Hopital Bichat

Paris, France

Hopital Bichat

Paris, France
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Preventive perinatal home visits are a powerful and effective tool, particularly to reach the most vulnerable families. These families, who accumulate multiple psycho-social difficulties, seldom use available medical and social institutions and find themselves at greater risk of developing disorders in early parent-child relationship and a subsequent psychopathology. This paper is based on a literature review of home-visiting programs, in France and other countries. Our purpose is both to describe better this practice, which hasn't yet been clearly formalized within institutions, and also to assess its impact and limitations. © Médecine & Hygiène. Tous droits réservés pour tous pays.

Thomas M.,St Thomas Hospital | Schymik G.,Stadisches Klinikum und Herzklinik | Walther T.,Herzzentrum | Himbert D.,Hopital Bichat | And 7 more authors.
Circulation | Year: 2010

Background-: Transcatheter aortic valve implantation was developed to mitigate the mortality and morbidity associated with high-risk traditional aortic valve replacement. The Edwards SAPIEN valve was approved for transcatheter aortic valve implantation transfemoral delivery in the European Union in November 2007 and for transapical delivery in January 2008. Methods and Results-: The SAPIEN Aortic Bioprosthesis European Outcome (SOURCE) Registry was designed to assess the initial clinical results of the Edwards SAPIEN valve in consecutive patients in Europe after commercialization. Cohort 1 consists of 1038 patients enrolled at 32 centers. Patients who were treated with the transapical approach (n=575) suffered more comorbidities than the transfemoral patients (n=463), resulting in a significantly higher logistic EuroSCORE (29.1% versus 25.7%; P<0.001). Therefore, these groups are considered different, and outcomes cannot be compared. Overall short-term procedural success was observed in 93.8%. The incidence of valve embolization was 0.3% (n=3), and coronary obstruction was reported for 0.6% (n=6 cases). Incidence of stroke was 2.5% and similar for both procedural approaches. Thirty-day mortality was 6.3% in transfemoral patients and 10.3% in transapical patients. The occurrence of vascular complications was not a predictor of <30-day mortality in the transfemoral population. CONCLUSION-: Technical proficiency can be learned and adapted readily as demonstrated by the short-term procedural success rate and low 30-day mortality rates reported in the SOURCE Registry. Specific complication management and refinement of patient selection are needed to further improve outcomes. © 2010 American Heart Association, Inc.

Thomas M.,Kings Health Partners | Schymik G.,Stadtisches Klinikum und Herzklinik | Walther T.,Herzzentrum | Himbert D.,Hopital Bichat | And 7 more authors.
Circulation | Year: 2011

Bacground-: Transcatheter aortic valve implantation was developed to provide a therapeutic option for patients considered to be ineligible for, and to mitigate mortality and morbidity associated with, high-risk surgical aortic valve replacement. Methods and Results-: The Edwards SAPIEN Aortic Bioprosthesis European Outcome (SOURCE) Registry was designed to assess initial post commercial clinical transcatheter aortic valve implantation results of the Edwards SAPIEN valve in consecutive patients in Europe. Cohort 1 consists of 1038 patients enrolled at 32 centers. One-year outcomes are presented. Patients with the transapical approach (n=575) suffered more comorbidities than transfemoral patients (n=463) with a significantly higher logistic EuroSCORE (29% versus 25.8%; P=0.007). These groups are different; therefore, outcomes cannot be directly compared. Total Kaplan Meier 1-year survival was 76.1% overall, 72.1% for transapical and 81.1% for transfemoral patients, and 73.5% of surviving patients were in New York Heart Association (NYHA) class I or II at 1 year. Combined transapical and transfemoral causes of death were cardiac in 25.1%, noncardiac in 49.2%, and unknown in 25.7%. Pulmonary complications (23.9%), renal failure (12.5%), cancer (11.4%), and stroke (10.2%) were the most frequent noncardiac causes of death. Multivariable analysis identified logistic EuroSCORE, renal disease, liver disease, and smoking as variables with the highest hazard ratios for 1-year mortality whereas carotid artery stenosis, hyperlipidemia, and hypertension were associated with lower mortality. Conclusion-: The SOURCE Registry is the largest consecutively enrolled registry for transcatheter aortic valve implantation procedures. It demonstrates that with new transcatheter aortic techniques excellent 1-year survival in high-risk and inoperable patients is achievable and provides a benchmark against which future transcatheter aortic valve implantation cohorts and devices can be measured. © 2011 American Heart Association, Inc.

