CHU Ambroise Pare

Boulogne-Billancourt, France

CHU Ambroise Pare

Boulogne-Billancourt, France
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PubMed | Baudour, CHU Sart Tilman, Hopital Civil Marie Curie, Hopital de la Citadelle and 8 more.
Type: Journal Article | Journal: The oncologist | Year: 2016

Cabazitaxel has activity in squamous cell carcinoma of the head and neck (SCCHN) and taxane-resistant cell lines. For the first time, cabazitaxel was investigated in incurable patients with recurrent SCCHN. Patients were randomly assigned to cabazitaxel every 3 weeks or weekly methotrexate.This phase II study did not meet its primary endpoint.Cabazitaxel has low activity in SCCHN.The toxicity profile in this population also was not favorable owing to the high rate of febrile neutropenia observed (17%).Cabazitaxel is a second-generation taxane that improves the survival of patients with metastatic castrate-resistant prostate cancer following docetaxel therapy. Cabazitaxel has activity in squamous cell carcinoma of the head and neck (SCCHN) and taxane-resistant cell lines. In this randomized phase II trial, we investigated cabazitaxel in patients with recurrent SCCHN.Patients with incurable SCCHN with progression after platinum-based therapy were randomly assigned to cabazitaxel every 3 weeks (cycle 1, 20 mg/mOf the 101 patients, 53 and 48, with a median age of 58.0 years (range, 41-80), were randomly assigned to cabazitaxel or methotrexate, respectively. The PFSR at 18 weeks was 13.2% (95% confidence interval [CI], 5%-25%) for cabazitaxel and 8.3% (95% CI, 2%-20%) for methotrexate. The median progression-free survival was 1.9 months in both arms. The median overall survival was 5.0 and 3.6 months for cabazitaxel and methotrexate, respectively. More patients experienced serious adverse events with cabazitaxel than with methotrexate (54% vs. 36%). The most common drug-related grade 3-4 AE in the cabazitaxel arm was febrile neutropenia (17.3%).This study did not meet its primary endpoint. Cabazitaxel has low activity in recurrent SCCHN.

PubMed | CH Saint Jean, CH Meaux, Marseille University Hospital Center, Hoffmann-La Roche and 17 more.
Type: | Journal: European journal of cancer (Oxford, England : 1990) | Year: 2016

Several predictors of metastatic colorectal cancer (mCRC) outcomes have been described. Specific geriatric characteristics could be of interest to determine prognosis.Elderly patients (75+) with previously untreated mCRC were randomly assigned to receive infusional 5-fluorouracil-based chemotherapy, either alone (FU) or in combination with irinotecan (IRI). Geriatric evaluations were included as an optional procedure. The predictive value of geriatric parameters was determined for the objective response rate (ORR), progression-free survival (PFS) and overall survival (OS).From June 2003 to May 2010, the FFCD 2001-02 randomised trial enrolled 282 patients. A baseline geriatric evaluation was done in 123 patients; 62 allocated to the FU arm and 61 to the IRI arm. The baseline Charlson index was 1 in 75%, Mini-Mental State Examinationwas 27/30 in 31%, Geriatric Depression Scalewas >2 in 10% and Instrumental Activities of Daily Living (IADL) was impaired in 34% of the patients. Multivariate analyses revealed that no geriatric parameter was predictive for ORR or PFS. Normal IADL was independently associated with better OS. The benefit of doublet chemotherapy on PFS differed in subgroups of patients 80 years, with unresected primary tumour, leucocytes >11,000mmThe autonomy score was an independent predictor for OS. A trend towarda better efficacy of doublet chemotherapy in some subgroups of patients was reported and should be further explored.

Flurin P.-H.,Clinique du Sport de Bordeaux Merignac | Hardy P.,CHU Ambroise Pare | Abadie P.,Clinique du Sport de Bordeaux Merignac | Desmoineaux P.,HOpital Andre Mignot | And 4 more authors.
Orthopaedics and Traumatology: Surgery and Research | Year: 2013

