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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.


Saadoun D.,Service de Medecine Interne | Saadoun D.,University Pierre and Marie Curie | Thibault V.,Groupe Hospitalier Pitie Salpetriere | Longuet M.,Service de Medecine Interne | And 9 more authors.
Annals of the Rheumatic Diseases | Year: 2014

Background The standard-of-care treatment of patients with hepatitis C virus (HCV)-mixed cryoglobulinemia (MC) vasculitis includes pegylated interferon a (PegIFN)-a plus ribavirin and/or rituximab. About 30-40% of patients are non-responders or relapsers to such combination. Objective To analyse the safety and efficacy of Peg-IFNa/ribavirin/protease inhibitor combination in HCV-MC vasculitis. Patients and methods Open-label, prospective, cohort study including 23 patients with HCV-MC vasculitis. Peg-IFNa/ribavirin was associated to telaprevir (375 mg three times daily, for 12 weeks, (n=15)) or boceprevir (800 mg three times daily, for 44 weeks, (n=8)) for 48 weeks. Results The median age was 59 (52.5-66) years, with 48.8% women. Thirteen patients (56.5%) were complete clinical responders, and 10 (43.5%) were partial responders at week 24. The virological response (ie, HCV RNA negativation) was of 69.6% at week 24 (p=0.005). The cryoglobulin level decreased from 0.44 to 0.06 g/l (p=0.0006) and the C4 level increased from 0.09 to 0.15 g/l (p=0.045). Grades 3 and 4 adverse events (mainly anaemia, neutropenia and thrombocytopenia) were observed in 10 cases (43.5%). Twenty patients (87%) received erythropoietin, 9 (39.1%) had red cell transfusion, and 2 (8.7%) had granulocyte stimulating agents. Antiviral therapy discontinuation was required in 8 (34.7%) patients for virological non-response (n=5), virological relapse (n=2) and depression (n=1). Conclusions Peg-IFNa/ribavirin/protease inhibitor combination seems highly effective in HCV-MC. Such therapeutic regimen should be administered cautiously considering the high rate of side effects.


Carcaillon L.,University Paris - Sud | Brailly-Tabard S.,Hopital Bicetre | Brailly-Tabard S.,University Paris - Sud | Ancelin M.-L.,Montpellier University | And 6 more authors.
Neurology | Year: 2014

Objective: We aimed to investigate the impact of endogenous estradiol (E2) on dementia and to evaluate the contribution of vascular risk factors and inflammatory and blood coagulation markers to this association. Methods: Using data from a French population-based prospective study (the Three-City Study) including 5,644 postmenopausal women aged 65 years or older, we investigated the association of endogenous total-E2 and bioavailable-E2 and total-testosterone with the 4-year incidence of all-cause dementia.We further focused on the role of dementia and cardiovascular risk factors as well as inflammation (C-reactive protein, fibrinogen) and hypercoagulability (fibrin D-dimers, thrombin generation) in these associations. We used a case-cohort design consisting of a random subcohort of 562 women not using hormone therapy and 132 incident dementia cases. Results: Adjusted Cox proportional hazards models showed a J-shaped relationship between total-E2 and risk of dementia (p5 0.001). Total-E2 values in the lower and upper quartiles were associatedwith an increased dementia risk (adjusted hazard ratio [HR] [95% confidence interval] 5 2.2 [1.1-4.5] and HR 5 2.4 [1.2-5.2], respectively). Importantly, the risk associated with higher E2 levels was dramatically increased in women with diabetes compared with nondiabetic women (adjusted HR associated with the upper E2 quartile 5 14.2 [1.60-123] and HR 5 3.4 [0.1-147], respectively, p interaction ,0.05). Similar results were found for bioavailable-E2. Adjustment for inflammatory and blood coagulation markers did not modify our results. No significant association was found for total-testosterone. Conclusion: High E2 level is an independent predictor of incident dementia, particularly in postmenopausal women with diabetes. © 2014 American Academy of Neurology.


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.


