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Pecorelli S, Ferdynus C, Delmas J, Harper L. Appearance of the bladder on initial voiding cystogram in boys with PUV and its relation to pre and postnatal findings. Front Pediatr 2024; 12:1380502. [PMID: 38699154 PMCID: PMC11063334 DOI: 10.3389/fped.2024.1380502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 04/04/2024] [Indexed: 05/05/2024] Open
Abstract
Introduction Bladder profile in boys with Posterior Urethral Valves can be very varied with a spectrum going from high pressure, unstable, hypocompliant small bladders to hypercompliant, large acontractile bladders, with some being near-normal. Our question was whether appearance, specifically of the bladder, on initial VCUG was correlated to prenatal features and whether it could predict early postnatal outcome. Method We used a prospectively gathered database of boys with prenatally suspected PUV. We analyzed whether the appearance, specifically of the bladder, was related to date of prenatal diagnosis, presence of a megacystis on prenatal ultrasound, presence of vesico-ureteral reflux (VUR), presence of abnormal DMSA scan, nadir creatinine or presence of febrile urinary tract infection (fUTI) during the first two years of life. Results The database comprised 90 cystograms. 15% of bladders were judged normal/regular, 54 % were small/diverticular and 31% were large/diverticular. Bladder appearance was not associated with presence of prenatal megacystis, abnormal DMSA scan, VUR, nor rate of fUTI. The only significant associations were normal/regular bladder and early prenatal diagnosis (p = 0.04) and normal/regular bladder and elevated nadir creatinine (>75µmol/l) (p = 0.01). Discussion We believe that when focusing solely on the appearance of the bladder, excluding information about the urethra and presence of reflux, the cystogram alone is insufficient to inform on future bladder function. This could be used as an argument in favor of performing early urodynamics in this population.
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Affiliation(s)
- S. Pecorelli
- Department of Pediatric Urology, Hôpital Pellegrin-Enfants, CHU Bordeaux, France
| | - C. Ferdynus
- Methodological SupportUnit, Reunion University Hospital, La Réunion, France
- Clinical Informatics Department, Reunion University Hospital, La Réunion, France
- Clinical Research Department, INSERM CIC1410, La Réunion, France
| | - J. Delmas
- Department of Pediatric Radiology, Hôpital Pellegrin-Enfants, CHU Bordeaux, France
| | - L. Harper
- Department of Pediatric Urology, Hôpital Pellegrin-Enfants, CHU Bordeaux, France
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Breuil T, Robert PY, Delmas J. Surgical management of orbital implant exposures after evisceration or enucleation: Retrospective study - Limoges University Hospital. J Fr Ophtalmol 2024; 47:104176. [PMID: 38582066 DOI: 10.1016/j.jfo.2024.104176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/17/2023] [Accepted: 10/22/2023] [Indexed: 04/08/2024]
Abstract
INTRODUCTION Implant exposure is the most frequent complication after evisceration or enucleation, and multiple surgical techniques for the management of orbital implant exposure. The goal of our study is to investigate the success rate and risk factors for failure of various surgical procedures. METHODS This was a retrospective study performed at the University Hospital of Limoges. We collected data from the files of every patient operated on for implant exposure between January 2005 and December 2020. The main criterion was the percentage of success for each procedure. Secondary objectives were to identify risk factors for failure of Müller's muscle flaps and to determine the incidence of post-enucleation socket syndrome depending on whether the orbital implant was maintained. RESULTS Fifty-one patients were included: 26 patients who underwent Müller's muscle flap, 16 dermis-fat graft, 3 conjunctival flap, 2 amniotic membrane graft, 1 temporalis fascia graft, 1 buccal mucosa graft, 1 implant rotation, and 1 implant exchange. The dermis-fat grafts were more successful (87.5%) than the Müller's muscle flaps (52.2%) (P=0.0213). The study highlighted the importance of good vascularization of the implant (OR=32.00, P-value=0.0245) for the success of Müller's muscle flaps, and we found no statistically significant difference between the patients who maintained their implants and those who did not (P=0.3865) with regard to the incidence of post-enucleation socket syndrome. CONCLUSION Müller's muscle flap may remain a reasonable option in the management of medium-sized implant exposures of well-vascularized implants confirmed on MRI in patients with no systemic healing disorders. Dermis-fat graft remains the option of choice in other cases, especially in large exposures or complicated orbits.
