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1.
J Intern Med ; 289(2): 193-205, 2021 02.
Article in English | MEDLINE | ID: mdl-32654192

ABSTRACT

BACKGROUND: Extracellular fluid volume (ECF) is independently associated with chronic kidney disease (CKD) progression and mortality in patients with CKD, but the prognostic value of the trajectory of ECF over time beyond that of baseline value is unknown. OBJECTIVES: To characterize ECF trajectory and evaluate its association with the risks of end-stage kidney disease (ESKD) and mortality. METHODS: From the prospective tricentric NephroTest cohort, we included 1588 patients with baseline measured glomerular filtration rate (mGFR) ≥15 mL min-1 /1.73 m2 and ECF measurement. ECF and GFR were measured repeatedly using the distribution volume and clearance of 51 Cr-EDTA, respectively. ESKD and mortality were traced through record linkage with the national registries. Adjusted shared random-effect joint models were used to analyse the association between the trajectory of ECF over time and the two competing outcomes. RESULTS: Patients were mean age 58.7 years, 66.7% men, mean mGFR of 43.6 ± 18.6 mL min-1 /1.73 m2 and mean ECF of 16.1 ± 3.6 L. Over a median follow-up of 5.3 [IQR: 3.0;7.4] years, ECF increased by 136 [95%CI 106;167] mL per year on average, whilst diuretic prescription and 24-hour urinary sodium excretion remained stable. ESKD occurred in 324 (20.4%) patients, and 185 (11.6%) patients died before ESKD. A higher current value of ECF was associated with increased hazards of ESKD (adjusted hazard ratio [aHR]: 1.12 [95%CI 1.06;1.18]; P < 0.001 per 1 L increase in ECF), and death before ESKD (aHR: 1.10 [95%CI 1.04;1.17]; P = 0.002). CONCLUSIONS: The current value of ECF was associated with the risks of ESKD and mortality, independent of multiple potential confounders, including kidney function decline. This highlights the need for a close monitoring and adjustment of treatment to avoid fluid overload in CKD patients.


Subject(s)
Extracellular Fluid/metabolism , Kidney Failure, Chronic/mortality , Disease Progression , Female , Glomerular Filtration Rate , Humans , Male , Middle Aged , Prognosis , Prospective Studies , Risk Factors
2.
J Hosp Infect ; 107: 28-34, 2021 Jan.
Article in English | MEDLINE | ID: mdl-32980490

ABSTRACT

INTRODUCTION: Pancreatic surgery is associated with high morbidity, mainly due to infectious complications, so many centres use postoperative antibiotics (ATBpo) for all patients. However, antibiotic regimens vary according to local practices. The aims of this study were to describe the occurrence of surgical site infection (SSI) and ATBpo prescription after pancreatic surgery, and to determine the risk factors of postoperative SSI, in order to better define the clinical indications for ATBpo in this context. PATIENTS AND METHODS: All patients undergoing scheduled major pancreatic surgery from January 2007 to November 2018 were included in this retrospective study. Patients were classified into four groups according to SSI and routine ATBpo prescription: SSI+/ATBpo+, SSI-/ATBpo+, SSI+/ATBpo- and SSI-/ATBpo-. In addition, risk factors (fever and pre-operative biliary prosthesis) associated with the occurrence of SSI and ATBpo were analysed using a logistic regression model. RESULTS: Data from 149 patients (115 pancreaticoduodenectomies and 34 splenopancreatectomies) were analysed. Thirty (20.1%) patients experienced SSI and 42 (28.2%) received ATBpo. No difference was found in routine ATBpo prescription between patients with and without SSI (26.7% vs 28.6%, respectively; P=0.9). Amongst the 107 patients who did not receive routine ATBpo, 85 (79.4%) did not develop an SSI. In-hospital mortality did not differ between infected and uninfected patients (7% vs 2%, respectively; P=0.13). The occurrence of postoperative fever differed between SSI+ and SSI- patients (73.3% vs 34.2%, respectively; P<0.001), while the prevalence of pre-operative biliary prosthesis was similar (37.9% vs 26.7%, respectively; P=0.3). CONCLUSION: Non-routine ATBpo after major pancreatic surgery resulted in 85 (56%) patients being spared unnecessary antibiotic treatment. This suggests that routine ATBpo prescription could be excessive, but further studies are needed to confirm such antibiotic stewardship. Fever appears to be a relevant clinical sign for individual-based prescription, but the presence of a biliary prosthesis does not.


