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Villejuif, France

Husson B.,Publique Hopitaux de Paris
Journal of Neuroimaging | Year: 2012

Background and Purpose: Neuroborreliosis is a rare cause of stroke in children. We aim here to demonstrate the diagnostic value of gadolinium-enhanced magnetic resonance imaging (MRI) for demonstrating vessel wall abnormality in a child with brainstem stroke. Results: We report here the case of an 8-year-old boy with cerebral vasculitis and stroke due to Lyme neuroborreliosis. Imaging studies revealed the presence of ischemic lesions in the pons and cerebellum, with focal stenosis of the basilar artery on magnetic resonance angiography and focal gadolinium enhancement of the basilar artery wall. Nine months after treatment, clinical outcome was favorable, with no enhancement of the basilar artery. Conclusions: Gadolinium-enhanced MRI provided additional information facilitating the diagnosis of vasculitis in a child with Lyme neuroborreliosis and stroke. The location of vessel wall enhancement was correlated with the topography of the acute infarct, and the lack of vessel lumen obstruction supported the diagnosis of vasculitis rather than any other cause. © 2010 by the American Society of Neuroimaging.

Saadoun D.,Publique Hopitaux de Paris | Pineton De Chambrun M.,University Pierre and Marie Curie | Hermine O.,Assistance Publique Hopitaux de Paris | Choquet S.,University Pierre and Marie Curie | And 3 more authors.
Arthritis Care and Research | Year: 2013

Objective Treatment of refractory mixed cryoglobulinemia (MC) with severe organ involvement remains challenging. Fludarabine, cyclophosphamide, and rituximab (FCR) treatment is highly effective for patients with chronic lymphocytic leukemia and marginal-zone lymphoma. We first report the safety and efficacy of FCR treatment in severe and refractory MC vasculitis associated with lymphoma. Methods We report the safety and efficacy of fludarabine (40 mg/m2 orally on days 2-4), cyclophosphamide (250 mg/m2 orally on days 2-4), and rituximab (375 mg/m2 on day 1), every 4 weeks, for 3 to 6 cycles in 7 consecutive patients with severe and refractory MC. Results Clinical features of MC included purpura (n = 7), polyneuropathy (n = 6), and kidney (n = 4) and cardiac involvement (n = 2). Previous treatment included rituximab (n = 5), corticosteroids (n = 5), antiviral therapy (n = 5), cyclophosphamide (n = 3), and plasmapheresis (n = 2). All patients achieved clinical response, with 3 patients (42.9%) achieving a complete remission and 4 patients (57.1%) a partial remission. Cryoglobulin decreased from 0.94 to 0.41 gm/liter (P = 0.015). After a followup of 27 months, 2 patients experienced a relapse of MC. Five patients (71.4%) experienced side effects, including cytopenia (n = 5), pneumopathy (n = 2), and serum sickness (n = 1). Conclusion The FCR regimen represents an effective treatment in severe and refractory MC. Copyright © 2013 by the American College of Rheumatology.

Blanco C.,U.S. National Institute on Drug Abuse | Hasin D.S.,Columbia University Medical Center | Wall M.M.,Columbia University Medical Center | Florez-Salamanca L.,Publique Hopitaux de Paris | And 6 more authors.
JAMA Psychiatry | Year: 2016

IMPORTANCE With rising rates of marijuana use in the general population and an increasing number of states legalizing recreational marijuana use and authorizing medical marijuana programs, there are renewed clinical and policy concerns regarding the mental health effects of cannabis use. OBJECTIVE To examine prospective associations between cannabis use and risk of mental health and substance use disorders in the general adult population. DESIGN, SETTING, AND PARTICIPANTS A nationally representative sample of US adults aged 18 years or older was interviewed 3 years apart in the National Epidemiologic Survey on Alcohol and Related Conditions (wave 1, 2001-2002; wave 2, 2004-2005). The primary analyses were limited to 34 653 respondents who were interviewed in both waves. Data analysis was conducted from March 15 to November 30, 2015. MAIN OUTCOMES AND MEASURES We used multiple regression and propensity score matching to estimate the strength of independent associations between cannabis use at wave 1 and incident and prevalent psychiatric disorders at wave 2. Psychiatric disorders were measured with a structured interview (Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV). In both analyses, the same set of wave 1 confounders was used, including sociodemographic characteristics, family history of substance use disorder, disturbed family environment, childhood parental loss, low self-esteem, social deviance, education, recent trauma, past and present psychiatric disorders, and respondent's history of divorce. RESULTS In the multiple regression analysis of 34 653 respondents (14 564 male [47.9% weighted]; mean [SD] age, 45.1 [17.3] years), cannabis use in wave 1 (2001-2002), which was reported by 1279 respondents, was significantly associated with substance use disorders in wave 2 (2004-2005) (any substance use disorder: odds ratio [OR], 6.2; 95%CI, 4.1-9.4; any alcohol use disorder: OR, 2.7; 95%CI, 1.9-3.8; any cannabis use disorder: OR, 9.5; 95%CI, 6.4-14.1; any other drug use disorder: OR, 2.6; 95%CI, 1.6-4.4; and nicotine dependence: OR, 1.7; 95%CI, 1.2-2.4), but not any mood disorder (OR, 1.1; 95%CI, 0.8-1.4) or anxiety disorder (OR, 0.9; 95%CI, 0.7-1.1). The same general pattern of results was observed in the multiple regression analyses of wave 2 prevalent psychiatric disorders and in the propensity score-matched analysis of incident and prevalent psychiatric disorders. CONCLUSIONS AND RELEVANCE Within the general population, cannabis use is associated with an increased risk for several substance use disorders. Physicians and policy makers should take these associations of cannabis use under careful consideration. Copyright 2016 American Medical Association. All rights reserved.

