Sainte-Foy-lès-Lyon, France
Sainte-Foy-lès-Lyon, France

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Beliard S.,Center Hospitalier Louis Pasteur | Beliard S.,University of Franche Comte | Chauveau M.,Laboratoires Innothera | Moscatiello T.,Laboratoires Innothera | And 3 more authors.
Journal of Sports Science and Medicine | Year: 2014

Compression garments on the lower limbs are increasingly popular among athletes who wish to improve performance, reduce exercise-induced discomfort, and reduce the risk of injury. However, the beneficial effects of compression garments have not been clearly established. We performed a review of the literature for prospective, randomized, controlled studies, using quantified lower limb compression in order to (1) describe the beneficial effects that have been identified with compression garments, and in which conditions; and (2) investigate whether there is a relation between the pressure applied and the reported effects. The pressure delivered were measured either in laboratory conditions on garments identical to those used in the studies, or derived from publication data. Twenty three original articles were selected for inclusion in this review. The effects of wearing compression garments during exercise are controversial, as most studies failed to demonstrate a beneficial effect on immediate or performance recovery, or on delayed onset of muscle soreness. There was a trend towards a beneficial effect of compression garments worn during recovery, with performance recovery found to be improved in the five studies in which this was investigated, and delayed-onset muscle soreness was reportedly reduced in three of these five studies. There is no apparent relation between the effects of compression garments worn during or after exercise and the pressures applied, since beneficial effects were obtained with both low and high pressures. Wearing compression garments during recovery from exercise seems to be beneficial for performance recovery and delayed-onset muscle soreness, but the factors explaining this efficacy remain to be elucidated. © 2014, Journal of Sports Science and Medicine.


PubMed | CHU Pitie Salpetriere, CHU Hopital Raymond Poincare, Center Hospitalier Louis Pasteur, CHU Dijon Bourgogne and 7 more.
Type: | Journal: Trials | Year: 2016

It is now well documented that critically ill patients are exposed to stressful conditions and experience discomforts from multiple sources. Improved identification of the discomforts of patients in intensive care units (ICUs) may have implications for managing their care, including consideration of ethical issues, and may assist clinicians in choosing the most appropriate interventions. The primary objective of this study was to assess the effectiveness of a multicomponent program of discomfort reduction in critically ill patients. The secondary objectives were to assess the sustainability of the impact of the program and the potential seasonality effect.We conducted a multicenter, cluster-randomized, controlled, single (patient)-blind study involving 34 French adult ICUs. The experimental intervention was a 6-month period during which the multicomponent program was implemented in the ICU and included the following steps: identification of discomforts, immediate feedback to the healthcare team, and implementation of targeted interventions. The control intervention was a 6-month period during which any program was implemented. The primary endpoint was the monthly overall score of self-reported discomfort from the French questionnaire on discomforts in ICU patients (IPREA). The secondary endpoints were the scores of the discomfort items of IPREA. The sample size was 660 individuals to obtain 80% power to detect a 25% difference in the overall discomfort score of IPREA between the two groups (design effect: 2.9).The results of this cluster-randomized controlled study are expected to confirm that a multicomponent program of discomfort reduction may be a new strategy in the management of care for critically ill patients.ClinicalTrials.gov NCT02442934, registered 11 May 2015.


PubMed | Service de Reanimation Medicale, Center Hospitalier, University of Angers, Center Hospitalier Sud Francilien and 13 more.
Type: Clinical Trial | Journal: Intensive care medicine | Year: 2016

Over the last two decades, noninvasive ventilation (NIV) has been proposed in various causes of acute respiratory failure (ARF) but some indications are debated. Current trends in NIV use are unknown.Comparison of three multicenter prospective audits including all patients receiving mechanical ventilation and conducted in 1997, 2002, and 2011 in francophone countries.Among the 4132 patients enrolled, 2094 (51%) required ventilatory support for ARF and 2038 (49 %) for non-respiratory conditions. Overall NIV use was markedly increased in 2010/11 compared to 1997 and 2002 (37% of mechanically ventilated patients vs. 16% and 28%, P < 0.05). In 2010/11, the use of first-line NIV for ARF had reached a plateau (24% vs. 16% and 23%, P < 0.05) whereas pre-ICU and post-extubation NIV had substantially increased (11% vs. 4% and 11% vs. 7%, respectively, P < 0.05). First-line NIV remained stable in acute-on-chronic RF, continued to increase in cardiogenic pulmonary edema, but decreased in de novo ARF (16% in 2010/11 vs. 23% in 2002, P < 0.05). The NIV success rate increased from 56% in 2002 to 70% in 2010/11 and remained the lowest in de novo ARF. NIV failure in de novo ARF was associated with increased mortality in 2002 but not in 2010/11. Mortality decreased over time, and overall, NIV use was associated with a lower mortality.Increases in NIV use and success rate, an overall decrease in mortality, and a decrease of the adverse impact NIV failure has in de novo ARF suggest better patient selection and greater proficiency of staff in administering NIV.Clinicaltrials.gov Identifier NCT01449331.