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Affiliation(s)
- T Breuil
- Department of Ophtalmology, Limoges Hospital, 2, avenue Martin-Luther-King, 87000 Limoges, France.
| | - P-Y Robert
- Department of Ophtalmology, Limoges Hospital, 2, avenue Martin-Luther-King, 87000 Limoges, France
| | - J Delmas
- Department of Ophtalmology, Limoges Hospital, 2, avenue Martin-Luther-King, 87000 Limoges, France
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Delmas J, Cherier L, Sauvestre F, Chateil JF. Vertical course of fetal anterior cerebral artery as clue to prenatal diagnosis of syntelencephaly. Ultrasound Obstet Gynecol 2022; 60:813-814. [PMID: 35809245 DOI: 10.1002/uog.26028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 06/26/2022] [Accepted: 06/29/2022] [Indexed: 06/15/2023]
Affiliation(s)
- J Delmas
- Service d'Imagerie Anténatale, de l'Enfant et de la Femme, Hôpital Pellegrin, CHU de Bordeaux, Bordeaux, France
| | - L Cherier
- Service d'Imagerie Anténatale, de l'Enfant et de la Femme, Hôpital Pellegrin, CHU de Bordeaux, Bordeaux, France
| | - F Sauvestre
- Unité de Fœtopathologie, Hôpital Pellegrin, CHU de Bordeaux, Bordeaux, France
| | - J F Chateil
- Service d'Imagerie Anténatale, de l'Enfant et de la Femme, Hôpital Pellegrin, CHU de Bordeaux, Bordeaux, France
- University of Bordeaux/CNRS, CRMSB, UMR 5536, Bordeaux, France
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Pradal M, Traoré O, Lautrette A, Robin F, Delmas J, Aumeran C. Analyse comparative des infections et colonisations urinaires associées au cathéter urinaire et différences entre les recommandations et la pratique clinique. Med Mal Infect 2020. [DOI: 10.1016/j.medmal.2020.06.290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Alturkistany W, Delmas J, Robert PY. The use of anterior segment optical coherence tomography in evaluation of punctal stenosis. J Fr Ophtalmol 2020; 43:494-499. [PMID: 32245579 DOI: 10.1016/j.jfo.2019.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 09/19/2019] [Accepted: 09/24/2019] [Indexed: 10/24/2022]
Abstract
PURPOSE To evaluate the applicability of anterior segment optical coherence tomography (AS-OCT) for objective diagnosis of punctal stenosis. METHODS We report the use of AS-OCT in 3 cases of epiphora related to punctal stenosis. We followed the methodology described in previous studies. The examination was performed by a single technician using a single Spectralis OCT with the AS-OCT module. Three patients with complaints of epiphora (mean age=80 years) were examined. The external punctal diameter was measured on both infrared (IR) and OCT images. The internal diameter was measured on OCT images at a depth of 500μm. The diagnosis was confirmed by clinical examination. RESULTS The external punctal diameters were 159μm in the right eye (Cases 1 and 2) and 195μm in the left eye (case 2; mean: 171μm). All measurements were lower than cadaveric measurements (200-500μm), as well as previously described average diameters, thus confirming the diagnosis of punctal stenosis. The AS-OCT diameter correlated moderately with the punctal diameter estimate on the IR photos (mean: 183μm). In addition, the mean internal diameter of the punctum at 500μm (cases 1 and 2) was 58μm, which is consistent with the mean diameter at 500μm described in previous studies. Case 3 involved an 88-year-old man who complained of chronic epiphora. Slit lamp examination showed total punctal stenosis associated with cicatricial ectropion in the left eye due to a cutaneous tumor treated with radiotherapy. AS-OCT confirmed the presence of total punctual stenosis and the absence of associated canalicular stenosis. LIMITATIONS Our study is obviously limited by its small study population. The decision to resort to surgery was made by 2 different surgeons. There was thus no homogeneity in terms of stenosis. There is difficulty in everting the lid without applying pressure to the globe or changing the punctal or canalicular morphology. This maneuver was difficult in the postoperative setting after ectropion repair. CONCLUSION Our study shows that AS-OCT can be a rapid, non-invasive method in diagnosing punctal stenosis. Further studies are necessary to assess the use of AS-OCT in punctal stenosis.
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Affiliation(s)
- W Alturkistany
- Limoges University Hospital, 2, avenue Martin-Luther-King, 87000 Limoges, France; King Abdulaziz University Hospital, Jeddah, Saudi Arabia.
| | - J Delmas
- Limoges University Hospital, 2, avenue Martin-Luther-King, 87000 Limoges, France
| | - P-Y Robert
- Limoges University Hospital, 2, avenue Martin-Luther-King, 87000 Limoges, France
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Delmas J, Marcelin C, Petitpierre F, Lebras Y, Grenier N. Page kidney after radiofrequency ablation of renal tumor: Successful management with percutaneous drainage. Diagn Interv Imaging 2019; 100:721-723. [PMID: 31405820 DOI: 10.1016/j.diii.2019.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 07/12/2019] [Accepted: 07/15/2019] [Indexed: 10/26/2022]
Affiliation(s)
- J Delmas
- Department of Radiology, Pellegrin Hospital, place Amélie Raba Léon, 33076 Bordeaux, France
| | - C Marcelin
- Department of Radiology, Pellegrin Hospital, place Amélie Raba Léon, 33076 Bordeaux, France.
