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Abdalkoddus M, Franklyn J, Balasubramanya S, Parker F, Zhao Z, Douie W, Smolarek S. Long-term mental and physical quality of life outcomes following ileal pouch anal anastomosis surgery. Ann R Coll Surg Engl 2024. [PMID: 38362797 DOI: 10.1308/rcsann.2023.0075] [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] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
INTRODUCTION This study presents the authors' experience over 14 years of performing restorative procto-colectomy with ileal pouch anal anastomosis (IPAA). The aim was to study the long-term quality of life outcomes and analyse the predictors of pouch function as well as physical and mental wellbeing. METHODS This is a single-centre retrospective study conducted in a specialised colorectal surgery unit in the UK. The study included patients who underwent two- or three-staged panproctocolectomy with defunctioning ileostomy for ulcerative colitis (UC) or familial adenomatous polyposis between 2004 and 2018. Data were collected from a prospectively, surgeon-maintained database. Pouch function and quality of life scores were obtained via validated questionnaires. A multivariate analysis was utilised to explore predictors of quality of life and pouch function. RESULTS The study reports 105 patients who underwent IPAA with a covering ileostomy. The majority of operations were performed for UC (97, 92.4%). The median age of patients was 36 years and the male to female ratio was 1:1. Thirty patients (28.5%) suffered early post-IPAA complications, while pouch failure rate was 11.4% (12/105). Late complications were reported at a rate of 45%. On long-term follow-up, the median Pouch Function Score was 7 (IQR 3-14). Both the physical and mental sections of the quality of life score were at a median indistinguishable from the normal population but had different predictors associated with them. CONCLUSION Our findings recognise the complex interplay between physical and psychological wellbeing after pouch surgery and advise psychological counselling where appropriate.
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Affiliation(s)
| | - J Franklyn
- University Hospitals Plymouth NHS Trust, UK
| | | | - F Parker
- University Hospitals Plymouth NHS Trust, UK
| | - Z Zhao
- University Hospitals Plymouth NHS Trust, UK
| | - W Douie
- University Hospitals Plymouth NHS Trust, UK
| | - S Smolarek
- University Hospitals Plymouth NHS Trust, UK
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Knafo S, Parker F. Malformazioni della giunzione craniovertebrale. Neurologia 2021. [DOI: 10.1016/s1634-7072(21)45321-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Knafo S, Aghakhani N, David P, Parker F. Management of intramedullary spinal cord tumors: A single-center experience of 247 patients. Rev Neurol (Paris) 2020; 177:508-514. [PMID: 33066996 DOI: 10.1016/j.neurol.2020.07.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 07/16/2020] [Indexed: 10/23/2022]
Abstract
Intramedullary spinal cord tumors (ISCT) are rare tumors requiring multidisciplinary care in an expert center. Here, we report a single-center experience including 247 patients with ISCT: 134 ependymomas, 54 astrocytomas and 59 hemangioblastomas. Preoperative evaluation and surgical considerations are discussed to share our principles in managing these patients. Ependymomas are largely benign lesions (95% of WHO grade II) for which total resection (91% rate of gross total resection (GTR)) without neurological impairment (79% of patients remained stable or improved) is the goal in order to ensure long-term oncological control (94.5% overall survival at 5 years, excluding anaplastic ependymomas). On the other hand, astrocytomas are more frequently high-grade tumors (30% of WHO grade III or IV) for which partial resection (60% of cases) is often necessary to preserve neurological status (48% of patients deteriorate at one year), leading to higher rates of recurrence (60% recurrence rate at 5 years for grade III astrocytomas). Lastly, spinal hemangioblastomas require a specific microsurgical resection with particular attention to the vasculature in order to ensure en bloc resection (95% GTR), allowing excellent neurological results (12% of patients improved, 86% remained stable). Altogether, these results demonstrate that ISCT can be managed surgically with good functional outcome, while oncological results will mostly depend on the histopathological grading.
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Affiliation(s)
- S Knafo
- Department of neurosurgery, Bicêtre hospital, Paris-Saclay university, AP-HP, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - N Aghakhani
- Department of neurosurgery, Bicêtre hospital, Paris-Saclay university, AP-HP, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - P David
- Department of neurosurgery, Bicêtre hospital, Paris-Saclay university, AP-HP, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - F Parker
- Department of neurosurgery, Bicêtre hospital, Paris-Saclay university, AP-HP, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France.
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Tuleasca C, Ducos Y, Knafo S, Levivier M, Aghakhani N, Parker F. Surgery for cyst dilatation of a ventriculus terminalis in adults: Keep it simple! Neurochirurgie 2020; 67:211-213. [PMID: 32504646 DOI: 10.1016/j.neuchi.2020.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 04/11/2020] [Indexed: 12/01/2022]
Affiliation(s)
- C Tuleasca
- Service de neurochirurgie, hôpitaux universitaires Paris Sud, CHU de Bicêtre, AP-HP, Le-Kremlin-Bicêtre, France; Faculté de médecine, Sorbonné Université, Paris, France; Neurosurgery Service and Gamma Knife Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland; Faculté de biologie et de médecine (FBM), université de Lausanne (Unil), Lausanne, Switzerland; Signal Processing Laboratory (LTS 5), Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland.
| | - Y Ducos
- Service de neurochirurgie, hôpitaux universitaires Paris Sud, CHU de Bicêtre, AP-HP, Le-Kremlin-Bicêtre, France
| | - S Knafo
- Service de neurochirurgie, hôpitaux universitaires Paris Sud, CHU de Bicêtre, AP-HP, Le-Kremlin-Bicêtre, France
| | - M Levivier
- Neurosurgery Service and Gamma Knife Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland; Faculté de biologie et de médecine (FBM), université de Lausanne (Unil), Lausanne, Switzerland
| | - N Aghakhani
- Service de neurochirurgie, hôpitaux universitaires Paris Sud, CHU de Bicêtre, AP-HP, Le-Kremlin-Bicêtre, France
| | - F Parker
- Service de neurochirurgie, hôpitaux universitaires Paris Sud, CHU de Bicêtre, AP-HP, Le-Kremlin-Bicêtre, France
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Faillot M, Herbrecht A, Ducreux D, Delphine S, Morar S, Parker F, Aghakhani N. Fentes médullaires et syringomyélies, est-il possible de les différencier ? Neurochirurgie 2019. [DOI: 10.1016/j.neuchi.2019.03.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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6
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Nivet A, Schernberg A, Louvel G, Dumont S, Ammary S, Rehalia-Blanchard A, Clavère P, Parker F, Pallud J, Dhermain F. P01.005 The impact of thrombocytopenia from concomitant and adjuvant temozolomide in patients with glioblastoma. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.047] [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: 11/13/2022] Open
Affiliation(s)
- A Nivet
- Department of Radiotherapy, Gustave Roussy University Hospital, Villejuif, France
- Department of Radiotherapy, Limoges University Hospital, Limoges, France
| | - A Schernberg
- Department of Radiotherapy, Gustave Roussy University Hospital, Villejuif, France
| | - G Louvel
- Department of Radiotherapy, Gustave Roussy University Hospital, Villejuif, France
| | - S Dumont
- Department of Oncology, Gustave Roussy University Hospital, Villejuif, France
| | - S Ammary
- Department of Radiology, Gustave Roussy University Hospital, Villejuif, France
| | - A Rehalia-Blanchard
- Department of Radiotherapy, Lucien Neuwirth Cancer Institute, Saint-Priest-En-Jarez, France
| | - P Clavère
- Department of Radiotherapy, Limoges University Hospital, Limoges, France
| | - F Parker
- Department of Neurosurgery, Kremlin Bicêtre University Hospital, Le Kremlin Bicêtre, France
| | - J Pallud
- Department of Neurosurgey, Sainte-Anne University Hospital, Paris, France
| | - F Dhermain
- Department of Radiotherapy, Gustave Roussy University Hospital, Villejuif, France
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Knafo S, Messerer M, Court C, Parker F. Facteurs prédictifs de déformation rachidienne postopératoire des tumeurs intramedullaires. Neurochirurgie 2017; 63:419-425. [DOI: 10.1016/j.neuchi.2015.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 10/24/2015] [Accepted: 12/18/2015] [Indexed: 11/25/2022]
