Mounir Aout

Hôpital Lariboisière - Fernand-Widal (Hôpitaux Universitaires Sant-Louis, Lariboisière, Fernand-Widal), Lutetia Parisorum, Île-de-France, France

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Publications (64)278.51 Total impact

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    ABSTRACT: Objectif Évaluer la valeur diagnostique des tests cliniques pour tendinopathies dégénératives de la coiffe des rotateurs (TDCR) en pratique médicale. Méthodes Des patients avec TDCR ont été inclus de façon prospective. Onze tests cliniques de la coiffe des rotateurs ont été pratiqués. Un échographiste réalisait les échographies d’épaule en insu. Les résultats échographiques étaient exprimés en tendon normal, tendinopathie et rupture transfixiante. Sensibilité, spécificité, valeurs prédictives positive et négative, exactitude, ratio de vraisemblance (RV) positif et négatif ont été calculés pour chaque test et chaque diagnostic échographique. La valeur diagnostique a été admise à partir d’un RV positif et négatif, ≥ 2 et ≤ 0,5. Résultats Trente-cinq patients et 39 épaules ont été inclus. Le test de Jobe (RV positif: 2,08, RV négatif: 0,31) et le full-can test (2, 0,5), avec pour réponse la faiblesse, atteignaient le seuil de valeur diagnostique pour la rupture du supra-épineux, la rotation latérale en position 1 (2,42, 0,5) pour celle de l’intra-épineux et le lift-off test (8,50, 0,27) pour celle du subscapulaire. Le test de Yergason (3,7, 0,41) atteignait ce seuil pour la tendinopathie du long biceps. Aucun test clinique n’atteignait ce seuil pour les tendinopathies des supra-épineux, infra-épineux et subscapulaire. Conclusions Ce travail montre la valeur diagnostique de 5 des 11 tests cliniques de la coiffe évalués.
    Annals of Physical and Rehabilitation Medicine. 01/2014;
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    ABSTRACT: Intravenous enoxaparin did not reduce significantly the primary end point (p = 0.06) compared with unfractionated heparin (UFH) in the randomized Acute Myocardial Infarction Treated with primary angioplasty and intravenous enoxaparin Or unfractionated heparin to Lower ischemic and bleeding events at short- and Long-term follow-up (ATOLL) trial. We present the results of the prespecified per-protocol analysis excluding patients who did not receive the treatment allocated by randomization or received both enoxaparin and UFH. We evaluated all-cause mortality, complication of myocardial infarction, procedural failure, or major bleeding (primary end point) and all-cause mortality, recurrent acute coronary syndrome, or urgent revascularization (main secondary end point). Baseline and procedural characteristics were well balanced between the 2 treatment groups. Of 910 randomized patients, 795 patients (87.4%) were treated according to the protocol with consistent anticoagulation using intravenous enoxaparin (n = 400) or UFH (n = 395). Enoxaparin reduced significantly the rates of the primary end point (relative risk [RR] 0.76, 95% confidence interval [CI] 0.62 to 0.94, p = 0.012) and the main secondary end point (RR 0.37, 95% CI 0.22 to 0.63, p <0.0001). There was less major bleeding with enoxaparin (RR 0.46, 95% CI 0.21 to 1.01, p = 0.050) contributing to the significant improvement of the net clinical benefit (RR 0.46, 95% CI 0.3 to 0.74, p = 0.0002). All-cause mortality was also reduced with enoxaparin (RR 0.36, 95% CI 0.18 to 0.74, p = 0.003). In conclusion, in the per-protocol analysis of the ATOLL trial, pertinent to >87% of the study population, enoxaparin was superior to UFH in reducing ischemic end points and mortality.
