Dacryocystostomies par voieendonasale:indications et technique chirurgicale

Introduction : La dacryocystorhinostomie consiste à dériver le contenu du sac lacrymal directement vers la lumière de la fosse nasale correspondante en réalisant une large ouverture dans la paroi osseuse et muqueuse du sac, court-circuitant ainsi le canal lacrymonasal obturé. nous nous proposons, à travers cette étude rétrospective, de discuter les aspects techniques chirurgicaux de la dacryocystostomie par voie endonasale et de revoir les indications opératoires.Mots-clefs : dacryocystite ; dacryocystorhinostomie ; chirurgie endonasaleThe purpose of dacryocystorhinostomy is to derive the content of the lacrimal sac directly into the light of the corresponding nasal cavity by making a large opening in the bony wall and sac mucosa, by passing the blocked nasolacrimal duct. We intend, through this retrospective study, discuss the technical aspects of surgical dacryocystostomy by endonasal and review the indications for surgery.Keywords : dacryocystitis; dacryocystorhinostomy; endonasal surgery

Towards effective capacity planning in a perinatal network centre

Objective To study the arrival pattern and length of stay (LoS) in a neonatal intensive care/high dependency unit (NICU/HDU) and special care baby unit (SCBU) and the impact of capacity shortage in a perinatal network centre, and to provide an analytical model for improving capacity planning. Methods The data used in this study have been collected through the South England Neonatal Database (SEND) and the North Central London Perinatal Network Transfer Audit between 1 January and 31 December 2006 for neonates admitted and refused from the neonatal unit at University College London Hospital (UCLH). Exploratory data analysis was performed. A queuing model is proposed for capacity planning of a perinatal network centre. Outcome measures Predicted number of cots required with existing arrival and discharge patterns; impact of reducing LoS. Results In 2006, 1002 neonates were admitted to the neonatal unit at UCLH, 144 neonates were refused admission to the NICU and 35 to the SCBU. The model shows the NICU requires seven more cots to accept 90% of neonates into the NICU. The model also shows admission acceptance can be increased by 8% if LoS can be reduced by 2 days. Conclusions The arrival, LoS and discharge of neonates having gestational ages of <27 weeks were the key determinants of capacity. The queuing model can be used to determine the cot capacity required for a given tolerance level of admission rejection

Penile hair coil strangulation of the child

AbstractWe report the case of a child with a delayed presentation of penile strangulation with a coil of hair that resulted in a complete transection of the urethra. Hair coil strangulation of the penis is uncommon. It is also known as penile Tourniquet syndrome. It has been reported with circumcised and uncircumcised penises and it can lead to serious complications like the amputation of the penis. Prompt diagnosis and treatment are necessary to prevent complications

Modelling home care organisations from an operations management perspective

Home Care (HC) service consists of providing care to patients in their homes. During the last decade, the HC service industry experienced significant growth in many European countries. This growth stems from several factors, such as governmental pressure to reduce healthcare costs, demographic changes related to population ageing, social changes, an increase in the number of patients that suffer from chronic illnesses, and the development of new home-based services and technologies. This study proposes a framework that will enable HC service providers to better understand HC operations and their management. The study identifies the main processes and decisions that relate to the field of HC operations management. Hence, an IDEF0 (Integrated Definition for Function Modelling) activity-based model describes the most relevant clinical, logistical and organisational processes associated with HC operations. A hierarchical framework for operations management decisions is also proposed. This analysis is derived from data that was collected by nine HC service providers, which are located in France and Italy, and focuses on the manner in which operations are run, as well as associated constraints, inputs and outputs. The most challenging research areas in the field of HC operations management are also discussed

Hurler disease (mucopolysaccharidosis type IH): clinical features and consanguinity in Tunisian population

Mucopolysaccharidosis type I (MPS I) was a group of rare autosomal recessive disorder caused by the deficiency of the lysosomal enzyme, alpha -L -iduronidase, and the resulting accumulation of undergraded dematan sulfate and heparan sulfate. MPS I patients have a wide range of clinical presentations, that makes it difficult to predict patient phenotype which is needed for genetic counseling and also impedes the selection and evaluation of patients undergoing therapy bone marrow transplantation

Mucopolysaccharidosis type I: molecular characteristics of two novel alpha-L-iduronidase mutations in Tunisian patients