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Parker F, Campello C, Lejeune JP, David P, Herbrecht A, Aghakhani N, Messerer M. Astrocytomes intramédullaires : analyse rétrospective française multicentrique. Neurochirurgie 2017; 63:402-409. [DOI: 10.1016/j.neuchi.2016.09.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 09/25/2016] [Accepted: 09/27/2016] [Indexed: 11/25/2022]
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Cossu G, Lacroix C, Adams C, Daniel R, Parker F, Messerer M. Neuroglial intramedullary tumors: The collaboration between neurosurgeons and neuropathologists. Neurochirurgie 2017; 63:413-418. [DOI: 10.1016/j.neuchi.2016.06.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 04/19/2016] [Accepted: 06/12/2016] [Indexed: 01/03/2023]
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Campello C, Parker F, Slimani S, Le Floch A, Herbrecht A, Aghakhani N, Lacroix C, Loiseau H, Lejeune J, Perrin G, Honnorat J, Dufour H, Chinot O, Figarella D, Bauchet L, Duffau H, Lonjon M, Labauge P, Messerer M, Daures J, Fabbro P, Ducot B. Tumeurs gliales intramédullaires de l’adulte : la série du rapport. Neurochirurgie 2017; 63:381-390. [DOI: 10.1016/j.neuchi.2016.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Revised: 09/18/2016] [Accepted: 10/23/2016] [Indexed: 10/19/2022]
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12
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Messerer M, Richoz B, Cossu G, Dhermain F, Hottinger A, Parker F, Levivier M, Daniel R. Recent advances in the management of atypical meningiomas. Neurochirurgie 2016; 62:213-22. [DOI: 10.1016/j.neuchi.2016.02.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 01/17/2016] [Accepted: 02/26/2016] [Indexed: 11/26/2022]
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Hirel PH, Parker F, Boiziau J, Jung G, Outerovitch D, Dugué A, Peltiers C, Giuliacci C, Boulay R, Lelièvre Y, Cambou B, Mayaux JF, Cartwright T. HIV-1 Aspartic Proteinase: High-Level Production and Automated Fluorometric Screening Assay of Inhibitors. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/095632029000100103] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The 99-amino-acid HIV-1 aspartic proteinase was expressed to high levels in Escherichia coli using a T7 expression system. About 50% of the insoluble material after sonication of the bacteria was composed of aggregated proteinase. Subsequent renaturation and purification yielded large quantities of a homogeneous enzyme able to cleave various heptapeptidic substrates in vitro with a Km around 2.5 mM. A fluorometric assay has been devised to allow automated screening of HIV proteinase inhibitors based on an analogous renin assay. We used the synthetic intramolecularly quenched fluorogenic substrate Suc-TLNFPIS-4MCA based on the heptapeptide TLNFPIS, which encompasses the proteinase/reverse transcriptase junction, coupled to the fluorophore 7-amino-4-methylcoumarin and blocked at the amino-terminus by a succinyl group. The enzyme cleaves the substrate between phenylalanine and proline, and conditions were optimized for liberation of 7AMC from the generated PIS-4MCA with aminopeptidase M as secondary enzyme. 7AMC was monitored with a microplate fluorescence scanner. The known aspartic proteinase inhibitor pepstatin A consistently gave Ki = 2 × 10−6M. Other synthetic and natural compounds are currently being tested.
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Affiliation(s)
- Ph.-H. Hirel
- Institut des Biotechnologies, Rhône-Poulenc, Santé, BP14, F94403 Vitry, France
| | - F. Parker
- Institut des Biotechnologies, Rhône-Poulenc, Santé, BP14, F94403 Vitry, France
| | - J. Boiziau
- Institut des Biotechnologies, Rhône-Poulenc, Santé, BP14, F94403 Vitry, France
| | - G. Jung
- Institut des Biotechnologies, Rhône-Poulenc, Santé, BP14, F94403 Vitry, France
| | - D. Outerovitch
- Institut des Biotechnologies, Rhône-Poulenc, Santé, BP14, F94403 Vitry, France
| | - A. Dugué
- Institut des Biotechnologies, Rhône-Poulenc, Santé, BP14, F94403 Vitry, France
| | - C. Peltiers
- Institut des Biotechnologies, Rhône-Poulenc, Santé, BP14, F94403 Vitry, France
| | - C. Giuliacci
- Institut des Biotechnologies, Rhône-Poulenc, Santé, BP14, F94403 Vitry, France
| | - R. Boulay
- Institut des Biotechnologies, Rhône-Poulenc, Santé, BP14, F94403 Vitry, France
| | - Y. Lelièvre
- Institut des Biotechnologies, Rhône-Poulenc, Santé, BP14, F94403 Vitry, France
| | - B. Cambou
- Institut des Biotechnologies, Rhône-Poulenc, Santé, BP14, F94403 Vitry, France
| | - J.-F. Mayaux
- Institut des Biotechnologies, Rhône-Poulenc, Santé, BP14, F94403 Vitry, France
| | - T. Cartwright
- Institut des Biotechnologies, Rhône-Poulenc, Santé, BP14, F94403 Vitry, France
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Giammattei L, Penet N, Parker F, Messerer M. Intramedullary ependymoma: Microsurgical resection technique. Neurochirurgie 2016; 63:398-401. [PMID: 27131635 DOI: 10.1016/j.neuchi.2016.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 09/18/2015] [Revised: 01/15/2016] [Accepted: 01/15/2016] [Indexed: 12/31/2022]
Abstract
Spinal ependymomas are predominantly slow-growing lesions constituting approximately 30-88% of primary spinal intramedullary tumors. They usually present as circumscribed lesions, with regular margins and a clear surgical plane. Gross-total resection is often feasible and potentially curative but neurosurgeons should keep in mind that the ultimate goal of surgery is the preservation of spinal cord function. We present the surgical technique to safely resect an intramedullary ependymoma using a posterior median sulcus approach. A brief description of current management of this pathology is also presented.
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Affiliation(s)
- L Giammattei
- University of Paris Sud, Kremlin-Bicêtre Hospital, Division of Neurosurgery, 78, rue du General-Leclerc, 94275 Kremlin-Bicêtre cedex, France; Ospedale Maggiore Policlinico, Fondazione IRCCS Ca' Granda, Division of Neurosurgery, Milan, Italy.
| | - N Penet
- University of Paris Sud, Kremlin-Bicêtre Hospital, Division of Neurosurgery, 78, rue du General-Leclerc, 94275 Kremlin-Bicêtre cedex, France
| | - F Parker
- University of Paris Sud, Kremlin-Bicêtre Hospital, Division of Neurosurgery, 78, rue du General-Leclerc, 94275 Kremlin-Bicêtre cedex, France
| | - M Messerer
- University of Paris Sud, Kremlin-Bicêtre Hospital, Division of Neurosurgery, 78, rue du General-Leclerc, 94275 Kremlin-Bicêtre cedex, France
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Chandran S, Parker F, Lontos S, Vaughan R, Efthymiou M. Can we ease the financial burden of colonoscopy? Using real-time endoscopic assessment of polyp histology to predict surveillance intervals. Intern Med J 2015; 45:1293-9. [DOI: 10.1111/imj.12917] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Revised: 09/15/2015] [Accepted: 09/18/2015] [Indexed: 12/14/2022]
Affiliation(s)
- S. Chandran
- Departments of Gastroenterology; Austin Health; Melbourne Australia
| | - F. Parker
- Anaesthetics; Austin Health; Melbourne Australia
| | - S. Lontos
- Departments of Gastroenterology; Austin Health; Melbourne Australia
- Department of Gastroenterology; Warringal Private Hospital; Melbourne Australia
| | - R. Vaughan
- Departments of Gastroenterology; Austin Health; Melbourne Australia
- Department of Gastroenterology; Warringal Private Hospital; Melbourne Australia
| | - M. Efthymiou
- Departments of Gastroenterology; Austin Health; Melbourne Australia
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Messerer M, Richoz B, Cossu G, Dhermain F, Hottinger A, Parker F, Levivier M, Daniel R. Recent Advances in the Management of Atypical Meningioma. J Neurol Surg A Cent Eur Neurosurg 2015. [DOI: 10.1055/s-0035-1564544] [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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Lipcsey M, McNicol L, Parker F, Poustie S, Liu G, Uchino S, Kattula A, Bellomo R. Effect of perfusion pressure on the splanchnic circulation after CPB: a pilot study. Minerva Anestesiol 2015; 81:752-764. [PMID: 25357214] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND The impact of different blood pressure targets is unknown for post cardiac surgery patient in the intensive care unit. We, therefore, investigated the effects of a mean arterial pressure (MAP) target of 65 or 85 mmHg on splanchnic oxygenation, metabolic function, cytokine regulation and gastric tonometry after cardiopulmonary bypass. METHODS Sixteen patients were randomized to the HLH group (high-low-high) where MAP of 85-65-85 mmHg was targeted or the LHL group where MAP 65-85-65 mmHg was targeted with norepinephrine infusion. RESULTS MAP targets were achieved in all patients at all timepoints (64 ± 3, 84 ± 4; 65 ± 5, LHL group; vs. 84 ± 3; 66 ± 2; 85 ± 5 mmHg, HLH group). At corresponding timepoints, hepatic venous saturation was 41 ± 15%; 58 ± 24%; 56 ± 21% in the LHL group vs. 50 ± 19%; 43 ± 20%; 41 ± 18% in the HLH group (P<0.05). No changes were observed in cardiac output, global or trans-splanchnic lactate levels and cytokine levels or in gastric tonometry CO2. CONCLUSION Achieving a MAP target of 85 mmHg by means of norepinephrine infusion after CPB appears safe for the splanchnic circulation.
