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This work aims to assess the exposure to permethrin of the adult French population from available contamination measurements of outdoor air, indoor air, and settled dust. Priority is given to the assessment of chronic exposure, given the potential of permethrin to induce cancers and/or endocrine disorders. A statistical method was devised to calculate exposure to permethrin by different pathways (inhalation, indirect dust ingestion, and dermal contact). This method considers anthropometric parameters, the population's space-time budget, and recent methods for calculating dermal exposure. Considering the media of interest, our results pointed to house dust as the main environmental source of permethrin exposure, followed by indoor and outdoor air. Dermal contact and indirect dust ingestion may be more important exposure pathways than inhalation. A sensitivity analysis indicated that exposure estimates were mainly affected by variability within contamination data. This study is the first step in aggregated exposure and risk assessment due to pyrethroid exposure. Outdoor air, indoor air, and settled dust may constitute significant exposure sources, in addition to diet, which could be important. The next step entails assessing internal doses and estimating the proportion of each exposure source and pathway relative to internal exposure.

The objective of this study was to evaluate the interest of using ropivacaine for outpatient laparoscopic cholecystectomy. The use of local anesthesia by instillation and infiltration could reduce pain and increase the number of outpatient cholecystectomies. A one-center randomized prospective clinical trial compared the use of ropivacaine during outpatient laparoscopic cholecystectomy to the control group of outpatients for laparoscopic cholecystectomy between April 2014 and May 2015. One hundred twenty-four were eligible, and 100 patients were randomized. Patients with outpatient cholecystectomy were randomized into 2 groups: ropivacaine group (Rop group) and control group (control group). We performed a ropivacaine intraperitoneal instillation and wound infiltration for the ropivacaine group at the end of the procedure. The primary observation was authorization for home discharge. The patient was evaluated by the surgeon using the Chung score. Secondary observations included postoperative pain at 2 h post-surgery, at 6 h post-surgery and the day following surgery. Ninety-eight were able to leave on the evening of surgery. At 6 h post-surgery, the Chung score was identical for both groups (p = 0.73). At 2 and 6 h post-surgery and the day following surgery, there was no significant difference in pain levels (p = 0.63; p = 0.61; p = 0.98). Analgesic consumption was no significant difference in the groups. The use of ropivacaine does not increase the rate of home discharge and does not change the postoperative pain of outpatient cholecystectomy.

Background Nonfunctioning pancreatic neuroendocrine tumors (NF-PNETs) are often discovered at a small size. No clear consensus exists on the management of NF-PNETs ≤ 2 cm. The aim of our study was to determine the prognostic value of indicators of malignancy in sporadic NF-PNETs ≤ 2 cm. Methods Eighty patients were evaluated retrospectively in 7 French University Hospital Centers. Patients were managed by operative resection (operative group [OG]) or observational follow-up (non-OG [NOG]). Pathologic characteristics and outcomes were analyzed. Results Sixty-six patients (58% women) were in the OG (mean age, 59 years; 95% CI, 56.0–62.3; mean tumor size, 1.6 cm; 95% CI, 1.5–1.7); 14 (72% women, n = 10) were in the NOG (mean age, 63 years; 95% CI, 56–70; mean tumor size, 1.4 cm; 95% CI, 1.0–1.7). All PNETs were ranked using the European Neuroendocrine Tumor Society grading system. Fifteen patients (19%) had malignant tumors defined by node or liver metastasis (synchronous or metachronous). The median disease-free survival was different between malignant and nonmalignant PNETs, respectively: 16 (range, 4–72) versus 30 months (range, 1–156; P = .03). On a receiver operating characteristic (ROC) curve, tumor size had a significant impact on malignancy (area under the curve [AUC], 0.75; P = .03), but not Ki-67 (AUC, 0.59; P = .31). A tumor size cutoff was found on the ROC curve at 1.7 cm (odd ratio, 10.8; 95% CI; 2.2–53.2; P = .003) with a sensitivity of 92% and a specificity of 75% to predict malignancy. Conclusion Based on our retrospective study, the cutoff of 2 cm of malignancy used for small NF-PNETs could be decreased to 1.7 cm to select patients more accurately.

