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Guedeney P, Laredo M, Zeitouni M, Hauguel-Moreau M, Wallet T, Alamowitch S, Sabben C, Deltour S, Benyounes N, Obadia M, Collet JP, Rouanet S, Hammoudi N, Silvain J, Montalescot G. Supraventricular arrhythmia following patent foramen ovale percutaneous closure. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Randomized studies have reported low rates of atrial fibrillation (AF) after patent foramen ovale (PFO) closure (<6%) but have relied on patients-reported symptomatic episodes, thus true incidence and timing of AF after PFO closure remain unknown.
Objective
To prospectively determine the incidence, timing, and determinants of supraventricular arrhythmia following PFO closure based on loop recorder monitoring.
Methods
Cardiac monitoring was proposed to all patients after PFO closure from June 2018 to October 2021 in our center by mean of implantable loop recorder (ILR) monitoring in patients considered at higher risk of AF (age ≥55 years, associated cardiovascular risk factors, prior palpitations, or documented supraventricular ectopic activity) or 4-week external loop recorder (ELR) monitoring in other patients. The primary endpoint was the incidence of AF, flutter, or atrial tachycardia lasting >30 seconds within 28 days of the procedure. Determinants of the primary endpoint were assessed with stepwise logistic regression model.
Results
A total of 225 patients were included. The primary endpoint occurred in 47/225 (20.9%) patients, including n=13 (9.9%) and n=24 (28.9%) among ELR- and ILR-monitored patients, respectively. Among ILR-monitored patients, median follow-up was 428 (211–752) days, and four more cases of supraventricular arrhythmia were diagnosed beyond 28 days (Figure 1). Overall, median delay from procedure to arrhythmia was 14.0 (6.5–19.0) days and half of these patients reported symptomatic episodes. Determinants of the primary endpoint were older age (adjusted odds ratio [aOR]: 1.67, 95% confidence interval [CI]: 1.18–2.36, per 10-year increase), device left disc diameter ≥25mm (aOR: 2.67, 95% CI: 1.19–5.98) and male sex (aOR: 4.78, 95% CI: 1.96–11.66) (Figure 2).
Conclusion
Using prolonged loop recorder monitoring, supraventricular arrhythmia was diagnosed in one patient out of five with a median delay of 14 days suggesting that this post-procedural event has been so far, underestimated.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- P Guedeney
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6, ACTION study group, Institut de cardiologie (AP-HP), INSERM UMRS 1166, , Paris , France
| | - M Laredo
- Hospital Pitie-Salpetriere , Paris , France
| | - M Zeitouni
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6, ACTION study group, Institut de cardiologie (AP-HP), INSERM UMRS 1166, , Paris , France
| | - M Hauguel-Moreau
- Ambroise Pare Aphp Site of Ouest University Hospital, cardiology , Boulogne Billancourt , France
| | - T Wallet
- Hospital Pitie-Salpetriere , Paris , France
| | | | - C Sabben
- Fondation Rothschild, Neurology , Paris , France
| | - S Deltour
- Hopital Raymond Poincare, Neurology , Garches , France
| | - N Benyounes
- Fondation Rothschild, Cardiology , Paris , France
| | - M Obadia
- Fondation Rothschild, Neurology , Paris , France
| | - J P Collet
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6, ACTION study group, Institut de cardiologie (AP-HP), INSERM UMRS 1166, , Paris , France
| | - S Rouanet
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6, ACTION study group, Institut de cardiologie (AP-HP), INSERM UMRS 1166, , Paris , France
| | - N Hammoudi
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6, ACTION study group, Institut de cardiologie (AP-HP), INSERM UMRS 1166, , Paris , France
| | - J Silvain
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6, ACTION study group, Institut de cardiologie (AP-HP), INSERM UMRS 1166, , Paris , France
| | - G Montalescot
- Hospital Pitie-Salpetriere, Sorbonne Université Paris 6, ACTION study group, Institut de cardiologie (AP-HP), INSERM UMRS 1166, , Paris , France
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Wymant C, Bezemer D, Blanquart F, Ferretti L, Gall A, Hall M, Golubchik T, Bakker M, Ong SH, Zhao L, Bonsall D, de Cesare M, MacIntyre-Cockett G, Abeler-Dörner L, Albert J, Bannert N, Fellay J, Grabowski MK, Gunsenheimer-Bartmeyer B, Günthard HF, Kivelä P, Kouyos RD, Laeyendecker O, Meyer L, Porter K, Ristola M, van Sighem A, Berkhout B, Kellam P, Cornelissen M, Reiss P, Fraser C, Aubert V, Battegay M, Bernasconi E, Böni J, Braun DL, Bucher HC, Burton-Jeangros C, Calmy A, Cavassini M, Dollenmaier G, Egger M, Elzi L, Fehr J, Fellay J, Furrer H, Fux CA, Gorgievski M, Günthard H, Haerry D, Hasse B, Hirsch HH, Hoffmann M, Hösli I, Kahlert C, Kaiser L, Keiser O, Klimkait T, Kouyos R, Kovari H, Ledergerber B, Martinetti G, de Tejada BM, Marzolini C, Metzner K, Müller N, Nadal D, Nicca D, Pantaleo G, Rauch A, Regenass S, Rudin C, Schöni-Affolter F, Schmid P, Speck R, Stöckle M, Tarr P, Trkola A, Vernazza P, Weber R, Yerly S, van der Valk M, Geerlings SE, Goorhuis A, Hovius JW, Lempkes B, Nellen FJB, van der Poll T, Prins JM, Reiss P, van Vugt M, Wiersinga WJ, Wit FWMN, van Duinen M, van Eden J, Hazenberg A, van Hes AMH, Rajamanoharan S, Robinson T, Taylor B, Brewer C, Mayr C, Schmidt W, Speidel A, Strohbach F, Arastéh K, Cordes C, Pijnappel FJJ, Stündel M, Claus J, Baumgarten A, Carganico A, Ingiliz P, Dupke S, Freiwald M, Rausch M, Moll A, Schleehauf D, Smalhout SY, Hintsche B, Klausen G, Jessen H, Jessen A, Köppe S, Kreckel P, Schranz D, Fischer K, Schulbin H, Speer M, Weijsenfeld AM, Glaunsinger T, Wicke T, Bieniek B, Hillenbrand H, Schlote F, Lauenroth-Mai E, Schuler C, Schürmann D, Wesselmann H, Brockmeyer N, Jurriaans S, Gehring P, Schmalöer D, Hower M, Spornraft-Ragaller P, Häussinger D, Reuter S, Esser S, Markus R, Kreft B, Berzow D, Back NKT, Christl A, Meyer A, Plettenberg A, Stoehr A, Graefe K, Lorenzen T, Adam A, Schewe K, Weitner L, Fenske S, Zaaijer HL, Hansen S, Stellbrink HJ, Wiemer D, Hertling S, Schmidt R, Arbter P, Claus B, Galle P, Jäger H, Jä Gel-Guedes E, Berkhout B, Postel N, Fröschl M, Spinner C, Bogner J, Salzberger B, Schölmerich J, Audebert F, Marquardt T, Schaffert A, Schnaitmann E, Cornelissen MTE, Trein A, Frietsch B, Müller M, Ulmer A, Detering-Hübner B, Kern P, Schubert F, Dehn G, Schreiber M, Güler C, Schinkel CJ, Gunsenheimer-Bartmeyer B, Schmidt D, Meixenberger K, Bannert N, Wolthers KC, Peters EJG, van Agtmael MA, Autar RS, Bomers M, Sigaloff KCE, Heitmuller M, Laan LM, Ang CW, van Houdt R, Jonges M, Kuijpers TW, Pajkrt D, Scherpbier HJ, de Boer C, van der Plas A, van den Berge M, Stegeman A, Baas S, Hage de Looff L, Buiting A, Reuwer A, Veenemans J, Wintermans B, Pronk MJH, Ammerlaan HSM, van den Bersselaar DNJ, de Munnik ES, Deiman B, Jansz AR, Scharnhorst V, Tjhie J, Wegdam MCA, van Eeden A, Nellen J, Brokking W, Elsenburg LJM, Nobel H, van Kasteren MEE, Berrevoets MAH, Brouwer AE, Adams A, van Erve R, de Kruijf-van de Wiel BAFM, Keelan-Phaf S, van de Ven B, van der Ven B, Buiting AGM, Murck JL, de Vries-Sluijs TEMS, Bax HI, van Gorp ECM, de Jong-Peltenburg NC, de Mendonç A Melo M, van Nood E, Nouwen JL, Rijnders BJA, Rokx C, Schurink CAM, Slobbe L, Verbon A, Bassant N, van Beek JEA, Vriesde M, van Zonneveld LM, de Groot J, Boucher CAB, Koopmans MPG, van Kampen JJA, Fraaij PLA, van Rossum AMC, Vermont CL, van der Knaap LC, Visser E, Branger J, Douma RA, Cents-Bosma AS, Duijf-van de Ven CJHM, Schippers EF, van Nieuwkoop C, van Ijperen JM, Geilings J, van der Hut G, van Burgel ND, Leyten EMS, Gelinck LBS, Mollema F, Davids-Veldhuis S, Tearno C, Wildenbeest GS, Heikens E, Groeneveld PHP, Bouwhuis JW, Lammers AJJ, Kraan S, van Hulzen AGW, Kruiper MSM, van der Bliek GL, Bor PCJ, Debast SB, Wagenvoort GHJ, Kroon FP, de Boer MGJ, Jolink H, Lambregts MMC, Roukens AHE, Scheper H, Dorama W, van Holten N, Claas ECJ, Wessels E, den Hollander JG, El Moussaoui R, Pogany K, Brouwer CJ, Smit JV, Struik-Kalkman D, van Niekerk T, Pontesilli O, Lowe SH, Oude Lashof AML, Posthouwer D, van Wolfswinkel ME, Ackens RP, Burgers K, Schippers J, Weijenberg-Maes B, van Loo IHM, Havenith TRA, van Vonderen MGA, Kampschreur LM, Faber S, Steeman-Bouma R, Al Moujahid A, Kootstra GJ, Delsing CE, van der Burg-van de Plas M, Scheiberlich L, Kortmann W, van Twillert G, Renckens R, Ruiter-Pronk D, van Truijen-Oud FA, Cohen Stuart JWT, Jansen ER, Hoogewerf M, Rozemeijer W, van der Reijden WA, Sinnige JC, Brinkman K, van den Berk GEL, Blok WL, Lettinga KD, de Regt M, Schouten WEM, Stalenhoef JE, Veenstra J, Vrouenraets SME, Blaauw H, Geerders GF, Kleene MJ, Kok M, Knapen M, van der Meché IB, Mulder-Seeleman E, Toonen AJM, Wijnands S, Wttewaal E, Kwa D, van Crevel R, van Aerde K, Dofferhoff ASM, Henriet SSV, Ter Hofstede HJM, Hoogerwerf J, Keuter M, Richel O, Albers M, Grintjes-Huisman KJT, de Haan M, Marneef M, Strik-Albers R, Rahamat-Langendoen J, Stelma FF, Burger D, Gisolf EH, Hassing RJ, Claassen M, Ter Beest G, van Bentum PHM, Langebeek N, Tiemessen R, Swanink CMA, van Lelyveld