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Affiliation(s)
- M Lipcsey
- Section of Anesthesiology and Intensive Care, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden -
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Rerat K, Parker F, Nasser G, Vidaud D, Riant F, Tournier-Lasserve E, Denier C. Occurrence of multiple Cerebral Cavernous Malformations in a patient with Neurofibromatosis type 1. J Neurol Sci 2015; 350:98-100. [PMID: 25702150 DOI: 10.1016/j.jns.2015.02.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [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: 11/27/2014] [Revised: 02/08/2015] [Accepted: 02/10/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Neurofibromatosis 1 (NF1) belongs to the autosomal dominant neurocutaneous disorders' group, which mainly includes NF1 and NF2, tuberous sclerosis, von Hippel-Lindau disease and Cerebral Cavernous Malformations (CCMs). NF1 has a major impact on the nervous system, eye, skin, bone or cardiovascular system. Cerebrovascular lesions have been reported in NF1 including aneurysm, pseudoaneurysm, arteriovenous malformations, vascular stenosis or occlusion and Moya moya syndrome. OBJECTIVE To report a case of an NF1 patient with multiple CCMs. OBSERVATION A 47-year-old man with café-au-lait skin lesions, countless cutaneous neurofibromas, short stature and scoliosis was admitted for progressive spinal cord compression due to histologically proven neurofibroma. Systematic cerebral MRI screening including gradient echo sequences showed multiple asymptomatic CCMs. Screening of CCM1, CCM2 and CCM3 genes was negative while a deleterious frameshift mutation was identified in NF1 gene. CONCLUSION While single CCM can occur in NF1 patients following radiation exposure, they are only rarely reported in non-irradiated NF1 brain. Even if it could be a fortuitous association, plausible links and explanations exist. If cerebral MRI can be systematic in NF1 to detect asymptomatic gliomas, used protocols in neuroradiology do not usually include gradient echo sequences, the most sensitive test for CCM detection, leading possibly to failure to detect these vascular lesions. More reports having this combination and further investigations of NF1 families will certainly provide a better understanding of links between these 2 phakomatoses, as recently reported with "multiple meningiomas" phenotype associated with multiple CCMs in patients with CCM3 gene mutations or café-au-lait skin lesions in CCM1 mutation carriers.
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Affiliation(s)
- K Rerat
- Department of Neurology, Université Paris Sud, Faculté de Médecine Paris Sud, Hôpital de Bicêtre, Assistance Publique, Hôpitaux de Paris (AP-HP), France; Department of Neurosurgery, Université Paris Sud, Faculté de Médecine Paris Sud, Hôpital de Bicêtre, Assistance Publique, Hôpitaux de Paris (AP-HP), France
| | - F Parker
- Department of Neurosurgery, Université Paris Sud, Faculté de Médecine Paris Sud, Hôpital de Bicêtre, Assistance Publique, Hôpitaux de Paris (AP-HP), France
| | - G Nasser
- Department of NeuroRadiology, Université Paris Sud, Faculté de Médecine Paris Sud, Hôpital de Bicêtre, Assistance Publique, Hôpitaux de Paris (AP-HP), France
| | - D Vidaud
- INSERM UMR745, Paris Descartes University, France
| | - F Riant
- AP-HP, Service de Génétique, Hôpital Lariboisière, France; INSERM UMR 1161, Paris Diderot University, France
| | - E Tournier-Lasserve
- AP-HP, Service de Génétique, Hôpital Lariboisière, France; INSERM UMR 1161, Paris Diderot University, France
| | - C Denier
- Department of Neurology, Université Paris Sud, Faculté de Médecine Paris Sud, Hôpital de Bicêtre, Assistance Publique, Hôpitaux de Paris (AP-HP), France.
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Graham JM, Sidebotham D, Story DA, Hu R, Parker F. Adequate Images in Intraoperative Transoesophageal Echocardiography: A Quality Improvement Project. Anaesth Intensive Care 2014; 42:640-8. [DOI: 10.1177/0310057x1404200515] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
A suggested standard examination (SSE) for intraoperative transoesophageal echocardiography for cardiac surgery was developed at the Green Lane Department of Cardiothoracic and Otorhinolaryngology Anaesthesia at the Auckland City Hospital. The examination includes views to be recorded in all patients pre- and post-cardiopulmonary bypass. There are also additional views to be recorded in patients with valvular pathology. Using the SQUIRE (Standards for Quality Improvement Reporting Excellence) guidelines, we report an audit comparing acquisition ratios before and after introduction of the SSE. A baseline mean acquisition ratio of 0.62 was achieved, which was not significantly changed by the introduction of the SSE. Nevertheless, we found the SSE to be a useful audit tool and believe it might be of interest to others to assist with perioperative transoesophageal echocardiography quality assurance and education.
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Affiliation(s)
- J. M. Graham
- Green Lane Department of Anaesthesia, Auckland City Hospital, Auckland, New Zealand
- Department of Anaesthesia, Austin Health, Melbourne, Victoria
| | - D. Sidebotham
- Green Lane Department of Anaesthesia, Auckland City Hospital, Auckland, New Zealand
- Green Lane Department of Anaesthesia, Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand
| | - D. A. Story
- Green Lane Department of Anaesthesia, Auckland City Hospital, Auckland, New Zealand
- Melbourne Medical School, The University of Melbourne, Melbourne, Victoria
| | - R. Hu
- Green Lane Department of Anaesthesia, Auckland City Hospital, Auckland, New Zealand
- Auckland District Health Board, Auckland, New Zealand
| | - F. Parker
- Green Lane Department of Anaesthesia, Auckland City Hospital, Auckland, New Zealand
- Department of Anaesthesia, Austin Health, Melbourne, Victoria
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Bah AB, N'dri OD, Herbrecht A, Parker F. MALIGNANT TRANSFORMATION OF CRANIAL NERVE SCHWANNOMA AFTER RADIOSURGERY - CASE REPORT. J West Afr Coll Surg 2014; 4:112-120. [PMID: 26587527 PMCID: PMC4500768] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
We describe an unusual case of malignant transformation of benign cranial nerves schwannoma eleven months after surgery and five months post radiotherapy. There has been no evidence of recurrence after 5 years follow-up. This early malignant transformation of a schwannoma involved cranial nerves IX, X, XI. Due to the uncommon presentation and the uncertainty of the actual role of the radiation on the tumor behavior, the report of this case was considered clinically important.