    The American journal of cardiology 09/2013; · 3.58 Impact Factor
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    ABSTRACT: The prognosis of hepatocellular carcinoma (HCC) treated by radiofrequency ablation (RFA) is mainly linked to tumor recurrence. So far, no tissue biomarker of recurrence has been validated in biopsy samples. We aimed to investigate the prognostic value of tissue biomarkers in HCC biopsy samples of patients treated by RFA. All consecutive naive patients from 3 university hospitals with compensated cirrhosis, early-stage (BCLC 0/A) uninodular HCC treated with RFA, and available tumor biopsy were included. Edmondson's grade, and the expression of cytokeratin 19, glutamine synthase, beta-catenin, epithelial cell adhesion molecule (EpCAM) and endothelial cell-specific molecule 1(ESM-1) were assessed. Main clinical end-points were overall and early recurrence. Statistical analyses were performed using Kaplan Meier, Log-Rang Test and Cox models. 150 patients were included. Recurrence, death or liver transplantation occurred in 85, 51 and 12 patients respectively. Median follow-up was 27 months. ESM-1 expression by HCC stromal endothelial cells was observed in 58 patients (40%) and was associated with higher serum AFP levels, larger tumor, and more frequent expressions of EpCAM and surrogate markers of activation of the Wnt-ßcatenin pathway. The 2 independent predictive factors for overall recurrence were serum AFP (HR 1.11 [1.002; 1.22], p = 0.045), and ESM-1 expression (HR 1.56 [1.004; 2.43], p = 0.048). ESM-1 expression was also an independent predictive factor for early recurrence (HR 1.81 [1.02; 3.21], p = 0.042). ESM-1 expression by stromal endothelial cells, in tumor biopsy samples, has an independent predictive value for early recurrence after RFA.
    Journal of Hepatology 08/2013; · 9.86 Impact Factor
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    ABSTRACT: Objectifs Évaluer la reproductibilité et les variations de la mesure du coefficient de diffusion apparent (ADC) dans le parenchyme pancréatique normal à 1,5 et 3 teslas (T) et déterminer s’il peut exister des différences entre les quatre segments du pancréas. Patients et méthodes Imagerie par résonance magnétique de diffusion du pancréas à 1,5 T chez 20 patients et à 3 T chez 20 autres patients strictement appariés en sexe et en âge, avec les mêmes valeurs de b (0, 400 et 800 s/mm2). Deux observateurs indépendants ont positionné les régions d’intérêt dans les quatre segments du pancréas afin de procéder à la mesure de l’ADC aux deux champs magnétiques. Nous avons utilisé la méthode de Bland-Altman pour apprécier la concordance intra- et inter-observateurs des mesures de l’ADC et avons comparé les valeurs d’ADC obtenues aux deux champs magnétiques avec des tests non paramétriques. Résultats Nous n’avons observé aucune différence significative, d’une part, entre les mesures répétées de l’ADC et, d’autre part, entre les mesures d’ADC obtenues à 1,5 et à 3 teslas (T). La concordance intra-observateur de l’ADC avait les limites à 95 % suivantes : 2,3–22,7 % à 1,5 T et 1–24,2 % à 3 T ; la concordance inter-observateurs avait comme limites 1,9–14 % à 1,5 T et 8–25 % à 3 T. À 3 T, les valeurs d’ADC étaient semblables dans tous les segments pancréatiques, tandis qu’à 1,5 T, l’ADC était plus bas dans la queue du pancréas. Conclusion La mesure de l’ADC offre un degré élevé de reproductibilité intra- et inter-observateurs. L’ADC a une distribution homogène dans les quatre segments pancréatiques à 3 T.
    Journal de Radiologie Diagnostique et Interventionnelle. 04/2013; 94(4):433–443.
