Ambroise Pare University Hospital

Boulogne-Billancourt, France

Ambroise Pare University Hospital

Boulogne-Billancourt, France

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PubMed | Ambroise Pare University Hospital, University of Oslo, Roskilde University, Brugmann University Hospital and 6 more.
Type: | Journal: Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association | Year: 2016

Upcoming KDIGO guidelines for the evaluation of living kidney donors are expected to move towards a personal risk-based evaluation of potential donors. We present the age and sex-specific lifetime risk of renal replacement therapy (RRT) for end-stage renal disease in 10 European countries.We defined lifetime risk of RRT as the cumulative incidence of RRT up to age 90 years. We obtained RRT incidence rates per million population by 5-year age groups and sex using data from the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) Registry, and used these to estimate the cumulative incidence of RRT, adjusting for competing mortality risk.Lifetime risk of RRT varied from 0.44% to 2.05% at age 20 years and from 0.17% to 1.59% at age 70 years across countries, and was twice as high in men as in women. Lifetime RRT risk decreased with age, ranging from an average of 0.77% to 0.44% in 20- to- 70-year-old women, and from 1.45% to 0.96% in 20- to- 70-year-old men. The lifetime risk of RRT increased slightly over the past decade, more so in men than in women. However, it appears to have stabilized or even decreased slightly in more recent years.The lifetime risk of RRT decreased with age, was lower in women as compared with men of equal age and varied considerably throughout Europe. Given the substantial differences in lifetime risk of RRT between the USA and Europe, country-specific estimates should be used in the evaluation and communication of the risk of RRT for potential living kidney donors.


PubMed | Brest University Hospital Center, Raymond Poincare University Hospital, District Hospital Center, University of Nantes and 19 more.
Type: Journal Article | Journal: Intensive care medicine | Year: 2016

Terminal extubation (TE) and terminal weaning (TW) are the methods available for withdrawing mechanical ventilation. Perceptions of TE and TW by intensive care unit (ICU) staff may influence bedside practices and the feasibility of studies comparing these methods.From January to June 2013, 5 nurses and 5 physicians in each of 46 (out of 70, 65.7%) French ICUs completed an anonymous self-questionnaire. Clusters of staff members defined by perceptions of TE and TW were identified by exploratory analysis. Denominators for computing percentages were total numbers of responses to each item; cases with missing data were excluded for the relevant item.Of the 451 (98%) participants (225 nurses and 226 physicians), 37 (8.4%) had never or almost never performed TW and 138 (31.3%) had never or almost never performed TE. A moral difference between TW and TE was perceived by 205 (45.8%) participants. The exploratory analysis identified three clusters defined by personal beliefs about TW and TE: 21.2% of participants preferred TW, 18.1% preferred TE, and 60.7% had no preference. A preference for TW seemed chiefly related to unfavorable perceptions or insufficient knowledge of TE. Staff members who preferred TE and those with no preference perceived TE as providing a more natural dying process with less ambiguity.Nearly two-fifths of ICU nurses and physicians in participating ICUs preferred TW or TE. This finding suggests both a need for shared decision-making and training before performing TE or TW and a high risk of poor compliance with randomly allocated TW or TE.


Mahjoub Y.,Intensive Care Unit | Lejeune V.,Intensive Care Unit | Muller L.,University of Nimes | Perbet S.,Clermont Ferrand University Hospital | And 19 more authors.
British Journal of Anaesthesia | Year: 2014

Background Respiratory variation in pulse pressure (ΔPP) is commonly used to predict the fluid responsiveness of critically ill patients. However, some researchers have demonstrated that this measurement has several limitations. The present study was designed to evaluate the proportion of patients satisfying criteria for valid application of ΔPP at a given time-point. Methods A 1 day, prospective, observational, point-prevalence study was performed in 26 French intensive care units (ICUs). All patients hospitalized in the ICUs on the day of the study were included. The ΔPP validity criteria were recorded prospectively and defined as follows: (i) mechanical ventilation in the absence of spontaneous respiration; (ii) regular cardiac rhythm; (iii) tidal volume ≥8 ml kg-1 of ideal body weight; (iv) a heart rate/respiratory rate ratio >3.6; (v) total respiratory system compliance ≥30 ml cm H2O-1; and (vi) tricuspid annular peak systolic velocity ≥0.15 m s-1. Results The study included 311 patients with a Simplified Acute Physiology Score II of 41 (39-43). Overall, only six (2%) patients satisfied all validity criteria. Of the 170 patients with an arterial line in place, only five (3%) satisfied the validity criteria. During the 24 h preceding the study time-point, fluid responsiveness was assessed for 79 patients. ΔPP had been used to assess fluid responsiveness in 15 of these cases (19%). Conclusions A very low percentage of patients satisfied all criteria for valid use of ΔPP in the evaluation of fluid responsiveness. Physicians must consider limitations to the validity of ΔPP before using this variable. © The Author [2013].