Mahe A.,Center hospitalier Louis Pasteur
Medecine/Sciences | Year: 2015

In this review we present a synthesis of the current knowledge of leprosy based on the epidemiological studies and the latest data obtained in basic research and the strategies undertaken to fight out this pathology. The significant progress in the genomic study of the leprosy bacillus, and in understanding the basic mechanisms governing the individual susceptibility to the disease, together with the stagnation in the incidence of the new cases observed for ten years, represent focus of interest. If the efficiency of the recommended treatments is actually confirmed by a low relapse rate, however the drying up of new cases, which could be expected by reducing the infectiousness of the treated cases, is nonetheless slow in coming. Recent studies support the effectiveness of prophylaxis based on a single dose of rifampicin and/or a BCG vaccination of patient contacts. This could allow an increased reduction of the incidence of the disease. However, no official position validates such strategies. Because of an ambiguity in the expression of the objectives for managing the disease, i.e. « elimination of a disease considered as a public health problem », which should not to be confused with « eradication of the disease », which, in fact, has no relevance today, demobilization in fighting against leprosy is to be feared. © 2015 médecine/sciences - Inserm.


Lungu G.,Center hospitalier Louis Pasteur | Mortada J.,Center hospitalier Louis Pasteur | Stilhart B.,Center hospitalier Louis Pasteur
Neurochirurgie | Year: 2010

Background and purpose: Surgical management of cerebellar infarction remains controversial. What surgical procedure should be performed when a patient presents neurological deterioration? When is the right moment to operate? Different treatments were proposed including decompressive suboccipital craniotomy, external ventricular drainage, or endoscopic third ventriculostomy. Methods: We retrospectively reviewed five cases of cerebellar infarction treated with suboccipital craniotomy, excision of necrotic tissue, and duraplasty within a period of six months. Results: The five patients were evaluated with regard to presenting symptoms, Glasgow Coma Scale (GCS) before surgery, timing of surgery, computed tomographic scans and magnetic resonance imaging (MRI), neurological improvement, and outcome within a follow-up period of one year. Four patients made a good recovery, one patient died three days after surgery without neurological improvement. Conclusion: These results suggest that decompressive suboccipital craniotomy may be an effective solution for good recovery if the patient is operated early, at the moment of the neurological deterioration. © 2009 Elsevier Masson SAS.


Schwartz C.,Center Hospitalier Louis Pasteur | Vautrin M.,Center Hospitalier Louis Pasteur
European Journal of Orthopaedic Surgery and Traumatology | Year: 2014

Management of bone loss in revision total hip replacement remains a challenge. To eliminate any immunological or infectious problem and so to try to improve the long-term results obtained with allografts, the authors used synthetic ceramics as bone substitutes since 1995. We reviewed 13 of the patients of our study, we previously reported in 2005 (Schwartz and Bordei in Eur J Orthop Surg Traumatol 15: 191 2005), which was a prospective cohort of thirty-two cases of acetabular revision reconstruction, with a mean follow-up of 14.4 years yet (from 9 to 16 years). Clinical results were assessed according to Oxford scale and Postel and Merle d’Aubigne (PMA) scale. Since 2005, no specific complications were noted. The average PMA functional hip score was 14.9 (vs. 9.2 before revision) at follow-up over 9 years. Nine patients still alive in 2013 were seen again by a surgeon, which was not the operator, with a mean follow-up of 15.3 years: Their Oxford average score was 40.3. Radiological assessment affirmed a good integration of the substitutes in bone without any edging in all cases. A progressive invasion of the ceramics by bone can be seen on the X-ray. We conclude that about 15 years of average delay, which is a significant follow-up in orthopedic surgery, the outcomes without specific complications are satisfactory and allow one to go with these materials in total hip revision surgery. © 2014, Springer-Verlag France.


