Toulon, France
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PubMed | CHU Saint Etienne Hopital Nord, Lyon University Hospital Center, CH Francois Quesnay, AP HP Hopital Louis Mourier and 10 more.
Type: Journal Article | Journal: Journal of the European Academy of Dermatology and Venereology : JEADV | Year: 2016

The development of vitiligo during treatment with biological agents is an unusual event and only a few isolated cases have been reported.To describe the clinical characteristics and evolution of patients developing new-onset vitiligo following initiation of a biological agent for chronic inflammatory disease; and also to report the clinical course of pre-existing vitiligo under biological therapy.This nationwide multicentre, retrospective study, carried out between July 2013 and January 2015, describes the characteristics of a large series of 18 patients (psoriasis N = 8, inflammatory rheumatic diseases N = 8, ulcerative colitis N = 1, uveitis N = 1) who developed new-onset vitiligo while receiving a biological agent.TNF inhibitors were the most common biological agent involved (13/18) while anti-IL-12/23 and anti-IL-17 agents or abatacept were less common (4/18 and 1/18 respectively). Mean duration of biological agent exposure before vitiligo onset was 13.9 16.5 months. Outcome was favourable for most patients (15/17) while maintaining the biological agent. Data were also collected for 18 patients (psoriasis N = 5, inflammatory rheumatic diseases N = 10, inflammatory bowel diseases N = 2, SAPHO N = 1) who had pre-existing vitiligo when treatment with a biological agent started (TNF inhibitors N = 15, ustekinumab N = 1, rituximab N = 1, tocilizumab N = 1). Vitiligo progressed in seven patients and was stable or improved in eight cases.Vitiligo may thus emerge and/or progress during treatment with various biological agents, mainly TNF inhibitors and could be a new paradoxical skin reaction. De novo vitiligo displays a favourable outcome when maintaining the biological agent, whereas the prognosis seems worse in cases of pre-existing vitiligo.


PubMed | University of Limoges, Montpellier University, Center Hospitalier, Hopital Europeen Georges Pompidou and 4 more.
Type: Comparative Study | Journal: Interactive cardiovascular and thoracic surgery | Year: 2015

Adjuvant chemotherapy with vinorelbine plus cisplatin (VC) improves survival in resected non-small-cell lung cancer (NSCLC), but has negative impact on quality of life (QoL). In advanced NSCLC, gemcitabine plus cisplatin (GC) and docetaxel plus cisplatin (DC) exhibit comparable efficacy, with possibly superior QoL compared to VC. This trial investigated these regimens in the adjuvant setting.Patients with Stage IB to III NSCLC were eligible following standardized surgery. Overall, 136 patients were included, with 67 and 69 assigned to the GC and DC arms, respectively. Cisplatin (75 mg/m(2), Day [D] 1) plus gemcitabine (1250 mg/m(2), D1 and D8) or docetaxel (75 mg/m(2) D1) were administered for three cycles. Primary end-point was QoL (EORTC QLQ-C30), with the study designed to detect a 10-point difference between arms. Overall survival, safety and cost were secondary end-points.No between-group imbalance was observed in terms of patient characteristics. At inclusion, global health status (GHS) scores (/100) were 63.5 and 62.7 in GC and DC, respectively (P = 0.8), improving to 64.5 and 65.4 after 3 months (P = 0.8). No significant difference in functional or symptoms scores was observed between the arms except for alopecia. Grade 3/4 haematological and non-haematological toxicities were found in 33.8 and 21.7% (P = 0.11), and 33.8 and 26.1% (P = 0.33) of patients, in GC and DC, respectively. At 2 years, 92.9 and 89.8% of patients remained alive in GC and DC, respectively (P = 0.88).DC and GC adjuvant chemotherapies for completely resected NSCLC were well tolerated and appear free of major QoL effects, and are therefore representing candidates for comparison with the standard VC regimen.


