Center Hospitalier Of Valence

Bourg-lès-Valence, France

Center Hospitalier Of Valence

Bourg-lès-Valence, France
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Chaby G.,University of Amiens | Senet P.,Paris West University Nanterre La Défense | Ganry O.,University of Amiens | Caudron A.,University of Amiens | And 7 more authors.
British Journal of Dermatology | Year: 2013

Background Some prognostic markers of venous leg ulcer (VLU) healing have been evaluated, mostly in retrospective studies. Objectives To identify which clinical characteristics, among those known as possible prognostic factors of VLU healing, and which VLU-associated sociodemographic and psychological factors, are associated with complete healing at week 24 (W24). Methods A prospective, multicentre, cohort study was conducted in 22 French dermatology departments between September 2003 and December 2007. The end point was comparison between healed and nonhealed VLUs at W24, for patient clinical and biological characteristics; psychological, cognitive and social assessments; affected leg inclusion characteristics; venous insufficiency treatment and percentage of initial wound area reduction during follow-up. Results In total, 104 VLUs in 104 patients were included; 94 were analysed. The mean VLU area and duration were 36·8 ± 55·5 cm2 and 24·8 ± 45·7 months, respectively. At W24, 41/94 VLUs were healed. Univariate analysis significantly associated complete healing with superficial venous surgery (P = 0·001), adherence to compression therapy at W4 (P = 0·03) and W24 (P = 0·01), ankle-joint ankylosis (P = 0·01) and mean percentage of VLU area reduction at W4 (P = 0·04). Multivariate analysis retained superficial venous surgery during follow-up [odds ratio (OR) 8·4, 95% confidence interval (CI) 1·9-48·2] and percentage reduction of the VLU area at W4 (OR 1·6, 95% CI 1·0-2·14) as being independently associated with healing. Conclusions These results indicate that complete healing of long-standing, large VLUs is independently associated with ablation of the incompetent superficial vein and percentage of wound area reduction after the first 4 weeks of treatment. What's already known about this topic? Despite advances in venous leg ulcer (VLU) management, the time to ulcer healing generally remains long. Some prognostic markers of healing have been evaluated, mostly in retrospective studies. What does this study add? In this prospective, multicentre, cohort study, complete healing of long-standing, large VLUs at 6 months was independently associated with ablation of the incompetent superficial vein and percentage of wound area reduction after the first 4 weeks of treatment. © 2013 British Association of Dermatologists.

Viart H.,Center Hospitalier Of Valence | Combe C.,Center Hospitalier Of Valence | Martinelli T.,Center Hospitalier Of Valence | Thomas J.,Center Hospitalier Of Valence | Hida H.,Center Hospitalier Of Valence
Annales Pharmaceutiques Francaises | Year: 2015

Introduction: Peripherally Inserted Central Catheter or PICC Line and implanted subcutaneous ports are two types of central catheters allowing drug administration and blood samplings. These two devices are very controversial (because of infectious and thrombotic complications), it seemed interesting to estimate their cost of implantation and to correlate them with the reimbursement by the Health Insurance. Materials and methods: Direct (material and drugs) and indirect (use of the room and staff) costs were prospectively evaluated for PICC Lines and implanted subcutaneous ports. Results: The global costs of the implantation of a PICC Line and of an implanted subcutaneous port in the interventional radiology room and in the operating room were respectively evaluated at 220.2€, 286.6€ and 666.3€. Discussion-conclusion: Only a PICC Line in outpatients can be reimbursed by the health insurance; which amounts to 110.4€. The establishment therefore loses money with every implantation. However, PICC Lines offer to the patients a fast access to a central venous way and thus an optimal therapeutic care, fulfilling one of the main missions of the public health institutions. Implanted subcutaneous ports are economically worth being implanted only in ambulatory inpatients. Its implantation in radiology seemed more profitable because the indirect costs were much more moderate. © 2014 Elsevier Masson SAS.

