Center hospitalier dAngouleme

Saint-Michel-sur-Orge, France

Center hospitalier dAngouleme

Saint-Michel-sur-Orge, France
SEARCH FILTERS
Time filter
Source Type

PubMed | Li Ka Shing Knowledge Institute, University of Barcelona, Assistance Publique Hopitaux de Paris, Hippocrateion General Hospital of Athens and 13 more.
Type: Comparative Study | Journal: Intensive care medicine | Year: 2016

Unlike in the outpatient setting, delivery of aerosols to critically ill patients may be considered complex, particularly in ventilated patients, and benefits remain to be proven. Many factors influence aerosol delivery and recommendations exist, but little is known about knowledge translation into clinical practice.Two-week cross-sectional study to assess the prevalence of aerosol therapy in 81 intensive and intermediate care units in 22 countries. All aerosols delivered to patients breathing spontaneously, ventilated invasively or noninvasively (NIV) were recorded, and drugs, devices, ventilator settings, circuit set-up, humidification and side effects were noted.A total of 9714 aerosols were administered to 678 of the 2808 admitted patients (24 %, CI95 22-26 %), whereas only 271 patients (10 %) were taking inhaled medication before admission. There were large variations among centers, from 0 to 57 %. Among intubated patients 22 % (n = 262) received aerosols, and 50 % (n = 149) of patients undergoing NIV, predominantly (75 %) inbetween NIV sessions. Bronchodilators (n = 7960) and corticosteroids (n = 1233) were the most frequently delivered drugs (88 % overall), predominantly but not exclusively (49 %) administered to patients with chronic airway disease. An anti-infectious drug was aerosolized 509 times (5 % of all aerosols) for nosocomial infections. Jet-nebulizers were the most frequently used device (56 %), followed by metered dose inhalers (23 %). Only 106 (<1 %) mild side effects were observed, despite frequent suboptimal set-ups such as an external gas supply of jet nebulizers for intubated patients.Aerosol therapy concerns every fourth critically ill patient and one-fifth of ventilated patients.


PubMed | Center Hospitalier Of Meaux, Center hospitalier Auban Moet, Center Hospitalier Of Saint Quentin, Center hospitalier Compiegne Noyon and 5 more.
Type: Journal Article | Journal: Revue des maladies respiratoires | Year: 2016

The Collge des Pneumologues des Hpitaux Gnraux has performed a prospective multicentre epidemiological study which aims to describe the baseline characteristics of all new cases of primary lung cancer histologically or cytologically diagnosed in 2010 and followed-up in the respiratory department of general hospitals. The present publication compares the characteristics of these presentations according to their smoking history.Seven thousand and fifty-one adult patients were included from 104 respiratory departments. A standardized form was completed at diagnosis and a steering committee checked the completeness of inclusion.Only 10.9% of patients were never-smokers and 89.1% ever-smokers (i.e., current or former smokers). Respectively, 3.7%, 10.7% and 85.6% of ever-smokers consumed/had consumed 1-10, 11-20, and >20 pack-years. Mean smoking duration was 37.5 years. Former smokers had stopped smoking on average 14.8 years previously. Only 20.7% of never-smokers reported that they had been exposed to tobacco smoke passively. At diagnosis, statistically significant differences were found between never- and ever-smokers (P<0.0001) for sex (women: 60.8% vs 18.8%), age (mean: 70.7 years vs 64.9 years), stage (IV: 70.8% vs 58.7%), histology (adenocarcinoma: 68.5% vs 42.6%), EGFR mutation exploration (51.4% vs 28.0%) and positivity (37.0% vs 4.6%). Differences between never- and ever-smokers rose with increasing tobacco consumption.This study confirms that differences exist between never- and ever-smoker patients presenting with primary lung cancer and shows the impact of the level of tobacco consumption, in particular on histology.


