Cardiac compression by a thymic cyst.
A patient with a giant thymic cyst, causing cardiac compression, is presented. Thymic cysts are uncommon and often asymptomatic.
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Biomedical subjects
C Dubois
Publications and source records attributed to C Dubois.
Early chronic ethanol exposure in rats disturbs respiratory network activity and increases sensitivity to ethanol.
Chronic ethanol exposure during the fetal period alters spontaneous neuronal discharge, excitatory and inhibitory amino acid neurotransmission and neuronal sensitivity to ethanol in the adult brain. However, nothing is known about the effects of such exposure on the central respiratory rhythmic network, which is highly dependent on ethanol-sensitive amino acid neurotransmission. In 3- to 4-week-old rats, we investigated (1) the effects of chronic ethanol exposure (10% v/v as only source of fluid) during gestation and lactation on phrenic (Phr) and hypoglossal (XII) nerve activity using an in situ preparation and on spontaneous breathing at rest in unanaesthetized animals using plethysmography; (2) the sensitivity of the respiratory system to ethanol re-exposure in situ; and (3) the phrenic nerve response to muscimol, a GABA(A) receptor agonist, applied systemically in an in situ preparation. In control rats, ethanol (10-80 mm) induced a concentration-dependent decrease in the amplitude of both XII and Phr motor outflows. At 80 mm ethanol, the amplitude of the activity of the two nerves displayed a difference in sensitivity to ethanol and respiratory frequency increased as a result of shortening of postinspiratory duration period. After chronic ethanol exposure, respiratory frequency was significantly reduced by 43% in situ and by 23% in unanaesthetized animals, as a result of a selective increase in expiratory duration. During Phr burst, the ramp was steeper, revealing modification of inspiratory patterning. Interestingly that re-exposure to ethanol in situ elicited a dramatic inhibitory effect. At 80 mm, ethanol abolished rhythmic XII nerve outflow in all cases and Phr nerve outflow in only 50% of cases. Furthermore, administration of 50 microm muscimol abolished Phr nerve activity in all control rats, but only in 50% of ethanol-exposed animals. Our results demonstrate that chronic ethanol exposure at an early stage of brain development depresses breathing in juvenile rats, and sensitizes the respiratory network to re-exposure to ethanol, which does not seem to involve GABAergic neurotransmission.
Animals↗
[Retraining between months 4 and 6 after anterior cruciate ligament reconstruction with hamstring graft: comparison between cycling and running with an untrained operated subject group].
OBJECTIVE: To study the effect of cycling or running retraining between 4 and 6 months after patients underwent anterior cruciate ligament reconstruction with hamstring grafting (Semitendinosus-Gracilis) compared with that in patients who had the same surgery but were untrained. METHOD: Patients who had undergone surgery for an anterior cruciate ligament reconstruction by the same surgeon who used hamstring grafting were included if they were free of knee pain 4 months after the surgery. After giving consent, patients were randomized to receive controlled retraining (cycling or running 3 times a week) or not. The effect of retraining was measured by the evolution of the knee isokinetic peak torque at 60 degrees/s and 180 degrees/s 6 months after surgery. RESULTS: Fifteen patients were retrained with cycling (GI), 17 with running (GII) and 15 patients did not retrain (GIII). Before retraining, the 3 groups had the same peak torque deficit, measured at an angular speed of 60 degrees/s and 180 degrees/s, for knee extensors (GI: 33+/-11% and 27+/-8%; GII: 30+/-13% and 24+/-10%; GIII: 31+/-15% and 24+/-13%, respectively) and knee flexors (GI: 26+/-11% and 20+/-13%; GII: 20+/-14% and 17+/-13%; GIII: 19+/-15% and 14+/-15%, respectively). After retraining, progress measured at 60 degrees /s of knee extensors and flexors on the operated knees was 18+/-9% and 16+/-10% for GI, 16+/-9% and 11+/-11% for GII and 12+/-15% and 8+/-12 for GIII, respectively. Progress measured at 180 degrees /s followed the same evolution. After comparison of the 3 groups, any significant difference was put in relief according to the type of retraining. CONCLUSION: Retraining after anterior cruciate ligament reconstruction is necessary for patients to practice their previous sport. In our study, aerobic cycling or running between 4 and 6 months after surgery did not improve peak torque in the operated knee extensors and flexors. However, these 2 types of retraining are well-tolerated.
