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Mejait A, Roux C, Soret M, Larrey E, Wagner M, Bijot JC, Lussey-Lepoutre C, Thabut D, Goumard C, Maksud P, Allaire M. Enhanced therapeutic outcomes with atezolizumab-bevacizumab and SIRT combination compared to SIRT alone in unresectable HCC: A promising approach for improved survival. Clin Res Hepatol Gastroenterol 2024; 48:102282. [PMID: 38191073 DOI: 10.1016/j.clinre.2024.102282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/22/2023] [Accepted: 01/05/2024] [Indexed: 01/10/2024]
Abstract
BACKGROUND Integrating immunotherapy with locoregional therapies marks a significant milestone in the realm of hepatocellular carcinoma (HCC) treatment . This study aimed to assess the impact of addition of Atezolizumab-Bevacizumab (AtezoBev) on the outcome patients treated with SIRT. METHODS We conducted a study that included all Child-Pugh A HCC treated with SIRT since 2017. We examined the effects of the addition of 3 infusions of AtezoBev before the SIRT procedure and after SIRT on patients outcome (AtezoBev-SIRT group). Time-to-event data were analyzed using Kaplan-Meier with the log-rank test. RESULTS Thirty five HCC patients treated with SIRT were included, of whom 23 % also received AtezoBev infusions. The two groups were similar in terms of liver function and HCC parameters. The median OS was not reached for patients who received AtezoBev in combination with SIRT and 14 months for patients only treated by SIRT. The median PFS was higher in the group treated by SIRT and AtezoBev vs SIRT alone (11.3 months vs 5.8 months). In the global cohort, 8 patients presented a downstaging (23 %), 4 underwent liver surgery (1 in the AtezoBev-SIRT group) and 4 liver transplantation (1 in the AtezoBev-SIRT group) CONCLUSIONS: The administration of AtezoBev, both before and after SIRT, is associated with enhanced OS and PFS outcomes compared to SIRT alone for unresectable HCC.
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Affiliation(s)
- Amel Mejait
- AP-HP Sorbonne Université, Hôpital Universitaire Pitié-Salpêtrière, Service d'Hépato-gastroentérologie, Paris, France
| | - Charles Roux
- AP-HP Sorbonne Université, Hôpital Universitaire Pitié-Salpêtrière, Service de radiologie interventionelle, Paris, France
| | - Marine Soret
- AP-HP Sorbonne Université, Hôpital Universitaire Pitié-Salpêtrière, Service de médecine nucléaire, Paris, France
| | - Edouard Larrey
- AP-HP Sorbonne Université, Hôpital Universitaire Pitié-Salpêtrière, Service d'Hépato-gastroentérologie, Paris, France
| | - Mathilde Wagner
- AP-HP Sorbonne Université, Hôpital Universitaire Pitié-Salpêtrière, Service de radiologie diagnostique, Paris, France
| | - Jean Charles Bijot
- AP-HP Sorbonne Université, Hôpital Universitaire Pitié-Salpêtrière, Service de radiologie interventionelle, Paris, France
| | - Charlotte Lussey-Lepoutre
- AP-HP Sorbonne Université, Hôpital Universitaire Pitié-Salpêtrière, Service de médecine nucléaire, Paris, France
| | - Dominique Thabut
- AP-HP Sorbonne Université, Hôpital Universitaire Pitié-Salpêtrière, Service d'Hépato-gastroentérologie, Paris, France; Sorbonne Université, INSERM, Centre de recherche Saint-Antoine (CRSA), Institute of Cardiometabolism and Nutrition (ICAN), F-75012 Paris, France
| | - Claire Goumard
- Sorbonne Université, INSERM, Centre de recherche Saint-Antoine (CRSA), Institute of Cardiometabolism and Nutrition (ICAN), F-75012 Paris, France; AP-HP Sorbonne Université, Hôpital Universitaire Pitié-Salpêtrière, Service de chirurgie digestive, Paris, France
| | - Philippe Maksud
- AP-HP Sorbonne Université, Hôpital Universitaire Pitié-Salpêtrière, Service de médecine nucléaire, Paris, France
| | - Manon Allaire
- AP-HP Sorbonne Université, Hôpital Universitaire Pitié-Salpêtrière, Service d'Hépato-gastroentérologie, Paris, France; INSERM UMR 1138, Centre de recherche des Cordeliers, 75006 Paris, France; Genomic Instability, Metabolism, Immunity and Liver Tumorigenesis laboratory, Equipe Labellisée LIGUE 2023, Paris, France.