| | - F Petitpierre
- Department of Radiology, Pellegrin Hospital, place Amélie Raba Léon, 33076 Bordeaux, France
| | - Y Lebras
- Department of Radiology, Pellegrin Hospital, place Amélie Raba Léon, 33076 Bordeaux, France
| | - N Grenier
- Department of Radiology, Pellegrin Hospital, place Amélie Raba Léon, 33076 Bordeaux, France
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Delmas J, Quenot JP, Constantin JM, Perbet S. État de choc après intubation : facteurs de risque et moyens de prévention en réanimation. Méd Intensive Réa 2018. [DOI: 10.3166/rea-2018-0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
La survenue d’un état de choc postintubation d’un patient de réanimation est fréquente. L’identification de facteurs de risque liés au patient (sujet âgé, pathologie respiratoire grave septique avec retentissement marqué, antécédents cardiorespiratoires) et à la procédure (hypnotiques, ventilation mécanique) est importante. Elle doit permettre d’anticiper des moyens de traitement de l’état de choc postintubation dans le cadre d’un bundle : présence de deux opérateurs, préoxygénation optimisée, expansion volémique, vasopresseurs, agents pour une induction en séquence rapide, préparation et initiation de la sédation d’entretien, capnographie, ventilation protectrice.
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Perbet S, Blanquet M, Mourgues C, Delmas J, Bertran S, Longère B, Boïko-Alaux V, Chennell P, Bazin JE, Constantin JM. Cost analysis of single-use (Ambu ® aScope™) and reusable bronchoscopes in the ICU. Ann Intensive Care 2017; 7:3. [PMID: 28050896 PMCID: PMC5209315 DOI: 10.1186/s13613-016-0228-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 12/20/2016] [Indexed: 11/25/2022] Open
Abstract
Background Flexible optical bronchoscopes are essential for management of airways in ICU, but the conventional reusable flexible scopes have three major drawbacks: high cost of repairs, need for decontamination, and possible transmission of infectious agents. The main objective of this study was to measure the cost of bronchoalveolar lavage (BAL) and percutaneous tracheostomy (PT) using reusable bronchoscopes and single-use bronchoscopes in an ICU of an university hospital. The secondary objective was to compare the satisfaction of healthcare professionals with reusable and single-use bronchoscopes. Methods The study was performed between August 2009 and July 2014 in a 16-bed ICU. All BAL and PT procedures were performed by experienced healthcare professionals. Cost analysis was performed considering ICU and hospital organization. Healthcare professional satisfaction with single-use and reusable scopes was determined based on eight factors. Sensitivity analysis was performed by applying discount rates (0, 3, and 5%) and by simulation of six situations based on different assumptions. Results At a discount rate of 3%, the costs per BAL for the two reusable scopes were 188.86€ (scope 1) and 185.94€ (scope 2), and the costs per PT for the reusable scope 1 and scope 2 and single-use scopes were 1613.84€, 410.24€, and 204.49€, respectively. The cost per procedure for the reusable scopes depended on the number of procedures performed, maintenance costs, and decontamination costs. Healthcare professionals were more satisfied with the third-generation single-use Ambu® aScope™. Conclusions The cost per procedure for the single-use scope was not superior to that for reusable scopes. The choice of single-use or reusable bronchoscopes in an ICU should consider the frequency of procedures and the number of bronchoscopes needed. Electronic supplementary material The online version of this article (doi:10.1186/s13613-016-0228-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- S Perbet
- Réanimation Adultes & USC, Pôle de Médecine Péri-Opératoire, CHU Clermont-Ferrand, Clermont-Ferrand, France. .,R2D2, EA 7281, Faculté de Médecine, Université d'Auvergne, Clermont-Ferrand, France. .,Réanimation Médico-Chirugicale, Pôle de Médecine Péri-Opératoire, Hôpital Gabriel-Montpied, CHU Clermont-Ferrand, 58 Rue Montalembert, 63000, Clermont-Ferrand Cedex, France.
