Groupe Hospitalier Paris Center

Paris, France

Groupe Hospitalier Paris Center

Paris, France
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Alfonsi P.,Groupe hospitalier Paris Center | Slim K.,Estaing University Hospital Center | Chauvin M.,Service anesthesie reanimation | Mariani P.,University Pierre and Marie Curie | And 2 more authors.
Annales Francaises d'Anesthesie et de Reanimation | Year: 2014

Early recovery after surgery provides patients with all means to counteract or minimize the deleterious effects of surgery. This concept is suitable for a surgical procedure (e.g., colorectal surgery) and comes in the form of a clinical pathway that covers three periods (pre-, intra- and postoperative). The purpose of this Expert panel guideline is firstly to assess the impact of each parameter usually included in the rehabilitation programs on 6foreseeable consequences of colorectal surgery: surgical stress, postoperative ileus, water and energy imbalance, postoperative immobility, sleep alterations and postoperative complications; secondly, to validate the usefulness of each as criteria of efficiency criteria for success of rehabilitation programs. Two main criteria were selected to evaluate the impact of each parameter: the length of stay and frequency of postoperative complications. Lack of information in the literature forced experts to assess some parameters with criteria (duration of postoperative ileus or quality of analgesia) that mainly surrogate a positive impact for the implementation of an early recovery program. After literature analysis, 19parameters were identified as potentially interfering with at least one of the foreseeable consequences of colorectal surgery. GRADE® methodology was applied to determine a level of evidence and strength of recommendation. After synthesis of the work of experts using GRADE® method on 19parameters, 35recommendations were produced by the organizing committee. The recommendations were submitted and amended by a group of reviewers. After three rounds of Delphi quotes, strong agreement was obtained for 28recommendations (80%) and weak agreement for seven recommendations. A consensus was reached among anesthesiologists and surgeons on a number of approaches that are likely not sufficiently applied for rehabilitation programs in colorectal surgery such as: preoperative intake of carbohydrates; intraoperative hemodynamic optimization; oral feeding resume before ha24; gum chewing after surgery; patient out of bed and walking at D1. The panel also clarified the value and place of such approaches such as: patient information; preoperative immunonutrition; laparoscopic surgery; antibiotic prophylaxis; prevention of hypothermia; systematic prevention of nausea and vomiting; morphine-sparing analgesic techniques; indications and techniques for bladder catheterization. The panel also confirmed the futility of approaches such as: bowel preparation for colon surgery; maintain of the nasogastric tube; surgical drainage for colonic surgery. © 2014 Société française d'anesthésie et de réanimation (Sfar).

Illamola S.M.,Unite de Recherche Clinique | Hirt D.,Groupe Hospitalier Paris Center | Hirt D.,University of Paris Descartes | Treluyer J.M.,Unite de Recherche Clinique | And 6 more authors.
Drug Discovery Today | Year: 2015

The unbound drug concentration in plasma is usually considered the only active fraction; thus the binding of a drug to a protein limits its pharmacological actions. This is of special importance for those highly bound drugs. Therefore, binding studies can be of great utility for those drugs where relationship between free and total drug concentration is variable among patients, or it can be altered by some condition or disease, or even by interactions with other drugs. However, there is a lack of validation guidelines for the determination of unbound concentrations. Antiretroviral drugs (ARVs), protease inhibitors (PIs), efavirenz and nevirapine are highly bound to proteins. Here, we present a review on the overall methods for the study of unbound fractions of highly bound plasma protein ARVs. We also provide a critical evaluation of the methods applied, their differences and the main points to be controlled and validated. © 2014 Elsevier Ltd. All rights reserved.

Benjamin L.,University of Paris Descartes | Benjamin L.,EHESP School of Public Health | Benjamin L.,Glaxosmithkline | Cotte F.-E.,Glaxosmithkline | And 5 more authors.
European Journal of Cancer | Year: 2012

Although efficacy and tolerability are classical criteria for treatment choice, patient adherence and tariff issues related to novel oral anticancer drugs may also influence therapeutic decisions. We estimated the relative influence of efficacy, tolerability, expected adherence and route of administration of a chemotherapy treatment on 203 French physicians' preferences who participated in a Discrete Choice Experiment (DCE), a quantitative method used to elicit preferences. From a questionnaire with six scenarii, respondents had to choose between two treatments which differed with respect to these four attributes. Scenarii were first presented in a curative setting then in a palliative setting. Efficacy, tolerability and expected adherence had two modalities (good versus moderate) and route of administration had three modalities (intravenous (286-379/session), oral with the current tariff (28/consultation), oral with a hypothetical tariff (114)). Efficacy was the reference criterion in choosing a treatment whatever the therapeutic goal (β: 2.114, p < 0.0001 in curative setting versus β: 1.063, p < 0.0001 in palliative setting). The oral route of administration was important but only in a palliative setting (β: 0.612, p = 0.035, and β: 0.506, p < 0.0001 for the current and hypothetical tariff, respectively). Removing the efficacy attribute from logistic regression model, tolerability (β: 1.228, p = 0.0001) and expected adherence (β: 1.223, p = 0.0001) were influent in curative setting while the route of administration was still predominant in palliative setting (β: 0.431, p < 0.0001). Results suggest that economic considerations as well as therapeutic efficacy play a significant role in choosing a treatment. Preference for oral chemotherapy with a hypothetical tariff for a patient support programme should be considered for the development of therapeutic education and healthcare coordination, currently not taken into account in the tariff of oral chemotherapy. © 2011 Elsevier Ltd. All rights reserved.

