Saint-Étienne, France
Saint-Étienne, France

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Haulon S.,Hopital Cardiologique | Amiot S.,Hopital Cardiologique | Magnan P.-E.,Marseille University Hospital Center | Becquemin J.-P.,CHU de Creteil | And 4 more authors.
Annals of Surgery | Year: 2010

Purpose: To evaluate the medium-term outcomes following aortic aneurysm repair utilizing fenestrated endografts performed in 13 French academic centers. MATERIALS AND Methods: A retrospective analysis of prospectively collected data. All patients had asymptomatic aneurysms involving or close to the visceral-bearing abdominal aorta and were judged to be at high-risk for open surgical repair. Fenestrated endografts were designed using computed tomography reconstructions performed on three-dimensional workstations. The procedures were conducted under fluoroscopic control by experienced endovascular teams. All patients were evaluated with computed tomography, duplex ultrasound, and plain film radiograph at discharge, 6, 12, 18, and 24 months, and annually thereafter. Results: Eighty patients (78 males) were treated over 44 months (May 2004-January 2008). Median age and aneurysm size were 78 years (range: 48-90 years) and 59 mm (range: 47-82 mm), respectively. A total of 237 visceral vessels were perfused through a fabric fenestration (median of 3 per patient). One early conversion to open surgery was required. Completion angiography showed that 234 of 237 (99%) target vessels were patent. Two patients (2.5%) died within 30 days of device implantation. Predischarge imaging identified 9 (11%) endoleaks: 3 type I, 5 type II, and 1 type III. The median duration of follow-up was 10 months (range: 1-38 months). No aneurysms ruptured or required open conversion during the follow-up period. Four of 78 (5%) died during follow-up (actuarial survival at 24 months 92%), none of these deaths were aneurysm related. Aneurysm sac size decreased by more than 5 mm in 33%, 53%, and 58% at 6, 12, and 18 months, respectively. One patient had sac enlargement within the first year, associated with a persistent type II endoleak. In-stent stenoses or occlusion affected 4 renal arteries. Secondary procedures were performed in 8 patients (10%) during follow-up, 5 to correct endoleaks and 3 to correct threatened visceral vessels. Conclusions: The use of endovascular prostheses with graft material incorporating the visceral arteries is safe in high risk patients with high risk aneurysms. In the medium-term it is effective in preventing rupture. However, meticulous follow-up to assess sac behavior and visceral ostia is critical to ensure optimal results. Copyright © 2010 by Lippincott Williams & Wilkins.


Decousus H.,Service de Medecine et Therapeutique | Quere I.,Montpellier University Hospital Center | Presles E.,CHU de Saint Etienne | Becker F.,40 Chemin Favrands | And 7 more authors.
Annals of Internal Medicine | Year: 2010

Background: Superficial venous thrombosis (SVT) is perceived to have a benign prognosis. Objective: To assess the prevalence of venous thromboembolism in patients with SVT and to determine the 3-month incidence of thromboembolic complications. Design: National cross-sectional and prospective epidemiologic cohort study. (ClinicalTrials.gov registration number: NCT00818688) Setting: French office- and hospital-based vascular medicine specialists. Patients: 844 consecutive patients with symptomatic SVT of the lower limbs that was at least 5 cm on compression ultrasonography. Measurements: Incidence of venous thromboembolism and extension or recurrence of SVT in patients with isolated SVT at presentation. Results: Among 844 patients with SVT at inclusion (median age, 65 years; 547 women), 210 (24.9%) also had deep venous thrombosis (DVT) or symptomatic pulmonary embolism. Among 600 patients without DVT or pulmonary embolism at inclusion who were eligible for 3-month follow-up, 58 (10.2%) developed thromboembolic complications at 3 months (pulmonary embolism, 3 [0.5%]; DVT, 15 [2.8%]; extension of SVT, 18 [3.3%]; and recurrence of SVT, 10 [1.9%]), despite 540 patients (90.5%) having received anticoagulants. Risk factors for complications at 3 months were male sex, history of DVT or pulmonary embolism, previous cancer, and absence of varicose veins. Limitation: The findings are from a specialist referral setting, and the study was terminated before the target patient population was reached because of slow recruitment. Conclusion: A substantial number of patients with SVT exhibit venous thromboembolism at presentation, and some that do not can develop this complication in the subsequent 3 months. Primary Funding Source: GlaxoSmithKline, sanofi-aventis, and the Ministère Français de la Santé et des Sports (Programme Hospitalier de Recherche Clinique). © 2010 American College of Physicians.


