Cochin Hospital

Paris, France

Cochin Hospital

Paris, France
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Briot K.,Cochin Hospital
Current Opinion in Rheumatology | Year: 2017

PURPOSE OF REVIEW: The purpose of this review is to report the evidence of beneficial effects of Fracture Liaison Service (FLS) including data regarding their impact on subsequent fracture, mortality risk and cost-effectiveness. This review also discusses the limitations of these data and the challenges faced during the implementation of FLS. RECENT FINDINGS: Recent studies showed the beneficial impact of implementation of FLS on the prevention of subsequent fracture risk, reduced mortality and cost-effectiveness. However, heterogeneity of FLS models and small number of studies limited the conclusion about the impact of FLS on secondary fracture prevention. SUMMARY: Patients with osteoporosis-related fractures are at higher risk of subsequent refractures. These subsequent fractures are associated with increased morbidity and premature mortality. However, there is a gap between evidence-based recommendations for postfracture care and actual clinical practice. FLS care is recommended for the management of the prevention of secondary fracture. FLS implementation reduces the risk of subsequent fracture, but the level of evidence is low as the interpretation of data is limited by the number of studies and their heterogeneity. FLS care significantly reduces the postfracture mortality, especially in patients with hip fractures. FLS implementation is cost-effective compared with usual care. Additional studies (with large sample and long-term follow-up) are needed to assess the impact of FLS care on subsequent fracture risk. Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

Bougie A.,University Paris - Sud | Bougie A.,Cochin Hospital | Harrois A.,University Paris - Sud | Duranteau J.,University Paris - Sud
Annals of Intensive Care | Year: 2013

Managing trauma patients with hemorrhagic shock is complex and difficult. Despite our knowledge of the pathophysiology of hemorrhagic shock in trauma patients that we have accumulated during recent decades, the mortality rate of these patients remains high. In the acute phase of hemorrhage, the therapeutic priority is to stop the bleeding as quickly as possible. As long as this bleeding is uncontrolled, the physician must maintain oxygen delivery to limit tissue hypoxia, inflammation, and organ dysfunction. This process involves fluid resuscitation, the use of vasopressors, and blood transfusion to prevent or correct acute coagulopathy of trauma. The optimal resuscitative strategy is controversial. To move forward, we need to establish optimal therapeutic approaches with clear objectives for fluid resuscitation, blood pressure, and hemoglobin levels to guide resuscitation and limit the risk of fluid overload and transfusion. © 2013 Bouglé et al.; licensee Springer.

Kroon F.,Leiden University | Landewe R.,Atrium Medical | Dougados M.,University of Paris Descartes | Dougados M.,Cochin Hospital | van der Heijde D.,Leiden University
Annals of the Rheumatic Diseases | Year: 2012

Objectives: The aim was to compare continuous and on-demand NSAID treatment with respect to their ability to suppress radiographic progression in subgroups of patients with high/elevated CRP-levels, ESR, ASDAS-levels or BASDAI-levels in comparison to patients with normal levels. Methods: Post-hoc analyses were performed in a randomized trial comparing continuous and on-demand NSAID treatment. Relevant high/elevated subgroups were created based on time-averaged (ta) CRP (>5mg/L), ta-ESR (>12mm/hr), ta-BASDAI (>4), ta-ASDAS-CRP (>2.1) and ta-ASDAS-ESR (>2.1). Subgroups were further split according to NSAID-use (continuous vs. on-demand). Radiological progression was presented in probability plots. Statistical interactions were tested using multiple and logistic regression analysis. Differences in radiological progression were analysed using the Chi-square and Mann-Whitney U test. Results: 150 participants randomized to either the continuous-treatment group (n=76), or the on-demand group (n=74) had complete radiographs and were included. The effect of slowing radiological progression with continuous NSAID therapy was more pronounced in patients with elevated ta-CRP-levels, elevated ta-ESR, high ta-ASDAS-CRP or high ta-ASDAS-ESR versus patients with low/normal values. No such effect was found for participants with high vs. low BASDAI. Also, in participants with elevated ta-ESR (irrespective of treatment), there appeared to be a higher rate of structural progression than in participants with normal ta-ESR. Regression analyses showed that continuous NSAID treatment neutralizes the negative effect of inflammation (high ta-ESR). Conclusions: Patients with elevated acute phase reactants seem to benefit most from continuous treatment with NSAIDs. Continuous NSAID-therapy in patients with elevated acute phase reactants may lead to an improved benefit-risk-ratio of these drugs. Copyright Article author (or their employer) 2012.

