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Le Touquet – Paris-Plage, France

Fischer Q.,University Paris Diderot | Kirsch M.,Groupe Hospitalier Bichat Claude Bernard | Brochet E.,University Paris Diderot | Juliard J.-M.,University Paris Diderot
Interactive Cardiovascular and Thoracic Surgery | Year: 2015

We describe the interdisciplinary management of a 59-year old man with ischaemic cardiomyopathy on a HeartMate II left ventricular assist device (LVAD) and temporary right extracorporeal membrane oxygenation (ECMO) as a bridge-to-heart transplantation. He suffered refractory hypoxaemia due to massive right-to-left shunting by a patent foramen ovale (PFO), diagnosed after weaning off of temporary right ECMO. Percutaneous closure of the PFO was successfully achieved with an Amplatzer septal occluder device, which allowed the patient's extubation and departure from hospital. The patient received heart transplantation 7 weeks after LVAD implantation and was discharged from the intensive care unit 2 weeks after transplantation. © 2015 The Author. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved. Source

Claessens Y.-E.,Center Hospitalier Princesse Grace | Tubach F.,University Paris Diderot | Hausfater P.,Paris-Sorbonne University | Leport C.,Groupe Hospitalier Bichat Claude Bernard | Duval X.,University Paris Diderot
American Journal of Respiratory and Critical Care Medicine | Year: 2015

Rationale: Clinical decision making relative to community-acquired pneumonia (CAP) diagnosis is difficult. Chest radiograph is key in establishing parenchymal lung involvement. However, radiologic performance may lead to misdiagnosis, rendering questionable the use of chest computed tomography (CT) scan in patients with clinically suspected CAP. Objectives: To assess whether early multidetector chest CT scan affects diagnosis and management of patients visiting the emergency department with suspected CAP. Methods: A total of 319 prospectively enrolled patients with clinically suspected CAP underwent multidetector chest CT scan within 4 hours. CAP diagnosis probability (definite, probable, possible, or excluded) and therapeutic plans (antibiotic initiation/discontinuation, hospitalization/discharge) were established by emergency physicians before and after CT scan results. The adjudication committee established the final CAP classification on Day 28. Measurements and Main Results: Chest radiograph revealed a parenchymal infiltrate in 188 patients.CAPwas initially classified as definite in 143 patients (44.8%), probable or possible in 172 (53.8%), and excluded in 4 (1.2%).CTscan revealed a parenchymal infiltrate in 40 (33%) of the patients without infiltrate on chest radiograph and excludedCAPin 56 (29.8%) of the 188 with parenchymal infiltrate on radiograph. CT scan modified classification in 187 (58.6%; 95% confidence interval, 53.2-64.0), leading to 50.8% definite CAP and 28.8% excluded CAP, and 80% of modifications were in accordance with adjudication committee classification. Because of CT scan, antibiotics were initiated in 51 (16%) and discontinued in 29 (9%), and hospitalization was decided in 22 and discharge in 23. Conclusions: In CAP-suspected patients visiting the emergency unit, early CT scan findings complementary to chest radiograph markedly affect both diagnosis and clinical management. © 2015 by the American Thoracic Socie. Source

Zhang X.,Institute Pasteur Paris | Zhang X.,French Institute of Health and Medical Research | Zhang X.,CAS Institut Pasteur of Shanghai | Lepelley A.,Institute Pasteur Paris | And 13 more authors.
PLoS ONE | Year: 2013

Neonates are highly susceptible to infectious diseases and defective antiviral pDC immune responses have been proposed to contribute to this phenomenon. Isolated cord blood pDCs innately responded to a variety of TLR7 and TLR9 dependent viruses, including influenza A virus (IAV), human immunodeficiency virus (HIV) or herpes-simplex virus (HSV) by efficiently producing IFN-α, TNF-α as well as chemokines. Interestingly, following activation by CpGA, but not viruses, cord pDCs tend to survive less efficiently. We found that a hallmark of pDCs in neonates is an extended CD2+pDCs compartment compared to adult pDCs without affecting the antiviral IFN-α response. Within CD2+pDCs, we identified a subpopulation expressing CD5 and responsible for IL-12p40 production, however this population is significantly decreased in cord blood compared to adult blood. Therefore, neonatal pDCs clearly display variation in phenotype and subset composition, but without major consequences for their antiviral responses. © 2013 Zhang et al. Source

Azria E.,Groupe Hospitalier Bichat Claude Bernard | Azria E.,University Paris Diderot | Anselem O.,Groupe Hospitalier Cochin Port Royal Saint Vincent de Paul | Anselem O.,University of Paris Descartes | And 6 more authors.
BJOG: An International Journal of Obstetrics and Gynaecology | Year: 2012

Objective: To assess perinatal outcomes after expectant management in the case of preterm prelabour rupture of membranes (PPROM) before 25 weeks of gestation, according to the rate of termination of pregnancy (TOP). Design Retrospective comparative cohort study. Population Singleton pregnancies complicated by PPROM between 15 0/7 and 24 6/7 weeks of gestation, from January 2003 to January 2007. Methods Comparison of perinatal outcomes in two French tertiary care referral centres presumed to have different rates of TOP. Main outcome measure Rates of TOP, survival and survival without major morbidity. Results A total of 113 women experienced PPROM (49 in centre A and 64 in centre B). A lower proportion of patients opted for TOP in centre A (40.8%) than in centre B (56.3%). The baseline characteristics of patients and pregnancies, and gestational age at PPROM, were not different between the two centres. Mean gestational age at delivery (28.1 versus 25.4 weeks of gestation; P < 0.01), mean latency period (45.5 versus 16.1 days; P < 0.01), mean birthweight (1295 versus 929 g; P = 0.04) and survival (46.9 versus 20.3%; P < 0.01) were significantly higher in centre A than in centre B. The percentage of neonates alive without major morbidity was also higher in centre A than in centre B (42.9 versus 20.3%; P = 0.01). Conclusions Perinatal outcomes of pregnancies managed expectantly were not better in the centre where the TOP rate was higher. The perinatal risk of pregnancies complicated by pre-viable PPROM remains high. © 2012 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2012 RCOG. Source

Bouvet P.,Institute Pasteur Paris | Ruimy R.,Center Hospitalier University | Bouchier C.,Institute Pasteur Paris | Faucher N.,Groupe Hospitalier Bichat Claude Bernard | And 2 more authors.
Journal of Clinical Microbiology | Year: 2014

A nontoxigenic strain isolated from a fatal human case of bacterial sepsis was identified as a Clostridium strain from Clostridium botulinum group III, based on the phenotypic characters and 16S rRNA gene sequence, and was found to be related to the mosaic C. botulinum D/C strain according to a multilocus sequence analysis of 5 housekeeping genes. Copyright © 2014, American Society for Microbiology. Source

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