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Affiliation(s)
- A B Bah
- Department of Neurosurgery Kremlin Bicetre University Hospital 78 rue du General Leclerc, 94200 Kremlin Bicetre, Paris, France. ; Department of Neurosurgery, Kipe Hospital, Conakry, Guinea
| | - O D N'dri
- Department of Neurosurgery Yopougon Hospital, Abidjan, Côte d'Ivoire
| | - A Herbrecht
- Department of Neurosurgery Kremlin Bicetre University Hospital 78 rue du General Leclerc, 94200 Kremlin Bicetre, Paris, France
| | - F Parker
- Department of Neurosurgery Kremlin Bicetre University Hospital 78 rue du General Leclerc, 94200 Kremlin Bicetre, Paris, France
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Puccinelli F, Knafo S, Parker F, Court C, Sachet M, Saliou G. Traitement percutané de fistule sous-arachnoido-pleurale par Onyx : 2 case reports. J Neuroradiol 2014. [DOI: 10.1016/j.neurad.2014.01.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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McNicol L, Lipcsey M, Bellomo R, Parker F, Poustie S, Liu G, Uchino S, Kattula A. Effects of perfusion pressure on the splanchnic circulation after cardiopulmonary bypass: a randomized double cross-over study. Crit Care 2014. [PMCID: PMC4068628 DOI: 10.1186/cc13376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Compaore P, Herbrecht A, Morar S, Aghakhani N, David P, Parker F. Traitement chirurgical des hernies médullaires trans-durales spontanées : à propos de 4 cas et revue de la littérature. Neurochirurgie 2013. [DOI: 10.1016/j.neuchi.2013.10.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Chivet A, Herbrecht A, Croitoru C, David P, Aghakhani N, Richard S, Parker F. Difficultés et résultats du traitement microchirurgical des hémangioblastomes bulbaires : analyse rétrospective d’une série de 31 cas. Neurochirurgie 2013. [DOI: 10.1016/j.neuchi.2013.10.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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McNicol L, Lipcsey M, Bellomo R, Parker F, Poustie S, Liu G, Kattula A. Pilot alternating treatment design study of the splanchnic metabolic effects of two mean arterial pressure targets during cardiopulmonary bypass. Br J Anaesth 2013; 110:721-728. [DOI: 10.1093/bja/aes493] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Parker F. Évaluation neurologique, prise en charge neurochirurgicale en phase chronique : syringomyélie. Rev Neurol (Paris) 2013. [DOI: 10.1016/j.neurol.2013.01.485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Knafo S, Pallud J, Le Rhun E, Emery E, Parker F, Iakovlev G, Laguerre D, Roux FX. Métastases rachidiennes intra-durales extra-médullaires (MERIDEM) de cancers d’origine non neurologique : une entité à part entière ou une forme particulière de méningite carcinomateuse ? Une étude cas-témoins. Neurochirurgie 2012. [DOI: 10.1016/j.neuchi.2012.10.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Caremel R, Hamel O, Gerardin E, Lenormand L, Parker F, Lefort M, Grise P, Perrouin-Verbe B. [Post-traumatic syringomyelia: What should know the urologist?]. Prog Urol 2012; 23:8-14. [PMID: 23287478 DOI: 10.1016/j.purol.2012.09.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2012] [Revised: 08/27/2012] [Accepted: 09/08/2012] [Indexed: 11/26/2022]
Abstract
The incidence of post-traumatic syringomyelia (PTS) is estimated according to recent studies at 25 to 30% of patients with traumatic spinal cord injuries in magnetic resonance imaging (MRI), which remains the gold standard exam for syringomyelia diagnosis and monitoring. Syringomyelia is translated by an increased cord signal (similar to CSF) with low-density T1-weighted image and high-density T2-weighted image, which extends beyond site of initial lesion at least to two vertebral segments. Two conditions are required for development of PTS: traumatic spinal cord injury and blocked the flow of CSF epidural. The mean interval from spinal cord injury to diagnosis SPT was 2.8years (range, 3months to 34years). The commonest symptoms are pain and sensory loss. PTS should be suspected if the patient has new neurological symptoms above level of injury, such as dissociated sensory injuries, reflexes abolition, and motor deficit, after the neural function becomes stable for certain time. In urologic practice, new neurological symptoms could be bladder and/or erectile dysfunction. The medical management based on prevention efforts with closed-glottis pushing, which could aggravate the syrinx cavity. In urology, extracorporeal shockwave lithotripsy, and laparoscopic or robotic surgery could extend the syrinx cavity for the same reason (increase abdominal pressure). The indications for surgical intervention and optimal surgical treatment technique for patients with PTS are not consensual. The literature demonstrated that surgery PTS is effective at arresting or improving motor deterioration, but not sensory dysfunction or pain syndromes.
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Affiliation(s)
- R Caremel
- Service d'urologie, hôpital Charles-Nicolle, 1, rue de Germont, 76000 Rouen, France.
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Parker F. Principe du traitement chirurgical des lésions vertébro-médullaires d’origine tumorale. Rev Neurol (Paris) 2012. [DOI: 10.1016/j.neurol.2012.01.477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Weinberg L, Scurrah N, Parker F, Story D, McNicol L. A reply. Anaesthesia 2010. [DOI: 10.1111/j.1365-2044.2010.06578.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Hatem SM, Attal N, Ducreux D, Gautron M, Parker F, Plaghki L, Bouhassira D. Clinical, functional and structural determinants of central pain in syringomyelia. Brain 2010; 133:3409-22. [DOI: 10.1093/brain/awq244] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
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Jackson H, Parker F, Glover EC. STUDIES OF DISEASES OF THE LYMPHOID AND MYELOID TISSUES. I : THE CHEMICAL METABOLISM OF NORMAL AND PATHOLOGICAL LYMPH NODES. ACTA ACUST UNITED AC 2010; 52:547-60. [PMID: 19869787 PMCID: PMC2131896 DOI: 10.1084/jem.52.4.547] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
From a study of the metabolism of 71 lymph nodes and tumors one may conclude: 1. The nature of a tumor can not be predicted from the metabolism because too much overlapping of metabolic rates exists between the pathological groups. 2. There is no evidence metabolically one way or another as to whether malignant lymphomata of any type should be classed as neoplastic or as infectious processes. 3. The degree of cell differentiation can in most cases be foretold by the percentage difference between the aerobic and the anaerobic glycolysis. The greater the differentiation the greater the percentage difference. Sarcomata in general constitute an exception to this rule. 4. The degree of malignancy in carcinoma, but not in other tumors, can, with certain exceptions, be predicted from the height of the value U. 5. Human sarcomata appear to have a metabolism far more closely comparable to that of benign tumors than to that of carcinomata. They do not behave as malignant tumors under the Warburg classification. Their energy requirements are not of the same order as those of carcinoma. 6. One can not from the value U or from the glycolytic rates predict whether or not a tissue should be classed as neoplastic. 7. Warburg's findings for carcinomata are confirmed and amplified.
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Affiliation(s)
- H Jackson
- Thorndike Memorial and Pathological Laboratories, Boston City Hospital, the Medical Service, Collis P. Huntington Memorial Hospital, and the Department of Medicine, Harvard University, Boston
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Abstract
SUMMARY We performed a prospective randomised trial to evaluate the analgesic efficacy of interpleural analgesia in patients undergoing hepatic resection. The control group (n = 25) received multimodal analgesia with intravenous morphine patient-controlled analgesia; in addition, the interventional group (n = 25) received interpleural analgesia with a 20-ml loading dose of levo bupivacaine 0.5% followed by a continuous infusion of levobupivacaine 0.125%. Outcome measures included pain intensity on movement using a visual analogue scale over 24 h, cumulative morphine and rescue analgesia requirements, patient satisfaction, hospital stay and all adverse events. Patients in the interpleural group were less sedated and none required treatment for respiratory depression compared to 6 (24%) in the control group (p< 0.01). Patients in the interpleural group also had lower pain scores during movement in the first 24 h. Patients' satisfaction, opioid requirements and duration of hospital stay were similar. We conclude that continuous interpleural analgesia augments intravenous morphine analgesia, decreases postoperative sedation and reduces respiratory depression after hepatic resection.
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Affiliation(s)
- L Weinberg
- Department of Surgery, University of Melbourne, Austin Hospital, Heidelberg, Victoria, Australia.
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Warrillow SJ, Weinberg L, Parker F, Calzavacca P, Licari E, Aly A, Bagshaw S, Christophi C, Bellomo R. Perioperative Fluid Prescription, Complications and Outcomes in Major Elective Open Gastrointestinal Surgery. Anaesth Intensive Care 2010; 38:259-65. [DOI: 10.1177/0310057x1003800206] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Perioperative fluid therapy and associated outcomes of patients undergoing major elective open gastrointestinal surgery are poorly understood. This study measured perioperative fluid therapy, complication rates and outcomes for major elective open gastrointestinal surgery in a tertiary care hospital. We obtained demographic data, operative details, fluid prescription, complications and outcomes in 100 patients. Patients were elderly and had multiple comorbidities. Median delivered intraoperative fluid volume was 4.2 litres, followed by 6.3 litres over the subsequent 24 hours. Perioperative fluid prescription was associated with a positive fluid balance. Complications occurred in 57% of patients with 32% experiencing at least one major complication. Serious complications were substantially more frequent in patients having non-colorectal operations. The most common adverse events were pulmonary oedema (21%), ileus (18%), serious sepsis (17%), pneumonia (17%), arrhythmias (14%), delirium (14%) and wound healing problems (infections 13%, anastomotic leaks 12%). Mortality at 30 days was 2%. This study provides planning data for future interventional studies.
