Clermont-Ferrand, France
Clermont-Ferrand, France

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Khellaf M.,University Paris Est Creteil | Charles-Nelson A.,University Paris Est Creteil | Fain O.,University of Paris 13 | Terriou L.,Lille University Hospital Center | And 21 more authors.
Blood | Year: 2014

We conducted a prospective multicenter registry of 248 adult patients with immune thrombocytopenia (ITP) treated with rituximab to assess safety. We also assessed response and predictive factors of sustained response. In total, 173 patients received 4 infusions of 375 mg/m2 and 72 received 2 fixed 1-g infusions 2 weeks apart. The choice of the rituximab regimen was based on the physician's preference and not patient characteristics. Overall, 38 patients showed minor intolerance to rituximab infusions; infusions had to be stopped for only 3 patients. Seven showed infection (n = 11 cases), with an incidence of 2.3 infections/100 patient-years. Three patients died of infection 12 to 14 months after rituximab infusions, but the role of rituximab was questionable. In total, 152 patients (61%) showed an overall initial response (platelet count ≥30 x 109/L and ≥2 baseline value). At a median follow-up of 24 months, 96 patients (39%) showed a lasting response. On multivariate analysis, the probability of sustained response at 1 year was significantly associated with ITP duration <1 year (P = .02) and previous transient complete response to corticosteroids (P = .05). The pattern of response was similar with the 2 rituximab regimens. With its benefit/risk ratio, rituximab used off-label may remain a valid option for treating persistent or chronic ITP in adults. This trial was registered at www.clinicaltrials.gov as #NC1101295. © 2014 by The American Society of Hematology.


Comarmond C.,University of Paris Descartes | Pagnoux C.,University of Paris Descartes | Pagnoux C.,Sinai University | Khellaf M.,University Paris Est Creteil | And 23 more authors.
Arthritis and Rheumatism | Year: 2013

Objective Earlier studies of eosinophilic granulomatosis with polyangiitis (Churg-Strauss) (EGPA), with limited patient numbers and followup durations, demonstrated that clinical presentation at diagnosis, but not outcome, differed according to antineutrophil cytoplasmic antibody (ANCA) status. This study was undertaken to describe the main characteristics of a larger patient cohort and their long-term outcomes. Methods A retrospective study of EGPA patients in the French Vasculitis Study Group cohort who satisfied the American College of Rheumatology criteria and/or Chapel Hill definitions was conducted. Patient characteristics and outcomes were compared according to ANCA status and year of diagnosis. Results We identified 383 patients diagnosed between 1957 and June 2009 (128 [33.4%] before 1997 or earlier) and followed up for a mean ± SD of 66.8 ± 62.5 months. At diagnosis, their mean ± SD age was 50.3 ± 15.7 years, and 91.1% had asthma (duration 9.3 ± 10.8 years). Main manifestations included peripheral neuropathy (51.4%); ear, nose, and throat (ENT) signs (48.0%); skin lesions (39.7%); lung infiltrates (38.6%); and cardiomyopathy (16.4%). Among the 348 patients tested at diagnosis for ANCA, the 108 ANCA-positive patients (31.0%) had significantly more frequent ENT manifestations, peripheral neuropathy, and/or renal involvement, but less frequent cardiac manifestations, than the ANCA-negative patients. Vasculitis relapses occurred in 35.2% of the ANCA-positive versus 22.5% of the ANCA-negative patients (P = 0.01), and 5.6% versus 12.5%, respectively, died (P < 0.05). The 5-year relapse-free survival rate was 58.1% (95% confidence interval [95% CI] 45.6-68.6) for ANCA-positive and 67.8% (95% CI 59.8-74.5) for ANCA-negative patients (P = 0.35). Multivariable analysis identified cardiomyopathy, older age, and diagnosis during or prior to 1996 as independent risk factors for death and lower eosinophil count at diagnosis as predictive of relapse. Conclusion The characteristics and long-term outcomes of EGPA patients differ according to their ANCA status. Although EGPA relapses remain frequent, mortality has declined, at least since 1996. Copyright © 2013 by the American College of Rheumatology.


Mortensen K.,University Hospital of Northern Norway | Nilsson M.,Karolinska University Hospital | Slim K.,Center Hospitalier University Estaing | Schafer M.,University of Lausanne | And 6 more authors.
British Journal of Surgery | Year: 2014

Background Application of evidence-based perioperative care protocols reduces complication rates, accelerates recovery and shortens hospital stay. Presently, there are no comprehensive guidelines for perioperative care for gastrectomy. Methods An international working group within the Enhanced Recovery After Surgery (ERAS®) Society assembled an evidence-based comprehensive framework for optimal perioperative care for patients undergoing gastrectomy. Data were retrieved from standard databases and personal archives. Evidence and recommendations were classified according to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system and were discussed until consensus was reached within the group. The quality of evidence was rated 'high', 'moderate', 'low' or 'very low'. Recommendations were graded as 'strong' or 'weak'. Results The available evidence has been summarized and recommendations are given for 25 items, eight of which contain procedure-specific evidence. The quality of evidence varies substantially and further research is needed for many issues to improve the strength of evidence and grade of recommendations. Conclusion The present evidence-based framework provides comprehensive advice on optimal perioperative care for the patient undergoing gastrectomy and facilitates multi-institutional prospective cohort registries and adequately powered randomized trials for further research. Best available evidence for these patients © 2014 BJS Society Ltd. Published by John Wiley & Sons Ltd.


