Davido B.,Raymond Poincare University Hospital |
Dinh A.,Raymond Poincare University Hospital |
Salomon J.,Institute Pasteur Paris |
Roux A.L.,Paris Ile Of France Ouest University |
And 4 more authors.
Scandinavian Journal of Infectious Diseases | Year: 2013
Background: The treatment of recurrent furunculosis is poorly documented and represents a public health challenge. The medical care of this disease is often disappointing, especially as the disease evolution is uncertain and relapses occur. We report the efficacy and safety of our CMC regimen: skin disinfection (chlorhexidine), local nasal antibiotic (mupirocin), and systemic antibiotic (clindamycin). Methods: Patients attending our institution during the period 2006-2012 for recurrent furunculosis (≥ 4 episodes/y) were enrolled in the study. Clinical and bacteriological data were collected. Staphylococcus aureus colonization was also investigated in close contacts, and carriers were treated. Patients were treated with the CMC regimen: skin disinfection with chlorhexidine for 21 days, nasal mupirocin ointment for 5 days, and oral clindamycin 1800-2400 mg for 21 days. Results: Nineteen patients were included. Their mean age was 36 ± 14.5 y and the male to female sex ratio was 1.1. Screening swabs from all sites were S. aureus-positive in 63% (n = 12), including 4 methicillin-resistant S. aureus (MRSA). Before the CMC regimen, the median time to relapse was 31 days (mean 52 days). The mean number of recurrences was 5.5 ± 2.4/y. After the CMC regimen, among 16 patients who had a complete follow-up, 14 were healed beyond 9 months. Two recurrences occurred, 1 in an MRSA carrier and 1 in a patient with an insufficiently treated dermatosis. No serious side effect occurred that required the cessation of treatment. Conclusions: There are 2 major routes involved in recurrent furunculosis: risk factors and staphylococcal colonization of close contacts. Our procedure is safe and effective, with 87% remission beyond 9 months. It merits testing on larger numbers of participants. © 2013 Informa Healthcare.
Chipaux M.,Paris Observatory |
Chipaux M.,Rothschild |
Szurhaj W.,Paris Observatory |
Szurhaj W.,Lille University of Science and Technology |
And 63 more authors.
Epilepsia | Year: 2016
Objective To obtain perspective on epilepsy in patients referred to tertiary centers in France, and describe etiology, epilepsy syndromes, and identify factors of drug resistance and comorbidities. Methods We performed a cross-sectional analysis of the characteristics of 5,794 pediatric and adult patients with epilepsy included in a collaborative database in France between 2007 and 2013. Comparisons between groups used Student's t-test or Fisher's exact test for binary or categorical variables. Factors associated with drug resistance and intellectual disability were evaluated in multi-adjusted logistic regression models. Results Mean age at inclusion was 17.9 years; children accounted for 67%. Epilepsy was unclassified in 20% of patients, and etiology was unknown in 65%, including those with idiopathic epilepsies. Etiologies differed significantly in adult- when compared to pediatric-onset epilepsy; however, among focal structural epilepsies, mesial temporal lobe epilepsy with hippocampal sclerosis began as often in the pediatric as in adult age range. Drug resistance concerned 53% of 4,210 patients evaluable for seizure control and was highest in progressive myoclonic epilepsy (89%), metabolic diseases (84%), focal cortical dysplasia (70%), other cortical malformations (69%), and mesial temporal lobe epilepsy with hippocampal sclerosis (67%). Fifty-nine percent of patients with focal structural epilepsy and 69% with epileptic encephalopathies were drug resistant; however, 40-50% of patients with West syndrome and epileptic encephalopathy with continuous spike-and-waves during sleep were seizure-free. Ages at onset in infancy and in young adults shared the highest risk of drug resistance. Epilepsy onset in infancy comprised the highest risk of intellectual disability, whereas specific cognitive impairment affected 36% of children with idiopathic focal epilepsy. Significance Our study provides a snapshot on epilepsy in patients referred to tertiary centers and discloses needs for diagnosis and treatment. Large databases help identify patients with rare conditions that could benefit from specific prospective studies. © 2016 International League Against Epilepsy.
PubMed | Charles University and Paris Ile Of France Ouest University
Type: Journal Article | Journal: European journal of trauma and emergency surgery : official publication of the European Trauma Society | Year: 2016
Tibial plateau fractures are efficiently treated using arthroscopy when limited to one condyle. Operative technique and early results are now well documented. However, long term results have not been widely reported. The goal of this study was to evaluate clinical and radiological outcomes of arthroscopically treated tibial plateau fractures in the long term.Fourteen out of thirty consecutive cases have been reviewed after more than 4 years post-op (4 to 8 years). The SF8 quality of life score and both IKS and Rasmussen knee function scores have been quoted. Radiological analysis looked at Resnick and Niwoyama osteoarthritis score.Functional knee scores at follow-up were 28.0 (Rasmussen) and 187.4 (IKS) in average. The average SF8 score was 4.64. The SF8 score did not correlated with Rasmussen and IKS scores, but with age. Radiological signs of osteoarthritis were noted in 50.0% of cases, with no relationships with the clinical status.Comparisons with historical long-term studies regarding open reduction and internal fixation show similar outcomes. No specific secondary degenerative problem would alleviate the advantages of the arthroscopic management of tibial plateau fractures in the early post-operative period.