Monville H.,Center hospitalier Louis Pasteur | Wagner L.,Center hospitalier Louis Pasteur | Dibo D.,Center hospitalier Louis Pasteur | Soustelle L.,Center hospitalier Louis Pasteur | And 3 more authors.
Progres en Urologie | Year: 2014

Objectives: The main objective was to investigate the long-term clinical and radiological effectiveness/safety of ethanol sclerotherapy for treating simple kidney cysts. The secondary objective was to evaluate the effectiveness of a second alcohol treatment after 24. hours of drainage for large cysts. Patients: A retrospective study was carried out from January 2005 to March 2012 on 24 patients with simple kidney cysts treated by percutaneous ethanol sclerotherapy during ambulatory surgery. Therapeutic success was defined as symptom resolution and regression of cyst size by>60%. Incomplete regression was defined as a decrease between 50 and 60% and a recurrence as a residual size>50%. Drainage was left in place for 24hours for patients with a cyst>900cm3 and a second alcohol treatment was performed the next day. All patients were invited for ultrasound follow up as part of the study. Results: Treatment success was observed in 91.6% of patients. Two patients had incomplete regression. No recurrence was observed. No intraoperative or postoperative complications were found. Conclusion: Sclerotherapy for simple kidney cysts is a safe and effective procedure that can be performed under local anesthesia and an outpatient setting in most cases. Systematic drainage for 24. hours followed by a second alcohol treatment may reduce the risk of recurrence for large cysts. © 2013 Elsevier Masson SAS.


PubMed | Center hospitalier Louis Pasteur
Type: Journal Article | Journal: Neuro-Chirurgie | Year: 2010

Surgical management of cerebellar infarction remains controversial. What surgical procedure should be performed when a patient presents neurological deterioration? When is the right moment to operate? Different treatments were proposed including decompressive suboccipital craniotomy, external ventricular drainage, or endoscopic third ventriculostomy.We retrospectively reviewed five cases of cerebellar infarction treated with suboccipital craniotomy, excision of necrotic tissue, and duraplasty within a period of six months.The five patients were evaluated with regard to presenting symptoms, Glasgow Coma Scale (GCS) before surgery, timing of surgery, computed tomographic scans and magnetic resonance imaging (MRI), neurological improvement, and outcome within a follow-up period of one year. Four patients made a good recovery, one patient died three days after surgery without neurological improvement.These results suggest that decompressive suboccipital craniotomy may be an effective solution for good recovery if the patient is operated early, at the moment of the neurological deterioration.


PubMed | Center Hospitalier Louis Pasteur and Center Hospitalier Louis Jaillon
Type: | Journal: Case reports in nephrology | Year: 2015

We report a unique observation characterized by the coexistence of idiopathic adulthood ductopenia (IAD), a rare cholestatic disease, and end stage renal failure treated by conventional hemodialysis in a patient awaiting double renal and liver transplantation. As pruritus gradually worsened, we hypothesized that intensified dialysis could alleviate the symptoms. Conventional hemodialysis following 3 hours/3 times a week regimen was initiated in December 2013. Due to increasing pruritus not responding to standard medical therapy, intensified hemodialysis following 2.5 hours/5 times a week regimen was started in May 2014. During two weeks, a temporary decrease in bilirubin levels was observed. No major changes on other liver function tests and inflammatory markers occurred. Nevertheless, a persistent improvement on pruritus and general wellbeing was obtained during the four weeks study period. The pathogenesis of itch encompasses multiple factors, and, in our case, both uremic and cholestatic pruritus are involved, although the latter is likely to account for a greater proportion. By improving itch intensity, through better clearance of uremic and cholestatic toxins which we detail further, intensive dialysis appears to be an acceptable short-term method for patients with hepatic cholestasis and moderate pruritus not responding to conventional therapy. Additional studies are needed to assess and differentiate precisely factors contributing to pruritus of both origins.


PubMed | Center hospitalier Louis Pasteur
Type: Journal Article | Journal: Medecine sciences : M/S | Year: 2015

In this review we present a synthesis of the current knowledge of leprosy based on the epidemiological studies and the latest data obtained in basic research and the strategies undertaken to fight out this pathology. The significant progress in the genomic study of the leprosy bacillus, and in understanding the basic mechanisms governing the individual susceptibility to the disease, together with the stagnation in the incidence of the new cases observed for ten years, represent focus of interest. If the efficiency of the recommended treatments is actually confirmed by a low relapse rate, however the drying up of new cases, which could be expected by reducing the infectiousness of the treated cases, is nonetheless slow in coming. Recent studies support the effectiveness of prophylaxis based on a single dose of rifampicin and/or a BCG vaccination of patient contacts. This could allow an increased reduction of the incidence of the disease. However, no official position validates such strategies. Because of an ambiguity in the expression of the objectives for managing the disease, i.e. elimination of a disease considered as a public health problem , which should not to be confused with eradication of the disease , which, in fact, has no relevance today, demobilization in fighting against leprosy is to be feared.

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