Aspects Épidémiologiques, Cliniques et Thérapeutiques des Tumeurs de la Parotide

Introduction: Les pathologies des glandes salivaires sont relativement rares, dominées par les tumeurs de la glande parotide. Elles sont caractérisées par leur polymorphisme clinique et leur grande diversité morpho-histologique. Le traitement est surtout chirurgical, la complication majeure de cette chirurgie reste la paralysie faciale pouvant être transitoire ou permanente. Dans ce sens, l’objectif de ce travail était de décrire les aspects épidémiologiques, cliniques, paracliniques et thérapeutiques des tumeurs parotidiennes rencontrées dans le service de l’odontostomatologie de l’Hôpital National de Niamey (HNN) durant la période de l’étude. Méthodologie: Il s’agissait d’une étude rétrospective et descriptive portant sur les tumeurs parotidiennes rencontrées au service d’odontostomatologie de l’Hôpital National de Niamey au Niger. Par ailleurs, la tumeur était homogène dans 2 cas sur 4 et bénigne également une fois sur 2. Résultats: 12 patients ont été colligés sur une période de 29 mois. La prévalence hospitalière était de 0,11% avec 4,97 cas par an. La tranche d’âge allait de 9 à 75 ans. Il y avait 8 hommes contre 4 femmes. La malignité a été suspectée cliniquement devant une masse dure, fixe, douloureuse avec présence d’adénopathies satellites et associée à une paralysie faciale. La parotidectomie totale conservatrice du nerf facial a été réalisée chez 10 patients sur 12 et la chimiothérapie a été préconisée chez 2 patients. L’examen ophtalmologique a été réalisé chez tous les patients à la recherche d’une atteinte oculaire ou de la glande lacrymale. L’histologie a été contributive dans tous les cas et les tumeurs bénignes dominaient dans 50% des cas avec comme chef de fil l’adénome pléomorphe. Conclusion: Les tumeurs de la glande parotide sont rares et leur prise en charge thérapeutique est essentiellement chirurgicale. Leur évolution est en général favorable. Néanmoins, l’accent devra être mis sur la surveillance à long terme de certaines formes histologiques dont le risque de dégénérescence et de récidive est élevé.  Introduction: Pathologies of the salivary glands are relatively rare and are dominated by tumors of the parotid gland. They are characterized by their clinical polymorphism and their great morpho-histological diversity. The treatment is mainly surgical. The major complication of this surgery is facial paralysis which can be transient or permanent. The objective of this work is to describe the epidemiological, clinical, paraclinical, and therapeutic aspects of parotid tumors encountered in the odontostomatology department of Niamey National Hospital during the study period. Methodology: This study is a retrospective and descriptive study on parotid tumors encountered in the odontostomatology department of the Niamey National Hospital in Niger. In addition, the tumor was homogeneous in 2 out of 4 cases and also benign once in 2. Results: 12 patients were collected over a period of 29 months. The hospital prevalence was 0.11% with 4.97 cases per year. The age range was from 9 to 75 years old. There were 8 men against 4 women. The malignancy was suspected clinically before a hard, fixed, and painful mass with the presence of satellite lymphadenopathy which is associated with facial paralysis. Total conservative facial nerve parotidectomy was performed in 10 out of 12 patients, and chemotherapy was recommended in 2 patients. The ophthalmic examination was performed in all patients looking for damage to the eyes or the lacrimal gland. Histology was contributory in all cases and benign tumors dominated in 50% of cases with pleomorphic adenoma as the lead. Conclusion: Tumors of the parotid gland are rare and their therapeutic management is essentially surgical. Their development is generally favorable. However, emphasis should be placed on the long-term monitoring of certain histological forms for which the risk of degeneration and recurrence is high.&nbsp

