Necker University Hospital

Paris, France

Necker University Hospital

Paris, France
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Laupland K.B.,Joseph Fourier University | Laupland K.B.,University of Calgary | Zahar J.-R.,Joseph Fourier University | Zahar J.-R.,Necker University Hospital | And 12 more authors.
Critical Care Medicine | Year: 2012

Objective: To determine the occurrence and determinants of temperature abnormalities among Patients presenting (<24 hrs) to an intensive care unit and assess their effect on mortality outcome. Design: Inception cohort. Setting: French intensive care units participating in the Outcomerea group. Patients: Adults (≥ 18 yrs) admitted to an intensive care unit between April 2000 and November 2010. Patients undergoing therapeutic hypothermia were excluded. Interventions: None. Measurements and Main Results: A total of 10,962 Patients were included. The median age was 63 yrs (interquartile range, 49-76), 6639 (61%) admissions were in males, and the median admission Simplified Acute Physiology Score II and Sequential Organ Failure Assessment scores were 39 (interquartile range, 27-54) and 5 (interquartile range, 3-8), respectively. Patients were classified as medical in 8,237 (75%), nonscheduled surgical in 1,507 (14%), and scheduled surgical in 1,218 (11%). At presentation, 1,046 (10%) Patients had mild hypothermia (35.0-35.9°C), 541 (5%) had moderate hypothermia (32-35.9°C), 72 (1%) had severe hypothermia (<32°C), 2,264 (21%) Patients had mild fever (38.3-39.4°C), and 559 (5%) had high fever (>39.5°C). Normothermia was present in 6,133 (55%) and mixed fever/hypothermia abnormalities occurred in 347 (3%) Patients overall. Medical Patients had the highest occurrence of any fever, whereas hypothermia was more common in surgical Patients. The overall intensive care unit case-fatality was 1,944 of 10,962 (18%) and 828 of 6,133 (14%) for normothermia, 235 of 1,046 (22%) for mild hypothermia, 205 of 541 (38%) for moderate hypothermia, 43 of 72 (60%) for severe hypothermia, 412 of 2,264 (18%) for mild fever, 117 of 559 (21%) for high fever, and 104 of 347 (30%) for those with mixed temperature abnormalities. After controlling for confounding variables in logistic regression analyses, fever at presentation was not associated with any significantly increased risk for death. However, hypothermia was a significant independent predictor for death in medical Patients. Conclusions: Temperature abnormalities are common among Patients presenting to the intensive care unit. Hypothermia is a major, potentially modifiable factor associated with increased risk for death. © 2012 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins.


Girard J.,Lille University Hospital Center | Glorion C.,Necker University Hospital | Bonnomet F.,University of Strasbourg | Fron D.,Lille University Hospital Center | Migaud H.,Lille University Hospital Center
Clinical Orthopaedics and Related Research | Year: 2011

Background: Numerous reports of THAs in patients younger than 30 years indicate a high risk of revision. Although risk factors for revision have been reported for older patients, it is unclear whether these risk factors are the same as those for patients younger than 30 years. Questions/purposes We therefore (1) determined function and survivorship of revision THAs performed in patients younger than 30 years, and (2) assessed the risk factors for revision THAs in this younger population by comparison with a group of patients younger than 30 years who did not undergo revision. Patients and Methods: We retrospectively reviewed the clinical records and radiographs of 55 patients younger than 30 years (average age at revision, 24.3 years; range, 14-30 years) who underwent 77 hip revisions. Revision was performed, on average, 4.6 years (range, 0.4-12 years) after the primary THA. The results for these 55 patients (77 revision THAs) were compared with results for a nonrevised group, including 819 THAs in patients younger than 30 years. Minimum followup of the revision group was 1 year (mean, 6.2 years; range, 1-15 years). Results: At followup after the revision, the Merle d'Aubigné-Postel score improved from 12.2 to 14.6. The rates of dislocation, neurologic lesions, and fractures were 15%, 7.8%, and 14%, respectively. The 10-year survival rate was 36% (95% confidence interval [CI], 21%-51%). Compared with the nonrevised group, the independent revision risk factors were young age at primary THA (OR 1.14 [1.07-1.19]), high number of previous surgeries (OR 5.41 [2.67-10.98]), and occurrence of at least one dislocation (OR 3.98 [1.74-9.07]). Hard-on-soft bearings had a higher risk (OR 3.42 [1.91-6.1]) of revision compared with hard-on-hard bearings. Conclusions: Revision THAs are likely in patients younger than 30 years, and the complication rate is high. The survivorship of hip revision in this population is low and alternative solutions should be advocated whenever possible. Level of Evidence: Level III, therapeutic study, case control study. See the Guidelines for Authors for a complete description of levels of evidence. © The Association of Bone and Joint Surgeons® 2010.


