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Fadel R, Taliercio JJ, Daou R, Layoun H, Bassil E, Fawaz A, Arrigain S, Schold JD, Herlitz L, Simon JF, Mehdi A, Nakhoul G. Urine Sediment Examination: Comparison Between Laboratory-Performed Versus Nephrologist-Performed Microscopy and Accuracy in Predicting Pathologic Diagnosis in Patients with Acute Kidney Injury. Kidney360 2023; 4:918-923. [PMID: 36810426 PMCID: PMC10371296 DOI: 10.34067/kid.0000000000000081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 01/17/2023] [Indexed: 02/23/2023]
Abstract
Key Points A nephrologist is more likely to recognize the presence of pathologic casts and dysmorphic red blood cells. Nephrologist-performed urine sediment analysis is also highly accurate in diagnosing acute tubular injury or glomerulonephritis when compared with kidney biopsy. Introduction Automated urine technology is becoming the standard for urinalysis microscopy. We sought to compare urine sediment analysis performed by a nephrologist with the analysis performed by the laboratory. When available, we also compared the suggested diagnosis per nephrologists' sediment analysis with the biopsy diagnosis. Methods We identified patients with AKI who had urine microscopy with sediment analysis performed by the laboratory (Laboratory-UrSA) and by a nephrologist (Nephrologist-UrSA) within 72 hours of each other. We collected data to determine the following: number of red blood cells (RBCs) and white blood cells (WBCs) per high-power field, presence and types of casts per low-power field, and presence of dysmorphic RBCs. We evaluated agreement between the Laboratory-UrSA and the Nephrologist-UrSA using cross-tabulation and the Kappa statistic. When available, we categorized the nephrologist sediment findings into four categories: (1) bland, (2) suggestive of acute tubular injury (ATI), (3) suggestive of glomerulonephritis (GN), and (4) suggestive of acute interstitial nephritis (AIN). In a group of patients with kidney biopsy within 30 days of the Nephrologist-UrSA, we assessed agreement between the nephrologist diagnosis and the biopsy diagnosis. Results We included 387 patients with both Laboratory-UrSA and Nephrologist-UrSA. The agreement was moderate for the presence of RBCs (Kappa, 0.46; 95% CI, 0.37 to 0.55) and fair for WBCs (Kappa, 0.36; 95% CI, 0.27 to 0.45). There was no agreement for casts (Kappa, 0.026; 95% CI, −0.04 to 0.07). Eighteen dysmorphic RBCs were detected on Nephrologist-UrSA compared with zero on Laboratory-UrSA. Among the 33 patients with kidney biopsy, 100% ATI and 100% GN suggested per Nephrologist-UrSA were confirmed on the biopsy. Of the five patients with bland sediment on the Nephrologist-UrSA, 40% showed ATI pathologically while the other 60% demonstrated GN. Conclusion A nephrologist is more likely to recognize the presence of pathologic casts and dysmorphic RBCs. Correct identification of these casts carries important diagnostic and prognostic value when evaluating kidney disease.
