Nouvel Hopital Civil

Strasbourg, France

Nouvel Hopital Civil

Strasbourg, France

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Muller C.,Nouvel Hopital Civil | Perrin P.,Nouvel Hopital Civil | Faller B.,Hopital Civil | Chantrel F.,Hopital Civil
Therapeutic Apheresis and Dialysis | Year: 2011

Inadequately treated thyroid storm can lead to death. Therapeutic plasma exchange (TPE) is a suggested treatment when conventional treatments fail, but its indication is not well codified. We report our experience through three explicit cases. Three elderly patients were admitted to our hospital for cardiac or neurologic symptoms due to thyroid storm. After initiation of conventional therapy, TPE was performed with clinical and biological improvement. The speed of symptom resolution varies depending on the severity. This technique must be carried out by experienced medical staff as many complications can occur; nevertheless, in our patients with severe comorbidities, no complications occurred. The action of TPE mainly results from plasma removal of cytokines, putative antibodies, and thyroid hormones and their bound proteins. TPE has a transitory effect and thus should be associated with other thyroid blockers. When there are threatening symptoms, TPE should be done early, without waiting for the efficiency of conventional treatment, since it is the fastest method known for the improvement of the clinical condition. We also suggest starting TPE in case of neurologic symptoms because of very slow and incomplete regression. The Burch and Wartofsky score seems to be a helpful tool in establishing the diagnosis of thyroid storm and for deciding on when to initiate TPE. © 2011 The Authors. Therapeutic Apheresis and Dialysis © 2011 International Society for Apheresis.


Penard-Morand C.,French Institute of Health and Medical Research | Penard-Morand C.,University Pierre and Marie Curie | Penard-Morand C.,Agro ParisTech | Raherison C.,Center Francois Magendie | And 7 more authors.
European Respiratory Journal | Year: 2010

The aim of this study was to evaluate the impact of urban air pollution, assessed through reliable indicators of exposure, on asthma and allergies in schoolchildren. A validated dispersion model combining data on traffic conditions, topography, meteorology and background pollution was used to relate 3-yrs averaged concentrations of major urban pollutants at the sites of schools to skin prick tests, exercise-induced asthma and reported asthma and allergies in 6,683 children (9-11 yrs) attending 108 schools randomly selected in six French communities. For the 4,907 children who had resided at their current address for the past 3 yrs, asthma (exercise induced, past year and lifetime) was significantly positively associated with benzene, SO2, particles with a 50% cut-off aerodynamic diameter of 10 μm (PM10), nitrogen oxides (NOx) and CO. In the same children, eczema (lifetime and past year) was significantly positively associated with benzene, PM10, NO2, NOx and CO, lifetime allergic rhinitis with PM10 and sensitisation to pollens with benzene and PM10. Among the 2,213 children residing at their current address since birth, the associations persisted for lifetime asthma with benzene (adjusted OR per interquartile range (95% CI) 1.3 (1.0-1.9)) and PM10 (1.4 (1.0-2.0)), and for sensitisation to pollens with volatile organic compounds (1.3 (1.0-1.9)) and PM10 (1.2 (1.0-1.9)). Accurately modelled urban air pollution was associated with some measures of childhood asthma and allergies. Copyright©ERS 2010.


Kessler R.,Nouvel Hopital Civil | Partridge M.R.,Imperial College London | Miravitlles M.,CIBER ISCIII | Cazzola M.,University of Rome Tor Vergata | And 4 more authors.
European Respiratory Journal | Year: 2011

In between exacerbations, chronic obstructive pulmonary disease (COPD) is usually regarded as a stable condition, but there is increasing recognition of variability in this state. This cross-sectional study assessed patients' perception of symptom variability. Participants were outpatients >45 yrs old with COPD, current or ex-smokers, forced expiratory volume in 1 s (FEV 1) <50% predicted, FEV1/forced vital capacity <0.7 and no exacerbation leading to therapeutic intervention in the previous 3 months. Patients' perceptions of COPD symptoms and their impact on daily life activities were recorded. Alterations in therapy use in response to COPD worsening were also recorded. COPD symptoms were experienced by 2,258 (92.5%) out of 2,441 patients during the 7 days before interview. Breathlessness was the most common symptom (72.5%). Daily and/or weekly symptom variability was reported by 62.7% of symptomatic patients; the morning was the worst time of day. Factors associated with perception of variability of breathlessness included younger age, symptom severity and recruitment to the study by general practitioners. The perception of variability was significantly different between European countries or regions. Patient-perceived COPD symptoms vary over the day and the week, and impact on daily activities; morning being the worst time of day. The majority of patients appear not to adjust treatment when symptoms worsen. Copyright©ERS 2011.


