Audemard A.,Caen University Hospital Center |
Comoz F.,University of Caen Lower Normandy |
Giraud J.M.,Clinique Ophthalmologique |
Dreno B.,University of Nantes |
And 2 more authors.
Dermatology | Year: 2013
Melanoma-associated retinopathy (MAR) is a rare autoimmune syndrome in patients with melanoma characterized by visual disorders. MAR is induced by the degeneration of bipolar cells of the retina and the presence of serum autoantibodies against retina proteins. Ipilimumab, an anti-cytotoxic T lymphocyte-associated antigen 4 antibody, improves survival in previously treated patients with metastatic melanoma, but is responsible for a spectrum of immune-related adverse events. Administration of ipilimumab to patients with autoimmune diseases (such as MAR or vitiligo) is actually not recommended. We report a patient presenting with MAR occurring during a melanoma relapse. Surgery and chemotherapy had no effect on visual acuity and melanoma increased. In the absence of alternative antitumoral treatment, we focused on the vital prognosis and treated the patient with ipilimumab. Two years after the treatment the patient is free from new metastasis but has presented with exacerbation of vitiligo and MAR. In the very rare case of melanoma with autoimmune disease without a therapy option, ipilimumab could be discussed, taking into account the fact that it can be effective on tumor burden but can also increase autoimmunity. © 2013 S. Karger AG, Basel.
Portalez D.,Clinique Pasteur |
Rollin G.,Hopital de Rangueil |
Leandri P.,Clinique Saint Jean |
Elman B.,Clinique Pasteur |
And 3 more authors.
European Radiology | Year: 2010
Objectives: To compare T2-weighted MRI and functional MRI techniques in guiding repeat prostate biopsies. Methods: Sixty-eight patients with a history of negative biopsies, negative digital rectal examination and elevated PSA were imaged before repeat biopsies. Dichotomous criteria were used with visual validation of T2-weighted MRI, dynamic contrast-enhanced MRI and literature-derived cut-offs for 3D-spectroscopy MRI (choline-creatine-to-citrate ratio >0.86) and diffusion-weighted imaging (ADC∈×∈10 3 mm2/s∈<∈1.24). For each segment and MRI technique, results were rendered as being suspicious/non-suspicious for malignancy. Sextant biopsies, transition zone biopsies and at least two additional biopsies of suspicious areas were taken. Results: In the peripheral zones, 105/408 segments and in the transition zones 19/136 segments were suspicious according to at least one MRI technique. A total of 28/68 (41.2%) patients were found to have cancer. Diffusion-weighted imaging exhibited the highest positive predictive value (0.52) compared with T2-weighted MRI (0.29), dynamic contrast-enhanced MRI (0.33) and 3D-spectroscopy MRI (0.25). Logistic regression showed the probability of cancer in a segment increasing 12-fold when T2-weighted and diffusion-weighted imaging MRI were both suspicious (63.4%) compared with both being non-suspicious (5.2%). Conclusion: The proposed system of analysis and reporting could prove clinically relevant in the decision whether to repeat targeted biopsies. © 2010 European Society of Radiology.
