The role of the family of a patient with a head injury

When someone suffers a head injury, it is not always easy for the family to find its place and adopt a suitable attitude. The French national association of families and victims of head injuries and brain-damaged people (UNAFTC) was created in 1986 in order to support families and to assist in the patient's social and/or professional reintegration.     

Neurovascular Neck-Bridging device in treatment of wide-necked splenic artery aneurysms

We report the cases of 2 female patients, 45-year-old and 49-year-old, affected by wide-necked splenic aneurysm. We embolized the 2 lesions assisted by a new scaffolding neurovascular device, the Cascade Net, an innovative –occlusive remodeling device for temporary bridging in endovascular coil embolization of intracranial aneurysms. Visceral artery aneurysms are rare with an estimated prevalence of 2%-3% in imaging series and up to 10% in autopsy series. Most are asymptomatic and their diagnosis is occasionally. Aneurysm spontaneous rupture has been demonstrated in 2%-10% of cases and it can result in significant morbidity and mortality. Conservative management and open repair were the preferred treatment options for many years. Endovascular repair has been increasingly used since 2000; and the most widespread method of treatment has been coiling. Because of tortuosity of the parent artery, wide neck, and unfavorable locations at arterial branch points, 6% of Visceral and renal artery aneurysms VRAA cannot be adequately treated by simple coiling and requires parent artery remodeling through balloon occlusion, stent placement or parent vessel occlusion, leading to, in the latter situation, a compromised organ perfusion. Increasingly, balloon-assisted, and stent-assisted approaches as well as novel scaffolding neurovascular devices such as the Cascade Net, have allowed wide necked aneurysms to be bridged during endovascular treatment with smaller delivery system, averting parent artery occlusion and risk of distal embolization.     

Efficacy and safety of deferasirox compared with deferoxamine in sickle cell disease: Two‐year results including pharmacokinetics and concomitant hydroxyurea

We report a prospective, randomized, Phase II study of deferasirox and deferoxamine (DFO) in sickle cell disease patients with transfusional iron overload, with all patients continuing on deferasirox after 24 weeks, for up to 2 years. The primary objective was to evaluate deferasirox safety compared with DFO; long‐term efficacy and safety of deferasirox was also assessed. We also report, for the first time, the safety and pharmacokinetics of deferasirox in patients concomitantly receiving hydroxyurea. Deferasirox (n = 135) and DFO (n = 68) had comparable safety profiles over 24 weeks. Adverse events (AEs) secondary to drug administration were reported in 26.7% of patients in the deferasirox cohort and 28.6% in the DFO cohort. Gastrointestinal disorders were more common with deferasirox, including diarrhea (10.4% versus 3.6%) and nausea (5.2% versus 3.6%). The most common AE in the DFO group was injection‐site pain irritation, which occurred in 7% of patients. Acute renal failure occurred in one patient on deferasirox who was continued on medication despite progressive impairment of renal function parameters. Serum ferritin levels were reduced in both treatment groups. Patients continuing on deferasirox for up to 2 years demonstrated an absolute median serum ferritin decrease of ?614 ng/mL (n = 96). Increasing deferasirox dose was associated with improved response and a continued manageable safety profile. Concomitant hydroxyurea administration (n = 28) did not appear to influence the efficacy, safety (including liver and kidney function), and pharmacokinetic parameters of deferasirox. Am. J. Hematol. 88:1068–1073, 2013. © 2013 Wiley Periodicals, Inc.     

Recurrences of supratentorial meningiomas. Apropos of 17 cases

17 cases of recurrent meningiomas observed during a 10 years period are reviewed. Meningiomas with a second localisation different from the first were excluded from the study. The tumor recurrence occurred mostly during the first five years after the surgical procedure. One case with femoral and pulmonary metastasis is described. Several factors may play a role in the genesis of the recurrence: age, sex, the tumor localisation, CT scan, the importance of the tumor ablation, the histology. In almost all cases a radiotherapy was carried out after the second surgical procedure. This retrospective study suggests the need for multifactorial prospective analysis with clinical, paraclinical and fundamental factors. Such a study would be useful to precise the natural history of meningiomas.     

Proteins with whey-acidic-protein motifs and cancer

The importance of early diagnosis to reduce the morbidity and mortality from cancer has led to a search for new sensitive and specific tumour markers. Molecular techniques developed over the past few years allow simultaneous screening of thousands of genes, and have been applied to different cancers to identify many genes that are modulated in various cancers. Of these, attention has focused on genes coding for a family of proteins with whey-acidic-protein (WAP) motifs. Most notably, the genes coding for elafin, antileukoproteinase 1 (previously called secretory leucocyte proteinase inhibitor, SLPI), WAP four disulphide core domain protein 1 (previously called prostate stromal protein 20 kDa, PS20), and WAP four disulphide core domain protein 2 (previously called major human epididymis-specific protein E4, HE4), have been identified as candidate molecular markers for several cancers. In this review, we assess data for an association between cancer and human WAP proteins, and discuss their potential role in tumour progression. We also propose a new mechanism by which WAP proteins might have a role in carcinogenesis.     

Sirolimus early graft nephrotoxicity: clinical and experimental data

Sirolimus (SRL) is a recently available immunosuppressive agent. SRL, is a macrolide isolated from Streptomyces hydroscopicus that, in complex with its cellular receptor, FK binding protein, potently inhibits downstream signaling by the mammalian target of rapamycin (mTOR). It has been shown to reduce the incidence of acute rejection episode after renal transplantation. SRL by itself does not seem to cause significant nephrotoxicity in most animals and human studies in normal conditions. However, when combined with calcineurin inhibitors, serum creatinine levels often increase. The mechanisms for the synergism of this side-effect are still discussed. Furthermore, recent clinical data have shown that the administration of SRL immediately after renal transplant delay the recovery from delayed graft function. This effect may be secondary to the inhibition of the proliferation of the renal tubular cells which is a normal process for tubular repair. Some experimental data have confirmed this hypothesis. Finally, in the long-term, SRL use has been associated with a significant increase of proteinuria which may in the long-term increase the risk of graft loss of cardio-vascular morbio-mortality. For all these reasons, SRL nephrotoxicty has become an important issue after renal transplantation. The review will discuss the clinical and the experimental data regarding this complication, which has been underestimated.