Maladie de hodgkin et cancer colique secondaire: à propos d'un cas

La maladie de HODGKIN (MDH) survient le plus souvent chez les enfants, adolescents et jeunes adultes. Elle représente une des tumeurs malignes les plus curables. Grâce aux progrès thérapeutiques actuels, plusieurs patients ont pu obtenir des réponses complètes durables, mais les tumeurs solides malignes, secondaires au traitement, demeurent la complication tardive la plus redoutable chez les longs survivants. Il s'agit d'un patient de 28 ans, sans antécédents pathologiques notables, suivi depuis l'age de 13 ans pour une MDH scléro-nodulaire stade IV (à localisation pulmonaire). Le patient a reçu initialement 06 cures de chimiothérapie, suivies d'une radiothérapie externe sus et sous-diaphragmatique. L’évolution a été marquée par la survenue de 02 rechutes, pour lesquelles, 02 autres lignes thérapeutiques ont été administrées. Puis, survenue d'une progression, pour laquelle il a été mis sous Cyclophosphamide par voie orale. Après 02 ans d'un bon contrôle clinique et radiologique sous cette dernière drogue cytotoxique, le patient a fait apparaître une hématurie macroscopique et parallèlement, un adénocarcinome (ADK) colique, survenant 15 ans après le début du traitement initial du lymphome, ayant nécessité une hémicolectomie droite élargie. Les modalités thérapeutiques de la MDH chez les adolescents et jeunes adultes ont subit des modifications remarquables ces dernières décennies. L’évaluation du risque de cancers secondaires chez les longs survivants, reflète souvent l'effet de modalités anciennes plus agressives. La plupart des études rapportant des cas de cancers secondaires, tiennent en compte la 1ère ligne thérapeutique et les traitements de rattrapage de la MDH. En effet, les jeunes patients traités par chimiothérapie et plus particulièrement par radiothérapie, sont à haut risque de développer des cancers secondaires. La radio-chimiothérapie parait par ailleurs, augmenter de façon plus significative ce risque. L'estimation du risque de cancers secondaires à long terme demeure alors essentielle, afin de minimiser les complications tardives, et ceci à travers des mesures de prévention et de dépistage chez les jeunes patients potentiellement à risque

Triple malignancy in a single patient including a cervical carcinoma, a basal cell carcinoma of the skin and a neuroendocrine carcinoma from an unknown primary site: A case report and review of the literature

<p>Abstract</p> <p>Introduction</p> <p>The occurrence of multiple primary cancers is rare. Only a few cases and patient reviews of an association of triple malignancy have been reported.</p> <p>Case presentation</p> <p>We report here a case of a 78-year-old Moroccan woman presenting initially with a synchronous double malignancy, the first in her cervix and the second in her skin. Our patient was treated with radiation therapy for both tumors and remained in good control for 17 years, when she developed a metastatic disease from a neuroendocrine carcinoma of an unknown primary site.</p> <p>Conclusions</p> <p>Although the association of multiple primary cancers can be considered a rare occurrence, improving survival in cancer patients has made this situation more frequent.</p

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Design and characterization of exchanger-reactors with multi-scale structuring