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Bouchut A, Lhote R, Maksud P, Ben Salem T, Fustier A, Moyon Q, Haroche J, Soussan M, Mathian A, Hie M, Amoura Z, Aubart FC. Prognostic value of hypermetabolic bone sarcoidosis observed by 18F-fluorodeoxyglucose positron emission tomography. Rheumatology (Oxford) 2024:keae019. [PMID: 38244563 DOI: 10.1093/rheumatology/keae019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 12/19/2023] [Accepted: 12/28/2023] [Indexed: 01/22/2024] Open
Abstract
OBJECTIVES Sarcoidosis is a multisystemic granulomatosis diagnosed mainly in young adults.18F-fluorodeoxyglucose (18F-FDG) positron emission tomography-computed tomography (PET-CT) is useful in sarcoidosis cases to search for a biopsiable site or assess disease activity.18F-FDG PET-CT can reveal bone hypermetabolism in sarcoidosis patients, even in the absence of osteoarticular symptoms. The aim of this study was to describe metabolic bone involvement in sarcoidosis patients and to evaluate its prognostic impact. METHODS This was an observational, comparative, retrospective, monocentric study. Inclusion criteria were a confirmed diagnosis of sarcoidosis according to the World Association of Sarcoidosis and Other Granulomatous Diseases (WASOG) criteria and at least one 18F-FDG PET-CT scan during follow-up. Metabolic bone involvement of sarcoidosis was defined as focal bone hypermetabolism with no argument for a differential diagnosis of bone 18F-FDG uptake. Patients with and without bone involvement were compared. RESULTS Among the 175 included patients, 32 (18%) had metabolic bone involvement of sarcoidosis. The metabolic bone involvement was mainly axial and mostly without bone abnormalities on CT. Metabolic bone involvement was associated with intrathoracic and extrathoracic lymph node involvement and with a higher number of organs involved. Patients with metabolic bone involvement more frequently received corticosteroids, methotrexate and tumor necrosis factor (TNF)-α inhibitors and a higher number of treatments. Relapse of sarcoidosis occurred sooner in patients with metabolic bone involvement. CONCLUSION These results suggest that metabolic bone involvement is associated with more diffuse and more severe sarcoidosis.
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Affiliation(s)
- Arthur Bouchut
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Service de Médecine Interne 2, Centre National de Référence Maladies Systémiques Rares et Histiocytoses, Hôpital Pitié-Salpêtrière, F-Paris, France
| | - Raphael Lhote
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Service de Médecine Interne 2, Centre National de Référence Maladies Systémiques Rares et Histiocytoses, Hôpital Pitié-Salpêtrière, F-Paris, France
| | - Philippe Maksud
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Service de Médecine nucléaire, Hôpital Pitié-Salpêtrière, Paris, France
| | - Thouraya Ben Salem
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Service de Médecine Interne 2, Centre National de Référence Maladies Systémiques Rares et Histiocytoses, Hôpital Pitié-Salpêtrière, F-Paris, France
| | - Anne Fustier
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Service de Radiologie, Hôpital Pitié-Salpêtrière, Paris, France
| | - Quentin Moyon
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Service de Médecine Interne 2, Centre National de Référence Maladies Systémiques Rares et Histiocytoses, Hôpital Pitié-Salpêtrière, F-Paris, France
| | - Julien Haroche
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Service de Médecine Interne 2, Centre National de Référence Maladies Systémiques Rares et Histiocytoses, Hôpital Pitié-Salpêtrière, F-Paris, France
| | - Michael Soussan
- Université Paris 13, Assistance Publique-Hôpitaux de Paris, Service de Médecine nucléaire, Hôpital universitaire Avicenne, Bobigny, France