Bodilis H.,French National Center for Scientific Research | Bodilis H.,Cochin Hospital | Guiso N.,Institute Pasteur Paris
Emerging Infectious Diseases | Year: 2013

Bordetella pertussis isolates that do not express pertactin (PRN) are increasing in regions where acellular pertussis vaccines have been used for >7 years. We analyzed data from France and compared clinical symptoms among infants <6 months old infected by PRN-positive or PRN-negative isolates. No major clinical differences were found between the 2 groups.

Significant hearing loss is one of the most common major abnormalities present at birth. If undetected, it will impede speech, language and cognitive development. Significant bilateral hearing loss is present in 1 to 3 per 1000 new born infants in the well-baby nursery population and in 2 to 4 per 100 infants in the intensive care unit population. It is an established fact that if hearing loss is present it should be detected and remediated before the baby is 6 months old. Neither universal screening nor a high risk screening, exists in majority of the hospitals in our country. In such a situation, a centralized facility catering to all hospitals in the city is a practical option. A two-stage screening protocol is projected, in which infants are screened first with otoacoustic emissions (OAE). Infants who fail the OAE are screened with auditory brainstem response (ABR). This two tier screening program (the second tier being ABR, which is more expensive) is required only for a selected few, making the program more practical and viable. It is the practicability of this program that makes it relevant for replication in other cities of the country, making it a model screening program for any developing country. © 2011 Indian Academy of Pediatrics.

Delongchamps N.B.,Cochin Hospital
Diagnostic and Interventional Imaging | Year: 2014

Recent advances need to be highlighted in the management of both localized and metastatic prostate cancer. New early detection and molecular characterization tools are being developed to improve differentiation of their progression profiles and reduce "overdetection" and "overtreatment" of clinically "insignificant" cancers. In addition, the development of multi-parametric MR has improved the characterization of localized cancer and introduced the new concept of focal treatment. Finally, several treatments for metastatic cancer which is resistant to castration have recently increased the therapeutic armamentarium. © 2014 Published by Elsevier Masson SAS on behalf of the Éditions françaises de radiologie.

Heshmati F.,Cochin Hospital
Transfusion and Apheresis Science | Year: 2014

Extracorporeal Photochemotherapy (ECP) consists in illumination of the patient's leukocytes in the presence of 8-Methoxy Psoralen (8-MOP) and its reinjection to the same patient. ECP is responsible for many cellular events, the most important being the induction of cell apoptosis. Apoptosis appears first in lymphocytes and activated lymphocytes (allo or auto) which are more sensitive and undergo faster apoptosis rather than other cells. Monocytes develop apoptosis later. The injection of apoptotic cells induces tolerance in patients with graft versus host disease (GvHD) and acute heart or lung graft rejection. In these patients, phagocytosis of apoptotic cells by antigen-presenting cells (APCs) and in particular dendritic cells is responsible for a shift from Th1 to Th2 immune response, an increase in anti-inflammatory cytokines such as interleukine 10 (IL-10) and Tumor Growth Factor Beta (TGF-β), a decrease in pro-inflammatory cytokines and finally, for the proliferation of regulatory cells. Among CD4/CD25 positive cells, only CD4+CD25hi are T-regulatory cells (T-regs). One subpopulation of T-regs produces IL-10 and inhibits Th1 CD4 cells, whereas other populations act as suppressors and inhibit the cytotoxic T-cells responsible for organ rejection and GvHD in an antigen specific fashion. It is not clear why the injection of early apoptotic cells induces tolerance in GvHD and organ graft rejection, but in Sézary syndrome, it induces up-regulation of anti-tumor immune response. Immune response modulation (up- or down-regulation) after ECP depends on many factors: early apoptotic cell injection; anti-inflammatory environment; impaired function of dendritic cells; dendritic type 2 cell dominance, lead to immune tolerance, whereas late apoptotic or necrotic cell injection and pro-inflammatory cytokines enhance immune response. Therefore, immune response to ECP depends on various factors responsible for the diversity of its mode of action in different diseases and further investigations are required. © 2014 Elsevier Ltd.

