Publications (4)2.72 Total impact

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    ABSTRACT: High dose steroids and intravenous immunoglobulins are the gold treatment of acute immune thrombocytopenic purpura, before splenectomy for severe and refractory forms of the disease. Authors report two cases of severe acute refractory immune thombocytopenia with a dramatic response to plasma exchanges. The first case was an idiopathic form, complicated by hemorragic peritoneal effusion. After failure of steroids, intravenous immunoglobulins and splenectomy and 2 courses of rituximab, plasmapheresis normalized in 3 days platelet count. In the second observation, ITP was associated to systemic lupus with antiphospholipids antibodies and multivisceral failure, despite steroids and intravenous immunoglobulins. After 3 plasma exchanges, platelet count was normalized, and the patient is under remission after 24 months follow-up. Plasmapheresis must be evaluated as an emergency treatment in refractory forms of acute immune thrombocytopenic purpura.
    No preview · Article · Nov 2005 · La Revue de Médecine Interne
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    ABSTRACT: Introduction. – High dose steroids and intravenous immunoglobulins are the gold treatment of acute immune thrombocytopenic purpura, before splenectomy for severe and refractory forms of the disease. Authors report two cases of severe acute refractory immune thombocytopenia with a dramatic response to plasma exchanges.Exegesis. – The first case was an idiopathic form, complicated by hemorragic peritoneal effusion. After failure of steroids, intravenous immunoglobulins and splenectomy and 2 courses of rituximab, plasmapheresis normalized in 3 days platelet count. In the second observation, ITP was associated to systemic lupus with antiphospholipids antibodies and multivisceral failure, despite steroids and intravenous immunoglobulins. After 3 plasma exchanges, platelet count was normalized, and the patient is under remission after 24 months follow-up.Conclusion. – Plasmapheresis must be evaluated as an emergency treatment in refractory forms of acute immune thrombocytopenic purpura.
    No preview · Article · Oct 2005 · La Revue de Médecine Interne
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    ABSTRACT: Objective. To determine the usefulness of monitoring of mannan antigenemia for early diagnosis of invasive candidosis in infectious high-risk patients hospitalized in medical intensive care units. Design: A 6 month prospective study was conducted in 105 patients admitted to the medical intensive care unit of the Nantes university hospital. Material and methods. The main inclusion criterion was inpatient care for seven days or more. The monitoring protocol included once a week: a blood sample for a search of mannan antigenemia by ELISA (Platelia® Candida Ag) and anti-Candida antibody by immunoelectrophoresis (Paragon®) and indirect hemagglutination (Fumouze®), peripheral samples (stools, urine, tracheal aspiration or oral mucosity) to search for colonization, deep samples according to clinical symptoms (mycological or standard blood culture, biopsy, venous catheter, bronchoalveolar lavage, peritoneal fluid, pleural fluid etc...). When all of the three systematic peripheral samples had been obtained, the colonization index (CI) as defined by Pittet (ratio of the number of positive sites on the total number of taken sites) was calculated. Results. We were able to obtain 187 serums samples, 478 peripheral samples and 388 deep samples. The diagnosis of invasive candidosis was suspected in 10 patients including 2 proven cases, 3 probable cases, 5 possible cases. The colonization rate of the patients was estimated at 70%. Mannan antigenemia was positive in 60% of invasive candidosis suspected patients, 43% of simply colonized patients and 25% of the non-colonized non-infected patients. On the whole 20% of the positive results were false positives. Comparing the results of the serologic tests according to the CI, we observe that they were more positive among patients having CI > 0.5 than in those having CI < 0.5 (antigenemia: p = 0.05, serology: p = 0.001, antigenemia + serology: p = 0.0003). Conclusion. It was difficult to determine the usefulness of monitoring mannan antigenemia for early diagnosis of invasive candidosis as the number of proven cases of invasive candidosis was negligible in this study. This mannan antigenemia was positive before the diagnosis of invasive candidosis in 1 of the 2 proven cases. Alone, this test is insufficient for the diagnosis of invasive candidosis since many patients with simple colonization (43%) and non-colonized non-infected patients (25%) were mannan antigen positive. The high rate of false positives (20%), for which in the current state of knowledge does not have a satisfactory explanation, is also a drawback. At the present time mannan antigenemia can only provide a supplementary argument favoring the diagnosis of invasive candidosis in patients with a suggestive clinical presentation. The test must however be interpreted with caution due to positive results observed in strongly colonized patients. A PCR method will undoubtedly be need to distinguish between colonization and invasive infection.
    No preview · Article · Mar 2004 · Journal de Mycologie Médicale/Journal of Medical Mycology
  • C. Guitton · B. Renard · L. Gabillet · D. Villers
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    ABSTRACT: Dyscalcemias are a common problem in the emergency department. Calcium homeostasis is a result of the collaboration between bone, kidney and intestinal tract mediated by an hormonal system involving parathyroid hormone and vitamin D. It seems better to analyze ionized calcium or to correct total calcemia according to underlying conditions. Serum abnormalities can be associated with dramatic visceral consequences including a lethal risk. The severity of symptoms is correlated with both the magnitude and the rapidity of the onset of the troubles, and should guide treatments. Etiologies of dyscalcemias are numerous and often multifactorial. In hypercalcemia, 90% of them are hyperparathyroidism or malignancy. Emergency treatment is based on rehydratation, diphosphonates and sometimes calcitonin. In hypocalcemia, treatment starts with calcium supplementation. In both situations, an etiologic treatment should be considered.
    No preview · Article · Nov 2002