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Bouhemad B.,Groupe Hospitalier Paris Saint Joseph | Monsel A.,University Pierre and Marie Curie | Brisson H.,University Pierre and Marie Curie | Arbelot C.,University Pierre and Marie Curie | Lu Q.,University Pierre and Marie Curie
Anesthesiology | Year: 2012

The aim of this review is to perform a critical analysis of experimental studies on aerosolized antibiotics and draw lessons for clinical use in patients with ventilator-associated pneumonia. Ultrasonic or vibrating plate nebulizers should be preferred to jet nebulizers. During the nebulization period, specific ventilator settings aimed at decreasing flow turbulence should be used, and discoordination with the ventilator should be avoided. The appropriate dose of aerosolized antibiotic can be determined as the intravenous dose plus extrapulmonary deposition. If these conditions are strictly respected, then high lung tissue deposition associated with rapid and efficient bacterial killing can be expected. For aerosolized aminoglycosides and cephalosporins, a decrease in systemic exposure leading to reduced toxicity is not proven by experimental studies. Aerosolized colistin, however, does not easily cross the alveolar-capillary membrane even in the presence of severe lung infection, and high doses can be delivered by nebulization without significant systemic exposure. © 2012, the American Society of Anesthesiologists, Inc.


van der Linden T.,Groupe Hospitalier Institute Catholique Of Lille Faculte Libre Of Medecine | Souweine B.,Service de Reanimation Polyvalente | Dupic L.,Service de Reanimation Medico Chirurgicale | Soufir L.,Groupe Hospitalier Paris Saint Joseph | Meyer P.,Service de Reanimation Polyvalente
Annals of Intensive Care | Year: 2012

Thrombocytopenia is a very frequent disorder in the intensive care unit. Many etiologies should be searched, and therapeutic approaches differ according to these different causes. However, no guideline exists regarding optimum practices for these situations in critically ill patients. We present recommendations for the management of thrombocytopenia in intensive care unit, excluding pregnancy, developed by an expert group of the French-Language Society of Intensive Care (Société de Réanimation de Langue Française (SRLF), the French Language Group of Paediatric Intensive Care and Emergencies (GFRUP) and of the Haemostasis and Thrombosis Study Group (GEHT) of the French Society of Haematology (SFH). The recommendations cover six fields of application: definition, epidemiology, and prognosis; diagnostic approach; therapeutic aspects; thrombocytopenia and sepsis; iatrogenic thrombocytopenia, with a special focus on heparin-induced thrombocytopenia; and thrombotic microangiopathy. © 2012 Van der Linden et al.; licensee Springer.


Kohler T.,University of Geneva | Guanella R.,University of Geneva | Carlet J.,Groupe Hospitalier Paris Saint Joseph | Van Delden C.,University of Geneva
Thorax | Year: 2010

Background: Pseudomonas aeruginosa frequently colonises intubated patients and causes life-threatening ventilator-associated pneumonia (VAP). The role of quorum sensing (QS), regulating virulence in this pathogen, during colonisation and development of VAP is unknown. Methods: P aeruginosa isolates and tracheal aspirates were prospectively collected from intubated patients. Genotypes and QS-independent virulence traits (exoU, exoS, PAPI-1 and PAPI-2) harboured by colonising isolates were identified in vitro with the CLONDIAG array. The production of elastase and rhamnolipids was measured to assess QS-dependent virulence. To monitor QS activity 'in patient', total RNA was extracted directly from tracheal aspirates and expression of QS genes was measured. Results: 320 P aeruginosa isolates and tracheal aspirates were obtained from 29 patients of whom 6 developed VAP (20%). Seven patients (24%) were initially colonised by QS-proficient isolates; 57% of them developed VAP as compared with 9% of patients colonised by QS-deficient isolates (p=0.018). Of all tested virulence traits from the initial colonising isolates, only rhamnolipids were associated with development of VAP (p=0.003). VAP occurred more frequently in patients colonised during the entire observation period by isolates producing high levels of rhamnolipids (p=0.001). 'In patient' monitoring of QS genes showed non-induced expression profiles in patients without VAP. In contrast, exponential induction of QS circuit and target gene expression was observed for two patients with VAP, and an 'in patient' QS gene expression profile and hierarchy similar to those in vitro was measured for one patient with VAP. Conclusions: Production of the QS-dependent virulence factor rhamnolipids by colonising P aeruginosa isolates is associated with development of VAP.


