Ryvlin P.,French Institute of Health and Medical Research |
Nashef L.,King's College |
Lhatoo S.D.,Case Western Reserve University |
Bateman L.M.,Columbia University |
And 24 more authors.
The Lancet Neurology | Year: 2013
Background: Sudden unexpected death in epilepsy (SUDEP) is the leading cause of death in people with chronic refractory epilepsy. Very rarely, SUDEP occurs in epilepsy monitoring units, providing highly informative data for its still elusive pathophysiology. The MORTEMUS study expanded these data through comprehensive evaluation of cardiorespiratory arrests encountered in epilepsy monitoring units worldwide. Methods: Between Jan 1, 2008, and Dec 29, 2009, we did a systematic retrospective survey of epilepsy monitoring units located in Europe, Israel, Australia, and New Zealand, to retrieve data for all cardiorespiratory arrests recorded in these units and estimate their incidence. Epilepsy monitoring units from other regions were invited to report similar cases to further explore the mechanisms. An expert panel reviewed data, including video electroencephalogram (VEEG) and electrocardiogram material at the time of cardiorespiratory arrests whenever available. Findings: 147 (92%) of 160 units responded to the survey. 29 cardiorespiratory arrests, including 16 SUDEP (14 at night), nine near SUDEP, and four deaths from other causes, were reported. Cardiorespiratory data, available for ten cases of SUDEP, showed a consistent and previously unrecognised pattern whereby rapid breathing (18-50 breaths per min) developed after secondary generalised tonic-clonic seizure, followed within 3 min by transient or terminal cardiorespiratory dysfunction. Where transient, this dysfunction later recurred with terminal apnoea occurring within 11 min of the end of the seizure, followed by cardiac arrest. SUDEP incidence in adult epilepsy monitoring units was 5·1 (95% CI 2·6-9·2) per 1000 patient-years, with a risk of 1·2 (0·6-2·1) per 10000 VEEG monitorings, probably aggravated by suboptimum supervision and possibly by antiepileptic drug withdrawal. Interpretation: SUDEP in epilepsy monitoring units primarily follows an early postictal, centrally mediated, severe alteration of respiratory and cardiac function induced by generalised tonic-clonic seizure, leading to immediate death or a short period of partly restored cardiorespiratory function followed by terminal apnoea then cardiac arrest. Improved supervision is warranted in epilepsy monitoring units, in particular during night time. Funding: Commission of European Affairs of the International League Against Epilepsy. © 2013 Elsevier Ltd.
Bioulac-Sage P.,Hopital Pellegrin |
Bioulac-Sage P.,French Institute of Health and Medical Research |
Cubel G.,French Institute of Health and Medical Research |
Rossi J.Z.,French Institute of Health and Medical Research |
And 2 more authors.
Liver International | Year: 2010
Background: Inflammatory hepatocellular adenoma (IHCA) defines a subgroup of hepatocellular adenomas characterized by the expression of members of the acute-phase inflammatory response [(serum amyloid A protein (SAA) and C-reactive protein (CRP)]. IHCA are unique or multiple as defined by the presence of several nodule(s) larger than 10mm using both imaging and macroscopic observation. Frequently, additional micronodules (<10 mm), previously undetected by imaging, can be observed in resected specimens. Aims: To analyse micronodules in multiple (group 1, nine patients) and single (group 2, eight patients) IHCA cases, immunohistochemistry using SAA and CRP antibodies was performed on all nodules detected under macroscopic examination as well as on surrounding tissue with no visible nodules. Results: Nodules of different sizes (>5≤10 mm, ≥1≤5mm) were found in group 1, whereas only rare nodules in the mm range were found in group 2. Micronodules shared the characteristics of large nodules, which justified surgery such as inflammatory infiltrates, abnormal arteries, sinusoidal dilatation or peliosis. However, the number of these characteristics was proportional to the size of the nodules. Conclusion: This study demonstrates that the real number of IHCA is greater than that predicted from imaging-based analyses. In addition, we show that patients with more than one nodule present a greater chance to display more and larger undetected micronodules than patients with a single nodule. © 2009 John Wiley & Sons A/S.
Amet S.,Service Information Conseil Adaptation Renale |
Launay-Vacher V.,Service Information Conseil Adaptation Renale |
Frances C.,Hopital Tenon |
Tricotel A.,Agence Nationale de Securite du Medicament |
And 7 more authors.
