Éditeur(s) : HAL CCSD
Résumé : International audience
OBJECTIVE: To analyze complications of endoscopic transsphenoidal surgery (ETS) for nonfunctioning pituitary macroadenomas (NFPAs).ăMETHODS: A retrospective study of 300 NFPAs was performed. Complications and factors that could influence these complications were analyzed.ăRESULTS: Visual and pituitary functions worsened in 2.4% and 13.7% of cases, respectively. Postoperative diabetes insipidus was permanent in 6.2% of cases. Postoperative meningitis occurred in 3.3% of patients. Meningitis was strongly associated with intraoperative cerebrospinal fluid (CSF) leaks (P = 0.01), postoperative CSF leaks (P = 0.0001), and operation times longer than 1 hour (P = 0.023). Detection of Staphylococcus aureus and preoperative treatment with mupirocin in the nostrils did not impact the occurrence of meningitis. Two patients with meningitis died (unique causes of death). Postoperative CSF leaks occurred in 2.7% of cases and were associated with intraoperative CSF leaks (P = 0.007) and permanent diabetes insipidus (P = 0.028). The rate of CSF leak decreased from 4% to 0.8% (P = 0.048) after we moved from a soft to hard reconstruction of the sella. The rate of postoperative epistaxis decreased from 6.7% to 1.25% after we stopped using monopolar coagulation (P = 0.013).ăCONCLUSIONS: ETS permits a wide view, allowing good conditions for a satisfactory resection in the majority of NFPAs. Some pitfalls of endoscopy can lead to complications that improve with modification of the operative technique (i.e., CSF leak and postoperative epistaxis). This study confirms an acceptable rate of complications associated with ETS.
World Neurosurgery

hal-01474296
https://hal.archives-ouvertes.fr/hal-01474296
DOI : 10.1016/j.wneu.2016.02.059
PUBMED : 26902781

Éditeur(s) : HAL CCSD Oxford University Press (OUP)
Résumé : International audience
OBJECTIVES: Tracheobronchial stenosis (TBS) is noted in 12-23% of patients with granulomatosis with polyangiitis (GPA), and includes subglottic stenosis and bronchial stenosis. We aimed to analyse the endoscopic management of TBS in GPA and to identify factors associated with the efficacy of endoscopic interventions. METHODS: We conducted a French nationwide retrospective study that included 47 patients with GPA-related TBS. RESULTS: Compared with patients without TBS, those with TBS were younger, more frequently female and had less frequent kidney, ocular and gastrointestinal involvement and mononeuritis multiplex. Endoscopic procedures included 137 tracheal and 50 bronchial interventions, mainly endoscopic dilatation, local steroid injection and conservative laser surgery, and less frequently stenting. After the first endoscopic procedure, the cumulative incidence of endoscopic treatment failure was 49% at 1 year, 70% at 2 years and 80% at 5 years. Factors significantly associated with a higher cumulative incidence of treatment failure were a shorter time from GPA diagnosis to endoscopic procedure [hazard ratio (HR) 1.08 (95% CI 1.01, 1.14); P = 0.01] and a bronchial stenosis [HR 1.96 (95% CI 1.28, 3.00); P = 0.002]. A prednisone dose ≥30 mg/day at the time of the procedure was associated with a lower cumulative incidence of treatment failure [HR 0.53 (95% CI 0.31, 0.89); P = 0.02]. CONCLUSION: TBS represents severe and refractory manifestations with a high rate of restenosis. High-dose systemic CSs at the time of the procedure and increased time from GPA diagnosis to bronchoscopic intervention are associated with a better event-free survival. In contrast, bronchial stenoses are associated with a higher rate of restenosis than subglottic stenosis.
ISSN: 1462-0324

hal-01155105
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01155105
DOI : 10.1093/rheumatology/kev129
PUBMED : 26001634