PubMed | Center hospitalier Albi, Center hospitalier La Rochelle, CHU Charles Nicolle, CHRU de Lille and 10 more.
Type: Journal Article | Journal: Archives of cardiovascular diseases | Year: 2014

The role of implantable loop recorders (ILRs) in the evaluation strategy for recurrent syncope in France is limited by lack of knowledge of the cost.To compare a conventional evaluation strategy for syncope with the early use of an ILR in low-risk patients, in terms of diagnostic yield, cost and impact on quality of life (QoL).National prospective randomized open-label multicenter study of patients with a single syncope (if severe and recent) or at least two syncopes in the past year.Seventy-eight patients (32 men) were randomized to the ILR strategy (ILR group, n=39) or the conventional evaluation strategy (CONV group, n=39): mean age 66.214.8 years; 4.36.4 previous syncopes. After 14 months of follow-up, a certain cause of syncope was established in 18 (46.2%) patients in the ILR group and two (5%) patients in the CONV group (P<0.001). Advanced cardiological tests were performed less frequently in the ILR group than in the CONV group (0.030.2 vs. 0.20.5 tests per patient; P=0.05). Patients in the ILR group were hospitalized for a non-significantly shorter period than patients in the CONV group (5.73.2 vs. 8.01.4 days). There was no difference between the two groups in terms of QoL main composite score.In patients with unexplained syncope, the early use of an ILR has a superior diagnostic yield compared with the conventional evaluation strategy, with lower healthcare-related costs.


Blatteau J.-E.,Institut Universitaire de France | Gempp E.,HIA Sainte Anne | Simon O.,Hopital Pasteur | Coulange M.,Hopital Sainte Marguerite | And 11 more authors.
Neurocritical Care | Year: 2011

Background This study aims to determine the potential risk factors associated with the development of severe diving-related spinal cord decompression sickness (DCS). Methods Two hundred and seventy nine injured recreational divers (42 ± 12 years; 53 women) presenting symptoms of spinal cord DCS were retrospectively included from seven hyperbaric centers in France and Belgium. Diving information, symptom latency after surfacing, time interval between symptom onset and hyperbaric treatment were studied. The initial severity of spinal cord DCS was rated with the Boussuges severity score, and the presence of sequelae was evaluated at 1 month. Initial recompression treatment at 2.8 ATA with 100% oxygen breathing or deeper recompression up to 4 or 6 ATA with nitrogen or helium- oxygen breathing mixture were also recorded. Results Twenty six percent of DCS had incomplete resolution after 1 month. Multivariate analysis revealed several independent factors associated with a bad recovery: age ≥42 [OR 1.04 (1-1.07)], depth ≥39 m [OR 1.04 (1-1.07)], bladder dysfunction [OR 3.8 (1.3-11.15)], persistence or worsening of clinical symptoms before recompression [OR 2.07 (1.23-3.48)], and a Boussuges severity score >7 [OR 1.16 (1.03-1.31)]. However, the time to recompression and the choice of initial hyperbaric procedure did not significantly influence recovery after statistical adjustment. Conclusions Clinical symptoms of spinal cord DCS and their initial course before admission to the hyperbaric center should be considered as major prognostic factors in recovery. A new severity score is proposed to optimize the initial clinical evaluation for spinal cord DCS. © Springer Science+Business Media, LLC 2010.


Stover J.F.,University Hospital Zuerich | Belli A.,University of Southampton | Boret H.,HIA Sainte Anne | Bulters D.,University of Southampton | And 6 more authors.
Journal of Neurotrauma | Year: 2014

