Franchitto N.,Toulouse University Hospital Center |
Franchitto N.,Toulouse Purpan University Hospital |
Pelissier F.,Toulouse University Hospital Center |
Lauque D.,Toulouse Purpan University Hospital
Alcohol and Alcoholism | Year: 2014
Aims: The aim of the study was to describe the characteristics and management of alcohol-dependent patients with co-existing psychiatric illness seen after self-intoxication with oral baclofen in an emergency department (ED). Methods: A retrospective review of medical records of such patients over a 12-month period from January 2012. Results: Twelve such patients were identified, median age 39.5 years. The median supposed ingested dose of baclofen was 340 mg (range 140-800 mg). Three patients who had coingested benzodiazepines had a decreased level of consciousness (Glasgow Coma Scale <8) and flumazenil had been given to reverse coma. Blood alcohol concentration, requested for all patients, was positive in three (ranging from 153 to 495 mg/100 ml). Gastric lavage was performed in two cases. All patients made a full recovery. They were discharged from the ED or intensive care unit after psychiatric assessment. Conclusion: Baclofen overdose affects the autonomic and central nervous system. Supportive care is symptom based. Care should be taken when prescribing baclofen with other central nervous system depressants and to patients with past attempted suicide. © The Author 2013. Medical Council on Alcohol and Oxford University Press. All rights reserved.
Thomas W.,Purpan University Hospital |
Thomas W.,Royal Free Hospital |
Brechemier D.,Toulouse Purpan University Hospital |
Dugert E.,Toulouse Purpan University Hospital |
And 4 more authors.
Cancer Imaging | Year: 2012
A 71-year-old woman was admitted to our hospital with asthenia, weight loss, fever, cognitive impairment and shortness of breath. Physical examination showed hemiparesis and cerebellar ataxia. There was no superficial lymphadenopathy. Blood tests showed raised levels of C-reactive protein and lactate dehydrogenase. Bone marrow aspiration and biopsy were negative. [ 18F]fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT) showed intense uptake within a right apical nodule and intense and diffuse uptake of FDG in the lungs without corresponding structural CT abnormality. Lung biopsy showed intravascular large B-cell lymphoma (IVLBCL). FDG-PET findings in IVLBCL and causes of diffuse FDG lung uptake with and without CT abnormalities are discussed. © 2012 International Cancer Imaging Society.
Pelissier F.,Toulouse University Hospital Center |
Lauque D.,Toulouse Purpan University Hospital |
Charpentier S.,Toulouse Purpan University Hospital |
Charpentier S.,University Paul Sabatier |
And 3 more authors.
Journal of Studies on Alcohol and Drugs | Year: 2014
Objective: The purpose of this study was to investigate whether blood alcohol concentration (BAC) measurement was routinely requested in emergency departments and whether the observation period in the emergency department allowed sufficient time for alcohol elimination before the patient was discharged.Method: A retrospective review of medical records of all emergency alcohol-related admissions over a 12-month period from January 2012, in patients older than 18 years, was conducted. We estimated BAC at discharge for each patient by using the following formula: [BAC at admission − (length of stay × 15)]. Then, we focused on patients discharged from the emergency department with an estimated BAC greater than 50 mg/100 ml because of the risk of subsequent legal proceedings, because this is the legal limit for driving in France.Results: A total of 907 patients admitted for acute alcohol intoxication (F10.0) were included, of whom 592 were male. Women were more likely to be admitted at night. The mean length of stay was 18.7 hours. BAC was measured in 893 patients. Patients ages 35–49 years had the highest measured BAC. No repeat BAC was taken before the discharge decision. Three hundred thirteen patients were discharged with an estimated BAC above 50 mg/100 ml.Conclusions: Emergency physicians routinely requested BAC at admission but did not request alcohol kinetics while the patient was under observation. The discharge decision was based on clinical judgment. Doctors who do not advise patients appropriately before discharge may be guilty of negligence in their duty of care. © 2014 Rutgers University.
