio, PaCO2, VR and VEcorr differed significantly between influenza and COVID-19 patients in the unmatched and matched populations. Mortality at day 60 did not differ significantly after matching (29%versus21.7%, p=0.43).ConclusionsVentilation was more impaired in influenza than in COVID-19 ARDS patients the first day of ARDS with important overlap of values. However, mortality at day 60 did not differ significantly in the matched population.
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Acquired agitation in acute respiratory distress syndrome with COVID-19 compared to influenza patients: a propensity score matching observational study. Virol J 2022; 19:145. [PMID: 36085163 PMCID: PMC9463051 DOI: 10.1186/s12985-022-01868-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A growing body of evidence reports that agitation and encephalopathy are frequent in critically ill Covid-19 patients. We aimed to assess agitation's incidence and risk factors in critically ill ARDS patients with Covid-19. For that purpose, we compared SARS-CoV-2 acute respiratory distress syndrome (ARDS) patients with a population of influenza ARDS patients, given that the influenza virus is also known for its neurotropism and ability to induce encephalopathy. METHODS We included all the patients with laboratory-confirmed Covid-19 infection and ARDS admitted to our medical intensive care unit (ICU) between March 10th, 2020 and April 16th, 2021, and all the patients with laboratory-confirmed influenza infection and ARDS admitted to our ICU between April 10th, 2006 and February 8th, 2020. Clinical and biological data were prospectively collected and retrospectively analyzed. We also recorded previously known factors associated with agitation (ICU length of stay, length of invasive ventilation, SOFA score and SAPS II at admission, sedative and opioids consumption, time to defecation). Agitation was defined as a day with Richmond Agitation Sedation Scale greater than 0 after exclusion of other causes of delirium and pain. We compared the prevalence of agitation among Covid-19 patients during their ICU stay and in those with influenza patients. RESULTS We included 241 patients (median age 62 years [53-70], 158 males (65.5%)), including 146 patients with Covid-19 and 95 patients with Influenza. One hundred eleven (46.1%) patients had agitation during their ICU stay. Patients with Covid-19 had significantly more agitation than patients with influenza (respectively 80 patients (54.8%) and 31 patients (32.6%), p < 0.01). After matching with a propensity score, Covid-19 patients remained more agitated than influenza patients (49 (51.6% vs 32 (33.7%), p = 0.006). Agitation remained independently associated with mortality after adjustment for other factors (HR = 1.85, 95% CI 1.37-2.49, p < 0.001). CONCLUSION Agitation in ARDS Covid-19 patients was more frequent than in ARDS influenza patients and was not associated with common risk factors, such as severity of illness or sedation. Systemic hyperinflammation might be responsible for these neurological manifestations, but there is no specific management to our knowledge.
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Troubles minéraux et osseux dans la maladie rénale chronique : physiopathologie, conséquences et prise en charge. Rev Med Interne 2022; 43:225-232. [DOI: 10.1016/j.revmed.2022.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 01/26/2022] [Accepted: 01/29/2022] [Indexed: 02/07/2023]
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Surgical treatment of rhinophyma: Retrospective monocentric study and literature review. Ann Dermatol Venereol 2021; 148:172-176. [PMID: 34176641 DOI: 10.1016/j.annder.2021.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 01/14/2021] [Accepted: 02/05/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Treatment of rhinophyma consists primarily of destructive procedures. There is currently no consensus regarding treatment. In this study, we propose an algorithm based on a cohort of 25 patients and a literature review. PATIENTS AND METHODS This was a retrospective study conducted between January 2016 and December 2018. The cosmetic outcome was evaluated by 2 independent assessors based on pre- and postoperative photographs. Patients were ranked according to the severity (mild, moderate, severe) of their rhinophyma. The different surgical methods used were cold blade excision or rhinoshave, electrosurgery or monopolar diathermy knife (MDK), and carbon dioxide laser (CO2 laser), either alone or in combination with another technique. All patients were contacted after the procedure to evaluate their satisfaction and to investigate for adverse effects. RESULTS Twenty-five patients were included retrospectively: 7 with mild rhinophyma (5 were treated by MDK, 1 by fractional CO2 laser, and 1 by cold-blade excision and TCA solution), 11 with moderate rhinophyma (2 were treated by MDK, 9 by continuous CO2 laser), and 7 with severe rhinophyma (2 were treated by MDK, 5 by MDK plus CO2 laser). Cosmetic outcomes were deemed good or excellent in 80% of cases, and 84% of patients were fully satisfied with the result. We observed 5 cases of hypertrophic scarring, 2 cases of hypopigmentation, 3 cases of notching of the nasal ala, and 7 cases of prolonged erythema, most of which were caused by the MDK technique. CONCLUSION A wide range of treatment options are available for rhinophyma. We suggest the use of cold-blade excision and trichloroacetic acid or fractional carbon dioxide laser for mild rhinophyma, continuous and pulsed CO2 laser for moderate rhinophyma, and MDK for severe rhinophyma.