Subject(s)
Antibiotic Prophylaxis , Antimicrobial Stewardship , Digestive System Surgical Procedures/adverse effects , Surgical Wound Infection , Anti-Bacterial Agents/therapeutic use , Humans , Pancreas/surgery , Retrospective Studies , Risk Factors , Surgical Wound Infection/drug therapy
3.
Ann Intensive Care ; 10(1): 49, 2020 Apr 25.
Article in English | MEDLINE | ID: mdl-32335780

ABSTRACT

BACKGROUND: The echocardiography working group of the European Society of Intensive Care Medicine recognized the need to provide structured guidance for future CCE research methodology and reporting based on a systematic appraisal of the current literature. Here is reported this systematic appraisal. METHODS: We conducted a systematic review, registered on the Prospero database. A total of 43 items of common interest to all echocardiography studies were initially listed by the experts, and other "topic-specific" items were separated into five main categories of interest (left ventricular systolic function, LVSF n = 15, right ventricular function, RVF n = 18, left ventricular diastolic function, LVDF n = 15, fluid management, FM n = 7, and advanced echocardiography techniques, AET n = 17). We evaluated the percentage of items reported per study and the fraction of studies reporting a single item. RESULTS: From January 2000 till December 2017 a total of 209 articles were included after systematic search and screening, 97 for LVSF, 48 for RVF, 51 for LVDF, 36 for FM and 24 for AET. Shock and ARDS were relatively common among LVSF articles (both around 15%) while ARDS comprised 25% of RVF articles. Transthoracic echocardiography was the main echocardiography mode, in 87% of the articles for AET topic, followed by 81% for FM, 78% for LVDF, 70% for LVSF and 63% for RVF. The percentage of items per study as well as the fraction of study reporting an item was low or very low, except for FM. As an illustration, the left ventricular size was only reported by 56% of studies in the LVSF topic, and half studies assessing RVF reported data on pulmonary artery systolic pressure. CONCLUSION: This analysis confirmed sub-optimal reporting of several items listed by an expert panel. The analysis will help the experts in the development of guidelines for CCE study design and reporting.

4.
Resuscitation ; 128: 70-75, 2018 07.
Article in English | MEDLINE | ID: mdl-29698751

ABSTRACT

AIM: Due to collapse and cardiopulmonary resuscitation (CPR) maneuvers, major traumatic injuries may complicate the course of resuscitation for out-of-hospital cardiac arrest patients (OHCA). Our goals were to assess the prevalence of these injuries, to describe their characteristics and to identify predictive factors. METHODS: We conducted an observational study over a 9-year period (2007-2015) in a French cardiac arrest (CA) center. All non-traumatic OHCA patients admitted alive in the ICU were studied. Major injuries identified were ranked using a functional two-level scale of severity (life-threatening or consequential) and were classified as CPR-related injuries or collapse-related injuries, depending of the predominant mechanism. Factors associated with occurrence of a CPR-related injury and ICU survival were identified using multivariable logistic regression. RESULTS: A major traumatic injury following OHCA was observed in 91/1310 patients (6.9%, 95%CI: 5.6, 8.3%), and was classified as a life-threatening injury in 36% of cases. The traumatic injury was considered as contributing to the death in 19 (21%) cases. Injuries were related to CPR maneuvers in 65 patients (5.0%, (95%CI: 3.8, 6.1%)). In multivariable analysis, age [OR 1.02; 95%CI (1.00, 1.04); p = 0.01], male gender [OR 0.53; 95%CI (0.31, 0.91); p = 0.02] and CA occurring at home [OR 0.54; 95%CI (0.31, 0.92); p = 0.02] were significantly associated with the occurrence of a CPR-related injury. CPR-related injuries were not associated with the ICU survival [OR 0.69; 95%CI (0.36, 1.33); p = 0.27]. CONCLUSIONS: Major traumatic injuries are common after cardiopulmonary resuscitation. Further studies are necessary to evaluate the interest of a systematic traumatic check-up in resuscitated OHCA patients in order to detect these injuries.


