Clinique Ambroise Pare

Neuilly-sur-Seine, France

Clinique Ambroise Pare

Neuilly-sur-Seine, France
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Proebstle T.M.,University of Mainz | Alm B.J.,Dermatologikum Hamburg | Gockeritz O.,Venenzentrum Leipzig | Wenzel C.,Venenzentrum Leipzig | And 5 more authors.
British Journal of Surgery | Year: 2015

Background: This was a prospective study of radiofrequency segmental thermal ablation (RFA) for the treatment of incompetent varicose great saphenous veins (GSVs). The present report describes long-term follow-up at 5 years. Methods: The 5-year follow-up of this multicentre European study included assessment of the Venous Clinical Severity Score (VCSS), and GSV occlusion and reflux on duplex imaging. Results: A total of 225 patients had 295 GSVs treated by RFA, achieving an initial vein occlusion rate of 100 per cent. With 80·0 per cent compliance, Kaplan-Meier analyses showed a GSV occlusion rate of 91·9 per cent and a reflux-free rate of 94·9 per cent at 5 years. Among the 15 GSVs noted with reflux during follow-up, only three showed full recanalization of the GSV at 1 week, 6 months and 3 years. Of the 12 legs with partial recanalization, reflux originated at the saphenofemoral junction in ten, with a mean length of the patent segment of 5·8 (range 3·2-10) cm; only six patients were symptomatic. Mean(s.d.) VCSS scores improved from 3·9(2·1) at baseline to 0·6(1·2), 0·9(1·3) and 1·3(1·7) at 1, 3 and 5 years. Conclusion: At 5 years RFA proved to be an efficient endovenous treatment for incompetent GSVs in terms of sustained clinical and anatomical success for the vast majority of treated patients. © 2015 The Authors. BJS published by John Wiley & Sons Ltd on behalf of BJS Society Ltd.

Bourquelot P.,Access France | Gaudric J.,Hopital de La Pitie Salpetriere | Turmel-Rodrigues L.,Clinique Ambroise Pare | FrancoG.,Clinique Arago | And 2 more authors.
European Journal of Vascular and Endovascular Surgery | Year: 2010

Objective: Juxta-anastomosis proximal radial artery ligation (PRAL) is a new surgical technique for reduction of excessive blood flow of radial cephalic fistulas (RCFs). Patients and methods: This prospective study included 37 consecutive patients (eight children and 29 adults) who underwent PRAL of high-flow RCFs causing ischaemia (n = 2), aneurysmal degeneration of the vein (n Z 14), and cardiac insufficiency (n = 7) or for prevention of cardiac overload (n Z 14). Mean fistula age was 2.6 years for children and 7.4 years for adults. None had diabetes. Anatomical prerequisites (side-to-end anastomosis fistula and retrograde flow in the distal radial artery) were checked by ultrasound or angiography. Division and ligation of the juxta-anastomosis proximal radial artery were performed under regional anaesthesia. Patency following ligation was estimated according to the life table method. Results: The success rate was 92% (34/37). The three failures included one excessive and two insufficient reductions of flow (<33%). Mean flow reduction rates were 50% in children and 53% in adults. Primary patency rates at 1 and 2 years were 88% ± 6% and 74% ± 9%, respectively. Secondary patency rates were 88% ± 6% and 78% ± 8%, respectively. Conclusion: PRAL is a simple, safe, and effective technique for reduction of flow in RCFs. © 2010 European Society for Vascular Surgery. Published by Elsevier Ltd.