Duron E.,Broca Hospital | Duron E.,University of Paris Descartes | Duron E.,French Institute of Health and Medical Research | Funalot B.,French Institute of Health and Medical Research | And 12 more authors.
Journal of Clinical Endocrinology and Metabolism | Year: 2012

Context: Few large studies have been conducted to assess the relationship between circulating IGF and late-life cognition. Objective: The aim of the study was to assess the relationship between IGF-I and IGF binding protein-3 (IGFBP-3) serum levels and cognitive impairment, including Alzheimer's disease (AD). Methods: In this multicentric cross-sectional study, 694 elderly subjects (218 men, 476 women; 78.6 ± 6.7 yr old)were included; 481 had memory complaints and were diagnosed, after comprehensive cognitive assessment, with AD (n = 224) or mild cognitive impairment (MCI) (n = 257). The control group was comprised of 213 subjects without memory complaint and with normal cognition (recruited among patients' caregivers). IGF-I and IGFBP-3 serum levels were determined by ELISA. Results: IGF-I and IGFBP-3 serum levels were significantly associated with cognitive status in men (IGF-I, 137 ± 69 ng/ml for AD vs. 178 ± 88 ng/ml for MCI and 172 ± 91 ng/ml for controls, P = 0.01; IGFBP-3, 3675 ± 1542 ng/ml for AD vs. 4143 ± 1828 ng/ml for MCI and 4488 ± 1893 ng/ml for controls, P = 0.04). In women, IGFBP-3 was significantly associated with cognitive status (3781 ± 1351 ng/ml for AD vs. 4190 ± 1408 ng/ml for MCI and 4390 ± 1552 ng/ml for controls; P < 0.001), but no significant differences between groups for IGF-I occurred. After adjustment for confounding variables (age, educational level, body mass index, diabetes, apolipoprotein E ε4 status), logistic regression indicated that IGF-I [odds ratio (95% confidence interval) = 0.48 (0.26-0.88)] and IGFBP-3 [odds ratio (95% confidence interval) = 0.71 (0.52-0.97)] serum levels were independently associated with AD in men, but not in women. Conclusions: We report a significant association between low IGF-I and IGFBP-3 serum levels and AD in men, but not in women. Copyright © 2012 by The Endocrine Society.

Kavian N.,University of Paris Descartes | Kavian N.,Groupe Hospitalier Paris Center | Batteux F.,University of Paris Descartes | Batteux F.,Groupe Hospitalier Paris Center
Vascular Pharmacology | Year: 2015

Vasculopathy is common in patients with connective tissue disease and can be directly implicated in the pathogenesis of the disease. Systemic sclerosis is an auto-immune multiorgan connective tissue disorder characterized by fibrosis of the skin and visceral organs and vascular disease. Micro- and macro-vessels are a direct target of the disease. In this review, we present the various clinical manifestations of the vasculopathy that can be present in SSc patients, and then discuss the various aspects of the pathophysiology of the vascular disorders. © 2015 Elsevier Inc..

Bernard R.,Hopital University Necker Enfants Malades | Salvi N.,Hopital University Necker Enfants Malades | Gall O.,Hopital University Necker Enfants Malades | Egan M.,Hopital University Necker Enfants Malades | And 3 more authors.
Paediatric Anaesthesia | Year: 2014

