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Bonnin M.P.,Center Orthopedique Santy | Laurent J.-R.,Center Orthopedique Santy | Zadegan F.,Center Hospitalier Of Versailles | Badet R.,Clinique Saint Vincent de Paul | And 2 more authors.
Knee Surgery, Sports Traumatology, Arthroscopy | Year: 2013

Purpose: The possibility to return to sporting activity can be an important consideration in the decision-making process in femorotibial osteoarthritis. We analyzed functional outcomes and sport participation in a continuous series of HTO and asked whether this procedure could match expectations in active and motivated patients. Methods: We retrospectively investigated activities, sports participation, and the level of satisfaction in 139 patients with unilateral noncomplicated HTO. The study included 41 women and 98 men with a mean age of 59 years and a mean 50 months of follow-up. Results: Eighty-seven patients (63%) reported that their knee was "normal," and eighty-six patients (62%) felt that their activities were limited by their knee. A total of 78 patients (56%) reported that they were as active as they expected to be before the intervention. Of these patients, 98% were satisfied. Of the patients who were not as active as they thought they would be, 51% were satisfied (P < 0. 0001). The duration of preoperative pain, the age at evaluation, and the number of previous surgeries did not influence the subjective result. Among patients under 75 years, 28% regularly participated in strenuous sports, but 40% were motivated for these activities. 66% of the motivated patients regularly participated in at least one impact sport. Conclusion: This study shows that young motivated patients are able to resume strenuous activities following HTO. However, patients must be informed that they will typically not recover their pre-pathology level and that residual pain during strenuous sports is not exceptional. Level of evidence: Therapeutic study, Level IV. © 2011 Springer-Verlag.

Simulation in obstetrical emergency is in expansion. The important economic and human cost in simulation needs a real evaluation about enhancement in technical and non-technical skills, maternal and neonatal morbidity and mortality. We present a literature review of the results published on the subject in shoulder dystocia, post-partum haemorrhage, eclampsia and cord prolaps with a selection of publications with high evidence level or positive impact of training on obstetrical emergencies. There are few publications with a positive impact of training on obstetrical emergencies. Some publications from 10 years by the same obstetrical team for training and shoulder dystocia reveal a 75% reduction in brachial plexus injury after 4 years of training, and 100% reduction in permanent injury after a decade of training. Only one publication is in accordance with a reduction of severe post-partum haemorrhage with training. For all obstetrical emergencies, crew resource management (communication, self-confidence…) and team training are improved. © 2016 Elsevier Masson SAS

Artesunate, a semi-synthetic derivative of artemisinin, has proven to be an efficient therapy for severe malaria. In endemic areas, the findings clearly support the superiority of intravenous artesunate over quinine for the treatment of severe malaria in both adults and children. In France, artesunate is available since May 2011. This review describes the history of artesunate, reports the major studies supporting the superiority of artesunate over quinine, details the use of artesunate in France and Europe, and describes the prescription practices and monitoring of artesunate. © SRLF et Springer-Verlag 2011.

Hentgen V.,Center Hospitalier Of Versailles | Grateau G.,Hopital Tenon | Stankovic-Stojanovic K.,Hopital Tenon | Amselem S.,French Institute of Health and Medical Research | Jeru I.,French Institute of Health and Medical Research
Arthritis and Rheumatism | Year: 2013

Objective Familial Mediterranean fever (FMF) is an autosomal-recessive autoinflammatory disease due to mutations in MEFV. Descriptions of disease manifestations among patients carrying a single mutated MEFV allele are becoming more frequent, although no data are available on the long-term outcome. We undertook this study to assess the accuracy of clinical diagnosis in children carrying a single mutated MEFV allele with symptoms of recurrent autoinflammatory disorder. Methods We performed a retrospective single-center study of 33 patients with autoinflammatory disorders age <6 years at disease onset with 1 mutated MEFV allele. The phenotype of the patients was investigated in detail, and the clinical picture and outcome of 18 patients with an initial FMF diagnosis according to current clinical criteria were compared to those of 25 homozygous or compound heterozygous FMF patients. Results No major differences in presenting signs or initial response to colchicine were observed between patient groups. During followup, heterozygotes had a milder disease course compared to homozygotes and were less prone than homozygotes to experience new clinical signs of FMF. At puberty, clinical signs of FMF completely disappeared in 5 of 18 heterozygotes, allowing them to discontinue colchicine without recurrence of symptoms or increases in inflammatory marker levels. Conclusion Our data suggest that the clinical diagnosis of FMF in very young heterozygous children should be made with caution. At this young age they can present with an FMF-like disease - similar to that seen in patients carrying 2 mutated alleles - that is not necessarily predictive of life-long illness. Copyright © 2013 by the American College of Rheumatology.