Fischer K.,University Utrecht | Lassila R.,University of Helsinki | Peyvandi F.,University of Milan | Calizzani G.,European Haemophilia consortium and Italian National Blood Center | And 6 more authors.
Thrombosis and Haemostasis | Year: 2015

Inhibitor development represents the most serious side effect of haemophilia treatment. Any difference in risk of inhibitor formation depending on the product used might be of clinical relevance. It was this study’s objective to assess inhibitor development according to clotting factor concentrate in severe haemophilia A and B. The European Haemophilia Safety Surveillance (EUHASS) was set up as a study monitoring adverse events overall and according to concentrate. Since October 2008, inhibitors were reported at least quarterly. Number of treated patients was reported annually, specifying the number of patients completing 50 exposure days (Previously Untreated Patients, PUPs) without inhibitor development. Cumulative incidence, incidence rates and 95% confidence intervals (CI) were calculated. Data from October 1, 2008 to December 31, 2012 were analysed for 68 centres that validated their data. Inhibitors developed in 108/417 (26%; CI 22–30%) PUPs with severe haemophilia A and 5/72 (7%; CI 2–16%) PUPs with severe haemophilia B. For Previously Treated Patients (PTPs), 26 inhibitors developed in 17,667 treatment years [0.15/100 treatment years; CI 0.10–0.22) for severe haemophilia A and 1/2836 (0.04/100; (CI 0.00–0.20) for severe haemophilia B. Differences between plasma-derived and recombinant concentrates, or among the different recombinant FVIII concentrates were investigated. In conclusion, while confirming the expected rates of inhibitors in PUPs and PTPs, no class or brand related differences were observed. © Schattauer 2015.


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.


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.


Bernard V.,French Institute of Health and Medical Research | Young J.,Hopital Bicetre | Chanson P.,Hopital Bicetre | Binart N.,French Institute of Health and Medical Research
Nature Reviews Endocrinology | Year: 2015

Prolactin is a hormone that is mainly secreted by lactotroph cells of the anterior pituitary gland, and is involved in many biological processes including lactation and reproduction. Animal models have provided insights into the biology of prolactin proteins and offer compelling evidence that the different prolactin isoforms each have independent biological functions. The major isoform, 23 kDa prolactin, acts via its membrane receptor, the prolactin receptor (PRL-R), which is a member of the haematopoietic cytokine superfamily and for which the mechanism of activation has been deciphered. The 16 kDa prolactin isoform is a cleavage product derived from native prolactin, which has received particular attention as a result of its newly described inhibitory effects on angiogenesis and tumorigenesis. The discovery of multiple extrapituitary sites of prolactin secretion also increases the range of known functions of this hormone. This Review summarizes current knowledge of the biology of prolactin and its receptor, as well as its physiological and pathological roles. We focus on the role of prolactin in human pathophysiology, particularly the discovery of the mechanism underlying infertility associated with hyperprolactinaemia and the identification of the first mutation in human PRLR. © 2015 Macmillan Publishers Limited. All rights reserved.


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.


Theaudin M.,AP HP | Crassard I.,AP HP | Bresson D.,AP HP | Saliou G.,Hopital Bicetre | And 4 more authors.
Stroke | Year: 2010

BACKGROUND AND PURPOSE-: In malignant cerebral venous thrombosis (CVT) patients, emergency decompressive surgery has been suggested as a life-saving procedure. We report 12 patients with malignant CVT, among whom 8 underwent operation. METHODS-: Retrospective study of 12 patients from 3 stroke units who had a malignant CVT as defined: (1) supratentorial cortical lesions attributable to superficial venous system thrombosis with or without sinus involvement; (2) with clinical (decreased consciousness and dilated pupils) or radiological signs of transtentorial herniation; (3) either at onset or after worsening despite heparin therapy. Surgery or abstention was decided individually by neurosurgeons on call. RESULTS-: There were 9 women and 3 men with a mean age of 45±15 years. The delay between heparin therapy and signs of malignancy ranged from 2 to 30 hours. At malignant worsening all but 1 patient had hemorrhagic lesions; the median deviation of septum pellucidum was 12 mm (interquartile range, 6.7-13); 5 patients (including 3 who underwent operation) had a unilateral dilated pupil; and 4 (2 who underwent operation) had bilateral dilated pupils. Eight patients underwent surgical decompression, external decompression in 4, both external and internal decompression in 3, and internal decompression in 1. The 4 patients who did not undergo operation died within 1 to 5 days after diagnosis. One patient who underwent operation died of a pulmonary embolism. The 7 others survived, with, at last follow-up (median, 23.1 months; interquartile range, 19.7-45.6), an excellent recovery of mRS 0 or 1 in 6 and mRS 3 in 1. CONCLUSION-: Decompressive surgery may save lives and may even allow a good functional outcome in malignant CVT, even in patients with bilateral dilated pupils. © 2010 American Heart Association, Inc.

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