Adult↗
[Consequences of pain on isokinetic performance after anterior cruciate ligament reconstruction using a semitendinosus and gracilis autograft].
PURPOSE OF THE STUDY: The purpose of this study was to investigate isokinetic performance of the knee twelve months after ligamentoplasty of the anterior cruciate ligament using four-strand hamstring autografts. We wanted to ascertain the effect of exercise-induced postoperative pain. MATERIAL AND METHODS: Between January 2001 and January 2003, at total of 75 patients underwent arthroscopic hamstring ligamentoplasty performed by the same surgeon. Isokinetic measurements were obtained at 4, 6, and 12 months postoperatively. At four months, four subpopulations were identified depending on the presence or not of exercise-induced pain. RESULTS: Fifty-two patients were pain free, seven presented exercise-induced posterior pain, nine exercise-induced anterior pain and seven diffuse pain with more than 5 degrees limitation of extension and 10 degrees for flexion. Isokinetic measurements at an angular speed of 60 degrees /s performed at the fourth postoperative month were compared with the pain-free population and demonstrated a significant flexion deficit in patients with exercise induced posterior pain (32% vs 18%, p = 0.04), significant extension deficit in patients with exercise-induced anterior pain (45% vs 30%, p = 0.02), and significant deficit in extension (58% vs 30%, p = 0.001) and flexion (39% vs 18%, p = 0.01) in patients with diffuse pain and limited joint motion. Certain deficits persisted one year after surgery. Patients did not achieve their prior level in contact pivot sports if they presented exercise-induced anterior pain. The population with diffuse pain and limited joint motion only resumed line sports. DISCUSSION: It is not easy to ascertain the origin of knee pain after ligamentoplasty. Posterior pain at the harvesting site occurs after hamstring reconstruction (defective regeneration or incomplete disinsertion with muscle retraction). The hamstring technique can also lead to anterior pain involving all the structures of the extension system. Diffuse pain with limited joint motion is related to "minor" reflex dystrophy. CONCLUSION: A mean 10% extensor and flexor isokinetic deficit can be expected one year after four-strand hamstring ligamentoplasty. Isokinetic tests performed four months postoperatively in patients with exercise-induced pain can provide objective evidence of difficult recovery. Posterior exercise-induced pain is associated with a flexion deficit of more than 30%. Anterior pain with exercise is associated with 45% deficit in extension. Diffuse pain with limited joint motion is associated with more than 40% in flexion and more than 55% in extension. These quantitative results enable the surgeon to inform the patient concerning potential sports level after repair since recovery will be longer with greater deficit.
Adult↗
[Long term results for the ATS valve, the first open pivot valve: 182 cases].
Between May 1995 and May 2004, 197 ATS valves were implanted in 182 patients: 120 males and 62 females with an average age of 58 +/- 13 years. 149 cases were for aortic valvular replacement and 48 cases were for the mitral valve. Fifteen patients had a double mitral and aortic replacement. Twelve tricuspid procedures were necessary, 17 patients underwent coronary revascularisation and 58 underwent an aortic procedure (Bentall, aortic sub-coronary, aortic cross). The in-hospital mortality (31 days) was 1.6%. The long term mortality at up to 9 years included 23 deaths. No death was attributed to the ATS valve. Nine thrombo-embolic events occurred, but six were minor. One mitral valve thrombosis was due to the voluntary cessation of anticoagulants and another was linked to a reduction in anticoagulant treatment. There were ten haemorrhagic events. They were all linked with an organic visceral lesion. Only one death was recorded. All patients received standard anticoagulant treatment with a target INR between 2.5 and 4. 155 patients were asked about the problem of valve noise. 139 (89.6%) stated that they did not notice any noise from their valves in everyday life. Conclusions The ATS valvular prosthesis is currently the only open pivot valve, fundamentally differentiating it from other valves with 2 leaflets. As a result of this, it has a very low rate of thrombo-embolic complications and a reduction in anticoagulant treatment could therefore be envisaged (Westaby, Van Nooten, Stefanidis). The haemodynamic characteristics are excellent and the ease of rotation of the leaflets allows optimal orientation. Finally, thanks to its structural characteristics, there is less leaflet closure noise and it is less perceptible than with other prostheses. It therefore offers an excellent quality of life.
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[Detraining and retraining after injury in a high-level cyclist].
