Joué-lés-Tours, France
Joué-lés-Tours, France

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Mertl P.,CHU Amiens | Rosset P.,CHU Tours | Migaud H.,Lille University Hospital Center | Tabutin J.,Orthopaedic Surgery | Van De Velde D.,Orthopaedic Surgery
International Orthopaedics | Year: 2011

Revision total hip arthroplasty in the setting of a large proximal femoral deficiency or a peri-prosthetic fracture remains a challenging problem. We describe the development, surgical technique and the use of cementless revision stems with distal inter-locking screws to provide immediate stability of the femoral implant. Results were assessed in a large multicentre French study conducted with the french hip and knee surgery society (SFHG). We retrospectively reviewed 725 revisions using interlocking stems from 14 French orthopaedic departments. Seven different stems were used in this series. In-patient records were retrieved, and in addition to demographic data the indication for revision, the preoperative and postoperative PMA and Harris hip scores were documented. The bone deficiency was classified on the basis of the French National Orthopaedic Meeting (SOFCOT) classification. Intraoperative complications and problems if any were retrieved from operative notes. Clinical status and radiographs at the final follow-up were evaluated, paying special attention to the metaphyseal filling index. Average follow-up was 4.5 years. As for the clinical results, the mean Harris hip score at last follow-up was 81. Therefore, it increased by an average of 31 points. Bone reconstruction was assessed on the cortico-medullary index in the metaphyseal area and at mid-shaft increasing from 36 to 45 and 54 to 63, respectively. Radiologically, 637 implants were stable, and 40 demonstrated subsidence. Forty-eight implants have been revised. We found a significant relation between the metaphyseal filling index, the stability of the stem and the quality of bone reconstruction. Results were analysed with respect to three groups of stems: group 1 was a straight, partially HA-coated implant; group 2 was a curved, fully HA-coated implant; and group 3 was a curved, partially-coated implant. Group 1 showed a significantly higher rate of failure when compared with the others types of implants. Group 2 had better functional results than group 3, which in turn reported better results than group 1. With regard to implant fixation, group 2 had significantly better results. Both groups 2 and 3 induced less thigh pain than group 1. The distal interlocking stem has shown promising results for femoral revisions. The advantages are initial axial and rotational stability and consistent bony in-growth owing to hydroxyapatite coating. Distal locked stems are mainly indicated to treat complex femoral revision with severe bone loss and peri-prosthetic fractures. © Springer-Verlag 2010.


Marie I.,CHU Rouen | Marie I.,University of Rouen | Hatron P.-Y.,Lille University Hospital Center | Cherin P.,Pitie Salpetriere Hospital | And 6 more authors.
Arthritis Research and Therapy | Year: 2013

Introduction: The aims of this present study were firstly to assess the outcome, including functional course, in anti-Jo1 positive patients with antisynthetase syndrome (ASS), and secondly to determine predictive parameters of poor outcome in these patients.Methods: The medical records of 86 consecutive anti-Jo1 patients with ASS were reviewed in 4 academic centers.Results: 13 patients (15.1%) achieved remission of ASS, whereas 55 (63.9%) improved and 18 (20.9%) deteriorated in their clinical status. Both steroid and cytotoxic drugs could be discontinued in only 4.7% of patients. ASS was associated with decreased quality of life at long-term follow-up: only 69.2% of patients considered to be in remission experienced a return to previous normal activities; and 24.7% of other patients with non-remitting ASS still had a marked reduction of activities (as shown by the disability scale of the Health Assessment Questionnaire). Decreased quality of life was further due to calcinosis cutis (8.1%) and adverse effects of steroid therapy (36%). Factors associated with ASS deterioration were older age, pulmonary and esophageal involvement, calcinosis cutis and cancer. Higher anti-Jo1 levels were further associated with disease severity in ASS patients.Conclusions: The present study shows high morbidity related to ASS. Furthermore, we suggest that patients with predictive factors of ASS deterioration may require more aggressive therapy. Our findings also suggest that in anti-Jo1 patients with severe esophageal manifestations, combined high dose steroids and intravenous immunoglobulins might be proposed as the first line therapy. Finally, as cancer occurred in 14% of anti-Jo1 patients, our findings underscore that the search for cancer should be performed in these patients. © 2013 Marie et al.; licensee BioMed Central Ltd.


