Biomedical subjects

D Jacob

Publications and source records attributed to D Jacob.

At least 19 recordsLinked to original sources

PubMed2007

Transabdominal ligation of the thoracic duct as treatment of choice for postoperative chylothorax after esophagectomy.

Postoperative chylothorax after injury of the thoracic duct during esophagectomy is a rare but severe complication which may lead to serious problems such as loss of fat and proteins, and immunodeficiency. Without treatment mortality can rise to over 50%. From 1988 to 2005, we treated 10 patients with postoperative chylothorax after 409 resections of the esophagus (2.4%). Of these 10 patients nine underwent transthoracic esophagectomy with gastric pull-up to enable an intrathoracic (n = 7) or cervical (n = 2) anastomosis and one patient received a transhiatal esophagectomy with gastric pull-up and cervical anastomosis. The average amount of postoperative chylus was 2205 mL (200-4500 mL) per day. After a median postoperative interval of 10 days, relaparotomy and transhiatal double ligation of the thoracic duct was performed in nine out of 10 patients. One patient could be managed conservatively. The average amount of chylus was reduced to 151 mL per day (90.5%). Seven patients had no complications, and three suffered from postoperative pneumonia. Two of the patients with pneumonia recovered, and one died. Discharge from hospital, after ligation of the thoracic duct, was possible after a median time of 18 days (11-52). Ligation of the thoracic duct via relaparotomy appeared to be a simple and safe method to treat postoperative chylothorax.

Aged↗

PubMed2006

[Traumatic aneurysm of the superior mesenteric artery associated with a burst- fracture of the second lumbar spine -- unforeseen sequelae of a fall from a ladder!].

Traumatic aneurysms of the superior mesenteric artery, although uncommon, are nevertheless life-threatening because of their high risk of rupture. In this case report the aneurysm was accompanied by a burst fracture of the second lumbar spine nearly at the same height. In a prolonged case the diagnosis of the injury was delayed. The clinical manifestation of repeated episodes of abdominal pain did not recur after resection of the aneurysm and interposition of a venous autograft.

Abdomen, Acute↗

PubMed2006

Evaluation of different methods to discriminate Bacillus anthracis from other bacteria of the Bacillus cereus group.

AIMS: To evaluate different methods that are useful for rapid and definitive discrimination of Bacillus anthracis from other bacteria of the Bacillus cereus group in environmental samples like letters claimed to contain anthrax spores. METHODS AND RESULTS: Characterized strains and bacteria from environmental samples were analysed by microbiological and molecular methods (PCR and restriction analysis). Environmental isolates often shared several microbiological features with B. anthracis, e.g. lack of beta-haemolysis and phospholipase C activity, and only the gamma phage assay was specific for B. anthracis. PCR assays targeting markers from the virulence plasmids exclusively detected B. anthracis, but other PCR targets were also detected in nonanthrax isolates. Additionally, the restriction pattern in an AluI restriction analysis of the SG-749 fragment is not 100% specific. The loci used for multiple-locus variable-number tandem repeat analysis of B. anthracis are also present in other members of the B. cereus group, but amplicon sizes are usually different. CONCLUSIONS: Environmental samples often contain borderline isolates closely related to B. anthracis both on microbiological and genetic levels. Real-time PCR targeting plasmidal and chromosomal markers should be used for rapid and definitive exclusion of a virulent strain of B. anthracis in such samples. SIGNIFICANCE AND IMPACT OF THE STUDY: This study gives an overview of the current microbiological and molecular methods used for identification of B. anthracis and shows that most assays have limits when borderline isolates present in environmental samples are analysed.

Bacillus Phages↗

PubMed2005

[Necrotizing fasciitis of the perineum secondary to a surgical treatment of Bartholin's gland abscess].

Necrotizing fasciitis of the perineum is a rare but of fast evolution, and potentially fatal infectious disease process. It is characterized by progressive inflammation and extensive necrosis of subcutaneous tissue involving the fascia and other adjacent tissues. This infection may be idiopathic or secondary to local trauma or pelvic surgery. Its mortality rate is 20%. We report a case of necrotzing fasciitis of the perineum in a 34-year-old woman following incision and drainage of Bartholin's gland abscess. Streptococcus A, Proteus mirabilis, Escherichia coli, and Candida albicans were isolated. Intravenous broad spectrum antibiotic therapy was promptly instituted. Concurrent surgical debridement of all necrotic areas was required. Post debridement therapy required a long period of dressing changes until cicatrisation. Necrotizing fasciitis of the perineum is a surgical emergency. Early diagnosis and prompt aggressive debridement are the keys to successful management.

Abscess↗

PubMed2005

[Efficient killing of anthrax spores using aqueous and alcoholic peracetic acid solutions].