Ferreira A.,Clinique du Parc Lyon |
Aslanian T.,Groupe Lepine |
Dalin T.,University Claude Bernard Lyon 1 |
Picaud J.,Clinique Saint Jean
International Orthopaedics | Year: 2016
Purpose: Using a ceramic-ceramic bearings, cementless total hip arthroplasty (THA) has provided good clinical results. To ensure longevity a good quality fixation of the implants is mandatory. Different surface treatments had been used, with inconsistent results. We hypothesized that a “bilayer coating” applied to both THA components using validated technology will provide a long-lasting and reliable bone fixation. Methods: We studied the survival and bone integration of a continuous, single-surgeon, retrospective series of 126 THA cases (116 patients) with an average follow-up of 12.2 years (minimum 10 years). The THA consisted of cementless implants with a bilayer coating of titanium and hydroxyapatite and used a ceramic–ceramic bearing. Results: With surgical revision for any cause (except infection) as the end point, THA survival was 95.1 % at 13 years. Stem (98.8 %) and cup (98.6 %) survival was similar at 13 years. Bone integration was confirmed in 100 % of implants (Engh-Massin score of 17.42 and ARA score of 5.94). There were no instances of loosening. Revisions were performed because of instability (1.6 %), prosthetic impingement or material-related issues. Conclusion: A bilayer titanium and hydroxyapatite coating provides strong, fast, reliable osseo integration, without deterioration at the interface or release of damaging particles. The good clinical outcomes expected of ceramic bearings were achieved, as were equally reliable stem and cup fixation. © 2016 SICOT aisbl
Huguet D.,Polyclinique de latlantique |
Rio B.,Clinique Gentilly |
Teissier J.,Clinique Saint Jean |
Zipoli B.,Dax Hospital
Journal of Shoulder and Elbow Surgery | Year: 2010
Hypothesis: In total shoulder arthroplasty, the humeral component, particularly the stem, can be involved in some of the complications and technical difficulties increase in posttraumatic arthritis with proximal humeral malunion. To decrease the intraoperative complications related to the stem, the TESS (Biomet Inc, Warsaw, IN) humeral implant, was designed in 2004 hypothesis that we can obtain a good fixation with a stemless prothesis. This investigation reports the preliminary results of this prosthesis with more than 3 years of follow-up. Methods: Between March 2004 and June 2005, 70 patients underwent 72 shoulder replacements with the TESS humeral prosthesis. Sixty-three patients were reviewed with a follow-up of more than 36 months (average, 45.2 months; range, 36-51 months). The mean preoperative Constant score was 29.6. Results: Gain in active mobility was 49° for forward flexion and 20° for external rotation. The postoperative Constant score was 75. Radiographic analysis showed no radiolucencies or implant migration. Functional results are comparable with previous reports on prosthetic glenohumeral replacement. Discussion: Our clinical results are similar to this with classical prosthesis. The humeral head removal facilitates the glenoid exposure and implantation. After the initial cases any specific complication was seen. Conclusions: Owing to the automatic central positioning of the implant, an anatomic reconstruction was achieved. In malunions, no tuberosity osteotomy was required. At 3 years of follow-up, there is radiologic evidence of maintained implant stability. These encouraging preliminary results confirm our belief that a stemless prosthesis can be used to obtain an anatomic reconstruction of the proximal humerus. A longer-term follow-up study is needed to validate these results. © 2010 Journal of Shoulder and Elbow Surgery Board of Trustees.
Germanova D.,Free University of Brussels |
Loi P.,Free University of Brussels |
Van Vyve E.,Clinique Saint Jean |
Johanet H.,Clinique Saint Marie |
And 2 more authors.
Acta Chirurgica Belgica | Year: 2013
Objectives: Sleeve gastrectomy (SG) has been used as the first step of a staged malabsorptive procedure for high-risk patients. More recently SG was proposed as an stand alone procedure in the treatment of morbidly obese patients. The aim of this study is to analyze perioperative outcome of morbid obese patients after SG. Methods: 301 patients, 201 women and 100 men, undergoing SG were retrospectively analyzed. SG was performed by 17 surgeons all member of the Club Coelio. The mean BMI was 44.7kg/m2 (27.4-70.3 kg/m2). 34 patients (11.3%) of our series had SG as revisional surgery. These revisional procedures consisted of 32 conversions from gastric banding, 1 conversion from vertical gastroplasty (VBG) and 1 from transoral endoscopic gastroplasty. Among the 32 patients that had revisional SG after a gastric banding, 13 bands were removed at least 3 months before the revisional SG and 19 bands were removed during the SG procedure. Endpoints were perioperative morbidity and mortality and potential risk factors for complications, mainly per or postoperative bleeding or leakage. Results: Overall mortality was 0% and morbidity was 10.3%. Perioperative bleeding occurred in 10 patients (3.3%), leakage in 12 patients (4%) patients and stenosis in 3 patients (1%). The risk of leakage was significantly higher after revisional bariatric surgery and in case of gastric perforation during surgery(p = 0.0001). Previous gastric banding is also associated with a higher risk of postoperative bleeding (p = 0.0006). Conclusions: SG can be safely performed but patients and surgeons must be aware of a higher risk of postoperative complications when SG is proposed as a revisional surgery.