Milleret R.,Polyclinique Pasteur | Huot L.,Hospices Civils de Lyon | Huot L.,University of Lyon | Nicolini P.,Clinique du Parc | And 7 more authors.
European Journal of Vascular and Endovascular Surgery | Year: 2013

Objective: To assess the safety and efficiency of steam vein sclerosis (SVS) of the great saphenous vein (GSV) in a multicentre open prospective cohort study. Design: 75 consecutive adult patients with GSV reflux, CEAP C2-C5 and vein diameter 4-13 mm. Methods: Patients treated using an SVS™ generator delivering homogenous pulses of superheated steam were followed up at 8 days and 1, 3, 6 and 12 months (clinical, duplex ultrasound, quality of life [QoL] with SF12). Results: 88 veins were treated in 75 patients. At 6 months, 72/75 (96%) veins were obliterated (95% CI: 89-99) and Kaplan-Meier analysis found an obliteration rate of 96.1% at 12 months. QoL increased at 6 months for both the physical and mental components (p = 0.049 and p < 0.001 respectively). SVS was well tolerated: no major complications were reported. Adverse events occurred mainly at day 8 and incidents amounted to ecchymosis (n = 60) and pain (n = 7). Conclusions: SVS achieved an obliteration rate similar to that of other thermal ablation techniques. It was well tolerated with minimal post-operative pain. © 2012 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

Creton D.,Clinique Ambroise Pare | Pichot O.,Grenoble University Hospital Center | Sessa C.,Grenoble University Hospital Center | Proebstle T.M.,University of Heidelberg
Annals of Vascular Surgery | Year: 2010

This prospective and multicenter study shows the results at 1 year of radiofrequency-powered segmental thermal obliteration (RSTO) carried out with the ClosureFast® procedure. The RSTO clinical and duplex ultrasound imaging results were evaluated at 3 days, 3 months, 6 months, and 1 year. All procedures were carried out on outpatients under tumescent local anesthesia. Among the 295 members who were treated, 289 were reexamined at 3 days, 290 at 3 months, 289 at 6 months, and 220 at 1 year. Occlusion scores were 99.7%, 99.3%, 98.6%, and 96.9% at, respectively, 3 days, 3 months, 6 months, and 1 year. At 3 cm below the saphenofemoral junction, before the procedure, the greater saphenous vein (GSV) diameter was 5.4 ± 2 mm (range 2-18). It decreased to 4.5 ± 1.7 mm at 3 days, 2.4 ± 1.5 mm at 6 months, and 1.3 ± 0.9 mm at 1 year. In members reexamined at 1 year, the decrease in diameter of the treated vein compared with the preprocedural measurement was 79% (p < 0.001, t-test). At 1 year, in 58% of the cases, duplex ultrasound imaging at mid-thigh level could not show the GSV trunk. Preprocedural pain that was present in 57.5% of the cases decreased to 10.8% of the cases at 3 days and 2% of the cases at 1 year (p < 0.001, χ2 test). Among the treated limbs, 70.1% did not present with any postprocedural pain at any time of the follow-up. On the third day, the patients evaluated the mean pain intensity at 0.7 ± 1.6 on a visual analog scale of 0-10. During the follow-up, no painful indurations were noticed in 67.7% of the legs. No thromboembolic complications were reported. Paresthesias were observed in 3.4% of the cases. Invalidity clinical score, evaluated at 3.9 ± 2 before the procedure, decreased to 3.5 ± 1.2 on the third day, 0.9 ± 1.5 at 3 months, 0.7 ± 1.2 at 6 months, and 0.5 ± 1.1 at 1 year. This study confirms the efficacy of RSTO when using ClosureFast, which allows obliteration of the GSV trunk in 97% of cases at 1 year with few side effects and almost no postprocedural pain. © 2010.

Squara P.,Clinique Ambroise Pare
Critical Care | Year: 2014

Central venous oxygen saturation (ScvO2) >70% or mixed venous oxygen saturation (SvO2) >65% is recommended for both septic and non-septic patients. Although it is the task of experts to suggest clear and simple guidelines, there is a risk of reducing critical care to these simple recommendations. This article reviews the basic physiological and pathological features as well as the metrological issues that provide clear evidence that SvO2 and ScvO2 are adaptative variables with large inter-patient variability. This variability is exemplified in a modeled population of 1,000 standard ICU patients and in a real population of 100 patients including 15,860 measurements. In these populations, it can be seen how optimizing one to three of the four S(c)vO2 components homogenized the patients and yields a clear dependency with the fourth one. This explains the discordant results observed in large studies where cardiac output was increased up to predetermined S(c)vO2 thresholds following arterial oxygen hemoglobin saturation, total body oxygen consumption needs and hemoglobin optimization. Although a systematic S(c)vO2 goal-oriented protocol can be statistically profitable before ICU admission, appropriate intensive care mandates determination of the best compromise between S(c)vO2 and its four components, taking into account the specific constraints of each individual patient. © 2014 Squara.

