Bondy, France
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Hequet D.,Lariboisiere Hospital | Bricou A.,Jean Verdier Hospital | Koual M.,Jean Verdier Hospital | Ziol M.,Jean Verdier Hospital | And 5 more authors.
European Journal of Surgical Oncology | Year: 2013

Background The status of the surgical margins of lumpectomy is one of the most important determinants of local recurrence in breast cancer. Systematically practicing cavity margin resection is debated but may avoid surgical re-excision and allow the diagnosis of multifocality. Methods This multicentric retrospective study included 294 patients who underwent conservative management of breast cancer with 2-4 systematic cavity shavings. Clinico-biological characteristics of the patients were collected in order to establish whether surgical management was modified by systematic cavity shaving. Local recurrence rate with a long-term follow up of minimum 4 years was evaluated. Results Cavity shaving avoided the need for re-excision in 25% of cases and helped in the diagnosis of multifocality in 8% of cases. Resection volume was not associated with usefulness of the cavity shaving. No predictive factor of positive cavity shaving was found. The rate of local recurrence was 3.7% and appeared in a median time of 3 years and 8 month. Only one quarter of the patients with local recurrence had initially positive lumpectomy margins but negative cavity shaving. Discussion Systematic cavity shaving can change surgical management of conservative treatment. No specific target population for useful cavity shaving was found, such that we recommend utilising it systematically. © 2013 Elsevier Ltd. All rights reserved.


Iordache L.,Jean Verdier Hospital | Launay O.,Cochin Hospital | Bouchaud O.,Avicenne Hospital | Jeantils V.,Jean Verdier Hospital | And 10 more authors.
Autoimmunity Reviews | Year: 2014

Objectives: 1) To describe autoimmune diseases (AD) in HIV-infected people, and 2) to perform a literature review concerning this issue. Design: 52 HIV-infected patients that presented an AD in 14 medical departments in Paris and Ile-de-France area were retrospectively included in this study. Results: The ADs were vasculitis (11), immune cytopenias (8), rheumatic diseases (8), lupus (7), sarcoidosis (7), thyroid diseases (6), hepatic diseases (5), and antiphospholipid syndrome (4). Four patients presented 2 ADs. In 5 patients the AD preceded HIV infection, in 14 HIV infection was diagnosed at the same time as the AD and 34 were HIV-infected when they developed an AD. 40 ADs (80%) occurred in patients with a CD4 T lymphocyte count of more than 200/mm3. Cases of autoimmune hemolytic anemia occurred only in patients severely immunodepressed. In five patients (a vasculitis case, a sarcoidosis case, three thyroid disease cases) the AD presented as a form of immune restoration inflammatory syndrome (IRIS). Some ADs allowed HIV-infection diagnosis at a stage of moderate immune deficiency (vasculitis, antiphospholipid syndrome, immune thrombocytopenia). 37 patients received immunosuppressant treatments with good tolerance.These results confirm in a large series of patients previous data concerning autoimmune diseases occurrence in HIV-infected people. Conclusion: In the HAART era, when HIV-infected people are treated more and more early, autoimmune diseases can occur, mainly at the phase of immunological recovery. HIV infection should not limit immunosuppressant treatment use. © 2014 Elsevier B.V.


Buffet P.A.,University Pierre and Marie Curie | Buffet P.A.,Pitie Salpetriere Hospital | Buffet P.A.,Institute Pasteur Paris | Safeukui I.,Institute Pasteur Paris | And 12 more authors.
Blood | Year: 2011

Clinical manifestations of Plasmodium falciparum infection are induced by the asexual stages of the parasite that develop inside red blood cells (RBCs). Because splenic microcirculatory beds filter out altered RBCs, the spleen can innately clear subpopulations of infected or uninfected RBC modified during falciparum malaria. The spleen appears more protective against severe manifestations of malaria in naïve than in immune subjects. The spleen-specific pitting function accounts for a large fraction of parasite clearance in artemisinin-treated patients. RBC loss contributes to malarial anemia, a clinical form associated with subacute progression, frequent splenomegaly, and relatively low parasitemia. Stringent splenic clearance of ring-infected RBCs and uninfected, but parasite-altered, RBCs, may altogether exacerbate anemia and reduce the risks of severe complications associated with high parasite loads, such as cerebral malaria. The age of the patient directly influences the risk of severe manifestations. We hypothesize that coevolution resulting in increased splenic clearance of P. falciparum-altered RBCs in children favors the survival of the host and, ultimately, sustained parasite transmission. This analysis of the RBC-spleen dynamic interactions during P falciparum infection reflects both data and hypotheses, and provides a framework on which a more complete immunologic understanding of malaria pathogenesis may be elaborated. © 2011 by The American Society of Hematology.


