1
|
Queyrel É, Lanaret M, Khalil T, Al Gahatany M, Chaix R, Lemaire JJ, Moisset X, Chassin V, Brun L, Dedieu V, Biau J. [Frameless trigeminal neuralgia radiosurgery with a dedicated linear accelerator: From equipment commissioning to initial clinical results]. Cancer Radiother 2024; 28:164-173. [PMID: 38490925 DOI: 10.1016/j.canrad.2023.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 07/07/2023] [Accepted: 07/18/2023] [Indexed: 03/17/2024]
Abstract
PURPOSE Radiosurgery for the treatment of trigeminal neuralgia delivers a very high dose in a single fraction, over a few millimeters, at a single isocenter placed along the nerve. We present here the different steps that have been performed to validate small beams by conical collimators, and report the clinical results of the first patients treated on Novalis Tx®, frameless. MATERIAL AND METHODS First, the geometric accuracy of 4 and 6mm conical collimators was evaluated using Winston-Lutz tests; then dosimetric data acquisition was performed using high spatial resolution detectors (PTW 60019 microdiamond and a PTW 60017 E-diode). The corrective factors of the TRS 483 report were applied to calculate the collimator aperture factors. These dosimetric data were then compared with the data implemented in the iPlan® treatment planning system. Then end-to-end tests were performed to control the entire treatment process using an anthropomorphic phantom "STEEV". Between 2020 and 2022, 18 patients were treated for refractory trigeminal neuralgia on Novalis Tx®, frameless, with Exactrac® repositioning. A total of 17 patients were evaluated (one was lost to follow-up) using the BNI score for pain assessment and MRI with a median follow-up of 12 months. RESULTS The quality criteria of geometric and dosimetric accuracy were met for the 6-mm cone but not for the 4-mm cone. All patients were treated with a 6-mm cone with a dose of 90Gy prescribed at the isocenter at the root entry zone. Initial pain control was obtained in 70.5% of our patients, and 53% maintained pain control with a median follow-up of 12 months. All recurrences occurred within 3 to 6 months after radiosurgery. No brainstem toxicity was observed. Six patients had non-disabling facial hypoesthesia, half of whom already had pretreatment hypoesthesia. CONCLUSION The treatment of trigeminal neuralgia on a dedicated linear accelerator is a highly technical treatment whose accuracy and safety are paramount. The physical measurements allowed the commissioning of the technique with a 6mm cone. Our first clinical results are in accordance with the literature.
Collapse
Affiliation(s)
- É Queyrel
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, 63011 Clermont-Ferrand cedex 1, France
| | - M Lanaret
- Département de physique médicale, centre Jean-Perrin, Clermont-Ferrand, France
| | - T Khalil
- Service de neurochirurgie, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - M Al Gahatany
- Service de neurochirurgie, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - R Chaix
- Service de neurochirurgie, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - J-J Lemaire
- Service de neurochirurgie, CHU de Clermont-Ferrand, Clermont-Ferrand, France; Institut Pascal, CNRS, Clermont-Auvergne INP, université Clermont-Auvergne, Clermont-Ferrand, France; Inserm U1240 IMoST, université Clermont-Auvergne, Clermont-Ferrand, France
| | - X Moisset
- Service de neurologie, Neuro-Dol, CHU de Clermont-Ferrand, université Clermont-Auvergne, Inserm U1107, Clermont-Ferrand, France
| | - V Chassin
- Département de physique médicale, centre Jean-Perrin, Clermont-Ferrand, France
| | - L Brun
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, 63011 Clermont-Ferrand cedex 1, France
| | - V Dedieu
- Département de physique médicale, centre Jean-Perrin, Clermont-Ferrand, France; Institut Pascal, CNRS, Clermont-Auvergne INP, université Clermont-Auvergne, Clermont-Ferrand, France; Inserm U1240 IMoST, université Clermont-Auvergne, Clermont-Ferrand, France
| | - J Biau
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, 63011 Clermont-Ferrand cedex 1, France; Institut Pascal, CNRS, Clermont-Auvergne INP, université Clermont-Auvergne, Clermont-Ferrand, France; Inserm U1240 IMoST, université Clermont-Auvergne, Clermont-Ferrand, France.
| |
Collapse
|
2
|
Khalil T, Okla MK, Al-Qahtani WH, Ali F, Zahra M, Shakeela Q, Ahmed S, Akhtar N, AbdElgawad H, Asif R, Hameed Y, Adetunji CO, Farid A, Ghazanfar S. Tracing probiotic producing bacterial species from gut of buffalo (Bubalus bubalis), South-East-Asia. BRAZ J BIOL 2024; 84:e259094. [DOI: 10.1590/1519-6984.259094] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 02/01/2022] [Indexed: 12/15/2022] Open
Abstract
Abstract Due to extensive application of antibiotics as growth promoters in animal feed, antimicrobial resistance has been increased. To overcome this challenge, rumen microbiologists search for new probiotics to improve the rate of livestock production. The present study was aimed to isolate and evaluate breed-specific lactic acid bacteria (LAB) as potential animal probiotics. The current study was conducted during 10 months from July 2020 to April 2021, in which a total of n=12 strains were isolated from different samples including milk, rumen, and feces of Nilli Ravi Buffaloes. These isolates were evaluated for their antimicrobial potential against common animal pathogens (Bacillus spp., E. coli, Staphylococcus aureus, Salmonella spp., Listeria spp.). All the isolates were identified using 16S rRNA gene sequencing and the phylogenetic analyses inferred that these strains showed close relations to the species of various genera; Enterococcus lactis, Pediococcus pentosaceus, Bacillus subtilis Weissella cibaria, Weissella soli, Bacillus tequilensis, Weissella bombi, Bacillus licheniformis, Lactococcus lactis, Bacillus megaterium, Lactobacillus ruminis, and Lactococcus lactis. NMCC-Ru2 has exhibited the enormous potential of antimicrobial activity, 28 mm, for Salmonella typhimurium;23 mm for Listeria monocytogenes 21 mm for E.coil. Highest resistance was seen in NMCC-Ru2 agasint test antbiotic, like 25.5 mm for Tetracycline. Overall results revesl that the probiotic profile of isolates was achieved using standard criteria, particularly with animal probiotic properties
Collapse
Affiliation(s)
- T. Khalil
- Hazara University Mansehra, Pakistan
| | | | | | - F. Ali
- Hazara University Mansehra, Pakistan
| | - M. Zahra
- University of Peshawar, Pakistan
| | - Q. Shakeela
- Faculty of Biological Science Quaid-i-Azam University, Pakistan
| | - S. Ahmed
- Hazara University Mansehra, Pakistan
| | - N. Akhtar
- National University of Medical Science, Pakistan
| | | | - Rizwan Asif
- Government College University Faisalabad, Pakistan
| | - Y. Hameed
- The Islamia University of Bahawalpur, Pakistan
| | | | | | | |
Collapse
|
3
|
Fahmy SB, Zamzam M, Khalil T, Abdalla Y, Loeffler T, Ahmed SA, Abd-Elhady MS. Influence of the hot water mass flow rate on heating of radiant floors of green buildings. Journal of Building Physics 2023; 47:182-203. [DOI: 10.1177/17442591231182330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
The objective of the research is to improve space heating of green buildings by examining experimentally the influence of the heating medium mass flow rate on thermal performance. A green building was built in Cairo, Egypt, that consists of two similar rooms: one is the heated room and the other is a reference for comparison. A photovoltaic thermal (PV/T) collector is used to heat up water in a storage tank, and the hot water in the tank is circulated in the radiant floor of the examined green building. The hot water mass flow rate was varied between 0.04 and 0.08 kg/s. It was found that decreasing the water mass flow rate improves the heating of the radiant floor. The percentage improvement in floor temperature due to heating over the reference room, reaches about 17% and 6% at mass flow rates of 0.04 and 0.08 kg/s, respectively. Engineering Equation Solver (EES) was used to solve the equations for the heat transfer process between the heating water and the floor. It was found that decreasing the mass flow rate increases the residence time of the heating water in the radiant floor, consequently, increases the heat energy transfer and the floor temperature. Increasing the heating fluid mass flow rate in green buildings could have a negative effect on the heat transfer, such that the appropriate heating fluid mass flow rate should be calculated based on the green building massive material as well as the operating conditions, for example, ambient temperature and wind speed.
Collapse
Affiliation(s)
- Sarah B Fahmy
- Mechanical Department, Faculty of Engineering, German International University, Cairo, Egypt
| | - M Zamzam
- Physics Department, Faculty of Engineering and Materials Science, German University in Cairo, Egypt
| | - T Khalil
- Physics Department, Faculty of Engineering and Materials Science, German University in Cairo, Egypt
| | - Yasmine Abdalla
- Electrical Department, Faculty of Engineering, German International University, Cairo, Egypt
| | - Thomas Loeffler
- Architecture and Urban Design Program, Building Technology, German University in Cairo, Egypt
| | - SA Ahmed
- Mechanical Engineering Department, Faculty of Engineering, Beni-Suef University, Beni-Suef, Egypt
| | - MS Abd-Elhady
- Mechanical Engineering Department, Faculty of Engineering, Beni-Suef University, Beni-Suef, Egypt
- Mechatronics Department, Faculty of Engineering and Materials Science, German University in Cairo, Egypt
| |
Collapse
|
4
|
Clark DL, Khalil T, Kim LH, Noor MS, Luo F, Kiss ZH. Aperiodic subthalamic activity predicts motor severity and stimulation response in Parkinson disease. Parkinsonism Relat Disord 2023; 110:105397. [PMID: 37060621 DOI: 10.1016/j.parkreldis.2023.105397] [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: 12/06/2022] [Revised: 03/31/2023] [Accepted: 04/07/2023] [Indexed: 04/17/2023]
Abstract
INTRODUCTION Rhythmic beta activity in the subthalamic nucleus (STN) local field potential (LFP) is associated with Parkinson disease (PD) severity, though not all studies have found this relationship. We investigated whether aperiodic 'noise' elements of LFP, specifically slope of the 1/f broadband, predict PD motor symptoms and outcomes of STN-DBS. METHODS We studied micro-LFP from 19 PD patients undergoing STN-DBS, relating the aperiodic 1/f slope and the periodic beta oscillation components to motor severity using the UPDRS-III and improvement with DBS at 1 year. RESULTS Beta power, not 1/f slope, independently predicted baseline UPDRS-III (r = 0.425, p = 0.020; r = -0.434, p = 0.032, respectively), but multiple regression using both predicted better (F (2, 16) = 6.621, p = 0.008, R2 = 0.453). Only multiple regression using both slope and beta power predicted improvement in UPDRS-III at 1 year post-operatively (F (2, 15) = 6.049, R2 = 0.446, p = 0.012). CONCLUSIONS Both beta synchronization and slope of the 1/f broadband are informative of motor symptoms in PD and predict response to STN-DBS.