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    ABSTRACT: BACKGROUND: The physiotherapy dynamic humeral centring (DHC) aims to prevent subacromial impingement of rotator cuff tendons during elevation of the arm. The objective of the study was to determine whether DHC acts via an effect on subacromial impingement mechanism by assessing its effect on painful elevation of the arm in subacromial impingement syndrome. METHODS: This is a secondary analysis of results of a randomised controlled trial of the effectiveness of DHC. Sixty-nine patients with subacromial impingement syndrome were prospectively included. Patients and the assessor were blinded to the study hypothesis and treatment, respectively. Patients underwent DHC or non-specific mobilisation as a control for 6 weeks in 15 supervised individual outpatient sessions with home exercises. Outcomes were pain-free range of motion and presence of painful arc of the shoulder, both in active flexion and abduction of the arm at 3 months. RESULTS: At 3 months, pain-free range of motion, both flexion and abduction, was greater in the DHC group than in the mobilisation group. The number of patients with painful arc during flexion was decreased in the DHC group. CONCLUSIONS: DHC improves painful active elevation of the arm. We suggest that DHC may act via a specific effect on subacromial impingement mechanism.
    British journal of sports medicine 03/2013; · 3.67 Impact Factor
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    ABSTRACT: The use of glycoprotein IIb/IIIa receptor inhibitors (GPIs) in high-risk patients with acute coronary syndromes has been associated with reductions in ischemic events but increases in bleeding complications. The role of GPIs in patients who undergo primary percutaneous coronary intervention (PCI) by the transradial approach (TRA) is not well studied. The aim of this post hoc analysis from the randomized prospective Acute Myocardial Infarction Treated With Primary Angioplasty and Intravenous Enoxaparin or Unfractionated Heparin to Lower Ischemic and Bleeding Events at Short- and Long-Term Follow-Up (ATOLL) trial was to assess the safety and efficacy of GPIs in primary PCI performed using the TRA. A total of 910 patients were enrolled in ATOLL; 522 patients (67%) underwent PCI using the TRA. Two comparative analyses were performed. First, patients who underwent PCI using the TRA who received GPIs were compared with those who did not receive GPIs. Second, patients who underwent PCI using the TRA who received GPIs were compared with those who underwent PCI using a nonradial route and received GPIs. Composite end points of net clinical benefit, ischemic outcomes, and safety consisting of bleeding and transfusion at 1 month were analyzed. A propensity score was constructed, and weight adjustment were made for variables, including but not limited to age, weight, gender, renal function, concomitant use of other medications, Killip class, and medical history, when analyzing the end points. There was no significant difference in net clinical benefit or ischemic outcomes between either TRA patients with versus without GPIs or TRA patients with GPIs versus non-TRA patients with GPIs. Additionally, there were significantly fewer major bleeding events and blood transfusions in TRA patients with GPIs compared with non-TRA patients with GPIs. In conclusion, the addition of GPIs in the setting of primary PCI using the TRA was not associated with bleeding liability. The use of GPIs with TRA was associated with safer outcomes than using GPIs with a nontransradial approach. This study was limited in that it was a nonrandomized retrospective analysis.
    The American journal of cardiology 03/2013; · 3.58 Impact Factor
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    ABSTRACT: BACKGROUND: Male lower urinary tract symptoms (LUTS) are one of the most treated diseases, but little is known about patient trajectories in current clinical practice. OBJECTIVE: To describe the dynamic treatment patterns of LUTS presumably due to benign prostatic obstruction (BPO). DESIGN, SETTINGS, AND PARTICIPANTS: All prescriptions of α1-adrenergic receptor blocking agents (α1-blockers), 5α-reductase inhibitors (5-ARIs), and phytotherapy, and all surgeries related to BPO performed in France from 2004 to 2008 were identified using two distinct administrative claim databases maintained by the National Health Insurance system that covers the entire population. After linking the two data sets, all consecutive treatment events were analyzed for each patient. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Drug prescription details were assessed for each year, region, and prescriber qualification. Medical treatment initiation, interruption, evolution, and events after surgical management (hospital stay, reoperation, complication rates, and subsequent medical prescriptions) were also investigated. RESULTS AND LIMITATIONS: Overall, 2 620 269 patients were treated within 5 yr, with important geographic variations. Medical treatment was interrupted for approximately 16% of patients. The α1-blockers were prescribed most frequently, but phytotherapy surprisingly accounted for 27% of all monotherapies and 54% of all combination therapies. General practitioners and urologists (92% and 3.7% of overall prescribers, respectively) exhibited a similar prescription profile. Treatment initiation was medical in 95.4% of cases, consisting primarily of monotherapy using α1-blockers (60.3%), phytotherapy (31.8%), or 5-ARIs (7.9%). Treatment was modified at extremely high rates within 12 mo of initiation (8.7%, 14.6%, and 12.9%, respectively). The median hospital stay for surgical management was far higher than in clinical trials. Long-term surgical complications and reoperation rates favored open prostatectomy. Incidence of pharmacologic treatment after surgery was as high as 13.8% at 12 mo. CONCLUSIONS: This unique dynamic evaluation of clinical practice revealed unexpected results that contrast with previously published evidence from clinical trials. This approach may merit monitored and targeted measures to improve the level of care in the field.