La présente thèse s’intéresse à la conception et la caractérisation des procédés microstructurés mettant en œuvre des réseaux de microcanaux de différentes dimensions. L’analyse de tels réseaux multi-échelles, représentatifs d’une parallélisastion de microsystèmes élémentaires, a essentiellement servi à identifier les principaux paramètres géométriques et physiques contrôlant les performances de ces réseaux complexes. On a cherché à quantifier l’influence des paramètres géométriques comme le rapport de résistances hydrodynamiques internes, le nombre de canaux et d’échelles opérant ainsi que leur répartition sur le réseau, sur des critères hydrodynamiques comme la maldistribution du fluide et la perte de charge résistive. Il est révélé qu’en fonction des contraintes imposées, un arrangement optimal des canaux sur un nombre pair d’échelles permet de réduire considérablement la maldistribution interne des flux et les pertes de charge résultantes. L’analyse thermique associée à l’analyse hydrodynamique a montré que les performances thermiques des réseaux sont fortement liées à leurs structurations géométriques internes. En présence de réactions catalytiques consécutives, ces mêmes réseaux enregistrent des déviations du rendement du produit désiré. Ces déviations peuvent être levées par une structuration appropriée du réseau catalytique multi-canal. La même architecture de ces réseaux peut être adaptée pour permettre le déroulement des opérations de mélange et/ou des réactions multi-phasiques. Ainsi, pour ces réseaux complexes, où un nombre élevé de variables imbriquées est considéré, des lignes directrices sont ressorties pour aider à leur conception et dimensionnementThis PhD thesis focuses on the design and the characterization of microstructured processes including microchannel networks of various dimensions. The analysis of such multi-scale networks, representative of elementary microsystems parallelization, is mainly used to identify the main geometrical and physical parameters controlling the network performances. Influence of geometrical parameters, such as the internal hydrodynamic resistances ratio, the number of channels and scales and their arrangement in the network, on hydrodynamic criteria like fluid maldistribution and pressure drop is investigated. It is shown that according to some specific constraints, an optimal arrangement of the channels on an even number of scales, allows to reduce significantly the internal flow maldistribution and the consequential pressure losses. The thermal analysis coupled with the hydrodynamic analysis illustrates that the thermal performances of microchannel networks are strongly affected by their internal geometrical arrangement. Nevertheless, the various mixture points located in the network compensate the fluid maldistribution resulting from a non appropriate geometrical arrangement. When consecutive catalytic reactions are performed inside these networks, deviations of the desired product rate can be recorded. These deviations can be reduced by an optimal catalytic network arrangement. The same architecture of these networks is also adapted to allow multi-phase mixing and /or reactions. Thus, using these complex networks, where several variables are considered, guidelines are derived in order to improve their design and their dimensionles

Conception et caractérisation d'échangeurs-réacteurs à structuration multi-échelle

This PhD thesis focuses on the design and the characterization of microstructured processes including microchannel networks of various dimensions. The analysis of such multi-scale networks, representative of elementary microsystems parallelization, is mainly used to identify the main geometrical and physical parameters controlling the network performances. Influence of geometrical parameters, such as the internal hydrodynamic resistances ratio, the number of channels and scales and their arrangement in the network, on hydrodynamic criteria like fluid maldistribution and pressure drop is investigated. It is shown that according to some specific constraints, an optimal arrangement of the channels on an even number of scales, allows to reduce significantly the internal flow maldistribution and the consequential pressure losses. The thermal analysis coupled with the hydrodynamic analysis illustrates that the thermal performances of microchannel networks are strongly affected by their internal geometrical arrangement. Nevertheless, the various mixture points located in the network compensate the fluid maldistribution resulting from a non appropriate geometrical arrangement. When consecutive catalytic reactions are performed inside these networks, deviations of the desired product rate can be recorded. These deviations can be reduced by an optimal catalytic network arrangement. The same architecture of these networks is also adapted to allow multi-phase mixing and /or reactions. Thus, using these complex networks, where several variables are considered, guidelines are derived in order to improve their design and their dimensionlessLa présente thèse s'intéresse à la conception et la caractérisation des procédés microstructurés mettant en oeuvre des réseaux de microcanaux de différentes dimensions. L'analyse de tels réseaux multi-échelles, représentatifs d'une parallélisastion de microsystèmes élémentaires, a essentiellement servi à identifier les principaux paramètres géométriques et physiques contrôlant les performances de ces réseaux complexes. On a cherché à quantifier l'influence des paramètres géométriques comme le rapport de résistances hydrodynamiques internes, le nombre de canaux et d'échelles opérant ainsi que leur répartition sur le réseau, sur des critères hydrodynamiques comme la maldistribution du fluide et la perte de charge résistive. Il est révélé qu'en fonction des contraintes imposées, un arrangement optimal des canaux sur un nombre pair d'échelles permet de réduire considérablement la maldistribution interne des flux et les pertes de charge résultantes. L'analyse thermique associée à l'analyse hydrodynamique a montré que les performances thermiques des réseaux sont fortement liées à leurs structurations géométriques internes. En présence de réactions catalytiques consécutives, ces mêmes réseaux enregistrent des déviations du rendement du produit désiré. Ces déviations peuvent être levées par une structuration appropriée du réseau catalytique multi-canal. La même architecture de ces réseaux peut être adaptée pour permettre le déroulement des opérations de mélange et/ou des réactions multi-phasiques. Ainsi, pour ces réseaux complexes, où un nombre élevé de variables imbriquées est considéré, des lignes directrices sont ressorties pour aider à leur conception et dimensionnemen

