Céline Genty

Centre Hospitalier Universitaire Rouen, Rouen, Upper Normandy, France

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Publications (43)100.87 Total impact

  • [show abstract] [hide abstract]
    ABSTRACT: Background Isolated distal deep-vein thrombosis (iDDVT) (i.e. without proximal DVT or pulmonary embolism (PE)) represents half of all lower limb DVT. Its clinical significance and management are controversial. Data on long-term follow-up are scarce, especially concerning risk and predictors of venous thromboembolism (VTE) recurrence. Methods Using data from the OPTIMEV study, a prospective, observational, multicentre study, we compared, three years after an index VTE event and after discontinuation of anticoagulants, i) the incidence and type of recurrence in patients without cancer with a first iDDVT vs. a first isolated proximal deep-vein thrombosis (iPDVT); ii) predictors of recurrence after iDDVT. ResultsAs compared with patients with iPDVT (n=259), patients with an iDDVT (n=490) had a lower annualized incidence of overall VTE recurrence (5.2% [3.6-7.6] vs. 2.7% (95% CI) [1.9-3.8]) respectively, p=0.02) but a similar incidence of PE recurrence (1.0% [0.5-2.3] vs. 0.9% [0.5-1.6] respectively, p=0.83). An Age>50 years, unprovoked character of index iDDVT, and involvement of more than one vein in one or both legs each independently tripled the risk of recurrence, this latter being then ≥3% per patient-year. Neither muscular vein nor deep-calf vein location of iDDVT nor clot diameter with compression influenced the risk of recurrence. Conclusion After stopping anticoagulants, patients with iDDVT have a significantly lower risk of overall VTE recurrence than patients with iPDVT, but a similar risk of serious recurrent VTE. Age>50, unprovoked iDDVT, and number of thrombosed veins (>1) influenced the risk of recurrence and may help to define patients at significant risk of recurrence.This article is protected by copyright. All rights reserved.
    Journal of Thrombosis and Haemostasis 01/2014; · 6.08 Impact Factor
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    ABSTRACT: Background. Infections are risk factors for venous thromboembolism, especially if severe and acute. The role of chronic infections such as active tuberculosis is ill-defined, although several case reports and small series have suggested an association between tuberculosis and venous thromboembolism. Methods. Using data from the Premier Perspective(TM) database (27,659,947 admissions) we performed a multivariate analysis to assess the specific venous thromboembolism risk associated with tuberculosis. The analysis was adjusted on classical risk factors for venous thromboembolism. Results. The prevalence of venous thromboembolism among the patients with active tuberculosis was 2.07% (1.62-2.59). In a multivariate analysis model, adults with active tuberculosis had a greater risk of venous thromboembolism than those without (OR=1.55, 1.23-1.97, p<0.001), close to the previously reported risk associated with neoplasia. No particular link was found between pulmonary tuberculosis and pulmonary embolism, or between extra-pulmonary tuberculosis and deep vein thrombosis. This may suggest the preponderant role of a systemic hypercoagulable state over an intrathoracic venous compression mechanism. In-hospital mortality of patients with both active tuberculosis and venous thromboembolism (11/72, 15%) was higher than mortality of patients with only active tuberculosis (92/3413, 2.7%) or only venous thromboembolism (5062/199480, 2.5%) (p<0.001). Pulmonary embolism was more frequent in black patients, suggesting that this population, which is also more likely to suffer from tuberculosis, should be followed carefully. Conclusion. Tuberculosis must be considered as a pertinent risk factor for venous thromboembolism and should be included in thromboembolism risk evaluation as any acute and severe infection.
