Hopitaux Universitaires Est Parisien

Sainte-Foy-lès-Lyon, France

Hopitaux Universitaires Est Parisien

Sainte-Foy-lès-Lyon, France
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Huguet F.,hopitaux universitaires Est parisien | Huguet F.,University Pierre and Marie Curie | Schick U.,Institute Of Cancerologie Et Dhematologie | Pointreau Y.,France Inter
Cancer/Radiotherapie | Year: 2017

The treatment of locally advanced head and neck squamous cell carcinoma is based on concomitant chemoradiotherapy. A sequential treatment combining induction chemotherapy with docetaxel, cisplatin and 5-fluorouracil (TPF), followed by (chemo)radiotherapy is frequently used as part of laryngeal preservation strategies. Apart from this particular situation, the benefit in terms of survival of induction chemotherapy has been much discussed in recent years. In five recent randomized trials, chemoradiotherapy was compared with TPF induction chemotherapy followed by chemoradiotherapy. Of these five trials, four concluded that these treatments were similar. A single trial reports a benefit for induction chemotherapy but its methodology is highly debatable. After TPF chemotherapy, chemoradiotherapy is less well tolerated. In patients with significant lymph node invasion (N2b-c-N3), induction chemotherapy reduces the occurrence of distant metastasis. The HPV status should not influence the therapeutic decision. © 2017 Société française de radiothérapie oncologique (SFRO).

Schernberg A.,hopitaux universitaires Est parisien | Hennequin C.,Service de cancerologie radiotherapie
Cancer/Radiotherapie | Year: 2017

In patients undergoing external radiation therapy, bone marrow and cortical bone structures are all often neglected as organs at risk. Still, from increased febrile neutropenia risk in patients undergoing chemoradiation for a pelvic tumour to increased risk of vertebral fracture when undergoing hypofractioned stereotactic radiotherapy of a spinal metastasis, adverse effects are frequent and sometimes serious. This literature review first defines the rules for contouring these structures, then the dose constraints currently recommended. This article focuses first on conventional irradiation or intensity modulation radiotherapy considering classical fractionation. Secondly, it focuses on stereotactic radiotherapy. The considered organs will be haematopoietic structures, and bone cortical structures. Current recommendations are summarised in a table. © 2017 Société française de radiothérapie oncologique (SFRO).

Poncelet E.,University of Lille Nord de France | Delpierre C.,University of Lille Nord de France | Kerdraon O.,Lille University Hospital Center | Lucot J.-P.,University of Lille Nord de France | And 2 more authors.
Clinical Radiology | Year: 2013

Aim To analyse the value of double contrast-enhanced (DCE) magnetic resonance imaging (MRI) in addition to conventional MRI to characterize ovarian teratomas subtypes with histological correlation. Materials and methods From January 2005 to December 2008, 38 women undergoing MRI and subsequent resection of ovarian teratomas were identified [40 mature cystic teratomas (MCT), two struma ovarii, three immature teratomas]. MRI images were analysed blindly by two radiologists according to morphological and vascular abnormalities. An experienced histopathologist reviewed all slides to determine the presence and histological composition of Rokitansky protuberances. Results Thirty-one MCT (77%) had at least one small, regular Rokitansky protuberance presenting at an acute angle with the cyst wall. Ten out of 31 MCT did not display any enhancement on contrast-enhanced MRI related to sebaceous glands, adipose lobules, keratin, and pilosebaceous adnexa at histology. Three different time-intensity curve (TIC), types 1, 2, and 3, were related to presence of smooth muscular cells and fibrous, neuroglial, or thyroid tissue, respectively, found at histology of MCT. Type 3 TIC was also present in one struma ovarii and two immature teratomas. Conclusion TIC types are related to the specific content of the solid tissue of ovarian teratomas but cannot be used to differentiate benign and malignant ovarian teratomas. © 2013 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

Beauvais C.,Hopitaux Universitaires Est Parisi | Rahal A.,Hopitaux Universitaires Paris Center | Hassani K.C.,Hopitaux Universitaires Est Parisien | Pouplin S.,University of Rouen
Education Therapeutique du Patient | Year: 2014

