Joué-lés-Tours, France
Joué-lés-Tours, France

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Albano L.,Hospital Pasteur | Buchler M.,Hospital Bretonneau | Cantarovich D.,Hospital Hotel Dieu | Cassuto E.,Hospital Pasteur | And 6 more authors.
Annals of Transplantation | Year: 2016

Background: Dosing of enteric-coated mycophenolate sodium (EC-MPS) should be adjusted to reflect concomitant immunosuppression, but it is largely undocumented whether such modifications are carried out during routine clinical practice. Material/Methods: MyLIFE was an observational study of adult kidney-only or kidney-pancreas transplant patients starting EC- MPS at 33 French transplant centers. Data were collected at first EC-MPS dose and 6 months later. The primary objective was to describe initial EC-MPS dosing according to concomitant immunosuppression. Results: There were 461 patients analyzed (174 started EC-MPS by month 1 post-transplant [‘de novo’] and 287 started EC-MPS >1 month post-transplant [‘maintenance’]), receiving cyclosporine (CsA) (n=76), tacrolimus (n=363), or a mammalian target of rapamycin (mTOR) inhibitor (n=22). Mean (SD) starting dose was 1130 (511) mg/day, 1006 (441) mg/day, and 769 (300) mg/day in the CsA, tacrolimus, and mTOR inhibitor groups, respectively (p=0.003). In the de novo subpopulation, the starting dose was 1440 mg/day in 66.7% (14/21) of CsA-treated patients and 71.9% (110/153) of tacrolimus-treated patients, with an intensified dose of 2160 mg/day in 28.6% (6/21) and 8.5% (13/153), respectively. There was a non-significant trend to a higher rate of biopsy-proven acute rejection in patients receiving CsA versus tacrolimus or an mTOR inhibitor (p=0.082). Adverse events with a suspected relation to EC-MPS occurred in 21.0%, 23.1%, and 9.1% of the CsA, tacrolimus, and mTOR inhibitor subpopulations, respectively. Conclusions: EC-MPS is usually initiated at the dose recommended for de novo CsA-treated kidney transplant patients, then titrated downwards as required. An early intensified regimen is not used frequently. The EC-MPS dose is modified in <20% of de novo patients to account for concomitant tacrolimus therapy instead of CsA administration. © Ann Transplant, 2016.


Badin J.,Hospital Bretonneau | Francois M.,Hospital Bretonneau | Birmele B.,Hospital Bretonneau | Nivet H.,Hospital Bretonneau | Pengloan J.,Hospital Bretonneau
Journal of Vascular Access | Year: 2013

Some hemodialysed patients need definitive central venous catheterization. One of the main complications is catheter infection, and each infection must be treated. We report a case of an unusual cause of central venous catheter (CVC) infection: physical examination and catheter opacification demonstrated two pin-holes in the catheter. It was possible to salvage the catheter following a treatment regimen combining systemic antibiotics, antibiotic locks, fibrinolytics, and removal of a catheter segment.


PubMed | Novartis, Hospital Hotel Dieu, Hospital Of Rangueil, University Paul Sabatier and 5 more.
Type: | Journal: Annals of transplantation | Year: 2016

BACKGROUND Dosing of enteric-coated mycophenolate sodium (EC-MPS) should be adjusted to reflect concomitant immunosuppression, but it is largely undocumented whether such modifications are carried out during routine clinical practice. MATERIAL AND METHODS MyLIFE was an observational study of adult kidney-only or kidney-pancreas transplant patients starting -EC-MPS at 33 French transplant centers. Data were collected at first EC-MPS dose and 6 months later. The primary objective was to describe initial EC-MPS dosing according to concomitant immunosuppression. RESULTS There were 461 patients analyzed (174 started EC-MPS by month 1 post-transplant [de novo] and 287 started EC-MPS >1 month post-transplant [maintenance]), receiving cyclosporine (CsA) (n=76), tacrolimus (n=363), or a mammalian target of rapamycin (mTOR) inhibitor (n=22). Mean (SD) starting dose was 1130 (511) mg/day, 1006 (441) mg/day, and 769 (300) mg/day in the CsA, tacrolimus, and mTOR inhibitor groups, respectively (p=0.003). In the de novo subpopulation, the starting dose was 1440 mg/day in 66.7% (14/21) of CsA-treated patients and 71.9% (110/153) of tacrolimus-treated patients, with an intensified dose of 2160 mg/day in 28.6% (6/21) and 8.5% (13/153), respectively. There was a non-significant trend to a higher rate of biopsy-proven acute rejection in patients receiving CsA versus tacrolimus or an mTOR inhibitor (p=0.082). Adverse events with a suspected relation to EC-MPS occurred in 21.0%, 23.1%, and 9.1% of the CsA, tacrolimus, and mTOR inhibitor subpopulations, respectively. CONCLUSIONS EC-MPS is usually initiated at the dose recommended for de novo CsA-treated kidney transplant patients, then titrated downwards as required. An early intensified regimen is not used frequently. The EC-MPS dose is modified in <20% of de novo patients to account for concomitant tacrolimus therapy instead of CsA administration.


Courcet J.-B.,University of Burgundy | Faivre L.,University of Burgundy | Michot C.,University of Paris Descartes | Burguet A.,Childrens Hospital | And 36 more authors.
Journal of Pediatrics | Year: 2013

Objective: To determine the frequency and types of renal malformations, and to evaluate renal function in a cohort of patients with Kabuki syndrome (KS). Study design: Renal ultrasound scans and plasma creatinine measurements were collected from a French cohort of 94 patients with genotyped KS. Renal function was evaluated based on the estimated glomerular filtration rate. A genotype-phenotype study was conducted for renal and urinary tract malformations. Results: Renal malformations were present in 22% of cases, and urinary tract anomalies were present in 15%. Renal malformations were observed in 28% of the MLL2 mutation-positive group and in 0% of the MLL2 mutation-negative group (P =.015). No correlation was found between the presence or absence of renal or urinary tract malformations and the location or type of MLL2 mutation. Renal function was normal except for 1 patient with a MLL2 mutation diagnosed in the first days of life and severe renal disease due to unilateral renal agenesia and controlateral severe hypoplasia that progressed to the terminal stage at age 2 years. Conclusion: Our study emphasizes the need for ultrasound and renal function screening in children diagnosed with KS. © 2013 Mosby Inc. All rights reserved.


Roux A.,Hospital Bretonneau | Roux A.,University of Tours | Alzharani M.A.,Hospital Bretonneau | Rousselot C.,Hospital Bretonneau | And 4 more authors.
Revue de Laryngologie Otologie Rhinologie | Year: 2013

Multifocal cervico-facial metastases are very rare. Medical history of the patient and clinical context make easier the diagnosis. A 54-year-old woman presenting with a nasal obstruction, was referred to our department. She had a past medical history of an operated renal cancer 12 years ago and a right hemithyroidectomy 30 years ago. Clinical examination revealed a polypoïd lesion obstructing the right nasal cavity and a thyroid goiter. Fine-needle aspiration was positive for a renal metastasis. Computed tomography confirmed the nasal lesion without bone destruction and a cervical cystic lesion into the left thyroid lobe. Completion thyroidectomy and polyp excision were performed. The final histologic examination revealed a metastasis from a renal cancer. The association of intrathyroid and nasal cavity metastases is uncommon and not related in the literature, the practitioner must suspect the diagnosis if the patient had a thyroid tumor, a suspicious nasal lesion and a past history of cancer. The surgical management is recommended for isolated metastasis to the nasal cavity and the thyroid gland especially in renal cancer.

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