Correas J.-M.,Necker University Hospital | Tissier A.-M.,Necker University Hospital | Khairoune A.,Necker University Hospital | Vassiliu V.,Necker University Hospital | And 4 more authors.
Radiology | Year: 2015

Purpose: To prospectively evaluate the performance of real-time ultrasonographic (US) shear-wave elastography (SWE) in the diagnosis of peripheral zone prostate cancer in patients with high and/or increasing prostate-specific antigen levels and/or abnormal digital rectal examination results. Materials and Methods: After signing an informed consent form, men referred for transrectal prostate biopsy were enrolled in this prospective HIPAA-compliant two-center study, which was conducted with institutional review board approval. Transrectal US SWE of the prostate was performed after a conventional transrectal US examination and immediately before US-guided 12-core sextant biopsy. For each sextant, the maximum SWE value was measured and matched to the pathologic results of that sextant biopsy. The diagnostic performance of SWE was assessed at both patient and sextant levels. The elasticity value maximizing the Youden index was used to derive sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Results: The elasticity values were matched to pathologic results for a total of 1040 peripheral zone sextants in 184 men. One hundred twenty-nine positive biopsy findings (size, ≥3 mm; Gleason score, ≥6) were identified in 68 patients. The sextant-level sensitivity, specificity, PPV, NPV, and area under the receiver operating characteristic curve for SWE with a cutoff of 35 kPa for differentiating benign from malignant lesions were 96% (95% confidence interval [CI]: 95%, 97%), 85% (95% CI: 83%, 87%), 48% (95% CI: 46%, 50%), 99% (95% CI: 98%, 100%), and 95% (95% CI: 93%, 97%), respectively. Conclusion: Use of a 35-kPa threshold at SWE may provide additional information for the detection and biopsy guidance of prostate cancer, enabling a substantial reduction in the number of biopsies while ensuring that few peripheral zone adenocarcinomas are missed. © RSNA, 2015.


Fauroux B.,Necker University Hospital | Fauroux B.,University of Paris Descartes | Fauroux B.,French Institute of Health and Medical Research | Desguerre I.,University of Paris Descartes | And 2 more authors.
Chest | Year: 2015

Routine lung function and respiratory muscle testing are recommended in children with neuromuscular disease (NMD), but these tests are based on noninvasive volitional maneuvers, such as the measurement of lung volumes and maximal static pressures, that young children may not always be able to perform. The realization of simple natural maneuvers such as a sniffor a cough, and the measurement of esophageal and gastric pressures during spontaneous breathing can add valuable information about the strength and endurance of the respiratory muscles in young children. Monitoring respiratory muscles in children with NMD may improve understanding of the natural history of NMD and the evaluation of disease severity. It may assist and guide clinical management and it may help the identification and selection of optimal end points, as well as the most informative parameters and patients for clinical trials. © 2015 American College of Chest Physicians.


PubMed | University of Limoges, Georges Pompidou University Hospital, Mayo Medical School, University Hospital of Amiens and 4 more.
Type: Journal Article | Journal: Leukemia | Year: 2016

We retrospectively reviewed 49 patients with light chain (LC) Fanconi syndrome (FS). Patients presented with chronic kidney disease (median estimated glomerular filtration rate (eGFR) of 33ml/min/1.73m


Piroth L.,University of Burgundy | Larsen C.,Institute of Veille Sanitaire | Binquet C.,University Hospital | Alric L.,University Paul Sabatier | And 9 more authors.
Hepatology | Year: 2010

Acute hepatitis C continues to be a concern in men who have sex with men (MSM), and its optimal management has yet to be established. In this study, the clinical, biological, and therapeutic data of 53 human immunodeficiency virus (HIV)-infected MSM included in a multicenter prospective study on acute hepatitis C in 2006-2007 were retrospectively collected and analyzed. The mean hepatitis C virus (HCV) viral load at diagnosis was 5.8 ± 1.1 log10 IU/mL (genotype 4, n = 28; genotype 1, n = 14, genotype 3, n = 7). The cumulative rates of spontaneous HCV clearance were 11.0% and 16.5% 3 and 6 months after diagnosis, respectively. Forty patients were treated, 38 of whom received pegylated interferon and ribavirin. The mean duration of HCV therapy was 39 ± 17 weeks (24 ± 4 weeks in 14 cases). On treatment, 18/36 (50.0%; 95% confidence interval 34.3-65.7) patients had undetectable HCV RNA at week 4 (RVR), and 32/39 (82.1%; 95 confidence interval 70.0-94.1) achieved sustained virological response (SVR). SVR did not correlate with pretreatment parameters, including HCV genotype, but correlated with RVR (predictive positive value of 94.4%) and with effective duration of HCV therapy (64.3% for 24 ± 4 weeks versus 92.0% for longer treatment; P = 0.03). Conclusion: The low rate of spontaneous clearance and the high SVR rates argue for early HCV therapy following diagnosis of acute hepatitis C in HIV-infected MSM. Pegylated interferon and ribavirin seem to be the best option. The duration of treatment should be modulated according to RVR, with a 24-week course for patients presenting RVR and a 48-week course for those who do not, irrespectively of HCV genotype. Copyright © 2010 American Association for the Study of Liver Diseases.