Background: Therapeutic Patient education (TPE) is part of the disease management of inflammatory rheumatic diseases. The detection of unmet educational needs by the rheumatologist may increase the patients' motivation for education.Objectives: (1) Assess the feasibility of a systematic procedure to detect patients educational needs in current practice. (2) Determine the type of patients' needs.Methods: In a pragmatic prospective pilot study, the rheumatologist invited outpatients with rheumatoid arthritis (RA) or spondyloarthritis (SpA) to complete a questionnaire of educational diagnosis. The questionnaire was elaborated according to the French National Health Authority guidelines. Six domains were assessed: knowledge and beliefs about disease and treatments, impact on family and social life, impact on professional life, emotional well-being and management by the health care system. For each domain, patients were asked whether they encountered difficulties or needed more information or help.Results: The questionnaire was proposed by the rheumatologist to 68 patients of the 120 outpatients during a 4 month period in hospital or private practice. 53/68 (78%) questionnaires were completed. The reasons of non-distribution were: lack of time (27), severe medical condition (20), oversight (11), literacy or cognitive barriers (6), recent contact with a TPE program (6), other reasons (10). Some patients experiencing language or cultural barriers were subsequently helped by a hospital pharmacist to fulfill the questionnaire. Seventy-four questionnaires were finally analyzed (55 RA and 19 SpA patients, mean age 57 years (24-87)) l'sixty-four percent patients expressed at least one educational need. Patients experienced difficulties or needed information or help in relation to the disease (14%experienced difficulties/55%needed information or help), treatment (respectively 10%/39%), social and family life (33%/35%), professional life (53%/44%), health care system (11%/34%), emotional status (38%/49%).There was no statistical difference between the expression of at least one educational need and age, type of arthritis, duration of disease, hospital or private care, biologic treatment. 61%patients wished to meet another health professional or other patients. The questionnaire was considered helpful by 77%patients. Only 3 patients found the questionnaire too long and none thought it was intrusive.Conclusions: Detection of patients' educational needs in current practice is feasible using a self-administrated questionnaire with good acceptability. This procedure is a first step in an educational process. For some patients having language or cultural barriers, the help of another professional is essential. Educational needs are high in patients with arthritis. They are widely underestimated in routine care and include major socio-professional and psychological issues. © EDP Sciences, SETE, 2014.

Svrcek M.,Hopitaux Universitaires Est Parisien | Svrcek M.,University Pierre and Marie Curie | Cros J.,Hopitaux Universitaires Paris Nord Val Of Seine | Cros J.,University Paris Diderot | And 6 more authors.
Histopathology | Year: 2015

Aims: The human equilibrative nucleoside transporter 1 (hENT1) expression level in pancreatic ductal adenocarcinoma (PDAC) may predict survival in gemcitabine-treated patients after resection. These results have been obtained with a murine anti-hENT1 antibody (10D7G2) that is not commercially available. Another antibody, which is rabbit-derived (SP120), appears to have no predictive value in local, advanced or metastatic PDAC. We aimed to study whether the two antibodies are equivalent. Methods and results: We compared hENT1 expression with both antibodies in resected PDAC. The results were correlated with overall survival (OS) following gemcitabine treatment. Tissues from two sets of patients (n = 147 each) were stained with SP120 by the use of different equipment, with an amplification technique being used for set 2. The rate of 'hENT1 high' cases was lower with SP120 (set 1, 7% versus 48%; set 2, 11% versus 38%). With the amplification technique, the rate of hENT1 high cases was globally similar between both antibodies. However, concordance between the antibodies was found in only 50% of cases. High hENT1 expression was predictive of OS only with 10D7G2 (hazard ratio 0.49; 95% confidence interval 0.24-0.98; P = 0.045). Conclusions: The two antibodies are not equivalent. Further prospective studies seem to be warranted before hENT1 testing for PDAC is used in daily practise. © 2014 John Wiley & Sons Ltd.

