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Marie I.,CHU Rouen | Lahaxe L.,CHU Rouen | Benveniste O.,CHU Pitie Salpetriere | Delavigne K.,Toulouse University Hospital Center | And 9 more authors.
British Journal of Dermatology | Year: 2010

Background To date, no series has analysed long-term outcome in patients with polymyositis/dermatomyositis (PM/DM) with anti-PM-Scl antibody. Objectives The aims of the present study were: (i) to assess clinical features and long-term outcome, including organ complications, functional course and mortality rate, in patients with isolated PM/DM with anti-PM-Scl antibody; and (ii) to evaluate prevalence, characteristics and long-term outcome of interstitial lung disease (ILD) in patients with isolated PM/DM with anti-PM-Scl antibody. Methods The medical records of 20 consecutive patients with isolated PM/DM with anti-PM-Scl antibody were reviewed. Results Two patients (10%) achieved remission of PM/DM, whereas 14 (70%) improved and four (20%) had a worsened clinical status. Short-term recurrences (during tapering of therapy) occurred in nine patients and long-term recurrences (after discontinuation of therapy) in three patients. Moreover, patients with PM/DM with anti-PM-Scl antibody exhibited severe complications, as follows: oesophageal involvement (n = 4) requiring enteral feeding in three cases, ventilatory insufficiency (n = 3) requiring mechanical ventilation in two cases; three other patients had cancer. Interestingly, patients with PM/DM with anti-PM-Scl antibody often presented symptoms that are usually found in antisynthetase syndrome, i.e. hyperkeratotic rhagadiform hand symptoms (n = 2; 10%), Raynaud's phenomenon (n = 8; 40%), arthralgia/arthritis (n = 7; 35%) and ILD (n = 12; 60%). In our cohort, the associated ILD often required combined therapy of steroids and immunosuppressive agents. Conclusions Our series suggests that the presence of anti-PM-Scl antibody is not a good prognostic factor in patients with PM/DM, as there appears to be an association with lung and oesophageal involvement; in addition, anti-PM-Scl antibody may coexist with malignancy in patients with PM/DM. Furthermore, anti-PM-Scl antibody-positive patients with PM/DM often exhibit 'mechanic's hands', Raynaud's phenomenon and joint involvement. Our latter findings raise the possibility that the immunogenetic background influences the autoantibody status of these patients; HLA-DR3 has, in fact, been found in association with antisynthetase syndrome antibodies and with anti-PM-Scl antibodies. © 2009 British Association of Dermatologists.


Courbiere B.,Obstetrics | Courbiere B.,Aix - Marseille University | Courbiere B.,French National Center for Scientific Research | Decanter C.,Lille University Hospital Center | And 12 more authors.
Human Reproduction | Year: 2013

