CHU Bicetre

Le Touquet – Paris-Plage, France

CHU Bicetre

Le Touquet – Paris-Plage, France
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PubMed | Center Francois Baclesse, McGill University, Institute Paoli Calmettes, Lyon University Hospital Center and 13 more.
Type: Journal Article | Journal: Annals of oncology : official journal of the European Society for Medical Oncology | Year: 2016

Dynamic contrast-enhanced ultrasonography (DCE-US) has been used for evaluation of tumor response to antiangiogenic treatments. The objective of this study was to assess the link between DCE-US data obtained during the first week of treatment and subsequent tumor progression.Patients treated with antiangiogenic therapies were included in a multicentric prospective study from 2007 to 2010. DCE-US examinations were available at baseline and at day 7. For each examination, a 3 min perfusion curve was recorded just after injection of a contrast agent. Each perfusion curve was modeled with seven parameters. We analyzed the correlation between criteria measured up to day 7 on freedom from progression (FFP). The impact was assessed globally, according to tumor localization and to type of treatment.The median follow-up was 20 months. The mean transit time (MTT) evaluated at day 7 was the only criterion significantly associated with FFP (P = 0.002). The cut-off point maximizing the difference between FFP curves was 12 s. Patients with at least a 12 s MTT had a better FFP. The results according to tumor type were significantly heterogeneous: the impact of MTT on FFP was more marked for breast cancer (P = 0.004) and for colon cancer (P = 0.025) than for other tumor types. Similarly, the differences in FFP according to MTT at day 7 were marked (P = 0.004) in patients receiving bevacizumab.The MTT evaluated with DCE-US at day 7 is significantly correlated to FFP of patients treated with bevacizumab. This criterion might be linked to vascular normalization.2007-A00399-44.

To guide nosology and classification of patients with eosinophilic granulomatosis with polyangiitis (EGPA) based on phenotype and presence or absence of ANCA.Organ manifestations and ANCA status were retrospectively analyzed based on the presence or not of predefined definite vasculitis features or surrogates of vasculitis in patients asthma, eosinophilia, and at least one systemic organ manifestation attributable to systemic disease.The study population included 157 patients (mean age 49.414.1), with a follow-up of 7.46.4years. Patients with ANCA (31%) more frequently had weight loss, myalgias, arthralgias, biopsy-proven vasculitis, glomerulonephritis on biopsy, hematuria, leukocytoclastic capillaritis and/or eosinophilic infiltration of arterial wall on biopsy, and other renal disease. A total of 41% of patients had definite vasculitis manifestations (37%) or strong surrogates of vasculitis (4%), of whom only 53% had ANCA. Mononeuritis multiplex was associated with systemic vasculitis (p=0.005) and with the presence of ANCA (p<0.001). Overall, 59% of patients had polyangiitis as defined by definite vasculitis, strong surrogate of vasculitis, mononeuritis multiplex, and/or ANCA with at least one systemic manifestation other than ENT or respiratory. Patients with polyangiitis had more systemic manifestations including arthralgias (p=0.02) and renal disease (p=0.024), had higher peripheral eosinophilia (p=0.027), and a trend towards less myocarditis (p=0.057). Using predefined criteria of vasculitis and surrogates of vasculitis, ANCA alone were found to be insufficient to categorise patients with vasculitis features.We suggest a revised nomenclature and definition for EGPA and a new proposed entity referred to as hypereosinophilic asthma with systemic (non vasculitic) manifestations.

PubMed | Besancon University Hospital Center, Center Georges Francois Leclerc, CHU Bichat Claude Bernard, CHU de Tours Hopital Trousseau and 7 more.
Type: Journal Article | Journal: Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation | Year: 2016