Plouin-Gaudon I.,Center Hospitalier Of Valence | Bossard D.,Hopital Prive Jean Mermoz | Ayari-Khalfallah S.,Hopital Femme Mere Enfant | Froehlich P.,Hopital Femme Mere Enfant
Archives of Otolaryngology - Head and Neck Surgery | Year: 2010

Objective: To evaluate the efficiency of diffusion-weighted magnetic resonance imaging (MRI) and highresolution computed tomographic (CT) scan coregistration in predicting and adequately locating primary or recurrent cholesteatoma in children. Design: Prospective study. Setting: Tertiary care university hospital. Patients: Ten patients aged 2 to 17 years (mean age, 8.5 years) with cholesteatoma of the middle ear, some of which were previously treated, were included for follow-up with systematic CT scanning and MRI between 2007 and 2008. Interventions: Computed tomographic scanning was performed on a Siemens Somaton 128 (0.5/0.2-mm slices reformatted in 0.5/0.3-mm images). Fine cuts were obtained parallel and perpendicular to the lateral semicircular canal in each ear (100x100-mm field of view). Magnetic resonance imaging was undertaken on a Siemens Avanto 1.5T unit, with a protocol adapted for young children. Diffusion-weighted imaging was acquired using a single-shot turbo spin-echo mode. To allow for diagnosis and localization of the cholesteatoma, CT and diffusion-weighted MRIs were fused for each case. Results: In 10 children, fusion technique allowed for correct diagnosis and precise localization (hypotympanum, epitympanum, mastoid recess, and attical space) as confirmed by subsequent standard surgery (positive predictive value, 100%). In 3 cases, the surgical approach was adequately determined from the fusion results. Lesion sizes on the CT-MRI fusion corresponded with perioperative findings. Conclusions: Recent developments in imaging techniques have made diffusion-weighted MRI more effective for detecting recurrent cholesteatoma. The major drawback of this technique, however, has been its poor anatomical and spatial discrimination. Fusion imaging using high-resolution CT and diffusion-weighted MRI appears to be a promising technique for both the diagnosis and precise localization of cholesteatomas. It provides useful information for surgical planning and, furthermore, is easy to use in pediatric cases. ©2010 American Medical Association. All rights reserved.

PubMed | CNRS Alpine Ecology Laboratory, Center Hospitalier Of Valence, Hospices Civils de Lyon and University of Lyon
Type: Journal Article | Journal: Diagnostic and interventional imaging | Year: 2016

To evaluate clinical and multidetector computed tomography (MDCT) features associated with the presence and size of microaneurysms in renal angiomyolipomas (AMLs).The MDCTs and digital subtraction angiographies (DSAs) of 31 patients who had further percutaneous arterial embolization of AMLs were retrospectively reviewed. They were 22 women and 9 men (mean age, 47.727.7 years). The medical files of the included patients were reviewed for age, gender and clinical features. MDCT and DSA images were analyzed by two readers working in consensus.Of the 31 patients, 15 had tuberous sclerosis complex (TSC) or lymphangioleiomyomatosis (LAM). In total, the 31 patients had 54 AMLs (5 ruptured). On DSA, 28 clusters of microaneurysms were found in 17 patients (21 AMLs). Four of the five ruptured AMLs had microaneurysms. None of the 12 AMLs40mm and 21 of the 42 AMLs>40mm had microaneurysms. Among AMLs>40mm, history of TSC/LAM (P=0.5), RENAL score (P=0.7) and relative volume of fat (P=0.11) did not significantly predict the presence of microaneurysms. Microaneurysms were significantly larger in ruptured (9.55.7mm) than non-ruptured (3.91.9mm, P=0.02) AMLs. No associations were found between the size of microaneurysms and the size of AMLs.Microaneurysms were found in no AML 40mm and in 50%of AMLs>40mm. In AMLs >40mm, history of TSC/LAM, RENAL score and relative volume of fat did not significantly predict the presence of microaneurysms.

Moos D.,Center Hospitalier Of Valence | Droitcourt C.,Center Hospitalier Of Valence | Rancherevince D.,Center Leon Berard | Marec Berard P.,Institute dHemato Oncologie Pediatrique | Skowron F.,Center Hospitalier Of Valence
Pediatric Dermatology | Year: 2012

We report a large infiltrating atypical granular cell tumor in a child with Noonan syndrome. Even though granular cell tumors are rare in childhood, five cases have been reported in children with Noonan syndrome. This study compares these different cases and explores the possibility of activation of the granular cell by the Ras pathway. © 2012 Wiley Periodicals, Inc.

