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Boleslawski E.,University of Lille Nord de France | Vibert E.,Center Hepato Biliaire | Pruvot F.-R.,University of Lille Nord de France | Le Treut Y.-P.,Hopital de la Conception | And 6 more authors.
Annals of Surgery | Year: 2014

Objectives: Determine whether inflow occlusion is correlated with peakpostoperative serum-transaminases (PSTs) and whether PST is predictive of outcome after liver resections. Background: PST is used as the surrogate of ischemia reperfusion and as the main endpoint in prospective trials of inflow occlusion. This assumption has, however, not been validated. Furthermore, the impact of PST on the postoperative course is unknown. Methods: This prospectively designed registered study included consecutive adult patients undergoing elective hepatectomy in 9 HPB centers. Primary outcome was PST of aspartate-amino-transferase (AST) and alanine-aminotransferase (ALT). Secondary outcome was 90-day morbidity (Dindo-Clavien grades) and length of stay. Explanatory variables were preoperative (including age, sex, body mass index, comorbidities, cirrhosis, and chemotherapy), and intraoperative variables (including procedure performed, inflow occlusion and its duration, length of surgery, vasoactive drugs used, blood loss, and transfusion) were collected prospectively on a dedicated Web site. Multivariable regression models were used to identify independent predictors of PST and of morbidity. Results: Between January 2013 and September 2013, 651 hepatectomieswere included. Inflowocclusionwas performed in 58% (intermittent in 32%, continuous in 24%) andwas not performed in 42%. PST-AST (336 IU/L; interquartile range: 204-573) and PST-ALT (336 IU/L; interquartile range: 205-557) occurred on postoperative day 1. PST was not correlated with the duration of inflow occlusion (ρ-AST = 0.20, P < 0.01; ρ-ALT = 0.18, P < 0.01). PST was not independently associated with morbidity. Receiver operating characteristic curve identified a cutoff of 450 IU/L but this prediction's accuracy was low: Area under the receiver operating characteristic curve for PST-AST: 0.61, confidence interval: 0.56-0.66, P < 0.01, and area under the receiver operating characteristic curve for PST-ALT: 0.57, confidence interval: 0.52-0.62, P = 0.01. Conclusions: PST is not correlated with ischemia time and should not be used as a surrogate of postoperative outcome. Copyright © 2014 by Lippincott Williams & Wilkins.


Couteau C.,Hopital Nord | Haumonte J.-B.,Hopital Nord | Bretelle F.,Hopital Nord | Capelle M.,Hopital de la Conception | D'Ercole C.,Hopital Nord
Journal de Gynecologie Obstetrique et Biologie de la Reproduction | Year: 2013

Introduction: Preterm premature rupture of the membranes (PPROM) is a frequent complication of pregnancy leading to prematurity and neonatal infection. The management of PPROM is not consensual in France and practices between maternities are variable. We subjected type 2B and 3 maternity units to a questionnaire regarding their practices concerning the PPROM. Results: Our study includes 59 type 2B maternity units and 59 type 3 maternity units. Corticotherapy is proposed in all of type 3 maternity units and in 96.5% of type 2B maternity units. Antibiotics are administered at the patient admission in 96.6% of type 3 maternity units and 86% of type 2B maternity units. Tocolytics are used systematically in 31% of maternity units and only in case of contractions in 62% of maternity units. No maternity unit indicates birth systematically after corticotherapy before 32 weeks of gestation (WG). An early delivery is proposed in 9.5% of maternity units between 32 and 34 WG and in 58% of maternity units between 34 and 37 WG. Conclusion: Corticotherapy and antibiotics are predominantly administered at the time of the diagnosis, as recommended by the HAS and CNGOF. Despite the lack of recommendation, an expectative management until 34 WG, in absence of any sign of chorioamnionitis, seems to be the choice of most maternity units. © 2012 Elsevier Masson SAS. All rights reserved.


