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8. Safety and technical efficacy of pre-operative embolization of head and neck paragangliomas: A 10-year mono-centric experience and systematic review

Author

Danoob Dalili, Pierre De Marini, Afshin Gangi, Julien Garnon, Iulian Enescu, Roberto Luigi Cazzato, Emanuele Boatta, Michel Greget, Christine Jahn, Laboratoire des sciences de l'ingénieur, de l'informatique et de l'imagerie (ICube), École Nationale du Génie de l'Eau et de l'Environnement de Strasbourg (ENGEES)-Université de Strasbourg (UNISTRA)-Institut National des Sciences Appliquées - Strasbourg (INSA Strasbourg), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de Recherche en Informatique et en Automatique (Inria)-Les Hôpitaux Universitaires de Strasbourg (HUS)-Centre National de la Recherche Scientifique (CNRS)-Matériaux et Nanosciences Grand-Est (MNGE), Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Réseau nanophotonique et optique, and Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Centre National de la Recherche Scientifique (CNRS)

Subjects
Adult, Male, medicine.medical_specialty, Percutaneous, medicine.medical_treatment, Technical success, Paraganglioma, Humans, Medicine, Radiology, Nuclear Medicine and imaging, Embolization, Head and neck, Aged, Retrospective Studies, Aged, 80 and over, business.industry, Middle Aged, Embolization, Therapeutic, Pre operative, Surgery, Treatment Outcome, Head and Neck Neoplasms, Dose area product, Cohort, [SDV.IB]Life Sciences [q-bio]/Bioengineering, Female, business, Complication
Abstract

Objectives To retrospectively evaluate the safety and technical success of pre-operative embolization (POE) of head and neck paragangliomas (HNP) in a single-center cohort over a 10-year period, and to benchmark our results with those derived from a systematic analysis of the available literature. Methods All consecutive HNP embolized between November 2010 and April 2020 were included and reviewed. In total, there were 27 HNP in 27 patients [8 (30%) males; 19 (70%) females; mean age 53 ± 16 years; range 30–86]. Embolization technique, total procedure time, dose area product (DAP), complications, rate of HNP devascularization, and technical success (i.e. ≥80% devascularization of the HNP) were recorded and analyzed. A systematic analysis on the safety and technical success of POE was then conducted according to the Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results Twenty-one (21/27; 78%) HNP were treated with an endovascular approach and 6/27 (22%) with a percutaneous or combined (endovascular/percutaneous) technique. Mean total procedure time and DAP were 108 ± 48 min (range 45–235) and 92.5 ± 61.3 Gy·cm2 (range 19.9–276.0), respectively. Two (2/27; 7%) complications (one minor, one major) were observed. Mean HNP devascularization was 88 ± 15% (range 23–100) with technical success achieved in 24/27 (89%) HNP. Literature analysis revealed a pooled rate of complication and technical success of 3.8% (95% CI: 0.5–8.8%) and 79.0% (95% CI: 63.6–91.6%), respectively. Conclusions POE of HNP is safe and results in extensive devascularization in the majority of treated tumors.

Published
2021
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10. Feasibility and efficacy of combined pancreatic islet-lung transplantation in cystic fibrosis-related diabetes-PIM study: A multicenter phase 1-2 trial

Author

Luc Rakotoarisoa, Clothilde Wagner, Marion Munch, Benjamin Renaud Picard, Dominique Grenet, Anne Olland, Michel Greget, Iulian Enescu, Florence Bouilloud, Pierre Bonnette, Axel Guth, Domenico Bosco, Catherine Mercier, Muriel Rabilloud, Thierry Berney, Pierre Yves Benhamou, Gilbert Massard, Coralie Camilo, Cyrille Colin, Cécile Arnold, Romain Kessler, and Laurence Kessler

Subjects
Adult, Glycated Hemoglobin, Transplantation, Cystic Fibrosis, Islets of Langerhans Transplantation, Pilot Projects, Islets of Langerhans, Young Adult, Diabetes Mellitus, Immunology and Allergy, Feasibility Studies, Humans, Insulin, Pharmacology (medical), Prospective Studies, Lung Transplantation
Abstract