Collapse
Affiliation(s)
- Darren L Clark
- Department of Clinical Neuroscience, Calgary, AB, Canada; Department of Psychiatry, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Talha Khalil
- Department of Clinical Neuroscience, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Linda H Kim
- Department of Clinical Neuroscience, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - M Sohail Noor
- Department of Clinical Neuroscience, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Feng Luo
- Department of Clinical Neuroscience, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Zelma Ht Kiss
- Department of Clinical Neuroscience, Calgary, AB, Canada; Department of Psychiatry, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.
| |
Collapse
|
5
|
Nicoll K, Lucocq J, Khalil T, Khalil M, Watson H, Patil P. Follow-up after emergency laparotomy suggests high one- and five-year mortality with risk stratified by ASA. Ann R Coll Surg Engl 2022; 104:202-209. [PMID: 34519559 PMCID: PMC9773906 DOI: 10.1308/rcsann.2021.0156] [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: 11/22/2022] Open
Abstract
INTRODUCTION We investigated all-cause mortality following emergency laparotomy at 1 and 5 years. We aimed to establish a basis from which to advise patients and relatives on long-term mortality. METHODS Local data from a historical audit of emergency laparotomies from 2010 to 2012 were combined with National Emergency Laparotomy Audit (NELA) data from 2017 to 2020. Covariates collected included deprivation status, preoperative blood work, baseline renal function, age, American Society of Anesthesiologists (ASA) grade, operative time, anaesthetic time and gender. Associations between covariates and survival were determined using multivariate logistic regression and Kaplan-Meier analysis. We used patients undergoing laparoscopic cholecystectomy between 2015 and 2020 as controls. RESULTS ASA grade was the best discriminator of long-term outcome following laparotomy (n=894) but was not a predictor of survival following cholecystectomy (n=1,834), with mortality being significantly greater in the laparotomy group. Following cholecystectomy, 95% confidence intervals for survival at 5 years were 98-99%. Following laparotomy these intervals were: ASA grade 1, 79-96%; ASA grade 2, 69-82%; ASA grade 3, 44-58%; ASA grade 4, 33-48%; and ASA grade 5, 4-51%. The majority of deaths occurred after 30 days. CONCLUSIONS Emergency laparotomy is associated with a significantly increased risk of death in the following 5 years. The risk is strongly correlated to ASA grade. Thirty-day mortality estimation is not a good basis on which to advise patients and carers on long-term outcomes. ASA grade can be used to predict long-term outcomes and to guide patient counsel.
Collapse
|
6
|
Lemaire JJ, Pontier B, Chaix R, El Ouadih Y, Khalil T, Sinardet D, Achim V, Postelnicu A, Coste J, Germain V, Sarret C, Sontheimer A. Neural correlates of consciousness and related disorders: From phenotypic descriptors of behavioral and relative consciousness to cortico-subcortical circuitry. Neurochirurgie 2021; 68:212-222. [PMID: 34051246 DOI: 10.1016/j.neuchi.2021.05.003] [Citation(s) in RCA: 2] [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: 01/20/2021] [Revised: 04/13/2021] [Accepted: 05/09/2021] [Indexed: 01/01/2023]
Abstract
We report a review of medical aspects of the consciousness. The behavioral dimension, phenotypic descriptors, relative consciousness and neural correlates of consciousness and related disorders were addressed successively in a holistic and chronological approach. Consciousness is relative, specific to each individual across time and space. Historically defined as the perception of the self and the environment, it cannot be separated from behaviors, entailing an idea of conscious behavior with metapractic and metagnostic aspects. Observation of spontaneous and evoked overt behavior distinguishes three main types of disorder of consciousness (DoC): coma, vegetative state or unresponsive wakefulness, and minimally conscious or relationally impoverished state. Modern functional exploration techniques, such as imaging, increase the understanding of DoCs and consciousness. Whether consciousness is a superior function and/or an instrumental function is discussed. Neural correlates can be subdivided into two wakefulness pathways (superior thalamic cholinergic and inferior extra-thalamic), and cortico-subcortical circuitry. The deep brain structures are those described in the well-known sensorimotor, associative and limbic loops, as illustrated in the mesolimbic model of DoC. The cortices can be segregated into several overlapping networks: (1) a global workspace including thalamo-cortical loops; (2) the default mode network (DMN) and related intrinsic connectivity networks (i.e., central executive, medial DMN and salience networks); (3) a 3-fold network comprising the fronto-parietal control system and its dorsal and ventral attentional sub-networks, the fronto-parietal executive control network, and the cingulo-opercular salience network; (4) the internal and external cortices, respectively medial, turned toward the self, and lateral, turned toward the environment. The network dynamics is the reflection of consciousness, notably anticorrelations such as the decrease in activity of the posterior cingulate-precuneus regions during attentional tasks. Thanks to recent advances in DoC pathophysiology, further significative therapeutic progress is expected, taking into account the societal context. This depends notably on the dissemination of medical knowledge and its transfer to a wider public.
Collapse
Affiliation(s)
- J-J Lemaire
- Service de neurochirurgie, CHU Clermont-Ferrand, Clermont-Ferrand, France; Institut Pascal, université Clermont Auvergne CNRS SIGMA, Clermont-Ferrand, France.
| | - B Pontier
- Service de neurochirurgie, CHU Clermont-Ferrand, Clermont-Ferrand, France; Institut Pascal, université Clermont Auvergne CNRS SIGMA, Clermont-Ferrand, France
| | - R Chaix
- Service de neurochirurgie, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Y El Ouadih
- Service de neurochirurgie, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - T Khalil
- Service de neurochirurgie, CHU Clermont-Ferrand, Clermont-Ferrand, France; Institut Pascal, université Clermont Auvergne CNRS SIGMA, Clermont-Ferrand, France
| | - D Sinardet
- Service de neurochirurgie, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - V Achim
- Service de neurochirurgie, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - A Postelnicu
- Service de neurochirurgie, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - J Coste
- Service de neurochirurgie, CHU Clermont-Ferrand, Clermont-Ferrand, France; Institut Pascal, université Clermont Auvergne CNRS SIGMA, Clermont-Ferrand, France
| | - V Germain
- Service de neurochirurgie, CHU Clermont-Ferrand, Clermont-Ferrand, France; Institut Pascal, université Clermont Auvergne CNRS SIGMA, Clermont-Ferrand, France
| | - C Sarret
- Institut Pascal, université Clermont Auvergne CNRS SIGMA, Clermont-Ferrand, France
| | - A Sontheimer
- Service de neurochirurgie, CHU Clermont-Ferrand, Clermont-Ferrand, France; Institut Pascal, université Clermont Auvergne CNRS SIGMA, Clermont-Ferrand, France
| |
Collapse
|
7
|
Brun L, Dupic G, Chassin V, Chautard E, Moreau J, Dedieu V, Khalil T, Verrelle P, Lapeyre M, Biau J. Hypofractionated stereotactic radiotherapy for large brain metastases: Optimizing the dosimetric parameters. Cancer Radiother 2020; 25:1-7. [PMID: 33257109 DOI: 10.1016/j.canrad.2020.04.011] [Citation(s) in RCA: 2] [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: 03/27/2020] [Revised: 04/14/2020] [Accepted: 04/27/2020] [Indexed: 11/17/2022]
Abstract
PURPOSE Stereotactic radiotherapy plays a major role in the treatment of brain metastases (BM). We aimed to compare the dosimetric results of four plans for hypofractionated stereotactic radiotherapy (HFSRT) for large brain metastases. MATERIAL AND METHODS Ten patients treated with upfront NovalisTx® non-coplanar multiple dynamic conformal arcs (DCA) HFSRT for≥25mm diameter single BM were included. Three other volumetric modulated arc therapy (VMAT) treatment plans were evaluated: with coplanar arcs (Eclipse®, Varian, VMATcEclipse®), with coplanar and non-coplanar arcs (VMATncEclipse®), and with non-coplanar arcs (Elements Cranial SRS®, Brainlab, VMATncElements®). The marginal dose prescribed for the PTV was 23.1Gy (isodose 70%) in three fractions. The mean GTV was 27mm3. RESULTS Better conformity indices were found with all VMAT techniques compared to DCA (1.05 vs 1.28, P<0.05). Better gradient indices were found with VMATncElements® and DCA (2.43 vs 3.02, P<0.001). High-dose delivery in healthy brain was lower with all VMAT techniques compared to DCA (5.6 to 6.3 cc vs 9.4 cc, P<0.001). Low-dose delivery (V5Gy) was lower with VMATncEclipse® or VMATncElements® than with DCA (81 or 94 cc vs 110 cc, P=0.02). CONCLUSIONS NovalisTx® VMAT HFSRT for≥25mm diameter brain metastases provides the best dosimetric compromise in terms of target coverage, sparing of healthy brain tissue and low-dose delivery compared to DCA.
Collapse
Affiliation(s)
- L Brun
- Department of radiation oncology, Jean-Perrin center, 63011 Clermont-Ferrand, France
| | - G Dupic
- Department of radiation oncology, Jean-Perrin center, 63011 Clermont-Ferrand, France.
| | - V Chassin
- Department of medical physics, Jean-Perrin center, Clermont-Ferrand, France
| | - E Chautard
- Clermont Auvergne university, INSERM, U1240 IMoST, 63000 Clermont-Ferrand, France; Department of pathology, Clermont Auvergne university, Jean-Perrin center, 63011 Clermont-Ferrand, France
| | - J Moreau
- Department of radiation oncology, Jean-Perrin center, 63011 Clermont-Ferrand, France
| | - V Dedieu
- Department of medical physics, Jean-Perrin center, Clermont-Ferrand, France
| | - T Khalil
- Department of neurosurgery, Clermont-Ferrand hospital, 63003 Clermont-Ferrand, France
| | - P Verrelle
- Department of radiation oncology, Jean-Perrin center, 63011 Clermont-Ferrand, France
| | - M Lapeyre
- Department of radiation oncology, Jean-Perrin center, 63011 Clermont-Ferrand, France
| | - J Biau
- Department of radiation oncology, Jean-Perrin center, 63011 Clermont-Ferrand, France; Clermont Auvergne university, INSERM, U1240 IMoST, 63000 Clermont-Ferrand, France
| |
Collapse
|
8
|
El Ouadih Y, Vernhes J, Mulliez A, Berton Q, Al Gahatany M, Traore O, Khalil T, Lemaire JJ. Postoperative empyema following chronic subdural hematoma surgery: Clinically based medicine. Neurochirurgie 2020; 66:365-368. [PMID: 32861684 DOI: 10.1016/j.neuchi.2020.06.132] [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] [Received: 04/10/2020] [Revised: 06/01/2020] [Accepted: 06/19/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Subdural empyema (SDE) is a rare complication of chronic subdural hematoma (CSDH) surgery. We introduced antibiotic prophylaxis (AP) for this procedure in 2014 following a morbidity-mortality conference (MMC) in our department. We report the results of retrospective data analysis to assess the effect of systematic AP and to identify risk factors for SDE. MATERIAL AND METHODS Two hundred eight patients were recruited between January 2013 and December 2015; 5 were excluded for incomplete data: 107 without and 96 with AP (n=203). SDE was confirmed by clinical examination, imaging and bacteriological analysis. Comparisons between AP-(no cefuroxime) and AP+ (cefuroxime) groups were made with Chi2 test and Student's t-test. RESULTS One empyema was found in each group, indicating that AP had no effect (P=1). The only criterion associated with SDE for these two patients was a greater number of reoperations for CSDH recurrence (P=0.013). DISCUSSION The incidence of postoperative empyema was 1%, similar to the range of 0.2%-2.1% reported in the literature. This rare incidence explains why we found no significant effect of AP. The medical decision taken at the MMC did not help to reduce the rate of postoperative SDE. MMCs can help to define factors associated with adverse surgical events and identify opportunities for improvement. CONCLUSION AP, introduced after an MMC, did not impact SDE rates. In practice, AP should be required only in case of reoperation for CSDH recurrence. However, we still continue to use AP following the MMC considering different parameters discussed in the manuscript.
