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Maurel B.,Nantes University Hospital Center | Hertault A.,Lille University Hospital Center | du Mont L.S.,University of Franche Comte | Cazaban S.,Center Hospitalier Of Beziers | Rinckenbach S.,University of Franche Comte
Annals of Vascular Surgery | Year: 2017

Background: The aim of this study is to evaluate radiation exposure, endovascular theatre equipment, and practices in France during iliac angioplasty. Methods: A prospective observational study was performed among vascular surgeons who attended a half day of radiation safety training in 2012 and 2015 and had to collect data on 3 patients undergoing iliac procedure. In 2012, 330 surgeons performed 899 procedures, compared with 114 surgeons and 338 procedures in 2015. Due to exclusions, 653 and 306 procedures were analyzed in 2012 and 2015, respectively. Endovascular environment, practices, anatomical characteristics, and radiation parameters were collected, analyzed, and compared generally and between the 2 groups. Results: Endovascular theatre equipment significantly improved over the 3 years: mobile flat-panel detector (1.1% vs. 5.9%), hybrid rooms (1.5% vs. 14.7%), and dedicated radiology tables (37.2% vs. 51.2%). Lesion's classification (Trans-Atlantic Society Consensus) was similar between groups but procedure complexity increased overtime: more than one stent implanted (32.3% vs. 41%, P < 0.01), cross over (11.5% vs. 16%, P < 0.05), and kissing procedures (19.3% vs. 24.2%, P = 0.05). The mean dose area product (DAP) was 14.2 ± 18.9 Gy cm2 in 2012 and 21.5 ± 37.6 Gy cm2 in 2015 (P < 0.01), and the mean fluoroscopy time was 4.8 ± 5.5 min and 5.2 ± 5.9 min, respectively (nonsignificant). Overall, hybrid rooms, body mass index over 25 kg/m2, more than one stent implanted, and crossover technique were associated with a significantly higher DAP. Conclusions: Over 3 years, a large population of vascular surgeons improved radiation safety knowledge, operative environment, and technical complexity. However, these changes have led to an increased DAP in 2015, which underline the outmost importance of low dose settings and application of ALARA (as low as reasonably achievable) principles in every day practice. © 2017 Elsevier Inc.


Corlobe A.,Montpellier University Hospital Center | Charif M.,Montpellier University Hospital Center | Mania A.,Center Hospitalier Of Beziers | Outteryck O.,University of Lille Nord de France | And 2 more authors.
Revue Neurologique | Year: 2014

Background Current treatment options for first-line immunotherapy in relapsing-remitting multiple sclerosis (MS) are recombinant interferon-β and glatiramer acetate. However, these therapies are only partially effective and certain patients may fail to respond. For this reason, it is important to elaborate alternative treatment strategies. Induction therapy represents a more aggressive approach in which powerful drugs are used right from the beginning to tackle the disease process hard and early. Natalizumab is a powerful monoclonal antibody approved for the treatment of relapsing-remitting MS and is known to silence disease activity. Methods We describe here the early outcome at 1 month and at 6 months of three patients treated with natalizumab for relapsing-remitting MS. Results All three patients had a high disease activity before the initiation of natalizumab, with 4, 8 and 5 gadolinium-enhancing lesions on brain MRI respectively. On the MRI scans made at 1 month after the first infusion, and at 6 months, there was no more gadolinium-enhancement and no new T2-lesion. Clinically, they did not experience any relapse. Discussion In these three cases, natalizumab showed a dramatic efficacy: the patients became "disease activity free" right from the first infusion. To our knowledge, natalizumab is not classically used as an induction therapy, unlike mitoxantrone. However, this treatment has potential hematological and cardiac toxicity and its use can be limited. Thus, in JC virus negative patients, natalizumab could be an interesting alternative treatment. Conclusion Our report suggests that induction strategy with natalizumab may be applicable in patients with aggressive multiple sclerosis. A study of more similar cases may be interesting to confirm these preliminary results. © 2013 Elsevier Masson SAS. Tous droits reserve s.


