Service des Explorations Fonctionnelles

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Service des Explorations Fonctionnelles

Paris, France

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Souberbielle J.-C.,Service des Explorations Fonctionnelles | Courbebaisse M.,Service des Explorations Fonctionnelles | Cormier C.,Service de Rhumatologie A | Pierrot-Deseilligny C.,Service de Neurologie 1 | And 2 more authors.
Scandinavian Journal of Clinical and Laboratory Investigation | Year: 2012

The many recently published data on vitamin D have raised much interest in the medical community. One of the consequences has been a great increase in the prescription of vitamin D concentration measurements in clinical practice. It must be reminded that only the measurement of 25-hydroxyvitamin D (25(OH)D) concentration is indicated to evaluate vitamin D status. Furthermore, since vitamin D insufficiency is so common, since treatment is inexpensive and has a large safety margin, and since we already have much data suggesting that besides its classic effects on bone and mineral metabolism, vitamin D may potentially be helpful for the prevention/management of several diseases, perhaps should it be prescribed to everyone without prior testing? In our opinion, there are however groups of patients in whom estimation of vitamin D status is legitimate and may be recommended. This includes patients in whom a "reasonably" evidence-based target concentration (i.e., based on randomized clinical trials when possible) should be achieved and/or maintained such as patients with rickets/osteomalacia, osteoporosis, chronic kidney disease and kidney transplant recipients, malabsorption, primary hyperparathyroidism, granulomatous disease, and those receiving treatments potentially inducing bone loss. Other patients in whom vitamin D concentration may be measured are those with symptoms compatible with a severe vitamin D deficiency or excess persisting without explanation such as those with diffuse pain, or elderly individuals who fall, or those receiving treatments which modify vitamin D metabolism such as some anti-convulsants. Measurement of Vitamin D concentrations should also be part of any exploration of calcium/phosphorus metabolism which includes measurement of serum calcium, phosphate and PTH. © 2012 Informa Healthcare.

Coupaye M.,University Paris Diderot | Castel B.,University Paris Diderot | Bogard C.,Service de Biochimie | Bogard C.,University Paris Diderot | And 6 more authors.
Obesity Surgery | Year: 2014

Sleeve gastrectomy (SG) is supposed to induce fewer nutritional deficiencies than gastric bypass (GBP). However, few studies have compared nutritional status after these two procedures, and the difference in weight loss (WL) between procedures may alter the results. Thus, our aim was to compare nutritional status after SG and GBP in subjects matched for postoperative weight. Forty-three subjects who underwent SG were matched for age, gender, and 6-month postoperative weight with 43 subjects who underwent GBP. Dietary intakes (DI), metabolic (MP), and nutritional parameters (NP) were recorded before and at 6 and 12 months after both procedures. Multivitamin supplements were systematically prescribed after surgery. Before surgery, BMI, DI, MP, and NP were similar between both groups. After surgery, LDL cholesterol, serum prealbumin, vitamin B12, urinary calcium, and vitamin D concentrations were lower after GBP than after SG, whereas WL and DI were similar after both procedures. However, the total number of deficiencies did not increase after surgery regardless of the procedure. In addition, we found a significant increase in liver enzymes and a greater decrease in C-reactive protein after GBP. In conclusion, during the first year after surgery, in patients with the same WL and following the same strategy of vitamin supplementation, global nutritional status was only slightly impaired after SG and GBP. However, some nutritional parameters were specifically altered after GBP, which could be related to malabsorption or other mechanisms, such as alterations in liver metabolism. © 2013 Springer Science+Business Media New York.

PubMed | Service de rhumatologie, Service de nephrologie pediatrique, Service des explorations fonctionnelles, Center hospitalier Lyon Sud and 2 more.
Type: Journal Article | Journal: Annales de biologie clinique | Year: 2016

The 25-hydroxyvitamin D (25OHD) serum concentration should not be measured to everybody but recommendations for this measurement in several clinical situations are available from numerous guidelines and expert positions. It can be proposed to measure 25OHD in diseases where a target range of 25OHD concentrations associated with better outcomes is defined with a sufficient level of evidence, and when this target concentration is difficult to reach without previous measurement (or may be exceeded in case of too large doses are provided). Many National and International Medical Societies recommend to measure 25OHD at least in any situation of bone fragility (defined by a low bone mineral density and/or a low energy fracture), in malabsorptions, in chronic kidney disease, in any phosphocalcic pathology, in patients with clinical signs of profound vitamin D deficiency or excess, and, more generally in any biological exploration of calcium/phosphorus metabolism that includes the measurement of PTH. Although these recommandations may seem discordant with the recent French restriction in the reimbursment of 25OHD measurement, they may still be reimbursed.

