Biomedical subjects
Publications and source records attributed to G Moulin.
Management of high-flow arteriovenous malformation remain often problematic. Complete eradication of the nidus is the only potential cure, but this, however, is often difficult if not impossible. Frequently, a multidisciplinary approach is required. In these article, techniques and results of the endovascular management of MAV are discussed.
Bacteria that are resistant to antimicrobials are widespread. This article reviews the distribution of resistant bacteria in farm environments. Humans, animals, and environmental sites are all reservoirs of bacterial communities that contain some bacteria that are susceptible to antimicrobials and others that are resistant. Farm ecosystems provide an environment in which resistant bacteria and genes can emerge, amplify and spread. Dissemination occurs via the food chain and via several other pathways. Ecological, epidemiological, molecular and mathematical approaches are being used to study the origin and expansion of the resistance problem and its relationship to antibiotic usage. The prudent and responsible use of antibiotics is an essential part of an ethical approach to improving animal health and food safety. The responsible use of antibiotics during research is vital, but to fully contribute to the containment of antimicrobial resistance 'prudent use' must also be part of good management practices at all levels of farm life.
The authors report the clinical and imaging features of a patient with rupture of an aortoiliac graft successfully treated by endovascular approach. The endovascular treatment is easy to perform and effective. The main pitfall of this technique is the limited availability of stent-grafts.
The sphenoid localization of aspergillosis is a rare sinusal disease, often latent or asymptomatic. The neurological complications are the result of invasive forms occurring in most cases for the immunocompromised or diabetic patients. Nevertheless, non-invasive sphenoid aspergillosis may cause also several complications and affect the vital prognosis of nonimmunocompromised patients. This report is about two cases of cavernous sinus thrombosis secondary to a non-invasive sphenoid aspergillosis. The authors refer to the clinical and radiological findings and therapeutic approach of this rare complication.
This paper describes particular aspects of the marketing of veterinary medicinal products (VMPs) that contain or consist of genetically modified micro-organisms (GMMs) or genetically modified organisms (GMOs). The regulatory requirements and the procedures applied in the European Union for each phase (pre-marketing, authorisation process, and post-authorisation labelling and monitoring) are explained. In most cases VMPs are subject to both pharmaceutical and GMO regulations. In the early stages of the process, before applications for marketing authorisation are submitted, the assessment of clinical trials and experiments in contained areas is principally the responsibility of national authorities. However, the marketing of all VMPs containing or consisting of GMOs must be authorised at European level, although the national authorities are informed and involved in the assessment process.
The aim of this retrospective study was to assess and compare the diagnostic value of fine-needle cytology and MRI for the prediction of malignancy in parotid tumors. During an 11-year period, 148 patients underwent preoperative fine-needle aspiration cytology in our institution. Eighty-seven patients underwent a preoperative MRI study, and 54 had both MRI and cytology. The study compares results of cytology and MRI with histological reports. The sensitivity, specificity and accuracy for detecting malignant lesions were 87, 94 and 93% respectively for MRI, 81, 95 and 92% respectively for cytology and 100, 88 and 91% respectively for both studies combined. Fine-needle cytology provided better information than MRI concerning precise histological diagnoses. Conversely, the proportion of non-diagnostic smears reached 10%. Fine-needle cytology and MRI are simple, well-tolerated diagnostic means with an impact on the management of salivary gland tumors. The associated anatomic information obtained by MRI imaging makes it the test of first choice in an optimal medical environment.
Ovine leptin was cloned in the methylotrophic yeast Pichia pastoris using a pPIC9K vector. Leptin was produced and secreted into the culture medium using the Saccharomyces cerevisiae alpha-mating factor prepro signal by five clones. Expression levels of leptin varied from clone to clone, depending on the copy number of the ob gene. Highest expression was observed with the single-copy clone S27 (250 mg/l). The modifications of culture conditions in batch and fed-batch culture increase the yield of protein. The use of higher cell concentration (63 g/l) before induction of oLept associate with a regulation of pH at 3.2, which decreases the effects of proteolysis, increases the expression level of the oLept to 402 mg/l. Moreover, compared with the non-producer clone, we observed a drastic decrease in growth rate and biomass yield in the leptin-producing clones. At the end of the fed-batch phase at pH 3.2 with clone S27, mortality rate reached 17.3%. Results showed that recombinant leptin production induced metabolic stress, and a negative impact on biomass yield and growth rate. We characterized the recombinant leptin produced by clone S27. It exhibited a molecular mass of 16 kDa, an N-terminal amino acid sequence identical to that of ovine leptin but with an additional tyrosine introduced by the cloning site. Moreover, it was found to be biologically active in vitro. The available production of a large quantity of oLept will strengthen the functional study for theoretical and practical purposes.