Cystic fibrosis-related diabetes (CFRD) is a common complication of cystic fibrosis (CF), and restoring metabolic control in these patients may improve their management after lung transplantation. In this multicenter, prospective, phase 1-2 trial, we evaluate the feasibility and metabolic efficacy of combined pancreatic islet-lung transplantation from a single donor in patients with CFRD, terminal respiratory failure, and poorly controlled diabetes. Islets were infused via the portal vein under local anesthesia, 1 week after lung transplantation. At 1 year, the primary outcome was transplant success as evaluated by a composite score including four parameters (weight, fasting glycemia, HbA1c, and insulin requirements). Ten participants (age: 24 years [17-31], diabetes duration: 8 years [4-12]) received a combined islet-lung transplant with 2892 IEQ/kg [2293-6185]. Transplant success was achieved in 7 out of 10 participants at 1-year post transplant. Fasting plasma C-peptide increased from 0.91 μg/L [0.56-1.29] to 1.15 μg/L [0.77-2.2], HbA1c decreased from 7.8% [6.5-8.3] (62 mmol/mol [48-67]) to 6.7% [5.5-8.0] (50 mmol/mol [37-64]), with 38% decrease in daily insulin doses. No complications related to the islet injection procedure were reported. In this pilot study, combined pancreatic islet-lung transplantation restored satisfactory metabolic control and pulmonary function in patients with CF, without increasing the morbidity of lung transplantation.

Published
2022

11. Lymphangiographie et embolisation du canal thoracique. Retour d’expérience monocentrique : indications, réalisation et voies de développement

Author

Afshin Gangi, Michel Greget, Roberto Luigi Cazzato, P. De Marini, Julien Garnon, Emanuele Boatta, Iulian Enescu, and Christine Jahn

Subjects
03 medical and health sciences, 0302 clinical medicine, 030220 oncology & carcinogenesis, 030218 nuclear medicine & medical imaging
Abstract

Resume Introduction Les fuites chyleuses sont des situations cliniques peu frequentes, souvent d’origine iatrogenique post-chirurgicale. Le chylothorax est le type le plus courant de fuite chyleuse entrainant un epanchement pleural necessitant un drainage percutane. Les fuites chyleuses se compliquent souvent d’une immunodepression, d’un desequilibre hydro-electrolytique et d’une perte nutritionnelle. Au cours des dernieres annees, l’embolisation du canal thoracique realisee apres une lymphangiographie diagnostique percutanee a enrichi l’arsenal therapeutique disponible pour le traitement des fuites chyleuses, et notamment du chylothorax. Messages principaux Dans notre serie institutionnelle, le succes clinique etait de 77 % et aucune complication precoce ou a moyen terme n’a ete notee, ce qui est conforme aux donnees de la litterature faisant etat d’un succes clinique variant entre 52 et 74 % et de complications precoces ou a moyen terme variant entre 0 et 3 %. En accord avec ces donnees, l’embolisation du canal thoracique est ainsi devenu le traitement standard du chylothorax refractaire a une prise en charge medicale conservatrice. Par ailleurs la lymphangiographie diagnostique percutanee telle que realisee avant l’embolisation du canal thoracique permet de mieux comprendre le systeme lymphatique, ouvrant ainsi la voie a de nouvelles approches diagnostiques et therapeutiques dans divers contextes cliniques, notamment l’insuffisance cardiaque congestive, les maladies hepatiques et auto-immunes, les lymphoceles et les therapies oncologiques par cellules CAR-T. Conclusion La lymphangiographie percutanee avec embolisation du canal thoracique est un traitement peu invasif, sur et efficace des fuites chyleuses iatrogenes refractaires au traitement medical.