Ruyssen-Witrand A.,University of Paris Descartes | Fautrel B.,University Pierre and Marie Curie | Saraux A.,Brest University Hospital Center | Le-Loet X.,University of Rouen | Pham T.,Hopital de la Conception
Joint Bone Spine | Year: 2010

Objective: To study the association between infection risk and low-dose corticosteroids (LD-CT, defined as a daily dose < 10 mg/day of prednisone) in rheumatoid arthritis (RA). Methods: Data source: a systematic review of the literature up to June 2009 was performed. Data extraction :all type of infections: bacterial, viral and postoperative; infection severity, RA activity, RA severity, comorbid conditions. Data analysis: descriptive, comparing infection risk between LD-CT-treated and LD-CT-not treated RA. Results: Of the 1310 screened reports, the literature analysis identified 15 assessing infection risk of LD-CT in RA patients. Of the eight reports that studied all types of infection, six articles found no association between risk of infection and LD-CT, one showed an association between severe infections and LD-CT (OR = 8 [1-64]) and another showed a dose-dependent association including doses of less than 5 mg/day: RR = 1.32 [1.06-1.63] and doses between 6 to 10 mg/day: RR = 1.95 [1.53-2.46]. Of the three trials that studied infection risk secondary to bacteria, one showed an increased risk (HR = 1.7 [1.5-2.0]) while two did not (respectively, exposure to < 5 mg/day: OR = 1.34 [0.85-2.13]; 6 to 9 mg/day: OR = 1.53 [0.95-2.48] and < 5 mg/day: OR = 1.49 [0.82-2.72]; 5 to 10 mg/day: OR = 1.46 [0.84-2.54]). None of the three trials studying postoperative infection risk found any association between infection risk and LD-CT treatment. Two reports studied herpes zoster risk and found no association with LD-CT. Conclusion: There was a paucity of data about LD-CT and infection risk in RA and that risk seems poorly increased. These findings need to be confirmed by further studies. © 2010 Société française de rhumatologie.


Schleinitz N.,Aix - Marseille University | Vely F.,Aix - Marseille University | Harle J.,Hopital de la Conception | Vivier E.,Aix - Marseille University | And 3 more authors.
Immunology | Year: 2010

Summary: Natural killer (NK) cells have been implicated in tumour surveillance and in the early control of several microbial infections. In autoimmune disease their involvement in these processes has been evaluated in animal models, with conflicting results. Both a disease-controlling and a disease-promoting role have been suggested. In human autoimmune disease only a few studies, mainly descriptive, have demonstrated qualitative and quantitative modification of NK cells. These changes were observed on blood- or tissue-infiltrating NK cells. Taken together with our expanding knowledge of the genetical variability of NK cell receptors and NK cell physiology, these findings pave the way for the dissection of the role of NK cells in human autoimmune diseases. NK cells may be directly involved in these diseases through their potential autoreactivity or through their interaction with dendritic cells, macrophages or T lymphocytes, thereby inducing excessive inflammation or favouring the adaptive autoimmune response. Thus, NK cells may be implicated in the onset, the maintenance or the progression of autoimmune diseases. Some reports also suggest the involvement of NK cells in the treatment of human autoimmune disease by biotherapies. All these observations suggest that NK cells are involved in the complex processes of autoimmune diseases. Nevertheless, further careful analysis of NK cells at different steps of these diseases, in different tissues and through combined genetical and functional studies will contribute to a better understanding of their role in autoimmune diseases. This knowledge might allow the development of new therapeutic strategies based on NK cells for the treatment of some autoimmune diseases. © 2010 The Authors. Immunology © 2010 Blackwell Publishing Ltd.


PubMed | French Institute of Health and Medical Research, Hopital Pitie Salpetriere, Hopital de la Conception, CEMKA EVAL and University Pierre and Marie Curie
Type: | Journal: Atherosclerosis | Year: 2017