Introduction: Arthroscopic repair of rotator cuff tears leads to better clinical outcomes than subacromial decompression alone; however the former is rarely proposed to patients above 70. years of age. Our hypothesis was that arthroscopic repair would be superior to decompression in patient 70. years or older. The primary goal was to compare the clinical results obtained with each technique. The secondary goal was to analyze the effects of age, tendon retraction and fatty infiltration on the outcome. Methods: This was a prospective, comparative, randomized, multicenter study where 154 patients were included who were at least 70. years of age. Of the included patients, 143 (70 repair and 73 decompression) were seen at one-year follow-up; these patients had an average age of 74.6. years. Shoulders had a complete supraspinatus tear with extension limited to the upper-third of the infraspinatus and Patte stage 1 or 2 retraction. Clinical outcomes were evaluated with the Constant, ASES and SST scores. Results: All scores improved significantly with both techniques: Constant +33.81 (P<. 0.001), ASES +52.1 (P<. 0.001), SST +5.86 (P<. 0.001). However, repair led to even better results than decompression: Constant (+35.85 vs. +31.8, P<. 0.05), ASES (+56.09 vs. +48.17, P=0.01), SST (+6.33 vs. +5.38, P=0.02). The difference between repair and decompression was not correlated with age; arthroscopic repair was also better in patients above 75. years of age (Constant, ASES and SST scores P<. 0.01). There was no significant correlation between the final outcomes and initial retraction: Constant (P=0.14), ASES (P=0.92), SST (P=0.47). The difference between repair and decompression was greater in patients with stages 0 and 1 fatty infiltration (Constant P<. 0.02) than in patients with stages 2 and 3 fatty infiltration (Constant P<. 0.05). Conclusion: There was a significant improvement in all-clinical scores for both techniques 1. year after surgery. Repair was significantly better than decompression for all clinical outcomes, even in patients above 75. years of age. The difference observed between repair and decompression was greater in patients with more retracted tears and lesser in patients with more severe fatty infiltration. Level of proof: II (prospective, randomized study with low power). © 2013 Elsevier Masson SAS.

PubMed | CHU Ambroise Pare and University Paris - Sud
Type: Journal Article | Journal: The British journal of general practice : the journal of the Royal College of General Practitioners | Year: 2016

Early diagnosis of HIV infection is a major public health issue worldwide. In 2009, the French National Authority for Health (Haute Autorit de Sant) developed specific guidelines and recommended mass screening of 15-70-year-olds across the general population. The guidelines were supported by communication directed at healthcare professionals, especially GPs.To assess the impact of the national mass screening policy on HIV testing.The study used data from the French National Health Insurance Fund database, from January 2006 to December 2013. Males and females aged 15-70 years, excluding HIV-positive individuals and pregnant females, were followed up throughout the 2006-2013 period. During the study period, 2 176 657 person-years and a total of 329 748 different individuals were followed up.Standardised and non-standardised rates of HIV screening were calculated for each year; the impact of the policy was assessed using adjusted segmented regression analyses.Overall, annual HIV screening rates increased over the study period, from 4.2% (95% confidence interval [CI] = 4.2 to 4.3) in 2006 to 5.8% (95% CI = 5.7 to 5.9) in 2013 with a more pronounced trend after 2010 (P<0.0001). This increase was more significant for those who regularly consulted a GP. For these individuals, the policy led to a 20.4% increase (95% CI = 17.0 to 23.8) in HIV screening in 2013 compared with only a 4.5% increase (95% CI = 4.4 to 4.5) for those who did not consult a GP regularly in 2013.The results show that the mass screening policy coordinated by GPs had a significant impact on HIV testing in France, which could result in positive impacts on public and individual health outcomes.

PubMed | CHU Ambroise Pare, French Institute of Health and Medical Research, University of Versailles and Center hospitalier Victor Dupouy
Type: Journal Article | Journal: Annales de dermatologie et de venereologie | Year: 2016

To better understand the potential risk associated with sun exposure during the school year, we decided to evaluate behaviour, risk [UV index (UVI), minimal erythema dose (MED)] and benefits (vitamin-D synthesis) of sun exposure in primary schoolchildren in France, as well as the various sun protection methods used for children.We performed the study on a sunny day (July 24) in a school in Antony (France). Evaluation of UVI (with calculation of MED) and the amount of vitamin D synthesized according to exposed body surface area and phototype were performed every 15minutes from 9 a.m. to 5 p.m. The effects of albedo and shade on UVI were assessed in 8different locations at the school. The sun-protection measures used by the children were systematically evaluated.Fifty-seven children were evaluated; the maximum UVI was 7.2 and the maximum temperature was 30.7C. Irrespective of phototype and clothing, 1MED was reached and an adequate level of vitamin D was synthesized in the skin before midday. Albedo had little impact on irradiation. The amount of protection afforded by shadow varied greatly, with the highest level occurring in the covered courtyard (99.5% reduction of UVI) and the lowest in the shadow of buildings (53.7% reduction of UVI). With strict sun protection measures concerning dress, children reached 1MED before synthesizing 1000IU of vitamin D, but with clothing suited to high temperatures, 1000IU of vitamin D were synthetized before 1MED was reached. Compliance with photoprotection measures was poor. Regardless of duration of exposure during the day (minimal model: two play breaks+lunchtime break) and of skin phototype, at least 1.5MED was reached during the day.This was an experimental study ignoring childrens actual behaviour (movement, sweating, application of sun protection products, etc.). Moreover, due to weather conditions, the study was performed at a recreation centre in July and not during the standard school year.Sun protection campaigns should naturally be directed chiefly towards children for several reasons relating to solar risk and learning. This study shows the complex link between UV, MED, vitamin D as well as the difficulties of implementing solar protection measures in schools in France.