Traumatic brain injury (TBI) is an important cause of death and disability. Safety and pharmacodynamics of 4-amino-tetrahydrobiopterin (VAS203), a nitric oxide (NO)-synthase inhibitor, were assessed in TBI in an exploratory Phase IIa study (NOSynthase Inhibition in TRAumatic brain injury=NOSTRA). The study included 32 patients with TBI in six European centers. In a first open Cohort, eight patients received three 12-h intravenous infusions of VAS203 followed by a 12-h infusion-free interval over 3 days (total dose 15 mg/kg). Patients in Cohorts 2 and 3 (24) were randomized 2:1 to receive either VAS203 or placebo as an infusion for 48 or 72 h, respectively (total dose 20 and 30 mg/kg). Effects of VAS203 on intracranial pressure (ICP), cerebral perfusion pressure (CPP), brain metabolism using microdialysis, and the therapy intensity level (TIL) were end points. In addition, exploratory analysis of the extended Glasgow Outcome Score (eGOS) after 6 months was performed. Metabolites of VAS203 were detected in cerebral microdialysates. No significant differences between treatment and placebo groups were observed for ICP, CPP, and brain metabolism. TIL on day 6 was significantly decreased (p<0.04) in the VAS203 treated patients. The eGOS after 6 months was significantly higher in treated patients compared with placebo (p<0.01). VAS203 was not associated with hepatic, hematologic, or cardiac toxic effects. At the highest dose administered, four of eight patients receiving VAS203 showed transitory acute kidney injury (stage 2-3). In conclusion, the significant improvement in clinical outcome indicates VAS203-mediated neuroprotection after TBI. At the highest dose, VAS203 is associated with a risk of acute kidney injury. © Mary Ann Liebert, Inc.


Gheorghiev C.,Service de psychiatrie | de Montleau F.,HIA Val de Grace | Clervoy P.,HIA Sainte Anne
Annales Medico-Psychologiques | Year: 2010

Objectives: This work consists in a study of the links between the concept of dangerousness and military environment so as to clarify predominant factors, which have an influence on the expression of a potential dangerousness in a hierarchical and well-organized setting. Methods: The concept of dangerousness refers to the uncertain eventuality of a threat, by implying potential realization of a danger, which can express himself according to multiple modalities, the common denominator of which articulates around a dimension of violence. The explicitation of the diverse notions, which are frequently associated with it in a partial semantic stepping, was a preliminary exercise necessary for the study of this complex phenomenon, by distinguishing what is of the register of the subject, its environment and the present situation. From these preliminary data, our study of the dangerousness was limited to that of a dangerousness applied to a given environment, the military environment, going from theoretical general points to a more restricted expression of the dangerousness. This transition finds its relevance in the absence of specificity a priori of the military population in comparison with the general population, where only the function here comes to particularize the subject. Peculiarities of expression of the dangerousness due to the dimension of constraints that the military environment implies, but also because of specificities organized around two essential coordinates, that liking the question of the weapons the availability of which appears to the foundation of the exercise of the function of serviceman and that bound to the question of the group within, which evolves the subject the interrelations of which modulate and sometimes condition the emergence of a potential dangerousness. Thus was described a particular dangerous collective phenomenon, the panic, whose emergence can deeply disorganize the group by representing a serious danger for its timelessness. The importance of the figure of the chief was emphasized by creating the unity of the group and giving sense to action; his lapse especially during time of war can be the source of important failures in the collective working leading to severe damages. Conclusions: Dangerousness seems to be connected with army for intrinsic reasons, as the use of weapons, which is correlative to its missions and the interrelations between a subject and a group whose disorganization can induce grave consequences. Military constraints due to its strict rules and discipline can participate to an appearance of dangerousness in particular during operational situations, whereas training and preparation enable to reduce the dangerousness, which is involved in these extreme conditions. © 2010 Elsevier Masson SAS.


PubMed | Service dUrologie, HIA Sainte Anne and Service de Chirurgie Viscerale
Type: | Journal: The Pan African medical journal | Year: 2015

The assessment of anesthetic risks is an essential component of preoperative evaluation. In developing world, preanesthesia evaluation may be challenging because patients medical history and records are scare, and language barrier limits physical examination. Our objective was to evaluate the impact of routine preoperative testing in a low-resources setting.Prospective observational study performed in a French forward surgical unit in Abidjan, Ivory Coast. 201 patients who were scheduled for non urgent surgery were screened with routine laboratory exams during preoperative evaluation. Changes in surgery were assessed (delayed or scheduled).Abnormal hemoglobin findings were reported in 35% of patients, abnormal WBC count in 11,1% of patients, abnormal platelets in 15,3% of patients. Positive HIV results were found in 8,3% of cases. Routine tests represented 43,6% of changes causes.Our study showed that in a developing country, routine preoperative tests showed abnormal results up to 35% of cases, and represented 43,5% of delayed surgery causes. The rate of tests leading to management changes varied widely, from 0% to 8,3%. These results suggested that selected tests would be useful to diagnose diseases that required treatment before non urgent surgery. However, larger studies are needeed to evaluate the cost/benefit ratio and the clinical impact of such a strategy.


