Hopitaux Universitaires Paris Est

Sainte-Foy-lès-Lyon, France

Hopitaux Universitaires Paris Est

Sainte-Foy-lès-Lyon, France
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Sonigo C.,University Paris - Sud | Dray G.,Interne | Chabbert-Buffet N.,Hopitaux Universitaires Paris Est
Journal de Gynecologie Obstetrique et Biologie de la Reproduction | Year: 2012

Menopause is a total follicular depletion leading to menstruation cessation. Climacterics symptoms are linked to estrogen decrease. Hormonal replacement therapy (HRT) was developed in 1940s in order to control these signs and to improve women's quality of life. In United States, conjugated equine estrogen, first estrogens developed, are the most common. In France, customs are different with the transdermic estrogen use. The progesterone use is also different between both countries: in USA, medroxyprogesteron acetate is the most common, whereas this treatment does not exist anymore in France. Indeed, lot of different progestagen is available in France: progesterone, dydrogesterone others progestin. Publication of randomized trials, as the Women's Health Initiative, had shown a long-term unfavorable HRT risk/benefit ratio, as prescribed in USA. These studies have led to prescription modification. Due to these results, recent trials, closers to French customs, allowed a new evaluation of HRT risk/benefit ratio. Today, clinical practices are based on these results and new trials are necessary. © 2012 Elsevier Masson SAS. All rights reserved.


Popa T.,Groupe Hospitalier Pitie Salpetriere | Popa T.,University Pierre and Marie Curie | Popa T.,French Institute of Health and Medical Research | Popa T.,French National Center for Scientific Research | And 29 more authors.
Brain Stimulation | Year: 2013

Background: Cerebello-thalamo-cortical (CTC) pathways dysfunction is involved in pathological oscillations causing tremor in essential tremor (ET). Low-frequency (1 Hz) repetitive transcranial magnetic stimulation (rTMS) of the cerebellum can effectively modulate the cerebellar output. Objective: As one session of rTMS can induce a brief improvement, we hypothesized that repeated sessions might have a cumulative and potentially long-term therapeutic effect on ET. We assessed, in an open label trial, the efficacy of one-week rTMS treatment on tremor and on the motor-CTC dysfunction in ET patients. Methods: Resting-state fMRI functional connectivity was used as an indicator of CTC network integrity in 11 ET patients and 11 healthy subjects. Resting-state fMRI connectivity was quantified at baseline in patients and control subjects between the cerebellum and the motor network, and between the cerebellum and the default brain network (DBN) taken as control. The fMRI study was repeated in patients after 5 days of bilateral 1 Hz rTMS applied to the posterior cerebellar cortex. Tremor was assessed clinically (Fahn-Tolosa-Marin scale) and quantified using electromyographic and accelerometric recordings at baseline (day 1, before the cerebellar stimulation) and after the end of the cerebellar stimulation period at day 5, day 12 and day 29. Results: Repeated rTMS over the cerebellum significantly improved total and specific (tremor, drawing, functional disability) scores, and reduced tremor amplitude (P < 0.006). It also re-established the defective information processing in the CTC network (P(Δ|y) > 0.909), but not in the DBN. The effects persisted for 3 weeks after the last session. Conclusion: Cerebellar stimulation could be an effective treatment option for patients with severe essential tremor. © 2013 Elsevier Inc. All rights reserved.


Thomassin-Naggara I.,Tenon Medical | Darai E.,Hopitaux Universitaires Paris Est | Bazot M.,Tenon Medical
Diagnostic and Interventional Imaging | Year: 2012

The diagnosis of pelvic infection is most often made clinically, based on a combination of pelvic pain and fever, and possibly a foul discharge. The patient is referred to radiology in two very different circumstances: either in the acute phase where the challenge is to differentiate a pelvic infection from appendicitis, urinary tract infection, and complications of a hemorrhagic luteal cyst; or some time after the infectious episode, which may have gone unnoticed, and the patient presents with an undetermined pelvic mass that needs to be characterized, where the challenge in that situation is not to confuse it with ovarian cancer. The signs and symptoms on the pelvic ultrasound, CT scan, and MRI suggest the correct diagnosis. © 2012 Published by Elsevier Masson SAS on behalf of the Éditions françaises de radiologie.


