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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.

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.

Bruneel F.,Center Hospitalier Of Versailles
Journal des Anti-Infectieux | Year: 2011

Severe malaria remains a major public health problem in endemic areas, with approximately one million deaths each year. In France, as well as in nonendemic industrialized countries, severe imported malaria still carries a high mortality rate despite a high-quality healthcare level. According to the 2000 World Health Organization definition, severe malaria is defined by the combination of asexual Plasmodium falciparum forms in blood and one or more clinical or biological severity criteria. Recently, this definition has been adapted to severe imported malaria in the 2007 French guidelines for the management of imported falciparum malaria. The treatment of severe imported malaria includes intravenous quinine and management of organ failure in the intensive care unit. Several targets for decreasing the mortality of falciparum malaria in France are proposed: to improve adherence to antimalarial chemoprophylaxis, to improve both the diagnosis and the management of uncomplicated malaria. When severe imported malaria is diagnosed, a more agressive supportive treatment in the intensive care unit, and the introduction of parenteral artesunate, might decrease the mortality rate of this disease. Finally, new antimalarial adjunctive therapies are still under study. © 2010 Elsevier Masson SAS.

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.

Bazin N.,Center Hospitalier Of Versailles
Geriatrie et Psychologie Neuropsychiatrie du Vieillissement | Year: 2011

The development of studies of aging patients with schizophrenia results from their increasing life expectancy in accordance with that of the general population, but remains far below that one. Studies devoted to cognitive deficits in these patients globally show various complex cognitive deficits, which usually remain stable in their evolution. However, some patients develop a severe cognitive decline after 65 years, following a long institutionalization. Complex cognitive functions particularly deserve to be systematically explored in patients presenting with cognitive complaints and/or communication difficulties. As an example, we present the case report of a patient showing a theory of mind deficit.

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