<p>Abstract</p> <p>Background</p> <p>Mucopolysaccharidosis type I (MPS I) is an autosomal storage disease resulting from defective activity of the enzyme α-L-iduronidase (IDUA). This glycosidase is involved in the degradation of heparan sulfate and dermatan sulfate. MPS I has severe and milder phenotypic subtypes.</p> <p>Aim of study: This study was carried out on six newly collected MPS I patients recruited from many regions of Tunisia.</p> <p>Patients and methods: Mutational analysis of the IDUA gene in unrelated MPS I families was performed by sequencing the exons and intron-exon junctions of IDUA gene.</p> <p>Results</p> <p>Two novel IDUA mutations, p.L530fs (1587_1588 insGC) in exon 11 and p.F177S in exon 5 and two previously reported mutations p.P533R and p.Y581X were detected. The patient in family 1 who has the Hurler phenotype was homozygous for the previously described nonsense mutation p.Y581X.</p> <p>The patient in family 2 who also has the Hurler phenotype was homozygous for the novel missense mutation p.F177S. The three patients in families 3, 5 and 6 were homozygous for the p.P533R mutation. The patient in family 4 was homozygous for the novel small insertion 1587_1588 insGC. In addition, eighteen known and one unknown IDUA polymorphisms were identified.</p> <p>Conclusion</p> <p>The identification of these mutations should facilitate prenatal diagnosis and counseling for MPS I in Tunisia.</p> <p>Background</p> <p>Mucopolysaccharidosis type I (MPS I) is an autosomal recessive lysosomal storage disorder caused by the deficient activity of the enzyme of α-L-iduronidase (IDUA, EC 3.2.1.76). This glycosidase is involved in the degradation of heparan sulfate and dermatan sulfate. The clinical phenotype of MPS I ranges from the very severe in Hurler syndrome (MPS IH) to the relatively benign in Scheie syndrome (MPS IS), with an intermediate phenotype designated Hurler/Scheie (MPS IH/S) <abbrgrp><abbr bid="B1">1</abbr></abbrgrp>. Isolation of complementary and genomic DNAs encoding human α -L- iduronidase <abbrgrp><abbr bid="B2">2</abbr><abbr bid="B3">3</abbr></abbrgrp> have enable the identification of mutations underlying the enzyme defect and resulting in MPS I clinical phenotype. More than 100 mutations have been reported in patients with the MPS I subtypes (Human Gene Mutation Database; <url>http://www.hgmd.org</url>). High prevalence of the common mutations p.W402X and p.Q70X has been described; both of them in the severe clinical forms <abbrgrp><abbr bid="B4">4</abbr><abbr bid="B5">5</abbr></abbrgrp>. A high prevalence of common mutation p.P533R has also been described in MPS I patients with various phenotypes <abbrgrp><abbr bid="B5">5</abbr><abbr bid="B6">6</abbr></abbrgrp>. In addition, rare mutations including single base substitution, deletion, insertion and splicing site mutation have been identified <abbrgrp><abbr bid="B7">7</abbr></abbrgrp>, indicating a high degree of allelic heterogeneity in IDUA gene.</p> <p>Here, we described two novel IDUA mutations in MPS I Tunisian patients. These lesions were homoallelic in all the patients of the six families investigated as consanguineous marriages are still frequent in Tunisia <abbrgrp><abbr bid="B8">8</abbr></abbrgrp>.</p

The multiplex bead array approach to identifying serum biomarkers associated with breast cancer