Detaint D.,Hopital Bichat | Detaint D.,Center National Of Reference Pour Le Syndrome Of Marfan Et Apparentes | Michelena H.I.,Mayo Medical School | Nkomo V.T.,Mayo Medical School | And 6 more authors.
Heart | Year: 2014

Background Bicuspid aortic valve (BAV) is related to aortic dilatation, but patterns/rates are conflicting with no comparison among aneurysms of different aetiology. We sought to define ascending aorta dilatation patterns/ progression rates in BAV versus other aortopathies (Marfan syndrome (MFS), degenerative aortopathy (DA)). Design and setting Retrospective, observational study. Aortic dilatation progression was evaluated in two tertiary care centres (US and European) by repeated echocardiography ≥2 years apart in adults with BAV (n=353), matched to MFS (n=50) and DA (n=51) for gender, blood pressure, and minimum follow-up time. Results At baseline, ascending aortic dilatation was present in 87% of BAV cases: tubular ascending aorta in 60% (irrespective of BAV morphology), and Valsalva sinuses dilatation in 27% (independently linked to typical BAV morphology and male gender (p=0.0001)). After 3.6±1.2 years, the aortic dilatation rate in BAV was higher than expected for the population for all aortic levels (p=0.005) and was maximal at the tubular ascending aorta for BAV (0.42±0.6 mm/year) and DA (0.20±0.3 mm/year), and was maximal at the Valsalva sinuses for MFS (0.49±0.5 mm/year). Maximal aortic dilatation rate was similar between BAV and MFS (p>0.40) and lower in DA (p=0.02) but was heterogeneous in BAV, with 43% of BAV not progressing (vs 20% of MFS, p=0.01). Aortic dilatation rate was not proportionally related to baseline aortic size or BAV type (all models p>0.40). Conclusions In patients with BAV, tubular ascending aorta dilatation is the most common pattern and exhibits the fastest growing rate, irrespective of valve morphology and function. Dilatation of the Valsalva sinuses is less common and associated with typical BAV morphology and male gender. Aortic dilatation progresses equally fast in BAV (tubular segment) and MFS (Valsalva sinuses), but a significantly higher proportion of BAV patients does not progress at all, irrespective of BAV type. Baseline aortic diameter does not proportionally predict progression rate; systematic follow-up is therefore warranted in patients with BAV.

Vahanian A.,Hopital Bichat | Iung B.,Hopital Bichat | Himbert D.,Hopital Bichat | Nataf P.,Hopital Bichat
International Journal of Cardiovascular Imaging | Year: 2011

Valvular heart disease remains frequent in industrialised countries since the decrease in frequency of rheumatic heart diseases has been accompanied by an increase in degenerative valve diseases. The prevalence of valvular disease increases sharply with age, as a consequence of the predominance of degenerative valvular diseases. Aortic stenosis and mitral regurgitation are the two most frequent diseases among patients referred because of valvular disease in Europe. The burden of heart valve disease in the elderly has an important impact on patient management, given the frequency of comorbidity and the increase in the risk of interventions. The changes in demographics explain why new procedures, such as transcatheter aortic valve implantation and percutaneous mitral valve repair, are potentially attractive in patients with high risk or even contraindications for surgery. © Springer Science+Business Media, B.V. 2011.

Oberlin C.,Hopital Bichat | Rantissi M.,Nasser hospital
Chirurgie de la Main | Year: 2011

The authors report their 10-year experience in the treatment of war injuries in the Gaza strip. Bullet injuries to nerves can be assessed using Sunderland's classification. Grade 4 and 5 lesions must be repaired in the same way as any traumatic nerve injuries. A detailed series of sciatic nerve repair is presented. In this series, 12 nerve gaps were repaired by direct nerve coaptation using 90° knee flexion for six weeks. The results of this technique at 1 to 4. years follow-up are better than to those of sciatic nerve grafting. © 2011 Published by Elsevier Masson SAS.

Fassa A.-A.,Hopital Bichat | Himbert D.,Hopital Bichat | Vahanian A.,Hopital Bichat
Current Cardiology Reports | Year: 2013

During the last decade, the rapid evolution of transcatheter aortic valve replacement (TAVR) has revolutionized the treatment of severe aortic stenosis. Since the PARTNER A and B trials, this technique has become the treatment of reference for inoperable patients, and an attractive alternative to surgical aortic valve replacement in those at high risk for surgery. Large multicenter registries conducted since 2007, mainly in Europe, confirmed the excellent hemodynamic performances of the 2 percutaneous valves currently available on the market, the Edwards SAPIEN, and the Medtronic CoreValve, as well as their benefits in terms of symptom relief and survival. The whole process of TAVR, from patient selection to post-procedural care and result evaluation, should be conducted by a dedicated multidisciplinary "heart team," within centers with expertise in valve disease. Though currently limited to those deemed at high risk for surgery or inoperable, indications for TAVR will likely be extended to a broader spectrum of patients, in particular those with surgical bioprosthetic failure or at intermediate risk for surgery. Beforehand, it will be essential to obtain more extensive data on the durability of percutaneous prostheses, since the available follow-up is seldom longer than 5 years, and in order to further decrease the rate of complications, mainly stroke, paravalvular regurgitation, and access site complications. Furthermore, the use of the transfemoral route will undoubtedly increase because of the miniaturization of the devices, at the expense of other approaches. Above all, multidisciplinary approach, excellent imaging, and careful evaluation will remain key to the success of this technique. © Springer Science+Business Media New York 2013.

