1: Ann Fr Anesth Reanim. 2009 Jul 31. [Epub ahead of print]
[Amniotic fluid embolism during curettage for a pregnancy arrest. Case report.]
[Article in French]
Fekhkhar K, Rachet B, Gillet R, Provost D, Lalo JP, Rieu M, Compère V, Roussel F,
Marpeau L, Dureuil B.
Département d'anesthésie-réanimation chirurgicale, CHU Charles-Nicolle, 1, rue de
Germont, 76031 Rouen cedex, France; Service de gynécologie et d'obstétrique, CHU
Charles-Nicolle, 1, rue de Germont, 76031 Rouen cedex, France; Service d'anatomie
et cytologie pathologiques, CHU Charles-Nicolle, 1, rue de Germont, 76031 Rouen
cedex, France.
Amniotic fluid embolism is always a serious complication during the peripartum
period. We report the case of an amniotic fluid embolism during curettage for a
pregnancy arrest at 13 weeks. The diagnosis was confirmed by the presence of
epithelial cells into the maternal blood.
PMID: 19647976 [PubMed - as supplied by publisher]
2: Urology. 2009 Jul 29. [Epub ahead of print]
Ineffectiveness of Associating a Suburethral Tape to a Transobturator Mesh for
Cystocele Correction on Concomitant Stress Urinary Incontinence.
Sergent F, Gay-Crosier G, Bisson V, Resch B, Verspyck E, Marpeau L.
Department of Gynaecology and Obstetrics, Rouen University Hospital, University
of Rouen, Rouen, France; Laboratoire Polymeres Biopolymeres Surfaces, INSA-ROUEN,
Mont-Saint-Aignan, France.
OBJECTIVES: To evaluate the effect of a transobturator subvesical mesh for
cystocele on concomitant stress urinary incontinence (SUI). Genital and urinary
prolapse surgery presents difficulties, particularly regarding cure of SUI.
Advances in vaginal prosthetic surgery could correct these difficulties. METHODS:
Between July 2003 and October 2007, a total of 74 patients with a minimum stage 2
anterior prolapse with concomitant SUI were operated on, using a porcine
collagen-coated large-pore-size monofilament polypropylene mesh with 2
transobturator expansions, but without an additional procedure for SUI. All
patients had a physical examination and a subjective symptoms assessment using a
questionnaire in the preoperative period and again 6 weeks, 6 months, and then
each year after surgery. The pelvic organ prolapse quantification system was used
for anatomic results. For SUI, Ingelman-Sundberg classification and cough test
were used. Loss of urine was measured by a 1-hour pad test. Functional results
were evaluated by visual analog scale, pelvic floor distress inventory, and
pelvic floor impact questionnaire. RESULTS: Median follow-up was 36 months (range
12-51). Seventy-two women (97%) were cured of their prolapse. A total of 53 women
(72%) were cured of their SUI and 11 (15%) were improved. Pad test, visual analog
scale, pelvic floor distress inventory, and pelvic floor impact questionnaire all
showed improvement (P <.05). Prolonged bladder catheterization was not required.
Complications consisted of 1 hematoma requiring blood transfusion and 5 vaginal
extrusions (6%). CONCLUSIONS: Transvaginal mono prosthesis for the simultaneous
correction of prolapse and SUI represents an effective treatment without the risk
of prolonged urinary retention.
PMID: 19643459 [PubMed - as supplied by publisher]
3: Intensive Care Med. 2009 Jul 29. [Epub ahead of print]
ICU mechanical ventilators, technological advances vs. user friendliness: the
right picture is worth a thousand numbers.
Richard JC, Kacmarek RM.
Medical Intensive Care Unit, UPRES EA 3830, Rouen University Hospital, Paris,
France.
PMID: 19639301 [PubMed - as supplied by publisher]
4: Acta Neurochir (Wien). 2009 Jul 29. [Epub ahead of print]
Usefulness of multislice computerized tomographic angiography in the
postoperative evaluation of patients with clipped aneurysms.
Gerardin E, Tollard E, Derrey S, Langlois O, Dacher JN, Douvrin F, Freger P,
Proust F.
Department of Neuroradiology, Rouen University Hospital, 1, rue de Germont,
76031, Rouen-cedex, France, emmanuel.gerardin@chu-rouen.fr.
BACKGROUND: The aim of our study was to evaluate the diagnostic efficacy of
multislice computed tomographic angiography (MSCTA) regarding exclusion quality
after aneurysm clipping. METHODS: Sixty patients (74 aneurysms) underwent
microsurgical exclusion using titanium clips. The presence of aneurysm remnants
on MSCTA was compared by a neuroradiologist to 2D digital subtraction angiography
(DSA), which was considered as a reference examination. The contribution of 3D
DSA was assessed in a subpopulation of 29 patients (35 aneurysms). RESULTS: With
2D DSA, six aneurysm remnants (8%) were diagnosed, and only five (7%) by MSCTA.
The specificity and sensitivity were 98.5 and 83%, respectively. MSCTA failed to
demonstrate one large remnant (>2 mm) because of clip artifacts (six clips). With
3D DSA six supplementary remnants were diagnosed. Two were large remnants blinded
by vessel overlaps and clip artifacts. Four were small "dog-eared" remnants (</=2
mm). No additional treatment was required for small remnants. CONCLUSION: In the
postoperative period, MSCTA was considered a useful tool to evaluate the large
remnants as well as a non-invasive ulterior examination for suspected
bifurcation. Nevertheless, 3D DSA is still required for an accurate evaluation of
aneurysms treated by more than three clips.
PMID: 19639249 [PubMed - as supplied by publisher]
5: J Clin Microbiol. 2009 Jul 22. [Epub ahead of print]
Census and analysis of persistent false-negative diagnoses of HIV-1 group O
infections.
Plantier JC, Djemai M, Lemée V, Reggiani A, Leoz M, Burc L, Vessière A, Rousset
D, Poveda JD, Henquell C, Gautheret-Dejean A, Barin F.
Laboratoire associé au Centre National de Référence du VIH, Centre Hospitalier
Universitaire de Rouen & EA2656, Université de Rouen, France; Unité de
Réactovigilance, Département des Vigilances, Direction de l'Evaluation des
Dispositifs Médicaux, AFSSAPS, Saint Denis, France; Laboratoire de Virologie,
Centre Pasteur du Cameroun, Yaoundé, Cameroun; Laboratoire Pasteur-Cerba,
Cergy-Pontoise, France; Laboratoire de Virologie, Chu de Clermont-Ferrand,
France; Service de Virologie, hôpital de la Pitié-Salpêtrière, AP-HP, Paris;
Centre National de Référence du VIH, Inserm U966, Université François Rabelais et
CHU Bretonneau, Tours, France.
Human immunodeficiency viruses (HIV) have a high level of genetic diversity. The
outlier variants of HIV-1 group O are distantly related to HIV-1 group M. Their
divergence has an impact on serological diagnosis, with a risk of false-negative
results. In this study, we report 20 failure cases, in patients with primary or
chronic infection, in France and Cameroon, between 2001 and 2008. Our results
indicate that some assays detected group O infection much less efficiently than
others. Two major reasons for these false-negative results were identified: the
presence or absence of a group O-specific antigen (and the designed sequence) for
the detection of antibodies and the greater envelope variability of group O than
of group M strains. This study highlights the complexity of screening for these
divergent variants, and the need to evaluate test performances with a large panel
of strains, due to the extensive diversity of group O variants.
PMID: 19625478 [PubMed - as supplied by publisher]
6: J Med Genet. 2009 Jul 9. [Epub ahead of print]
MEF2C haploinsufficiency caused either by microdeletion of the 5q14.3 region or
mutation is responsible for severe mental retardation with stereotypic movements,
epilepsy and/or cerebral malformations.
Le Meur N, Holder-Espinasse M, Jaillard S, Goldenberg A, Joriot S, Amati-Bonneau
P, Guichet A, Barth M, Charollais A, Journel H, Auvin S, Boucher C, Kerckaert JP,
David V, Manouvrier-Hanu S, Saugier-Veber P, Frébourg T, Dubourg C, Andrieux J,
Bonneau D.
Génétique, CHU de Rouen and EFS Normandie, France.
Over the last few years, array-CGH has remarkably improved the ability to detect
cryptic unbalanced rearrangements in patients presenting with syndromic mental
retardation. Using whole genome oligonucleotide array-CGH, we detected 5q14.3
microdeletions ranging from 216 kb to 8.8 Mb in 5 unrelated patients showing
phenotypic similarities, namely severe mental retardation with absent speech,
hypotonia and stereotypic movements. Most of the patients presented also with
facial dysmorphic features, epilepsy and/or cerebral malformations. The minimal
common deleted region of these 5q14 microdeletions encompassed only MEF2C, known
to act in brain as a neurogenesis effector which regulates excitatory synapse
number. In a patient presenting a similar phenotype, we subsequently identified a
MEF2C nonsense mutation. Taken together, these results strongly suggest that
haploinsufficiency of MEF2C is responsible for severe mental retardation with
stereotypic movements, seizures and/or cerebral malformations.
PMID: 19592390 [PubMed - as supplied by publisher]
7: Ann Fr Anesth Reanim. 2009 Jul-Aug;28(7-8):704-5. Epub 2009 Jul 9.
[False capillary hyperglycaemia and true iatrogenic postoperative hypoglycaemia.]
[Article in French]
Marguerite C, Provost D, Compère V, Jean J, Dureuil B.
Département d'anesthésie-réanimation chirurgicale, CHU Charles-Nicolle, 1, rue de
Germont, 76031 Rouen, France.
We describe a case-report of a 64-year-old woman who presented an acute
iatrogenic hypoglycaemia after gynecological surgery. An inadequate keeping of
Dextrostix led to wrong hyperglycaemia measurement and inappropriate insulin
administration. The mistake was treated with complete recovery.
Publication Types:
English Abstract
PMID: 19592199 [PubMed - in process]
8: Neurochirurgie. 2009 Jul 8. [Epub ahead of print]
[Severe orthostatic hypotension and intramedullary tumor: A case report and
review of the literature.]
[Article in French]
Derrey S, Maltête D, Ahtoy P, Fregey P, Proust F.
Service de neurochirurgie, CHU Charles-Nicolle, 1, rue de Germont, 76031 Rouen
cedex 1, France.
A 55-year-old woman presented with bilateral neuropathic pain of the upper limbs,
motor palsy of the right arm, urinary dysfunction, and postural dizziness. MRI
showed an intramedullary cervical tumor with a solid portion extended from C1 to
C3 surrounded by a cystic portion. A macroscopic complete resection was performed
and histological examination confirmed the diagnosis of ependymoma.
Postoperatively, the patient's neuropathic pain and postural dizziness worsened,
with syncopal attack while upright because of severe orthostatic hypotension
(OH). On physical examination, her supine systolic blood pressure was 130 mmHg
and fell to 80 mmHg while sitting with no change in heart rate. We found motor
palsy of the left arm, bilateral ataxia, and urinary retention. Three months
later, the patient was still bedridden, notably because of the OH. After 6
months, with the association of preventative measures of OH and high doses of a
direct alpha1-adrenoreceptor agonist, a vasoconstricting agent, the patient
recovered an independent gait permitting her to walk unassisted. The main causes
of OH include medication, nonneurogenic causes such as cardiac insufficiency, and
central or peripheral neurogenic causes such as diabetic insufficiency. Brainstem
tumors are known to provide severe OH but this symptom has been seldom described
in a purely spinal cord lesion. We report an interesting case of severe OH that
had complicated the surgical treatment of a high cervical spinal cord ependymoma
and we review the literature.
PMID: 19592056 [PubMed - as supplied by publisher]
9: Neurochirurgie. 2009 Jul 4. [Epub ahead of print]
[Polyostotic fibrous dysplasia of the thoracic spine. A case study and review of
the literature.]
[Article in French]
Ould Slimane M, Foulongne E, Derrey S, Fréger P, Proust F.
Service de neurochirurgie, CHU de Rouen, 1, avenue de Germont, 76031 Rouen cedex,
France.
Polyostotic fibrous dysplasia of the thoracic spine is extremely rare and
considered a benign disease. We report the case of a 46-year-old woman admitted
to the emergency department for subacute paraplegia. The spinal X-ray showed a
spontaneous fracture at the T4-T5 level. The CT scan revealed a tumor
infiltration of the vertebral body responsible for lysis. Spinal MRI confirmed
the neoplasia also located in the epidural space with spinal cord compression.
The patient underwent an emergency laminectomy associated with transpedicular
screw fixation between the T2 and T6 levels. At 2 months, she had evolved to a
normal gait. In the second session, a transthoracic approach was used for a
bone-graft-assisted fusion procedure to achieve long-term stabilization. At 4
years, the bone fusion was excellent and the patient was able to resume
socioprofessional activities. The diagnosis of fibrous dysplasia is usually made
histologically on surgical biopsy but MRI and CT scan sometimes provide a
preliminary indication. Although a consensus for management of this disease has
not been achieved, the authors recommend radical removal of all involved tissues
accompanied by internal fixation and bone-graft-assisted fusion.
PMID: 19577779 [PubMed - as supplied by publisher]
10: Ann Fr Anesth Reanim. 2009 Jul-Aug;28(7-8):625. Epub 2009 Jul 1.
[The annual congress of Adarpef.]
[Article in French]
Courrèges P, Laudenbach V.
Service de pédiatrie néonatale et réanimation, 1, rue de Germont, 76031 Rouen
cedex, France.
Publication Types:
Editorial
PMID: 19574020 [PubMed - in process]
11: Inflamm Bowel Dis. 2009 Jul 1. [Epub ahead of print]
Potential for amino acids supplementation during inflammatory bowel diseases.
Coëffier M, Marion-Letellier R, Déchelotte P.
Appareil Digestif Environnement Nutrition (ADEN EA4311), Institute for Biomedical
Research, European Institute for Peptide Research (IFRMP 23), Rouen University
and Rouen University Hospital, Rouen, France.
: The pathophysiology of inflammatory bowel diseases (IBDs) is multifactorial and
involves interactions of gut luminal content with mucosal barrier and especially
immune cells. Malnutrition is a frequent issue during IBD flares, especially in
Crohn's disease (CD) patients, and nutritional support is frequently used to
treat malnutrition but also in an attempt to modulate intestinal inflammation.
The use of oral or enteral nutrition intervention in IBDs may be effective, alone
or in combination with drugs, to achieve and maintain remission. However,
standard diets are less effective than new-generation biotherapies and could be
improved by supplementation with specific immunomodulatory amino acids.
Experimental studies evaluating glutamine, the preferential substrate for
enterocytes, are promising. Some clinical studies with oral glutamine in CD are
until now disappointing, but new formulations and targeting could enhance
glutamine efficacy at the site of mucosal lesions. The role of arginine, involved
in nitric oxide and polyamines synthesis, still remains debated. However, the
effects of these amino acids in IBD have been poorly documented in humans. Other
candidates like glycine, cysteine, histidine, or taurine should also be evaluated
in the future. Inflamm Bowel Dis 2009.
PMID: 19572337 [PubMed - as supplied by publisher]
12: Thromb Haemost. 2009 Jul;102(1):131-6.
Rare genotypes of protein Z gene are a risk factor for premature myocardial
infarction but not protein Z plasma level.
Le Cam-Duchez V, Soria C, Dit Sollier CB, Borg JY, Coudert M, Montalescot G,
Esposito G, Drouet L, Collet JP.
Unit of Vascular Haemostasis, Rouen University Hospital, Rouen, France.
Veronique.Le-Cam-Duchez@chu-rouen.fr
Protein Z (PZ) is the cofactor of PZ dependent inhibitor (ZPI) that inhibits
activated coagulation factor X. PZ was expected to play a role in coronary artery
disease (CAD) but with inconsistent clinical findings. We therefore evaluated
whether PZ plasma level and/or three genetic variants encoding for low PZ plasma
level were associated with premature CAD in stable young post-myocardial
infarction (MI) patients. PZ plasma level and three polymorphisms A-13G, G-103A
and G79A were determined in 176 young stable post-MI patients and in 176 sex- and
age-matched controls (FITE-NAT population). Moreover the genotypes, resulting
from the combination of the three polymorphisms (A-13G/G-103A/G79A), were
studied. PZ plasma level and the number of patients disclosing a PZ deficiency
did not differ between post-MI patients and controls. The presence of the mutated
allele for each polymorphism was associated with a significantly reduced level of
PZ. The A-13G polymorphism was associated with premature CAD only in univariate
analysis. Whereas, the presence of rare genotypes of PZ gene was an independent
risk factor for premature CAD. In conclusion, PZ plasma level is not a key player
in the pathophysiology of premature coronary artery disease. But, rare genotypes
of PZ gene were found to be associated with premature CAD.
PMID: 19572077 [PubMed - in process]
13: Joint Bone Spine. 2009 Jul;76(4):343-9. Epub 2009 Jun 12.
Diagnostic and prognostic usefulness of antibodies to citrullinated peptides.
Goëb V, Jouen F, Gilbert D, Le Loët X, Tron F, Vittecoq O.
Service de Rhumatologie, Institut de Recherche Biomédicale, CHU-Hôpitaux de
Rouen, France. goebvince@yahoo.fr
The diagnosis of rheumatoid arthritis (RA) must be made early, because prompt
initiation of treatments tailored to disease activity is crucial to improve
structural and functional outcomes. Anti-citrullinated peptide antibodies (ACPAs)
are well-established diagnostic markers for RA and should be included in the
classification criteria. Here, we describe the main tests for detecting ACPAs and
we underline the diagnostic and prognostic usefulness of ACPAs in patients with
RA. The presence of ACPAs predicts poorer functional and structural outcomes, and
ACPA titers respond to some of the medications used in RA. Therefore, ACPA titers
should be determined at regular intervals throughout follow-up.
PMID: 19524474 [PubMed - in process]
14: Colorectal Dis. 2009 Jul;11(6):572-83. Epub 2009 Apr 15.
Sacral nerve stimulation in faecal incontinence: position statement based on a
collective experience.
Leroi AM, Damon H, Faucheron JL, Lehur PA, Siproudhis L, Slim K, Barbieux JP,
Barth X, Borie F, Bresler L, Desfourneaux V, Goudet P, Huten N, Lebreton G,
Mathieu P, Meurette G, Mathonnet M, Mion F, Orsoni P, Parc Y, Portier G, Rullier
E, Sielezneff I, Zerbib F, Michot F; Club NEMO.
ADEN EA 3234/IFRMP 23, Faculté de Médecine de Rouen, France.
anne-marie.leroi@chu-rouen.fr
OBJECTIVE: Since the first paper published by Matzel et al., in 1995, on the
efficacy of sacral nerve stimulation (SNS) in patients with faecal incontinence,
the indications, the contraindications, the stimulation technique and follow up
of implanted patients have changed. The aim of this article was to provide a
consensus opinion on the management of patients with faecal incontinence treated
with SNS. METHOD: Recommendations were based on a critical review of the
literature when available and on expert opinions in areas with insufficient
evidence. RESULTS: We have reviewed the indications and contraindications,
proposed an algorithm for patient management showing the place of SNS. The
temporary test technique, the implantation technique, the patient follow up and
the approach in case of treatment failure were discussed. CONCLUSION: We hope not
only to provide a guide on patient management to clinical practitioners
interested in SNS but also to harmonize our practices.
PMID: 19508514 [PubMed - in process]
15: Int J Gynecol Pathol. 2009 Jul;28(4):367-71.
Oligodendroglioma arising in an ovarian mature cystic teratoma.
Opris I, Ducrotoy V, Bossut J, Lamy A, Sabourin JC.
Department of Pathology, Rouen University Hospital, Mont-Saint-Aignan, France.
SUMMARY: We describe a case of oligodendroglioma arising in an ovarian mature
cystic teratoma associated with a loss of heterozygosity on the long arm of
chromosomes 19 and 10. To our knowledge it is the second case reported in the
literature at this site and the first one described in association with a
characterized genetic alteration. The patient was 29 years old and presented with
a history of 4 months of pelvic pain. Ultrasound examination showed a cystic mass
arising in the left adnexa suggesting a teratoma. At laparotomy a cystic ovoid
mass was found arising from the left adnexa, completely replacing the ovary. An
ovariectomy was performed. Macroscopically a multilocular cyst containing hair,
sebum, and a relatively well-defined solid zone of grayish-pink color strongly
suggestive of a cerebral tissue, was observed. Microscopic analyses confirmed the
teratomatous nature of the cyst. The solid area was composed of mature glial
tissue in which was observed a proliferation of monotonous cells with round and
homogenous nuclei, surrounded by a clear halo of cytoplasm ("honeycomb
appearance") which immunohistochemically showed positivity for glial fibrilar
acidic protein and for neurofilament protein. Ki-67 labeling index was about 3%.
These findings were consistent with a low-grade oligodendroglioma arising in a
mature ovarian cystic teratoma. Reverse transcription-polymerase chain reaction
analysis showed a characterized loss of heterozygosity occurring in tumor DNA on
chromosomes 10q and 19q13.
PMID: 19483626 [PubMed - in process]
16: Am J Pathol. 2009 Jul;175(1):46-53. Epub 2009 May 28.
Novel serum markers of fibrosis progression for the follow-up of hepatitis C
virus-infected patients.
Caillot F, Hiron M, Goria O, Gueudin M, Francois A, Scotte M, Daveau M, Salier
JP.
Inserm Unité 905, Faculté de Médecine-Pharmacie, Rouen cedex, France.
frederique.caillot@etu.univ-rouen.fr
Liver biopsy is considered the gold-standard method for the assessment of liver
fibrosis during follow-up of hepatitis C virus-infected patients, but this
invasive procedure is not devoid of complications. The aim of the present study
was to identify novel non-invasive markers of fibrosis progression. By microarray
analysis, we compared transcript levels in two extreme stages of fibrosis from 16
patients. Informative transcripts were validated by real-time PCR and used for
the assessment of fibrosis in 23 additional patients. Sixteen transcripts were
found to be dysregulated during the fibrogenesis process. Among them, some were
of great interest because their corresponding proteins could be serologically
measured. Thus, the protein levels of inter-alpha inhibitor H1, serpin peptidase
inhibitor clade F member 2, and transthyretin were all significantly different
according to the four Metavir stages of fibrosis. In conclusion, we report here
that dysregulation, at both the transcriptional and protein levels, exists during
the fibrogenesis process. Our description of three novel serum markers and their
potential use as serological tests for the non-invasive diagnosis of liver
fibrosis open new opportunities for better follow-up of hepatitis C
virus-infected patients.
Publication Types:
Research Support, Non-U.S. Gov't
PMID: 19477948 [PubMed - indexed for MEDLINE]
17: Arch Pediatr. 2009 Jul;16(7):1071-1072. Epub 2009 May 6.
[Neuromotor outcome at 2 years of age in children born between 27 and 32 GW with
periventricular leukomalacia. Retrospective 11-year study at the Rouen University
Hospital.]
[Article in French]
Gobalakichenane P, Labarre A, Mons F, Galène-Gromez S, Laudenbach V, Marret S; le
Réseau périnatalité de Haute-Normandie.
Service de pédiatrie néonatale et réanimation, CHU de Rouen, 1, rue de Germont,
76031 Rouen cedex, France; EA 4309 endothélium microvasculaire et lésions
cérébrales néonatales, institut hospitalo-universitaire de recherche biomédicale,
université de Rouen, boulevard Gambetta, 76031 Rouen cedex, France.
Publication Types:
LETTER
PMID: 19423304 [PubMed - as supplied by publisher]
18: Presse Med. 2009 Jul-Aug;38(7-8):1056-61. Epub 2009 May 6.
[Reliability of a bibliometric tool used in France for hospital founding]
[Article in French]
Darmoni SJ, Ladner J, Devos P, Gehanno JF.
CISMeF, CHU de Rouen & GCSIS, TIBS, LITIS EA 4108, Université de Rouen, France.
SIGAPS is a bibliometric score that aims at making an inventory, evaluating and
promoting scientific publications of hospitals that perform research. It has
become a major stake in France since it is one of the most important components
of the MERRI (Mission Training, Research, Reference and Innovation) founding of
hospitals. This score is based on the points attributed to the authors of
articles published in journals indexed in Medline, according to the rank of the
authors and the Impact Factor of the journal. OBJECTIVES: to compare the
reliability of the score when applying different way of computing it, and
different weights for the rank or the Impact Factor. MATERIAL AND METHODS: we
computed the scores of all the physicians of a University Hospital, using the
rules that are actually applied at the national level. We then used 4 different
scenarios, with different weight given to the rank of authors or the Impact
Factor. We compared the scores obtained by each author according to the different
scenarios with the Spearman's rank and Pearson's correlation coefficients.
RESULTS: The score is not significantly affected when no points are given to the
fourth authors and above, when the last author get more points or to change the
points according to the Impact Factor of the journal. CONCLUSION: The different
scenarios do not lead to significant changes for the physicians' scores, and
therefore for the cumulated score of the hospital. Despite the well known limits
of bibliometric indicators, the SIGAPS score appears reliable to compare the
hospitals for founding decisions.
Publication Types:
English Abstract
PMID: 19423277 [PubMed - indexed for MEDLINE]
19: Eur J Gastroenterol Hepatol. 2009 Jul;21(7):827-9.
Jaundice revealing a k light chain myeloma because of liver light chain deposits.
Montialoux H, Savoye G, Savoye-Collet C, Ramirez S, François A, Lerebours E,
Goria O.
Department of Hepatogastroenterology, Rouen University Hospital, France.
We report the case of a 77-year-old man referred for jaundice and diagnosed with
intrahepatic light chain deposit as primary manifestation of a kappa light chain
multiple myeloma. Jaundice is a very rare way of presentation for myeloma. In our
observation, diagnosis was made by liver biopsy, which found light chain deposits
infiltrating perisinusoidal spaces. We discuss jaundice's possible mechanisms in
myeloma.
PMID: 19404208 [PubMed - in process]
20: Rheumatology (Oxford). 2009 Jul;48(7):761-4. Epub 2009 Apr 24.
Paradoxical adverse events of anti-tumour necrosis factor therapy for
spondyloarthropathies: a retrospective study.
Fouache D, Goëb V, Massy-Guillemant N, Avenel G, Bacquet-Deschryver H,
Kozyreff-Meurice M, Ménard JF, Muraine M, Savoye G, Le Loët X, Tharasse C,
Vittecoq O.
Department of Pharmacy, University of Medicine-Pharmacy, Rouen University
Hospital and Inserm U905 (IFRMP 23), Institute for Biomedical Research,
University of Rouen, Rouen,France.
OBJECTIVES: Several paradoxical adverse events (PAEs), e.g. IBDs, acute anterior
uveitis (AAU) and psoriasis, have been described in patients taking anti-TNF
drugs. This retrospective study aimed to describe the different PAEs that have
occurred in a population of SpA patients treated with anti-TNF drugs, and to
determine whether they are drug specific. METHODS: Since 2000, we have followed
296 patients with SpA [198 AS, 21 SpA associated with IBD (9 ulcerative colitis,
12 Crohn's disease) and 77 psoriatic arthritis] treated with at least one
anti-TNF drug (infliximab, etanercept or adalimumab), and 112 SpA patients
treated only with conventional DMARDs who served as controls. Considering the
cumulative time of exposure to each anti-TNF agent, the frequencies of new-onset
PAEs in exposed patients were calculated. RESULTS: Respective cumulative exposure
times were 287, 290 and 62 patient-years for infliximab, etanercept and
adalimumab. We observed the following PAEs: five psoriasis (three under
infliximab and one with etanercept or adalimumab), three AAU (1/100
patient-years, all under etanercept) and four IBD (three under etanercept and one
under infliximab). There was no significant association among any of these PAEs
and a specific anti-TNF agent; nor significant difference in the overall PAEs
among patients receiving anti-TNF drugs or controls (P = 0.303), the latter
experiencing two psoriasis and three AAU. CONCLUSIONS: Undesirable side
effects--IBD, AAU and psoriasis--may appear with anti-TNF drugs. Even if they
are, a priori, paradoxical, no evidence supports any PAEs to be anti-TNF
agent-specific in SpA.
PMID: 19395543 [PubMed - in process]
21: J Clin Endocrinol Metab. 2009 Jul;94(7):2406-13. Epub 2009 Apr 21.
The paradoxical increase in cortisol secretion induced by dexamethasone in
primary pigmented nodular adrenocortical disease involves a glucocorticoid
receptor-mediated effect of dexamethasone on protein kinase A catalytic subunits.
Louiset E, Stratakis CA, Perraudin V, Griffin KJ, Libé R, Cabrol S, Fève B, Young
J, Groussin L, Bertherat J, Lefebvre H.
Institut National de la Santé et de la Recherche Médicale, Unité 413, EA4310,
Laboratory of Differentiation and Neuronal and Neuroendocrine Communication,
University of Rouen, Mont Saint Aignan, France.
CONTEXT: Primary pigmented nodular adrenocortical disease (PPNAD) results in most
cases from mutations of the protein kinase A (PKA) regulatory subunit 1A
(PRKAR1A) gene. Patients with PPNAD exhibit a paradoxical increase in cortisol
secretion in response to dexamethasone. OBJECTIVE: The aim was to investigate the
mechanism of the action of dexamethasone on adrenocortical cells removed from
patients with PPNAD and a transgenic model of PPNAD [Tg(tTA/X2AS) mice]. DESIGN
AND SETTING: We performed an in vitro study in an academic research laboratory.
PATIENTS: Eleven patients with histologically proven PPNAD were included in the
study. Intervention: Cultured PPNAD cells were incubated with dexamethasone in
the presence of various modulators of the cAMP/PKA pathway and the glucocorticoid
receptor antagonist RU486. MAIN OUTCOME MEASURE: Cortisol and corticosterone were
measured by radioimmunological assays in cell culture supernatants. Results:
Dexamethasone stimulated in vitro cortisol secretion from PPNAD tissues in six
patients. The stimulatory effect of dexamethasone on cortisol release was not
reduced by the adenylyl cyclase inhibitor SQ22536 or potentiated by the
phosphodiesterase inhibitor IMBX and the cAMP analog 8Br-cAMP. Conversely, the
PKA inhibitor H89 and RU486 inhibited the cortisol response to dexamethasone.
Dexamethasone had no effect on cortisol production from normal human
adrenocortical cells but stimulated corticosteroidogenesis in the presence of
RU486. Similarly, dexamethasone failed to influence corticosterone release by
adrenocortical cells removed from Tg(tTA/X2AS) mice but stimulated
corticosteroidogenesis in the presence of RU 486. CONCLUSIONS: These results
indicate that, in human PPNAD tissues, dexamethasone paradoxically stimulates
cortisol release through a glucocorticoid receptor-mediated effect on PKA
catalytic subunits.
Publication Types:
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
PMID: 19383776 [PubMed - in process]
22: Rev Med Interne. 2009 Jul;30(7):567-72. Epub 2009 Mar 18.
[Anticoagulation clinics for outpatients: a 5-year experience]
[Article in French]
Benhamou Y, Le Cam-Duchez V, Schneller JM, Cailleux N, Magne JC, Soubrane JC,
Borg JY, Lévesque H.
Département de médecine interne, CHU Bois-Guillaume, 147, avenue du
Maréchal-Juin, 7620 Bois-Guillaume, 76031 Rouen cedex, France.
ygal.benhamou@chu-rouen.fr
INTRODUCTION: Anticoagulation clinics and computerized management of chronic oral
anticoagulation increase the time spent in the therapeutic range with both
mortality and morbidity reduction. Usually, anticoagulation clinics are
hospital-based medical care centers. We report the five-year results from a
general medicine center (CSCTA) using a computer-assisted management. METHODS: A
prospective cohort observational study of 530 primary care patients that were
receiving long term oral anticoagulation. RESULTS: Cardiac arrhythmia (55%),
heart valve disease and venous thrombo-embolic disease (30%) represented the most
common indications of oral anticoagulation. Patients received fluindione,
warfarin and acenocoumarol in 80%, 13% and 7%, respectively. The duration of
treatment was at least one year in 54% of the cases, and was at least three years
in 25% of the cases. The rate of patients that were in average within the
therapeutic range (INR 2-3) was 72%, while 12% were under and 16% over the
therapeutic range. Corresponding rates were 82, 17 and 1% respectively for all
anticoagulation targets (INR 1.5-4.5). Twenty-six bleeding events (4.9 per 100
patient-years) and four thrombotic complications (0.75 per 100 patient-years)
occurred. Life-threatening hemorrhage occurred in 1.3 per 100 patient-years.
After the equilibration of the anticoagulation, the average delay of control
between two consecutive INR was 19 days. CONCLUSION: The results obtained with
CSCTA were similar to those reported by other anticoagulation clinics regarding
hemorrhagic complications and time spent in the therapeutic range. In contrast,
thrombotic events were less frequent. Because of the absence of a control group,
a medico-economic analysis could not be performed.
Publication Types:
English Abstract
PMID: 19299042 [PubMed - in process]
23: J Invest Dermatol. 2009 Jul;129(7):1681-7. Epub 2009 Jan 29.
A comparison of two regimens of topical corticosteroids in the treatment of
patients with bullous pemphigoid: a multicenter randomized study.
Joly P, Roujeau JC, Benichou J, Delaporte E, D'Incan M, Dreno B, Bedane C, Sparsa
A, Gorin I, Picard C, Tancrede-Bohin E, Sassolas B, Lok C, Guillaume JC, Doutre
MS, Richard MA, Caux F, Prost C, Plantin P, Chosidow O, Pauwels C, Maillard H,
Saiag P, Descamps V, Chevrant-Breton J, Dereure O, Hellot MF, Esteve E, Bernard
P.
Department of Dermatology, INSERM U901, University of Rouen, Rouen, France.
Pascal.Joly@chu-rouen.fr
Superpotent topical corticosteroids (CS) have been demonstrated to improve
bullous pemphigoid (BP) patients' survival. We assessed whether a mild regimen
using lower doses of topical CS and a shorter duration could improve the outcome
of BP patients even more. Three-hundred and twelve BP patients were included in a
multicenter randomized controlled trial and stratified depending on the extent of
BP as moderate (n=134) or extensive (n=178). Patients were randomly assigned to
the standard regimen (clobetasol propionate cream, 40 g per day initially, with
CS tapering over 12 months) or the mild regimen (10-30 g per day), with CS
tapering over 4 months. A noninferior rate of BP control was obtained with the
mild regimen 156/159 (98%) as compared with the standard regimen 150/150 (100%;
P=0.005). Event-free survival, that is, the combined outcome of deaths and
life-threatening adverse events did not differ between the two treatment groups
(P=0.77). However, upon adjusting through the Cox model for age and Karnofsky
score, a strong beneficial effect of the mild regimen was observed in patients
with moderate BP, with an almost twofold decrease in the risk of death or
life-threatening adverse events relative to the standard regimen (hazard
ratio=0.54; 95% confidence interval, 0.30-0.97; P=0.039). This mild regimen
allows a 70% reduction of the cumulative doses of CS and improves BP patients'
outcome.
Publication Types:
Comparative Study
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
PMID: 19177141 [PubMed - indexed for MEDLINE]
24: Rev Med Interne. 2009 Jul;30(7):613-4. Epub 2008 Oct 7.
[A spurious temporal arteritis]
[Article in French]
Proux A, Druesne L, De Barros A, Chassagne P.
Service de médecine interne gériatrique, CHU de Rouen, 76031 Rouen cedex, France.
PMID: 18842325 [PubMed - in process]
25: Dig Liver Dis. 2009 Jul;41(7):e1-3. Epub 2008 Feb 21.
Unusual iris metastasis from anal cancer: a case report.
Tougeron D, Tougeron-Brousseau B, Nasser Z, Benzerroug M, Lefebure B, Hamidou H,
Michel P, Muraine M.
Department of Hepatogastroenterology, Rouen University Hospital, Rouen, France.
davidtougeron@infonie.fr
We report a case of anal cancer with iris metastasis and summarize the iris
metastasis literature. A 69 years old woman with a history of anal cancer
presented with a visual field loss. Slit lamp examination showed a pink ovular
mass on the iris of the left eye which was typical of iris metastasis. Because of
worse prognosis of metastatic cancer and any ocular complications, the patient
was treated by radiotherapy which allowed a clinical improvement. A review of
medical records was performed to assess the clinical presentation, diagnosis and
treatment. Anal carcinoma can metastasize to the iris. Radiotherapy allows a good
local control of tumour but the prognosis depends on systemic disease which is
generally bad.
PMID: 18294934 [PubMed - in process]
