Dohner H.,University of Ulm |
Lubbert M.,Albert Ludwigs University of Freiburg |
Fiedler W.,University of Hamburg |
Fouillard L.,Center Hospitalier Rene Dubos |
And 14 more authors.
Blood | Year: 2014
Treatment outcomes for older patients with acute myeloid leukemia (AML) have remained dismal. This randomized, phase 2 trial in AML patients not considered suitable for intensive induction therapy compared low-dose cytarabine (LDAC) with orwithout volasertib, a highly potent and selective inhibitor of polo-like kinases. Eighty-seven patients (median age 75 years) received LDAC 20mg twice daily subcutaneously days 1-10 or LDAC + volasertib 350 mg IV days 1 + 15 every 4 weeks. Response rate (complete remission and complete remission with incomplete blood count recovery)was higher for LDAC+volasertib vs LDAC (31.0% vs 13.3%; odds ratio, 2.91; P = .052). Responses in the LDAC + volasertib arm were observed across all genetic groups, including 5 of 14 patients with adverse cytogenetics. Median event-free survival wassignificantly prolonged by LDAC+ volasertib comparedwith LDAC (5.6 vs 2.3 months; hazard ratio, 0.57; 95% confidence interval, 0.35-0.92; P = .021); median overall survival was 8.0 vs 5.2 months, respectively (hazard ratio, 0.63; 95% confidence interval, 0.40-1.00; P5.047). LDAC+ volasertib led to an increased frequency of adverse events that was most pronounced for neutropenic fever/infections and gastrointestinal events; there was no increase in the death rate at days 60 + 90. This study was registered at www.clinicaltrials.gov as #NCT00804856. © 2014 by The American Society of Hematology.
Bismuth V.,General Electric |
Bismuth V.,University Paris Est Creteil |
Vaillant R.,General Electric |
Funck F.,Center Hospitalier Rene Dubos |
And 2 more authors.
Medical Image Analysis | Year: 2011
In this work we propose a comprehensive study of Digital Stent Enhancement (DSE), from the analysis of the requirements to the validation of the proposed solution. First, we derive the stent visualization requirements in the context of the clinical application and workflow. Then, we propose a DSE algorithm combining automatic detection, tracking, registration and contrast enhancement. The most original parts of our solution: landmark segmentation and non-linear image registration are detailed. Finally, we validate the algorithm on a large number of synthetic and clinical cases. Performance is characterized in terms of automation, image quality and execution time. This work is, to the best of our knowledge, the first comprehensive article on DSE, covering problem statement, proposed solution, and validation strategies. © 2011 Elsevier B.V.
The practices of withdrawing artificial nutrition and hydration in the neonatal intensive care unit: A preliminary study [Étude pilote sur les pratiques de larrêt de la nutrition/hydratation artificielle en réanimation néonatale]
Beranger A.,University of Paris Descartes |
Boize P.,Center hospitalier Rene Dubos |
Viallard M.-L.,University of Paris Descartes
Archives de Pediatrie | Year: 2014
Introduction: Prematurity is one of the etiologies for severe neurological complications. Decisions to withdraw therapeutics, including artificial nutrition and hydration (ANH), are sometimes discussed. But can one withdraw ANH if the patient is a child suffering from severe neurological conditions, based on his best interests? The aim of this study was to further the understanding of the complexity of the withdrawal of ANH and its implementation in the neonatal intensive care unit (NICU). Method: This qualitative preliminary study based on a questionnaire was conducted on the staff in the NICU of the Pontoise medical center (France) in February 2012. The results were compared with the current knowledge on this issue and sociological data. Results: Ten of the hospital staff members responded to the questionnaire: 60% considered ANH as a treatment, but the status of ANH (i.e., treatment or care) remained undefined for several respondents. Comparison with the withdrawal of mechanical ventilation or adult practices seemed to be inadequate. The staff had little experience in the domain and therefore few certainties on practices. Half of the respondents indicated that terminal sedation needed to be used. For the other half, it depended on the patient's pain. Timing was also an important notion given that the newborn is a being developing and evolving each in its own way. Conclusion: The withdrawal of ANH remains controversial in the NICU. Humanity, culture, and the relationship to others are ever present in the decision-making process, creating a moral opposition above and beyond ethical reflection. © 2013 Elsevier Masson SAS.