Kirsch M.,Institute Of Cardiologie | Mazzucotelli J.-P.,Nouvel Hopital Civil | Roussel J.-C.,Institute du Thorax | Bouchot O.,Hopital du Bocage | And 4 more authors.
Journal of Heart and Lung Transplantation | Year: 2012

Background: Biventricular support can be achieved using paracorporeal biventricular assist devices (BiVADs), the total artificial heart (TAH), and implantable VADs. This study evaluated the influence of the device on patient survival. Methods: Data from 383 patients (321 men [84%]) undergoing primary, planned biventricular support using durable devices between 2000 and 2010 were extracted from the French multicentric Groupe de Réflexion sur l'Assistance Mécanique (GRAM) registry. Mean age was 41.6 ± 14.0 years. Patients were classified as group 1, 255 (67%) with paracorporeal BiVADs; group 2, 90 (24%) with TAH; and group 3, 38 (10%) with implantable BiVADs. Results: Mean patient support duration was 82.8 ± 107.4 days and similar among groups (p = 0.53). Bridging to transplantation was successful in 211 patients (55%) and to recovery in 23 (6%). Mortality on device was similar among groups (p = 0.16). TAH patients had a significantly lower stroke rate (p < 0.0001). Actuarial estimates for survival while on support were 75.2% ± 2.3%, 64.4% ± 2.7%, 61.1% ± 2.8%, and 56.8% ± 3.1% at 30, 60, 90, and 180 days, respectively, and were similar among groups. However, TAH patients undergoing prolonged support (<90 days) showed a trend toward improved survival (p = 0.08). Actuarial post-transplant survival estimates were, respectively, 81.7 ± 2.7, 75.3 ± 3.0, 73.0 ± 3.0, and 64.7 ± 3.7 at 1 month and 1, 3, and 5 years and were similar among groups (p = 0.84). Conclusion: Survival while on support and after heart transplantation did not differ significantly in patients supported with paracorporeal BiVADs, implantable BiVADs, or the TAH. Patients undergoing prolonged support (>90 days) tended to have improved survival when supported with TAH compared with BiVADs, which may be related to a lower incidence of neurologic events. © 2012 International Society for Heart and Lung Transplantation. All rights reserved.


Wu Q.,Chongqing Medical University | Marescaux C.,University of Strasbourg | Wolff V.,University of Strasbourg | Jeung M.-Y.,University of Strasbourg | And 3 more authors.
European Neurology | Year: 2010

Tacrolimus (TAC) is an immunosuppressant drug discovered in 1984 by Fujisawa Pharmaceutical Co., Ltd. This drug belongs to the group of calcineurin inhibitors, which has been proven highly effective in preventing acute rejection after transplantation of solid organs. However, neurotoxicity and nephrotoxicity are its major adverse effects. Posterior reversible encephalopathy syndrome (PRES) is the most severe and dramatic consequence of calcineurin inhibitor neurotoxicity. It was initially described by Hinchey et al. in 1996 [N Engl J Med 1996;334:494-450]. Patients typically present with altered mental status, headache, focal neurological deficits, visual disturbances, and seizures. Magnetic resonance imaging is the most sensitive imaging test to detect this. With the more deep-going studies done recently, we have learnt more about this entity. It was noted that this syndrome is frequently reversible, rarely limited to the posterior regions of the brain, and often located in gray matter and cortex as well as in white matter. Therefore, in this review, the focus is on the current understanding of clinical recognition, pathogenesis, neuroimaging and management of TAC-associated PRES after solid organ transplantation. Copyright © 2010 S. Karger AG.