Eastern Cooperative Oncology Group Performance Status (ECOG-PS) is currently an important parameter in the choice of treatment strategy for metastatic pancreatic adenocarcinoma (mPA) patients. However, previous research has shown that patients self-reported health-related quality of life (HRQOL) scales provided additional prognostic information in homogeneous groups of patients with respect to ECOG-PS. The aim of this study was to identify HRQOL scales with independent prognostic value in mPA and to propose prognostic groups for these patients.We analysed data from 98 chemotherapy-naive patients with histologically proven mPA recruited from 2007 to 2011 in the FIRGEM phase II study which aimed to compare the effectiveness of two chemotherapy regimen. HRQOL data were assessed with the European Organization for Research and Treatment of Cancer QLQ-C30 questionnaire. A random survival forest methodology was used to impute missing data and to identify major prognostic factors for overall survival.Baseline HRQOL assessment was completed by 60% of patients (59/98). Twelve prognostic variables were identified. The three most important prognostic variables were fatigue, appetite loss, and role functioning, followed by three laboratory variables. The models discriminative power assessed by Harrells C statistic was 0.65. Fatigue score explained almost all the survival variability.HRQOL scores have prognostic value for mPA patients with good ECOG-PS. Moreover, the patients fatigue, appetite loss, and self-perception of daily activities were more reliable prognostic indicators than clinical and laboratory variables. These HRQOL scores, especially the fatigue symptom, should be urgently included for prognostic assessment of mPA patients (with good ECOG-PS).

Transanal excision has emerged as an alternative treatment to radical resection for selected patients with early-stage cancer. Transanal excision can be only attempted as the definitive treatment of well or moderate differentiated rectal tumours of less than 4 cm diameter that are mobile, involve less than half the rectal circumference, lift completely after submucosal injection at endoscopy and are classified usT1N0 by endorectal ultrasound. Poor indicated transanal excision can worsen long-term oncologic results. Transanal excision can be combined with radiotherapy as palliative treatment for more locally advanced rectal tumor in high-risk patients who are unsuitable for major surgery. Finally, in the near future, transanal excision could probably be proposed as curative treatment for patients with no or minimal residual disease after neoadjuvant radiochemotherapy. From a technical point of view, transanal endoscopic microsurgery (TEM) might be considered as the transanal technique of reference since it improves R0 resection and decreases in situ recurrence rate. Transanal excision is a safe technique with near zero mortality, a low morbidity and a decreased risk of long term impairment when compared to rectal resection with total mesorectal excision. © Copyright 2016 JLE.

Voicu S.,Lariboisiere University Hospital | Voicu S.,University Paris Diderot | Deye N.,Lariboisiere University Hospital | Deye N.,University Paris Diderot | And 16 more authors.
Critical Care Medicine | Year: 2014

Objectives: In patients treated with therapeutic hypothermia after out-of-hospital cardiac arrest, two blood gas management strategies are used regarding the PaCO2 target: α-stat or pH-stat. We aimed to compare the effects of these strategies on cerebral blood flow and oxygenation. Design: Prospective observational single-center crossover study. Setting: ICU of University hospital. Patients: Twenty-one therapeutic hypothermia-treated patients after out-of-hospital cardiac arrest more than 18 years old without history of cerebrovascular disease were included. Interventions: Cerebral perfusion and oxygenation variables were compared in α-stat (PaCO 2 measured at 37°C) versus pH-stat (PaCO2 measured at 32-34°C), both strategies maintaining physiological PaCO2 values: 4.8-5.6 kPa (36-42 torr). Measurements and main results: Bilateral transcranial middle cerebral artery flow velocities using Doppler and jugular vein oxygen saturation were measured in both strategies 18 hours (14-23 hr) after the return of spontaneous circulation. Pulsatility and resistance indexes and cerebral oxygen extraction were calculated. Data are expressed as median (interquartile range 25-75) in α-stat versus pH-stat. No differences were found in temperature, arterial blood pressure, and oxygenation between α-stat and pH-stat. Significant differences were found in minute ventilation (p = 0.006), temperature-corrected PaCO2 (4.4 kPa [4.1-4.6 kPa] vs 5.1 kPa [5.0-5.3 kPa], p = 0.0001), and temperature-uncorrected PaCO2 (p = 0.0001). No differences were found in cerebral blood velocities and pulsatility and resistance indexes in the overall population. Significant differences were found in jugular vein oxygen saturation (83.2% [79.2-87.6%] vs 86.7% [83.2-88.2%], p = 0.009) and cerebral oxygen extraction (15% [11-20%] vs 12% [10-16%], p = 0.01), respectively. In survivors, diastolic blood velocities were 25 cm/s (19-30 cm/s) versus 29 cm/s (23-35 cm/s) (p = 0.004), pulsatility index was 1.10 (0.97-1.18) versus 0.94 (0.89-1.05) (p = 0.027), jugular vein oxygen saturation was 79.2 (71.1-81.8) versus 83.3% (76.6-87.8) (p = 0.033), respectively. However, similar results were not found in nonsurvivors. Conclusions: In therapeutic hypothermia-treated patients after out-of-hospital cardiac arrest at physiological PaCO2, α-stat strategy increases jugular vein blood desaturation and cerebral oxygen extraction compared with pH-stat strategy and decreases cerebral blood flow velocities in survivors. Copyright © 2014 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins.