Stone G.W.,Columbia University | Adams D.H.,Mount Sinai Health System | Abraham W.T.,Ohio State University | Kappetein A.P.,Erasmus Medical Center | And 10 more authors.
Journal of the American College of Cardiology | Year: 2015

Mitral regurgitation (MR) is one of the most prevalent valve disorders and has numerous etiologies, including primary (organic) MR, due to underlying degenerative/structural mitral valve (MV) pathology, and secondary (functional) MR, which is principally caused by global or regional left ventricular remodeling and/or severe left atrial dilation. Diagnosis and optimal management of MR requires integration of valve disease and heart failure specialists, MV cardiac surgeons, interventional cardiologists with expertise in structural heart disease, and imaging experts. The introduction of transcatheter MV therapies has highlighted the need for a consensus approach to pragmatic clinical trial design and uniform endpoint definitions to evaluate outcomes in patients with MR. The Mitral Valve Academic Research Consortium is a collaboration between leading academic research organizations and physician-scientists specializing in MV disease from the United States and Europe. Three in-person meetings were held in Virginia and New York during which 44 heart failure, valve, and imaging experts, MV surgeons and interventional cardiologists, clinical trial specialists and statisticians, and representatives from the U.S. Food and Drug Administration considered all aspects of MV pathophysiology, prognosis, and therapies, culminating in a 2-part document describing consensus recommendations for clinical trial design (Part 1) and endpoint definitions (Part 2) to guide evaluation of transcatheter and surgical therapies for MR. The adoption of these recommendations will afford robustness and consistency in the comparative effectiveness evaluation of new devices and approaches to treat MR. These principles may be useful for regulatory assessment of new transcatheter MV devices, as well as for monitoring local and regional outcomes to guide quality improvement initiatives. © 2015 American College of Cardiology Foundation.

Andre J.,Free University of Colombia | Moulonguet I.,Cabinet de Dermatopathologie | Goettmann-Bonvallot S.,Hopital Bichat
Archives of Dermatology | Year: 2010

Background: Nail apparatus melanoma is known to be associated with a poor prognosis, mainly because of a delay in diagnosis that is made at an invasive stage. This delay is particularly true in cases involving amelanotic melanoma. To our knowledge, only 1 case of in situ amelanotic melanoma of the nail unit has previously been described. We report 3 cases of in situ amelanotic melanoma with clinical lichenoid features. Observations: We describe 3 cases of in situ amelanotic melanoma of the nail unit. The patients ranged in age from 39 to 60 years. The lesions were located on the thumb (2 cases) or on the index finger (1 case). The duration of evolution was 6 to 18 months. Nail alterations were characterized by lichenoid changes with longitudinal striation, distal splitting, and nail plate atrophy. Histologic examination revealed in situ amelanotic melanoma extending from the proximal matrix up to the distal part of the nail bed. Complete excision of the nail apparatus was performed. There has been no sign of recurrence after follow-up of 1, 5, and 6 years. Conclusions: Monodactylic lichenoid nail changes should be added to the more conventional signs of incipient nail melanoma. Chronic unexplained monodactylic nail dystrophy, especially in adults, should always be investigated histologically. ©2010 American Medical Association. All rights reserved.

Calvert P.A.,Hopital Bichat | Calvert P.A.,University of Cambridge | Steg P.G.,Hopital Bichat | Steg P.G.,French Institute of Health and Medical Research | Steg P.G.,University Paris Diderot
European Heart Journal | Year: 2012

Percutaneous coronary intervention (PCI) has matured from a pioneering adventure focused on feasibility to a major sub-specialty delivering real clinical results to patients. Despite delivering reductions in mortality and morbidity in the field of acute coronary syndrome and overcoming in-stent restenosis, several challenges still remain. Firstly, we need to adhere to practices supported by established trials: data relating to PCI in stable angina and late reopening of occluded infarct-related vessels suggest that this is not always the case. Secondly, we must develop new trials asking clinically relevant questions in 'real-world' populations that are focused on patient-based outcomes. Finally, given the current global financial crisis, it is now more important than ever that we demonstrate cost-effectiveness in our clinical practice. In these turbulent times, we discuss the challenges ahead for PCI in its journey towards evidence-based practice. © The Author 2011.

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