Valensi P.,Jean Verdier Hospital | Picard S.,Point medical
Diabetes and Metabolism | Year: 2011

Cardiovascular disease (CVD) remains the primary cause of morbidity and mortality in patients with diabetes. Lipid-lowering therapy (LLT) is often required, and statin drugs are usually the first-line therapy. However, even when LDL-cholesterol values are within the target range, a substantial residual risk persists. Fibrates may help to lower this risk, especially in patients with high triglyceride and low HDL-cholesterol levels, as suggested by the lipid ACCORD trial. Furthermore, they may even have beneficial effects on the development of microvascular complications such as nephropathy and especially retinopathy, as suggested by the results of the FIELD study. Data suggest benefit with fenofibrate on diabetic retinopathy, with significant effects on the requirement for first laser treatment and macular oedema. Fibrates, like statins, may act directly to decrease the progression of diabetic complications through their lipid-lowering effects, but may also go beyond that via pleiotropic effects. Recent data and the possible underlying mechanisms are analyzed in this review. © 2010 Elsevier Masson SAS.


Trinchet J.-C.,Jean Verdier Hospital | Trinchet J.-C.,University of Paris 13 | Trinchet J.-C.,French Institute of Health and Medical Research
Diagnostic and Interventional Imaging | Year: 2014

The leading causes of chronic liver disease associated with HCC are hepatitis B and C viruses throughout the world, and alcohol and NASH in France. After increasing for 20-30 years in France, the rise in the incidence of HCC appears to be slowing and the death rates appear to be falling. Screening for HCC by liver ultrasound is performed every 6 months. Assay of serum alpha-fetoprotein has no benefit. In developed countries, failure to identify patients with cirrhosis and inadequate adherence to guidelines greatly reduces the effectiveness of screening for HCC. © 2014 Published by Elsevier Masson SAS on behalf of the Éditions françaises de radiologie.


Cosson E.,University of Paris 13 | Benbara A.,University of Paris 13 | Pharisien I.,University of Paris 13 | Nguyen M.T.,University of Paris 13 | And 9 more authors.
Diabetes Care | Year: 2013

OBJECTIVEdWe aimed to evaluate a selective screening strategy for gestational diabetes mellitus (GDM) based on the presence of risk factors: BMI 25 kg/m2, age 35 years, family history of diabetes, personal history of GDM, or birth of a child with macrosomia. RESEARCH DESIGN ANDMETHODSdOf 20,630 deliveries between 2002 and 2010, we selected 18,775 deliveries in women with no known diabetes and for whom all risk factors were known. GDM was universally screened and defined as fasting plasma glucose level 5.3 mmol/L and/or 2-h postload (75 g) glucose level 7.8 mmol/L. RESULTSdThe prevalence of at least one risk factor has increased since 2002 (P < 0.001) from 51.7 to 61.5%, with no change in the GDM prevalence (mean 14.4%, intention to screen). At least one risk factor was present in 58.5% of women who represented 65.3% of all those with GDM. The presence of risk factors was significantly associatedwith GDM(odds ratio 1.4 [95%CI 1.3-1.5], P < 0.001) and with GDM-related events (preeclampsia/large for gestational age/ dystocia) (P < 0.001) with the following incidences: no GDM/no risk factor 8.8%, no GDM/ risk factor 11.1%, GDM/no risk factor 16.7%, and GDM/risk factor 18.2%. CONCLUSIONSdThe presence of risk factors increased during the last decade. This condition is predictive of GDM and GDM-related events. However, a selective screening would lead to missing one-third of the women with GDM who, even without risk factors, had more events than women without GDM. Therefore, these data stand against the present selective screening currently proposed in the French guidelines. Copyright © 2013 by the American Diabetes Association.