PubMed | Center National Of Reference Des Maladies Pulmonaires Rares Center Expert National Associe Du Reseau Rythmic Tumeurs Thymiques Et Cancer, Center Hospitalier dAngouleme, Center Hospitalier Of Pessac, Groupe Hospitalier Pitie Salpetriere and University Pierre and Marie Curie
Type: | Journal: Immunologic research | Year: 2016

Pulmonary hyalinizing granuloma (PHG) is a rare disease characterized by single or multiple benign lung nodules mimicking lung neoplasma. Histologic analysis reveals homogenous hyaline lamellae, usually surrounded by collection of plasma cells, lymphocytes and histiocytes in a perivascular distribution. The clinical and radiological findings have been described in small series, but the long-term outcomes have rarely been reported. The objectives were to describe the clinical, radiological and outcomes of PHG in new cases and through a literature review. Patients with PHG were found by a multicenter search among French departments of internal medicine, pulmonology and anatomo-pathology. Review of the literature was made through the National Library of Medicines MEDLINE database using keywords hyalinizing granuloma. Five news cases and 135 cases of the literature were found. There were 82 men and 57 women, mean age at the diagnosis 44.6years (15-83). Patients were frequently asymptomatic (n=39, 27.4%). The nodule was unique in 37 cases (28.9%) and multiple in 91 cases (71.1%). 18FDG PET scan revealed hypermetabolism of the nodule in 9/15 cases (60%). A systemic disease was associated in 65 cases (mainly mediastinal and retroperitoneal fibrosis, autoimmune, tumoral or infectious disease or thromboembolism). The outcomes were evaluated in 73 patients when follow-up was available: 14 patients had a surgical resection of the nodule. Forty-five patients did not receive any immunosuppressive drug. Among these patients, 2 improved, 29 were stable and 14 worsened. Corticosteroids were used as a monotherapy in 19 patients and led to radiological improvement in 8 cases, stabilization in 8 cases and worsening in 3 cases. Five patients were treated with corticosteroids and at least one immunosuppressive drug and 4 patients improved. PHG is a rare benign disease, mimicking lung neoplasma, frequently associated with systemic diseases.


Frossard B.,Hopitaux universitaires Paris Sud | Combret C.,Center hospitalier dAngouleme | Benhamou D.,Hopitaux universitaires Paris Sud
Annales Francaises d'Anesthesie et de Reanimation | Year: 2013

A patient presenting with paramyotonia congenita (Eulenburg's paramyotonia) was seen at the preanaesthetic visit during pregnancy. The underlying disease was known for years. Analysis of the literature and advice taken from specialists emphasized the safe use of regional anaesthesia and analgesia which was indeed used for labour and delivery without any complication. By contrast, the limited information available on the use of general anaesthesia suggests the risks associated with the use of succinylcholine and possibly with halogenated agents. Additional and useful factors that may limit the occurrence of myotonic crises such as maintenance of normal temperature and plasma potassium concentration, should be undertaken simultaneously. © 2013.


Cracco C.,Center Hospitalier dAngouleme
Cahiers de l'Annee Gerontologique | Year: 2011

Community-acquired pneumonia is frequent in the elderly. Because of its subtle clinical presentation, and atypical symptoms, chest radiography is recommended as part of the routine evaluations to establish the diagnosis for all patients. Tachypnea must be systematically researched. Prognostic scoring systems help to decide if hospitalization is necessary or not, but do not take the social context into account. Streptococcus pneumoniae is still the main pathogen identified in the elderly; however the initial empirical antibiotherapy must be active against Gram-negative bacilli and Staphylococcus species. © Springer-Verlag France 2011.


Eguienta S.,Bordeaux University Hospital Center | Martigne L.,Center hospitalier dAngouleme | Dulucq S.,Bordeaux University Hospital Center | Fayon M.,Bordeaux University Hospital Center
Archives de Pediatrie | Year: 2015

The measurement of oxygen saturation by pulse oximetry (SpO2) is simple and fast. This non-invasive and widespread technique gives an indication of the oxygen level in arterial blood. While the method is reliable, there are limitations that can compromise the diagnostic procedure. The objective of the present paper is to list these limitations and discuss the precautions to be taken to optimize the interpretation of the results. Based on the case of a 3-year-old patient who presented with chronic hemoglobin oxygen desaturation, we discuss a decision-making algorithm in order to avoid unnecessary, expensive, and stressful investigations. © 2015 Elsevier Masson SAS.