Esnault P.,HIA Sainte Anne | Cungi P.J.,HIA Sainte Anne | Romanat P.E.,HIA Sainte Anne | D'Aranda E.,HIA Sainte Anne | And 6 more authors.
Annales Francaises d'Anesthesie et de Reanimation | Year: 2013

Objectives: Blood transfusion is an aspect of medical care on the battlefield. French assets include: red blood cell units (RBCu), lyophilized plasma (PLYO), fresh whole blood (FWB) but neither fresh-frozen plasma (FFP) nor platelets. French transfusion strategy in military operations follows the evolution of knowledge and resources. We describe the characteristics of the transfusion at the military hospital in Kabul. Patients and methods: Retrospective study of records of patients transfused between October 2010to December 2011conducted in Kabul from transfusion register. Variables studied were: patient characteristics, biology at admission, type and amount of transfusion products, evolution. Results: One hundred and twenty-six patients were transfused: 49military (39%) which 22French soldier (17%), most of time afghan (n= 97; 77%), mean age at 24years old (3-66). Two hundred and seventy-three RBCu from France were transfused and 350unused were destroyed. Conditions leading to a transfusion were: 76war wounds (60%), 21trauma (17%) and 29other (23%). In the first 24. hours, patients received in mean: two RBCu (0-12), one unit of FWB (0-18) and two PLYO (0-14). PLYO/RBCu ratio was 1/1.6. A massive transfusion (more than 10RBCu) concerned 9% of patients. Twenty-seven percent of patients received FWB. We note 17dead people (13.5%). Conclusion: The use of the FWB and PLYO in substitution of FFP and platelets can provide cares of high quality in a logistically constrained context while controlling costs. © 2013 Société française d'anesthésie et de réanimation (Sfar).


Bordes J.,HIA Sainte Anne | Boret H.,HIA Sainte Anne | Lacroix G.,HIA Sainte Anne | Prunet B.,HIA Sainte Anne | And 2 more authors.
Acta Anaesthesiologica Scandinavica | Year: 2011

Bacterial meningitis remains a life-threatening disease mainly due to intracranial hypertension. However, decompressive craniectomy (DC) and the use of cerebral microdialysis (MD) and brain tissue oxygen pressure measurement (pTiO 2) are poorly described in this disease. We report a case of a 56-year-old woman admitted for severe bacterial meningitis complicating mastoiditis. Despite maximal medical treatment, intracranial pressure increased above 30 mmHg, with a decline in pTiO 2 and MD results indicating cerebral ischaemia. A bilateral DC was performed. Neurological outcome was favourable, and on discharge, the patient was able to live independently. This is the first report of DC in meningitis guided by cerebral MD and pTiO 2. Invasive multimodal neuromonitoring should be used in severe meningitis and DC could be considered in the case of refractory intracranial hypertension. © 2010 The Acta Anaesthesiologica Scandinavica Foundation.


PubMed | HIA Sainte Anne
Type: | Journal: BMJ case reports | Year: 2011

We present the case of a young adult who developed acute encephalopathy with severe status epilepticus and rapid deterioration to vegetative state and death within 6 weeks. Although the clinical picture, MRI and EEG findings were atypical, the hypothesis of subacute sclerosing panencephalitis (SSPE) was suggested by markedly increased intrathecal IgG synthesis in the cerebrospinal fluid, and diagnosis was confirmed by the presence of high antimeasles antibodies in cerebrospinal fluid and brain biopsy findings. Acute SSPE is an exceptionally rare and little-known form of SSPE with protean symptomatology, and this case is to our knowledge the first observation of SSPE presenting with status epilepticus in adults. Our case reinforces the need to include, even in developed countries, SSPE as a diagnostic possibility in unexplained acute encephalopathies.

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