    European Urology 02/2013; · 10.48 Impact Factor
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    ABSTRACT: PURPOSE: To evaluate reproducibility and variations in apparent diffusion coefficient (ADC) measurement in normal pancreatic parenchyma at 1.5- and 3.0-Tesla and determine if differences may exist between the four pancreatic segments. MATERIALS AND METHODS: Diffusion-weighted MR imaging of the pancreas was performed at 1.5-Tesla in 20 patients and at 3.0-Tesla in other 20 patients strictly matched for gender and age using the same b values (0, 400 and 800s/mm(2)). Two independent observers placed regions of interest within the four pancreatic segments to measure ADC at both fields. Intra- and inter-observer agreement in ADC measurement was assessed using Bland-Altman analysis and comparison between ADC values obtained at both fields using non-parametrical tests. RESULTS: There were no significant differences in ADC between repeated measurements and between ADC obtained at 1.5-Tesla and those at 3.0-Tesla. The 95% limits of intra-observer agreement between ADC were 2.3%-22.7% at 1.5-Tesla and 1%-24.2% at 3.0-Tesla and those for inter-observer agreement between 1.9%-14% at 1.5-Tesla and 8%-25% at 3.0-Tesla. ADC values were similar in all pancreatic segments at 3.0-T whereas the tail had lower ADC at 1.5-Tesla. CONCLUSION: ADC measurement conveys high degrees of intra- and inter-observer reproducibility. ADC have homogeneous distribution among the four pancreatic segments at 3.0-Tesla.
    Diagnostic and interventional imaging. 02/2013;
  • Bruno Mégarbane, Mounir Aout
    La Presse Médicale. 01/2013; 42(1):120–122.
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    ABSTRACT: AIM: This study assessed whether the poor correlation between HbA(1c) and oral glucose tolerance test (OGTT) for dysglycaemia diagnosis may be explained by haemoglobin glycation (HbG). METHODS: A total of 1033 consecutive overweight or obese patients with no known diabetes underwent OGTT and measurement of HbA(1c) to diagnose diabetes and dysglycaemia (American Diabetes Association criteria). For each OGTT result category, low, medium and high HbG was defined according to the mean HbA(1c)/fructosamine ratio and mean fructosamine. High HbG was defined as values greater than mean values in each OGTT category for both HbA(1c)/fructosamine ratio and fructosamine levels, and low HbG was defined as lower values of both. The remaining patients were considered medium HbG. RESULTS: Based on OGTT and HbA(1c) values, 267 (25.8%) and 443 (42.8%) patients had intermediate hyperglycaemia, and 66 (6.4%) and 95 (9.2%) patients had diabetes, respectively. The results were discordant for intermediate hyperglycaemia or diabetes diagnosis in 41.7% and for diabetes diagnosis in 10.0% of the patients. The proportion of patients with HbA(1c)≥6.5%, but without OGTT-diagnosed diabetes, was 0%, 3.8% and 32.8% in the low-HbG, medium-HbG and high-HbG groups, respectively. In contrast, the proportion of patients with HbA(1c)<5.7%, but with an abnormal OGTT, was 30.4%, 11.1% and 0%, respectively. The AUROC of HbA(1c) to detect OGTT-diagnosed diabetes was better in the medium-HbG group [0.874 (0.816-0.931)] than in those with low or high HbG [0.628 (0.489-0.768); P<0.01]. Only age was independently associated with high-HbG status [10-year OR: 1.3 (1.1-1.5); P<0.0001]. CONCLUSION: Haemoglobin glycation may explain many of the discordant results between HbA(1c) and OGTT when used for dysglycaemia diagnosis.