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Hydroxychloroquine pharmacokinetic in COVID-19 critically ill patients: an observational cohort study. Intensive Care Med 2020; 46:1772-1773. [PMID: 32514594 PMCID: PMC7276495 DOI: 10.1007/s00134-020-06142-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2020] [Indexed: 11/13/2022]
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A spray containing extracts of oat plantlets and Uncaria tomentosa relieves pain associated with chronic inflammatory skin diseases and dermatological procedures. J Eur Acad Dermatol Venereol 2020; 34 Suppl 2:3-11. [PMID: 32476176 DOI: 10.1111/jdv.16428] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 03/25/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Inflammation from skin conditions such as psoriasis, eczema-like atopic dermatitis (AD) and hand eczema (HE) and following dermatological procedures (post-acts) can result in intense itching and cutaneous pain. Dermo-cosmetics containing plant extracts have been shown to reduce or alleviate these symptoms. OBJECTIVES Assessment of the tolerability and efficacy of a spray containing Rhealba\xAE Oat plantlets and Uncaria tomentosa extracts in adults and children with inflammatory skin diseases and after dermatological procedures. METHODS Data from five open label studies were analysed (Study 1: adults with AD; Study 2: children with AD; Study 3: adults with psoriasis; Study 4: adults with HE; Study 5: adults who had undergone a dermatological procedure: laser, intense pulsed light, glycolic acid peeling, photodynamic therapy or cryotherapy procedure). In all studies, subjects could use the test product up to six times per day for symptom relief. Physical and functional signs of inflammation, treatment-emergent adverse events (TEAEs), soothing effect, changes in quality of life, cutaneous pain and cosmetic acceptability were compared pre- and postapplication. RESULTS A total of 176 subjects were enrolled across the five studies. Overall, investigators judged the dermatological tolerance of the test product containing Rhealba\xAE Oat plantlets extract and Uncaria tomentosa as good to excellent. All studies showed significant improvements in physical signs, reduction in itching and feeling of pain (P < 0.05). The soothing effect was evident after the first application. TEAEs were mostly mild, transient and occurred within the first few days of treatment. The majority of subjects reported improved QoL across the studies. CONCLUSIONS The dermo-cosmetic spray containing Rhealba\xAE Oat plantlets extract and U. tomentosa was well tolerated and efficacious in providing relief of symptoms associated with cutaneous pain from inflammatory skin diseases and following dermatological procedures; however, further studies are needed to rule out alternative explanations of symptom reduction such as natural history and response biases.
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Fibrous dysplasia of the orbital region: Series of 12 cases and review of the literature. J Fr Ophtalmol 2020; 43:467-476. [PMID: 32376037 DOI: 10.1016/j.jfo.2019.10.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 10/16/2019] [Accepted: 10/18/2019] [Indexed: 10/24/2022]
Abstract
PURPOSE Fibrous dysplasia (FD) is a benign fibro-osseous developmental disorder of growing bone, sometimes involving the craniofacial skeleton (CFD). We wish to present a patient series with CFD of the orbital region and discuss treatment modalities. METHODS Twelve patients were referred for orbital CFD in the Nantes University Hospital between 2000 and 2018 and studied according to the clinical parameters, radiological features, and modalities of treatment. RESULTS The mean age was 25.6 years. Ten patients exhibited facial asymmetry with vertical globe dystopia (75%), proptosis (58%) and facial bump (50%). The disease was monostotic in 83% of patients, involving the frontal bone (25%), the sphenoidal bone (33%), the fronto-sphenoidal complex (25%), and the skull base (17%). Unilateral radiological proptosis was found in 7 patients, with a mean protrusion 3.9mm. The optic canal was involved in 75% of patients, with no functional impairment. Three patients were treated with bisphosphonate therapy to stop progression of the disease; 6 patients were given a bone remodelling procedure with good aesthetic outcomes. CONCLUSION The orbit is a rare localization for FD causing aesthetic and functional disabilities. Medical and surgical treatment can be proposed as part of a multidisciplinary approach.
