Pierre-Yves Milliez

Centre Hospitalier Universitaire Rouen, Rouen, Upper Normandy, France

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Publications (6)5.88 Total impact

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    ABSTRACT: Introduction La télémédecine est une forme de pratique médicale à distance utilisant les technologies de l’information et de la communication. Il existe plusieurs formes dont la téléconsultation qui se définit comme une consultation à distance entre un médecin et un patient. La chirurgie ambulatoire se décompose en plusieurs étapes dont le suivi du patient qui doit être assuré par un appel téléphonique le lendemain de l’intervention. Le but de l’étude était d’évaluer l’intérêt pratique et le bénéfice de la téléconsultation en ambulatoire de chirurgie de la main. Matériel et méthode Nous avons inclus 5 patientes opérées en chirurgie ambulatoire pour un syndrome du canal carpien ou un doigt à ressaut. L’âge moyen était de 6e ans. La téléconsultation était proposée à toutes les patientes qui disposaient d’un logiciel Skype® ou autres et d’une connexion Internet fiable. Un formulaire de consentement avec information sur le caractère non sécurisé de l’entretient était signé par toutes les patientes. L’entretient était réalisé le lendemain matin vers 12h30 entre le praticien et la patiente. L’entretien débutait par un appel téléphonique pour réaliser la connexion Internet et débuter la « visioconversation » (enregistrée). Une série de 11 questions standardisées étaient posées à la patiente. Toutes les cicatrices étaient montrées en présence d’une infirmière à domicile. À 2 mois, les patientes étaient revues en consultation et remplissaient un questionnaire de satisfaction. À noter que tous les enregistrements vidéo de l’entretient étaient intégrés au dossier informatique du patient. Résultats Cette prise en charge a été bénéfique pour toutes les patientes. L’entretient a été rassurant, adapté et préféré à l’entretient téléphonique simple post opératoire. La qualité de l’image et du son a permis une bonne évaluation clinique post-opératoire. Toutes les patientes ont été très satisfaites de l’entretient et du caractère ludique de la téléconsultation. Discussion La télémédecine est un nouvel outil de consultation qui permet de faciliter le suivi médical de certains patients. La qualité des outils informatiques est adaptée à cette prise en charge. Le point négatif est l’utilisation d’un réseau non sécurisé mais la qualité, le consentement, l’information du patient et le secret professionnel ainsi que la traçabilité des informations étaient respectés. Conclusion Ces résultats mettent en avant le rôle bénéfique de cette prise en charge. La téléconsultation est un outil d’avenir à développer à plus grande échelle mais qui nécessite un cadre législatif et administratif mieux définis. Mots clés: Télémédecine; Téléconsultation; Ambulatoire
    Congrès GEM 2014 Paris; 12/2014
  • Revue du Rhumatisme 10/2012; 79(5):436-443. DOI:10.1016/j.rhum.2012.02.002
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    ABSTRACT: OBJECTIVE: Because available biomarkers (rheumatoid factors [RF], anti-cyclic citrullinated autoantibodies [anti-CCP2], erythrocyte sedimentation rate at 1st hour [ESR]/C-reactive peptide [CRP] and bone erosions) are insufficient to predict rheumatoid arthritis (RA) structural damage, to determine whether synovium expression of greater or equal to 1 markers could constitute new prognostic factor(s). METHOD: The study was conducted on 18 prospectively enrolled disease-modifying anti-rheumatic drug (DMARD)- and glucocorticoid-naïve, VErA cohort patients with very-early arthritis (median duration: 4months). Recorded at baseline were: clinical and biological (serum ESR, CRP, RF-isotypes, anti-CCP2, osteoprotegerin, receptor activator of nuclear κB-ligand [RANK-L] and cartilage oligomeric matrix protein [COMP] levels) data; synovium expression (HLA-DR, CD163, CD3, CD20, VEGF, osteoprotegerin, RANK-L, Bcl2 and global inflammation index) for a metacarpophalangeal joint-synovium biopsy. Baseline and 3-year hand-and-foot X-rays were graded with the van der Heijde-modified-Sharp score; the judgment criterion was its progression during follow-up. Pearson's product moment correlation statistics were used to test for association between paired samples. RESULTS: A baseline, a significant relationship