    Diabetes & Metabolism 12/2012; · 2.39 Impact Factor
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    ABSTRACT: Objective: To assess the results of transurethral needle ablation (TUNA) (Prostiva®, Medtronic, France) performed in an ambulatory setting in men with lower urinary tract symptoms (LUTS)/benign prostatic hyperplasia (BPH). Materials and Methods: A multicenter open-label study was conducted. Short-term success was defined by ability to leave the hospital on the evening of the intervention, and absence of rehospitalization due to complications during the first postoperative month. Sexual and urinary functions were evaluated by validated questionnaires. Results: The procedure was successful in 44/49 patients. Sexual and ejaculatory function was not affected or slightly improved in the majority of patients. Urinary parameters improved with a 32% decrease in the International Prostate Symptom Score. At 1 month postoperation, more than 80% of patients were satisfied, and 36/41 patients were prepared to undergo the procedure again if needed. Our study was limited by the short follow-up duration. Conclusions: TUNA can be successfully performed in an ambulatory setting under local and/or general anesthesia with a high level of patient satisfaction and a low short-term morbidity, especially on sexual function. Thus, the procedure is a suitable mini-invasive option for patients who cannot/do not want to take medical therapy or undergo invasive surgical procedures, or want to preserve their sexual function.
    Urologia Internationalis 10/2012; · 1.07 Impact Factor
  • Bruno Mégarbane, Mounir Aout
    La Presse Médicale 08/2012; · 0.87 Impact Factor
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    ABSTRACT: OBJECTIVE: To perform a meta-analysis to determine sensitivity and specificity estimates of helical CT-enteroclysis in the detection of small-bowel tumours. METHODS: A search for relevant articles published from January 1992 to November 2010 was performed. Study design, patient characteristics and 2 × 2 contingency tables were recorded for eligible studies. Heterogeneity was assessed with the I (2) statistic. A bivariate generalised linear random-effects model was used to summarise sensitivity and specificity estimates for small-bowel tumour detection on a per-patient basis. Sensitivity and specificity estimates were compared in different subgroups. RESULTS: Twelve studies (696 patients) were eligible. The mean small-bowel tumour prevalence was 22.6 % (range 7.7-45.8 %). Inter-study heterogeneity was substantial for sensitivity (I (2) = 66.9 %; 95 % CI 28.7-88.5 %) and low for specificity (I (2) = 10.6 %; 95 % CI 0.0-55.0 %). On a per-patient basis, pooled sensitivity was 92.8 % (95 % CI 71.3-98.5 %) and pooled specificity 99.2 % (95 % CI 94.2-99.9 %) for the diagnosis of small-bowel tumour. Subgroup analysis revealed that small-bowel preparation, more than one imaging pass and large volumes (≥2 L) of enteral contrast agent did not improve tumour detection. CONCLUSION: Our meta-analysis confirms that helical CT-enteroclysis has high degrees of sensitivity and specificity for small-bowel tumour detection. However, our findings reinforce the need for more standardised individual studies. KEY POINTS : • Helical CT-enteroclysis is highly sensitive for the diagnosis of small-bowel tumours. • Helical CT-enteroclysis is highly specific for the diagnosis of small-bowel tumours, • Helical CT-enteroclysis can be used as a first-line investigation. • A single enteric phase examination provides optimal tumour detection.