OBJECTIVES: To define clinical and radiological characteristics of nasal septal schwannoma, and to propose endoscopic surgery. PATIENT AND METHODS: We report a case of an isolated schwannoma of the anterior part of the nasal septum, without involvement of any local structure. The only preoperative symptom was nasal obstruction. Imaging study included a CT scan and an MRI study. RESULTS: Schwannoma is a sheath tumor originating from Schwann cells of peripheral nerves. It rarely occurs in nasal and paranasal sinuses and its development on the nasal septum is extremely rare. Complete removal of the tumor was performed by endoscopic sinus surgery technique. Limits of the excision were free of tumor and the histological type was Antoni type A Schwannoma. After a year of follow up, the patient is free of recurrence. CONCLUSION: The Schwannoma of the nasal septum is a rare tumour whose clinical and radiological diagnosis by CT scan and IRM is relatively easy. Its treatment is surgical and the endoscopic surgery can be proposed in the forms slightly extensive.
Arrhythmogenic right ventricular dysplasia (ARVD) is a cardiomyopathy of unknown etiology responsible for 20% of cases of sudden death in young adults secondary to arrhythmia. It is characterized histologically by fatty or fibro-fatty infiltration of the right ventricular myocardium. Diagnostic criteria have been proposed for diagnosing ARVD. Imaging, especially MRI, plays an important role. MR imaging must be performed using cardiac gating, and should include both cine-MR sequences for evaluation of segmental and global right ventricular function or any morphological change of the right ventricular shape, and anatomic sequences to detect fatty or fibro-fatty infiltration of the right ventricular myocardium.
PURPOSE: To evaluate the ability of CT imaging to detect infectious lesions in total hip prosthesis. PATIENTS AND METHODS: CT was performed in 17 cases of suspected total hip prosthesis infection. Images were reviewed to evaluate for the presence of soft tissue abscess, hip joint effusion or fistula and peri-prosthetic lucency or erosion at bone window setting. The feasibility of CT imaging is assessed with regards to metallic artifacts. RESULTS: Infection was confirmed in 10 hips. A soft tissue abscess was present in 8 of these cases, in association to a joint effusion, presumably septic, in 7 cases. A fistula was identified in 8 cases. A peri-prosthetic lucency was present in 10 cases, 7 of which with infection, and erosions were noted in 4 patients, 2 of which with infection. Metallic artifacts reduced image quality but did not prevent detection of soft tissue abscesses. CONCLUSION: CT is useful for detection of soft tissue abscesses in patients with infected hip prosthesis. CT is useful for surgical planning or follow-up of patients treated conservatively.
Conventional surgical treatment of anastomotic false abdominal aortic aneurysms (AFAA) is technically difficult. Morbidity-mortality rates are higher than those for surgery of infrarenal abdominal aortic aneurysm (AAA). Endovascular management without laparotomy or aortic clamping represents an attractive alternative. The purpose of this study was to determine the immediate and middle-term outcome of endovascular management of AFAA. Between 1998 and 2001, 10 patients were treated for AFAA by placement of an endograft. The initial procedure was aortobifemoral bypass for occlusive artery disease in eight cases and resection and grafting for AAA in two cases. Mean age was 70 years. Seven patients were classified ASA 3 or 4. Three patients presented cardiac insufficiency with left ventricular ejection fraction <40%. Eight patients were treated using an aortounilateral iliac artery endograft in association with crossover femorofemoral bypass (3 AneuRx, 2 Endologix, 1 Talent, 1 Zenith, 1 surgeon-made stent). Two patients were treated with an aortoaortic endograft (1 Talent, 1 surgeon-made stent). In two patients extraperitoneal exposure of the common iliac artery was required for introduction of the stent in one case and for surgical closure of the iliac artery in the other case. A total of nine patients underwent another surgical procedure in association with stenting. Four endografts were custom-made. Endograft deployment was successful in all cases. No patient died during the postoperative period. Postoperative computed tomography (CT) scan confirmed exclusion of the aneurysmal sac in all cases. The mean duration of hospitalization was 13 days (range, 5-28 days). During follow-up (mean duration, 17.7 months; range, 5-42 months), one patient died from heart-related causes. No direct or indirect endoleak was detected by CT scan follow-up and a significant reduction in AFAA diameter was noted in the eight patients with follow-up periods lasting 6 months or more. One patient developed occlusion of an aortounilateral iliac artery endograft and was treated by axillobifemoral bypass. In one patient stenosis of the distal end of an aortounilateral iliac endograft was discovered by duplex scan and successfully treated by dilatation. Endovascular treatment of AFAA is technically feasible but requires more complex procedures involving associated surgical procedures and use of custom-made endografts. The morbidity-mortality rate in this small series of high-risk patients was low. Immediate and middleterm exclusion of AFAA was good.