Sudarshan S.,University of Alabama at Birmingham | Karam J.A.,University of Houston | Brugarolas J.,University of Texas Southwestern Medical Center | Thompson R.H.,Mayo Medical School | And 6 more authors.
European Urology | Year: 2013

Context: There is increasing evidence for the role of altered metabolism in the pathogenesis of renal cancer. Objective: This review characterizes the metabolic effects of genes and signaling pathways commonly implicated in renal cancer. Evidence acquisition: A systematic review of the literature was performed using PubMed. The search strategy included the following terms: renal cancer, metabolism, HIF, VHL. Evidence synthesis: Significant progress has been made in the understanding of the metabolic derangements present in renal cancer. These findings have been derived through translational, in vitro, and in vivo studies. To date, the most well-characterized metabolic features of renal cancer are linked to von Hippel-Lindau (VHL) loss. VHL loss and the ensuing increase in the expression of hypoxia-inducible factor affect several metabolic pathways, including glycolysis and oxidative phosphorylation. Collectively, these changes promote a glycolytic metabolic phenotype in renal cancer. In addition, other histologic subtypes of renal cancer are also notable for metabolic derangements that are directly related to the causative genes. Conclusions: Current knowledge of the genetics of renal cancer has led to significant understanding of the metabolism of this malignancy. Further studies of the metabolic basis of renal cell carcinoma should provide the foundation for the development of new treatment approaches and development of novel biomarkers. © 2012 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Capitanio U.,Vita-Salute San Raffaele University | Becker F.,Boxberg Center | Blute M.L.,Mayo Medical School | Mulders P.,Radboud University Nijmegen | And 4 more authors.
European Urology | Year: 2011

Context: Although lymphadenectomy (lymph node dissection [LND]) is currently accepted as the most accurate and reliable staging procedure for the detection of lymph node invasion (LNI), its therapeutic benefit in renal cell carcinoma (RCC) still remains controversial. Objective: Review the available literature concerning the role of LND in RCC staging and outcome. Evidence acquisition: A Medline search was conducted to identify original articles, review articles, and editorials addressing the role of LND in RCC. Keywords included kidney neoplasms, renal cell cancer, renal cell carcinoma, kidney cancer, lymphadenectomy, lymph node excision, lymphatic metastases, nephrectomy, imaging, and complications. The articles with the highest level of evidence were identified with the consensus of all of the collaborative authors and were critically reviewed. This review is the result of an interactive peer-reviewing process by an expert panel of co-authors. Evidence synthesis: Renal lymphatic drainage is unpredictable. The newer available imaging techniques are still immature in detecting small lymph node metastases. Results from the European Organization for Research and Treatment of Cancer trial 30881 showed no benefit in performing LND during surgery for clinically node-negative RCC, but the results are limited to patients with the lowest risk of developing LNI. Numerous retrospective series support the hypothesis that LND may be beneficial in high-risk patients (clinical T3-T4, high Fuhrman grade, presence of sarcomatoid features, or coagulative tumor necrosis). If enlarged nodes are evident at imaging or palpable during surgery, LND seems justified at any stage. However, the extent of the LND remains a matter of controversy. Conclusions: To date, the available evidence suggests that an extended LND may be beneficial when technically feasible in patients with locally advanced disease (T3-T4) and/or unfavorable clinical and pathologic characteristics (high Fuhrman grade, larger tumors, presence of sarcomatoid features, and/or coagulative tumor necrosis). Although node-positive patients often harbor distant metastases as well, the majority of retrospective nonrandomized trials seem to suggest a possible benefit of regional LND even for this group of patients. In patients with T1-T2, clinically negative lymph nodes and absence of unfavorable clinical and pathologic characteristics, regional LND offers limited staging information and no benefit in terms of decreasing disease recurrence or improving survival. © 2011 European Association of Urology.