Allanore Y.,University of Paris Descartes | Meune C.,Cochin Hospital
Clinical and Experimental Rheumatology | Year: 2010

Systemic sclerosis (SSc) is a connective tissue disease characterised by widespread vascular lesions and fibrosis of the skin and internal organs. Cardiac involvement is recognised as a poor prognostic factor when clinically evident. Primary myocardial involvement is common in SSc. Increasing evidence strongly suggests that myocardial involvement is related to repeated focal ischaemia leading to myocardial fibrosis with irreversible lesions. Reproducible data have shown that this relates to microcirculation impairment with abnormal vasoreactivity, with or without associated structural vascular abnormalities. Consistently, atherosclerosis and macrovascular coronary lesions do not seem to be increased in SSc. Myocardial involvement leads to abnormal systolic and diastolic left ventricular dysfunction and right ventricular dysfunction. Sensitive and quantitative methods have demonstrated the ability of vasodilators, including calcium channel blockers and angiotensin converting enzyme inhibitors, to improve both perfusion and function abnormalities further emphasising the critical role of microcirculation impairment. Recent quantitative methods such as tissue Doppler echocardiography and magnetic resonance imaging have underlined these results. © Copyright CLINICAL AND.

Gaujoux S.,Cochin Hospital | Gaujoux S.,French Institute of Health and Medical Research | Brennan M.F.,Sloan Kettering Cancer Center
Surgery (United States) | Year: 2012

Background: Operative resection is the only potentially curative treatment for primary adrenocortical carcinoma (ACC), but standards of operative care are not defined with regards to the extent of local resection. We propose recommendations for operative management. Methods: Anatomic and clinical literature review focusing on local management of ACC, including lymphadenectomy and resection of adjacent organs or large vessels. Results: First-order drainage nodes of the adrenal gland include the renal hilum lymph nodes, the celiac lymph nodes, and the para-aortic and paracaval lymph nodes, mainly above the renal pedicle and ipsilateral to the adrenal glands. Lymph node involvement occurs in about 20% of patients with ACC, and is an important prognostic factor, but lymphadenectomy is performed infrequently. The adrenal glands and kidneys are contained in the same anatomic space, but systematic en bloc nephrectomy has no proven benefits for survival. Direct invasion of the kidney or adjacent organs is rare, but major venous invasion with tumor thrombus is relatively common. Both are associated with decreased survival, but complete resection can lead to long-term survival. Conclusion: Standardization of regional lymphadenectomy including first-order drainage nodes is proposed. Systematic nephrectomy is not necessary in the absence of gross local invasion, but locally involved organs or large veins should be resected en bloc, with tumor thrombus embolectomy, if R0 resection is possible. Operative standardization improves tumor staging, potentially decreases local recurrence, and may be associated with better survival. Evidence-based standards of operative care and prospective investigations within international collaborating groups are necessary. © 2012 Mosby, Inc. All rights reserved.

Paul A.K.,Cochin Hospital
Indian Pediatrics | Year: 2016

A two-stage centralized newborn screening program was initiated in Cochin in January 2003. Infants are screened first with otoacoustic emission (OAE). Infants who fail OAE on two occasions are screened with auditory brainstem response (ABR). All Neonatal intensive care unit babies undergo ABR. This successful model subsequently got expanded to the whole district of Ernakulam, and some hospitals in Kottayam and Thrissur districts. Over the past 11 years, 1,01,688 babies were screened. Permanent hearing loss was confirmed in 162 infants (1.6 per 1000). This practical model of centralized newborn hearing screening may be replicated in other districts of our country or in other developing countries. © 2016, Indian Academy of Pediatrics.

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