Touvier M.,University of Paris 13 | Fezeu L.,University of Paris 13 | Ahluwalia N.,University of Paris 13 | Julia C.,University of Paris 13 | And 9 more authors.
American Journal of Epidemiology | Year: 2013

Experimental and prevalent case-control studies suggest an association between biomarkers of inflammation, endothelial function, and adiposity and cancer risk, but results from prospective studies have been limited. The authors' objective was to prospectively examine the relations between these biomarkers and cancer risk. A nested case-control study was designed within the Supplémentation en Vitamines et Minéraux Antioxydants (SU.VI.MAX) Study, a nationwide French cohort study, to include all first primary incident cancers diagnosed between 1994 and 2007 (n = 512). Cases were matched with randomly selected controls (n = 1,024) on sex, age (in 2-year strata), body mass index (weight (kg)/height (m)2; <25 vs. ≥25), and SU.VI.MAX intervention group. Conditional logistic regression was used to study the associations between prediagnostic levels of high-sensitivity C-reactive protein (hs-CRP), adiponectin, leptin, soluble intercellular adhesion molecule 1 (sICAM-1), soluble vascular cell adhesion molecule 1, soluble E-selectin, and monocyte chemoattractant protein 1 and cancer risk. All statistical tests were 2-sided. Plasma sICAM-1 level was positively associated with breast cancer risk (for quartile 4 vs. quartile 1, multivariate odds ratio (OR) = 1.86, 95% confidence interval (CI): 1.06, 3.26; Ptrend = 0.048). Plasma hs-CRP level was positively associated with prostate cancer risk (for quartile 4 vs. quartile 1, multivariate OR = 3.04, 95% CI: 1.28, 7.23; Ptrend = 0.03). These results suggest that prediagnostic hs-CRP and sICAM-1 levels are associated with increased prostate and breast cancer risk, respectively. © The Author 2012. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved.


Mekinian A.,Jean Verdier Hospital
Clinical nuclear medicine | Year: 2011

We report a case of 63-year-old man with symmetrical joint swelling of the interphalangeal and metacarpal joints, associated with isolated hypogammaglobulinemia. Accessory glands biopsy revealed the presence of amyloidal deposits. PET/CT showed increased F-18 FDG activity in thickened soft tissues corresponding to amyloid arthropathy. Like multiple myeloma, PET/CT could be an interesting imaging in light-chain amyloidosis.


Seror O.,Jean Verdier Hospital
Diagnostic and Interventional Imaging | Year: 2014

Percutaneous treatments for liver tumors were initially reserved for patients deemed to be inoperable and whose tumors were small in both size and number. As a result of the widening range of both techniques and technologies these treatments have gradually become incorporated into increasingly complex treatment strategies for increasingly broad patient groups. The place reserved for these techniques, which are still dominated by monopolar radiofrequency ablation, which is now facing strong competition from second-generation microwaves, is governed by each center's knowledge and skills in the techniques. This review describes the possible indications for percutaneous ablation depending on clinical findings and the technical and technological choices made. © 2014 Éditions françaises de radiologie. Published by Elsevier Masson SAS. All rights reserved.


Ahmad M.I.M.,Jean Verdier Hospital
Egyptian Journal of Radiology and Nuclear Medicine | Year: 2013

Objective: The objective of our study was to assess the impact of thrombocytopenia on percutaneous radiofrequency ablation (RFA) therapy of Hepatocellular carcinoma (HCC) in patients with liver cirrhosis. Material and methods: We analyzed retrospectively 64 patients with liver cirrhosis and thrombocytopenia, defined as a platelet count of less than 100 × 10 3/mm3 that had undergone percutaneous RFA to treat 86 HCCs. The Kaplan-Meier and Cox regression methods were used to predict hemorrhage, and time to the first decompensation event, defined as the development of ascites, hepatic encephalopathy, variceal hemorrhage, and deterioration of liver function to Child-Pugh class B/C. Results: There were no significant risk factors of hemorrhage. Univariate and multivariate analyses revealed that liver decompensation was clearly linked to prothrombin activity (p = 0.010 and p = 0.006, respectively) and a ≤ 63% of prothrombin activity was found as significant threshold for the occurrence of liver decompensation (p = 0.003) confirmed by the Cox model (p = 0.05). Conclusion: Percutaneous RFA for HCC can be performed safely without the need for support, in patients with liver cirrhosis and thrombocytopenia up to 37 × 103/mm3. © 2013 Egyptian Society of Radiology and Nuclear Medicine. Production and hosting by Elsevier B.V. All rights reserved.

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