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Affiliation(s)
- S. J. Warrillow
- Departments of Intensive Care and Anaesthesia, Austin Hospital, Heidelberg, Victoria, Australia
- Consultant Intensivist, Department of Intensive Care
| | - L. Weinberg
- Departments of Intensive Care and Anaesthesia, Austin Hospital, Heidelberg, Victoria, Australia
- Consultant Anaesthetist, Department of Anaesthesia
| | - F. Parker
- Departments of Intensive Care and Anaesthesia, Austin Hospital, Heidelberg, Victoria, Australia
- Consultant Anaesthetist, Department of Anaesthesia
| | - P. Calzavacca
- Departments of Intensive Care and Anaesthesia, Austin Hospital, Heidelberg, Victoria, Australia
- Senior Registrar, Department of Intensive Care
| | - E. Licari
- Departments of Intensive Care and Anaesthesia, Austin Hospital, Heidelberg, Victoria, Australia
- Senior Registrar, Department of Intensive Care
| | - A. Aly
- Departments of Intensive Care and Anaesthesia, Austin Hospital, Heidelberg, Victoria, Australia
- Consultant Surgeon, Department of Surgery
| | - S. Bagshaw
- Departments of Intensive Care and Anaesthesia, Austin Hospital, Heidelberg, Victoria, Australia
- Senior Registrar, Department of Intensive Care
| | - C. Christophi
- Departments of Intensive Care and Anaesthesia, Austin Hospital, Heidelberg, Victoria, Australia
- Surgery, Austin Health
| | - R. Bellomo
- Departments of Intensive Care and Anaesthesia, Austin Hospital, Heidelberg, Victoria, Australia
- Professor and Head of Research, Department of Intensive Care
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Hatem SM, Attal N, Ducreux D, Gautron M, Parker F, Plaghki L, Bouhassira D. Assessment of spinal somatosensory systems with diffusion tensor imaging in syringomyelia. J Neurol Neurosurg Psychiatry 2009; 80:1350-6. [PMID: 19535353 DOI: 10.1136/jnnp.2008.167858] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE The use of diffusion tensor imaging with three-dimensional fibre tracking (DTI-FT) was tested for the assessment of spinal sensory tract lesions. The relationships between tract lesions quantified with DTI-FT were systematically examined, and somatosensory dysfunction was assessed with quantitative sensory testing (QST) and laser-evoked potentials (LEP), in patients with syringomyelia. METHODS 28 patients with cervical syringomyelia and thermosensory impairment of the hands, and 19 healthy volunteers, were studied. A DTI-FT of the spinal cord was performed, focusing on the upper segment (C3-C4) of the syrinx. Three-dimensional DTI-FT parameters (fractional anisotropy (FA) and apparent diffusion coefficient (ADC)) of the full, anterior and posterior spinal cord were individually compared with QST (thermal detection thresholds) and LEP (amplitude, latency and spinothalamic tract (STT) conduction time) of the hands. RESULTS Patients had a significantly lower FA, but not ADC, than healthy subjects. The mean FA of the full section of the spinal cord was correlated both to sensory deficits (ie, increase in warm (rho = -0.63, p<0.010) and cold thresholds (rho = -0.72; p<0.001 of the hands)) and to changes in LEP parameters, in particular STT conduction time (rho = -0.75; p<0.010). Correlations between FA and the clinical and electrophysiological measures were higher in the anterior area (where the spinothalamic tracts are located) than in the posterior area of the spinal cord. CONCLUSIONS The data indicate that diffusion tensor imaging with 3D-fibre tracking is a new imaging method suitable for the objective and quantitative anatomical assessment of spinal somatosensory system dysfunction.
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Affiliation(s)
- S M Hatem
- INSERM-U792, CHUAmbroise Paré, APHP, Boulogne-Billancourt, France
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Dhermain F, Ducreux D, Parker F, Page P, Hoang-Xuan K, Lacroix C, Daumas-Duport C, Lasjaunias P, Tournay E, Bourhis J. Gliomes de bas grade : importance de la perfusion et de la perméabilité dans la prédiction des rechutes. Cancer Radiother 2008. [DOI: 10.1016/j.canrad.2008.08.245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Morar S, Aghakhani N, Parker F, Paradot G, Choukri M, Tadié M. Intérêt de l’hypnose en neurochirurgie. Neurochirurgie 2008. [DOI: 10.1016/j.neuchi.2008.08.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Bekaert O, Mendili H, Vigue B, Paradot G, Morar S, Choukry M, Aghakhani N, Parker F, Tadié M. Résultats de craniectomies décompressives chez les traumatisés crâniens graves. Neurochirurgie 2008. [DOI: 10.1016/j.neuchi.2008.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Dauvilliers Y, Stal V, Abril B, Coubes P, Bobin S, Touchon J, Escourrou P, Parker F, Bourgin P. Chiari malformation and sleep related breathing disorders. J Neurol Neurosurg Psychiatry 2007; 78:1344-8. [PMID: 17400590 PMCID: PMC2095590 DOI: 10.1136/jnnp.2006.108779] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2006] [Revised: 02/06/2007] [Accepted: 03/09/2007] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To estimate the frequency, mechanisms and predictive factors of sleep apnoea syndrome (SAS) in a large group of children and adults with type I (CMI) and II (CMII) Chiari malformation (CM). BACKGROUND The anatomical and functional integrity of both respiratory circuits and lower cranial nerves controlling the upper airway is necessary for breathing control during sleep. These latter structures may be altered in CM, and a few investigations have reported CM related sleep disordered breathing. METHODS Forty-six consecutive unrelated patients with CM (40 CMI, six CMII), of which 20 were children (eight males) and 26 were adults (12 males), underwent physical, neurological and oto-rhino-laryngoscopic examination, MRI and polysomnography. RESULTS SAS was present in 31 (67.4%) of the patients with CM (70% of CMI, 50% of CMII, including mainly children). Sixty per cent of children with CM exhibited SAS, including 35% with obstructive (OSAS) and 25% with central (CSAS) sleep apnoea syndrome. SAS was observed in 73% of CM adults (57.7% OSAS, 15.4% CSAS). Severe SAS was found in 23% of CM adults. Multiple regression analysis revealed that age, type II Chiari and vocal cord paralysis predicted the central apnoea index. CONCLUSION SAS is highly prevalent in all age groups of patients suffering from CM. CSAS, a rare condition in the general population, was common among the patients with CM in our study. Sleep disordered breathing associated with CM may explain the high frequency of respiratory failures observed during curative surgery of CM. Our results suggest that SAS should be systematically screened for in patients with CM, especially before surgery.
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Affiliation(s)
- Y Dauvilliers
- Service de Neurologie, Hôpital Gui-de-Chauliac, INSERM U888 Montpellier, France
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Baussart B, Aghakhani N, David P, Parradot G, Tadié M, Parker F. Restauration des espaces péri-médullaires par arachnoïdolyse dans les syringomyélies post-traumatiques: évaluation rétrospective à moyen termes de 19 patients. Neurochirurgie 2007. [DOI: 10.1016/j.neuchi.2007.09.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Parker F, Lejeune JP, Bouly S, Lonjon M, Emery E, Proust F, Auque J, Loiseau H, Gallas S, Boetto S, Labauge P. [Natural history of intramedullary cavernomas. Results of the French Multicentric Study]. Neurochirurgie 2007; 53:208-16. [PMID: 17507049 DOI: 10.1016/j.neuchi.2007.02.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2007] [Accepted: 02/28/2007] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The prevalence of cerebral cavernomas is about 0.5% in the general population. In contrast, spinal cord cavernomas are considered as rare. The objective of this study was to determine the natural history of spinal cord cavernomas in a multicentric study. METHODS Clinical and neuroradiological findings were retrospectively collected. Diagnosis was based on pathological criteria or magnetic resonance (MR) findings. RESULTS Fifty-three patients were included (26 males, 27 females). Mean age at onset of symptoms was 40.2 years (range: 11-80). Initial symptoms were progressive (32) and acute myelopathy (20). One patient was asymptomatic. Clinical symptoms were related to spinal cord compression (24) and hematomyelia (19). Cavernoma location was dorsal (41) and cervical (12.). MR findings consisted of hyperintense signal on T1 and T2 sequences (19 cases), mixed hyperintense and hypointense signal (33 cases), and hypointense signal on T1 and T2 sequences in 1 case. Mean size was 16.3 mm (range: 3-54). Forty patients underwent surgical resection. Improvement was observed in 20 patients and worsening of neurological symptoms in 11. Length of follow up was 7.1 years. At the end of the study, 26 patients were autonomous, 18 handicapped and 1 bedridden. CONCLUSION This study provided precise data on the clinical and MR patterns of these lesions. The natural history is associated with a higher risk of hemorrhage recurrence, but is favorable in many operated patients. Microsurgery is the treatment of choice for most of these lesions.
