Hopital Prive Claude Galien

Quincy-sous-Sénart, France

Hopital Prive Claude Galien

Quincy-sous-Sénart, France
SEARCH FILTERS
Time filter
Source Type

Rostoker G.,Hopital Prive Claude Galien | Vaziri N.D.,University of California at Irvine
Hemodialysis International | Year: 2017

About 2.5% of the world population, corresponding to about 177 million individuals, are infected by hepatitis C virus (HCV), a small, single-stranded RNA virus. The prevalence of HCV infection among dialysis patients in Japan, Europe, and North America during the 2012 to 2015 period was found to be 8.7% in the DOPPS study. Nosocomial HCV spread in hemodialysis facilities still occurs. Increased hepatic tissue iron has been shown to play a deleterious role in the course of hepatitis C, favor development of fibrosis and cirrhosis and possibly increase the risk of liver cancer in the general population. Regular loss of blood in the hemodialysis circuit, in routine blood sampling for laboratory tests (for uremia monitoring), and in gut due to uremic enteropathy, invariably results in iron deficiency for which patients are commonly treated with intravenous (IV) iron preparations. Data on the effects of IV iron in hemodialysis patients with hepatitis C are limited (2 studies) and strongly suggest that parenteral iron may contribute to hepatocellular injury. Iatrogenic iron overload is extremely prevalent among hemodialysis population worldwide. Iron overload and toxicity has emerged as one of the most controversial topic in the management of anemia in dialysis patients. Given the known impact of iron in promoting growth and virulence of HCV and the associated liver disease, it is necessary to use iron therapy cautiously and closely monitor plasma markers of iron metabolism and liver iron stores non-invasively by means of MRI to avoid iron overload in this vulnerable population. © 2017 International Society for Hemodialysis


Rostoker G.,Hopital Prive Claude Galien | Rostoker G.,Service Route | Vaziri N.D.,University of California at Irvine
Drugs | Year: 2016

Iron overload used to be considered rare in hemodialysis patients but its clinical frequency is now increasingly realized. The liver is the main site of iron storage and the liver iron concentration (LIC) is closely correlated with total iron stores in patients with secondary hemosideroses and genetic hemochromatosis. Magnetic resonance imaging is now the gold standard method for LIC estimation and monitoring in non-renal patients. Studies of LIC in hemodialysis patients by quantitative magnetic resonance imaging and magnetic susceptometry have demonstrated a strong relation between the risk of iron overload and the use of intravenous (IV) iron products prescribed at doses determined by the iron biomarker cutoffs contained in current anemia management guidelines. These findings have challenged the validity of both iron biomarker cutoffs and current clinical guidelines, especially with respect to recommended IV iron doses. Three long-term observational studies have recently suggested that excessive IV iron doses may be associated with an increased risk of cardiovascular events and death in hemodialysis patients. We postulate that iatrogenic iron overload in the era of erythropoiesis-stimulating agents may silently increase complications in dialysis patients without creating frank clinical signs and symptoms. High hepcidin-25 levels were recently linked to fatal and nonfatal cardiovascular events in dialysis patients. It is therefore tempting to postulate that the main pathophysiological pathway leading to these events may involve the pleiotropic master hormone hepcidin (synergized by fibroblast growth factor 23), which regulates iron metabolism. Oxidative stress as a result of IV iron infusions and iron overload, by releasing labile non-transferrin-bound iron, might represent a 'second hit' on the vascular bed. Finally, iron deposition in the myocardium of patients with severe iron overload might also play a role in the pathogenesis of sudden death in some patients. © 2016 The Author(s).


