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Saint-André-lez-Lille, France

The orthopedic surgical treatment of metastases is very important in the treatment of osteophile cancers. The surgical option is always proposed after a multidisciplinary decision. The main risk of the metastases is the pathological fracture. This risk has to be evaluated and a preventive treatment can often be performed. The surgical options are multiple: such as preventive osteosynthesis, pathological fracture treatment, reconstruction with prosthesis, carcinological excision.̇̇ The choice of the treatment is support on the life expectancy and the functional risk of the metastatic bone lesion. Source

Bourgault C.,Orthopedics Unit A | Vervoort T.,Orthopedics Unit A | Szymanski C.,Orthopedics Unit A | Chastanet P.,CHRU de Lille | Maynou C.,Orthopedics Unit A
Orthopaedics and Traumatology: Surgery and Research | Year: 2014

Introduction: Osteoid osteoma is a painful, benign bone tumor that mainly affects young people. Thermocoagulation is one of the recommended percutaneous treatment methods. This study sought to assess its efficacy and identify risk factors for osteoma recurrence. Methods: Results were analyzed retrospectively for a group of 87 patients treated by thermocoagulation between 2002 and 2011. The recurrence rate was calculated and analyzed relative to patient and tumor characteristics. The treatment efficacy was determined and methods to prevent complications were analyzed. Results: The mean follow-up time was 34 months. The average patient age was 23 years. There were seven complications including three patients with delayed wound healing, mainly at tibial sites. The recurrence rate was 10.4%. The success rate for first-line treatment was 89.6% and it was 97.5% for second-line treatment. Analysis of patient characteristics and tumor locations revealed no risk factors for recurrence. Conclusion: Percutaneous thermocoagulation is a reliable and effective technique that provides fast, long-lasting pain relief. However recurrence can occur even after the nidus is completely resected. These recurrences can be effectively managed by repeat treatment. Recent technical improvements have reduced the risk of thermocoagulation-related complications. Level of evidence: IV. © 2014 Elsevier Masson SAS. Source

Zeymer U.,Herzzentrum Ludwigshafen | Zeymer U.,Institute Fr Herzinfarktforschung Ludwigshafen | Margenet A.,CHU Henri Mondor | Haude M.,Lukas Krankenhaus Neuss | And 9 more authors.
Journal of the American College of Cardiology | Year: 2010

Objectives: The aim of this study was to compare eptifibatide and abciximab as adjuncts to primary percutaneous coronary intervention (PCI). Background: The glycoprotein (GP) IIb/IIIa receptor inhibitor abciximab as adjunct to primary PCI in patients with ST-segment elevation myocardial infarctions has been shown to reduce ischemic complications and improve clinical outcomes. So far, no trial has been performed to compare the efficacy of another GP IIb/IIIa receptor inhibitor, eptifibatide, and abciximab in primary PCI. Methods: A total of 427 patients with ST-segment elevation myocardial infarctions <12 h and planned primary PCI were randomized to double-bolus eptifibatide (n = 226) followed by a 24-h infusion or single-bolus abciximab (n = 201) followed by a 12-h infusion. In this noninferiority trial, the primary end point was the incidence of complete (<70%) ST-segment resolution (STR) 60 min after PCI, a measure of myocardial reperfusion. The assumption was a 60% complete STR rate in the abciximab group. The noninferiority margin was set to 15%. Results: The incidence of complete STR at 60 min after PCI in the intention-to-treat analysis was 62.6% after eptifibatide and 56.3% after abciximab (adjusted difference: 7.1%; 95% confidence interval: 2.7% to 17.0%). All-cause mortality 6.2% versus 4.5% (p = 0.50); reinfarction 0.4% versus 3.5% (p = 0.03); target vessel revascularization 4.4% versus 6.5% (p = 0.40); the combined end point of death, nonfatal reinfarction, and target vessel revascularization 10.6% versus 10.9% (p = 0.90); stroke 0.5% versus 0.5% (p = 1.00) after 6 months; and Thrombolysis In Myocardial Infarction major bleeding complications 4.0% versus 2.0% (p = 0.20) after 30 days were observed after eptifibatide and abciximab, respectively. Conclusions: Eptifibatide as an adjunct to primary PCI is equally as effective as abciximab with respect to STR. (Efficacy of Eptifibatide Compared to Abciximab in Primary Percutaneous Coronary Intervention [PCI] for Acute ST Elevation Myocardial Infarction [STEMI]; NCT00426751) © 2010 American College of Cardiology Foundation. Source

Masson R.,Caen University Hospital Center | Colas V.,CHRU de Lille | Parienti J.-J.,Caen University Hospital Center | Parienti J.-J.,University Paris Diderot | And 5 more authors.
Resuscitation | Year: 2012