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Affiliation(s)
- F Parker
- Service de neurochirurgie, CHU de Bicêtre, université Paris-XI, 78 rue du Général-Leclerc, 94275 Le-Kremlin-Bicêtre cedex, France.
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Labauge P, Bouly S, Parker F, Lejeune J, Lonjon M, Emery E, Proust F, Auque J, Loiseau H, Gallas S, Boetto S. Histoire naturelle des cavernomes intramédullaires. Étude rétrospective de 53 cas. Résultats de l’étude française multicentrique. Rev Neurol (Paris) 2007. [DOI: 10.1016/s0035-3787(07)90894-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Baussart B, Aghakhani N, Portier F, Chanson P, Tadié M, Parker F. Endoscopie et traitement chirurgical des macroadénomes hypophysaires endo- et suprasellaires invasifs. Neurochirurgie 2005; 51:455-63. [PMID: 16327678 DOI: 10.1016/s0028-3770(05)83503-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND PURPOSE Surgery of invasive endo- and suprasellar pituitary macroadenomas remains difficult. The records of 13 consecutive patients who underwent transsphenoidal surgery were analyzed in order to evaluate advantages and limitations of endoscopy for surgery of invasive pituitary macroadenomas. METHODS A transseptal transsphenoidal intersepto-columellar approach was performed with a nasal 0-degree endoscope. Removal of the macroadenoma was performed under the control of a microscope. When the tumor seemed to be completely removed with microscope, a rigid 30-degree endoscope was inserted in the intrasellar and suprasellar regions in order to detect residual adenoma tissue. These residues were removed when technically possible. RESULTS No rhinologic complication was noted. In 7 patients, the intra- and suprasellar endoscopic view detected a tumor residue which could be removed in each case. Two cases of cerebrospinal fluid leakage occurred during the complementary tumor resection. Two cases of diabetes insipidus and two of rhinorrhea were reported postoperatively. The analysis of the postoperative MRIs showed a complete removal in 23% of the patients (3/13), 75 to 100% removal in 54% of the patients (7/13), 50 to 75% removal in 8% of the patients (1/13) and 50% removal in 15% of the patients (2/13). More than 75% removal was thus achieved in 77% of the patients (10/13). The mean follow-up was 27.2 months. CONCLUSIONS Rhinologic morbidity was reduced with the endoscopic endonasal approach. Endoscopy complemented with a microscope offered an optimal view of the intra- and suprasellar regions. Endoscopy also improved tumor resection of the invasive endo- and suprasellar pituitary macroadenomas by visualizing hidden suprasellar tumor residues. However, endoscopy was associated with a higher rate of postoperative rhinorrhea.
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Affiliation(s)
- B Baussart
- Service de Neurochirurgie, Hôpital de Bicêtre, Le Kremlin-Bicêtre
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Richard S, Parker F, Aghakhani N, Allegre G, Portier F, David P, Marsot-Dupuch K. Maladie de von Hippel-Lindau : progrès génétiques et cliniques récents. J Neuroradiol 2005; 32:157-67. [PMID: 16134297 DOI: 10.1016/s0150-9861(05)83133-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Von Hippel-Lindau (VHL) disease is a hereditary cancer syndrome that predisposes to the development of a panel of highly vascularized tumors including CNS and retinal hemangioblastomas, endolymphatic sac tumors, clear-cell renal cell carcinomas (RCC), pheochromocytomas and pancreatic neuroendocrine tumors. CNS hemangioblastomas and RCC are the two main life-threatening manifestations. The disease is caused by germline mutations in the VHL tumor-suppressor gene that plays a major role in regulating the oxygen-sensing pathway by targeting the hypoxia-inducible factor HIF for degradation in proteasome. Somatic inactivation of the VHL gene occurs also in most sporadic RCC and sporadic CNS hemangioblastomas. The demonstration of the critical role of VHL in angiogenesis is paving the way for the development of new specific drugs that could represent an attractive potential treatment for VHL but also for sporadic RCC and other cancers.
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Affiliation(s)
- S Richard
- Laboratoire de Génétique Oncologique EPHE, UMR 8125, Faculté de Médecine Paris-Sud, 94276 Le Kremlin-Bicêtre, France.
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Bergametti F, Denier C, Labauge P, Arnoult M, Boetto S, Clanet M, Coubes P, Echenne B, Ibrahim R, Irthum B, Jacquet G, Lonjon M, Moreau JJ, Neau JP, Parker F, Tremoulet M, Tournier-Lasserve E. Mutations within the programmed cell death 10 gene cause cerebral cavernous malformations. Am J Hum Genet 2005; 76:42-51. [PMID: 15543491 PMCID: PMC1196432 DOI: 10.1086/426952] [Citation(s) in RCA: 319] [Impact Index Per Article: 16.8] [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: 09/07/2004] [Accepted: 10/11/2004] [Indexed: 11/03/2022] Open
Abstract
Cerebral cavernous malformations (CCMs) are hamartomatous vascular malformations characterized by abnormally enlarged capillary cavities without intervening brain parenchyma. They cause seizures and cerebral hemorrhages, which can result in focal neurological deficits. Three CCM loci have been mapped, and loss-of-function mutations were identified in the KRIT1 (CCM1) and MGC4607 (CCM2) genes. We report herein the identification of PDCD10 (programmed cell death 10) as the CCM3 gene. The CCM3 locus has been previously mapped to 3q26-27 within a 22-cM interval that is bracketed by D3S1763 and D3S1262. We hypothesized that genomic deletions might occur at the CCM3 locus, as reported previously to occur at the CCM2 locus. Through high-density microsatellite genotyping of 20 families, we identified, in one family, null alleles that resulted from a deletion within a 4-Mb interval flanked by markers D3S3668 and D3S1614. This de novo deletion encompassed D3S1763, which strongly suggests that the CCM3 gene lies within a 970-kb region bracketed by D3S1763 and D3S1614. Six additional distinct deleterious mutations within PDCD10, one of the five known genes mapped within this interval, were identified in seven families. Three of these mutations were nonsense mutations, and two led to an aberrant splicing of exon 9, with a frameshift and a longer open reading frame within exon 10. The last of the six mutations led to an aberrant splicing of exon 5, without frameshift. Three of these mutations occurred de novo. All of them cosegregated with the disease in the families and were not observed in 200 control chromosomes. PDCD10, also called "TFAR15," had been initially identified through a screening for genes differentially expressed during the induction of apoptosis in the TF-1 premyeloid cell line. It is highly conserved in both vertebrates and invertebrates. Its implication in cerebral cavernous malformations strongly suggests that it is a new player in vascular morphogenesis and/or remodeling.