PubMed | Hopital Prive Claude Galien and University of California at Irvine
Type: Journal Article | Journal: Drugs | Year: 2016

Iron overload used to be considered rare in hemodialysis patients but its clinical frequency is now increasingly realized. The liver is the main site of iron storage and the liver iron concentration (LIC) is closely correlated with total iron stores in patients with secondary hemosideroses and genetic hemochromatosis. Magnetic resonance imaging is now the gold standard method for LIC estimation and monitoring in non-renal patients. Studies of LIC in hemodialysis patients by quantitative magnetic resonance imaging and magnetic susceptometry have demonstrated a strong relation between the risk of iron overload and the use of intravenous (IV) iron products prescribed at doses determined by the iron biomarker cutoffs contained in current anemia management guidelines. These findings have challenged the validity of both iron biomarker cutoffs and current clinical guidelines, especially with respect to recommended IV iron doses. Three long-term observational studies have recently suggested that excessive IV iron doses may be associated with an increased risk of cardiovascular events and death in hemodialysis patients. We postulate that iatrogenic iron overload in the era of erythropoiesis-stimulating agents may silently increase complications in dialysis patients without creating frank clinical signs and symptoms. High hepcidin-25 levels were recently linked to fatal and nonfatal cardiovascular events in dialysis patients. It is therefore tempting to postulate that the main pathophysiological pathway leading to these events may involve the pleiotropic master hormone hepcidin (synergized by fibroblast growth factor 23), which regulates iron metabolism. Oxidative stress as a result of IV iron infusions and iron overload, by releasing labile non-transferrin-bound iron, might represent a second hit on the vascular bed. Finally, iron deposition in the myocardium of patients with severe iron overload might also play a role in the pathogenesis of sudden death in some patients.


Geantot A.,Pole Anesthesie reanimation Chirurgicale et Urgences | Colmont D.,Hopital Prive Claude Galien
Oxymag | Year: 2017

Health care institutions are now undergoing the certification process for the fourth time. Caregivers are increasingly involved in this process. It is important that they appropriate this approach and participate actively in the improvement of the quality and safety of care. Ultimately, all nursing activity carries a potential risk. © 2016 Elsevier Masson SAS.


Colmont D.,Hopital prive Claude Galien
Oxymag | Year: 2017

As with minors, the management of protected adult patients sometimes raises questions in terms of consent to treatment. A review of the obligations of caregivers is useful. Article 42 of the public health code is central to the care of adults placed under guardianship in the event of an emergency. © 2017 Elsevier Masson SAS.


Obesity is a disease, recognised as such by the World Health Organization (WHO) since 1997. Its prevention is a major public health issue. Indeed, this multifactorial pathology, considered by some to be a pandemic, is now being treated as a health priority, even though it is not an infectious disease. Dr Patricia Le Roux, a nutritionist for the nutritional medicine unit of Claude-Galien hospital in Quincy-sous-Sénart, throws light on obesity and its treatment. © 2016 Elsevier Masson SAS.


Rostoker G.,Nephrology and Dialysis Unit | Cohen Y.,Hopital Prive Claude Galien
Journal of Computer Assisted Tomography | Year: 2014

During the past 2 decades, routine use of recombinant erythropoiesis-stimulating agents (ESAs) has enabled anemia to be corrected in dialysis patients, thereby improving their quality of life and permitting better outcomes. As successful use of ESA requires sufficient available iron, almost all end-stage renal disease patients on ESA now receive concomitant parenteral iron therapy. Radiologists must be aware that iron overload among dialysis patients is now an increasingly recognized clinical situation in the ESA era yet was previously considered rare. The KDIGO Controversies Conference on Iron Management in Chronic Kidney Disease, which took place in San Francisco on March 27 to 30, 2014, recognized the entity of iron overload in hemodialysis patients and called for an agenda of research on this topic, especially by means of magnetic resonance imaging (MRI). It is therefore very likely that radiologists will be heavily solicited in the future by nephrology teams requesting quantitative hepatic MRI in dialysis patients, both for research purposes and for diagnosis and follow-up of iron overload. Radiologists should be aware of the marked differences in the pharmacological properties of available intravenous iron products and their potential interference with MRI. Specific MRI protocols need to be established in radiology divisions for each pharmaceutical iron product, especially for treated dialysis patients. © 2014 Lippincott Williams & Wilkins.