Unger P.,ULB Erasme Hospital |
Magne J.,University of Liège |
Vanden Eynden F.,Free University of Colombia |
Plein D.,Clinique Saint Jean |
And 5 more authors.
Heart | Year: 2010
Background: Mitral regurgitation is frequently observed in patients undergoing aortic valve replacement (AVR) for aortic stenosis and often improves postoperatively, mainly due to left ventricular remodelling and changes in loading conditions. Aortic prosthesis-patient mismatch (PPM) is associated with poor outcome and lesser left ventricular remodelling. This study tested the hypothesis that aortic PPM affects mitral regurgitation. Methods and results: Echocardiography was performed preoperatively and before discharge in 42 patients with aortic stenosis undergoing isolated AVR and presenting mitral regurgitation with an effective regurgitant orifice (ERO) of 10 mm2 or greater, as assessed by the proximal isovelocity surface area method. Postoperatively, mitral ERO and the regurgitant volume decreased from 16±5 mm2 to 12plusmn;6 mm2 (p<0.001) and from 28plusmn;8 ml to 16plusmn;9 ml (p<0.0001), respectively. PPM (indexed effective prosthetic valve area (EOAi) ≤0.85 cm2/m2), present in 23 patients (55%), was associated with a smaller decrease in regurgitant volume (p=0.0025) and ERO (p=0.02). A functional aetiology of mitral regurgitation was associated with a larger improvement in mitral regurgitation. In the whole cohort, EOAi correlated with the changes in mitral regurgitation severity (ERO r=0.44, p=0.01; regurgitant volume r=0.47, p=0.003). However, these relationships were no longer significant in the subset of patients with functional mitral regurgitation in whom mitral regurgitation changes were mainly related to postoperative changes in mitral valve deformation. Conclusions: The presence of PPM after AVR attenuates postoperative mitral regurgitation changes, mainly in patients with organic mitral regurgitation.
Unger P.,ULB Erasme Hospital |
Dedobbeleer C.,ULB Erasme Hospital |
Van Camp G.,Universitair Ziekenhuis Brussel |
Plein D.,Clinique Saint Jean |
And 2 more authors.
Heart | Year: 2010
Mitral regurgitation is a frequent finding in patients with aortic stenosis scheduled for aortic valve replacement. Detection of mitral regurgitation in such patients has important implications, as it can independently affect functional status and prognosis. When mitral regurgitation is moderate to severe, a decision to operate on both valves should only be made following a careful clinical and echocardiographic assessment. Indeed, double-valve surgery increases perioperative and postoperative risks, and mitral regurgitation may improve spontaneously after isolated aortic valve replacement. Better understanding of the determinants of these changes appears particularly crucial in the light of recent advances in percutaneous aortic valve replacement.
Vico P.G.,Clinique Saint Jean |
De Vooght A.,Clinique Saint Jean |
Nokerman B.,Clinique Saint Jean
Journal of Plastic, Reconstructive and Aesthetic Surgery | Year: 2010
Background: Obesity is a serious global health-care concern, with rates in Europe and North America estimated at about 20-30% of the adult population. Bariatric surgery forms the basis of modified surgical approaches to body-contouring procedures, especially those involving circumferential abdominoplasty. This procedure produces tremendous aesthetic results with very high patient satisfaction. We applied this technique, as an alternative to classic abdominoplasty, on moderately to severely obese patients and on patients with no excess-weight problem but some degree of skin laxity and with no history of bariatric surgery. Methods: The first author performed 80 consecutive circumferential abdominoplasties during a 4-year period. The patients consisted of two groups: post-bariatric patients (n = 23) and those with no history of bariatric surgery (n = 57). Factors such as age, gender, duration of the procedure and hospitalisation, among other relevant ones, are studied and the data are compared between the two groups, with a third group of patients who underwent, during the same period, a classical abdominoplasty (n = 38), and with data from the literature. Results: Circumferential abdominoplasty produces excellent aesthetical results with a high degree of satisfaction for patients with no bariatric history. The patients in this group are younger, their preoperative weight loss is lower, operative time shorter and per-operative blood loss lower. There is no statistical difference between the groups in terms either of the body mass index (BMI) at the time of circumferential abdominoplasty or of the resected tissue weight. Morbidity and rate of complications between these groups are not significant statistically, as with the case of data available in the literature. Compared with patients undergoing a classical abdominoplasty, we observe more complications related to delay in wound healing, less haematoma and less combined procedures in cases of circumferential abdominoplasty. Conclusions: Circumferential abdominoplasty is a body-contouring procedure initially developed for post-bariatric patients. This procedure can be ethically proposed to patients with body-contour deformities in a non-bariatric context (and even to non-obese patients with a skin laxity problem), giving excellent results with minor morbidity. © 2009 British Association of Plastic, Reconstructive and Aesthetic Surgeons.
