Center Hospitalier dArras

Saint-Nicolas, France

Center Hospitalier dArras

Saint-Nicolas, France
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Mallat J.,Service Route | Mallat J.,Center Hospitalier Darras | Mohammad U.,Center Hospitalier Darras | Lemyze M.,Service Route | And 12 more authors.
Annals of Intensive Care | Year: 2017

Background: To evaluate the effects of acute hyperventilation on the central venous-to-arterial carbon dioxide tension difference (∆PCO2) in hemodynamically stable septic shock patients. Methods: Eighteen mechanically ventilated septic shock patients were prospectively included in the study. We measured cardiac index (CI), ∆PCO2, oxygen consumption (VO2), central venous oxygen saturation (ScvO2), and blood gas parameters, before and 30 min after an increase in alveolar ventilation (increased respiratory rate by 10 breaths/min). Results: Arterial pH increased significantly (from 7.35 ± 0.07 to 7.42 ± 0.09, p < 0.001) and arterial carbon dioxide tension decreased significantly (from 44.5 [41–48] to 34 [30–38] mmHg, p < 0.001) when respiratory rate was increased. A statistically significant increase in VO2 (from 93 [76–105] to 112 [95–134] mL/min/m2, p = 0.002) was observed in parallel with the increase in alveolar ventilation. While CI remained unchanged, acute hyperventilation led to a significant increase in ∆PCO2 (from 4.7 ± 1.0 to 7.0 ± 2.6 mmHg, p < 0.001) and a significant decrease in ScvO2 (from 73 ± 6 to 67 ± 8%, p < 0.001). A good correlation was found between changes in arterial pH and changes in VO2 (r = 0.67, p = 0.002). Interestingly, we found a strong association between the increase in VO2 and the increase in ∆PCO2 (r = 0.70, p = 0.001). Conclusions: Acute hyperventilation provoked a significant increase in ∆PCO2, which was the result of a significant increase in VO2 induced by hyperventilation. The clinician should be aware of the effects of acute elevation of alveolar ventilation on ∆PCO2. © 2017, The Author(s).

Plaisancie J.,Toulouse University Hospital Center | Bailleul-Forestier I.,University Paul Sabatier | Gaston V.,Toulouse University Hospital Center | Vaysse F.,University Paul Sabatier | And 21 more authors.
American Journal of Medical Genetics, Part A | Year: 2013

Ectodermal dysplasias (ED) are a clinically and genetically heterogeneous group of hereditary disorders that have in common abnormal development of ectodermal derivatives. Hypohidrotic ectodermal dysplasia (HED) is characterized by abnormal development of eccrine sweat glands, hair, and teeth. The X-linked form of the disease, caused by mutations in the EDA gene, represents the majority of patients with the hypohidrotic form. Autosomal dominant and autosomal recessive forms are occasionally seen, and result from mutations in at least three genes (WNT10A, EDAR, or more rarely EDARADD). We have screened for mutations in EDAR (commonly involved in the hypohidrotic form) and WNT10A (involved in a wide spectrum of ED and in isolated hypodontia) in a cohort of 36 patients referred for EDA molecular screening, which failed to identify any mutation. We identified eight EDAR mutations in five patients (two with homozygous mutations, one with compound heterozygous mutations, and two with heterozygous mutation), four of which were novel variants. We identified 28 WNT10A mutations in 16 patients (5 with homozygous mutations, 7 with compound heterozygous mutations, and 4 with heterozygous mutations), seven of which were novel variants. Our study allows a more precise definition of the phenotypic spectrum associated with EDAR and WNT10A mutations and underlines the importance of the implication of WNT10A among patients with ED. © 2013 Wiley Periodicals, Inc.

PubMed | Center hospitalier dArras, Caen University Hospital Center, Center hospitalier Yves le Foll, Center Hospitalier Of Hyeres and 2 more.
Type: | Journal: Nephrologie & therapeutique | Year: 2016

Since 2011, a new device is available for low flux dialysate quotidian home hemodialysis in France and Belgium. This study aims to evaluate the characteristics and dialysis prescriptions for Nx Stage System One users. We retrospectively included patients trained between 2011 and 2013 in France and Belgium. We collected data concerning their clinical features, their dialysis prescriptions, their laboratory parameters until 6months of dialysis and, reason for dropping in case of cessation. Sixty-two patients from 31centers, aged 4818years old, with a sex ratio 46/16 (M/F) are included with a median Charlson comorbidity index of 1 [0-3]. Of these patients, 71% are anuric and have been on dialysis for a mean time of 136.6125months. Previously, most of them had been taken care of in satellite units of dialysis (45%) and 14% are incident patients. In total, A total of 60% have an arterio-veinous fistula (AVF), with 18patients using the Buttonhole system and 2patients have a tunneled catheter. Median time for training was 26.5days (17-45). Among the patients, 69% are dialyzed 6days a week, during a mean time of 142.520minutes with a volume of 20.93liters of dialysate and without anticoagulant (63%). Predialytic levels of hemoglobin, creatinin, urea, phosphorus and 2microglobulin remain stable. On the contrary, there is a significant improvement of albumin and bicarbonate levels. Technique survival was 75% at 1year, and major reason for cessation was kidney transplant. It seems that this device fits for young patients, with few comorbidities and a long past in renal chronic failure. These results suggest that dialysis adequacy is acceptable despite low dialysate volumes but need confirmation with a longer follow up and a larger cohort.

