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Dreuil-lès-Amiens, France

Bremond-Gignac D.,CHU dAmiens
Medecine Therapeutique Pediatrie | Year: 2015

Congenital ptosis refers to the drooping of the upper or lower eyelid and is a common pathology in children. It may be moderate, intermediate or severe. It affects the levator palpebrae superioris muscle and may be myogenic or neurological in origin. Ptosis examination must be thorough, particularly when confirming that it is congenital. The degree and effect on visual function and ocular motility must be assessed. Rare forms of ptosis should be considered in combination with genetic syndromes or possible orbital tumours. Clinical examination may lead to a diagnosis of astigmatism, ocular motility anomalies, or amblyopia. The time and type of surgery are evaluated depending on the age of the child. Coordination by a paediatrician and the provision of support for parents are essential for optimal treatment of this disease. Source

Leuillet P.,CHU dAmiens | Cour F.,Service durologie et transplantation | Droupy S.,Nimes University Hospital Center
Progres en Urologie | Year: 2013

Introduction: The homosexuality, which expresses itself through a varied and complex behavior that those whom are shared by the heterosexual majority, is not that a simple sexual behavior, obvious or not, but a whole set of attitudes, affects, preferences, values, lifestyle which concern profoundly the individual, as the heterosexuality. Material and methods: A review of the literature using PubMed database has been performed to select 38 articles. Results: Among sexual difficulties met by the gays, erectile dysfunction and hypoactive sexual desire are the more frequent. Concerning the ejaculation disorders observed in the gay population, premature ejaculation is rather rare in comparison with heterosexual men; however delayed ejaculation or anejaculation are more frequent. Painful sexual disorders in particular anodyspareunia are also reported. Sexual disorder management must follows the classic rules but it is necessary to be aware how to approach the specific questions affecting the homosexual persons. Still the homosexual person has to find a competent therapist, "opened" to the sexual problem of the homosexuals, with the aim of a care privileging the efficiency to efficacy in the respect for the truth of the homosexual person. Conclusion: The homosexuality is the only one of the "unusual" sexual conducts to possibly concern the daily medical practice due to is prevalence. The management of sexual dysfunctions must privilege the "meeting" in a quest of sense in front of any sexual symptom, whatever the individual sexual orientation. © 2013 Elsevier Masson SAS. Source

Vignes S.,Center National Of Reference Des Maladies Vasculaires Rares | Brunet M.,Center National Of Reference Des Maladies Vasculaires Rares | Blanchard M.,Center National Of Reference Des Maladies Vasculaires Rares | Smail A.,CHU dAmiens | Arrault M.,Center National Of Reference Des Maladies Vasculaires Rares
Lymphatic Research and Biology | Year: 2014

Objective: To analyze upper-limb lymphedema characteristics of renal transplant recipients taking sirolimus, an mTOR inhibitor. Method: Cross-sectional study of sirolimus-treated upper-limb lymphedema patients (01/2009-12/2013). Results: Three men and two women, whose mean age at transplantation was 60 (range: 49-76) years, were included. Sirolimus (1-2.5mg/day) had been taken for 27.5±21 (range: 7-58) months before left (n=4) or right (n=1), whole limb (n=4), or hand and forearm (n=1) upper-limb lymphedema onset, always ipsilateral to the functional arteriovenous fistula. Ultrasonography or fistulography excluded venous thrombosis in all patients. At the time lymphedema appeared, all five arteriovenous fistulas were functional. Mean upper-limb lymphedema volume, calculated with the truncated-cone formula, was 774±162 [range: 594-1035] mL, (i.e. 44%±11% [range: 36%-64%] excess volume compared to the contralateral limb. One patient also had ipsilateral breast lymphedema. The three lymphoscintigraphies obtained showed total absence of ipsilateral axillary-region tracer uptake. Sirolimus was maintained in all cases. Upper-limb lymphedema treatment included low-stretch bandages (n=4) and elastic sleeve (20-36mm Hg) (n=5) without fistula complications. Two patients had their fistulas closed without any impact on lymphedema volume. Conclusion: Sirolimus may be implicated in large-volume upper-limb lymphedema in kidney-transplant recipients, ipsilateral to the arteriovenous fistula, and requires compression-based therapy. © Mary Ann Liebert, Inc. 2014. Source