Adénome Pléomorphe Géant à Localisation Submandibulaire: À Propos d’un Cas

Introduction: The pleomorphic adenoma is a benign tumor of the salivary glands. Its extra parotid locations are rare. The aim of this study is to describe the particular management of the pleomorphic adenoma in its unusual location. Observation: This patient was a 35 - year - old patient referred from Zinder Hospital for the management of tumefaction in the mandibular region that had been undergoing surgery for 10 years. The clinical and paraclinical examinations led to the conclusion of a pleomorphic adenoma of the submandibular gland, by imaging and confirmed by the anatomo-pathological examination of the surgical specimen, which measured 15x12x8cm following submandibulectomy with complete tumor resection. The follow-up was simple and no recurrence or malignant transformation was reported after a mean follow-up of one year. Conclusion: The extra-parotid localization of the pleomorphic adenoma is dominated by the submandibular gland. This localization stands out in its clinical and therapeutic peculiarities. Introduction: L’adénome pléomorphe est une tumeur bénigne des glandes salivaires. Ses localisations extra parotidiennes sont rares. L’objectif de ce travail est de décrire la prise en charge particulière de l’adénome pléomorphe dans sa localisation inhabituelle. Observation: Ils’agissait d’un patient de 35 ans, référé de l’Hôpital National de Zinder pour la prise en charge d’une tumeur de la région mandibulaire évoluant depuis 10 ans. Les examens cliniques et paracliniques avaient permis de conclure à un adénome pléomorphe de la glande submandibulaire, par l’imagerie et confirmé par l’examen anatomo-pathologique de la pièce opératoire qui mesurait 15x12x 8cm suite à la submandibulectomie avec résection tumorale complète. Les suites opératoires étaient simples et aucune récidive ni transformation maligne n’a été rapportée après un recul d’un an. Conclusion: La localisation extra-parotidienne de l’adénome pléomorphe est dominée par la glande submandibulaire. Cette localisation se distingue dans ses particularités cliniques et thérapeutiques

Kerr/CFT, dipole theories and nonrelativistic CFTs

We study solutions of type IIB supergravity which are SL(2,R) x SU(2) x U(1)^2 invariant deformations of AdS_3 x S^3 x K3 and take the form of products of self-dual spacelike warped AdS_3 and a deformed three-sphere. One of these backgrounds has been recently argued to be relevant for a derivation of Kerr/CFT from string theory, whereas the remaining ones are holographic duals of two-dimensional dipole theories and their S-duals. We show that each of these backgrounds is holographically dual to a deformation of the DLCQ of the D1-D5 CFT by a specific supersymmetric (1,2) operator, which we write down explicitly in terms of twist operators at the free orbifold point. The deforming operator is argued to be exactly marginal with respect to the zero-dimensional nonrelativistic conformal (or Schroedinger) group - which is simply SL(2,R)_L x U(1)_R. Moreover, in the supergravity limit of large N and strong coupling, no other single-trace operators are turned on. We thus propose that the field theory duals to the backgrounds of interest are nonrelativistic CFTs defined by adding the single Schroedinger-invariant (1,2) operator mentioned above to the original CFT action. Our analysis indicates that the rotating extremal black holes we study are best thought of as finite right-moving temperature (non-supersymmetric) states in the above-defined supersymmetric nonrelativistic CFT and hints towards a more general connection between Kerr/CFT and two-dimensional non-relativistic CFTs.Comment: 48+8 pages, 4 figures; minor corrections and references adde

PCA3 molecular urine assay for prostate cancer: association with pathologic features and impact of collection protocols

IntroductionPCA3 is a non-coding mRNA molecule that is overexpressed in prostate cancer. The purpose of this study is to evaluate the utility of the PCA3 molecular urine test scores to predict adverse pathologic features and catheterized specimen collection.MethodsHundred men with clinically localized prostate cancer scheduled to undergo robotic prostatectomy were enrolled in the study following a standard consent process. The study protocol consisted of providing four urine samples. Voided urine obtained following digital rectal examination (DRE) pre-operatively (Vl), catheterized urine without DRE (V2), and l0-day and 6-week postoperative voided (V3 and V4) urine samples were collected and analyzed. These four urine specimens underwent target capture, transcription-mediated amplification, and hybridization in order to quantify both PCA3 and PSA mRNA. The PCA3 score was calculated as the ratio of PCA3 to PSA.ResultsInformative rates (sufficient mRNA for analysis) for VI, V2, V3 and V4 were 91, 85, 0 and 2%, respectively. There was no significant associations with pathological stage, Gleason score >6. Higher PCA3 scores at V1 correlated with increased risk for perineural invasion (P = 0.0479).ConclusionsInformative PCA3 scores can be obtained from post-DRE voided urine as well as catheterized urine without a DRE. The PCA3 test does not seem to predict adverse pathologic features, though, may have an association with perineural invasion. The ability of PCA3 score to predict clinical outcome remains to be determined

Association of Panton Valentine Leukocidin (PVL) genes with methicillin resistant Staphylococcus aureus (MRSA) in Western Nepal: a matter of concern for community infections (a hospital based prospective study)