SFL, Soetekouw R, van der Prijt LMM, van der Swaluw J, Bermon N, van der Reijden WA, Jansen R, Herpers BL, Veenendaal D, Verhagen DWM, Lauw FN, van Broekhuizen MC, van Wijk M, Bierman WFW, Bakker M, Kleinnijenhuis J, Kloeze E, Middel A, Postma DF, Schölvinck EH, Stienstra Y, Verhage AR, Wouthuyzen-Bakker M, Boonstra A, de Groot-de Jonge H, van der Meulen PA, de Weerd DA, Niesters HGM, van Leer-Buter CC, Knoester M, Hoepelman AIM, Arends JE, Barth RE, Bruns AHW, Ellerbroek PM, Mudrikova T, Oosterheert JJ, Schadd EM, van Welzen BJ, Aarsman K, Griffioen-van Santen BMG, de Kroon I, van Berkel M, van Rooijen CSAM, Schuurman R, Verduyn-Lunel F, Wensing AMJ, Bont LJ, Geelen SPM, Loeffen YGT, Wolfs TFW, Nauta N, Rooijakkers EOW, Holtsema H, Voigt R, van de Wetering D, Alberto A, van der Meer I, Rosingh A, Halaby T, Zaheri S, Boyd AC, Bezemer DO, van Sighem AI, Smit C, Hillebregt M, de Jong A, Woudstra T, Bergsma D, Meijering R, van de Sande L, Rutkens T, van der Vliet S, de Groot L, van den Akker M, Bakker Y, El Berkaoui A, Bezemer M, Brétin N, Djoechro E, Groters M, Kruijne E, Lelivelt KJ, Lodewijk C, Lucas E, Munjishvili L, Paling F, Peeck B, Ree C, Regtop R, Ruijs Y, Schoorl M, Schnörr P, Scheigrond A, Tuijn E, Veenenberg L, Visser KM, Witte EC, Ruijs Y, Van Frankenhuijsen M, Allegre T, Makhloufi D, Livrozet JM, Chiarello P, Godinot M, Brunel-Dalmas F, Gibert S, Trepo C, Peyramond D, Miailhes P, Koffi J, Thoirain V, Brochier C, Baudry T, Pailhes S, Lafeuillade A, Philip G, Hittinger G, Assi A, Lambry V, Rosenthal E, Naqvi A, Dunais B, Cua E, Pradier C, Durant J, Joulie A, Quinsat D, Tempesta S, Ravaux I, Martin IP, Faucher O, Cloarec N, Champagne H, Pichancourt G, Morlat P, Pistone T, Bonnet F, Mercie P, Faure I, Hessamfar M, Malvy D, Lacoste D, Pertusa MC, Vandenhende MA, Bernard N, Paccalin F, Martell C, Roger-Schmelz J, Receveur MC, Duffau P, Dondia D, Ribeiro E, Caltado S, Neau D, Dupont M, Dutronc H, Dauchy F, Cazanave C, Vareil MO, Wirth G, Le Puil S, Pellegrin JL, Raymond I, Viallard JF, Chaigne de Lalande S, Garipuy D, Delobel P, Obadia M, Cuzin L, Alvarez M, Biezunski N, Porte L, Massip P, Debard A, Balsarin F, Lagarrigue M, Prevoteau du Clary F, Aquilina C, Reynes J, Baillat V, Merle C, Lemoing V, Atoui N, Makinson A, Jacquet JM, Psomas C, Tramoni C, Aumaitre H, Saada M, Medus M, Malet M, Eden A, Neuville S, Ferreyra M, Sotto A, Barbuat C, Rouanet I, Leureillard D, Mauboussin JM, Lechiche C, Donsesco R, Cabie A, Abel S, Pierre-Francois S, Batala AS, Cerland C, Rangom C, Theresine N, Hoen B, Lamaury I, Fabre I, Schepers K, Curlier E, Ouissa R, Gaud C, Ricaud C, Rodet R, Wartel G, Sautron C, Beck-Wirth G, Michel C, Beck C, Halna JM, Kowalczyk J, Benomar M, Drobacheff-Thiebaut C, Chirouze C, Faucher JF, Parcelier F, Foltzer A, Haffner-Mauvais C, Hustache Mathieu M, Proust A, Piroth L, Chavanet P, Duong M, Buisson M, Waldner A, Mahy S, Gohier S, Croisier D, May T, Delestan M, Andre M, Zadeh MM, Martinot M, Rosolen B, Pachart A, Martha B, Jeunet N, Rey D, Cheneau C, Partisani M, Priester M, Bernard-Henry C, Batard ML, Fischer P, Berger JL, Kmiec I, Robineau O, Huleux T, Ajana F, Alcaraz I, Allienne C, Baclet V, Meybeck A, Valette M, Viget N, Aissi E, Biekre R, Cornavin P, Merrien D, Seghezzi JC, Machado M, Diab G, Raffi F, Bonnet B, Allavena C, Grossi O, Reliquet V, Billaud E, Brunet C, Bouchez S, Morineau-Le Houssine P, Sauser F, Boutoille D, Besnier M, Hue H, Hall N, Brosseau D, Souala F, Michelet C, Tattevin P, Arvieux C, Revest M, Leroy H, Chapplain JM, Dupont M, Fily F, Patra-Delo S, Lefeuvre C, Bernard L, Bastides F, Nau P, Verdon R, de la Blanchardiere A, Martin A, Feret P, Geffray L, Daniel C, Rohan J, Fialaire P, Chennebault JM, Rabier V, Abgueguen P, Rehaiem S, Luycx O, Niault M, Moreau P, Poinsignon Y, Goussef M, Mouton-Rioux V, Houlbert D, Alvarez-Huve S, Barbe F, Haret S, Perre P, Leantez-Nainville S, Esnault JL, Guimard T, Suaud I, Girard JJ, Simonet V, Debab Y, Schmit JL, Jacomet C, Weinberck P, Genet C, Pinet P, Ducroix S, Durox H, Denes É, Abraham B, Gourdon F, Antoniotti O, Molina JM, Ferret S, Lascoux-Combe C, Lafaurie M, Colin de Verdiere N, Ponscarme D, De Castro N, Aslan A, Rozenbaum W, Pintado C, Clavel F, Taulera O, Gatey C, Munier AL, Gazaigne S, Penot P, Conort G, Lerolle N, Leplatois A, Balausine S, Delgado J, Timsit J, Tabet M, Gerard L, Girard PM, Picard O, Tredup J, Bollens D, Valin N, Campa P, Bottero J, Lefebvre B, Tourneur M, Fonquernie L, Wemmert C, Lagneau JL, Yazdanpanah Y, Phung B, Pinto A, Vallois D, Cabras O, Louni F, Pialoux G, Lyavanc T, Berrebi V, Chas J, Lenagat S, Rami A, Diemer M, Parrinello M, Depond A, Salmon D, Guillevin L, Tahi T, Belarbi L, Loulergue P, Zak Dit Zbar O, Launay O, Silbermann B, Leport C, Alagna L, Pietri MP, Simon A, Bonmarchand M, Amirat N, Pichon F, Kirstetter M, Katlama C, Valantin MA, Tubiana R, Caby F, Schneider L, Ktorza N, Calin R, Merlet A, Ben Abdallah S, Weiss L, Buisson M, Batisse D, Karmochine M, Pavie J, Minozzi C, Jayle D, Castel P, Derouineau J, Kousignan P, Eliazevitch M, Pierre I, Collias L, Viard JP, Gilquin J, Sobel A, Slama L, Ghosn J, Hadacek B, Thu-Huyn N, Nait-Ighil L, Cros A, Maignan A, Duvivier C, Consigny PH, Lanternier F, Shoai-Tehrani M, Touam F, Jerbi S, Bodard L, Jung C, Goujard C, Quertainmont Y, Duracinsky M, Segeral O, Blanc A, Peretti D, Cheret A, Chantalat C, Dulucq MJ, Levy Y, Lelievre JD, Lascaux AS, Dumont C, Boue F, Chambrin V, Abgrall S, Kansau I, Raho-Moussa M, De Truchis P, Dinh A, Davido B, Marigot D, Berthe H, Devidas A, Chevojon P, Chabrol A, Agher N, Lemercier Y, Chaix F, Turpault I, Bouchaud O, Honore P, Rouveix E, Reimann E, Belan AG, Godin Collet C, Souak S, Mortier E, Bloch M, Simonpoli AM, Manceron V, Cahitte I, Hiraux E, Lafon E, Cordonnier F, Zeng AF, Zucman D, Majerholc C, Bornarel D, Uludag A, Gellen-Dautremer J, Lefort A, Bazin C, Daneluzzi V, Gerbe J, Jeantils V, Coupard M, Patey O, Bantsimba J, Delllion S, Paz PC, Cazenave B, Richier L, Garrait V, Delacroix I, Elharrar B, Vittecoq D, Bolliot C, Lepretre A, Genet P, Masse V, Perrone V, Boussard JL, Chardon P, Froguel E, Simon P, Tassi S, Avettand Fenoel V, Barin F, Bourgeois C, Cardon F, Chaix ML, Delfraissy JF, Essat A, Fischer H, Lecuroux C, Meyer L, Petrov-Sanchez V, Rouzioux C, Saez-Cirion A, Seng R, Kuldanek K, Mullaney S, Young C, Zucchetti A, Bevan MA, McKernan S, Wandolo E, Richardson C, Youssef E, Green P, Faulkner S, Faville R, Herman S, Care C, Blackman H, Bellenger K, Fairbrother K, Phillips A, Babiker A, Delpech V, Fidler S, Clarke M, Fox J, Gilson R, Goldberg D, Hawkins D, Johnson A, Johnson M, McLean K, Nastouli E, Post F, Kennedy N, Pritchard J, Andrady U, Rajda N, Donnelly C, McKernan S, Drake S, Gilleran G, White D, Ross J, Harding J, Faville R, Sweeney J, Flegg P, Toomer S, Wilding H, Woodward R, Dean G, Richardson C, Perry N, Gompels M, Jennings L, Bansaal D, Browing M, Connolly L, Stanley B, Estreich S, Magdy A, O'Mahony C, Fraser P, Jebakumar SPR, David L, Mette R, Summerfield H, Evans M, White C, Robertson R, Lean C, Morris S, Winter A, Faulkner S, Goorney B, Howard L, Fairley I, Stemp C, Short L, Gomez M, Young F, Roberts M, Green S, Sivakumar K, Minton J, Siminoni A, Calderwood J, Greenhough D, DeSouza C, Muthern L, Orkin C, Murphy S, Truvedi M, McLean K, Hawkins D, Higgs C, Moyes A, Antonucci S, McCormack S, Lynn W, Bevan M, Fox J, Teague A, Anderson J, Mguni S, Post F, Campbell L, Mazhude C, Russell H, Gilson R, Carrick G, Ainsworth J, Waters A, Byrne P, Johnson M, Fidler S, Kuldanek K, Mullaney S, Lawlor V, Melville R, Sukthankar A, Thorpe S, Murphy C, Wilkins E, Ahmad S, Green P, Tayal S, Ong E, Meaden J, Riddell L, Loay D, Peacock K, Blackman H, Harindra V, Saeed AM, Allen S, Natarajan U, Williams O, Lacey H, Care C, Bowman C, Herman S, Devendra SV, Wither J, Bridgwood A, Singh G, Bushby S, Kellock D, Young S, Rooney G, Snart B, Currie J, Fitzgerald M, Arumainayyagam J, Chandramani S. A highly virulent variant of HIV-1 circulating in the Netherlands. Science 2022; 375:540-545. [PMID: 35113714 DOI: 10.1126/science.abk1688] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
We discovered a highly virulent variant of subtype-B HIV-1 in the Netherlands. One hundred nine individuals with this variant had a 0.54 to 0.74 log10 increase (i.e., a ~3.5-fold to 5.5-fold increase) in viral load compared with, and exhibited CD4 cell decline twice as fast as, 6604 individuals with other subtype-B strains. Without treatment, advanced HIV-CD4 cell counts below 350 cells per cubic millimeter, with long-term clinical consequences-is expected to be reached, on average, 9 months after diagnosis for individuals in their thirties with this variant. Age, sex, suspected mode of transmission, and place of birth for the aforementioned 109 individuals were typical for HIV-positive people in the Netherlands, which suggests that the increased virulence is attributable to the viral strain. Genetic sequence analysis suggests that this variant arose in the 1990s from de novo mutation, not recombination, with increased transmissibility and an unfamiliar molecular mechanism of virulence.