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Affiliation(s)
- Remy Fadel
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Jonathan J. Taliercio
- Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Ohio
| | - Remy Daou
- Department of Family Medicine, Saint Joseph University, Beirut, Lebanon
| | - Habib Layoun
- Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic, Ohio
| | - Elias Bassil
- Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Ohio
| | - Adam Fawaz
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Susana Arrigain
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Jesse D. Schold
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Leal Herlitz
- Department of Anatomic Pathology, Cleveland Clinic, Cleveland, Ohio
| | - James F. Simon
- Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Ohio
| | - Ali Mehdi
- Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Ohio
| | - Georges Nakhoul
- Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Ohio
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Herlihy E, Antao B, Fawaz A, McDermott J, Patterson K, Nason G, O'Kelly F. Adapting lean methodology towards surgical tray rationalisation in inguinoscrotal day case surgery in the republic of Ireland. J Pediatr Urol 2023:S1477-5131(23)00107-9. [PMID: 37029012 DOI: 10.1016/j.jpurol.2023.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 02/13/2023] [Accepted: 03/16/2023] [Indexed: 04/09/2023]
Abstract
INTRODUCTION Lean methodologies have been used successfully in both industry and healthcare to reduce waste. The operating room (OR) and central supplies department (CSD) are areas associated with high hospital costs. The aim of this study was to employ Lean methodologies to support the rationalisation of surgical trays in paediatric inguinoscrotal surgery in order to reduce instrument wastage, processing times and overall costs in a European setting. METHODS This was a prospective, pilot observation and implementation study using Lean methodology including DMAIC (Define, Measure, Analyse, Improve and Control) cycles. Relevant tray set-up included trays for boys ≥12 months age undergoing open elective inguinoscrotal surgery. A comparative analysis of two phases, pre and post-standardization was then carried out with respect to operating times, instrument set-up times, tray weights, and costs. Instruments that were used <40% of the time were eliminated from the surgical tray. RESULTS Rationalization of the inguinoscrotal tray led to a 34.7% reduction in tray size, with a concomitant time-reduction of >2 min per case. The average overall instrument utilisation rate increased from 56% to 80% across users. Cost savings were projected at €5380.40 per annum based on current changes. There were no differences in operative time, or adverse outcomes. DISCUSSION At the hospital level, the reduction in variation, and rationalisation of this single surgical tray could lead to both operational (Tray assembly process; Operating rooms; Ergonomic functionality) as well as economic (Sterilisation; Instrument repair; Purchases) financial and ergonomic improvements for the healthcare system. The reduction in time taken to count and sterilise instruments can lead to a potential manpower saving involving a redistribution of activities to other areas which may require them. CONCLUSION Surgical tray rationalisation is emerging Lean concept with overlap across a number of specialities, and represents a technique by which to manage costs, and improve supply chain efficiency without any adverse effect in patient healthcare outcomes.
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Affiliation(s)
- E Herlihy
- Division of Paediatric Surgical Services, Beacon Hospital and University College Dublin, Ireland
| | - B Antao
- Division of Paediatric Surgical Services, Beacon Hospital and University College Dublin, Ireland; Department of Paediatric Surgery, Childrens Health Ireland, Crumlin, Dublin, Ireland
| | - A Fawaz
- Division of Paediatric Surgical Services, Beacon Hospital and University College Dublin, Ireland
| | - J McDermott
- Division of Paediatric Surgical Services, Beacon Hospital and University College Dublin, Ireland
| | - K Patterson
- Department of Urological Surgery and Renal Transplantation, Beaumont Hospital, Dublin, Ireland
| | - G Nason
- Department of Urological Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - F O'Kelly
- Division of Paediatric Surgical Services, Beacon Hospital and University College Dublin, Ireland; Division of Surgical Affairs, Royal College of Surgeons in Ireland, Dublin, Ireland.
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Ntiamoah P, Fawaz A, Mehta AC, Gildea TR. Tracheobronchial Smooth Muscle Atrophy and Separation. Am J Respir Crit Care Med 2022; 206:e73. [PMID: 35767022 DOI: 10.1164/rccm.202202-0258im] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Prince Ntiamoah
- Cleveland Clinic Foundation, 2569, Respiratory institute, Cleveland, Ohio, United States
| | - Adam Fawaz
- Cleveland Clinic Foundation, 2569, Respiratory institute, Cleveland, Ohio, United States
| | - Atul C Mehta
- The Cleveland Clinic Foundation, Pulmonary and Critical Care, Cleveland, Ohio, United States
| | - Thomas R Gildea
- The Cleveland Clinic Foundation, Pulmonary and Critical Care, Cleveland, Ohio, United States;
