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Descazeaud A.,University of Limoges | Mathieu R.,University Hospital of Rennes
Current Opinion in Urology | Year: 2015

Purpose of review To update on the available literature that assessed laser surgery for benign prostatic obstruction (BPO) in patients under antithrombotic. Recent findings All types of laser might be suitable to decrease the bleeding risk in patients under antithrombotic. However, there is no consensus on the appropriate perioperative management of antithrombotic. Most of the studies mixed patients with coumarin derivatives or platelet aggregation inhibitors and did not discriminate the results according to the type of antithrombotic. The continuation of low-dose aspirin is feasible and might not increase bleeding risk during the perioperative period. Conversely, the literature is still too sparse and the protocols reported are too heterogeneous to provide any firm recommendation regarding the continuation, withdrawn, or bridging of clopidogrel and coumarin derivatives during laser procedures for BPO. The approach with new oral anticoagulants is even more uncertain as no data are available in this setting. Summary The decision to stop, continue, or replace antithrombotic should rely on both thrombotic and hemorrhagic risks. Therefore, urologist, cardiologist, and anesthesiologist should discuss altogether each case. Further studies are needed to provide a high level of evidence regarding the perioperative management of antithrombotic in the era of laser BPO procedures. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.


Morin L.,Karolinska Institutet | Laroche M.-L.,University of Limoges | Texier G.,University Hospital of Rennes | Johnell K.,Karolinska Institutet
Journal of the American Medical Directors Association | Year: 2016

Importance As older adults living in nursing homes are at a high risk of adverse drug-related events, medications with a poor benefit/risk ratio or with a safer alternative should be avoided. Objectives To systematically evaluate the prevalence of potentially inappropriate medication use in nursing home residents. Evidence review We searched in PubMed and EMBASE databases (1990–2015) for studies reporting the prevalence of potentially inappropriate medication use in people ≥60 years of age living in nursing homes. The risk of bias was assessed with an adapted version of the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist. Findings A total of 91 articles were assessed for eligibility, and 48 met our inclusion criteria. These articles reported the findings from 43 distinct studies, of which 26 presented point prevalence estimates of potentially inappropriate medication use (227,534 nursing home residents). The overall weighted point prevalence of potentially inappropriate medication use in nursing homes was 43.2% [95% confidence interval (CI) 37.3%–49.1%], increasing from 30.3% in studies conducted during 1990–1999 to 49.8% in studies conducted after 2005 (P < .001). Point prevalence estimates reported in European countries were found to be higher (49.0%, 95% CI 42.5–55.5) than those reported in North America (26.8%, 95% CI 16.5–37.1) or in other countries (29.8%, 95% CI 19.3–40.3). In addition, 18 studies accounting for 326,562 nursing home residents presented 20 distinct period prevalence estimates ranging from 2.3% to 50.3%. The total number of prescribed medications was consistently reported as the main driving factor for potentially inappropriate medications use. Conclusions and relevance This systematic review shows that almost one-half of nursing home residents are exposed to potentially inappropriate medications and suggests an increase prevalence over time. Effective interventions to optimize drug prescribing in nursing home facilities are, therefore, needed. © 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine


Bouguen G.,University of California at San Diego | Bouguen G.,University Hospital of Rennes | Bouguen G.,University of Rennes 1 | Levesque B.G.,University of California at San Diego | And 3 more authors.
Clinical Gastroenterology and Hepatology | Year: 2014

Background & Aims: Mucosal healing has been proposed as a goal for treatment because it is associated with improved clinical outcomes of patients with Crohn's disease (CD). However, little is known about the feasibility or probability of achieving mucosal healing in clinical practice. We evaluated the feasibility of treating patients to achieve mucosal healing based on endoscopic evaluation (treating to target). Methods: We reviewed the endoscopic outcomes of 67 patients with CD who had lesions detected by endoscopy. Patients underwent 2 to 4 subsequent endoscopic evaluations at the University of California San Diego and were followed up from 2011 through 2012; data were collected on therapies and patient management. The cumulative incidences of mucosal healing and endoscopic improvement were estimated using the Kaplan-Meier method. Factors independently associated with mucosal healing were identified using a Cox proportional hazards model. Results: After a median follow-up period of 62 weeks, 34 patients (50.7%) had mucosal healing and 41 patients (61.1%) had endoscopic improvement. The cumulative probabilities of mucosal healing were 12.7% and 45.0% at 24 and 52 weeks of treatment, respectively. Factors associated with mucosal healing were as follows: fewer than 26 weeks between endoscopic procedures (hazard ratio, 2.35; 95% confidence interval, 1.15-4.97; P=.035) and adjustment to medical therapy when mucosal healing was not observed (hazard ratio, 4.28; 95% confidence interval, 1.9-11.5; P=.0003). Conclusions: In an endoscopic study of patients with CD, we found that assessment of endoscopic disease activity and adjustments to medical therapy (treat to target) increase the likelihood of mucosal healing. © 2014 AGA Institute.