Investigative Radiology | Year: 2014
Background: Nephrogenic systemic fibrosis (NSF) has been related to the use of gadolinium-based contrast agents (GBCAs) in patients undergoing dialysis. The Prospective Fibrose Nephrogénique Systémique study, a French prospective study supported by the French drug regulatory agency (Agence Nationale de Sécurité du Médicament) and the French Societies of Nephrology, Dermatology, and Radiology, aimed at determining the incidence of NSF in patients undergoing long-term dialysis. Materials and Methods: Adult patients undergoing long-term dialysis receiving a magnetic resonance imaging (MRI) examination prescribed between January 15, 2009 and May 31, 2011, with or without GBCA were included. The methodology was based on a patient form intended to detect any dermatological event (DE) that may occur within 4 months after the examination. Further investigations were planned with their physicians if a DE was reported. Results: A total of 571 patients were included. A total of 50.3% received GBCA. Among them, 93.4% received a macrocyclic GBCA, usually gadoteric acid (88.9%). All in all, 22 patients (3.9%) reported a DE. Dermatological diagnoses did not reveal any evidence of NSF. Conclusions: The incidence of NSF after a single dose of a macrocyclic GBCA is null in our sample of 268 patients undergoing dialysis (hemodialysis and peritoneal dialysis). This incidence is just lower than 0.5%. When contrast-enhanced MRI can be essential, or even decisive, to the diagnosis, these results are important and reassuring if physicians need to perform contrast-enhanced MRI in patients undergoing dialysis. Copyright © 2013 Lippincott Williams & Wilkins.
Lefebvre J.-L.,Center Oscar Lambret |
Andry G.,Institute Jules Bordet |
Chevalier D.,Center Hospitalier Regional Claude Huriez |
Luboinski B.,Institute Gustave Roussy |
And 11 more authors.
Annals of Oncology | Year: 2012
Background: We report the 10-year results of the EORTC trial 24891 comparing a larynx-preservation approach to immediate surgery in hypopharynx and lateral epilarynx squamous cell carcinoma. Material and methods: Two hundred and two patients were randomized to either the surgical approach (total laryngectomy with partial pharyngectomy and neck dissection, followed by irradiation) or to the chemotherapy arm up to three cycles of induction chemotherapy (cisplatin 100 mg/m. 2 day 1 + 5-FU 1000 mg/m. 2 day 1-5) followed for complete responders by irradiation and otherwise by conventional treatment. The end points were overall survival [OS, noninferiority: hazard ratio (preservation/surgery) ≤ 1.428, one-sided α = 0.05], progression-free survival (PFS) and survival with a functional larynx (SFL). Results: At a median follow-up of 10.5 years on 194 eligible patients, disease evolution was seen in 54 and 49 patients in the surgery and chemotherapy arm, respectively, and 81 and 83 patients had died. The 10-year OS rate was 13.8% in the surgery arm and 13.1% in the chemotherapy arm. The 10-year PFS rates were 8.5% and 10.8%, respectively. In the chemotherapy arm, the 10-year SFL rate was 8.7%. Conclusion: This strategy did not compromise disease control or survival (that remained poor) and allowed more than half of the survivors to retain their larynx. © The Author 2012. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved.
Vendittoli P-A.,Hopital Maisonneuve Rosemont |
Riviere C.,Hopital Pellegrin |
Roy A.G.,Hopital Maisonneuve Rosemont |
Barry J.,Hopital Maisonneuve Rosemont |
And 2 more authors.
Bone and Joint Journal | Year: 2013
A total of 219 hips in 192 patients aged between 18 and 65 years were randomised to 28-mm metal-on-metal uncemented total hip replacements (THRs, 107 hips) or hybrid hip resurfacing (HR, 112 hips). At a mean follow-up of eight years (6.6 to 9.3) there was no significant difference between the THR and HR groups regarding rate of revision (4.0% (4 of 99) vs 5.8% (6 of 104), p = 0.569) or re-operation rates without revision (5.1% (5 of 99) vs 2.9% (3 of 104), p = 0.428). In the THR group one recurrent dislocation, two late deep infections and one peri-prosthetic fracture required revision, whereas in the HR group five patients underwent revision for femoral head loosening and one for adverse reaction to metal debris. The mean University of California, Los Angeles activity scores were significantly higher in HR (7.5 (SD 1.7) vs 6.9 (SD 1.7), p = 0.035), but similar mean Western Ontario and McMaster Universities Osteoarthritis Index scores were obtained (5.8 (SD 9.5) in HR vs 5.1 (SD 8.9) in THR, p = 0.615) at the last follow-up. Osteolysis was found in 30 of 81 THR patients (37.4%), mostly in the proximal femur, compared with two of 83 HR patients (2.4%) (p < 0.001). At five years the mean metal ion levels were < 2.5 μg/l for cobalt and chromium in both groups; only titanium was significantly higher in the HR group (p = 0.001). Although revision rates and functional scores were similar in both groups at mid-term, longterm survival analysis is necessary to determine whether one procedure is more advantageous than the other. © 2013 The British Editorial Society of Bone & Joint Surgery.
