Hopital Dupuytren

Limoges, France

Hopital Dupuytren

Limoges, France
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Jouary T.,Skin Cancer Unit | Leyral C.,Skin Cancer Unit | Doussau A.,University of Bordeaux Segalen | Bedane C.,Hopital Dupuytren | And 7 more authors.
Annals of Oncology | Year: 2012

Background: The treatment of stage I Merkel cell carcinoma (MCC) usually includes wide local excision (WLE) combined with irradiation of the tumor bed (ITB). No randomized study has ever been conducted in MCC. The purpose of this study was to assess the efficacy and safety of prophylactic adjuvant radiotherapy on the regional nodes. Patients and methods: In this randomized open controlled study, patients for a stage I MCC treated by WLE and ITB were randomly assigned to regional adjuvant radiotherapy versus observation. Overall survival (OS) and probability of regional recurrence (PRR) were primary end points. Progression-free survival (PFS) and tolerance of irradiation were secondary end points. Results: Eighty-three patients were included before premature interruption of the trial, due to a drop in the recruitment mainly due to the introduction of the sentinel node dissection in the management of MCC. No significant improvement in OS (P = 0.989) or PFS (P = 0.4) could be demonstrated after regional irradiation, which, however, significantly reduced the PRR (P = 0.007) with 16.7% regional recurrence rate in the observation arm versus 0% in the treatment arm. The treatment was well tolerated. Conclusion: The adjuvant regional irradiation significantly decreased the PRR in MCC, but benefit in survival could not be demonstrated. © The Author 2011. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved.

Dallocchio A.,University of Paris Descartes | Canioni D.,University of Paris Descartes | Ruemmele F.,University of Paris Descartes | Duquesne A.,Hopital Femme Mere Enfant | And 8 more authors.
Rheumatology | Year: 2010

Objectives. To identify juvenile idiopathic arthritis (JIA) patients who developed IBD during treatment with anti-TNF-α agents and better characterize the IBD clinical and pathological presentation. Methods. A retrospective French multicentre study included patients with a diagnosis of JIA according to the ILAR criteria who developed IBD while under anti-TNF-α therapy before 18 years of age. Intestinal biopsies were collected and reviewed by the same pathologist. Results. Eight patients were included. They had been treated with etanercept from 11 to 78 months before IBD onset. Gastro-intestinal symptoms included abdominal pain (six patients), diarrhoea (four patients), anorexia (four patients), anal abscess (three patients) and oral ulcers (one patient). Five patients presented with Crohn's disease (CD) and three with indeterminate IBD, of whom four had severe pancolitis. Clinical remission of IBD was obtained in all patients after discontinuation of etanercept and initiation of IBD-specific therapy, including infliximab in six patients. Conclusion. IBD must be suspected in JIA patients treated with etanercept who develop intestinal symptoms, including anal abscess. This series raises the possibility of a relationship between etanercept therapy and the occurrence of IBD in a subset of patients with JIA. © The Author 2010. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved.

PubMed | Hopital Europeen, Hopital Henri Mondor, Center Hospitalier, Hopital Europeen Georges Pompidou and 10 more.
Type: | Journal: Rheumatology (Oxford, England) | Year: 2016

Renal involvement is a rare event during primary SS (pSS). We aimed to describe the clinico-biological and histopathological characteristics of pSS-related nephropathy and its response to treatment.We conducted a French nationwide, retrospective, multicentre study including pSS patients fulfilling American-European Consensus Group criteria or enlarged American-European Consensus Group criteria, and with biopsy-proven renal involvement.A total of 95 patients were included (median age 49 years). An estimated glomerular filtration rate (eGFR) of <60 ml/min was found in 82/95 patients (86.3%). Renal biopsy demonstrated tubulointerstitial nephritis (TIN) in 93 patients (97.9%), and frequent (75%) plasma cell infiltrates. Glomerular lesions were found in 22 patients (23.2%), mainly related to cryoglobulin. The presence of anti-SSA (76.8%) and anti-SSB (53.8%) antibodies was particularly frequent among patients with TIN and was associated with a worse renal prognosis. Eighty-one patients (85.3%) were treated, with CSs in 80 (98.8%) and immunosuppressive agents (mostly rituximab) in 21 cases (25.9%). Despite marked interstitial fibrosis at initial biopsy, kidney function improved significantly during the 12-month period following diagnosis (final eGFR 49.9 vs 39.8 ml/min/1.73 mRenal involvement of pSS is mostly due to TIN with marked T, B and especially plasma cell infiltration. Renal dysfunction is usually isolated but can be severe. Use of CSs can improve the eGFR, but further studies are needed to define the best therapeutic strategy in this disease.