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Affiliation(s)
- Chris Wymant
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | - François Blanquart
- Centre for Interdisciplinary Research in Biology (CIRB), Collège de France, CNRS, INSERM, PSL Research University, Paris, France.,IAME, UMR 1137, INSERM, Université de Paris, Paris, France
| | - Luca Ferretti
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Astrid Gall
- European Molecular Biology Laboratory, European Bioinformatics Institute, Wellcome Genome Campus, Hinxton, Cambridge, UK
| | - Matthew Hall
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Tanya Golubchik
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Margreet Bakker
- Laboratory of Experimental Virology, Department of Medical Microbiology and Infection Prevention, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Swee Hoe Ong
- Wellcome Sanger Institute, Wellcome Genome Campus, Cambridge, UK
| | - Lele Zhao
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - David Bonsall
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Mariateresa de Cesare
- Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - George MacIntyre-Cockett
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Lucie Abeler-Dörner
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Jan Albert
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
| | - Norbert Bannert
- Division for HIV and Other Retroviruses, Department of Infectious Diseases, Robert Koch Institute, Berlin, Germany
| | - Jacques Fellay
- School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.,Swiss Institute of Bioinformatics, Lausanne, Switzerland.,Precision Medicine Unit, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - M Kate Grabowski
- Department of Pathology, John Hopkins University, Baltimore, MD, USA
| | | | - Huldrych F Günthard
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Pia Kivelä
- Department of Infectious Diseases, Helsinki University Hospital, Helsinki, Finland
| | - Roger D Kouyos
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | | | - Laurence Meyer
- INSERM CESP U1018, Université Paris Saclay, APHP, Service de Santé Publique, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - Kholoud Porter
- Institute for Global Health, University College London, London, UK
| | - Matti Ristola
- Department of Infectious Diseases, Helsinki University Hospital, Helsinki, Finland
| | | | - Ben Berkhout
- Laboratory of Experimental Virology, Department of Medical Microbiology and Infection Prevention, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Paul Kellam
- Kymab Ltd., Cambridge, UK.,Department of Infectious Diseases, Faculty of Medicine, Imperial College London, London, UK
| | - Marion Cornelissen
- Laboratory of Experimental Virology, Department of Medical Microbiology and Infection Prevention, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands.,Molecular Diagnostic Unit, Department of Medical Microbiology and Infection Prevention, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Peter Reiss
- Stichting HIV Monitoring, Amsterdam, Netherlands.,Department of Global Health, Amsterdam University Medical Centers, University of Amsterdam and Amsterdam Institute for Global Health and Development, Amsterdam, Netherlands
| | - Christophe Fraser
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Lapergue B, Lyoubi A, Meseguer E, Avram I, Denier C, Venditti L, Consoli A, Guedon A, Houdart E, Weisenburger-Lile D, Piotin M, Maier B, Obadia M, Broucker TDE. Large vessel stroke in six patients following SARS-CoV-2 infection: a retrospective case study series of acute thrombotic complications on stable underlying atherosclerotic disease. Eur J Neurol 2020; 27:2308-2311. [PMID: 32761999 PMCID: PMC7436672 DOI: 10.1111/ene.14466] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 05/28/2020] [Accepted: 08/01/2020] [Indexed: 12/11/2022]
Abstract
Background and purpose Ischaemic stroke has been described in association with COVID‐19. Several pathophysiological mechanisms have been suggested, i.e. prothrombotic state, cardiac injury etc. It was sought to assess the potential association between ischaemic stroke associated with SARS‐CoV‐2 infection and underlying atherosclerotic lesions. Methods A retrospective analysis of stroke related to large vessel occlusion was conducted amongst patients with SARS‐CoV‐2 infection and underlying mild atherosclerotic disease, between 19 March and 19 April 2020 in six different stroke centers in the Île‐de France area, France. Results The median age was 52 years, median body mass index was 29.5 kg/m2. All patients displayed previous vascular risk factors such as high blood pressure, diabetes, dyslipidemia or body mass index > 25. The delay between the first respiratory symptoms of COVID‐19 and stroke was 11.5 days. At baseline, all had tandem occlusions, i.e. intracerebral and extracerebral thrombus assessed with computed tomography or magnetic resonance imaging. Cases displayed a large thrombus in the cervical carotid artery with underlying mild non‐stenosing atheroma, after an etiological workup based on angio‐computed tomography or magnetic resonance imaging and/or cervical echography. Conclusion Our study should alert clinicians to scrutinize any new onset of ischaemic stroke during COVID‐19 infection, mainly in patients with vascular risk factors or underlying atherosclerotic lesions.
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Affiliation(s)
- B Lapergue
- Neurovascular Unit, Interventional Neuroradiology Department, Foch Hospital, Suresnes, France
| | - A Lyoubi
- Neurovascular Unit, Saint Denis Hospital, Paris, France
| | - E Meseguer
- Neurovascular Unit, Bichat University Hospital, Paris, France
| | - I Avram
- Neurovascular Unit, Bichat University Hospital, Paris, France
| | - C Denier
- Neurovascular Unit, Interventional Neuroradiology Department, Kremlin-Bicetre University Hospital, Kremlin-Bicetre, France
| | - L Venditti
- Neurovascular Unit, Interventional Neuroradiology Department, Kremlin-Bicetre University Hospital, Kremlin-Bicetre, France
| | - A Consoli
- Neurovascular Unit, Interventional Neuroradiology Department, Foch Hospital, Suresnes, France
| | - A Guedon
- Neurovascular Unit, Interventional Neuroradiology Department, Lariboisiere University Hospital Paris, Paris, France
| | - E Houdart
- Neurovascular Unit, Interventional Neuroradiology Department, Lariboisiere University Hospital Paris, Paris, France
| | - D Weisenburger-Lile
- Neurovascular Unit, Interventional Neuroradiology Department, Foch Hospital, Suresnes, France
| | - M Piotin
- Interventional Neuroradiology Department Rothschild Fundation, Paris, France
| | - B Maier
- Interventional Neuroradiology Department Rothschild Fundation, Paris, France
| | - M Obadia
- Interventional Neuroradiology Department Rothschild Fundation, Paris, France
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4
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Sabben C, Desilles JP, Charbonneau F, Savatovsky J, Morvan E, Obadia A, Raynouard I, Fela F, Escalard S, Redjem H, Smajda S, Ciccio G, Blanc R, Fahed R, Le Guerinel C, Engrand N, Ben Maacha M, Labreuche J, Mazighi M, Piotin M, Obadia M. Early successful reperfusion after endovascular therapy reduces malignant middle cerebral artery infarction occurrence in young patients with large diffusion-weighted imaging lesions. Eur J Neurol 2020; 27:1988-1995. [PMID: 32431009 DOI: 10.1111/ene.14330] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 04/29/2020] [Accepted: 05/08/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Malignant middle cerebral artery infarction (MMI) is a severe complication of acute ischaemic stroke (AIS). The aim of our study was to assess whether successful reperfusion after endovascular therapy (EVT) in AIS with clinical and imaging predictors of MMI decreased its occurrence. METHODS Data were collected between January 2014 and July 2018 in a monocentric prospective AIS registry of patients treated with EVT. Patients selected were <65 years old with severe anterior circulation AIS with a National Institutes of Health Stroke Scale score >15, baseline Diffusion-Weighted Imaging-Alberta Stroke Program Early Computed Tomography Score ≤ 6 and baseline diffusion-weighted imaging lesion volume >82 mL within 6 h of symptom onset. Successful reperfusion was defined as a Thrombolysis in Cerebral Ischemia score ≥ 2b. Occurrence of MMI was the primary endpoint. RESULTS A total of 66 EVT-treated patients were included in our study. MMI occurred in 27 patients (41%). In unadjusted analysis, successful reperfusion was associated with fewer MMIs (31.8% vs. 65.0%; P = 0.015) and with more favorable outcome at 3 months (50% vs. 20%; P = 0.023). In multivariate analysis, successful reperfusion was associated with an adjusted odds ratio (95% confidence intervals) of 0.35 (0.10-1.12) for MMI and 2.77 (0.84-10.43) for 3-month favorable outcome occurrence. CONCLUSIONS Early successful reperfusion performed in patients with AIS with clinical and imaging predictors of MMI was associated with decreased MMI occurrence. Reperfusion status might be considered in evaluating the need for craniectomy in patients with early predictors of MMI.
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Affiliation(s)
- C Sabben
- Department of Neurology, Rothschild Foundation Hospital, Paris
| | - J P Desilles
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris.,Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Paris, Paris
| | - F Charbonneau
- Department of Neuroradiology, Rothschild Foundation Hospital, Paris
| | - J Savatovsky
- Department of Neuroradiology, Rothschild Foundation Hospital, Paris
| | - E Morvan
- Department of Neurology, Rothschild Foundation Hospital, Paris
| | - A Obadia
- Department of Neurology, Rothschild Foundation Hospital, Paris
| | - I Raynouard
- Department of Neurology, Rothschild Foundation Hospital, Paris
| | - F Fela
- Department of Neurology, Rothschild Foundation Hospital, Paris
| | - S Escalard
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris
| | - H Redjem
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris
| | - S Smajda
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris
| | - G Ciccio
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris
| | - R Blanc
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris.,Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Paris, Paris
| | - R Fahed
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris
| | - C Le Guerinel
- Department of Neurosurgery, Rothschild Foundation Hospital, Paris
| | - N Engrand
- Neuro Intensive Care Unit, Rothschild Foundation Hospital, Paris
| | - M Ben Maacha
- Research and Biostatistics Unit, Rothschild Foundation Hospital, Paris
| | - J Labreuche
- ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, CHU Lille, Université de Lille, Lille, France
| | - M Mazighi
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris.,Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Paris, Paris
| | - M Piotin
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris.,Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Paris, Paris
| | - M Obadia
- Department of Neurology, Rothschild Foundation Hospital, Paris
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5
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Vigneron C, Lécluse A, Ronzière T, Bouillet L, Boccon-Gibod I, Gayet S, Doche E, Smadja D, Di Legge S, Dumont F, Gaudron M, Ion I, Marcel S, Sévin M, Vlaicu MB, Launay D, Arnaud I, Girard-Madoux P, Héroum C, Lefèvre S, Marc G, Obadia M, Sablot D, Sibon I, Suissa L, Gobert D, Detante O, Alamowitch S, Fain O, Javaud N. Angioedema associated with thrombolysis for ischemic stroke: analysis of a case-control study. J Intern Med 2019; 286:702-710. [PMID: 31319000 DOI: 10.1111/joim.12962] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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] [Indexed: 11/29/2022]
Abstract
BACKGROUND Bradykinin-mediated angioedema (AE) is a complication associated with thrombolysis for acute ischemic stroke. Risk factors are unknown and management is discussed. OBJECTIVES To clarify risk factors associated with bradykinin-mediated AE after thrombolysis for acute ischemic stroke. METHODS In a case-control study conducted at a French reference centre for bradykinin angiœdema, patients with thrombolysis for acute ischemic stroke and a diagnosis of bradykinin-mediated angiœdema, were compared to controls treated with thrombolysis treatment without angiœdema. RESULTS Fifty-three thrombolysis-related AE were matched to 106 control subjects. The sites of attacks following thrombolysis for ischemic stroke mainly included tongue (34/53, 64%) and lips (26/53, 49%). The upper airways were involved in 37 (70%) cases. Three patients required mechanical ventilation. Patients with bradykinin-mediated angiœdema were more frequently women [33 (62%) vs. 44 (42%); P = 0.01], had higher frequency of prior ischemic stroke [12 (23%) vs. 9 (8%); P = 0.01], hypertension [46 (87%) vs. 70 (66%); P = 0.005], were more frequently treated with angiotensin-converting enzyme inhibitor [37 (70%) vs. 28 (26%); P < 0.001] and were more frequently hospitalized in intensive care medicine [ICU; 11 (21%) vs. 5 (5%); P = 0.004]. In multivariate analysis, factors associated with thrombolysis-related AE were female sex [odds ratio (OR), 3.04; 95% confident interval (CI), 1.32-7.01; P = 0.009] and treatment with angiotensin-converting enzyme inhibitors [(OR), 6.08; 95% (CI), 2.17-17.07; P < 0.001]. CONCLUSIONS This case-control study points out angiotensin-converting enzyme inhibitors and female sex as risk factors of bradykinin AE associated with thrombolysis for ischemic stroke.
