Chambéry, France
Chambéry, France

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Goulle J.P.,Groupe Hospitalier du Havre | Saussereau E.,Groupe Hospitalier du Havre | Grosjean J.,Center Hospitalier Of Chambery | Doche C.,Center Hospitalier Of Chambery | And 3 more authors.
Forensic Science International | Year: 2012

Intoxications by chromium (Cr) compounds are very life threatening and often lethal. After oral ingestion of 2 or 3g of hexavalent Cr (Cr VI), gastrointestinal injury, but also hepatic and renal failure, often occurs which each leads to a fatal outcome in most patients. Cellular toxicity is associated with mitochondrial and lysosomal injury by biologically Cr VI reactive intermediates and reactive oxygen species. After Cr VI has been absorbed, there is not much that can be done except to control the main complications as the treatment is only symptomatic. The biotransformation of Cr VI to Cr III reduces the toxicity because the trivalent form does not cross cellular membranes as rapidly. In fact, more than 80% of Cr VI is cleared in urine as Cr III.We report the case of a 58-year-old male patient who was admitted to hospital after accidental oral ingestion of a 30. g/L potassium dichromate (the estimated amount of ingested Cr is about 3. g). ICP-MS equipped with a collision/reaction cell (CRC) and validated methods were used to monitor plasma (P), red blood cells (RBCs), urine (U) and hair chromium. For urine the results were expressed per gram of creatinine.After 7. days in the intensive care unit, the patient was discharged without renal or liver failure. P, RBC and U were monitored during 49. days. During this period Cr decreased respectively from 2088 μg/L to 5 μg/L, 631 μg/L to 129 μg/L and 3512 μg/g to 10 μg/g. The half-life was much shorter in P than in RBC as the poison was more quickly cleared from the P than from the RBC, suggesting a cellular trapping of the metal. Hair was collected 2. months after the intoxication.We report a very rare case of survival after accidental Cr poisoning which has an extremely poor prognosis and usually leads to rapid death. For the first time, this toxicokinetic study highlights a sequestration of chromium in the RBC and probably in all the cells. © 2011 Elsevier Ireland Ltd.


PubMed | Joseph Fourier University, 73300 Saint Jean de Maurienne, 38000 Grenoble, Center Hospitalier Of Chambery and 3 more.
Type: Journal Article | Journal: Revue des maladies respiratoires | Year: 2016

COLIBRI-COPD is a francophone consultation web portal accessible to pulmonologists in the hospital and in the community. We present this observation which describes the phenotype of COPD patients entered (anthropometry, exposures, addictions, functional impairments, questionnaires: MRC, DIRECT, CAT, HAD, Epworth, co-morbidities, incidence of exacerbations, drug treatment or other treatments). The results of the first 1079 patients show a high level of completeness for the main data items. A comparison of patients seen in outpatient consultations shows significant variability between patients with the same GOLD stage, regarding the incidence of exacerbations, signs of anxiety-depression, of diabetes mellitus, or the prescriptions of anticholinergics and inhaled corticosteroids. These initial results suggest that data collection in real life gives a reliable database to obtain longitudinal data on various aspects of COPD. The data quality (completeness, reliability) is partly related to the usability of the web tool and to the possibility of doing self-assessment of practitioners own recorded data.


Peyrade F.,Center Regional Of Lutte Contre Le Cancer Of Nice | Jardin F.,University of Rouen | Thieblemont C.,Hopital Saint Louis | Thyss A.,Center Regional Of Lutte Contre Le Cancer Of Nice | And 17 more authors.
The Lancet Oncology | Year: 2011