STUDY QUESTIONWhat are the outcomes of French emergency IVF procedures involving embryo freezing for fertility preservation before gonadotoxic treatment?SUMMARY ANSWERPregnancy rates after emergency IVF, cryopreservation of embryos, storage, thawing and embryo transfer (embryo transfer), in the specific context of the preservation of female fertility, seem to be similar to those reported for infertile couples undergoing ART.STUDY DESIGN, SIZE, DURATIONA French retrospective multicentre cohort study initiated by the GRECOT network - the French Study Group for Ovarian and Testicular Cryopreservation. We sent an e-mail survey to the 97 French centres performing the assisted reproduction technique in 2011, asking whether the centre performed emergency IVF and requesting information about the patients' characteristics, indications, IVF cycles and laboratory and follow-up data. The response rate was 53.6% (52/97).PARTICIPANTS/MATERIALS, SETTING, METHODSFourteen French centres reported that they performed emergency IVF (56 cycles in total) before gonadotoxic treatment, between 1999 and July 2011, in 52 patients.MAIN RESULTS AND THE ROLE OF CHANCEThe patients had a mean age of 28.9 ± 4.3 years, and a median length of relationship of 3 years (1 month-15 years). Emergency IVF was indicated for haematological cancer (42%), brain tumour (23%), sarcoma (3.8%), mesothelioma (n = 1) and bowel cancer (n = 1). Gynaecological problems accounted for 17% of indications. In 7.7% of cases, emergency IVF was performed for autoimmune diseases. Among the 52 patients concerned, 28% (n = 14) had undergone previous courses of chemotherapy before beginning controlled ovarian stimulation (COS). The initiation of gonadotoxic treatment had to be delayed in 34% of the patients (n = 19). In total, 56 cycles were initiated. The mean duration of stimulation was 11.2 ± 2.5 days, with a mean peak estradiol concentration on the day on which ovulation was triggered of 1640 ± 1028 pg/ml. Three cycles were cancelled due to ovarian hyperstimulation syndrome (n = 1), poor response (n = 1) and treatment error (n = 1). A mean of 8.2 ± 4.8 oocytes were retrieved, with 6.1 ± 4.2 mature oocytes and 4.4 ± 3.3 pronuclear-stage embryos per cycle. The mean number of embryos frozen per cycle was 4.2 ± 3.1. During follow-up, three patients died from the consequences of their disease. For the 49 surviving patients, 22.5% of the couples concerned (n = 11) requested embryo replacement. A total of 33 embryos were thawed with a post-thawing survival rate of 76%. Embryo replacement was finally performed for 10 couples with a total of 25 embryos transferred, leading to one biochemical pregnancy, one miscarriage and three live births. Clinical pregnancy rate and live birth per couple who wanted a pregnancy after cancer were, respectively, 36% (95% CI = 10.9-69.2%) and 27% (95% CI = 6.0-61%).LIMITATIONS, REASONS FOR CAUTIONThe overall response rate for clinics was 53.6%. Therefore, it is not only that patients may not have been included, but also that those that were included were biased towards the University sector with a response rate of 83% (25/30) for a small number of patients.WIDER IMPLICATIONS OF THE FINDINGSAccording to literature, malignant disease is a risk factor for a poor response to COS. However, patients having emergency IVF before gonadotoxic treatment have a reasonable chance of pregnancy after embryo replacement. Embryo freezing is a valuable approach that should be included among the strategies used to preserve fertility. © The Author 2013. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved.


PubMed | McMaster University, University of Liège, CHU Amiens, Lille University of Science and Technology and 23 more.
Type: Journal Article | Journal: Gastroenterology | Year: 2016

Parenteral methotrexate is an effective treatment for patients with Crohns disease, but has never been adequately evaluated in patients with ulcerative colitis (UC). We conducted a randomized controlled trial to determine its safety and efficacy in patients with steroid-dependent UC.We performed a double-blind, placebo-controlled trial to evaluate the efficacy of parenteral methotrexate (25 mg/wk) in 111 patients with corticosteroid-dependent UC at 26 medical centers in Europe from 2007 through 2013. Patients were given prednisone (10 to 40 mg/d) when the study began and were randomly assigned to groups (1:1) given placebo or methotrexate (intramuscularly or subcutaneously, 25 mg weekly) for 24 weeks. The primary end point was steroid-free remission (defined as a Mayo score 2 with no item >1 and complete withdrawal of steroids) at week 16. Secondary endpoints included clinical remission (defined as a Mayo clinical subscore 2 with no item >1) and endoscopic healing without steroids at weeks 16 and/or 24, remission without steroids at week 24, and remission at both weeks 16 and 24.Steroid-free remission at week 16 was achieved by 19 of 60 patients given methotrexate (31.7%) and 10 of 51 patients given placebo (19.6%)--a difference of 12.1% (95% confidence interval [CI]: -4.0% to 28.1%; P = .15). The proportion of patients in steroid-free clinical remission at week 16 was 41.7% in the methotrexate group and 23.5% in the placebo group, for a difference of 18.1% (95% CI: 1.1% to 35.2%; P = .04). The proportions of patients with steroid-free endoscopic healing at week 16 were 35% in the methotrexate group and 25.5% in the placebo group--a difference of 9.5% (95% CI: -7.5% to 26.5%; P = .28). No differences were observed in other secondary end points. More patients receiving placebo discontinued the study because of adverse events (47.1%), mostly caused by UC, than patients receiving methotrexate (26.7%; P = .03). A higher proportion of patients in the methotrexate group had nausea and vomiting (21.7%) than in the placebo group (3.9%; P = .006).In a randomized controlled trial, parenteral methotrexate was not superior to placebo for induction of steroid-free remission in patients with UC. However, methotrexate induced clinical remission without steroids in a significantly larger percentage of patients, resulting in fewer withdrawals from therapy due to active UC. ClinicalTrials.gov ID NCT00498589.


