Center Hospitalier Regional Orleans

Orléans, France

Center Hospitalier Regional Orleans

Orléans, France

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Mourvillier B.,Groupe Hospitalier Bichat Claude Bernard | Tubach F.,University Paris Diderot | Van De Beek D.,University of Amsterdam | Garot D.,University of Tours | And 35 more authors.
JAMA - Journal of the American Medical Association | Year: 2013

IMPORTANCE: Despite advances in care, mortality and morbidity remain high in adults with acute bacterial meningitis, particularly when due to Streptococcus pneumoniae. Induced hypothermia is beneficial in other conditions with global cerebral hypoxia. OBJECTIVE: To test the hypothesis that induced hypothermia improves outcome in patients with severe bacterial meningitis. DESIGN, SETTING, AND PATIENTS: An open-label, multicenter, randomized clinical trial in 49 intensive care units in France, February 2009-November 2011. In total, 130 patients were assessed for eligibility and 98 comatose adults (Glasgow Coma Scale [GCS] score of ≤8 for <12 hours) with community-acquired bacterial meningitis were randomized. INTERVENTIONS: Hypothermia group received a loading dose of 4°C cold saline and were cooled to 32°C to 34°C for 48 hours. The rewarming phase was passive. Controls received standard care. MAIN OUTCOMES AND MEASURES: Primary outcome measure was the Glasgow Outcome Scale score at 3 months (a score of 5 [favorable outcome] vs a score of 1-4 [unfavorable outcome]). All patients received appropriate antimicrobial therapy and vital support. Analyses were performed on an intention-to-treat basis. The data and safety monitoring board (DSMB) reviewed severe adverse events and mortality rate every 50 enrolled patients. RESULTS: After inclusion of 98 comatose patients, the trial was stopped early at the request of the DSMB because of concerns over excess mortality in the hypothermia group (25 of 49 patients [51%]) vs the control group (15 of 49 patients [31%]; relative risk [RR], 1.99; 95% CI, 1.05-3.77; P = .04). Pneumococcal meningitis was diagnosed in 77% of patients. Mean (SD) temperatures achieved 24 hours after randomization were 33.3°C (0.9°C) and 37.0°C (0.9°C) in the hypothermia and control group, respectively. At 3 months, 86% in the hypothermia group compared with 74% of controls had an unfavorable outcome (RR, 2.17; 95% CI, 0.78-6.01; P = .13). After adjustment for age, score on GCS at inclusion, and the presence of septic shock at inclusion, mortality remained higher, although not significantly, in the hypothermia group (hazard ratio, 1.76; 95% CI, 0.89-3.45; P = .10). Subgroup analysis on patients with pneumococcal meningitis showed similar results. Post hoc analysis showed a low probability to reach statistically significant difference in favor of hypothermia at the end of the 3 planned sequential analyses (probability to conclude in favor of futility, 0.977). CONCLUSIONS AND RELEVANCE: Moderate hypothermia did not improve outcome in patients with severe bacterial meningitis and may even be harmful. Careful evaluation of safety issues in future trials on hypothermia are needed and may have important implications in patients presenting with septic shock or stroke. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00774631. Copyright 2013 American Medical Association. All rights reserved.


PubMed | Besancon University Hospital Center, Center Hospitalier University Gabriel Montpied, University of Nantes, University of Strasbourg and 9 more.
Type: Journal Article | Journal: Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases | Year: 2016

The main objective of this study was to assess the diagnostic performance of a set of three Mucorales quantitative PCR assays in a retrospective multicentre study. Mucormycosis cases were recorded thanks to the French prospective surveillance programme (RESSIF network). The day of sampling of the first histological or mycological positive specimen was defined as day 0 (D0). Detection of circulating DNA was performed on frozen serum samples collected from D-30 to D30, using quantitative PCR assays targeting Rhizomucor, Lichtheimia, Mucor/Rhizopus. Forty-four patients diagnosed with probable (n=19) or proven (n=25) mucormycosis were included. Thirty-six of the 44 patients (81%) had at least one PCR-positive serum. The first PCR-positive sample was observed 9days (range 0-28days) before diagnosis was made using mycological criteria and at least 2days (range 0-24days) before imaging. The identifications provided with the quantitative PCR assays were all concordant with culture and/or PCR-based identification of the causal species. Survival rate at D84 was significantly higher for patients with an initially positive PCR that became negative after treatment initiation than for patients whose PCR remained positive (48% and 4%, respectively; p <10