| | - Alexis Mathian
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Service de Médecine Interne 2, Centre National de Référence Maladies Systémiques Rares et Histiocytoses, Hôpital Pitié-Salpêtrière, F-Paris, France
| | - Miguel Hie
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Service de Médecine Interne 2, Centre National de Référence Maladies Systémiques Rares et Histiocytoses, Hôpital Pitié-Salpêtrière, F-Paris, France
| | - Zahir Amoura
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Service de Médecine Interne 2, Centre National de Référence Maladies Systémiques Rares et Histiocytoses, Hôpital Pitié-Salpêtrière, F-Paris, France
| | - Fleur Cohen Aubart
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Service de Médecine Interne 2, Centre National de Référence Maladies Systémiques Rares et Histiocytoses, Hôpital Pitié-Salpêtrière, F-Paris, France
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Oprea-Lager DE, Gontier E, García-Cañamaque L, Gauthé M, Olivier P, Mitjavila M, Tamayo P, Robin P, García Vicente AM, Bouyeure AC, Bailliez A, Rodríguez-Fernández A, Mahmoud SB, Vallejo-Casas JA, Maksud P, Merlin C, Blanc-Durand P, Drouet C, Tissot H, Vierasu I, Vander Borght T, Boos E, Chossat F, Hodolic M, Rousseau C. [ 18F]DCFPyL PET/CT versus [ 18F]fluoromethylcholine PET/CT in Biochemical Recurrence of Prostate Cancer (PYTHON): a prospective, open label, cross-over, comparative study. Eur J Nucl Med Mol Imaging 2023; 50:3439-3451. [PMID: 37341747 PMCID: PMC10542307 DOI: 10.1007/s00259-023-06301-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 06/05/2023] [Indexed: 06/22/2023]
Abstract
PURPOSE Primary objective was to compare the per-patient detection rates (DR) of [18F]DCFPyL versus [18F]fluoromethylcholine positron emission tomography/computed tomography (PET/CT), in patients with first prostate cancer (PCa) biochemical recurrence (BCR). Secondary endpoints included safety and impact on patient management (PM). METHODS This was a prospective, open label, cross-over, comparative study with randomized treatment administration of [18F]DCFPyL (investigational medicinal product) or [18F]fluoromethylcholine (comparator). Men with rising prostate-specific antigen (PSA) after initial curative therapy were enrolled. [18F]DCFPyL and [18F]fluoromethylcholine PET/CTs were performed within a maximum time interval of 12 days. DR was defined as the percentage of positive PET/CT scans identified by 3 central imaging readers. PM was assessed by comparing the proposed pre-PET/CT treatment with the local treatment", defined after considering both PET/CTs. RESULTS A total of 205 patients with first BCR after radical prostatectomy (73%; median PSA = 0.46 ng/ml [CI 0.16;27.0]) or radiation therapy (27%; median PSA = 4.23 ng/ml [CI 1.4;98.6]) underwent [18F]DCFPyL- and/or [18F]fluoromethylcholine -PET/CTs, between July and December 2020, at 22 European sites. 201 patients completed the study. The per-patient DR was significantly higher for [18F]DCFPyL- compared to [18F]fluoromethylcholine -PET/CTs (58% (117/201 patients) vs. 40% (81/201 patients), p < 0.0001). DR increased with higher PSA values for both tracers (PSA ≤ 0.5 ng/ml: 26/74 (35%) vs. 22/74 (30%); PSA 0.5 to ≤ 1.0 ng/ml: 17/31 (55%) vs. 10/31 (32%); PSA 1.01 to < 2.0 ng/ml: 13/19 (68%) vs. 6/19 (32%);PSA > 2.0: 50/57 (88%) vs. 39/57 (68%) for [18F]DCFPyL- and [18F]fluoromethylcholine -PET/CT, respectively). [18F]DCFPyL PET/CT had an impact on PM in 44% (90/204) of patients versus 29% (58/202) for [18F]fluoromethylcholine. Overall, no drug-related nor serious adverse events were observed. CONCLUSIONS The primary endpoint of this study was achieved, confirming a significantly higher detection rate for [18F]DCFPyL compared to [18F]fluoromethylcholine, in men with first BCR of PCa, across a wide PSA range. [18F]DCFPyL was safe and well tolerated.