Guet-Revil let H.,University of Paris Descartes | Guet-Revil let H.,Institute National Of La Sante Et Of La Recherche U1151 Eq11 | Coignard-Biehler H.,Publique Hopitaux de Paris | Jais J.-P.,University of Paris Descartes | And 16 more authors.
Emerging Infectious Diseases | Year: 2014

Hidradenitis suppurativa (HS) is a frequent skin disease characterized by recurrent nodules or abscesses and chronic suppurating lesions. In the absence of clear pathophysiology, HS is considered to be an inflammatory disease and has no satisfactory medical treatment. Recently, prolonged antimicrobial treatments were shown to improve or resolve HS lesions. We prospectively studied the microbiology of 102 HS lesions sampled from 82 patients by using prolonged bacterial cultures and bacterial metagenomics on 6 samples. Staphylococcus lugdunensis was cultured as a unique or predominant isolate from 58% of HS nodules and abscesses, and a polymicrobial anaerobic microflora comprising strict anaerobes, milleri group streptococci, and actinomycetes was found in 24% of abscesses or nodules and in 87% of chronic suppurating lesions. These data show that bacteria known to cause soft tissue and skin infections are associated with HS lesions. Whether these pathogens are the cause of the lesions or are secondary infectious agents, these findings support targeted antimicrobial treatment of HS. © 2014, Centers for Disease Control and Prevention (CDC). All rights reserved.

Buffet A.,Publique Hopitaux de Paris | Smati S.,Nantes University Hospital Center | Mansuy L.,Nantes University Hospital Center | Lebras M.,Nancy University Hospital Center | And 6 more authors.
Journal of Clinical Endocrinology and Metabolism | Year: 2014

Context: HIF2A germline mutations were known to cause congenital polycythemia. Recently, HIF2A somatic mutations were found in several patients with polycythemia and paraganglioma, pheochromocytoma, or somatostatinoma, suggesting the occurrence of a de novo postzygotic HIF2A mutation that has not been demonstrated clearly. Patients: Patient 1 is a woman suffering from polycythemia diagnosed at the age of 16 years. She was operated on for a pheochromocytoma at 45 years and for two abdominal paragangliomas at 59 years. Shewasalso diagnosed with somatostatinoma. Patient 2 is ayoungboywhosufferedfrom polycythemia since infancy. He underwent surgery for a nonfunctional adrenal paraganglioma at the age of 9 years. Methods: We sequenced by Sanger and next-generation sequencing the HIF2A gene in DNA extracted from tumors, leukocytes, and buccal cells. Results: In patient 1, we identified a somatic HIF2A mutation (c.1586T>C; p.Leu529Pro) in DNA extracted from both paragangliomas. The mutation was detected as a somatic mosaic in DNA extracted from somatostatinoma and was absent from germline DNA. In patient 2,wefound an HIF2A heterozygous mutation (c.1625T>C; p.Leu542Pro) in the paraganglioma, but the mutation was also present as a mosaic in leukocyteDNAand inDNAextracted from buccal cells (3.3 and 8.96% of sequencing reads, respectively). Both mutations disrupt the hydroxylation domain of the HIF2&alfa; protein. Conclusions: Our study shows that HIF2A-related tumors are caused by postzygotic mutations occurring in early developmental stages. Potential germline mosaicism should be considered during the familial genetic counseling when an individual has been diagnosed with HIF2A-related polycythemia-paraganglioma syndrome. Copyright © 2014 by the Endocrine Society.

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