Collapse
Affiliation(s)
- Y El Ouadih
- Service de neurochirurgie, CHU de Clermont Ferrand, 58, rue Montalembert, 63000 Clermont-Ferrand, France; Université Clermont-Auvergne, Clermont-Ferrand, France; SIGMA Clermont, CNRS, Clermont-Ferrand, France.
| | - J Vernhes
- Service de neurochirurgie, CHU de Clermont Ferrand, 58, rue Montalembert, 63000 Clermont-Ferrand, France
| | - A Mulliez
- Service de biostatistiques, CHU de Clermont Ferrand, Clermont-Ferrand, France
| | - Q Berton
- Service de neurochirurgie, CHU de Clermont Ferrand, 58, rue Montalembert, 63000 Clermont-Ferrand, France
| | - M Al Gahatany
- Service de neurochirurgie, CHU de Clermont Ferrand, 58, rue Montalembert, 63000 Clermont-Ferrand, France
| | - O Traore
- Service d'hygiène hospitalière, CHU de Clermont Ferrand, Clermont-Ferrand, France; Université Clermont-Auvergne, Clermont-Ferrand, France
| | - T Khalil
- Service de neurochirurgie, CHU de Clermont Ferrand, 58, rue Montalembert, 63000 Clermont-Ferrand, France
| | - J-J Lemaire
- Service de neurochirurgie, CHU de Clermont Ferrand, 58, rue Montalembert, 63000 Clermont-Ferrand, France; Université Clermont-Auvergne, Clermont-Ferrand, France; SIGMA Clermont, CNRS, Clermont-Ferrand, France
| |
Collapse
|
9
|
Dupic G, Biau J, Lemaire JJ, Ortholan C, Clavelou P, Lapeyre M, Colin P, Khalil T. [Functional stereotactic radiosurgery: Indications and perspectives]. Cancer Radiother 2020; 24:166-173. [PMID: 32220562 DOI: 10.1016/j.canrad.2020.01.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 10/16/2019] [Revised: 01/07/2020] [Accepted: 01/13/2020] [Indexed: 01/03/2023]
Abstract
Stereotactic radiosurgery (SRS) is a non-invasive technique that enables to create brain focal lesions with a high precision and localization. Thus, functional brain disorders can be treated by SRS in case of pharmacoresistance or inoperability. To date, treatment of trigeminal neuralgia is the most described and known indication. Other indications will be developed in the future like movement disorders, refractory epilepsy, obsessive compulsive disorder and severe depression. We present here a review of actual and future indications of functional brain SRS with their level of evidence. All these SRS treatments have to be strictly conducted by trained teams with an excellent collaboration between radiation physicists, medical physicists, neurosurgeons, neurologists, psychiatrists and probably neuroradiologists.
Collapse
Affiliation(s)
- G Dupic
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, 63000 Clermont-Ferrand, France.
| | - J Biau
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, 63000 Clermont-Ferrand, France
| | - J J Lemaire
- Département de neurochirurgie, centre hospitalier universitaire Gabriel-Montpied, 58, rue Montalembert, 63000 Clermont-Ferrand, France
| | - C Ortholan
- Département de radiothérapie, centre hospitalier Princesse-Grace, 1, avenue Pasteur, 98000 Monaco, France
| | - P Clavelou
- Département de neurologie, centre hospitalier universitaire Gabriel-Montpied, 58, rue Montalembert, 63000 Clermont-Ferrand, France
| | - M Lapeyre
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, 63000 Clermont-Ferrand, France
| | - P Colin
- Département de radiothérapie, Institut du cancer Courlancy, 38, rue de Courlancy, 51100 Reims, France
| | - T Khalil
- Département de neurochirurgie, centre hospitalier universitaire Gabriel-Montpied, 58, rue Montalembert, 63000 Clermont-Ferrand, France
| |
Collapse
|
10
|
Pou P, Biau J, Verrelle P, Lemaire JJ, El Ouadih Y, Chassin V, Magnier F, Dedieu V, Lapeyre M, Dupic G, Khalil T. Long-Term Outcomes After Linac Radiosurgery for Benign Meningiomas. Clin Oncol (R Coll Radiol) 2020; 32:452-458. [PMID: 32201158 DOI: 10.1016/j.clon.2020.02.006] [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: 04/18/2019] [Revised: 11/27/2019] [Accepted: 01/25/2020] [Indexed: 10/24/2022]
Abstract
AIMS Although several studies on outcomes following stereotactic radiosurgery (SRS) for benign meningiomas have been reported, Linac-based SRS outcomes have not been as widely evaluated. The aim of this retrospective institutional single-centre study was to determine long-term outcomes of Linac-based SRS for benign intracranial meningiomas. MATERIALS AND METHODS From July 1996 to May 2011, 60 patients with 69 benign meningiomas were included. All patients were treated with single-fraction Linac-based SRS with four to five non-coplanar arcs, dynamic or not. The marginal dose prescribed for the periphery was 16 Gy. Prognostic factors associated with local control, progression-free survival (PFS) and overall survival were tested. RESULTS The median follow-up was 128 months. No patient was lost to follow-up. The values observed at 1, 5 and 10 years were, respectively, 100%, 98.4% and 92.6% for local control, 94.9%, 93.2% and 78% for PFS and 100%, 94.7% and 92.7% for overall survival. In univariate analysis, local control after SRS was significantly higher for skull base and parasagittal meningiomas compared with convexity meningiomas (P = 0.031). Multivariate analyses showed significantly longer PFS when the minimum dose delivered to the tumour was greater than 10 Gy (P = 0.0082). No grade 5 toxicity was reported. CONCLUSION Our long-term results from a large sample size of benign meningiomas treated with Linac-based SRS confirmed excellent local control (>90%) and good safety, which is in line with published studies on Gamma Knife surgery. Above all, we showed significantly poorer PFS if the minimum dose to the tumour was under 10 Gy.
Collapse
Affiliation(s)
- P Pou
- Department of Radiation Oncology, Jean Perrin Center, Clermont-Ferrand, France
| | - J Biau
- Department of Radiation Oncology, Jean Perrin Center, Clermont-Ferrand, France
| | - P Verrelle
- Department of Radiation Oncology, Jean Perrin Center, Clermont-Ferrand, France; Clermont Auvergne University, Clermont-Ferrand, France; Department of Radiation Oncology, Institut Curie, Paris, France
| | - J J Lemaire
- Clermont Auvergne University, Clermont-Ferrand, France; Department of Neurosurgery, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Y El Ouadih
- Department of Neurosurgery, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - V Chassin
- Department of Medical Physics, Jean Perrin Center, Clermont-Ferrand, France
| | - F Magnier
- Department of Medical Physics, Jean Perrin Center, Clermont-Ferrand, France
| | - V Dedieu
- Department of Medical Physics, Jean Perrin Center, Clermont-Ferrand, France
| | - M Lapeyre
- Department of Radiation Oncology, Jean Perrin Center, Clermont-Ferrand, France
| | - G Dupic
- Department of Radiation Oncology, Jean Perrin Center, Clermont-Ferrand, France.
| | - T Khalil
- Department of Neurosurgery, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| |
Collapse
|
11
|
Urcissin M, Khalil T, Lemaire JJ, Mom T, Verrelle P, Chassin V, Lapeyre M, Biau J, Dupic G. Radiochirurgie stéréotaxique des schwannomes vestibulaires : 11 Gy en dose d’enveloppe permet de réduire la toxicité. Cancer Radiother 2019. [DOI: 10.1016/j.canrad.2019.07.026] [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: 10/26/2022]
|
12
|
Khalil M, Adams L, Khalil T, Ibrahim I, Wilson M. Comparing mortality in patients undergoing emergency laparotomy: General surgery vs non-general surgery. Int J Surg 2018. [DOI: 10.1016/j.ijsu.2018.05.530] [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]
|
13
|
Biau J, Chautard E, De Schlichting E, Dupic G, Pereira B, Fogli A, Müller-Barthélémy M, Dalloz P, Khalil T, Dillies AF, Durando X, Godfraind C, Verrelle P. Radiotherapy plus temozolomide in elderly patients with glioblastoma: a "real-life" report. Radiat Oncol 2017; 12:197. [PMID: 29212499 PMCID: PMC5719937 DOI: 10.1186/s13014-017-0929-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 11/21/2017] [Indexed: 11/22/2022] Open
Abstract
Background The optimization of the management for elderly glioblastoma patients is crucial given the demographics of aging in many countries. We report the outcomes for a “real-life” patient cohort (i.e. unselected) comprising consecutive glioblastoma patients aged 70 years or more, treated with different radiotherapy +/− temozolomide regimens. Methods From 2003 to 2016, 104 patients ≥ 70 years of age, consecutively treated by radiotherapy for glioblastoma, were included in this study. All patients were diagnosed with IDH-wild type glioblastoma according to pathological criteria. Results Our patient cohort comprised 51 female patients (49%) and 53 male. The median cohort age was 75 years (70–88), and the median Karnofsky performance status (KPS) was 70 (30–100). Five (5%) patients underwent macroscopic complete resection, 9 (9%) had partial resection, and 90 (86%), a stereotactic biopsy. The MGMT promoter was methylated in 33/73 cases (45%). Fifty-two (50%), 38 (36%), and 14 (14%) patients were categorized with RPA scores of III, IV, and I-II. Thirty-three (32%) patients received normofractionated radiotherapy (60 Gy, 30 sessions) with temozolomide (Stupp), 37 (35%) received hypofractionated radiotherapy (median dose 40 Gy, 15 sessions) with temozolomide (HFRT + TMZ), and 34 (33%) HFRT alone. Patients receiving only HFRT were significantly older, with lower KPSs. The median overall survival (OS; all patients) was 5.2 months. OS rates at 12, 18, and 24 months, were 19%, 12%, and 5%, respectively, with no statistical differences between patients receiving Stupp or HFRT + TMZ (P = 0.22). In contrast, patients receiving HFRT alone manifested a significantly shorter survival time (3.9 months vs. 5.9 months, P = 0.018). In multivariate analyses, the prognostic factors for OS were: i) the type of surgery (HR: 0.47 [0.26–0.86], P = 0.014), ii) RPA class (HR: 2.15 [1.17–3.95], P = 0.014), and iii) temozolomide use irrespective of radiotherapy schedule (HR: 0.54 [0.33–0.88], P < 0.02). MGMT promoter methylation was neither a prognostic nor a predictive factor. Conclusions These outcomes agree with the literature in terms of optimal surgery and the use of HFRT as a standard treatment for elderly GBM patients. Our study emphasizes the potential benefit of using temozolomide with radiotherapy in a real-life cohort of elderly GBM patients, irrespective of their MGMT status.
Collapse
Affiliation(s)
- J Biau
- Radiotherapy Department, Université Clermont Auvergne, Centre Jean Perrin, 63011, Clermont-Ferrand, France. .,Université Clermont Auvergne, INSERM, U1240 IMoST, F-63000, Clermont Ferrand, France.