Pelissier F.,Toulouse University Hospital Center |
Claudet I.,Toulouse Purpan University Hospital |
Pelissier-Alicot A.-L.,Aix - Marseille University |
Franchitto N.,Toulouse University Hospital Center
Pediatric Emergency Care | Year: 2014
Objectives: Cannabis intoxication in toddlers is rare and mostly accidental. Our objectives were to focus on the characteristics and management of children under the age of 6 years who were admitted to our emergency department with cannabis poisoning reported as accidental by parents, and to point out the need to consider accidental cannabis ingestions as an indicator of neglect.Methods: The medical records of children hospitalized for cannabis poisoning in a pediatric emergency department from January 2007 to November 2012 were retrospectively evaluated. Data collected included age, sex, drug ingested, source of drug, intentional versus accidental ingestion, pediatric intensive care unit or hospital admission, treatment and length of hospital stay, toxicology results, and rate of child protectives services referral.Results: Twelve toddlers (4 boys and 8 girls; mean age, 16.6 months) were included. All had ingested cannabis. Their parents reported the ingestion. Seven children experienced drowsiness or hypotonia. Three children were given activated charcoal. Blood screening for cannabinoids, performed in 2 cases, was negative in both, and urine samples were positive in 7 children (70%). All children had favorable outcomes after being hospitalized from 2 to 48 hours. Nine children were referred to social services for further assessment before discharge.Conclusions: Cannabis intoxication in children should be reported to child protection services with the aim of prevention, to detect situations of neglect and at-risk families. Legal action against the parents may be considered. Accidental intoxication and caring parents should be no exception to this rule. Copyright © 2014 by Lippincott Williams & Wilkins.
Ranty M.-L.,Toulouse University Hospital Center |
Laurent C.,Toulouse Purpan University Hospital |
Aziza J.,Toulouse University Hospital Center |
Mahieu L.,Toulouse Purpan University Hospital |
And 7 more authors.
Histopathology | Year: 2015
Aims: To improve the cytological diagnosis of retinal lymphoma on vitreous fluid using improved cell collection and systematic analyses. Methods and results: Since October 2010, we have developed and optimized in our department a method with which to perform the diagnosis of retinal lymphoma. The vitreous sample was collected in a tube containing RPMI-1640 medium, decomplemented fetal bovine serum, and gentamicin. The transport and technical steps were performed at 4°C. Systematically, cytological examination with May-Grünwald-Giemsa staining and immunocytochemistry (mainly anti-CD3, anti-CD20 and anti-CD68 antibodies) were performed on cytospins. Whenever possible, determination of B-cell clonality, flow cytometry and determination of the interleukin (IL)-10/IL-6 ratio were performed. From October 2010 to June 2013, with this optimized protocol, 38 vitreous cytological samples from 32 patients were analysed, and a final diagnosis was possible, avoiding a biopsy, in all cases except one. Conclusion: The preservation of vitreous fluid cells on culture medium led to the diagnosis of retinal lymphoma in 10 of 12 cases, and exclusion of this diagnosis in 26 cases. This protocol may be applied even when the delay in shipping from the surgery to the pathology departments exceeds 1 h. © 2014 John Wiley & Sons Ltd.
PubMed | Toulouse University Hospital Center, Toulouse Purpan University Hospital and University of Lyon
Type: Journal Article | Journal: Histopathology | Year: 2015
To improve the cytological diagnosis of retinal lymphoma on vitreous fluid using improved cell collection and systematic analyses.Since October 2010, we have developed and optimized in our department a method with which to perform the diagnosis of retinal lymphoma. The vitreous sample was collected in a tube containing RPMI-1640 medium, decomplemented fetal bovine serum, and gentamicin. The transport and technical steps were performed at 4C. Systematically, cytological examination with May-Grnwald-Giemsa staining and immunocytochemistry (mainly anti-CD3, anti-CD20 and anti-CD68 antibodies) were performed on cytospins. Whenever possible, determination of B-cell clonality, flow cytometry and determination of the interleukin (IL)-10/IL-6 ratio were performed. From October 2010 to June 2013, with this optimized protocol, 38 vitreous cytological samples from 32 patients were analysed, and a final diagnosis was possible, avoiding a biopsy, in all cases except one.The preservation of vitreous fluid cells on culture medium led to the diagnosis of retinal lymphoma in 10 of 12 cases, and exclusion of this diagnosis in 26 cases. This protocol may be applied even when the delay in shipping from the surgery to the pathology departments exceeds 1h.
Pauwels C.,University Paul Sabatier |
Bulai Livideanu C.,University Paul Sabatier |
Maza A.,University Paul Sabatier |
Lamant L.,Toulouse Purpan University Hospital |
Paul C.,University Paul Sabatier
Dermatology | Year: 2011
Cytophagic histiocytic panniculitis (CHP) is a rare disease mostly caused by viral infections and/or lymphoproliferative diseases. We describe a case of CHP associated with H1N1 vaccine during the winter 2009-2010 vaccination campaign and discuss the cutaneous side effects of influenza vaccines. A 6-year-old child presented with inflammatory subcutaneous nodules, which had appeared 1 month after the first injection of H1N1 vaccine and 1 week after the second injection. There was no history of recent infection. The skin lesions spontaneously disappeared without scarring. In CHP the abnormal cytokine secretion from neoplastic or reactive T cells promotes monocyte-macrophage activation and haemophagocytosis. Vaccination is not a common cause of CHP, but it seems possible that, as in infectious diseases, reactive T cells to the vaccine antigen could trigger CHP. © 2011 S. Karger AG, Basel.