Alouini S.,Center Hospitalier Regional Orleans | Randriambololona D.,Center Hospitalier Regional Orleans | Randriambololona D.,University of Antananarivo | Randriamboavonjy R.,Laboratoire dAppui Aux Recherches
Journal de Gynecologie Obstetrique et Biologie de la Reproduction | Year: 2015

Objective To evaluate the obstetric outcome of teenage pregnancies compared to adult women in the department of Loiret. Methods A retrospective study of adolescents (10-19 years) delivered after 22 weeks compared to adult women aged 20-35 years (controls) from the first January to the 31 December 2012 in a maternity level 3. The two groups were compared by the Chi2 test or the exact test of Fisher. A P-value < 0.05 was considered significant. Results Adolescent had less prenatal consultations than controls (4 versus 7). They used more tobacco during pregnancy than adult controls. Urinary infections and preterm threat and births were more frequent in the adolescent group compared to the controls (P = 0.04 and 0.018). However, the gestational diabetes was less frequent in the adolescent group versus controls (P = 0.0005, OR: 0.16 [IC95%: 0.03-0.54]). The adolescent group represented 2.38 of total deliveries. The rate of vaginal deliveries and caesarean section was similar in the two groups. Vaginal tears were significantly more frequent among adolescents than controls (P = 0.0019). Conclusion The adolescents were more likely to preterm delivery and to have urinary infections than the adult women (controls). They are less likely to have gestational diabetes than older women. The rates of vaginal deliveries are comparable; however, the adolescents are more likely to experience vaginal tears than controls. © 2014 Elsevier Masson SAS.


PubMed | Center Hospitalier Regional Orleans, Service de Reanimation, Center Chirurgical Marie Lannelongue, Nantes University Hospital Center and 6 more.
Type: Journal Article | Journal: Annals of intensive care | Year: 2016

Cardiogenic shock which corresponds to an acute state of circulatory failure due to impairment of myocardial contractility is a very rare disease in children, even more than in adults. To date, no international recommendations regarding its management in critically ill children are available. An experts recommendations in adult population have recently been made (Levy et al. Ann Intensive Care 5(1):52, 2015; Levy et al. Ann Intensive Care 5(1):26, 2015). We present herein recommendations for the management of cardiogenic shock in children, developed with the grading of recommendations assessment, development, and evaluation system by an expert group of the Groupe Francophone de Ranimation et Urgences Pdiatriques (French Group for Pediatric Intensive Care and Emergencies). The recommendations cover four major fields of application such as: recognition of early signs of shock and the patient pathway, management principles and therapeutic goals, monitoring hemodynamic and biological variables, and circulatory support (indications, techniques, organization, and transfer criteria). Major principle care for children with cardiogenic shock is primarily based on clinical and echocardiographic assessment. There are few drugs reported as effective in childhood in the medical literature. The use of circulatory support should be facilitated in terms of organization and reflected in the centers that support these children. Children with cardiogenic shock are vulnerable and should be followed regularly by intensivist cardiologists and pediatricians. The experts emphasize the multidisciplinary nature of management of children with cardiogenic shock and the importance of effective communication between emergency medical assistance teams (SAMU), mobile pediatric emergency units (SMUR), pediatric emergency departments, pediatric cardiology and cardiac surgery departments, and pediatric intensive care units.


Fama' F.,Messina University | Berry M.G.,Messina University | Linard C.,Messina University | Gioffre-Florio M.,Messina University | Metois D.,Center Hospitalier Regional Orleans
Thoracic and Cardiovascular Surgeon | Year: 2010

Ectopic parathyroid glands are frequently located in the thymus and may become hyperplasic in patients with secondary hyperparathyroidism. When medical management fails, surgical removal is required, using either a traditional open sternotomy approach or video-assisted thoracic surgery (VATS). We were able to excise large, bilateral, mediastinal parathyroid glands using only left VATS. To the authors' knowledge, this is the first reported case of the use of unilateral thoracoscopic subtotal thymectomy for the excision of bilateral ectopic mediastinal parathyroid glands. © Georg Thieme Verlag KG Stuttgart.