Background: Little information is available on the titration of morphine postoperatively in children. This observational study describes the technique in terms of the bolus dose, the number of boluses required, the time to establish analgesia, and side effects noted. Methods: Morphine was administered if pain score (VAS or FLACC) was >30. Patients weighing less than 45 kg received a 50 μg·kg-1 bolus of morphine with subsequent boluses of 25 μg kg-1 as required. Patients weighing over 45 kg received boluses of 2 mg. Pain and Ramsay scores were recorded up to 90 min after the end of the titration and any side effect or complication was noted. Data are presented as the median [interquartile Q1-Q3 range]. Results: Overall, 103 children were studied. The median age was 4.2 years [0.8-12.2 years]. The median weight was 15.5 kg [8.2-35.0 kg]. The protocol was effective for pain control with a significant decrease in pain scores over time. The median pain score (VAS or FLACC) was 70 [50-80] prior to the initial bolus and 0 [0-10] 90 min after the last bolus. Median Ramsay score was 1 [1-2] before the initial bolus administration and 4 [2-4] at 90 min. The median total dose of morphine was 100 [70-140] μg·kg-1, and the median number of boluses was 3 [2-5]. Side effects were observed in 17% of cases. No serious complications were observed. Conclusions: Our study of morphine titration for children shows that our protocol was effective for pain control with a significant decrease in pain scores over time. No serious complications were encountered. More studies on larger cohorts of patients are needed to confirm the efficacy and safety of this protocol. © 2013 John Wiley & Sons Ltd.

Fauchet F.,University of Paris Descartes | Treluyer J.-M.,University of Paris Descartes | Preta L.-H.,University of Paris Descartes | Valade E.,University of Paris Descartes | And 3 more authors.
Antimicrobial agents and chemotherapy | Year: 2014

For the first time, a population approach was used to describe abacavir (ABC) pharmacokinetics in HIV-infected pregnant and nonpregnant women. A total of 266 samples from 150 women were obtained. No covariate effect (from age, body weight, pregnancy, or gestational age) on ABC pharmacokinetics was found. Thus, it seems unnecessary to adapt the ABC dosing regimen during pregnancy. Copyright © 2014, American Society for Microbiology. All Rights Reserved.

Fauchet F.,University of Paris Descartes | Treluyer J.-M.,University of Paris Descartes | Treluyer J.-M.,Groupe Hospitalier Paris Center | Treluyer J.-M.,French Institute of Health and Medical Research | And 8 more authors.
Antimicrobial Agents and Chemotherapy | Year: 2014

For the first time, a population approach was used to describe abacavir (ABC) pharmacokinetics in HIV-infected pregnant and nonpregnant women. A total of 266 samples from 150 women were obtained. No covariate effect (from age, body weight, pregnancy, or gestational age) on ABC pharmacokinetics was found. Thus, it seems unnecessary to adapt the ABC dosing regimen during pregnancy.Copyright © 2014 American Society for Microbiology All Rights Reserved.

Benaboud S.,University of Paris Descartes | Hirt D.,University of Paris Descartes | Hirt D.,French Institute of Health and Medical Research | Launay O.,University of Paris Descartes | And 11 more authors.
Antimicrobial Agents and Chemotherapy | Year: 2012

According to the European AIDS Clinical Society, tenofovir disoproxil fumarate can be used in HIV-infected pregnant women if started prior to pregnancy, although no data are available on the pharmacokinetics of tenofovir (TFV) during pregnancy. The aim of this study was to describe TFV pharmacokinetics in HIV-infected women and to evaluate the effect of pregnancy on TFV disposition. Samples were collected according to a therapeutic drug monitoring in 186 women, including 46 pregnant women treated with TFV and retrospectively analyzed by a population approach. TFV pharmacokinetics were ascribed to an open two-compartment model with linear absorption and elimination. The mean population parameter estimates (between-subject variability) were as follows: absorption rate constant, 0.56 h-1; elimination clearance, 59.9 liters h-1 (0.436); central volume of distribution, 552 liters (1.96); intercompartmental clearance, 172 liters/h; and peripheral volume of distribution, 1,390 liters. Pregnant women had a 39% higher apparent clearance compared to nonpregnant women. Apparent clearance significantly decreased with age. In order to obtain an exposure similar to the known exposure in adults and guarantee similar trough concentrations (C min) as observed in adults, an increase in the TFV dose should be considered for women from the second trimester to delivery. Copyright © 2012, American Society for Microbiology. All Rights Reserved.

PubMed | Groupe hospitalier Paris Center
Type: Journal Article | Journal: Presse medicale (Paris, France : 1983) | Year: 2016

The existing recommendations for fluorine-18fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) use in digestive cancers (excluding neuroendocrine tumours) are summarized in the present article. FDG-PET/CT is nowadays a routine imaging modality for digestive malignancies and its use is currently increasing. FDG-PET/CT is considered to be a crucial tool in pretherapeutic assessment of esophageal, localized pancreatic and anal cancer. It represents a key exam in suspicion of recurrence of colorectal cancer in case of elevated serum tumor markers. New data are emerging regarding FDG-PET/CT in therapeutic efficacy assessment, radiotherapy treatment planning and detection of recurrence in many digestive cancers. Incidental focal colonic FDG uptake has to be explored by colonoscopy, as often associated with premalignant or malignant lesions.

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