A Léon

Centre Hospitalier Universitaire de Reims, Rheims, Champagne-Ardenne, France

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Publications (65)62.62 Total impact

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    Annales francaises d'anesthesie et de reanimation 01/2014; · 0.77 Impact Factor
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    ABSTRACT: The causes of hemodynamic instability in acute pancreatitis are numerous. Although pericardial effusion during pancreatitis is common, a cardiac tamponade is rarely reported. The diagnosis of compressive cardiac disorders (CDD) by echocardiography is easily reported when the patient is breathing spontaneously; it becomes difficult when the patient is assisted with positive pressure ventilation.
    Annales francaises d'anesthesie et de reanimation 10/2013; · 0.77 Impact Factor
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    Critical Care 04/2012; 4:1-2. · 4.93 Impact Factor
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    Critical Care 04/2012; 4:1-1. · 4.93 Impact Factor
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    ABSTRACT: Dental injuries are among the most common complications of general anesthesia. Yet few studies have assessed the costs and factors that involve the responsibility of the anesthetist. A retrospective study was conducted at the university hospital of Reims on 46 cases of dental injuries directly related to anaesthesia. Ten patients made a claim for compensation. Two of them have received compensation following a medical expertise, which revealed for the first patient a possible alternative to general anaesthesia, and the second, hardware failure of intubation. The Administrative Court was entered once in 9 years. The global insurance-cost amounts to 4476 euros for all patients. The review of all cases of anaesthesia shows clearly that the dental claims are associated with a significant under clinical evaluation of dental status and criteria for difficult intubation during the anaesthesia. The information to the patient on this risk is not obvious from reading the anaesthesia records. No mouth guard was used. This work proves that the statements of caution are the most common and a minority of dental trauma lead to a claim. Claims are due to the high cost of dental care repair. The proportion of patients receiving benefits is extremely low. Medical expertise is an essential part of the evaluation of medical responsibilities. No compensation was paid without expertise. The lack of physical examination and information are contrary to our professional obligations and may involve our responsibility. The lack of patient information is not generated for compensation to the extent that the consequences of failure are easily dental weighed against the benefits of the entire medical-surgical procedure that the patient has agreed.
    Annales francaises d'anesthesie et de reanimation 02/2012; 31(3):191-5. · 0.77 Impact Factor
  • Annales francaises d'anesthesie et de reanimation 11/2011; 30(11):852-4. · 0.77 Impact Factor
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    ABSTRACT: Disulfiram is commonly used in the treatment of alcohol dependence. It induces aversive symptoms after alcohol ingestion: the "acetaldehyde syndrome". Most often "acetaldehyde syndrome" is moderate but severe life-threatening symptoms may occur in specific circumstances. We report the case of a serious "acetaldehyde syndrome" with shock compounded by the initial administration of dopamine. Discussion clarifies the pathophysiology and develops the therapeutic management.
    Annales francaises d'anesthesie et de reanimation 02/2011; 30(2):150-2. · 0.77 Impact Factor
  • Annales Francaises D Anesthesie Et De Reanimation - ANN FR ANESTH REANIM. 01/2011; 30(11):852-854.
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    ABSTRACT: During the 2009-2010 winter season, the new pandemic influenza A/H1N1 virus (S-OIV) was responsible for 1,334 hospitalized severe infection cases including 312 (23.4%) deaths in metropolitan France. In the Champagne-Ardenne area (north eastern) this new epidemic strain was detected in the respiratory samples of 14 severe S-OIV infection cases resulting in 5 deaths. Here we report two of these 14 cases who were suffering from a bilateral pneumonia related to S-OIV infection and who were hospitalized in the Intensive Care Unit (ICU) of the Reims University Medical Centre during December 2009. These two patients were male with at least one known risk factor for severe S-OIV infection (chronic obstructive pulmonary disease (COPD) and morbid obesity, respectively); the COPD patient developed an acute respiratory distress syndrome. The etiological diagnosis of S-OIV infection was performed by use of a real time RT-PCR (rRT-PCR) assay allowing the detection of all the known human influenza A viruses (rRT-PCR targeting the influenza gene M) and of the new influenza A/H1N1 pandemic strain. This rRT-PCR assay was positive in bronchoalveolar lavage samples taken from the two patients, whereas the nasal swab (using Virocult® collection system) appeared to be positive for only one of them. For both patients, a presumptive treatment combining oseltamivir and broad-spectrum antibiotics was started at the time of hospital admission, 24 hours at least before obtaining the results of the virological and bacteriological analyses. These two patients did not develop any secondary bacterial pneumonia and their clinical outcome was good after one and six weeks of hospitalization in ICU, respectively.
