Hopital University

Bern, Switzerland

Hopital University

Bern, Switzerland
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Bohlender J.,hopital University | Nussberger J.,University of Lausanne | Menard J.,University of Paris Descartes
Annales de Cardiologie et d'Angeiologie | Year: 2017

Aim: Carotid artery stenosis increases with age and may cause brain ischemia if arterial hypotension occurs. We performed a monocentric pilot study to investigate its prevalence in the very elderly and to assess its potential influence on blood pressure (BP) goals during antihypertensive treatment. Methods: All patients. ≥. 90 years of a primary care medical ward were prospectively included over 15 months. Ultrasound exams of the precerebral arteries were offered to all elderly patients for routine evaluation of their cardiovascular risk. Frequencies of stenosed common, internal and external carotid arteries (CCA, ICA, ECA) were analyzed together with clinical BP and antihypertensive therapy. Patients with circulatory shock and readmissions were excluded. Results: Sixty-three patients aged 92. ±. 3 years (78% female) hospitalized for a median of 11 days were included. On admission, 76% were on antihypertensive drugs vs. 86% at discharge. Mean admission BP was 149/77 vs. 129/72. mmHg at discharge; systolic BP. <. 140. mmHg 36% vs 64% (P <. 0.05). Mean intima-media thickness (ACC, right/left) was 8.7/9.4. mm. Prevalence of plaque or stenosis. <. 60% was: CCA 19.0%, ICA 19.0%, ECA 31.7%, bulb 74.6%; of stenosis. ≥. 60%: CCA 0%, ICA 7.9%, ECA 19.0%, ICA bilateral 1.6% (unilateral occlusion 3.1%, no bilateral). Coincidence of systolic BP. <. 120. mmHg and ACI stenosis. ≥. 60% had a probability of 1-2%. Conclusion: Concerning the risk of brain ischemia due to carotid artery stenosis, a BP goal. <. 140. mmHg should be safe for most nonagenarians. If individual BP goals are lower, searching for significant stenosis by ultrasound may be useful. © 2017 Elsevier Masson SAS.

Mazieres G.,Hopital University | Souteyrand G.,Hopital University | Eschalier R.,Hopital University | Guerin R.,Nouvel Hopital University | Motreff P.,Nouvel Hopital University
Critical Care Medicine | Year: 2012

AIM: Describe the interaction between the use of mild induced hypothermia and acute diffuse coronary spasm. METHODS: We report the case of a 52-yr-old Caucasian woman resuscitated after initial cardiac arrest, with normal postresuscitation electrocardiogram, sufficient hemodynamic conditions, and decreased level of consciousness, who received mild induced hypothermia to reduce brain damage as suggested by cardiopulmonary resuscitation guidelines. RESULTS: After the beginning of mild therapeutic hypothermia, the patient experienced malignant diffuse coronary artery spasm, so-called Prinzmetal's angina, leading to myocardial ischemia and ventricular tachycardia, which was only resolved by intracoronary vasodilator injection. CONCLUSION: Mild induced hypothermia was apparently the trigger of a severe and diffuse coronary artery spasm. Copyright © 2012 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins.

PubMed | hopital University and Service de chirurgie thoracique
Type: | Journal: Revue des maladies respiratoires | Year: 2016

Lung resection for cancer is the cause of significant postoperative pain. The aim of this study was to determine whether pulmonary rehabilitation could induce a resurgence of pain.In 2014and 2015, pulmonary rehabilitation was offered to all patients referred to our institution after lung resection for cancer. Patients were assessed at entry and departure for nociceptive pain, neuropathic pain (DN4), for quality of life using questionnaire EORTC QlQ-C30and for anxiety and depression (HAD questionnaire). Pain was studied before and after the sessions of cycloergometer, gym and massages.During the period, 99patients were admitted to our institution following lung resection for cancer. Medians changed during pulmonary rehabilitation from 3to 1for nociceptive pain (p<0.001), 3to 3for DN4 (NS), 50to 67for the quality of life score (p<0.001), 7to 5for the anxiety (p<0.001) and 5to 3for depression (p<0.0001). Pain remained stable during the sessions of cycloergometer and gym, and decreased during massage. Patients undergoing thoracotomy or video-assisted thoracic surgery evolved identically.Postoperative pulmonary rehabilitation after lung resection for cancer was not harmful. It was associated with a decrease in nociceptive pain and was without effect on neuropathic pain.