We analysed the sporicidal effect of different concentrations of aqueous and alcoholic peracetic acid (PAA) solutions on anthrax spores in suspension and germ carrier tests. In activation of anthrax spores in suspension assays was achieved in less than 2 min using 1% PAA solution and in less than 3 min using 0.5% PAA solution, respectively. In contrast, in germ carrier as says, a test under practical conditions, spores on 38% of the germ carriers survived treatment with 1% PAA solution for 15 min. The use of PAA in 80% ethyl alcohol outclassed the sporicidal effect of aqueous PAA solutions in both suspension and germ carrier assays. Anthrax spores on 14% of germ carriers tested survived 30 min of treatment with a 1% aqueous PAA solution. In contrast anthrax spores were reliably inactivated under the same test procedure using a 1% alcoholic PAA solution for 30 min. The proven enhancement of the sporicidal effect of alcoholic PAA solutions should be kept in mind when using disinfectants in practice. In further surveys we will optimise the test conditions.

Bacillus anthracis↗

PubMed2005

Repeated steroid pulse therapies in HCV-positive liver recipients: significant risk factor for HCV-related graft loss.

BACKGROUND: The optimal immunosuppressive regimen for HCV-positive liver transplant recipients has not been established. Treatment for acute cellular rejection (ACR) with steroids is associated with increased viral replication and graft hepatitis. We retrospectively analyzed 232 patients after orthotopic liver transplantation (OLT) for HCV cirrhosis to determine the influence of methylprednisolone pulse therapy on long-term outcome after OLT. METHODS: Two hundred thirty-two liver transplants were performed in HCV-positive recipients between 1989 and 2001. Median follow-up was 4.4 years and median age of patients was 53 years (range 15 to 72 years). Immunosuppression consisted of tacrolimus (Tac) or cyclosporine (CyA) in different protocols. All rejection episodes were histologically proven. RESULTS: Twenty-eight of 232 (12.06%) graft losses were due to severe hepatitis C reinfection. Of 232 patients, 105 showed a minimum of one episode of ACR (45.25%). Of 232 patients, 71 (30.6%) received methylprednisolone pulse therapy once and 15 of 232 required OKT3 treatment for steroid-resistant rejection (6.4%). Of 232 patients, 19 (8.1%) required repeated steroid pulse therapy due to more than one episode of ACR. In patients with more than one episode of ACR, the risk of HCV-related graft loss was significantly enhanced (6/19, P < .05). The primary immunosuppression had no influence on the outcome in our data. CONCLUSION: Our data show that outcome of HCV-positive patients who require repeated steroid pulse therapy (RSPT) for ACR is significant worse than that in patients with a single pulse therapy. Therefore RSPT should be avoided in HCV-positive transplant recipients. New strategies to manage acute rejection are required for these patients.

Adolescent↗

PubMed2005

[Tendons: traumatic lesions].

In the recent years there has been an increase in the number of tendon tears (TT) seen in routine daily outpatient practice secondary to the increasing popularity of sport activities. Tears require early diagnosis to ensure proper treatment and reduce functional impairment. Since local pain, edema and reflex muscle contraction can significantly limit the usefulness of clinical examination, imaging is usually required to confirm the clinical diagnosis, differentiate between partial and complete tear, and localize the retracted tendon stump. Several imaging modalities can be used in the evaluation of TT. Ultrasound is an efficient, dynamic, low cost and non invasive modality that is being increasingly utilized in the evaluation of the musculoskeletal system. It is well accepted by the acutely injured patient. The aim of this review article is to describe the ultrasound findings of the most common tendon tears.

Ankle Joint↗

PubMed2005

[Interventional sonography].

Diagnostic and therapeutic interventional procedures are rapidly expanding and, when guided by imaging, are more efficient then when performed with a blinded technique. Compared to fluoroscopy and CT, ultrasound does not utilize ionizing radiation. It can facilitate needle placement for arthrography, tenography or bursography or it can guide a variety of procedures such as aspiration, arthrocentesis, local steroid injections and needling of tendon calcifications. Technological improvements have increased the precision of ultrasound guidance and have contributed to reduce the risk of complication. Real time scanning allows simultaneous visualization of the target and of needle progression and has diminished the rate of complications, that are infrequent if the operator uses a strict sterile technique and respects the contraindications.

Humans↗

PubMed2005

[Paediatric musculoskeletal ultrasound].

Ultrasound examination is often the most effective and sometimes the only practical means of examining children with soft tissue, tendon and joint diseases. This review will cover the important application of diagnostic ultrasound in children musculoskeletal disorders. We will consider topics where ultrasound is the only sensible means of examination such as developmental dysplasia of the hip, where it is the best choice of several possible methods such as painful hip and when it provides an alternative or adjunct to other imaging such as the examination of soft tissue masses.

Child↗

PubMed2004

Sonoanatomy of the ulnar nerve in the cubital tunnel: a multicentre study by the GEL.