Dommergues M.-A.,Center Hospitalier Of Versailles | Hentgen V.,Center Hospitalier Of Versailles
Scandinavian Journal of Infectious Diseases | Year: 2012

Background: Antibiotic consumption is one of the main causes of bacterial resistance to antibiotics and a major public health problem worldwide, especially in France. A national campaign was implemented in 2001 to reduce the inappropriate use of antibiotics in France, and guidelines for the management of respiratory tract infections were published in 2005. Methods: In this study, data on paediatric outpatient antibiotic use in France between 2000 and 2010 were derived from prescribing panels of the Permanent Survey of Medical Prescription, which analyzed prescriptions by 835 French general practitioners and specialists. Results: Overall, antibiotic prescriptions decreased by 57.2% between 2001 and 2010 in children aged 024 months, by 50.0% in children aged 25 months to 6 y, and by 45.8% in children older than 6 y of age. In the 3 age groups, the greatest reduction was for rhinopharyngitis (83.4%) and the lowest was for otitis (22.4%). Because otitis is one of the most common diseases in childhood, the proportion of antibiotic prescriptions due to otitis in children aged 024 months consequently increased from 22.5% in 2000 to 42.3% in 2010. Conclusion: Additional measures may be necessary to decrease antibiotic consumption related to otitis in young children. © 2012 Informa Healthcare.

Paule B.,Service dOncologie Medicale | Brion N.,Center Hospitalier Of Versailles | Brion N.,University of Versailles
Anticancer Research | Year: 2011

Chromophobe renal cell carcinoma (chRCC) is a common subtype of renal cell carcinoma (RCC), occurring in 6-11% of renal carcinoma patients. Limited clinical trial data have shown minimal activity with cytokines and chemotherapy, although small-molecule inhibitors of the vascular endothelial growth factor and platelet-derived growth factor pathways such as sunitinib and sorafenib, which are associated with significant clinical activity in clear-cell RCC (ccRCC), have been associated with a 25% response rate in chRCC. The mammalian target of rapamycin kinase inhibitor temsirolimus demonstrates good clinical activity in ccRCC patients with poor prognosis, with further data suggesting it is an effective treatment for all RCC tumour histologies. This report describes the case of a patient with chRCC who experienced rapid improvement in his general condition and stable disease on treatment with temsirolimus, following disease progression on interferon alfa and sorafenib treatment. This case report suggests that temsirolimus is an effective and appropriate treatment for this RCC tumour subtype.

Mornet E.,Center Hospitalier Of Versailles
Sub-Cellular Biochemistry | Year: 2015

Hypophosphatasia (HPP) is due to deficient activity of the tissue-nonspecific isoenzyme of alkaline phosphatase (TNAP). This enzyme cleaves extracellular substrates inorganic pyrophosphates (PPi), pyridoxal-5′- phosphate (PLP), phosphoethanolamine (PEA) and nucleotides, and probably other substrates not yet identified. During the last 15 years the role of TNAP in mineralization, and to a less degree in brain, has been investigated, providing hypotheses and explanations for both bone and neuronal HPP phenotypes. ALPL, the gene encoding TNAP, is subject to many mutations, mostly missense mutations. A few number of mutations are recurrently found and may be quite frequent in particular populations. This reflects founder effects. The great variety of mutations results in a great number of compound heterozygous genotypes and in highly variable clinical expressivity. A good correlation was observed between the severity of the disease and in vitro enzymatic activity of the mutant protein measured after site-directed mutagenesis. Many missense mutations found in severe hypophosphatasia produced a mutant protein that failed to reach the cell membrane, was accumulated in the cis-Golgi and was subsequently degraded in the proteasome. Missense mutations located in the catalytic site or in the homodimer interface were often shown by site-directed mutagenesis to have a dominant negative effect. Currently molecular diagnosis of HPP is based on the sequencing of the coding sequence of ALPL that allows detection of approximately 95 % of mutations in severe cases. In addition, other genes, especially genes encoding proteins involved in the regulation of extracellular PPi concentration, could modify the phenotype (modifier genes). © Springer Science+Business Media Dordrecht 2015.