Poisson D.-M.,Center Hospitalier Regional Orleans | Chandemerle M.,Center Hospitalier Regional Orleans | Guinard J.,Center Hospitalier Regional Orleans | Evrard M.-L.,Center Hospitalier Regional Orleans | And 2 more authors.
Journal of Microbiological Methods | Year: 2010

A selective and chromogenic medium, the CHROMagar™ StrepB agar (CHROM-B) designed for aerobic isolation of Group B Streptococci (GBS) in pregnancy-related specimens, was evaluated in a two-Phase study. CHROM-B was evaluated against CPS3 during the first Phase and against Granada afterwards. It was compared to blood agar plates (COH) and to colimycin nalidixic agar plates (CNA) over both Phases. The study which included 1356 samples, yielded 124 GBS. CHROM-B was significantly more sensitive than COH (76.6% vs 53.2% on d1 and 92.7% vs 64.5% on d2; p<0.001 for both). CHROM-B yielded positive results sooner than CNA. CPS3 under-performed, partly because of microbiota overgrowth and partly because it did not produce a single and unique colour from the GBS colonies. CHROM-B produced its unique GBS-expected colour sooner than Granada yielding a significantly sooner result for 10% (6/60; p<0.025). Every 124 GBS could grow typical colonies on CHROM-B and False Negatives were only due to paucimicrobial samples. Granada failed to produce the expected colour from one non-haemolytic GBS. We conclude that CHROMagar™ StrepB performed significantly better, irrespective of the haemolytic properties of GBS strains, and significantly sooner than COH, CNA, CPS3 and Granada. © 2010 Elsevier B.V.


Poisson D.-M.,Center Hospitalier Regional Orleans | Evrard M.-L.,Center Hospitalier Regional Orleans
Journal of Microbiological Methods | Year: 2012

We used RambaQUICK StrepB in enrichment broth with samples taken from 31 pregnant women and compared its performance to that of standard enrichment media. RambaQUICK StrepB shortened the required incubation time and raised the sensitivity of streptococcal screening by 1.6 fold. © 2012 Elsevier B.V.


Poisson D.-M.,Center Hospitalier Regional Orleans | Evrard M.-L.,Center Hospitalier Regional Orleans | Freneaux C.,Center Hospitalier Regional Orleans | Vives M.-I.,Center Hospitalier Regional Orleans | Mesnard L.,Center Hospitalier Regional Orleans
Journal of Microbiological Methods | Year: 2011

An aerobic chromogenic medium, CHROMagar™ StrepB agar, designed for isolation of group B Streptococci, was evaluated on 285 prepartum vaginal/rectal swabs from pregnant women. After overnight enrichment in Todd-Hewitt broth containing 15 μg/ml nalidixic acid and 10 μg/ml colistin, sensitivities were respectively 79% on day 1 and 92% on day 2, and significantly higher than those achieved by blood agar (40% and 58%) and colimycin-nalidixic-acid agar (82% on day 2). © 2011 Elsevier B.V.


PubMed | Center Hospitalier Regional Orleans
Type: Journal Article | Journal: Journal of microbiological methods | Year: 2011

An aerobic chromogenic medium, CHROMagar StrepB agar, designed for isolation of group B Streptococci, was evaluated on 285 prepartum vaginal/rectal swabs from pregnant women. After overnight enrichment in Todd-Hewitt broth containing 15g/ml nalidixic acid and 10g/ml colistin, sensitivities were respectively 79% on day 1 and 92% on day 2, and significantly higher than those achieved by blood agar (40% and 58%) and colimycin-nalidixic-acid agar (82% on day 2).


PubMed | Center Hospitalier Regional Orleans
Type: Evaluation Studies | Journal: Journal of microbiological methods | Year: 2012

We used RambaQUICK StrepB in enrichment broth with samples taken from 31 pregnant women and compared its performance to that of standard enrichment media. RambaQUICK StrepB shortened the required incubation time and raised the sensitivity of streptococcal screening by 1.6 fold.

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