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Le Touquet – Paris-Plage, France

Audouin M.,Hopital Tenon
Medecine Therapeutique Medecine de la Reproduction, Gynecologie et Endocrinologie | Year: 2015

Urinary tract infections represent the most frequent bacterial infectious complications during pregnancy. The gravidic characteristics, especially due to estrogens and progesterone, are responsible for modifications of the urine composition, the physiology and the anatomy of the urinary tract. These modifications increase the risk of bacteriuria, cystitis and acute pyelonephritis. An inadequate treatment or a lack of treatment can have very serious consequences for the women and the foetus. It is important to quickly detect the situations at high risk of complications, to understand when to treat and to use antibiotics known to be harmless for the foetus. An asymptomatic bacteriuria must always be treated with antibiotics according to the results of the antibiogram during five days. Concerning cystitis and acute pyelonephritis, the antibiotic must be first delivered before the result of the antibiogram. After the result of the antibiogram, the antibiotic must be adjusted if it was ineffective for five days for cystitis and for two or three weeks for acute pyelonephritis. The monitoring of the mother and the foetus involve that every acute pyelonephritis during pregnancy must be attended in a specialized unit. Source

Rouzier R.,Hopital Tenon | Rouzier R.,University Pierre and Marie Curie | Giordanella J.-P.,Caisse Primaire dAssurance Maladie de Paris
Journal of Adolescent Health | Year: 2010

Objective: To evaluate the coverage and compliance of the Human Papilloma Virus (HPV) vaccine in Paris. Methods: We selected a female population living in Paris, between the ages of 14 and 23 years (French recommendations) on December 31st, 2008, that was affiliated to social security (n = 77,744). We evaluated the dynamic of HPV vaccine dose reimbursement between July 2007 and April/May 2009 for this population. Results: The coverage rate in the study population with at least one dose of the vaccine was 17%. A complete vaccination scheme (three doses) was observed in less than 43% of affiliates, whereas two doses have been reimbursed to 26% of the affiliates and only one dose to 31%. Higher rates of coverage and compliance were observed among girls between 15 and 17 years of age. Conclusion: Coverage and compliance rates corresponding to the French HPV vaccine program appear to be lower than those observed in countries with different recommendations and implementation strategies, and particularly school-based program. Our study suggests that health authorities should modify current recommendations. © 2010 Society for Adolescent Health and Medicine. All rights reserved. Source

Haab F.,Hopital Tenon | Braticevici B.,Spitalul Clinic | Krivoborodov G.,Russian National Research Medical University | Palmas M.,Helsinn Healthcare SA | And 2 more authors.
Neurourology and Urodynamics | Year: 2014

Aim: NK-1 receptors in sensory nerves, the spinal cord and bladder smooth muscle participate in complex sensory mechanisms that regulate bladder activity. This study was designed to assess the efficacy and safety of a new NK-1 receptor antagonist, netupitant, in patients with OAB. Methods: This was a phase II, multicenter, double-blind study in which adults with OAB symptoms >6 months were randomized to receive 1 of 3 doses of netupitant (50, 100, 200 mg) or placebo once daily for 8 weeks. The primary efficacy endpoint was percentage change from baseline in average number of daily micturitions at week 8. Urinary incontinence, urge urinary incontinence (UUI), and urgency episodes were also assessed. Results: The primary efficacy endpoint was similar in the treatment groups (-13.85 for placebo to -16.17 in the netupitant 200 mg group) with no statistically significant differences between netupitant and placebo. The same was true for most secondary endpoints although a significant difference for improvement in UUI episodes and a trend for the greatest decrease in urgency episodes were seen in the netupitant 100 mg group. Netupitant was well tolerated with most treatment emergent adverse events (AEs) being mild. While the overall incidence of AEs increased with netupitant dose, there was no evidence for this dose dependency based on relationship to treatment, intensity, or time to onset. Conclusions: The study failed to demonstrate superiority of netupitant versus placebo in decreasing OAB symptoms, despite a trend favoring netupitant 100 mg. There were no safety concerns with daily administration of netupitant over 8 weeks. © 2013 Wiley Periodicals, Inc. Source

Balogova S.,Comenius University | Balogova S.,University Pierre and Marie Curie | Talbot J.-N.,University Pierre and Marie Curie | Nataf V.,Hopital Tenon | And 4 more authors.
European Journal of Nuclear Medicine and Molecular Imaging | Year: 2013