Devalois B.,Center hospitalier Rene Dubos |
Puybasset L.,Hopital Pitie Salpetriere
Presse Medicale | Year: 2016
New French 2016' Act recognizes 3 new rights for patients at the end of their life: right to dead without futilities, right to have their wishes respected and right to be comfortable in all circumstances.Medical acts must not be continued in an unreasonable way. Futility is defined by useless, disproportionate or without another aim that an artificial life sustaining acts.For patients who cannot tell their wishes, a withdrawing or withholding decision of life sustaining treatments can be taken with a collegiate process.Doctors must always care about patient comfort with palliative care. Artificial hydration and nutrition can be considered as futile.Patients can write advanced directives or design confidence person to attest their wishes if they should be unable to do it.Doctors must respect advanced directives, except in emergency cases or if there are inappropriate. In such cases, the decision not to respect advanced directives must be taken collegially.Sedation is a therapeutic solution to alleviate refractory suffering for patients at the end of life, even if there is a risk to shorten their life, if the aim is to make patient comfortable and if it is the only way to achieve this goal.A specific right to deep and continuous sedation until death is created, only for patients with a short life prognosis (for. hours to days). It is an exceptional practice with very strict conditions including a collegiate deliberation including non-medical team members.If they wish, patients at the end of life should be cared at home with comfort treatments if needed. Referent doctor must inform patients about their rights. An initial and continuous formation on this field is required.For every decision, it is important to keep a record in the patient chart. If not, it will be a fault. © 2016 Elsevier Masson SAS.
Perret A.,Center hospitalier Rene Dubos
Neuropsychiatrie de l'Enfance et de l'Adolescence | Year: 2013
Adolescence can be viewed as to either a specific period of time introducing a sudden break into previous development or a critical moment of developmental tuning-in. Psychoanalysis considers adolescence as an auspicious moment during which the unconscious and its psychodynamics can be revealed. As such, the period of adolescence represents a particular clinical phase speaking each time of a unique history made of the desire that brings the adolescent face to face with the actuality of castration, and exposes him or her to major signifiers. As far as adolescence mobilizes founding psychodynamic processes, it can be considered as a critical " border period" characterized by continuous remodeling. Hence, a psychotic breakdown at this age can either spontaneously resolve or turn out to mark the beginning of a full-blown adult psychosis. In this article, two clinical vignettes will be used to show that, by metaphorizing parental identifications, adolescence plays a key role in symbolization processes. © 2013.
Devalois B.,Center hospitalier Rene Dubos
Annales Francaises d'Anesthesie et de Reanimation | Year: 2014
For the last 20 years or so, conflicts on life-support have become the object of widespread media coverage. By focusing public opinion on the alleged physicians' unreasonable obstinacy, these publicized cases impact social debates on life-support. By these, they justify claims for the legalization of assisted suicide, specifically the practice of termination of life by lethal injection. Via a conducted survey of the various caretakers and families involved in this type of situation, we propose an analysis based on the different forms of unreasonable obstinacy. The reasonable or unreasonable nature of treatments can often be perceived differently by physicians, caretakers and families. At least 6 unreasonable obstinacy cases can be brought to light. Publicized cases always involve a conflict between the physicians in charge and the families who view the situation as unreasonable. Nonetheless, evidence shows that in these situations, the roles are often reversed, and the families are the ones demanding the use of unreasonable care. A typical example of this is a recent case that became the object of legal proceedings in France. As it turns out, the publicized filter does not reflect the true reality of cases involving unreasonable care. Specific procedures could aid in notifying the existence of such situations. The role of health care professionals (excluding physicians) appears to play an essential part in preventing these situations from happening. © 2013.