| | - M Blanquet
- Service de Santé Publique, CHU Clermont-Ferrand, 7, Place Henri-Dunant, 63058, Clermont-Ferrand Cedex 1, France.,Clermont Université, Université d'Auvergne, EA 4681, PEPRADE (Périnatalité, grossesse, Environnement, PRAtiques médicales et DEveloppement), Clermont-Ferrand, France
| | - C Mourgues
- Service de Santé Publique, CHU Clermont-Ferrand, 7, Place Henri-Dunant, 63058, Clermont-Ferrand Cedex 1, France.,Clermont Université, Université d'Auvergne, EA 4681, PEPRADE (Périnatalité, grossesse, Environnement, PRAtiques médicales et DEveloppement), Clermont-Ferrand, France
| | - J Delmas
- Réanimation Adultes & USC, Pôle de Médecine Péri-Opératoire, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - S Bertran
- Réanimation Adultes & USC, Pôle de Médecine Péri-Opératoire, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - B Longère
- Réanimation Adultes & USC, Pôle de Médecine Péri-Opératoire, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - V Boïko-Alaux
- Pharmacie centrale, Centrale d'Approvisionnement de Matériel Stérile, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - P Chennell
- Pharmacie centrale, Centrale d'Approvisionnement de Matériel Stérile, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - J-E Bazin
- Réanimation Adultes & USC, Pôle de Médecine Péri-Opératoire, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - J-M Constantin
- Réanimation Adultes & USC, Pôle de Médecine Péri-Opératoire, CHU Clermont-Ferrand, Clermont-Ferrand, France.,R2D2, EA 7281, Faculté de Médecine, Université d'Auvergne, Clermont-Ferrand, France
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Abstract
Most cases of colorectal cancer (CRC) are sporadic, and numerous studies have suggested that gut microbiota may play a crucial role in CRC development. Escherichia coli is a member of the gut microbiota frequently associated with colorectal tumors. CRC-associated E. coli strains frequently harbor the pks genomic island. This genomic island is responsible for the synthesis of colibactin genotoxin, which increases tumor numbers in CRC mouse models. We recently showed that targeting ClbP, a key enzyme involved in colibactin synthesis, blocks the deleterious effect of this toxin in vitro and leads to a significant decrease in tumor numbers in vivo. Altogether, our results suggest that the personalized treatment of CRC should also take into consideration the bacteria associated with the tumor in order to limit their deleterious effects.
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Affiliation(s)
- T. Faïs
- Microbes, Inflammation, Intestin et Susceptibilité de l'Hôte (M2iSH), Clermont Université, Université d'Auvergne, Inserm U1071, INRA USC2018, Clermont-Ferrand, France,Laboratoire de Bactériologie, Center Hospitalier Universitaire, Clermont-Ferrand, France,Institut Universitaire de Technologie, Université d'Auvergne, Aubière, France
| | - J. Delmas
- Microbes, Inflammation, Intestin et Susceptibilité de l'Hôte (M2iSH), Clermont Université, Université d'Auvergne, Inserm U1071, INRA USC2018, Clermont-Ferrand, France,Laboratoire de Bactériologie, Center Hospitalier Universitaire, Clermont-Ferrand, France,Institut Universitaire de Technologie, Université d'Auvergne, Aubière, France
| | - A. Cougnoux
- Microbes, Inflammation, Intestin et Susceptibilité de l'Hôte (M2iSH), Clermont Université, Université d'Auvergne, Inserm U1071, INRA USC2018, Clermont-Ferrand, France,Institut Universitaire de Technologie, Université d'Auvergne, Aubière, France
| | - G. Dalmasso
- Microbes, Inflammation, Intestin et Susceptibilité de l'Hôte (M2iSH), Clermont Université, Université d'Auvergne, Inserm U1071, INRA USC2018, Clermont-Ferrand, France,Institut Universitaire de Technologie, Université d'Auvergne, Aubière, France
| | - R. Bonnet
- Microbes, Inflammation, Intestin et Susceptibilité de l'Hôte (M2iSH), Clermont Université, Université d'Auvergne, Inserm U1071, INRA USC2018, Clermont-Ferrand, France,Laboratoire de Bactériologie, Center Hospitalier Universitaire, Clermont-Ferrand, France,Institut Universitaire de Technologie, Université d'Auvergne, Aubière, France
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Gavard-Perret A, Lagier J, Delmas J, Delas J, Adenis JP, Robert PY. [Rationale for a diagnostic approach in non-Graves' orbital inflammation--Report of 61 patients]. J Fr Ophtalmol 2015; 38:912-23. [PMID: 26604081 DOI: 10.1016/j.jfo.2015.04.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Revised: 04/13/2015] [Accepted: 04/29/2015] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Orbital inflammatory syndromes include a wide variety of inflammatory intraorbital processes which are very different in terms of clinical presentation and prognosis. We currently prefer to differentiate so-called "specific" inflammations, for which an etiology is able to be identified, from idiopathic orbital inflammatory syndromes (IOIS), for which the etiology remains unknown and the histology is nonspecific. PURPOSE To propose an efficient diagnostic approach for clinicians managing patients with non-Graves' orbital inflammations. MATERIALS AND METHODS This is a retrospective and prospective study concerning 61 patients managed by the medical team for non-Graves' orbital inflammations between May, 1999 and May, 2013 in the ophthalmology departments of Nice and Limoges university hospitals in France. Seventeen specific inflammations, 19 orbital lymphomas and 25 idiopathic orbital inflammatory syndromes were included. Patients were divided into two groups. Thirty-six patients (group 1) underwent primary biopsy, while for the other 25 (group 2), therapy was begun empirically without biopsy. We could therefore compare both approaches in terms of diagnostic efficiency and time until identification of a specific etiology. RESULTS Our statistical results show that an approach without primary biopsy leads to a number of specific diagnoses statistically much lower than that obtained by the approach with primary biopsy. Also, the risk of missing a specific inflammation (with as a consequence an inappropriate treatment and a risk of functional sequelae as well as a fatal risk of missing a lymphoproliferative pathology) is very clearly higher in the case of not performing primary biopsy. Finally, the average time elapsed between the initial consultation with the ophthalmologist and a specific diagnosis was one month in the case of the first approach, while this delay was almost three times higher with the second approach, with a mean of 2.91 months (P<0.01). DISCUSSION Our study shows that biopsy should be the mainstay of diagnostic management. A trial of empiric treatment is only performed first in myositis or in locations where biopsy could jeopardize functional prognosis. It should only be done after biopsy in all other cases. Of course, in all cases of relapse or recurrence after treatment, biopsy should be performed or repeated. CONCLUSION The diagnostic work-up of a patient with an orbital inflammatory process must of course include blood testing and orbital imaging, but also a systematic primary biopsy for histological examination in the vast majority of cases. It must be repeated at least in the case of any doubt about the diagnosis or in the case of any recurrence or resistance to treatment.