OBJECTIVE: To define retraining after injury in a high-level cyclist by taking into account the consequences of detraining. METHOD: From three clinical cases and from the analysis of the consequences of detraining, three principles of retraining were determined. RESULTS: 1. The high-level cyclist is not protected and loses cycling capacity after four weeks of inactivity. The delay in recovery is longer the higher the adaptations. 2. Recovery of cycling capacity is based on bicycle exercises that are greater in intensity than quantity, taking into account delays in injury consolidation. 3. Retraining requires appreciating the individual physiological level by evaluating force and endurance before envisaging the resumption of training and competition. CONCLUSION: The injury of a high-level cyclist is at the origin of detraining, which has been evaluated so that sports rehabilitation may enable the cyclist to find a previous state without relapse, complication or overtraining.
Adult↗
[Imaging of adrenal ganglioneuroma: a case report].
The authors report a case of adrenal ganglioneuroma diagnosed in a young woman with melanoma. This benign hormone silent tumor arises from neural crest tissue. The imaging features at US, CT and MRI are described. Diagnosis was confirmed at CT guided biopsy.
Adrenal Gland Neoplasms↗
Images in cardiology: Coronary fistula: a rare case of right heart failure.
Explore the source record for details and available documents.
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[The PACIFIQUE registry in post PCI patients: study protocol].
This paper presents the protocol of the PACIFIQUE survey, carried out in the most important French interventional cardiology centres (>600 procedures/year) during a 2-week period in January 2004, in order to determine actual practices in terms of medical management at hospital discharge and 6-month follow-up in patients treated with coronary angioplasty.
Angioplasty, Balloon, Coronary↗
[Stress fracture in athletes and prevalence of extensive rehabilitation].
OBJECTIVE: The aim of this work was to review the literature for the place of extensive rehabilitation for athletes with stress fractures. METHOD: We searched the Medline and Embase databases using the keywords stress fracture, sports, rehabilitation, management and treatment. Only French and English articles were included, and articles about bone physiology, animal models, and spine and chest localisations were excluded. From 468 scientific articles, 62 were chosen because they corresponded to literary reviews or to therapeutic evaluations. RESULTS: Treatment of stress fracture is justified according to risk factors, stress-fracture complications, the precocity of diagnosis, the therapeutic method and when the athlete needs to return to the sport. The most common treatment is discontinuing the sport, followed by rest. The progressive resumption of sport is rarely described but must take into account mechanical constraints that can be controlled by the use of shoes adapted to a supple ground. Some treatments such as immobilization by pneumatic splint surgery or use of electric fields are controversial. CONCLUSION: Extensive treatment of stress fractures is mainly dedicated to high-level athletes who need to regain previous physical capacities as soon as possible.
Athletic Injuries↗
[Is it possible to propose the abolition of crutches according to the gait speed in patients with total knee arthroplasty?].
OBJECTIVE: To determine the stop of crutches to walk in patients with total knee arthroplasty from the test of maximal gait speed. METHOD: 46 patients (73.6 +/- 4.6 years) carried out the maximal gait speed test on a 10-meter track, with two crutches, at the 3rd week after a total knee arthroplasty surgery for gonarthrosis. Two groups were separated according to the need of crutches to walk. Various threshold values of maximal gait speed were then determined (ROC curve) to know if this parameter could define the stop of crutches to walk (Predictive value). RESULTS: Patients able to stop crutches (n = 27) walk faster, than the patients who still need crutches (n = 19), (0.86 +/- 0.17 m/s vs 0.65 +/- 0.14 m/s; p < 0.01). According to the ROC curve, two speeds were chosen: 1.11 m/s (9 s) and 0.55 m/s (18 s). A gait speed superior or equal to 1.11 m/s presents a positive predictive value of 86% to authorize to stop crutches. Below 0.55 m/s, the positive predictive value is 83% to keep crutches. Between these two speeds, the test of maximal gait speed does not help the clinician to decide to stop crutches. CONCLUSION: The test of maximal gait speed brings a help to decide to stop crutches only for speeds superior to 1.11 m/s.
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[Rehabilitation after shoulder rotator cuff surgery: in-patient or day-hospitalization (about 76 cases)].
