Roux C.,University of Paris Descartes |
Baron G.,University of Paris Descartes |
Audran M.,French Institute of Health and Medical Research |
Breuil V.,Nice University Hospital Center |
And 5 more authors.
Rheumatology | Year: 2011
Objective: Vertebral fracture assessment (VFA) is a radiographic method using DXA to diagnose vertebral fractures, validated for reproducibility, sensitivity and specificity as compared with spine radiographs. This study was designed to assess the impact of VFA results on decision-marking in osteoporosis, using a clinical vignette-based approach. Methods: Twenty-nine rheumatologists provided data on post-menopausal women consulting for BMD measurement, clinical risk factors for osteoporosis, clinical characteristics of patients, BMD, T-score and VFA images. Standardized clinical vignettes were generated from these patients, and each rheumatologist assessed five vignettes assigned at random, in two distinct steps, first step without and second step with VFA data. At each step, they had to answer questions about the prescription of radiographs and treatments, using a yes/no format. Results: A total of 117 vignettes were available [117 patients, mean age 65.1 (10.1) years, lumbar spine T-score, -1.64 (0.92)], 36.7% with a personal history of fracture. Rheumatologists intended to prescribe radiographs in 62.4 and 46.2% cases (P = 0.0206) before and after VFA results, respectively, a change occurred in 36.8% of patients, i.e. a de novo prescription of radiographs in 12 patients, and a deleted prescription in 31 patients. VFA data induced a therapeutic change for 30.8% of patients. Conclusion: This study shows that VFA results influence patient management, both for radiographs and treatment prescriptions. © The Author 2011. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved.
Farges O.,University Paris Diderot |
Fuks D.,CHU dAmiens |
Le Treut Y.-P.,Hopital Conception |
Castaing D.,Hopital Paul Brousse |
And 6 more authors.
Annals of Surgery | Year: 2011
OBJECTIVE: Define the optimal surgical margin in patients undergoing surgery for intrahepatic cholangiocarcinoma (IHCC). BACKGROUND DATA: Surgery is the most effective treatment for IHCC. However, the influence of R1 resection on outcome is controversial and that of margin width has not been evaluated. METHODS: We studied 212 patients undergoing curative resection of mass-forming-type IHCC. The respective influences on survival of resection status (R0 vs R1), surgical margin width, pTNM stage, and the latter's components were evaluated. RESULTS: Incidence of R1 resection was 24%. Overall, R1 resection was not an independent predictor of survival [odds ratio (OR) 1.2 (0.7-2.1)] in contrast to the pTNM stage [OR 2.10 (1.2-3.5)]. In the 78 pN+ patients, survival was similar after R0 and R1 resections (median: 18 vs 13 months, respectively, P = 0.1). In the 134 pN0 patients, R1 resection was an independent predictor of poor survival [OR 9.6 (4.5-20.4)], as was the presence of satellite nodules [OR 1.9 (1.1-3.2)]. In the 116 pN0 patients with R0 resections, median survival was correlated with margin width (≤1 mm: 15 months; 2-4 mm: 36 months; 5-9 mm: 57 month; ≥10 mm: 64 month, P < 0.001) and a margin >5 mm was an independent predictor of survival [OR 2.22 (1.59-3.09)]. CONCLUSION: Patients undergoing surgery for IHCC are at high risk of R1 resections. In pN0 patients, R1 resection is the strongest independent predictor of poor outcome and a margin of at least 5 mm should be created. The survival benefits of resection in pN+ patients and R1 resection in general are very low. Copyright © 2011 by Lippincott Williams &Wilkins.
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.
PubMed | Center Francois Baclesse, Center Georges Francois Leclerc, Center Paul Strauss, Caen University Hospital Center and 4 more.
Type: | Journal: British journal of clinical pharmacology | Year: 2016
Cetuximab is an anti-epidermal growth factor receptor antibody used for the treatment of metastatic colorectal cancer and head and neck cancer. Hypersensitivity reactions (HSRs) are associated with cetuximab use. The aim of the study was to evaluate the utility of anti-cetuximab immunoglobulin E (IgE) detection in order to identify patients at risk of HSR to cetuximab.We included patients ready to receive a first cetuximab infusion in a prospective cohort carried out at nine French centres. Pretreatment anti-cetuximab IgE levels were measured. We compared the proportion of severe HSRs in the low anti-cetuximab IgE levels (29 IgE arbitrary units) subgroup with that in a historical cohort of 213 patients extracted from a previous study.Of the 301 assessable patients (mean age: 60.99.3years, head-and-neck cancer: 77%), 66 patients (22%) had high anti-cetuximab IgE levels, and 247 patients received cetuximab (including 38 with high anti-cetuximab levels). Severe HSRs occurred in eight patients (five grade 3 and three grade 4). The proportion of severe HSRs was lower in the low anti-cetuximab IgE levels subgroup vs. the historical cohort (3/209 [1.4%] vs. 11/213 [5.2%], odds ratio, 0.27, 95% confidence interval, 0.07-0.97), and higher in high vs. low anti-cetuximab IgE levels subgroup (5/38 [13.2%] vs. 3/209 [1.4%]; odds ratio, 10.4, 95% confidence interval, 2.4-45.6). Patients with severe HSRs had higher anti-cetuximab IgE levels than patients without reaction (median, 45 vs. 2 IgE arbitrary units, P=0.006).Detection of pretreatment anti-cetuximab IgE is feasible and helpful to identify patients at risk of severe cetuximab-induced HSRs.