Plouin-Gaudon I.,Center Hospitalier Of Valence | Bossard D.,Hopital Prive Jean Mermoz | Fuchsmann C.,University of Lyon | Ayari-Khalfallah S.,University of Lyon | Froehlich P.,University of Lyon
International Journal of Pediatric Otorhinolaryngology | Year: 2010

Objective: To compare the efficiency of diffusion-weighted MR imaging (MRI) vs. high resolution CT in predicting recurrent or residual cholesteatoma in children who underwent prior middle ear surgery. Design: Prospective study. Setting: Tertiary care university hospital. Patients: Seventeen patients (4 with 2 recurrences) aged 5-17 years (mean 11.4) previously surgically treated for a cholesteatoma of the middle ear, were included for follow-up with systematic CT scan and MRI, between 2005 and 2007. Methodology: CT scan was performed on a Siemens Somaton 64 (0.5/0.2 mm slices reformatted in 0.5/0.3 mm images), parallel and perpendicular to the lateral semi-circular canal for each ear (100 mm × 100 mm FOV). MRI was undertaken on a Siemens Avanto 1.5 T unit, with an adapted protocol for young children. Diagnosis of recurrent cholesteatoma was based on the evidence of a hyperintense image at B1000 on diffusion-weighted images. Results of CT scan and MRI were compared with operative diagnosis. Results: Nine patients had a positive MRI, among which 8 had cholesteatoma confirmed during revision surgery. In the 12 negative MRI cases, 5 were positive on revision surgery. None of these lesions was over 3 mm. Two of them were diagnosed on the CT scan. CT scan alone had a positive predictive value of 75%, and a negative predictive value of 58%. Conclusion: Diffusion-weighted MRI is associated with a high positive predictive value for the detection of recurrent cholesteatoma. CT scan remains the first choice imaging technique. In case of doubtful CT scan, diffusion-weighted MRI could confirm a recurrence or, when negative, avoid second-look surgery. © 2009 Elsevier Ireland Ltd. All rights reserved.

Recurrent fever of unknown origin is probably the most difficult to diagnose subtype of fever of unknown origin. It represents between 18 and 42% of the cases in large series of patients with fever of unknown origin. The limited literature data do not allow one to construct a diagnostic algorithm. However, the diagnostic strategy is different from classic fever of unknown origin. The spectrum of causative disorders is different from continuous fever with less infections and tumors. Among systemic inflammatory diseases, adult-onset Still's disease is the most common cause. More than 50% of the cases remain unexplained. Hereditary recurrent fevers, the prototype of autoinflammatory diseases, are now more easily discuss in a young adult. © 2014 Société nationale française de médecine interne (SNFMI).

This case report describes a 20 months-old toddler with a multifocal S. pyogenes invasive infection cutaneous and articular, which outcome was favorable after implementation of a medical and surgical treatment. The antibiotic treatment was based on the association of amoxicillin and clindamycin which duration was guided by the clinical course and the secondary locations. A surgical management with joint irrigation lavage and drainage was necessary to induce a complete recovery. © 2014 Elsevier Masson SAS.

Zenone T.,Center Hospitalier Of Valence | Chan V.,Center Hospitalier Of Valence
Clinical Neurology and Neurosurgery | Year: 2011

Several epidemiologic studies suggest that Fabry disease should be considered in young patients with cryptogenic stroke. We report a case of a young woman presenting with recurrent ischemic strokes who was finally diagnosed with Fabry disease after impaired kidney function had been identified. Fabry disease should be considered in unexplained cases of first or recurrent strokes in young patients disregarding the gender of the patient, especially when chronic kidney disease and/or proteinuria are present. Renal function should be closely monitored in patients with strokes and followed up after the event. In this case, intravenous thrombolysis was performed after the second ischemic event. No other case of thrombolysis for ischemic stroke in Fabry disease has been described in the literature. © 2011 Elsevier B.V.

Skowron C.,Center Hospitalier Of Valence | Raoulx M.,Center Hospitalier Of Valence | Skowron F.,Center Hospitalier Of Valence
Annales de Dermatologie et de Venereologie | Year: 2010

Background: Treatment of anogenital warts (AW) in children and infants is painful because of the destructive techniques involved, as a result of which general anaesthesia may be required. For adults, topical imiquimod is an efficient and well-tolerated product used for these lesions. Here, we report a case demonstrating the benefits of topical imiquimod in the treatment of AW in infant. Patients and methods: A ten-month-old infant was presenting large AW in the inguinal and perianal folds for a period of two months, which persisted despite one month of treatment with podophyllotoxin. After a month of daily application of imiquimod, the AW was completely cured, with no recurrence at six months. Discussion: In the literature, we found four similar case reports concerning the efficacy and safety of topical imiquimod for AW in infants. Although topical imiquimod is not licensed for paediatric use, these case reports highlight the benefits of this approach in infants. © 2010 Elsevier Masson SAS. Tous droits réservés.

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