Éditeur(s) : HAL CCSD Elsevier Masson
Résumé : International audience
Autostatic ureteral stents have been commonly used in urology for more than 20 years. Encrustation is a frequent and well described phenomenon that sometimes makes stent removal difficult. The main predisposing factors are: duration of stenting, history or concomitant stone disease, urinary tract infection or bacterial colonization, pregnancy and chemotherapy. Treatment depends on the degree of encrustation, especially when it involves the proximal loop. Extracorporeal lithotripsy alone or combined with endoscopic treatment is very effective, but open surgery may sometimes be necessary. The authors report a case in which drainage was exceptionally prolonged as the stent was removed after a period of 10 years. Stent removal required 3 operations, including one open procedure. The steps of treatment are described and the aetiologies of encrustation and the therapeutic strategy are discussed.
ISSN: 1166-7087

hal-00697503
https://hal.archives-ouvertes.fr/hal-00697503
PUBMED : 16734247

Éditeur(s) : HAL CCSD Elsevier Masson
Résumé : National audience
Introduction L’objectif de cette étude est de disposer de données qualitatives et quantitatives sur la contamination de l’environnement intérieur hospitalier, microbiologique et chimique, afin d’évaluer l’exposition du personnel, des visiteurs et des patients et la variabilité spatio-temporelle de la contamination. Méthodes L’étude s’est déroulée dans différents lieux des CHU de Rennes et de Nancy : hall d’accueil, salle de soins infirmiers, salle de réveil post-opératoire, chambre d’un patient, unité de désinfection des endoscopes, laboratoire de parasitologie et salle de découpe de plâtres. Deux campagnes de prélèvement ont eu lieu en été 2014 et en hiver 2015. Les méthodes de prélèvement étaient nombreuses et complémentaires (Fig. 1). L’analyse des données a été réalisée sous IBM SPSS grâce au test de Mann-Whitney et le coefficient de corrélation de Pearson. Résultats Les concentrations d’aldéhydes, de composés organiques volatils (COV) et semi-volatils étaient faibles à très faibles dans les 2 établissements. Étaient détectables, mais sans différences globales entre les 2 établissements : la contamination fongique (m = 226 UFC/m3 ; p = 0,97) ou bactérienne (m = 352 UFC/m3 ; p = 0,14), les particules PM2,5 (m = 2,1 μg/m3 ; p = 0,97) et PM10 (m = 6,6 μg/m3 ; p = 0,84). Sur le plan saisonnier, la contamination fongique était plus importante en été pour les 2 établissements (p = 0,002). La contamination bactérienne ne varie pas significativement entre les locaux (p = 0,14) contrairement à la contamination fongique (p = 0,02) et particulaires PM2,5 (p = 0,01) ou PM10 (p = 0,01). Cette dernière est plus importante dans le hall (m = 879 UFC/m3), le laboratoire de parasitologie (m = 333 UFC/m3) et la salle de plâtre (m = 310 UFC/m3). Nous ne retrouvons pas de corrélation significative entre le nombre de personnes, le taux de CO2, l’humidité relative et le dénombrement bactérien ou fongique. Néanmoins nous retrouvons une relation forte entre la température du local et la contamination bactérienne (r = 0,7, p = 0,008) ou la contamination fongique (r = 0,56, p = 0,045) d’une part, et entre la contamination fongique et les PM10 (r = 0,52, p = 0,022) d’autre part. Conclusion Notre étude montre une très faible contamination par les aldéhydes, COV et sCOV comparativement à d’autres lieux publics. La forte variabilité spatio-temporelle de la contamination fongique et particulaire est liée à la saison, à l’activité et à la ventilation
ISSN: 1156-5233

hal-01334070
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01334070
DOI : 10.1016/j.mycmed.2016.04.026