Kany J.,Clinique de lUnion | Flurin P.-H.,Clinique du Sport de Bordeaux Merignac | Richardi G.,Clinique de lUnion | Hardy P.,CHU Ambroise Pare
Orthopaedics and Traumatology: Surgery and Research | Year: 2013

Background: During the symposium held by the French Arthroscopy Society on rotator cuff tears in patients over 70. years of age, the absence of studies into potential specific pathological features in this age group was pointed out. Here, our main objective was to describe magnetic resonance imaging (MRI) findings in this patient population. Hypothesis: Tendons and muscles are smaller, lamellar dissection more prominent, and dystrophic changes more marked in patients over 70. years of age. Material and method: We retrospectively studied 50 patients with isolated supraspinatus tears, including 25 younger than 50 and 25 older than 70. years of age. Tear size and retraction were evaluated according to Patte; tendon thickness, lamellar dissection, and fatty infiltration according to Goutallier; muscle size according to Thomazeau; and the tangent sign according to Zanetti. Results: In contradiction to our study hypothesis, lateral tendon thickness was similar in the two age groups. Medial thickness of the tendon-muscle junction, however, was greater in the younger group. Lamellar dissection was more marked and fatty infiltration more severe in the older group. As expected, marked muscle wasting and a positive tangent sign were noted in over two-thirds of patients in the older group. Conclusion: This preliminary study in a small number of patients identified specific MRI features of supraspinatus tears in patients older than 70. years compared to younger patients. A larger study would be useful to confirm these findings. Level of evidence: Level II. © 2013 Elsevier Masson SAS.

Clavert P.,CCOM CHU Strasbourg | Bouchaib J.,CCOM CHU Strasbourg | Sommaire C.,CCOM CHU Strasbourg | Flurin P.-H.,Clinique du Sport de Bordeaux Merignac | Hardy P.,CHU Ambroise Pare
Orthopaedics and Traumatology: Surgery and Research | Year: 2014

Introduction: There are no published studies on bone density of the greater tuberosity of the humerus, which could influence the stability of reinsertion by suture anchors. The goal of our study was to determine the influence of age, gender and the type of tear on the quality of bone in the greater tuberosity. Methodology: Ninety-eight patients over the age of 60 were included, 41 without a rotator cuff tear and 57 with an isolated stage 1 or 2 supraspinatus tear and fatty infiltration (FI) ≤ 2. The areas of measurement included cancellous bone located under the cortex of the greater tuberosity. Measurements were obtained either across from the tear or from the middle facet with greater tuberosity if the cuff was not torn. We measured average, maximum and minimum bone density and the standard deviation (SD) in each region with Osirix software. Results: The two groups were similar for age (73), investigated side and mean densities (0.282g/cm2 vs 0.210g/cm2). Age over 70 was a predictive factor for osteoporosis of the greater tuberosity whether or not a rotator cuff tear was present (P<0.0001). There was less trabecular bone in women with cuff tears (P=0.009). Stage 2 cuff retraction was predictive of osteoporosis of the greater tuberosity (P=0.0001). Conclusion: This is the first study in the literature to evaluate bone density of the greater tuberosity in relation to the presence or not of a rotator cuff tear in an elderly population. Female gender, age over 70 and stage 2 cuff retraction are factors responsible for osteoporosis of the greater tuberosity of the humeral head. The osteoporosis is not severe, and normally the quality of bone of the greater tuberosity should not limit stability of suture anchors. Level of evidence: 3. © 2014 Elsevier Masson SAS.

