B Acad Nat Med Paris
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B Acad Nat Med Paris · Mar 2006
Review Comparative Study[Medical treatment of critical leg ischemia: current status and future perspectives of gene and cell therapy].
Critical limb ischemia (CLI) is associated with a high risk of amputation and death. For patients who cannot be surgically revascularized, medical options include prostanoids, spinal cord stimulation and lumbar sympathectomy, but none of these treatments has a demonstrated impact on the amputation rate at six months. Gene and cell therapy, aimed at stimulating angiogenesis, have mainly been tested in phase I and II clinical trials. These approaches appear to be feasible and safe in the short-term, but large randomized studies are necessary to demonstrate their clinical benefits and long-term safety.
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B Acad Nat Med Paris · Mar 2006
Review[Role of interventional radiology in the management of critical limb ischemia].
Critical limb ischemia is a growing public health problem with major human and medical costs. Primary amputation is the rule in most countries and hospitals, but has major functional, psychological and financial consequences. By using a combination of endovascular and surgical techniques, it is now possible to save 9/10 limbs at risk. ⋯ Arteriography is currently the only technique that offers a robust workup and, in most cases, permits interventional radiology procedures under local anesthesia and during the same session. Various techniques can be used, depending on the type of lesions, from plain balloon angioplasty to stenting, subintimal recanalization, and use of a cutting balloon. We review the different interventional radiology approaches available in this setting, and their results relative to bypass surgery.
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Emerging and re-emerging infectious diseases have again entered the public arena in recent years. This is due to factors such as evolving lifestyles, ecological and socio-political upheavals, and recent diagnostic advances. Numerous pathogens, including viruses like West Nile, Chikungunya and Japanese encephalitis on the one hand, and hemorrhagic fever viruses like Ebola and Maburg, are particular concerns. ⋯ It is in this context that so-called "bird flu'", may be on the verge of causing a human pandemic. Pox and Monkeypox are "virtually emerging" viruses that have potential for use in bioterrorism. The management and treatment of these emerging infectious diseases calls for new approaches, organizations and infrastructures.
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B Acad Nat Med Paris · Mar 2006
Review Comparative Study[How to define the species barrier to pathogen transmission?].
A given microbial pathogen usually targets a restricted number of animal species. Some pathogens can be transmitted to humans from another animal species, either directly (rabies, brucellosis, etc.) or through a vector (Lyme's disease, West Nile fever, etc.). Few infectious agents with animal reservoirs infect humans, and even fewer are capable of human-human transmission. ⋯ The full series of events must be "reprogrammed" for efficient implantation in a new host. These changes occur through mutations or genetic exchanges. Direct human-to-human transmission often requires additional adaptive modifications.
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Effective management of critical limb ischemia (CLI) requires a multidisciplinary approach. Vascular surgeons have a wide range of methods that can avoid major amputation. From January 2004 to December 2005, we treated 95 lower limbs with CLI in 81 patients. ⋯ With aggressive treatment, 93.7% of CLI limbs were revascularized, with a peri-operative mortality rate of 2.5%. The limb salvage rate was 68% in 59 patients after a mean follow-up of 6.9 months. Failed revascularization was often due to late patient referral.