Colombat P.,University of Tours | Brousse N.,Necker University hospital | Salles G.,University of Lyon | Morschhauser F.,Claude Huriez University hospital | And 12 more authors.
Annals of Oncology | Year: 2012

Background: The purpose of this study was to report long-term results of rituximab induction monotherapy in patients with low-tumor-burden follicular lymphoma (LTBFL). Patients and methods: Of 49 first-line LTBFL patients who received weekly doses of rituximab (375 mg/m. 2), 46 have been followed with a long-term analysis of clinical and molecular responses. Results: Best clinical response (at any staging within a year following treatment) was 80%, 24 (52%) patients had complete or unconfirmed complete response, 13 (28%) had partial response and 9 (20%) had stable or progressive disease. Of 31 patients having a positive bcl2-JH rearrangement, 15 (48%) became negative following treatment. After 83.9 months of follow-up (95% confidence interval 6.4-92.8 months), the median progression-free survival is 23.5 months and overall survival (OS) is 91.7%. Five patients died (one progression, one myelodysplasia, one diffuse large B-cell lymphoma and two solid tumors). Seven patients (15%) are progression-free including five who are bcl2 informative. No unexpected long-term adverse event has been observed. Conclusion: A significant proportion of patients remain progression-free 7 years after a single 4-dose rituximab treatment in first-line LTBFL. The 7-year overall survivalOS is very high in this selected population of patients. © The Author 2012. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved.


Joannides R.,University of Rouen | Monteil C.,University of Rouen | De Ligny B.H.,University of Caen Lower Normandy | Westeel P.F.,Amiens University Hospital | And 9 more authors.
American Journal of Transplantation | Year: 2011

Whether or not a cyclosporine A (CsA)-free immunosuppressant regimen based on sirolimus (SRL) prevents aortic stiffening and improves central hemodynamics in renal recipients remains unknown. Forty-four patients (48 ± 2 years) enrolled in the CONCEPT trial were randomized at week 12 (W12) to continue CsA or switch to SRL, both associated with mycophenolate mofetil. Carotid systolic blood pressure (cSBP), pulse pressure (cPP), central pressure wave reflection (augmentation index, AIx) and carotid-tofemoral pulse-wave velocity (PWV: aortic stiffness) were blindly assessed at W12, W26 and W52 together with plasma endothelin-1 (ET-1), thiobarbituric acidreactive substances (TBARS) and superoxide dismutase (SOD) and catalase erythrocyte activities. At W12, there was no difference between groups. At followup, PWV, cSBP, cPP and AIx were lower in the SRL group. The difference in PWV remained significant after adjustment for blood pressure and eGFR. In parallel, ET-1 decreased in the SRL group, while TBARS, SOD and catalase erythrocyte activities increased in both groups but to a lesser extent in the SRL group. Our results demonstrate that a CsA-free regimen based on SRL reduces aortic stiffness, plasma endothelin-1 and oxidative stress in renal recipients suggesting a protective effect on the arterial wall that may be translated into cardiovascular risk reduction. © Copyright 2011 The American Society of Transplantation.


Khraiche D.,Necker University Hospital | Ben Moussa N.,Necker University Hospital
Archives of Cardiovascular Diseases | Year: 2016

Postoperative impairment of right ventricular (RV) systolic function can appear after surgical repair of complex congenital heart defects, such as tetralogy of Fallot; it is caused by chronic volume and/or pressure overload due to pulmonary regurgitation and/or stenosis. RV dysfunction is strongly associated with prognosis in these patients. Cardiac magnetic resonance imaging is the gold standard for quantification of RV volumes and ejection fraction in patients with congenital heart diseases; however, it is costly and is not widely available. Echocardiography is the imaging modality that is most available and most frequently used to assess RV systolic function. However, RV ejection fraction cannot be measured accurately by standard two-dimensional echocardiography because of its pyramidal shape. Surrogate parameters of RV systolic function are mostly used in routine practice. New techniques of two-dimensional strain and three-dimensional quantification of RV volumes and ejection fraction have been developed in recent years. The aim of this article is to show the pertinence of each variable of RV systolic function measured by echocardiography in patients with repaired congenital heart disease and residual chronic RV overload. © 2015 Elsevier Masson SAS.


PubMed | Necker University Hospital
Type: Journal Article | Journal: Archives of cardiovascular diseases | Year: 2016

Postoperative impairment of right ventricular (RV) systolic function can appear after surgical repair of complex congenital heart defects, such as tetralogy of Fallot; it is caused by chronic volume and/or pressure overload due to pulmonary regurgitation and/or stenosis. RV dysfunction is strongly associated with prognosis in these patients. Cardiac magnetic resonance imaging is the gold standard for quantification of RV volumes and ejection fraction in patients with congenital heart diseases; however, it is costly and is not widely available. Echocardiography is the imaging modality that is most available and most frequently used to assess RV systolic function. However, RV ejection fraction cannot be measured accurately by standard two-dimensional echocardiography because of its pyramidal shape. Surrogate parameters of RV systolic function are mostly used in routine practice. New techniques of two-dimensional strain and three-dimensional quantification of RV volumes and ejection fraction have been developed in recent years. The aim of this article is to show the pertinence of each variable of RV systolic function measured by echocardiography in patients with repaired congenital heart disease and residual chronic RV overload.

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