Panel P.,Center Hospitalier Of Versailles | Grosdemouge I.,Center Hospitalier Of Versailles
Fertility and Sterility | Year: 2010

Objective: To assess a new hysteroscopic method of tubal sterilization; specifically, to examine the factors associated with placement failure of Essure® implants. Design: Observational, multicenter, 6-month study. Setting: Seven gynecology clinics, including five public hospitals and two private clinics, in France. Patient(s): A total of 495 women who provided informed consent. Intervention(s): All procedures were done by a vaginoscopic approach with a 5-mm operating hysteroscope. Main Outcome Measure(s): Data collected were age, parity, type of anesthesia, premedication, endometrial aspect, ostia visualization, duration of the procedure, pain during the procedure, and associated procedures. Unilateral and bilateral placement rates were assessed. Adverse events at 3 months (expulsion, migration, perforation) were also recorded. Result(s): Mean parity was 2.45; 20 women were nulliparous. In 56.3% of cases (n = 277), none or local anesthesia was used for the placement procedure. Overall, 86% of the women (n = 423) had nonsteroidal anti-inflammatory drug (NSAID) premedication, and 8.1% (n = 40) had another intrauterine surgical procedure performed at the same time. In 24 cases, at least one of the tubal ostia could not be visualized well during hysteroscopy. Conclusion(s): The failure rate for Essure® micro-insert placement was 6% at first attempt and 3.3% after two attempts. Success rate was not significantly associated with parity, mode of analgesia, NSAID premedication, or combination with another procedure. The only factor significantly associated with the failure rate was poor visualization of the tubal ostia. © 2010 American Society for Reproductive Medicine.

Le Boeuf D.,Center Hospitalier Of Versailles
Soins; la revue de référence infirmière | Year: 2016

Participating in the coordination of care in order to provide global patient management is an integral part of nursing activities. The term nurse coordinator, however, encompasses diverse realities. Legally defined within in-home nursing care services, it remains vague in all other care organisations which call upon these nursing competencies. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Pujol N.,Center Hospitalier Of Versailles | Tardy N.,Center Hospitalier Of Versailles | Boisrenoult P.,Center Hospitalier Of Versailles | Beaufils P.,Center Hospitalier Of Versailles
International Orthopaedics | Year: 2013

Purpose: The purpose of this study was to assess the MRI features of the all-inside repaired meniscus in the long-term. Methods: Among 27 consecutive all-inside arthroscopic meniscal repairs, 23 patients aged 25 ± 5 years at the time of surgery were reviewed at a median follow-up of 10 ± 1 years. Retrospective clinical examinations and imaging assessments using a 1.5-T MRI after all-inside arthroscopic meniscal repair were conducted. Results: At follow-up, Lysholm and IKDC averaged 89 ± 11 and 95 ± 8, respectively. MRI examinations revealed no meniscal signal alteration in three patients (13 %), a vertical signal located in the previously torn area in seven (30 %), a horizontal grade 3 in nine (39 %), and a complex tear (grade 4) in four (17.5 %). There were no differences between medial and lateral menisci (p = 0.15), stable and stabilised knees (p = 0.56). Conclusions: Several abnormal vertical and/or horizontal hypersignals are still present on MRI examination ten years after arthroscopic all-inside meniscal repair. The appearance of early signs of osteoarthritis is rare, suggesting a chondroprotective effect of the repaired meniscus. © 2013 Springer-Verlag Berlin Heidelberg.

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