CHU de Tours

Joué-lés-Tours, France

CHU de Tours

Joué-lés-Tours, 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.

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.

Mohty M.,University Paris Est Creteil | Bacigalupo A.,IRCCS San Martino | Saliba F.,Hepatobiliary Center | Zuckermann A.,Medical University of Vienna | And 2 more authors.
Drugs | Year: 2014

In the 30 years since the rabbit antithymocyte globulin (rATG) Thymoglobulin® was first licensed, its use in solid organ transplantation and hematology has expanded progressively. Although the evidence base is incomplete, specific roles for rATG in organ transplant recipients using contemporary dosing strategies are now relatively well-identified. The addition of rATG induction to a standard triple or dual regimen reduces acute cellular rejection, and possibly humoral rejection. It is an appropriate first choice in patients with moderate or high immunological risk, and may be used in low-risk patients receiving a calcineurin inhibitor (CNI)-sparing regimen from time of transplant, or if early steroid withdrawal is planned. Kidney transplant patients at risk of delayed graft function may also benefit from the use of rATG to facilitate delayed CNI introduction. In hematopoietic stem cell transplantation, rATG has become an important component of conventional myeloablative conditioning regimens, following demonstration of reduced acute and chronic graft-versus-host disease. More recently, a role for rATG has also been established in reduced-intensity conditioning regimens. In autoimmunity, rATG contributes to the treatment of severe aplastic anemia, and has been incorporated in autograft projects for the management of conditions such as multiple sclerosis, Crohn's disease, and systemic sclerosis. Finally, research is underway for the induction of tolerance exploiting the ability of rATG to induce immunosuppresive cells such as regulatory T-cells. Despite its long history, rATG remains a key component of the immunosuppressive armamentarium, and its complex immunological properties indicate that its use will expand to a wider range of disease conditions in the future. © 2014 The Author(s).

Cavailles A.,Nantes University Hospital Center | Brinchault-Rabin G.,Hopital Pontchaillou | Dixmier A.,CHR dOrleans | Goupil F.,Center Hospitalier Le Mans | And 9 more authors.
European Respiratory Review | Year: 2013

By 2020, chronic obstructive pulmonary disease (COPD) will be the third cause of mortality. Extrapulmonary comorbidities influence the prognosis of patients with COPD. Tobacco smoking is a common risk factor for many comorbidities, including coronary heart disease, heart failure and lung cancer. Comorbidities such as pulmonary artery disease and malnutrition are directly caused by COPD, whereas others, such as systemic venous thromboembolism, anxiety, depression, osteoporosis, obesity, metabolic syndrome, diabetes, sleep disturbance and anaemia, have no evident physiopathological relationship with COPD. The common ground between most of these extrapulmonary manifestations is chronic systemic inflammation. All of these diseases potentiate the morbidity of COPD, leading to increased hospitalisations and healthcare costs. They can frequently cause death, independently of respiratory failure. Comorbidities make the management of COPD difficult and need to be evaluated and treated adequately. © ERS 2013.

PubMed | UMR 1282 Infectiologie et sante publique 37200 Tours, University of Tours, Service de parasitologie and CHU de Tours
Type: Journal Article | Journal: Medecine et sante tropicales | Year: 2017

Mosquitoes of the genus Anopheles are malaria vectors in tropical areas and were of course designated as primary targets by programs for malaria control. Repellent sprays, indoor use of insecticides, and massive delivery of mosquito nets are standard examples of the means widely used to combat malaria. This synthetic review supplies an overview of all of the modes of resistance developed by Anopheles mosquitoes against these human actions. The misuse of each available tool has gradually led to a decrease in its global effectiveness. Newly-emerging forms of resistance, due to modification or overexpression of molecular targets, as well as behavioral adaptations by mosquitoes, are some examples of the consequences. To enable a categorical reduction in malaria incidence, a thorough adjustment of the use of the various means of control should be envisioned.

Ebalard M.,Rennes University Hospital Center | Le Henaff G.,Brest University Hospital Center | Sigonney G.,Brest University Hospital Center | Lopes R.,Nantes University Hospital Center | And 3 more authors.
Orthopaedics and Traumatology: Surgery and Research | Year: 2014

Introduction: The goal of this retrospective, multicentre study was to evaluate the long-term outcomes in patients who have undergone partial or total arthrodesis of the subtalar and midtarsal joints. Hypothesis: Secondary osteoarthritis of the adjacent joints can negatively affect the outcomes more than 10 years after these fusion procedures. Material and Methods: The outcomes of 72 fusions (total: 22; partial: 50) performed between 1981 and 2002 were evaluated using the Maryland Foot Score (MFS), self-evaluation questionnaire and three weight-bearing X-ray views (Meary's with cerclage wire around heel, lateral and dorsoplantar). The average follow-up was 15. ±. 5 years (range 10-31). Results: There were two deep infections that resolved after lavage and antibiotics therapy. There were 21 early complications (10 complex regional pain syndrome, 7 delayed wound healing, 2 superficial infections, 2 venous thrombosis) that all resolved. There were five cases of non-union (6.9%) that healed after being re-operated. After five years, secondary osteoarthritis led to the fusion being extended to the tibotalar joint (1 case) and midtarsal joint (1 case). At the last follow-up, the average MFS was 71.5 (range 25-100). Patient deemed the result as either excellent (10%), very good (9%), good (55%), poor (19%) or bad (7%). Pain at the last follow-up was present in 84% of cases. The rear-foot was normally aligned in 45% of cases, varus aligned in 22% and valgus aligned in 33%. The MFS was significantly better in patients with normal alignment. Patients with neurological foot disorders had significantly more preoperative (80% cavovarus) and postoperative foot deformity (. P<0.05). At the last follow-up, the rate of secondary osteoarthritis in the surrounding joints was elevated: 73% tibiotalar, 58.3% subtalar, 65.8% talonavicular, 53.5% calaneocuboid. The presence of osteoarthritis was not correlated with pain or lower MFS. However there was significantly more pain at last follow-up than at 12 months postoperative and two fusions were required in patients with secondary osteoarthritis. Conclusion: Although partial or total arthrodesis of the subtalar and midtarsal joints is a reliable procedure, it induces secondary osteoarthritis. Even though it seems to be well tolerated more than 10 years after the initial procedure, this possibility must be discussed with young, active patients. Level of evidence: IV, retrospective study. © 2014 Elsevier Masson SAS.

