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Necib S.,Beaujon University Hospital | Necib S.,University Paris Diderot | Tubach F.,University Paris Diderot | Tubach F.,French Institute of Health and Medical Research | And 9 more authors.
Journal of Neurosurgical Anesthesiology | Year: 2014

INTRODUCTION:: Rapid recovery after supratentorial tumors (STT) removal is important. Short-acting anesthetics, such as propofol and remifentanil might favor this objective. The aim of this study was to compare the recovery of 2 Bispectral index (BIS)-guided anesthesia protocols combining sevoflurane-sufentanil (SS) or propofol-remifentanil (PR) administered during craniotomy for STT. MATERIALS AND METHODS:: After IRB approval and written consent, patients scheduled for surgical removal of STT were randomized to receive PR or SS. Anesthesia was adjusted to maintain BIS values between 45 and 55. The primary outcome was the time from discontinuation of anesthetics to extubation. Secondary endpoints were: time to respond to a simple order, and to achieve spontaneous ventilation, agitation score at emergence, postoperative Mini Mental State, postoperative Aldrete score, pain Visual Analogical Score, simplified sedation score, Glasgow Coma Scale, and surgical complications. Statistical analyses were performed using analysis of variance. RESULTS:: Thirty-five and 31 were included in the SS and PR groups, respectively. Times to extubation was not different between the 2 groups (11.8±6.9 vs. 13.0±8.1 min in PR and SS groups, respectively, P=0.577). Although times to achieve an Aldrete score to 10, a Glasgow Coma Scale to 15, and a MMS to 30 significantly were lower in SS group, no significant difference was found when analyzing time course of these 3 factors over the first postoperative day. All other secondary endpoints were not different between the 2 groups. CONCLUSION:: During craniotomy for STT, we could not demonstrate a reduction in the time to extubation when comparing a BIS-guided anesthesia associating PR to a BIS-guided anesthesia associating SS (Clinicatrials.gov identifier: NCT00389883). © 2013 by Lippincott Williams and Wilkins.

Lang P.O.,University of Lausanne | Lang P.O.,Anglia Ruskin University | Brechat P.H.,Paris-Sorbonne University | Vogel T.,University of Strasbourg | And 6 more authors.
European Geriatric Medicine | Year: 2016

To evaluate the efficiency of this structured individualized program in "real life" context and to investigate the association of participation, and regularity and organizational context of participation with socioeconomic status and location from an intermittent work exercise program (IWEP) in seniors, we conducted a longitudinal prospective study in 3 cities in France. The 18-session 9-week IWEP was run on ergometric bicycles. Participants' attitudes and behaviors with respect to IWEP, and quality of life (QoL) were assessed. A total of 232 volunteers (mean age 66.0. ±. 6.5 years) were enrolled. For half, maintaining physical fitness was the main motivation to participate; 15.9% were completely sedentary. The programme adherence was 100%. A significant gain was measured in 92.2% of participants. At baseline, QoL scores were already high. After the IWEP, they were further enhanced of 10.0. ±. 20.0% on average. In multifactorial analysis, none sociodemographic and financial characteristics were found to be linked with gain in performance. Previously sedentary individuals were those who beneficiate the most of the IWEP, and, this, whatever their health and sociodemographic status. Participants living in a northern urban area (Strasbourg) beneficiated the most from the IWEP compared to southern city (Toulouse) and rural district (Baume-les-Dames). Finally the health status did not influence the impact of the IWEP as well as tobacco and alcohol consumption or the quality of food intakes. This real life study confirmed that the IWEP enhanced endurance capacities and QoL in seniors and gives clues about determinants of the gain of endurance capacities in seniors. © 2016 Elsevier Masson SAS and European Union Geriatric Medicine Society.

PubMed | University Hospitals of Besancon and University Paris Diderot
Type: | Journal: European journal of radiology | Year: 2017

To evaluate if the presence/size of a para-umbilical vein (PUV) on computed tomography (CT) are associated with a first esophageal variceal hemorrhage (EVH) in patients with cirrhosis and whether imaging features can help identify patients at increased risk of EVH.From January 2010 to June 2012 patients with cirrhosis who underwent CT and upper gastrointestinal endoscopy within six months were included. The presence/size of PUV was noted. PUV>5mm were considered large (LPUV). Association with a first EVH was searched for, and validated in a prospective cohort of 55 patients.172 patients (113 men, mean 6012 yo) were included. Forty-three patients (25%) experienced a first EVH. LPUV were more frequent in the group without EVH (27% vs. 7%, p=0.005). At multivariate analysis, factors associated with a first EVH were spleen size>135mm (Odd Ratio [OR]=1.32 [95% confident interval [CI] 1.16-1.51], p<0.001), ascites (OR=4.07 [95%CI-1.84-9.01], p=0.001) and small/absent PUV (OR=3.06 [95%CI-1.86-5.05], p<0.001). An imaging score combining these factors was significantly associated with first EVH in the study and the validation cohorts (EVH in 0%, 19%, and 33% when score 0-1, 2-3, and 4-5, respectively).A simple imaging score combining the PUV and spleen size, and the presence of ascites could help to identify cirrhotic patients at high-risk for EVH.

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