Psychiatric symptoms of a paraneoplastic anti-N-methyl-D-aspartate receptor encephalitis: A case report [Symptômes psychiatriques dune encéphalite paranéoplasique anticorps antirécepteurs NMDA : propos dun cas]
Le Foll J.,Center Hospitalier Rene Dubos |
Pelletier A.,Center Hospitalier Rene Dubos
Encephale | Year: 2010
Introduction: We describe the case of a young woman affected by a benign ovarian teratoma with paraneoplastic encephalitis. Several cases have already been reported, but it is the first article that focuses on details of the psychiatric symptoms of this disorder. Background: Paraneoplastic encephalitis usually begins with a prodromal phase, followed first by prominent psychiatric symptoms or, less frequently, short-term memory loss, seizure, catatonia-like symptoms, dyskynesias and, secondly, by autonomic instability and central hypoventilation requiring intensive care. In our case and to our knowledge, for the first time in the literature, the patient was hospitalized in a psychiatric unit for a suspected manic episode with psychotic features, in association with short-term memory impairment and anxiety. It has been shown that patients suffering from paraneoplastic encephalitis associated with ovarian teratoma display antibodies for anti-N-methyl-D-aspartate (NMDA) receptors in CSF or plasma (more specifically for the NR1 subunit of the NRl/NR2 heteromers required to form a functional NMDA receptor). The NR1/NR2B heteromers are preferentially expressed in the adult hippocampus/forebrain, which are brain regions involved in the pathogenesis of various psychiatric, psychotic in particular, symptoms. Furthermore, the glutamatergic NMDA receptors are the major mediator of excitotoxicity and their dysfunction had been associated with neurologic disorders, but also with schizophrenia and, more recently, with mood disorders. Case report: This case supports the idea that the dysfunction of NMDA receptors may play a major role in psychiatric disorders, especially in psychosis and affective disorders. This article will briefly summarize the different evidences and hypotheses reported in the literature on NMDA receptors implication and will report how these receptors may serve as therapeutic targets. © 2009 LEncéphale, Paris.
Broughton A.,Catholic University of Louvain |
Verger C.,Center Hospitalier Rene Dubos |
Goffin E.,Catholic University of Louvain
Seminars in Dialysis | Year: 2010
Infectious peritonitis is still a major concern in peritoneal dialysis (PD). Standard antibiotic regimens target common causative microorganisms such as Staphylococcus aureus and epidermidis or Pseudomonas aeruginosa. When the infection does not respond, unusual infective agents are to be considered including zoonoses-infections with an animal source. Companion animals or occupations involving animal contact favor the development of zoonoses, especially for immunocompromised patients such as those with end-stage renal disease. We reviewed the literature for all animals-related peritonitis in PD and analyzed data from our own PD unit and from the French-speaking registry for peritoneal dialyis (RDPLF) to assess both the frequency and the potential risk for PD patients in owning a pet or to working with animals. In a literature search, we identified 124 cases of PD peritonitis caused by 12 different zoonotic agents. Animals were involved in 24% of the cases. Overall mortality rate was 13.5% and Tenckhoff catheters had to be removed in 27% of the cases. The results from RDPLF analysis show that zoonotic microorganisms were responsible for 0.54% of the peritonitis episodes (51 out of a total of 9433 during a 9-year period). In our unit, zoonotic microorganisms were responsible for 0.03% of the peritonitis episodes (four out of a total of 128 during a 9-year period). Considering those results, some specific treatment recommendations can be made, but the major factor still remains prevention, by insisting on strict hygenic measures when a PD patient owns a pet. © 2010 Wiley Periodicals, Inc.
Pantalone L.,Center Hospitalier Rene Dubos |
Lambert A.,Center Hospitalier Rene Dubos
Soins Pediatrie/Puericulture | Year: 2016
The use of an insulin pump in the treatment of diabetes in children has constantly increased over the last 15 years. This intensive form of treatment results in better glycaemic control, the disappearance of severe hypoglycaemic episodes and greater comfort. The quality of life of the patients and their family is thereby vastly improved. © 2015 Elsevier Masson SAS.
Cani P.,Center Hospitalier Rene Dubos
Soins Psychiatrie | Year: 2014
The increasing activity of mental health centres for children and adolescents and longer waiting times in obtaining a first appointment have led an area of child psychiatry to question the organisation of new consultation applications. Two CMP in the sector had a waiting period of over 40 days for half of the patients. Two improvement actions were implemented: the implementation of organisation and reception nurses and the development of a new applications management process. The evaluation after one year showed a decrease of half of the appointment waiting time without changing the non showed up rate. © 2014 Elsevier Masson SAS.