Subject(s)
Cardiopulmonary Resuscitation/adverse effects , Out-of-Hospital Cardiac Arrest/mortality , Wounds and Injuries/diagnosis , Adult , Aged , Aged, 80 and over , Emergency Medical Services/statistics & numerical data , Female , Humans , Injury Severity Score , Longitudinal Studies , Male , Middle Aged , Paris/epidemiology , Registries , Wounds and Injuries/etiology
5.
Resuscitation ; 103: 60-65, 2016 06.
Article in English | MEDLINE | ID: mdl-27068401

ABSTRACT

AIM: Hypoxic hepatitis (HH) may complicate the course of resuscitated out-of-hospital cardiac arrest (OHCA) patients admitted in intensive care unit (ICU). Aims of this study were to assess the prevalence of HH, and to describe the factors associated with HH occurrence and outcome. METHODS: We conducted an observational study over a 6-year period (2009-2014) in a cardiac arrest center. All non-traumatic OHCA patients admitted in the ICU after return of spontaneous circulation (ROSC) and who survived more than 24h were included. HH was defined as an elevation of alanine aminotransferase over 20 times the upper limit of normal during the first 72h after OHCA. Factors associated with HH and ICU mortality were picked up by multivariate logistic regression. RESULTS: Among the 632 OHCA patients included in the study, HH was observed in 72 patients (11.4% (95% CI: 9.0%, 14.1%)). In multivariate analysis, time from collapse to ROSC [OR 1.02 per additional minute; 95% CI (1.00, 1.04); p=0.01], male gender [OR 0.53; 95% CI (0.29, 0.95); p=0.03] and initial shockable rhythm [OR 0.35; 95% CI (0.19, 0.65); p<0.01] were associated with HH occurrence. After adjustment for confounding factors, HH was associated with ICU mortality [OR 4.39; 95% CI (1.71, 11.26); p<0.01] and this association persisted even if occurrence of a post-CA shock was considered in the statistical model [OR 3.63; 95% CI (1.39, 9.48); p=0.01]. CONCLUSIONS: HH is not a rare complication after OHCA. This complication is mainly triggered by the duration of resuscitation and is associated with increased ICU mortality.


Subject(s)
Hepatitis/epidemiology , Out-of-Hospital Cardiac Arrest/complications , Aged , Alanine Transaminase/blood , Cardiopulmonary Resuscitation , Female , Hepatitis/complications , Hepatitis/enzymology , Humans , Hypoglycemia/complications , Hypoxia/complications , Incidence , Intensive Care Units/statistics & numerical data , Male , Middle Aged , Multivariate Analysis , Out-of-Hospital Cardiac Arrest/mortality , Time Factors
6.
Resuscitation ; 92: 38-44, 2015 Jul.
Article in English | MEDLINE | ID: mdl-25917260

ABSTRACT

AIM: Low survival rate was previously described after cardiac arrest in cancer patients and may challenge the appropriateness of intensive care unit (ICU) admission after return of spontaneous circulation (ROSC). Objectives of this study were to report outcome and characteristics of cancer patients admitted to the ICU after cardiac arrest. METHODS: A retrospective chart review in seven medical ICUs in France, in 2002-2012. We studied consecutive patients with malignancies admitted after out-of-hospital cardiac arrest (OHCA) or in-hospital cardiac arrest (IHCA). RESULTS: Of 133 included patients of whom 61% had solid tumors, 48 (36%) experienced OHCA and 85 (64%) IHCA. Cardiac arrest was related to the malignancy or its treatment in 47% of patients. Therapeutic hypothermia was used in 51 (41%) patients. The ICU mortality rate was 98/133 (74%). Main causes of ICU death were refractory shock or multiple organ failure (n = 64, 48%) and neurological injury (n = 27, 20%); 42 (32%) patients died in ICU after treatment-limitation decisions. Twenty-four (18%) patients were discharged alive from the hospital. Overall 6-month survival rate was 14% (18/133, 95% confidence interval, 8-21%). Survival rates at ICU discharge and after 6 months did not differ significantly across type of malignancy or between the OHCA and IHCA groups, and neither were they significantly different from those in matched controls who had cardiac arrest but no malignancy. CONCLUSIONS: Even if low, the 6-month survival rate of 14% observed in cancer patients admitted to the ICU after cardiac arrest and ROSC may support the admission of these patients to the ICU and may warrant an initial full-code ICU management.