    Clinical Infectious Diseases 11/2013; · 9.37 Impact Factor
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    ABSTRACT: Apart from compression therapy, physical therapy has scarcely been evaluated in the treatment of chronic venous disorders (CVDs). Spa treatment is a popular way to administer physical therapy for CVDs in France, but its efficacy has not yet been assessed in a large trial. The objective was to assess the efficacy of spa therapy for patients with advanced CVD (CEAP clinical classes C4-C5). This was a single-blind (treatment concealed to the investigators) randomized, multicenter, controlled trial (French spa resorts). Inclusion criteria were primary or post-thrombotic CVD with skin changes but no active ulcer (C4a, C4b, or C5). The treated group had the usual 3-week spa treatment course soon after randomization; the control group had spa treatment after the 1-year comparison period. All patients continued their usual medical care including wearing compression stockings. Treatment consisted of four balneotherapy sessions/d, 6/7 days. Follow-up was performed at 6, 12 and 18 months by independent blinded investigators. The main outcome criterion was the incidence of leg ulcers at 12 months. Secondary criteria were a modified version of the Venous Clinical Severity Score, a visual analog scale for leg symptoms, and the Chronic Venous Insufficiency Questionnaire 2 and EuroQol 5D quality-of-life autoquestionnaires. Four hundred twenty-five subjects were enrolled: 214 in the treatment group (Spa) and 211 in the control group (Ctr); they were similar at baseline regarding their demographic characteristics, the severity of the CVD, and the outcome variables. At 1 year, the incidence of leg ulcers was not statistically different (Spa: 9.3%; 95% confidence interval [CI], 5.6-14.3; Ctr: 6.1%; 95% CI, 3.2-10.4), whereas the Venous Clinical Severity Score improved significantly in the treatment group (Spa: -1.2; 95% CI, -1.6 - -0.8; Ctr: -0.6; 95% CI, -1.0 - -0.2; P = .04). A significant difference favoring spa treatment was found regarding symptoms after 1 year (Spa: -0.03; 95% CI, -0.57 - +0.51; Ctr: +0.87; 95% CI,+0.46 - +1.26; P = .009). EuroQol 5D improved in the treatment group (Spa: +0.01; 95% CI, -0.02 - +0.04) while it worsened (Ctr: -0.07; 95% CI, -0.10 - -0.04) in the control group (P < .001). A similar pattern was found for the Chronic Venous Insufficiency Questionnaire 2 scale (Spa: -2.0; 95% CI, -4.4 - +0.4; Ctr: +2.4; 95% CI, +0.2 - 4.7; P = .008). The control patients showed similar improvements in clinical severity, symptoms, and quality of life after their own spa treatment (day 547). In this study, the incidence of leg ulcers was not reduced after a 3-week spa therapy course. Nevertheless, our study demonstrates that spa therapy provides a significant and substantial improvement in clinical status, symptoms, and quality of life of patients with advanced venous insufficiency for at least 1 year.
    Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter 10/2013; · 3.52 Impact Factor
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    ABSTRACT: The early diagnosis of pelvic arterial haemorrhage is challenging for initiating treatment by transcatheter arterial embolization (TAE) in multiple trauma patients. We use an institutional algorithm focusing on haemodynamic status on admission and on a whole-body CT scan in stabilized patients to screen patients requiring TAE. This study aimed to assess the effectiveness of this approach. This retrospective cohort study included 106 multiple trauma patients admitted to the emergency room with serious pelvic fracture [pelvic abbreviated injury scale (AIS) score of 3 or more]. Of the 106 patients, 27 (25%) underwent pelvic angiography leading to TAE for active arterial haemorrhage in 24. The TAE procedure was successful within 3h of arrival in 18 patients. In accordance with the algorithm, 10 patients were directly admitted to the angiography unit (n=8) and/or operating room (n=2) for uncontrolled haemorrhagic shock on admission. Of the remaining 96 stabilized patients, 20 had contrast media extravasation on pelvic CT scan that prompted pelvic angiography in 16 patients leading to TAE in 14. One patient underwent a pelvic angiography despite showing no contrast media extravasation on pelvic CT scan. All 17 stabilized patients who underwent pelvic angiography presented a more severely compromised haemodynamic status on admission, and they required more blood products during their initial management than the 79 patients who did not undergo pelvic angiography. The incidence of unstable pelvic fractures was however comparable between the two groups. Overall, haemodynamic instability and contrast media extravasation on the CT-scan identified 26 out of the 27 patients who required subsequent pelvic angiography leading to TAE in 24. An algorithm focusing on haemodynamic status on arrival and on the whole-body CT scan in stabilized patients may be effective at triaging multiple trauma patients with serious pelvic fractures.