Boulet L.-P.,Laval University | Vervloet D.,Aix - Marseille University | Magar Y.,Groupe Hospitalier Paris Saint Joseph | Foster J.M.,University of New South Wales
Clinics in Chest Medicine | Year: 2012

Asthma management requires adequate adherence to many recommendations, including therapy, monitoring of asthma control, avoidance of environmental triggers, and attending follow-up appointments. Poor adherence is common in patients with asthma and is often associated with increased health care use, morbidity, and mortality. Many determinants of poor adherence have been identified and should be addressed, but there is no clear profile of the nonadherent patient. Interventions to improve adherence therefore demand tailoring to the individual by including patient-specific education, addressing patient fears and misconceptions, monitoring adherence, and developing a shared decision process. © 2012.


Philippart F.,Institute Pasteur Paris | Philippart F.,Groupe Hospitalier Paris Saint Joseph | Fitting C.,Institute Pasteur Paris | Cavaillon J.-M.,Institute Pasteur Paris
Critical Care Medicine | Year: 2012

Objective: Endotoxin tolerance corresponds to reprogramming of mononuclear phagocytes after iterative encounters with toll-like receptor agonists aimed to dampen the inflammatory response. We investigated why this phenomenon cannot be observed with murine alveolar macrophages. Design: Animal study. Setting: Research institution laboratory. Subjects: rag2-/-, rag2γc-/-, cd3ε-/-, μ-/-, il-15-/-, Jα18-/-, ifnγr-/-, il-18r-/-, and wild-type mice. Interventions: Alveolar macrophages were harvested from untreated mice or after injection of endotoxin. Alveolar macrophages were activated in vitro with endotoxin (lipopolysaccharide), and tumor necrosis factor production was monitored. Measurements and Main Results: In contrast to monocytes or peritoneal macrophages, alveolar macrophages did not display endotoxin tolerance in an ex vivo model after injection of endotoxin. An in vivo systemic inhibition of granulocyte-macrophage colony-stimulating factor or interferon-γ allowed the induction of alveolar macrophage endotoxin tolerance, which was also observed in interferon-γ receptor-deficient mice. Using mice missing different leukocyte subsets and adoptive cell transfers, we demonstrated the involvement of B lymphocytes in interferon-γ production within the lung microenvironment and in the prevention of alveolar macrophage endotoxin tolerance. Furthermore, we demonstrated the importance of interleukin-18 in preventing alveolar macrophage endotoxin tolerance through studies of interleukin-18 messenger RNA expression in il-18r-/-mice and injection of interleukin-18 in rag2-/-and μ-/-mice. Conclusions: Our results support the conclusion that at homeostasis in the lungs, constitutive expression of granulocyte-macrophage colony-stimulating factor, interleukin-18, interferon-γ and possibly interleukin-15, and a cross-talk between B lymphocytes and alveolar macrophages create a microenvironment specific to the lungs that prevents alveolar macrophages from becoming tolerant to endotoxin. © 2012 by the Society of Critical Care Medicine and Lippincott Williams and Wilkins.


de Parades V.,groupe hospitalier Paris Saint Joseph
Journal of visceral surgery | Year: 2013

Pilonidal disease is a frequent suppurative condition that occurs twice as often in men as in women, usually between the ages of 15 and 30. Pilonidal disease is located beneath the skin of the sacro-coccygeal region. It presents acutely as an abscess under tension while the chronic form gives rise to intermittent discharge from pilonidal sinus(es). Diagnosis is clinical and usually straightforward. In the large majority of cases, treatment is surgical but there is no consensus as to the 'ideal' technique. Acute abscess must be evacuated and an off-midline incision seems preferable. Excision is the standard definitive treatment but the choice of wide versus limited excision depends on the school of thought. The widespread practice in France is to leave the wound open, relying on postoperative healing by secondary intention. This technique has a low rate of recurrence but has the disadvantages of requiring local nursing care; the healing process is prolonged, usually associated with a temporary but prolonged cessation of activity. Primary wound closure techniques are less restrictive but their recurrence rate is probably higher. A direct midline suture is best after a small excision, but for a more extended wound, plastic reconstruction techniques are preferred; data in the literature favor asymmetric closure techniques such as those described by Karydakis and Bascom. Copyright © 2013 Elsevier Masson SAS. All rights reserved.