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Affiliation(s)
- C Vigneron
- From the, AP-HP, Médecine Interne, DHUi2B, Centre de Référence Associé sur les Angiœdèmes à Kinines (CRéAk), Hôpital Saint-Antoine, Université Paris 6, Paris, France
| | - A Lécluse
- Neurologie, CHU Angers, Angers, France
| | - T Ronzière
- Neurologie, CHU Pontchaillou, Rennes, France
| | - L Bouillet
- Médecine Interne, Centre de Référence sur les Angiœdèmes à Kinines (CRéAk), CHU de Grenoble, Grenoble, France
| | - I Boccon-Gibod
- Médecine Interne, Centre de Référence sur les Angiœdèmes à Kinines (CRéAk), CHU de Grenoble, Grenoble, France
| | - S Gayet
- AP-HM, Médecine Interne, Centre de Compétence Angioedèmes non Histaminiques, Hôpital la Timone, Marseille, France
| | - E Doche
- AP-HM, Neurologie, Hôpital la Timone, Marseille, France
| | - D Smadja
- Neurologie, CH Sud Francilien, Corbeil-Essonnes, France
| | - S Di Legge
- Neurologie, CH du Pays d'Aix-CH Intercommunal Aix-Pertuis, Aix-en-Provence, France
| | - F Dumont
- Neurologie, CH Tourcoing, Tourcoing, France
| | - M Gaudron
- Neurologie, CHU Tours, Tours, France
| | - I Ion
- Neurologie, CHU Nîmes, Nîmes, France
| | - S Marcel
- Neurologie, CH Métropole Savoie, Chambéry, France
| | - M Sévin
- Neurologie Institut du Thorax et du Système Nerveux, CHU Nantes, Nantes, France
| | - M B Vlaicu
- AP-HP, Service de Neurochirurgie, Hôpital Pitié Salpétrière, INSERM U955, Hôpital Orsay, Paris, France
| | - D Launay
- U995-LIRIC-Lille Inflammation Research International Center, INSERM, U995, Département de Médecine Interne et Immunologie Clinique, Centre de Référence sur les Angiœdèmes à Kinines (CRéAk), Université de Lille, CHU de Lille, Lille, France
| | - I Arnaud
- Neurologie, CHU Pointe-à-Pitre, Pointe-à-Pitre, France
| | | | - C Héroum
- Neurologie, GH Portes-de-Provence, Montélimar, France
| | - S Lefèvre
- Institut d'allergologie, CHR Metz-Thionville, Metz, France
| | - G Marc
- Neurologie, CH Saint-Nazaire, Saint-Nazaire, France
| | - M Obadia
- Neurologie, Fondation Ophtalmologique Rothschild, Paris, France
| | - D Sablot
- Neurologie, CH Perpignan, Perpignan, France
| | - I Sibon
- Neurologie, CHU Bordeaux, Université de Bordeaux, Bordeaux, France
| | - L Suissa
- Neurologie, CHU Nice, Nice, France
| | - D Gobert
- From the, AP-HP, Médecine Interne, DHUi2B, Centre de Référence Associé sur les Angiœdèmes à Kinines (CRéAk), Hôpital Saint-Antoine, Université Paris 6, Paris, France
| | - O Detante
- Neurologie, CHU de Grenoble, Grenoble, France
| | - S Alamowitch
- AP-HP, Service de Neurologie, Hôpital Saint-Antoine, Sorbonne Universités, UPMC Univ Paris 06, UMRS 938, Paris, France
| | - O Fain
- From the, AP-HP, Médecine Interne, DHUi2B, Centre de Référence Associé sur les Angiœdèmes à Kinines (CRéAk), Hôpital Saint-Antoine, Université Paris 6, Paris, France
| | - N Javaud
- AP-HP, Urgences, CréAk, Hôpital Louis Mourier, Université Paris 7, Colombes, France
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Benyounes Iglesias N, Van Der Vynckt C, Sabben C, Salomon L, Tibi T, Medaouri S, Gout O, Obadia M. P2469The yield of transoesophageal echocardiography in embolic stroke of unknown source. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Purpose
Transthoracic echocardiography (TTE) and transoesophageal (TOE) are the main diagnostic tools for the detection of potential cardiac and aortic sources of embolism (PCSE).
TOE is superior to TTE. However, its therapeutic impact is questioned. TOE is no longer recommended in ESUS (embolic stroke of unknown source), which is thought to be caused by undiagnosed atrial fibrillation (AF). Recent studies however report an about 10% change in therapeutic management due to TOE.
We aimed to assess prospectively, in patients admitted to our stoke unit and diagnosed ESUS, the rate of treatment change induced by TOE.
Methods
Patients diagnosed with acute (≤7 days) ESUS were included to undergo TOE. ON TTE, PCSE, left ventricular ejection fraction (LVEF, %), left atrial area (LA-A, cm2), indexed left atrial volume (LAV, ml/m2) were recorded. On TOE, PCSE, left atrial appendage area (LAA-A, cm2), left atrial appendage emptying velocity (LAA-EV, cm/s) were recorded. PCSE on TTE and TOE were classified according to EAE guidelines.
Results
Between October 2016 and May 2018, 1322 TTEs were performed in patients admitted to our newly labelled stroke unit. ESUS was diagnosed in 152 patients, who underwent TOE.
Mean delay (95% CI) between stroke onset and TTE was 2.2 days (1.9–2.5).
Mean (95% CI) age was 61 years (58–63). 56/152 were female (37%). On TTE, mean (95% CI) LVEF was 62% (61–64), mean LA-A was 19 cm2 (19–20) and mean LA-V was 32 ml/m2 (31–34) ml/m2.
In 38 patients, a major PCSE was identified by TTE. In 4 cases, there were 2 potential major PCSE and in one case 3.
In 79 patients, at least one minor PCSE was identified by TTE, among which 35 PFO.
On TEE, mean (95% CI) LAA-A and LAA-EV were: 5.2 cm2 (4.9–5.5) % and 76 cm/s (72–80) cm/s.
In 50 patients, a major PCSE was identified by TOE. Eleven patients had 2 major PCSE.
In 115 patients, at least one minor PCSE was identified by TOE, among which 34 PFO.
According to EAE guidelines, a treatment change induced by TOE occurred in 12 patients. Anticoagulation in 5 patients (aortic arch thrombus in 2, thrombus of the proximal descending aorta in 1, LAA thrombus in 1, and thrombotic non-infectious vegetations in 2). Surgery in one patient (LAA fibroelastoma), antibiotics in two patients with infectious endocarditis,
One patient had aortic fibroelastoma not seen on TTE. Finally, two patients with mobile aortic arch debris had dual antiplatelet therapy (DAT).
In two other patients, TOE showed a mitral fibroelastoma and a mobile aortic arch thrombus, but these abnormalities were already seen on TTE, hence not taken into account.
When considering the eight patients who had, at neurologist's discretion, the instauration of DAT for complex aortic arch atheroma, 12+8 patients had therapeutic modifications induced by TOE (13%).
Conclusion
Major PCSE on TOE lead to a treatment change in 12/152 patients (8%) according to EAE guidelines, and 13% when complex aortic arch atheroma was considered.
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Affiliation(s)
| | - C Van Der Vynckt
- Fondation Ophtalmologique A. de Rothschild, Cardiology Unit, Paris, France
| | - C Sabben
- Fondation Ophtalmologique A. de Rothschild, Neurology, Paris, France
| | | | - T Tibi
- Fondation Ophtalmologique A. de Rothschild, Neurology, Paris, France
| | | | - O Gout
- Fondation Ophtalmologique A. de Rothschild, Neurology, Paris, France
| | - M Obadia
- Fondation Ophtalmologique A. de Rothschild, Neurology, Paris, France
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7
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Coulette S, Lecler A, Saragoussi E, Zuber K, Savatovsky J, Deschamps R, Gout O, Sabben C, Aboab J, Affortit A, Charbonneau F, Obadia M. Diagnosis and Prediction of Relapses in Susac Syndrome: A New Use for MR Postcontrast FLAIR Leptomeningeal Enhancement. AJNR Am J Neuroradiol 2019; 40:1184-1190. [PMID: 31248864 DOI: 10.3174/ajnr.a6103] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 05/13/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Leptomeningeal enhancement can be found in a variety of neurologic diseases such as Susac Syndrome. Our aim was to assess its prevalence and significance of leptomeningeal enhancement in Susac syndrome using 3T postcontrast fluid-attenuated inversion recovery MR imaging. MATERIALS AND METHODS From January 2011 to December 2017, nine consecutive patients with Susac syndrome and a control group of 73 patients with multiple sclerosis or clinically isolated syndrome were included. Two neuroradiologists blinded to the clinical and ophthalmologic data independently reviewed MRIs and assessed leptomeningeal enhancement and parenchymal abnormalities. Follow-up MRIs (5.9 MRIs is the mean number per patient over a median period of 46 months) of patients with Susac syndrome were reviewed and compared with clinical and retinal fluorescein angiographic data evaluated by an independent ophthalmologist. Fisher tests were used to compare the 2 groups, and mixed-effects logistic models were used for analysis of clinical and imaging follow-up of patients with Susac syndrome. RESULTS Patients with Susac syndrome were significantly more likely to present with leptomeningeal enhancement: 5/9 (56%) versus 6/73 (8%) in the control group (P = .002). They had a significantly higher leptomeningeal enhancement burden with ≥3 lesions in 5/9 patients versus 0/73 (P < .001). Regions of leptomeningeal enhancement were significantly more likely to be located in the posterior fossa: 5/9 versus 0/73 (P < .001). Interobserver agreement for leptomeningeal enhancement was good (κ = 0.79). There was a significant association between clinical relapses and increase of both leptomeningeal enhancement and parenchymal lesion load: OR = 6.15 (P = .01) and OR = 5 (P = .02), respectively. CONCLUSIONS Leptomeningeal enhancement occurs frequently in Susac syndrome and could be helpful for diagnosis and in predicting clinical relapse.
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Affiliation(s)
- S Coulette
- From the Neurology Department (S.C., R.D., O.G., C.S., J.A., M.O.)
| | - A Lecler
- Neuroradiology Department (A.L.. E.S., J.S., F.C.)
| | - E Saragoussi
- Neuroradiology Department (A.L.. E.S., J.S., F.C.)
| | - K Zuber
- Clinical Research Unit (K.Z.)
| | - J Savatovsky
- Neuroradiology Department (A.L.. E.S., J.S., F.C.)
| | - R Deschamps
- From the Neurology Department (S.C., R.D., O.G., C.S., J.A., M.O.)
| | - O Gout
- From the Neurology Department (S.C., R.D., O.G., C.S., J.A., M.O.)
| | - C Sabben
- From the Neurology Department (S.C., R.D., O.G., C.S., J.A., M.O.)
| | - J Aboab
- From the Neurology Department (S.C., R.D., O.G., C.S., J.A., M.O.)
| | - A Affortit
- Ophthalmology Department (A.A.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | | | - M Obadia
- From the Neurology Department (S.C., R.D., O.G., C.S., J.A., M.O.)
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8
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Bidouze L, Gaches F, Catros F, Ancellin S, Cella A, Garipuy D, Ferro M, Obadia M, Fourcade C, Bicart See A, Bonnet E, Michaud M. Intérêt du bilan annuel pour le dépistage des complications chez les personnes vivant avec le VIH. Rev Med Interne 2018. [DOI: 10.1016/j.revmed.2018.03.337] [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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9
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Bidouze L, Gaches F, Catros F, Ancellin S, Obadia M, Bicart See A, Fourcade C, Bonnet E, Cella A, Garipuy D, Ferro M, Michaud M. Intérêt du bilan annuel pour le dépistage des complications chez les personnes vivant avec le VIH. Rev Med Interne 2018. [DOI: 10.1016/j.revmed.2018.03.060] [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: 11/26/2022]
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10
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Lecler A, Obadia M, Savatovsky J, Picard H, Charbonneau F, Menjot de Champfleur N, Naggara O, Carsin B, Amor-Sahli M, Cottier JP, Bensoussan J, Auffray-Calvier E, Varoquaux A, De Gaalon S, Calazel C, Nasr N, Volle G, Jianu DC, Gout O, Bonneville F, Sadik JC. TIPIC Syndrome: Beyond the Myth of Carotidynia, a New Distinct Unclassified Entity. AJNR Am J Neuroradiol 2017; 38:1391-1398. [PMID: 28495942 DOI: 10.3174/ajnr.a5214] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 03/05/2017] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND PURPOSE The differential diagnosis of acute cervical pain includes nonvascular and vascular causes such as carotid dissection, carotid occlusion, or vasculitis. However, some patients present with unclassified vascular and perivascular changes on imaging previously reported as carotidynia. The aim of our study was to improve the description of this as yet unclassified clinico-radiologic entity. MATERIALS AND METHODS From January 2009 through April 2016, 47 patients from 10 centers presenting with acute neck pain or tenderness and at least 1 cervical image showing unclassified carotid abnormalities were included. We conducted a systematic, retrospective study of their medical charts and diagnostic and follow-up imaging. Two neuroradiologists independently analyzed the blinded image datasets. RESULTS The median patient age was 48 years. All patients presented with acute neck pain, and 8 presented with transient neurologic symptoms. Imaging showed an eccentric pericarotidian infiltration in all patients. An intimal soft plaque was noted in 16 patients, and a mild luminal narrowing was noted in 16 patients. Interreader reproducibility was excellent. All patients had complete pain resolution within a median of 13 days. At 3-month follow-up, imaging showed complete disappearance of vascular abnormalities in 8 patients, and a marked decrease in all others. CONCLUSIONS Our study improved the description of an unclassified, clinico-radiologic entity, which could be described by the proposed acronym: TransIent Perivascular Inflammation of the Carotid artery (TIPIC) syndrome.