Published
2019
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12. Accuracy of a CT-Ultrasound Fusion Imaging Guidance System Used for Hepatic Percutaneous Procedures

Author

Julien Garnon, Afshin Gangi, Fabrice Bing, Iulian Enescu, Jonathan Vappou, Elodie Breton, Laboratoire des sciences de l'ingénieur, de l'informatique et de l'imagerie (ICube), École Nationale du Génie de l'Eau et de l'Environnement de Strasbourg (ENGEES)-Université de Strasbourg (UNISTRA)-Institut National des Sciences Appliquées - Strasbourg (INSA Strasbourg), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Centre National de la Recherche Scientifique (CNRS)-Matériaux et nanosciences d'Alsace (FMNGE), Institut de Chimie du CNRS (INC)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Institut de Chimie du CNRS (INC)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Réseau nanophotonique et optique, Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA), Service imagerie médicale et interventionnelle [Saint-Julien-en-Genevois], Centre Hospitalier Annecy-Genevois [Saint-Julien-en-Genevois], Département de Radiologie Interventionnelle [CHU Strasbourg], CHU Strasbourg, Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de Recherche en Informatique et en Automatique (Inria)-Les Hôpitaux Universitaires de Strasbourg (HUS)-Centre National de la Recherche Scientifique (CNRS)-Matériaux et Nanosciences Grand-Est (MNGE), Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Réseau nanophotonique et optique, Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Centre National de la Recherche Scientifique (CNRS), Les Hôptaux universitaires de Strasbourg (HUS), Institut National des Sciences Appliquées - Strasbourg (INSA Strasbourg), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université de Strasbourg (UNISTRA)-Centre National de la Recherche Scientifique (CNRS)-École Nationale du Génie de l'Eau et de l'Environnement de Strasbourg (ENGEES)-Réseau nanophotonique et optique, Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Matériaux et nanosciences d'Alsace (FMNGE), and Institut de Chimie du CNRS (INC)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Institut de Chimie du CNRS (INC)-Université de Strasbourg (UNISTRA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)

Subjects
Male, Tomography Scanners, X-Ray Computed, Percutaneous, [SDV.IB.IMA]Life Sciences [q-bio]/Bioengineering/Imaging, Radiography, Thermal ablation, Computed tomography, [SDV.CAN]Life Sciences [q-bio]/Cancer, Radiography, Interventional, Multimodal Imaging, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, Spinal needles, Predictive Value of Tests, medicine, Humans, Radiology, Nuclear Medicine and imaging, Prospective Studies, Ultrasonography, Interventional, ComputingMilieux_MISCELLANEOUS, Aged, Radiofrequency Ablation, Image fusion, medicine.diagnostic_test, business.industry, Liver Neoplasms, Ultrasound, Reproducibility of Results, Middle Aged, 3. Good health, Needles, 030220 oncology & carcinogenesis, Radiographic Image Interpretation, Computer-Assisted, Female, [SDV.IB]Life Sciences [q-bio]/Bioengineering, Tomography, Tomography, X-Ray Computed, Cardiology and Cardiovascular Medicine, business, Nuclear medicine
Abstract

To evaluate the accuracy of a fusion imaging guidance system using ultrasound (US) and computerized tomography (CT) as a real-time imaging modality for the positioning of a 22-gauge needle in the liver.The spatial coordinates of 23 spinal needles placed at the border of hepatic tumors before radiofrequency thermal ablation were determined in 23 patients. Needles were inserted up to the border of the tumor with the use of CT-US fusion imaging. A control CT scan was carried out to compare real (x, y, z) and virtual (x', y', z') coordinates of the tip of the needle (D for distal) and of a point on the needle located 3 cm proximally to the tip (P for proximal).The mean Euclidian distances were 8.5 ± 4.7 mm and 10.5 ± 5.3 mm for D and P, respectively. The absolute value of mean differences of the 3 coordinates (|x' - x|, |y' - y|, and |z' - z|) were 4.06 ± 0.9, 4.21 ± 0.84, and 4.89 ± 0.89 mm for D and 3.96 ± 0.60, 4.41 ± 0.86, and 7.66 ± 1.27 mm for P. X = |x' - x| and Y = |y' - y| coordinates were7 mm with a probability close to 1. Z = |z' - z| coordinate was not considered to be larger nor smaller than 7 mm (probability7 mm close to 50%).Positioning errors with the use of US-CT fusion imaging used in this study are not negligible for the insertion of a 22-gauge needle in the liver. Physicians must be aware of such possible errors to adapt the treatment when used for thermal ablation.