Background: Diffuse large B-cell lymphoma is a common cancer in elderly patients. Although treatment has been standardised in younger patients, no prospective study has been done in patients over 80 years old. We aimed to investigate the efficacy and safety of a decreased dose of CHOP (doxorubicin, cyclophosphamide, vincristine, and prednisone) chemotherapy with a conventional dose of rituximab in elderly patients with diffuse large B-cell lymphoma. Methods: We did a prospective, multicentre, single-arm, phase 2 study of patients aged over 80 years who had diffuse large B-cell lymphoma. Patients were included from 38 centres in France and Belgium. All patients received six cycles of rituximab combined with low-dose CHOP (R-miniCHOP) at 3-week intervals. Patients received 375 mg/m2 rituximab, 400 mg/m2 cyclophosphamide, 25 mg/m2 doxorubicin, and 1 mg vincristine on day 1 of each cycle, and 40 mg/m2 prednisone on days 1-5. The primary endpoint was overall survival, both unadjusted and adjusted for treatment and baseline prognostic factors. Analysis was by intention to treat. This study is registered with ClinicalTrials.gov, NCT01087424. Findings: 150 patients were enrolled between Jan 9, 2006, and Jan 23, 2009 and 149 were included in the intention-to-treat analyses. Median age was 83 years (range 80-95). After a median follow-up of 20 months (range 0-45), the median overall survival was 29 months (95% CI 21 to upper limit not reached); 2-year overall survival was 59% (49-67%). In multivariate analyses, overall survival was only affected by a serum albumin concentration of 35 g/L or less (hazard ratio 3·2, 95% CI 1·4-7·1; p=0·0053). Median progression-free survival was 21 months (95% CI 13 to upper limit not reached), with a 2-year progression free survival of 47% (38-56). 58 deaths were reported, 33 of which were secondary to lymphoma progression. 12 deaths were attributed to toxicity of the treatment. The most frequent side-effect was haematological toxicity (grade ≥3 neutropenia in 59 patients; febrile neutropenia in 11 patients). Interpretation: R-miniCHOP offers a good compromise between efficacy and safety in patients aged over 80 years old. R-miniCHOP should be considered as the new standard treatment in this subgroup of patients. Funding: Groupe d'Etude des Lymphomes de l'Adulte (GELA). © 2011 Elsevier Ltd.


Casez P.,CNRS Complex Medical Engineering Laboratory | Labarere J.,Grenoble University Hospital Center | Sevestre M.-A.,Amiens University Hospital | Haddouche M.,CNRS Complex Medical Engineering Laboratory | And 6 more authors.
Journal of Clinical Epidemiology | Year: 2010

Objective: To estimate the sensitivity of International Classification of Diseases, Tenth revision (ICD-10) hospital discharge diagnosis codes for identifying deep vein thrombosis (DVT) and pulmonary embolism (PE). Study Design and Setting: We compared predefined ICD-10 discharge diagnosis codes with the diagnoses that were prospectively recorded for 1,375 patients with suspected DVT or PE who were enrolled at 25 hospitals in France. Sensitivity was calculated as the percentage of patients identified by predefined ICD-10 codes among positive cases of acute symptomatic DVT or PE confirmed by objective testing. Results: The sensitivity of ICD-10 codes was 58.0% (159 of 274; 95% CI: 51.9, 64.1) for isolated DVT and 88.9% (297 of 334; 95% CI: 85.6, 92.2) for PE. Depending on the hospital, the median values for sensitivity were 57.7% for DVT (interquartile range, IQR, 48.6-66.7; intracluster correlation coefficient, 0.02; P = 0.31) and 88.9% for PE (IQR, 83.3-96.3; intracluster correlation coefficient, 0.11; P = 0.03). The sensitivity of ICD-10 codes was lower for surgical patients and for patients who developed PE or DVT while they were hospitalized. Conclusion: ICD-10 discharge diagnosis codes yield satisfactory sensitivity for identifying objectively confirmed PE. A substantial proportion of DVT cases are missed when using hospital discharge data for complication screening or research purposes. © 2010 Elsevier Inc. All rights reserved.