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Affiliation(s)
- A Gavard-Perret
- Ophtalmologie pédiatrique, hôpital Robert-Debré, 48, boulevard Sérurier, 75019 Paris, France.
| | - J Lagier
- CHU de Nice, 30, voie Romaine, 06001 Nice, France
| | - J Delmas
- CHU de Limoges, 2, avenue Martin-Luther-King, 87000 Limoges, France
| | - J Delas
- CHU de Nice, 30, voie Romaine, 06001 Nice, France
| | - J-P Adenis
- CHU de Limoges, 2, avenue Martin-Luther-King, 87000 Limoges, France
| | - P-Y Robert
- CHU de Limoges, 2, avenue Martin-Luther-King, 87000 Limoges, France
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Barreau G, Bourmault L, Delmas J, Adenis JP, Robert PY. [Double corneo-scleral graft]. J Fr Ophtalmol 2015; 38:e87-8. [PMID: 25913658 DOI: 10.1016/j.jfo.2014.05.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Revised: 05/24/2014] [Accepted: 05/26/2014] [Indexed: 11/17/2022]
Affiliation(s)
- G Barreau
- Service d'ophtalmologie, CHU Dupuytren, 2, avenue Martin-Luther-King, 87000 Limoges, France.
| | - L Bourmault
- Service d'ophtalmologie, CHU Dupuytren, 2, avenue Martin-Luther-King, 87000 Limoges, France
| | - J Delmas
- Service d'ophtalmologie, CHU Dupuytren, 2, avenue Martin-Luther-King, 87000 Limoges, France
| | - J-P Adenis
- Service d'ophtalmologie, CHU Dupuytren, 2, avenue Martin-Luther-King, 87000 Limoges, France
| | - P-Y Robert
- Service d'ophtalmologie, CHU Dupuytren, 2, avenue Martin-Luther-King, 87000 Limoges, France
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Delmas J, Cessot C, Gavard-Perret A, Adenis JP, Robert PY. [Repair of post-traumatic upper lid anterior lamellar foreshortening: a case report]. J Fr Ophtalmol 2014; 37:667-9. [PMID: 25169144 DOI: 10.1016/j.jfo.2014.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 02/23/2014] [Accepted: 03/07/2014] [Indexed: 11/30/2022]
Affiliation(s)
- J Delmas
- Service d'ophtalmologie, CHU Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges cedex, France.
| | - C Cessot
- Service d'ophtalmologie, CHU Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges cedex, France
| | - A Gavard-Perret
- Service d'ophtalmologie, CHU Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges cedex, France
| | - J-P Adenis
- Service d'ophtalmologie, CHU Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges cedex, France
| | - P-Y Robert
- Service d'ophtalmologie, CHU Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges cedex, France
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Gibold L, Robin F, Tan RN, Delmas J, Bonnet R. Four-year epidemiological study of extended-spectrum β-lactamase-producing Enterobacteriaceae in a French teaching hospital. Clin Microbiol Infect 2013; 20:O20-6. [PMID: 23927626 DOI: 10.1111/1469-0691.12321] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 06/21/2013] [Accepted: 06/30/2013] [Indexed: 11/30/2022]
Abstract
Since the end of the last century resistance to oxyimino β-lactams has steadily increased in Enterobacteriaceae. In the present work we studied extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae strains isolated in the teaching hospital of Clermont-Ferrand, France, between 2006 and 2009. A total of 1368 ESBL-producing isolates were collected. Most of these isolates (69%) were CTX-M-producing Escherichia coli. During the study, the clinical incidence increased by more than 400%, even in the emergency department, and especially in community-acquired infections, as is the case elsewhere in the world. Most of the ESBL-producing isolates remained susceptible to furans and fosfomycin, but only 50% to fluoroquinolons. In conclusion, ESBL-producing bacteria constantly increased during the study period. Unlike many studies, this increase was associated with the wide dissemination of three different CTX-M enzymes: CTX-M-14, CTX-M-15 and CTX-M-1.
