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Renaud B.,Service dUrgence | Renaud B.,University Paris Est Creteil | Schuetz P.,Harvard University | Claessens Y.-E.,Center Hospitalier Princesse Grace | And 3 more authors.
Chest | Year: 2012

Background: Whether proadrenomedullin (ProADM) improves the performance of the Risk of Early Admission to ICU (REA-ICU) score in predicting early, severe community-acquired pneumonia (ESCAP) has not been demonstrated. Methods: Secondary analysis was completed of the original data from 877 consecutive patients with community-acquired pneumonia (CAP) enrolled in the Procalcitonin-Guided Antibiotic Therapy and Hospitalization in Patients With Lower Respiratory Tract Infections (ProHOSP) study, a multicenter trial in EDs of six tertiary-care hospitals in Switzerland. ESCAP was defined by either the requirement for mechanical ventilation or vasopressive drugs or occurrence of death within 3 days of ED presentation. Results: Eighty patients (9.1%) developed ESCAP (47 required mechanical ventilation, 19 vasopressive drugs, and 16 died) within 3 days of ED presentation. They had a higher median ProADM value (2.18 nmol/L vs 1.15 nmol/L, P<.001). Combining ProADM testing with the REA-ICU score improved the area under the curve (0.81) compared with either parameter (ProADM [0.73] or REA-ICU score [0.76], P<.001) and resulted in a net reclassification improvement of 0.20 (P<.001). A ProADM value ≥ 1.8 nmol/L or assignment to REA-ICU risk classes III-IV predicted ESCAP with a sensitivity of 76.3% and a negative predictive value of 96.7%. Excluding 21 patients with major criteria of severe CAP on presentation showed similar results. Conclusion: These study findings demonstrate that the addition of ProADM to the REA-ICU score improves the classification of a substantial proportion of patients in the ED at intermediate or high risk for ESCAP, which may translate into better triage decisions. ©2012 American College of Chest Physicians. Source


Charachon A.,Center Hospitalier Princesse Grace
Acta Endoscopica | Year: 2013

Zenker's diverticulum is an outpouching of the mucosa through the Killian's triangle due to a default of the cricopharyngeal muscle. The reference surgical treatment including diverticulectomy and section of the cricopharyngeal muscle tends to be replaced by rigid or flexible endoscopic treatment. Endoscopic treatment consists in the section of the wall between the diverticulum and the esophagus, and of the cricopharyngeal muscle in it. For flexible endoscopy, exposure of this wall is best obtained with the help of a flexible diverticuloscope. The section is done with the help of endoscopic knives and must be limited to the section of the cricopharyngeal muscle or by the diverticulum's bottom. Symptoms resolution is usually obtained in one treatment session with a very low morbidity. Food intakes can usually restart within 12-24 hours. Infection, and particularly its extent to the mediastinum, is the most feared complication. Using CO2 insufflation and endoscopic clips could help avoiding part of the complications. © Springer-Verlag 2013. Source


Missana M.C.,Center Hospitalier Princesse Grace
Journal of visceral surgery | Year: 2013

Skin-sparing mastectomies (SSM) have gained acceptance among teams performing immediate breast reconstruction because this technique provides the best cosmetic outcome. Nevertheless, in France, concerns have been raised that limited skin excision during mastectomy could result in an increased risk of local recurrence especially in invasive breast cancer; many surgeons continue to have reservations regarding the oncologic safety of this operation. This is a retrospective, long-term follow-up study of 400 patients operated and followed by two oncoplastic surgeons. A total of 400 patients with breast cancer underwent SSM with immediate breast reconstruction from January 1, 1992 to December 31, 2002. The American Joint Committee on Cancer pathological staging was Stage 0 (41.5%), Stage I (33.25%), Stage II (16%), Stage III (7.5%), while 1.75% were non-stageable. With a mean follow-up period of 88 months (range: 13-215 months), the locoregional recurrence rate was 3.5%, the rate of distant metastases was 13.5%, and 83% of patients have remained free of recurrent disease. This study provides encouraging results suggesting that skin-sparing mastectomy is a safe and reliable option for the management of selected cases of women with invasive or in situ breast cancer. Copyright © 2013. Published by Elsevier Masson SAS. Source


Chenevier-Gobeaux C.,Groupe Hospitalier Cochin Broca Hotel Dieu | Trabattoni E.,Groupe Hospitalier Cochin Broca Hotel Dieu | Trabattoni E.,University of Paris Descartes | Roelens M.,Groupe Hospitalier Cochin Broca Hotel Dieu | And 3 more authors.
Clinica Chimica Acta | Year: 2014

Presepsin is elevated in patients developing infections and increases in a severity-dependent manner. We aimed to evaluate circulating values of this new biomarker in a population free of any acute infectious disorder. We recruited 144 consecutive patients presenting at the emergency department (ED) without acute infection or acute/unstable disorder, and 54 healthy participants. Presepsin plasmatic concentrations were measured on the PATHFAST point-of-care analyzer. The 95th percentile of presepsin values in the ED population is 750. ng/L. Presepsin was significantly increased in patients aged ≥. 70. years vs. younger patients (470 [380-601] ng/L vs. 300 [201-457] ng/L, p. <. 0.001). Prevalence of elevated presepsin values was increased in patients in comparison to controls (80% vs.13%, p. <. 0.001), and in patients aged ≥. 70. years in comparison to younger patients (87% vs. 47%, p. <. 0.001). Presepsin concentrations were significantly increased in patients with kidney dysfunction. Aging was an independent predictor of an elevated presepsin value. In conclusion, presepsin concentrations increase with age and kidney dysfunction. Therefore interpretation of presepsin concentrations might be altered in the elderly or in patients with impaired renal function. Adapted thresholds are needed for specific populations. © 2013 Elsevier B.V. Source


Latcu G.D.,Center Hospitalier Princesse Grace
Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing | Year: 2011

Analysing ventricular fibrillation (VF) rate and regularity at different sites and at different times may help understanding some of the mechanisms underlying VF in humans. Twelve episodes of VF (19.4±5.6 s) were induced during electrophysiological study in eight men (63±14 years old). Calculation of dominant frequency (DF) by fast Fourier transform, short-time Fourier transform, and analysis of the pitch frequency [VF cycle length duration (CL)] were performed. For each episode, we analysed the 12 lead-surface ECG, three unipolar, 10 near-field, and three far-field bipolar recordings by means of three quadripolar catheters positioned at the right ventricular apex (RV apex), right ventricular outflow tract, and at the coronary sinus (exploring the lateral left ventricular epicardium) (LV). Fast and regular discrete activation covered the whole duration of every intracardiac recording, whereas surface ECG consistently displayed chaotic and fibrillatory pattern. DF (5.25±0.64 Hz) was very similar on surface ECG recordings and in various intracardiac recordings. Intracardiac activation was rather regular during VF despite the fibrillatory process with very low SD of the CL. There were some significant inverse correlations between VF rate and VF regularity. Intracardiac sites displaying the fastest and most regular activations were those including the RV apex. VF rate and stability slightly increased over time. Finally, the parameters exploring the VF rate were found to be well correlated together, as well as parameters of VF regularity Human VF induced during electrophysiological study has a clear DF of activation and appears quite regular in intracardiac recordings. There is some spatial heterogeneity, which needs to be more detailed in order to localize possible driving sources. Fastest VF are the most regular. Rate and stability tend to increase during the initial phases of VF. Source

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