Marie I.,University of Rouen | Josse S.,University of Rouen | Decaux O.,Rennes University Hospital Center | Dominique S.,CHU Rouen | And 10 more authors.
Autoimmunity Reviews | Year: 2012

The aims of the present study were to: compare the characteristics between antisynthetase syndrome (ASS) patients with anti-Jo1 antibody and those with anti-PL7/PL12 antibody. The medical records of 95 consecutive patients with ASS were reviewed. Seventy-five of these patients had anti-Jo1 antibody; the other patients had anti-PL7 (n = 15) or anti-PL12 (n = 5) antibody. At ASS diagnosis, the prevalence of myalgia (p = 0.007) and muscle weakness (p = 0.02) was significantly lower in the group of anti-PL7/PL12-positive patients than in those with anti-Jo1 antibody; median value of CK (p = 0.00003) was also lower in anti-PL7/PL12 patients. Anti-Jo1 positive patients developed more rarely myositis resolution (21.3% vs. 46.2%); in addition, the overall recurrence rate of myositis was higher in anti-Jo1 positive patients than in patients with anti-PL7/PL12 antibody (65.9% vs. 19.4%). Anti-Jo1-positive patients, compared with those with anti-PL7/PL12 antibody, more often experienced: joint involvement (63.3%vs. 40%) and cancer (13.3% vs. 5%). By contrast, anti-PL7/PL12 positive patients, compared with those with anti-Jo1 antibody, more commonly exhibited: ILD (90% vs. 68%); in anti-PL7/PL12 positive patients, ILD was more often symptomatic at diagnosis, and led more rarely to resolution of lung manifestations (5.6% vs. 29.4%). Finally, the group of anti-PL7/PL12 positive patients more commonly experienced gastrointestinal manifestations related to ASS (p = 0.02). Taken together, although anti-Jo1 positive patients with ASS share some features with those with anti-PL7/PL12 antibody, they exhibit many differences regarding clinical phenotype and long-term outcome. Our study underscores that the presence of anti-Jo1 antibody results in more severe myositis, joint impairment and increased risk of cancer. On the other hand, the presence of anti-PL7/PL12 antibody is markedly associated with: early and severe ILD, and gastrointestinal complications. Thus, our study interestingly indicates that the finding for anti-Jo1 and anti-PL7/PL12 antibodies impacts both the long-term outcome and prognosis of patients with ASS. © 2012 Elsevier B.V..


Picard N.,French Institute of Health and Medical Research | Picard N.,Limoges University Hospital Center | Picard N.,University of Limoges | Yee S.W.,University of California at San Francisco | And 9 more authors.
Clinical Pharmacology and Therapeutics | Year: 2010

The goal of this study was to determine the roles of the organic anion-transporting polypeptides (OATPs) OATP1A2, OATP1B1, and OATP1B3 and their genetic variants in the pharmacokinetics of the immunosuppressive drug mycophenolate mofetil (MMF). Using OATP-transfected human embryonic kidney (HEK) cells, we measured the uptake of mycophenolic acid (MPA) and its glucuronide (MPAG). MPAG, but not MPA, significantly accumulated in cells expressing OATP1B3 or OATP1B1 (P 0.05). The pharmacokinetics of both MPA and MPAG were significantly influenced by the OATP1B3 polymorphism 334TG/699GA in 70 renal transplant patients receiving combination treatment of MMF with either tacrolimus or sirolimus, but not in 115 patients receiving MMF and cyclosporine. The decrease in dose-normalized (dn) MPA exposure and the concomitant increase in the MPAG/MPA metabolic ratio are consistent with reduced enterohepatic cycling in patients carrying the OATP1B3 334G-699A haplotype. Further studies demonstrated that this variant of OATP1B3 exhibited a reduced maximal velocity (V max) in transfected HEK cells, thereby providing functional evidence to support our clinical findings. © 2009 American Society for Clinical Pharmacology and Therapeutics.


PubMed | Besancon University Hospital Center, CHU Tours, University of Nantes, Limoges University Hospital Center and 16 more.
Type: | Journal: Transplant international : official journal of the European Society for Organ Transplantation | Year: 2017

Kidney transplantation is one of the therapeutic options for end-stage renal disease (ESRD) in systemic sclerosis (SS). Current evidence demonstrates poorer patient and graft survival after transplantation in SS than in other primary kidney diseases. All the patients presenting ESRD associated with SS who had received a kidney allograft between 1987 and 2013 were systematically included from 20 French kidney transplantation centres. Thirty-four patients received 36 kidney transplants during the study period.. Initial kidney disease was scleroderma renal crisis in 76.4%. Extra-renal involvement of SS was generally stable, excepted cardiac and gastro intestinal involvements, which worsened after kidney transplantation in 45% and 26% of cases respectively. Patient survival was 100%, 90.3% and 82.5% at 1, 3, and 5 years post transplant respectively. Pulmonary involvement of SS was an independent risk factor of death after transplantation. Death-censored graft survival was 97.2% after 1 and 3 years, and 92.8% after 5 years. Recurrence of scleroderma renal crisis was diagnosed in 3 cases. In our study, patient and graft survivals after kidney transplantation can be considered as excellent. On this basis, we propose that in the absence of extra-renal contraindication, SS patients presenting with ESRD should be considered for kidney transplantation. This article is protected by copyright. All rights reserved.