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Traitement chirurgical du rhinophyma : cohorte monocentrique, revue de la littérature et proposition d’un algorithme de prise en charge. Ann Dermatol Venereol 2019. [DOI: 10.1016/j.annder.2019.09.261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Effect of parathyroidectomy on quality of life and non-specific symptoms in normocalcaemic primary hyperparathyroidism. Br J Surg 2018; 105:223-229. [PMID: 29405278 DOI: 10.1002/bjs.10739] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 06/16/2017] [Accepted: 09/29/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Normocalcaemic primary hyperparathyroidism (NcPHPT) is a new clinical entity being diagnosed increasingly among patients with mild primary hyperparathyroidism (PHPT). The aim of this study was to evaluate quality of life and non-specific symptoms before and after parathyroidectomy in patients with NcPHPT compared with those with hypercalcaemic mild PHPT (Hc-m-PHPT). METHODS This was a prospective multicentre study of patients with mild PHPT from four university hospitals. Patients were evaluated before operation, and 3, 6 and 12 months after surgery for quality of life using the SF-36-v2® questionnaire, as well as for 25 non-specific symptoms. RESULTS Before operation, the only statistically significant difference between the NcPHPT and Hc-m-PHPT groups was in the mean(s.d.) blood calcium level (2·54 versus 2·73 mmol; P < 0·001). At 1 year after surgery, the blood calcium level had improved significantly in both groups, with no significant difference between them. Quality of life improved significantly in each group compared with its preoperative score, with regard to the physical component summary (P = 0·040 and P = 0·016 respectively), whereas the mental component summary improved significantly in the Hc-m-PHPT group only (P = 0·043). Only two non-specific symptoms improved significantly in the NcPHPT group compared with nine in the Hc-m-PHPT group. CONCLUSION Parathyroidectomy mildly improves quality of life and some non-specific symptoms in patients with NcPHPT.
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Efficacy of a repair cream containing Rhealba oat plantlets extract l-ALA-l-GLU dipeptide, and hyaluronic acid in wound healing following dermatological acts: a meta-analysis of >2,000 patients in eight countries corroborated by a dermatopediatric clinical case. Clin Cosmet Investig Dermatol 2018; 11:579-589. [PMID: 30519069 PMCID: PMC6239097 DOI: 10.2147/ccid.s177614] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Background The frequency of dermatological acts is increasing. These procedures often cause injuries and traumatic alterations in specific skin layers, slowing down wound healing. Patients and methods An open observational study lasting 1 month was conducted on 2,363 patients who had undergone various dermatological procedures. This study was conducted in eight European countries and an Asian country during which the tolerance and efficacy of a cosmetic cream based on Rhealba oat plantlets’ extract, l-ALA–l-GLU dipeptide, and hyaluronic acid were assessed on patients’ wounds. Results Efficacy was observed 5′ after the first application, which leads to an immediate relief, confirmed by the overall efficacy judged by the doctors as good or very good in 96.8% of the cases. In Germany, the efficacy of the same cream was assessed on children suffering from first- or second-degree burns. In this dermatopediatric case, the aim was to support the regeneration process and prevent scarring by using a topical cream rather than a silicon bandage or corticosteroids. A positive effect on skin regeneration and prevention of scaring could already be observed after 4 weeks of application without any undesired complication. Conclusion This clinical focus complements the previous meta-analysis by demonstrating that the tested cream containing Rhealba oat plantlets’ extracts, l-ALA–l-GLU dipeptide, and hyaluronic acid could also be used with a great efficacy in children after thermal burns to prevent scaring.