Piroth L.,University of Burgundy | Pol S.,CHU Cochin | Lacombe K.,French Institute of Health and Medical Research | Miailhes P.,Lyon University Hospital Center | And 9 more authors.
Journal of Hepatology | Year: 2010

Background & Aims: To compare the management and the virological and serological efficacy of treatments for chronic hepatitis B (CHB) in HIV positive and negative patients. Methods: Two hundred and forty-six HIV positive and 205 HIV negative consecutive patients with past or present CHB, seen in October 2008 in participating departments, were included in a multicenter study. All the data were retrospectively collected from the first visit to October 2008 through a standardized questionnaire. Results: Compared to HIV negative patients, HIV positive patients more often presented positive HBeAg (46.4% vs. 32.8%, p = 0.01), HBV genotype A (54.8% vs. 17.1%, p <0.0001), co-infection with HCV (12.4% vs. 5.9%, p = 0.0002) or HDV (12.6% vs. 2.9%, p = 0.04). HIV positive patients were more often on HBV therapy (92.7% vs. 57.1%, p <0.0001), leading to undetectable serum HBV DNA levels (71.0% vs. 44.1%, p <0.0001). In HIV positive patients, multivariate analysis showed that older age, lower initial HBV DNA levels, and longer time on HBV therapy significantly correlated with undetectable HBV DNA. No difference in efficacy was observed between tenofovir used alone or in combination. HBsAg (but not HBe) loss was more often observed in HIV positive patients, sometimes followed by HBsAg re-appearance after withdrawal of HBV treatment. Excluding the 37 HBV-HCV-co-infected patients, the last clinical presentation and liver fibrosis scores were similar in HIV positive and negative patients. Conclusions: The assessment of CHB and the efficacy of HBV therapy have improved in HIV positive patients. HIV infection did not have a negative impact on the likelihood of HBV therapeutic success. © 2010 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.


Pillebout E.,CHU St Louis | Alberti C.,University Paris Diderot | Guillevin L.,CHU Cochin | Ouslimani A.,Assistance Publique Hpitaux de Paris | Thervet E.,CHU Necker
Kidney International | Year: 2010

Henoch Schönlein Purpura (HSP) is a common disease in children, usually associated with a good prognosis. In adults there are no prospective studies concerning its prognosis or treatment, especially in cases of severe visceral involvement. Here we compared steroid therapy without or with cyclophosphamide co-treatment in adults with severe HSP in a 12-month, multi-center, prospective, open-label trial that treated 54 adults with biopsy-proven HSP including proliferative glomerulonephritis and severe visceral manifestations. All received steroids; however, 25 were randomized to also receive cyclophosphamide. The primary endpoint that occurred in three patients in each group was complete disease remission defined as zero on the Birmingham Vasculitis Activity Score with no persistent or new clinical and/or biological vasculitis at 6 months. No patient had active visceral involvement. The secondary endpoints were renal outcome, deaths, and adverse events at 12 months. Renal function, proteinuria, safety data, incidence of diabetes, and severe infections were similar between the two groups. At the last follow-up, renal function remained stable. The small population size of our study does not permit definitive conclusions; however, we suggest that treatment of adults with severe HSP by adding cyclophosphamide provides no benefit compared with steroids alone. © 2010 International Society of Nephrology.


