[Mohs micrographical surgery].
Explore the source record for details and available documents.
Basal Cell Carcinoma↗
Biomedical subjects
J Martel
Publications and source records attributed to J Martel.
[Adrien Doyon (1827-1907). Creator of the Annals, but also well-known balneologist and European scholar].
Explore the source record for details and available documents.
Balneology↗
[Adenoid cystic carcinoma of the head and neck: a review of 30 cases].
OBJECTIVES: To evaluate treatment results and identify prognostics factors which determine local and regional treatment failure and crude survival in adenoid cystic tumours (ACT) in the head and neck. METHODS: A retrospective study (1984 to 2001) of 30 cases of adenoid cystic tumour. The mean age was 56.9 years, with a sex ratio female to male of 2:1. Tumours of all sites were encountered, most (26.7%) being in the nose and sinuses and major salivary glands (26.6%). Tumours at the T4 stage were found in 14 cases, mainly situated in the nose and sinuses (50%). No patient had cervical lymphadenopathy, while two patients (6.7%) had bony metastases at the time of diagnosis. Two patients (6.7%) were treated by surgery alone, for T1 and T2 tumours; four patients (13%) had radiotherapy alone, and 24 patients (80%) had surgery with post-operative radiotherapy with a mean dose of 60.3 Grays (56-65 Grays). RESULTS: Local recurrence occurred in 30.8% (nine cases) after a mean interval of 43 months (1 to 10 years). Treatment of these recurrences was by revision surgery in six cases, leading to local control in one case, but in a patient with pulmonary metastases. No cases of lymph node recurrence were observed. 30% of patients developed metastases; these were pulmonary in 44% and bony in 33.3%. Mean follow-up was five years. Crude survival at 3 years was 91%, at 5 years 86%, and at 10 years 50%. The percentage tumour-free survival was 70% at 3 years, and 57% at 5 years. 22 patients (73.3%) are still alive, 17 of them recurrence-free. Analysis of the prognostic factors has shown tumour to be more aggressive in the nose and sinuses when they presented at an advanced stage (T4); recurrence was more common when excision was incomplete, or if there was peri-neural spread. Tumours of "massive" histological type carried a poorer prognosis than those of cribrigorm type (60% death compared with 10%). The development of metastases is independent of local recurrence. Metastases to bone appear to be more rapidly aggressive than pulmonary metastases, which may remain asymptomatic for some time. CONCLUSION: Combined radiotherapy and surgery have allowed improved local control of ACT, but the therapeutic challenge remains the multiply recurrent ACT, or those with symptomatic metastases, and this despite new research techniques (neutral therapy, immuno-histochemistry, molecular biology). ACT are rare tumours, whose prognosis remains poor.
Adult↗
Left-handed-media simulation and transmission of EM waves in subwavelength split-ring-resonator-loaded metallic waveguides.
At microwave frequencies, hollow metallic waveguides behave in certain aspects as a "one-dimensional plasma." This feature will be advantageously used for simulating the propagation of electromagnetic (EM) waves in left-handed metamaterials provided the hollow waveguide is periodically loaded with split ring resonators. It will be shown that EM transmission in this structure is feasible within a certain frequency band even if the transverse dimensions of the waveguide are much smaller than the associated free-space wavelength. This effect can be qualitatively and quantitatively explained by the left-handed metamaterial theory, thus providing a new experimental validation for such a theory.
Journal Article↗
[Dermatology in private practice in France in 2000].
OBJECTIVES: Data regarding French dermatological practice are scarce. Our objective was to identify the skin disorders most commonly diagnosed by office-based dermatologists. We also documented the severity of these skin disorders, as reflected by the repercussions on patient's everyday life, and the way physicians managed patients. DESIGN: We carried out a one-day survey of visits to a randomly selected sample of 900 French office-based dermatologists. The randomization was stratified according to the five French different dialing area codes. RESULTS: Office-based dermatologists saw 6411 patients with 7839 skin disorders during the survey. The daily number of visits to French dermatologists was estimated at 47 000 and the annual number between 12 and 14 millions. Office-based dermatologists mostly managed warts, acne, nevus, dermatitis, malignancies and pre-malignancies, fungal infection and psoriasis. Repercussions on patients'everyday life were assessed by physicians as important or very important in 28 p. 100 of cases. Half of the patients received topical treatment, 20.5 p. 100 a systemic drug and 40 p. 100 a minor surgical procedure (including cryotherapy). CONCLUSION: Although dermatologists frequently see benign skin disorders such as warts or nevus, more severe diseases represent an important part of their activity.
