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Le Touquet – Paris-Plage, France

Sanchez O.,Service de Pneumologie et Soins Intensifs | Trinquart L.,University of Paris Descartes | Caille V.,Hopital Ambroise Pare | Couturaud F.,European University of Brittany | And 13 more authors.
American Journal of Respiratory and Critical Care Medicine | Year: 2010

Rationale: The short-term prognosis of pulmonary embolism (PE) depends on hemodynamic status and underlying disease. The prognostic value of right ventricular dysfunction and injury is less well established. Objectives: To evaluate prognostic factors of PE in a multicenter prospective cohort study. Methods: Echocardiography, brain natriuretic peptide (BNP), N-terminal-proBNP and cardiac troponin I measurements were done on admission of 570 consecutive patients with an acute PE. A predictive model was based on independent predictors of 30-day adverse events defined as death, secondary cardiogenic shock, or recurrent venous thromboembolism. Measurements and Main Results: At 30 days, 42 patients (7.4%; 95% confidence interval [CI], 5.5-9.8%) had adverse events. On multivariate analysis, altered mental state (odds ratio [OR] 6.8; 95% confidence interval [CI], 2.0-23.3), shock on admission (OR 2.8; 95% CI, 1.1-7.5), cancer (OR 2.9; 95% CI, 1.2-6.9), BNP (OR 1.3 for an increase of 250 ng/L; 95% CI, 1.1-1.6) and right to left ventricle diameter ratio (OR 1.2 for an increase of 0.1; 95% CI, 1.1-1.4) were associated with 30-days of adverse events. The predictive performance of the model was good (area under receiver operating characteristics curve 0.84 [95% CI, 0.78-0.90]), making it possible to develop a bedside prognostic score. Conclusions: BNP and echocardiography may be useful determinants of the short-term outcome for patients with PE, together with clinical findings. Patients with PE can be stratified according to the initial risk of adverse outcome, using a simple score based on clinical, echocardiographic, and biochemical variables. Source

Chassagnon G.,Hopital Bretonneau | Favelle O.,Hopital Bretonneau | Marchand-Adam S.,Hopital Bretonneau | De Muret A.,Hopital Trousseau | Revel M.P.,University of Paris Descartes
Clinical Radiology | Year: 2015

Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) is an under-recognized disease characterized by proliferation of neuroendocrine cells in the bronchial wall. It is considered a pre-invasive lesion for lung carcinoid tumours and is found in 5.4% of patients undergoing surgical resection for lung carcinoid tumours. Other manifestations of DIPNECH include bronchial obstruction and formation of tumorlets. DIPNECH preferentially affects middle-aged women. Patients are either asymptomatic or present with long-standing dyspnoea due to obstructive syndrome that can be mistaken for asthma. At CT, mosaic attenuation with multiple small nodules is very suggestive of DIPNECH. The aim of this review is to describe DIPNECH-related CT features and correlate them with histology, in order to help radiologists suggest this diagnosis and distinguish DIPNECH from other causes of mosaic perfusion. © 2014 The Royal College of Radiologists. Source

Bacq Y.,Hopital Trousseau
Hepato-Gastro | Year: 2013

Liver diseases during pregnancy should be recognized and understood because early diagnosis and specific treatment may improve both maternal and fetal outcomes. Hyperemesis gravidarum which occurs during early pregnancy may be associated with liver dysfunction. Vomiting and biochemical abnormalities improve thanks to intravenous perfusion and vitamins. Pruritus is the main symptom of intrahepatic cholestasis of pregnancy which typically occurs during the second or third trimester. Ursodeoxycholic acid is the most effective medical treatment in improving pruritus and liver tests. Ursodeoxycholic acid therapy might also benefit to fetal outcome. Liver function tests should be performed after delivery, and during oral contraception. Mutations in gene encoding biliary transporters, especially ABCB4 encoding the multidrug resistance 3 protein, have been found to be associated with this complex disease. Acute fatty liver of pregnancy is a rare and potentially fatal disease of the third trimester. Clinicians must have a high index of suspicion for this condition when a woman presents nausea or vomiting, epigastric pain, jaundice, or polyuria-polydipsia during the third trimester. Maternal and fetal prognosis has been radically transformed by early delivery. Acute fatty liver of pregnancy has been found to be associated with fatty acid oxidation defects and mothers and their offspring should undergo DNA testing for the common mutation in the HADHA gene coding subunit longchain 3-hydroxyacyl coenzyme A dehydrogenase (mutation c.1528G>C). In patients suffering from pre-eclampsia, HELLP syndrome (Hemolysis-Elevated Liver enzymes-Low Platelets) is a life-threatening complication which should discuss early delivery. Source

Collin P.,Saint Gregoire Private Hospital Center | Treseder T.,Royal Melbourne Hospital | Ladermann A.,University of Geneva | Benkalfate T.,Clinique mutualiste la Sagesse | And 2 more authors.
Journal of Shoulder and Elbow Surgery | Year: 2014

Background: An association between massive rotator cuff tear (RCT) and suprascapular nerve neuropathy has previously been suggested. The anatomic course of the suprascapular nerve is relatively fixed along its passage. Thus, injury to the nerve by trauma, compression, and iatrogenic reasons is well documented. However, the association between retraction of the RCT and development of neuropathy of the suprascapular nerve remains unclear.We aimed to prospectively evaluate the suprascapular nerve for preoperative neurodiagnostic abnormalities in shoulders with massive RCT. Methods and materials: A prospective study was performed in 2 centers. Fifty patients with retracted tears of both supraspinatus and infraspinatus were evaluated. This was confirmed with preoperative computed tomography arthrography, and the fatty infiltration of the affected muscles was graded. Forty-nine preoperative electromyograms were performed in a standardized fashion and the results analyzed twice. Results: Of 49 shoulders, 6 (12%) had neurologic lesions noted on electromyography: 1 suprascapular nerve neuropathy, 1 radicular lesion of the C5 root, 1 affected electromyogram in the context of a previous stroke, and 3 cases of partial axillary nerve palsy with a history of shoulder dislocation. No difference or diminution of the latency or amplitude of the electromyographic curve was found in the cases that presented significant fatty infiltration. Conclusion: This study did not detect a suprascapular lesion in the majority of cases of massive RCT. With a low association of neuropathy with massive RCT, we find no evidence to support the routine practice of suprascapular nerve release when RCT repair is performed. © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Source

Bacq Y.,Hopital Trousseau | Gaudy-Graffin C.,French Institute of Health and Medical Research
Virologie | Year: 2013

Hepatitis B Virus (HBV) infection is a worldwide health problem, and mother-to-infant (or vertical) transmission is the main source of chronic infection in Asian countries. Administration of HBV vaccine to the infant at birth, with or without concurrent specific immunoglobulin, is efficient to prevent such transmission (efficacy>90%). In France, testing Ag HBs is mandatory during the 6th month of pregnancy in all pregnant women; the infants born to Ag HBs positive women should receive the first injection of vaccine and one injection of specific immunoglobulins at birth. Vaccination should thereafter be completed according to a three injections protocol (at one and six months), or a four injections protocol in case of prematurity. Failure of immunoprophylaxis can be observed when the viral load is very high in the mother during pregnancy (>200 000 IU/ml). In such women, antiviral therapy with analogues (lamivudine, telbivudine, or tenofovir) during the third trimester of pregnancy and one-month post-partum, in association with accurate immunoprophylaxis, may prevent vertical transmission. In rare cases, failure of immunoprophylaxis could be associated with a mutant virus. Source

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