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Philippart F.,Medical Surgical ICU | Bouroche G.,CNRS Gustave Roussy Institute | Timsit J.-F.,Joseph Fourier University | Garrouste-Orgeas M.,Medical Surgical ICU | And 33 more authors.
PLoS ONE | Year: 2015

Rationale: Experimental studies suggest that intra-abdominal infection (IAI) induces biological alterations that may affect the risk of lung infection. Objectives: To investigate the potential effect of IAI at ICU admission on the subsequent occurrence of ventilator-associated pneumonia (VAP). Methods: We used data entered into the French prospective multicenter Outcomerea database in 1997-2011. Consecutive patients who had severe sepsis and/or septic shock at ICU admission and required mechanical ventilation for more than 3 days were included. Patients with acute pancreatitis were not included. Measurements and Main Results: Of 2623 database patients meeting the inclusion criteria, 290 (11.1%) had IAI and 2333 (88.9%) had other infections. The IAI group had fewer patients with VAP (56 [19.3%] vs. 806 [34.5%], P<0.01) and longer time to VAP (5.0 vs.10.5 days; P<0.01). After adjustment on independent risk factors for VAP and previous antimicrobial use, IAI was associated with a decreased risk of VAP (hazard ratio, 0.62; 95% confidence interval, 0.46-0.83; P<0.0017). The pathogens responsible for VAP were not different between the groups with and without IAI (Pseudomonas aeruginosa, 345 [42.8%] and 24 [42.8%]; Enterobacteriaceae, 264 [32.8%] and 19 [34.0%]; and Staphylococcus aureus, 215 [26.7%] and 17 [30.4%], respectively). Crude ICU mortality was not different between the groups with and without IAI (81 [27.9%] and 747 [32.0%], P = 0.16). Conclusions: In our observational study of mechanically ventilated ICU patients with severe sepsis and/or septic shock, VAP occurred less often and later in the group with IAIs compared to the group with infections at other sites. © 2015 Philippart et al. Source


Bouziane Z.,St Etienne University Hospital | Nourissat G.,St Etienne University Hospital | Duprey A.,St Etienne University Hospital | Albertini J.N.,St Etienne University Hospital | And 2 more authors.
Annals of Vascular Surgery | Year: 2012

Background: Carotid angioplasty and stenting has been proposed as an alternative to carotid endarterectomy (CEA) in patients deemed as at high risk for this surgical procedure. To date, definitely accepted criteria to identify "high-risk" patients for CEA do not exist. Our objective was to assess the relevance of numerous supposed high-risk factors in our experience, as well as their possible effect on our early postoperative results. Methods: A retrospective review of 1,033 consecutive CEAs performed during a 5.6-year period at a single institution was conducted (Vascular Surgery Department, St. Etienne University Hospital, France). Early results in terms of mortality and neurologic events were recorded. Univariate and multivariate analyses for early risk of stroke, myocardial infarction, and death were performed, considering the influence of age, sex, comorbidities, clinical symptoms, and anatomic features. Results: The cumulative 30-day stroke and death rate was 1.2%. A total of 10 strokes occurred and resulted in three deaths. The postoperative stroke risk was significantly higher in the subgroup of patients treated for symptomatic carotid artery disease: 2,6% (P = 0,004). Univariate analysis and logistic regression did not show statistical significance for 30-day results in any of the considered variables. Conclusion: Patients with significant medical comorbidities, contralateral carotid occlusion, and high carotid lesions can undergo surgery without increased complications. Those parameters should not be used as exclusion criteria for CEA. © 2012 Annals of Vascular Surgery Inc. Source


Vola M.,St Etienne University Hospital | Fuzellier J.F.,St Etienne University Hospital | Campisi S.,St Etienne University Hospital | Favre J.-P.,St Etienne University Hospital | And 2 more authors.
Annals of Thoracic Surgery | Year: 2016

We report the case of a 61-year-old man who underwent a Bentall procedure with a BioValsalva conduit for an acute type A aortic dissection. Two years later the patient presented at our institution with severe aortic regurgitation caused by the rupture of one cusp of the bioprosthesis (Elan valve) included in the conduit. A transcatheter valve-in-valve option was discussed by the heart team but was dismissed in favor of a sutureless 3f Enable valve implantation into the failing bioprosthesis after leaflet removal. This strategy simplified the surgical procedure and provided excellent postoperative hemodynamics at follow-up. © 2016 The Society of Thoracic Surgeons. Source


Khaddage A.,St Etienne University Hospital | Berremila S.-A.,St Etienne University Hospital | Forest F.,St Etienne University Hospital | Clemenson A.,St Etienne University Hospital | And 3 more authors.
Anticancer Research | Year: 2011

Background: Sentinel lymph node (SLN) biopsy is used as a staging procedure in early breast cancer, however, histology based intra-operative assessment of the SLN status has a low sensitivity. The one-step nucleic acid amplification (OSNA) method was developed to detect metastases by amplification of cytokeratin (CK) 19 mRNA. Experience with OSNA during a French multi-centric prospective study, as well as intra-operative clinical routine use, is reported. Patients and Methods: For the clinical study 80 SLNs from 46 patients were assessed. During routine use, the central slice of the SLN from 197 patients was investigated by permanent histology and the remainder was assessed by OSNA. Results: During the clinical study, OSNA detected 15/17 metastases, including all the macrometastases, reaching a 96.3% concordance rate, 88.2% sensitivity and 98.4% specificity. During routine use, both OSNA and histology detected 25 patients with metastasis. Conclusion: OSNA is an accurate tool for intra-operative assessment of SLN status and could reduce the need for second surgery. Source


Vola M.,St Etienne University Hospital | Fuzellier J.-F.,St Etienne University Hospital | Anselmi A.,St Etienne University Hospital | Campisi S.,St Etienne University Hospital | And 4 more authors.
Journal of Cardiac Surgery | Year: 2015

Background and Aim We present our experience in the use of the sutureless valve in patients undergoing aortic valve replacement for pure aortic regurgitation. Methods Out of 167 patients who underwent sutureless aortic valve implantation with a Medtronic 3f Enable prosthesis in our unit between March 2011 and February 2014, 12 (7.1%) received a sutureless valve for pure aortic regurgitation. Results Mean age, logistic EuroSCORE, and left ventricular ejection fraction were 72-±-5 years, 6.3-±-2.9%, and 52.5-±-15.3%, respectively. The sutureless valve could be successfully implanted in all cases; nine patients had a full sternotomy (associated coronary artery bypass graft in four cases and associated mitral surgery in five), one patient had a ministernotomy, and two had a thoracoscopic approach. Average cross-clamping and cardiopulmonary bypass times were 90-±-30 and 127-±-51 minutes, respectively. At the outpatient echocardiography, average mean gradient was 10.54-±-4.99-mmHg and a grade I-II paravalvular leakage (PVL) was detected in the first patient of the cohort (ministernotomy approach). At a mean follow-up of 11.1-±-5.5 months, average mean gradient was 9.75-±-2.87-mmHg, no new PVL was detected, and the known PVL was stable. No pacemaker implantation was required. Conclusions Implantation of the 3f Enable sutureless valve is technically possible with pure aortic regurgitation in selected patients. Multicenter investigations are necessary to assess the mid-term benefits of such a device in this subset of patients. © 2015 Wiley Periodicals, Inc. Source

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