| | - E Chautard
- Radiotherapy Department, Université Clermont Auvergne, Centre Jean Perrin, 63011, Clermont-Ferrand, France.,Université Clermont Auvergne, INSERM, U1240 IMoST, F-63000, Clermont Ferrand, France
| | - E De Schlichting
- Neurosurgery Department, Clermont-Ferrand Hospital, 63003, Clermont-Ferrand, France
| | - G Dupic
- Radiotherapy Department, Université Clermont Auvergne, Centre Jean Perrin, 63011, Clermont-Ferrand, France
| | - B Pereira
- Biostatistics Department, DRCI, Clermont-Ferrand Hospital, 63003, Clermont-Ferrand, France
| | - A Fogli
- Université Clermont Auvergne, CNRS UMR 6293, INSERM U1103, GReD Laboratory, 63000, Clermont-Ferrand, France
| | - M Müller-Barthélémy
- Université Clermont Auvergne, INSERM, U1240 IMoST, F-63000, Clermont Ferrand, France
| | - P Dalloz
- Oncology Department, Université Clermont Auvergne, Centre Jean Perrin, 63011, Clermont-Ferrand, France
| | - T Khalil
- Neurosurgery Department, Clermont-Ferrand Hospital, 63003, Clermont-Ferrand, France
| | - A F Dillies
- Oncology Department, Université Clermont Auvergne, Centre Jean Perrin, 63011, Clermont-Ferrand, France
| | - X Durando
- Université Clermont Auvergne, INSERM, U1240 IMoST, F-63000, Clermont Ferrand, France.,Oncology Department, Université Clermont Auvergne, Centre Jean Perrin, 63011, Clermont-Ferrand, France
| | - C Godfraind
- Université Clermont Auvergne, INSERM, U1240 IMoST, F-63000, Clermont Ferrand, France.,Anatomopathology Department, Clermont-Ferrand Hospital, 63003, Clermont-Ferrand, France
| | - P Verrelle
- Radiotherapy Department, Université Clermont Auvergne, Centre Jean Perrin, 63011, Clermont-Ferrand, France.,Radiation Oncology Department, Institut Curie, 75248, Paris, France
| |
Collapse
|
14
|
Moreau J, Khalil T, Lemaire J, Magnier F, Dedieu V, Lapeyre M, Verrelle P, Biau J. Seconde radiochirurgie pour récidive locale de métastase cérébrale après échec d’une première radiochirurgie. Cancer Radiother 2016. [DOI: 10.1016/j.canrad.2016.08.003] [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]
|
15
|
Zerroug A, Gabrillargues J, Coll G, Vassal F, Jean B, Chabert E, Claise B, Khalil T, Sakka L, Feschet F, Durif F, Boyer L, Coste J, Lemaire JJ. Personalized mapping of the deep brain with a white matter attenuated inversion recovery (WAIR) sequence at 1.5-tesla: Experience based on a series of 156 patients. Neurochirurgie 2016; 62:183-9. [PMID: 27236731 DOI: 10.1016/j.neuchi.2016.01.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 10/19/2015] [Revised: 12/29/2015] [Accepted: 01/26/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Deep brain mapping has been proposed for direct targeting in stereotactic functional surgery, aiming to personalize electrode implantation according to individual MRI anatomy without atlas or statistical template. We report our clinical experience of direct targeting in a series of 156 patients operated on using a dedicated Inversion Recovery Turbo Spin Echo sequence at 1.5-tesla, called White Matter Attenuated Inversion Recovery (WAIR). METHODS After manual contouring of all pertinent structures and 3D planning of trajectories, 312 DBS electrodes were implanted. Detailed anatomy of close neighbouring structures, whether gray nuclei or white matter regions, was identified during each planning procedure. We gathered the experience of these 312 deep brain mappings and elaborated consistent procedures of anatomical MRI mapping for pallidal, subthalamic and ventral thalamic regions. We studied the number of times the central track anatomically optimized was selected for implantation of definitive electrodes. RESULTS WAIR sequence provided high-quality images of most common functional targets, successfully used for pure direct stereotactic targeting: the central track corresponding to the optimized primary anatomical trajectory was chosen for implantation of definitive electrodes in 90.38%. CONCLUSION WAIR sequence is anatomically reliable, enabling precise deep brain mapping and direct stereotactic targeting under routine clinical conditions.
Collapse
Affiliation(s)
- A Zerroug
- Image-guided clinical neuroscience and connectomics, Clermont université, université d'Auvergne, EA7282, 63000 Clermont-Ferrand, France; Service of radiology, neuroradiology unit, CHU de Clermont-Ferrand, 63003 Clermont-Ferrand, France
| | - J Gabrillargues
- Image-guided clinical neuroscience and connectomics, Clermont université, université d'Auvergne, EA7282, 63000 Clermont-Ferrand, France; Service of radiology, neuroradiology unit, CHU de Clermont-Ferrand, 63003 Clermont-Ferrand, France
| | - G Coll
- Image-guided clinical neuroscience and connectomics, Clermont université, université d'Auvergne, EA7282, 63000 Clermont-Ferrand, France; Service of neurosurgery, CHU Gabriel-Montpied, 58, rue Montalembert, 63003 Clermont-Ferrand, France
| | - F Vassal
- Image-guided clinical neuroscience and connectomics, Clermont université, université d'Auvergne, EA7282, 63000 Clermont-Ferrand, France
| | - B Jean
- Service of radiology, neuroradiology unit, CHU de Clermont-Ferrand, 63003 Clermont-Ferrand, France
| | - E Chabert
- Image-guided clinical neuroscience and connectomics, Clermont université, université d'Auvergne, EA7282, 63000 Clermont-Ferrand, France; Service of radiology, neuroradiology unit, CHU de Clermont-Ferrand, 63003 Clermont-Ferrand, France
| | - B Claise
- Image-guided clinical neuroscience and connectomics, Clermont université, université d'Auvergne, EA7282, 63000 Clermont-Ferrand, France; Service of radiology, neuroradiology unit, CHU de Clermont-Ferrand, 63003 Clermont-Ferrand, France
| | - T Khalil
- Image-guided clinical neuroscience and connectomics, Clermont université, université d'Auvergne, EA7282, 63000 Clermont-Ferrand, France; Service of neurosurgery, CHU Gabriel-Montpied, 58, rue Montalembert, 63003 Clermont-Ferrand, France
| | - L Sakka
- Image-guided clinical neuroscience and connectomics, Clermont université, université d'Auvergne, EA7282, 63000 Clermont-Ferrand, France; Service of neurosurgery, CHU Gabriel-Montpied, 58, rue Montalembert, 63003 Clermont-Ferrand, France
| | - F Feschet
- Image-guided clinical neuroscience and connectomics, Clermont université, université d'Auvergne, EA7282, 63000 Clermont-Ferrand, France
| | - F Durif
- Service of neurology, CHU de Clermont-Ferrand, 63003 Clermont-Ferrand, France
| | - L Boyer
- Service of radiology, CHU de Clermont-Ferrand, 63003 Clemront-Ferrand, France
| | - J Coste
- Image-guided clinical neuroscience and connectomics, Clermont université, université d'Auvergne, EA7282, 63000 Clermont-Ferrand, France; Service of neurosurgery, CHU Gabriel-Montpied, 58, rue Montalembert, 63003 Clermont-Ferrand, France
| | - J-J Lemaire
- Image-guided clinical neuroscience and connectomics, Clermont université, université d'Auvergne, EA7282, 63000 Clermont-Ferrand, France; Service of neurosurgery, CHU Gabriel-Montpied, 58, rue Montalembert, 63003 Clermont-Ferrand, France.
| |
Collapse
|
16
|
Abd-Elhady M, Fouad M, Khalil T. Improving the efficiency of photovoltaic (PV) panels by oil coating. Energy Conversion and Management 2016; 115:1-7. [DOI: 10.1016/j.enconman.2016.02.040] [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] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
|
17
|
Biau J, Khalil T, Verrelle P, Lemaire JJ. Fractionated radiotherapy and radiosurgery of intracranial meningiomas. Neurochirurgie 2015; 64:29-36. [PMID: 26100035 DOI: 10.1016/j.neuchi.2014.10.112] [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: 03/25/2014] [Revised: 10/27/2014] [Accepted: 10/31/2014] [Indexed: 01/10/2023]
Abstract
This review focuses on the role of radiosurgery and fractionated radiotherapy in the management of intracranial meningiomas, which are the most common benign intracranial tumors. Whenever feasible, surgery remains a cornerstone of treatment in effective health care treatment where modern radiotherapy plays an important role. Irradiation can be proposed as first-line treatment, as adjuvant treatment, or as a second-line treatment after recurrence. Stereotactic radiosurgery consists of delivering, a high-dose of radiation with high precision, to the tumor in a single-fraction with a minimal exposure of surrounding healthy tissue. Stereotactic radiosurgery, especially with the gamma knife technique, has reached a high level of success for the treatment of intracranial meningiomas with excellent local control and low morbidity. However, stereotactic radiosurgery is limited by tumor size,<3-4cm, and location, i.e. reasonable distance from the organs at risk. Fractionated radiation therapy is an interesting alternative (5 to 6weeks treatment time) for large inoperable tumors. The results of fractionated radiation therapy seem encouraging as regards both local control and morbidity although long-term prospective studies are still needed.
Collapse
Affiliation(s)
- J Biau
- Centre Jean-Perrin, Département de Radiothérapie, 63000 Clermont-Ferrand, France
| | - T Khalil
- CHU de Clermont-Ferrand, Hôpital Gabriel-Montpied, Service de Neurochirurgie, 63003 Clermont-Ferrand, France
| | - P Verrelle
- Centre Jean-Perrin, Département de Radiothérapie, 63000 Clermont-Ferrand, France
| | - J-J Lemaire
- CHU de Clermont-Ferrand, Hôpital Gabriel-Montpied, Service de Neurochirurgie, 63003 Clermont-Ferrand, France.
| |
Collapse
|
18
|
Lemaire JJ, Delom C, Coste A, Khalil T, Jourdy JC, Pontier B, Gabrillargues J, Sinardet D, Chabanne A, Achim V, Sakka L, Coste J, Chazal J, Salagnac A, Coll G, Irthum B. [Medico-economic analysis of a neurosurgery department at a university hospital]. Neurochirurgie 2015; 61:2-15. [PMID: 25665774 DOI: 10.1016/j.neuchi.2014.11.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 09/10/2014] [Revised: 10/29/2014] [Accepted: 11/11/2014] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Economic and societal constraints require to take into account the economic dimension and medical performance of hospital departments. We carried out a self-assessment study, which we thought could be useful to share with the neurosurgical community. MATERIAL AND METHODS Care and research activities were assessed from 2009 to 2013. We used institutional and assessment-body parameters in order to describe activities and perform a financial evaluation. It was a retrospective descriptive study based on the guidelines of the DHOS/O4 circular No. 2007/390 of October 29, 2007. RESULTS The average annual, analytic income statement was +1.39 millions euros, for 63 beds with a 92% occupancy rate, including 6.7 full-time equivalent neurosurgeons (and assistants), for 2553 patients and 1975 surgeries. The average mortality rate was 2.74%. The annual mean length of stay was 6.82 days. Per year, on average 15.6% of patients were admitted in emergency and 76.9% returned home. The annual, act-related-pricing and publication-related incomes represented 77% and 0.6%, respectively of the total funding. Difficulties to find downstream beds for the most severe patients induced 1401 "waiting days" in 2012. CONCLUSION Medico-economic analysis of a neurosurgery department at a university hospital was useful in order to take into account the care, teaching and research activities, as well as its related financial value.
Collapse
Affiliation(s)
- J-J Lemaire
- Service de neurochirurgie, hôpital Gabriel-Montpied, CHU de Clermont-Ferrand, 51, rue Montalembert, 63003 Clermont-Ferrand, France.