Subject(s)
Cardiopulmonary Resuscitation/methods , Intensive Care Units , Neoplasms/complications , Out-of-Hospital Cardiac Arrest/therapy , Aged , Female , France/epidemiology , Hospital Mortality/trends , Humans , Hypothermia, Induced/methods , Male , Middle Aged , Neoplasms/mortality , Out-of-Hospital Cardiac Arrest/etiology , Out-of-Hospital Cardiac Arrest/mortality , Retrospective Studies , Survival Rate/trends , Treatment Outcome
7.
Arthritis Rheumatol ; 67(5): 1353-60, 2015 May.
Article in English | MEDLINE | ID: mdl-25604824

ABSTRACT

OBJECTIVE: Takayasu arteritis (TAK) is a large-vessel vasculitis that induces damage to the aorta and its branches. Glucocorticoids remain the gold standard of therapy for TAK. The nature of the T cells driving vascular inflammation and the effects of glucocorticoids on the systemic components of TAK are not understood. The aim of this study was to analyze T cell homeostasis and cytokine production in peripheral blood and inflammatory lesions of the aorta in patients with TAK. METHODS: T cell homeostasis and cytokine production in peripheral blood and inflammatory lesions of the aorta were analyzed using Luminex analysis, flow cytometry, and immunohistochemical analysis. The study included 41 patients fulfilling the American College of Rheumatology 1990 criteria for the classification of TAK (17 patients with active TAK and 24 patients with disease in remission), 30 patients with giant cell arteritis and 39 patients with Behçet's disease (disease controls), and 20 age- and sex-matched healthy control subjects. RESULTS: We observed a marked increase in the expression of Th1 and Th17 cells, which correlated with TAK disease activity. The addition of serum from patients with active TAK to sorted CD4+ T cells from healthy donors in culture medium induced significant production of interferon-γ (IFNγ) and interleukin-17A (IL-17A). We demonstrated the presence of IFNγ-, IL-6-, and IL-17A-producing T cells in vascular inflammatory infiltrates in patients with TAK. Corticosteroid therapy was associated with decreased levels of circulating Th1 cytokines in corticosteroid-treated patients with TAK compared with steroid-free patients with TAK (for IL-2, mean ± SD 5,079 ± 5,300 versus 7,359 ± 3,197 pg/ml; for IFNγ, 2,592 ± 3,072 versus 8,393 ± 3,392 pg/ml; for tumor necrosis factor α, 847 ± 724 versus 1,491 ± 392 pg/ml). However, glucocorticoids had essentially no effect on the frequency of Th17 cytokines (IL-1 receptor, IL-17, and IL-23). CONCLUSION: The Th17 and Th1 pathways contribute to the systemic and vascular manifestations of TAK. Glucocorticoid treatment suppresses Th1 cytokines but spares Th17 cytokines in patients with TAK.


Subject(s)
Cytokines/immunology , Takayasu Arteritis/immunology , Th1 Cells/immunology , Th17 Cells/immunology , Adolescent , Adult , Aged , Aged, 80 and over , Behcet Syndrome/immunology , Case-Control Studies , Cytokines/metabolism , Female , Giant Cell Arteritis/immunology , Glucocorticoids/therapeutic use , Humans , Inflammation , Interferon-gamma/immunology , Interferon-gamma/metabolism , Interleukin-17/immunology , Interleukin-17/metabolism , Interleukin-2/immunology , Interleukin-2/metabolism , Interleukin-23/immunology , Interleukin-23/metabolism , Interleukin-6/immunology , Interleukin-6/metabolism , Male , Middle Aged , Receptors, Interleukin-1/immunology , Severity of Illness Index , Takayasu Arteritis/drug therapy , Th1 Cells/metabolism , Th17 Cells/metabolism , Tumor Necrosis Factor-alpha/immunology , Tumor Necrosis Factor-alpha/metabolism , Young Adult
8.
Ann Fr Anesth Reanim ; 33(4): e79-81, 2014 Apr.
Article in English | MEDLINE | ID: mdl-24630168