PubMed | CIDDIST Tarnier, Center hospitalier Le Mans, CIDDIST de Nantes, DGAS DPMISP and 10 more.
Type: Journal Article | Journal: Annales de dermatologie et de venereologie | Year: 2016

Since 2007 in France, human papilloma virus (HPV) vaccination has been licensed for use as a vaccine against HPV 6, 11, 16 and 18. The impact on the epidemiology of external genital warts (EGWs) in a large population remains unclear.To determine epidemiologic and clinical features of patients presenting EGWs in France in the era of HPV vaccination.In this prospective, observational study, we analyzed clinical features and treatments between January 1st, 2012 and March 31, 2012 for patients consulting for EGWs at 15 STI clinics throughout France.A total of 372 men and 111 women were included; mean age 31.2 years. The women were younger than the men (31.7 and 28.9 years respectively P<0.05). Among the patients, 416 (85.7%) were heterosexual, 13 bisexual and 54 (11.2%) homosexual, including one female. Males reported more sexual partners in the last 12 months (more than 3 partners in 32.6% versus 11.9%, P<0.01). Among the men, 230 had involvement of the penis alone and 46 had involvement of the anus alone. Seventy-six patients had EGWs of the anus, and of these 26 were MSM. In females, 76 had an infection of the vulva alone and 22 co-infection of the vulva and anus. MSM and females were at higher risk than heterosexual males for anal involvement (P<0.0001 and P=0.004, respectively). Three women had been vaccinated: two with GardasilWith the advent of HPV vaccination, a global strategy for the prevention and treatment of EGW should be implemented.

Cottin V.,Hospices Civils de Lyon | Nunes H.,Hopital Avicenne and Assistance Publique Hopitaux de Paris | Mouthon L.,University of Paris Descartes | Gamondes D.,Hopital Louis Pradel | And 6 more authors.
Arthritis and Rheumatism | Year: 2011

Objective Connective tissue diseases (CTDs) are associated with several interstitial lung diseases. The aim of this study was to describe the recently individualized syndrome of combined pulmonary fibrosis and emphysema (CPFE) in a population of patients with CTD. Methods In this multicenter study, we retrospectively investigated data from patients with CTD who also have CPFE. The demographic characteristics of the patients, the results of pulmonary function testing, high-resolution computed tomography, lung biopsy, and treatment, and the outcomes of the patients were analyzed. Results Data from 34 patients with CTD who were followed up for a mean ± SD duration of 8.3 ± 7.0 years were analyzed. Eighteen of the patients had rheumatoid arthritis (RA), 10 had systemic sclerosis (SSc), 4 had mixed or overlap CTD, and 2 had other CTDs. The mean ± SD age of the patients was 57 ± 11 years, 23 were men, and 30 were current or former smokers. High-resolution computed tomography revealed emphysema of the upper lung zones and pulmonary fibrosis of the lower zones in all patients, and all patients exhibited dyspnea during exercise. Moderately impaired pulmonary function test results and markedly reduced carbon monoxide transfer capacity were observed. Five patients with SSc exhibited pulmonary hypertension. Four patients died during follow up. Patients with CTD and CPFE were significantly younger than an historical control group of patients with idiopathic CPFE and more frequently were female. In addition, patients with CTD and CPFE had higher lung volumes, lower diffusion capacity, higher pulmonary pressures, and more frequently were male than those with CTD and lung fibrosis without emphysema. Conclusion CPFE warrants inclusion as a novel, distinct pulmonary manifestation within the spectrum of CTD-associated lung diseases in smokers or former smokers, especially in patients with RA or SSc. © 2011 by the American College of Rheumatology.