| | - C Delom
- Direction des finances, hôpital Gabriel-Montpied, CHU de Clermont-Ferrand, 63003 Clermont-Ferrand, France
| | - A Coste
- Service de neurochirurgie, hôpital Gabriel-Montpied, CHU de Clermont-Ferrand, 51, rue Montalembert, 63003 Clermont-Ferrand, France
| | - T Khalil
- Service de neurochirurgie, hôpital Gabriel-Montpied, CHU de Clermont-Ferrand, 51, rue Montalembert, 63003 Clermont-Ferrand, France
| | - J-C Jourdy
- Département d'information médicale, hôpital Gabriel-Montpied, CHU de Clermont-Ferrand, 63003 Clermont-Ferrand, France
| | - B Pontier
- Coordination soins de suite et réadaptation, agence régional de santé - Auvergne, 63057 Clermont-Ferrand, France
| | - J Gabrillargues
- Unité de neuroradiologie, hôpital Gabriel-Montpied, CHU de Clermont-Ferrand, 63003 Clermont-Ferrand, France
| | - D Sinardet
- Service de neurochirurgie, hôpital Gabriel-Montpied, CHU de Clermont-Ferrand, 51, rue Montalembert, 63003 Clermont-Ferrand, France
| | - A Chabanne
- Service de neurochirurgie, hôpital Gabriel-Montpied, CHU de Clermont-Ferrand, 51, rue Montalembert, 63003 Clermont-Ferrand, France
| | - V Achim
- Service de neurochirurgie, hôpital Gabriel-Montpied, CHU de Clermont-Ferrand, 51, rue Montalembert, 63003 Clermont-Ferrand, France
| | - L Sakka
- Service de neurochirurgie, hôpital Gabriel-Montpied, CHU de Clermont-Ferrand, 51, rue Montalembert, 63003 Clermont-Ferrand, France
| | - J Coste
- Service de neurochirurgie, hôpital Gabriel-Montpied, CHU de Clermont-Ferrand, 51, rue Montalembert, 63003 Clermont-Ferrand, France
| | - J Chazal
- Service de neurochirurgie, hôpital Gabriel-Montpied, CHU de Clermont-Ferrand, 51, rue Montalembert, 63003 Clermont-Ferrand, France
| | - A Salagnac
- Délégation à la recherche clinique & à l'innovation, direction générale adjointe, hôpital Gabriel-Montpied, CHU de Clermont-Ferrand, 63003 Clermont-Ferrand, France
| | - G Coll
- Service de neurochirurgie, hôpital Gabriel-Montpied, CHU de Clermont-Ferrand, 51, rue Montalembert, 63003 Clermont-Ferrand, France
| | - B Irthum
- Service de neurochirurgie, hôpital Gabriel-Montpied, CHU de Clermont-Ferrand, 51, rue Montalembert, 63003 Clermont-Ferrand, France
| |
Collapse
|
19
|
Moreau J, Biau J, Khalil T, Lemaire J, Dedieu V, Donnarieix D, Lapeyre M, Verrelle P. Radiochirurgie par arcthérapie des métastases cérébrales : analyse rétrospective des dossiers de 181 patients. Cancer Radiother 2014. [DOI: 10.1016/j.canrad.2014.07.036] [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: 10/24/2022]
|
20
|
Madero B, Avan P, Bazin A, Chays A, Mom T, Khalil T, Tringali S, Zaouche S, Dubreuil C, Hassoun T. Cochlear Microphonics: A Promising Tool for Hearing Monitoring in Cerebellopontine Angle Surgery. Skull Base Surg 2014. [DOI: 10.1055/s-0034-1384102] [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]
|
21
|
Mom T, Djennaoui I, Saroul N, Pavier Y, Khalil T, Gilain L, Avan P. Significance of Postoperative ABRs after Cerebellopontine Angle Surgery. Skull Base Surg 2014. [DOI: 10.1055/s-0034-1384103] [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]
|
22
|
Dalloz P, Biau J, Dillies AF, Durando X, Kemeny JL, Khalil T, Kwiatkowski F, Toledano Y, Verrelle P. Radiothérapie des gliomes de haut grade chez les patients de plus de 70ans : étude rétrospective sur 80 patients, résultats et facteurs pronostiques. Cancer Radiother 2012. [DOI: 10.1016/j.canrad.2012.07.146] [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: 10/27/2022]
|
23
|
Biau J, Khalil T, Bellière A, Pereira B, Dedieu V, Donnarieix D, Lemaire JJ, Toledano I, Lapeyre M, Verrelle P. Radiochirurgie des métastases cérébrales dans les cancers bronchiques non à petites cellules : expérience monocentrique de 76 patients. Cancer Radiother 2012. [DOI: 10.1016/j.canrad.2012.07.082] [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]
|
24
|
Wang M, Yan G, Yue W, Siu C, Tse H, Perperidis A, Cusack D, White A, Macgillivray T, Mcdicken W, Anderson T, Ryabov V, Shurupov V, Suslova T, Markov V, Elmstedt N, Ferm Widlund K, Lind B, Brodin LA, Westgren M, Mantovani F, Barbieri A, Bursi F, Valenti C, Quaglia M, Modena M, Peluso D, Muraru D, Dal Bianco L, Beraldo M, Solda' E, Tuveri M, Cucchini U, Al Mamary A, Badano L, Iliceto S, Goncalves A, Almeria C, Marcos-Alberca P, Feltes G, Hernandez-Antolin R, Rodriguez H, Maroto L, Silva Cardoso J, Macaya C, Zamorano J, Squarciotta S, Innocenti F, Guzzo A, Bianchi S, Lazzeretti D, De Villa E, Vicidomini S, Del Taglia B, Donnini C, Pini R, Mennie C, Salmasi AM, Kutyifa V, Nagy V, Edes E, Apor A, Merkely B, Nyrnes S, Lovstakken L, Torp H, Haugen B, Said K, Shehata A, Ashour Z, El-Tobgy S, Cameli M, Bigio E, Lisi M, Righini F, Franchi F, Scolletta S, Mondillo S, Gayat E, Weinert L, Yodwut C, Mor-Avi V, Lang R, Hrynchyshyn N, Kachenoura N, Diebold B, Khedim R, Senesi M, Redheuil A, Mousseaux E, Perdrix L, Yurdakul S, Erdemir V, Tayyareci Y, Memic K, Yildirimturk O, Aytekin V, Gurel M, Aytekin S, Gargani L, Fernandez Cimadevilla C, La Falce S, Landi P, Picano E, Sicari R, Smedsrud MK, Gravning J, Eek C, Morkrid L, Skulstad H, Aaberge L, Bendz B, Kjekshus J, Edvardsen T, Bajraktari G, Hyseni V, Morina B, Batalli A, Tafarshiku R, Olloni R, Henein M, Mjolstad O, Snare S, Folkvord L, Helland F, Torp H, Haraldseth O, Grimsmo A, Haugen B, Berry M, Zaghden O, Nahum J, Macron L, Lairez O, Damy T, Bensaid A, Dubois Rande J, Gueret P, Lim P, Nciri N, Issaoui Z, Tlili C, Wanes I, Foudhil H, Dachraoui F, Grapsa J, Dawson D, Nihoyannopoulos P, Gianturco L, Turiel M, Atzeni F, Sarzi-Puttini P, Stella D, Donato L, Tomasoni L, Jung P, Mueller M, Huber T, Sevilmis G, Kroetz F, Sohn H, Panoulas V, Bratsas A, Dawson D, Nihoyannopoulos P, Raso R, Tartarisco G, Gargani L, La Falce S, Pioggia G, Picano E, Gargiulo P, Petretta M, Cuocolo A, Prastaro M, D'amore C, Vassallo E, Savarese G, Marciano C, Paolillo S, Perrone Filardi P, Aggeli C, Felekos I, Roussakis G, Poulidakis E, Pietri P, Toutouzas K, Stefanadis C, Kaladaridis A, Skaltsiotis I, Kottis G, Bramos D, Takos D, Matthaios I, Agrios I, Papadopoulou E, Moulopoulos S, Toumanidis S, Carrilho-Ferreira P, Cortez-Dias N, Jorge C, Silva D, Silva Marques J, Placido R, Santos L, Ribeiro S, Fiuza M, Pinto F, Stoickov V, Ilic S, Deljanin Ilic M, Kim W, Woo J, Bae J, Kim K, Descalzo M, Rodriguez J, Moral S, Otaegui I, Mahia P, Garcia Del Blanco L, Gonzalez Alujas T, Figueras J, Evangelista A, Garcia-Dorado D, Takeuchi M, Kaku K, Otani K, Iwataki M, Kuwaki H, Haruki N, Yoshitani H, Otsuji Y, Kukucka M, Pasic M, Unbehaun A, Dreysse S, Mladenow A, Kuppe H, Hetzer R, Rajamannan N, Yurdakul S, Tayyareci Y, Tanrikulu A, Yildirimturk O, Aytekin V, Aytekin S, Kristiansson L, Gustafsson S, Lindmark K, Henein MY, Evdoridis C, Stougiannos P, Thomopoulos M, Fosteris M, Spanos P, Sionis G, Giatsios D, Paschalis A, Sakellaris C, Trikas A, Yong ZY, Boerlage-Van Dijk K, Koch K, Vis M, Bouma B, Piek J, Baan J, Abid L, Frikha Z, Makni K, Maazoun N, Abid D, Hentati M, Kammoun S, Barbier P, Staron A, Cefalu' C, Berna G, Gripari P, Andreini D, Pontone G, Pepi M, Ring L, Rana B, Ho S, Wells F, Yurdakul S, Tayyareci Y, Yildirimturk O, Dogan A, Aytekin V, Aytekin S, Karaca O, Guler G, Guler E, Gunes H, Alizade E, Agus H, Gol G, Esen O, Esen A, Turkmen M, Agricola E, Ingallina G, Ancona M, Maggio S, Slavich M, Tufaro V, Oppizzi M, Margonato A, Orsborne C, Irwin B, Pearce K, Ray S, Garcia Alonso C, Vallejo N, Labata C, Lopez Ayerbe J, Teis A, Ferrer E, Nunez Aragon R, Gual F, Pedro Botet M, Bayes Genis A, Santos CM, Carvalho M, Andrade M, Dores H, Madeira S, Cardoso G, Ventosa A, Aguiar C, Ribeiras R, Mendes M, Petrovic M, Petrovic M, Milasinovic G, Vujisic-Tesic B, Nedeljkovic I, Zamaklar-Trifunovic D, Petrovic I, Draganic G, Banovic M, Boricic M, Villarraga H, Molini-Griggs Bs C, Silen-Rivera Bs P, Payne Mph Ms B, Koshino Md Phd Y, Hsiao Md J, Monivas Palomero V, Mingo Santos S, Mitroi C, Garcia Lunar I, Garcia Pavia P, Castro Urda V, Toquero J, Gonzalez Mirelis J, Cavero Gibanel M, Fernandez Lozano I, Oko-Sarnowska Z, Wachowiak-Baszynska H, Katarzynska-Szymanska A, Trojnarska O, Grajek S, Bellavia D, Pellikka P, Dispenzieri A, Oh JK, Polizzi V, Pitrolo F, Musumeci F, Miller F, Ancona R, Comenale Pinto S, Caso P, Severino S, Cavallaro C, Vecchione F, D'onofrio A, Calabro' R, Maceira Gonzalez AM, Ripoll C, Cosin-Sales J, Igual B, Salazar J, Belloch V, Cosin-Aguilar J, Pinamonti B, Iorio A, Bobbo M, Merlo M, Barbati G, Massa L, Faganello G, Di Lenarda A, Sinagra GF, Ishizu T, Seo Y, Enomoto M, Kameda Y, Ishibashi N, Inoue M, Aonuma K, Saleh A, Matsumori A, Negm H, Fouad H, Onsy A, Hamodraka E, Paraskevaidis I, Kallistratos M, Lezos V, Zamfir T, Manetos C, Mavropoulos D, Poulimenos L, Kremastinos D, Manolis A, Citro R, Rigo F, Ciampi Q, Patella M, Provenza G, Zito C, Tagliamonte E, Rotondi F, Silvestri F, Bossone E, Monivas Palomero V, Mingo Santos S, Beltran Correas P, Gutierrez Landaluce C, Mitroi C, Garcia Lunar I, Gonzalez Mirelis J, Cavero Gibanel M, Gomez Bueno M, Segovia Cubero J, Beladan C, Matei F, Popescu B, Calin A, Rosca M, Boanta A, Enache R, Savu O, Usurelu C, Ginghina C, Ciobanu AO, Dulgheru R, Magda S, Dragoi R, Florescu M, Vinereanu D, Silva Marques J, Robalo Martins S, Jorge C, Calisto C, Goncalves S, Ribeiro S, Barrigoto I, Carvalho De Sousa J, Almeida A, Nunes Diogo A, Sargento L, Satendra M, Sousa C, Lousada N, Palma Reis R, Schiano Lomoriello V, Esposito R, Santoro A, Raia R, Schiattarella P, Dores E, Galderisi M, Mansencal N, Caille V, Dupland A, Perrot S, Bouferrache K, Vieillard-Baron A, Jouffroy R, Moceri P, Liodakis E, Gatzoulis M, Li W, Dimopoulos K, Sadron M, Seguela PE, Arnaudis B, Dulac Y, Cognet T, Acar P, Shiina Y, Gatzoulis M, Uemura H, Li W, Kupczynska K, Kasprzak J, Michalski B, Lipiec P, Carvalho V, Almeida AMG, David C, Marques J, Silva D, Cortez-Dias N, Ferreira P, Amaro M, Costa P, Diogo A, Tritakis V, Ikonomidis I, Paraskevaidis I, Lekakis J, Tzortzis S, Kadoglou N, Papadakis I, Trivilou P, Koukoulis C, Anastasiou-Nana M, Bombardini T, Picano E, Gherardi S, Arpesella G, Maccherini M, Serra W, Magnani G, Del Bene R, Pasanisi E, Sicari R, Startari U, Panchetti L, Rossi A, Piacenti M, Morales M, Mansencal