Doury-Panchout F.,CHU Tours | Metivier J.-C.,Renault S.A. | Fouquet B.,France Inter
European Journal of Physical and Rehabilitation Medicine | Year: 2015

Background. The influence of kinesiophobia on disability in patients with knee osteoarthritis is known, but its influence on functional recovery after total knee arthroplasty remains unexplored. Aims. To assess the influence of kinesiophobia on functional recovery following total knee arthroplasty (TKA) in patients with knee osteoarthritis and to investigate if kinesiophobia was more common in obese patients than in non-obese patients. Design. Cohort study. Setting. Inpatients of the Physical Medicine and Rehabilitation unit of the Château-Renault hospital (France). Population. The study included 89 consecutive patients (mean age = 72.6 years) hospitalized for post-operative rehabilitation after TKA. All patients completed the study. Methods. We evaluated functional outcome by testing maximum passive flexion, pain intensity, the duration of hospitalization, and performance in a six minute walk test. Kinesiophobia was assessed by the Tampa Scale for Kinesiophobia (TSK) score. Obesity was assessed by calculation of body mass index (BMI). A Stepwise multiple linear regression was used to determine significant independent predictors of the distance at the six minute walk test. Results. During the six minute walk test, patients without kinesiophobia walked significantly farther than patients with kinesiophobia (309.5 [83.6] m vs. 264.8 [96.5] m, P=0.048). There were no significant differences in the duration of hospitalization, the maximum passive flexion, or pain intensity between the two groups. The best multivariate model of factors associated with the performance in the 6 minute walk test included the Lequesne's score before surgery, the degree of active extension of the knee at the beginning of hospitalization, the TSK scores (total score, classification with the TSK score, "avoidance" subscale score). The overall TSK score did not differ between the obese and non-obese groups. Conclusion. Our study is consistent with previous reports that cognitive and behavioral maladaptative strategies can impair functional recovery after TKA. Moreover, unlike previous work, the principal end-point of our study is an objective measurement of walking capacity, and not a questionnaire. Clinical Rehabilitation Impact. We suggest that programs aimed at the management of such cognitive and behavioral factors which contribute to activity avoidance during rehabilitation are likely to improve functional recovery after TKA.


Duchesne M.,University of Poitiers | Mathis S.,University of Poitiers | Corcia P.,CHU Tours | Jaccard A.,Limoges University Hospital Center | Vallat J.-M.,Limoges University Hospital Center
Medicine (United States) | Year: 2015

Hematological malignancies include several diseases that may affect the peripheral nervous system (PNS) through various mechanisms. A common and challenging situation is represented by the occurrence of an active peripheral neuropathy in a patient with a supposed inactive hematological disorder.We report clinical, electrophysiological, biological, and pathological data of 8 patients with latent malignant hemopathies (most were considered in remission): B-cell chronic lymphocytic leukemia in 3 patients, B-cell lymphoma in 1 patient, low-grade non-Hodgkin?s lymphoma in 1 patient, Waldenström?s macroglobulinemia in 1 patient, smoldering multiple myeloma in 1 patient, and monoclonal gammopathy of undetermined significance in 1 patient.In all these cases, the nerve biopsy (NB) helped to diagnose the hematological relapse or detect a pathological mechanism linked to the hematological disorder: epineurial lymphocytic infiltration in 5 patients (including one with antimyelin-associated glycoprotein antibodies), cryoglobulin deposits in 1 patient, chronic inflammatory demyelinating polyneuropathy in 1 patient, and necrotizing vasculitis in 1 patient. In each case, pathological findings were crucial to select the adequate treatment, leading to an improvement in the neurological and biological manifestations.These observations illustrate the value of NB and the need for active collaboration between neurologists and hematologists in such cases. © 2015 Wolters Kluwer Health, Inc.