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Lupus érythémateux subaigu induit par la capécitabine : 2 cas. Rev Med Interne 2018. [DOI: 10.1016/j.revmed.2018.03.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Critères de transformation du dermatofibrosarcome de Darier-Ferrand : implications thérapeutique et pronostique. Ann Dermatol Venereol 2015. [DOI: 10.1016/j.annder.2015.10.275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Face dorsale de la main : de l’exérèse-suture aux autoplasties. Ann Dermatol Venereol 2014. [DOI: 10.1016/j.annder.2014.04.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Lambeaux en îlot : introduction, notions théoriques. Ann Dermatol Venereol 2014. [DOI: 10.1016/j.annder.2014.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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SAT0509 Three-Dimensional Versus Two-Dimensional Ultrasonography in the Assessment of Peripheral Enthesitis in Spondylarthritis. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.2233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Top ten. Ann Dermatol Venereol 2013. [DOI: 10.1016/j.annder.2013.03.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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[No interrupted surgical defects of the white upper lip: repair by a combined advancement and rotation flap in the lip subunit]. REVUE DE LARYNGOLOGIE - OTOLOGIE - RHINOLOGIE 2013; 134:203-206. [PMID: 25252575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
A solid understanding of anatomy, basic surgical principles, and tissue movement is essential when undertaking the reconstruction of facial cutaneous surgical defects. Aesthetic facial reconstruction requires understanding ability to use the tissue adjacent to the defect to create a reconstruction that preserves the function of the area and the cosmetic facial units and subunits. The closure of non interrupted white upper lip defects by using a combined advancement and rotation flap is preferred for defects not overtaking 2.5 cm in diameter.
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Chirurgie oncologique des carcinomes cutanés du cuir chevelu. Ann Dermatol Venereol 2012. [DOI: 10.1016/j.annder.2012.04.180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Gestion du risque infectieux. Ann Dermatol Venereol 2012. [DOI: 10.1016/j.annder.2012.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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High frequency of vitamin D deficiency in HIV-infected patients: effects of HIV-related factors and antiretroviral drugs. J Antimicrob Chemother 2012; 67:2222-30. [PMID: 22589455 DOI: 10.1093/jac/dks176] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES The aim of this study was to assess 25-hydroxyvitamin D (vitamin D) status in an HIV-infected adult population and to define HIV- and antiretroviral-related factors associated with vitamin D deficiency. METHODS Using data from a prospective cohort of HIV-infected adult patients followed in five French centres (Dat'AIDS cohort), we evaluated the prevalence of vitamin D deficiency/insufficiency (<30 ng/mL). A multiple linear regression model was used to examine risk factors for vitamin D deficiency (≤10 ng/mL). RESULTS Vitamin D deficiency/insufficiency was observed in 86.7% of the 2994 patients, including 55.6% with vitamin D insufficiency and 31.1% with vitamin D deficiency. In multivariate analysis, factors associated with vitamin D deficiency were current smoking [adjusted OR (aOR) 1.55], estimated glomerular filtration rate ≥90 mL/min/1.73 m(2) (aOR 1.51), vitamin D measurement not performed in summer (aOR 0.27), CD4 <350 cells/mm(3) (aOR 1.37 for CD4 200 to <350 and 1.62 for CD4 <200 cells/mm(3)) and antiretroviral therapy (aOR 2.61). Gender, body mass index, age, coinfection and previous AIDS were not associated factors. In the antiretroviral-treated population (n = 2660), besides the same factors found in the whole population, efavirenz was the only drug to be significantly associated with deficiency, with an aOR of 1.89 (95% CI 1.45-2.47). CONCLUSIONS Vitamin D deficiency is frequent in this HIV-infected population. Patients on antiretroviral therapy are at higher risk of vitamin D deficiency than antiretroviral-naive patients, with an increased risk in patients receiving efavirenz. No effect of the other antiretrovirals, including the latest (etravirine, darunavir, raltegravir), was found.