Fares-Taie L.,University of Paris Descartes |
Gerber S.,University of Paris Descartes |
Chassaing N.,Toulouse University Hospital Center |
Chassaing N.,University Paul Sabatier |
And 21 more authors.
American Journal of Human Genetics | Year: 2013
Anophthalmia and microphthalmia (A/M) are early-eye-development anomalies resulting in absent or small ocular globes, respectively. A/M anomalies occur in syndromic or nonsyndromic forms. They are genetically heterogeneous, some mutations in some genes being responsible for both anophthalmia and microphthalmia. Using a combination of homozygosity mapping, exome sequencing, and Sanger sequencing, we identified homozygosity for one splice-site and two missense mutations in the gene encoding the A3 isoform of the aldehyde dehydrogenase 1 (ALDH1A3) in three consanguineous families segregating A/M with occasional orbital cystic, neurological, and cardiac anomalies. ALDH1A3 is a key enzyme in the formation of a retinoic acid gradient along the dorso-ventral axis during early eye development. Transitory expression of mutant ALDH1A3 open reading frames showed that both missense mutations reduce the accumulation of the enzyme, potentially leading to altered retinoic acid synthesis. Although the role of retinoic acid signaling in eye development is well established, our findings provide genetic evidence of a direct link between retinoic-acid- synthesis dysfunction and early-eye-development anomalies in humans. © 2013 The American Society of Human Genetics.
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.
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.
PubMed | CHU dAmiens
Type: Journal Article | Journal: Hand surgery and rehabilitation | Year: 2016
The purpose of this study was to assess the inter-observer and intra-observer reproducibility of the interpretation of CT arthrography and plain X-rays for scapholunate advanced collapse (SLAC), scaphoid non-union advanced collapse (SNAC) and scaphoid chondrocalcinosis advanced collapse (SCAC) wrist conditions, as well as the clinical relevance of these imaging modalities. The CT and X-rays images were reviewed twice in a blinded and randomized manner by two experienced orthopedic surgeons specialized in hand surgery, two orthopedic surgery residents and two experienced radiologists specialized in bone and joint imaging. Cohens kappa and Fleiss kappa coefficients were used to analyze the reproducibility of interpretation of the radiological examinations. With CT arthrography, the overall diagnosis was often a problem, in terms of both inter- or intra-observer reproducibility. The assessment of the joint line appeared to be fairly reproducible for each observer but was poorly reproducible between different observers. Plain X-rays are not sufficient to assess cartilage quality in degenerative wrist disease. CT arthrography is a reliable examination, but its interpretation is not always standardized. Diagnostic arthroscopy may be justified in doubtful cases.
PubMed | CHU dAmiens
Type: Journal Article | Journal: Orthopaedics & traumatology, surgery & research : OTSR | Year: 2016
Tibial non-union is a complication that poses a real challenge for surgeons. Several forms of treatment, depending on the type of non-union, have been described. The present study sought to assess results for treatment of tibial non-union by inter-tibiofibular graft (ITFG).An exhaustive cohort study was performed on the files of 33 patients: 25 male, 8 female; mean age, 44years. Twenty cases involved high-energy trauma. Twenty-four were open fractures. Twenty-two concerned diaphyseal fracture, 10 of which were complex segmental. Eleven concerned distal fracture, including 4 complete articular fractures. There were 17 cases of septic non-union. There were no cases of severe bone defect. ITFG was performed at a mean 8.7 months post-trauma, as first-line treatment in 30 cases and in second line in 3.Thirty-one patients showed bone consolidation, at a mean 7.2 months. The 2 failures resulted from technical error. Trauma kinetics emerged as a risk factor for failure.ITFG remains a useful treatment option in tibial non-union, whether infected or not. The present results are comparable with those of the literature. Although the present series comprised only tight non-union, a study of the literature showed that ITFG can treat bone defects up to 4 or 5cm. Functional results showed tibiotalar joint stiffening, due more to immobilization and non-weight-bearing than to syndesmosis. ITFG thus remains relevant to the treatment of tibial non-union.IV, retrospective study.
PubMed | Center Hospitalier Of Laval, CHU dAmiens and Polyclinique du Maine
Type: | Journal: Annals of physical and rehabilitation medicine | Year: 2016
Gait disorders are associated with increased fall risk, dementia and loss of autonomy. Gait analysis has previously been validated in the identification of motor phenotypes in mild cognitive impairment . We hypothesized that gait analysis under dual-task conditions in elderly patients with gait disorders might allow the identification of motor phenotypes linked to specific brain abnormalities.An observational study was instructed for elderly patients with gait disorders or memory impairment. Gait analysis under dual-task conditions was carried out for all patients (LocometrixOne hundred and three patients (mean age 76.37.2, women 56%) were included. Four clinical subgroups were identified: gait instability (45%), recurrent falls (29%), memory impairment (18%), and cautious gait (8%). The quartile analysis of DTC for stride frequency and stride regularity allowed the identification of 3 motor phenotypes (<0.01KW), with no link to either sex or clinical subgroups, but characterized by different Scheltens scores (P=0.05). Twenty-six patients with a low value of DTC for stride frequency and a high value of DTC for Stride Regularity (Scheltens 2.61.6). Forty-seven patients with the same value of DTC for both stride frequency and regularity (Scheltens 3.31.6). 30 patients with a high value of DTC for stride frequency and a low value of DTC for stride regularity (Scheltens 4.01.9).The identification of different motor phenotypes in elderly patients with gait disorders can help the clinician with diagnoses and tailored cognitivo-motor gait rehabilitation.