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Affiliation(s)
- L Gibold
- Laboratoire de Bactériologie, CHU Clermont-Ferrand, Centre de Biologie, Clermont-Ferrand, France; Microbes, Intestins, Inflammation et Susceptibilité de l'Hôte, INSERM U1071, INRA, USC2018, Clermont Université, Université d'Auvergne, Clermont-Ferrand, France
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Delmas J, Adenis JP, Robert PY. [Choroiditis and Crohn disease: a case report]. J Fr Ophtalmol 2011; 34:653.e1-5. [PMID: 21561686 DOI: 10.1016/j.jfo.2011.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2009] [Accepted: 01/18/2011] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Crohn disease is an inflammatory bowel disease. Extradigestive manifestations can occur, especially ocular inflammation, but posterior choroidal inflammation is more unusual. OBSERVATION We report the case of a 42-year-old woman, suffering from histologically proven Crohn disease for one year, who developed choroiditis in the left eye of unknown etiology. Fundus and fluorescein angiography displayed an aspect mimicking ampiginous choroiditis, and indocyanine green (ICG) angiography disclosed a large choroidal subtractive aspect. CONCLUSION This case is a rare example of posterior segment manifestation in Crohn disease, possibly due to choroidal infiltration by inflammatory cells or choroidal focal ischemia.
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Affiliation(s)
- J Delmas
- Service d'ophtalmologie, CHU de Limoges, 2, avenue Martin-Luther-King, 87000 Limoges, France.
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Robin F, Delmas J, Schweitzer C, Bonnet R. Evaluation of the Vitek-2 extended-spectrum beta-lactamase test against non-duplicate strains of Enterobacteriaceae producing a broad diversity of well-characterised beta-lactamases. Clin Microbiol Infect 2007; 14:148-54. [PMID: 18076663 DOI: 10.1111/j.1469-0691.2007.01893.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The Vitek-2 extended-spectrum beta-lactamase (ESBL) test was assessed using a collection of 94 ESBL-positive and 71 ESBL-negative non-duplicate isolates of Enterobacteriaceae. These isolates produced a wide diversity of well-characterised beta-lactamases, including 61 different ESBLs, two class A carbapenemases and various species-specific beta-lactamases. ESBL detection was performed using (i) the conventional synergy test as recommended by the Comité de l'Antibiogramme de la Société Française de Microbiologie, (ii) the CLSI phenotypic confirmatory test for ESBLs, and (iii) the Vitek-2 ESBL test. For Escherichia coli and klebsiellae, the sensitivity/specificity values were 97.3%/96.9% for the synergy test, 91.8%/100% for the CLSI phenotypic confirmatory test, and 91.8%/100% for the Vitek-2 ESBL test. For other organisms, the sensitivity/specificity values were 100%/97.4% for the synergy test, 90.5%/100% for the CLSI phenotypic confirmatory test, and 90.5%/100% for the Vitek-2 ESBL test. The Vitek-2 ESBL test seemed to be an efficient method for routine detection of ESBL-producing isolates of Enterobacteriaceae, including isolates producing AmpC-type enzymes.
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Affiliation(s)
- F Robin
- CHU Clermont-Ferrand, Centre de Biologie, Laboratoire de Bactériologie Clinique, and Université Clermont 1, UFR Médecine, Laboratoire de Bactériologie, EA3844, Clermont-Ferrand, France.
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Delmas J, Robin F, Carvalho F, Mongaret C, Bonnet R. Prediction of the evolution of ceftazidime resistance in extended-spectrum beta-lactamase CTX-M-9. Antimicrob Agents Chemother 2006; 50:731-8. [PMID: 16436733 PMCID: PMC1366911 DOI: 10.1128/aac.50.2.731-738.2006] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A random mutagenesis technique was used to predict the evolutionary potential of beta-lactamase CTX-M-9 toward the acquisition of improved catalytic activity against ceftazidime. Thirty CTX-M mutants were obtained during three rounds of mutagenesis. These mutants conferred 1- to 128-fold-higher MICs of ceftazidime than the parental enzyme CTX-M-9. The CTX-M mutants contained one to six amino acid substitutions. Mutants harbored the substitutions Asp240Gly and Pro167Ser, which were previously observed in clinical CTX-M enzymes. Additional substitutions, notably Arg164His, Asp179Gly, and Arg276Ser, were observed near the active site. The kinetic constants of the three most active mutants revealed two distinct ways of improving catalytic efficiency against ceftazidime. One enzyme had a 17-fold-higher k(cat) value than CTX-M-9 against ceftazidime. The other two had 75- to 300-fold-lower Km values than CTX-M-9 against ceftazidime. The current emergence of CTX-M beta-lactamases with improved activity against ceftazidime may therefore be the beginning of an evolutionary process which might subsequently generate a great diversity of CTX-M-type ceftazidimases.