Liabeuf S.,French Institute of Health and Medical Research |
Liabeuf S.,University of Picardie Jules Verne |
Neirynck N.,Ghent University |
Drueke T.B.,French Institute of Health and Medical Research |
And 3 more authors.
Seminars in Nephrology | Year: 2014
This article summarizes relevant clinical studies that recently were devoted to the role of uremic toxins in outcomes of patients with chronic kidney disease and uremia. We summarize observational data linking uremic toxins (phosphate, the dimethylarginines, uric acid, and several large peptidic middle molecules and protein-bound solutes) to outcomes in observational studies. Interventional studies that evaluate the impact of different removal strategies on uremic toxin concentration in end-stage renal disease are then summarized along with clinical outcome studies with different dialysis strategies. Finally, we focuse on interventions in chronic kidney disease patients who are not yet on dialysis. We conclude that although there are more and more data on how to better remove uremic toxins by dialysis and nondialysis strategies, convincing evidence of the impact of these strategies on hard outcomes is much scarcer. © 2014 Elsevier Inc.
Vervloet M.G.,VU University Amsterdam |
Massy Z.A.,Paris Ile Of France Ouest University |
Massy Z.A.,French Institute of Health and Medical Research |
Brandenburg V.M.,RWTH Aachen |
And 5 more authors.
The Lancet Diabetes and Endocrinology | Year: 2014
Recent reports of several bone-derived substances, some of which have hormonal properties, have shed new light on the bone-cardiovascular axis. Deranged concentrations of humoral factors are not only epidemiologically connected to cardiovascular morbidity and mortality, but can also be causally implicated, especially in chronic kidney disease. FGF23 rises exponentially with advancing chronic kidney disease, seems to reach maladaptive concentrations, and then induces left ventricular hypertrophy, and is possibly implicated in the process of vessel calcification. Sclerostin and DKK1, both secreted mainly by osteocytes, are important Wnt inhibitors and as such can interfere with systems for biological signalling that operate in the vessel wall. Osteocalcin, produced by osteoblasts or released from mineralised bone, interferes with insulin concentrations and sensitivity, and its metabolism is disturbed in kidney disease. These bone-derived humoral factors might place the bone at the centre of cardiovascular disease associated with chronic kidney disease. Most importantly, factors that dictate the regulation of these substances in bone and subsequent secretion into the circulation have not been researched, and could provide entirely new avenues for therapeutic intervention. © 2014 Elsevier Ltd.
PubMed | Institute Mutualiste Montsouris, University Pierre and Marie Curie and Paris Ile Of France Ouest University
Type: | Journal: Spinal cord | Year: 2016
A retrospective observational study.To describe specificities of pregnancy in a traumatic spinal cord-injured (SCI) population managed by a coordinated medical care team involving physical medicine and rehabilitation (PMR) physicians, urologists, infectious diseases physicians, obstetricians and anaesthesiologists.NeuroUrology Department in a University Hospital, France.All consecutive SCI pregnant women managed between 2001 and 2014 were included. A preconceptional consultation was proposed whenever possible. Obstetrical and urological outcomes, delivery mode and complications were reported.Overall, thirty-seven pregnancies in 25 women, of a mean age of 324 years, were included. Thirty-five children were born alive (three miscarriages, a twin pregnancy) without complications except for a case of neonatal respiratory distress in premature twins born at 33 weeks. The mean birth weight was 2979599g. Twenty-one (57%) pregnancies benefited from preconceptional care. A weekly oral cyclic antibiotic programme was prescribed in 28 (75%) pregnancies. The main complications during pregnancy included pyelonephritis (30%), lower urinary tract infections (UTI) (32%), pressure sores (8.8%) and prematurity (12% deliveries before 37 weeks, with only one delivery before 36 weeks). Two patients suffered from autonomic dysreflexia, one with serious complication (brain haematoma). Caesarean sections were performed for 68% of deliveries (23/34) to prevent syringomyelia deterioration (n=10), stress urinary incontinence aggravation (n=3) or for obstetrical reasons (n=7).Mothers and infants outcomes were satisfying after pregnancy in SCI women, but required many adjustments. Pregnancy must be prepared by a preconceptional consultation, and managed by a multidisciplinary team involving specialists of neurological disability and pregnancy.Spinal Cord advance online publication, 27 September 2016; doi:10.1038/sc.2016.138.
Gross P.,French Institute of Health and Medical Research |
Six I.,French Institute of Health and Medical Research |
Kamel S.,French Institute of Health and Medical Research |
Kamel S.,Amiens University Medical Center |
And 2 more authors.