Da Costa J.B.,Tenon Hospital | Cornu J.-N.,Tenon Hospital | Levgraverend D.,Tenon Hospital | Cordel H.,Infectious Diseases | And 5 more authors.
Urologia Internationalis | Year: 2016

Introduction: Salmonella is a rare cause of urinary tract infections. We report here a unique case of pyonephrosis due to Salmonella Typhi ( S. Typhi) complication, a stone-related obstructive pyelonephritis. Case Report: A 47-year-old man, without any history of typhoid fever or gastrointestinal symptoms, presented with a pyonephrosis and lifethreatening bacteremia following an acute obstructive right pyelonephritis caused by S. Typhi. The patient was treated by urinary drainage (ureteral stent), antibiotics, and delayed right nephrectomy. We postulated that urolithiasis could explain asymptomatic chronic urinary carriage of S. Typhi. Conclusion: S. Typhi is one possible cause of lifethreatening urinary tract infection, especially in the context of urolithiasis. © 2015 S. Karger AG, Basel.


Arana R.,Hopitaux Universitaires Paris Est | Arana R.,University Pierre and Marie Curie | Flejou J.-F.,Hopitaux Universitaires Paris Est | Flejou J.-F.,University Pierre and Marie Curie | And 3 more authors.
Colorectal Disease | Year: 2015

Aim: The clinicopathological and virological characteristics of anal superficially invasive squamous-cell carcinoma (SISCCA) were determined. Method: Seventeen patients with a completely excised stage T1N0M0 anal squamous-cell carcinoma (SCC) were included in the study. The tumours were divided into superficially invasive and invasive. Patients with anal high-grade squamous intraepithelial dysplasia, which corresponded to anal intraepithelial neoplasia (AIN) Grades 2 or 3, were used as a control group. Clinicopathological and virological characteristics were investigated. Overall survival and cancer recurrence-free survival were also assessed. Results: Of the 17 patients, 12 (70.5%) were men. Ten (58.8%) were human immunodeficiency virus positive. Seven (41%) patients met the same diagnostic criteria as those recently proposed for anal SISCCA. According to the results obtained using the polymerase chain reaction, human papillomavirus (HPV) 16 was the most commonly detected (94%) type of HPV. Twelve (70.6%) patients with an inadequate surgical margin around the tumour received adjuvant radiotherapy, including the two (11.7%) tumours that locally recurred, one of which was an anal SISCCA. Superficially invasive anal cancers differed from the other T1N0M0 anal carcinomas according to the clinical presentation and the absence of lymph-vascular invasion (LVI). There were no differences in cancer recurrence-free and overall survival rates between the superficially invasive and invasive groups. Conclusion: Anal SISCCAs have a low index of clinical suspicion, are associated with an absence of LVI and are linked to high-risk HPV. Prospective studies are needed to define the clinical behaviour of these anal tumours and to determine their best therapeutic strategy. © 2015 The Association of Coloproctology of Great Britain and Ireland.


PubMed | hopitaux universitaires Paris Est, Reseau sein a risque and University Pierre and Marie Curie
Type: Journal Article | Journal: Annales d'endocrinologie | Year: 2014

Breast cancer prevention can be provided by using SERMs or aromatase inhibitors depending on the ovarian status, with a global risk reduction of 50 to 60%. Prophylactic annexectomy offered to reduce ovarian risk in BRCA mutation carriers also lowers breast cancer risk by 50%. Main side effects include deep vein thrombosis for SERMs, hot flushes and joint pain (although less frequently than initially suspected) with aromatase inhibitors. Other strategies based on progesterone, insulin or prolactin signaling modulation may be offered in the future. Criteria for candidate selection remain to be established.


PubMed | Hopitaux Universitaires Paris Est, Hopitaux Universitaires Paris Ouest and Groupe Hospitalier Diaconesses Croix Saint Simon
Type: Journal Article | Journal: Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland | Year: 2015

The clinicopathological and virological characteristics of anal superficially invasive squamous-cell carcinoma (SISCCA) were determined.Seventeen patients with a completely excised stage T1N0M0 anal squamous-cell carcinoma (SCC) were included in the study. The tumours were divided into superficially invasive and invasive. Patients with anal high-grade squamous intraepithelial dysplasia, which corresponded to anal intraepithelial neoplasia (AIN) Grades 2 or 3, were used as a control group. Clinicopathological and virological characteristics were investigated. Overall survival and cancer recurrence-free survival were also assessed.Of the 17 patients, 12 (70.5%) were men. Ten (58.8%) were human immunodeficiency virus positive. Seven (41%) patients met the same diagnostic criteria as those recently proposed for anal SISCCA. According to the results obtained using the polymerase chain reaction, human papillomavirus (HPV) 16 was the most commonly detected (94%) type of HPV. Twelve (70.6%) patients with an inadequate surgical margin around the tumour received adjuvant radiotherapy, including the two (11.7%) tumours that locally recurred, one of which was an anal SISCCA. Superficially invasive anal cancers differed from the other T1N0M0 anal carcinomas according to the clinical presentation and the absence of lymph-vascular invasion (LVI). There were no differences in cancer recurrence-free and overall survival rates between the superficially invasive and invasive groups.Anal SISCCAs have a low index of clinical suspicion, are associated with an absence of LVI and are linked to high-risk HPV. Prospective studies are needed to define the clinical behaviour of these anal tumours and to determine their best therapeutic strategy.