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Affiliation(s)
- J Delmas
- Laboratoire de Bactériologie, Faculté de Médecine, Centre Hospitalo-Universitaire, Clermont-Ferrand, France.
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Friggeri A, Radji M, Badaoui R, Delmas J, Byhet N, Jakobina S. [Easy tracheal intubation? Mallampati class zero airway]. Ann Fr Anesth Reanim 2006; 25:314-5. [PMID: 16311007 DOI: 10.1016/j.annfar.2005.10.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
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Abstract
The clinical isolate Escherichia coli CF884 exhibited low-level resistance to ceftazidime (4 mug/ml) by a positive double-disk synergy test and apparent susceptibility to cefuroxime, cefotaxime, cefepime, cefpirome, and aztreonam. The enzyme implicated in this phenotype was a novel 180-kb plasmid-encoded TEM-type extended-spectrum beta-lactamase designated TEM-126 which harbors the mutations Asp179Glu and Met182Thr. TEM-126 exhibited significant hydrolytic activity (k(cat), 2 s(-1)) and a K(m) value of 82 muM against ceftazidime. Molecular dynamics simulations suggested that the substitution Asp179Glu induces subtle conformational changes to the omega loop which may favor the insertion of ceftazidime in the binding site and the correct positioning of the crucial residue Glu166. Overall, these results highlight the remarkable plasticity of TEM enzymes, which can expand their activity against ceftazidime by the addition of one carbon atom in the side chain of residue 179.
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Affiliation(s)
- J Delmas
- Faculté de Médecine, Centre Hospitalo-Universitaire, Clermont-Ferrand, France.
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Robin F, Delmas J, Chanal C, Sirot D, Sirot J, Bonnet R. TEM-109 (CMT-5), a natural complex mutant of TEM-1 beta-lactamase combining the amino acid substitutions of TEM-6 and TEM-33 (IRT-5). Antimicrob Agents Chemother 2006; 49:4443-7. [PMID: 16251281 PMCID: PMC1280126 DOI: 10.1128/aac.49.11.4443-4447.2005] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Escherichia coli CF349 exhibited a complex beta-lactam resistance phenotype, including resistance to amoxicillin and ticarcillin alone and in combination with clavulanate and to some extended-spectrum cephalosporins. The double-disk synergy test was positive. CF349 harbored an 85-kb conjugative plasmid which encoded a beta-lactamase of pI 5.9. The corresponding bla gene was identified by PCR and sequencing as a bla(TEM) gene. The deduced protein sequence revealed a new complex mutant of TEM-1 beta-lactamase designated TEM-109 (CMT-5). TEM-109 contained both the substitutions Glu104Lys and Arg164His of the expanded-spectrum beta-lactamase (ESBL) TEM-6 and Met69Leu of the inhibitor-resistant TEM-33 (IRT-5). TEM-109 exhibited hydrolytic activity against ceftazidime similar to that of TEM-6 (k(cat), 56 s(-1) and 105 s(-1), respectively; K(m) values, 226 and 247 microM, respectively). The 50% inhibitory concentrations of clavulanate and tazobactam (0.13 microM and 0.27 microM, respectively) were 5- to 10-fold higher for TEM-109 than for TEM-6 (0.01 and 0.06 microM, respectively) but were almost 10-fold lower than those for TEM-33. The characterization of this novel CMT, which exhibits a low level of resistance to inhibitors, highlights the emergence of this new ESBL type.
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Affiliation(s)
- F Robin
- Faculté de Médecine, Centre Hospitalo-Universitaire, Clermont-Ferrand, France.
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Delmas J, Robin F, Romaszko JP, Baraduc R, Lesens O, Sirot J, Bonnet R. [VCA agar (bioMérieux) for selective isolation of vancomycin-resistant Enterococci (VRE) from fecal specimens]. ACTA ACUST UNITED AC 2005; 53:485-9. [PMID: 16084029 DOI: 10.1016/j.patbio.2005.06.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2005] [Accepted: 06/30/2005] [Indexed: 10/25/2022]
Abstract
Screening for Vancomycin Resistant Enterococci (VRE) is recommended for preventing nosocomial infections with VRE. The aim of this study was to assess the performance of VCA3 agar (bioMérieux) in VRE isolation from fecal specimens. 220 specimens were cultured on VCA3 agar, which contains vancomycin and in parallel, on CAP agar (Oxoid), which is vancomycin-free. 36 vancomycin resistant enterococci were isolated: 24 isolates of Enterococcus faecium expressed a high-level resistance to vancomycin and 12 isolates of E. gallinarum/casseliflavus exhibited resistance at low-level. The sensitivity of VCA3 appeared greater than that of CAP for VRE isolation: 92% (22/24) vs 79% (19/24) for E. faecium (NS, P>0.05) ; 83% (10/12) vs 50% (6/12) for E. gallinarum/casselliflavus (NS, P>0.05). As expected, initial cultures of multiple gram positive organisms were far more frequent on CAP agar than on VCA3 agar. The isolation rate of vancomycin susceptible gram positive strains was impressively lower on VCA3 medium than on CAP medium. VCA3 agar avoided therefore additional subcultures, useless identification and susceptibility tests. In conclusion, VCA3 medium could be useful for the direct, rapid and selective isolation of VRE from fecal specimens.