Danilin S.,University of Strasbourg | Sourbier C.,University of Strasbourg | Thomas L.,University of Strasbourg | Lindner V.,Hopital de Mulhouse | And 6 more authors.
Carcinogenesis | Year: 2010

Human conventional renal cell carcinoma (CRCC) remains resistant to therapy. The RNA-binding protein HuR regulates the stability and/or translation of multiple messenger RNAs involved in malignant transformation. In this study, we aimed to evaluate the potential role of HuR in this pathology. Using seven human CRCC cell lines expressing or not the von Hippel-Lindau (VHL) tumor suppressor gene as well as 15 normal/renal cell carcinoma tumor pairs, we showed that HuR is overexpressed in all tumors independently of the VHL status. Futhermore, HuR cytoplasmic presence appears to be more common in early tumor stages, suggesting a role in tumor promotion. We then assessed the effect of HuR knockdown using small interfering RNA in cultured cell and in tumor-bearing mice. Both in vitro and in vivo, we observed that cell growth was inhibited by 60% and that this effect was obtained through an inhibition of cell proliferation and an induction of cell apoptosis. Finally, we found that expression of vascular endothelium growth factor, tumor growth factor-β and of the hypoxiainduced transcription factor-2α as well as the constitutive activation of the oncogenic phosphoinositide 3-kinase/Akt, nuclear factor-kappaB and mitogen-activated protein kinase pathways were decreased in HuR-depleted cells and tumors. All these results suggest a pivotal role for HuR in human CRCC. © The Author 2010. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org.


Muller C.,University of Strasbourg | Caillard S.,University of Strasbourg | Jesel L.,University of Strasbourg | El Ghannudi S.,University of Strasbourg | And 7 more authors.
American Journal of Kidney Diseases | Year: 2012

Background: The reasons that decreased glomerular filtration rate (GFR) might alter the clinical efficacy of clopidogrel are poorly understood. Study Design: In this study, we sought to evaluate whether decreased GFR alters platelet response to clopidogrel in patients receiving a maintenance dose of clopidogrel (75 mg/d for at least 8 days). Settings & Participants: 126 consecutive patients categorized by estimated GFR: stages 1-2 (>60 mL/min/1.73 m 2; n = 29), stage 3a (45-59 mL/min/1.73 m 2; n = 21); stage 3b (30-44 mL/min/1.73 m 2; n = 26), stage 4 (15-29 mL/min/1.73 m 2; n = 14), and stage 5 (<15 mL/min/1.73 m 2; n = 36) were prospectively enrolled. Predictor: Residual platelet reactivity, defined in the VASP (Vasodilator Stimulated Phosphoprotein) flow cytometry test as platelet reactivity index (PRI) <61% and in the VerifyNow turbidimetric-based assay as a value >235 PRU (adenosine diphosphate receptor reaction units) or percentage of platelet inhibition <15%. Outcomes: We examined factors associated with low response to clopidogrel using logistic regression. Results: A significant relationship between estimated GFR, PRI, PRU, and percentage of inhibition was found. The prevalence of residual platelet reactivity was highest in patients with GFR stage 5. PRI <61% occurred in 52.8% of patients with stage 5 versus 30.8% of stage 3b and 24.1% of stages 1-2 (P = 0.1). PRU >235 was found in 63.6% of patients with stage 5 versus 36.8% of stage 3b and 17.2% of stages 1-2 (P = 0.005). Inhibition <15% affected 66.7% of patients with stage 5 versus 21.1% of stage 3b and 17.2% of stages 1-2 (P < 0.001). In the multivariable model, GFR stage 5 (adjusted prevalence ratio [PR], 3.10; 95% CI, 1.23-9.43; P = 0.02), and obesity (adjusted PR, 1.92; 95% CI, 1.34-2.23; P = 0.004) were the sole predictors of residual platelet reactivity. Limitations: Interference of hemodialysis with the pharmacokinetics of clopidogrel could not be excluded. Conclusion: GFR stage 5 is associated with substantial impairment of platelet inhibition independently of diabetes mellitus. © 2012 National Kidney Foundation, Inc.


Garnon J.,Nouvel Hopital Civil | Schlier A.,Nouvel Hopital Civil | Buy X.,Institute Bergonie | Tsoumakidou G.,Nouvel Hopital Civil | And 4 more authors.
European Radiology | Year: 2014

Objective: To determine whether MRI allows safe and accurate guidance for biopsies of renal masses. Materials and methods: Between May 2010 and September 2013, 26 patients (15 men and 11 women) with 26 renal masses underwent MRI-guided percutaneous biopsy. For each patient, we retrospectively collected the epidemiological, procedural and histopathological data. Results: Mean size of tumour was 3.6 cm (range 0.6 – 9 cm). Mean procedure time was 48 minutes (range 37 – 70 min). Malignancy was found in the percutaneous samples in 81 % (21/26) of the masses. All these cases were considered as true positive biopsies. Benignity was found in the percutaneous samples in 5/26 (19 %) of the masses but was confirmed only in 3 cases. The other 2 cases included one false negative case and one undetermined biopsy, as patient was lost to follow-up. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of this study were 95.4 %, 100 %, 100 %, 75 % and 96 %, respectively Conclusion: MRI-guidance is safe and accurate to target renal masses. Key Points: • Percutaneous interventions can be performed with MRI-guidance • MRI offers real-time multiplanar imaging capabilities without radiation • MRI-guidance allows to target renal tumours. © 2014, European Society of Radiology.