News Article | January 16, 2016
Site: motherboard.vice.com

On Friday several French agencies opened an investigation into a clinical drug trial that has hospitalized six men in the last week, leaving one permanently brain dead and three in critical condition, likely with permanent brain damage. At a press conference held Friday afternoon at the University Hospital of Rennes, where the six victims are currently being treated, the French Minister of Health, Marisol Touraine, vowed to “get to the bottom of this…tragic incident.” She also denied reports that the experimental drug contained cannabis or cannabis derivatives, as some French media agencies had originally reported. When the story of the hospitalizations broke, several French media agencies erroneously reported that a “cannabis based product was in question” and i-Télé reported that a cannabis-based pain killing drug was being injected into the trial participants. This assertion was categorically denied by Touraine during her press conference. “Contrary to what I've heard, this drug does not contain cannabis and is not a cannabis derivative,” said Touraine. “It acts on the endo-cannabinoid system.” The confusion likely stems from the use of the word ‘cannabinoid,’ the term for a wide variety of compounds which act on the cannabinoid receptors in the brain. These cannabinoid receptors are part of the endocannabinoid system, which is found in a wide variety of mammals and is responsible for helping regulate everything from memory and pain to appetite and mood. There are three major types of cannabinoids: endocannabinoids (produced naturally in humans and animals), synthetic cannabinoids (manufactured artificially) and phytocannabinoids (which are found naturally in some plants, such as cannabis). Although tetrahydrocannabinol (also known as THC, the main psychoactive compound in cannabis) is perhaps the most well-known cannabinoid, it is not a part of the drug that was being tested in Rennes. Just which molecule was being tested is not known for sure: a press release from Bial, the Portuguese pharmaceutical company that produced the drug in question, described the molecule as a type of pain medication known as an FAAH enzyme inhibitor. There is a chance the molecule was BIA 10-2474, an experimental drug for “neurological and psychiatric pathologies” and one of two substances listed on Bial’s website as in the first phase of clinical trials. The clinical trial for the molecule that has left six men, ages 28-49, with varying degrees of neural complications (one brain dead, three in critical condition, one with neurological problems and one under close observation) began last year in July. It has been executed by Biotrial, a research company operating on behalf of Bial. So far the molecule has been administered to a total 90 participants, although the six hospitalized last week were the first to show such severe adverse effects. The six men began taking the molecule on January 7, and by January 10 the first man was hospitalized and his condition rapidly deteriorated until he was declared to be brain dead by Gilles Edan, the chief neuroscientist at the Rennes hospital. According to Edan, there is no known antidote to the compound. This calamitous occurrence is a first for France, which maintains strict national and international regulations for carrying out drug testing on humans. Typically, a drug undergoing a clinical trial goes through three phases. In Phase I, the drug is administered to healthy patients in incremental doses—the first patients will receive a single dose while latter patients will receive multiple doses over several days. In Phase II, experimental drugs are given to patients with relevant conditions to see if the drug helps them. In Phase III, the drug is tested against a placebo and compared with existing treatments to gauge its effectiveness. The six hospitalized participants were participating in the first phase of the clinical trials for this molecule and were all declared healthy prior to beginning the study. According to Bial’s press release, the company had the clinical trial approved by the French Regulatory Authorities as well as the French Ethics committee in accordance with the guidelines laid out in Good Clinical Practices and Declaration of Helsinki. The trials related to the Bial drug have been suspended as of January 11 and at her press conference Touraine promised a full scale investigation into the trial spearheaded by the French General Inspectorate of Social Affairs. The Health Minister said she expected a final report on the occurrence by the end of March at the latest.