BACKGROUND AND PURPOSE: To compare the efficacy and vascular toxicity of embolization with radical (NBCA+metacryloxysulpholane=CS) versus conventional anionic (NBCA alone=CA) polymerization of NBCA. MATERIALS AND METHODS: Under continuous digital subtracted angiography (DSA) recordings, a 0.2 mL volume of identical glue mixtures were injected in a single-step procedure, concomitantly, in left and right (with CS and CA, respectively) renal arterial branches (RAB) and ascending pharyngeal arteries (APA) in 8 swines. Arterial histopathology and morphometry of inflammation were investigated at 2 weeks. RESULTS: Complete embolization was achieved with equivalent cast homogeneity on DSA with both NBCA mixtures in RAB and APA. Inflammatory crowns in APA and RAB were significantly lower in CS - than in CA-treated sites (p<0.001). CS plug was scarcely adhesive to the vascular wall, and pulled apart from the wall by a residual thrombotic lining; in contrast with CA casts that were strongly adhesive to walls with endothelium stripping. CONCLUSIONS: Anionic and radical polymerization of NBCA embolization was identical with regards to occlusion rate; whereas radical pathway of polymerization with cyanoacrylates lowered histotoxicity with a less sustained adhesiveness of casts against vascular walls.
Sphenoid sinusitis is uncommon, with an incidence of about 2.7%. Failure to diagnose and treat sphenoid sinus disease has been shown to lead to serious neurologic sequellae. Plain radiographs play a limited role in the management of sinusitis. CT scan can provide a positive diagnosis by the visualization of mucosal thickening, air-fluid level and complete opacification of the sinusal cavities. In addition, CT can provide more information about the anatomy and abnormalities of the sphenoid sinus. MRI is used in cases of suspected tumors or neurologic involvement. The most common presenting symptom is headache that arise characteristically, but rarely, from the vertex. Sphenoiditis has a high risk of severe neurologic involvement, cavernous sinus thrombosis being one of the most serious complications.
Static and dynamic pelvic IRM is nowadays part of the diagnostic work up of pelvic prolapse. It is a second line examination, diagnosis being made primarily on the basis of findings at physical pelvic examination. Advantages of MR imaging include lack of ionising radiation, simplicity, multiplanar imaging capability, and possibility to explore at the same time the three compartments and the pelvic floor. The dynamic MR Imaging can be coupled with a clinical examination at the magnet. Imaging is useful in patients in whom findings at physical examination are equivocal. Dynamic MR imaging can be useful in evaluating pelvic organ prolapse. It allows detection of hidden prolapses and assessment of muscle trophycity. Post-operatively it allows assessment of surgical results and failures or recurrences.
