Percutaneous endoscopic gastrostomy in head and neck cancer patients: indications, techniques, complications and results

The aim of this study was to review our experience in percutaneous endoscopic gastrostomy (PEG) performed in patients with cancer of the upper aerodigestive tract. Descriptive retrospective study of 142 patients (115 males, 27 females), mean age 62.4years (25-84years), with head and neck or esophageal cancer, who underwent PEG tube insertion between January 2006 and December 2008. The studied parameters were indications, success rate, rate and type of complications, and their management. Percutaneous endoscopic gastrostomy was inserted before chemoradiation therapy in 80% and during or after cancer treatment in 20% of the patients. PEG placement was possible in 137 patients (96%). Major complications were observed in 9 (7%) and minor complications in 22 (17%) of the 137 patients. Seven of the 9 patients with a major complication needed revision surgery. The mortality directly related to the procedure was 0.7%. Percutaneous endoscopic gastrostomy tube insertion has a high success rate. In patients with upper aerodigestive tract cancer, PEG should be the first choice for enteral nutrition when sufficient oral intake is not possible. Although apparently easy, the procedure may occasionally lead to severe complications. Therefore, a strict technique and knowledge of clinical signs of possible complications are mandator

Extended endoscopic mucosal resection in the esophagus and hypopharynx: a new rigid device

We present a new device allowing for the diagnosis and treatment of extended superficial lesions of the esophagus and hypopharynx such as early squamous cell carcinoma, intestinal metaplasia with high grade intraepithelial neoplasia or early adenocarcinoma arising in Barrett's esophagus. A new modified rigid esophagoscope (Karl Storz GmbH, Germany) has been designed. A large mucosal area is sucked against a transparent and perforated hemi-cylindrical window. Mucosal resection is performed by an electrical wire loop at a constant depth of 1±0.1mm. The resected surface varies from 4 to 12cm2. Circumferential resection consists of two opposite individual hemi-circumferential resections. We performed three series of animal trials: hemicircumferential mucosectomies; circumferential resections of variable (2 to 6cm) length and long-segment mucosectomies with follow-up. Hemi- and circumferential resections could be done in one or two specimens only which allowed precise histological studies. This facilitated easy orientation and analysis of the surgical margins. The deep resection margin was precisely located at the submucosal level, a prerequisite for a safe resection of superficial cancers of the esophagus and hypopharyn

Un exemple de dispositif constructiviste en Licence 2 Informatique

International audienceL'apprentissage par projet est souvent utilisé en informatique. L'apprentissage du SQL présenté ici s'appuie sur le paradigme d'apprentissage de Dwyer. Les objectifs d'apprentissage, les pratiques pédagogiques et le rôle des élèves sont présentés ainsi que le practicum où le projet prend place. Cet article présente aussi le point de vue des constructeurs-les élèves, grâce à un questionnaire et la participation de cinq élèves à l'analyse des données recueillies et à la rédaction de cet article