Vasseur M.,University of Angers | Carsin-Nicol B.,University Hospital of Rennes | Ebran J.M.,University of Angers | Willoteaux S.,University of Angers | And 2 more authors.
European Journal of Vascular and Endovascular Surgery | Year: 2011

We report the case of a young female patient with a transient amaurosis due to a carotid rete mirabile (CRM), a rare congenital carotid malformation, and pseudoxanthoma elasticum (PXE), an inherited autosomal recessive systemic metabolic disorder characterised by fragmentation and mineralisation of elastic fibres in connective tissues (skin, eyes) and the vascular system. CRM is a rare form of intracranial carotid malformation whose association with PXE (6 cases at present) would appear not to be accidental. This observation suggests a new link between congenital arterial remodelling and the PXE. © 2011 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.


Biver E.,University of Lille Nord de France | Chopin F.,University Hospital of St etienne | Coiffier G.,University Hospital of Rennes | Brentano T.F.,University of Paris Descartes | And 3 more authors.
Joint Bone Spine | Year: 2012

Objective: Osteoporosis diagnosis is based on bone mineral density (BMD) but bone remodeling is also a crucial issue. It can be assessed by bone turnover markers (BTMs). Their interest for the positive and etiological diagnosis of osteoporosis at baseline, and their predictive value for past asymptomatic vertebral fractures, were evaluated by a systematic review of the literature. Methods: Medline database was searched to identify all published reports analyzing BTMs and BMD or fractures. We conducted meta-analyses on BTMs levels according to osteoporotic status using random effects models. Results: Moderate and negative correlations were found, mainly in postmenopausal women, between BTMs and BMD, especially with bone alkaline phosphatase (bone ALP), osteocalcin, serum C-terminal and urine N-terminal crosslinking telopeptides of type I collagen (sCTX and uNTX). Bone ALP and sCTX levels are higher in osteoporotic patients compared to controls. High levels of bone ALP in primary hyperparathyroidism and low levels of osteocalcin in endogenous hypercorticism are the most relevant data reported in endocrine diseases associated with osteoporosis. High levels of BTMs, especially osteocalcin, bone ALP or sCTX, may be associated with prevalent vertebral fractures. Conclusion: The diagnosis value of BTMs at baseline in osteoporosis is very low. The interest of BTMs for the etiological diagnostic of secondary osteoporosis has not been demonstrated. Data are lacking to address the interest of BTMs assessment to screen for vertebral fractures in asymptomatic patients with high risk factors of fractures. © 2011 Société française de rhumatologie.


Couturier A.,Paris West University Nanterre La Défense | Dupas B.,Paris West University Nanterre La Défense | Guyomard J.-L.,University Hospital of Rennes | Massin P.,Paris West University Nanterre La Défense
Retina | Year: 2014

PURPOSE:: To evaluate the effectiveness of vitreoretinal surgery combined with antivascular endothelial growth factor therapy to treat florid diabetic retinopathy, a rare and severe form of diabetic retinopathy in young patients. METHODS:: Retrospective observational case series including 61 eyes of 45 patients operated on for florid diabetic retinopathy over the past 5 years, with preoperative or intraoperative intravitreal injection of bevacizumab. Cases were classified into three stages of disease severity, according to the extension of the fibrovascular membranes. Main outcome measures were mean change in visual acuity, anatomical outcome, and surgical complications. RESULTS:: After a mean follow-up of 20.3 months, the mean visual acuity significantly increased from +1.7 logMAR before surgery to +0.8 logMAR after surgery (P < 0.01). The visual gain was significant in Stages I and II (P < 0.05) but not significant in Stage III. A flat retina without silicone oil was achieved in 84% of eyes. Eight eyes (13%) progressed to neovascular glaucoma and/or phthisis despite repeated surgeries. CONCLUSION:: Vitrectomy combined with antivascular endothelial growth factor therapy allows both favorable visual and anatomical outcomes in this rapidly evolving disease. Prognosis remains poor in severe stages, suggesting that the earlier the surgery performed, the better is the visual prognosis. Copyright © by Ophthalmic Communications Society, Inc.