Bataille A.,Hopitaux universitaires Est Parisien | Rousset J.,Hopitaux universitaires Est Parisien | Marret E.,Hopitaux universitaires Est Parisien | Bonnet F.,Hopitaux universitaires Est Parisien | Bonnet F.,University Pierre and Marie Curie
British Journal of Anaesthesia | Year: 2014

Background Women in labour are considered at risk of gastric content aspiration partly because the stomach remains full before delivery. Ultrasonographic measurement of antral cross-sectional area (CSA) is a validated method of gastric content assessment. Our aim was to determine gastric content volume and its changes in parturients during labour under epidural analgesia using bedside ultrasonography. Methods The cut-off value corresponding to an increased gastric content was determined by ultrasound measurement of antral CSA in six pregnant women in late pregnancy before and after ingestion of 250 ml of non-clear liquid. Antral CSA was then measured twice in 60 parturients who presented in spontaneous labour: when the anaesthesiologist was called for epidural analgesia catheter placement, and at full cervical dilatation. Patient-controlled epidural analgesia was performed with a solution of ropivacaine and sufentanil. Results After liquid ingestion, antral CSA (mm 2) increased from 90 (range, 80-151) to 409 (range, 317-463). A CSA of 320 was taken as cut-off value. The feasibility rate of antral CSA determination was 96%. CSA decreased from 319 [Q1 158-Q3 469] to 203 [Q1 123-Q3 261] during labour (P=2×10-7). CSA was >320 in 50% of parturients at the beginning of labour vs 13% at full cervical dilatation (P=0.006). Conclusions Bedside ultrasonographic antral CSA measurement is feasible in pregnant women during labour and easy to perform. The observed decrease in antral CSA during labour suggests that gastric motility is preserved under epidural anaesthesia. The procedure could be used to assess individual risk of gastric content aspiration during labour. © 2014 © The Author [2014]. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com © The Author [2013].

Guechot J.,Hopitaux Universitaires Est Parisien | Trocme C.,Grenoble University Hospital Center | Renversez J.-C.,Grenoble University Hospital Center | Sturm N.,French Institute of Health and Medical Research | And 3 more authors.
Clinical Chemistry and Laboratory Medicine | Year: 2012

Background : The Enhanced Liver Fibrosis (ELF) score combining serum hyaluronan, N-terminal peptide of type III procollagen and tissue inhibitor of metalloproteinase-1, was reported as relevant in predicting liver fibrosis in chronic liver disease and proposed as an alternative to liver biopsy. Methods : We evaluated the ELF score in a cohort of chronic hepatitis C (CHC) patients included in a multicenter prospective study (ANRS HC EP 23 Fibrostar) using commercial reagents, different from those developed by the manufacturer of the Siemens ELF™ test. Results : In 512 CHC, the ELF score, using ROC curves, showed good predictive performances for severe fibrosis [AUROC0.82; 95 confidence interval (CI) 0.780.86]and for cirrhosis (AUROC0.85; 95 CI 0.810.90), but slightly lower for significant fibrosis (AUROC0.78; 95 CI 0.740.82). The Obuchowski measure (0.81) showed that the ELF score globally performed as a marker of liver fibrosis. The ELF score predicted significant fibrosis (cut-off9.0) with a sensitivity of 0.86, a specificity of 0.62, a positive predictive value (PPV) of 0.80 and a negative predictive value (NPV) of 0.70. For extensive fibrosis (cut-off9.33), sensitivity was 0.90, specificity was 0.63, PPV was 0.73 and NPV was 0.85. For cirrhosis (cut-off9.35), sensitivity was 0.83, specificity was 0.75, PPV was 0.44 and NPV was 0.95. Conclusions : This study confirms the ELF score performance as an index to predict liver fibrosis or cirrhosis in CHC. The ELF test, using validated reagents, could be added to the health authorities approved non-invasive tests in assessing fibrosis as surrogate to liver biopsy. © 2012 by Walter de Gruyter Berlin Boston.