Wagner T.,Toulouse Purpan University Hospital |
Meyer N.,University Paul Sabatier |
Zerdoud S.,Institute Claudius Regaud |
Julian A.,Toulouse Purpan University Hospital |
And 3 more authors.
British Journal of Dermatology | Year: 2011
Background Positron emission tomography (PET) using fluorodeoxyglucose (FDG) has proven to be more sensitive and accurate than other imaging modalities for the detection of distant metastases in patients with melanoma. Sentinel lymph node (SLN) status is the most important prognostic factor in melanoma patients with no evidence of distant metastasis. Objectives To assess the rate of distant metastases in patients with a positive SLN biopsy (SLNB). Methods Forty-six consecutive patients with a positive SLNB underwent PET or PET-computed tomography within 6 weeks of the SLNB procedure. The patients did not present any clinical sign of nodal involvement or of distant metastasis. PET findings were classified as positive, negative or nonconclusive. Results No patient had a positive PET scan for distant metastasis. Six patients (13%) had a nonconclusive PET scan; none of them presented distant metastasis within 12 months. Forty patients (87%) had a negative PET scan; among them five (12%) presented with distant metastasis within 12 months. Conclusions Fluorodeoxyglucose positron emission tomography failed to detect distant metastases at initial staging in patients with a positive SLNB, even in patients who presented with distant metastases within 12 months after the FDG PET scan. These results could be explained by the low prevalence of macroscopic metastatic disease at this stage and by the important delay between the onset of the spread of microscopic metastatic disease and the identification by PET scan of macroscopic metastatic disease. © 2011 The Authors. BJD © 2011 British Association of Dermatologists.
Chemama B.,Toulouse Purpan University hospital |
Bonnevialle N.,Toulouse Purpan University hospital |
Peter O.,Toulouse Purpan University hospital |
Mansat P.,Toulouse Purpan University hospital |
Bonnevialle P.,Toulouse Purpan University hospital
Orthopaedics and Traumatology: Surgery and Research | Year: 2010
Introduction: Dislocation of the elbow joint combined with fractures of the radial head and ulnar coronoid process is referred to as Terrible Triad Injury (TTI). The purpose of this study is to report our experience in the management of this specific injury and to validate the therapeutic choices of our treatment. Material and methods: Between 1996 and 2006, 23 TTI in 22 patients were treated in our department. Fifteen males and seven females of mean age 46 years were included in this series. Internal fixation of the radial head was performed in 13 cases and arthroplasty in four. Fractures of the coronoid process were managed by surgical fixation in 10 cases. All torn ligaments were reconstructed which include 19 lateral and six medial ligament reconstructions. Results: Thirteen patients (14 elbows) were reviewed at a mean follow-up of 63 months, four patients at a mean follow-up of 11 month (range, 6 to 18 months), and five patients were lost to follow-up. All patients had stable elbow joint and in 90% of the cases, patients reported mild or no elbow pain. The arc of extension-flexion ranged from 18 to 127°, while the average arc of pronation-supination was 134°. The mean Mayo Elbow Performance Score was 87. Only one patient suffered from osteoarthritis 8 years after trauma and all elbows were centred on X-rays. Negative prognosis factor was associated with Mason type 3 radial head fractures. Discussion and conclusion: The principle of the surgical management is based on two main objectives: restoration of bony stabilizing structures (radial head and coronoid process) and lateral collateral ligament reconstruction. A medial surgical approach is recommended in the case of persistent posterolateral instability following lateral collateral ligament reconstruction or when fixation of a large coronoid process fragment is indicated. The use of an external fixator is only advocated in case of persistent instability following the reconstruction of bony and ligamentous structures. Level of evidence: Level IV: Retrospective study. © 2010 Elsevier Masson SAS. All rights reserved.
PubMed | Toulouse Purpan University Hospital
Type: Journal Article | Journal: Diagnostic and interventional imaging | Year: 2016
Magnetic resonance imaging has now an indisputable role for the diagnosis of meniscus and ligament injuries of the knee. Some technical advances have improved the diagnostic capabilities of magnetic resonance imaging so that diagnoses, which may change the therapeutic approach, such as a partial tear of the anterior cruciate ligament or confirmation of unstable meniscal injuries, are now made easier. This article describes the essential about magnetic resonance imaging technique and pathological results for the menisci, collateral ligaments and damage to the central pivot of the cruciate knee ligaments.