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Affiliation(s)
- A Lecler
- From the Departments of Radiology (A.L., J.S., F.C., J.C.S.)
| | | | - J Savatovsky
- From the Departments of Radiology (A.L., J.S., F.C., J.C.S.)
| | - H Picard
- Clinical Research Unit (H.P.), Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - F Charbonneau
- From the Departments of Radiology (A.L., J.S., F.C., J.C.S.)
| | - N Menjot de Champfleur
- Department of Neuroradiology (N.M.d.C.), Montpellier University Hospital Center, Gui de Chauliac Hospital, Montpellier, France
| | - O Naggara
- Department of Neuroradiology (O.N.), Centre Hospitalier Sainte-Anne, Paris, France
| | - B Carsin
- Department of Radiology (B.C.), Centre Hospitalier Régional Universitaire de Rennes, Rennes, France
| | - M Amor-Sahli
- Department of Neuroradiology (M.A.-S.), Pitié-Salpêtrière Hospital, Paris, France.,Centre D'imagerie Médicale Tourville (M.A.-S.), Paris, France
| | - J P Cottier
- Department of Radiology (J.P.C.), Centre Hospitalier Régional Universitaire de Tours, Tours, France.,Brain and Imaging Laboratory Unite Mixte de Recherche U930 (J.P.C.), Institut National de la Santé et de la Recherche Médicale, François-Rabelais University, Tours, France
| | - J Bensoussan
- Department of Radiology (J.B.), Hotel-Dieu Hospital, Paris, France
| | | | - A Varoquaux
- Department of Radiology (A.V.), Conception Hospital, Aix-Marseille University, Marseille, France
| | - S De Gaalon
- Neurology Department (S.D.G.), Hôpital René et Guillaume-Laënnec, Centre Hospitalier Universitaire de Nantes, Saint-Herblain, France
| | - C Calazel
- Departments of Neuroradiology (C.C., F.B.)
| | - N Nasr
- Neurology (N.N.), Hôpital Pierre-Paul-Riquet, Centre Hospitalier Universitaire Purpan, Toulouse, France
| | - G Volle
- Neurology (M.O., G.V., O.G.)
| | - D C Jianu
- Department of Neurology (D.C.J.), Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | - O Gout
- Neurology (M.O., G.V., O.G.)
| | | | - J C Sadik
- From the Departments of Radiology (A.L., J.S., F.C., J.C.S.)
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Héran-Dreyfus F, Deschamps R, Lafitte F, Savatovsky J, Blanc R, Moulignier A, Gueguen A, Obadia M. Risonanza magnetica pratica ad uso dei neurologi. Neurologia 2017. [DOI: 10.1016/s1634-7072(17)83853-8] [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] Open
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12
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Sabben C, Obadia M, Deschamps R, Grosliere L, Aboab J, Heran F, Gout O. Atteinte leptoméningée dans le syndrome de Susac. Rev Neurol (Paris) 2014. [DOI: 10.1016/j.neurol.2014.01.655] [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: 11/16/2022]
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13
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Defline A, Obadia M, El Djerbi A, Plevy P, Lepercq J. [Maternal refusal to consent to a cesarean delivery, stillbirth]. ACTA ACUST UNITED AC 2013; 43:71-6. [PMID: 23972774 DOI: 10.1016/j.jgyn.2013.06.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 03/20/2013] [Revised: 06/05/2013] [Accepted: 06/20/2013] [Indexed: 10/26/2022]
Abstract
The doctor-lawyer perspective that we discuss is a maternal refusal to consent to a cesarean delivery for a fetal indication in June 2011. Despite repeated information of the risks during a three-week hospitalization for pre-eclampsia, after being assured of the proper understanding of the seriousness of the situation by the patient and spouse, and after consideration to transfer to another hospital, the reiterated refusal led to a late fetal extraction resulting in term stillbirth.
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Affiliation(s)
- A Defline
- Maternité Port-Royal, hôpital Cochin Saint-Vincent-de-Paul, Assistance publique-Hôpitaux de Paris, 53, avenue de l'Observatoire, 75014 Paris, France
| | - M Obadia
- Direction des affaires juridiques, Assistance publique-Hôpitaux de Paris, 75004 Paris, France
| | - A El Djerbi
- Direction des affaires juridiques, Assistance publique-Hôpitaux de Paris, 75004 Paris, France
| | - P Plevy
- Maternité Port-Royal, hôpital Cochin Saint-Vincent-de-Paul, Assistance publique-Hôpitaux de Paris, 53, avenue de l'Observatoire, 75014 Paris, France
| | - J Lepercq
- Maternité Port-Royal, hôpital Cochin Saint-Vincent-de-Paul, Assistance publique-Hôpitaux de Paris, 53, avenue de l'Observatoire, 75014 Paris, France; Faculté de médecine Paris Descartes, 75006 Paris, France.
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14
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Bonnet E, Ruidavets JB, Genoux A, Mabile L, Busato F, Obadia M, Prévoteau F, Marchou B, Massip P, Marion-Latard F, Delpierre C, Bernard J, Perret B. Early loss of bone mineral density is correlated with a gain of fat mass in patients starting a protease inhibitor containing regimen: the prospective Lipotrip study. BMC Infect Dis 2013; 13:293. [PMID: 23809140 PMCID: PMC3707772 DOI: 10.1186/1471-2334-13-293] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2012] [Accepted: 05/17/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND HIV-infected patients starting antiretroviral treatment (ART) experience deep and early disorders in fat and bone metabolism, leading to concomitant changes in fat mass and bone mineral density. METHODS We conducted a prospective study in treatment-naive HIV-infected patients randomized to receive two nucleoside reverse transcriptase inhibitors in combination with either a protease inhibitor (PI) or a non-nucleosidic reverse transcriptase inhibitor (NNRTI), to evaluate early changes in body composition, bone mineral density and metabolic markers as differentially induced by antiretroviral therapies. We measured changes in markers of carbohydrate, of fat and bone metabolism, and, using dual-emission X-ray absorptiometry (DXA), body composition and bone mineral density (BMD). Complete data on changes between baseline and after 21 months treatment were available for 35 patients (16 in the PI group and 19 in the NNRTI group). RESULTS A significant gain in BMI and in total and lower limb fat mass was recorded only in patients receiving PI. A loss of lumbar BMD was observed in both groups, being higher with PI. Plasma markers of bone metabolism (alkaline phosphatase, osteocalcin, collagen crosslaps) and levels of parathormone and of 1,25diOH-vitamin D3 significantly increased in both groups, concomitant with a decline in 25OH-vitamin D3. Lipids and glucose levels increased in both groups but rise in triglyceride was more pronounced with PI. A correlation between loss of BMD and gain of fat mass is observed in patients starting PI. CONCLUSIONS We evidenced an early effect of ART on lipid and bone metabolisms. PI lead to a significant gain in fat mass correlated with a sharp drop in BMD but active bone remodelling is evident with all antiretroviral treatments, associated with low vitamin D levels and hyperparathyroidism. In parallel, signs of metabolic restoration are evident. However, early increases in lean and fat mass, triglycerides, waist circumference and leptin are much more pronounced with PI.
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15
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Ukkola-Pons E, Sadik JC, Champtiaux N, Savatovsky J, Heran F, Gout O, Obadia M. Thrombus flottant sur un mégabulbe carotidien ou sur un bulbe suspendu, quel type de dysplasie ? Rev Neurol (Paris) 2012; 168:53-6. [DOI: 10.1016/j.neurol.2011.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Revised: 01/27/2011] [Accepted: 03/01/2011] [Indexed: 11/16/2022]
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16
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Biotti D, Deschamps R, Shotar E, Maillart E, Obadia M, Mari I, Savatovsky J, Gout O. CLIPPERS: Chronic Lymphocytic Inflammation with Pontine Perivascular Enhancement Responsive to Steroids. Pract Neurol 2011; 11:349-51. [DOI: 10.1136/practneurol-2011-000043] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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17
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Biotti D, Savatovski J, Bidot S, Shotar E, Charbonneau F, Obadia M, Gueguen A. Diffusion MR imaging of the optic nerve in a patient with giant-cell arteritis and vertebral artery vasculitis. Eur Neurol 2011; 66:83-4. [PMID: 21778731 DOI: 10.1159/000329885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Accepted: 06/01/2011] [Indexed: 11/19/2022]
Affiliation(s)
- D Biotti
- Department of Neurology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France.
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18
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Maillart E, Gueguen A, Obadia M, Moulignier A, Vignal-Clermont C, Gout O. Hypertension intracrânienne et lupus. Rev Neurol (Paris) 2011; 167:505-10. [DOI: 10.1016/j.neurol.2010.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2010] [Revised: 03/19/2010] [Accepted: 10/15/2010] [Indexed: 11/24/2022]
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19
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Brem S, Sampath R, Yu D, Staller A, Obadia M, Ewend MG. Stereotactic volumetric resection, intracavitary carmustine wafers, and radiation therapy for brain metastases: The Moffitt Cancer Center experience. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.2077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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20
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Benyounes N, Obadia M, Gout O. Non compaction cardiomyopathy: A rare cause of cerebral infarction in a young adult. Rev Neurol (Paris) 2011; 167:356-7. [DOI: 10.1016/j.neurol.2010.10.011] [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] [Received: 08/30/2010] [Revised: 10/19/2010] [Accepted: 10/26/2010] [Indexed: 10/18/2022]
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21
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Obadia M, Boydell K, Dettmer E, Parkin P, Birken C, McCrindle B. Perspectives of parents of obese children regarding physician management of childhood obesity. Can J Diabetes 2011. [DOI: 10.1016/s1499-2671(11)52029-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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22
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Cavezian C, Perez C, Obadia M, Gout O, Buchsbaum M, Chokron S. Global and local attentional processing following optic neuritis. J Vis 2010. [DOI: 10.1167/10.7.278] [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: 11/24/2022] Open
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23
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Degris E, Delpierre C, Sommet A, Sire S, Lassoued S, Aquilina C, Marchou B, Massip P, Obadia M, Marion-Latard F, Bonnet E, Bernard J. Longitudinal study of body composition of 101 HIV men with lipodystrophy: dual-energy X-ray criteria for lipodystrophy evolution. J Clin Densitom 2010; 13:237-44. [PMID: 20347366 DOI: 10.1016/j.jocd.2009.12.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2009] [Revised: 12/29/2009] [Accepted: 12/30/2009] [Indexed: 10/19/2022]
Abstract
The aim of this study was to define evolution profiles of body composition among human immunodeficiency virus (HIV)-infected men with lipodystrophy. The design is a retrospective analysis using observational data collected longitudinally. We included 101 HIV-infected men with lipodystrophy managed in routine practice and who had 2 dual energy X-ray absorptiometry scans within a minimum interval of 18 mo. Lipodystrophy was defined as a fat mass ratio (FMR, defined as the ratio of the percentage of the trunk fat mass over the percentage of the lower limbs fat mass) equal or superior to 1.5. Patients were classified in "improved" group (IG: increase of lower limbs fat mass >/= 10%) or "nonimproved" group (NIG). Body composition, immunovirological and epidemiological data were collected and compared between the 2 groups. In the whole population, over a 4-yr period, a significant increase was observed for total fat mass, trunk fat mass, and lower limbs fat mass, whereas total lean mass was stable. Total body mineral density decreased. Fifty-nine patients (IG), less exposed to zidovudine than the NIG, had an increase of lower limbs fat mass higher than 10%. But only 13 (22%) regained a normal distribution of fat mass (FMR < 1.5), showing that lipodystrophy was slowly reversible. Among the NIG, 5 patients (11.9%), less exposed to zidovudine and with a higher mean of viral load, reached an FMR below 1.5. It was mainly because of a loss of trunk fat mass, which could be the sign of a lipodystrophy worsening. Lipodystrophy improved for 58.4% of men. The improvement was very slow. Recovery was observed only in patients with an earlier intervention. No correlation was observed between lipodystrophy and total body bone mineral density. The loss of trunk fat mass without gain of lower limbs fat mass may indicate a worsening of HIV disease.