    European Radiology 08/2012; · 4.34 Impact Factor
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    ABSTRACT: To determine the frequency of skin cancers associated with chronic leg ulcers (CLUs) presumably of vascular origin and failing to heal (ie, increased wound area or depth) despite 3 months or more of appropriate treatment. Prospective cross-sectional study. Ambulatory or hospitalized patients from 17 dermatology departments. Between January 1, 2006, and May 31, 2008, a total of 144 patients consulted for CLUs, attributed to venous and/or peripheral arterial disease(s), increasing in wound size, that is, larger area and/or depth, despite appropriate standard treatment for at least 3 months. At inclusion, at least two 6-mm punch biopsies, 1 at the wound edge and 1 in the wound bed, in the most clinically suspicious areas, were systematically performed. The primary end point was the skin cancer frequency diagnosed in at least 1 wound biopsy specimen obtained at inclusion. The 144 patients included had 154 CLUs. The overall skin cancer frequency in the CLUs was 10.4%: 9 squamous cell and 5 basal cell carcinomas, 1 melanoma, and 1 leiomyosarcoma; 56.3% had persisted for at least 3 years. Univariate analyses retained older age, abnormal excessive granulation tissue at wound edges, high clinical suspicion of cancer, and number of biopsies, but not wound area or duration, as being significantly associated with skin cancer in 1 or more biopsy specimens. The combined primary ulcerated cancer or malignant transformation frequency was sufficiently high in CLUs referred to tertiary care centers to consider systematic biopsy of a wound refractory to 3 months or more of appropriate treatment.
    Archives of dermatology 06/2012; 148(6):704-8. · 4.76 Impact Factor
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    ABSTRACT: Propranolol bears antioxidant, anti-inflammatory, and antiangiogenic properties and antitumoral effects and therefore is potentially active in the prevention of hepatocellular carcinoma (HCC). We retrospectively assessed the impact of propranolol treatment on HCC occurrence in a cohort of 291 patients with compensated viral C (HCV) cirrhosis, prospectively followed and screened for HCC detection. Of the 291 patients included in the cohort, 93 patients [50 males: mean age, 59.5 ± 12 years; body mass index (BMI), 25.7 ± 4.4 kg/m(2); and platelet count, 111 ± 53 Giga/L] developed esophageal varices (OV) or had OV at inclusion and 198 patients (111 males: mean age, 55.8 ± 13 years; BMI, 25.7 ± 5 kg/m(2); platelet count, 137 ± 59 Giga/L) did not. Among patients with OV, 50 received treatment by propranolol. During a median follow-up of 54 months interquartile range (32-82), 61 patients developed an HCC. The 3- and 5-year HCC incidence was 4% and 4%, and 10% and 20% for patients treated and not treated by propranolol, respectively (Gray test, P = 0.03). In multivariate analysis, propranolol treatment was associated with a decrease risk of HCC occurrence [HR, 0.25; 95% confidence interval (CI), 0.09-0.65; P = 0.004], and was the only independent predictive factor of HCC occurrence in patients with OV (HR, 0.16; CI, 0.06-0.45; P = 0.0005). The benefit of propranolol was further supported by propensity scores analyses. Conclusion: This retrospective long-term observational study suggests that propranolol treatment may decrease HCC occurrence in patients with HCV cirrhosis. These findings need to be verified by prospective clinical trial.