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Carcinomes basocellulaires de la pointe et de l’aile du nez : étude prospective de 149 patients. Ann Dermatol Venereol 2011. [DOI: 10.1016/j.annder.2011.09.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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A comparison between bisphosphonates and other treatments for osteoporosis. Curr Pharm Des 2011; 16:3037-44. [PMID: 20722614 DOI: 10.2174/138161210793563563] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Accepted: 08/08/2010] [Indexed: 11/22/2022]
Abstract
Since their development 30 years ago, bisphosphonates are now one of the standard therapy in the management of osteoporosis. Improvements in terms of anti-resorptive potency have leaded to new molecules available either orally or intravenously, from weekly to yearly administration. Overall tolerance of bisphosphonates is good with regards to the risk of mandibular necrosis, not comparable with those observed in cancer treatment, and with no causal link yet established in osteoporotic patients. Compliance remains poor and should be improved by a better education of the patients about their treatment. Other treatments like teriparatide, raloxifene or strontium ranelate are now also available and give more therapeutic options but also more questions on the best molecule to choose for each patient. There is currently no valid basis for distinguishing in a formal and objective manner the different new-generation bisphosphonates, in terms of efficacy against either vertebral, peripheral or hip fractures. In a same way, comparison between bisphosphonates and the other treatments available for osteoporosis is hard in absence of proper randomised controlled study. This review gives an overview of the recent data on the efficacity and tolerance of bisphosphonates in the different forms of osteoporosis and compares them to the other treatments currently available.
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27
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[Superficial acral fibromyxoma: three cases]. Ann Dermatol Venereol 2010; 137:789-93. [PMID: 21134581 DOI: 10.1016/j.annder.2010.08.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2009] [Accepted: 08/02/2010] [Indexed: 11/28/2022]
Abstract
BACKGROUND in this report of three new cases of superficial acral fibromyxoma (SAF), we discuss the clinicopathological features of this acral fibrous tumour as well as the differential diagnoses for hard nodules affecting the extremities. PATIENTS AND METHODS these three lesions involved the standard presentation of a large solitary flesh coloured nodule causing deformation of a toenail or a fingernail. Biopsy showed the presence within a fibromyxoid tumour of proliferating fusiform cells having no atypical features and expressing CD 34 diffusely, and in more focal and less consistent fashion, epithelial membrane antigen (EMA) and CD 99. FISH testing for translocation t(17; 22) proved negative. DISCUSSION this fairly common acral fibrous tumour is poorly known and in certain cases histology results may suggest myxoid dermatofibrosarcoma, which carries a completely different prognosis.
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28
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[Urachal sinus presenting as umbilical drainage in an adult male]. Ann Dermatol Venereol 2009; 136:536-9. [PMID: 19560617 DOI: 10.1016/j.annder.2009.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2008] [Accepted: 02/20/2009] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although urachal remnants are very rare, dermatologists must be aware of them in order to ensure suitable treatment by urologists. Lack of appropriate treatment exposes patients to the risks of recurrent infectious complications or degeneration to vesical adenocarcinoma. CASE REPORT A 32-year-old man consulted for mild and recurring umbilical weeping for approximately 1 year. He had previously undergone unsuccessful treatment, comprising application of liquid nitrogen and of silver nitrate to an umbilical lesion measuring several millimetres regarded as pyogenic granuloma. The diagnosis of urachal sinus was suspected clinically (umbilical weeping or inflammation) and confirmed by urological scan. DISCUSSION A defect involving partial or total obliteration of the urachal canal after the fifth month of gestation can result in four types of benign abnormalities. Patent urachus (50%) is diagnosed during the neonatal period, while in adults, the most frequent form is a urachal cyst (30%), with sinuses (15%) and the diverticula (5%) being very rare. The urachus and its implantation base on the bladder must be removed surgically. Laparoscopic surgery offers a valuable alternative to open-surgery and probably leads to less morbidity and shorter convalescence in active young subjects.