PubMed | Service Route, Center hospitalier, hopital University, University dAuvergne and 2 more.
Type: Journal Article | Journal: Revue des maladies respiratoires | Year: 2016

With an aging population and an increase in the prevalence of asthma, this disease is becoming more common in the elderly. Nevertheless, the management of severe asthma can be complex, due to an increased risk of uncontrolled disease in patients over 65years old and partly to the inherent characteristics of old age: comorbidities, underestimation of the role of allergies, poor adherence, difficulties with inhalation devices, etc.We report two cases of women over 75with severe persistent allergic asthma not controlled by high doses of inhaled corticosteroids and long-acting beta-2-agonists in whom treatment with omalizumab was initiated. Following treatment with omalizumab a decrease in the number and severity of exacerbations, improved asthma control and dose reduction or discontinuation of systemic corticosteroids were observed. The tolerance of omalizumab was good in both cases.Omalizumab is to be considered an effective and well-tolerated therapeutic option for elderly patients with inadequately controlled severe allergic asthma.

Misery L.,Hopital University | Sibaud V.,Laboratoires dermatologiques Avene | Merial-Kieny C.,Laboratoires dermatologiques Avene | Taieb C.,Pierre Fabre
International Journal of Dermatology | Year: 2011

Introduction Sensitive skin is a complex dermatological condition, defined by abnormal sensory symptoms. The aim of this epidemiological survey was to assess the prevalence of sensitive skin and collect data on sensitive skin in the US population. Methods A phone survey was conducted in the USA by a poll institute in 2007. A sample was drawn from a representative national cohort of the American population at least 18years of age through the quota method. Data on demographic characteristics, environmental and climatic factors, skin characteristics, dermatological disorders, cosmetics use, and visits to the dermatologist were collected. Results Of 994 subjects who answered (495 men and 499 women), 44.6% declared having "sensitive" or "very sensitive" skin. Women were more concerned than men (50.9% vs. 38.2%, P<0.0001). There was no significant difference related to geographic localization, age, or ethnic distribution. Subjects with sensitive skin had mainly dry (34.5%) or mixed skin (35.7%), fair phototypes, dermatological disorders, higher skin reactivity to cosmetics and various environmental factors in comparison with subjects who stated having only a "slightly" sensitive or not sensitive skin. The dermatologist had a strong influence on subjects with "sensitive" or "very sensitive" skin through the prescription of skin care products. Conclusion This study, based on a representative sample of the American population, reveals a high prevalence of sensitive skin in the USA. Sensitive skin is mainly associated with dry skin, fair phototype, reactivity to climatic and environmental factors, and cosmetics. American dermatologists seem largely involved in the care of this condition. © 2011 The International Society of Dermatology.

Neuville A.,Institut Universitaire de France | Neuville A.,French Institute of Health and Medical Research | Neuville A.,Institute Bergonie | Collin F.,Center Georges Francois Leclerc | And 16 more authors.
American Journal of Surgical Pathology | Year: 2014

We report novel molecular and pathologic features of sarcomas involving the heart. Intimal sarcoma appears as the most frequent primary cardiac sarcoma within the largest described series of 100 primary cardiac sarcomas. Immunohistochemical analysis, fluorescence in situ hybridization, real-time polymerase chain reaction, and array-comparative genomic hybridization were performed on materials from 65 women and 35 men, aged 18 to 82 years (mean 50 y), retrieved from the French Departments of Pathology, between 1977 and early 2013. Right and left heart was involved in 44 and 56 cases, respectively. There were 42 intimal sarcomas, 26 angiosarcomas, 22 undifferentiated sarcomas, 7 synovial sarcomas, 2 leiomyosarcomas, and 1 peripheral neuroectodermal tumor. All but 1 angiosarcomas originated from the right heart, whereas 83% of the intimal sarcomas and 72% of the undifferentiated sarcomas were from the left heart. MDM2 overexpression was immunohistochemically observed in all intimal sarcomas, as well as in 10 of the 22 undifferentiated sarcomas and in 5 of the 26 angiosarcomas. MDM2 amplification was only demonstrated in intimal sarcomas. Genomic analysis showed a complex profile, with recurrent 12q13-14 amplicon involving MDM2, 4q12 amplicon involving KIT and PDGFRA, 7p12 gain involving EGFR, and 9p21 deletion targeting CDKN2A. Immunohistochemical detection of MDM2 overexpression can easily detect intimal sarcoma, provided that molecular aberration is proved. As resections are limited to the left atrium, this histologic subtype could benefit from therapies targeting PDGFRA or MDM2. © 2014 by Lippincott Williams & Wilkins.