Deranlot J.,CHU Ambroise Pare | Flurin P.-H.,Clinique du Sport de Bordeaux Merignac | Hardy P.,CHU Ambroise Pare | Klouche S.,CHU Ambroise Pare
Orthopaedics and Traumatology: Surgery and Research | Year: 2013

Introduction: Whether rotator cuff repair is indicated in an elderly subject depends on the patient's activity profile and functional demand. A Senior Shoulder Activity (SSA) score is described, as a support for indications and analysis of clinical results according to activity level. Material and method: The SSA score, comprising 4 levels from "sedentary" to "very active", was validated by comparison against a control group of 113 asymptomatic patients. It was included in the protocol of the French Arthroscopy Society's comparative study of repair versus simple decompression in 143 rotator cuff tears. Recovery of activity was assessed according to procedure. Results: At 1-year follow-up, suturing was associated with recovery of previous activity level in 87% of the cases and in 80% for decompression, a non-significant difference. When, however, less active patients (SSA 1 and 2) were contrasted with the more active (SSA 3 and 4), clinical results with suture versus decompression on Constant score showed a greater difference in the SSA 3-4 group. Discussion: The SSA score is not the same as the activity item of the Constant score, as it assesses the patient's usual activity level, before symptom onset, whereas the Constant item assesses activity at a given moment, independently of the patient's normal activity profile. Conclusion: The Senior Shoulder Activity score is a simple, reproducible complement to the Constant score, revealing differences in clinical results on the latter, according to activity profile. Rotator cuff repair or simple decompression provided recovery of previous SSA activity level in more than 80% of the cases. The difference in clinical results between the two was significantly greater in more active patients. It would seem to follow that suture is more beneficial for more active subjects while simple decompression may be suitable for those with lower functional demand. Level of evidence II: Prospective, randomized, low-power study. © 2013.

PubMed | Catholic University of Louvain and CHU Ambroise Pare
Type: | Journal: Alcoholism, clinical and experimental research | Year: 2017

Alcohol craving is a major cause of relapse in alcohol-dependent (AD) patients. It is closely related to the high depression and anxiety symptoms that are frequently observed at the early stages of abstinence, and these comorbid symptoms might thus constitute a relapse factor when they persist after detoxification. As these negative affects are known to evolve during the detoxification process, the aim of this study was to investigate the course of the relation between affects and craving during detoxification, with a particular attention given to gender in light of the known differences in affects between AD men and women.AD patients (n=256) undergoing a detoxification program were evaluated for positive (PA) and negative affectivity (NA), depression and anxiety symptoms, and craving, twice within a 3-week interval (on the first [T1] and the eighteenth day [T2] of abstinence).Detoxification course was associated with improvements regarding NA, depression and anxiety symptoms, and craving. Moreover, these negative affects were related to craving intensity. However, for men, the relation was only present at the beginning of detoxification, while, for women, it persisted at the end of detoxification as did high levels of depression. Furthermore, only with women was the level of craving at T2 proportional to negative affects reported at T1, and depression symptoms experienced at T1 were reliable predictors of craving at T2.Given the importance of craving in relapse, special care should be given to improve depressive symptoms in AD women to promote long-term abstinence. Also, the remaining portion of AD women who still exhibit substantial symptoms of anxiety and depression at the end of detoxification could benefit from an integrated treatment simultaneously tackling mood and alcohol-dependence disorders.

PubMed | CHC Saint Joseph, Jolimont Hospital, Catholic University of Louvain, CHU Ambroise Pare and Free University of Colombia
Type: Journal Article | Journal: European journal of nuclear medicine and molecular imaging | Year: 2016

The introduction of targeted drugs has had a significant impact on the approach to assessing tumour response. These drugs often induce a rapid cytostatic effect associated with a less pronounced and slower tumoural volume reduction, thereby impairing the correlation between the absence of tumour shrinkage and the patients unlikelihood of benefit. The aim of the study was to assess the predictive value of early metabolic response (mR) evaluation after one cycle, and its interlesional heterogeneity to a later metabolic and morphological response assessment performed after threecycles in metastatic colorectal cancer (mCRC) patients treated with combined sorafenib and capecitabine.This substudy was performed within the framework of a wider prospective multicenter study on the predictive value of early FDG PET-CT response assessment (SoMore study). A lesion-based response analysis was performed, including all measurable lesions identified on the baseline PET. On a per-patient basis, a descriptive 4-class response categorization was applied based upon the presence and proportion of non-responding lesions. For dichotomic response comparison, all patients with at least one resistant lesion were classified as non-responding.On baseline FDG PET-CT, 124 measurable target lesions were identified in 38 patients. Early mR assessments showed 18 patients (47%) without treatment resistant lesions and 12 patients (32%) with interlesional response heterogeneity. The NPV and PPV of early mR were 85% (35/41) and 84% (70/83), respectively, on a per-lesion basis and 95% (19/20) and 72% (13/18), respectively, on a dichotomized per-patient basis.Early mR assessment performed after one cycle of sorafenib-capecitabine in mCRC is highly predictive of non-response at a standard response assessment time. The high NPV (95%) of early mR could be useful as the basis for early treatment discontinuation or adaptation to spare patients from exposure to non-effective drugs.

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