was found between erosive damage and markers of B-cell activation, notably the synovium CD20 expression (r=0.68; P=0.0001). Quantified by the modified-Sharp erosion score variation, the 3-year structural damage progression was significantly correlated with: serum levels of RF-IgG (r=0.75; P=0.0003), -IgM (r=0.69; P=0.001), anti-CCP2 (r=0.53; P=0.02) and RANK-L (r=0.61; P=0.007); synovium CD20 expression (r=0.70; P=0.001). CONCLUSION: This analysis of the prognostic value of a large panel of synovium markers in a limited sample of prospectively followed, well-documented patients suggested that both synovial CD20 and serum RANK-L levels might be new predictors of structural damage progression in very-early RA.
    Joint, bone, spine: revue du rhumatisme 03/2012; 79(6). DOI:10.1016/j.jbspin.2011.11.006 · 3.22 Impact Factor
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    ABSTRACT: The authors present an anatomical study of the flexor digitorum superficialis synovial flap and its clinical application for palmar soft tissue defects in hand trauma. Green latex was injected into the brachial artery of thirty-one human upper limbs from corpses donated to science. Anatomical features of this pedicled flap were assessed: arterial vascularization, dimensions and covering surface. The anatomical support of this flap is the synovial tissue of the flexor tendons, and particularly the superficial layer of the synovial system, covering the flexor digitorum superficialis (FDS) tendons in the forearm. It is vascularized by four different arteries: a constant collateral branch of the ulnar artery, and three inconstant arterial supports: from collateral branches of the superficial palmar arch, from the radial artery, and from the vasa nervorum of the median nerve. The flap is harvested from proximal to distal on the ulnar pedicle to cover the palmar soft tissue defects of the hand. A clinical application of this synovial flap is presented via a case report for covering a palmar skin defect secondary to a hand injury. The synovial flap contains a constant ulnar pedicle and could be considered a useful alternative to cover palmar soft tissue defects.
    Anatomia Clinica 03/2012; 34(6):493-8. DOI:10.1007/s00276-012-0942-y · 1.33 Impact Factor
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    ABSTRACT: In reconstructive techniques, the use of the composite gracilis skin flap may be complicated by a total or partial necrosis of the cutaneous paddle. Our study was aimed to describe the vascular anatomy of the gracilis muscle and the related skin, in order to have a better understanding of the skin's blood supply, and to help in determining a safer cutaneous paddle during transfer. We performed a detailed anatomical description of the gracilis vessels on 32 human cadavers' thighs. Selective injections of methylene blue and then colored fluid latex were carried out in the principal pedicle of the gracilis, to color and to measure the perforator vessels and the associated cutaneous paddle. The contour and the anatomical situation of the paddles were digitized in order to have precise data and to try to model a standard theoretical skin paddle. The 32 dissections showed that the principal pedicle of the gracilis originated mainly from the adductor artery (26/32), it penetrated into the muscle 92.8 mm (78-114) below the pubis with a small dispersion of the values that assessed a rather reliable parameter of location. Each muscle had 1-6 perforators (at mean 3.78); 80% of these perforators had their exits from the opposite side to the principal pedicle, included within a 60 mm length of muscle. A skin paddle was quite constantly colored (31/32), located over the proximal half of the muscle with a complex design. Its mean dimensions of length and width were 110 (72-158) and 91.4 mm (65-144), respectively. The computerized surface of the paddle was at a mean of 79.5 cm(2) (42.4-139.3), and it was significantly correlated to the number of the perforators from the muscle. Our quantitative values concerning the skin paddle related to the perforator arteries may be of significant interest to the surgeon who aims to harvest a composite musculocutaneous gracilis flap, in order to improve its reliability by reducing the risk of cutaneous necrosis.
    Surgical and Radiologic Anatomy 01/2007; 28(6):588-95. DOI:10.1007/s00276-006-0150-8 · 1.33 Impact Factor