Jauvert G.,Clinique Ambroise PARE | Grimard C.,Clinique Ambroise PARE | Lazarus A.,Clinique Ambroise PARE | Alonso C.,Clinique Ambroise PARE
Heart Lung and Circulation | Year: 2015

Introduction: This study aimed to evaluate the safety and efficacy of utilising an innovative radiofrequency (RF) powered flexible needle to achieve transseptal puncture (TSP). Methods and Results: A RF powered flexible needle (Toronto catheter, Baylis Medical Company Inc.) associated with a stiffer dilator (Torflex Superstrong, Baylis Medical Company Inc.) was used in 125 consecutive patients referred for left sided ablations (mean age. =. 55.6, male. =. 86.5%) and compared with a standard transseptal set (BRK needle, SL0 sheath and dilator, St Jude Medical, Inc.) used in the previous 100 patients (mean age. =. 56, male 82%). TSP was achieved in 95/100 patients in the Brockenbrough group and in all 125 patients in the Toronto group (p=0.01) despite an equivalent proportion of difficult situations (8 and 9% respectively) and patients with a prior TSP (17% vs 24%). 7/100 needle related events (failure, aborted attempt or pericardial effusion) occurred in the Brockenbrough group and none in the Toronto group (p=0.01). The Toronto needle crossed the septum at the first attempt in 123/125 (98.4%) patients and the Brockenbrough needle in 84/95 (88%) patients (p<0.001). Conclusion: Our data suggest that the Toronto RF powered flexible needle is safer and more efficient than a standard Brockenbrough needle and can be used not only in difficult situations but routinely to achieve TSP. © 2014 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ).

Proebstle T.M.,University of Mainz | Proebstle T.M.,University of Pécs | Alm J.,Dermatologikum Hamburg | Gckeritz O.,Venenzentrum Leipzig | And 6 more authors.
Journal of Vascular Surgery | Year: 2011

Background: Radiofrequency segmental thermal ablation (RSTA) has become a commonly used technology for occlusion of incompetent great saphenous veins (GSVs). Midterm results and data on clinical parameters are still lacking. Methods: A prospective multicenteral trial monitored 295 RSTA-treated GSVs for 36 months. Clinical control visits included flow and reflux analysis by duplex ultrasound imaging and assessment of clinical parameters according to the CEAP classification and Venous Clinical Severity Score (VCSS). Results: A total of 256 of 295 treated GSVs (86.4%) were available for 36 months of follow-up. At 36 months, Kaplan-Meier survival analysis showed the probability of occlusion was 92.6% and the probability of no reflux was 95.7%, and 96.9% of legs remained free of clinically relevant axial reflux. If complete occlusion was present at the 12-month follow-up, the risk of developing new flow by 24 and 36 months of follow-up was 3.7% and 4.1%, respectively. Diameters of the GSV measured 3 cm distal to the saphenofemoral junction reduced from 5.8 ± 2.1 mm at screening to 2.2 ± 1.1 mm at 36 months. The average VCSS score improved from 3.9 ± 2.1 before treatment to 0.9 ± 1.5 at 3 months (P <.0001) and stayed at an average <1.0 during the complete 36 months of follow-up. Only 41.1% of patients were free of pain before treatment; at 36 months, 251 (98.0%) reported no pain and 245 (95.7%) did not experience pain during the 24 months before. At 36 months, 189 of 255 legs (74.1%) showed an improvement in CEAP class compared with the clinical assessment before treatment (P <.001). Stages C3 and C4 combined to 46% before treatment and dropped constantly to a combined level of 8% at 36 months. However, the proportion of C2 legs that dropped from 52.3% before treatment to <10% at 12 months showed a constant increase thereafter, reaching 33.3% at 36 months. Conclusion: RSTA showed a high and durable success rate in vein ablation in conjunction with sustained clinical efficacy. © 2011 Society for Vascular Surgery.