    Injury 07/2013; · 1.93 Impact Factor
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    ABSTRACT: Objective Assessment of cancer screening in the context of venous thromboembolic disease (VTE) remains controversial. We tried to characterize a population at high risk of developing cancer among patients suffering from VTE. Method We conducted a retrospective ancillary case-control study among patients with VTE who later had a positive diagnosis of cancer. We assessed the association of cancer with characteristic features of VTE and with the results for four biological markers. Results Our population included 142 patients (53% men, median age 71 years). Two years after VTE, 24 patients (17%) had cancer. Median values for D-dimers, fibrin monomers and SP-selectin were significantly higher among patients who developed cancer. Logistic regression enabled us to identify two parameters targeting patients with a high risk of cancer: bilateral venous thrombosis (OR: 4.41, 95%CI: 1.41–13.78, P = 0.01) and D-dimers superior to 3.8 μg/mL (OR: 3.68, 95%CI: 1.36–9.94, P = 0.01). The information provided by these two characteristics was additive; 58% of patients in our population who had both factors developed cancer. Conclusion Bilateral venous thrombosis and D-dimers superior to 3.8 μg/mL are highly associated with carcinoma. This result requires a prospective validation. It could be useful in limiting the screening process to the population most at risk.
    Journal des Maladies Vasculaires 05/2013; 38(3):172–177. · 0.24 Impact Factor
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    ABSTRACT: CONTEXT: Pupillary reflex dilation appears to be a reliable indicator of response to noxious stimulation even under general anaesthesia. The ability of pupillometry to detect the effects of extremity blocks during continuous infusion of opioids remains unknown. OBJECTIVE: To explore the performance of pupillometry to detect differences in pupillary reflex dilation response to a standardised noxious stimulus applied to each leg following unilateral popliteal sciatic nerve block during continuous infusion of remifentanil. DESIGN: Prospective, observational study. SETTING: University hospital anaesthesia department, between June 2010 and December 2010. PATIENTS: Twenty-four adult patients undergoing elective foot or ankle surgery under general anaesthesia who requested a peripheral nerve block. Unilateral popliteal sciatic nerve block with 0.75% ropivacaine and 1% lidocaine was performed awake. General anaesthesia was maintained with steady-state infusions of propofol and remifentanil. MAIN OUTCOME MEASURE: Video-based pupillometer was used to determine pupillary reflex dilation during tetanic stimulation (60 m, 100 Hz) applied to the skin area innervated by the sciatic nerve for 5 s after the onset of general anaesthesia. RESULTS: Sensory nerve block led to a blunted maximal pupillary reflex dilation response to noxious stimulation compared with the non-blocked leg: median (interquartile range) change from baseline 2% (1 to 4%) versus 17% (13 to 24%), respectively (P < 0.01). The differences in the response persisted throughout the 5-s stimulus and the recovery phase. CONCLUSION: These results are a proof of concept. The effects of peripheral nerve block can be detected via the measurement of pupillary reflex dilation response to noxious stimulation of the skin in patients receiving remifentanil.
    European Journal of Anaesthesiology 04/2013; · 2.79 Impact Factor
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    ABSTRACT: PURPOSE: We searched for factors independently associated with the prescription of multimodal (balanced) analgesia in mechanically ventilated critically ill patients. METHODS: In this post hoc analysis of a cohort study, 172 patients who received a combination of 1 opioid with nonopioids, that is, paracetamol and/or nefopam, (multimodal analgesia), were compared with 302 patients who received opioid only on day 2 of their stay in the intensive care unit. RESULTS: Patients given multimodal analgesia were more likely to have fewer organ failures and received fewer hypnotics compared with patients who received opioid only. They self-reported more frequently their pain level. There were no differences in the daily dose of opioids between the 2 groups. A low illness severity score, no more than 1 organ failure on day 2, the ability to self-rate pain, and a moderate-to-severe pain rated on day 2 were factors independently associated with the prescription of multimodal analgesia on day 2 (all P < .01). CONCLUSIONS: In mechanically ventilated patients, the addition of nonopioids to opioids is mostly prescribed for patients with lower illness severity scores and who are able to self-rate their pain intensity. These findings suggest that the concept of multimodal analgesia must be promoted in the intensive care unit.