Homozygous familial hypercholesterolaemia (HoFH) is a rare inherited condition characterized by elevated plasma low-density lipoprotein-cholesterol (LDL-C) levels, severe, accelerated atherosclerosis and premature coronary heart disease. We evaluated cardiovascular complications in HoFH patients over extended follow-up and investigated their association with changes in cholesterol over time, as well as total cholesterol burden.In this retrospective single-centre study, 53 patients (baseline meanstandard deviation [SD], total cholesterol 15.53.7mmol/L and LDL-C 13.22.6mmol/L) were followed for up to 38 years (21.210 years). The primary outcome was an adverse clinical event, defined as cardiovascular death, nonfatal myocardial infarction, or angina.Twenty-eight patients experienced an event, of whom 8 died due to complications of major surgery (4), myocardial infarction (3) or stroke (1). While total cholesterol levels were comparable in patients with and without an event at baseline (20mmol/L), those who subsequently experienced an event showed a slower decline in total cholesterol. Cumulative total cholesterol (i.e. total-cholesterol year score) was highly associated with the incidence of an adverse clinical event in a linear dose-response relation. A 100mmol/L increase in cumulative total cholesterol (i.e. an average exposure of 10mmol/L per 10 years or 20mmol/L per 5 years) was associated with a doubling of the risk of a cardiovascular event (age-adjusted incidence rate ratio: 1.99, 95% CI, 1.16-3.41).Our findings reinforce the importance of early diagnosis and initiation of maximal treatment, including lipoprotein apheresis, to ensure long-term reduction in the cholesterol burden, expressed as the total-cholesterol year score, and risk of cardiovascular complications in HoFH.


Cohen L.,Hopital de la Conception | Ranque S.,Marseille University Hospital Center | Raoult D.,Aix - Marseille University
Medical Mycology Case Reports | Year: 2013

We report the case of a young psychotic intravenous drug user injecting herself with Saccharomyces cervisiae (boulardii). She experienced a 24 h fever, resolving spontaneously confirming, quasi experimentally, the inocuity of this yeast in a non-immunocompromised host. © 2013 International Society for Human and Animal Mycology. Published by Elsevier B.V All rights reserved.


Nguyen P.S.A.,Hopital de la Conception | Desouches C.,Hopital de la Conception | Gay A.M.,Hopital de la Conception | Hautier A.,Hopital de la Conception | Magalon G.,Hopital de la Conception
Journal of Plastic, Reconstructive and Aesthetic Surgery | Year: 2012

Background: Autologous fat graft, by virtue of its volumetric qualities and its action on skin trophicity, can be considered as a gold standard implant. Current techniques do not allow very superficial or subdermal injections of adipose tissue. The authors report technical modifications that enable fat transfer through a 25-gauge cannula. The viability of grafted fat was assessed after subcutaneous injection on a murine model. Methods: Micro-fat grafting consists of harvesting fat tissue using a multiperforated cannula with holes of 1 mm. Fat tissue is refined as described by SR Coleman and transferred through a micro-cannula. Initially, human fat was first harvested using two different procedures: Coleman's technique and the modified harvesting technique. Preliminary comparative histologic analyses were performed. Sixteen nude mice received human fat tissue: one side was filled with 0.7 cc through a 17-G cannula using Coleman's technique, and the opposite side was grafted using smaller cannulae (20G, 23G and 25G) following the modified harvesting technique. Mice were euthanised at 12 weeks and skin biopsies were performed. Results: Experimental fat grafts on mice were observed and analysed: macroscopically, the fat tissue of each side showed the same healthy aspect. Haematoxylin-eosin- saffron staining revealed intact adipocytes and anti-CD31 antibody immunohistochemical staining highlighted an abundant neo-vessel network. Conclusion: Fat graft obtained by the modified technique maintains a normal histologic structure. Fat injection with micro-cannulae extends the application of lipostructure to the superficial layers of the skin. © 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.