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Levanon S, Gotlieb V, Kraus Y, Novofastovski I, Brikman S, Fawaz A, Aghbariyya M, Butbul Y, Balbir-Gurman A, Mader R, Bieber A. POS0831 IgA VASCULITIS IN ADULTS, PEDIATRICS AND NON-VASCULITIC IgA NEPHROPATHY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundIgA vasculitis (IgAV) has been extensively studied in children, while its natural history remains poorly studied in adults. Sparse data comparing childhood and adult-onset disease has shown significant differences in their clinical presentation, especially in the severity of renal involvement, which accounts for the major long-term morbidity. IgAV shares similar renal histologic features with IgA nephropathy (IgAN), while clinically IgAN is a chronic kidney disease which may lead to end stage renal disease and dialysis. The extent of kidney injury among adults with IgAV is still a matter of uncertainty.ObjectivesWe aimed to evaluate clinical manifestations, laboratory data, treatment patterns and long-term outcomes of pediatric and adult-onset IgAV in comparison to IgAN.MethodsThis retrospective collaborative study examined medical records of adults and children with IgAV and IgAN adult patients admitted to rheumatology clinic and in hospital pediatric departments in a 13-year period (2007-2019). Diagnosis of adults with IgAV relied on the Ankara criteria and was confirmed by a consistent skin biopsy with positive IgA staining by immunofluorescence. Children with IgAV were included in our study on a clinical basis. All IgAN patients had a kidney biopsy proven disease. We analyzed and compared frequencies of clinical manifestations, laboratory findings, treatment regimens and long-term outcomes at one year follow-up. Finally, we assessed long term outcomes, such as time to dialysis and all-cause mortality, till the end of the follow-up time.ResultsA total of 60 adult IgAV, 60 pediatric IgAV and 45 IgAN patients were included in our study. There were significantly more males in the IgAN group compared to the adult and pediatric IgAV groups (77.8%, 41.7% and 55% respectively, p=0.01). Adult IgAV patients were significantly older than IgAN patients (53.1±17.4 years vs. 45.1±15.7 years, p=0.02) and had significantly higher rates of diabetes (43.3% vs. 24.4%, p=0.05) and ischemic heart disease (18.3% vs. 4.4%, p=0.03). The pediatric IgAV group had a statistically higher rate of previous infection compared to the adult IgAV group (44.8% vs. 20%, p=0.02). At one year follow-up, IgAN patients had higher levels of serum creatinine compared to the adult IgAV group (2.002 vs. 1.100, p<0.01). Data observed until the end of the follow-up time showed no difference in time to dialysis (IgAV adults: 9.8-12.4 years, IgAN: 5.0-6.6 years, p>.41). Nevertheless, IgAV adult patients had significantly shorter survival time (5.5 years, 95% CI: 4.8-6.2 years) than IgAN patients (7.0 years, 95% CI: 6.6-7.5 years, p<.01).ConclusionThis retrospective study demonstrates that IgAV in adults presents substantial clinical manifestations, including high risk of progression to persistent renal impairment and possesses higher mortality rate in comparison with pediatric-onset disease and IgAN.References[1]Blanco R, Martínez-Taboada VM, Rodríguez-Valverde V, García-Fuentes M, González-Gay MA. Henoch-Schönlein purpura in adulthood and childhood: two different expressions of the same syndrome. Arthritis Rheum. 1997 May;40(5):859-64. doi: 10.1002/art.1780400513. PMID: 9153547.[2]Nossent J, Raymond W, Isobel Keen H, Preen D, Inderjeeth C. Morbidity and mortality in adult-onset IgA vasculitis: a long-term population-based cohort study. Rheumatology (Oxford). 2021 Dec 24;61(1):291-298. doi: 10.1093/rheumatology/keab312. PMID: 33779729.Figure 1.Disclosure of InterestsNone declared
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Goldstein L, Gabin A, Fawaz A, Freedberg N, Schwartz N, Elias M, Saliba W. Azithromycin Is not Associated With Qt Prolongation In Patients Hospitalized With Community Acquired Pneumonia. Clin Ther 2015. [DOI: 10.1016/j.clinthera.2015.05.112] [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: 10/23/2022]
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Calmels B, Boulanger F, Baudoux E, Decot V, Fawaz A, Giraud C, Hivert B, Garderet L, Milpied N, Yakoub-Agha I. [Conservation and destruction of autologous and allogeneic cryopreserved cellular products: recommendations from the SFGM-TC]. ACTA ACUST UNITED AC 2014; 62:221-5. [PMID: 24996844 DOI: 10.1016/j.patbio.2014.05.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Accepted: 05/14/2014] [Indexed: 11/16/2022]
Abstract
Thousands of autologous and at less extent allogeneic hematopoietic stem cells (HSC) bags are cryopreserved in France. The majority of autologous HSC grafts are used within a year after collection. However, many bags are still unused and cryopreserved for many years. In France and on a European scale, the ever-growing number of cryopreserved bags represents a real economic health concern. Indeed, the cost of storage is about 100€ per bag and per year. In addition, quality and therapeutic value of these long-term cryopreserved grafts needs to be evaluated. In the attempt to harmonize clinical practices between different French transplantation centers, the French Society of Bone Marrow Transplantation and Cell Therapies (SFGM-TC) set up its fourth annual series of workshops which brought together practitioners from its member centers across France. These workshops took place in September 2013 in Lille. In this article, we addressed the issue of the destruction of long-term cryopreserved grafts be them autologous or allogeneic and provide recommendations regarding their destruction.