Éditeur(s) : HAL CCSD Oxford University Press
Résumé : International audience
Chronic rhinosinusitis (CRS) rank second at chronic inflammatory diseases in industrialized countries and are an important public health concern. Diagnosis relies on a set of arguments including clinical signs, imaging, histopathologic and mycological analyses of sinus specimens, collected during nasal endoscopy. The sensitivity of fungal cultures is reported to be poor, even when direct examination is positive, thus the epidemiology of fungal chronic sinusitis is ill-known. This study evaluated the sensitivity of molecular diagnosis in 70 consecutive samples (61 patients with CRS) analysed at the University Hospital of Rennes during a 3-year period. DNA detection was performed using a conventional PCR method targeting the ITS1/ITS2 sequence and the resulting amplification products were sequenced. Fungal CRS was proven in 42 patients (69%), of which only 20 (48%) had a positive culture. 37/42 (88%) patients were diagnosed with a fungus ball, 3 with allergic fungal CRS and 2 with undetermined fungal CRS. PCR was positive in all 42 cases and direct sequencing allowed to identify fungi in all cases but one, and detected multiple infection in 3. Aspergillus fumigatus was present in 69% of patients; Cladosporium cladosporoides in 9.5%, Scedosporium sp., A. nidulans and A. flavus in 7% each. In 2/19 patients with negative direct examination, sequencing analysis revealed the presence of Capnobotryella sp. and C. cladosporoides, in clinical settings compatible with fungal sinusitis. In conclusion, ITS1/ITS2 PCR had a twice better sensitivity than culture, and combined sequencing provides accurate epidemiological data on fungal CRS.
ISSN: 1369-3786

hal-01383632
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01383632
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01383632/document
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01383632/file/Contribution%20of%20molecular%20tools%20for%20the%20diagnosis.pdf
DOI : 10.1093/mmy/myw041

Éditeur(s) : HAL CCSD Public Library of Science
Résumé : International audience
BACKGROUND: We aimed to assess, for the first time, the nature of the indoor air contamination of hospitals. METHODS AND FINDINGS: More than 40 volatile organic compounds (VOCs) including aliphatic, aromatic and halogenated hydrocarbons, aldehydes, alcohols, ketones, ethers and terpenes were measured in a teaching hospital in France, from sampling in six sampling sites--reception hall, patient room, nursing care, post-anesthesia care unit, parasitology-mycology laboratory and flexible endoscope disinfection unit--in the morning and in the afternoon, during three consecutive days. Our results showed that the main compounds found in indoor air were alcohols (arithmetic means ± SD: 928±958 µg/m³ and 47.9±52.2 µg/m³ for ethanol and isopropanol, respectively), ethers (75.6±157 µg/m³ for ether) and ketones (22.6±20.6 µg/m³ for acetone). Concentrations levels of aromatic and halogenated hydrocarbons, ketones, aldehydes and limonene were widely variable between sampling sites, due to building age and type of products used according to health activities conducted in each site. A high temporal variability was observed in concentrations of alcohols, probably due to the intensive use of alcohol-based hand rubs in all sites. Qualitative analysis of air samples led to the identification of other compounds, including siloxanes (hexamethyldisiloxane, octamethyltrisiloxane, decamethylcyclopentasiloxane), anesthetic gases (sevoflurane, desflurane), aliphatic hydrocarbons (butane), esters (ethylacetate), terpenes (camphor, α-bisabolol), aldehydes (benzaldehyde) and organic acids (benzoic acid) depending on sites. CONCLUSION: For all compounds, concentrations measured were lower than concentrations known to be harmful in humans. However, results showed that indoor air of sampling locations contains a complex mixture of VOCs. Further multicenter studies are required to compare these results. A full understanding of the exposure of healthcare workers and patients to complex mixtures of chemical compounds can then be related to potential health outcomes.
ISSN: 1932-6203

hal-00874694
https://hal.archives-ouvertes.fr/hal-00874694
https://hal.archives-ouvertes.fr/hal-00874694/document
https://hal.archives-ouvertes.fr/hal-00874694/file/VOC_Contamination-accepted.pdf
DOI : 10.1371/journal.pone.0055535