Background: The use of extracorporeal life support (ECLS) as a treatment for severe cardiovascular impairment due to poisoning is unclear. Therefore, we conducted a retrospective cohort analysis to compare survival among critically ill poisoned patients treated with or without ECLS. Methods: All consecutive patients admitted into 2 university hospitals in northwestern France over the past decade for persistent cardiac arrest or severe shock following poisoning due to drug intoxication were included. ECLS was preferentially performed in 1 of the 2 centers. Results: Sixty-two patients (39 women, 23 men; mean age 48 ± 17 years) fulfilled inclusion criteria: 10 with persistent cardiac arrest and 42 with severe shock. Fourteen patients were treated with ECLS and 48 patients with conventional therapies. All subjects received vasopressor and fluid loading. Patients treated with or without ECLS at ICU admission had comparable drug ingestion histories, Simplified Acute Physiology Score (SAPS II score) (66 ± 18), Sequential Organ Failure Assessment (SOFA) score (median: 11 [IQR, 9-13]), Glasgow Coma Scale score (median: 3 [IQR, 3-11]), need for ventilator support (n=56) and extra renal support (n=23). Thirty-five (56%) patients survived: 12/14 (86%) ECLS patients and 23/48 (48%) non-ECLS patients (p=0.02, by Fisher exact test). None of the patients with persistent cardiac arrest survived without ECLS support. Based on admission data, beta-blocker intoxication (p=0.02) was also associated with lower mortality. In multivariate analysis, adjusting for SAPS II and beta-blocker intoxication, ECLS support remained associated with lower mortality [Adjusted Odds Ratio, 0.18; 95% CI, 0.03-0.96; p=0.04]. Conclusion: In the absence of response to conventional therapies, we consider that ECLS may improve survival in critically ill poisoned patients experiencing cardiac arrest and severe shock. © 2012 Elsevier Ireland Ltd. Source

Collet J.-P.,Institut Universitaire de France | Silvain J.,Institut Universitaire de France | Barthelemy O.,Institut Universitaire de France | Range G.,Les Hopitaux de Chartres | And 20 more authors.
The Lancet | Year: 2014

Background: Optimum duration of dual antiplatelet treatment (DAPT) after coronary stenting remains uncertain, with an unknown efficacy to safety ratio of extended treatment leading to discrepancies between international guidelines and clinical practice. We assessed whether DAPT continuation beyond 1 year after coronary stenting is beneficial. Methods: This analysis was a planned extension of the previously published ARCTIC-Monitoring trial, in which we randomly allocated 2440 patients to a strategy of platelet function testing with antiplatelet treatment adjustment or a conventional strategy after coronary stenting with drug-eluting stent (DES). We recruited patients (aged 18 years or older) scheduled for planned DES implantation at 38 centres in France. After 1 year of follow-up, patients without contraindication to interruption of DAPT were eligible for a second randomisation to this second phase of the study (ARCTIC-Interruption). Using a computer-generated randomisation sequence (1:1; stratified by centre), we allocated patients to a strategy of interruption of DAPT where the thienopyridine was interrupted and single aspirin antiplatelet treatment was maintained (interruption group) or a strategy of DAPT continuation for 6-18 months (continuation group). The primary endpoint was the composite of death, myocardial infarction, stent thrombosis, stroke, or urgent revascularisation, analysed by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00827411. Findings: Between Jan 4, 2011, and March 3, 2012, 1259 eligible patients were randomly allocated to treatment in ARCTIC-Interruption: 624 to the interruption group and 635 to the continuation group. After a median follow-up of 17 months (IQR 15-18), the primary endpoint occurred in 27 (4%) patients in the interruption group and 24 (4%) patients in the continuation group (hazard ratio [HR] 1·17 [95% CI 0.68-2.03]; p=0.58). STEEPLE major bleeding events occurred more often in the continuation group (seven [1%] patients) compared with the interruption group (one [<0.5%] patient; HR 0.15 [0.02-1.20]; p=0.073). Major or minor bleedings were also more common in the continuation group compared with the interruption group (12 [2%] patients vs three [1%] patients; HR 0.26 [0.07-0.91]; p=0.04). Interpretation: Our finding suggests no apparent benefit but instead harm with extension of DAPT beyond 1 year after stenting with DES when no event has occurred within the first year after stenting. No conclusion can be drawn for high-risk patients who could not be randomised. The consistency between findings from all trials of such interruption suggests the need for a reappraisal of guidelines for DAPT after coronary stenting towards shorter duration of treatment. Funding: Allies in Cardiovascular Trials Initiatives and Organized Networks (ACTION Study Group), Fondation de France, Sanofi-Aventis, Cordis, Medtronic, Boston Scientific, Fondation SGAM. Source

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