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Affiliation(s)
- B Calmels
- Centre de thérapie cellulaire et génique, institut Paoli-Calmettes, 232, boulevard Sainte-Marguerite, BP 156, 13273 Marseille cedex 09, France; EFS centre atlantique, site de Poitiers, 350, avenue Jacques-Cœur, BP 482, 86012 Poitiers cedex, France
| | - F Boulanger
- EFS Nord de France, laboratoire de thérapie cellulaire, 96, rue de Jemmapes, CS 22018, 59013 Lille cedex, France; EFS centre atlantique, site de Poitiers, 350, avenue Jacques-Cœur, BP 482, 86012 Poitiers cedex, France
| | - E Baudoux
- Laboratoire de thérapie cellulaire et génique, CHU de Liège, Tour 2 niveau -4(E), 4000 Liège, Belgique; EFS centre atlantique, site de Poitiers, 350, avenue Jacques-Cœur, BP 482, 86012 Poitiers cedex, France
| | - V Decot
- Unité de thérapie cellulaire et banque de tissus, CHU Nancy-Brabois, rue du Morvan, 54511 Vandœuvre-lès-Nancy cedex, France; EFS centre atlantique, site de Poitiers, 350, avenue Jacques-Cœur, BP 482, 86012 Poitiers cedex, France
| | - A Fawaz
- Service hématologie clinique, hôpital Victor-Provo, boulevard Lacordaire, 59100 Roubaix, France; EFS centre atlantique, site de Poitiers, 350, avenue Jacques-Cœur, BP 482, 86012 Poitiers cedex, France
| | - C Giraud
- CHU de Poitiers, 2, rue de La-Milétrie, BP 577, 86021 Poitiers cedex, France; EFS centre atlantique, site de Poitiers, 350, avenue Jacques-Cœur, BP 482, 86012 Poitiers cedex, France
| | - B Hivert
- EFS centre atlantique, site de Poitiers, 350, avenue Jacques-Cœur, BP 482, 86012 Poitiers cedex, France; Maladies du sang, CHRU de Lille, rue Michel-Polonovski, 59037 Lille cedex, France
| | - L Garderet
- EFS centre atlantique, site de Poitiers, 350, avenue Jacques-Cœur, BP 482, 86012 Poitiers cedex, France; Inserm, UMR_S 938, proliferation and differentiation of stem cells, hôpital Saint-Antoine, AP-HP, 75012 Paris, France; Département d'hématologie et de thérapie cellulaire, université Pierre et Marie-Curie Paris 6, 75012 Paris, France
| | - N Milpied
- EFS centre atlantique, site de Poitiers, 350, avenue Jacques-Cœur, BP 482, 86012 Poitiers cedex, France; Service des maladies du sang, G.H. du Haut Levêque, avenue de Magellan, 33604 Pessac, France
| | - I Yakoub-Agha
- EFS centre atlantique, site de Poitiers, 350, avenue Jacques-Cœur, BP 482, 86012 Poitiers cedex, France; Maladies du sang, CHRU de Lille, rue Michel-Polonovski, 59037 Lille cedex, France.