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29
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269 Déficit focal des fibres optiques chez des patients diabétiques présentant une absence de rétinopathie ou une rétinopathie minime. J Fr Ophtalmol 2009. [DOI: 10.1016/s0181-5512(09)73396-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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30
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Pathologies bénignes de l’ouraque chez l’adulte : origine embryologique, présentation clinique et traitements. Prog Urol 2008; 18:634-41. [DOI: 10.1016/j.purol.2008.04.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2008] [Revised: 03/20/2008] [Accepted: 04/30/2008] [Indexed: 10/21/2022]
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31
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Spatiotemporal instability of a confined capillary jet. PHYSICAL REVIEW. E, STATISTICAL, NONLINEAR, AND SOFT MATTER PHYSICS 2008; 78:046312. [PMID: 18999531 DOI: 10.1103/physreve.78.046312] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2008] [Revised: 09/29/2008] [Indexed: 05/12/2023]
Abstract
Recent experimental studies on the instability of capillary jets have revealed the suitability of a linear spatiotemporal instability analysis to ascertain the parametrical conditions for specific flow regimes such as steady jetting or dripping. In this work, an extensive analytical, numerical, and experimental description of confined capillary jets is provided, leading to an integrated picture both in terms of data and interpretation. We propose an extended, accurate analytic model in the low Reynolds number limit, and introduce a numerical scheme to predict the system response when the liquid inertia is not negligible. Theoretical predictions show remarkable accuracy when compared with the extensive experimental mapping.
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32
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[Site-specific technique. Red lip tumour resection]. Ann Dermatol Venereol 2008; 135:620-3. [PMID: 18789304 DOI: 10.1016/j.annder.2008.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2008] [Accepted: 05/16/2008] [Indexed: 10/21/2022]
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A simple method for measuring plasma power in rf-GDOES instruments. Anal Bioanal Chem 2007; 389:763-7. [PMID: 17676313 DOI: 10.1007/s00216-007-1509-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2007] [Revised: 07/11/2007] [Accepted: 07/12/2007] [Indexed: 10/23/2022]
Abstract
A method for determining plasma power in rf-GDOES is presented. It is based on an effective resistance located in the inductive coil of the impedance matching. The amount of electrical power consumed in the matching system depends on the capacitive current flowing through the matching system, which depends on the applied voltage, the stray capacity, and the frequency. This correction method is experimentally evaluated and compared with the integral plasma power calculation.
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34
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[Pertrochanteric fractures in elderly subjects aged over 75]. REVUE DE CHIRURGIE ORTHOPEDIQUE ET REPARATRICE DE L'APPAREIL MOTEUR 2007; 93:2S33-46. [PMID: 17646827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Pertrochanteric fractures constitute a major public health concern. This retrospective multicentric study evaluated outcome after treatment in patients aged over 75 years hospitalized for pertrochanteric fractures over a one year period (May 2004-May 2005). Five University Hospitals in the cities of Angers, Brest, Rennes, Tours, Nantes participated in this evaluation. The quality of the reduction and the position of the osteosynthesis were the two main criteria for good outcome. The type of material implanted had little effect on outcome. The results emphasized the importance of preventing osteoporosis. Fracture prevention and treatment of osteoporosis are crucial, even after fracture.
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Infection control practices and infectious complications in dermatological surgery. J Hosp Infect 2007; 65:258-63. [PMID: 17244515 DOI: 10.1016/j.jhin.2006.09.030] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2006] [Accepted: 09/15/2006] [Indexed: 11/25/2022]
Abstract
The aim of this study was to assess infection control practices and their impact upon infectious complications in skin surgery conducted by private dermatologists. A prospective study was carried out by 73 volunteers belonging to the Surgical Group of the Société Française de Dermatologie over a period of three months. Data were collected for surgical procedures performed during this period, including the excision of all benign or malignant tumours, but excluding sebaceous cysts and pyodermas. A total of 3491 dermatological surgical procedures were included in the survey. Post-operative infections occurred in 67 patients (1.9%), with superficial suppuration accounting for 92.5% of surgical site infections. The incidence was higher in the excision group with a reconstructive procedure (4.3%) than in excisions alone (1.6%). Infection control precautions varied according to the site of procedure; multivariate analysis showed that haemorrhagic complications were an independent factor for infection in both types of surgical procedure. The male gender, immunosuppressive therapy and not wearing sterile gloves were independent factors for infections occurring following excisions with reconstruction. Not all of the procedures needed the use of a hospital theatre. It is clear that for excisions with a reconstructive procedure or for certain anatomical sites, such as the nose, there should be more emphasis upon infection control precautions. Further studies are needed to establish optimal guidelines for this kind of surgery.