    Cancer Prevention Research 04/2012; 5(8):1007-14. · 4.89 Impact Factor
  • European Urology 03/2012; · 10.48 Impact Factor
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    ABSTRACT: The objective of this study was to assess the results and tolerance of radiofrequency ablation in patients with cirrhosis and hepatocellular carcinoma (HCC) older than 75 years. Over a period of 9 years from January 2001, 235 patients with cirrhosis and 3 or less HCC≤5 cm of diameter were treated by radiofrequency ablation. Among them, 52 patients older than 75 years were selected for this study. The mean age was 79.4±3. 5 years. There were 36 males, cirrhosis was classified Child-Pugh class A (n=52) related to alcohol (n=13), HCV infection (n=33), or other causes (n=6). The mean tumour diameter was 32.5±10.6 mm, and 14 patients had a multifocal HCC. A complete ablation was obtained in 50/52 patients (96%). No severe complication occurred. The estimated overall survival rates were 62%, 52% and 36% at 3 years, 4 years and 5 years, respectively; it was similar to those observed in patients younger than 75 years. In patients with cirrhosis older than 75 years, radiofrequency ablation of 3 or less HCC≤5cm is well tolerated and survivals rates are similar to those of younger patients.
    La Revue de Médecine Interne 03/2012; 33(3):128-33. · 0.90 Impact Factor
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    ABSTRACT: Evidence supporting the widespread use of GreenLight High Performance System (HPS) 120-W photoselective vaporization of the prostate (PVP) is lacking. To assess the noninferiority of PVP compared with transurethral resection of the prostate (TURP) on urinary symptoms and the superiority of PVP over TURP on length of hospital stay. A multicenter randomized controlled trial was conducted. Patients underwent monopolar TURP or PVP with the GreenLight HPS 120-W laser. International Prostate Symptom Score (IPSS), Euro-QOL questionnaire, uroflowmetry, Danish Prostate Symptom Score Sexual Function Questionnaire, sexual satisfaction, and adverse events were collected at 1, 3, 6, and 12 mo. The two groups were compared using the 95% confidence interval (CI) of median difference for testing noninferiority of the IPSS at 12 mo and the student t test for testing the difference in length of hospital stay. A total of 139 patients (70 vs 69 men in each group) were randomized. Median IPSS scores at 12-mo follow-up were 5 (interquartile range [IQR]: 3-8) for TURP versus 6 (IQR: 3-9) for PVP, and the 95% CI of the difference of the median was equal to -2 to 3. Because the upper limit of the 95% CI was >2 (the noninferiority margin), the hypothesis of noninferiority could not be considered demonstrated. Median length of stay was significantly shorter in the PVP group than in the TURP group, with a median of 1 (IQR: 1-2) versus 2.5 (IQR: 2-3.5), respectively (p<0.0001). Uroflowmetry parameters and complications were comparable in both groups. Sexual outcomes were slightly better in the PVP group without reaching statistical significance. The present study failed to demonstrate the noninferiority of 120-W GreenLight PVP versus TURP on prostate symptoms at 1 yr but showed that PVP was associated with a shorter length of stay in the hospital. NCT01043588.
    European Urology 02/2012; 61(6):1165-73. · 10.48 Impact Factor
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    ABSTRACT: To test if the use of either HbA(1c) level or calculated clinical scores including two published scores and a new score (the Bondy score) could help in selecting overweight or obese women who should benefit from oral glucose tolerance test (OGTT) to detect dysglycaemia. The French Data from an Epidemiological Study on the Insulin Resistance Syndrome (DESIR) score and the Finnish Diabetes risk score (Findrisk) were calculated, whereas the Bondy score was built in a development sample of 698 women, BMI 37±7 kg/m(2), without known diabetes. External validation was performed in a validation sample of 212 women. A dysglycaemia (according to OGTT results, WHO criteria) was diagnosed in 161 (23.1%) patients. Sensitivity of fasting plasma glucose (FPG)≥6.1 mmol/l and HbA(1c)≥6% to identify dysglycaemia were respectively 27 and 41%. Areas under Receiver Operator Curve (AROC) of HbA(1c), DESIR score and Findrisk to detect dysglycaemia were 0.630 [95% confidence interval 0.580-0.680], 0.606 [0.561-0.652] and 0.635 [0.588-0.683], respectively. The Bondy score, based on age and waist circumference, had a better AROC (0.674 [0.626-0.721]) than the DESIR score (P<0.05). These performances were confirmed in the validation sample. Performing OGTT only in subjects with a Bondy score≥4 (41% of the sample) had a sensitivity of 61% and a better net benefit (0.128) than measuring FPG in all subjects (0.069). Performing OGTT in obese women selected on a simple clinical score is more sensitive to identify dysglycaemia than measuring FPG in all of them and may be cost-effective.