    Journal of critical care 03/2013; · 2.13 Impact Factor
  • Journal des Maladies Vasculaires 03/2013; 38(2):110. · 0.24 Impact Factor
  • Journal des Maladies Vasculaires 03/2013; 38(2):117. · 0.24 Impact Factor
  • Journal des Maladies Vasculaires 03/2013; 38(2):110. · 0.24 Impact Factor
  • Journal des Maladies Vasculaires 03/2013; 38(2):124. · 0.24 Impact Factor
  • Journal des Maladies Vasculaires 03/2013; 38(2):109. · 0.24 Impact Factor
  • Journal des Maladies Vasculaires 03/2013; 38(2):109. · 0.24 Impact Factor
  • Journal des Maladies Vasculaires 09/2012; 37(5):262–263. · 0.24 Impact Factor
  • Journal des Maladies Vasculaires 09/2012; 37(5):266–267. · 0.24 Impact Factor
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    ABSTRACT: OBJECTIVE: To assess the impact of four patient information leaflets on patients' behavior in primary care. DESIGN: Cluster randomized multicenter controlled trial between November 2009 and January 2011. PARTICIPANTS: French adults and children consulting a participating primary care physician and diagnosed with gastroenteritis or tonsillitis. Patients were randomized to receive patient information leaflets or not, according to the cluster randomization of their primary care physician. INTERVENTION: Adult patients or adults accompanying a child diagnosed with gastroenteritis or tonsillitis were informed of the study. Physicians in the intervention group gave patients an information leaflet about their condition. Two weeks after the consultation patients (or their accompanying adult) answered a telephone questionnaire on their behavior and knowledge about the condition. MAIN MEASURES: The main and secondary outcomes, mean behavior and knowledge scores respectively, were calculated from the replies to this questionnaire. RESULTS: Twenty-four physicians included 400 patients. Twelve patients were lost to follow-up (3 %). In the group that received the patient information leaflet, patient behavior was closer to that recommended by the guidelines than in the control group (mean behavior score 4.9 versus 4.2, p < 0.01). Knowledge was better for adults receiving the leaflet than in the control group (mean knowledge score 4.2 versus 3.6, p < 0.01). There were fewer visits for the same symptoms by household members of patients given leaflets (23.4 % vs. 56.2 %, p < 0.01). CONCLUSION: Patient information leaflets given by the physician during the consultation significantly modify the patient's behavior and knowledge of the disease, compared with patients not receiving the leaflets, for the conditions studied.
    Journal of General Internal Medicine 07/2012; · 3.28 Impact Factor
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    ABSTRACT: Background Compression therapy constitutes the cornerstone of prevention of post-thrombotic syndrome in patients with deep-vein thrombosis (DVT). However, no consensus has been reached regarding the optimal timing for initiation, duration, and strength of compression therapy. Objective To document prescribing practices of compression therapy in case of DVT by French Vascular Medicine physicians. Methods E-mail survey sent in 2009 to all physicians members of the French Society of Vascular Medicine. Results Seven hundred and sixty-one vascular medicine physicians (56.6% private practice, 19.8% hospital-based and 23.6% both private practice and hospital-based physicians) responded. At diagnosis, 94.3% (n = 707) systematically prescribed compression therapy. The initial compression consisted in elastic compression stockings (ECS) for 57.3% of patients (n = 426) and in bandages for 42.7% (n = 317). When physicians initially prescribed bandages, in 92.3% of cases they later switched to elastic compression stockings (ECS). Finally, 95.8% (n = 712) of vascular medicine physicians reported prescribing ECS during DVT follow-up. The ECS ankle pressure gradient was 15–20 mmHg in 64.3% of cases and 20–36 mmHg in 35.5%. Most physicians (85.9%, n = 631) modulated the duration of compression therapy according to the results of follow-up compression ultrasonographic explorations. Only a limited proportion of physicians took into account thrombus localization or its initial extention. Conclusion In case of DVT, French vascular medicine physicians systematically prescribed compression therapy. However, the strength of compression was lower than recommended by international guidelines. Efficacy and benefits (potential better compliance) of this common practice should be assessed with a randomized controlled trial.
    Journal des Maladies Vasculaires 06/2012; 37(3):140–145. · 0.24 Impact Factor
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    ABSTRACT: Compression therapy constitutes the cornerstone of prevention of post-thrombotic syndrome in patients with deep-vein thrombosis (DVT). However, no consensus has been reached regarding the optimal timing for initiation, duration, and strength of compression therapy. To document prescribing practices of compression therapy in case of DVT by French Vascular Medicine physicians. E-mail survey sent in 2009 to all physicians members of the French Society of Vascular Medicine. Seven hundred and sixty-one vascular medicine physicians (56.6% private practice, 19.8% hospital-based and 23.6% both private practice and hospital-based physicians) responded. At diagnosis, 94.3% (n=707) systematically prescribed compression therapy. The initial compression consisted in elastic compression stockings (ECS) for 57.3% of patients (n=426) and in bandages for 42.7% (n=317). When physicians initially prescribed bandages, in 92.3% of cases they later switched to elastic compression stockings (ECS). Finally, 95.8% (n=712) of vascular medicine physicians reported prescribing ECS during DVT follow-up. The ECS ankle pressure gradient was 15-20 mmHg in 64.3% of cases and 20-36 mmHg in 35.5%. Most physicians (85.9%, n=631) modulated the duration of compression therapy according to the results of follow-up compression ultrasonographic explorations. Only a limited proportion of physicians took into account thrombus localization or its initial extention. In case of DVT, French vascular medicine physicians systematically prescribed compression therapy. However, the strength of compression was lower than recommended by international guidelines. Efficacy and benefits (potential better compliance) of this common practice should be assessed with a randomized controlled trial.