BACKGROUND: Methicillin resistant Staphylococcus aureus (MRSA) is a major human pathogen associated with nosocomial and community infections. Panton Valentine leukocidin (PVL) is considered one of the important virulence factors of S. aureus responsible for destruction of white blood cells, necrosis and apoptosis and as a marker of community acquired MRSA. This study was aimed to determine the prevalence of PVL genes among MRSA isolates and to check the reliability of PVL as marker of community acquired MRSA isolates from Western Nepal. METHODS: A total of 400 strains of S. aureus were collected from clinical specimens and various units (Operation Theater, Intensive Care Units) of the hospital and 139 of these had been confirmed as MRSA by previous study. Multiplex PCR was used to detect mecA and PVL genes. Clinical data as well as antimicrobial susceptibility data was analyzed and compared among PVL positive and negative MRSA isolates. RESULTS: Out of 139 MRSA isolates, 79 (56.8 %) were PVL positive. The majority of the community acquired MRSA (90.4 %) were PVL positive (Positive predictive value: 94.9 % and negative predictive value: 86.6 %), while PVL was detected only in 4 (7.1 %) hospital associated MRSA strains. None of the MRSA isolates from hospital environment was found positive for the PVL genes. The majority of the PVL positive strains (75.5 %) were isolated from pus samples. Antibiotic resistance among PVL negative MRSA isolates was found higher as compared to PVL positive MRSA. CONCLUSION: Our study showed high prevalence of PVL among community acquired MRSA isolates. Absence of PVL among MRSA isolates from hospital environment indicates its poor association with hospital acquired MRSA and therefore, PVL may be used a marker for community acquired MRSA. This is first study from Nepal, to test PVL among MRSA isolates from hospital environment. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12879-016-1531-1) contains supplementary material, which is available to authorized users

Comparison of Patient and Surgeon Expectations of Total Hip Arthroplasty

OBJECTIVES: Analysis of discrepancies between patient and surgeon expectations before total hip arthroplasty (THA) should enable a better understanding of motives of dissatisfaction about surgery, but this question has been seldom studied. Our objectives were to compare surgeons' and patients' expectations before THA, and to study factors which affected surgeon-patient agreement. METHODS: 132 adults (mean age 62.8+/-13.7 years, 52% men) on waiting list for THA in three tertiary care centres and their 16 surgeons were interviewed to assess their expectations using the Hospital for Special Surgery Total Hip Replacement Expectations Survey (range 0-100). Patients' and surgeons' answers were compared, for the total score and for the score of each item. Univariate analyses tested the effect of patients' characteristics on surgeons' and patients' expectations separately, and on surgeon-patient differences. RESULTS: Surgeon and patient expectations' mean scores were high (respectively 90.9+/-11.1 and 90.0+/-11.6 over 100). Surgeons' and patients' expectations showed no systematic difference, but there was little agreement on Bland and Altman graph and correlation coefficient was low. Patients had higher expectations than surgeons for sports. Patients rated their expectations according to trust in physician and mental quality of life, surgeons considered disability. More disabled patients and patients from a low-income professional category were often "more optimistic" than their surgeons. CONCLUSION: Surgeons and patients often do not agree on what to expect from THA. More disabled patients expect better outcomes than their surgeons

Measurement of the Bottom-Strange Meson Mixing Phase in the Full CDF Data Set

We report a measurement of the bottom-strange meson mixing phase \beta_s using the time evolution of B0_s -> J/\psi (->\mu+\mu-) \phi (-> K+ K-) decays in which the quark-flavor content of the bottom-strange meson is identified at production. This measurement uses the full data set of proton-antiproton collisions at sqrt(s)= 1.96 TeV collected by the Collider Detector experiment at the Fermilab Tevatron, corresponding to 9.6 fb-1 of integrated luminosity. We report confidence regions in the two-dimensional space of \beta_s and the B0_s decay-width difference \Delta\Gamma_s, and measure \beta_s in [-\pi/2, -1.51] U [-0.06, 0.30] U [1.26, \pi/2] at the 68% confidence level, in agreement with the standard model expectation. Assuming the standard model value of \beta_s, we also determine \Delta\Gamma_s = 0.068 +- 0.026 (stat) +- 0.009 (syst) ps-1 and the mean B0_s lifetime, \tau_s = 1.528 +- 0.019 (stat) +- 0.009 (syst) ps, which are consistent and competitive with determinations by other experiments.Comment: 8 pages, 2 figures, Phys. Rev. Lett 109, 171802 (2012

Major Reduction in Anti-Malarial Drug Consumption in Senegal after Nation-Wide Introduction of Malaria Rapid Diagnostic Tests