Neve S.,Ehpad | Bouchara J.,Clinique Ambroise Pare
Soins. Gérontologie | Year: 2016

The suicide of an older person has a significant emotional impact on the nursing teams. Firstly, shock, incomprehension, confoundment, then a questioning of individual convictions and missions. Caregivers are poorly equipped and lack training with regard to this issue. Suicide can be analysed from the perspective of different factors and requires on the part of health institutions discussion and support for health professionals. Copyright © 2016. Published by Elsevier Masson SAS.

Benomar B.,University Paris - Sud | Ouattara A.,Groupe Hospitalier Sud | Estagnasie P.,Clinique Ambroise Pare | Brusset A.,Clinique Ambroise Pare | Squara P.,Clinique Ambroise Pare
Intensive Care Medicine | Year: 2010

Purpose: To study the feasibility of predicting fluid responsiveness (FR) by passive leg raising (PLR) using a Bioreactance-based noninvasive cardiac output monitoring device (NICOM). Method: This prospective, two-center study included 75 consecutive intensive care unit (ICU) adult patients immediately after cardiac surgery. NICOM was used to continuously record cardiac output (CO) at baseline, during a PLR, and then during a 500 ml i.v. rapid colloid infusion. We estimated the precision of NICOM at baseline to derive the least minimum significant change (LMSC) in CO. We studied the predictability of PLR for FR by systematic analysis of different categorizations of PLR and FR, based on percentage change in CO (from 0 to 20%). Results: The LMSC was 8.85%. CO was 4.17 ± 1.04 L min-1 at baseline, 4.38 ± 1.14 L min -1 during PLR, 4.16 ± 1.08 L min-1 upon return to baseline, and 4.85 ± 1.41 L min-1 after fluid infusion. The change in CO following fluid bolus was highly correlated with the change in CO following PLR≥ y = 0.91x + 4.3, r = 0.77. The Pearson correlation coefficient showed that the best pair of thresholds was found for PLR C0% predicting ≥ FR C0%. Using this pair of thresholds, PLR had 88% sensitivity and 100% specificity for predicting FR. When we restricted the analysis to change in CO>LMSC, the best pair of thresholds was obtained for PLR>9% predicting FR>9%. Using this pair of thresholds, PLR sensitivity was reduced to 68% and specificity to 95%. Conclusions: In this specific population of patients, it is clinically valid to use the bioreactance-based NICOM system to predict FR from changes in CO during PLR. © The Author(s) 2010.

PubMed | CHU Saint Etienne, Clinique Ambroise Pare, Beaujon Hospital, Nice University Hospital Center and 2 more.
Type: | Journal: Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver | Year: 2017

Crohns disease (CD) is a chronic and disabling condition. There is no curative medical treatment but current treatments provide increasingly sustainable control of the disease and allow patients a better quality of life. There is limited evidence supporting CD management in specific clinical situations, thus precluding an evidence-based approach.To help clinicians in making informed treatment decisions, a group of 59 French gastroenterologists with experience in the management of CD met to develop straightforward and practical algorithms based on the European Crohns and Colitis Organisation (ECCO) recommendations.This experts opinion was developed following a Nominal Group consensus methodology. Nine clinical situations were identified: mildly active CD; uncomplicated moderately active CD, with, and without poor prognostic factors; uncomplicated severely active CD; perianal CD with a single fistula; perianal CD with complex fistula with or without abscess; complicated CD with abscess; intestinal stricture; and post-operative CD. Two working groups were formed and proposed algorithms that were then approved by a two-thirds majority of the Nominal Group.These algorithms represent the pragmatic consensus of a group of experts in gastroenterology on the modalities of therapeutic care in different clinical situations in CD. They are available via a web application at:

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