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Le Touquet – Paris-Plage, France

Sariali E.,Hopital Pitie Salpetriere | Klouche S.,Hopital la Croix Saint Simon | Mamoudy P.,Hopital la Croix Saint Simon
Clinical Biomechanics | Year: 2012

Background: The components position is a major factor under the surgeon's control in determining the risk of dislocation post total hip arthroplasty. The aim of this study was to investigate the proper three-dimensional components position including the centre of rotation in the case of anterior dislocation. Methods: Among 1764 consecutive patients who underwent total hip arthroplasty using a direct anterior approach, 27 experienced anterior dislocation. The three-dimensional hip anatomy was investigated in 12 patients who were paired with 12 patients from the same initial cohort who did not experience dislocation and also with 36 control patients with osteoarthritis. A pelvic Cartesian referential was defined to perform the acetabular analysis. The coordinates were expressed as percentages of the pelvic width, height and depth. The anteversion angles were measured. Findings: The hip centre of rotation was significantly shifted medially and posteriorly in the dislocation group when compared to the non-dislocation group and also to the control group. There was no significant difference in component angular position between the dislocation-group and the non-dislocation group. However, the stem anteversion in the dislocation group was increased in comparison to the mean natural femoral anteversion of the control group. Interpretation: A medial and posterior displacement of the hip rotation centre was found to correlate to anterior dislocation post total hip arthoplasty. These results suggest the importance of an accurate restoration of the centre of rotation, whilst avoiding an excessive acetabular reaming which may induce a medial and a posterior displacement. Level of evidence: III comparative non randomised. © 2011 Elsevier Ltd. Source

Mercadal L.,Hopital Pitie Salpetriere
Nephrologie et Therapeutique | Year: 2015

Tumour markers are high molecular weight glycoproteins whose interpretation in the presence of chronic renal disease may be disturbed. Apart from the prostate specific antigen, human chorionic gonadotropin and α-fetoprotein, their levels rise with chronic renal failure. For some markers, such as carcinoembryonic antigen, carcinogen antigen (CA) 15-3, cytokeratin fragment 21-1 or calcitonin, a threshold may be defined in a population with chronic renal failure, which may allow their use in cancer surveillance. Others, such as CA125, CA19-9, squamous cell carcinoma and neurospecific enolase, have a high variability and their use in patients with chronic renal disease remains difficult. © 2015 Association Société de néphrologie. Source

Pradat P.-F.,Hopital Pitie Salpetriere | Delanian S.,Oncologie Radiotherapie Radiopathologie
Handbook of Clinical Neurology | Year: 2013

Although the peripheral nerve has often been considered as radioresistant, clinical practice demonstrates the occurrence of radiation-induced peripheral neuropathies. Because these complications appear late, usually several years after the course of radiotherapy, their occurrence is explained by improvement in the prognosis of several cancers. Their physiopathology is not fully understood. Compression by radio-induced fibrosis probably plays a central role but direct injury to nerves and blood vessels is probably also involved. The most frequent and best known form of postradiation neuropathy is brachial plexopathy, which may follow irradiation for breast cancer. Recent reports demonstrate that postradiation neuropathies show a great heterogeneity, particularly in the anatomical sites, but also in the clinical, electrophysiological, and neuroimaging features. The link with radiotherapy may be difficult for the clinician to establish. Patients with radiation-induced lumbosacral radiculoplexopathy may be misdiagnosed with amyotrophic lateral sclerosis as they often present with pure lower motor neuron syndrome, or with leptomeningeal metastases since nodular MRI enhancement of the nerve roots of the cauda equina and increased CSF protein content can be observed. From a pathophysiological perspective, radiation-induced neuropathy offers an interesting model for deciphering the mechanisms of peripheral neuropathies due to environmental factors. Recent developments show promising strategies for the prevention and treatment of these complications, which have a considerable impact on a patient's quality of life. © 2013 Elsevier B.V. Source

Ratziu V.,Hopital Pitie Salpetriere
Nature Reviews Gastroenterology and Hepatology | Year: 2013

NASH is a common liver disease that increases liver-related mortality and reduces survival. The need for optimal management of NASH is therefore a priority for today's practicing hepatologist. The rationale for specific pharmacological therapy for NASH is based on the potential for disease progression and the difficulties that many patients have successfully implementing, in the long term, diet and lifestyle changes. Even in those that succeed, limited evidence exists that severe liver injury in patients with NASH can be reversed by diet and lifestyle measures alone. This Review provides a personal and critical assessment of the histological efficacy and safety of agents tested in randomized trials in patients with NASH. © 2013 Macmillan Publishers Limited. All rights reserved. Source

Godet-Mardirossian H.,Institute of Veille Sanitaire | Girerd X.,Hopital Pitie Salpetriere | Vernay M.,Institute of Veille Sanitaire | Chamontin B.,Toulouse University Hospital Center | And 2 more authors.
European Journal of Preventive Cardiology | Year: 2012

Objectives: The objectives of this study were to describe the hypertensive population and therapeutic management of hypertension in subjects between 18 and 74 years of age in continental France in 2006.Methods: ENNS was a cross-sectional survey conducted in continental France in 2006-2007. Blood pressure (BP) was measured in a national sample of non-institutionalized adults aged 18-74 years and pharmacological treatment was collected by a self-questionnaire. Hypertension was defined by systolic blood pressure (SBP) <140 mmHg, diastolic blood pressure (DBP) <90 mmHg, or treatment with BP-lowering drugs. The therapeutic control of treated hypertensive patients was defined by SBP <140 mmHg and DBP <90 mmHg.Results: The prevalence of hypertension was 31.0%. Half of hypertensive subjects reported taking an antihypertensive drug (50.3%) and nearly half of them were treated with a single antihypertensive pharmacological class (44.3%). Overall, among hypertensives, 25.6% had a satisfactory BP control.Conclusions: Our survey revealed a high prevalence of hypertension in continental France, with only half of the hypertensive subjects receiving pharmacological therapy and one treated out of two with BP at goal. More effective measures are needed to improve clinical management of hypertension. © The European Society of Cardiology 2011 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav. Source

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