    Journal des Maladies Vasculaires 05/2012; 37(3):140-5. · 0.24 Impact Factor
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    ABSTRACT: The management strategies for symptomatic isolated superficial vein thrombosis (SVT) (without concomitant deep vein thrombosis [DVT] or pulmonary embolism [PE]) have yet to achieve widespread consensus. Concerns have been raised regarding the usefulness of prescribing anticoagulant treatments to all patients with isolated SVT. Determining the isolated SVT subgroups who have the highest risks of venous thromboembolism (VTE) recurrence (composite of DVT, PE, and new SVT) may facilitate the identification of patients who are likely to benefit from anticoagulant treatment. We performed a pooled analysis on individual data from two observational, multicenter, prospective studies, to determine predictors for VTE recurrence and their impact in an unselected population of symptomatic isolated SVT patients. One thousand and seventy-four cases of symptomatic isolated SVT were followed up at 3 months. VTE recurrence was observed in 3.9% of the patients; 16.2% of the patients did not receive anticoagulants, and 0.6% experienced a VTE recurrence. Cancer, personal history of VTE and saphenofemoral/popliteal involvement significantly increased the risk of subsequent VTE or DVT/PE in univariate analyses. Only male sex significantly increased the risk of VTE or DVT/PE recurrence in multivariate analyses. Twelve percent of the patients had cancer or saphenofemoral junction involvement, and were at higher risk of DVT/PE recurrence than patients without those characteristics (4.7% vs. 1.9%, P= 0.06). In patients with symptomatic SVT, only male sex significantly and independently increased the risk of VTE recurrence. Cancer or saphenofemoral junction involvement defined a population at high risk for deep VTE recurrence. Some SVTs might be safely managed without anticoagulants.
    Journal of Thrombosis and Haemostasis 03/2012; 10(6):1004-11. · 6.08 Impact Factor
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    ABSTRACT: Suspected deep vein thrombosis (DVT) of lower limbs (LL) may require different tools to rule out or confirm the diagnosis. Clinical probability provides help to select useful tests, interpret their results, and decide to treat the patient meanwhile. Clinical prediction rules that risk stratify patients with suspected DVT can be established from inpatients, but no prediction rule not requiring laboratory tests has been established from primary care patients. We previously derived and internally validated such a prediction rule. The aim of this study is to externally validate this score. The score was applied to Optimev outpatients with suspected LL-DVT, and without suspected pulmonary embolism. Sensitivity and specificity were calculated for proximal and distal DVT, according to each score. The area under the ROC curve was calculated for each kind of DVT, in order to assess the validity of the score on predicting the presence or absence of DVT. Among 3523 outpatients prospectively included in the Optimev study for suspected LL DVT, overall prevalence of DVT was 29.7% (n=1046), ranging from 21.7% in the non-high score probability, to 61.4% in the high score probability. The area under the ROC curve was 0.79 [CI 95%, 0.77-0.80]. With subgroup analysis, the area under curve was 0.83 [CI 95%, 0.82-0.85] for proximal DVT, and 0.75 [CI 95%, 0.73-0.77] for distal DVT. This score reliably identifies primary care patients with LL DVT, whether proximal or distal.
    Journal des Maladies Vasculaires 12/2011; 37(1):9-14. · 0.24 Impact Factor

Publication Stats

335 Citations
76 Downloads
2k Views
100.87 Total Impact Points

Institutions

  • 2013
    • Centre Hospitalier Universitaire Rouen
      Rouen, Upper Normandy, France
  • 2012–2013
    • French National Centre for Scientific Research
      Lutetia Parisorum, Île-de-France, France
  • 2010–2013
    • University of Grenoble
      Grenoble, Rhône-Alpes, France
    • Centre Hospitalier Universitaire de Montpellier
      Montpelhièr, Languedoc-Roussillon, France
  • 2007–2011
    • University Joseph Fourier - Grenoble 1
      Grenoble, Rhône-Alpes, France