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* mutation : 12/08/16 - bonjour je suis m?decin g?n?raliste exer?ant depuis 4 ans .je voudrais savoir quelle est la proc?dure pour faire une mutation vers un autre h?pital hors wilayas et combien de temps ca prend merci
* Les dates pr?inscriptions affectations bacheliers 2016 : 25/07/16 - Cher bachelier, toutes nos f?licitations. Dates importantes ? retenir pour les bacheliers 2016 soumis ? la proc?dure de pr?inscription en ligne La p?riode des pr?inscriptions en ligne est...

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* The thoracic duct: clinical importance, anatomic variation, imaging, and embolization : 01/08/16 -

Abstract

The thoracic duct is the body’s largest lymphatic conduit, draining upwards of 75 % of lymphatic fluid and extending from the cisterna chyli to the left jugulovenous angle. While a typical course has been described, it is estimated that it is present in only 40-60% of patients, often complicating already challenging interventional procedures. The lengthy course predisposes the thoracic duct to injury from a variety of iatrogenic disruptions, as well as spontaneous benign and malignant lymphatic obstructions and idiopathic causes. Disruption of the thoracic duct frequently results in chylothoraces, which subsequently cause an immunocompromised state, contribute to nutritional depletion, and impair respiratory function. Although conservative dietary treatments exist, the majority of thoracic duct disruptions require embolization in the interventional suite. This article provides a comprehensive review of the clinical importance of the thoracic duct, relevant anatomic variants, imaging, and embolization techniques for both diagnostic and interventional radiologists as well as for the general medical practitioner.

Key Points

Describe clinical importance, embryologic origin, and typical course of the thoracic duct.

Depict common/lesser-known thoracic duct anatomic variants and discuss their clinical significance.

Outline the common causes of thoracic duct injury and indications for embolization.

Review the thoracic duct embolization procedure including both pedal and intranodal approaches.

Present and illustrate the success rates and complications associated with the procedure.


* Role of Pericellular Matrix in the Regulation of Cancer Stemness : 01/08/16 - Abstract Cancer stem cells (CSC) are a prominent component of the tumor bulk and extensive research has now identified them as the subpopulation responsible for tumor relapse and resistance to anti-cancer treatm...
* Closing faucets: the role of anti-angiogenic therapies in malignant pleural diseases : 01/08/16 -

Abstract

Malignant pleural effusion (MPE) represents 15–35 % of pleural effusions and markedly worsens the prognosis and quality of life of patients with cancer. Malignant mesothelioma (MM) and lung adenocarcinoma are the most frequent primary and secondary causes, respectively, of MPE. Effective treatments for cancer-related MPE are warranted in order to improve symptoms, reduce the number of invasive pleural procedures, and prolong patient life. Since angiogenesis plays a key role in MPE development, the potential role of bevacizumab and other anti-angiogenic therapies have been explored in this review. No relevant phase III trials have specifically analysed the benefit from adding bevacizumab to platinum-based chemotherapy in lung cancer-related MPE. However, small retrospective series reported 71.4–93.3 % MPE control rate, a reduction in invasive procedures, and a safe profile with this combination. Being approved for the first-line treatment of non-squamous advanced NSCLC, the addition of bevacizumab should be considered for patients presenting with MPE. In addition, further studies in this are recommended. In MM, the addition of bevacizumab to platinum-based chemotherapy did not meet primary endpoints in two phase II trials. However, the beneficial results on OS reported in comparison with historical cohorts and the statistically significant benefit on PFS and OS observed in the phase III MAPS trial foretell an eventual role for the combination of platinum/pemetrexed/bevacizumab as front-line systemic therapy for pleural MM. To date, no other anti-angiogenic drug has showed significant benefit in the treatment of patients with either MPE or MM. However, new promising drugs such as ramucirumab or recombinant human endostar warrant further investigation.


* Current surgical strategies for malignant pleural mesothelioma : 01/08/16 - Abstract Malignant pleural mesothelioma (MPM) is associated with a poor prognosis. The main components of multimodality treatment include surgery, chemotherapy, and radiation therapy. Surgery remains controversi...
* Evaluating the Impact of Total Intravenous Anesthesia on the Clinical Outcomes and Perioperative NLR and PLR Profiles of Patients Undergoing Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy : 01/08/16 -

Abstract

Purpose

The aim of this study was to assess the impact of total intravenous anesthesia (TIVA) on the perioperative inflammatory profile and clinical outcomes of patients undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS–HIPEC).