OBJECTIVES: we investigated the therapeutic effect of angioplasty with local drug delivery (LDD) of the wall-accumulating NO-donor molsidomine (M) in the superficial femoral arteries (SFA) of atherosclerotic swine. MATERIALS AND METHODS: atherosclerotic Pietrin swines (n=14) underwent PTA-LDD-M (4 mg/2 ml) vs contralateral PTA-LDD-Placebo in the SFA using a channelled balloon angioplasty catheter. Invasive and colour Doppler energy (CDE) assessments of haemodynamics and wall mechanics were performed at 24 h (n=4) and 5 months (n=10). Immuno-histolabelling of cell proliferation and histomorphometry were serially performed in perfusion fixed SFA samples. RESULTS: at 24 h, PCNA-positive nuclei revealed 33+/-14 and 12+/-3 proliferating cells/mm2 at placebo and molsidomine PTA-LDD sites, respectively (p<0.001). At 5 months, PTA-LDD-M vessels, compared with PTA-LDD-P, had increased compliance (66+/-9 vs 11+/-4 ml/mmHg) and lowered impedance (0.11+/-0.05 vs 0.45+/-0.14 mmHg/ml x min(-1)) (p<0.05). CDE revealed low, middle and high velocity peaks at 7.5, 20 and 35, and 8, 15 and 22 cm x s(-1) in systolic and diastolic flows, respectively; and PTA-LDD-M prevented emergence of restenosis-associated increases in low blood velocities (p<0.01). PTA-LDD-M inhibited restenotic intimal thickening and medial thinning which decreased mean lumenal diameter in placebo-treated (2.6+/-0.3) as compared to molsidomine-treated (3.4+/-0.3 mm) vessels (p<0.05). CONCLUSIONS: in the atherosclerotic porcine SFA model, PTA-LDD with molsidomine consistently improved haemodynamic wall mechanics, lowered cell proliferation and prevented late lumen loss observed with PTA-LDD with placebo.
Apart from a clinical examination including direct laryngoscopy and biopsy, pretherapeutic staging for local extension of laryngeal carcinoma requires computed tomography. The role of magnetic resonance imaging (MRI) remains controversial. The aim of this study was to determine its value for detecting invasion of the main laryngeal structures. Histological findings were compared with axial MRI slices to remain in the same plane. A double-blind study of 10 areas of the larynx was performed: vocal muscle, anterior and posterior paraglottic spaces, anterior and posterior laryngeal commissures, anterior and posterior subglottic area, arytenoid, thyroid, and cricoid cartilages. MRI appeared to be the method of choice to detect neoplastic cartilage, and subglottic and commissural invasion. MRI allows a treatment strategy adapted to the areas involved by the laryngeal carcinoma.
The aim of this study was to compare the clinical usefulness of ultrasmall superparamagnetic iron oxide (USPIO) MR contrast media (Sinerem, Guerbet Laboratories, Aulnay-sous-Bois, France) with precontrast MRI in the diagnosis of metastatic lymph nodes in patients with head and neck squamous cell carcinoma, using histology as gold standard. Eighty-one previously untreated patients were enrolled in a multicenter phase-III clinical trial. All patients had a noncontrast MR, a Sinerem MR, and surgery within a period of 15 days. The MR exams were analyzed both on site and by two independent radiologists (centralized readers). Correlation between histology and imaging was done per lymph node groups, and per individual lymph nodes when the short axis was > or = 10 mm. For individual lymph nodes, Sinerem MR showed a high sensitivity (> or = 88%) and specificity (> or = 77%). For lymph node groups, the sensitivity was > or = 59% and specificity > or = 81%. False-positive results were partially due to inflammatory nodes; false-negative results from the presence of undetected micrometastases. Errors of interpretation were also related to motion and/or susceptibility artifacts and problems of zone assignment. Sinerem MR had a negative predictive value (NPV) > or = 90% and a positive predictive value (PPV) > or = 51%. The specificity and PPV of Sinerem MR were better than those of precontrast MR. Precontrast MR showed an unexpectedly high sensitivity and NPV which were not increased with Sinerem MR. The potential contribution of Sinerem MR still remains limited by technical problems regarding motion and susceptibility artifacts and spatial resolution. It is also noteworthy that logistical problems, which could reduce the practical value of Sinerem MR, will be minimized in the future since Sinerem MR alone performed as good as the combination of precontrast and Sinerem MR.
Postgenomic studies have led to an increasing demand for isotope-labeled proteins. We present a method for producing large quantities of truly native (15)N-labeled protein. Based on the secretion capabilities of the yeast Pichia pastoris, the recombinant protein is easily purified in a single step as it is secreted. Control of all nitrogen sources permits very high labeling yields. As a result, accumulation and folding of the recombinant protein can be monitored by heteronuclear NMR without purification. Comparison of sample spectra with the spectrum of the purified recombinant protein allows detection of the secreted protein in the culture and monitoring of its folding, from the start of the induction phase. The detection limit for a (15)N-labeled protein is estimated as 20 microM and corresponds, for a 10-kDa protein, to a load of 40 mg/liter in the fermentor. This concentration is reached by most reported preparations in P. pastoris. Further concentration by ultrafiltration would compensate for lower production. This procedure may be useful in many structural genomics and combinatorial chemistry screening projects where most protein productions meet the requirements for this method.