Axial Dispersion Based on the Residence Time Distribution Curves in a Millireactor Filled with β-SiC Foam Catalyst

International audienc

Conception et caractérisation d'échangeurs-réacteurs à structuration multi-échelle

La présente thèse s intéresse à la conception et la caractérisation des procédés microstructurés mettant en œuvre des réseaux de microcanaux de différentes dimensions. L analyse de tels réseaux multi-échelles, représentatifs d une parallélisastion de microsystèmes élémentaires, a essentiellement servi à identifier les principaux paramètres géométriques et physiques contrôlant les performances de ces réseaux complexes. On a cherché à quantifier l influence des paramètres géométriques comme le rapport de résistances hydrodynamiques internes, le nombre de canaux et d échelles opérant ainsi que leur répartition sur le réseau, sur des critères hydrodynamiques comme la maldistribution du fluide et la perte de charge résistive. Il est révélé qu en fonction des contraintes imposées, un arrangement optimal des canaux sur un nombre pair d échelles permet de réduire considérablement la maldistribution interne des flux et les pertes de charge résultantes. L analyse thermique associée à l analyse hydrodynamique a montré que les performances thermiques des réseaux sont fortement liées à leurs structurations géométriques internes. En présence de réactions catalytiques consécutives, ces mêmes réseaux enregistrent des déviations du rendement du produit désiré. Ces déviations peuvent être levées par une structuration appropriée du réseau catalytique multi-canal. La même architecture de ces réseaux peut être adaptée pour permettre le déroulement des opérations de mélange et/ou des réactions multi-phasiques. Ainsi, pour ces réseaux complexes, où un nombre élevé de variables imbriquées est considéré, des lignes directrices sont ressorties pour aider à leur conception et dimensionnementThis PhD thesis focuses on the design and the characterization of microstructured processes including microchannel networks of various dimensions. The analysis of such multi-scale networks, representative of elementary microsystems parallelization, is mainly used to identify the main geometrical and physical parameters controlling the network performances. Influence of geometrical parameters, such as the internal hydrodynamic resistances ratio, the number of channels and scales and their arrangement in the network, on hydrodynamic criteria like fluid maldistribution and pressure drop is investigated. It is shown that according to some specific constraints, an optimal arrangement of the channels on an even number of scales, allows to reduce significantly the internal flow maldistribution and the consequential pressure losses. The thermal analysis coupled with the hydrodynamic analysis illustrates that the thermal performances of microchannel networks are strongly affected by their internal geometrical arrangement. Nevertheless, the various mixture points located in the network compensate the fluid maldistribution resulting from a non appropriate geometrical arrangement. When consecutive catalytic reactions are performed inside these networks, deviations of the desired product rate can be recorded. These deviations can be reduced by an optimal catalytic network arrangement. The same architecture of these networks is also adapted to allow multi-phase mixing and /or reactions. Thus, using these complex networks, where several variables are considered, guidelines are derived in order to improve their design and their dimensionlessNANCY-INPL-Bib. électronique (545479901) / SudocSudocFranceF

Residence time distribution, axial liquid dispersion and dynamic–static liquid mass transfer in trickle flow reactor containing β-SiC open-cell foams

International audienc