PubMed | Center Hospitalier University Estaing, Montpellier University and Academie Nationale de Medecine
Type: | Journal: European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society | Year: 2016

Thoraco-lumbo-sacral orthosis (TLSO) is an effective treatment in adolescent idiopathic scoliosis (AIS) patients, but cervical sagittal alignment (CSA) variations after bracing have never been evaluated. The purpose of this study was to assess changes in CSA before, during and after TLSO treatment, and to determine whether patients developed cervical pain.This was a retrospective study in 38 AIS patients (33 females; mean age 10.8years) treated by TLSO. Patients were Risser 0 (n=34) or 1 (n=4). Major curve deformity (MC) in the coronal plane and cervical (CSA), thoracic (TSA) and lumbar (LSA) sagittal alignment were evaluated radiographically at start of treatment (t The TLSO was worn for an average of 4.6years. Mean CSA, TSA and LSA were significantly lower at t The TLSO can control progression of the deformity in the frontal plane, but it influences CSA, TSA and LSA. In particular, it decreases cervical spine lordosis, with reduction maintained 1year after the end of treatment. Numerical differences, although statistically significant, were not clinically relevant.


Shah H.,Kasturba Medical College | Rousset M.,Center Hospitalier University Estaing | Canavese F.,Center Hospitalier University Estaing
Indian Journal of Orthopaedics | Year: 2012

Congenital pseudarthrosis of the tibia (CPT) is a rare pathology, which is usually associated with neurofibromatosis type I. The natural history of the disease is extremely unfavorable and once a fracture occurs, there is a little or no tendency for the lesion to heal spontaneously. It is challenging to treat effectively this difficult condition and its possible complications. Treatment is mainly surgical and it aims to obtain a long term bone union, to prevent limb length discrepancies, to avoid mechanical axis deviation, soft tissue lesions, nearby joint stiffness, and pathological fracture. The key to get primary union is to excise hamartomatous tissue and pathological periosteum. Age at surgery, status of fibula, associated shortening, and deformities of leg and ankle play significant role in primary union and residual challenges after primary healing. Unfortunately, none of invasive and noninvasive methods have proven their superiority. Surgical options such as intramedullary nailing, vascularized fibula graft, and external fixator, have shown equivocal success rate in achieving primary union although they are often associated with acceptable results. Amputation must be reserved for failed reconstruction, severe limb length discrepancy and gross deformities of leg and ankle. Distinct advantages, complications, and limitation of each primary treatment as well as strategies to deal with potential complications have been described. Each child with CPT must be followed up till skeletal maturity to identify and rectify residual problems after primary healing.


Bui-nguyen B.,Institute Bergonie | Ray-coquard I.,Center Leon Berard | Chevreau C.,Institute Claudius Regaud | Penel N.,Center Oscar Lambret | And 10 more authors.
Annals of Oncology | Year: 2012

Background: Metastatic soft tissue sarcoma (STS) prognosis remains poor and few cytotoxic agents offer proven efficacy. This randomized open phase III study examines whether high-dose (HD) chemotherapy with peripheral blood stem cells (PBSCs) could improve overall survival (OS) of chemosensitive patients. Patients and methods: Advanced STS patients aged 18-65 years received four courses of standard mesna, adryamycin, ifosfamide and dacarbazine (MAID) treatment. Chemotherapy-responding patients and patients with at least stable disease amenable to complete surgical resection were randomized to receive standard dose (SD) with two successive MAID cycles or HD treatments of one MAID then MICE intensification: mesna (3.6 g/m 2, day 1-5), ifosfamide (2.5 g/m 2, day 1-4), carboplatin [area under the curve (AUC) 5/day 2-4] and etoposide (300 mg/m 2, day 1-4) with PBSC reinjection at day 7. Results: From 2000 to 2008, 207 patients received four cycles of MAID and 87 assessable patients were randomly assigned to receive the following: 46 SD, 41 HD, with 45 and 38 maintained for analyses after secondary centralized histological review. Futility analyses led to study closure in November 2008. Three-year OS was 49.4% for the SD group versus 32.7% for HD arm, hazard ratio= 1.26, 95% confidence interval 0.70-2.29; progression-free survival was 32.4% and 14.0%, respectively. HD treatment led to higher grades 3-4 toxicity. Conclusion: This study failed to show an OS advantage for advanced STS patients treated with dose-intensified chemotherapy with PBSC. © The Author 2011. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved.