Biancheri-Mounicq I.,Center Hospitalier dAngouleme
Clinical nuclear medicine | Year: 2011

A 69-year-old woman with a 20-year history of psychiatric disorders was referred to our Nuclear Medicine Department because of an extrapyramidal syndrome. Because the differential diagnosis between neuroleptic-induced parkinsonism and Parkinson disease was difficult, I-123 FP-CIT brain SPECT was performed. The transverse slices demonstrated an unexpected image of the left striatum which seemed moved backward and toward the midline. A space occupying lesion was suspected and later confirmed by CT. This case highlights the significance of structural neuroimaging and of careful check of the striatum morphology.


Mesnier T.,Center Hospitalier Dangouleme | Mimoz O.,University of Poitiers | Oriot D.,University of Poitiers | Ghazali D.A.,Service des urgences SAMU 86
Annales Francaises de Medecine d'Urgence | Year: 2015

Background: Emergency Medicine (EM) is a new specialty in France. Since 2004, the training is validated after obtaining an additional specialized diploma in EM. No studies have evaluated the training so far in France.Objectives: To assess the EM training program in France from the young physician’s perspective.Materials and methods: Opinion survey. A questionnaire assessing the theoretical and the practical training was sent between July and September 2014 by email to second year EM students in France. Five areas were discussed: profile of respondents, theoretical training, practical training, general training, future and questions about EM.Results: The response rate was 47%. The training was generally considered good by 79% of young physicians. 77% expressed that training had enabled them to improve their skills. The theoretical training was judged good by 69% of respondents but 56% felt the lack of practical training in two years. Training of many skills seemed insufficient and 99% thought it would be necessary to do more simulation trainings. Although satisfied with the training, only 40% would have chosen the EM program if it had existed at the beginning of their residency.Discussion: EM training in France should evolve to enhance it on a plane both theoretical and practical. It appears essential to increase the training and to practice teaching by simulation. This first national evaluation of EM training should be repeated to contribute to the evolution and the growth of our specialty. © 2015, Société française de médecine d'urgence and Springer-Verlag France.


PubMed | Center hospitalier dAngouleme and Bordeaux University Hospital Center
Type: Case Reports | Journal: Archives de pediatrie : organe officiel de la Societe francaise de pediatrie | Year: 2015

The measurement of oxygen saturation by pulse oximetry (SpO2) is simple and fast. This non-invasive and widespread technique gives an indication of the oxygen level in arterial blood. While the method is reliable, there are limitations that can compromise the diagnostic procedure. The objective of the present paper is to list these limitations and discuss the precautions to be taken to optimize the interpretation of the results. Based on the case of a 3-year-old patient who presented with chronic hemoglobin oxygen desaturation, we discuss a decision-making algorithm in order to avoid unnecessary, expensive, and stressful investigations.


PubMed | Center Hospitalier dAngouleme
Type: Case Reports | Journal: Clinical nuclear medicine | Year: 2011

A 69-year-old woman with a 20-year history of psychiatric disorders was referred to our Nuclear Medicine Department because of an extrapyramidal syndrome. Because the differential diagnosis between neuroleptic-induced parkinsonism and Parkinson disease was difficult, I-123 FP-CIT brain SPECT was performed. The transverse slices demonstrated an unexpected image of the left striatum which seemed moved backward and toward the midline. A space occupying lesion was suspected and later confirmed by CT. This case highlights the significance of structural neuroimaging and of careful check of the striatum morphology.

Loading Center hospitalier dAngouleme collaborators
Loading Center hospitalier dAngouleme collaborators