Le Touquet – Paris-Plage, France
Le Touquet – Paris-Plage, France

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Arnaud L.,systemIC | Arnaud L.,French Institute of Health and Medical Research | Hervier B.,systemIC | Hervier B.,University Pierre and Marie Curie | And 28 more authors.
Blood | Year: 2011

Erdheim-Chester disease (ECD) is a rare form of non-Langerhans histiocytosis, with noncodified therapeutic management and high mortality. No treatment has yet been shown to improve survival in these patients. We conducted a multicenter prospective observational cohort study to assess whether extraskeletal manifestations and interferon-α treatment would influence survival in a large cohort of ECD patients. To achieve this goal, we thoroughly analyzed the clinical presentation of 53 patients with biopsyproven ECD, and we performed a survival analysis using Cox proportional hazard model. Fifty-three patients (39 men and 14 women) with biopsy-proven ECD were followed up between November 1981 and November 2010. Forty-six patients (87%) received interferon-α and/or PEGylated interferon-α. Multivariate survival analysis using Cox proportional hazard model revealed that central nervous system involvement was an independent predictor of death (hazard ratio = 2.51; 95% confidence interval, 1.28-5.52; P = .006) in our cohort. Conversely, treatment with interferon-α was identified as an independent predictor of survival (hazard ratio = 0.32; 95% confidence interval, 0.14-0.70; P = .006). Although definitive confirmation would require a randomized controlled trial, these results suggest that interferon-α improves survival in ECD patients. This may be seen as a significant advance, as it is the first time a treatment is shown to improve survival in this multisystemic disease with high mortality. © 2011 by The American Society of Hematology.


PubMed | Leclerc Center for Fight against Cancer, Besancon University Hospital Center, University Hospital, University of Lorraine and 15 more.
Type: Journal Article | Journal: Cancer medicine | Year: 2016

Glioblastoma is the most common malignant brain tumor in adults. Baseline health-related quality of life (HRQoL) is a major subject of concern for these patients. We aimed to assess the independent prognostic value of HRQoL in unresectable glioblastoma (UGB) patients for death risk stratification. One hundred and thirty-four patients with UGB were enrolled from the TEMAVIR trial. HRQoL was evaluated at baseline using the EORTC QLQ-C30 and BN20 brain cancer module. Clinical and HRQoL parameters were evaluated in univariable and multivariable Cox analysis as prognostic factors for overall survival (OS). Performance assessment and internal validation of the final model were evaluated with Harrels C-index, calibration plot, and bootstrap sample procedure. Two OS independent predictors were identified: future uncertainty and sensitivity deficit. The final model exhibited good calibration and acceptable discrimination (C statistic=0.63). The internal validity of the model was verified with robust uncertainties around the hazard ratio. The prognostic score identified three groups of patients with distinctly different risk profiles with median OS estimated at 16.2, 9.2, and 4.5months. We demonstrated the additional prognostic value of HRQoL in UGB for death risk stratification and provided a score that may help to guide clinical management and stratification in future clinical trials.


Carassou P.,British Petroleum | Meijer L.,French National Center for Scientific Research | Le Moulec S.,HIA Val de Grace | Aoun J.,British Petroleum | Bengrine-Lefevre L.,University Paris Est Creteil
Bulletin du Cancer | Year: 2012

Protein phosphorylation is a fundamental post-translational modification. It regulates a large number of critical cellular processes (differentiation, division, proliferation, apoptosis). Cell division is a process including a series of phases by which a parent cell divides into two daughter cells. The cells enter these stages then progress within the cell division under an accurate control by many proteins. These proteins are activated by phosphorylation. Cyclin-dependent kinases are responsible for this phosphorylation and therefore represent potential therapeutic targets especially in oncology.


