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Biomedical subjects

F Mignon

Publications and source records attributed to F Mignon.

At least 19 recordsLinked to original sources
PubMed2003

[Preoperative selective embolization allowing a partial splenectomy for splenic hamartoma].

PURPOSE OF THE STUDY: To underline value of the preoperative splenic embolization with haemostatic aim to facilitate partial splenectomy. MATERIAL: Observation of a 23-year-old woman, admitted for pain, anemia, and mass of the left hypochondrium. Sonography, helical CT and MRI showed that the bulky mass was developed from the upper pole of spleen, and dislodged the left kidney towards the pelvis. This mass had fibrous characteristics in favour of a primary lesion with recent bleeding and was compatible with a splenic hamartoma. METHODS: Selective partial splenic embolization with haemostatic aim using metal coils, immediately followed by surgery. RESULTS: Preoperative embolisation made possible to carry out under optimal surgical conditions a partial splenectomy with en-bloc resection of the splenic mass. Histologic diagnosis was splenic hamartoma of pulpar type. CONCLUSION: This case illustrates the interest of accurate characterization of splenic lesions by several imaging techniques allowing indication for conservative surgery, and of preoperative embolization facilitating a partial splenectomy.

Adult↗
PubMed2003

[Invasive infra centimetric breast lobular carcinoma: ultrasonographic features].

PURPOSE: To evaluate the ability of breast ultrasound to detect and analyze small (less than 1 cm in size) invasive lobular carcinomas. MATERIAL: and methods. A retrospective analysis of 93 small invasive carcinomas measuring less than 10 mm in size diagnosed between 1998 and 2000 in our institution was performed. In this group, 15 invasive lobular carcinomas were identified in 12 patients. All mammograms and ultrasound examinations were reviewed. RESULTS: Twelve cases of less than 10 mm invasive lobular carcinomas were diagnosed. Two lesions in one patient and one in an other patient were not detected at ultrasound and mammogram (multifocal carcinomas). All invasive lobular carcinomas were found as hypoechogenic masses with ill-defined margins and posterior shadowing. Four lesions showed evidence of microlobulations, 6 lesions an hyperechogenic halo and only one showed a vertical axis. The sensitivity of ultrasound in this group was recorded as 80% (12/15). CONCLUSION: The study confirms a high sensitivity of ultrasound examination in detection and characterization of small infiltrative lobular carcinoma.

Aged↗
PubMed2003

[Demography of nephrologists in France in 2002].

This survey was performed using data generated by a mailing sent with the collaboration of regional coordinators in 2002 to all the nephrologists identified in France. 1326 nephrologists were included in the pool, with an average of 22 nephrologists per million population (pmp), ranging from 14 to 29 pmp according to the different regions. Their mean (and median) age was 46.6 years, 30% were female. 63.5% of the nephrologists were working in a public hospital, 19.3% in private clinics, 13.3% in non-profit associations, 2% and 0.4% in research units or with industry, respectively. The data were used to generate a register of all the French nephrologists. 47 retirements per year are anticipated between 2010 and 2019, which yields an indication for the number of new nephrologists to be certified in this time-span. The gap between the future retirees and the newly trained nephrologists is very deep and cannot be bridged with the currently operating modes of recruitment. The increasing incidence and prevalence of patients with end stage renal failure will considerably increase the need of nephrologists, which is all the more amplified by the recent modification of the French law concerning the weekly upper limit of working time for physicians. Urgent measures have to be taken for preventing the consequences of dearth of nephrologists clearly anticipated for the next 10 years.

Female↗
PubMed2002

Hyperhomocysteinemia, low folate status, homozygous C677T mutation of the methylene tetrahydrofolate reductase and renal arterial thrombosis.

We report a renal artery thrombosis in a 42-year-old man. Fasting homocysteinemia was at 23 micromol/l 3 months later and at 33 pmol/l 5 months after the vascular event. A homozygous C677T MTHFR was found with low folate status. Active smoking may also have contributed to the pathogenesis of renal arterial thrombosis. The other causes of thrombophilia were ruled out. Homocysteine lowering treament was started: homocysteine normalized at 10.6 micromol/l. There was no recurrence of vascular event within 18 months. We propose mild or moderate hyperhomocysteinemia triggered by low folate status in patients with homozygous C677T MTHFR as a cause of renal arterial thrombosis.

Adult↗
PubMed2002

[Antibodies against human recombinant erythropoietin: an unusual cause of erythropoietin resistance].

In a 70 year old man with primary glomerulonephritis, severe anemia occurred after 4 years on hemodialysis and rHu-EPO. The usual mechanisms of EPO-resistance were excluded. A bone marrow sample showed red all aplasia. No circulating EPO could be detected; the serum inhibited the growth of erythroid precursors in bone marrow cultures. Immunoprecipitation identified an IgG anti-EPO, still active against deglycosylated EPO, i.e. directed against the peptidic matrix. Its high neutralising capacity and the absence of any immune abnormality rule out an auto-antibody. Anti-rHu EPO immunisation is a very rare occurrence, made severe by transfusion-dependence and the risk of hemosiderosis. An immuno-modulating treatment can therefore be justified.

Aged↗
PubMed2002

[Miliary induced by intravesical BCG immunotherapy for carcinoma of the bladder: CT Findings].