PubMed | Center Georges Francois Leclerc, Hopital Charles Nicolle, Hopital de Rangueil, Institute Du Cancer Of Montpellier Val Daurelle and 11 more.
Type: Journal Article | Journal: Bulletin du cancer | Year: 2014

The last years are marked by the emergence of new molecules for the treatment of metastatic cutaneous melanoma with a significant benefit on the survival. Besides, some techniques are in development for the loco-regional treatment of the metastatic sites, bringing new therapeutic perspectives. However, their respective use and place in the therapeutic strategy are debated by healthcare professionals.The French National Cancer Institute leads a national clinical practice guidelines project since 2008. It realized a review of these modalities of treatment and developed recommendations.The clinical practice guidelines development process is based on systematic literature review and critical appraisal by a multidisciplinary expert workgroup. The recommendations are thus based on the best available evidence and expert agreement. Prior to publication, the guidelines are reviewed by independent practitioners in cancer care delivery.This article presents recommendations for loco-regional treatments of the pulmonary, bone, cutaneous, hepatic and digestive metastatic sites for patients with pauci-metastatic cutaneous melanoma.

PubMed | Hopital Hotel Dieu, Brest University Hospital Center, Hopital Sud, Joseph Fourier University and 16 more.
Type: Comparative Study | Journal: Arthritis & rheumatology (Hoboken, N.J.) | Year: 2016

Findings from the WEGENT trial and other short-term studies have suggested that azathioprine (AZA) or methotrexate (MTX) could effectively maintain remission of granulomatosis with polyangiitis (Wegeners) (GPA) or microscopic polyangiitis (MPA). This study was undertaken to examine whether differences in rates of relapse or adverse events would appear after discontinuation of these 2 maintenance regimens, when assessed over a longer followup period.Long-term outcomes in patients enrolled in the WEGENT trial were analyzed according to their randomized treatment group (AZA or MTX). Parameters at trial entry were evaluated as potential prognostic factors for death, relapse, or damage in multivariate models.Data from 10 years of followup were available for 112 (88.8%) of the 126 original trial participants. The median followup time was 11.9 years (95% confidence interval [95% CI] 11.3-12.5 years). In patients receiving AZA and those receiving MTX, the 10-year overall survival rates were 75.1% (95% CI 64.8-86.9%) and 79.9% (95% CI 70.3-90.8%) (P=0.56), respectively, and relapse-free survival rates were 26.3% (95% CI 17.3-40.1%) and 33.5% (95% CI 23.5-47.7%) (P=0.29), respectively. No between-treatment differences were observed with regard to rates of relapse, adverse events, damage, survival without severe side effects, and survival without relapse and severe side effects. In analyses limited to the 97 patients with GPA, no between-treatment differences in survival rates were observed. The 10-year relapse-free survival rate was lower in patients with GPA than in patients with MPA. However, in the multivariate analysis, anti-proteinase 3 antineutrophil cytoplasmic antibody (ANCA) positivity, and not GPA, was retained as being independently associated with the relapse rate.The results of this long-term analysis confirm that AZA and MTX are comparable treatment options for maintaining remission of GPA or MPA. Despite achieving good overall survival with these treatments, relapse rates, adverse events, and damage remain matters of concern and further studies are needed to reduce their frequency in these ANCA-associated vasculitides.

Mazzucotelli J.-P.,Service de chirurgie cardiaque | P. Pascal,Hopital La Pitie Salpetriere | Litzler P.-Y.,Hopital Charles Nicolle | Vincentelli A.,Hopital Cardiologique | And 4 more authors.
European Journal of Cardio-thoracic Surgery | Year: 2011