The objective is to determine the normal appearance of the ulnar nerve on a posterior axial sonogram section of the elbow through the medial epicondyle and the humeroulnar joint space. Ultrasound evaluation was carried out on 400 elbows with measurement of the ulnar nerve cross-sectional area and ulnar nerve-cortex distance, as well as recording of apparent ulnar nerve division. Factors that significantly influenced the study variables were sought by statistical analysis. Mean cross-sectional area of the ulnar nerve at the elbow was 7.9 +/- 3.1 mm2 overall. Values were lower in females than in males and increased between 40 and 60 years of age. The ulnar nerve-cortex distance was 0.8 +/- 0.4 mm and varied widely across individuals. Apparent ulnar nerve division at the elbow was noted in about one-fifth of individuals, with no difference between females and males or between the right and left elbows. When present, apparent division was often bilateral and was not associated with changes in cross-sectional area or in distance from the medial epicondyle cortex. This study provides normative data on ulnar nerve sonoanatomy at the elbow and establishes that apparent ulnar nerve division at the elbow is a normal variant.

Adult↗

PubMed2004

[Puerperal uterine inversion: about two cases].

Two cases of third- and second-degree acute puerperal uterine inversions that required surgical management after manual attempts failed are reported. The diagnosis was obvious in the first case but the second inversion was misdiagnosed as a myoma, which led to severe morbidity, linked with the hemorrhage.

Adult↗

PubMed2004

[Uterine fibroids. Embolization: state-of-the-art].

Uterine artery embolization is a radiological procedure consisting in occluding the perifibroid arterial plexus to induce fibroid ischemia. To date, with more than 50,000 women treated worldwide, embolization seems to be a valuable alternative to hysterectomy and multiple myomectomies particularly in women with severe menorrhagia. Embolization should ideally be performed in case of intramural or submucosal uterine fibroids. It must be preferrably realized in case of multiple fibroids, be they intramural or submucosal (when hysteroscopic resection is not feasible). Complication rates are low if large calibrated microspheres are used to perform embolization and if pedunculated subserosal fibroids are excluded. In case of associated adenomyosis clinical recurrence seems more frequent. The role of embolization as an alternative to a single myomectomy, particularly in young women desiring future pregnancy remains a matter of debate and should be evaluated with clinical randomized trials. Pluridisciplinary management of women is the key to a widespread acceptance of uterine artery embolization in the management of uterine fibroids.

Adult↗

PubMed2004

[Embolization of uterine arteries for uterine fibroids: state-of-the-art].

Embolization of uterine arteries for fibroids is a modern minimally invasive method for treatment of uterine fibroids. Results from published data show a substantial short-term uterine reduction, an improvement in menorrhagias, and a reduction in fibroid related pain. Hospital stay and recovery are shortened compared with hysterectomy. One randomised comparative trial EAU vs hysterectomy has showed a reduction in hospital stay length and in the rate of major complications, but an increased rate of minor complications. Pregnancies and uneventful deliveries have been reported after uterine arteries embolization. Rare but severe complications have been described. Embolization of uterine arteries can be considered as a safe alternative to hysterectomy or myomectomy in selected cases. It cannot be a routine method for treating fibroids with women of childbearing age.

Arteries↗

PubMed2004

[Adenoviral vector expressing the TRAIL gene driven by the hTERT promoter].

BACKGROUND: Resistance can be overcome by modified adenoviral vectors containing an Arg-Gly-Asp (RGD) sequence. We constructed an adenoviral vector with RGD-modified fibers, expressing the TRAIL gene from the human telomerase reverse transcriptase (hTERT) promoter (designated Ad/TRAIL-F/RGD), and evaluated its antitumor activity in vitro and in vivo. METHODS: The induction of apoptosis by the new vector Ad/TRAIL-F/RGD was evaluated in human carcinoma cells derived from hepatocellular carcinoma (Hep G2, Hep 3b), pancreatic carcinoma (Panc-1, Capan-1), and colon carcinoma (LOVO, SW 620) . Cell viability was measured by the XTT assay and GFP expression and apoptosis induction by fluorescence-activated cell sorting (FACS) and Western blot. In vivo experiments were performed in an orthotopic pancreas tumor model in nu/nu nude mice. RESULTS: Treatment with Ad/TRAIL-F/RGD and Ad/gTRAIL resulted in significantly reduced cell viability in comparison to PBS and Ad/CMV-GFP treatment in all examined human carcinoma cell lines. In addition, mice treated with Ad/TRAIL-F/RGD showed a significantly decreased tumor growth than both control groups. CONCLUSIONS: Our results suggest that Ad/TRAIL-F/RGD may become a potent therapeutic agent for the treatment of different human solid carcinomas.

Adenoviruses, Human↗

PubMed2003

[Ultrasonic diagnosis of chorionicity in multiple pregnancies].

