University hospital Le Bocage

Dijon, France

University hospital Le Bocage

Dijon, France
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Chahraoui K.,University of Burgundy | Laurent A.,University of Franche Comte | Bioy A.,University of Burgundy | Quenot J.-P.,University Hospital Le Bocage
Journal of Critical Care | Year: 2015

Purpose: The purpose was to describe psychological experiences of patients 3 months after a stay in the intensive care unit (ICU) using qualitative methods. Methods: Twenty patients underwent clinical interview lasting 1 hour and completed the Impact of Event Scale-Revised and Hospital Anxiety and Depression questionnaires. All interviews were recorded and coded using thematic analysis. Results: All patients (100%) reported that they could not remember their ICU stay; half reported confused memories (50%) or disorientation (50%). Negatives memories were also reported (20%-45%), namely, pain, distress, sleep difficulties, noise, fear, feeling of abandonment; 20% reported positive memories. At 3 months, for 10 (50%) of 20 patients, their ICU experience was characterized by anxiety; 3 (15%) of 20 presented posttraumatic stress disorder; 7 (35%) of 20 reported a feeling of well-being with positive life changes. Well-being seems to be associated with use of coping strategies, such as active coping, positive reframing, optimism, humor, acceptance, leisure activities, and family support. Conclusion: Our study highlights the need to investigate patients' memories of ICU and the coping strategies used by patients to improve their ICU experience. Our findings suggest that a systematic follow-up consultation after ICU discharge would be useful for monitoring of post-ICU psychological outcomes. © 2015 Elsevier Inc.


Lepinoy A.,University of Burgundy | Lepinoy A.,University Hospital Jean Minjoz | Cochet A.,University of Burgundy | Cochet A.,Georges Francois Leclerc Cancer Center | And 9 more authors.
Radiotherapy and Oncology | Year: 2014

Introduction The purpose of this study was to describe the pattern of nodal relapse with 18F-fluoro-choline (FCH) Positron Emission Tomography/Computerized Tomography (PET/CT) in prostate cancer patients after radiotherapy. Materials and methods Eighty-three patients had a FCH PET/CT at time of biochemical failure. Of 65 patients with positive findings, 33 had positive nodes. This analysis included 31 patients who had undergone prior prostate-only radiotherapy with or without a prior radical prostatectomy. Each FCH positive node was assigned to a lymph node station with respect to the CTV defined by the RTOG guidelines (CTVRTOG). 3D mapping was performed after each node was manually placed in a reference planning CT scan after automatic co-registration of the two scans based on bone anatomy. Eighteen patients (58%) underwent focal salvage FCH PET-guided stereotactic radiotherapy with no hormones. Results Fourteen patients (45.2%) had a relapse outside the CTVRTOG. Of the 17 patients with a positive node inside the CTV RTOG, 15 had a single node (88.2%) while seven patients out of the 13 evaluable patients (53.9%) who had a relapse outside the CTVRTOG had ≥2 positive nodes on FCH PET/CT (OR = 8.75, [95% CI: 1.38-54.80], p = 0.020). Relapses that occurred outside the CTVRTOG involved the proximal common iliac (19.3%) and lower periaortic nodes (19.3%) up to L2-L3. Conclusion 3D mapping of nodal relapses evaluated with FCH PET/CT suggests that with IMRT the upper field limit of pelvic radiotherapy could be extended to L2-L3 safely to cover 95% of nodal stations at risk of an occult relapse. © 2014 Elsevier Ireland Ltd. All rights reserved.


Lepage C.,University of Burgundy | Lepage C.,University Hospital le Bocage | Cottet V.,University of Burgundy | Chauvenet M.,University of Burgundy | And 7 more authors.
Journal of Hepatology | Year: 2011

Background & Aims: The trends in incidence and management of biliary tract cancer (BTC) were investigated in a well-defined French population over a 30-year period (1976-2005). Methods: Data were obtained from the Burgundy digestive cancer registry. Age-standardised incidence rates and trends in incidence were determined. Treatment and stage at diagnosis were also investigated. Five-year survival rates were calculated. Results: Six hundred and fifteen cases of BTC were recorded. There was no significant change in BTC incidence over the 30-year period. For extrahepatic BTC age-standardised incidence rates were 1.1/100,000 for 1976-80 and 2001-2005. These rates were respectively 0.3 and 0.2/100,000 for intrahepatic BTC. The proportion of patients undergoing resection for cure increased over time from 4.8% to 14.2% (p <0.001). The proportion of stage I-II cases ranged from 3.2% to 7.1% but did not vary significantly over time (p = 0.55). Most cases were metastatic or unresectable at diagnosis. Five-year relative survival rates were 4.5% for 1976-85 and 6.7% for 1996-2005, ranging from 35.1% for stages I-II to 4.3% for advanced BTC. Age and stage at diagnosis were independent prognostic factors. Conclusions: The incidence of BTC has remained stable in Burgundy over the past 30 years. BTC prognosis remains poor and has only improved slightly over time. © 2010 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.