    Annales de biologie clinique 01/2010; 68(6):719-24. · 0.30 Impact Factor
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    ABSTRACT: Necrotizing fasciitis is a severe skin infection. Fluidized bed may be indicated to improve healing. We report a 36-year-old woman case, who developed an important skin emphysema on a fluidized bed that may have worsen the situation.
    Annales francaises d'anesthesie et de reanimation 09/2009; 28(9):803-5. · 0.77 Impact Factor
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    ABSTRACT: The case of a 21-year old man who died due to an intracranial thrombosis just after diagnosis of Goodpasture's disease, is reported. Discussion deals with the putative mechanisms, which could be responsible for the thrombosis.
    Annales francaises d'anesthesie et de reanimation 09/2009; 28(9):799-802. · 0.77 Impact Factor
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    ABSTRACT: We report a case of Epstein-Barr virus (EBV) primo infection with the development of successive infectious mononucleosis, hemophagocytic lymphohistiocytosis, and B-cell lymphoproliferative disorder in a patient treated with azathioprine for Crohn's disease. This case report suggests that specific EBV-related clinical and virological management should be considered when treating a patient with inflammatory bowel disease with azathioprine.
    Journal of clinical microbiology 03/2009; 47(4):1252-4. · 4.16 Impact Factor
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    ABSTRACT: Introduction et objectifs Évaluer l’intérêt de l’administration continue de ceftazidime en termes de concentration tissulaire pulmonaire dans les pneumonies graves. Matériels et méthodes Étude prospective (32 patients) contrôlée et randomisée comparant 2 modalités d’administration de la ceftazidime chez des patients présentant une pneumonie à bacille à Gram négatif. Le groupe I recevait de la ceftazidime à la posologie de 60 mg/kg/j après une dose de charge de 20 mg/kg. Le groupe II recevait 20 mg/kg en 30 minutes toutes les 8 h. Dans les 2 groupes la tobramycine était associée à la posologie de 5 mg/kg. Pour chaque patient 12 (groupe I) et 18 (groupe II) prélèvements sériques étaient effectués sur la période de l’étude (48 h). Le prélèvement du liquide alvéolaire était pratiqué à la période d’équilibre pharmacocinétique à la 44e heure. Les concentrations de ceftazidime dans le sérum et le film alvéolaire étaient déterminés par chromatographie liquide à haute performance couplée à une détection ultra violette. Du fait de notre écologie locale (CMI de ceftazidime pour Pseudomonas aeruginosa < 4 mg/l) notre objectif de concentration minimale dans le film alvéolaire était de 8 mg/l. Résultats Les 2 groupes de patients étaient homogènes en termes de poids, d’age, de clairance de créatinine et d’indice de gravité. La concentration moyenne de ceftazidime dans le film alvéolaire était de 13,2 ± 10,5 mg/l dans le groupe I et de 8,6 ± 7,8 mg/l dans le groupe II. Il y a 2 fois plus de patients dans le groupe I (10/16) que dans le groupe II (5/16) qui répondent au seuil retenu de 8 mg/l. Conclusion Basée sur un objectif de concentration au niveau du tissu cible, cette étude suggère que le débit continu présente un avantage pharmacodynamique en terme prédictif d’efficacité dans les pneumonies hypoxémiantes.
    Medecine Et Maladies Infectieuses - MED MAL INFEC. 01/2009; 39.
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    ABSTRACT: The case of a 21-year old man who deceased due to an intracranial thrombosis just after diagnosis of Goodpasture's disease, is reported. Discussion deals with the putative mechanisms, which could be responsible for the thrombosis.
    Annales Francaises D Anesthesie Et De Reanimation - ANN FR ANESTH REANIM. 01/2009; 28(9):799-802.