PubMed | University Creteil, University of Liège, CHU Amiens, CHI Le Raincy Montfermeil and 20 more.
Type: | Journal: Gut | Year: 2017

Ciclosporin and infliximab have demonstrated short-term similar efficacy as second-line therapies in patients with acute severe UC (ASUC) refractory to intravenous steroids. The aim of this study was to assess long-term outcome of patients included in a randomised trial comparing ciclosporin and infliximab.Between 2007 and 2010, 115 patients with steroid-refractory ASUC were randomised in 29 European centres to receive ciclosporin or infliximab in association with azathioprine. Patients were followed until death or last news up to January 2015. Colectomy-free survival rates at 1 and 5years and changes in therapy were estimated through Kaplan-Meier method and compared between initial treatment groups through log-rank test.After a median follow-up of 5.4years, colectomy-free survival rates (95% CI) at 1 and 5years were, respectively, 70.9% (59.2% to 82.6%) and 61.5% (48.7% to 74.2%) in patients who received ciclosporin and 69.1% (56.9% to 81.3%) and 65.1% (52.4% to 77.8%) in those who received infliximab (p=0.97). Cumulative incidence of first infliximab use at 1 and 5years in patients initially treated with ciclosporin was, respectively, 45.7% (32.6% to 57.9%) and 57.1% (43.0% to 69.0%). Only four patients from the infliximab group were subsequently switched to ciclosporin. Three patients died during the follow-up, none directly related to UC or its treatment.In this cohort of patients with steroid-refractory ASUC initially treated by ciclosporin or infliximab, long-term colectomy-free survival was independent from initial treatment. These long-term results further confirm a similar efficacy and good safety profiles of both drugs and do not favour one drug over the other.EudraCT: 2006-005299-42; ClinicalTrials.gouv number: NCT00542152; post-results.


Laharie D.,Bordeaux University Hospital Center | Laharie D.,University of Bordeaux 1 | Bourreille A.,Nantes University Hospital Center | Branche J.,CHRU de Lille | And 27 more authors.
The Lancet | Year: 2012

Background Ciclosporin and infliximab are potential rescue treatments to avoid colectomy in patients with acute severe ulcerative colitis refractory to intravenous corticosteroids. We compared the efficacy and safety of these drugs for this indication. Methods In this parallel, open-label, randomised controlled trial, patients were aged at least 18 years, had an acute severe flare of ulcerative colitis defined by a Lichtiger score greater than 10 points, and had been given an unsuccessful course of high-dose intravenous steroids. None of the patients had previously received ciclosporin or infliximab. Between June 1, 2007, and Aug 31, 2010, patients at 27 European centres were randomly assigned (via computerderived permutation tables; 1:1) to receive either intravenous ciclosporin (2 mg/kg per day for 1 week, followed by oral drug until day 98) or infliximab (5 mg/kg on days 0, 14, and 42). In both groups, azathioprine was started at day 7 in patients with a clinical response. Neither patients nor investigators were masked to study treatment. The primary efficacy outcome was treatment failure defined by absence of a clinical response at day 7, a relapse between day 7 and day 98, absence of steroid-free remission at day 98, a severe adverse event leading to treatment interruption, colectomy, or death. Analysis was by intention to treat. This trial is registered with EudraCT (2006-005299-42) and ClinicalTrials.gov (NCT00542152). Findings 115 patients were randomly assigned; 58 patients were allocated to receive ciclosporin and 57 to receive infliximab. Treatment failure occurred in 35 (60%) patients given ciclosporin and 31 (54%) given infliximab (absolute risk difference 6%; 95% CI -7 to 19; p=0·52). Nine (16%) patients in the ciclosporin group and 14 (25%) in the infliximab group had severe adverse events. Interpretation Ciclosporin was not more effective than infliximab in patients with acute severe ulcerative colitis refractory to intravenous steroids. In clinical practice, treatment choice should be guided by physician and centre experience.