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Affiliation(s)
- J Delmas
- Service de bactériologie, faculté de médecine, CHU Clermont-Ferrand, 28 place H.-Dunant, 63001 Clermont-Ferrand, France.
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Crousier M, Delmas J, Blanchet MC, Lepape A, Perdrix JP, Gueugniaud PY. [Necrotizing bacterial skin and software tissue infection with muscular involvement revealing of cancer of the colon]. ACTA ACUST UNITED AC 2005; 24:412-5. [PMID: 15826791 DOI: 10.1016/j.annfar.2005.01.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2004] [Accepted: 01/25/2005] [Indexed: 10/25/2022]
Abstract
We report the case of a 38-year-old woman with a necrotizing bacterial skin and soft tissue infection with muscular involvement. The clinical picture was similar to a gaseous gangrene of the right lower limb with a septic shock and multiple organ failure, without predisposing factor such as trauma, and necessitating a hip amputation. The primary site of the disease was a perforated colic adenocarcinoma with peritoneal and retroperitoneal infection. The association of necrotizing skin and soft tissue infection with muscular involvement due to Clostridium septicum to a neoplasma is classical and in front of such an infection a neoplasma should be researched.
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Affiliation(s)
- M Crousier
- Service d'anesthésie-réanimation 1, unité de réanimation, centre hospitalo-universitaire Lyon Sud, 69495 Pierre-Bénite cedex, France.
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Badaoui R, Chebboubi K, Delmas J, Jakobina S, Mahjoub Y, Riboulot M. [Splenic rupture and anticoagulant therapy]. ACTA ACUST UNITED AC 2004; 23:748-50. [PMID: 15324967 DOI: 10.1016/j.annfar.2004.04.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2003] [Revised: 03/30/2004] [Accepted: 03/30/2004] [Indexed: 11/28/2022]
Abstract
Splenic rupture associated with anticoagulant therapy is a rare entity. We report a case of spontaneous splenic rupture in a 62-year-old man who was treated by acenocoumarol orally after an aortic-valve replacement. Unrecognised, minor trauma may lead to splenic haemorrhage in patients receiving anticoagulant therapy. The symptoms and signs may mimic those of acute myocardial infarction and cardiogenic shock. Early diagnosis is essential. Reversal of the anticoagulant and emergent splenectomy are the treatments of choice.
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Affiliation(s)
- R Badaoui
- Département d'anesthésie-réanimation B, CHU d'Amiens, place Victor-Pauchet, 80054 Amiens, France.
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Delmas J. [Not Available]. Bull Soc Fr Hist Hop 2001:17-25. [PMID: 11629379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
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Delmas J, Monneret G, Lapillonne A, Basson E, Isaac C, Bienvenu F, Putet G, Bienvenu J. [Procalcitonin and C-reactive protein kinetics in neonates with group B streptococcus infection]. Ann Biol Clin (Paris) 2000; 58:208-11. [PMID: 10760709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Affiliation(s)
- J Delmas
- Service d'immunobiologie, Centre hospitalier Lyon-Sud, 69495 Pierre-Bénite, France. E-mail :
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Hutin JF, Grenier N, Schmitt N, Pledran B, Elie G, Philippe JC, Delmas J, Broussin J. [Angiography of hepatic angiomatosis in Rendu-Osler disease. Apropos of 3 cases]. J Radiol 1989; 70:621-7. [PMID: 2693699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The hepatic changes in hereditary hemorrhagic telangiectasia (Rendu Osler's disease) involve the extra- and intrahepatic vessels (enlarged hepatic artery, arteriovenous fistulas and inhomogeneous perfusion) and the hepatic parenchyma (fibrosis, telangiectasic cirrhosis). From three observations with liver involvement and imaged with angiography and dynamic CT, the authors emphasize on the role of the latter for detection of these changes, mostly arteriovenous fistulas.
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Affiliation(s)
- J F Hutin
- Service de Radiologie, Hôpital Pellegrin Tripode, Bordeaux
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Delmas J, Farizon F, Philippon J, Baratgin B. [Endometriosis of the sigmoid colon]. J Radiol Electrol Arch Electr Medicale 1958; 39:896-7. [PMID: 13631654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/23/2023]
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