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Affiliation(s)
- Emilie Degris
- Unit of Pharmacy, Paule de viguier Hospital, Toulouse, France
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Meynard JL, Morand-Joubert L, Chêne G, Landman R, Obadia M, Castrec E, Barbaza MO, Vivier G, Rose S, Moser A, Pinta A, Kraemer S, Girard PM. Validité interne et validité externe d’une cohorte demandée par la commission de la transparence : suivi sur deux ans de 364 patients infectés par le VIH-1 et traités par enfuvirtide (cohorte ZOOM). Rev Epidemiol Sante Publique 2009. [DOI: 10.1016/j.respe.2009.07.036] [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: 10/20/2022] Open
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25
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Maillart E, Deschamps R, Moulignier A, Vignal-Clermont C, Obadia M, Le Mer Y, Laloum L, Gout O. Syndrome de Susac : étude de cinq cas. Rev Neurol (Paris) 2009; 165:575-82. [DOI: 10.1016/j.neurol.2008.10.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2008] [Revised: 07/01/2008] [Accepted: 10/08/2008] [Indexed: 11/29/2022]
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Meynard J, Morand-Joubert L, Chêne G, Landman R, Aslan A, Obadia M, Girard P. L-08 Évaluation à 12 mois de l’efficacité et la tolérance de l’enfuvirtide (Fuzeon®) chez 361 patients infectés par le VIH-1 : cohorte ZOOM. Med Mal Infect 2008. [DOI: 10.1016/s0399-077x(08)73171-8] [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: 10/21/2022]
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28
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Deschamps R, Dehais C, Heran F, Obadia M, Laloum L, Fechner C, Vignal-Clermont C, Gout O. [Bilateral papilledema: prospective study of fifty patients]. Rev Neurol (Paris) 2008; 164:42-6. [PMID: 18342056 DOI: 10.1016/j.neurol.2007.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2007] [Revised: 09/25/2007] [Accepted: 10/21/2007] [Indexed: 10/22/2022]
Abstract
In this prospective study, we report fifty consecutive cases of bilateral papilledema without neurosurgical or obvious ophthalmologic etiology, referred to our institution between January 2005 and March 2007. Lumbar puncture with opening CSF pressure measurement distinguished two groups of patients: Group 1 (n=39) with and Group 2 (n=11) without intracranial hypertension. In Group 1, 9/39 patients presented secondary intracranial hypertension mainly due to cerebral venous thrombosis. In 30 patients, after complete investigations, a diagnosis of idiopathic intracranial hypertension was made: as commonly reported, patients were predominantly overweight (96.7% with body mass index>25kg/m2) young (mean age=27.6 years) and women (96.7%). Eleven patients with intracranial hypertension had no headaches. In Group 2, the most common diagnosis was bilateral non-arteritic anterior ischemic optic neuropathy, but rare causes have been identified.
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Affiliation(s)
- R Deschamps
- Service de neurologie, fondation ophtalmologique Adolphe-de-Rothschild, 25 à 29, rue Manin, 75940 Paris cedex 19, France.
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Delpierre C, Bonnet E, Marion-Latard F, Aquilina C, Obadia M, Marchou B, Massip P, Perret B, Bernard J. Impact of HIV infection on total body composition in treatment-naive men evaluated by dual-energy X-ray absorptiometry comparison of 90 untreated HIV-infected men to 241 controls. J Clin Densitom 2007; 10:376-80. [PMID: 17888698 DOI: 10.1016/j.jocd.2007.07.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2007] [Revised: 07/26/2007] [Accepted: 07/27/2007] [Indexed: 11/18/2022]
Abstract
The aim of this study was to establish the contribution of human immunodeficiency virus (HIV) itself on body composition changes evaluated by dual-energy X-ray absorptiometry (DXA). Body composition evaluated by DXA in 90 HIV never treated men, without comorbidity, or current or past opportunistic infections were compared with 241 healthy volunteers. The mean duration of seropositivity from HIV diagnosis was 41+/-62 mo, mean CD4 and viral load at the time of DXA were 402/mm(3)+/-263 (control values 500-1200/mm(3)) and 4.2 log copies/mL+/-1.3. Mean age (41 vs 39 yr, respectively, for HIV never treated patients and controls) and mean height (174.5 vs 176 cm) were not different, but mean weight was lower among HIV never treated patients (69.8 vs 78.7 kg). Mean total body bone mineral density (BMD) of naive HIV-infected patients was lower than that of controls (1.20 vs 1.23 g/cm(2), p=0.01) but not after adjustment on age, height, lean mass (LM), and fat mass ratio (FMR=% trunk fat mass/% lower limb fat mass). Fat mass (13.2 vs 16.5 kg, p<0.0001) and LM (53.5 vs 59 kg, p<0.0001) of naive HIV-infected patients were lower whatever the adjustment variables. The FMR was lower in naive HIV-infected men (1.0 vs 1.3, p<0.0001) because of a decreased trunk fat mass. After adjustment on age, height, LM, and fat mass, the lower limbs fat mass percentage was higher in HIV-infected men. The profile of naïve HIV-infected patients displayed low lean and fat masses, and a fat mass repartition characterized by a predominant loss in the trunk. Those alterations may result from the catabolic effect of the chronic HIV infection.
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Affiliation(s)
- C Delpierre
- Unit of Infectious and Tropical Disease, Purpan Hospital, Toulouse, France.
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Gérard L, Bérezné A, Galicier L, Meignin V, Obadia M, De Castro N, Jacomet C, Verdon R, Madelaine-Chambrin I, Boulanger E, Chevret S, Agbalika F, Oksenhendler E. Prospective study of rituximab in chemotherapy-dependent human immunodeficiency virus associated multicentric Castleman's disease: ANRS 117 CastlemaB Trial. J Clin Oncol 2007; 25:3350-6. [PMID: 17664482 DOI: 10.1200/jco.2007.10.6732] [Citation(s) in RCA: 155] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Single-agent chemotherapy is usually effective in HIV-associated multicentric Castleman's disease (MCD). However, in most patients, chemotherapy cannot be discontinued. PATIENTS AND METHODS To evaluate the efficacy of four weekly rituximab infusions (375 mg/m(2)) after discontinuation of chemotherapy in HIV-associated MCD, 24 patients were enrolled onto a prospective open-label trial. RESULTS At study entry, the median time from MCD diagnosis was 21 months. All patients had stable disease on chemotherapy and were dependent on chemotherapy for a median time of 13 months. The median CD4 cell count was 270 x 10(6)/L, and the plasma HIV RNA was less than 50 copies/mL in 18 patients. One patient died with progressive disease at day 15, and 23 patients completed the four cycles of rituximab. Sustained remission (SR) off treatment at day 60 (primary end point) was achieved in 22 patients (92%). From day 60 to day 365, one patient died with acute respiratory failure of undetermined origin, and four patients experienced relapse. Seventeen patients (71%) were alive in SR at day 365 without specific treatment, and the overall survival rate was 92% (95% CI, 71% to 98%). Rituximab was well tolerated, and the majority of adverse events were mild to moderate infections. Mild exacerbation of Kaposi's sarcoma (KS) lesions was observed in eight of 12 patients with previous KS. CONCLUSION Rituximab was both effective and safe in HIV-infected patients with chemotherapy-dependent MCD.
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Affiliation(s)
- Laurence Gérard
- Department of Clinical Immunology, Laboratory of Virology, Paris VII University, Paris, France.
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Tavassoli N, Bagheri H, Sommet A, Delpierre C, Marion-Latard F, Massip P, Aquilina C, Bonnet E, Obadia M, Labau E, Montastruc JL, Bernard J. Effects of discontinuing stavudine or protease inhibitor therapy on human immunodeficiency virus-related fat redistribution evaluated by dual-energy x-ray absorptiometry. Pharmacotherapy 2006; 26:154-61. [PMID: 16466321 DOI: 10.1592/phco.26.2.154] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [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: 11/23/2022]
Abstract
STUDY OBJECTIVE To determine whether discontinuation of stavudine or protease inhibitor therapy improves human immunodeficiency virus (HIV)-related fat distribution in men. DESIGN Observational, retrospective study consisting of a cross-sectional (part 1) and a longitudinal (part 2) study. DATA SOURCE Medical records from Purpan University Hospital and La Grave University Hospital, Toulouse, France. Subjects. Eighty men with HIV infection treated with antiretrovirals and 151 healthy male controls matched for age. MEASUREMENTS AND MAIN RESULTS In part 1, body composition and fat distribution of the HIV-infected men were compared by dual energy x-ray absorptiometry (DEXA) with those of the controls to determine whether body fat distribution is altered in HIV-infected men. In part 2, we analyzed modifications of body composition and fat distribution in 45 of the 80 patients. These 45 had been exposed to antiretroviral drugs, including stavudine and a protease inhibitor, for at least 5 months before the first of two DEXA assessments. They received three different treatment strategies for several months. In group 1, stavudine was withdrawn; in group 2, protease inhibitor was discontinued, and in group 3, stavudine plus protease inhibitor were continued. Group 1 showed a significant fat gain in the lower extremities 31.7 +/- 5.9 months after stavudine discontinuation (p<0.0001). Group 2 did not show any significant modification of total body, lower limb, or trunk fat despite protease inhibitor discontinuation for 35.2 +/- 6.6 months. Findings were similar for group 3, who continued receiving stavudine-protease inhibitor therapy for 21.2 +/- 12.8 months. CONCLUSION These data suggest that long-term withdrawal of stavudine from the antiretroviral therapy regimen may be associated with significant improvement in lipoatrophy in the lower extremities, whereas long-term protease inhibitor withdrawal did not modify fat distribution.
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Affiliation(s)
- Neda Tavassoli
- Service de Pharmacologie Clinique, Cent re Midi-Pyrénées de Pharmacovigilance, de Pharmacoépidémiologie et d'Informations sur le Médicament, Faculté de Médecine, Hôpitaux de Toulouse, Toulouse, France.