PubMed | Center Hospitalier University Of Reims, Center Hospitalier Of Metz Thionville, University of Poitiers, University of Caen Lower Normandy and 21 more.
Type: Journal Article | Journal: Autoimmunity reviews | Year: 2016

Kawasaki disease (KD) is a vasculitis that mostly occurs in young children and rarely in adults. We analyzed the characteristics of adult-onset KD (AKD) in France.We collected retrospective and prospective data for patients with a diagnosis of KD occurring after the age of 18 years. Cases were obtained via various French medical networks and identified from the international literature.We included 43 patients of AKD at 26 institution from 1992 to 2015, with mean (SD) age 30 (11) years (range 18-68) and sex ratio (M/F) 1.2; 34 patients met the American Heart Association criteria and 9 were incomplete AKD. The median time to diagnosis was 13 days (interquartile range 8-21). The main symptoms were fever (100%), exanthema (98%), changes in the extremities (91%), conjunctivitis (77%), oral cavity changes (89%), cervical adenitis (55%) and cardiac abnormalities (45%). Overall, 35% of patients showed large-vessel vasculitis: coronary vasculitis (26%) and coronary aneurysm (19%). Treatment was mostly intravenous immunoglobulins (79%) and aspirin (81%). Four patients showed myocardial infarction due to coronary vasculitis, but none were treated with IVIg because of late diagnosis. After a median follow-up of 5 months (range 1-117), persistent aneurysm was noted in 9% of cases. Damage was significantly lower with early treatment than late or no treatment (p=0.01).Given the high frequency of cardiac involvement and complications in this series of AKD, diagnosis and treatment should not be delayed, and early IVIg treatment seems to improve the outcome.


PubMed | University of Lille Nord de France, Center Hospitalier Of Beziers, Montpellier University Hospital Center and Service de neurologie
Type: Case Reports | Journal: Revue neurologique | Year: 2014

Current treatment options for first-line immunotherapy in relapsing-remitting multiple sclerosis (MS) are recombinant interferon- and glatiramer acetate. However, these therapies are only partially effective and certain patients may fail to respond. For this reason, it is important to elaborate alternative treatment strategies. Induction therapy represents a more aggressive approach in which powerful drugs are used right from the beginning to tackle the disease process hard and early. Natalizumab is a powerful monoclonal antibody approved for the treatment of relapsing-remitting MS and is known to silence disease activity.We describe here the early outcome at 1 month and at 6 months of three patients treated with natalizumab for relapsing-remitting MS.All three patients had a high disease activity before the initiation of natalizumab, with 4, 8 and 5 gadolinium-enhancing lesions on brain MRI respectively. On the MRI scans made at 1 month after the first infusion, and at 6 months, there was no more gadolinium-enhancement and no new T2-lesion. Clinically, they did not experience any relapse.In these three cases, natalizumab showed a dramatic efficacy: the patients became disease activity free right from the first infusion. To our knowledge, natalizumab is not classically used as an induction therapy, unlike mitoxantrone. However, this treatment has potential hematological and cardiac toxicity and its use can be limited. Thus, in JC virus negative patients, natalizumab could be an interesting alternative treatment.Our report suggests that induction strategy with natalizumab may be applicable in patients with aggressive multiple sclerosis. A study of more similar cases may be interesting to confirm these preliminary results.


Obiols J.,Center Hospitalier Of Beziers | Bardo P.,Pharmacie | Garnier J.-P.,Service de Biochimie | Brouard B.,Pharmacie
Annales de Biologie Clinique | Year: 2013

Ninety four per cent of health professionals use their smartphone for business purposes and more than 50% has medical applications. The «Blood Gas» application was created to be part of this dynamic and participate to e-health development in France. The «Blood Gas» application facilitates interpretation of the results of blood gas analysis using an algorithm developed with reference to a medical bibliography. It can detect some complex or intricate acid-base disorders in evaluating the effectiveness of the secondary response. The application also studied the respiratory status of the patient by calculating the PaO2/FiO2 ratio and the alveol-arterial gradient. It also indicates the presence of a shunt effect. Finally, a specific module to calculate the SID (strong ion difference) depending on the model of Stewart can detect complex acid-base disorders.


PubMed | Montpellier University, Center Leon Berard, University of Rouen, Nestlé and 4 more.
Type: Clinical Trial, Phase III | Journal: Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver | Year: 2016

Patients with gastrointestinal (GI) cancer are exposed to cachexia, which is highly correlated with chemotherapy-induced side effects. Research suggests that specific immunonutrients could prevent such toxicities.The primary objective of this phase III study was to evaluate the efficacy of glutamine and transforming growth factor-2 (TGF-2) in the prevention of grade 3-4 non-hematological toxicities induced by chemotherapy in patients with GI cancer.We designed a double-blind, randomized, controlled and multicenter trial stratified according to center, type of chemotherapy, presence of cachexia, and age. Patients were randomized to receive either Clinutren Protect() (CP) or a control isocaloric diet (without TGF-2 or glutamine).Between November 2007 and October 2011, 210 patients were enrolled in the study, of which 201 were included in the intention-to-treat analysis. Grade 3-4 non-hematological toxicities were not significantly different between the CP and control groups when evaluated by univariate and multivariate analyses. Likewise, no difference was observed regarding grade 3-4 hematological toxicities or reasons for treatment interruption.This randomized study does not support the hypothesis that oral glutamine and TGF-2 supplementation is effective to reduce grade 3 or 4 non-hematological toxicities induced by chemotherapy in patients with GI neoplasm.