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Corbani S, Chouery E, Fayyad J, Fawaz A, El Tourjuman O, Badens C, Lacoste C, Delague V, Megarbane A. Molecular screening of MECP2 gene in a cohort of Lebanese patients suspected with Rett syndrome: report on a mild case with a novel indel mutation. J Intellect Disabil Res 2012; 56:415-420. [PMID: 21954873 DOI: 10.1111/j.1365-2788.2011.01479.x] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Rett syndrome (RTT), an X-linked, dominant, neurodevelopment disorder represents 10% of female subjects with profound intellectual disability. Mutations in the MECP2 gene are responsible for up to 95% of the classical RTT cases, and nearly 500 different mutations distributed throughout the gene have been reported. METHODS We report here the molecular study of two isoforms, MECP2_e1 and MECP2_e2, in 45 Lebanese girls presenting developmental delay and at least one of the following features: microcephaly, neurodegeneration, abnormal behaviour, stereotypical hand movements, teeth grinding and difficulty in walking. Mutation screening was performed by denaturating high-performance liquid chromatography combined with direct sequencing. RESULTS Sixteen variants were noted, of which 14 have been previously reported: five suspected polymorphisms and nine mutations. Two variants were novel mutations in exon 4: c.1093_1095delGAG (p.E365del) and c.1164_1184delACCTCCACCTGAGCCCGAGAGinsCTGAGCCCCAGGACTTGAGCA (p.P388PfsX389). The deletion was found in an 8-year-old girl with typical clinical features of RTT. The indel was found in a 6-year-old girl with a very mild phenotype. CONCLUSION Genotype/phenotype correlation is discussed and the importance of a molecular study of MECP2 gene in patients with very mild features or a regression after the age of 2 is raised.
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Affiliation(s)
- S Corbani
- Unité de Génétique Médicale et laboratoire associé INSERM à l'Unité UMR_S910, Université Saint-Joseph, Beirut, Lebanon
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Yamout B, Herlopian A, Issa Z, Habib RH, Fawaz A, Salame J, Wadih A, Awdeh H, Muallem N, Raad R, Al-Kutoubi A. Authors' reply to 'Report of extracranial venous stenosis in relapsing-remitting multiple sclerosis patients'. Mult Scler 2011; 17:643-644. [PMID: 28071243 DOI: 10.1177/1352458511400478] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- B Yamout
- 1 Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - A Herlopian
- 1 Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Z Issa
- 1 Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - R H Habib
- 2 Division of Outcomes Research and Biostatistics, American University of Beirut Medical Center, Beirut, Lebanon
| | - A Fawaz
- 1 Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - J Salame
- 3 Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - A Wadih
- 4 Department of Radiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - H Awdeh
- 4 Department of Radiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - N Muallem
- 4 Department of Radiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - R Raad
- 4 Department of Radiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - A Al-Kutoubi
- 4 Department of Radiology, American University of Beirut Medical Center, Beirut, Lebanon
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de Botton S, Fawaz A, Chevret S, Dombret H, Thomas X, Sanz M, Guerci A, San Miguel J, de la Serna J, Stoppa AM, Reman O, Stamatoulas A, Fey M, Cahn JY, Sotto JJ, Bourhis JH, Parry A, Chomienne C, Degos L, Fenaux P. Autologous and allogeneic stem-cell transplantation as salvage treatment of acute promyelocytic leukemia initially treated with all-trans-retinoic acid: a retrospective analysis of the European acute promyelocytic leukemia group. J Clin Oncol 2004; 23:120-6. [PMID: 15534358 DOI: 10.1200/jco.2005.03.127] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To retrospectively determine the outcome of acute promyelocytic leukemia (APL) patients who underwent autologous or allogeneic stem-cell transplantation (SCT) during second complete remission. PATIENTS AND METHODS Of 122 relapsing patients included in two successive multicenter APL trials who achieved hematological second complete remission (generally after a salvage regimen of all-trans-retinoic acid [ATRA] combined with chemotherapy), 73 (60%) received allogeneic (n = 23) or autologous (n = 50) SCT. RESULTS Seven-year relapse-free survival (RFS), event-free survival (EFS), and overall survival (OS) in the autologous SCT group were 79.4%, 60.6%, and 59.8%, respectively, with a transplant-related mortality (TRM) of 6%. Of the 28 and two patients autografted with negative and positive, respectively, reverse transcriptase-polymerase chain reaction before auto SCT, three (11%) and one relapsed, respectively. In the allogeneic SCT group, 7-year RFS, EFS, and OS were 92.3%, 52.2%, and 51.8%, respectively, with 39% TRM. OS was significantly better in the autologous SCT group than in the allogeneic SCT group (P = .04), whereas RFS and EFS did not differ significantly (P = .19 and P = .11, respectively). In patients not receiving transplantation, 7-year RFS, EFS, and OS were 38%, 30.4%, and 39.5%, respectively. CONCLUSION These retrospective data suggest that autologous SCT is very effective in APL relapsing after treatment with ATRA if performed in molecular remission. Allogeneic SCT yields few relapses, but it is associated with high TRM when performed after salvage with very intensive chemotherapy. Salvage with arsenic trioxyde, which has lower toxicity, should further improve the outcome of relapsing APL, especially before allogeneic SCT.