Managing irritable bowel syndrome: The impact of micro-physiotherapy

Contexte : Le syndrome du colon irritable (SCI) présente une pathologie complexe, une prévalence élevée et un impact important sur la qualité de vie des patients. Comme la thérapie conventionnelle n’apporte souvent que des résultats insatisfaisants, une approche plus holistique peut être souhaitable. L’étude actuelle a évalué l’effet de la microkinésithérapie sur la sévérité des symptômes du SCI. Méthodes : Dans cette étude en double aveugle, 61 patients récurrents du SCI ont été randomisés pour recevoir deux séances d’un traitement de microkinésithérapie ou d’un traitement simulé de microkinésithérapie. Les critères d’inclusion étaient la présence de ≥1 symptôme SCI de douleurs abdominales, constipation, diarrhée ou ballonnements. Les critères d’exclusion étaient une chirurgie intestinale majeure antérieure et la présence de maladies chroniques. L’âge moyen du patient était de 53,5 ± 15,3 ans. La microkinésithérapie consistait en un examen micro-palpatoire pour identifier les lésions ostéopathiques, suivi d’un micro-massage pour stimuler l’auto-guérison. Le groupe témoin a subi une procédure simulée. La présence et la gravité des symptômes ont été évaluées lors du suivi par un même gastro-entérologue au départ de l’étude et 1 mois après les séances. Résultats : Deux patients n’ont pas terminé l’étude. Il y a une différence significative entre le pourcentage de patients qui s’est amélioré après la première séance, à 74 % pour le groupe de microkinésithérapie et à 38 % pour le groupe placebo (p = 0,005). Après la deuxième séance, l’amélioration initiale a été maintenue dans les deux groupes, bien que sans plus de gains, et les différences entre les groupes d’étude sont demeurées significatives (p = 0,007). Conclusions : La microkinésithérapie améliore considérablement les symptômes du SCI et devrait être explorée plus avant pour une utilisation dans les soins de santé traditionnels.Background: Irritable bowel syndrome (IBS) has a complex pathology, high prevalence and large impact on patients’ quality of life. As conventional therapy may yield unsatisfactory results, a more holistic approach may be desirable. The current study assessed the effect of micro-physiotherapy on the severity of IBS symptoms. Methods: In a double-blind study, 61 recurrent IBS patients were randomised to two sessions of microphysiotherapy or sham micro-physiotherapy. Inclusion criteria were the presence of ≥1 IBS symptom from abdominal pain, constipation, diarrhoea or bloating. Exclusion criteria were previous major intestinal surgery and the presence of chronic diseases. The mean patient age was 53.5±15.3 years. Micro-physiotherapy consisted of micro-palpatory examination to identify osteopathic lesions, followed by micro-massage to stimulate self healing. The control group underwent a sham procedure. The presence and severity of symptoms was assessed at baseline and at 1-month follow-up by the same gastroenterologist. Results: Two patients did not complete the study. There was a significant difference in percentage of patients that improved after the first session, at 74 % for the micro-physiotherapy group and 38% for the sham group, respectively (p=0.005). After the second session, the initial improvement was maintained in both groups, although with no further gains, and the differences between the study groups remained significant (p=0.007). Conclusions: Micro-physiotherapy significantly improves IBS symptoms and should be further explored for use in mainstream healthcare

Exploring a Mediterranean mesozooplankton 13 year time-series.

Zooplankton plays diverse crucial roles within the marine ecosystem and can also be used as bio- indicator of climate changes since it is very sensitive to environmental changes. Therefore it is essential to consider long-term plankton series. Given the analysis of plankton samples is time- consuming, it requires an effective and rapid analytical method. We have used in this work a supervised learning approach adapted for the semi-automatic classification of digital images of the mesozooplankton of the Bay of Calvi (Corsica, France) by using the Zoo/PhytoImage software. Together with a 11-years long zooplankton time-series, a set of nine environmental variables were monitored in order to identify controlling factors and determine whether the communities were sensitive to global environmental changes. The main components of the mesozooplankton community were characterized by both seasonal and inter-annual variability. Additionally, variation of holoplankton and meroplankton differentiated one from each other. The holoplanktonic community could be split into two subgroups according to its variation in function of the environment: cladocerans and appendicularians, and to a lesser extent, copepods on one hand, and cnidarians, chaetognathes and thaliaceans, on the other hand. Regarding inter-annual variation, one year (2007) showed particularly low production of total zooplankton which was also the case for all the different holoplanktonic taxa. Accounting for that phenomenon were identified some potentially underlying environmental factors. Finally, although water temperature increased significantly over the last years along with the frequency of marine heat wave events, no evident change in the global zooplankton composition was observed yet.STARECAPME

In vitro activities of 18 antimicrobial agents against Staphylococcus aureus isolates from the Institut Pasteur of Madagascar

<p>Abstract</p> <p>Background</p> <p><it>Staphylococcus aureus</it>, one of the most frequently isolated pathogens in both hospitals and the community, has been particularly efficient at developing resistance to antimicrobial agents. In developed countries, as methicillin-resistant <it>S. aureus </it>(MRSA) has prevailed and, furthermore, as <it>S. aureus </it>with reduced susceptibility to vancomycin has emerged, the therapeutic options for the treatment of <it>S. aureus </it>infections have become limited. In developing countries and especially African countries very little is known concerning the resistance of <it>S. aureus </it>to antibiotics. In Madagascar no data exist concerning this resistance.</p> <p>Objective</p> <p>To update the current status of antibiotic resistance of <it>S. aureus </it>in Antananarivo, Madagascar.</p> <p>Methods</p> <p>Clinical <it>S. aureus </it>isolates were collected from patients at the Institut Pasteur of Madagascar from January 2001 to December 2005. Susceptibility tests with 18 antibiotics were performed by the disk diffusion method.</p> <p>Results</p> <p>Among a total of 574 isolates, 506 were from community-acquired infections and 68 from nosocomial infections. There was no significant difference in the methicillin resistance rate between community-acquired strains (33 of 506; 6.5%) and nosocomial strains (3 of 68, 4.4%). Many MRSA isolates were resistant to multiple classes of antibiotics. Resistance to tetracyclin, trimethoprim-sulfamethoxazole and erythromycin was more common. Among MRSA isolates resistance rates to rifampicin, fusidic acid, gentamicin and ciprofloxacin were lower than that observed with other drugs easily available in Madagascar. No isolates were resistant to glycopeptides.</p> <p>Conclusion</p> <p>The rate of methicillin-resistant <it>S. aureus </it>is not different between community-acquired and nosocomial infections and is still rather low in Madagascar.</p