Leclerc M.,Reims University Hospital Center | Suarez F.,Assistance Publique Hopitaux de Paris AP HP | Noel M.-P.,Lille University Hospital Center | Vekhoff A.,AP HP | And 8 more authors.
Annals of Hematology | Year: 2015

The purine analogs (PAs) cladribine and pentostatin have transformed the prognosis of hairy cell leukemia (HCL). However, some patients still relapse after PAs, or fail to reach an optimal response, and new agents are needed to further improve treatment outcome. We retrospectively studied 41 HCL patients from 10 centers in France and Belgium, who received 49 treatment courses with the anti-CD20 monoclonal antibody rituximab. Most of the patients were treated at relapse (84 % of cases) and rituximab was combined to a PA in 41 % of cases. Overall, response rate is 90 % including 71 % complete hematologic responses (CHRs). Frontline treatment, combination therapy, and absolute neutrophil count were associated with response in multivariate analysis. Three-year relapse-free and overall survivals are 68 and 90 %, respectively. When combined to a PA, rituximab yields a 100 % response rate, even beyond frontline therapy. In contrast, response rate is only 82 % (59 % CHR) when rituximab is used alone. In this latter setting, relapse rate is 56 % and median time to relapse is 17.5 months. All eight patients who were treated two times with the antibody responded again to re-treatment. We confirm the high efficacy of the combination rituximab + PA. However, when rituximab is used as monotherapy, response rate is lower and the high relapse rate is a concern. Prospective clinical trials are needed to confirm the superiority of the combination rituximab + PA over PA alone, both as frontline therapy and at relapse. © 2014, Springer-Verlag Berlin Heidelberg. Source

Fakhouri F.,Nantes University Hospital Center | Delmas Y.,Bordeaux University Hospital Center | Provot F.,Lille University Hospital Center | Barbet C.,CHU de Tours | And 14 more authors.
American Journal of Kidney Diseases | Year: 2014

Background Atypical hemolytic uremic syndrome (aHUS) is a devastating form of renal thrombotic microangiopathy. Despite plasma exchange, the standard treatment of aHUS for decades, the renal prognosis for patients with aHUS has remained poor. We assessed the off-trial use of eculizumab in adult patients with aHUS affecting the native kidneys. Study Design A retrospective study was conducted. aHUS was defined as the presence of 3 or more of the following: acute kidney injury (serum creatinine >1.4 mg/dL [120 μmol/L]), mechanical hemolytic anemia, thrombocytopenia, and the presence of thrombotic microangiopathy features in a kidney biopsy specimen. Patients who had received 4 or more weekly 900-mg infusions of eculizumab were included. Setting & Participants 19 patients were identified through a query sent to all French nephrology centers. Outcomes & Measurements Evolution of kidney function, hemolysis, and thrombocytopenia after the initiation of eculizumab therapy. Results All patients had acute kidney injury (serum creatinine range, 2.2-17.0 mg/dL) and 12 required hemodialysis. Thirteen patients carried a mutation in 1 complement gene and 1 had anti-factor H antibodies. For first-line therapy, 16 patients underwent plasma exchange and 3 patients received eculizumab. Median time between aHUS onset and eculizumab therapy initiation was 6 (range, 1-60) days and median time to platelet count normalization after eculizumab therapy initiation was 6 (range, 2-42) days. At the 3-month follow-up, 4 patients still required dialysis, 8 had non-dialysis-dependent chronic kidney disease, and 7 had normalized kidney function. At last follow-up (range, 4-22 months), 3 patients remained dialysis dependent, 7 had non-dialysis-dependent chronic kidney disease (estimated glomerular filtration rate, 17-55 mL/min/1.73 m 2), and 9 had normal kidney function. Risks of reaching end-stage renal disease within 3 months and 1 year of aHUS onset were reduced by half in eculizumab-treated patients compared with recent historical controls. Limitations Retrospective study and use of historical controls. Conclusions Our data indicate that eculizumab improves kidney disease outcome in patients with aHUS. © 2013 by the National Kidney Foundation, Inc. Source

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