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Polar body diagnosis: A highly reliable tool to diagnose age related aneuploidies. Geburtshilfe Frauenheilkd 2006. [DOI: 10.1055/s-2006-952285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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37
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Polar body diagnosis of 263 unfertilised oocytes: Frequent finding of aneuploidies. Geburtshilfe Frauenheilkd 2006. [DOI: 10.1055/s-2006-952704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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38
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P-698. Fertil Steril 2006. [DOI: 10.1016/j.fertnstert.2006.07.1081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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39
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Improved voltage transfer coefficients for nonconductive materials in radiofrequency glow discharge optical emission spectrometry. Anal Bioanal Chem 2006; 386:163-8. [PMID: 16724217 DOI: 10.1007/s00216-006-0503-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2006] [Revised: 04/12/2006] [Accepted: 04/21/2006] [Indexed: 10/24/2022]
Abstract
In radiofrequency glow discharge emission spectrometry (RF-GDOES), the excitation voltage used to create the plasma is applied to the back or front end of the sample to be analyzed. In this paper we focus on back-applied voltage systems (a configuration that represents about half of the instruments available on the market), and on applied voltage problems (the power coupling efficiency and materials analysis are beyond the scope of this study). In the RF-GDOES of nonconductive samples, a voltage drop develops inside the material. The voltage transfer coefficient is defined as the ratio between the peak voltage in front of the sample (facing the plasma) and the peak voltage applied to the back of the sample. In this work, we show that it is possible to increase the voltage transfer coefficient by increasing the capacitance of the sample. The capacitance of a given nonconductive material depends on its surface, its thickness and its permittivity. Increasing the voltage transfer coefficient permits higher power deposition in the plasma. This study is based on an electrical equivalent circuit for the discharge device, which takes into account the sample and reactor capacitances as well as the voltage probes used for the measurements. This circuit, when modeled by a commercial electrical circuit simulator, gives the voltage transfer coefficient as a function of the sample capacitance. Different approaches to increasing the sample capacitance and their influence on the voltage transfer coefficient are presented and related to the 750.4 nm argon line intensity, which is correlated to the electron density.
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40
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Selection of two-phase flow patterns at a simple junction in microfluidic devices. PHYSICAL REVIEW LETTERS 2006; 96:134505. [PMID: 16711995 DOI: 10.1103/physrevlett.96.134505] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2006] [Indexed: 05/09/2023]
Abstract
We study the behavior of a confined stream made of two immiscible fluids when it reaches a T junction. Two flow patterns are witnessed: the stream is either directed in only one sidearm, yielding a preferential flow pathway for the dispersed phase, or splits between both. We show that the selection of these patterns is not triggered by the shape of the junction nor by capillary effects, but results from confinement. It can be anticipated in terms of the hydrodynamic properties of the flow. A simple model yielding universal behavior in terms of the relevant adimensional parameters of the problem is presented and discussed.
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[Retroauricular islet flap]. Ann Dermatol Venereol 2005; 132:916-20. [PMID: 16327726 DOI: 10.1016/s0151-9638(05)79515-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
BACKGROUND Dermatological surgery is a relatively new and expanding subspecialty within dermatology. Little information is available about complications in this kind of surgery in the European setting. OBJECTIVES The aim of this study was to assess the incidence of anaesthetic, haemorrhagic and infectious complications in dermatological surgery and to highlight the factors associated with these complications. METHODS Data were collected prospectively over a 3-month period for all surgical procedures performed by a network of dermatologists (n = 84 dermatologists) in France, including the excision of all benign or malignant tumours but excluding sebaceous cysts and pyodermas. Information was collected regarding dermatologists, patients, procedures and complications. RESULTS A total of 3788 surgical procedures were available for review; 236 complications, mostly minor, occurred in a total of 213 surgical procedures (6%), bleeding being the most common (3%). Vaso-vagal syncope was the main anaesthetic complication (51 of 54). Infectious complications occurred in 79 patients (2%). Superficial suppuration accounted for 92% of surgical site infections. Only one patient had a systemic infection. Complications requiring additional antibiotic treatment or repeat surgery accounted for only 22 cases of 3788 (1%). No statistically significant correlation was found with the characteristics of the dermatologists, especially with respect to their training or amount of surgical experience. Similarly, no link could be established between complications and surgical conditions. Multivariate analysis showed that anaesthetic or haemorrhagic complications were independent factors for infectious complications. Sex, administration of an anticoagulant or immunosuppressant, type of procedure performed and duration exceeding 24 min were independent factors for haemorrhagic complications. CONCLUSIONS This study shows a low rate of complications associated with dermatological surgery performed by dermatologists under local anaesthesia on an outpatient basis.