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    ABSTRACT: Necrotizing fasciitis is a severe skin infection. Fluidized bed may be indicated to improve healing. We report a 36-year-old woman case, who developed an important skin emphysema on a fluidized bed that may have worsen the situation.
    Annales Francaises D Anesthesie Et De Reanimation - ANN FR ANESTH REANIM. 01/2009; 28(9):803-805.
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    ABSTRACT: Introduction L’importance pronostique sur la mortalité et sur l’incidence des complications d’un traitement précoce et adapté des pneumonies à pneumocoque est connue. Streptococcus pneumoniae constitue l’étiologie la plus fréquente et la plus grave. Le but de cette étude était d’évaluer le test BINAX NOW S. pneumoniae dans le diagnostic précoce des pneumonies chez les patients ventilés en réanimation. Matériel et méthodes Étude prospective de 2003 à 2006, incluant les pneumopathies communautaires hypoxémiantes (score de FINE V). Le diagnostic de pneumonie reposait sur les critères d’ANDREW. Recueil : âge, sexe, IGS II, antibiothérapie préalable. Un lavage broncho-alvéolaire (LBA), des hémocultures (HC), une antigénurie S. pneumoniae étaient effectués dès l’admission. Deux groupes étaient individualisés. Groupe I : patients infectés à S. pneumoniae, Groupe II : patients non infectés à S. pneumoniae. Résultats Inclusion de 333 patients. Âge moyen : 59 ans, sex ratio de 3, IGS II à 41, 65 % avaient reçu une antibiothérapie avant les prélèvements. 52 patients (groupe I) présentaient une pneumonie à S. pneumoniae dont 11 associés à une bactériémie. Le groupe II comprenait 281 patients. 60 patients avaient une antigénurie positive, 21 patients du groupe I et 39 patients du groupe II. La sensibilité (Se) est égale à 40,4 % [24 %-62,8 %] IC 95 % et la spécificité (Sp) à 86,1 % [64,4 %-85,6 %] IC 95 %. La VPP n’était que de 35 % alors que la VPN était de 88,6 %. En prenant comme test de référence l’HC seule, la Se était de 45,5 % [22,1 %-59,3 %] IC 95 % et la Sp de 82,9 % [57,7 %-85,6 %] IC 95 %. Conclusions L’intérêt du test réside dans la rapidité du résultat et du caractère non invasif de cette technique, mais la sensibilité médiocre de ce test incite à ne plus pratiquer cet examen en réanimation.
    Medecine Et Maladies Infectieuses - MED MAL INFEC. 01/2008; 38.
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    ABSTRACT: Introduction La mise en place d’un traitement antifongique préemptif en rénimation reste discutée et ne dépend plus uniquement de l’index de colonisation corrigé. Notre étude devait comparer deux stratégies préemptives sur 2 périodes consécutives 2005-2006 et réaliser une analyse de coût. Matériels et Méthodes Étude prospective monocentrique incluant de façon consécutive tous les patients à haut risque de candidoses invasives définis de la façon suivante (chirurgie abdominale lourde, pancréatite aiguë, antibiothérapie large spectre, corticoïdes, nutrition parentérale totale, hémodialyse). Une cartographie mycologique (5 sites minimums urines, gorge, liquide digestif, trachée, écouvillonnage rectal) et des hémocultures mycologiques étaient réalisées chaque semaine. Pendant l’année 2005, le traitement préemptif était instauré sur la colonisation et/ou l’apparition de nouveaux facteurs de risque. Pendant l’année 2006, l’évolution clinique chiffrée par le Sofa Score était ajoutée à l’arbre décisionnel. Résultats 196 patients ont été inclus. Les 107 patients en 2005 et les 89 patients en 2006 étaient homogènes en termes d’âge (p = 0,12) et de gravité (p = 0,22). Vingtquatre patients ont été traité en 2005, 14 en 2006. Le coût direct hebdomadaire des examens mycologiques était de 100 euros. Le coût annuel du traitement était respectivement de 21 258 et de 10 472 euros pour 2005/2006. Le coût global était de 54 800 en 2005 et de 40 700 euros en 2006. La dose définie journalière de fluconazole (DDJ/1000jrs) était de 182 en 2005 et 87 en 2007. Conclusions Dans notre population, C. albicans reste l’espèce prédominante (80 %). Cette nouvelle stratégie thérapeutique permet de diminuer l’exposition au fluconazole de près de 50 % en incluant dans l’arbre décisionnel l’évolution du Sofa Score qui nous apparaît comme un élément pertinent à prendre en compte.