Bouhassira D.,French Institute of Health and Medical Research | Bouhassira D.,University of Versailles | Chassany O.,AP HP | Chassany O.,University Paris Diderot | And 8 more authors.
Pain | Year: 2012

Understanding the effect of herpes zoster and zoster-related pain should inform care to improve health-related quality of life in elderly patients. A 12-month, longitudinal, prospective, multicenter observational study conducted in primary care in France enrolled patients aged ≥50 years with acute eruptive herpes zoster. Patient-reported zoster-related pain was assessed by validated questionnaires (Douleur Neuropathique en 4 Questions [DN4], Zoster Brief Pain Inventory [ZBPI], and Neuropathic Pain Symptom Inventory [NPSI]) on days 0 and 15, and at months 1, 3, 6, 9, and 12. Health-related quality of life was assessed by the 12-item short-form health survey (SF-12) and the Hospital Anxiety and Depression scale on day 0 and at months 3, 6, and 12. Of 1358 patients included, 1032 completed follow-up. Mean ± standard deviation age was 67.7 ± 10.7 (range, 50-95) years; 62.2% were women. Most patients (94.1%) were prescribed antiviral drugs. The prevalence of zoster-related pain on day 0 and at months 3, 6, 9, and 12 was 79.6%, 11.6%, 8.5%, 7.4%, and 6.0%, respectively. Patients with persistent pain had lower scores on the physical and mental component summaries of the SF-12 and the ZBPI interference score than those without pain. By logistic regression analysis, main predictive factors on day 0 for postherpetic neuralgia at month 3 were age, male sex, ZBPI interference score, Physical Component Summary score of the SF-12, and neuropathic quality of pain (DN4 score ≥4). Despite early diagnosis and treatment with antiviral agents, many patients with herpes zoster experience persistent pain and marked long-term reduction in health-related quality of life. © 2011 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.


PubMed | Center Hospitalier Of Chambery and Sina
Type: | Journal: The Pan African medical journal | Year: 2016

The fracture of the upper end of the humerus is the third most frequent fracture in the elderly and its distribution is bimodal, preferentially affecting osteoporotic elderly patients after low energy trauma or, more rarely, young subjects as a consequence of severe kinetic mechanism The treatment of complex fractures of the proximal humerus is the subject of much controversy. Telegraph nail is a highly effective therapeutic approach for displaced fractures of the upper end of the humerus. Surgical procedure is easy but with a learning curve; it allows to start rehabilitation protocol immediately after surgery. It is an antegrade nailing material, 15 cm long, with full proximal and distal locking. Proximal locking is secured by 4 cancellous screws, long thread, stable in the nail ensuring perfect solidity of the assembly while the distal locking screw is secured to deltoid tuberosity in the avascular zone and where there is no neural pathway. This study reports 19 case of patients with fractures of the humerus treated with short Telegraph nail between 2013 and 2015. It aims to investigate radio-clinical results and to assess the impact of this technique on shoulder function. Telegraph nail that has been used for more than 12 years or so met and continues to meet with strong success. It allows to trat very effectively simple fractures type 2 and 3, but also 4-fragment valgus impacted fractures Osteosynthesis by Telegraph nail is an efficient, rapid and reproducible surgical treatment option of the fractures of the upper end of the humerus even in case of complex fractures and allows for a more rapid return of shoulder mobility.


PubMed | Center Hospitalier Of Chambery and Sina
Type: | Journal: The Pan African medical journal | Year: 2016

Pelvic fractures, usually are multiple, unstable fractures occuring most frequently due to violent traumatic events. Orthopedic treatment of these lesions is often distressing both to patients and medical personnel since it requires bed discharge or sometimes tractions which can have a duration up to 45 days and can compromise the static and the walking mechanisms; open operative management is difficult, carrying a significant burden in terms of morbidity and associated with vascular (venous plexus), nervous (sacred roots) or septic risk to take into account. For this reason it is generally reserved for patients with neurologic and strongly displaced forms. Percutaneous fixation under fluoroscopy in unstable type B and type C pelvic fractures allows the synthesis of posterior lesions causing instability by fixing the hip bone to S1 or S2 body, a rapid recovery and rehabilitation of walking.

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