Schmidt-Erfurth U.,University of Vienna |
Eldem B.,Hacettepe University |
Guymer R.,University of Melbourne |
Korobelnik J.-F.,Hopital Pellegrin |
And 6 more authors.
Ophthalmology | Year: 2011
Objective To demonstrate noninferiority of a quarterly treatment regimen to a monthly regimen of ranibizumab in patients with subfoveal choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD). Design A 12-month, multicenter, randomized, double-masked, active-controlled, phase IIIb study. Participants Patients with primary or recurrent subfoveal CNV secondary to AMD (353 patients), with predominantly classic, minimally classic, or occult (no classic component) lesions. Intervention Patients were randomized (1:1:1) to 0.3 mg quarterly, 0.5 mg quarterly, or 0.3 mg monthly doses of ranibizumab. Treatment comprised of a loading phase (3 consecutive monthly injections) followed by a 9-month maintenance phase (either monthly or quarterly injection). Main Outcome Measures Mean change in best-corrected visual acuity (BCVA) and central retinal thickness (CRT) from baseline to month 12 and the incidence of adverse events (AEs). Results In the per-protocol population (293 patients), BCVA, measured by Early Treatment Diabetic Retinopathy Study-like charts, increased from baseline to month 12 by 4.9, 3.8, and 8.3 letters in the 0.3 mg quarterly (104 patients), 0.5 mg quarterly (88 patients), and 0.3 mg monthly (101 patients) dosing groups, respectively. Similar results were observed in the intent-to-treat (ITT) population (353 patients). The mean decrease in CRT from baseline to month 12 in the ITT population was -96.0 μm in 0.3 mg quarterly, -105.6 μm in 0.5 mg quarterly, and -105.3 μm in 0.3 mg monthly group. The most frequent ocular AEs were conjunctival hemorrhage (17.6%, pooled quarterly groups; 10.4%, monthly group) and eye pain (15.1%, pooled quarterly groups; 20.9%, monthly group). There were 9 ocular serious AEs and 3 deaths; 1 death was suspected to be study related (cerebral hemorrhage; 0.5 mg quarterly group). The incidences of key arteriothromboembolic events were low. Conclusions After 3 initial monthly ranibizumab injections, both monthly (0.3 mg) and quarterly (0.3 mg/0.5 mg) ranibizumab treatments maintained BCVA in patients with CNV secondary to AMD. At month 12, BCVA gain in the monthly regimen was higher than that of the quarterly regimens. The noninferiority of a quarterly regimen was not achieved with reference to 5.0 letters. The safety profile was similar to that reported in prior ranibizumab studies. Financial Disclosure(s) Proprietary or commercial disclosure may be found after the references. © 2011 American Academy of Ophthalmology.
Daien C.I.,Montpellier University |
Duny Y.,Institut Universitaire de France |
Barnetche T.,Hopital Pellegrin |
Daures J.-P.,Institut Universitaire de France |
And 2 more authors.
Annals of the Rheumatic Diseases | Year: 2012
Background: Patients with rheumatoid arthritis (RA) are at increased risk of cardiovascular disease. Lipid changes related to inflammation have been described in RA. Tumour necrosis factor α (TNFα) inhibitor (TNFi) treatment is effective in controlling inflammation and decreasing the number of cardiovascular events. Objective: To assess the change in lipid levels with TNFi treatment in patients with RA by systematic review and meta-analysis. Methods: A Medline search was performed for articles published up to March 2011. Reports describing values for total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglycerides (TGs), atherogenic index (AI) and apolipoprotein B/A (apoB/A) collected before and after TNfiinitiation were included. Data were analysed according to short-, mid- and long-term treatment. Statistical analysis of pre-post data was performed by comprehensive meta-analysis. A random effects model was used when there was evidence of heterogeneity. Results: The search retrieved 32 articles, of which 13 prospective before/after studies were analysed. Longterm TNfitreatment was associated with increased levels of HDL (+0.27 mmol/l, p<0.0001) and TC (+0.27 mmol/l, p=0.03), whereas LDL levels and AI remained unchanged. After long-term treatment, TG levels increased (+0.28 mmol/l, p<0.001) and apoB/A decreased (-0.3, p<0.0001). Conclusion: The presumed cardioprotective effects of TNfiin RA do not seem to be explained by quantitative lipid changes since long-term treatment has no effect on LDL levels or on AI. Increased HDL levels could have some beneficial effects, but this needs to be confirmed by prospective studies with long-term follow-up.