N, El Hajjaji I, El Mahmoud R, Digne F, Dubourg O, Gargani L, Agoston G, Moreo A, Pratali L, Moggi Pignone A, Pavellini A, Doveri M, Musca F, Varga A, Picano E, Pratali L, Faita F, Rimoldi S, Sartori C, Alleman Y, Salinas Salmon C, Villena M, Scherrer U, Picano E, Sicari R, Baptista R, Serra S, Castro G, Martins R, Salvador M, Monteiro P, Silva J, Szudi L, Temesvary A, Fekete B, Kassai I, Szekely L, Abdel Moneim SS, Martinez M, Mankad S, Bernier M, Dhoble A, Pellikka P, Chandrasekaran K, Oh J, Mulvagh S, Hong GR, Kim JY, Lee SC, Choi SH, Sohn IS, Seo HS, Choi JH, Cho KI, Yoon SJ, Lim SJ, Lipiec P, Wejner-Mik P, Kusmierek J, Plachcinska A, Szuminski R, Kasprzak J, Stoebe S, Tarr A, Trache T, Hagendorff A, Mor-Avi V, Yodwut C, Jenkins C, Kuhl H, Nesser H, Marwick T, Franke A, Niel J, Sugeng L, Lang R, Gustafsson S, Henein M, Soderberg S, Lindmark K, Lindqvist P, Necas J, Kovalova S, Saha SK, Kiotsekoglou A, Toole R, Govind S, Gopal A, Amzulescu MS, Florian A, Bogaert J, Janssens S, Voigt J, Parisi V, Losi M, Parrella L, Contaldi C, Chiacchio E, Caputi A, Scatteia A, Buonauro A, Betocchi S, Rimbas R, Dulgheru R, Mihaila S, Vinereanu D, Caputo M, Navarri R, Innelli P, Urselli R, Capati E, Ballo P, Furiozzi F, Favilli R, Mondillo S, Lindquist R, Miller A, Reece C, O'leary P, Cetta F, Eidem BW, Cikes M, Gasparovic H, Bijnens B, Velagic V, Kopjar T, Biocina B, Milicic D, Ta-Shma A, Nir A, Perles Z, Gavri S, Golender J, Rein A, Pinnacchio G, Barone L, Battipaglia I, Cosenza A, Marinaccio L, Coviello I, Scalone G, Sestito A, Lanza G, Crea F, Cakal S, Eroglu E, Ozkan B, Kulahcioglu S, Bulut M, Koyuncu A, Acar G, Alici G, Dundar C, Esen A, Labombarda F, Zangl E, Pellissier A, Bougle D, Maragnes P, Milliez P, Saloux E, Aggeli C, Lagoudakou S, Felekos I, Gialafos E, Poulidakis E, Tsokanis A, Roussakis G, Stefanadis C, Nagy A, Kovats T, Apor A, Vago H, Toth A, Sax B, Kovacs A, Merkely B, Elnoamany MF, Badran H, Abdelfattah I, Khalil T, Salama M, Butz T, Taubenberger C, Thangarajah F, Meissner A, Van Bracht M, Prull M, Yeni H, Plehn G, Trappe H, Rydman R, Bone D, Alam M, Caidahl K, Larsen F, Staron A, Gasior Z, Tabor Z, Sengupta P, Liu D, Niemann M, Hu K, Herrmann S, Stoerk S, Morbach C, Knop S, Voelker W, Ertl G, Weidemann F, Cawley P, Hamilton-Craig C, Mitsumori L, Maki J, Otto C, Astrom Aneq M, Nylander E, Ebbers T, Engvall J, Arvanitis P, Flachskampf F, Duvernoy O, De Torres Alba F, Valbuena Lopez S, Guzman Martinez G, Gomez De Diego J, Rey Blas J, Armada Romero E, Lopez De Sa E, Moreno Yanguela M, Lopez Sendon J, Aggeli C, Felekos I, Poulidakis E, Trikalinos N, Siasos G, Aggeli A, Roussakis G, Stefanadis C, Tomaszewski A, Kutarski A, Tomaszewski M, Ikonomidis I, Lekakis J, Tritakis V, Tzortzis S, Kadoglou N, Papadakis I, Trivilou P, Anastasiou-Nana M, Koukoulis C, Paraskevaidis I, Vriz O, Driussi C, Bettio M, Pavan D, Bossone E, Antonini Canterin F, Doltra Magarolas A, Fernandez-Armenta J, Silva E, Solanes N, Rigol M, Barcelo A, Mont L, Berruezo A, Brugada J, Sitges M, Ciciarello FL, Mandolesi S, Fedele F, Agati L, Marceca A, Rhee S, Shin S, Kim S, Yun K, Yoo N, Kim N, Oh S, Jeong J, Alabdulkarim N. Poster Session 4: Friday 9 December 2011, 14:00-18:00 * Location: Poster Area. European Journal of Echocardiography 2011. [DOI: 10.1093/ejechocard/jer216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
|
25
|
Otsuka T, Suzuki M, Yoshikawa H, Hashimoto G, Ishida T, Osaki T, Itou N, Ono T, Yamamoto M, Sugi K, Zaidi A, Gati S, Sheikh N, Ghani S, Howes R, Sharma R, Sharma S, Esposito R, Schiano Lomoriello V, Santoro A, Raia R, Ippolito R, De Palma D, Galderisi M, Merino Sierra B, Bijnens B, Pare C, Azqueta M, Vidal B, Hernandez G, Yanguas X, Mont L, Brugada J, Sitges M, Mykland J, Skjorten I, Humerfelt S, Hansteen V, Melsom M, Hisdal J, Steine K, Elnoamany MF, Dawood A, Khalil T, Elhabeeby M, Smith B, Grapsa J, Dawson D, Coulter T, Rendon A, Gorissen W, Nihoyannopoulos P, Satendra M, Sargento L, Sousa C, Lousada N, Palma Reis R, Gual Capllonch F, Teis A, Lopez Ayerbe J, Ferrer E, Vallejo N, Gomez Denia E, Bayes Genis A, Landolff Q, Vallet C, Dominique S, Viacroze C, Kurtz B, Eltchaninoff H, Bauer F. Moderated Poster Sessions 3: Right ventricle in normal conditions and under pressure * Friday 9 December 2011, 08:30-12:30 * Location: Moderated Poster Area. European Journal of Echocardiography 2011. [DOI: 10.1093/ejechocard/jer213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
26
|
Khalil T, Lemaire JJ, Donnarieix D, Dedieu V, Pereira B, Thalami A, Kemeny JL, Chazal J, Verrelle P. Réponse tumorale et survie après radiochirurgie Linac de 50 gliomes malins intracrâniens récidivants. Neurochirurgie 2010. [DOI: 10.1016/j.neuchi.2010.10.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
27
|
Stoupa A, Khalil T, Brachet C. P022 - Triple A syndrome. Arch Pediatr 2010. [DOI: 10.1016/s0929-693x(10)70423-1] [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: 11/30/2022]
|
28
|
Mendes Martins V, Khalil T, Verelle P, Donnarieix D, Dedieu V, Irthum B, Chazal J, Lemaire JJ. Radiochirurgie par LINAC des schwannomes vestibulaires : résultats sur 38 patients consécutifs. Neurochirurgie 2008. [DOI: 10.1016/j.neuchi.2008.08.062] [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: 11/30/2022]
|
29
|
Willems A, Otte F, Fonteyne C, Jacobs A, Khalil T, Biarent D. Parents’ and physicians’ perception of pediatric emergency: A comparison. Resuscitation 2008. [DOI: 10.1016/j.resuscitation.2008.03.099] [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: 11/30/2022]
|
30
|
Lemaire JJ, Mendes-Martins V, Sakka L, Vassal F, Caire F, Coste J, Khalil T, Chazal J. Étude anatomique du thalamus en IRM à 4,7 Tesla et apport pour la segmentation manuelle des noyaux intra-thalamiques en chirurgie stéréotaxique. Neurochirurgie 2007. [DOI: 10.1016/j.neuchi.2007.09.018] [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]
|
31
|
Coste A, Khalil T, Lemaire JJ, Tao Y, Donnarieix D, Chazal J, Verrelle P. Radiochirurgie par Linac des métastases cérébrales d'origine rénale: résultats sur 19 patients consécutifs. Neurochirurgie 2007. [DOI: 10.1016/j.neuchi.2007.09.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
32
|
Toledano I, Khalil T, Gilliot O, Durando X, Bay JO, Tortochaux J, Bourry N, Kémény JL, Lapeyre M, Verrelle P. Association concomitante deradiothérapie témozolomide chezlespatients atteints deglioblastome: résultats d'une étude monocentrique rétrospective. Cancer Radiother 2007. [DOI: 10.1016/j.canrad.2007.09.130] [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]
|
33
|
Khalil T, Lemaire JJ, Chazal J, Verrelle P. [Role of radiosurgery in the management of intracranial cavernomas. Review of the literature]. Neurochirurgie 2007; 53:238-42. [PMID: 17498754 DOI: 10.1016/j.neuchi.2007.03.004] [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: 03/27/2007] [Indexed: 10/19/2022]
Abstract
From a review of the literature dealing with radiosurgery of cavernous malformations, we have analyzed its impact on hemorrhagic risk, epilepsy, histological modifications, morbidity and potential indications of treatment. Radiosurgery could significantly reduce the hemorrhagic risk, in a selected population with a high risk of hemorrhage, after an interval of about 2 years, but cannot provide protection against rebleeding. As for epilepsy related to the lesion, a significant reduction of seizures has been observed in certain cases, with better control in case of recent evolution and simple seizures linked to the site of the vascular malformation. Histologic lesions are vascular fibrosis, fibrinoid necrosis and ferrugination, without good correlation with results of CT scan or MRI. Morbidity of radiosurgery seems higher compared to other diseases with similar doses and target volumes. The rate of transient complications was about 25%, with permanent sequelae in 5 to 10% of patients. This would be due to a radiosensitizing effect of the hemosiderin halo around the lesion. Radiosurgery can be proposed for non-surgical lesions with a high risk of hemorrhage, nevertheless the superiority of the technique over conservative treatment has to be proven. Without long-term prospective studies, the efficiency of RS for cavernomas remains questionable and subject to debate. New imaging methods proving the obstruction of the cavernous malformation are needed.
Collapse
Affiliation(s)
- T Khalil
- Service de neurochirurgie A, hôpital Gabriel-Montpied, CHU, 63003 Clermont-Ferrand cedex, France.
| | | | | | | |
Collapse
|
34
|
Gilliot O, Khalil T, Irthum B, Zasadny X, Verrelle P, Tauveron I, Pontvert D. Radiotherapy of pituitary adenomas: state of the art. Annales d'Endocrinologie 2007; 68:337-48. [PMID: 17512895 DOI: 10.1016/j.ando.2007.03.012] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Received: 12/19/2006] [Revised: 02/26/2007] [Accepted: 03/13/2007] [Indexed: 11/26/2022]
Abstract
Pituitary adenomas represent approximately 12% of intracranial tumors. They are defined as tumors that are functional or nonfunctional and invasive or noninvasive. Therapeutic strategies rely on surgery, medical treatment, and radiotherapy depending on histology. Neither the role of external radiotherapy nor the technique to be used are firmly established. Nonfunctioning adenomas must be operated on to relieve the compression. Prolactin-secreting adenomas are first treated with dopamine agonists, and GH-secreting adenomas are first treated by surgery if excising the complete tumor is possible; otherwise medical treatment is started. The first-line treatment of ACTH-secreting adenomas is surgery; however, in many cases, insufficient control of either secretion or tumoral volume leads to consideration of irradiation. Complications of conventional radiotherapy are well known and fractionated stereotactic radiotherapy appears to be as safe as radiosurgery. The volume to irradiate is still difficult to define, and this parameter can influence the technique chosen for treatment. Because the indications of radiotherapy are still debated, irradiation of pituitary adenomas must be decided by the complete team of endocrinologists, neurosurgeons, radiologists and radiotherapists.