Vryghem J.C.,Clinique Saint Jean |
Heireman S.,Clinique Saint Jean
Clinical Ophthalmology | Year: 2013
Purpose: To evaluate the subjective and objective visual results after the implantation of a new trifocal diffractive intraocular lens.Methods: A new trifocal diffractive intraocular lens was designed combining two superimposed diffractive profles: one with +1.75 diopters (D) addition for intermediate vision and the other with +3.50 D addition for near vision. Fifty eyes of 25 patients that were operated on by one surgeon are included in this study. The uncorrected and best distance-corrected monocular and binocular, near, intermediate, and distance visual acuities, contrast sensitivity, and defocus curves were measured 6 months postoperatively. In addition to the standard clinical follow-up, a questionnaire evaluating individual satisfaction and quality of life was submitted to the patients. Results: The mean age of patients at the time of surgery was 70 ± 10 years. The mean uncorrected and corrected monocular distance visual acuity (VA) were LogMAR 0.06 ± 0.10 and LogMAR 0.00 ± 0.08, respectively. The outcomes for the binocular uncorrected distance visual acuity were almost the same (LogMAR -0.04 ± 0.09). LogMAR -010 ± 0.15 and 0.02 ± 0.06 were measured for the binocular uncorrected intermediate and near VA, respectively. The distance-corrected visual acuity was maintained in mesopic conditions. The contrast sensitivity was similar to that obtained after implantation of a bifocal intraocular lens and did not decrease in mesopic conditions. The binocular defocus curve confrms good VA even in the intermediate distance range, with a moderate decrease of less than LogMAR 0.2 at -1.5 D, with respect to the best distance VA at 0 D defocus. Patient satisfaction was high. No discrepancy between the objective and subjective outcomes was evidenced. Conclusion: The introduction of a third focus in diffractive multifocal intraocular lenses improves the intermediate vision with minimal visual discomfort for the patient. © 2013 Vryghem and Heireman, publisher and licensee Dove Medical Press Ltd.
Rubay R.,Clinique Saint Jean
Journal of visceral surgery | Year: 2012
To assess the cosmetic outcome after single umbilical incision laparoscopic cholecystectomies (SILC) performed by the surgeons of the Coelio Club. Multicenter prospective study concerning 105 consecutive patients operated between December 2009 and February 2011 by SILC for non-complicated gallstones. Perioperative and postoperative parameters were analyzed with a systematic follow-up at 1 and 6months postoperative. Conversion to conventional laparoscopic cholecystectomy (CLC) was required for six patients (5.7%). Conversion rate is higher in case of acute cholecystitis (25%, P<0.001). Cosmetic outcome is found excellent by the patient (in 86% of the cases at 6months) and by the surgeon (in 90% of the cases at 6months) using an EVA scale. An incisional hernia was found in two cases (1.9%) and a superficial wound infection in four cases (3.8%). The cosmetic outcome after SILC is found excellent. SILC has its place in the surgical management of the non-complicated gallstone. We did not notice higher level of peroperative complications (biliary tract injury) during SILC than during CLC. Postoperative higher level of abdominal wall complications than after a CLC makes the surgeon caution to a careful abdominal wall closure. Copyright © 2012. Published by Elsevier Masson SAS.