PubMed | CHU Bobigny, Angers University Hospital Center, Bordeaux University Hospital Center, CHU St. Philibert and 5 more.
Type: Clinical Trial | Journal: Endoscopy | Year: 2015

Esophageal video capsule endoscopy (ECE) is a new technique that allows examination of the esophagus using a noninvasive approach. The aim of this study was to compare ECE with esophagogastroduodenoscopy (EGD) for the diagnosis of esophageal varices in patients with cirrhosis.A total of 330 patients with cirrhosis and with no known esophageal varices were prospectively enrolled. Patients underwent ECE first, followed by EGD (gold standard). The endoscopists who performed EGD were blind to the ECE result. Patient satisfaction was assessed using a visual analog scale (maximum score 100).A total of 30 patients were excluded from the analysis because they did not undergo any endoscopic examinations. Patients (mean age 56 years; 216 male) had mainly alcoholic (45%) or viral (27%) cirrhosis. The diagnostic indices of ECE to diagnose and correctly stage esophageal varices were: sensitivity 76% and 64%, specificity 91% and 93%, positive predictive value 88% and 88%, and negative predictive value 81% and 78%, respectively. ECE patient satisfaction scored significantly higher than EGD (8722 vs. 5835; P<0.0001).ECE was well tolerated and safe in patients with liver cirrhosis and suspicion of portal hypertension. The sensitivity of ECE is not currently sufficient to replace EGD as a first exploration in these patients. However, due to its excellent specificity and positive predictive value, ECE may have a role in cases of refusal or contraindication to EGD. ECE might also improve compliance to endoscopic follow-up and aid important therapeutic decision making in the prophylaxis of bleeding.EudraCT (ID RCB 2009-A00532-55) and ClinicalTrials.gov (NCT00941421).


Several types of endocrine complications and metabolic disorders can occur during treatment with targeted therapies: thyroid dysfunction, hyperglycaemia, hyperlipidaemia, etc. Thyroid dysfunctions are mainly observed with tyrosine kinase inhibitors (TKI), with a high frequency with sunitinib (18 to 85%) and sorafenib (21%). Hypothyroidism can be symptomatic with clinical signs including asthenia, constipation, cold intolerance, with elevated TSH and low free T4 levels; or subclinical with non-specific clinical signs (asthenia) with TSH less than 8-10 mIU/L and free T4 normal, and often requiring supplementation with thyroid hormones. The occurrence of thyroid dysfunction does not mean that treatment with TKI must be stopped. Thyrotoxicosis, usually transient, can precede the onset of hypothyroidism during treatment with TKI. Specialist opinion from an endocrinologist should be considered with the occurrence of thyroid dysfunction. Abnormalities in the glycaemic and lipid profile are often seen with mTOR inhibitors and require monitoring before and during the treatment, as well as a specialist opinion from an endocrinologist in the event of hyperglycaemia or dyslipidaemia. ©John Libbey Eurotext.


PubMed | Toulouse University Hospital Center, Institute Paoli Calmettes, CHU Cochin and CHU HEGP
Type: Journal Article | Journal: Bulletin du cancer | Year: 2015