Haegeman N.,Center Hospitalier Of Beziers | Beziat O.,Center Hospitalier Of Beziers | Cavero L.,Center Hospitalier Of Beziers | Biau A.,Center Hospitalier Of Beziers
Soins Psychiatrie | Year: 2016

Care in prison must be based as much as possible on the model used for the general population. The system of psychiatric care in prisons comprises three levels of provision. The presentation of the pathway of a young patient with severe mental disordersshows the possibilities and the diffi culties involved in caring within a healthcare unit. © 2016 Published by Elsevier Masson SAS.


PubMed | Center Hospitalier Of Beziers
Type: Comparative Study | Journal: Annales de cardiologie et d'angeiologie | Year: 2012

To assess the practical implementation of international guidelines and their impact on syncope management in a 500-bed general hospital.Three groups of 63consecutive patients admitted for syncope to the emergency care unit (ECU) were studied: group 1, before the guidelines delivered to the practitioners, group 2immediately after the diffusion of guidelines and group 3, one year later. The study evaluates the mean duration of stay (MDS) and the relevance of the diagnostic strategy.In group 1compared to group 2, MDS were respectively 6.85.5and 5.42.8days (P=0.07) and the unexplained syncope number respectively 22% and 24% (P=0.8). The search of orthostatic hypotension became more systematic (13% versus 86% in group 1and 2respectively, P<0.001). The agreement (kappa coefficient) between initial and final diagnostic increased in 0.34to 0.44. One year later MDS in group 3was 7.14.7days (P=0.8versus group 1and P=0.015versus group 2) with only 6.3% systematic search for orthostatic hypotension (P<0.001).Guidelines optimize the syncope management in the ECU and the agreement between the emergency and discharge diagnostic without change of unexplained syncope and. MDS tend to be shorter when guidelines are actively implemented. Nevertheless, the positive impact of guidelines implementation is of limited duration.


PubMed | Center Hospitalier Of Beziers
Type: Journal Article | Journal: Annales de biologie clinique | Year: 2013

Ninety four per cent of health professionals use their smartphone for business purposes and more than 50% has medical applications. The Blood Gas application was created to be part of this dynamic and participate to e-health development in France. The Blood Gas application facilitates interpretation of the results of blood gas analysis using an algorithm developed with reference to a medical bibliography. It can detect some complex or intricate acid-base disorders in evaluating the effectiveness of the secondary response. The application also studied the respiratory status of the patient by calculating the PaO2/FiO2 ratio and the alveol-arterial gradient. It also indicates the presence of a shunt effect. Finally, a specific module to calculate the SID (strong ion difference) depending on the model of Stewart can detect complex acid-base disorders.


PubMed | Center Hospitalier Of Beziers and Laboratoire Of Biologie Medicale
Type: Journal Article | Journal: Annales de biologie clinique | Year: 2016

There is currently no consensus for the quantification and identification of weak gammaglobulin monoclonal spike. We conducted a study of 12 months including 410 serum protein electrophoresis (SPE) with suspected weak monoclonal spike in gammaglobulin area without anteriority, which led to the realization of an immunofixation (IF); 276 SPE has a weak spike in gammaglobulins (defined with perpendicular drop method (orthogonal (O) quantification <5 g/L) but only 157 (57%) has monoclonal immunoglobulin by immunofixation of serum. The monitoring of 50 true positive monoclonal immunoglobulins showed the stability of the spike at more than half of the patients and its disappearance in 28% of cases. The number of true positives spike raise when using the tangent skimming method quantification (T) rather than the orthogonal method (O). The distribution of true positives based on T/O ratio propose a 6% threshold below which a monoclonal immunoglobulin is rarely found (VPNR>6%=73.7%), and a 10% threshold above more than 80% of true positives are detected (VPPR>10%=94.4%). The use of the T/O ratio could i) help to predict the presence of an IM when low intensity spike is detected, and help to choose between the realization of an immunofixation or a control of SPE later; ii) be a key tool for an inter-laboratory harmonization of IM follow up.

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