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Abstract
BACKGROUND Dermatological surgery is a relatively new and expanding subspecialty within dermatology. Little information is available about complications in this kind of surgery in the European setting. OBJECTIVES The aim of this study was to assess the incidence of anaesthetic, haemorrhagic and infectious complications in dermatological surgery and to highlight the factors associated with these complications. METHODS Data were collected prospectively over a 3-month period for all surgical procedures performed by a network of dermatologists (n = 84 dermatologists) in France, including the excision of all benign or malignant tumours but excluding sebaceous cysts and pyodermas. Information was collected regarding dermatologists, patients, procedures and complications. RESULTS A total of 3788 surgical procedures were available for review; 236 complications, mostly minor, occurred in a total of 213 surgical procedures (6%), bleeding being the most common (3%). Vaso-vagal syncope was the main anaesthetic complication (51 of 54). Infectious complications occurred in 79 patients (2%). Superficial suppuration accounted for 92% of surgical site infections. Only one patient had a systemic infection. Complications requiring additional antibiotic treatment or repeat surgery accounted for only 22 cases of 3788 (1%). No statistically significant correlation was found with the characteristics of the dermatologists, especially with respect to their training or amount of surgical experience. Similarly, no link could be established between complications and surgical conditions. Multivariate analysis showed that anaesthetic or haemorrhagic complications were independent factors for infectious complications. Sex, administration of an anticoagulant or immunosuppressant, type of procedure performed and duration exceeding 24 min were independent factors for haemorrhagic complications. CONCLUSIONS This study shows a low rate of complications associated with dermatological surgery performed by dermatologists under local anaesthesia on an outpatient basis.
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Présentation du CD-ROM de chirurgie cutané oncologique et lasers chirurgicaux. Ann Dermatol Venereol 2005. [DOI: 10.1016/s0151-9638(05)79372-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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48
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[To each localization its own technique: tunneling preauricular flap]. Ann Dermatol Venereol 2005; 132:388-90. [PMID: 15886573 DOI: 10.1016/s0151-9638(05)79291-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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49
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[To each localization its own technique. Graft of whole skin of the nose tip]. Ann Dermatol Venereol 2005; 131:1111-5. [PMID: 15692452 DOI: 10.1016/s0151-9638(04)93854-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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50
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Alternatively activated antigen-presenting cells: molecular repertoire, immune regulation, and healing. SKIN PHARMACOLOGY AND APPLIED SKIN PHYSIOLOGY 2001; 14:272-9. [PMID: 11586068 DOI: 10.1159/000056357] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The Th1/Th2 paradigm has stimulated extensive research into the mechanisms underlying T-cell polarization; alternative activation of antigen-presenting cells (APCs) has turned out to be the corresponding concept APC polarization. Macrophages (M phi) as well as dendritic cells (DCs) can undergo Th1- or Th2-like polarization; APC1 and APC2 thus acquire the capacity to drive the development of naive T cells and the reactivation of resting T cells towards either a Th1 or a Th2 phenotype, respectively. Among polarized APC, effector macrophages are classically activated by mediators such as IFN-gamma, TNF-alpha or LPS (M phi 1), while M phi 2 are alternatively activated by IL-4, IL-10 or PGE(2). M phi 2 exhibit a unique molecular repertoire including receptors of innate immunity with broad specificity for foreign antigen and anti-inflammatory cytokines such as IL-1 receptor antagonist and alternative macrophage activation-associated CC-chemokine (AMAC)-1. While DC1 are well characterized, contradictory results have been obtained for DC2 that may either represent immature myeloid DCs or lymphoid DCs. Altogether, APC2 have come to age; they mediate Th2 differentiation, tolerance induction, downregulation of inflammation and healing. Thus, APC2 represent a hitherto neglected, but indispensable major pathway of APC activation and function.
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