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Affiliation(s)
- S de Botton
- Service d'Hématologie Clinique, Hôpital Avicenne, Université Paris XIII, 125 rue de Stalingrad, 93009 Bobigny, France
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Yakoub-Agha I, Fawaz A, Folliot O, Guillerm G, Quesnel B, Fenaux P, Bauters F, Jouet JP, Morschhauser F. Allogeneic bone marrow transplantation in patients with follicular lymphoma: a single center study. Bone Marrow Transplant 2002; 30:229-34. [PMID: 12203139 DOI: 10.1038/sj.bmt.1703625] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2001] [Accepted: 04/12/2002] [Indexed: 11/08/2022]
Abstract
The role of allogeneic BMT for follicular lymphoma remains to be established. From 1995 to 2000, 16 patients with follicular lymphoma underwent allogeneic BMT at our center. At the time of transplantation, two patients were in complete remission, 11 in partial remission and three had refractory disease. Fourteen patients were transplanted using a standard myeloablative conditioning regimen and two a nonmyeloablative conditioning regimen. With a median follow-up of 1184 days (range 403-1999 days) after BMT, 11 patients were alive, whereas five died of transplant-related mortality. Eight patients remained in CR 284+ to 1022+ days (median 560+ days) after BMT. Two patients relapsed 63 and 1073 days after BMT. They achieved a further complete remission after salvage treatment and remained alive 403 and 1224 days after BMT, respectively. One patient with autologous reconstitution had never been in CR after BMT. He was retreated with salvage chemotherapy but only achieved CR with subsequent rituximab treatment and was still alive, 1999 days after transplantation. The estimated 2-year overall survival and event-free survival rates were 68% and 55%, respectively. Age greater than 37 years at diagnosis, positive recipient CMV serology and ECOG performance status > or =1 at diagnosis were associated with shorter overall survival (P = 0.05, P = 0.009 and P = 0.03, respectively). Ann Arbor III-IV stage at diagnosis was associated with shorter event-free survival (P < 0.04). Allogeneic BMT seems to be effective for patients with follicular lymphoma. However, the relatively high rate of early transplant-related mortality emphasizes the need to define indications and use prospective protocols involving a less toxic transplant procedure.
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Affiliation(s)
- I Yakoub-Agha
- Unité de Greffes de moelle, Services des Maladies du Sang, CHRU, Lille, France
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Senneville E, Savage C, Lamy O, Fawaz A, Bourez J, Ajana F, Dubreuil L, Chidiac C, Mouton Y. Failure of intravenous antibiotic therapy of multiple temporal brain abscesses due to Propionibacterium acnes requiring temporal lobectomy. J Infect 1997; 34:269-71. [PMID: 9200038 DOI: 10.1016/s0163-4453(97)94479-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [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: 02/04/2023]
Abstract
Propionibacterium acnes is a common skin colonizer. Its involvement in brain abscesses is generally described as a complication of neurosurgical intervention. Propionibacterium acnes is susceptible to antibiotics used as treatment of anaerobic infections, except for the 5-nitroimidazoles. Surgical excision or drainage of a simple abscess combined with a long course of antibiotics is considered the treatment of choice. A case of a patient with multiple brain abscesses located in the right temporal lobe that occurred after the manipulation of an abscess of the right upper maxillary is reported. The patient did not improve despite a prolonged course of high-dose intravenous penicillin plus thiamphenicol and cure was finally obtained after the excision of the right temporal lobe. Culture of the purulent material and the shell of the abscesses yielded P. acnes which was sensitive to all the antibiotics administered to the patient up to the intervention. The temporal lobectomy was followed by a 6-month course of ofloxacin. One year after the intervention, the patient remained apyretic without any other abscess on cranial computed tomography scan.