PubMed | University hospital Le Bocage, French Institute of Health and Medical Research, University of Burgundy and University of Paris Descartes
Type: Journal Article | Journal: Diabetes & metabolism | Year: 2016

Type A personality, although classically known as a factor linked to increased vascular risk, has recently been associated with increased survival in patients with diabetes. As low-grade inflammation predicts a poor outcome, the present study explored the potential associations between Type A and plasma levels of C-reactive protein (CRP) in diabetes.Type A personality was assessed by the Bortner questionnaire in people with diabetes. The association between Type A and plasma CRP levels was examined by multivariable linear regression, and structural equation modelling (SEM) was performed to determine the impact of the major clinical, biological and psychological confounders.The study included 626 participants with type 1 and type 2 diabetes from the Diabetes and Psychological Profile study. Multivariable analyses showed an independent inverse association between Type A score and CRP levels. The structural model adjusted for age, gender, diabetes type and duration, body mass index (BMI), smoking status, alcohol abuse, oral antidiabetic and statin treatments, HbA1c levels, lipids, perceived stress, anxiety and depression revealed significant associations between CRP and Type A (=-0.135, 95% CI: -0.242, -0.028; P=0.014), BMI (=0.194, 95% CI: 0.038, 0.350; P=0.015) and HDL cholesterol (=-0.132, 95% CI: -0.245, -0.020; P=0.014).Our present study data indicate that Type A personality is independently associated with lower CRP levels. This lower level of inflammation might explain the better clinical outcomes associated with Type A personality in patients with diabetes.


PubMed | Georges Francois Leclerc Cancer Center, University of Burgundy and University Hospital Le Bocage
Type: Journal Article | Journal: Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology | Year: 2015

To determine whether post-implant MRI-based dosimetry of the Dominant Intra-prostatic Lesion (DIL) could best predict the occurrence of PSA bounce after prostate brachytherapy.We selected 66 patients with a low risk prostate cancer treated with (125)I prostate brachytherapy as monotherapy. Post-implant dosimetry based on day 30 CT-scan and multiparametric MRI co-registration was generated: planned D90, D95, V100, V150 values were calculated for each DIL. Bounce was defined as a PSA elevation 0.2 ng/mL from the previous baseline value followed by a decrease to or below the prior nadir with no additional treatment.After a median follow-up of 35.5 months (range 13.2-72.5), a PSA bounce occurred in 24 (36.4%) patients. The mean planned D90 of the DIL was significantly lower in bouncers: 196 61 Gy vs. 234 62 Gy, p = 0.018. The mean planned V150 of the DIL was 56 32% for bouncers while it was 75 30% for non-bouncers, p = 0.026.A lower planned D90 or V150 in the DIL were predictive of PSA bounce after prostate brachytherapy. PSA bounce could be caused by delayed cell death related to sublethal damage accumulation in the tumor.


PubMed | University of Franche Comte, University of Burgundy and University Hospital Le Bocage
Type: Journal Article | Journal: Journal of critical care | Year: 2015

The purpose was to describe psychological experiences of patients 3 months after a stay in the intensive care unit (ICU) using qualitative methods.Twenty patients underwent clinical interview lasting 1 hour and completed the Impact of Event Scale-Revised and Hospital Anxiety and Depression questionnaires. All interviews were recorded and coded using thematic analysis.All patients (100%) reported that they could not remember their ICU stay; half reported confused memories (50%) or disorientation (50%). Negatives memories were also reported (20%-45%), namely, pain, distress, sleep difficulties, noise, fear, feeling of abandonment; 20% reported positive memories. At 3 months, for 10 (50%) of 20 patients, their ICU experience was characterized by anxiety; 3 (15%) of 20 presented posttraumatic stress disorder; 7 (35%) of 20 reported a feeling of well-being with positive life changes. Well-being seems to be associated with use of coping strategies, such as active coping, positive reframing, optimism, humor, acceptance, leisure activities, and family support.Our study highlights the need to investigate patients memories of ICU and the coping strategies used by patients to improve their ICU experience. Our findings suggest that a systematic follow-up consultation after ICU discharge would be useful for monitoring of post-ICU psychological outcomes.