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Béquet D, Obadia M, Seilhean D. [Subacute deterioration of imbalance associated with headaches in an 81-year-old male]. Rev Neurol (Paris) 2006; 162:388-94. [PMID: 16585898 DOI: 10.1016/s0035-3787(06)75030-5] [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] [Indexed: 11/29/2022]
Affiliation(s)
- D Béquet
- Service de Neurologie, Hôpital du Val de Grâce, Paris
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Samson Y, Crozier S, Deltour S, Obadia M, Bruandet M, Leger A. Does acute occlusion of the carotid T invariably have a poor outcome? Neurology 2006; 64:1664; author reply 1664. [PMID: 15883348 DOI: 10.1212/wnl.64.9.1664-a] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Delobel P, Sandres-Sauné K, Cazabat M, L'Faqihi FE, Aquilina C, Obadia M, Pasquier C, Marchou B, Massip P, Izopet J. Persistence of distinct HIV-1 populations in blood monocytes and naive and memory CD4 T cells during prolonged suppressive HAART. AIDS 2005; 19:1739-50. [PMID: 16227781 DOI: 10.1097/01.aids.0000183125.93958.26] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.6] [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: 11/26/2022]
Abstract
OBJECTIVE Reservoirs of HIV-1 are a major obstacle to virus eradication. There is therefore a need to clearly understand the molecular nature of the virus populations that persist in patients with sustained suppression of plasma viraemia on highly active antiretroviral therapy (HAART). DESIGN We performed a detailed analysis of the genotypes of HIV-1 quasispecies isolated from highly purified blood cell types taken from three selected patients with sustained undetectable viral loads on HAART for 7 years. METHODS We used polychromatic flow cytometry to sort naive and memory CD4 T cells, CD14 monocytes, and CD56+CD3- natural killer (NK) cells from the total peripheral blood mononuclear cells after 7 years of HAART. Clonal analysis was used to determine coreceptor use and drug-resistance genotypes of HIV-1 quasispecies in the sorted blood cell types. RESULTS We detected HIV-1 DNA in memory and naive CD4 T cells and in CD14 monocytes, but not in the CD56+CD3- NK cells. Phylogenetic analysis demonstrated that the various blood cells types of two of the three patients harboured genetically distinct HIV-1 quasispecies. Drug-resistance mutations were also distributed differently from one cell type to another. This compartmentalization suggests a minimal virus trafficking between blood cell types during suppressive HAART. CONCLUSIONS We observed a cell-specific compartmentalization of the residual virus populations during prolonged suppressive HAART. The coexistence of numerous HIV-1 quasispecies with different resistance genotypes and coreceptor use in cellular reservoirs may be relevant for future antiretroviral treatment strategies.
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MESH Headings
- Antiretroviral Therapy, Highly Active
- CD4-Positive T-Lymphocytes/virology
- DNA, Viral/analysis
- Disease Reservoirs
- Drug Resistance, Viral
- Flow Cytometry
- Genes, env/genetics
- Genes, pol/genetics
- Genotype
- HIV Infections/drug therapy
- HIV Infections/genetics
- HIV Infections/immunology
- HIV-1/genetics
- Humans
- Immunologic Memory
- Killer Cells, Natural/virology
- Leukocytes, Mononuclear/virology
- Polymerase Chain Reaction
- Receptors, CCR5
- Receptors, CXCR4
- Sequence Analysis, DNA
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Affiliation(s)
- Pierre Delobel
- Laboratory of Virology EA2046-IFR30, Toulouse University Hospital, France
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35
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Samson Y, Bruandet M, Lapergue B, Deltour S, Lejeune M, Crozier S, Obadia M, Léger A, Grimaldi A. L’insuline est-elle un traitement efficace de l’infarctus cérébral ? Rev Neurol (Paris) 2005. [DOI: 10.1016/s0035-3787(05)85012-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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36
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Bonnet E, Delpierre C, Sommet A, Marion-Latard F, Hervé R, Aquilina C, Labau E, Obadia M, Marchou B, Massip P, Perret B, Bernard J. Total body composition by DXA of 241 HIV-negative men and 162 HIV-infected men: proposal of reference values for defining lipodystrophy. J Clin Densitom 2005; 8:287-92. [PMID: 16055958 DOI: 10.1385/jcd:8:3:287] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2004] [Revised: 01/21/2004] [Accepted: 02/02/2005] [Indexed: 11/11/2022]
Abstract
The aim of this study was to define standard values for fat mass distribution by dual-energy X-ray absorptiometry in human immunodeficiency virus (HIV)-negative men and to analyze factors associated with lipodystrophy in HIV-infected men. Total-body composition was analyzed in 241 HIV-negative men (controls) and 162 HIV-infected men. We created a fat mass ratio (FMR) as the ratio of the percentage of the trunk fat mass to the percentage of the lower limbs fat mass. We defined the FMR standard values as the mean value+/-standard deviation. We compared body mass index (BMI), fat mass percentage (%FM), lean mass (LM), bone mineral density (BMD), and FMR between the control group and HIV-infected men, by age range, according to prescription of treatment and presence of clinical lipodystrophy. The FMR standard value is equal to 1.3+/-0.2. The FMR was higher in treated HIV-infected men with or without clinical lipodystrophy. The FMR was similar for naïve HIV-infected men and controls. It was positively correlated with age, cumulative time on treatment, zidovudine, stavudine, or indinavir. BMD and fat mass were lower for treated and naïve HIV-infected men than for HIV-negative men. The FMR seems to be a valuable index for measuring fat mass distribution. We defined FMR standard values from the largest group of HIV-negative men to our knowledge. Applying FMR to HIV patients could help physicians to diagnose lipodystrophy earlier.
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Affiliation(s)
- E Bonnet
- Unit of Infectious and Tropical Disease, INSERM U 563, Purpan Hospital, Toulouse, France.
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Alvarez M, Delpierre C, Delobel P, Obadia M, Cuzin L, Lefevre JC, Marchou B, Massip P. D-19 Epidémie de syphilis à toulouse chez les patients séropositifs: Description de 27 CAS pris en charge dans le service des maladies infectieuses. Med Mal Infect 2004. [DOI: 10.1016/s0399-077x(04)90177-1] [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: 11/16/2022]
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Lastere S, Dalban C, Collin G, Descamps D, Girard PM, Clavel F, Costagliola D, Brun-Vezinet F, Brun-Vezinet F, Clavel F, Costagliola D, Dalban C, Girard PM, Matheron S, Meynard JL, Morand-Joubert L, Peytavin G, Vray M, Beguinot I, Waldner A, Beumont M, Semaille C, Bentata M, Berlureau P, Gérard L, Molina JM, Hor R, Bayol-Honnet G, Lascoux-Combe C, Drobacheff C, Hoen B, Dupon M, Lacut JY, Goujard C, Rousseau C, Vincent V, Diemer M, Lepeu G, Zerazhi H, de Truchis P, Berthé H, Jeantils V, Tazi CT, Vittecoq D, Escaut L, Dupont B, Nait-Ighil L, Rozenbaum W, Nguyen TH, Boué F, Galanaud P, Kazatchkine M, Piketty C, Bernasconi C, Salmon-Ceron D, Michon C, Chandemerle C, Lascaux AS, Magnier JD, Schneider L, Ait-Mohand H, Simon A, Herson S, Bollens D, Picard O, Tangre P, Bonarek M, Morlat P, Trépo C, Cotte L, Gastaut JA, Poizot-Martin I, Moran G, Masson S, Bennai Y, Belarbi L, Prevot MH, Fournier I, Reynes J, Baillat V, Raffi F, Esnault JL, Ceppi C, Cassuto JP, Arvieux C, Chapplain JM, Rey D, Krantz V, Besnier JM, Bastides F, Obadia M, Aquilina C, Bazin C, Verdon R, Piroth L, Grappin M, Sissoko D, Valette M, May T, Burty C, Debab Y, Caron F, Elharrar B, Launay O, Winter C, Chapuis L, Auperin I, Gilquin J. Impact of Insertions in the HIV-1 P6 Ptapp Region on the Virological Response to Amprenavir. Antivir Ther 2004. [DOI: 10.1177/135965350400900215] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We evaluated the impact of genetic changes within p6Gag gene on the virological response (VR, mean decrease in plasma viral load at week 12) to unboosted amprenavir (APV). Gag-protease fragments, including gag p2, p7, p1, p6 regions and whole protease (PR) were sequenced from baseline plasma specimens of 84 highly pre-treated but APV-naive patients included in the NARVAL (ANRS 088) trial. The correlation between baseline p6Gag polymorphism, PR mutations, baseline characteristics and VR to APV was analysed in univariate analysis. Insertions (P459Ins) within p6 protein, leading to partial or complete duplication of the PTAPP motif, were significantly associated with a decreased VR (P459Ins versus wild-type; –0.3 ±0.8 vs –1.1 ±1.2 log copies/ml, P=0.007) and were more frequent when the V82A/F/T/S PR mutation was present ( P=0.020). In multivariate analysis, after adjustment on the predictive factors of the VR in the NARVAL trial and on the PR mutations linked with response, there was a strong trend to an association ( P=0.058) between the presence of P459Ins and an altered VR. In conclusion, these results suggest that insertions in the p6 region of HIV-1 gag gene may affect the VR, in highly pre-treated patients receiving an unboosted APV-containing regimen.
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Affiliation(s)
| | - Stephane Lastere
- Laboratoire de Virologie, Hopital Bichat – Claude Bernard, Paris, France
| | - Cecile Dalban
- INSERM EMI0214, Universite Pierre et Marie Curie – Paris 6, Paris, France
| | - Gilles Collin
- Laboratoire de Virologie, Hopital Bichat – Claude Bernard, Paris, France
| | - Diane Descamps
- Laboratoire de Virologie, Hopital Bichat – Claude Bernard, Paris, France
| | - Pierre-Marie Girard
- Service des Maladies Infectieuses et Tropicales, Hopital Saint Antoine, Paris, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - R Hor
- Hôpital Saint-Louis, Paris
| | | | | | | | - B Hoen
- Hôpital Saint-Jacques, Besançon
| | | | | | - C Goujard
- Hôpital de Bicêtre, Le Kremlin Bicêtre
| | | | | | | | - G Lepeu
- Hôpital Henri Duffaut, Avignon
| | | | | | - H Berthé
- Hôpital Raymond Poincaré, Garches
| | | | | | | | | | - B Dupont
- Institut Pasteur/Hôpital Necker, Paris
| | | | | | | | - F Boué
- Hôpital Antoine Béclère, Clamart
| | | | | | - C Piketty
- Hôpital Européen Georges Pompidou, Paris
| | | | | | | | | | | | | | | | | | - A Simon
- Hôpital Pitié-Salpétrière, Paris
| | - S Herson
- Hôpital Pitié-Salpétrière, Paris
| | | | | | | | | | | | | | | | | | | | - G Moran
- Hôpital Bichat Claude Bernard, Paris
| | - S Masson
- Hôpital Bichat Claude Bernard, Paris
| | - Y Bennai
- Hôpital Bichat Claude Bernard, Paris
| | - L Belarbi
- Hôpital Bichat Claude Bernard, Paris
| | - MH Prevot
- Hôpital Bichat Claude Bernard, Paris
| | | | - J Reynes
- Hôpital Gui de Chauliac, Montpellier
| | - V Baillat
- Hôpital Gui de Chauliac, Montpellier
| | | | | | | | | | | | | | - D Rey
- Centre Hospitalier Universitaire, Strasbourg
| | - V Krantz
- Centre Hospitalier Universitaire, Strasbourg
| | | | | | | | | | - C Bazin
- Centre Hospitalier Universitaire de Caen
| | - R Verdon
- Centre Hospitalier Universitaire de Caen
| | | | | | - D Sissoko
- Centre Hospitalier Univeristaire, Tourcoing
| | - M Valette
- Centre Hospitalier Univeristaire, Tourcoing
| | - T May
- Hôpital de Brabois, Nancy
| | | | - Y Debab
- Hôpital Charles Nicolle, Rouen
| | - F Caron
- Hôpital Charles Nicolle, Rouen
| | - B Elharrar
- Centre Hospitalier Intercommunal, Créteil
| | - O Launay
- Centre Hospitalier Intercommunal, Créteil
| | - C Winter
- Hôpital André Grégoire, Montreuil
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Samson Y, Deltour S, Crozier S, Obadia M, Bruandet M, Dormont D, Chiras J. Glycémie, volume de l’infarctus et pronostic de la thrombolyse. Rev Neurol (Paris) 2004. [DOI: 10.1016/s0035-3787(04)70881-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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40
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Cohen L, Martinaud O, Lemer C, Lehéricy S, Samson Y, Obadia M, Slachevsky A, Dehaene S. Visual Word Recognition in the Left and Right Hemispheres: Anatomical and Functional Correlates of Peripheral Alexias. Cereb Cortex 2003; 13:1313-33. [PMID: 14615297 DOI: 10.1093/cercor/bhg079] [Citation(s) in RCA: 288] [Impact Index Per Article: 13.7] [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: 11/12/2022] Open
Abstract
According to a simple anatomical and functional model of word reading, letters displayed in one hemifield are first analysed through a cascade of contralateral retinotopic areas, which compute increasingly abstract representations. Eventually, an invariant representation of letter identities is created in the visual word form area (VWFA), reproducibly located within the left occipito-temporal sulcus. The VWFA then projects to structures involved in phonological or lexico-semantic processing. This model yields detailed predictions on the reading impairments that may follow left occipitotemporal lesions. Those predictions were confronted to behavioural, anatomical and functional MRI data gathered in normals and in patients suffering from left posterior cerebral artery infarcts. In normal subjects, alphabetic stimuli activated both the VWFA and the right-hemispheric symmetrical region (R-VWFA) relative to fixation, but only the VWFA showed a preference for alphabetic strings over simple chequerboards. The comparison of normalized brain lesions with reading-induced activations showed that the critical lesion site for the classical syndrome of pure alexia can be tightly localized to the VWFA. Reading impairments resulting from deafferentation of an intact VWFA from right- or left-hemispheric input were dissected using the same methods, shedding light on the connectivity of the VWFA. Finally, the putative role of right-hemispheric processing in the letter-by-letter reading strategy was clarified. In a letter-by-letter reader, the R-VWFA assumed some of the functional properties normally specific to the VWFA. These data corroborate our initial model of normal word perception and underline that an alternative right-hemispheric pathway can underlie functional recovery from alexia.