Published
2019
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13. Intraabdominal urokinase in the treatment of loculated infected ascites in cirrhosis

Author

Patrick Pessaux, Thomas F. Baumert, François Habersetzer, Axenia Svab, Iulian Enescu, Simona Tripon, Pierre Mayer, Pôle Hépato-digestif [Strasbourg] (HUS - Nouvel Hôpital Civil), Les Hôpitaux Universitaires de Strasbourg (HUS), Institut de Recherche sur les Maladies Virales et Hépatiques (IVH), Université de Strasbourg (UNISTRA)-Institut National de la Santé et de la Recherche Médicale (INSERM), Département de Radiologie Interventionnelle [Strasbourg] (Nouvel Hôpital Civil - HUS), CHU Strasbourg-Les Hôpitaux Universitaires de Strasbourg (HUS)-Nouvel Hôpital Civil de Strasbourg, and univOAK, Archive ouverte

Subjects
medicine.medical_specialty, Cirrhosis, medicine.medical_treatment, Loculated ascites, Sciences du Vivant [q-bio]/Médecine humaine et pathologie, Fibrin, 03 medical and health sciences, 0302 clinical medicine, Infected ascites, Antibiotic therapy, Ascites, Fibrinolysis, Paracentesis, medicine, Urokinase, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, Hepatology, medicine.diagnostic_test, biology, business.industry, Gastroenterology, medicine.disease, 3. Good health, Surgery, 030228 respiratory system, biology.protein, 030211 gastroenterology & hepatology, medicine.symptom, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, medicine.drug
Abstract

Cirrhotic patients may present loculated ascites. We report a case of a 49-years old patient with cirrhosis and loculated infected ascites. Conventional and ultrasound (US)-guided paracentesis were ineffective. Moreover, US-guided drainages with 10 F drains could drain only small quantities of ascites localized in the largest loculated areas. Despite an adapted and long antibiotic therapy, the infection persisted. Intraabdominal fibrinolysis allowed the destruction of the fibrin septa, a better drainage and the sterilization of the ascites fluid. This is the first case report of effective intraabdominal fibrinolysis with urokinase in difficult to treat loculated infected ascites. case reports 2020 Jul 09 2020 07 09 imported

Published
2021
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14. Islet transplantation versus insulin therapy in patients with type 1 diabetes with severe hypoglycaemia or poorly controlled glycaemia after kidney transplantation (TRIMECO): a multicentre, randomised controlled trial