Delaplace M.,CHU de Tours | Lhommet C.,CHU de Tours | De Pinieux G.,CHU de Tours | De Pinieux G.,University of Tours | And 6 more authors.
British Journal of Dermatology | Year: 2012

Background Despite intensive treatment, the overall prognosis of Ewing sarcoma of the bone remains poor. Primary cutaneous Ewing sarcoma very rarely occurs and the prognosis has been reported to be better in some small series. All cases of Ewing sarcoma are currently treated in the same way, regardless of their location. Objectives To determine whether Ewing sarcoma of the bone and primary cutaneous Ewing sarcoma are different in terms of epidemiology and prognosis. Methods A systematic review of the literature was carried out using the keywords 'cutaneous Ewing's sarcoma', 'primary Ewing's sarcoma of skin' and 'primary neuroectodermal tumour and skin' in the Medline database. Series of five or more cases were included. Results Six series met the inclusion criteria, making a total of 61 patients. Median age at diagnosis was 17 years and 33% were male. The median size of the tumour was 2·3 cm. The treatment consisted of surgery in all cases, adjuvant multiagent chemotherapy in 69% of cases, adjuvant chemoradiotherapy in 38% of cases and adjuvant radiotherapy without adjuvant chemotherapy in 3% of cases. Six patients developed metastases, four of whom died. The overall survival was 93% and the 10-year probability of survival was estimated at 91% (95% confidence interval 83-100). Conclusion This systematic review demonstrated epidemiological and prognostic differences between Ewing sarcoma of the bone and primary cutaneous Ewing sarcoma. Primary cutaneous Ewing sarcoma has a female predominance, occurs at a later age, but, more importantly, has a better outcome. Multimodal therapy for Ewing sarcoma is associated with immediate and long-term morbidity and mortality. Although the size of our study does not allow a definitive conclusion about treatment modalities, we suggest that a less toxic approach compared with conventional treatment should be investigated in primary cutaneous Ewing sarcoma. © 2011 The Authors. BJD © 2011 British Association of Dermatologists.

Zemmoura I.,CHU de Tours | Ismail M.B.,CHU de Tours | Travers N.,CHU de Tours | Jan M.,CHU de Tours | Francois P.,CHU de Tours
British Journal of Neurosurgery | Year: 2012

Seeding on surgical pathway is a rare form of clival chordoma treatment failure. We report the case of a 42-year-old male with a clival chondroid chordoma removed by a sublabial transsphenoidal approach followed by proton beam radiotherapy, who developed a maxillary bone recurrence 3 years after surgery. © 2012 The Neurosurgical Foundation.

Following a referral by a patient organization, the Constitutional Council gave on 20th April 2012 a decision on the law without consent of hospitalizations for mental patients. Four sections of the Act were examined. This results in one hand that ambulatory care is now supervised by a plan of care (POC) is constitutional. However, sections that provided a more rigorous regime for certain categories of patients deemed more dangerous than others are too vague. Lawmakers need to reform this part of the law before 1st October 2013. © 2012 Elsevier Masson SAS. All rights reserved.

Etienne A.,CHU de Tours | Waynberger E.,CHU de Tours | Druon J.,CHU de Tours
Diagnostic and Interventional Imaging | Year: 2013

Purpose: The aim of our retrospective study was to evaluate the efficacy of interstitial laser photocoagulation for the treatment of osteoid osteomas and to identify the factors leading to failure of the procedure. Material and methods: Thirty-five patients received interstitial laser photocoagulation treatment. A minimum of 3 months follow-up was required. The laser fibre was positioned within the nidus under CT guidance, and energy between 500 and 1800 J was delivered at a power of 2 Watts/s. Follow-up was by outpatient appointment and through a questionnaire sent to the patients. Results: Thirty patients replied to the questionnaire. Mean follow-up was 40 months. The technical success rate was 100%. The primary success rate (no pain at 1 month) was 94.3%. The rate of recurrence was 6%. The rate of complications was 11.4% (a skin burn, patellar enthesopathy, a broken item of material, sacro-iliac fibrous alterations). Factors likely to favour failure of the procedure are the size of the nidus (P = 0.04) and poor positioning of the laser fibre (P = 0.03). Conclusion: Interstitial laser photocoagulation is an effective and safe treatment for osteoid osteomas. © 2013 Published by Elsevier Masson SAS on behalf of the Éditions françaises de radiologie.

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