    Medecine Et Maladies Infectieuses - MED MAL INFEC. 01/2008; 38.
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    ABSTRACT: Candida glabrata has emerged as one of the leading agents of fungal infections and strain typing is essential for epidemiological investigation that is generally achieved by molecular techniques. In this work, we studied twenty-nine C. glabrata strains isolated from different patients, using a phenotypic approach based on Fourier Transform Infrared (FTIR) spectroscopy, which has been in a previous study successfully applied as a rapid typing method for Candida albicans. A two-step procedure was used for the analysis. The first step included sixteen strains for the internal validation phase, which aimed at finding the spectral windows that would provide the best differentiation between strains. In this phase, hierarchical cluster analysis (HCA) carried out using three spectral windows (900-1200, 1540-1800, 2800-3000 cm(-1)) allowed to obtain the best classification, where each patient strains could be clustered together. A genotypic technique based on randomly amplified polymorphic DNA-analysis (RAPD) confirmed these results. In a second step, the external validation phase, thirteen other clinical strains of C. glabrata isolated from multiple sites in four ICU patients, were tested by FTIR spectroscopy. The analysis was based on the spectral regions previously found in the first step. HCA classification of the strains gave four groups, one group per patient. These results suggest that no inter-human transmission took place. This study shows the potential of FTIR approach for typing of C. glabrata with several advantages compared to other techniques. FTIR typing is fast, effective, and reagent free. Moreover, it is applicable to all micro-organisms and requires a small quantity of biomass.
    Journal of Microbiological Methods 01/2008; 71(3):325-31. · 2.16 Impact Factor
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    ABSTRACT: Sepsis-associated encephalopathy is a global cerebral dysfunction induced by the systemic response to inflammation and infection, without a liver or renal injury. Alteration of consciousness, from confusion to coma, is the main clinical symptom. This encephalopathy is associated with an increase in mortality due to sepsis. Its physiopathology is unknown. There is frequently an increased permeability of the blood-brain barrier, which might explain a role of endotoxins on cerebral metabolism. Changes in neurotransmitter release or concentrations (norepinephrine, serotonin, dopamine, GABA) have been reported. There is not any specific treatment of septic encephalopathy. In most cases, this syndrome is rapidly reversible after the treatment of sepsis.
    Annales Françaises d Anesthésie et de Réanimation 09/2006; 25(8):863-7. · 0.84 Impact Factor
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    ABSTRACT: Emergence delirium in the post-anaesthesia care unit (PACU) is poorly understood. The goal of this prospective study was to determine frequency and risk factors of emergence delirium in adults after general anaesthesia. In this prospective study, 1,359 consecutive patients were included. Contextual risk factors and occurrence of delirium according to the Riker sedation scale were documented. Groups were defined for the analysis according to the occurrence or not of agitation, then after exclusion of patients with preoperative anxiety and neuroleptics, or both, and antidepressants or benzodiazepines treatments. Sixty-four (4.7%) patients developed delirium in the PACU, which can go from thrashing to violent behaviour and removal of tubes and catheters. Preoperative anxiety was not found to be a risk factor. Preoperative medication by benzodiazepines (OR=1.910, 95% CI=1.101-3.315, P=0.021), breast surgery (OR=5.190, 95% CI=1.422-18.947, P=0.013), abdominal surgery (OR=3.206, 95% CI=1.262-8.143, P=0.014), and long duration of surgery increased the risk of delirium (OR=1.005, 95% CI=1.002-1.008, P=0.001), while a previous history of illness and long-term treatment by antidepressants decreased the risk (respectively, OR=0.544, 95% CI=0.315-0.939, P=0.029 and OR=0.245, 95% CI=0.084-0.710, P=0.010). Preoperative benzodiazepines, breast and abdominal surgery and surgery of long duration are risk factors for emergence delirium.
    BJA British Journal of Anaesthesia 07/2006; 96(6):747-53. · 4.24 Impact Factor