Tattevin P.,Pontchaillou University Hospital | Tattevin P.,University of Rennes 1 | Saleh-Mghir A.,University of Versailles | Saleh-Mghir A.,Raymond Poincare University Hospital | And 10 more authors.
Antimicrobial Agents and Chemotherapy | Year: 2013

Concerns have recently emerged about the potency and the quality of generic vancomycin (VAN) products approved for use in humans, based on experiments in a neutropenic mouse thigh infection model. However, other animal models may be more appropriate to decipher the bactericidal activities of VAN generics in vivo and to predict their efficacy in humans. We aimed to compare the bactericidal activities of six generic VAN products currently used in France (Mylan and Sandoz), Spain (Hospira), Switzerland (Teva), and the United States (Akorn-Strides and American Pharmaceutical Products [APP]) in a rabbit model of aortic valve endocarditis induced by 8×107 CFU of methicillin-resistant Staphylococcus aureus (MRSA) strain COL (VAN MIC, 1.5 μg/ml). In vitro, there were no significant differences in the time-kill curve studies performed with the six generic VAN products. Ten rabbits in each group were treated with intravenous (i.v.) VAN, 60 mg/kg of body weight twice a day (b.i.d.) for 4 days. Mean peak serum VAN levels, measured 45 min after the last injection, ranged from 35.5 (APP) to 45.9 μg/ml (Teva). Mean trough serum VAN levels, measured 12 h after the last injection, ranged from 2.3 (Hospira) to 9.2 (APP) μg/ml. All generic VAN products were superior to controls (no treatment) in terms of residual organisms in vegetations (P<0.02 for each comparison) and in the spleen (P<0.005 for each comparison). Pairwise comparisons of generic VAN products found no significant differences. In conclusion, a stringent MRSA endocarditis model found no significant differences in the bactericidal activities of six generic VAN products currently used in Europe and America. Copyright © 2013, American Society for Microbiology.


Bellemain-Appaix A.,Institut Universitaire de France | Montalescot G.,Institut Universitaire de France | Silvain J.,Institut Universitaire de France | Barthelemy O.,Institut Universitaire de France | And 11 more authors.
Journal of the American College of Cardiology | Year: 2010

Objectives: The purpose of this study was to determine whether the speed of response to clopidogrel loading predicts the final degree of response. Background: Fast inhibition of platelet aggregation is important in the setting of acute coronary syndromes and percutaneous coronary intervention, but its association with the final degree of inhibition is not well established. Methods: We performed a post hoc analysis of the ALBION study; early kinetic profiles of adenosine diphosphate 20 μmol/l maximal platelet aggregation (MPA) and ΔMPA (with baseline sample as reference) were studied at 8 time points within the 24 h after clopidogrel loading (300, 600, or 900 mg) in non-ST-segment elevation acute coronary syndrome patients. Low response was defined as ΔMPA <10% over the first 24 h, fast response as ΔMPA ≥10% at 1 h or before loading (the others being slow responders), and high post-treatment platelet reactivity as MPA ≥56.56% (fourth quartile). Inflammatory markers (PAC-1 and P-selectin) and vasodilator-stimulated phosphoprotein (VASP) were also evaluated according to onset of action. Results: Fifty-five percent of patients were slow responders. Noncurrent smoking and body mass index ≥25 kg/m2 were associated with slower and lower responses. High post-treatment platelet reactivity was more frequent in slow responders (28% vs. 14%, p < 0.0001). There was a clopidogrel dose-effect relationship on ΔMPA, with a trend toward faster onset of platelet inhibition in the 900-mg loading dose group. Slow responders had a slower and lower decrease in PAC-1 and P-selectin and higher VASP index at 6 h (76.5% vs. 66.4%, p = 0.019) and 24 h (70.3% vs. 61.5%, p = 0.049). Conclusions: Slow response to clopidogrel, within the first hour of administration, is a reliable marker of low response at 24 h and high post-treatment platelet reactivity. © 2010 American College of Cardiology Foundation.


Touma J.,Ambroise Pare University Hospital | Touma J.,University of Versailles | Coscas R.,Ambroise Pare University Hospital | Coscas R.,University of Versailles | And 8 more authors.
Journal of Vascular Surgery | Year: 2015

Laparoscopy is a minimally invasive alternative for type II endoleak repair after endovascular aneurysm repair. However, control of lumbar and median sacral arteries is considered technically difficult due to the dense inflammatory tissue surrounding the aorta. We describe a technical tip that avoids close dissection of the aneurysm sac. After the transperitoneal approaches we commonly use during laparoscopic aortic surgery, the aneurysm is drawn rightward to access the plane of the anterior longitudinal ligament. This technique allows a direct exposure of the lumbar and median sacral arteries, which are all methodically dissected and ligated along the anterior wall of the spine without close dissection of the aneurysm sac. In our experience, this technical tip was always feasible and simplified laparoscopic type II endoleak repair. © 2015 Society for Vascular Surgery.