Salvatella N.,Institute Hospitalier Jacques Cartier | Morice M.-C.,Institute Hospitalier Jacques Cartier | Darremont O.,Clinique Saint Augustin | Tafflet M.,French Institute of Health and Medical Research | And 9 more authors.
EuroIntervention | Year: 2011

Aims: We sought to assess the efficacy and safety of everolimus-eluting stents for unprotected left main disease. Methods and results: A total of 173 consecutive patients with de novo significant unprotected left main stenosis received an everolimus-eluting stent in four French centres. Among them, 140 (81%) had involvement of the distal portion of left main, and 129/140 (92%) were treated with provisional side branch T-stenting, with a side branch stenting rate of 20%. Angiographic success was achieved in all cases. At 12 months, the cumulative rate of major adverse cardiac or cerebrovascular events (MACCE) was 26/173 (15%) including death from any cause (N=5, 2.9%), stroke (N=4, 2.3%), Q-wave myocardial infarction (MI) (N=2, 1.2%), non-Q-wave MI (N=6, 3.5%) and any repeat revascularisation (N=16, 9.3%). At one year, the rate of targetlesion revascularisation (TLR) was 5/173 (2.9%), target-vessel revascularisation was 12/173 (7%) and the rate of definite or probable left main stent thrombosis 1/173 (0.6%). Conclusions: Unprotected left main stenting using everolimus-eluting stents and a strategy of provisional side branch T-stenting for distal lesions, is safe and effective in the midterm, with a relatively low rate of events and reintervention at one year. © Europa Edition 2011. All rights reserved.


Bronchial carcinoma may involve the phrenic nerve, confronting the surgeon with a difficult choice. In 10 patients undergoing surgery for bronchial carcinoma without previous diaphragmatic palsy, extension to the nerve was discovered during the thoracotomy, leading to a choice between radical surgery involving resection of the nerve, with subsequent diaphragmatic palsy, or incomplete conservative resection preserving the lung function. Conservative surgery was chosen. The subsequent evolution validated this choice. However, the paucity of papers on such cases, although they are not outstandingly unusual, should be noted. © 2009 Elsevier Masson SAS.


Rostoker G.,Hopital Prive Claude Galien | Griuncelli M.,Hopital Prive Claude Galien | Loridon C.,Hopital Prive Claude Galien | Couprie R.,Hopital Prive Claude Galien | And 8 more authors.
American Journal of Medicine | Year: 2012

Background: Most dialysis patients receiving erythropoesis-stimulating agents (ESA) also receive parenteral iron supplementation. There are few data on the risk of hemosiderosis in this setting. Methods: We prospectively measured liver iron concentration by means of T1 and T2 (*) contrast magnetic resonance imaging (MRI) without gadolinium, in a cohort of 119 fit hemodialysis patients receiving both parenteral iron and ESA, in keeping with current guidelines. Results: Mild to severe hepatic iron overload was observed in 100 patients (84%; confidence interval, [CI] 76%-90%), of whom 36% (CI, 27%-46%) had severe hepatic iron overload (liver iron concentration >201 μmol/g of dry weight). In the cross-sectional study, infused iron, hepcidin, and C-reactive protein values correlated with hepatic iron stores in both univariate analysis (P <.05, Spearman test) and binary logistic regression (P <.05). In 11 patients who were monitored closely during parenteral iron therapy, the iron dose infused per month correlated strongly with both the overall increase and the monthly increase in liver iron concentration (respectively, rho = 0.66, P =.0306 and rho = 0.85, P = 0.0015, Spearman test). In the 33 patients with iron overload, iron stores fell significantly after iron withdrawal or after a major reduction in the iron dose (first MRI: 220 μmol/g (range: 60-340); last MRI: 50 μmol/g (range: 5-210); P <.0001, Wilcoxon's paired test). Conclusions: Most hemodialysis patients receiving ESA and intravenous iron supplementation have hepatic iron overload on MRI. These findings call for a revision of guidelines on iron therapy in this setting, especially regarding the amount of iron infused and noninvasive methods for monitoring iron stores. © 2012 Elsevier Inc. All rights reserved.

Loading Hopital Prive Claude Galien collaborators
Loading Hopital Prive Claude Galien collaborators