Bouguen G.,University Hospital of Rennes | Siproudhis L.,University Hospital of Rennes | Bretagne J.-F.,University Hospital of Rennes | Bigard M.-A.,University of Lorraine | Peyrin-Biroulet L.,University of Lorraine
Inflammatory Bowel Diseases | Year: 2010

Nonfistulizing perianal lesions, including ulcerations, strictures, and anal carcinoma, are frequently observed in Crohn's disease. Their clinical course remains poorly known. The management of these lesions is difficult because none of the treatments used is evidence-based. Ulcerations may be symptomatic in up to 85% of patients. Most ulcerations heal spontaneously but may also progress to anal stenosis or fistula/abscess. Topical treatments only improve symptoms, while complete healing can occur in patients with perianal ulcerations receiving infliximab therapy. Half of all patients with anal strictures will require permanent fecal diversion. Dilatation for symptomatic strictures should be performed on a highly selective basis in the absence of active rectal disease in order to avoid infectious complications. Anorectal strictures associated with rectal lesions should first be managed with medical therapy. Skin tags are usually painless and may hide other perianal lesions. Anal cancer is uncommon. Its treatment is similar to that recommended for anal cancer occurring in non-Crohn's disease patients. After reviewing the classification, clinical features, and epidemiology of each type of nonfistulizing perianal lesion (ulceration, stricture, skin tags, and anal cancer), we discuss the efficacy of medical treatment and surgery. This review article may help physicians in decision-making when managing potentially disabling lesions. Copyright © 2010 Crohn's & Colitis Foundation of America, Inc.


Lalys F.,Institut Universitaire de France | Riffaud L.,Institut Universitaire de France | Riffaud L.,University Hospital of Rennes | Bouget D.,Institut Universitaire de France | Jannin P.,Institut Universitaire de France
IEEE Transactions on Biomedical Engineering | Year: 2012

The need for a better integration of the new generation of computer-assisted-surgical systems has been recently emphasized. One necessity to achieve this objective is to retrieve data from the operating room (OR) with different sensors, then to derive models from these data. Recently, the use of videos from cameras in the OR has demonstrated its efficiency. In this paper, we propose a framework to assist in the development of systems for the automatic recognition of high-level surgical tasks using microscope videos analysis. We validated its use on cataract procedures. The idea is to combine state-of-the-art computer vision techniques with time series analysis. The first step of the framework consisted in the definition of several visual cues for extracting semantic information, therefore, characterizing each frame of the video. Five different pieces of image-based classifiers were, therefore, implemented. A step of pupil segmentation was also applied for dedicated visual cue detection. Time series classification algorithms were then applied to model time-varying data. Dynamic time warping and hidden Markov models were tested. This association combined the advantages of all methods for better understanding of the problem. The framework was finally validated through various studies. Six binary visual cues were chosen along with 12 phases to detect, obtaining accuracies of 94%. © 2006 IEEE.


Millon A.,Hospital e Herriot | Paquet Y.,Hospital e Herriot | Ben Ahmed S.,University Hospital of Clermont Ferrand | Pinel G.,University Hospital of Rennes | And 2 more authors.
European Journal of Vascular and Endovascular Surgery | Year: 2013

Objectives: There is no standardised technique for internal iliac artery aneurysm (IIAA) embolisation and results of long-term prevention of rupture are unknown. Design: We retrospectively evaluated technical aspects and results of IIAA embolisation in a multicentre study. Methods: Aneurysm morphology and embolisation techniques were reviewed. Aneurysm-related death, rupture, diameter increase, endoleak, secondary procedure and complication related to the IIA occlusion were recorded. Results: Between 2001 and 2011, 53 patients with 57 IIAA were treated. Mean diameter of IIAA was 41 mm (range: 25-88 mm). Embolisation techniques were distal and proximal occlusion (n = 24), proximal occlusion (n = 18) and sac packing (n = 15). Cumulative overall survival rate was 92% at 1 year, 83% at 3 years and 59% at 5 years. No cause of deaths was related to aneurysm. Aneurysm diameter increased in five patients and endoleak was observed in 11 patients. One secondary open conversion and five secondary endovascular procedures were performed for increase of diameter or proximal endoleak. Two patients experienced a disabling buttock claudication. Conclusions: Embolisation of IIAA is safe in the short- and midterm. However, endoleak and aneurysm diameter increases are not rare. Yearly post-procedure computed tomography angiography seems appropriate.© 2012 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

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