Dermatology↗
Practical and highly regio- and stereoselective synthesis of 2-substituted dihydropyridines and piperidines: application to the synthesis of (-)-coniine.
Explore the source record for details and available documents.
Dihydropyridines↗
[Maxillary sinus hypoplasia].
Maxillary sinus hypoplasia is rare, with an estimated prevalence of 1-5%. Out of the CT scans performed in sinusal patients between March 1998 and June 1999, we report on 4 isolated maxillary sinus hypoplasia, 4 maxillary sinus hypoplasia associated to concha bullosa, and 10 isolated conchae bullosas. All cases were evaluated by nasosinusal endoscopy and CT scan. Size, location and uni/bilateral presentation of concha bullosa is correlated to maxillary sinus hypoplasia presence, specially with regards to uncinate process presence, medial or lateral retraction. The pathogenesis of maxillary sinus hypoplasia is reviewed, and its relation to concha bullosa, evaluating how this could explain some cases of the so called chronic maxillary sinus atelectasia, as an acquired and progressive variant of maxillary sinus hypoplasia in adults.
Adolescent↗
[Macro-CK disclosing disseminated epidermoid carcinoma of the pyriform sinus in a patient with dermatomyositis].
INTRODUCTION: The association between dermatomyositis and cancer is clearly established, but its frequency remains difficult to define. EXEGESIS: We report the case of an association between a dermatomyositis and a cancer of the piriform antrum. Four months after surgical treatment and radiotherapy, the increased macro-CK level gave us reason to suspect a cancer relapse with pulmonary, hepatic, splenic and renal metastases without progressive clinical signs. CONCLUSION: Mitochondrial macro-CK detection must evoke the presence of neoplasia with or without metastasis, which would be a poor prognosis, as has been shown in our patient.
Carcinoma, Squamous Cell↗
Examining the foreseeable: assisted suicide as a herald of changing moralities.
After her intense battle for the decriminalization of assisted suicide in the Supreme Court of Canada, Sue Rodriguez committed suicide with medical assistance in 1994. Following her suicide, government and law representatives remained silent and no criminal charges were ever brought against the person(s) who presumably assisted Ms Rodriguez in her death. This apparent non-intervention of criminal law is examined in view of the useful role that the Rodriguez event may have played in a possible shift in the dominant morality. It is argued that the Rodriguez assisted suicide may have been a useful 'crime' (in the Durkheimian sense) in that it brought to the fore the possibility that social conditions--which made the 'crime' possible--may no longer be in harmony with conventional morality. Similarly to Socrates' crime, the Rodriguez case can be seen as an anticipation of a new morality. It can be analyzed as a prelude to alterations, as directly preparing the way for changes in the dominant morality. The role of criminal law as a preferred mode of moral regulation is also examined in relation to the moral demands and expectations that arose during as well as after the judicial saga.
Canada↗
Renal expression of the sodium/phosphate cotransporter gene, Npt2, is not required for regulation of renal 1 alpha-hydroxylase by phosphate.