The management of multiple pregnancies requires a correct diagnosis of chorionicity. This assessment is easy and reliable before 15 weeks of gestation by ultrasonography, but becomes much more difficult during the second and third trimester for same sex foetuses. From 5 to 8 weeks of gestation, the visualization of two gestational sacs assesses bichorionicity. From 8 to 14 weeks, the diagnosis of chorionicity is based on the presence of the lambda sign, completed by the evaluation of the thickness of the inter-twin membrane and the placenta localisation. From 15 weeks onward, the twin peak (or lambda) sign remains the best predictor of dichorionicity but is valuable only if it is present. The measurement of the thickness of the inter-twin membrane and the count of its layers are not available in all cases. From March 1999 to March 2000, we studied 31 multiple pregnancies with same sex foetuses, referred to our centre during the second trimester. The patients were asked for their former ultrasound reports. Chorionicity was mentioned only in 77% of the cases and when mentioned the information was correct in 85% of the cases. Thus, improving on that point is necessary. Prospective studies focusing on ultrasound determination of chorionicity show accuracy close to 100% when the ultrasonography is correctly realized before 15 weeks of gestation.

Chorion↗

PubMed2003

Interpretation of unexpected rocking curve asymmetry in LACBED patterns of semiconductors.

Transmission electron microscopy rocking curves diffracted from inclined planes in argon ion-thinned Si and III-V semiconductors display a significant asymmetry around the Bragg condition. Kinematical and dynamical calculations of the rocking curves show that such an asymmetry can be attributed to the dilation of coherent crystalline surface layers implanted with argon atoms. The surface layers are characterized with two parameters, their width h and the strain component epsilon (z) normal to the thin foil plane. The dark-field rocking curve asymmetry is shown, for sufficiently high values of h (> approximately 2 nm), to strongly depend on epsilon (z) which is directly related to the density of implanted argon atoms in the surface layers. Calculations also show that a significant rocking curve asymmetry is only observed for intermediate values of epsilon (z) of about a few percentage points.

Algorithms↗

PubMed2002

[Interventional radiology in managing post-partum hemorrhage].

UNLABELLED: EMBOLISATION OF THE UTERINE ARTERIES: Is the technique of choice for the management of post-partum hemorrhage, since it is efficient and virtually non-invasive. However, initial obstetrical measures and appropriate reanimation should never be neglected. The decision for embolisation must be made by all of the competent staff (obstetrician, reanimator, interventional radiologist). The clinical state of the patient must be assessed and the biological controls analyzed and eventually the decision can be made to transfer the patient to a specialized unit equipped not only with a team of interventional radiologists but also a multi-disciplinary team, experienced in the management of this type of pathology. PRACTICAL METHODS: An arterial inducer is placed in the femoral artery under local anesthesia. The angiographic exploration includes, when necessary, a global series showing the aorta and the pelvic vessels followed by the successive exploration of the two internal iliac arteries. Embolisation, conducted under scopic control, must be bilateral. Gelatin fragments or powder is the most appropriate embolus. LIMITS: Very few maternal delivery structures are able to perform an arterial embolisation at any time of the day or night. This raises the problem of transporting patients with uncontrolled hemorrhages; only those who exhibit no hemorrhagic disorders can be transported fairly easily. EFFICACY AND COMPLICATIONS: Concerning the three principle causes at the origin of post-partum hemorrhages, efficacy is constant in the case of uterine atonia; conversely, failures have been reported in the case of cervical-vaginal tearing and abnormal placental insertion (placenta accreta). In young women with healthy arteries, the complications of uterine embolisation during post-partum hemorrhage are exceptional.

Adult↗

PubMed2002

Low-protein medium affects the 293SF central metabolism during growth and infection with adenovirus.

In this study the metabolism of 293SF cells grown in serum-free and low-protein medium was analyzed. This cell line is known for its ability to replicate recombinant adenovirus, mainly used in gene therapy applications. A complete model composed of the main glycolytic, glutaminolytic, and amino acids pathways, as well as the internalization fluxes of certain compounds into the mitochondria, is used for metabolic flux calculations. The pentose-phosphate cycle is also added to the biochemical reactions set and was independently measured with labeled 14C-glucose. Different feeding strategies in two different media were analyzed with the model, and the theoretical ATP production was also calculated. The two media were similar in their glucose and amino acid composition, but one contained BSA at 1g/L whereas the other had a very low protein content. Use of low-protein medium resulted in up to fourfold higher adenoviral vector production. In this medium, glucose utilization was more efficient, as it entered the TCA cycle more efficiently. Also, lower glutamine and amino acids consumption were observed as well as lower lactate and ammonia production. This increased TCA activity led to a twofold higher ATP production in the low-protein medium.

Adenosine Triphosphate↗