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Hôpital-Camfrout, France

Herbrecht R.,Hopital de Hautepierre | Cernohous P.,Cell Therapeutics | Engert A.,University of Cologne | Le Gouill S.,Hematology Service | And 7 more authors.
Annals of Oncology | Year: 2013

Background: Pixantrone is an aza-anthracenedione with enhanced, preclinical antitumor activity and reduced cardiotoxicity compared with doxorubicin. Patients and methods: We compared the efficacy and toxic effect of CPOP-R (substituting pixantrone for doxorubicin) against CHOP-R in untreated, diffuse large B-cell lymphoma (DLBCL) patients. The primary objective was to demonstrate non-inferiority of CPOP-R by complete response/complete response unconfirmed (CR/CRu) rate. Results: The CR/CRu rate for CPOP-R was 75% versus 84% for CHOP-R. Three-year overall survival was lower for CPOP-R (69% versus 85%) (P = 0.029). Median progression-free survival (PFS) was not reached for CPOP-R and was 40 months for CHOP-R [HR 95% confidence interval (CI) = 1.02 (0.60, 1.76), P = 0.934]. Fewer CPOP-R patientsdeveloped congestive heart failure (CHF) (0% versus 6%, P = 0.120), >20% declines in ejection fraction (2% versus 17%, P = 0.004), or elevations in troponin-T (P = 0.003). Conclusions: CPOP-R is an active regimen with modestly lower response rates than CHOP-R but similar PFS and event-free survival. This study demonstrates a substantially lower cardiotoxicity of pixantrone compared with doxorubicin when used as first-line therapy in DLBCL. © The Author 2013.

Canovas F.,Montpellier University Hospital Center | Girard J.,Lille University Hospital Center | Roche O.,Center Chirurgical Emile Galle | Migaud H.,Lille University Hospital Center | And 3 more authors.
International Orthopaedics | Year: 2015

Purpose: The purpose of this study was to finalize a method allowing a qualitative and numerical evaluation of the bone stock and to confirm its reproducibility, to verify the relationship between the secondary bone stock value and the functional results, and to determine the main factors influencing the value of the bone stock. Methods: A clinical and radiological evaluation was performed in a group of 150 revisions of total hip replacements according to a new method taking into account cortical bone thickness, bone density and bone defects. Results: Interobserver reproducibility was evaluated at an average of 0.6 and intra-observer reproducibility was considered good at 0.8. Between the initial bone stock and at the last follow-up, no significant difference was noticed. For secondary bone stock considered as “very good or good”, the gain was +38.1 points versus +29.9 points for patients evaluated as “average or poor” (p < 0.0001). Between the initial bone stock assessment and at last follow-up, a significant relation was found in numerical values for the global type of primary fixation and in the presence of osteopenia (p < 0.0001). Conclusions: Deficient secondary bone stock can result in less favourable functional results. The numerical scores confirm the importance of strategic choices during surgery in order to manage bone stock preservation. © 2015, SICOT aisbl.

Roch A.M.D.,University of Angers | Brachet D.,University of Angers | Lermite E.,University of Angers | Pessaux P.,Hopital de Hautepierre | Arnaud J.-P.,University of Angers
Journal of Gastrointestinal Surgery | Year: 2012

Background: The aim of this prospective study was to determine the short- and long-term results of the Frey procedure in the treatment of chronic pancreatitis. Methods: From September 2000 to November 2009, 44 consecutive patients underwent the Frey procedure. Patients were included in the study before surgery and followed prospectively with assessment of pain relief, weight gain and exocrine/endocrine insufficiency. Twenty-one patients (47.7%) were followed for more than 5 years. Results: This study included 40 men (91%) and four women (9%) (mean age: 49 years) with a mean follow-up of 51.5 months. The primary etiology of chronic pancreatitis was chronic alcohol abuse in 38 patients (86.4%). The major indication for surgery was disabling pain (95.5%). There was no postoperative mortality. Postoperative morbidity occurred in 15 patients (34.1%), with specific surgical complications in 11 patients (25%). The percentage of pain-free patients after surgery was 68.3%. Eight patients (18.1%) and seven patients (16%) developed diabetes de novo and exocrine insufficiency, respectively. The Body Mass Index showed statistically significant improvement during follow-up. Similar beneficial results concerning pain relief and weight gain persisted after the initial 5-year follow-up. Conclusions: The Frey procedure is an appropriate, safe and effective technique for management of patients with chronic pancreatitis in the absence of neoplasia, based on long-term follow-up. © 2012 The Society for Surgery of the Alimentary Tract.

Langer B.,Hopital de Hautepierre
Revue de Medecine Perinatale | Year: 2013

Intrapartum asphyxia is defined as metabolic acidemia measured at birth with pH < 7.00 and base deficit ≥ 12 mmol/L. It is today established that the proportion of cerebral palsy associated with intrapartum hypoxia-ischemia is about 14.5%. Intrapartum asphyxia is screened in France by the continuous fetal heart rate (FHR) monitoring which presents a good sensitivity for its detection. His low specificity justifies the use of second line methods to reduce the increase of cesarean deliveries associated with the use of continuous FHR monitoring. Fetal scalp pH and lactate measurements are still the reference method. The conclusions of the last meta-analysis on the RCTs of the use of the fetal electrocardiogram (STAN®) appear to be disappointing, because no differences were found in the rates of metabolic acidosis and the rates of cesarean deliveries. Intrapartum asphyxia's diagnostic can be made by analysis of the acidbase status on the cord arterial blood. Therefore, it should be systematically performed after every births. © 2013 Springer-Verlag France.

Collongues N.,University of Strasbourg | De Seze J.,Hopital de Hautepierre
Therapeutic Advances in Neurological Disorders | Year: 2016

Neuromyelitis optica spectrum disorders (NMOSDs) is a new concept which includes classical neuromyelitis optica (NMO) and partial forms of NMO such as recurrent optic neuritis with positive aquaporin-4 antibodies (AQP4) or brainstem symptoms (intractable hiccups or vomiting). This disease is clearly distinguished from multiple sclerosis (MS) and the therapeutic approach is clearly different. Rituximab is actually considered to be one of the most efficient treatments of NMOSD, even if class I studies are clearly lacking. In the present review, we describe the state of the art about rituximab treatment in NMOSD, including adults and children, plus its efficacy and tolerance and we also underline the questions that should be addressed in the near future. © The Author(s), 2015.

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