Methods

A retrospective review of patients undergoing CRS–HIPEC was performed. Patients receiving a combination of preoperative tramadol extended release (ER), celecoxib, and pregabalin, along with combined intraoperative infusions of propofol, dexmedetomidine, lidocaine, and ketamine were classified as receiving a TIVA regimen (TIVA group). The second group consisted of patients receiving volatile–opioid-based anesthesia (VO group). The neutrophil:leukocyte (NLR) and platelet: leukocyte (PLR) ratios were calculated to evaluate the perioperative inflammatory status of both groups. Length of stay (LOS) and complications of both groups were also evaluated.

Results

A total of 213 patients were included in the study—139 in the VO group and 74 in the TIVA group. No statistically significant differences were observed between the groups with regard to their postoperative inflammatory profiles, LOS, or complications by organ system; however, the incidence of renal complications was higher in the TIVA group (8.1 vs. 2.2 %) and approached statistical significance (p = 0.068).

Conclusions

In this retrospective study of patients undergoing CRS–HIPEC, the combined use of preoperative celecoxib, tramadol ER and pregabalin followed by intraoperative TIVA with infusions of propofol, dexmedetomidine, ketamine, and lidocaine was not associated with a reduction in LOS or complications by organ system. Postoperative NLR and PLR profiles were also not significantly impacted.


* Diagnostic impact of digital tomosynthesis in oncologic patients with suspected pulmonary lesions on chest radiography : 01/08/16 -

Abstract

Objectives

To assess the actual diagnostic impact of digital tomosynthesis (DTS) in oncologic patients with suspected pulmonary lesions on chest radiography (CXR).

Methods

A total of 237 patients (135 male, 102 female; age, 70.8 ± 10.4 years) with a known primary malignancy and suspected pulmonary lesion(s) on CXR and who underwent DTS were retrospectively identified. Two radiologists (experience, 10 and 15 years) analysed in consensus CXR and DTS images and proposed a diagnosis according to a confidence score: 1 or 2 = definitely or probably benign pulmonary or extrapulmonary lesion, or pseudolesion; 3 = indeterminate; 4 or 5 = probably or definitely pulmonary lesion. DTS findings were proven by CT (n = 114 patients), CXR during follow-up (n = 105) or histology (n = 18).

Results

Final diagnoses included 77 pulmonary opacities, 26 pulmonary scars, 12 pleural lesions and 122 pulmonary pseudolesions. DTS vs CXR presented a higher (P < 0.05) sensitivity (92 vs 15 %), specificity (91 vs 9 %), overall accuracy (92 vs 12 %), and diagnostic confidence (area under ROC, 0.997 vs 0.619). Mean effective dose of CXR vs DTS was 0.06 vs 0.107 mSv (P < 0.05).

Conclusions

DTS improved diagnostic accuracy and confidence in comparison to CXR alone in oncologic patients with suspected pulmonary lesions on CXR with only a slight, though significant, increase in radiation dose.

Key points

Digital tomosynthesis (DTS) improves accuracy of chest radiography (CXR) in oncologic patients.

DTS improves confidence of CXR in oncologic patients.

DTS allowed avoidance of CT in about 50 % of oncologic patients.


* Comment calculer nombre de goutte par minute pour perfusion par 24heures : 16/07/16 - Comment calculer nombre de goutte par minute pour perfusion par 24heures 1 ml contient 20 gouttes, pour passer 1 litre et demi (1500ml) en 12 heures , on doit multiplier 1500 x 20 gouttes = 30000 goutes en divise par la durée (12 heures x 60)= 720 minutes 30000/720 = 42 gouttes/minutes  pour 24heures 30000/1440 = […]
* Impetigo Infection : 16/07/16 - 16/07/2016 5:56:58 PM GMT
* Lichenification and Lichen Simplex Chronicus : 16/07/16 - 16/07/2016 5:56:58 PM GMT
* Psoriasis Nail Abnormalities : 16/07/16 - 16/07/2016 5:56:58 PM GMT

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