ABSTRACT

Ethylene glycol poisoning is rare, but prompt diagnosis is crucial, in order to initiate specific treatments. Herein, we report the case of a patient who was admitted to ICU for coma and extreme metabolic acidosis with unexpected hyperlactatemia on initial ICU blood gas analyzer. Ethylene glycol poisoning was diagnosed, and hyperlactatemia was ruled out on a blood sample sent to the biochemistry department. Interference of blood gas analyzers lactate electrodes with metabolites of ethylene glycol were the source of this apparent hyperlactatemia. Symptoms gradually improved and false hyperlactatemia resolved after renal replacement therapy and fomepizole administration. Time course of ethylene glycol concentration showed similar evolution. After initial confirmation of ethylene glycol presence, this biological interference could thus be used as a surrogate of costly and highly specialised dosages.


Subject(s)
Ethylene Glycol/poisoning , Hyperlactatemia/chemically induced , Acidosis, Lactic/chemically induced , Acidosis, Lactic/therapy , Coma/chemically induced , Ethylene Glycol/blood , Ill-Housed Persons , Humans , Hyperlactatemia/blood , Kidney Diseases/chemically induced , Kidney Diseases/therapy , Male , Middle Aged , Renal Replacement Therapy
9.
Ann Fr Anesth Reanim ; 33(2): 98-101, 2014 Feb.
Article in English | MEDLINE | ID: mdl-24361281

ABSTRACT

With increasing public education in basic life support and with the widespread use of automated defibrillators, post-cardiac arrest comatose patients represent a growing part of ICU admissions. However the prognosis remains very poor and only a very low proportion of these resuscitated patients will recover and will leave the hospital without major neurological impairments. Neurological dysfunction predominantly includes disorders of consciousness, and may also include other manifestations such as seizures, myoclonus status epilepticus and other forms of movement disorders including post-anoxic myoclonus. In the most severe cases, coma may be irreversible or evolve towards a minimally conscious state, a vegetative state or even brain death. These severe conditions represent by far the leading cause of mortality and disability in such patients. Currently, early use of mild therapeutic hypothermia is the only treatment that demonstrated its ability to decrease neurological consequences and to improve the prognosis. Prognostication outcome is still mainly based on a rigorous clinical evaluation coupled with neuro-physiological investigations, but brain functional imaging could become a valuable tool in the near future. Clinical research focusing on survivors should be strongly encouraged in order to assess the mid- and long-terms outcome of survivors and to evaluate the impact of new treatments or strategies.


Subject(s)
Brain Damage, Chronic/etiology , Consciousness Disorders/etiology , Heart Arrest/complications , Hypoxia, Brain/etiology , Brain Damage, Chronic/physiopathology , Brain Damage, Chronic/prevention & control , Brain Damage, Chronic/psychology , Brain Death , Cardiopulmonary Resuscitation , Critical Care , Heart Arrest/therapy , Humans , Hypothermia, Induced , Medical Futility/ethics , Neuroprotective Agents/therapeutic use , Prognosis , Quality of Life , Seizures/etiology , Status Epilepticus/etiology , Survivors , Treatment Outcome
10.
Ann Fr Anesth Reanim ; 32(11): 779-86, 2013 Nov.
Article in French | MEDLINE | ID: mdl-24138773

ABSTRACT

OBJECTIVE: This review aims at providing an update on post-cardiac arrest syndrome, from pathophysiology to treatment. DATA SOURCES: Medline database. DATA EXTRACTION: All data on pathophysiology, clinical manifestations and therapeutic management, with focus on the publications of the 5 last years. DATA SYNTHESIS: Care of the patients after cardiac arrest is a medical challenge, in face of "post-cardiac arrest syndrome", which culminates into multi-organ failure. This syndrome mimics sepsis-related dysfunctions, with all clinical and biological manifestations related to the phenomenon of global ischemia-reperfusion. Acute cardiocirculatory dysfunction is usually controlled through pharmacological and mechanical support. Meanwhile, as a majority of cardiac arrest is related to myocardial infarction, early angiographic exploration should then be discussed when there is no obvious extracardiac cause, percutaneous coronary revascularization being associated with improved short and long-term prognosis. Therapeutic hypothermia is the cornerstone of neuroprotective armamentarium, beyond hemodynamic stabilization and metabolic maintenance. CONCLUSION: If ongoing evaluations should shed light on potential efficiency of new therapeutic drugs, a multidisciplinary approach of the post-cardiac arrest syndrome in expertise centre is essential.