The authors describe the case of a patient presenting miliary involvement of the lung due to mycobacterium bovis after intravesical BCG administration. After initial transurethral resection, the patient was treated with immunotherapy by intravesical instillation of BCG and received 9 treatments without any problem. After the 10th treatment, the patient presented with cough and signs of urinary infection. At admission the chest radiograph showed a miliary pattern, better seen at high resolution CT, and using helical technique with the maximum intensity projection (MIP) reconstructions. MIP demonstrated to better advantage the well defined contours of the nodules, distributed evenly and randomly in the whole lung. After anti-TB treatment, the patient had regained full activity with persistence of the miliary pattern but a decreased number and size of nodules and calcification in some of them. This case illustrates a rare complication of intravesical immunotherapy, and points out the superiority of Sliding Thin Slab MIP (STS-MIP) compared with standard HRCT which allows a better detection of extent and follow-up of a military pattern, notably in moderate forms, by improvement of the anatomical resolution.

Adjuvants, Immunologic↗
PubMed2002

[CT guided adrenal biopsies: remaining indications?].

The need for adrenal gland biopsy has much decreased since CT and MR criteria have been introduced for further characterization of adrenal lesions. Several diagnostic criteria have been described for characterization of benign versus malignant adrenal lesions based on density measurements and contrast wash-out. Adrenal biopsy may be indicated for lesions that remain indeterminate in nature after CT and MRI. Such lesions include those with a percentage of wash-out near the 50% threshold or lesions that have increased in size at follow-up imaging in spite of their benign appearance based on density measurement at prior CT evaluation. The location of the adrenal glands has an impact on the technical difficulties during biopsy and the types of complications. Ipsilateral lateral decubitus seems the more logical approach and can be used for right or left adrenal lesions; this approach is generally well tolerated by patients. Biochemical evaluation should be performed prior to biopsy in order to exclude pheochromocytoma. The overall accuracy of adrenal biopsy, considering both positive predictive value and negative predictive value, compared to the gold standard is between 80 and 95% with a complication rate of about 10%.

Adrenal Gland Diseases↗
PubMed2002

[Pheochromocytomas and CT: can size predict malignancy?].

OBJECTIVES: The purpose of this study was to determine clinical and imaging findings associated with malignancy in pheochromocytomas. MATERIAL: and methods. A multicentric retrospective CT study including 50 lesions (23 benign and 27 malignant histologically proven pheochromocytomas) was conducted. The diagnosis of malignancy was based on histological criteria (capsular rupture, local invasion), on synchronous metastases or on the occurrence of locoregional recurrences or metastases during the outcome. The analysis was based on clinical data (age, sex, secretion of the lesion and hypertension) and on radiological criteria (largest diameter of the tumor, side, homogeneity, regularity and sharpness of contours). RESULTS: A statistical difference was found between the median largest diameter, the regularity and sharpness of contours benign and malignant lesions (p<0.0001); other clinical and radiological criteria being non significantly different. A largest diameter greater than 45 mm enabled to suggest malignancy with a sensitivity of 100% and a specificity of 69%. CONCLUSION: A diameter larger than 50mm, presence of a locoregional invasion and of metastases are strong arguments favouring.

Adolescent↗
PubMed2001

Induction versus noninduction in renal transplant recipients with tacrolimus-based immunosuppression.

BACKGROUND: The aim of this study was to compare the efficacy and safety of induction treatment with antithymocyte globulins (ATG) followed by tacrolimus therapy with immediate tacrolimus therapy in renal transplant recipients. METHODS: This 12-month, open, prospective study was conducted in 15 centers in France and 1 center in Belgium; 309 patients were randomized to receive either induction therapy with ATG (n=151) followed by initiation of tacrolimus on day 9 or immediate tacrolimus-based triple therapy (n=158). In both study arms, the initial daily tacrolimus dose was 0.2 mg/kg. Steroid boluses were given in the first 2 days and tapered thereafter from 20 mg/day to 5 mg/day. Azathioprine was administered at 1-2 mg/kg per day. RESULTS: At month 12, biopsy-confirmed acute rejections were reported for 15.2% (induction) and 30.4% (noninduction) of patients (P=0.001). The incidence of steroid-sensitive acute rejections was 7.9% (induction) and 22.2% (noninduction)(P=0.001). Steroid-resistant acute rejections were reported for 8.6% (induction) and 8.9% (noninduction) of patients. A total of nine patients died. Patient survival and graft survival at month 12 was similar in both treatment groups (97.4% vs. 96.8% and 92.1% vs. 91.1%, respectively). Statistically significant differences in the incidence of adverse events were found for cytomegalovirus (CMV) infection (induction, 32.5% vs. noninduction, 19.0%, P=0.009), leukopenia (37.3% vs. 9.5%, P<0.001), fever (25.2% vs. 10.1%, P=0.001), herpes simplex (17.9% vs. 5.7%, P=0.001), and thrombocytopenia (11.3% vs. 3.2%, P=0.007). In the induction group, serum sickness was observed in 10.6% of patients. The incidence of new onset diabetes mellitus was 3.4% (induction) and 4.5% (noninduction). CONCLUSION: Low incidences of acute rejection were found in both treatment arms. Induction treatment with ATG has the advantage of a lower incidence of acute rejection, but it significantly increases adverse events, particularly CMV infection.

Adult↗