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Affiliation(s)
- E Senneville
- Service Universitaire Régional des Maladies Infectieuses et du Voyageur, Hôpital Dron, Tourcoing, France
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Jomin M, Debout J, Krivosic I, Lesoin F, Lozes G, Villette L, Autricque A, Fawaz A. [Natural history and current surgical prognosis of intracranial arterial aneurysms]. Agressologie 1990; 31:231-4. [PMID: 2288332] [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: 12/31/2022]
Abstract
The abrupt flow of blood in the meninges or in the brain after fissure or rupture of an arterial aneurysm still remains a medico-surgical emergency which includes the mobilisation of important technical and financial means which justifies itself by the reduction of the occurrence of a more severe accident and to give the patient its best chances. The cure of a cerebral aneurysm and its intracranial consequences must not be dissociated from its clinical context. Surgical indication must take into account the cause of the vascular lesion, the background on which it has evoked, its natural outcome which is characterised by rebleeding and vasospasm. Surgical cure of intracranial aneurysm is one of the great achievement of modern surgery. A better understanding of the malformation, the improvement of neuro-anesthesia and intensive care, and the use of pre-operatoire adjuvants have considerably improved the surgical results over the years. At the moment, alternative treatment start to emerge such as selective vascular catheterism with ejectable balloon which become more feasible and seductive.
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Affiliation(s)
- M Jomin
- Service de neurochirurgie B, Centre hospitalier universitaire, Hôpital B, Lille
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Lozes G, Fawaz A, Mescola P, Marnay T, Herlant M, Devos P, Cama A, Sertl GO, Brambillas Bas M, Leclercq X, Duhamel P, Skondia V, Jomin M. Percutaneous interbody osteosynthesis in the treatment of thoracolumbar traumatic or tumoural lesions. A review of 51 cases. Acta Neurochir (Wien) 1990; 102:42-53. [PMID: 2407052 DOI: 10.1007/bf01402185] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The authors describe a technique of percutaneous interbody osteosynthesis applicable to the dorsal and lumbar spine. 51 patients were so treated for different aetiologies: traumatic conditions (35 cases) and tumoural lesions (16 cases). The material used consisted of special instruments that are positioned in double obliquity by a percutaneous posterolateral approach. A posterior approach limited to the pathological focus was used jointly whenever a graft or a decompression was necessary (19 cases). Several types of anaesthesia were used (local, local-regional, general, neuroleptanalgesia). The patients benefited by the advantages that usually accompany percutaneous techniques. The advantages and limitations of the method are discussed.
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Affiliation(s)
- G Lozes
- Department of Neurosurgery B, University Hospital, Lille, France
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Lozes G, Fawaz A, Cama A, Krivosic I, Devos P, Herlant M, Sertl GO, Clarisse J, Jomin M. Discectomies of the lower cervical spine using interbody biopolymer (B.O.P.) implants. Advantages in the treatment of complicated cervical arthrosis. A review of 150 cases. Acta Neurochir (Wien) 1989; 96:88-93. [PMID: 2711904 DOI: 10.1007/bf01456164] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The authors report their experience with 150 cases of discectomies performed with interbody grafts using a copolymer (Biocompatible Orthopedic Polymer or BOP). Made of N-Vinylpyrrolidone-Methylmethacrylate monomers, polyamide fibres and calcium gluconate. BOP is a biocompatible, biodegradable, osteoconductive matrix, easy to use and quite safe. These properties are quite well appreciated for cervical interbody grafting. After discectomy, stabilization of the spine is immediate, and fusion slowly occurs around and through the biopolymer within one year. The biomaterial avoids morbidity inherent in the harvesting of an autograft, as well as any limitations resulting from the use of allografts.