Several reports have suggested that the regulation of renal 1,25-dihydroxyvitamin D [1,25-(OH)(2)D] synthesis by extracellular phosphate (Pi) is dependent on normal transepithelial Pi transport by the renal tubule. Mice homozygous for the disrupted Na/Pi cotransporter gene Npt2 (Npt2(-/-)) exhibit renal Pi wasting, an approximately 85% decrease in renal brush border membrane Na/Pi cotransport, hypophosphatemia, and an increase in serum 1,25-(OH)(2)D concentration. We undertook 1) to determine the mechanism for the increased circulating levels of 1,25-(OH)(2)D in Npt2(-/-) mice and 2) to establish whether renal 1alpha-hydroxylase was appropriately regulated by dietary Pi in the absence of Npt2 gene expression. On a control diet, the 2.5-fold increase in the serum 1,25-(OH)(2)D concentration in Npt2(-/-) mice, relative to that in Npt2(+/+) littermates, is associated with a corresponding increase in renal mitochondrial 25-hydroxyvitamin D-1 alpha-hydroxylase (1 alpha-hydroxylase) activity and messenger RNA (mRNA) abundance. A low Pi diet elicits an increase in serum 1,25-(OH)(2)D concentration, renal 1alpha-hydroxylase activity, and mRNA abundance in Npt2(+/+) and Npt2(-/-) mice to similar levels in both mouse strains. A high Pi diet has no effect on serum 1,25-(OH)(2)D concentration, renal 1 alpha-hydroxylase activity, or mRNA abundance in Npt2(+/+) mice, but normalizes these parameters in Npt2(-/-) mice. In addition, renal 24-hydroxylase mRNA abundance is significantly reduced in Npt2(-/-) mice compared with that in Npt2(+/+) mice under all dietary conditions. In summary, we demonstrate that 1) increased renal synthesis of 1,25-(OH)(2)D is responsible for the increased serum 1,25-(OH)(2)D concentration in Npt2(-/-) mice; and 2) renal 1alpha-hydroxylase gene expression is appropriately regulated by dietary manipulation of serum Pi in both Npt2(+/+) and Npt2(-/-) mice. Thus, intact renal Na/Pi cotransport is not required for the regulation of renal 1alpha-hydroxylase by Pi.
25-Hydroxyvitamin D3 1-alpha-Hydroxylase↗
[Subcutaneous mycosis due to Scopulariopsis brevicaulis in an immunocompromised patient].
BACKGROUND: Scopulariopsis brevicaulis is a causal agent of onchomycosis. We report the unusual clinical manifestations caused by this opportunist fungus. CASE REPORT: A 61-year-old man consulted in February 1997 for a budding lesion located on the right medial malleolus. This patient had had a liver transplantation for primary biliary cirrhosis in 1990 and had been taking prednisone and cyclosporine since this time. Cyclosporine had been recently replaced by tacrolimus. The histology examination of a lesion specimen taken from the ankle evidenced a dermal mycosis due to opportunist filamentous fungus. Total excision was performed. The patient then developed nodular lesions of the left elbow during the summer of 1997. Mycology culture of a skin biopsy grew numerous colonies of Scopulariopsis brevicaulis. Excision of the elbow lesion was delayed due to hospitalization for suspected graft rejection and development of insulin-dependent diabetes. The elbow lesion was then resected followed by a skin graft. The mycology examination identified the same causal agent. DISCUSSION: This liver transplant recipient developed two unusual extra-ungual localizations (ankle and elbow) of a Scopulariopsis brevicaulis infection. Chronic immunosuppression favored development of the infection with a pseudo-epithéliomatous presentation. The histology and mycology examinations were necessary for positive diagnosis.
Biopsy↗
Effects of Resource Availability on Carbon Allocation and Developmental Instability in Cloned Birch Seedlings.
Abundant nitrogen improves seedling growth and establishment. Vigorous growth brings about changes in rates and patterns of plant development and changes in the relationship between primary and secondary metabolism, which may make seedlings more susceptible to herbivores and pathogens than are slow-growing seedlings. We studied how nitrogen fertilization and manual defoliation of source leaves affect growth, carbon allocation, and developmental instability in cloned seedlings of white birch (Betula pubescens Ehrh.). Biomass was higher, whereas concentrations of most classes of phenolic compounds were lower in the nitrogen-rich environment. Interestingly, fertilization did not change the concentrations of cell wall-bound proanthocyanidins, which represent an important fraction of the group of phenolic compounds. Nitrogen enrichment increased levels of fluctuating asymmetry, an index of developmental instability. This result confirms that not only stress but also any deviation from normal resource availability may increase leaf developmental instability in birches. In contrast to fertilization, a one-time defoliation of source leaves did not shape seedling growth, development, or carbon allocation. This could be the result of compensatory growth or of the fact that the defoliation treatment was not strong enough to induce detectable effects until the end of the growing season.
Journal Article↗
Comparative multicentre study of a panel of thyroid tests using different automated immunoassay platforms and specimens at high risk of antibody interference.
