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Le Touquet – Paris-Plage, France

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. (ClinicalTrials.gov 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.

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.

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.

Ea H.-K.,French Institute of Health and Medical Research | Ea H.-K.,University Paris Diderot | Chobaz V.,University of Lausanne | Nguyen C.,French Institute of Health and Medical Research | And 13 more authors.
PLoS ONE | Year: 2013

Background: basic calcium phosphate (BCP) crystals are commonly found in osteoarthritis (OA) and are associated with cartilage destruction. BCP crystals induce in vitro catabolic responses with the production of metalloproteases and inflammatory cytokines such as interleukin-1 (IL-1). In vivo, IL-1 production induced by BCP crystals is both dependant and independent of NLRP3 inflammasome. We aimed to clarify 1/ the role of BCP crystals in cartilage destruction and 2/ the role of IL-1 and NLRP3 inflammasome in cartilage degradation related to BCP crystals. Methodology/ Principal Findings: synovial membranes isolated from OA knees were analysed by alizarin Red and FTIR. Pyrogen free BCP crystals were injected into right knees of WT, NLRP3 -/-, ASC -/-, IL-1α -/- and IL-1β-/- mice and PBS was injected into left knees. To assess the role of IL-1, WT mice were treated by intra-peritoneal injections of anakinra, the IL-1Ra recombinant protein, or PBS. Articular destruction was studied at d4, d17 and d30 assessing synovial inflammation, proteoglycan loss and chondrocyte apoptosis. BCP crystals were frequently found in OA synovial membranes including low grade OA. BCP crystals injected into murine knee joints provoked synovial inflammation characterized by synovial macrophage infiltration that persisted at day 30, cartilage degradation as evidenced by loss of proteoglycan staining by Safranin-O and concomitant expression of VDIPEN epitopes, and increased chondrocyte apoptosis. BCP crystal-induced synovitis was totally independent of IL-1α and IL-1β signalling and no alterations of inflammation were observed in mice deficient for components of the NLRP3-inflammasome, IL-1α or IL-1β. Similarly, treatment with anakinra did not prevent BCP crystal effects. In vitro, BCP crystals elicited enhanced transcription of matrix degrading and pro-inflammatory genes in macrophages. Conclusions/ Significance: intra-articular BCP crystals can elicit synovial inflammation and cartilage degradation suggesting that BCP crystals have a direct pathogenic role in OA. The effects are independent of IL-1 and NLRP3 inflammasome. © 2013 Ea et al.

Daudon M.,Service des Explorations Fonctionnelles
Nephrologie et Therapeutique | Year: 2015

Abstract Crystalluria is the presence of crystals in urine. It results from excessive supersaturation and may induce kidney problems such as nephrolithiasis, nephrocalcinosis and sometimes acute or chronic kidney impairment able to result in end stage renal failure. Crystalluria is not, per se, a marker of a pathologic condition. For distinguishing between physiologic and pathologic crystalluria, various criteria may be considered (1) either related to the sample such as urine pH, crystal identity, crystal habit, abundance of the crystals, aggregation and also the occurrence of crystalluria judged on serial samples, (2) or related to the clinical context such as nephrolithiasis, nephrocalcinosis or renal failure. The choice of the sample and the pre-analytical conditions are critical to validate the results from a clinical point of view. In our experience, the first morning urine sample is often the best one to assess, through the crystalluria analysis, the main metabolic factors involved in the crystal and stone formation. The storage of urine sample should be less than two hours at room temperature following the voiding. Crystalluria examination allows identifying simply monogenic crystallogenetic pathologies, providing explanation for acute renal failure related to drug intake, helping the physician for identifying the main metabolic disorders involved in stone formation and assessing the efficacy of preventive measures proposed to avoid stone recurrence in stone former patients. Crystalluria study is by far the best marker for predicting stone recurrence during the follow-up of stone formers, offering the opportunity to adjust dietary advices or drug management and thus to prevent stone formation. In conclusion, crystalluria examination is a major tool for the diagnosis and the management of most lithogenetic diseases and pathologic conditions responsible for intratubular crystal formation and renal impairment. © 2015 Association Société de néphrologie.

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