Duval X.,Center dInvestigation Clinique | Duval X.,University Paris Diderot | Iung B.,Service de Cardiologie | Iung B.,University Paris Diderot | And 15 more authors.
Annals of Internal Medicine | Year: 2010

Background: Neurologic complications of endocarditis can influence diagnosis, therapeutic plans, and prognosis. Objective: To describe how early cerebral magnetic resonance imaging (MRI) affects the diagnosis and management of endocarditis in hospitalized adults. Design: Single-center prospective study between June 2005 and October 2008. ( registration number: NCT00144885) Setting: Tertiary care university hospital in France. Patients: 130 patients with endocarditis. Intervention: Cerebral MRI with angiography performed up to 7 days after admission and before any surgical intervention. Measurements: 2 experts jointly established the endocarditis diagnostic classification (according to Duke-modified criteria) and therapeutic plans just before and after MRI and then compared them. Results: Endocarditis was initially classified as definite in 77 patients and possible in 50 and was excluded in 3. Sixteen patients (12%) had acute neurologic symptoms. Cerebral lesions were detected by MRI in 106 patients (82% [95% CI, 75% to 89%]), including ischemic lesions in 68, microhemorrhages in 74, and silent aneurysms in 10. Solely on the basis of MRI results and excluding microhemorrhages, diagnostic classification of 17 of 53 (32%) cases of nondefinite endocarditis was upgraded to either definite (14 patients) or possible (3 patients). Endocarditis therapeutic plans were modified for 24 (18%) of the 130 patients, including surgical plan modifications for 18 (14%). Overall, early MRI led to modifications of diagnosis or therapeutic plan in 36 patients (28% [CI, 20% to 36%]). Limitation: Investigators did not assess whether the MRI-related changes in diagnosis and therapeutic plans improved patient outcomes or led to unnecessary procedures and increased costs. Conclusion: Cerebral lesions were identified by MRI in many patients with endocarditis but no neurologic symptoms. The MRI findings affected both diagnostic classifications and clinical management plans. Primary Funding Source: French Ministry of Health. © 2010 American College of Physicians.

Hannache B.,University Paris - Sud | Hannache B.,University of Mentouri Constantine | Bazin D.,University Paris - Sud | Boutefnouchet A.,University of Monastir | Daudon M.,Service des explorations fonctionnelles
Progres en Urologie | Year: 2012

Aim: Assessing the efficacy to dissolve cystine stones in vitro of plant extracts used in traditional medicine to treat or prevent urolithiasis. Material and method: Pure cystine stones were incubated during 8 weeks under magnetic stirring in the presence of four plant extracts or of NaCl 9. g/l solution used as control. Plants under examination were . Arenaria ammophila (leaves and stems), Parietaria officinalis (leaves and flowers studied separately), Paronychia argentea (flowers). Each experiment was performed in triplicate. The mass loss of the stones and the pH of the solution were measured after each two weeks period. Possible changes in the cystine crystals at the stone surface were assessed at the mesoscopic scale using a scanning electron microscope. Results: None of the plant extracts has revealed a significant effect to dissolve cystine stones by comparison to the control during the time of the experiment. The best result was a mass loss of 99. mg at the end of experiment in the presence of A. ammophila vs. 43.7. mg for the NaCl solution (P= 0.051). Considering the slopes of the dissolution, only that extract could have an actual efficacy on a more prolonged period. Conclusion: Our study failed to demonstrate a significant effect of the tested plant extracts to dissolve cystine stones in vitro. However, the examination of the dissolution curves suggests that a more prolonged test period could allow an efficacy of some extracts, especially A. ammophila. Further studies are needed to verify such hypothesis. However, we cannot recommend the use of the tested plants to treat cystine stones in vivo. © 2012 Elsevier Masson SAS.

Knockaert L.,French Institute of Health and Medical Research | Knockaert L.,University of Rennes 1 | Berson A.,French Institute of Health and Medical Research | Ribault C.,French Institute of Health and Medical Research | And 14 more authors.
Laboratory Investigation | Year: 2012

Although carbon tetrachloride (CCl 4)-induced acute and chronic hepatotoxicity have been extensively studied, little is known about the very early in vivo effects of this organic solvent on oxidative stress and mitochondrial function. In this study, mice were treated with CCl 4 (1.5 ml/kg ie 2.38 g/kg) and parameters related to liver damage, lipid peroxidation, stress/defense and mitochondria were studied 3 h later. Some CCl 4-intoxicated mice were also pretreated with the cytochrome P450 2E1 inhibitor diethyldithiocarbamate or the antioxidants Trolox C and dehydroepiandrosterone. CCl 4 induced a moderate elevation of aminotransferases, swelling of centrilobular hepatocytes, lipid peroxidation, reduction of cytochrome P4502E1 mRNA levels and a massive increase in mRNA expression of heme oxygenase-1 and heat shock protein 70. Moreover, CCl 4 intoxication induced a severe decrease of mitochondrial respiratory chain complex IV activity, mitochondrial DNA depletion and damage as well as ultrastructural alterations. Whereas DDTC totally or partially prevented all these hepatic toxic events, both antioxidants protected only against liver lipid peroxidation and mitochondrial damage. Taken together, our results suggest that lipid peroxidation is primarily implicated in CCl 4-induced early mitochondrial injury. However, lipid peroxidation-independent mechanisms seem to be involved in CCl 4-induced early hepatocyte swelling and changes in expression of stress/defense-related genes. Antioxidant therapy may not be an efficient strategy to block early liver damage after CCl 4 intoxication. © 2012 USCAP, Inc All rights reserved.

