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Vons C.,Hopital Antoine Beclre | Barry C.,University of Paris Descartes | Maitre S.,Hopital Antoine Beclre et de Radiologie | Pautrat K.,Hopital Lariboisire | And 8 more authors.
The Lancet | Year: 2011

Researchers have suggested that antibiotics could cure acute appendicitis. We assessed the efficacy of amoxicillin plus clavulanic acid by comparison with emergency appendicectomy for treatment of patients with uncomplicated acute appendicitis. In this open-label, non-inferiority, randomised trial, adult patients (aged 18-68 years) with uncomplicated acute appendicitis, as assessed by CT scan, were enrolled at six university hospitals in France. A computer-generated randomisation sequence was used to allocate patients randomly in a 1:1 ratio to receive amoxicillin plus clavulanic acid (3 g per day) for 8-15 days or emergency appendicectomy. The primary endpoint was occurrence of postintervention peritonitis within 30 days of treatment initiation. Non-inferiority was shown if the upper limit of the two-sided 95 CI for the difference in rates was lower than 10 percentage points. Both intention-to-treat and per-protocol analyses were done. This trial is registered with ClinicalTrials.gov, number NCT00135603. Of 243 patients randomised, 123 were allocated to the antibiotic group and 120 to the appendicectomy group. Four were excluded from analysis because of early dropout before receiving the intervention, leaving 239 (antibiotic group, 120; appendicectomy group, 119) patients for intention-to-treat analysis. 30-day postintervention peritonitis was significantly more frequent in the antibiotic group (8, n=9) than in the appendicectomy group (2, n=2; treatment difference 5·8; 95 CI 0·3-12·1). In the appendicectomy group, despite CT-scan assessment, 21 (18) of 119 patients were unexpectedly identified at surgery to have complicated appendicitis with peritonitis. In the antibiotic group, 14 (12 [7·1-18·6]) of 120 underwent an appendicectomy during the first 30 days and 30 (29 [21·4-38·9]) of 102 underwent appendicectomy between 1 month and 1 year, 26 of whom had acute appendicitis (recurrence rate 26; 18·0-34·7). Amoxicillin plus clavulanic acid was not non-inferior to emergency appendicectomy for treatment of acute appendicitis. Identification of predictive markers on CT scans might enable improved targeting of antibiotic treatment. French Ministry of Health, Programme Hospitalier de Recherche Clinique 2002. © 2011 Elsevier Ltd. Source


Brouquet A.,Hopital Bicetre
Nature reviews. Gastroenterology & hepatology | Year: 2013

Various factors are reported to affect the risk of local recurrence after resection of colorectal liver metastases. This article discusses the findings of a recent study that investigated the effect of fatty liver disease on the risk of recurrence. Source


Seror P.,Laboratoire delectromyographie | Seror R.,Hopital Bicetre
Rheumatology | Year: 2012

Objective: To evaluate the effect of hand workload, especially computer use, on the incidence of severe, idiopathic median nerve lesions at the wrist (MNLW) in patients with idiopathic CTS. Methods: Data were prospectively collected for 444 patients with classic or probable CTS who were of working age and referred to our electrodiagnostic (EDX) laboratories. Clinical items recorded were age, gender, intensity of hand workload, BMI and bilaterality of the MNLW. EDX data recorded were results of needle examination of the abductor pollicis brevis (APB), distal motor latency (DML) to the APB and orthodromic sensory conduction velocity. MNLW was considered severe if the DML to the APB was ≥6.0 ms. Patients were divided into two groups: those exhibiting at least one severe MNLW or not. They were classified into three categories according to occupational activity related to the intensity of hand workload: (i) non-workers (reference category); (ii) white-collar workers using computers; and (iii) blue-collar or manual workers. We determined factors associated with severe and non-severe MNLW. Results: We investigated 92 patients with 119 severe MNLW and 352 with 589 non-severe MNLW. The risk of severe MNLW was similar for non-workers and blue-collar workers and was 2.5-fold higher than for workers using computers [adjusted odds ratio = 0.41; (95% CI)] after adjusting for age, gender and BMI. Conclusion: Workers who use computers, who represent, in many countries, a large number of compensation claims, have a lower risk of severe MNLW as compared with blue-collar workers and also non-workers. © The Author 2011. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. Source


Fernandez H.,Hopital Bicetre
Gynecological Endocrinology | Year: 2011

Hysterectomy has traditionally been the definitive surgical approach for heavy menstrual bleeding. However, the more modern concept of 'save the uterus' has led to new surgical approaches for the treatment of heavy menstrual bleeding, based on second-generation endometrial destruction (ablation/resection) techniques, including microwave endometrial ablation, thermal balloon endometrial ablation, radiofrequency electrosurgery, hydrothermal ablation and cryoablation. As pregnancy following endometrial ablation is still possible, we proposed to combine endometrial ablation and sterilization with Essure® micro-inserts in women with confirmed menometrorrhagia and the desire, or medical need, for permanent tubal sterilization. Although large diameter resectoscopy provides excellent results in the surgical treatment of myomas, the technique requires dilation of the cervical canal (difficult in nulliparous or menopausal patients), and requires general or epidural anaesthesia and, therefore, must be performed in an operating theatre. A major advance in terms of hysteroscopic procedures is the 'see and treat' approach (i.e. when performing an initial diagnostic hysteroscopy, it is now possible to treat the pathology concurrently). Newer hysteroscopic techniques, often not requiring anaesthesia or analgesia, include OPPIuM (Office Preparation of Partially Intramural Myomas) and use of a mini-resectoscope, allowing office diagnostic-operative hysteroscopic procedures. © 2011 Informa UK, Ltd. Source


De Bennetot M.,Center Hospitalier University Estaing | Rabischong B.,Center Hospitalier University Estaing | Aublet-Cuvelier B.,University Gabriel Montpied | Belard F.,University Gabriel Montpied | And 4 more authors.
Fertility and Sterility | Year: 2012

Objective: To assess the reproductive outcome after an ectopic pregnancy (EP) based on the type of treatment used, and to identify predictive factors of spontaneous fertility. Design: Observational population based-study. Setting: Regional sistry. Patient(s): One thousand sixty-four women registered from 1992 to 2008. Intervention(s): Laparoscopic (radical or conservative), or medical treatment. Main Outcome Measure(s): Epidemiologic characteristics, clinical presentation, treatments performed, reproductive outcome, recurrence. Result(s): The 24-month cumulative rate of intrauterine pregnancy (IUP) was 67% after salpingectomy, 76% after salpingostomy, and 76% after medical treatment. IUP rate was lower after radical treatment compared with conservative treatments in univariable analysis. In multivariate analysis, IUP rate was significantly lower for patients >35 years old or with history of infertility or tubal disease. For them, IUP rate was significantly higher after conservative treatment compared with salpingectomy. The 2-year cumulative rate of recurrences was 18.5% after salpingostomy or salpingectomy and 25.5% after medical treatment. History of infertility or of previous live birth would be protective, in contrast to history of voluntary termination of pregnancy. Conclusion(s): Conservative strategy seems to be preferred, whenever possible, to preserve patients' fertility without increasing the risk of recurrence. The choice between conservative treatments does not rely on subsequent fertility, but more likely on their own indications and therapeutic effectiveness. Risk factors of recurrence could be considered for secondary prevention. Copyright © 2012 American Society for Reproductive Medicine, Published by Elsevier Inc. Source

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