Introduction Breast cancer is the most common type of cancer seen in women in western countries. Thus, diagnostic modalities sensitive to early-stage breast cancer are needed. Antibody-based array platforms of a data-driven type, which are expected to facilitate more rapid and sensitive detection of novel biomarkers, have emerged as a direct, rapid means for profiling cancer-specific signatures using small samples. In line with this concept, our group constructed an antibody bead array panel for 35 analytes that were selected during the discovery step. This study was aimed at testing the performance of this 35-plex array panel in profiling signatures specific for primary non-metastatic breast cancer and validating its diagnostic utility in this independent population. Methods Thirty-five analytes were selected from more than 50 markers through screening steps using a serum bank consisting of 4,500 samples from various types of cancer. An antibody-bead array of 35 markers was constructed using the Luminex (TM) bead array platform. A study population consisting of 98 breast cancer patients and 96 normal subjects was analysed using this panel. Multivariate classification algorithms were used to find discriminating biomarkers and validated with another independent population of 90 breast cancer and 79 healthy controls. Results Serum concentrations of epidermal growth factor, soluble CD40-ligand and proapolipoprotein A1 were increased in breast cancer patients. High-molecular-weight-kininogen, apolipoprotein A1, soluble vascular cell adhesion molecule-1, plasminogen activator inhibitor-1, vitamin-D binding protein and vitronectin were decreased in the cancer group. Multivariate classification algorithms distinguished breast cancer patients from the normal population with high accuracy (91.8% with random forest, 91.5% with support vector machine, 87.6% with linear discriminant analysis). Combinatorial markers also detected breast cancer at an early stage with greater sensitivity. Conclusions The current study demonstrated the usefulness of the antibody-bead array approach in finding signatures specific for primary non-metastatic breast cancer and illustrated the potential for early, high sensitivity detection of breast cancer. Further validation is required before array-based technology is used routinely for early detection of breast cancer.Kenny HA, 2008, J CLIN INVEST, V118, P1367, DOI 10.1172/JCI33775Shah FD, 2008, INTEGR CANCER THER, V7, P33, DOI 10.1177/1534735407313883Carlsson A, 2008, EUR J CANCER, V44, P472, DOI 10.1016/j.ejca.2007.11.025Nolen BM, 2008, BREAST CANCER RES, V10, DOI 10.1186/bcr2096Brogren H, 2008, THROMB RES, V122, P271, DOI 10.1016/j.thromres.2008.04.008Varki A, 2007, BLOOD, V110, P1723, DOI 10.1182/blood-2006-10-053736Madsen CD, 2007, J CELL BIOL, V177, P927, DOI 10.1083/jcb.200612058Levenson VV, 2007, BBA-GEN SUBJECTS, V1770, P847, DOI 10.1016/j.bbagen.2007.01.017VAZQUEZMARTIN A, 2007, EUR J CANCER, V43, P1117GARCIA M, 2007, GLOBAL CANC FACTS FIMoore LE, 2006, CANCER EPIDEM BIOMAR, V15, P1641, DOI 10.1158/1055-9965.EPI-05-0980Borrebaeck CAK, 2006, EXPERT OPIN BIOL TH, V6, P833, DOI 10.1517/14712598.6.8.833Zannis VI, 2006, J MOL MED-JMM, V84, P276, DOI 10.1007/s00109-005-0030-4Jemal A, 2006, CA-CANCER J CLIN, V56, P106Silva HC, 2006, NEOPLASMA, V53, P538Chahed K, 2005, INT J ONCOL, V27, P1425Jain KK, 2005, EXPERT OPIN PHARMACO, V6, P1463, DOI 10.1517/14656566.6.9.1463Abe O, 2005, LANCET, V365, P1687Paradis V, 2005, HEPATOLOGY, V41, P40, DOI 10.1002/hep.20505Molina R, 2005, TUMOR BIOL, V26, P281, DOI 10.1159/000089260Furberg AS, 2005, CANCER EPIDEM BIOMAR, V14, P33Benoy IH, 2004, CLIN CANCER RES, V10, P7157Song JS, 2004, BLOOD, V104, P2065, DOI 10.1182/blood-2004-02-0449Schairer C, 2004, J NATL CANCER I, V96, P1311, DOI 10.1093/jnci/djh253Hellman K, 2004, BRIT J CANCER, V91, P319, DOI 10.1038/sj.bjc.6601944Roselli M, 2004, CLIN CANCER RES, V10, P610Zhou AW, 2003, NAT STRUCT BIOL, V10, P541, DOI 10.1038/nsb943Hapke S, 2003, BIOL CHEM, V384, P1073Miller JC, 2003, PROTEOMICS, V3, P56Amirkhosravi A, 2002, BLOOD COAGUL FIBRIN, V13, P505Bonello N, 2002, HUM REPROD, V17, P2272Li JN, 2002, CLIN CHEM, V48, P1296Louhimo J, 2002, ANTICANCER RES, V22, P1759Knezevic V, 2001, PROTEOMICS, V1, P1271Di Micco P, 2001, DIGEST LIVER DIS, V33, P546Ferrigno D, 2001, EUR RESPIR J, V17, P667Webb DJ, 2001, J CELL BIOL, V152, P741Gion M, 2001, EUR J CANCER, V37, P355Schonbeck U, 2001, CELL MOL LIFE SCI, V58, P4Blackwell K, 2000, J CLIN ONCOL, V18, P600Carriero MV, 1999, CANCER RES, V59, P5307Antman K, 1999, JAMA-J AM MED ASSOC, V281, P1470Loskutoff DJ, 1999, APMIS, V107, P54Molina R, 1998, BREAST CANCER RES TR, V51, P109Bajou K, 1998, NAT MED, V4, P923Chan DW, 1997, J CLIN ONCOL, V15, P2322Chu KC, 1996, J NATL CANCER I, V88, P1571vanDalen A, 1996, ANTICANCER RES, V16, P2345Yamamoto N, 1996, CANCER RES, V56, P2827KOCH AE, 1995, NATURE, V376, P517HADDAD JG, 1995, J STEROID BIOCHEM, V53, P579FOEKENS JA, 1994, J CLIN ONCOL, V12, P1648GEARING AJH, 1993, IMMUNOL TODAY, V14, P506HUTCHENS TW, 1993, RAPID COMMUN MASS SP, V7, P576DECLERCK PJ, 1992, J BIOL CHEM, V267, P11693GABRIJELCIC D, 1992, AGENTS ACTIONS S, V38, P350BIEGLMAYER C, 1991, TUMOR BIOL, V12, P138DNISTRIAN AM, 1991, TUMOR BIOL, V12, P82VANDALEN A, 1990, TUMOR BIOL, V11, P189KARAS M, 1988, ANAL CHEM, V60, P2299, DOI 10.1021/ac00171a028LERNER WA, 1983, INT J CANCER, V31, P463WESTGARD JO, 1981, CLIN CHEM, V27, P493TROUSSEAU A, 1865, CLIN MED HOTEL DIEU, V3, P654*R PROJ, R PROJ STAT COMP1