Author

Yvan Bricault, Gwen Grguric, Valery Gmyr, Eric Renard, Mathieu Rodière, Bruno Guerci, M. Greget, Anaïck Moisan, François Pattou, Cyrille Colin, Sophie Logerot, François Moreau, Frédéric Thony, Jean-Luc Bosson, C. Thivolet, Marie-Ange Pierredon, Sandrine Lablanche, Nadine Pernin, Kanza Benomar, Anne Wojtusciszyn, Jean Champagnac, Béatrice Roche, Christian Noel, Julie Kerr-Conte, Kristina Skaare, Violetta Raverdy, Pierre-Jean Valette, Kristel Le Mapihan, Christian Sengel, Fanny Buron, Thibault Bahoune, Igor Tauveron, Iulian Enescu, Arnaud Muller, Lionel Badet, Virginie Persoons, Marie-Christine Vantyghem, Marc Hazzan, Lucy Chaillous, Thierry Berney, Emmanuel Morelon, Rimed Ezzouaoui, R. Caiazzo, Sophie Borot, Domenico Bosco, Jacques Dantal, Laurence Kessler, Fanelly Torres, Paolo Malvezzi, Pierre-Yves Benhamou, Philippe Baltzinger, Coralie Camillo-Brault, Luc Frimat, Sophie Girerd, Alfred Penfornis, Harald Egelhofer, Jean-Pierre Riveline, Pierre Cattan, Rachel Tetaz, Laboratoire de bioénergétique fondamentale et appliquée (LBFA), Université Joseph Fourier - Grenoble 1 (UJF)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Grenoble Alpes (UGA), Centre Hospitalier Universitaire [Grenoble] (CHU), Université de Strasbourg (UNISTRA), CHU Strasbourg, Institut de Génomique Fonctionnelle (IGF), Université de Montpellier (UM)-Université Montpellier 1 (UM1)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Montpellier 2 - Sciences et Techniques (UM2)-Centre National de la Recherche Scientifique (CNRS), Hôpital Lapeyronie [Montpellier] (CHU), Service de diabétologie - endocrinologie, Centre Hospitalier Régional Universitaire [Besançon] (CHRU Besançon)-Hôpital Jean Minjoz, Université de Franche-Comté (UFC), Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Institut National de la Recherche Agronomique (INRA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hospices Civils de Lyon (HCL), Service de Néphrologie [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Laboratoire d'Hématologie, CHU Grenoble, Centre de Recherche en Cancérologie de Lyon (CRCL), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Centre Léon Bérard [Lyon]-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Hospices Civils de Lyon (HCL), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Hôpital Lariboisière, Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Lariboisière-Université Paris Diderot - Paris 7 (UPD7), Service d'urologie [Centre Hospitalier Lyon Sud - HCL], Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Geneva University Hospital (HUG), Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Université Lille Nord (France), Laboratory of Fundamental and Applied Bioenergetics = Laboratoire de bioénergétique fondamentale et appliquée (LBFA), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Service de Diabétologie - Endocrinologie [CHRU Besançon], Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Université Bourgogne Franche-Comté [COMUE] (UBFC), Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Institut National de la Recherche Agronomique (INRA), Centre de Recherche en Cancérologie de Lyon (UNICANCER/CRCL), Centre Léon Bérard [Lyon]-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Université Paris Diderot - Paris 7 (UPD7)-Hôpital Lariboisière-Fernand-Widal [APHP], and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)

Subjects
Male, endocrine system diseases, Endocrinology, Diabetes and Metabolism, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Islets of Langerhans Transplantation, 030230 surgery, law.invention, 0302 clinical medicine, Endocrinology, Randomized controlled trial, law, Medicine, Insulin, awareness, Kidney transplantation, geography.geographical_feature_category, ddc:617, Immunosuppression, Middle Aged, Islet, 3. Good health, surgical procedures, operative, Treatment Outcome, Female, Adult, medicine.medical_specialty, endocrine system, 030209 endocrinology & metabolism, 03 medical and health sciences, Endocrinology & Metabolism, beta-score, Diabetes mellitus, Internal medicine, Internal Medicine, Humans, Hypoglycemic Agents, improvement, renal-function, Glycated Hemoglobin, Type 1 diabetes, geography, business.industry, medicine.disease, Kidney Transplantation, Hypoglycemia, Transplantation, Diabetes Mellitus, Type 1, quality-of-life, Quality of Life, progression, business, mellitus
Abstract