PubMed | Annaba University, EHS duro nephrologie Daksi, University of Mentouri Constantine and Service des explorations fonctionnelles
Type: Journal Article | Journal: Progres en urologie : journal de l'Association francaise d'urologie et de la Societe francaise d'urologie | Year: 2016

Determine stones composition of the upper urinary tract in the eastern region of Algeria.Our study focuses on a set of 359 stones of the upper urinary tract collected between January 2007 and December 2012 at hospitals in the eastern region of Algeria and analyzed by Fourier transform infrared spectroscopy.The male/female ratio was only 1.32. Calcium oxalate prevailed in 68.5% of stones and 49.3% of nuclei, mainly as whewellite (51.8% of stones and 37.9% of nuclei vs 16.7% and 11.4% respectively for weddellite). Carbapatite prevailed in 15% of stones and 29.8% of nuclei. The struvite, identified in 11.1% of calculi, prevailed in 3.9% of stones and 3.1% of nuclei. Among purines, uric acid prevailed with frequencies quite close to 8.9% and 7% respectively in the stone and in the nucleus while the ammonium urate prevailed in only 0.3% of stones and 3.3% of nuclei. The cystine frequency was 3.6% in both stone and nucleus. The frequency of stone with umbilication was 26.2%. Whewellite was the main component of umbilicated stones with Randalls plaque.Our results suggest that stones of the urinary tract in the Algerian east region resemble those observed in industrialized countries. Some features such as stones location, the whewellite prevalence, the frequencies of main components in both the stone and the nucleus as well as the formation of stones on renal papilla confirm this trend.4.

Nguyen M.T.,University of Paris 13 | Cosson E.,University of Paris 13 | Valensi P.,University of Paris 13 | Poignard P.,Service des explorations fonctionnelles | And 3 more authors.
Diabetes and Metabolism | Year: 2011

Aims: This study aimed to assess, on routine echocardiography, cardiac left ventricular (LV) disorders, their determinants and their role in the screening process of silent myocardial ischaemia (SMI) in asymptomatic diabetic patients. Methods: A total of 586 asymptomatic diabetic patients with one or more additional cardiovascular risk factors, but no history of heart failure or myocardial infarction, prospectively underwent rest echocardiography and myocardial scintigraphy. Those with SMI (abnormal scintigraphy) were subsequently screened for angiographic coronary artery disease (CAD). Results: LV hypertrophy, LV dilatation, systolic dysfunction and hypokinesia were found in 33.6, 8.6, 3.2 and 6.1%, respectively, of the study population. SMI was found in 156 (26.6%) patients, 55 of whom had silent CAD. On multivariate analysis, age (OR: 1.03 [1.00-1.05], P=0.02), microalbuminuria (OR: 2.2 [1.4-3.2], P<0.0001) and silent CAD (OR: 2.4 [1.3-4.6], P=0.007) were predictive of LV hypertrophy. Creatinine clearance (OR: 0.97 [0.96-0.99], P=0.002) and silent CAD (OR: 3.7 [1.3-10.0]) were associated with LV dilatation. LV systolic dysfunction was associated with microalbuminuria (OR: 3.8 [1.3-11.4], P=0.02) and silent CAD (OR: 3.8 [1.1-12.6], P=0.03). Hypokinesia was associated with retinopathy (OR: 2.4 [1.1-5.4], P=0.04), microalbuminuria (OR: 2.3 [1.1-5.0], P=0.04) and LV dilatation (OR: 3.0 [1.1-8.1], P=0.03). In patients with SMI, the positive predictive value of LV hypertrophy associated with another echocardiographic abnormality (n=19) for CAD was 63.2%. Conclusion: LV hypertrophy was found in one-third of asymptomatic diabetic patients, while LV dilatation, systolic dysfunction or hypokinesia was seen in < 10%. The main predictors of LV abnormalities were microalbuminuria and silent CAD. The presence of LV hypertrophy with another abnormality should raise the possibility of the presence of silent CAD. © 2011 Elsevier Masson SAS.

Daudon M.,Service des Explorations Fonctionnelles
Progres en Urologie - FMC | Year: 2012

Morphoconstitutional analysis of calculi is often very useful for identifying the cause of urolithiasis while the clinical signs and the past history of the patient are not contributive. Stone morhology, in addition to crystalline composition may be of a valuable help for the early detection of severe lithogenic conditions such as primary hyperoxaluria, adenine phosphoribosyltransferase deficiency or acquired distal tubular acidosis. © 2012 Elsevier Masson SAS. Tous droits reserves.

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