PubMed | Hopitaux Universitaires Paris Est, University of Paris Descartes and Center dEpidemiologie Clinique
Type: Journal Article | Journal: PloS one | Year: 2016

To assess the impact of a standardized pre-operative telephone checklist on the rate of late cancellations of ambulatory surgery (AMBUPROG trial).Multicenter, two-arm, parallel-group, open-label randomized controlled trial.11 university hospital ambulatory surgery units in Paris, France.Patients scheduled for ambulatory surgery and able to be reached by telephone.A 7-item checklist designed to prevent late cancellation, available in five languages and two versions (for children and adults), was administered between 7 and 3 days before the planned date of surgery, by an automated phone system or a research assistant. The control group received standard management alone.Rate of cancellation on the day of surgery or the day before.The study population comprised 3900 patients enrolled between November 2012 and September 2013: 1950 patients were randomized to the checklist arm and 1950 patients to the control arm. The checklist was administered to 68.8% of patients in the intervention arm, 1002 by the automated phone system and 340 by a research assistant. The rate of late cancellation did not differ significantly between the checklist and control arms (109 (5.6%) vs. 113 (5.8%), adjusted odds ratio [95% confidence interval] = 0.91 [0.65-1.29], (p = 0.57)). Checklist administration revealed that 355 patients (28.0%) had not undergone tests ordered by the surgeon or anesthetist, and that 254 patients (20.0%) still had questions concerning the fasting state.A standardized pre-operative telephone checklist did not avoid late cancellations of ambulatory surgery but enabled us to identify several frequent causes.ClinicalTrials.gov NCT01732159.


PubMed | Hopitaux Universitaires Paris Est
Type: | Journal: Clinica chimica acta; international journal of clinical chemistry | Year: 2012

Noninvasive methods for liver fibrosis evaluation in chronic liver diseases have been recently developed, i.e. transient elastography (Fibroscan) and blood tests (Fibrometer, Fibrotest, and Hepascore). In this study, we aimed to design a new score in chronic hepatitis C (CHC) by selecting blood markers in a large panel and we compared its diagnostic performance with those of other noninvasive methods.Sixteen blood tests were performed in 306 untreated CHC patients included in a multicenter prospective study (ANRS HC EP 23 Fibrostar) using METAVIR histological fibrosis stage as reference. The new score was constructed by non linear regression using the most accurate biomarkers.Five markers (alpha-2-macroglobulin, apolipoprotein-A1, AST, collagen IV and osteoprotegerin) were included in the new function called Coopscore. Using the Obuchowski Index, Coopscore shows higher diagnostic performances than for Fibrometer, Fibrotest, Hepascore and Fibroscan in CHC. Association between Fibroscan and Coopscore might avoid 68% of liver biopsies for the diagnosis of significant fibrosis.Coopscore provides higher accuracy than other noninvasive methods for the diagnosis of liver fibrosis in CHC. The association of Coopscore with Fibroscan increases its predictive value.


PubMed | hopitaux universitaires Paris Est
Type: Journal Article | Journal: Diagnostic and interventional imaging | Year: 2012

The standard breast MRI protocol includes T2 sequences (anatomy and signal analysis), T1 gradient-echo sequences which can detect markers placed after biopsy, and injected dynamic 3D sequences for performing volume and multiplanar reconstructions, which are particularly useful for locating lesions well. Good patient positioning is essential and is obtained by using foam wedges for small breasts, ensuring there are no folds, and the correct position of the nipples. These aspects limit movement artefacts which alter subtraction sequences, so that it must always be possible for reading these sequences to be assisted by comparing them with the native sequences. New functional imaging sequences are now appearing in an attempt to increase the specificity of MRI, which is one of its main limitations. Of these, magnetic resonance spectroscopy appears to be the most promising, highlighting an abnormal choline peak in malignant lesions. This molecular signature provides early information (24 hours after beginning neoadjuvant treatment) on the chemosensitivity of a breast tumour.

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