BACKGROUND: While WHO recently recommended universal parasitological confirmation of suspected malaria prior to treatment, debate has continued as to whether wide-scale use of rapid diagnostic tests (RDTs) can achieve this goal. Adherence of health service personnel to RDT results has been poor in some settings, with little impact on anti-malarial drug consumption. The Senegal national malaria control programme introduced universal parasite-based diagnosis using malaria RDTs from late 2007 in all public health facilities. This paper assesses the impact of this programme on anti-malarial drug consumption and disease reporting. METHODS AND FINDINGS: Nationally-collated programme data from 2007 to 2009 including malaria diagnostic outcomes, prescription of artemisinin-based combination therapy (ACT) and consumption of RDTs in public health facilities, were reviewed and compared. Against a marked seasonal variation in all-cause out-patient visits, non-malarial fever and confirmed malaria, parasite-based diagnosis increased nationally from 3.9% of reported malaria-like febrile illness to 86.0% over a 3 year period. The prescription of ACT dropped throughout this period from 72.9% of malaria-like febrile illness to 31.5%, reaching close equivalence to confirmed malaria (29.9% of 584,873 suspect fever cases). An estimated 516,576 courses of inappropriate ACT prescription were averted. CONCLUSIONS: The data indicate high adherence of anti-malarial prescribing practice to RDT results after an initial run-in period. The large reduction in ACT consumption enabled by the move from symptom-based to parasite-based diagnosis demonstrates that effective roll-out and use of malaria RDTs is achievable on a national scale through well planned and structured implementation. While more detailed information on management of parasite-negative cases is required at point of care level to assess overall cost-benefits to the health sector, considerable cost-savings were achieved in ACT procurement. Programmes need to be allowed flexibility in management of these funds to address increases in other programmatic costs that may accrue from improved diagnosis of febrile disease

Prediction of the survival and functional ability of severe stroke patients after ICU therapeutic intervention

<p>Abstract</p> <p>Background</p> <p>This study evaluated the benefits and impact of ICU therapeutic interventions on the survival and functional ability of severe cerebrovascular accident (CVA) patients.</p> <p>Methods</p> <p>Sixty-two ICU patients suffering from severe ischemic/haemorrhagic stroke were evaluated for CVA severity using APACHE II and the Glasgow coma scale (GCS). Survival was determined using Kaplan-Meier survival tables and survival prediction factors were determined by Cox multivariate analysis. Functional ability was assessed using the stroke impact scale (SIS-16) and Karnofsky score. Risk factors, life support techniques and neurosurgical interventions were recorded. One year post-CVA dependency was investigated using multivariate analysis based on linear regression.</p> <p>Results</p> <p>The study cohort constituted 6% of all CVA (37.8% haemorrhagic/62.2% ischemic) admissions. Patient mean(SD) age was 65.8(12.3) years with a 1:1 male: female ratio. During the study period 16 patients had died within the ICU and seven in the year following hospital release.</p> <p>The mean(SD) APACHE II score at hospital admission was 14.9(6.0) and ICU mean duration of stay was 11.2(15.4) days. Mechanical ventilation was required in 37.1% of cases. Risk ratios were; GCS at admission 0.8(0.14), (p = 0.024), APACHE II 1.11(0.11), (p = 0.05) and duration of mechanical ventilation 1.07(0.07), (p = 0.046). Linear coefficients were: type of CVA – haemorrhagic versus ischemic: -18.95(4.58) (p = 0.007), GCS at hospital admission: -6.83(1.08), (p = 0.001), and duration of hospital stay -0.38(0.14), (p = 0.40).</p> <p>Conclusion</p> <p>To ensure a better prognosis CVA patients require ICU therapeutic interventions. However, as we have shown, where tests can determine the worst affected patients with a poor vital and functional outcome should treatment be withheld?</p

Evaluation of in-stent restenosis in the APPROACH trial (assessment on the prevention of progression by Rosiglitazone on atherosclerosis in diabetes patients with cardiovascular history)

To determine (1) the medium-term effect of rosiglitazone and glipizide on intra-stent neointima hyperplasia, (2) restenosis pattern as assessed by intra-vascular ultrasound (IVUS) and quantitative coronary angiography (QCA) in patients with T2DM and coronary artery disease. A total of 462 patients with T2DM were randomized to rosiglitazone or glipizide for up to 18 months in the APPROACH trial, and had evaluable baseline and follow-up IVUS examinations. There was no significant difference in the size of plaque behind stent between the rosiglitazone and glipizide groups at 18 months among those treated with a bare metal stent (−5.6 mm3 vs. 1.9 mm3; P = 0.61) or with a drug-eluting stent (12.1 mm3 vs. 5.5 mm3; P = 0.09). Similarly, there was no significant difference in percentage intimal hyperplasia volume between the rosiglitazone and glipizide groups at 18 months among those treated with a bare metal stent (24.1% vs. 19.8%; P = 0.38) or with a drug-eluting stent (9.8% vs. 8.3%; P = 0.57). QCA data (intra-stent late loss, intra-stent diameter stenosis or binary restenosis) were not different between the rosiglitazone and glipizide groups. This study suggests that both rosiglitazone and glipizide have a similar effect on neointimal growth at medium term follow-up, a finding that warrants investigation in dedicated randomized trials