Subject(s)
Heart Arrest/physiopathology , Heart Arrest/therapy , Cross Infection/prevention & control , Humans , Hypothermia, Induced , Multiple Organ Failure/etiology , Multiple Organ Failure/physiopathology , Multiple Organ Failure/therapy , Nervous System Diseases/etiology , Nervous System Diseases/therapy , Neuroprotective Agents/therapeutic use , Shock/etiology , Shock/physiopathology , Shock/therapy , Syndrome
11.
Infection ; 41(2): 537-43, 2013 Apr.
Article in English | MEDLINE | ID: mdl-23203899

ABSTRACT

PURPOSE: Tuberculous paradoxical reactions (PR) have been seldom studied in non-immunocompromised patients. We conducted a study to describe the incidence, clinical and biological features, treatment and outcome of PR in human immunodeficiency virus (HIV)-negative patients treated for extrapulmonary tuberculosis (TB) and to identify predictive factors of PR. METHODS: A single-center retrospective study was conducted in consecutive HIV-negative patients presenting with TB with at least one extrapulmonary manifestation who were hospitalized in an internal medicine department between 2000 and 2010. RESULTS: Seventy-six patients were enrolled in the study. Lymphadenitis was the most common extrapulmonary manifestation of tuberculosis among this patient population (72 %). PR occurred in 19 (25 %) patients, mostly involving the lymph nodes (68 %) and lung (16 %), but also the pericardium, pleura, bone, muscle and brain. Median time to PR onset after initiation of anti-TB regimen was 86 days (interquartile range 36-125). Treatment of PR consisted mainly of corticosteroids (47 % of patients) and needle aspiration of PR lymph nodes (31 %). Peripheral lymph node involvement (p = 0.009), lymphopenia (p = 0.03) and anemia (p = 0.002) at presentation were associated with PR occurrence. Outcome was favorable in all patients with PR but one; the latter suffered residual paraplegia. CONCLUSIONS: Paradoxical reactions are frequent in the course of extrapulmonary TB treatment in HIV-negative patients but their outcome is excellent, except in some cases with central nervous system involvement.


Subject(s)
Antitubercular Agents/adverse effects , HIV Seronegativity , Tuberculosis, Lymph Node/drug therapy , Adult , Anemia/microbiology , Anemia/pathology , Female , Hospitalization , Humans , Incidence , Kaplan-Meier Estimate , Lung/pathology , Lymph Nodes/pathology , Lymphadenitis/microbiology , Male , Middle Aged , Pericardium/pathology , Pleura/microbiology , Pleura/pathology , Retrospective Studies , Treatment Outcome , Tuberculosis, Lymph Node/microbiology , Tuberculosis, Lymph Node/pathology
13.
J Viral Hepat ; 19(7): 497-500, 2012 Jul.
Article in English | MEDLINE | ID: mdl-22676362

ABSTRACT

Therapeutic options in hepatitis C virus (HCV)-related vasculitis may target the viral trigger using antiviral therapy [pegylated interferon plus ribavirin (PEG-IFN/RBV)], and/or the downstream B-cell arm of autoimmunity with rituximab (RTX). To date, no study has compared the efficacy of RTX combined with PEG-IFN/RBV on biomarkers of liver insufficiency in patients with severe liver fibrosis. Twenty-eight untreated HCV-related vasculitis patients with severe liver fibrosis (Metavir F3-F4) were included: 14 patients received RTX plus PEG-IFN/RBV and 14 patients PEG-IFN/RBV. The main clinical and biological data were recorded and compared at baseline, month 3 (M3), M12 and M24 of follow-up. Baseline epidemiological, clinical, virological and immunological features were similar between the groups. The virological response did not differ between cases and controls. The alanine aminotransferase (ALT) level and HCV viral load did not increase in patients treated with RTX. Serum albumin levels increased in patients treated with RTX at M3 and M6 (108% and 111% of baseline value; P = 0.06 and P = 0.13), whereas it was stable in patients treated without RTX. FibroTest values decreased from 0.70 at baseline to 0.59 at M3 (P = 0.5) and returned to 0.69 at M24 in the RTX-PEG-IFN/RBV group, whereas they were stable in the PEG-IFN/RBV group. RTX is safe in patients with severe HCV liver fibrosis and vasculitis. No beneficial effects of RTX were evidenced on liver fibrosis progression, but we found interesting correlations with the serum albumin level, FibroTest values and B-cell count.