Osman D.,Hopitaux universitaires Paris Sud | Djibre M.,Hopitaux universitaires Est Parisien | da Silva D.,Hopital Delafontaine | Goulenok C.,Hopital Prive Jacques Cartier
Annals of Intensive Care | Year: 2012

Intensivists are regularly confronted with the question of gastrointestinal bleeding. To date, the latest international recommendations regarding prevention and treatment for gastrointestinal bleeding lack a specific approach to the critically ill patients. We present recommendations for management by the intensivist of gastrointestinal bleeding in adults and children, developed with the GRADE system by an experts group of the French-Language Society of Intensive Care (Société de Réanimation de Langue Française (SRLF), with the participation of the French Language Group of Paediatric Intensive Care and Emergencies (GFRUP), the French Society of Emergency Medicine (SFMU), the French Society of Gastroenterology (SNFGE), and the French Society of Digestive Endoscopy (SFED). The recommendations cover five fields of application: management of gastrointestinal bleeding before endoscopic diagnosis, treatment of upper gastrointestinal bleeding unrelated to portal hypertension, treatment of upper gastrointestinal bleeding related to portal hypertension, management of presumed lower gastrointestinal bleeding, and prevention of upper gastrointestinal bleeding in intensive care. © 2012 Osman et al.

Diallo S.,Hopitaux Universitaires Est Parisien | Cour F.,Hopital Foch | Josephson A.,Hopitaux Universitaires Est Parisien | Vidart A.,Hopital Foch | And 4 more authors.
Urology | Year: 2012

To evaluate the usefulness and applicability of the Consolidated Standards of Reporting Trials (CONSORT) for journal articles reporting randomized, controlled trials evaluating single-incision slings in the treatment of female stress urinary incontinence. Original articles reporting randomized, controlled trials assessing single-incision slings in the treatment of female stress urinary incontinence were searched for in the PubMed and Embase databases in 2011. Reporting quality was studied by 2 hospital pharmacists and 2 urologic surgeons. Primary outcome was the score out of 20 in the abstract CONSORT checklist. Secondary outcomes were the scores in the standard CONSORT checklist and the extension CONSORT additional items for trials assessing nonpharmacologic treatments. Among 135 articles retrieved, 8 met the inclusion criteria and were assessed. Abstract scores ranged from 4.7-14.1. Standard scores were >10.0 out of 20 for most articles; the extension scores did not exceed 5.0 out of 10. Four reported trials were not identified as randomized in the title. The interventions were incompletely reported. Four articles reported whether blinding was achieved but lack of blinding was never discussed as a potential source of bias. Few articles reported the operators and centers characteristics and their impact on statistical analysis. The combination of the 3 checklists was considered a useful guideline to enhance and assess the reporting quality of a surgical trial. Our results support the further use of CONSORT criteria as a basic standardized tool in all stages of clinical evaluation for any prosthetic device in female pelvic surgery. © 2012 Elsevier Inc. All Rights Reserved.

Perraudin C.,French Institute of Health and Medical Research | Fleury B.,Hopitaux Universitaires Est Parisien | Pelletier-Fleury N.,French Institute of Health and Medical Research
Journal of Sleep Research | Year: 2015

Despite its high prevalence and major public health ramifications, obstructive sleep apnea syndrome (OSAS) remains underdiagnosed. The aim of this study was to determine whether the involvement of a community pharmacist (CP) in the care pathway of a patient at risk of OSAS, through the implementation of a community pharmacist (CP) intervention, was effective, i.e. increased the use of diagnostic tests in this population. We compared a cohort of patients included in a research protocol (exposed to a CP intervention) with patients having the same characteristics taken from a general population database who did not receive the intervention (unexposed group). The aim of the CP intervention was to educate patients about the risk of untreated OSAS, encouraging them to consult their general practitioner, and urging the doctor to continue investigations. We included 782 patients at risk of OSAS, i.e. taking one or more anti-hypertensive drugs, being overweight (body mass index >25) and snoring almost every night (88 in the exposed group and 694 in the unexposed group). After a 6-month follow-up, the number of patients who underwent an OSAS diagnostic test was significantly higher in the exposed group compared to the unexposed group (22.7 versus 11.4%, P = 0.003). Being exposed to the pharmacist intervention was associated with a higher chance of undergoing a diagnostic test for OSAS, adjusted odds ratio: 2.24 (1.25-4.01). In conclusion, these findings provide arguments for the implementation of a CP OSAS screening intervention in CP routine practice. © 2014 European Sleep Research Society.

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