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Affiliation(s)
- G Lozes
- Department of Neurosurgery B, University Hospital, Lille, France
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Lozes G, Fawaz A, Thevenon T, Pruvo JP, Herlant M, Mescola P, Courchelle E, Krivosic I, Jomin M. [Lumbar neurinoma with corporeal-pedicle development. Apropos of a case]. Rev Rhum Mal Osteoartic 1989; 56:333-5. [PMID: 2711111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- G Lozes
- Service de Neurochirurgie B, Hôpital B, Lille
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Lozes G, Fawaz A, Devos P, Wyremblewski P, Kassiotis P, Perper H, Gozet G, Pruvo JP, Jomin M. Operative treatment of thoraco-lumbar metastases, using methylmetacrylate and Kempf's rods for vertebral replacement and stabilization. Report of 15 cases. Acta Neurochir (Wien) 1987; 84:118-23. [PMID: 3577855 DOI: 10.1007/bf01418836] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The authors report their experience in the treatment of 15 cases in thoracolumbar metastases with spinal cord compression. A decompressive laminectomy was routinely performed and followed by a transversoarthropediculectomy. Most part of the neoplastic tissue was removed from the epidural space, vertebral body and retroperitoneal or retro-pleural areas. Complete decompression of the nervous elements was always achieved. Stabilization was obtained by replacement of the neoplastic vertebral body with a methylmetacrylate prothesis and eventually by Kempf's compression instrumentation. The surgical treatment was completed in a single stage operation, by a classical posterolateral approach. Orthopaedic, neurologic and oncologic advantages of this treatment are discussed.
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Jomin M, Lesoin F, Lozes G, Fawaz A, Villette L. Surgical prognosis of unruptured intracranial arterial aneurysms. Report of 50 cases. Acta Neurochir (Wien) 1987; 84:85-8. [PMID: 3577859 DOI: 10.1007/bf01418829] [Citation(s) in RCA: 35] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The authors analyze a series of 53 patients who presented with unruptured intracranial aneurysms. Fifty were operated upon, 2 died during the post-operative period, 5 were left with their pre-operative neurological deficit, 43 were cured and have not subsequently presented with any cerebral or meningeal haemorrhages. None of the 3 patients who were not operated upon has since presented with a cerebro-vascular accident. Twenty-five aneurysms were asymptomatic, discovered fortuitously during angiographic examination, and their size was generally between 3 and 6 mm. Twenty-eight aneurysms presented with various neurological signs and symptoms (headaches, facial pain on 9 occasions, ischaemic vascular accidents on 7 occasions, ocular signs on 8 occasions and generalized epilepsy on 4 occasions), with a range in size from 7 to 10 mm. The clinical and autopsy series published in the literature show the usefulness of surgery when certain factors come together and increase the risk of rupture: middle-aged patients (between 40 and 65), arterial hypertension, aneurysm located on the anterior part of the circle of Willis and with a diameter close to the critical size (10 mm) for rupture.
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Abstract
The authors report a case of cervical chondroma presenting with a syndrome of spinal cord compression in a 76-year-old woman. Total surgical removal of the lesion was followed by partial neurological recovery. Chondromas of the vertebral column are rarely reported in the literature.
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Lozes G, Fawaz A, Devos P, Delandsheer E, Salvetti B, Hurtevent JF, Jomin M, Guieu JD. [New approach to traumatic quadriplegia: diaphragmatic electromyography]. Ann Chir 1986; 40:260-5. [PMID: 3777817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Lozes G, Vanhee P, Fawaz A, Wyremblewski P, Branca V, Jomin M, Clarisse J, Krivosik I. [Cervicobrachial neuralgia and vertebral osteochondroma. Apropos of a case]. Rev Med Interne 1986; 7:177-80. [PMID: 3715252 DOI: 10.1016/s0248-8663(86)80111-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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