6-Fluoro-(18F)-L-3,4-dihydroxyphenylalanine (FDOPA) is an amino acid analogue for positron emission tomography (PET) imaging which has been registered since 2006 in several European Union (EU) countries and by several pharmaceutical firms. Neuroendocrine tumour (NET) imaging is part of its registered indications. NET functional imaging is a very competitive niche, competitors of FDOPA being two well-established radiopharmaceuticals for scintigraphy, 123I-metaiodobenzylguanidine (MIBG) and 111In-pentetreotide, and even more radiopharmaceuticals for PET, including fluorodeoxyglucose (FDG) and somatostatin analogues. Nevertheless, there is no universal single photon emission computed tomography (SPECT) or PET tracer for NET imaging, at least for the moment. FDOPA, as the other PET tracers, is superior in diagnostic performance in a limited number of precise NET types which are currently medullary thyroid cancer, catecholamine-producing tumours with a low aggressiveness and well-differentiated carcinoid tumours of the midgut, and in cases of congenital hyperinsulinism. This article reports on diagnostic performance and impact on management of FDOPA according to the NET type, emphasising the results of comparative studies with other radiopharmaceuticals. By pooling the results of the published studies with a defined standard of truth, patient-based sensitivity to detect recurrent medullary thyroid cancer was 70 % [95 % confidence interval (CI) 62.1-77.6] for FDOPAvs 44 % (95 % CI 35-53.4) for FDG; patient-based sensitivity to detect phaeochromocytoma/paraganglioma was 94 % (95 % CI 91.4-97.1) for FDOPA vs 69 % (95 % CI 60.2-77.1) for 123I-MIBG; and patient-based sensitivity to detect midgut NET was 89 % (95 % CI 80.3- 95.3) for FDOPA vs 80 % (95 % CI 69.2-88.4) for somatostatin receptor scintigraphy with a larger gap in lesion-based sensitivity (97 vs 49 %). Previously unpublished FDOPA results from our team are reported in some rare NET, such as small cell prostate cancer, or in emerging indications, such as metastatic NET of unknown primary (CUP-NET) or adrenocorticotropic hormone (ACTH) ectopic production. An evidence-based strategy in NET functional imaging is as yet affected by a low number of comparative studies. Then the suggested diagnostic trees, being a consequence of the analysis of present data, could be modified, for some indications, by a wider experience mainly involving face-toface studies comparing FDOPA and 68Ga-labelled peptides. © 2013 Springer-Verlag Berlin Heidelberg. Source

Hentgen V.,French Reference Center for Auto Inflammatory Diseases | Grateau G.,Hopital Tenon | Stankovic-Stojanovic K.,Hopital Tenon | Amselem S.,French Institute of Health and Medical Research | Jeru I.,French Institute of Health and Medical Research
Arthritis and Rheumatism | Year: 2013

Objective Familial Mediterranean fever (FMF) is an autosomal-recessive autoinflammatory disease due to mutations in MEFV. Descriptions of disease manifestations among patients carrying a single mutated MEFV allele are becoming more frequent, although no data are available on the long-term outcome. We undertook this study to assess the accuracy of clinical diagnosis in children carrying a single mutated MEFV allele with symptoms of recurrent autoinflammatory disorder. Methods We performed a retrospective single-center study of 33 patients with autoinflammatory disorders age <6 years at disease onset with 1 mutated MEFV allele. The phenotype of the patients was investigated in detail, and the clinical picture and outcome of 18 patients with an initial FMF diagnosis according to current clinical criteria were compared to those of 25 homozygous or compound heterozygous FMF patients. Results No major differences in presenting signs or initial response to colchicine were observed between patient groups. During followup, heterozygotes had a milder disease course compared to homozygotes and were less prone than homozygotes to experience new clinical signs of FMF. At puberty, clinical signs of FMF completely disappeared in 5 of 18 heterozygotes, allowing them to discontinue colchicine without recurrence of symptoms or increases in inflammatory marker levels. Conclusion Our data suggest that the clinical diagnosis of FMF in very young heterozygous children should be made with caution. At this young age they can present with an FMF-like disease - similar to that seen in patients carrying 2 mutated alleles - that is not necessarily predictive of life-long illness. Copyright © 2013 by the American College of Rheumatology. Source

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