De Bennetot M.,Center Hospitalier University Estaing | Rabischong B.,Center Hospitalier University Estaing | Aublet-Cuvelier B.,University Gabriel Montpied | Belard F.,University Gabriel Montpied | And 4 more authors.
Fertility and Sterility | Year: 2012

Objective: To assess the reproductive outcome after an ectopic pregnancy (EP) based on the type of treatment used, and to identify predictive factors of spontaneous fertility. Design: Observational population based-study. Setting: Regional sistry. Patient(s): One thousand sixty-four women registered from 1992 to 2008. Intervention(s): Laparoscopic (radical or conservative), or medical treatment. Main Outcome Measure(s): Epidemiologic characteristics, clinical presentation, treatments performed, reproductive outcome, recurrence. Result(s): The 24-month cumulative rate of intrauterine pregnancy (IUP) was 67% after salpingectomy, 76% after salpingostomy, and 76% after medical treatment. IUP rate was lower after radical treatment compared with conservative treatments in univariable analysis. In multivariate analysis, IUP rate was significantly lower for patients >35 years old or with history of infertility or tubal disease. For them, IUP rate was significantly higher after conservative treatment compared with salpingectomy. The 2-year cumulative rate of recurrences was 18.5% after salpingostomy or salpingectomy and 25.5% after medical treatment. History of infertility or of previous live birth would be protective, in contrast to history of voluntary termination of pregnancy. Conclusion(s): Conservative strategy seems to be preferred, whenever possible, to preserve patients' fertility without increasing the risk of recurrence. The choice between conservative treatments does not rely on subsequent fertility, but more likely on their own indications and therapeutic effectiveness. Risk factors of recurrence could be considered for secondary prevention. Copyright © 2012 American Society for Reproductive Medicine, Published by Elsevier Inc.


Dimeglio A.,Montpellier University | Canavese F.,Center Hospitalier University Estaing
Orthopedic Clinics of North America | Year: 2011

Imaging in Legg-Calvé-Perthes disease should help assess the severity and the stage of the disease, detect severe forms earlier, and provide guidance to therapy. However, due to the complexity of the disease, not all examinations can be performed at the same time with the same goals. The scope of this work is to provide an overview of all imaging techniques available today, and to help understand when to use a particular examination. Advantages and limitations of plain radiographs, bone scintigraphy, magnetic resonance imaging, arthrography, computed tomography, and ultrasonography are identified. © 2011 Elsevier Inc.


Dimeglio A.,Montpellier University | Canavese F.,Center Hospitalier University Estaing
European Spine Journal | Year: 2012

Purpose This article aims to provide an overview of how spinal deformities can alter normal spine and thoracic cage growth. Methods Some of the data presented in this article are gathered from studies performed in 1980 and 1990, and their applicability to populations of different ethnicity, geography or developmental stage has not yet been elucidated. In the present article, older concepts have been integrated with newer scientific data available to give the reader the basis for a better understanding of both normal and abnormal spine and thoracic cage growth. Results A thorough analysis of different parameters, such as weight, standing and sitting height, body mass index, thoracic perimeter, arm span, T1-S1 spinal segment length, and respiratory function, help the surgeon to choose the best treatment modality. Respiratory problems can develop after a precocious vertebral arthrodesis or as a consequence of pre-existing severe vertebral deformities and can vary in patterns and timing, according to the existing degree of deformity. The varying extent of an experimental arthrodesis also affects differently both growth and thoracopulmonary function. Conclusions Growth is a succession of acceleration and deceleration phases and a perfect knowledge of normal growth parameters is mandatory to understand the pathologic modifications induced on a growing spine by an early onset spinal deformity. The challenges associated with the growing spine for the surgeon include preservation of the thoracic spine, thoracic cage, and lung growth without reducing spinal motion. © 2011 Springer-Verlag.


Canavese F.,Center hospitalier University Estaing | De Coulon G.,Hopitaux Universitaires Of Geneva
Orthopaedics and Traumatology: Surgery and Research | Year: 2014

The aim of this study was to describe the surgical technique of and indications for percutaneous pelvic osteotomy in patients with severe cerebral palsy. Forty non-ambulatory children and adolescents (47 hips) were consecutively treated with percutaneous pelvic osteotomy. The mean preoperative Reimers' migration percentage improved from 66.2% to 4.9% at the final follow-up. The mean preoperative acetabular angle (AA) improved from 32.4° to 13.2° at last follow-up. Percutaneous pelvic osteotomy is a less invasive surgical approach and appears to be a valid option with similar outcomes to standard techniques.This method results in less muscle stripping and blood loss and a shorter operating time. © 2014 Elsevier Masson SAS.

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