Subject(s)
Antibodies, Monoclonal, Murine-Derived/administration & dosage , Antiviral Agents/administration & dosage , Biomarkers/blood , Hepatic Insufficiency/pathology , Interferons/administration & dosage , Liver Cirrhosis/pathology , Ribavirin/administration & dosage , Aged , Alanine Transaminase/blood , Drug Monitoring , Female , Hepacivirus/isolation & purification , Hepatic Insufficiency/drug therapy , Humans , Liver Cirrhosis/drug therapy , Male , Middle Aged , Prospective Studies , Rituximab , Treatment Outcome , Viral Load
14.
Rev Med Interne ; 32(12): 736-41, 2011 Dec.
Article in French | MEDLINE | ID: mdl-21440342

ABSTRACT

Recurrent pericarditis are common and their management remains a matter of debate. Their precise pathophysiology is unclear, and both innate and adaptative immunity seem involved. An extensive work-up seeking for etiology seems to be unnecessary during the first episode of acute pericarditis, whereas it is mandatory in recurrent pericarditis. Despite extensive investigations, up to 80 % of recurrent pericarditis remains of unknown origin. Colchicin associated to non steroidal antiinflammatory drugs is the first line treatment whereas immunosuppressive drugs are exceptionally required.


Subject(s)
Pericarditis/therapy , Acute Disease , Algorithms , Aspirin/administration & dosage , Colchicine/administration & dosage , Disease Progression , Humans , Pericarditis/diagnosis , Pericarditis/epidemiology , Pericarditis/etiology , Recurrence , Standard of Care
15.
Rev Med Interne ; 32(8): 486-93, 2011 Aug.
Article in French | MEDLINE | ID: mdl-20934791

ABSTRACT

Liver involvement is common in connective tissue disorders and usually asymptomatic. However, it may be symptomatic and cases of fulminant hepatitis have been reported. A diagnosis of specific hepatic involvement needs to rule out drug toxicity, viral hepatitis, or auto-immune liver disease. The large panel of auto-antibodies that is now available to the clinician is helpful to differentiate auto-immune hepatitis and specific liver involvement associated with connective tissue disease. In the latter, the outcome is generally favourable with immunosuppressive treatment.


Subject(s)
Liver Diseases/etiology , Connective Tissue Diseases/complications , Humans , Sarcoidosis/complications , Vascular Diseases/etiology
16.
Rev Med Interne ; 32(9): 560-6, 2011 Sep.
Article in French | MEDLINE | ID: mdl-20832918

ABSTRACT

Liver granulomas are histopathologically defined and associated with various liver and non-livers disorders. There are five main causes of liver granulomatosis: primary biliary cirrhosis, tuberculosis, sarcoidosis, B and C viral hepatitis, and drug related. In the other cases, not associated with an underlying systemic granulomatous disease, a systematic diagnostic approach should be used to identify less common etiologies. After a careful diagnostic work-up, a long-term follow-up of patients with undetermined liver granulomatosis is mandatory as it may be a presenting feature of liver lymphoma.


Subject(s)
Granuloma , Liver Diseases , Decision Trees , Granuloma/diagnosis , Granuloma/etiology , Humans , Liver Diseases/diagnosis , Liver Diseases/etiology
17.
J Exp Psychol Hum Percept Perform ; 34(2): 475-88, 2008 Apr.
Article in English | MEDLINE | ID: mdl-18377183

ABSTRACT

The use of visual occlusion as a cue to altitude maintenance in low-altitude flight (LAF) was investigated. The extent to which the ground surface is occluded by 3-D objects varies with altitude and depends on the height, radius, and density of the objects. Participants attempted to maintain a constant altitude during simulated flight over an undulating terrain with trees of various heights, radii, and densities. As would be predicted if participants used occlusion, root-mean-square error was related to the product of tree height and tree density (Experiment 1) and to the product of tree radius and tree density (Experiment 2). This relationship was also found for simulated terrains with a more realistic mixture of tree heights (Experiment 4). The authors present a modification to an occlusion model (T. Leung & J. Malik, 1997) that can be used to approximate occlusion in the context of LAF, and they evaluate the modified model using the present LAF data. On a practical level, simulating 3-D objects is computationally expensive. The present results suggest that performance may be maintained with fewer objects if their size is increased.