OBJECTIVE: To define criteria of orientation in day-hospitalized or in-patient after shoulder rotator cuff surgery. METHOD: Population of 71 patients (53.2 years +/-7) (76 shoulders) operated for rotator cuff tear by the same surgeon, then treated by physical therapy either in day-hospitalization or in-patient. Weekly, evaluation until the second month after surgery by setting as criteria: pain, passive and active range of motion and complications. RESULTS: Fifty-three shoulders benefited from rehabilitation therapy in hospitalization and 23 in day-hospitalization. There is no significant difference for criteria studied between the 2 populations except for pains at the fifteenth day after surgery. Pain and articular steepness seem more frequent if the surgery is complex. DISCUSSION: Day-hospitalization and in-patient give equivalent results, which explain themselves by the possibility of identical physical medicine and rehabilitation performances. The knowledge of the social context is important to choose the most adapted rehabilitation type because patients can benefit from assistance for the acts of the daily life and the domestic tasks. In-patient allows more comfort but implies a familial break.
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[Orientation after peripartum asphyxia in the maternity ward: which infants should be transferred to pediatric care units?].
Per-partum anoxia is a frequent situation facing the pediatrician in the maternity ward. The question is to decide which infants require care in a specialized unit. If transfer is decided, the infant must be referred to an appropriate pediatric unit (intensive care or neonatal unit). Cases of severe anoxia are exceptional. Intermediary situations are however much more frequent and raise difficult evaluation problems due to the lack of any specific test. The pediatrician must rely on a combination of elements from the clinical presentation, the medical history, the clinical course, and laboratory tests. Different elements suggest a prudent approach with referral to a pediatric unit. These elements include: imperfect clinical recovery (5-min Agpar <7), major intensive care at delivery (intubation, ventilation, vasoactive agents), anomalies in the cord blood or first hour blood tests (cord pH<7, base deficit 12, cord or blood lactate 9 mmol/l). Obstetrical circumstances which led to per-partum anoxia must be well identified because those interrupting placental flow (abruptio placenta, uterine rupture) suggest prudence is necessary even if the infant appears to have recovered well. All neonatal disorders (macrosomia, prematurity, infection, respiratory distress) increase the risk of rapid decompensation and may argue for hospitalization. Likewise, if even minimal signs of neurological, respiratory or hemodynamic disorders are present from birth to two hours, surveillance in a specialized unit is required, the level depending on local facilities. Certain situations nevertheless always require referral to a pediatric intensive care unit: use of vasoactive drugs, respiratory distress, abnormal neurological exam, poor recovery (5-min Agpar <4).Finally, it must be remembered that per-partum anoxia is rarely predictable and can occur any at any time of day or night. The pediatrician must also train other delivery room personnel, including the midwives, in intensive care techniques.
Apgar Score↗
Detection of explosives and their degradation products in soil environments.
Polynitro organic explosives [hexahydro-1,3,5-trinitro-1,3,5-triazine (RDX), octahydro-1,3,5,7-tetranitro-1,3,5,7-tetrazocine (HMX) and 2,4,6-trinitrotoluene (TNT)] are typical labile environmental pollutants that can biotransform with soil indigenous microorganisms, photodegrade by sunlight and migrate through subsurface soil to cause groundwater contamination. To be able to determine the type and concentration of explosives and their (bio)transformation products in different soil environments, a comprehensive analytical methodology of sample preparation, separation and detection is thus required. The present paper describes the use of supercritical carbon dioxide (SC-CO2), acetonitrile (MeCN) (US Environmental Protection Agency Method 8330) and solid-phase microextraction (SPME) for the extraction of explosives and their degradation products from various water, soil and plant tissue samples for subsequent analysis by either HPLC-UV, capillary electrophoresis (CE-UV) or GC-MS. Contaminated surface and subsurface soil and groundwater were collected from either a TNT manufacturing facility or an anti-tank firing range. Plant tissue samples were taken fromplants grown in anti-tank firing range soil in a greenhouse experiment. All tested soil and groundwater samples from the former TNT manufacturing plant were found to contain TNT and some of its amino reduced and partially denitrated products. Their concentrations as determined by SPME-GC-MS and LC-UV depended on the location of sampling at the site. In the case of plant tissues, SC-CO2 extraction followed by CE-UV analysis showed only the presence of HMX. The concentrations of HMX (<200 mg/kg) as determined by supercritical fluid extraction (SC-CO2)-CE-UV were comparable to those obtained by MeCN extraction, although the latter technique was found to be more efficient at higher concentrations (>300 mg/kg). Modifiers such as MeCN and water enhanced the SC-CO2 extractability of HMX from plant tissues.