Pascher A.,Charité - Medical University of Berlin | De Simone P.,Azienda Ospedaliero Universitaria Pisana | Pratschke J.,Innsbruck Medical University | Salame E.,CHU Tours | And 5 more authors.
American Journal of Transplantation | Year: 2015

Efficacy and safety of protein kinase C inhibitor sotrastaurin (STN) with tacrolimus (TAC) was assessed in a 24-month, multicenter, phase II study in de novo liver transplant recipients. A total of 204 patients were randomized (1:1:1:1) to STN 200 mg b.i.d. + standard-exposure TAC (n = 50) or reduced-exposure TAC (n = 52), STN 300 mg b.i.d. + reduced-exposure TAC (n = 50), or mycophenolate mofetil (MMF) 1 g b.i.d. + standard-exposure TAC (control, n = 52); all with steroids. Owing to premature study termination, treatment comparisons were only conducted for Month 6. At Month 6, composite efficacy failure rates (treated biopsy-proven acute rejection episodes of Banff grade ≥1, graft loss, or death) were 25.0%, 16.5%, 20.9% and 15.9% for STN 200 mg + standard TAC, STN 200 mg + reduced TAC, STN 300 mg + reduced TAC and control groups, respectively. Median estimated glomerular filtration rates were 84.0, 83.3, 81.1 and 75.3 mL/min/1.73 m2, respectively. Gastrointestinal events (constipation, diarrhea, and nausea), infection, and tachycardia were more frequent in STN groups. More patients in STN groups experienced serious adverse events compared with the control group (62.3-70.8% vs. 51.9%). STN-based regimens were associated with a higher efficacy failure rate and higher incidence of adverse events with no significant difference in renal function between the groups. © Copyright 2015 The American Society of Transplantation and the American Society of Transplant Surgeons.


Brilhault J.,C.H.U. Tours | Brilhault J.,University of Tours | Noel V.,C.H.U. Tours
Foot and Ankle International | Year: 2012

Background: The decision to offer surgery for Stage II posterior tibial tendon deficiency (PTTD) is a difficult one since orthotic treatment has been documented to be a viable alternative to surgery at this stage. Taking this into consideration we limited our treatment to bony realignment by a lengthening calcaneus Evans osteotomy and tendon balancing. The goal of the study was to clinically evaluate PTT functional recovery with this procedure. Method: The patient population included 17 feet in 13 patients. Inclusion was limited to early Stage II PTTD flatfeet with grossly intact but deficient PTT. Deficiency was assessed by the lack of hindfoot inversion during single heel rise test. The surgical procedure included an Evans calcaneal opening wedge osteotomy with triceps surae and peroneus brevis tendon lengthening. PTT function at follow up was evaluated by an independent examiner. Evaluation was performed at an average of 4 (range, 2 to 6.3) years. Results: One case presented postoperative subtalar pain that required subtalar fusion. Every foot could perform a single heel rise with 13 feet having active inversion of the hindfoot during elevation. Conclusions: The results of this study provide evidence of PTT functional recovery without augmentation in early Stage II. It challenges our understanding of early Stage II PTTD as well as the surgical guidelines recommending PTT augmentation at this specific stage. Copyright © 2012 by the American Orthopaedic Foot & Ankle Society.


There is a continuous relationship between arterial pressure and the risk of chronic kidney disease (CKD), although the risk of CKD is much greater in African Americans than in other patients. The cause of the greater risk of CKD in this population is presently unknown; however, many hypotheses have been made, including the lower number of nephrons and the higher frequency of apolipoprotein-1 polymorphism associated with protection against trypanosomiasis, with greater risk of renal lesions, especially within the podocytes. Regardless of the cause of the elevation of arterial pressure, the greater the arterial pressure, the faster the evolution toward terminal renal failure. Current guidelines indicate that arterial pressure should be lowered to 130/80mmHg in patients with renal dysfunction and diabetes mellitus (British and Canadian guidelines kept this cut-off value for arterial pressure). Results of randomized clinical trials are less convincing. Lowering systolic arterial pressure toward 134mmHg was associated with less renal lesions in patients with type 2 diabetes mellitus; however, lowering of arterial pressure had no protective renal effect in African-American patients with CKD and probable nephrosclerosis (AASK study) when proteinuria was<0.22 g/g urine creatinine), thus confirming previous meta-analyses. Finally, lowering arterial pressure toward 130mmHg or lower should be reserved to patients with CKD and proteinuria (and in those with diabetes); in CKD patients without proteinuria, arterial pressure lowering< 130/80mmHg affords no nephroprotection (the real effect of renin-angiotensin blockade is not even fully demonstrated): the cut-off value of 140/90mmHg can be kept in these patients.

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