International audience; Background Islet transplantation is indicated for patients with type 1 diabetes with severe hypoglycaemia or after kidney transplantation. We did a randomised trial to assess the efficacy and safety of islet transplantation compared with insulin therapy in these patients. Methods In this multicentre, open-label, randomised controlled trial, we randomly assigned (1:1) patients with type 1 diabetes at 15 university hospitals to receive immediate islet transplantation or intensive insulin therapy (followed by delayed islet transplantation). Eligible patients were aged 18-65 years and had severe hypoglycaemia or hypoglycaemia unawareness, or kidney grafts with poor glycaemic control. We used computer-generated randomisation, stratified by centre and type of patient. Islet recipients were scheduled to receive 11000 islet equivalents per kg bodyweight in one to three infusions. The primary outcome was proportion of patients with a modified (beta-score (in which an overall score of 0 was not allocated when stimulated C-peptide was negative) of 6 or higher at 6 months after first islet infusion in the immediate transplantation group or 6 months after randomisation in the insulin group. The primary analysis included all patients who received the allocated intervention; safety was assessed in all patients who received islet infusions. This trial is registered with ClinicalTrials.gov, number NCT01148680, and is completed. Findings Between July 8, 2010, and July 29, 2013, 50 patients were randomly assigned to immediate islet transplantation (n=26) or insulin treatment (n=24), of whom three (one in the immediate islet transplantation group and two in the insulin therapy group) did not receive the allocated intervention. Median follow-up was 184 days (IQR 181-186) in the immediate transplantation group and 185 days (172-201) in the insulin therapy group. At 6 months, 16 (64% [95% CI 43-82]) of 25 patients in the immediate islet transplantation group had a modified (beta-score of 6 or higher versus none (0% [0-15]) of the 22 patients in the insulin group (p\textless0.0001). At 12 months after first infusion, bleeding complications had occurred in four (7% [2-18]) of 55 infusions, and a decrease in median glomerular filtration rate from 90-5 mL/min (IQR 76-6-94-0) to 71-8 mL/min (59-0-89-0) was observed in islet recipients who had not previously received a kidney graft and from 63 .0 mL/min (55.0-71-0) to 57. 0 mL/min (45-5-65 . 1) in islet recipients who had previously received a kidney graft. Interpretation For the indications assessed in this study, islet transplantation effectively improves metabolic outcomes. Although studies with longer-term follow-up are needed, islet transplantation seems to be a valid option for patients with severe, unstable type 1 diabetes who are not responding to intensive medical treatments. However, immunosuppression can affect kidney function, necessitating careful selection of patients. Copyright (C) 2018 Elsevier Ltd. All rights reserved.

Published
2017
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15. Imaging-Guided Percutaneous Cryotherapy of Bone and Soft-Tissue Tumors: What Is the Impact on the Muscles Around the Ablation Site?

Author

Julien Garnon, Georgia Tsoumakidou, Iulian Enescu, Afshin Gangi, Nitin Ramamurthy, and Fabrice Bing

Subjects
Adult, Male, medicine.medical_specialty, Percutaneous, medicine.medical_treatment, Bone Neoplasms, Soft Tissue Neoplasms, Cryotherapy, Cryosurgery, medicine, Humans, Radiology, Nuclear Medicine and imaging, Clinical significance, Myositis, Aged, Retrospective Studies, Aged, 80 and over, business.industry, Soft tissue, Cryoablation, General Medicine, Middle Aged, medicine.disease, Ablation, Magnetic Resonance Imaging, Hyperintensity, Treatment Outcome, Surgery, Computer-Assisted, Female, Radiology, business
Abstract

The objectives of our study were to evaluate the incidence of muscular injury after cryoablation of bone and soft-tissue tumors, to relate MRI findings to the size of the intramuscular ice ball, and to determine the clinical significance of postcryotherapy myositis.Between January 2010 and October 2012, 24 bone and soft-tissue lesions (16 pelvic lesions, three shoulder lesions, and five paravertebral lesions) in 21 patients treated by imaging-guided percutaneous cryoablation and followed up with MRI were retrospectively analyzed. Muscular hyperintensity on T2 STIR images was graded as follows: grade 0, no myositis; grade 1, local myositis; grade 2, myositis in less than half of the volume of the muscle; or grade 3, myositis in half of the volume of the muscle or more. The presence of T2 STIR hyperintensity in the muscles surrounding the cryoablation site was correlated with the volume of the intramuscular ice ball.Muscular T2 STIR hyperintensity was observed in 87.5% of cases (grade 0 in 12.5%, grade 1 in 45.8%, grade 2 in 20.8%, and grade 3 in 20.8%). The volume of the intramuscular ice ball and grade of myositis (mean volume: grade 0, 2.8 cm(3); grade 1, 9.2 cm(3); grade 2, 17.1 cm(3); grade 3, 42.9 cm(3)) were positively correlated in the 24 lesions in the study cohort (r = 0.64, p0.001). Only two cases of myositis (grade 3) were symptomatic, and antiinflammatory drugs promoted pain resolution in both cases.Muscular injury around the cryoablation site is commonly observed and is correlated with the volume of the ice ball. When muscular injury around the cryoablation site causes pain, the symptoms differ from the initial tumoral pain and can be treated with antiinflammatory drugs.