PubMed | German Oesophageal Study Group GOSG, University Hospital Lille, Innsbruck Medical University, Heinrich Heine University Düsseldorf and 5 more.
Type: | Journal: Radiation oncology (London, England) | Year: 2015

Oesophageal carcinoma is a rare disease with often dismal prognosis. Despite multiple trials addressing specific issues, currently, many questions in management remain unanswered. This work aimed to specifically address areas in the management of oesophageal cancer where high level evidence is not available, performing trials is very demanding and for many questions high-level evidence will not be available in the forseeable future.Two experts of each national, oesophageal cancer research group from Austria, France, Germany, the Netherlands and Switzerland were asked to provide statements to controversial issues. After an initial survey, further questions were formulated and answered by all experts. The answers were then discussed and qualitatively analysed for consensus and controversy.Topics such as indications for PET-CT, reasons for induction chemotherapy, radiotherapy dose, the choice of definitive chemo-radiotherapy versus surgery in squamous cell cancer, the role of radiotherapy in adenocarcinoma and selected surgical issues were identified as topics of interest and discussed.Areas of significant controversy exist in the management of oesophageal cancer, mostly due to high-level evidence. This is not expected to change in the upcoming years.


Daniel R.,University hospital Le Bocage | Didier P.,University hospital Le Bocage | Helene P.,University hospital Le Bocage
Clinical Nutrition | Year: 2014

Background & aims: To study the 1-yr follow-up of 118 bulimia nervosa (BN) patients after a 3-month at-home tube feeding (TF) in a prospective study. Methods: At-home TF lasted 3 months, including one month of exclusive TF (no food). All patients fulfilled 4 questionnaires (score of binge/purging episodes (BP), eating disorder inventory, anxiety, depression), before, at the 3-month TF point, and 6 and 12 months latter. Results: The score of BP episodes dramatically decreased from 28.8 ± 15 (before TF) to 7.3 ± 5.4 at 3 months, as well as at 1 yr (15.1 ± 6.2). We also obtained a 50% decrease in Beck score (depression) and Hamilton score (anxiety). Curiously, there was no difference between the BP scores of the patients following psychotherapy and those who did not, despite lower scores for anxiety and depression. Conclusion: In conclusion, in bulimia nervosa patients having normal BMI and purging behavior, home-TF allow to obtain total withdrawal from bingeing/purging in at least 75% of the cases at short term (3 months) and in 25% of the patients at one year, whatever the patients have or have not psychotherapy. © 2013 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism.


Crehange G.,Center Leclerc | Bonnetain F.,Center Leclerc | Peignaux K.,Center Leclerc | Truc G.,Center Leclerc | And 5 more authors.
Critical Reviews in Oncology/Hematology | Year: 2010

Preoperative chemoradiation (P-CRT) remains a controversial strategy in the treatment of squamous cell cancer (SCC) and adenocarcinoma (ADC) of the oesophagus. Until recently, randomised studies mixed the two, often without any distinction. In randomised studies involving exclusively SCC, P-CRT increases the rate of local control, R0 resection, pCR and disease-free survival. The absence of any impact on overall survival may be linked to the toxic effects of this treatment. Meta-analyses have revealed a survival benefit of approximately +13% at 2 years. However, the methodology used was perhaps questionable. Five randomised trials involving ADC patients compared P-CRT with surgery alone. The results were contradictory with insufficient statistical power in selected positive studies to answer this issue once and for all. P-CRT is unsatisfactory as a standard treatment. Although local control rates were increased with P-CRT, it should be considered only for selected patients in selected centres. © 2009 Elsevier Ireland Ltd.


PubMed | University Hospital le Bocage
Type: Comparative Study | Journal: Journal of clinical anesthesia | Year: 2015

Dilution is often required to obtain appropriate concentrations of intrathecal morphine for analgesia. We compared techniques of diluting by measuring the quantity of morphine actually obtained in the final solution.This is an experimental study by 3 experienced anesthesiologists.The setting is at a university teaching hospital.There are no patients.There are no interventions.Five techniques for obtaining 100 g from 10 mg/mL were compared: technique 1 (T1) = extraction up to 0.1 graduation on a 1-mL syringe, followed by simple dilution (SD). Technique 2 (T2) = As for T1 but syringe was shaken to mix solution. Technique 3 (T3): SD with 10-mL syringe. Technique 4 (T4): Double dilution with 10-mL syringe. Technique 5 (T5): Extraction up to the 0.1 graduation of a 1-mL syringe, then SD, then shake solution by hand. Three tests using high-performance liquid chromatography with ultraviolet were performed on each syringe prepared 3 consecutive times, namely, at the first (beginning, B), fifth (middle, M) and last (end, E) milliliter or 0.1 mL (depending on syringe type).Average overall concentrations were 208 19, 199 24, 120 13, 136 9, and 119 16 g/0.1 mL, T1-T5, respectively. By Kruskal-Wallis test, we classified the techniques according to the magnitude of the difference between the observed concentration of morphine and the desired (theoretical) concentration of 100 g/0.1 mL. In ascending order, techniques ranked as follows: T5 (smallest difference), T3, T4, T2, and T1 (greatest difference) (P = .0001).There is significant variability in the concentration of morphine actually contained in final solutions after dilution. Morphine presented in different premixed concentrations increases the risk of error. We advocate technique 5 as described above, whereas technique 1 should be prohibited.

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