The introduction of automation for immunoassays in recent years has brought about important and evident improvements in assay precision. Increasing standardization and comparability between platforms should enable the development of clinical guidelines and diagnostic algorithms for appropriate clinical decision making. A continuing source of variation between different automated immunoassay platforms is the sporadic effect of interfering antibodies or substances, thus causing aberrant results not supporting the patient's clinical status. The aim of this study was to describe current thyroid panel variation between automated immunoassay platforms including population specimens at risk of antibody interference. A multisite design with laboratories in three different countries using four different automated immunoassay platforms (Roche-Boehringer Mannheim Elecsys (Italy), Roche-Boehringer Mannheim ES300 (Wales), Bayer Immuno 1 and the Bayer ACS:180 evaluated the thyroid panel of thyrotropin (TSH), triiodothyromine (T3), free thyroxine (FT4) and free triiodothyronine (FT3). A common set of 158 randomly selected patient samples of non-thyroid and thyroid disorders, with and without treatment, was tested. Included were 62 patient samples at risk for endogenous antibody interference with high antimicrosomal antibody, anti-TSH receptor antibody and increased rheumatoid factor sub-populations. Across all controls and between platforms, precision measurements were comparable and varied between 0.7% and 12.8% for TSH, 2.8% and 13% for FT4, 1.8% and 10.5% for FT3 and 3.1% and 16% for T3 assay. Acceptable correlation and reproducibility were found between the three Bayer Immuno 1 platforms at each country's site with all four thyroid panel assays demonstrating r-values of 0.989 to 1.000 and slopes of 0.915 to 1.078. Comparisons between the different platforms showed acceptable correlation for all thyroid panel assays. Specimens containing rheumatoid factor were associated with a significantly increased variation between systems for the FT4 and FT3 assays (p < 0.01). This effect did not appear to be selective for a given platform. For specimens with raised autoimmune antibodies and therefore at risk of assay antibody interference, no variation could be observed between the platforms.
Antibodies↗
[Malignant or necrotizing otitis externa: experience in 22 cases].
Malignant or progressive necrotizing otitis extrema is an uncommon but severe infectious condition of the external auditory canal. Over a period of four years, we treated 22 patients: 60% had diabetes (1/4 insulin dependent) and 13% were immunodepressed. The causal germ was Pseudomonas aeruginosa in 87% of cases. The pretherapeutic work-up included a computed tomography scan and a technetium scintigraphy to confirm diagnosis and assess extension. Repeated scintigraphies with gallium were used to follow the course under treatment. Medical treatment was used in most cases (16/22) with parenteral antibiotic therapy using a third-generation cephalosporin (ceftazidime or ceftriaxone) and a fluoroquinolone (ciprofloxacin or ofloxacin) and, if there was no contraindication, hyperbaric oxygen. Surgery is not indicated in malignant otitis externa. We had a 95% cure rate with only 10% recurrence. We reviewed the data in the literature on malignant otitis externa and present the important diagnostic, imaging and therapeutic aspects.
Adult↗
[Abnormal trajectory of the internal carotid artery in the middle ear. Report of a case].
The authors report a case with an aberrant course of the internal carotid artery within the middle ear--a rare abnormality with only about fifty cases so far reported in the literature. The combination of pulsatile tinnitus and a retro-tympanic mass calls for a precise anatomical investigation of the temporal bone before any surgery is undertaken. The role of the various complementary investigations is discussed. A high resolution CT scan is the key investigation, and is sufficient to give the diagnosis in the majority of cases. Angio-MRI currently affords the possibility of confirming this vascular malpositioning in a non-invasive way. Arteriography should be used only when there is remaining doubt about the possibility of a glomus tumour, or before treatment by clamping. The most logical course to adopt would seem to us to be to abstain from treatment once this diagnosis has been made, given the risk of major haemorrhage and the potential neurological complications.
Adult↗
[Olfactory esthesioneuromas].