Azocines↗
[Total knee arthroplasty: reproducibility of gait speed].
OBJECTIVE: To calculate the inter-session (test-retest) and inter-observers' reproducibility of the maximal gait speed measured in patients recently operated for osteoarthritis with a total knee arthroplasty. METHODS: Evaluation of the maximal gait speed in 20 patients [t72 +/- 6.5 years] on a 10-meter track by two observers using a manual stopwatch and by an automatic photoelectric stopwatch. The maximal gait speed was measured from three trials in two conditions, with and without crutches, with 1 day of interval at the third and the fourth post-surgery week. RESULTS: The inter-session reproducibility (1-day test-retest) is 0.91 [intraclass correlation coefficient] with crutches and 0.9 without crutches at the third post-surgery week, and 0.96 and 0.94 at the fourth post-surgery week with and without crutches respectively. The inter-observers' reproducibility is 0.9 to 0.99. CONCLUSION: When a standardized protocol is used, the reproducibility of maximal gait speed measurements is excellent. These tests evaluate easily and objectively the maximal gait speed in patients recently operated with a total knee arthroplasty.
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Vascular aphasias: main characteristics of patients hospitalized in acute stroke units.
BACKGROUND AND PURPOSE: Aphasia is frequent in stroke patients and is associated with poor prognosis. However, characteristics and determinants of vascular aphasias remain controversial. The aim of this study was to evaluate aphasia characteristics at the acute stage in patients admitted to a stroke unit. METHODS: The study was performed in 308 patients consecutively assessed with a standardized aphasia battery. RESULTS: Aphasia was observed in 207 patients; global and nonclassified aphasias accounted for 50% of aphasic syndromes at the acute stage, whereas classic aphasias (Wernicke's, Broca's, transcortical, and subcortical aphasias) were less frequent. Age differed across aphasic syndromes in ischemic stroke patients only; patients with conduction aphasia were younger, and patients with subcortical aphasia were older. Sex did not significantly differ across aphasic syndromes. The presence of a previous stroke was more frequent in nonclassified aphasia. CONCLUSIONS: This study shows (1) that vascular aphasias are frequently severe or nonclassic at the acute stage, a finding explained in part by the presence of a previous stroke; (2) that the age effect is due mainly to its influence on infarct location; and (3) that the main determinant of aphasia characteristics is lesion location.
Adolescent↗
[Dog bite in a splenectomized patient].
We present a case of Capnocytophaga canimorsus fulminant infection linked to a dog bite in a splenectomized patient. Capnocytophaga canimorsus is a gram-negative rod that typically causes septicaemia with disseminated intravascular coagulation in both immunocompromised and immunocompetent hosts. It is associated with high mortality. We also reviewed the literature and provide some recommendations on the management of bite wound as well as on both prevention and treatment of infection in asplenic state.
Adult↗
Transforming growth factor-beta inhibition of insulin-like growth factor-binding protein-5 synthesis in skeletal muscle cells involves a c-Jun N-terminal kinase-dependent pathway.
Transforming growth factor-beta (TGF-beta) and insulin-like growth factors (IGFs) play critical roles in the control of myogenesis. Insulin-like growth factor-binding protein-5 (IGFBP-5), by regulating the bioavailability of IGFs, is involved in controlling IGF-dependent differentiation. We investigated the effects of TGF-beta on the IGFBP-5 production induced by IGFs in mouse myoblasts. TGF-beta leads to a decrease in IGFBP-5 synthesis at both transcript and protein levels, and blocked muscle differentiation. The Smad proteins and the c-Jun N-terminal kinase (JNK) have been shown to be involved in TGF-beta signaling pathways. We provide evidence that the JNK pathway, rather than Smad proteins, is involved in the response of muscle cells to TGF-beta. This factor failed to stimulate the GAL4-Smad 2/3 transcriptional activities of the constructs used to transfect myoblasts. Moreover, stable expression of the antagonistic Smad7 did not abolish the inhibitory effect of TGF-beta on IGFBP-5 production whereas expression of a dominant-negative version of MKK4, an upstream activator of JNK, did. We also showed, using a specific inhibitor, that the p38 mitogen-activated protein kinase (p38 MAPK) was not involved in the inhibition of IGFBP-5 production. Thus, TGF-beta-mediated IGFBP-5 inhibition is independent of Smads and requires activation of the JNK signaling pathway.
Animals↗