Therapeutic potential of stem cells of the nasal cavity for the treatment of clefts palate

La thérapie cellulaire apparaît comme une alternative attrayante pour traiter les défauts osseux. Certaines équipes chirurgicales pratiquent déjà un rapprochement des tissus avec le périoste et l’interposition d’un lambeau muqueux nasal permettant de fermer le versant vestibulaire de la gencive, en prolongeant la plastie vestibulaire sur la crête gingivale. Ils ont constaté des défauts osseux moins importants et même, chez certains patients, un comblement du défaut osseux sans apport d’os complémentaire. Notre cohorte porteuse de fentes comprend des sujets d’étude opportuns car ils ne sont pas porteurs de polypathologies, ne sont pas polymédicamentés et n’ont pas de comportement addictif pouvant fausser les résultats des greffes. Dans ce contexte, les cellules souches mésenchymateuses nasales représentent une alternative intéressante car elles sont facilement accessibles chez des enfants opérés sous anesthésie générale de façon itérative. Nous pensons pouvoir démontrer la capacité de remodelage osseux chez des patients bien portants, sans tare associée, après greffe autologue de cellules ecto-mésenchymateuses de la cavité nasale. Pour cela, nous souhaitons récupérer des cellules de la muqueuse olfactive chez 5 patients porteur de fentes labio-maxillo-palatine, afin d’évaluer leur potentiel en thérapie cellulaire pour la régénération osseuse. Nous allons donc caractériser cette population cellulaire, étudier la possibilité de conservation de ces cellules souches nasales dans un but thérapeutique et vérifier l’absence d’altération de leur capacité ostéogénique. Ceci est une étape indispensable avant d’envisager un essai clinique de thérapie cellulaire.Cell therapy appears to be an attractive alternative for treating bone defects. Some surgical teams are already practicing a tissue filling with the periosteum and the interposition of a nasal mucosal flap to close the vestibular side of the gingiva, extending the vestibular plasty on the gingival crest. They found less important bone defects in some patients, a filling of the bone defect without adding additional bone. However, it remains a surgical intuition, based on findings during the evolution of the surgical technique. Our cohort includes young patients that do not carry polypathologies, are not polymedicated and have no addictive behavior that could potentially affect the results. In this context, nasal mesenchymal stem cells represent an attractive alternative because they are readily available in children undergoing general anesthesia iteratively. Here, we want to demonstrate the potential of autologous ecto-mesenchymal stem cells of the nasal cavity in the bone regeneration. To do that, we will collect nasal mesenchymental stem cells in 5 young patients with cleft in view to study their potential for bone regeneration. We will characterise this cell population, we will study parameters of conservation before their therapeutical use and their subsequent osteogenic properties. This is a crucial step before an eventual cell therapy clinical trial

Mégavessies anténatales (évaluation de la prise en charge(2004/2011))

AIX-MARSEILLE2-BU Méd/Odontol. (130552103) / SudocSudocFranceF

Congenital pulmonary airway malformation and sequestration: Two standpoints for a single condition

In adults, congenital pulmonary malformations are candidates for surgery due to symptoms. A pre-natal diagnosis is simple and effective, and allows an early thoracoscopic surgical treatment. A retrospective study was performed to assess management in two different populations of adults and children to define the best strategy. Subjects and Methods: Pulmonary malformations followed at the University Hospital from 2000 to 2012 were reviewed. Clinical history, malformation site, duration of hospitalisation, complications and pathology examinations were collected. Results: A total of 52 cases (33 children, 19 adults) were identified. In children, 28 asymptomatic cases were diagnosed pre-natally and 5 during the neonatal period due to infections. Surgery was performed on the children between the ages of 2 and 6 months. Nineteen adults underwent surgery, 16 because of symptoms and 3 adults for anomalies mimicking tumours. The mean age within the adult group was 42.5 years. In children, there was one thoracotomy and 32 thoracoscopies, with 7 conversions for difficult exposure, dissection of vascular pedicles, bleeding or bronchial injury. In the adults, there were 15 thoracotomies and 4 thoracoscopies, with one conversion. Post-operative complications in the adults were twice as frequent than in children. The mean time of the children′s hospitalisation was 7.75 days versus 7.16 days for the adults. Pathological examinations showed in the children: 7 sequestrations, 18 congenital cystic pulmonary malformations (CPAM), 8 CPAM associated sequestrations; in adults: 16 sequestrations, 3 intra-pulmonary cysts. Conclusion: Early thoracoscopic surgery allows pulmonary parenchyma conservation with pulmonary development, reduces respiratory and infectious complications, eliminates a false positive cancer diagnosis later in life and decreases risks of thoracic parietal deformation

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially