1: Gastroenterol Clin Biol. 2009 Aug 28. [Epub ahead of print]
[Gastroentérologie clinique et biologique: A century's history of digestive
system diseases.]
[Article in French]
Hecketsweiler P, Frexinos J.
Département des maladies de l'appareil digestif et de la nutrition, CHU de Rouen,
1, rue de Germont, 76031 Rouen cedex, France.
The journal Gastroentérologie clinique et biologique succeded to Archives des
maladies de l'appareil digestif published since 1907 and is one of the world's
oldest journals in gastroenterology. Gastroentérologie Clinique et Biologique was
created as the discipline was emerging, benefiting from new techniques such as
nasogastric intubation, coprologic examinations, the first images from
gastrointestinal radiology, as well as the enormous progress made in
gastrointestinal surgery. The journal was founded by Albert Mathieu, a remarkable
chef d'école at Paris's Saint-Antoine Hospital. The journal showed rapid success,
becoming the official organ of several learned societies, in particular the
French National Society of Gastroenterology (Société nationale française de
gastroentérologie [SNFGE]). Thoroughly updated in the 1970s, Gastroentérologie
clinique et biologique has never ceased to evolve, adapting to technical and
scientific upheavals, the globalization of knowledge, and the domination of the
English language.
PMID: 19717255 [PubMed - as supplied by publisher]
2: Arthritis Rheum. 2009 Aug 27;60(9):2847. [Epub ahead of print]
Clinical images: Muscle sarcoidosis demonstrated on positron emission tomography.
Marie I, Josse S, Lahaxe L, Levesque H, Hitzler A.
Centre Hospitalier Universitaire Rouen, Rouen, France.
PMID: 19714617 [PubMed - as supplied by publisher]
3: Herz. 2009 Aug;34(5):347-56.
Technique of transcatheter aortic valve implantation with the Edwards-Sapien
heart valve using the transfemoral approach.
Cribier A, Litzler PY, Eltchaninoff H, Godin M, Tron C, Bauer F, Bessou JP.
Department of Cardiology, Rouen University, Hospital Charles, Nicolle and INSERM
144, Rouen, France. Alain.Cribier@chu-rouen.fr
Transcatheter aortic valve implantation (TAVI) using a balloon-expandable valve
has been developed by the authors' group 7 years ago to offer a therapeutic
solution to nonoperable or surgical high-risk patients with degenerative aortic
stenosis. The technique and the devices used have rapidly evolved thereafter and
TAVI has become a clinical reality with more than 3,500 patients implanted
worldwide with this device. The currently used Edwards-Sapien Transcatheter Heart
Valve (THV) consists of a balloon-expandable stent with an integrated bovine
pericardial valve. It can be implanted within the diseased native aortic valve
using either the retrograde transfemoral or antegrade transapical routes. This
article is aimed at describing the updated transfemoral technique. Appropriate
patient selection is crucial for a successful procedure including close
evaluation of the arterial characteristics. After predilatation of the native
valve with a balloon catheter, the THV with its delivery system is introduced
within the femoral artery, advanced to the native aortic valve under X-ray
control, positioned across the aortic annulus, and delivered by balloon inflation
under rapid heart pacing. The acute procedural success is 96% and the technique
leads to an immediate and lasting improvement of hemodynamics and clinical
status. Complications are rare and the mortality rate is 6.3% at 1 month in this
cohort of very sick patients. Procedural complications are headed by vascular
injury related to the large size of the arterial introducers. An upcoming lower-
profile Edwards THV should improve this issue and increase the indication for
this less invasive approach in the near future. At the present time, the
indications should be restricted to nonoperable or surgical high-risk patients
and the procedure performed by experienced and formally trained physicians
working in an optimal multidisciplinary environment.
PMID: 19711030 [PubMed - in process]
4: Eur J Obstet Gynecol Reprod Biol. 2009 Aug 24. [Epub ahead of print]
Mechanical evaluation of synthetic biomaterials used in the correction of pelvic
floor disorders-Experimental study in rabbits.
Sergent F, Desilles N, Lacoume Y, Bunel C, Marie JP, Marpeau L.
Clinique Gynécologique et Obstétricale, CHU-Hôpitaux de Rouen, 1 rue de Germont,
76031 Rouen Cedex, France; INSA-ROUEN, Polymères, Biopolymères, Surfaces, CNRS
FRE 3101, 76131 Mont-Saint-Aignan Cedex, France; Laboratoire de Chirurgie
Expérimentale, Faculté de Médecine-Pharmacie Rouen, UPRES EA 3830 GRHV, 22
boulevard Gambetta, 76183 Rouen Cedex 1, France.
OBJECTIVE: To evaluate the biomechanical properties of the principal prosthetic
materials currently used in genital prolapse surgery. STUDY DESIGN: Based on an
animal model of incisional abdominal hernia, 40 adult rabbits were implanted.
Four 2.5cmx2.5cm parietal defects, were created in the abdominal fascia and
muscles while respecting the peritoneum. For each rabbit, the defect was repaired
by four different large pore size prostheses which varied according to the
material used: two with monofilament of heavy (75g/m(2)) or low (38g/m(2)) weight
polypropylene (PP), and two with multifilament of heavy (115g/m(2)) or low
(59g/m(2)) weight polyethylene-terephthalate (PET). Animals were sacrificed in
groups of 10 after 14, 30, 90 and 180 days to evaluate contraction, solidity and
elasticity of the prostheses. RESULTS: PP and PET retracted, independently of
their weight, in 81.25% and 20% respectively. Intensity of contraction was not
predictable but median value of retracted surface was 14% with PP, none with PET.
Contraction settled quickly after tissue integration and did not subsequently
occur. Heavyweight PET was considered the most solid material (70Ncm(-1)),
low-weight PP the most fragile (20Ncm(-1)). Heavy forms of PP or PET resisted
better to the rupture than the light forms which were sometimes insufficient to
resist the extreme values of the human abdominal pressure (16Ncm(-1)). PP was
more flexible than PET, but PET was the only form which was able to support
extreme values of the abdominal pressure and remain in the elastic range.
Duration of implantation did not modify solidity or elasticity of the prostheses.
CONCLUSION: In our abdominal rabbit model, as regards mechanical properties,
heavyweight PET seems to be the optimal biomaterial.
PMID: 19709796 [PubMed - as supplied by publisher]
5: J Clin Oncol. 2009 Aug 24. [Epub ahead of print]
Professionals Assess the Acceptability of Preimplantation Genetic Diagnosis and
Prenatal Diagnosis for Managing Inherited Predisposition to Cancer.
Julian-Reynier C, Chabal F, Frebourg T, Lemery D, Noguès C, Puech F,
Stoppa-Lyonnet D.
Institut de Recherche et Développement (IRD), L'Institut National de la Santé et
de la Recherche Médicale (INSERM), U912; Aix-Marseille II Université; Institut
Paoli-Calmettes, Marseille; Service de Génétique, Centre Hospitalier
Universitaire (CHU) de Rouen, INSERM U614, Faculté de Médecine et de Pharmacie,
Rouen; GReD, UMR CNRS 6247, Clermont Université, INSERM U931, CHU
Clermont-Ferrand, Pôle Gynecologie Obstetrique Reproduction Humaine,
Clermont-Ferrand; Centre René Huguenin; INSERM U735, Saint-Cloud; Université
Lille 2 Droit et Santé; Hôpital Jeanne de Flandre CHRU, Lille; and Institut
Curie, Hôpital, Département de Biologie, Université Paris Descartes, Paris,
France.
PURPOSE: Preimplantation genetic diagnosis (PGD) and prenatal diagnosis (PND)
practices for inherited predisposition to cancer are heterogeneous in
industrialized countries. In France, permission to perform PGD/PND must be
obtained from registered Multidisciplinary Prenatal Diagnosis Teams (MPDTs). The
aim of this study was to determine French professionals' attitudes about the
acceptability of PGD and PND for inherited predisposition to cancer. METHODS: A
cross-sectional survey was performed, involving self-administered questionnaires
mailed to all registered cancer geneticists (CGs; n = 123) and MPDTs (n = 47) in
France. RESULTS: The response rates of CGs and MPDTs were 62% and 64%,
respectively; 59% and 50% of the CGs had at least discussed PGD and PND,
respectively, with their consultees during the previous year. When severe cancer
is liable to occur in childhood with a high penetrance and no effective methods
of prevention/treatment exist, high rates of acceptability of PGD/PND were
recorded (> 80%). When cancer is liable to occur before the age of 50 years but
not in childhood and some form of prevention/treatment is available that
preserves quality of life, PGD was rated as acceptable by one MPDT (3.3%) and 10
CGs (13.2%), and PND was rated acceptable by nine CGs (11.8%). Most respondents
agreed that the acceptability of PND/PGD depends on patients' family history of
cancer and their reproductive history. CONCLUSION: With the most severe forms of
inherited cancer, no differences were observed between the acceptability to
practitioners of PND and PGD, but with late-onset syndromes, there is still much
uncertainty. Guidelines would help to standardize the practices of professionals
handling these reproductive issues.
PMID: 19704065 [PubMed - as supplied by publisher]
6: Rheumatology (Oxford). 2009 Aug 20. [Epub ahead of print]
Small intestinal bacterial overgrowth in systemic sclerosis.
Marie I, Ducrotté P, Denis P, Menard JF, Levesque H.
Department of Internal Medicine, Department of Gastroenterology, Department of
Digestive Physiology and Department of Biostatistics, Rouen University Hospital,
Rouen Cedex, France.
Objectives. The aims of this study were to: (i) determine the prevalence of small
intestinal bacterial overgrowth (SIBO) in unselected patients with SSc; (ii)
assess both clinical presentation and outcome of SIBO; and (iii) make predictions
about which SSc patients are at risk for SIBO. Methods. Fifty-one consecutive
patients with SSc underwent glucose hydrogen and methane (H(2)/CH(4)) breath
test. All SSc patients also completed a questionnaire for intestinal symptoms,
and a global symptomatic score (GSS) was calculated. SSc patients with SIBO were
given rotating courses of antibiotics (norfloxacin/metronidazole) for 3 months;
glucose H(2)/CH(4) breath test was performed at 3-month follow-up. Results. The
prevalence of SIBO was 43.1% in our SSc patients. After logistic regression, we
identified the following risk factors for SIBO: presence of diarrhoea and
constipation. Interestingly, we observed a marked correlation between values of
GSS of digestive symptoms (>/=5) and the presence of SIBO (P = 10(-6)); indeed,
both sensitivity and specificity of GSS >/=5 to predict SIBO were as high as
0.909 and 0.862, respectively. Finally, eradication of SIBO was obtained in 52.4%
of the SSc patients with a significant improvement of intestinal symptoms.
Conclusion. Our study underscores that SIBO often occurs in SSc patients. We
further suggest that GSS may be systematically performed in SSc patients; since
we found a correlation between GSS of digestive symptoms >/=5 and SIBO, we
suggest that glucose H(2)/CH(4) breath test may be performed in the subgroup of
SSc patients exhibiting GSS >/=5.
PMID: 19696066 [PubMed - as supplied by publisher]
7: Ann Fr Anesth Reanim. 2009 Aug 18. [Epub ahead of print]
[Tongue haematoma after difficult intubation facilitated by the presence of an
infraclinic tumor.]
[Article in French]
Sueur G, Baert O, Rozada P, Rezig N, Dureuil B.
Département d'anesthésie-réanimation chirurgicale, hôpital Charles-Nicolle, 1,
rue de Germont, 76031 Rouen cedex, France.
Publication Types:
LETTER
PMID: 19695827 [PubMed - as supplied by publisher]
8: Surg Radiol Anat. 2009 Aug 20. [Epub ahead of print]
Contribution of the anatomy laboratory to the practical training of residents in
regional anesthesia.
Demars N, Compère V, Duparc F, Fourdrinier V, Dureuil B.
Department of Anesthesia and Intensive Care, Rouen University Hospital, 1 rue de
Germont, 76031, Rouen, France.
INTRODUCTION: Dissection workshop has never been assessed in the initial training
of resident medical students in anesthesia. This work aimed at assessing the
impact of this educational tool on the rates of success of the main blocks the
resident in anesthesia achieved during their training. MATERIALS AND METHODS: The
primary outcome measure studied in this work was the self-assessment by the
resident of the rate of success of every block before and after the complementary
training in regional anesthesia included dissection workshop, determined by a
questionnaire sent by post at least 6 months after the teaching. Besides, the
seminar was estimated at once by a questionnaire evaluating the quality as well
as the interest of the education on a scale ranging from 0 to 10. RESULTS:
Forty-two anesthesia residents went through the training. Thirty-four (77%)
handed back the questionnaire assessing the global interest an average of 8.9
(1.4). Theoretical training received an average score of 7.7 (1.4) and dissection
workshop in anatomy laboratory, a score of 7.8 (1.6). The quality of teaching
methods used was marked nine (0.8). Twenty-seven residents (61.36%) mailed the
questionnaire. The rate of success concerning each block in their clinical
practice before and after the training is not different, only concerning the
humeral canal block. CONCLUSION: Although the educational quality of the training
was acknowledged as responding to the expectancies of the anesthesia residents,
the dissection workshop do not meet with the expected requirements of rates
improval of the different blocks part from the humeral canal one's, within this
medical sample in initial training.
PMID: 19693429 [PubMed - as supplied by publisher]
9: Int J Qual Health Care. 2009 Aug 19. [Epub ahead of print]
Does comparison of performance lead to better care? A pilot observational study
in patients admitted for hip fracture in three French public hospitals.
Merle V, Moret L, Pidhorz L, Dujardin F, Gouin F, Josset V, Graveleau S, Petit J,
Riou F, Lombrail P, Czernichow P.
1Department of Epidemiology and Public Health, Rouen University Hospital, 1 rue
de Germont, 76031 Rouen cedex, France.
OBJECTIVE: /st> To assess whether comparison of quality of hip fracture care
among three teams located in different hospitals is associated with improvement
in process and outcomes. DESIGN: /st> A baseline assessment was performed using
quality indicators selected by professionals. RESULTS: were discussed among the
three teams followed by a post-comparison assessment of the same indicators.
SETTING: /st> Three hospitals in North Western France. PARTICIPANTS: /st>
Professionals caring for patients operated on for a low-impact hip fracture.
INTERVENTION: /st> Review and discussion of comparative performance results by
three teams followed by implementation of quality improvement as deemed necessary
by each team. MAIN OUTCOME MEASURES: /st> Fifteen quality indicators of health
care during orthopedic and rehabilitation stay, mobility, dependence and place of
residence before hip fracture and 3 months after discharge, 3 month post-surgery
mortality and readmission rates. Results Major differences were observed among
hospitals throughout the care process during baseline period. Comparison of
performance and discussion among the three teams were followed by corrective
action in 11 areas. After comparison, a significant improvement was observed in
10 areas, seven of which corresponded to quality improvement areas chosen for
improvement action by professionals. A significant decrease in readmission rate
(6.7% vs. 15.7%, P < 0.001) was observed but there was no change in mortality,
functional outcome or length of stay. CONCLUSIONS: /st> Comparison of performance
among voluntary teams, on fields selected by health-care professionals, was
associated with improvement in the care process and with improvement of some
related outcomes.
PMID: 19692425 [PubMed - as supplied by publisher]
10: Proc Am Thorac Soc. 2009 Aug 15;6(5):444-9.
Confocal fluorescence endomicroscopy of the human airways.
Thiberville L, Salaün M, Lachkar S, Dominique S, Moreno-Swirc S, Vever-Bizet C,
Bourg-Heckly G.
Rouen University Hospital, CHU de Rouen, 1 rue de Germont, 76031 Rouen Cedex,
France. Luc.Thiberville@univ-rouen.fr
Confocal endomicroscopes aim at providing to the clinician microscopic imaging of
a living tissue. The currently available microendoscopic devices use the
principle of confocal fluorescent microscopy, in which the objective is replaced
by an optical fiber and a miniaturized scanhead at the distal end of the
endoscope or by a retractable bundle of optical fibers. Such systems have
recently been applied to the explorations of several organs, including the
gastrointestinal tract, and more recently to the proximal and distal airways in
vivo. Respiratory fluorescence microendoscopes use 488 nm or 660 nm excitation
laser light and thin flexible miniprobes that are introduced into the working
channel of the bronchoscope. The devices have a lateral resolution of 3 microm, a
field of view of 600 microm, and produce real-time imaging at 9 frames per
second. For in vivo imaging, the miniprobe is applied onto the bronchial wall
surface or advanced into a distal bronchiole down to the acinus. In nonsmokers,
the 488-nm excitation device images the autofluorescence of the elastin that is
contained in the basement membrane of the proximal airways and that participates
to the axial backbone of the peripheral interstitial respiratory system. In
smokers, a specific tobacco tar-induced fluorescence allows in vivo macrophage
and alveolar wall imaging. Using 660 nm excitation and topical methylene blue,
the technique enables cellular imaging of both bronchial epithelial layer and
peripheral lung nodules. This article reviews the capabilities and possible
limitations of confocal microendoscopy for in vivo proximal and distal lung
explorations.
Publication Types:
Research Support, Non-U.S. Gov't
PMID: 19687217 [PubMed - in process]
11: Infect Immun. 2009 Aug 17. [Epub ahead of print]
Cryptosporidium parvum isolate-dependent post-infectious jejunal hypersensitivity
and mast cell accumulation in an immunocompetent rat model.
Khaldi S, Gargala G, Le Goff L, Parey S, Francois A, Fioramonti J, Ballet JJ,
Dupont JP, Ducrotté P, Favennec L.
Parasitology Laboratory, Rouen University hospital & ADEN EA 4311-IFRMP 23,
Institute for Biomedical Research, University of Rouen, France; Histopathology
Laboratory, Rouen University hospital & University of Rouen, France;
Neurogastroenterology and Nutrition Unit, INRA, Toulouse, France; Immunology
Department, Caen University hospital & UPRES EA2128, University of Caen, France;
M2C UMR CNRS 6143, University of Rouen, France; Gastroenterology Unit, Rouen
University hospital & ADEN EA 4311-IFRMP 23, Institute for Biomedical Research,
University of Rouen, France.
Cryptosporidium spp. are cause of self-limited diarrhea in immunocompetent hosts.
In immunocompetent rats, C. parvum infection induced digestive hypersensitivity,
a key physiopathological factor in functional digestive disorders such as
irritable bowel syndrome (IBS). In such a rat model, we aimed to document whether
jejunal hypersensitivity depends on C. parvum isolate and is associated with a
mast cell accumulation. Five day-old rats were orally administered 10(5) oocysts
of either Nouzilly (NoI) or Iowa (IoI) C. parvum isolate. NoI-infected rats
exhibited the lowest food intake on days 7 and 14 post-infection (p.i.). On day 7
p.i., small intestine villus atrophy, crypt hyperplasia and inflammatory cell
infiltration were prominent in NoI-infected rats with higher numbers of
Cryptosporidium forms than in IoI-infected rats. Compared with non-infected
control rats, jejunal intra-epithelial lymphocytes (IELs) were increased only in
NoI-infected rats on day 14 p.i. On day 50 p.i., jejunal hypersensitivity to
distension was found only in NoI-infected rats which is associated with activated
mast cell accumulation. In NoI-infected the number of mast cells in the jejunal
lamina propria was increased from day 36 p.i. in NoI-infected rats and only at
day 120 p.i. in IoI-infected rats. Present data suggest that both the severity of
infection (weight loss, reduced food intake, villus atrophy and IELs
accumulation) and the onset of a post-infectious jejunal hypersensitivity in
association with an activated mast cell accumulation are isolate-dependent and
related to NoI infection. This cryptosporidiosis rat model is a relevant model
for the study of underlying mechanisms of post-infectious IBS-like symptoms.
PMID: 19687199 [PubMed - as supplied by publisher]
12: J Anesth. 2009;23(3):472-3. Epub 2009 Aug 14.
Failure of lipid emulsion to reverse neurotoxicity after an ultrasound-guided
axillary block with ropivacaine and mepivacaine.
Calenda E, Dinescu SA.
Centre Hospitalier Universitaire de Rouen, Rouen University Hospital, 1 rue de
Germont, 76031, Rouen CEDEX, France.
PMID: 19685142 [PubMed - in process]
13: Fertil Steril. 2009 Aug 13. [Epub ahead of print]
Ovarian tissue thawing: A comparison of two conditions.
Perdrix A, Macé B, Milazzo JP, Liard-Zmuda A, Baron M, Rives N.
Reproductive Biology Laboratory-Centre D;Etude et de Conservation des Deufs et du
Sperde, Rouen University Hospital, Institute for Biomedical Research, University
of Rouen, Rouen, France.
Two different protocols to thaw cryopreserved human ovarian cortex have been
evaluated using a histological analysis. The slower one, based on a progressive
dilution of cryoprotectants, seems to maintain an optimal follicle morphology.
PMID: 19683233 [PubMed - as supplied by publisher]
14: Gastroenterol Clin Biol. 2009 Aug 12. [Epub ahead of print]
[Irritable bowel syndrome: From the gut to the brain-gut.]
[Article in French]
Ducrotté P.
ADEN EA 4311/IFRMP 23, département d'hépatogastroentérologie et de nutrition,
hôpital Charles-Nicolle, 1, rue de Germont, 76031 Rouen cedex, France.
Irritable bowel syndrome is not only a digestive motor disorder. It is a
multifactorial disease for which many data have highlighted the
pathophysiological importance of visceral hypersensitivity in the onset of
symptoms, particularly abdominal pain. Hypersensitivity is due either to an
afferent neurons dysfonction at the enteric nervous system level, either to an
abnormal brain-gut axis processing of sensory or nociceptive inputs arising from
the gut, at the spinal or supraspinal level. Disturbances of the autonomic
nervous system occur in IBS as a consequence of this brain-gut axis dysfunction.
Neurological abnormalities may be triggered by inflammation, mast cell
dysfunction or increased intestinal permeability while the neuro-immune
consequences of stress (mainly chronic) play a major role in the genesis and the
maintenance of irritable bowel syndrome. The role of emotions and mood
disturbances cannot be omitted in the interpretation the central processing of
digestive sensory inputs. Neurosciences, in particular brain imaging techniques,
have contributed to this better understanding of irritable bowel syndrome
pathophysiology. It is likely to play a major role in the future to improve our
knowledge of the brain-gut axis function (mechanisms, neurotransmitters and
receptors involved both in normal and pathological conditions). This knowledge is
crucial because of the need for updated treatment strategies and new
pharmacological and/or cognitive or behavioral therapies.
PMID: 19682813 [PubMed - as supplied by publisher]
15: J Strength Cond Res. 2009 Aug 10. [Epub ahead of print]
Apnea Training Effects on Swimming Coordination.
Lemaître F, Seifert L, Polin D, Juge J, Tourny-Chollet C, Chollet D.
1C.E.T.A.P.S., UPRES EA N degrees 3832: University of Rouen, Faculty of Sports
Sciences, 76130 Mont-Saint-Aignan, France; 2Association for the Promotion of
Research on breath-holding and subaquatic activities (A.P.R.A.A.S.), 13000
Marseille; and 3Respiratory Sports and Physiology service, Hospital of Bois
Guillaume, 76031 Rouen.
Lemaître, F, Seifert, L, Polin, D, Juge, J, Tourny-Chollet, C, and Chollet, D.
Apnea training effects on swimming coordination. J Strength Cond Res 23(x):
000-000, 2009-Triathletes and elite breath-hold divers show an adaptive response
to hypoxia induced by repeated epochs of breath holding. We hypothesized that
hypoxic training could also improve swimming coordination. Before and after a
3-month breath-hold training program, 4 male swimmers performed a maximal
incremental test on bicycle and a 50-m front crawl race at maximal speed without
breathing so that interarm coordination could be assessed. Swim velocity, stroke
rate (SR), stroke length (SL), and the arm stroke phases were calculated from
video analysis. Arm coordination was quantified in terms of an index of
coordination (IdC) based on the time gap between the propulsive phases of each
arm. After apnea training, the forced expiratory volume in 1 second was higher
(4.85 +/- 0.78 vs. 4.94 +/- 0.81 L, p < 0.05), with concomitant increases in
&OV0312;o2peak, minimal arterial oxygen saturation, and respiratory compensation
point values (W and W.kg) during the incremental test. Swimming performance was
not improved (clean velocity and time on 50 m); however, SR was decreased and SL
and IdC were increased. These results indicate that apnea training improves
effectiveness at both peak exercise and submaximal exercise and can also improve
swimming technique by promoting greater propulsive continuity.
PMID: 19675466 [PubMed - as supplied by publisher]
16: Presse Med. 2009 Aug 6. [Epub ahead of print]
[Diagnosis and treatment of community-acquired urinary tract infections in
adults: what has changed. Comments on the 2008 guidelines of the French Health
Products Safety Agency (AFSSAPS).]
[Article in French]
Caron F.
Expert auprès de l'Afssaps, président du groupe de travail "Recommandations de
bonne pratique : diagnostic et antibiothérapie des infections urinaires
bactériennes communautaires chez l'adulte" ; Groupe de recherche sur les
antimicrobiens et les micro-organismes (GRAM, EA2656), Université de Rouen ;
Service des maladies infectieuses et tropicales, CHU de Rouen, F-76031 Rouen
Cedex, France.
This article comments on the new recommendations for the diagnosis and treatment
of adult patients with community-acquired urinary tract infections (UTIs), issued
in 2008 by the French Health Products Safety Agency (AFSSAPS). The terms
uncomplicated and complicated UTIs have been retained ; complicated UTIs are
those with risk factor for complication (rather than with established
complications). In women, age (>/= 65 years) is no longer considered itself a
risk factor for complications. In men, cystitis must be treated as prostatitis.
The bacterial levels defining UTIs have been revised, but levels below the
threshold cannot be used to rule out UTI in the presence of symptoms. For
uncomplicated cystitis, only fosfomycin-trometamol is recommended as a first-line
treatment, essentially because of its ecological advantages (resistance uncommon,
no cross resistance with other antibiotic classes, specific class, sparing
others). For recurrent cystitis, prophylactic antibiotic treatment must be
limited to cases when other preventive measures are impossible. For complicated
cystitis, the principle is to delay antibiotic therapy until the resistance
profile results are available, when possible (because of the high risk of
resistance). Delay must be avoided during pregnancy, however, because of
maternal-fetal risks. The strategy for uncomplicated pyelonephritis has been
simplified : no plain abdominal radiography, antibiotic therapy shortened to
10-14 days (even 7 days for regimen or relay including fluoroquinolone), and no
routine verification by urine culture. For prostatitis, PSA testing is not
recommended during the acute phase of prostatitis, and a 14-day antibiotic
regimen is enough for the easiest-to-treat infections.
PMID: 19665343 [PubMed - as supplied by publisher]
17: Therapie. 2009 Mar-Apr;64(2):93-100. Epub 2009 Aug 11.
[New Pharmacological Approaches in Heart Failure: Should we Treat the
Endothelium?]
[Article in French]
Richard V, Vercauteren M, Gomez E, Thuillez C.
Inserm U644 & CHU de Rouen, Institut de Recherche Biomédicale et IRFMP23,
Université de Rouen, France.
Heart failure is associated with endothelial dysfunction, characterized
especially by a decreased nitric oxide (NO) production. The main consequences of
this dysfunction appear to be: 1) at the coronary level, an altered myocardial
perfusion associated with increased cardiac metabolic demand and, 2) at the
peripheral level, an increased arterial resistance leading to increased afterload
and cardiac work. Such an endothelial dysfunction may thus contribute to
aggravate heart failure and represents an important pharmacological target in
this disease. Indeed, these endothelial alterations may be reduced by "classic"
treatments of heart failure (e.g. inhibitors of the renin angiotensin aldosterone
system), as well as more recent approaches (e.g. ivabradine). Moreover, new
approaches have been recently developped to specifically target the endothelial
NO production, for example via inhibition of protein tyrosine phosphatase 1B,
that may ultimately lead to new treatment of heart failure based on endothelial
protection. L'insuffisance cardiaque affecte de façon importante l'endothélium
vasculaire, en particulier la production de monoxyde d'azote (NO). Les
principales conséquences attendues de cette dysfonction sont : 1) au niveau
coronaire, une altération de la perfusion et une augmentation des besoins
métaboliques cardiaques, et 2) au niveau périphérique, une augmentation des
résistances artérielles conduisant à une augmentation de la postcharge et du
travail cardiaque. On peut donc considérer qu'une telle dysfonction endothéliale
participe à l'aggravation de l'insuffisance cardiaque, et constitue une cible
pharmacologique majeure dans ce contexte. Cette dysfonction peut être réduite par
des traitements "classiques" de l'insuffisance cardiaque (inhibiteurs du système
rénine-angiotensine-aldostérone), ainsi que des traitements plus récents (tels
que l'ivabradine). Enfin, de nouvelles approches ont été développées récemment
dans l'optique de cibler spécifiquement l'endothélium et la production de NO, par
exemple les inhibiteurs de tyrosine phosphatases 1B, avec l'objectif de traiter
secondairement l'insuffisance cardiaque via la protection endothéliale.
Publication Types:
English Abstract
PMID: 19664402 [PubMed - in process]
18: Rev Stomatol Chir Maxillofac. 2009 Sep;110(4):217-20. Epub 2009 Aug 5.
[Mixed odontogenic tumours.]
[Article in French]
Peron JM, Hardy H.
Service de chirurgie maxillofaciale, université et hôpital universitaire de
Rouen, 1, rue de Germont, 76031 Rouen cedex, France.
Mixed odontogenic tumors include all tumors of the teeth both epithelial and
mesenchymatous. Most of these tumors are rare (ameloblastic fibroma, ameloblastic
fibro-odontoma and fibrodentinoma, odontoameloblastoma, calcified odontogenic
cyst). Other tumors such as odontoma are frequent. They have in common a benign
aspect, their often-fortuitous observation, a higher rate in the young adult and
surgical treatment by complete exeresis preventing recurrence. They present a
radiolucent lacuna but appear different depending on the presence or not of
intralesional calcifications revealing the production of more or less mature
dental tissue. The diagnosis may be confirmed only by an anatomopathological
examination, along with clinical and radiological observations.
Publication Types:
English Abstract
PMID: 19660774 [PubMed - in process]
19: J Clin Oncol. 2009 Aug 3. [Epub ahead of print]
2009 Version of the Chompret Criteria for Li Fraumeni Syndrome.
Tinat J, Bougeard G, Baert-Desurmont S, Vasseur S, Martin C, Bouvignies E, Caron
O, Bressac-de Paillerets B, Berthet P, Dugast C, Bonaïti-Pellié C, Stoppa-Lyonnet
D, Frébourg T.
Inserm U614, Faculty of Medicine, University of Rouen; and Department of
Genetics, University Hospital, Institute for Medical Research, Rouen, France.
PMID: 19652052 [PubMed - as supplied by publisher]
20: Rheumatology (Oxford). 2009 Aug 3. [Epub ahead of print]
Sustained response to infliximab in a patient with relapsing polychondritis with
aortic involvement.
Marie I, Lahaxe L, Josse S, Levesque H.
Département de Médecine Interne, CHU Rouen, Rouen, France.
PMID: 19651886 [PubMed - as supplied by publisher]
21: Nat Med. 2009 Aug;15(8):871-2. Epub 2009 Aug 2.
A new human immunodeficiency virus derived from gorillas.
Plantier JC, Leoz M, Dickerson JE, De Oliveira F, Cordonnier F, Lemée V, Damond
F, Robertson DL, Simon F.
Laboratoire Associé au Centre National de Référence du Virus de
l'Immunodéficience Humaine, Equipe d'Accueil EA2656, Faculté de
Médecine-Pharmacie, Université de Rouen, France.
jean-christophe.plantier@univ-rouen.fr
We have identified a new human immunodeficiency virus in a Cameroonian woman. It
is closely related to gorilla simian immunodeficiency virus (SIVgor) and shows no
evidence of recombination with other HIV-1 lineages. This new virus seems to be
the prototype of a new HIV-1 lineage that is distinct from HIV-1 groups M, N and
O. We propose to designate it HIV-1 group P.
Publication Types:
Research Support, Non-U.S. Gov't
PMID: 19648927 [PubMed - indexed for MEDLINE]
22: J Am Coll Surg. 2009 Aug;209(2):215-21. Epub 2009 Jun 18.
Gastric electrical stimulation in intractable nausea and vomiting: assessment of
predictive factors of favorable outcomes.
Gourcerol G, Chaput U, LeBlanc I, Gallas S, Michot F, Leroi AM, Ducrotte P.
Department of Physiology, Digestive Tract Research Group (ADEN EA 4311) and
European Institute for Peptide Research (IFRMP23), Rouen University Hospital,
University of Rouen, 1 Rue de Germont, 76031 Rouen cedex, France.
BACKGROUND: Gastric electrical stimulation (GES) represents a new therapy in
patients with intractable vomiting and nausea. We aimed to determine preoperative
factors associated with positive response during GES. Thirty-three consecutive
patients received implants for medically refractory nausea or vomiting or both.
STUDY DESIGN: Symptoms, Quality of Life (QOL), and gastric emptying (GE) were
monitored before and 6 months after implantation. Compared with baseline,
dyspeptic symptoms including nausea and vomiting, and QOL all improved at 6
months, yielding a significant weight gain while the GE rate remained unchanged.
Twenty-four patients reported improvement; nine remained unimproved at 6 months.
RESULTS: In multivariate analysis, baseline QOL and appetite alterations were
predictive of improvement; previous history of gastric surgery was associated
with failure. Surprisingly, patients with initial delayed GE (21 of 33) displayed
similar improvement compared with patients with normal GE. Likewise, basal GE was
not found to be predictive of positive outcomes, QOL, or symptoms improvement.
CONCLUSIONS: Patients with severe symptoms and altered QOL at inclusion
particularly benefit from GES; delay in GE is not predictive of positive
outcomes. This suggests that indication for GES should be based on clinical
settings rather than initial GE, and then possibly extended to patients with
normal GE.
PMID: 19632598 [PubMed - in process]
23: Obes Surg. 2009 Aug;19(8):1170-5. Epub 2009 Jun 11.
Abdominoplasty after major weight loss: improvement of quality of life and
psychological status.
Lazar CC, Clerc I, Deneuve S, Auquit-Auckbur I, Milliez PY.
Department of Plastic and Reconstructive Surgery, Rouen University Hospital, 1
rue de Germont, 76000, Rouen, France. lazarcalin@yahoo.fr
Abdominoplasty provides a reconstructive but rarely aesthetic cosmetic solution
after major weight loss. Few articles document quality of life (QOL) issues and
the psychological impact of abdominoplasty on obese patients. We report a
retrospective study of 41 abdominoplasties performed after an average weight loss
of 40.2 kg. Data were obtained through review of patient medical files,
double-blind surgical and psychological examinations, and two specifically
designated questionnaires used to assess pre-abdominoplasty body perception and
QOL, post-body contouring perception of improvement, and psychological status. To
date, 14 patients have regained >10 kg; 84.6% have improved QOL; 86.5% have
improved psychological status; 74% have better sexual relations; 53.9% admit
liking their body; 76.9% are satisfied with the results of abdominoplasty; and
96.1% would be willing to undergo abdominoplasty again. Anterior dermolipectomy
improves both QOL and psychological status. Provision of patient education,
multidisciplinary management, and long-term follow up are necessary to obtain
satisfactory results.
PMID: 19517201 [PubMed - in process]
24: Aliment Pharmacol Ther. 2009 Aug 15;30(4):399-405. Epub 2009 May 26.
Endoscopic band ligation could decrease recurrent bleeding in Mallory-Weiss
syndrome as compared to haemostasis by hemoclips plus epinephrine.
Lecleire S, Antonietti M, Iwanicki-Caron I, Duclos A, Ramirez S, Ben-Soussan E,
Hervé S, Ducrotté P.
Gastroenterology Department, Digestive Endoscopy Unit, Rouen University Hospital,
Rouen Cedex, France. stephane.lecleire@churouen.fr
BACKGROUND: Mallory-Weiss syndrome (MWS) with active bleeding at endoscopy may
require endoscopic haemostasis the modalities of which are not well-defined. AIM:
To compare the efficacy of endoscopic band ligation vs. hemoclip plus epinephrine
(adrenaline) in bleeding MWS. METHODS: From 2001 to 2008, 218 consecutive
patients with a MWS at endoscopy were hospitalized in our Gastrointestinal
Bleeding Unit. In 56 patients (26%), an endoscopic haemostasis was required
because of active bleeding. Band ligation was performed in 29 patients (Banding
group), while hemoclip application plus epinephrine injection was performed in 27
patients (H&E group). Treatment efficacy and early recurrent bleeding were
retrospectively compared between the two groups. RESULTS: Primary endoscopic
haemostasis was achieved in all patients. Recurrent bleeding occurred in 0% in
Banding group vs. 18% in H&E group (P = 0.02). The use of hemoclips plus
epinephrine (OR = 3; 95% CI = 1.15-15.8) and active bleeding at endoscopy (OR =
1.9; 95% CI = 1.04-5.2) were independent predictive factors of early recurrent
bleeding. CONCLUSIONS: Haemostasis by hemoclips plus epinephrine was an
independent predictive factor of rebleeding. This result suggests that band
ligation could be the first choice endoscopic treatment for bleeding MWS, but
requires further prospective assessment.
PMID: 19485979 [PubMed - in process]
25: Eur J Emerg Med. 2009 Aug;16(4):177-82.
Waiting time and assessment of patient satisfaction in a large reference
emergency department: a prospective cohort study, France.
Pitrou I, Lecourt AC, Bailly L, Brousse B, Dauchet L, Ladner J.
Epidemiology and Public Health Department, Rouen University Hospital, Rouen,
France.
OBJECTIVES: To assess patient satisfaction in a French Emergency Department (ED)
and to determine factors associated with dissatisfaction. METHODS: From July 2003
to February 2004, a prospective cohort study was conducted in an ED (Elbeuf
Reference Hospital, Upper-Normandy region). Baseline data collection was
performed during individual interview at inclusion. Waiting time in the ED was
recorded. Patient satisfaction was assessed by telephone 1 month later. Questions
included assessment of overall satisfaction and three different areas of
satisfaction: quality of reception, patient-doctor communication, and delays.
RESULTS: One hundred sixty-five patients were included, 146 patients (88.5%)
responded to the telephone follow-up. We found high levels of satisfaction in the
ED (89.7%). Highest satisfaction rate (92.5%) was for reception. Lower
satisfaction rates were reported for waiting times (72.6%) and medical
information provided by physicians (71.9%). The mean total time spent was 149.9
min (median=133.5). In multivariate analysis, waiting time was the unique
independent determinant of patient dissatisfaction: second quartile odds ratio
(OR)=0.40; 95% confidence interval (CI)=(0.06-2.66), third quartile OR=1.45; 95%
CI=(0.32-6.47), last quartile OR=2.69; 95% CI=(0.65-11.08); ptrend=0.04.
CONCLUSION: Elevated waiting times appeared as the unique independent risk factor
of patient dissatisfaction. Information on delays and reasons for this delay
could be systematically communicated to patients attending EDs; it could be an
effective strategy to reduce perceived waiting times and improve patient
satisfaction.
Publication Types:
Research Support, Non-U.S. Gov't
PMID: 19318959 [PubMed - in process]
26: Int J Colorectal Dis. 2009 Aug;24(8):969-74. Epub 2009 Mar 13.
Constipation in 44 patients implanted with an artificial bowel sphincter.
Gallas S, Leroi AM, Bridoux V, Lefebure B, Tuech JJ, Michot F.
Digestive Tract Research Group EA3234/IFRMP23, Rouen University Hospital, Rouen
Cedex, France.
PURPOSE: Constipation with or without obstructed defecation (OD) is frequent in
patients with artificial bowel sphincter (ABS). The aims of this study were (1)
to evaluate the functional outcome of ABS based on postoperative constipation and
(2) to assess pre-implantation data to predict post-implantation constipation.
MATERIALS AND METHODS: Thirteen men and 31 women were followed up. Both fecal
incontinence and constipation with and without OD were assessed after
implantation. Pre-implantation characteristics were compared in patients with and
without postoperative constipation. RESULTS: After implantation, nine patients
(20.4%) had constipation without OD, 16 patients (36.4%) had OD, and 19 patients
(43.2%) had neither of these. Incontinence was significantly more frequent in
patients with postoperative constipation with or without OD. In these patients,
an increase in preoperative constipation, anismus, and ultraslow waves was noted.
CONCLUSION: Constipation with and without OD is frequent after implantation and
interfere with the functional outcome of ABS.
PMID: 19283389 [PubMed - in process]
27: Dig Dis Sci. 2009 Aug;54(8):1746-52. Epub 2008 Nov 12.
Predicting factors of fistula healing and clinical remission after
infliximab-based combined therapy for perianal fistulizing Crohn's disease.
Tougeron D, Savoye G, Savoye-Collet C, Koning E, Michot F, Lerebours E.
Department of Gastroenterology and Hepatology, ADEN EA 4311, Rouen University
Hospital C Nicolle, 1 rue de Germont, 76031, Rouen, France.
Perianal fistulizing Crohn's disease (PFCD) treatment is based on fistula
drainage, antibiotics, immunosuppressant (IS) drugs, and infliximab. Our aim was
to study the effectiveness of combination therapy on PFCD and to search for
clinical or imaging features associated with the initial complete clinical
response and its stability overtime. PATIENTS AND METHODS: All patients with PFCD
treated in our tertiary center between 2000 and 2005 by infliximab in combination
with seton placement and/or IS and evaluated by MRI before treatment were
included in the study. Basal clinical and MRI characteristics were recorded.
Response to treatment was evaluated after the infliximab induction regiment and
at the end of the follow-up. RESULTS: Twenty-six patients were included and
followed-up for an average 4.9 years. A complex fistula was present in 69% (18/26
patients) of cases and eight (8/26 patients) had an ano-vaginal fistula. After
infliximab induction therapy, 13 patients (50%) achieved a complete clinical
response. The initial clinical response was significantly associated with the
absence of both, active intestinal disease (54% vs. 8%, P = 0.03) and active
proctitis (77% vs. 23%, P = 0.01). No initial MRI characteristics were linked to
the initial response. In multivariate analysis, only the presence of active
proctitis was associated with the lack of response (P = 0.047). At the end of the
follow-up, 42% of the patients remained in clinical remission. No clinical
characteristics were associated to sustained response when among long-standing
responders two exhibited a normal post-treatment MRI. CONCLUSION: An initial
complete response of PFCD was observed in half of the patients after combined
therapy including infliximab that decreased to 42% later on. Complete healing of
fistulas on MRI was possible but unusual. The initial response seemed related to
the absence of active intestinal disease, especially in the rectum, when the
long-term response could not be predicted by the basal characteristics of
patients.
PMID: 19003531 [PubMed - indexed for MEDLINE]
28: J Am Soc Nephrol. 2009 Sep;20(9):1929-40. Epub 2009 Jul 2.
Comment in:
J Am Soc Nephrol. 2009 Sep;20(9):1862-4.
Podocyte glutamatergic signaling contributes to the function of the glomerular
filtration barrier.
Giardino L, Armelloni S, Corbelli A, Mattinzoli D, Zennaro C, Guerrot D, Tourrel
F, Ikehata M, Li M, Berra S, Carraro M, Messa P, Rastaldi MP.
Renal Research Laboratory, Fondazione IRCCS Ospedale Maggiore Policlinico,
Mangiagalli e Regina Elena and Fondazione D'Amico per la Ricerca sulle Malattie
Renali, Milan, Italy.
Podocytes possess the complete machinery for glutamatergic signaling, raising the
possibility that neuron-like signaling contributes to glomerular function. To
test this, we studied mice and cells lacking Rab3A, a small GTPase that regulates
glutamate exocytosis. In addition, we blocked the glutamate ionotropic
N-methyl-d-aspartate receptor (NMDAR) with specific antagonists. In mice, the
absence of Rab3A and blockade of NMDAR both associated with an increased urinary
albumin/creatinine ratio. In humans, NMDAR blockade, obtained by addition of
ketamine to general anesthesia, also had an albuminuric effect. In vitro,
Rab3A-null podocytes displayed a dysregulated release of glutamate with higher
rates of spontaneous exocytosis, explained by a reduction in Rab3A effectors
resulting in freedom of vesicles from the actin cytoskeleton. In addition, NMDAR
antagonism led to profound cytoskeletal remodeling and redistribution of nephrin
in cultured podocytes; the addition of the agonist NMDA reversed these changes.
In summary, these results suggest that glutamatergic signaling driven by
podocytes contributes to the integrity of the glomerular filtration barrier and
that derangements in this signaling may lead to proteinuric renal diseases.
PMID: 19578006 [PubMed - in process]