    Diabetes & Metabolism 01/2012; 38(3):217-24. · 2.39 Impact Factor
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    ABSTRACT: Despite effective treatments, tuberculosis-related mortality remains high among patients requiring admission to the intensive care unit (ICU). To determine prognostic factors of death in tuberculosis patients admitted to the ICU, and to develop a simple predictive scoring system. A 10-year, retrospective study of 53 patients admitted consecutively to the Hôpitaux de Paris, Hôpital Lariboisière (Paris, France) ICU with confirmed tuberculosis, was conducted. A multivariate analysis was performed to identify risk factors for death. A predictive fatality score was determined. Diagnoses included pulmonary tuberculosis (96%) and tuberculous encephalomeningitis (26%). Patients required mechanical ventilation (45%) and vasopressor infusion (28%) on admission. Twenty patients (38%) died, related to direct tuberculosis-induced organ failure (n=5), pulmonary bacterial coinfections (n=14) and pulmonary embolism (n=1). Using a multivariate analysis, three independent factors on ICU admission were predictive of fatality: miliary pulmonary tuberculosis (OR 9.04 [95% CI 1.25 to 65.30]), mechanical ventilation (OR 11.36 [95% CI 1.55 to 83.48]) and vasopressor requirement (OR 8.45 [95% CI 1.29 to 55.18]). A score generated by summing these three independent variables was effective at predicting fatality with an area under the ROC curve of 0.92 (95% CI 0.85 to 0.98). Fatalities remain high in patients admitted to the ICU with tuberculosis. Miliary pulmonary tuberculosis, mechanical ventilation and vasopressor requirement on admission were predictive of death.
    The Canadian journal of infectious diseases & medical microbiology = Journal canadien des maladies infectieuses et de la microbiologie medicale / AMMI Canada 01/2012; 23(4):173-178. · 1.02 Impact Factor

Publication Stats

518 Citations
278.51 Total Impact Points

Institutions

  • 2009–2014
    • Hôpital Lariboisière - Fernand-Widal (Hôpitaux Universitaires Sant-Louis, Lariboisière, Fernand-Widal)
      • Service de Rhumatologie A
      Lutetia Parisorum, Île-de-France, France
    • Hôpital La Pitié Salpêtrière (Groupe Hospitalier "La Pitié Salpêtrière - Charles Foix")
      Lutetia Parisorum, Île-de-France, France
  • 2013
    • Pierre and Marie Curie University - Paris 6
      Lutetia Parisorum, Île-de-France, France
    • Hôpital Ambroise Paré – Hôpitaux universitaires Paris Ile-de-France Ouest
      Billancourt, Île-de-France, France
    • Beth Israel Medical Center
      New York City, New York, United States
  • 2012–2013
    • Paris Diderot University
      Lutetia Parisorum, Île-de-France, France
    • Centre Hospitalier Universitaire Hassan II
      Fez, Fès-Boulemane, Morocco
  • 2011–2013
    • Hôpitaux Universitaires La Pitié salpêtrière - Charles Foix
      Lutetia Parisorum, Île-de-France, France
  • 2010–2013
    • Unité de Recherche Clinique de Nanoro
      Wagadugu, Centre, Burkina Faso
    • Hôpital Jean-Verdier – Hôpitaux Universitaires Paris-Seine-Saint-Denis
      Bondy, Île-de-France, France
  • 2010–2012
    • Assistance Publique – Hôpitaux de Paris
      Lutetia Parisorum, Île-de-France, France