Sibon D.,Center Hospitalier Lyon Sud | Cannas G.,Center Hospitalier Lyon Sud | Baracco F.,Center Hospitalier Lyon Sud | Prebet T.,Institute Paoli Calmette | And 10 more authors.
British Journal of Haematology | Year: 2012

Lenalidomide (LEN) has been shown to yield red blood cell (RBC) transfusion independence in about 25% of lower risk myelodysplastic syndromes (MDS) without del(5q), but its efficacy in patients clearly refractory to erythropoiesis-stimulating agents (ESA) is not known. We report on 31 consecutive lower-risk non-del(5q) MDS patients with anaemia refractory to ESA and treated with LEN in a compassionate programme, 20 of whom also received an ESA. An erythroid response was obtained in 15 patients (48%), including 10 of the 27 (37%) previously transfusion-dependent (RBC-TD) patients, who became transfusion-independent (RBC-TI). Nine of the responders relapsed, whereas 6 (40%) were still responding and transfusion-free after 11 +-31 +months. Median response duration was 24months. The erythroid response rate was lower in refractory cytopenia with multilineage dysplasia (27% vs. 60%) and tended to be higher in patients treated with LEN+ESA (55% vs. 36%). Response duration was significantly longer in responders who obtained RBC-TI and in patients treated with LEN after primary resistance to ESA. The main toxicity of LEN was cytopenias. We confirm that, in a patient population of lower risk MDS without del 5q clearly resistant to ESA, LEN is an interesting second line therapeutic option. Its combination with ESAs in this context warrants prospective studies. © 2011 Blackwell Publishing Ltd.

Hanss J.,Service dOtorhinolaryngologie et Chirurgie Cervicofaciale | Nowak C.,Service dOtorhinolaryngologie et Chirurgie Cervicofaciale | Decaux A.,CHU Bicetre | Penon C.,CHU Bicetre | Bobin S.,Service dOtorhinolaryngologie et Chirurgie Cervicofaciale
European Annals of Otorhinolaryngology, Head and Neck Diseases | Year: 2011

Objectives: To report our centre's experience of outpatient tonsillectomy in children over a 7-year period and to evaluate the postoperative complication rate in this type of procedure compared to tonsillectomy performed in the context of conventional hospitalisation. Material and methods: Retrospective review of medical charts. Results: From May 2002 to April 2009, 276 tonsillectomies were performed on an outpatient basis, i.e. 55.4% of all paediatric tonsillectomies, in children with a mean age of 5.28 years. Ninety-six children (34.8%) presented clinical OSAS. Development of an early postoperative complication (before H8) required conventional hospitalisation on D0 in six (2.1%) of these 276 children operated on an outpatient basis: early postoperative bleeding in four cases (1.4%), which required reoperation to control bleeding in three cases, refusal to feed in one case (0.3%), and a parental problem in one case (0.3%). Postoperative complications occurring after H8 required readmission in six cases (2.1%): pain and feeding difficulties in two cases (0.7%) on D1 and D5, respectively, bleeding in four cases (1.4%) with reoperation before H24 for one patient, D5 for two patients and D7 for one patient. Only one case of bleeding occurred between H8 and H24. No perioperative respiratory complications were observed in children with clinical OSAS. Conclusion: The results of this study show that, in line with international publications and meta-analyses, post-tonsillectomy complications between H8 and H24 postoperatively, mainly bleeding, are exceptional. Respiratory complications usually occur in high-risk clinical settings that are not eligible for outpatient surgery. Outpatient tonsillectomy is therefore a safe procedure in children presenting all of the required medical, social and organizational conditions. © 2011 Elsevier Masson SAS. All rights reserved.

Barennes H.,Agence Nationale de Recherche sur le VIH et Hepatite | Pussard E.,CHU Bicetre
American Journal of Tropical Medicine and Hygiene | Year: 2015

Improving the availability of point-of-care (POC) diagnostics for glucose is crucial in resource-constrained settings (RCS). Both hypo and hyperglycemia have an appreciable frequency in the tropics and have been associated with increased risk of deaths in pediatrics units. However, causes of dysglycemia, including hyperglycemia, are numerous and insufficiently documented in RCS. Effective glycemic control with glucose infusion and/or intensive insulin therapy can improve clinical outcomes in western settings. A non-invasive way for insulin administration is not yet available for hyperglycemia. We documented a few causes and developed simple POC treatment of hypoglycemia in RCS. We showed the efficacy of sublingual sugar in two clinical trials. Dextrose gel has been recently tested for neonate mortality. This represents an interesting alternative that should be compared with sublingual sugar in RCS. New studies had to be done to document dysglycemia mechanism, frequency and morbid-mortality, and safe POC treatment in the tropics. Copyright © 2015 by The American Society of Tropical Medicine and Hygiene.

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