PubMed | Ambroise Pare University Hospital, Valenciennes Hospital, University of Rouen, Amiens University Hospital and 3 more.
Type: Journal Article | Journal: Journal of vascular surgery | Year: 2016

Persistent type II endoleaks (T2Ls) with sac enlargement after endovascular abdominal aortic aneurysm repair are still of concern in view of the potential for rupture. Current treatments (embolization and stent graft [SG] explantation) are associated with lack of efficacy or high perioperative morbidity and mortality. This study evaluated an alternative technique that combines sacotomy, ligation of patent back-bleeding vessels, and SG preservation for T2L or unspecified endoleak repair.This multicenter study in France included 28 patients (27 men; median age, 78years). Twenty-one patients (75%) had a bifurcated SG (including 3 fenestrated SGs) and seven (25%) had an aortouni-iliac SG (2 for ruptured aneurysm). Unsuccessful embolization had been performed in 10 patients (36%). Four patients (14%) presented sac enlargement with no endoleak visible on computed tomography. The origin of the endoleak remained unspecified in three patients 3 (11%). The median diameter of the aneurysmal sac was 78mm (vs 55mm at the time of endovascular abdominal aortic aneurysm repair) after a median follow-up of 24months.A transperitoneal approach was used in 21 patients (75%) and a retroperitoneal approach was used in seven (25%). A guidewire was placed in the supraceliac aorta in 14 patients, and an occlusion balloon was temporarily inflated in six. Aortic cross-clamping was performed in five patients. T2Ls were identified in 26 patients, and associated with a distal type I endoleak in 1 patient, a type III endoleak in 3, and a type IV endoleak in 1. Two patients presented with endotension. All the endoleaks were treated successfully, with a mean operating time of 120minutes and a mean blood loss of 450mL. One SG was explanted 12days after the procedure because of early infection. One patient died during SG explantation for an aortoduodenal fistula 26months after the endoaneurysmorrhaphy. During a median follow-up of 24months, the control computed tomography scan showed shrinkage of the aneurysmal sac with stable diameters in all patients. No missed T2Ls, no recurrence of T2L, and no SG migration or disjunction was observed.Obliterating endoaneurysmorrhaphy with SG preservation can be considered as an alternative to SG removal in cases of persistent T2L responsible for aneurysmal sac enlargement after embolization failure. By avoiding extensive dissection for surgical aortic cross-clamping, minimizing hemodynamic changes, and reducing blood loss and operating time, this procedure can be performed even in patients initially considered unfit for surgery.


Sei J.-F.,Ambroise Pare University Hospital | Sei J.-F.,University of Versailles | Amini M.,University of Lyon | Beauchet A.,Assistance Publique Hopitaux de Paris | And 3 more authors.
Archives of Dermatology | Year: 2012

Objective: To summarize evidence about the recurrence of dermatofibrosarcoma protuberans (DFSP) following Mohs micrographic surgery (MMS). Data Sources: MEDLINE, Cochrane Library, EMBASE, Pascal, Biosis, CisMef, BDSP, Scopus, and Web of Knowledge databases were searched for the period January 1, 1995, to August 31, 2011. Search terms were Mohs micrographic surgery, dermatofibrosarcoma protuberans, and their synonyms. No language restriction was used. Study Selection: Two of us selected randomized controlled trials or nonrandomized trials comparing the recurrence of DFSP among patients undergoing MMS vs wide local excision. The search retrieved 384 references, of which 31 were reviewed in detail. Data Extraction: Twenty-three nonrandomized trials (4 comparative and 19 noncomparative) were included, from which data were extracted by 2 of us independently. The methodological quality was assessed using the Cochrane Handbook for Systematic Reviews of Interventions. Data Synthesis: Moderate-quality evidence (level B) was found for recurrence of DFSP after MMS (1.11%; 95% CI, 0.02%-6.03%) vs after wide local excision (6.32%, 95% CI, 3.19%-11.02%). A mean raw recurrence rate of 1.03% (95% CI, 0.37%-2.22%) was found after MMS among 19 nonrandomized noncomparative trials (low-quality evidence [level C]). The mean follow-up periods ranged from 26 to 127 months. The mean time to recurrence was 68 months. Conclusions: A weak recommendation is given in favor of MMS or similar surgical techniques with meticulous histologic evaluation of all margins as the first-line therapy for DFSP, particularly in recurrence-prone regions. Attention should be given to longer than a 5-year follow-up period. High-quality trials with sufficient follow-up periods should be encouraged. ©2012 American Medical Association. All rights reserved.

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