Collapse
Affiliation(s)
- O Gilliot
- Département d'oncologie-radiothérapie, centre Jean-Perrin, 58, rue Montalembert, BP 392, 63011 Clermont-Ferrand cedex 01, France.
| | | | | | | | | | | | | |
Collapse
|
35
|
Chomicki A, Sakka L, Avan P, Khalil T, Lemaire JJ, Chazal J. Dérivation du liquide cérébrospinal avec valve: ses conséquences sur la biomécanique de l'oreille interne chez les patients atteints d'hydrocéphalie chronique de l'adulte. Neurochirurgie 2007; 53:265-71. [PMID: 17559890 DOI: 10.1016/j.neuchi.2007.04.005] [Citation(s) in RCA: 8] [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] [Received: 11/17/2006] [Accepted: 04/10/2007] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND PURPOSE Patients suffering from hydrocephalus are often treated by the surgical placement of a shunt, directing the excess of cerebrospinal fluid towards another body compartment. However, the degree of clinical improvement is variable and the dynamics of cerebrospinal fluid pressure in shunted hydrocephalus is poorly understood. A recently developed noninvasive technique makes it possible to follow pressure variations: it is based on otoacoustic emissions, sounds naturally emitted by the cochlea and routinely detected in audiology. When cerebrospinal fluid pressure changes, emissions undergo a phase shift while crossing the oval window. The goal of this work is to study how this shift is affected by shunt placement. METHOD Otoacoustic emissions were recorded repeatedly in 22 adult patients who suffered from chronic hydrocephalus. Their phase shifts were measured, in sitting and recumbent positions, before and after surgical placement of a ventriculo-peritoneal shunt (Sophysa SM8). RESULTS Postural shift in normal subjects is a phase lead, and this outcome was found in 17 of 22 patients preoperatively. After shunt placement, the postural effect became a phase lag in 18 patients of 20. In a given posture, sitting or recumbent, phase shifts changed from pre to postoperative measurements in a systematic manner. CONCLUSION Otoacoustic emissions respond in a characteristic way to posture changes in normal adults, and having received a shunt for chronic hydrocephalus reverses the effect, presumably in relation to the existence of a "vacuum" in the inner ear.
Collapse
Affiliation(s)
- A Chomicki
- Laboratoire de biophysique sensorielle (EA 2667), faculté de médecine, université d'Auvergne, CHU de Clermont-Ferrand, PO Box 38, 63000 Clermont-Ferrand, France
| | | | | | | | | | | |
Collapse
|
36
|
Abstract
We describe the therapeutic indications for central nervous system cavernomas based on three criteria: 1) Single and multiple lesions: indications are the same, considering that in multiple lesions, one location can be symptomatic; 2) locations: indications are easy to define for exophytic cavernomas close to the hemisphere, brain stem or cerebellum pial surface, or to the ventricular ependyma; 3) symptomatic and non symptomatic presentations: usually, symptomatic forms require surgery except deep lesions located in functional zones distant from the ependyma or the pia matter, unless life prognosis is compromised. Treatment of a symptomatic forms remains debatable, opinion being divided between therapeutic abstention and surgery (in case of cavernomas close to the pia matter or the ependyma). Scientific data strongly support surgical indication for lesions presenting with epilepsy specially when drug-resistant; 4) natural history: prevention against hemorrhage is an argument in favor of surgery for the lesions located in non functional zones or where the risk of bleeding is higher, especially in the brain stem. Discrepancy in the risk of bleeding reported in the literature tends to temper this attitude. Radiosurgery is exceptionally reserved for technically inoperable cavernomas. Partial protection for two years can be expected. Epileptic seizures decrease but few prospective randomised studies are available. The rate of complication appears to be higher than in other affections.
Collapse
Affiliation(s)
- J Chazal
- Service de neurochirurgie A, hôpital Gabriel-Montpied, CHU de Clermont-Ferrand, BP 69, 63003 Clermont-Ferrand cedex 01, France.
| | | | | |
Collapse
|
37
|
Ghannane H, Khalil T, Sakka L, Chazal J. Analyse d'une série de cavernomes du système nerveux central: 39 cas non opérés, 39 cas opérés et un cas décédé. Neurochirurgie 2007; 53:217-22. [PMID: 17475289 DOI: 10.1016/j.neuchi.2007.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2007] [Accepted: 03/21/2007] [Indexed: 10/19/2022]
Abstract
Cavernomas are vascular malformations frequently localized in the central nervous system. Debate remains open concerning proper treatment. We reviewed a series of cavernomas in order to collect information concerning the natural history. This retrospective study concerned 79 patients seen over a 15-year period. The epidemiologic, clinical, radiological, therapeutic and follow-up data were analyzed. The cavernomas were encephalic (including brain stem and cerebellum) in 74 patients, and in the spinal cord in 5 patients. Average age was 40.08 years, without sex predominance. The most frequent clinical sign was a focal neurological deficit. The cavernoma was solitary in 71 patients. The subtentorial localization was most frequent (44 cases). Bleeding was observed in 31 patients giving a hemorrhagic risk of 0.013%/patient/year. One patient died at admission, 39 were operated and surgical abstention with clinical and radiological follow up was decided for 39 patients (no bleeding in 64.2%). The course in these patients was marked by bleeding in six during 29.5 months follow-up of (rate of hemorrhagic risk 6.27%/patient/year). These results are not in total agreement with the literature. They demonstrate the difficulties for an exact evaluation of the hemorrhagic risk in cavernomas of the central nervous system. So, it is very important to meticulously discuss surgical indications.
Collapse
Affiliation(s)
- H Ghannane
- Service de neurochirurgie A, hôpital Gabriel-Montpied, Clermont-Ferrand, France.
| | | | | | | |
Collapse
|
38
|
Tchirkov A, Khalil T, Chautard E, Mokhtari K, Véronèse L, Irthum B, Vago P, Kémény JL, Verrelle P. Interleukin-6 gene amplification and shortened survival in glioblastoma patients. Br J Cancer 2007; 96:474-6. [PMID: 17224923 PMCID: PMC2360031 DOI: 10.1038/sj.bjc.6603586] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Interleukin-6 (IL-6) is known to promote tumour growth and survival. We evaluated IL-6 gene amplification in tumours from 53 glioma patients using fluorescence in situ hybridisation. Amplification events were detected only in glioblastomas (15 out of 36 cases), the most malignant tumours, and were significantly associated with decreased patient survival.
Collapse
Affiliation(s)
- A Tchirkov
- EA 3846, Université d'Auvergne, Clermont-Ferrand, F-63001, France.
| | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Abstract
An 18-year-old woman underwent an (111)In octreotide scan for evaluation of a possible insulinoma. This showed mildly increased radiopharmaceutical uptake involving the right lung base. The patient reported a productive cough for 5 days before the octreotide scan. A chest radiograph was taken, which showed increased airspace opacification in the right lower lobe, corresponding to the uptake seen on the octreotide scan. After a course of oral antibiotics, the patient's chest symptoms improved and the radiograph opacification resolved, confirming the diagnosis of community-acquired pneumonia. This case stresses the need to correlate scan results with the patient's presentation and symptoms to avoid false-positive data.
Collapse
Affiliation(s)
- T Yenson
- Department of Nuclear Medicine and Ultrasound, Westmead Hospital, Wentworthville, NSW, Australia
| | | | | |
Collapse
|
40
|
Biarent D, Otte F, Fonteyne C, Khalil T. [The future of pediatric intensive care]. Rev Med Brux 2006; 27 Spec No:Sp39-Sp43. [PMID: 21818892] [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: 05/31/2023]
Abstract
Paediatric intensive care is born 40 years ago. It has been shown that admission of critically ill children in intensive care (ICU) where no paediatric intensivists worked increased significantly the mortality and the length of stay. The recognition of Paediatric Intensive Care (PICU) does not exist in Belgium and children are admitted in both adult and paediatric intensive care units. It is mandatory to recognise the PICU specificity and the usefulness of a fellowship in paediatric intensive care. Development of molecular biology and genetics will permit in the near future to understand reversible and irreversible cellular processes of the majority of problems responsible for mortality in critical care and to allow the development of new diagnostic and therapeutic techniques. Rapid development of information will permit the creation of multicenter databases including all PICU's data. The final goal is an intelligent tool for making decision process. Telemedecine is born which permits a virtual consultation of the patient. Technological progress must not impair the wellbeing of the child and its family. The PICU of the future must be "parents admitted". PICU profile is progressively changing, the way of taking care of the critically ill child and its family is also changing and improving. An ethical reflexion among the health care providers' team and a dialogue with parents will blossom.
Collapse
Affiliation(s)
- D Biarent
- Unité de Soins Intensifs Pédiatriques, Hôpital Universitaire des Enfants Reine Fabiola, ULB
| | | | | | | |
Collapse
|
41
|
Abstract
Radiosurgery of oligodendrogliomas is not specific. It must be integrated into the overall treatment scheme for gliomas which remains to be strictly defined. Nevertheless, empirically, and in light of the limited constraints for the patient and the encouraging radiological and clinical benefits, radiosurgical teams usually propose this technique in the event of recurrence of malignant gliomas, as a second line treatment. Exceptionally radiation can be used for some small benign gliomas which could not be treated by open surgery and accurately defined radiologically. Radiosurgery can achieve local control of the lesion, mostly transitionally, with 15 to 18 Gy at the reference isodose. One of the key problems is the definition of the glioma boundaries. Despite progress in neuroimaging techniques most the limits of malignant forms are still not accessible. In routine practice, the nodular area, considered as the most active on MRI, i.e. the contrast enhanced area, is accepted as the target. Its widest dimension must be about 35-40 mm. Only patients with minimal disability can benefit from radiosurgery. Optimization of the target definition (in particular the most active zone) and prospective randomized studies should be helpful in clarifying indications for this technique.
Collapse
Affiliation(s)
- J-J Lemaire
- Service de Neurochirurgie A, CHU, Clermont-Ferrand.
| | | | | | | |
Collapse
|
42
|
Khalil T, Achim V, Bard J, Tao Y, Verrelle P, Chazal J, Lemaire J. Radiochirurgie dans les gliomes malins récidivants hémisphériques de l’adulte. À propos de 16 Patients traitées par LINAC. Neurochirurgie 2005. [DOI: 10.1016/s0028-3770(05)83428-9] [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]
|
43
|
Khalil T, Puget S, Lemaire JJ, Chazal J, Irthum B. [Spontaneous intrasphenoidal encephalocele. Report of two cases revealed by rhinorrhea]. Neurochirurgie 2003; 49:114-8. [PMID: 12746728] [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: 03/02/2023]
Abstract
We report two cases of spontaneous anteromedial temporo-sphenoidal meningo-encephalocele. The first patient was a 67-year-old man with a history of treated epiglotic cancer 6 years ago, was referred to us for CSF rhinorrhea. Lateral sphenoidal CSF fistula was confirmed by CT cisternography. Four lumbar taps were performed and rhinorrhea stopped for 2 years. At relapse of rhinorrhea, the patient was operated on via a subtemporal approach. The dural defect was filled by an intradural patch of pericranium. Four years later patient showed no evidence of cerebrospinal fluid leakage. The second patient was a 54-year-old woman referred to us after a one year history of CSF rhinorrhea. CT cisternography confirmed lateral sphenoidal CSF fistula. The patient was operated on via a subtemporal approach. The dural defect was filled by a patch of pericranium. Three years later the patient had no evidence of cerebrospinal fluid leakage. Twenty-one cases of anteromedial temporosphenoidal meningo-encephaloceles have been reported in the literature. They probably are of a developmental origin. Some cases have been successfully treated via a transsphenoidal route. However surgical failures related to this approach can be due to the lack of control of the lateral recess of the sphenoid sinus. Therefore, the frontotemporal approach seems more adequate but the transphenoidal endoscopic approach will probably be used in the future.