Objective: To present the analyzed results on mechanical circulatory support (MCS) collected over a 7-year period, from 2000 to 2006, in France. Methods: A cohort of 520 patients was analyzed. Mean age was 43.7 ± 13.6 years. The main causes of cardiac failure were ischemic cardiomyopathy (39%), idiopathic dilated cardiomyopathy (41.3%), or myocarditis (6.4%). Bridge to transplantation was indicated in 87.8% of patients, bridge to recovery in 9%, while destination therapy was proposed in 3.2% of patients. Results: For patients in cardiogenic shock or advanced heart failure undergoing device implantation as bridge to transplantation or recovery (n = 458), overall mortality was 39% (n = 179). The main causes of mortality under MCS were multi-organ failure (MOF) (57.4%), neurological events (14.1%), or infections (11.9%). Heart transplantation was performed in 249 (54.3%) patients. The main causes of death following heart transplantation were primary graft failure (22.4%), MOF (14.3%), neurological event (14.3%), or infection (10.2%). Long-term survival in transplanted patients was 75 ± 2.8% at 1 year and 66 ± 3.4% at 5 years. Conclusions: MCS is an essential therapeutic tool to save the life of young patients with cardiogenic shock or advanced cardiac failure. Early MCS implantation and the availability of a device that is adapted to the patient's clinical status are prerequisites for reducing overall mortality rates. © 2011 European Association for Cardio-Thoracic Surgery.

Beuselinck B.,University Hospitals Leuven | Beuselinck B.,French Institute of Health and Medical Research | Karadimou A.,French Institute of Health and Medical Research | Lambrechts D.,Catholic University of Leuven | And 21 more authors.
British Journal of Cancer | Year: 2013

Background:There are no validated markers that predict response in metastatic renal cell cancer (RCC) patients treated with sunitinib. We aim to study the impact of single-nucleotide polymorphisms (SNPs) that have recently been proposed as predictors of outcome to anti-VEGF-targeted therapy in metastatic RCC in an independent cohort of patients.Methods:We genotyped 16 key SNPs in 10 genes involved in sunitinib pharmacokinetics, pharmacodynamics and VEGF-independent angiogenesis in patients with metastatic clear-cell RCC treated with sunitinib as the first-line targeted therapy. Association between SNPs, progression-free survival (PFS) and overall survival (OS) were studied by multivariate Cox regression using relevant clinical factors associated with PFS and OS as covariates.Results:In a series of 88 patients, both PFS and OS were associated significantly with SNP rs1128503 in ABCB1 (P=0.027 and P=0.025), rs4073054 in NR1/3 (P=0.025 and P=0.035) and rs307821 in VEGFR3 (P=0.032 and P=0.011). Progression-free survival alone was associated with rs2981582 in FGFR2 (P=0.031) and rs2276707 in NR1/2 (P=0.047), whereas OS alone was associated with rs2307424 in NR1/3 (P=0.048) and rs307826 in VEGFR3 (P=0.013).Conclusion: Our results confirm former communications regarding the association between SNPs in ABCB1, NR1/2, NR1/3 and VEGFR3 and sunitinib outcome in clear-cell RCC. Prospective validation of these SNPs is now required. © 2013 Cancer Research UK.

Labarde S.,Hopital Dupuytren | Bugeaud J.-L.,Hopital Dupuytren | Nouaille Y.,Hopital Dupuytren
Actualites Pharmaceutiques | Year: 2013

The French list of banned doping substances and methods of doping is based on the list developed and proposed by the World Anti Doping Agency (WADA), adopted by the International Olympic Committee (IOC) and international sports federations. It includes classes of substances and methods banned at all times (in and out of competition), substances banned in competition only and classes of substances banned in certain sports. Knowledge of the adverse affects caused by these products contributes to the education of the athlete. © 2012 Elsevier Masson SAS. Tous droits réservés.

Labarde S.,Limoges University Hospital Center | Bugeaud J.-L.,Hopital Dupuytren | Nouaille Y.,Hopital Dupuytren
Actualites Pharmaceutiques | Year: 2013

The Medical Agency of Doping Prevention (AMPD) in Limousin regularly receives enquiries from athletes, health professionals or sports associations. It provides answers and advice. © 2012 Elsevier Masson SAS. Tous droits réservés.

Labarde S.,Hopital Dupuytren | Bugeaud J.-L.,Hopital Dupuytren | Nouaille Y.,Hopital Dupuytren
Actualites Pharmaceutiques | Year: 2013

Following the Tour de France scandal in 1998, the International Olympic Committee (IOC) organized the first World Conference on Doping in Sport in February 1999. The World Anti-Doping Agency (WADA), whose creation was proposed at this Conference, was founded on November 10, 1999. In France, the French anti-doping agency (AFLD) and the medical agency of doping prevention are the main players in the fight and prevention against doping. © 2012 Elsevier Masson SAS. Tous droits réservés.

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