Departement Hospitalo University Fibrosis

Paris, France

Departement Hospitalo University Fibrosis

Paris, France
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Delaval L.,University Paris Diderot | Goulenok T.,University Paris Diderot | Achouh P.,University of Paris Descartes | Saadoun D.,University Pierre and Marie Curie | And 12 more authors.
Journal of Vascular Surgery | Year: 2017

Objective: Aortitis is an exceedingly rare manifestation of tuberculosis. We describe 11 patients with tuberculous aortitis (TA). Methods: Multicenter medical charts of patients hospitalized between 2003 and 2015 with TA in Paris, France, were reviewed. Demographic, medical history, laboratory, imaging, pathologic findings, treatment, and follow-up data were extracted from medical records. TA was considered when aortitis was diagnosed in a patient with active tuberculosis. Results: Eleven patients (8 women; median age, 44.6 years) with TA were identified during this 12-year period. No patient had human immunodeficiency virus infection. Tuberculosis was active in all cases, with a median delay of 18 months between the first symptoms and diagnosis. At disease onset, vascular signs were mainly claudication, asymmetric blood pressure, and diminished distal pulses. Constitutional symptoms or extravascular signs were present in all patients at some point. Aortic pseudoaneurysm was the most frequent lesion, but three patients had isolated inflammatory aortic stenosis. TA appeared as extension from a contiguous infection in only three cases. Tuberculosis was considered because of clinical features, tuberculin skin or QuantiFERON-TB Gold (Quest Diagnostics, Madison, NJ) test results, pathologic findings, and improvement on antituberculosis therapy. A definite Mycobacterium tuberculosis identification was made in only three cases. All patients received antituberculosis therapy for 6 to 12 months. Surgery including Bentall procedures, aortic bypass, and open abdominal aneurysm repair was performed at diagnosis in eight patients. Seven patients received steroids as an adjunct therapy. All patients clinically improved under treatment. No patients died for a median follow-up duration of 4 years. Conclusions: TA may result in aneurysms contiguous to regional adenitis but also in isolated inflammatory aortic stenosis. Steroids may be associated with antituberculosis therapy for inflammatory stenotic lesions. Surgery is indicated for aneurysms and in case of worsening stenotic lesions despite anti-inflammatory drugs. No patient died after such combined treatment strategy. © 2017 Society for Vascular Surgery.


Lindholm D.,Uppsala University | Lindback J.,Uppsala University | Armstrong P.W.,University of Alberta | Budaj A.,Grochowski Hospital | And 28 more authors.
Journal of the American College of Cardiology | Year: 2017

Background Currently, there is no generally accepted model to predict outcomes in stable coronary heart disease (CHD). Objectives This study evaluated and compared the prognostic value of biomarkers and clinical variables to develop a biomarker-based prediction model in patients with stable CHD. Methods In a prospective, randomized trial cohort of 13,164 patients with stable CHD, we analyzed several candidate biomarkers and clinical variables and used multivariable Cox regression to develop a clinical prediction model based on the most important markers. The primary outcome was cardiovascular (CV) death, but model performance was also explored for other key outcomes. It was internally bootstrap validated, and externally validated in 1,547 patients in another study. Results During a median follow-up of 3.7 years, there were 591 cases of CV death. The 3 most important biomarkers were N-terminal pro–B-type natriuretic peptide (NT-proBNP), high-sensitivity cardiac troponin T (hs-cTnT), and low-density lipoprotein cholesterol, where NT-proBNP and hs-cTnT had greater prognostic value than any other biomarker or clinical variable. The final prediction model included age (A), biomarkers (B) (NT-proBNP, hs-cTnT, and low-density lipoprotein cholesterol), and clinical variables (C) (smoking, diabetes mellitus, and peripheral arterial disease). This “ABC-CHD” model had high discriminatory ability for CV death (c-index 0.81 in derivation cohort, 0.78 in validation cohort), with adequate calibration in both cohorts. Conclusions This model provided a robust tool for the prediction of CV death in patients with stable CHD. As it is based on a small number of readily available biomarkers and clinical factors, it can be widely employed to complement clinical assessment and guide management based on CV risk. (The Stabilization of Atherosclerotic Plaque by Initiation of Darapladib Therapy Trial [STABILITY]; NCT00799903) © 2017 American College of Cardiology Foundation


Schurder J.,hopital Bichat | Schurder J.,University Paris Diderot | Goulenok T.,hopital Bichat | Goulenok T.,University Paris Diderot | And 13 more authors.
Joint Bone Spine | Year: 2017

Objective: Our study aimed to analyze the risk factors associated with the occurrence and severity of pneumococcal infection (PI) in systemic lupus erythematosus (SLE) patients. Methods: Medical records of all SLE patients admitted in our department from January 2005 to December 2014 were retrospectively reviewed. SLE patients were separated in 2 groups according to whether they had PI or not. Medical records of all consecutive patients (with and without SLE) admitted in our department for PI over the same period of time were also reviewed. Clinical characteristics associated with PI occurrence and severity were analyzed in SLE patients. Results: One hundred and ninety SLE patients (42.2 + 14.9 years; 87.4% females) were hospitalized over a 10-year period. PI was the reason for admission in 6 (3.2%) patients, including 5 cases of invasive infection. With a follow-up of 2112.8 patient-years for the total cohort, incidence of invasive PI in SLE was of 236/100,000 patient-years. PI occurred at a younger age (43.5 + 14.9 versus 65.3 + 18.7 years, P <. 0.01) and were more severe, with a higher frequency of invasive infection (P <. 0.001) and higher need for ICU admission (P <. 0.05) in SLE as compared to non SLE patients. Risk factors associated with PI in SLE patients were a serum gammaglobulin level. <. 5. g/L (P <. 0.01) and a past history of lupus nephritis (P <. 0.05), only. Steroids (P <. 0.001) and immunosuppressive drugs (P <. 0.05) were associated with infection severity. Conclusion: SLE is a disease of high susceptibility for invasive pneumococcal infections. Our study points to the need for vaccination against Streptococcus pneumoniae in SLE. © 2017 Société française de rhumatologie.

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