Bellete B.,Laboratoire Of Parasitologie Mycologie | Raberin H.,Laboratoire Of Parasitologie Mycologie | Morel J.,Groupe Immunite des Muqueuses et Agents Pathogenes GIMAP | Flori P.,CHU de Saint Etienne | And 2 more authors.
Medical Mycology | Year: 2010

We describe the development of resistance in an Aspergillus fumigatus strain, originally sensitive to itraconazole and voriconazole, recovered from a case of pulmonary aspergilloma treated with voriconazole. A G448S mutation on the cyp51A gene was detected by sequencing. Frequent culture and in vitro antifungal susceptibility testing is suggested for early detection of the development of multi-azole resistance in patients on long-term therapy for A. fumigatus infections. © 2010 ISHAM.


Virus-induced rhabdomyolysis rarely induces respiratory failure. We discuss here a case of severe rhabdomyolysis with acute respiratory failure secondary to a cytomegalovirus (CMV) primary infection. We report a case of severe acute rhabdomyolysis, leading to respiratory failure and mechanical ventilation, associated with CMV primary infection in a young and otherwise healthy woman. We excluded other aetiologies such as metabolic myopathies, electrolyte disorders or Guillain-Barré syndrome with exhaustive researches. After 1 year, the patient recovered completely, apart from a slight muscle deconditioning. In this report, we compare our patient with five other similar cases found in the literature; our patient had the most severe presentation. The mechanism of acute viral-induced rhabdomyolysis remains elusive.


In a complex context of national financial constraints, dispersed medical resources and growing media hype, the hospital is under permanent pressure sometimes caught between contradictory objectives. Managers must shoulder this pressure in their management as well as in their way of being. How can they and how should they manage an unpopular announcement within a hospital? Literature and experience provide useful guidance for managing unpopular announcements within a hospital. © 2016 Elsevier Masson SAS.


Gonthier R.,CHU de SAINT ETIENNE | Crawford-Achour E.,CHU de SAINT ETIENNE
Revue de Geriatrie | Year: 2011

Assessing fitness to drive in patient with cognitive impairment appears to be essential as we all know that severe form of dementia (CDR ≥ 1) is associated with a high risk of road accident. This assessment is ever more difficult in patient suffering from mild to moderate dementia, especially in the presence of comorbidities. The risk cannot be assessed using only one test. Only a global approach focused on cognition, attention, motor skills, autonomy and lifestyle, can help in the analysis. Sometimes, further on-raod driving test will be required. © La Revue de Gériatrie 2011.


Objectives: Questioning intensive care physicians of the Rhone-Alps region about their knowledge of the law 2005-370 of 22 April 2005 "Léonetti Act" and their vision of the process of decisions to withhold and withdraw therapies (DWWT) in the ward where they work. Methods: Self-administered questionnaire sent in spring 2011 to 69 intensive care units of the Rhone-Alps region. Results: One hundred and twenty-two questionnaires, from 65% of wards questioned, were received. The systematic search of advance directives and the support person is minority. For 62% of respondents, at least a quarter of DWWT are taken under conditions away from the spirit of the Leonetti Act (alone, "on call" time, at the bedside). Forty-two percent of respondents said they were uncomfortable with the way recent decisions of DWWT were taken, mainly because of problems of temporality (time for reflection, time of application) or because of the place the decision was taken. The opinion of a physician not working in the ward is rarely sought (70% in less than a quarter of cases). For 30% of respondents, there is no time dedicated to the afterthought on the DWWT. Conclusion: Despite the daily concern of intensive care physicians who responded on the decisions of DWWT, Leonetti law is still poorly understood and DWWT decisions are not always taken as provided by law. © 2012.

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