Several types of endocrine complications and metabolic disorders can occur during treatment with targeted therapies: thyroid dysfunction, hyperglycaemia, hyperlipidaemia, etc. Thyroid dysfunctions are mainly observed with tyrosine kinase inhibitors (TKI), with a high frequency with sunitinib (18 to 85%) and sorafenib (21%). Hypothyroidism can be symptomatic with clinical signs including asthenia, constipation, cold intolerance, with elevated TSH and low free T 4 levels; or subclinical with non-specific clinical signs (asthenia) with TSH less than 8-10mIU/L and free T 4 normal, and often requiring supplementation with thyroid hormones. The occurrence of thyroid dysfunction does not mean that treatment with TKI must be stopped. Thyrotoxicosis, usually transient, can precede the onset of hypothyroidism during treatment with TKI. Specialist opinion from an endocrinologist should be considered with the occurrence of thyroid dysfunction. Abnormalities in the glycaemic and lipid profile are often seen with mTOR inhibitors and require monitoring before and during the treatment, as well as a specialist opinion from an endocrinologist in the event of hyperglycaemia or dyslipidaemia.


Chapron C.,CHU Cochin | Chapron C.,University of Paris Descartes | Chapron C.,French Institute of Health and Medical Research | Chiodo I.,CHU Cochin | And 7 more authors.
Fertility and Sterility | Year: 2010

Objective: To evaluate the rate of intrinsic ureteral endometriosis in patients presenting with severe ureteral endometriosis. Design: Observational study between June 1992 and December 2007. Setting: University tertiary referral center. Patient(s): Twenty-nine patients presenting deeply infiltrating endometriosis (DIE) with severe ureteral endometriosis. Severe ureteral endometriosis was defined as DIE lesions causing significant obstruction to the urinary flow with ureteral stenosis. Intervention(s): Complete surgical exeresis of DIE lesions. Main Outcome Measure(s): Pre-and peroperative evaluation associated with histologic analysis. Intrinsic ureteral endometriosis was defined as presence of DIE lesions infiltrating the ureteral muscularis. Result(s): In a series of 627 patients with histologic proved DIE, we observed 29 (4.6%) patients with severe ureteral endometriosis. Ureteral lesions (n = 34) were right sided in 7 (24.1%) patients, left sided in 17 (58.6%) patients, and bilateral in 5 (17.3%) patients. Eleven (37.9%) patients presented intrinsic lesions. Out of the 34 ureteral lesions 13 (38.2%) were intrinsic. In cases of radical ureteral surgery (n = 21 patients; n = 24 ureteral lesions) intrinsic ureteral DIE was observed in 52.4% (11 cases) of the patients and in 54.2% (13 cases) of the ureteral lesions. Conclusion(s): The prevalence of intrinsic ureteral endometriosis is underestimated. This result must be taken into account when specifying the surgical modalities for patients presenting with severe ureteral endometriosis. © 2010 by American Society for Reproductive Medicine.


PubMed | CHU Cochin
Type: | Journal: Annals of physical and rehabilitation medicine | Year: 2016

Scapular motion is essential for full, functional mobility of the arm. Many shoulder pathologies are associated with alterations of scapular kinematics which have been only little studied in total shoulder arthroplasties. The aim of this study was to compare the 3D scapula kinematics in two groups of patients with total shoulder anatomic (aTSA) or reverse (rTSA) arthoplasties to asymptomatic controls of comparable age during two arm elevation tasks (abduction and flexion) and two simulations of activity of daily living (hair combing and back washing).Scapular kinematics was assessed using a Polhemus Fastrak electromagnetic device in 14patients with aTSA (and 14controls) and 9patients with rTSA (and 9controls). The 3D rotations and the 3D displacements of the barycenter of the scapula were measured at 30, 60 and 90 of humero-thoracic (HT) elevation. Patient groups were compared with each other by Mann-Whitney U test and with their respective controls by Wilcoxon test.Scapulohumeral rhythm was reduced in both patient groups as compared with controls. Patients with aTSA showed more lateral rotation and more linear displacements of the scapula compared to rTSA and control groups. Nevertheless, the global kinematics pattern remained unchanged in both groups of patients.Patients showed a greater participation of the scapula in HT elevation movements and kinematic modifications of small amplitude that could suggest a compensation mechanism for patients with aTSA. However, having a total shoulder arthroplasty does not alter the global kinematic pattern of the scapula.

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