Baumert H.,Groupe hospitalier Paris Saint Joseph
Cancer/Radiotherapie | Year: 2010

Local recurrence after external radiotherapy or brachytherapy occurs in 30% of patients treated for prostate cancer. These recurrences can be localised to the prostate and controlled by salvage treatment. Salvage prostatectomy is the gold standard treatment, however, it is associated with a high morbidity rate. Minimally invasive treatments such as cryotherapy and high intensity focused ultrasound (HIFU) can be proposed to treat local recurrences. Indications, complications and oncological results of these salvage treatments are discussed in this article. © 2010 Société française de radiothérapie oncologique (SFRO).


Costil V.,groupe hospitalier Paris Saint Joseph
Journal of visceral surgery | Year: 2012

This case report describes a 77-year-old male, who presented to the emergency room with symptoms of an acute proximal small bowel obstruction. Abdominal CT scan with multi-planar reconstructions led to the diagnosis of an intestinal obstruction due to impaction of a large gallstone in the second portion of the duodenum. The CT scan demonstrated a large cholecysto-duodenal fistula as the origin of the gallstone migration. Surgical treatment consisted of milking the stone down beyond the ligament of Treitz, where it was removed through a jejunal enterotomy. The postoperative course was uncomplicated. No attempt was made to repair the choledocho-duodenal fistula at the initial intervention nor subsequently, and there have been no complications due to the fistula over 36 months of follow-up observation. Copyright © 2012. Published by Elsevier Masson SAS.


Barbier E.,Groupe Hospitalier Paris Saint Joseph
Revue de l'Infirmiere | Year: 2015

The portacath reflects the cancer and its future treatments. Its insertion causes high levels of anxiety for patient. Thanks to medical hypnosis, he can use its internal resources to help them manage the situation and the symptoms he feels. © 2015 Elsevier Masson SAS. All rights reserved.


Ratto C.,University Catholique | De Parades V.,Groupe Hospitalier Paris Saint Joseph
Journal de Chirurgie Viscerale | Year: 2015

Purpose. - The Transanal Hemorrhoidal Dearterialization (THD) procedure is an effective treat-ment of hemorrhoidal disease. The ligation of hemorrhoidal arteries ("dearterialization") canprovide a significant reduction of arterial blood flow to the hemorrhoidal tissues. Plication of redundant rectal mucosa/submucosa ("mucopexy") can reposition prolapsing tissue to its original anatomical site. In this paper the surgical technique using a specific device (THD®Doppler)and perioperative patient management are illustrated. Methods. - After appropriate clinical assessment, patients undergo the THD procedure undergeneral or spinal anesthesia, in either the dorsal lithotomy or prone jackknife position. A speci-fically designed device is used. In all patients, THD is performed, consisting of selective ligationof hemorrhoidal arteries identified by Doppler and marked with a mucosal stitch overlying theartery. In patients with hemorrhoidal or mucosal prolapse, a mucopexy is also performed usingcontinuous suture(s) that include the redundant prolapsing mucosa and submucosa. Results. - In long-term follow-up, THD results in resolution of symptoms in the majority of patients. The most common complication is transient but sometimes painful tenesmus. Rectalbleeding occurs in only a very limited number of patients. There is little or no risk of fecalincontinence or chronic pain. Anorectal manometry and endo-anal ultrasound show no evidence of injury to physiologic sphincteric function. Conclusions. - THD is a safe procedure and is, at present, one of the most effective treatments of hemorrhoidal disease. © 2014 Elsevier Masson SAS.

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