Collapse
Affiliation(s)
- T Khalil
- Service de Neurochirurgie, Hôpital Gabriel-Montpied, CHU, BP 69, 63003 Clermont-Ferrand Cedex 1.
| | | | | | | | | |
Collapse
|
44
|
Tchirkov A, Rolhion C, Kémény JL, Irthum B, Puget S, Khalil T, Chinot O, Kwiatkowski F, Périssel B, Vago P, Verrelle P. Clinical implications of quantitative real-time RT-PCR analysis of hTERT gene expression in human gliomas. Br J Cancer 2003; 88:516-20. [PMID: 12592364 PMCID: PMC2377176 DOI: 10.1038/sj.bjc.6600754] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
The presence of telomerase activity in a glioma may be a predictor of its malignant potential. Activation of telomerase is regulated at the transcriptional level of the human telomerase reverse transcriptase (hTERT). Here, we evaluated whether the amount of hTERT mRNA provides a molecular marker of glioma malignancy that would have clinical utility. We used a real-time RT-PCR to assess the number of hTERT transcripts in primary tumour samples derived from 70 glioma patients. Results were standardised by quantifying the number of ABL transcripts as internal control and expressed as hTERT/ABL ratio. The percentage of patients with detectable hTERT mRNA markedly increased with enhanced malignancy: low-grade gliomas expressed hTERT in one out of 14 cases (7.1%), anaplastic gliomas in four out of 13 cases (30.8%) and glioblastoma multiforme (GBM) tumours in 30 out of 43 cases (69.8%). The mean hTERT/ABL ratio was significantly higher in GBMs than in non-GBMs. Subdividing hTERT/ABL ratios as low (< pr = 25%) and high (>25%), we found that the overall survival among hTERT-positive GBMs was significantly worse in high hTERT expressors than in low hTERT expressors (P=0.0082). We conclude that the amount of hTERT mRNA may represent a diagnostic and prognostic indicator for GBM patients.
Collapse
Affiliation(s)
- A Tchirkov
- Département de Radiothérapie, Centre Jean Perrin, Clermont-Ferrand, France.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Khalil T, Schmidtke B, Drescher M, Müller N, Heinzmann U. Experimental verification of quadrupole-dipole interference in spin-resolved photoionization. Phys Rev Lett 2002; 89:053001. [PMID: 12144439 DOI: 10.1103/physrevlett.89.053001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2002] [Indexed: 05/23/2023]
Abstract
We have measured the spin polarization of Xe (4p)(-1) photoelectrons after ionization with circularly polarized light at photon energies close to the ionization threshold where a resonant enhancement of quadrupole transitions has recently been predicted. At a reaction angle of 90 degrees a nonvanishing longitudinal spin polarization component of about 4% clearly indicates a quadrupole contribution to the photoexcitation. This is the first experimental evidence for the influence of nondipole transitions on the photoionization process at excitation energies much below 1 keV in an observable other than the intensity angular distribution.
Collapse
Affiliation(s)
- T Khalil
- Universität Bielefeld, Fakultät für Physik, Universitätsstrasse 25, 33615 Bielefeld, Germany
| | | | | | | | | |
Collapse
|
46
|
Abstract
Slowly varying pressure oscillations in the cranial enclosure are well known, especially intracranial pressure waves as best described by the pioneering works of Janny and Lundberg. Nevertheless, in spite of over twenty five years research on intracranial pressure waves, their origin and regulation remain unclear but are often considered only as pathological. Our aim was to review data on these phenomena to clarify their biological status and the role that they could play in the management of patients suffering from such intracranial neurosurgical diseases as intracranial hypertension, severe head injury, and hydrocephalus. It appears that these pressure waves reveal important information on the function of the cerebral vasculature and as such have significance for influencing intracranial compliance. Pressure waves are also closely associated with autoregulation, in particular dynamic autoregulation. It seems evident that they are not only pathophysiological but also physiological, linked with other biological parameters such as the neurovegetative cardiovascular system, breathing, and sleeping. This study shows that it is not only important to continue to explore these slow waves, but also the methods of analysis in order to more fully clarify their clinical significance.
Collapse
Affiliation(s)
- J J Lemaire
- Department of Neurosurgery, University Hospital, Clermont-Ferrand, France
| | | | | | | | | | | | | | | |
Collapse
|
47
|
Abstract
The field of orthotics has gained scientific attention over the last few years. Its objective is to correct, adjust, or modify the operation of human limbs, joints, or muscles. Thoracolumbosacral orthosis (TLSO) braces are used by scoliosis and postoperative patients who need back correction and/or support. The anatomic dimensions for TLSO braces have been acquired mainly by casting the patient. Casting is a time-proven method for obtaining surface geometry, but it can be inconvenient in certain situations. For example, casting might not be suitable for postoperative and trauma patients owing to the risk of further injury. Such prohibitive cases can still be handled safely by X-ray CT or MR scanning. This article presents an alternative method for data acquisition of TLSO patients' anatomic dimensions using CT/MRI. The experimental results show the method to be statistically accurate, efficient, and feasible compared with the conventional casting method.
Collapse
Affiliation(s)
- H Eldeeb
- BioSculptor Corporation, Department of Industrial Engineering, University of Miami, Coral Gables, FL 33124-0623, USA
| | | | | | | | | |
Collapse
|
48
|
Böwering N, Lischke T, Schmidtke B, Müller N, Khalil T, Heinzmann U. Asymmetry in photoelectron emission from chiral molecules induced by circularly polarized light. Phys Rev Lett 2001; 86:1187-1190. [PMID: 11178040 DOI: 10.1103/physrevlett.86.1187] [Citation(s) in RCA: 149] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2000] [Indexed: 05/23/2023]
Abstract
In photoionization of free, unoriented chiral molecules with circularly polarized radiation, a significant circular dichroism, i.e., an asymmetry in the forward-backward electron emission, has been observed in the photoelectron angular distribution. This leads also to an asymmetry in the momentum transfer to the photoions. The spectra for the left- and right-handed enantiomers of bromocamphor exhibit asymmetries up to several percent which vary as a function of orbital binding energy. This enantioselective effect can similarly occur for biomolecules with handedness, like amino acids, and may thus be a contributing factor related to the origin of the terrestrial biomolecular homochirality.
Collapse
|
49
|
Sinardet D, Chabane A, Khalil T, Seigneuret E, Sankari F, Lemaire JJ, Chazal J, Irthum B. [Neurological outcome of 152 surgical patients with spinal metastasis]. Neurochirurgie 2000; 46:4-10. [PMID: 10790638] [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: 02/16/2023]
Abstract
BACKGROUND AND PURPOSE The aim of this study is to evaluate retrospectively the benefit of the surgical spinal decompression in 152 patients with spinal metastasis. METHODS Based on clinical notes and GP inquiry, we determined the actuarial survival curve, and assessed the pain level one month post-operatively and the motor, the sensory and sphincter distrurbances three months after surgery. RESULTS Thoraco-lumbar lesions were usually treated using a posterior approach, with a laminectomy and if necessary an osteosynthesis. Cervical lesions were treated with an anterior approach, i.e. a corporectomy and a methylmetacrylate stabilization. Sixty eight percent of patients (103/152) had pre or postoperative radiotherapy. After the surgical decompression for a spinal metastasis, our study demonstrated an improvement in sensory status (31 % of the patients), in motor ability (56 %), in sphincter function (51 %), and a decrease in the pain intensity in 47 % of the patients. Among 83 patients who could not walk on admission (grade A, B and C of Frankel), 52 % recovered a gait function 3 months post operatively. The best benefit after surgery concerned grade C patients, of which 71 % recovered the gait function. Two percent of the patients had postoperative worsening of their motor strength. No operative mortality was noted, and the postoperative mortality rate was 3 % at 7 days and 9 % at 30 days. The analysis of the actuarial survival curve demonstrated a mean follow up of 3.7 years. The mean survival time was 12 months with 25 % of patients surviving 2 years. CONCLUSION Surgical decompression is effective in relieving neurological symptoms from spinal metastasis. In our experience a complete motor deficit does not seem to be a good surgical indication because of the lack of postoperative improvement.
Collapse
Affiliation(s)
- D Sinardet
- Service de Neurochirurgie, Hôpital Gabriel-Montpied, BP 69, 63003 Clermont-Ferrand Cedex
| | | | | | | | | | | | | | | |
Collapse
|
50
|
Fishbain DA, Cutler RB, Rosomoff HL, Khalil T, Steele-Rosomoff R. Prediction of "intent", "discrepancy with intent", and "discrepancy with nonintent" for the patient with chronic pain to return to work after treatment at a pain facility. Clin J Pain 1999; 15:141-50. [PMID: 10382929 DOI: 10.1097/00002508-199906000-00012] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We previously determined that "intent" to return to work post pain facility treatment is the strongest predictor for actual return to work. The purposes of the present study were the following: to identify variables predicting "intent"; to predict membership in the "discrepant with intent" group [those chronic pain patients (CPPs) who do intend to return to work but do not]; and to predict membership in the "discrepant with nonintent" group (those CPPs who do not intend to return to work but do). DESIGN A total of 128 CPPs completed a series of rating scales and yes/no questions relating to their preinjury job perceptions and a question relating to "intent" to return to the same type of preinjury job post-pain facility treatment. These CPPs were part of a grant study for prediction of return to work, and therefore their work status was determined at 1, 3, 6, 12, 18, 24, and 30 months posttreatment. Preinjury job perceptions and other demographic variables were utilized using stepwise discriminant analysis to identify variables predicting "intent" and predicting membership in the "discrepant with intent" and "discrepant with nonintent" groups. SETTING Pain facility (multidisciplinary pain center). PATIENTS Consecutive low back pain CPPs, mean age 41.66+/-9.54 years, with the most frequent highest educational status being high school completion (54.7%) and 60.2% being worker compensation CPPs. RESULTS "Intent" was predicted by (in decreasing order of probability) postinjury job availability variables, job characteristic variables, and a litigation variable. "Discrepant with intent" was predicted by (in decreasing order of probability) for the 1-month follow-up time point, postinjury job availability variables, pain variables, a litigation variable, and a function perception variable, and for the final follow-up time point, pain variables only. "Discrepant with nonintent" was predicted by (in order of decreasing probability) for the 1-month follow-up time point, a job availability variable, a demographic variable, and a functional perception variable, and for the final follow-up time point a pain variable and a job availability variable. The percentage of CPPs correctly classified by each of these analyses was as follows: "intent" 81.25%, "discrepant with intent" 87.01% (at 1-month follow-up) and 74.03% (final follow-up), "discrepant with nonintent" 92.16% (at 1-month follow-up) and 75.00% (final follow-up). CONCLUSIONS CPPs intentions of returning to their preinjury jobs are mainly determined by job availability and job characteristic variables but surprisingly not by pain variables. However, the results with "discrepant with intent" and "discrepant with nonintent" groups indicate that actual return to work is determined by an interaction between job availability variables and pain variables with pain variables predominating for long-term outcome.
Collapse
Affiliation(s)
- D A Fishbain
- Department of Psychiatry, University of Miami School of Medicine and Comprehensive Pain and Rehabilitation Center at South Shore Hospital, Florida 33139, USA
| | | | | | | | | |
Collapse
|