Hum P.,2nter psychiatrique daccueil et dadmission | Boury D.,Institute Catholique Of Lille | Danel T.,F2RSM federation de recherche regionale en sante mentale du Nord Pas de Calais | Demailly L.,Lille University of Science and Technology | And 9 more authors.
Ethique et Sante | Year: 2015

The act of giving consent plays a primordial role in the delivery of care as perceived from a clinical, legal or ethical standpoint. Recourse to psychiatric care measures the effects even though psychiatry is not the only discipline concerned. Nevertheless, can it be said that the concept of consent truly achieves its supposed ambitions? The notion of refusing care sheds light on these varying problems. Indeed, refusing care is not simply an obstacle to receiving care: what value can be granted to giving consent if it is not possible to negotiate the issue, or if refusing care is not a viable option? This perspective enables giving the precise immanent characteristics for consent. It also highlights certain misrepresentations concerning consent, together with types of almost formal constraint that are seen in cases of false consent, consent given by force, and disagreements that are not expressed directly or misinterpreted. It is through a critical perspective that the weaknesses and limits to the notion of consent will be considered. It is also the reason why we resort to this at the very moment when refusal of care occurs. Maybe this moment should not be considered as negative, and it does help in formulating a limited and pertinent use of the consent. Consenting to care involves a negotiation period that relies on a basis of relational dynamics, with a view to obtaining acceptance for care. © 2014 Elsevier Masson SAS.

The concept of psychological pain has been developped during the xixth century in mental medicine. It became a major symptom for several mental diseases, especially melancholia. Psychological pain was both a descriptive and a comprehensive notion. This clinical concept seems to be forgotten in the modern classifications but recent works of epidemiology and brain imaging focus their interest on this topic. Beyond the modernity of the clinical concept of psychological pain, we propose a reflexion, in an epistemological point of view, about the ratio between semiological researches during the xixth century (mostly considered according to the Jean-Pierre Falret's principles) and the modern neurosciences. It appears that these two approaches try to prove the validity of the clinical concepts. Therefore, semiological research and neuroscience are fundamentally different to the modern classifications that tend to describe the mental disorders in searching of statistical consensus (fiability). © 2016 Published by Elsevier Masson SAS.

Danjou M.,Center hospitalier dArras | Guardia D.,Clinique Lautreamont | Geoffroy P.-A.,French Institute of Health and Medical Research | Geoffroy P.-A.,Paris West University Nanterre La Défense | And 5 more authors.
Encephale | Year: 2016

Introduction: The Mitochondrial Neurogastrointestinal Encephalopathy (MNGIE) disease is an extremely underrated syndrome beginning around the age of eighteen years. Because of its severity, this diagnosis should be considered when a patient presents an atypical anorexia nervosa. MNGIE disease is inherited in an autosomal recessive manner and related to mutations of the TYMP gene (ch22q13.32-qter), encoding the thymidine phosphorylase. The MNGIE is often misdiagnosed and is associated with a time to diagnostic of about 12 years after first symptoms. Thus this critical review aims to help clinicians better identify symptoms and paraclinical markers of the MNGIE as a differential diagnosis of atypical anorexia nervosa. Methods: A literature search was performed using PubMed and Google Scholar databases. Results: The clinical diagnosis of the MNGIE disease should be based on the association of severe loss of weight and some additional symptoms: (1) severe gastrointestinal dysmotility (nausea, vomiting, intestinal pseudo-obstruction), (2) ptosis or external ophtalmoplegia and (3) peripheral sensorimotor neuropathy. When MNGIE disease is clinically suspected, paraclinical testing can help to validate the MNGIE diagnostic: (1) Arterial blood test reveals lactic acidemia (e.g. an increased serum concentration of lactate without pH modifications), and (2) Brain MRI indicates leukoencephalopathy, usually asymptomatic. Direct evidence of MNGIE disease is based on specific testing of: (1) the thymidine phopshorylase enzyme activity in leukocytes is less than 10% of the control, (2) the increase of plasmatic thymidine (> 3. μmol/L) and the increase of plamatic deoxyuridine (> 5. μmol/L), (3) the evidence of mutations of the TYMP gene by molecular genetic testing. Conclusion: The MNGIE disease is a severe trouble with multisystemic complications. The thymidine phopshorylase enzyme activity in leukocytes should be measured as soon as possible when a patient presents atypical anorexia nervosa. © 2016 L'Encéphale, Paris.