Vidal C.,Montpellier University |
Barnetche T.,Hopital Pellegrin |
Morel J.,Montpellier University |
Combe B.,Montpellier University |
Daien C.,Montpellier University
Journal of Rheumatology | Year: 2015
Objective. Obesity and overweight are increasing conditions. Adipose tissue with proinflammatory properties could be involved in rheumatoid arthritis (RA) activity and radiographic progression. This study aims to investigate the influence of overweight and obesity on RA activity and severity. Methods. We conducted a systematic review and metaanalysis to assess the association of body mass index (BMI) categories with the Disease Activity Score in 28 joints (DAS28), functional disability [Health Assessment Questionnaire (HAQ)], and radiographic joint damage in patients with RA. We searched Medline through PubMed, EMBASE, and the Cochrane Database of Systematic Reviews for all studies assessing DAS28, HAQ, or/and radiographic damage according to predefined BMI groups. Results. Among the 737 citations retrieved, 58 articles met the inclusion criteria and 7 were included in the metaanalysis. DAS28 was higher in obese (BMI > 30 kg/m2) than non-obese (BMI ≤ 30 kg/m2) patients (mean difference 0.14, 95% CI 0.01-0.27, p = 0.04, I2 = 0%). HAQ score was also higher among obese patients (mean difference 0.10, 95% CI 0.01-0.19, p = 0.03, I2 = 0%). Radiographic joint damage was negatively associated with obesity (standardized mean difference -0.15, 95% CI -0.29 to -0.02, p = 0.03, I2 = 38%). Conclusion. Obesity in RA is associated with increased DAS28 and HAQ score and with lower radiographic joint damage. These associations mainly result from an increase of subjective components of the DAS28 (total joint count and global health assessment) in obese patients. Conflicting results were reported concerning inflammation markers (C-reactive protein and erythrocyte sedimentation rate). © Copyright 2015 The Journal of Rheumatology. All rights reserved.
Torossian M.,Hopital Pellegrin
Revue Francophone d'Orthoptie | Year: 2016
Le coordimètre de Hess Weiss est l'outil permettant l'étude de la déviation oculaire par dissociation. Un œil est localisateur et l'autre est fixateur. Selon la trame utilisée, il est possible de maintenir la fusion ou de la rompre. © 2016 Elsevier Masson SAS.
Fabre T.,Hopital Pellegrin |
Abi-Chahla M.L.,Hopital Pellegrin |
Billaud A.,Hopital Pellegrin |
Geneste M.,Hopital Pellegrin |
Durandeau A.,Hopital Pellegrin
Journal of Shoulder and Elbow Surgery | Year: 2010
Background: The purpose of this study was to evaluate the long-term outcome (>20 years) of patients who underwent an open Bankart procedure, many of them contact athletes, in terms of shoulder stability, return to sport, and the development of osteoarthritis. Methods: We retrospectively reviewed 49 patients (50 shoulders) who underwent an open Bankart procedure for recurrent shoulder instability. There were 36 contact athletes (73%) in this cohort. Mean follow-up was 28 years (25-32). Clinical examination was performed by an independent reviewer, with standard shoulder radiographs obtained. Results: Eight patients had recurrence of dislocation after a new traumatic episode, in six cases while playing rugby, with two of them requiring re-operation. Forty (82%) patients returned to their previous level of sports activities, including all 31 rugby players. No statistically significant loss of motion occurred in this group, although there was slight loss of flexion (6°) and external rotation (9°). The mean Rowe score at final follow-up was 82 (25-97), and all but two patients considered themselves satisfied with the results of the surgery. Thirty-four (69%) patients showed signs of osteoarthritis at follow-up, as follows: Stage 1 -18, Stage 2 - 5, Stage 3 - 5, and Stage 4 - 1. Conclusion: At long-term follow-up, patients undergoing an open Bankart procedure for recurrent shoulder instability obtained a high percentage of shoulder stability, and reliably returned to high-level sports activities. However, 69% did show radiographic signs of osteoarthritis. © 2010 Journal of Shoulder and Elbow Surgery Board of Trustees.