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Affiliation(s)
- F. Bergametti
- INSERM E365, Faculté de Médecine Lariboisière, and Laboratoire de Cytogénétique et Génétique Moléculaire, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris; Service de Neurologie, Nîmes, France; Services des Neurochirurgie and Neurologie, Toulouse; Services des Neurochirurgie and Neuropédiatrie, Montpellier, France; Service de Neurochirurgie, Nantes, France; Service de Neurochirurgie, Limoges, France; Service de Neurochirurgie, Besançon, France; Service de Neurochirurgie, Nice; Service de Neurochirurgie, Poitiers, France; and Service de Neurochirurgie, Kremlin-Bicêtre, France
| | - C. Denier
- INSERM E365, Faculté de Médecine Lariboisière, and Laboratoire de Cytogénétique et Génétique Moléculaire, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris; Service de Neurologie, Nîmes, France; Services des Neurochirurgie and Neurologie, Toulouse; Services des Neurochirurgie and Neuropédiatrie, Montpellier, France; Service de Neurochirurgie, Nantes, France; Service de Neurochirurgie, Limoges, France; Service de Neurochirurgie, Besançon, France; Service de Neurochirurgie, Nice; Service de Neurochirurgie, Poitiers, France; and Service de Neurochirurgie, Kremlin-Bicêtre, France
| | - P. Labauge
- INSERM E365, Faculté de Médecine Lariboisière, and Laboratoire de Cytogénétique et Génétique Moléculaire, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris; Service de Neurologie, Nîmes, France; Services des Neurochirurgie and Neurologie, Toulouse; Services des Neurochirurgie and Neuropédiatrie, Montpellier, France; Service de Neurochirurgie, Nantes, France; Service de Neurochirurgie, Limoges, France; Service de Neurochirurgie, Besançon, France; Service de Neurochirurgie, Nice; Service de Neurochirurgie, Poitiers, France; and Service de Neurochirurgie, Kremlin-Bicêtre, France
| | - M. Arnoult
- INSERM E365, Faculté de Médecine Lariboisière, and Laboratoire de Cytogénétique et Génétique Moléculaire, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris; Service de Neurologie, Nîmes, France; Services des Neurochirurgie and Neurologie, Toulouse; Services des Neurochirurgie and Neuropédiatrie, Montpellier, France; Service de Neurochirurgie, Nantes, France; Service de Neurochirurgie, Limoges, France; Service de Neurochirurgie, Besançon, France; Service de Neurochirurgie, Nice; Service de Neurochirurgie, Poitiers, France; and Service de Neurochirurgie, Kremlin-Bicêtre, France
| | - S. Boetto
- INSERM E365, Faculté de Médecine Lariboisière, and Laboratoire de Cytogénétique et Génétique Moléculaire, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris; Service de Neurologie, Nîmes, France; Services des Neurochirurgie and Neurologie, Toulouse; Services des Neurochirurgie and Neuropédiatrie, Montpellier, France; Service de Neurochirurgie, Nantes, France; Service de Neurochirurgie, Limoges, France; Service de Neurochirurgie, Besançon, France; Service de Neurochirurgie, Nice; Service de Neurochirurgie, Poitiers, France; and Service de Neurochirurgie, Kremlin-Bicêtre, France
| | - M. Clanet
- INSERM E365, Faculté de Médecine Lariboisière, and Laboratoire de Cytogénétique et Génétique Moléculaire, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris; Service de Neurologie, Nîmes, France; Services des Neurochirurgie and Neurologie, Toulouse; Services des Neurochirurgie and Neuropédiatrie, Montpellier, France; Service de Neurochirurgie, Nantes, France; Service de Neurochirurgie, Limoges, France; Service de Neurochirurgie, Besançon, France; Service de Neurochirurgie, Nice; Service de Neurochirurgie, Poitiers, France; and Service de Neurochirurgie, Kremlin-Bicêtre, France
| | - P. Coubes
- INSERM E365, Faculté de Médecine Lariboisière, and Laboratoire de Cytogénétique et Génétique Moléculaire, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris; Service de Neurologie, Nîmes, France; Services des Neurochirurgie and Neurologie, Toulouse; Services des Neurochirurgie and Neuropédiatrie, Montpellier, France; Service de Neurochirurgie, Nantes, France; Service de Neurochirurgie, Limoges, France; Service de Neurochirurgie, Besançon, France; Service de Neurochirurgie, Nice; Service de Neurochirurgie, Poitiers, France; and Service de Neurochirurgie, Kremlin-Bicêtre, France
| | - B. Echenne
- INSERM E365, Faculté de Médecine Lariboisière, and Laboratoire de Cytogénétique et Génétique Moléculaire, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris; Service de Neurologie, Nîmes, France; Services des Neurochirurgie and Neurologie, Toulouse; Services des Neurochirurgie and Neuropédiatrie, Montpellier, France; Service de Neurochirurgie, Nantes, France; Service de Neurochirurgie, Limoges, France; Service de Neurochirurgie, Besançon, France; Service de Neurochirurgie, Nice; Service de Neurochirurgie, Poitiers, France; and Service de Neurochirurgie, Kremlin-Bicêtre, France
| | - R. Ibrahim
- INSERM E365, Faculté de Médecine Lariboisière, and Laboratoire de Cytogénétique et Génétique Moléculaire, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris; Service de Neurologie, Nîmes, France; Services des Neurochirurgie and Neurologie, Toulouse; Services des Neurochirurgie and Neuropédiatrie, Montpellier, France; Service de Neurochirurgie, Nantes, France; Service de Neurochirurgie, Limoges, France; Service de Neurochirurgie, Besançon, France; Service de Neurochirurgie, Nice; Service de Neurochirurgie, Poitiers, France; and Service de Neurochirurgie, Kremlin-Bicêtre, France
| | - B. Irthum
- INSERM E365, Faculté de Médecine Lariboisière, and Laboratoire de Cytogénétique et Génétique Moléculaire, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris; Service de Neurologie, Nîmes, France; Services des Neurochirurgie and Neurologie, Toulouse; Services des Neurochirurgie and Neuropédiatrie, Montpellier, France; Service de Neurochirurgie, Nantes, France; Service de Neurochirurgie, Limoges, France; Service de Neurochirurgie, Besançon, France; Service de Neurochirurgie, Nice; Service de Neurochirurgie, Poitiers, France; and Service de Neurochirurgie, Kremlin-Bicêtre, France
| | - G. Jacquet
- INSERM E365, Faculté de Médecine Lariboisière, and Laboratoire de Cytogénétique et Génétique Moléculaire, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris; Service de Neurologie, Nîmes, France; Services des Neurochirurgie and Neurologie, Toulouse; Services des Neurochirurgie and Neuropédiatrie, Montpellier, France; Service de Neurochirurgie, Nantes, France; Service de Neurochirurgie, Limoges, France; Service de Neurochirurgie, Besançon, France; Service de Neurochirurgie, Nice; Service de Neurochirurgie, Poitiers, France; and Service de Neurochirurgie, Kremlin-Bicêtre, France
| | - M. Lonjon
- INSERM E365, Faculté de Médecine Lariboisière, and Laboratoire de Cytogénétique et Génétique Moléculaire, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris; Service de Neurologie, Nîmes, France; Services des Neurochirurgie and Neurologie, Toulouse; Services des Neurochirurgie and Neuropédiatrie, Montpellier, France; Service de Neurochirurgie, Nantes, France; Service de Neurochirurgie, Limoges, France; Service de Neurochirurgie, Besançon, France; Service de Neurochirurgie, Nice; Service de Neurochirurgie, Poitiers, France; and Service de Neurochirurgie, Kremlin-Bicêtre, France
| | - J. J. Moreau
- INSERM E365, Faculté de Médecine Lariboisière, and Laboratoire de Cytogénétique et Génétique Moléculaire, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris; Service de Neurologie, Nîmes, France; Services des Neurochirurgie and Neurologie, Toulouse; Services des Neurochirurgie and Neuropédiatrie, Montpellier, France; Service de Neurochirurgie, Nantes, France; Service de Neurochirurgie, Limoges, France; Service de Neurochirurgie, Besançon, France; Service de Neurochirurgie, Nice; Service de Neurochirurgie, Poitiers, France; and Service de Neurochirurgie, Kremlin-Bicêtre, France
| | - J. P. Neau
- INSERM E365, Faculté de Médecine Lariboisière, and Laboratoire de Cytogénétique et Génétique Moléculaire, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris; Service de Neurologie, Nîmes, France; Services des Neurochirurgie and Neurologie, Toulouse; Services des Neurochirurgie and Neuropédiatrie, Montpellier, France; Service de Neurochirurgie, Nantes, France; Service de Neurochirurgie, Limoges, France; Service de Neurochirurgie, Besançon, France; Service de Neurochirurgie, Nice; Service de Neurochirurgie, Poitiers, France; and Service de Neurochirurgie, Kremlin-Bicêtre, France
| | - F. Parker
- INSERM E365, Faculté de Médecine Lariboisière, and Laboratoire de Cytogénétique et Génétique Moléculaire, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris; Service de Neurologie, Nîmes, France; Services des Neurochirurgie and Neurologie, Toulouse; Services des Neurochirurgie and Neuropédiatrie, Montpellier, France; Service de Neurochirurgie, Nantes, France; Service de Neurochirurgie, Limoges, France; Service de Neurochirurgie, Besançon, France; Service de Neurochirurgie, Nice; Service de Neurochirurgie, Poitiers, France; and Service de Neurochirurgie, Kremlin-Bicêtre, France
| | - M. Tremoulet
- INSERM E365, Faculté de Médecine Lariboisière, and Laboratoire de Cytogénétique et Génétique Moléculaire, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris; Service de Neurologie, Nîmes, France; Services des Neurochirurgie and Neurologie, Toulouse; Services des Neurochirurgie and Neuropédiatrie, Montpellier, France; Service de Neurochirurgie, Nantes, France; Service de Neurochirurgie, Limoges, France; Service de Neurochirurgie, Besançon, France; Service de Neurochirurgie, Nice; Service de Neurochirurgie, Poitiers, France; and Service de Neurochirurgie, Kremlin-Bicêtre, France
| | - E. Tournier-Lasserve
- INSERM E365, Faculté de Médecine Lariboisière, and Laboratoire de Cytogénétique et Génétique Moléculaire, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris; Service de Neurologie, Nîmes, France; Services des Neurochirurgie and Neurologie, Toulouse; Services des Neurochirurgie and Neuropédiatrie, Montpellier, France; Service de Neurochirurgie, Nantes, France; Service de Neurochirurgie, Limoges, France; Service de Neurochirurgie, Besançon, France; Service de Neurochirurgie, Nice; Service de Neurochirurgie, Poitiers, France; and Service de Neurochirurgie, Kremlin-Bicêtre, France
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Abstract
Neuropathic arthropathy of the spine is a destructive condition of the spine which is secondary to a loss of the protective proprioceptive reflexes. In the majority of cases, it occurs in patients who have suffered from traumatic medullary lesions and is responsible for destruction of the vertebral bodies and considerable spinal deformity. We report a case of neurogenic lumbar arthropathy in a patient with a spinal arteriovenous malformation. This vascular lesion caused considerable disturbances of proprioception. The course was favorable with regard to the deformity after correction and fusion by posterior approach.