Published
2014
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16. Guest speakers lectures, oral presentations, clinical case presentations

Author

Gregor Recnik, Giorgio Maria Calori, Yaron Zaulan, Stephan Werle, Kazuhiro Hasegawa, Dirk Wiese, Gabor Jakab, Tristan Ferry, Benjemin Bernfeld, Matjaž Voršič, Marton Ronai, Jean-Edouard Loret, Julien Garnon, Jean-Sebastien Steffen, C. Dova, Jean-Paul Steib, C. Chidiac, Martin Dostal, Wafa Skalli, Angel Escamez, Ely Ashkenazi, Didier Mainard, Murat Aksakal, Suzanne E. L. Detiger, Carlos Barrios, Samo K. Fokter, B. Richard, Iñaki Arrotegui, Cédric Barrey, Sang Soo Eun, Aysun Yilmazlar, André J. Kaelin, Shigeo Sano, Marion Prud’homme, Marco N. Helder, C. Mazel, Fabrice Bing, Boris Zilberstein, P. Antonietti, Masahiro Kanayama, Iulian Enescu, Sang-Ho Lee, Gilles Norotte, Burak Akesen, I. Caux, Georgia Tsoumakidou, Frédéric Sailhan, Ibrahim Obeid, C. Ripamonti, Laurence Mainard-Simard, M. Colombo, P. P. A. Vergroesen, Afshin Gangi, Guy Matgé, Ali Sulliman, Denis L. Kaech, Jean-François Cazeneuve, Ufuk Aydinli, Philippe Rouch, C. P. L. Paul, Cesar Hernandez, Dick Zeilstra, Heinrich Boehm, O. Gille, Fadi Khazin, S. Lustig, B. J. Vanroyen, Alex Puhov, R. J. W. Hoogendoorn, Matías Alfonso, R. J. Kroeze, Jean-Marc Vital, Müren Mutlu, Vitaly Alexandrovsky, Janez Ravnik, F. Laurent, Gilles Perrin, J. M. Casamitjana Ferrandiz, Franz E. Weber, Theo H. Smit, E. Mazza, Yann Philippe Charles, Gorazd Bunc, Alexander Bruskin, Laurent Balabaud, and Kürşat Kara

Subjects
medicine.medical_specialty, business.industry, Biomedical Engineering, medicine, Radiology, Nuclear Medicine and imaging, Orthopedics and Sports Medicine, Surgery, Medical physics, Neurology (clinical), Clinical case, Anatomy, business
Published
2012
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17. Overview of Thermal Ablation Devices: HIFU, Laser Interstitial, Chemical Ablation

Author

Afshin Gangi, Georgia Tsoumakidou, Iulian Enescu, Julien Garnon, and Xavier Buy

Subjects
High energy, Materials science, medicine.medical_treatment, Thermal ablation, Cellular death, Chemical ablation, Acoustic lens, Laser, Ablation, law.invention, law, medicine, Hifu ablation, Biomedical engineering
Abstract

HIFU is a noninvasive ablation technique, which uses the property of ultrasounds (US) to propagate harmlessly energy through human tissues. HIFU focuses high-intensity US waves into a target area, thus generating focal deposition of high energy that leads to cellular death in living tissues.

Published
2012
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18. FOREX application for BlackBerry device

Author

Nicolae Iulian Enescu and Dan Mancas

Subjects
Embedded software, Software, Computer science, business.industry, Systems design, Market trend, Android (operating system), Telecommunications, business, Stock market index, Foreign exchange market, Mobile device, Simulation
Abstract

In this paper it is described our research and development work for implementing advanced software solutions, of a high quality standard, in the financial-banking domain, on mobile devices (such as Blackberry, iPhone, Android based devices etc), by using state-of-the-art technologies. The paper is focused on the implementation of a finance application which runs on BlackBerry smart phone devices and it is used for retrieving and displaying streaming interbank currency rates as well as global stock indices, commodities and real-time forex. The application includes news from Market News International also and gives an unprecedented market trend overview. The system design and implementation was co-financed through EU funds within the framework of the project "Embedded Software for Mobile Devices", project co-financed through European Fund of Regional Development.

Published
2012
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