Pennaforte T.,Pole de medecine neonatale | Pennaforte T.,Lille University of Science and Technology | Klosowski S.,Center hospitalier Docteur Schaffner Lens | Klosowski S.,Lille University of Science and Technology | And 6 more authors.
Archives de Pediatrie | Year: 2010

Objective: To evaluate prospectively the benefit of posterior liver mobilization during umbilical venous catheterization to place the umbilical venous catheter (UVC) in the central position (inferior vena cava). Patients and methods: Sixty-five successive newborn infants admitted in 3 neonatal intensive care units who required a UVC were enrolled over a 4-month period. UVC positions were assessed by X-ray. UVCs were placed either in an adequate position (at the right atrial-inferior vena cava junction, indicating success) or inserted within the portal system (failure). In this case, the UVC was drawn back to the 3. cm mark and then, an additional attempt to insert the UVC was made during lateroposterior liver mobilization by the operator's hand. The success and failure rates at 1st and 2nd attempts were evaluated and compared. Characteristics of the population and possible catheter-related complications were recorded. Results: A total of 31 of 65 (55%) UVC insertions failed at the 1st attempt. Among these UVCs, 16 (52%) were correctly repositioned in the central position by hepatic mobilization. The success rate increased by 50% (p<0.05). No life-threatening complications were observed during the procedure. Conclusion: Hand liver mobilization during umbilical venous catheterization improves the rate of adequate insertion of the UVC into the inferior vena cava. It is a simple, quick, and safe procedure. © 2010 Elsevier Masson SAS.

Andrieux S.,Center hospitalier dArras | Gaudrat B.,Center hospitalier dArras | Mariau F.,Center hospitalier dArras | Mulliez E.,Center hospitalier dArras
Obesite | Year: 2014

The obese patient's evaluation is a key time during which the challenge is to establish a strong therapeutic alliance. Weight is only a symptom and so, the evaluation time should be allowed, among other things, to understand the reasons of weight gain and the mechanisms that maintain the excess weight. Frequently, the excess weight seems not to be related to food intake. This phenomenon, described first 30 years ago as under-reporting, is strongly linked to dietary restraint. Nevertheless, causes of under-reporting seem to be more complex than it appears. Standards, norms, dietary prescriptions turn obese patient's purpose towards it would be good to report. Guilty also distorts the evaluation putting the patient in an uncomfortable situation. But, according to us, the main reason of under-reporting would be due to a misunderstanding of eating disorders causing weight gain. It's time to question the reasons that lead obese patients not to report all their food intake. © 2013 Springer-Verlag France.

Desbeaux A.,Center Hospitalier dArras
Journal of visceral surgery | Year: 2010

Gallstones are commonly observed after rapid weight loss, particularly after bariatric surgery. Preventive measures of gallstone formation and potential related complications are still debated. This study aimed to propose a standardized strategy according to the results of the literature. Thus, preventive measures should be determined according to patient status (evaluated clinically and by routine ultrasound) and the type of bariatric surgery. Cholecystectomy should be performed in patients with symptomatic gallstones irrespective of the planned operation, or for asymptomatic gallstones during a gastric by-pass. In other settings, ursodesoxycholic acid should be given postoperatively for 6 months. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

PubMed | Center hospitalier dArras
Type: Journal Article | Journal: Journal de gynecologie, obstetrique et biologie de la reproduction | Year: 2012

Among risk factors of prematurity, bacterial vaginosis (BV) could play an important role, but few studies took place in our country.In a French population of women booking in a hospital maternity, to search a link between prematurity and BV in the first trimester of pregnancy.A hospital cohort study was carried out between May 2006 and September 1(st), 2009. Pregnant women were screening for BV before 13+6 weeks gestation. BV was determined by a Gram-Stained Vaginal score greater or equal to 7.One thousand three hundred and thirty-six patients were included in the study among whom 203 patients had BV and 1133 patients did not have. The presence of BV was significantly associated with preterm delivery (OR: 1.6; 95% IC: 1.1-2.7). But this increase concerned only the spontaneous prematurity (ORa: 1.8, 95% IC: 1.0-3.2) and the statistical association disappeared after taking into account maternal tobacco addiction and socio-economic weak level (ORa: 1.6; 95% IC: 0.9-2.9). At the patient with BV, moreover, the risk of miscarriage before 16SA was significantly augmented at the patient with BV (OR: 3.4; 95% IC: 1.1-10.4), but this risk disappeared after taking into account tobacco addiction and maternal level of studies (ORa: 1.9; 95% IC: 0.5-7.2).The presence of BV in the first trimester of pregnancy seems to be associated with increased risks of preterm delivery and early spontaneous miscarriage. However, this relation seems to be partly linked to a level of weaker study and a more frequent tobacco addiction among the women with BV.

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