Olfactory neuroblastomas are rare malignant tumours of the nose arising from the olfactory epithelium. In a retrospective series of 18 cases and a review of the literature, the authors establish the main features of this tumour. They emphasise the difficulties of histological examination, often requiring immuno-cyt-chemistery and electron microscopy. They point out the value of a new classification, and confirm treatments being radio-surgical, with use of the combined rhino-neurosurgical approach when there is extension to the cribriform plate. They report a 5-year survival of 91.5%, with 87.5% at 10 years. The high incidence of lymph gland metastases (16.6%) is greater than that of local recurrence (11%) especially in the more advanced cases. The question of prophylactic treatment of the neck nodes is one to be considered.
Adolescent↗
Effects of Npt2 gene ablation and low-phosphate diet on renal Na(+)/phosphate cotransport and cotransporter gene expression.
The renal Na(+)/phosphate (Pi) cotransporter Npt2 is expressed in the brush border membrane (BBM) of proximal tubular cells. We examined the effect of Npt2 gene knockout on age-dependent BBM Na(+)/Pi cotransport, expression of Na(+)/Pi cotransporter genes Npt1, Glvr-1, and Ram-1, and the adaptive response to chronic Pi deprivation. Na(+)/Pi cotransport declines with age in wild-type mice (Npt2(+/+)), but not in mice homozygous for the disrupted Npt2 allele (Npt2(-/-)). At all ages, Na(+)/Pi cotransport in Npt2(-/-) mice is approximately 15% of that in Npt2(+/+) littermates. Only Npt1 mRNA abundance increases with age in Npt2(+/+) mice, whereas Npt1, Glvr-1, and Ram-1 mRNAs show an age-dependent increase in Npt2(-/-) mice. Pi deprivation significantly increases Na(+)/Pi cotransport, Npt2 protein, and mRNA in Npt2(+/+) mice. In contrast, Pi-deprived Npt2(-/-) mice fail to show the adaptive increase in transport despite exhibiting a fall in serum Pi. We conclude that (a) Npt2 is a major determinant of BBM Na(+)/Pi cotransport; (b) the age-dependent increase in Npt1, Glvr-1, and Ram-1 mRNAs in Npt2(-/-) mice is insufficient to compensate for loss of Npt2; and (c) Npt2 is essential for the adaptive BBM Na(+)/Pi cotransport response to Pi deprivation.
Adaptation, Physiological↗
A study of the diagnostic accuracy and reliability of the Scoliometer and Adam's forward bend test.
STUDY DESIGN: Study of the diagnostic accuracy and interexaminer reliability of scoliosis diagnostic tests. OBJECTIVES: To estimate the sensitivity, specificity, and predictive value of the Scoliometer (National Scoliosis Foundation, Watertown, MA) and Adam's forward bend test in diagnosing scoliosis, and to determine the interexaminer reliability of the Scoliometer and Adam's forward bend test. SUMMARY OF BACKGROUND DATA: Exposure to diagnostic radiation in patients with adolescent idiopathic scoliosis may result in a small but significant increase in cancer rates. The full-spine radiographic examination remains the standard procedure for the assessment of scoliosis. There is a need for a valid and reliable noinvasive test to assess scoliosis. METHODS: Two examiners independently assessed 105 patients presenting to a scoliosis clinic for trunk asymmetry with Adam's forward bend test and axial trunk rotation with the Scoliometer. The Cobb method served as the gold standard. RESULTS: The interexaminer agreement for the Scoliometer is excellent in the thoracic spine and substantial in the lumbar spine. The interexaminer measurement error shows poor precision for thoracic and lumbar Scoliometer measurements. The interexaminer agreement for Adam's forward bend test is substantial in the thoracic spine and poor in the lumbar spine. Adam's forward bend test is more sensitive than the Scoliometer in detecting thoracic curves measuring 20 degrees or more by the Cobb method. Receiver operating characteristic curve analysis suggests that the use of the Scoliometer marginally improves the ability of diagnosing a scoliosis in the thoracic spine. CONCLUSIONS: The Scoliometer and Adam's forward bend tests have adequate interexaminer reliability for the assessment of thoracic curves. The Scoliometer has better interexaminer agreement in the lumbar spine. However, the Scoliometer has a high level of interexaminer measurement error that limits its use as an outcome instrument. Because Adam's forward bend test is more sensitive than the Scoliometer, the authors believe that it remains the best noninvasive clinical test to evaluate scoliosis.
Adolescent↗