In current psychoanalytical perspectives, one of the central axes of development at adolescence is envisaged as a subjective process of appropriation which can only be conceived as a second period of preliminary deconstruction. Deconstruction is often experienced by adults, and secondarily by the adolescents themselves as violent, although this violence, which is deeply structuring, constitutes a condition of psychic growth and authentic personal development above all else. In fact, it responds to the violence which is inherent in the primary narcissistic contract. The distinction between deconstruction and destructiveness constitutes a condition of appreciation of the dynamics at play during adolescence which preserve their potential for vitality and creativity as well as they can. From this point of view, on the level of psychoanalytical theory, it is important to dispel the confusion introduced by Freud beginning in 1920 between the processes of bonding-debonding, an inherent part of development and of thought, from the range of destructiveness. The movements of deconstruction at adolescence concern the body, the connections to parents and the modalities of relationships to social structures. They can be hindered by the limitations linked to capacities specific to adolescence as well as to different forms of taboos. They can also deteriorate in the direction of destructiveness. In this respect, the differentiation between movements of deconstruction which attempt to transform objectal links and those which aim to abolish them is important on the clinical and therapeutic levels. This difference is illustrated by the comparison between two films dealing with adolescent revolt, Rebel without a Cause and Into the Wild.

Amoureux L.,Hopital University | Bador J.,Hopital University | Fardeheb S.,Hopital University | Mabille C.,Hopital University | And 6 more authors.
Applied and Environmental Microbiology | Year: 2013

Achromobacter xylosoxidans is an aerobic nonfermentative Gram-negative rod considered an important emerging pathogen among cystic fibrosis (CF) patients worldwide and among immunocompromised patients. This increased prevalence remains unexplained, and to date no environmental reservoir has been identified. The aim of this study was to identify potential reservoirs of A. xylosoxidans in hospital, domestic, and outdoor environments and to compare the isolates with clinical ones. From 2011 to 2012, 339 samples were collected in Dijon's university hospital, in healthy volunteers' homes in the Dijon area, and in the outdoor environment in Burgundy (soil, water, mud, and plants). We designed a protocol to detect A. xylosoxidans in environmental samples based on a selective medium: MCXVAA (MacConkey agar supplemented with xylose, vancomycin, aztreonam, and amphotericin B). Susceptibility testing, genotypic analysis by pulsed-field gel electrophoresis, and blaOXA-114 sequencing were performed on the isolates. A total of 50 strains of A. xylosoxidans were detected in hospital (33 isolates), domestic (9 isolates), and outdoor (8 isolates) samples, mainly in hand washing sinks, showers, and water. Most of them were resistant to ciprofloxacin (49 strains). Genotypic analysis and blaOXA-114 sequencing revealed a wide diversity among the isolates, with 35 pulsotypes and 18 variants of oxacillinases. Interestingly, 10 isolates from hospital environment were clonally related to clinical isolates previously recovered from hospitalized patients, and one domestic isolate was identical to one recovered from a CF patient. These results indicate that A. xylosoxidans is commonly distributed in various environments and therefore that CF patients or immunocompromised patients are surrounded by these reservoirs. © 2013, American Society for Microbiology.

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