Tesse S.,HIA Val de Grace | Trueba F.,HIA Val de Grace | Berthet N.,Institute Pasteur Paris | Berthet N.,French National Center for Scientific Research | And 2 more authors.
Antimicrobial Agents and Chemotherapy | Year: 2013

There exist numerous genes disseminated by mobile elements that can confer cross-resistance to lincosamides and streptogramin A compounds in staphylococci. This study investigated the nature and means of dissemination of genes responsible for LSA resistance among 24 French clinical isolates screened for reduced susceptibility to lincomycin. The vga(A)v gene was found to be the most prevalent determinant of LSA resistance, while Tn5406 appeared to be its exclusive gene support. Copyright © 2013, American Society for Microbiology. All Rights Reserved.


Bone metastases are frequent in advanced metastatic solid tumors. These secondary lesions are responsible for significant impairment of quality of life of patients with onset of pain, which is frequently resistant to standard analgesics. The therapeutic challenge for a patient with spinal metastasis is to maintain a quality of life as good as possible, commensurate with its life expectancy. Radiotherapy can provide efficient pain relief, but it should be integrated into a multidisciplinary approach. In the case of epidural spinal cord compression, it should be performed whenever possible after surgery. New highly conformal irradiation modalities have emerged for treatment of spinal metastases with therapeutic perspectives. Stereotactic radiosurgery could be provided for patients with single lesions or oligometastatic disease, a good general condition, absence of cord compression, and a life expectancy greater than 6 months. It is particularly promising for the treatment of classically radioresistant tumors or relapsing disease. Intensity-modulated radiotherapy, including Helical Tomotherapy, is a new perspective for treatment of multiple metastases. However, if these new techniques can provide efficient pain sedation, hindsight is currently low to judge their therapeutic benefit and these techniques are hardly available in most centers. Here, we offer a quick review of current strategies and new modalities of radiotherapy to put into perspective the place of these techniques in therapy of spinal metastases.


Dubost C.,HIA Val de Grace | Motuel J.,University Paul Sabatier | Geeraerts T.,University Paul Sabatier
Annales Francaises d'Anesthesie et de Reanimation | Year: 2012

The invasive monitoring of intracranial pressure is useful in circumstances associated with high-risk of raised intracranial pressure. However the placement of intracranial probe is not always possible and non-invasive assessment of intracranial pressure may be useful, particularly in case of emergencies. Transcranial Doppler measurements allow the estimation of perfusion pressure with the pulsatility index. Recently, new ultrasonographic methods of cerebral monitoring have been developed: the diameter of the optic nerve sheath diameter, a surrogate marker of raised intracranial pressure and the estimation of median shift line deviation. © 2012.


De Vaumas C.,Clinique Saint Jean LgErmitage | Auroy Y.,HIA Val de Grace
Praticien en Anesthesie Reanimation | Year: 2015

Both anesthetists and surgeons are concerned by postoperative orders. Nevertheless, audits document that formalization and safety of postoperative orders are incomplete, leading to an iatrogenic risk. Predetermined protocols which may cover the main fields of application of postoperative orders are analgesia, prevention of nausea and vomiting, thromboprophylaxis, and nutrition and hydratation. © 2015 Elsevier Masson SAS.


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 | HIA Val de Grace
Type: Case Reports | Journal: Clinical nuclear medicine | Year: 2012

An 82-year-old woman was followed up for an uterine cervical adenocarcinoma treated by surgery. A whole-body fluorodeoxyglucose positron emission tomography study revealed a pathologic fluorodeoxyglucose uptake located in the umbilicus associated to peritoneal carcinomatosis. Biopsy of the umbilical nodule demonstrated an umbilical metastasis from the uterine adenocarcinoma, the so-called Sister Mary Josephs nodule.


PubMed | HIA Val de Grace
Type: Journal Article | Journal: Annales francaises d'anesthesie et de reanimation | Year: 2012

The invasive monitoring of intracranial pressure is useful in circumstances associated with high-risk of raised intracranial pressure. However the placement of intracranial probe is not always possible and non-invasive assessment of intracranial pressure may be useful, particularly in case of emergencies. Transcranial Doppler measurements allow the estimation of perfusion pressure with the pulsatility index. Recently, new ultrasonographic methods of cerebral monitoring have been developed: the diameter of the optic nerve sheath diameter, a surrogate marker of raised intracranial pressure and the estimation of median shift line deviation.

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