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Affiliation(s)
- R Vialle
- Service de Neurochirurgie, CHU de Bicêtre, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France.
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Abdulkarim BS, Hasbini A, Cougnard J, Djafari L, Lacroix C, Parker F, Haie C, Cioloca C, Deutsch E, Raymond E. Baseline pathological and radiological assessment of tumor angiogenesis predicts survival in patients with oligodendrogliomas. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.1545] [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: 11/20/2022] Open
Affiliation(s)
- B. S. Abdulkarim
- IGR, Villejuif, France; Shering-Plough, Levalois-Perret, France; Hopital Kremlin Bicetre, Kremlin Bicetre, France; Hopital Ste Anne, Paris, France
| | - A. Hasbini
- IGR, Villejuif, France; Shering-Plough, Levalois-Perret, France; Hopital Kremlin Bicetre, Kremlin Bicetre, France; Hopital Ste Anne, Paris, France
| | - J. Cougnard
- IGR, Villejuif, France; Shering-Plough, Levalois-Perret, France; Hopital Kremlin Bicetre, Kremlin Bicetre, France; Hopital Ste Anne, Paris, France
| | - L. Djafari
- IGR, Villejuif, France; Shering-Plough, Levalois-Perret, France; Hopital Kremlin Bicetre, Kremlin Bicetre, France; Hopital Ste Anne, Paris, France
| | - C. Lacroix
- IGR, Villejuif, France; Shering-Plough, Levalois-Perret, France; Hopital Kremlin Bicetre, Kremlin Bicetre, France; Hopital Ste Anne, Paris, France
| | - F. Parker
- IGR, Villejuif, France; Shering-Plough, Levalois-Perret, France; Hopital Kremlin Bicetre, Kremlin Bicetre, France; Hopital Ste Anne, Paris, France
| | - C. Haie
- IGR, Villejuif, France; Shering-Plough, Levalois-Perret, France; Hopital Kremlin Bicetre, Kremlin Bicetre, France; Hopital Ste Anne, Paris, France
| | - C. Cioloca
- IGR, Villejuif, France; Shering-Plough, Levalois-Perret, France; Hopital Kremlin Bicetre, Kremlin Bicetre, France; Hopital Ste Anne, Paris, France
| | - E. Deutsch
- IGR, Villejuif, France; Shering-Plough, Levalois-Perret, France; Hopital Kremlin Bicetre, Kremlin Bicetre, France; Hopital Ste Anne, Paris, France
| | - E. Raymond
- IGR, Villejuif, France; Shering-Plough, Levalois-Perret, France; Hopital Kremlin Bicetre, Kremlin Bicetre, France; Hopital Ste Anne, Paris, France
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Attal N, Parker F, Tadié M, Aghakani N, Bouhassira D. Effects of surgery on the sensory deficits of syringomyelia and predictors of outcome: a long term prospective study. J Neurol Neurosurg Psychiatry 2004; 75:1025-30. [PMID: 15201364 PMCID: PMC1739115 DOI: 10.1136/jnnp.2003.026674] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To quantify the effects of surgery on the thermal deficits of syringomyelia and assess the predictors for such effects. METHODS The subjects were 16 consecutive patients (12 men, 4 women; mean (SD) duration of sensory symptoms, 5.1 (4.5) years) presenting with the typical symptoms of syringomyelia related to Chiari I malformation or trauma, and requiring surgical treatment. They were evaluated before surgery, then at six months and two years. Sensory evaluation included determination of the extent of thermal deficits and quantitative assessment of thermal, mechanical, vibration detection, and pain thresholds. Neuropathic pain intensity was evaluated on visual analogue scales. Magnetic resonance imaging was done before and after surgery to measure syrinx dimensions. RESULTS The magnitude and extent of thermal deficits improved in a subgroup of patients and this was best predicted by the duration of sensory symptoms: patients operated on less than two years after the onset of their symptoms tended to improve, while those operated on later were stabilised or deteriorated slightly. The effect of surgery on thermal deficits was correlated with the duration of sensory symptoms. Surgery also affected vibration deficits in patients with the Chiari malformation, neuropathic pain on effort, and syrinx dimensions. CONCLUSIONS The duration of sensory deficits is the best predictive factor of the efficacy of surgery for the thermal symptoms of syringomyelia. Early surgery is required if these deficits are to be minimised.
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Affiliation(s)
- N Attal
- INSERM E-332, Centre d'Evaluation et de Traitement de la Douleur, Hôpital Ambroise Paré, Boulogne-Billancourt, France.
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Vera K, Djafari L, Faivre S, Guillamo JS, Djazouli K, Osorio M, Parker F, Cioloca C, Abdulkarim B, Armand JP, Raymond E. Dose-dense regimen of temozolomide given every other week in patients with primary central nervous system tumors. Ann Oncol 2004; 15:161-71. [PMID: 14679137 DOI: 10.1093/annonc/mdh003] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [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: 11/13/2022] Open
Abstract
BACKGROUND Temozolomide has shown activity and limited toxicity in patients with primary brain tumors at doses of 150-200 mg/m(2)/day on days 1-5 every 4 weeks. In this study, a new alternative dose-dense regimen of temozolomide was explored in patients with recurrent brain tumors. PATIENTS AND METHODS In this study, we evaluated the safety, dose-limiting toxicity, maximum tolerated dose, recommended dose and activity of temozolomide given on days 1-3 and 14-16 every 28 days (one cycle). The starting daily dose was 200 mg/m(2) in a group of at least six patients, with subsequent increments of 50 mg/m(2) in groups of at least 12 patients until unacceptable toxicity was reached. Oral ondansetron (8 mg) was given 1 h prior to temozolomide administration. McDonald's criteria were used to evaluate antitumor activity. RESULTS Seventy patients with brain tumors entered this study. The median number of prior chemotherapy treatments was two (range 1-3). Patients were assigned to one of four groups to receive temozolomide at daily doses of 200 (seven patients), 250 (13 patients), 300 (38 patients) and 350 mg/m(2)/day (12 patients). The absence of dose-limiting toxicity at cycle 1 led us to establish dose recommendations based on toxicity after repeated cycles. A total of 23, 72, 192 and 83 cycles were given at daily doses of 200, 250, 300 and 350 mg/m(2), respectively. Grade 3-4 thrombocytopenia was observed in 0/7, 1/13, 5/38 and 4/12 patients treated at doses of 200, 250, 300 and 350 mg/m(2)/day, respectively. Grade 3-4 neutropenia was observed in 1/7, 0/13, 3/38 and 4/12 patients treated with 200, 250, 300 and 350 mg/m(2)/day temozolomide, respectively. At a dose of 350 mg/m(2), sustained grade 2-3 thrombocytopenia did not allow treatment to be resumed at day 14 in >40% of patients, and this dose was considered to be the maximum tolerated dose. Thus, a dose of 300 mg/m(2)/day that was associated with <20% treatment delay due to sustained hematological toxicity was considered as the recommended dose. Objective responses were reported in 13 patients. CONCLUSIONS Temozolomide can be given safely using a dose-dense regimen of 300 mg/m(2)/day for 3 consecutive days every 2 weeks in patients with recurrent brain tumors.
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Affiliation(s)
- K Vera
- Department of Medicine, Institute Gustave-Roussy, Villejuif, France
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Ducreux D, Attal N, Parker F, Bouhassira D. P-02 IRM fonctionnelle d’activation de patients syringomyéliques allodyniques au froid. J Neuroradiol 2004. [DOI: 10.1016/s0150-9861(04)96931-3] [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: 10/22/2022]
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