Comparaison de l'échantillonnage horizontal et vertical dans la série spatio-temporelle du plancton de Corse (France) avec ZooImage

Le plancton est composé entre autres des méduses, des larves de poissons ou encore de copépodes. Les organismes planctoniques sont à la base de nombreuses chaines alimentaires marines. Les étudier est par conséquent d'une importance capitale aussi bien du point de vue écologique qu'économique. On compte neuf sites où les prélèvements sont réguliers et sur plus de dix ans en Mer Méditerranée. Différentes méthodes d'échantillonnage sont employées dont la plus utilisée est le trait de filet (vertical, horizontal, double oblique). La comparaison entre ces méthodes est un point essentiel dans la compréhension globale du plancton en mer Méditerranée

Zooplankton dynamics in a changing environment: A 13-year survey in the northwestern Mediterranean Sea

peer reviewedDynamics of the subsurface (2-3 m) mesozooplankton (i.e., > 200 μm) in the Bay of Calvi (Corsica, France) were explored, combining time series (2004-2016) of 14 zooplankton groups, wind gusts, water temperature, nitrate and chlorophyll-a. Zooplankton data was obtained through image analysis. While contrasted group-specific sea- sonal patterns were observed, the most productive zooplankton annual event occurred in April (spring peak), concentrating on average 25% of the total annual abundance. A 'typical' year was defined based on the annual succession of different community states, highlighting particular years (2007, 2015 and 2012), mainly character- ized by weak spring peak. Environmental influences on the interannual variability of zooplankton were explored and while relationship between chlorophyll-a and zooplankton abundance was unclear, the availability of nu- trients (December-March), potentially mediated via the wind regime (October-January) seemed to be essential to the occurrence of the spring peak. Additionally, we observed an influence of temperature, with winter ther- mal thresholds (between 12.1 °C and 13.4 °C) conditioning the spring peak. Also, the occurrence of lower annual abundances after 2010 was synchronous with the sharp increase of seawater warming trend, especially regarding winter temperature (0.30 °C.year-1). Finally, winter North Atlantic Oscillation (NAO) was found to be correlated to both winter water temperature and spring peak abundance, which suggests large-scale processes to impact re- gional zooplankton community

Long-term changes of the zooplankton community in the Bay of Calvi (Corsica, France)

Zooplankton plays diverse crucial roles within the marine ecosystem and can also be used as bio- indicator of climate changes since it is very sensitive to environmental changes. Therefore it is essential to consider long-term plankton series. Given the analysis of plankton samples is time- consuming, it requires an effective and rapid analytical method. We have used in this work a supervised learning approach adapted for the semi-automatic classification of digital images of the mesozooplankton of the Bay of Calvi (Corsica, France) by using the Zoo/PhytoImage software. Together with a 11-years long zooplankton time-series, a set of nine environmental variables were monitored in order to identify controlling factors and determine whether the communities were sensitive to global environmental changes. The main components of the mesozooplankton community were characterized by both seasonal and inter-annual variability. Additionally, variation of holoplankton and meroplankton differentiated one from each other. The holoplanktonic community could be split into two subgroups according to its variation in function of the environment: cladocerans and appendicularians, and to a lesser extent, copepods on one hand, and cnidarians, chaetognathes and thaliaceans, on the other hand. Regarding inter-annual variation, one year (2007) showed particularly low production of total zooplankton which was also the case for all the different holoplanktonic taxa. Accounting for that phenomenon were identified some potentially underlying environmental factors. Finally, although water temperature increased significantly over the last years along with the frequency of marine heat wave events, no evident change in the global zooplankton composition was observed yet