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Affiliation(s)
- L Cohen
- Institut de Neurologie, Hôpital de la Salpêtrière, AP-HP, Paris, France.
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41
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Vallée JN, Crozier S, Guillevin R, Obadia M, Lo D, Barragan-Campos HM, Samson Y, Chiras J. Acute basilar artery occlusion treated by thromboaspiration in a cocaine and ecstasy abuser. Neurology 2003; 61:839-41. [PMID: 14504335 DOI: 10.1212/wnl.61.6.839] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Thromboaspiration was performed in a young adult in a coma because of acute basilar artery occlusion associated with cocaine and ecstasy abuse 30 hours after symptom onset. There was complete recanalization of the basilar artery and favorable recovery. Because cocaine and ecstasy abuse has been reported to be a risk factor for ischemic stroke and fatal brain hemorrhage, thromboaspiration may be an alternative therapy to thrombolysis.
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Affiliation(s)
- J-N Vallée
- Department of Diagnostic and Interventional Neuroradiology, Pitié-Salpétrière Hospital, Medical Université of Paris, France.
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Delobel P, Khatibi S, Alvarez M, Obadia M, Bonnet E, Massip P, Marchou B. Reversible nucleoside analogue-associated lactic acidosis despite a prolonged course. Intensive Care Med 2003; 29:1028-1029. [PMID: 12684748 DOI: 10.1007/s00134-003-1750-y] [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: 01/15/2003] [Accepted: 03/14/2003] [Indexed: 10/22/2022]
Affiliation(s)
- P Delobel
- Department of Infectious and Tropical Diseases, Purpan University Hospital, Place Baylac, 31059, Toulouse cedex, France.
| | - S Khatibi
- Department of Infectious and Tropical Diseases, Purpan University Hospital, Place Baylac, 31059, Toulouse cedex, France
| | - M Alvarez
- Department of Infectious and Tropical Diseases, Purpan University Hospital, Place Baylac, 31059, Toulouse cedex, France
| | - M Obadia
- Department of Infectious and Tropical Diseases, Purpan University Hospital, Place Baylac, 31059, Toulouse cedex, France
| | - E Bonnet
- Department of Infectious and Tropical Diseases, Purpan University Hospital, Place Baylac, 31059, Toulouse cedex, France
| | - P Massip
- Department of Infectious and Tropical Diseases, Purpan University Hospital, Place Baylac, 31059, Toulouse cedex, France
| | - B Marchou
- Department of Infectious and Tropical Diseases, Purpan University Hospital, Place Baylac, 31059, Toulouse cedex, France
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Izopet J, Souyris C, Sandres-Sauné K, Puissant B, Obadia M, Pasquier C, Puel J, Blancher A, Massip P. Virological and immunological effects of salvage therapy following treatment interruption and a shift in HIV-1 resistance genotype. J Med Virol 2002; 68:305-10. [PMID: 12226815 DOI: 10.1002/jmv.10204] [Citation(s) in RCA: 7] [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] [Indexed: 11/07/2022]
Abstract
The circulating human immunodeficiency virus type 1 (HIV-1) population of patients in whom many prior therapy regimens have failed often undergo a shift from a drug-resistant virus to a wild-type virus following interruption of treatment. This study analyses the virological and immunological effects of salvage therapy following treatment interruption and a shift from a drug-resistance genotype. Twenty-one HIV-1 infected patients who had genotype reversion by population-based sequencing after 3 months of treatment interruption were given a new salvage regimen consisting of 3-5 drugs selected according to their treatment history. Seven (33%) of 21 patients who had fewer than 200 HIV-1 RNA copies/ml until month 12 were defined as virological responders. Four patients were transient responders and 10 were nonresponders. The virological responders were more frequently CDC group A and had higher CD4 + T lymphocyte counts at the time of treatment resumption. The peripheral blood T CD4 + and T CD8 + lymphocyte populations of the patients declined significantly during treatment interruption. Only virological responders showed significant increases in their CD4 + T lymphocyte count 12 months after treatment resumption and these counts rapidly returned to pre-interruption baseline values in most of these patients. Treatment interruption could be useful for optimising salvage therapy for patients previously given many failing regimens. However, controlled trials are needed to assess the clinical benefit of this strategy.
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Affiliation(s)
- Jacques Izopet
- Laboratoire de Virologie, Hôpital Purpan, CHU Toulouse, Place du Dr Baylac, Toulouse, France.
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Izopet J, Massip P, Souyris C, Sandres K, Puissant B, Obadia M, Pasquier C, Bonnet E, Marchou B, Puel J. Shift in HIV resistance genotype after treatment interruption and short-term antiviral effect following a new salvage regimen. AIDS 2000; 14:2247-55. [PMID: 11089612 DOI: 10.1097/00002030-200010200-00005] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate the changes in genotypic drug-resistance pattern, plasma HIV RNA and CD4 cell count after treatment interruption and assess the short-term antiviral effect of a new salvage regimen. DESIGN Prospective study of 38 patients with multiple failing regimens who had completely stopped all medication for 3 months before a three to five-drug regimen was reintroduced according to clinical guidelines. METHODS Patients were tested for HIV resistance before and after treatment interruption by population-based sequencing and clonal analysis of selected patients. RESULTS Discontinuation of therapy for 3 months was associated with a median increase in HIV RNA of 0.4 log10 and a median decrease in CD4 cell count of 43 x 10(6)/l. Sixty-one per cent of patients had a shift from the drug-resistant genotype to a predominantly wild-type genotype. The patients significantly likely to show genotype reversion were those in Centers for Disease Control groups A or B, who had been exposed to few drugs, had a low plasma HIV RNA, or a high CD4 cell count. The only independent factor predicting genotype reversion was the clinical stage. The median change in plasma HIV RNA at month 3 after treatment reintroduction was -2.3 log10 copies/ml in patients who had genotype reversion compared with -0.6 log10 copies/ml in patients without genotype reversion (P = 0.004). CONCLUSION Suspending treatment for 3 months after multiple failures could be a suitable strategy for optimizing salvage therapy provided it is instituted early, before the HIV disease becomes too advanced.
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Affiliation(s)
- J Izopet
- Laboratoire de Virologie, Hôpital Purpan, CHU Toulouse, France.
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Mary-Krause M, Rabaud C, Jouan M, Obadia M, de la Blanchardière A, Raffi F, May T. [Mycobacterium avium complex disease in HIV seropositive patients: incidence and risk factors before and after the introduction of highly active antiretroviral treatments. Clinical Epidemiology Group of the Information and Care Center for Human Immunodeficiency]. Pathol Biol (Paris) 2000; 48:495-504. [PMID: 10949848] [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: 02/17/2023]
Abstract
The objective of this study was to determine the risk factors of the first occurrence of Mycobacterium avium complex disease (MAC) infection among human immunodeficiency virus (HIV)-infected subjects during two different time periods: before and after the introduction of protease inhibitor (respectively, period 1: 1 January 1992 to 31 December 1995, and period 2: 1 January 1996 to 30 June 1998). This study was performed using the French Hospital Database on HIV (FHDH). Subjects were included when their CD4+ cell count was less than 100/mm3. If they did not die or develop MAC within the first 6 months after the inclusion, their follow-up had to be longer than 6 months to be included. Cox's model was used to calculated the relative hazards (RH) of MAC occurrence according to the age and time-dependent variables, such as CD4+ below 50/mm3, previous occurrence of tuberculosis, cytomegalovirus (CMV) infection and other acquired immunodeficiency syndrome (AIDS)-defining disease, nature of antiretroviral treatment and MAC prophylaxis. Among the 14,779 subjects followed during period 1, 1,710 (11.6%) had a diagnosis of MAC infection during their follow-up (incidence: 8.4 +/- 0.2 for 100 persons per year), while only 453 (4.4%) among 10,239 subjects presented this infection during period 2 (2.8 +/- 0.1 for 100 persons per year). Rifabutin regular prescription was a protective factor of MAC occurrence during period 1 (RH = 0.51 95% confidence interval (CI) = [0.37-0.69]), whereas this protective effect was not observed during period 2 (RH = 1.05 CI = [0.63-1.67]). Thus, during the HAART period, the results that we present do not indicate an interest into continuing MAC prophylaxis.
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Affiliation(s)
- M Mary-Krause
- Inserm SC4, faculté de médecine Saint-Antoine, Paris, France
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Obadia M, Crozier S, Azoulay A, Dormont D, Clémenceau S, Mokhtari K, Lubetzki C. [Unique medullary neurosarcoidosis]. Rev Neurol (Paris) 1999; 155:46-7. [PMID: 10093848] [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: 02/11/2023]
Affiliation(s)
- M Obadia
- Fédération de Neurologie, Hôpital de la Salpêtrière, Paris
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Garat H, el Sayed F, Obadia M, Bazex J. [Erythema multiforme caused by saquinavir]. Ann Dermatol Venereol 1998; 125:42-3. [PMID: 9747207] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Saquinavir is a protease inhibitor used for the treatment of HIV infection. Adverse skin reactions have been rare. We report here the first case of erythema multiforme in a patient given saquinavir. CASE REPORT A 32-year-old man was seropositive for HIV and consulted due to the development of round maculo-papular lesions centered on a bulla and two erosive lesions of the palate five days after the introduction of saquinavir. Histology was compatible with erythema multiforme. After withdrawal of saquinavir, the skin and mucosal lesions regressed in 15 days, with no recurrence at 3 months. DISCUSSION Adverse skin reactions to saquinavir are exceptional (eruptions, pruritus). We describe here the first case of erythema multiforme caused by saquinavir (imputability criteria 12 BO). Due to the structural analogy of saquinavir with other protease inhibitors (indiravir, ritonavir, nelfinavir) it would be difficult to prescribe a compound of the same class.
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Affiliation(s)
- H Garat
- Département de Dermatologie, Vénéréologie et Allergologie, Centre Hospitalier Universitaire Purpan, Toulouse
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Bicart-Sée A, Obadia M, Gonzalez C, Averous S, Maurette M, Auvergnat JC. Foscarnet administered by portable infusion device in AIDS patients with CMV infection. AIDS Patient Care STDS 1997; 11:76-8. [PMID: 11361767 DOI: 10.1089/apc.1997.11.76] [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] [Indexed: 11/12/2022] Open
Affiliation(s)
- A Bicart-Sée
- Department of Infectious Diseases, Hôpitaux de Toulouse, France
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Bicart-See A, Marchou B, Bauriaud R, Louis D, Obadia M, Auvergnat J. Particularités de la tuberculose au cours de l'infection par le VIH. Med Mal Infect 1995. [DOI: 10.1016/s0399-077x(05)80314-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Piccoli S, Picot N, Obadia M, Auvergnat J, Armengaud M. Vaccination anti-amarile et associations vaccinales. Med Mal Infect 1989. [DOI: 10.1016/s0399-077x(89)80062-9] [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: 10/25/2022]
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