Schnell F.,Rennes1 University | Schnell F.,University of Rennes 2 – Upper Brittany | Schnell F.,French Institute of Health and Medical Research | Riding N.,Qatar Orthopaedic and Sports Medicine Hospital | And 14 more authors.
Circulation | Year: 2014

Background-Pathological T-wave inversion (PTWI) is rarely observed on the ECG of healthy athletes, whereas it is common in patients with certain cardiac diseases. All ECG interpretation guidelines for use within athletes state that PTWI (except in leads aVR, III and V1 and in V1-V4 when preceded by domed ST segment in asymptomatic Afro-Caribbean athletes only) cannot be considered a physiological adaptation. The aims of the present study were to prospectively determine the prevalence of cardiac pathology in athletes presenting with PTWI, and to examine the efficacy of cardiac magnetic resonance in the work-up battery of further examinations. Methods and Results-Athletes presenting with PTWI (n=155) were investigated with clinical examination, ECG, echocardiography, exercise testing, 24h Holter ECG, and cardiac magnetic resonance. Cardiac disease was established in 44.5% of athletes, with hypertrophic cardiomyopathy (81%) the most common pathology. Echocardiography was abnormal in 53.6% of positive cases, and cardiac magnetic resonance identified a further 24 athletes with disease. Five athletes (7.2%) considered normal on initial presentation subsequently expressed pathology during follow-up. Familial history of sudden cardiac death and ST-segment depression associated with PTWI were predictive of cardiac disease. Conclusions-PTWI should be considered pathological in all cases until proven otherwise, because it was associated with cardiac pathology in 45% of athletes. Despite echocardiography identifying pathology in half of these cases, cardiac magnetic resonance must be considered routine in athletes presenting with PTWI with normal echocardiography. Although exclusion from competitive sport is not warranted in the presence of normal secondary examinations, annual follow-up is essential to ascertain possible disease expression. © 2015 American Heart Association, Inc.


Argemi X.,Nouvel Hopital Civil | Dara S.,Junka Jek Hospital | You S.,Junka Jek Hospital | Mattei J.F.,Red Cross | And 5 more authors.
AIDS | Year: 2012

Objectives: Determining the impact of malnutrition, anaemia and social determinants on survival once starting antiretroviral therapy (ART) in a cohort of HIV-infected adults in a rural HIV care centre in Sihanoukville, Cambodia. Methods: Retrospective and descriptive cohort study of adults starting ART between December 2004 and July 2009. We used the Kaplan-Meier and Cox regression survival analyses to identify predictors of death. Results: Out of 1002 patients, 49.7% were men; median age was 40; median time of follow-up was 2.4 years and 10.4% died during the follow-up. At baseline, median CD4 + cell count was 83 cells/μl, 79.9% were at WHO stage III or IV. In multivariate analysis, malnutrition appeared to be a strong and independent risk factor of death; 11.2% had a BMI less than 16 kg/m and hazard ratio was 6.97 [95% confidence interval (CI), 3.51-13.89], 21.5% had a BMI between 16 and 18 kg/m and hazard ratio was 2.88 (95% CI, 1.42-5.82), 30.8% had a BMI between 18 and 20 kg/m and hazard ratio was 2.18 (95% CI, 1.09-4.36). Severe anaemia (haemoglobin ≤8.4 g/dl) and CD4 + cell count below 100 cells/μl also predicted mortality, hazard ratio were 2.25 (95% CI, 1.02-4.34) and 2.29 (95% CI, 1.01-2.97), respectively. Social determinants were not significantly associated with death in univariate analysis. Conclusion: Malnutrition and anaemia are strong and independent prognostic factors at the time of starting ART. Nutritional cares are essential for the clinical success of HIV programs started in developing countries. © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins.

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