Circulation Journal | Year: 2014
Chronic kidney disease (CKD) is characterized by high cardiovascular morbidity/mortality, which is linked in part to vascular calcification (VC) and endothelial dysfunction (ED). Hyperphosphatemia, a feature of CKD, is a well-known inducer of VC in preclinical models and is associated with poor outcomes in epidemiological studies. However, it remains to be seen whether lowering phosphate levels in CKD patients reduces VC and the morbidity/mortality rate. Furthermore, it is now clear from preclinical and clinical studies that phosphate is involved in ED. The present article reviews the direct and indirect mechanisms (eg, via fibroblast growth factor 23 and/or parathyroid hormone) by which hyperphosphatemia influence the onset of VC and ED in CKD. © Japanese Circulation Society. All rights reserved.
Bover J.,Fundacio Puigvert |
Evenepoel P.,University Hospitals |
Urena-Torres P.,Clinique du Landy |
Urena-Torres P.,University of Paris Descartes |
And 8 more authors.
Nephrology Dialysis Transplantation | Year: 2015
It is increasingly acknowledged that mineral and bone disorders (MBDs) contribute to the excessively high cardiovascular (CV) disease morbidity and mortality observed in patients with chronic kidney disease (CKD). There is ongoing debate as to whether screening for CV calcification, one of the hallmarks of CKD-MBD, should be implemented in clinical practice in patients with CKD. Issues to be considered in this controversy relate to prevalence, severity, relevance, and last but not least, modifiability and reversibility of vascular and valvular calcifications in the setting of CKD. The recent expansion of the armamentarium to treat CKD-MBD (calcium-free phosphate binders and calcimimetics) creates new opportunities. Mounting experimental and clinical evidence indicates that progression of CV calcification may indeed be attenuated. Whether this will translate into better outcomes remains to be proven. We acknowledge that hard outcome data so far are limited and, overall, yielded inconclusive results. Nevertheless, in an era in which personalized medicine has gained much popularity, we consider it reasonable, awaiting the results of additional studies, to screen for CV calcification in selected individuals. This policy may help to stratify CV risk and to guide therapy. We speculate that such an approach will ultimately improve outcomes and reduce health costs. © © The Author 2015. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.
Goldsmith D.J.A.,Guys and St Thomas Hospitals |
Massy Z.A.,Paris Ile Of France Ouest University |
Massy Z.A.,French Institute of Health and Medical Research |
Brandenburg V.,RWTH Aachen
Seminars in Nephrology | Year: 2014
Vitamin D is of paramount importance to skeletal development, integrity and health. Vitamin D homeostatis is typically deranged in a number of chronic conditions, of which chronic kidney disease is one of the most important. The use of vitamin D based therapy to target secondary hyperparathyroidism is now several decades old, and there is a large body of clinical practice, experience, guidelines and research to underpin this. However, there are many unknowns, of significant clinical relevance. Amongst which is what "species" of vitamin D we should be using, in what patient, and, under what conditions. Sadly, there has been a real dearth of randomised controlled trials, and trials with outputs of clinical relevance, which means our clinical practice has not developed and refined adequately ove the last 4 decades. This article will discuss the vexed but critical questions of which vitamin D therapies might suit which kidney patients, and will high-light the many important clinical questions which urgently require answering. © 2014 Published by Elsevier Inc.
Dinh A.,Paris Ile Of France Ouest University
Spinal Cord | Year: 2016
Study design:A retrospective observational study.Objective:To describe specificities of pregnancy in a traumatic spinal cord-injured (SCI) population managed by a coordinated medical care team involving physical medicine and rehabilitation (PMR) physicians, urologists, infectious diseases' physicians, obstetricians and anaesthesiologists.Setting:NeuroUrology Department in a University Hospital, France.Methods:All consecutive SCI pregnant women managed between 2001 and 2014 were included. A preconceptional consultation was proposed whenever possible. Obstetrical and urological outcomes, delivery mode and complications were reported.Results:Overall, thirty-seven pregnancies in 25 women, of a mean age of 32±4 years, were included. Thirty-five children were born alive (three miscarriages, a twin pregnancy) without complications except for a case of neonatal respiratory distress in premature twins born at 33 weeks. The mean birth weight was 2979±599 g. Twenty-one (57%) pregnancies benefited from preconceptional care. A weekly oral cyclic antibiotic programme was prescribed in 28 (75%) pregnancies. The main complications during pregnancy included pyelonephritis (30%), lower urinary tract infections (UTI) (32%), pressure sores (8.8%) and prematurity (12% deliveries before 37 weeks, with only one delivery before 36 weeks). Two patients suffered from autonomic dysreflexia, one with serious complication (brain haematoma). Caesarean sections were performed for 68% of deliveries (23/34) to prevent syringomyelia deterioration (n=10), stress urinary incontinence aggravation (n=3) or for obstetrical reasons (n=7).Conclusions:Mothers’ and infants’ outcomes were satisfying after pregnancy in SCI women, but required many adjustments. Pregnancy must be prepared by a preconceptional consultation, and managed by a multidisciplinary team involving specialists of neurological disability and pregnancy.Spinal Cord advance online publication, 27 September 2016; doi:10.1038/sc.2016.138. © 2016 International Spinal Cord Society