Scalabre A.,Service de Chirurgie Pediatrique | Gorincour G.,Service de Radiologie Pediatrique | Hery G.,Service de Chirurgie Pediatrique | Gamerre M.,Hopital de la Conception | And 2 more authors.
Journal of Pediatric Surgery | Year: 2012

Objective: The objective of this study is to describe the evolution of 8 cases of congenital malformations of the umbilical-portal-hepatic venous system diagnosed before the first month of life. Materials and methods: All cases of congenital malformation of the portal and hepatic venous system diagnosed prenatally or during the first month of life in our institution were systematically reviewed since November 2000. Clinical features, imaging, and anatomical findings were reviewed, focusing primarily on clinical and radiologic evolution. Results: Eight cases of congenital malformation of the umbilical-portal-hepatic venous system were studied. Fifty percent of these malformations were diagnosed prenatally. We report 4 portosystemic shunts. Three involuted spontaneously, and the fourth one required surgical treatment. We report a variation of the usual anatomy of portal and hepatic veins that remained asymptomatic, an aneurysmal dilatation of a vitelline vein causing portal vein thrombosis that needed prompt surgical treatment with good result, a complex portal and hepatic venous malformation treated operatively, and a persistent right umbilical vein that remained asymptomatic. Conclusion: Prenatal diagnosis of malformations of the umbilical-portal-hepatic venous network is uncommon. Little is known about the postnatal prognosis. Clinical, biologic, and radiologic follow-up by ultrasonography is essential to distinguish pathologic situations from normal anatomical variants. © 2012 Elsevier Inc. All rights reserved.


Mouttet A.,Saint Roch private hospital | Louis M.-L.,Hopital De La Conception | Sourdet V.,EUROS corporation
Orthopaedics and Traumatology: Surgery and Research | Year: 2011

Introduction: The success of total knee arthroplasty is measured by pain relief, functional recovery, and implant survival duration.The aim of the present study was to evaluate the long-term clinical, functional and radiological results of the posterior cruciate ligament (PCL)-retaining fixed bearing EUROP implant. Hypothesis: The long-term results of EUROP implants are similar to those reported with comparable prostheses. Patients and methods: We performed a prospective, monocentric study of a series of 121 cemented EUROP total knee arthroplasties, implanted between 1994 and 1996 in 117 patients mean age 73. A clinical and radiological evaluation was performed at 10 years of follow-up according to the International Knee Society (IKS) score. Twenty-three patients died, 14 were lost to follow-up, 43 underwent clinical and radiological evaluation and 37 were questioned by telephone. Results: The preoperative IKS knee score was 31 points (0-60) and increased to 88 points (30-98) at final follow-up, IKS function increased from 40 (0-90) to 80 points (25-100). Radiolucencies were observed in 56% of the condyles and 60% of tibial plates. Ninety-three percent of these radiolucent lines were less than 1. mm wide. Three patients underwent revision TKA at 32 months, eight and 11 years respectively. Global implant survival was 99% at five years, 97.8% at 10 years and 95.8% at 12 years. Discussion: The clinical and radiological results of the cruciate-retaining fixed bearing EUROP total knee arthroplasties, with three cases of revision arthroplasty at 12 years of follow-up are satisfactory and comparable to similar implants. Level of evidence: Level IV; prospective study. © 2011 Elsevier Masson SAS.


Guillaume F.,Aix - Marseille University | Thomas E.,Hopital de la Conception | Faget C.,Service Hospitalo University Of Psychiatrie | Richieri R.,Service Hospitalo University Of Psychiatrie | Lancon C.,Service Hospitalo University Of Psychiatrie
Psychiatry Research | Year: 2015

This study explored the effects of exemplar changes on visual object recognition in patients with schizophrenia and paired control subjects. The experimental design was derived from the process-dissociation procedure (PDP: Jacoby, 1991). The objects presented at test could be the same exemplar as at study (physically identical picture), a different exemplar of the same object category, or a new, non-studied object. In the inclusion task, participants had to generalize their recognition to the conceptual level by accepting both different and identical exemplars as old. In the exclusion task, on the other hand, they had to accept only the same exemplars of the studied objects as old. Overall, performance was better on the inclusion task than on the exclusion task; schizophrenia patients performed worse than controls on the inclusion task but not the exclusion task, misrecognizing different exemplars more often than healthy controls. The present findings reveal that both recollection and familiarity are impaired in patients with schizophrenia, who present a relational, conceptually driven memory deficit. This deficit does not allow them to recognize an object as a member of a specific category independently of perceptual variations. This retrieval mode influences their subjective awareness of items' familiarity, and should be considered as a target for remediation. © 2014 Elsevier Ireland Ltd.

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