International audience; Vertical banded gastroplasty (VBG), introduced by Mason in 1982, is now discarded because of important long-term complications and technical difficulties to do revisional surgery. We investigated the long-term complications of VBG in our center and compared it with the literature data. Patients who underwent an open VBG at the University Hospital of Nantes between October 1991 and May 2006 were included. We reviewed preoperative clinical data, long-term outcome in weight loss, complications, and revisional surgeries with a long follow-up. Sixty-three patients (52 women and 11 men) were included, with a mean age of 43 ± 10 years and a body mass index of 46.7 ± 8.3 kg/m². The mean follow-up was 8.2 ± 4.2 years. At the end of follow-up, the mean excess weight loss (EWL) was 29.8%. Long-term success (excess weight loss > 50%) of the procedure was observed in 25 patients (39.7%). A second intervention was performed in 15 patients (23.8%), and three needed a third redo procedure. Six patients (40%) had this new intervention for late complications, and nine (60%) for weight regain. Weight loss is satisfying in the long term although the rate of reintervention is high. Long-term complication can be severe, especially with gastric stenosis that could lead to esophageal cancer. A second reintervention could be technically demanding, especially by laparoscopy, and the patients should be referred to a specialized center.

In France, the present regulations on occupational exposure to asbestos fibers take into account fibers (FRp: fibers measured for industrial hygiene) with the following dimensions: L > 5 μm, D 3 where L is the length and D the diameter of the fiber. The limit value is set at 0.1 f/cm3 for 1 hr. By definition short asbestos fibers (SAFs) are the fibers with 0.5 μm < L< 5 μm, D < 3 μm, and L/D ≥ 3; thin asbestos fibers (TAFs) are the fibers with L ≥ 5 μm, D < 0.2 μm, and L/D ≥ 3. The aim assigned to the French Agency for Environmental and Occupational Health Safety (AFSSET) Occupational Exposure Limit (OEL) Committee, was essentially to evaluate the following elements: the relevance of the present French OEL, knowing that this limit excludes the counting of SAFs and TAFs; the consistency of the OEL in light of the different varieties of asbestos by studying possible differential toxicity according to the type of asbestos (chrysotile vs. amphiboles); and the assessment of different measurin...

The fibrogenicity and carcinogenicity of asbestos fibers are dependent on several fiber parameters including fiber dimensions. Based on the WHO (World Health Organization) definition, the current regulations focalise on long asbestos fibers (LAF) (Length: L ≥ 5 μm, Diameter: D < 3 μm and L/D ratio > 3). However air samples contain short asbestos fibers (SAF) (L < 5 μm). In a recent study we found that several air samples collected in buildings with asbestos containing materials (ACM) were composed only of SAF, sometimes in a concentration of ≥10 fibers.L-1. This exhaustive review focuses on available information from peer-review publications on the size-dependent pathogenetic effects of asbestos fibers reported in experimental in vivo and in vitro studies. In the literature, the findings that SAF are less pathogenic than LAF are based on experiments where a cut-off of 5 μm was generally made to differentiate short from long asbestos fibers. Nevertheless, the value of 5 μm as the limit for length is not based on scientific evidence, but is a limit for comparative analyses. From this review, it is clear that the pathogenicity of SAF cannot be completely ruled out, especially in high exposure situations. Therefore, the presence of SAF in air samples appears as an indicator of the degradation of ACM and inclusion of their systematic search should be considered in the regulation. Measurement of these fibers in air samples will then make it possible to identify pollution and anticipate health risk. © 2014 Boulanger et al. licensee BioMed Central Ltd., SCOPUS: re.j, info:eu-repo/semantics/published