Hopital Trousseau

Paris, France

Hopital Trousseau

Paris, France
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Carbonne B.,Center Hospitalier Princesse Grace | Pons K.,Hopital Trousseau | Maisonneuve E.,Hopital Trousseau
Best Practice and Research: Clinical Obstetrics and Gynaecology | Year: 2016

Second-line methods of foetal monitoring have been developed in an attempt to reduce unnecessary interventions due to continuous cardiotocography (CTG), and to better identify foetuses that are at risk of intrapartum asphyxia. Very few studies directly compared CTG with foetal scalp blood (FBS) and CTG only. Only one randomised controlled trial (RCT) was published in the 1970s and had limited power to assess neonatal outcome. Direct and indirect comparisons conclude that FBS could reduce the number of caesarean deliveries associated with the use of continuous CTG. The main drawbacks of FBS are its invasive and discontinuous nature and the need for a sufficient volume of foetal blood for analysis, especially for pH measurement, resulting in failure rates reaching 10%. FBS for lactate measurement became popular with the design of test-strip devices, requiring <0.5 mL of foetal blood. RCTs showed similar outcomes with the use of FBS for lactates compared with pH in terms of obstetrical interventions and neonatal outcomes. In conclusion, there is some evidence that FBS reduces the need for operative deliveries. However, the evidence is limited with regard to actual standards, and large RCTs, directly comparing CTG only with CTG with FBS, are still needed. © 2015 Elsevier Ltd. All rights reserved.

Collin P.,Saint Gregoire Private Hospital Center | Treseder T.,Royal Melbourne Hospital | Ladermann A.,University of Geneva | Ladermann A.,La Tour Hospital | And 4 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.

Louis E.,University of Liège | Mary J.-Y.,University Paris Diderot | Verniermassouille G.,University of Lille Nord de France | Grimaud J.-C.,Aix - Marseille University | And 15 more authors.
Gastroenterology | Year: 2012

It is important to determine whether infliximab therapy can be safely interrupted in patients with Crohn's disease who have undergone a period of prolonged remission. We assessed the risk of relapse after infliximab therapy was discontinued in patients on combined maintenance therapy with antimetabolites and identified factors associated with relapse. We performed a prospective study of 115 patients with Crohn's disease who were treated for at least 1 year with scheduled infliximab and an antimetabolite and had been in corticosteroid-free remission for at least 6 months. Infliximab was stopped, and patients were followed up for at least 1 year. We associated demographic, clinical, and biologic factors with time to relapse using a Cox model. After a median follow-up period of 28 months, 52 of the 115 patients experienced a relapse; the 1-year relapse rate was 43.9% ± 5.0%. Based on multivariable analysis, risk factors for relapse included male sex, the absence of surgical resection, leukocyte counts >6.0 × 10 9/L, and levels of hemoglobin ≤145 g/L, C-reactive protein <5.0 mg/L, and fecal calprotectin <300 μg/g. Patients with no more than 2 of these risk factors (approximately 29% of the study population) had a 15% risk of relapse within 1 year. Re-treatment with infliximab was effective and well tolerated in 88% of patients who experienced a relapse. Approximately 50% of patients with Crohn's disease who were treated for at least 1 year with infliximab and an antimetabolite agent experienced a relapse within 1 year after discontinuation of infliximab. However, patients with a low risk of relapse can be identified using a combination of clinical and biologic markers. © 2012 AGA Institute.

Young A.A.,Sydney Shoulder Specialists | Walch G.,Center Orthopedique Santy | Pape G.,University of Heidelberg | Gohlke F.,Rhoen Klinikum | Favard L.,Hopital Trousseau
Journal of Bone and Joint Surgery - Series A | Year: 2012