Subject(s)
Aircraft , Altitude , Orientation , Psychomotor Performance , Visual Perception , Adult , Association Learning , Computer Simulation , Humans , Models, Psychological , Sensory Deprivation , User-Computer Interface
18.
Rev Med Interne ; 29(7): 568-72, 2008 Jul.
Article in French | MEDLINE | ID: mdl-18192090

ABSTRACT

INTRODUCTION: Purulent pneumoccocal pericarditis are extremely rare since the introduction of antibiotics. EXEGESIS: A 59-year-old woman presented to the emergency room with a seven-day history of dyspnea and fever. No signs of heart failure or cardiac friction rub were evidenced. Laboratory tests disclosed elevated acute phase reactants and elevated white blood cells with a high neutrophil count. Chest radiograph showed cardiomegaly and a bilateral pleural effusion. Chest-computed tomography confirmed the pleural effusion and evidenced a large pericardial effusion. Streptoccocus pneumoniae grew up form pericardial fluid and blood cultures. In addition to the pericardial drainage, the patient received intravenous amoxicillin therapy. Outcome was favourable. There was no evidence of immunodeficiency. CONCLUSION: Although exceptional, diagnosis of purulent pneumococcal pericarditis should not be missed as it may compromise vital prognosis. Therapy should combine pericardial drainage and antibiotics.


Subject(s)
Pericarditis/diagnostic imaging , Pneumococcal Infections/diagnostic imaging , Amoxicillin/administration & dosage , Amoxicillin/therapeutic use , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/therapeutic use , Cardiomegaly/diagnostic imaging , Cardiomegaly/etiology , Female , Humans , Infusions, Intravenous , Middle Aged , Pericarditis/drug therapy , Pleural Effusion/diagnostic imaging , Pleural Effusion/etiology , Pneumococcal Infections/drug therapy , Radiography, Thoracic , Tomography, X-Ray Computed , Treatment Outcome
19.
J Opt Soc Am A Opt Image Sci Vis ; 18(2): 294-301, 2001 Feb.
Article in English | MEDLINE | ID: mdl-11205974

ABSTRACT

In order to test a model of peripheral vision, various contrast sensitivity functions (CSF's) and fundamental eccentricity constants (FEC's) [see J. Opt. Soc. Am. A 8, 1762 (1991)] were applied to real-world, wide-field (6.4 degrees-32 degrees eccentricity) images. The FEC is used to model the change in contrast sensitivity as a function of retinal eccentricity. The processed test images were tested perceptually by determining the threshold FEC for which the observers could discriminate the test images from the original image. It was expected that higher CSF sensitivity would be associated with higher FEC's; and in fact, for images processed with low-pass (variable-window stimuli) CSF's, the threshold FEC's were larger for the higher-sensitivity (pattern-detection) CSF than for the lower-sensitivity (orientation detection) CSF. When two higher-sensitivity CSF's were compared, the bandpass (constant-window stimuli) CSF resulted in essentially the same FEC threshold as did the low-pass (variable-window stimuli) CSF. The fact that the FEC compensated for complex differences in the form of the CSF suggested that the discrimination task was mediated by a limited range of spatial frequencies over which the two CSF's were similar. Image contrast was then varied in order to extend the range of spatial frequencies tested. The FEC's estimated with the lower-contrast test images were unchanged for test images obtained with the high-sensitivity, bandpass CSF but increased for test images obtained with the high-sensitivity, low-pass CSF. These results suggest that peripheral contrast sensitivity as used in the present discrimination task is based on a high-sensitivity, bandpass CSF. The peripheral-vision model validated by the present analysis has practical applications in the evaluation of wide-field simulator images as well as area-of-interest or other foveating systems.


Subject(s)
Discrimination, Psychological/physiology , Models, Biological , Space Perception/physiology , Visual Perception/physiology , Adult , Contrast Sensitivity/physiology , Humans , Middle Aged , Sensory Thresholds/physiology
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