Background: Secondary rotator cuff dysfunction is a recognized complication following shoulder arthroplasty. We hypothesized that the rate of secondary rotator cuff dysfunction would increase with follow-up and result in less satisfactory clinical and radiographic outcomes. Our aim was to investigate the rate of secondary rotator cuff dysfunction following shoulder arthroplasty for primary osteoarthritis and identify factors associated with the dysfunction. Methods: Between 1991 and 2003, in ten European centers, 704 total shoulder arthroplasties were performed for primary glenohumeral osteoarthritis. Complete radiographic and clinical follow-up of more than five years was available for 518 shoulders. The diagnosis of secondary rotator cuff dysfunction was made when moderate or severe superior subluxation of the prosthetic humeral head was present on radiographs. Multivariate logistic regression identified factors associated with the development of rotator cuff dysfunction. Kaplan-Meier survivorship analysis was performed, with the end point being secondary rotator cuff failure. Clinical outcome was assessed with use of the Constant score, a subjective assessment of the shoulder, and an evaluation of shoulder motion. Results: At an average of 103.6 months (range, sixty to 219 months) after shoulder arthroplasty, the rate of secondary rotator cuff dysfunction was 16.8%. Survivorship free of secondary cuff dysfunction was 100% at five years, 84% at ten years, and 45% at fifteen years. Duration of follow-up (p < 0.0001), implantation of the glenoid implant with superior tilt (p < 0.001), and fatty infiltration of the infraspinatus muscle (p < 0.05) were risk factors for the development of secondary cuff dysfunction. Patients with secondary rotator cuff dysfunction had significantly worse clinical outcomes (Constant score, subjective assessment, and range of motion; p < 0.0001) and radiographic results (radiolucent line score, radiographic loosening, glenoid component migration; p < 0.0001). Conclusions: In this study, rates of secondary rotator cuff dysfunction with moderate or severe superior subluxation of the prosthetic humeral head increased with the duration of follow-up and significantly influenced the clinical and radiographic outcome of total shoulder arthroplasty performed for primary glenohumeral osteoarthritis. Preoperative fatty infiltration of the infraspinatus muscle and implantation of the glenoid component with superior tilt were prognostic factors. Level of Evidence: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence. Copyright © 2012 by The Journal of Bone and Joint Surgery, Incorporated.

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.

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.

Millot F.,French Institute of Health and Medical Research | Claviez A.,University of Kiel | Leverger G.,Hopital Trousseau | Corbaciglu S.,University of Ulm | And 2 more authors.
Pediatric Blood and Cancer | Year: 2014

Imatinib can be safely discontinued in adults with chronic myeloid leukemia (CML) where there is a prolonged complete molecular response (CMR). No data are available in the pediatric population. Six children with CML discontinued imatinib by themselves. Only three of them were in CMR but for <2 years. A significant increase in transcript level was observed in all six patients after cessation of imatinib and five patients lost the major molecular response (MMR). Four patients regained the MMR within 3 months. Cessation of imatinib in children is not recommended outside a trial, particularly in patients without prolonged CMR. © 2013 Wiley Periodicals, Inc.

Moubarak H.,HOpital Trousseau | Brilhault J.,HOpital Trousseau
Orthopaedics and Traumatology: Surgery and Research | Year: 2014

Patient-specific cutting guides (PSCG) are an extension of preoperative planning for total knee arthroplasty (TKA). We wanted to evaluate their contribution to postoperative lower limb alignment. This study involved primary TKA cases being performed with PSCG between 10/05/2010 and 05/03/2013 and then followed prospectively. The analysis involved the PSCG usage and postoperative measurement of the patient's HKA, medial distal femoral joint angle (MDFA) and medial proximal tibia joint angle (MPTA). Of the 104 eligible cases, 68 were included; 11 of these cases were not performed completely with the PSCG as initially planned. Thus we compared these 11 cases with the 57 where PSCG were used. The preoperative HKA in the included cases was 175.8°. ±. 7.8; the postoperative angles on average were 179.2°. ±. 2.9 for the HKA, 89.9°. ±. 1.6 for the MDFA and 89.0°. ±. 2.3 for the MPTA. The average postoperative deviation from the target values was 2.22°. ±. 2.14 for the HKA angle, 1.07°. ±. 1.15 for the MDFA and 1.66°. ±. 1.90 for the MPTA. There were no significant differences between the two groups in any of the measurements. The lower limb alignment goal was achieved in 50 cases (73%), with 41 of these achieved with PSCG (82%). Of the 18 cases where the target was not achieved, PSCG were used 16 times (88%). In this study cohort, lower limb alignment was not significantly closer to an HKA of 180° or achieved more often with the use of PSCG versus standard instrumentation. Since the results of the two groups can be superimposed, we found no evidence that use of PSCG improves postoperative lower limb alignment. Level of evidence: IV. Study type: Cohort. © 2014 Elsevier Masson SAS.

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.

Rapid sequence induction includes preoxygenation, rapid injection of predetermined doses of a hypnotic agent and succinylcholine, cricoid pressure, and tracheal intubation before any mechanical ventilation. In adults and children, it is the gold standard for anesthetic induction of patients with a full stomach. However, several changes have been considered for this technique, and different "modified" rapid sequence inductions have been suggested. In the context of pediatric rapid sequence induction, this review will discuss the importance and optimization of preoxygenation, the interest of cricoid pressure, the choice of anesthetic agents and their technique of administration, the risks and potential benefits of beginning mechanical ventilation before tracheal intubation. © 2013 Published by Elsevier Masson SAS.

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