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Affiliation(s)
- Daniela-Elena Oprea-Lager
- Department of Radiology & Nuclear Medicine, Amsterdam University Medical Centers, VU University Medical Center, Cancer Center Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
| | - Eric Gontier
- Service de Médecine Nucléaire, Centre de Cancérologie de La Sarthe, Le Mans, France
| | - Lina García-Cañamaque
- Servicio de Medicina Nuclear, Grupo HM Hospitales, Universidad CEU San Pablo, Madrid, Spain
| | - Mathieu Gauthé
- Service de Médecine Nucléaire, Hôpital Tenon, Paris, France
| | | | - Mercedes Mitjavila
- Servicio de Medicina Nuclear, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Pilar Tamayo
- Servicio de Medicina Nuclear, IBSAL, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Philippe Robin
- Service de Médecine Nucléaire, Centre Hospitalier Universitaire de Brest, Brest, France
- UMR 1304, Inserm, Univ Brest, CHRU Brest, GETBO, Brest, France
| | | | | | - Alban Bailliez
- Service de Médecine Nucléaire Humanitep, Groupement Des Hôpitaux de L'Institut Catholique de Lille, Hôpital Saint-Philibert, Lomme, France
- Service de Médecine Nucléaire, Hôpital Privé Le Bois, Iris Imagerie, Lille, France
| | - Antonio Rodríguez-Fernández
- Servicio de Medicina Nuclear, Hospital Universitario Virgen de Las Nieves, Granada, Spain
- Instituto de Investigación Biosanitaria IBS, Granada, Spain
| | - Sinan Ben Mahmoud
- Service de médecine nucléaire, Hôpital de Mercy, CHR Metz-Thionville, Thionville, France
| | - Juan Antonio Vallejo-Casas
- UGC Medicina Nuclear, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Philippe Maksud
- Service de médecine nucléaire Hôpital de la Pitié-Salpétriére, Sorbonne-Université, Paris, France
| | - Charles Merlin
- Service de médecine nucléaire, Centre Jean Perrin, Clermont-Ferrand, France
- Imagerie moléculaire et stratégies théranostiques, UMR1240, Université Clermont Auvergne, Inserm, Clermont-Ferrand, France
| | - Paul Blanc-Durand
- Service de médecine nucléaire, CHU H. Mondor, Créteil, France; Université Paris Est Créteil (U-PEC), Créteil, France
| | - Clément Drouet
- Service de médecine nucléaire, Centre Georges-François-Leclerc, Dijon, France
| | - Hubert Tissot
- Service de médecine nucléaire, Institut Curie, Paris, France
| | - Irina Vierasu
- Department of Nuclear Medicine, HUB, Hôpital Erasme Université libre de Bruxelles (ULB), Brussels, Belgium
| | | | | | | | | | - Caroline Rousseau
- Univ Nantes, Univ Angers, INSERM, CNRS, CRCI2NA, Nantes, France
- Service de médecine nucléaire, Institut de cancérologie de l'Ouest, Saint-Herblain, France
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Soret M, Maisonobe J, Maksud P, Payen S, Savier E, Brochériou I, Lepoutre CL, Kas A. Délais entre une greffe hépatique et une radio-embolisation à l’Yttrium-90 : un retour d’expérience. Médecine Nucléaire 2023. [DOI: 10.1016/j.mednuc.2023.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Bouchut A, Lhote R, Maksud P, Ben Salem T, Fustier A, Moyon Q, Taieb D, Soussan M, Mathian A, Hie M, Haroche J, Amoura Z, Cohen Aubart F. Pronostic associé à l’atteinte osseuse en 18FDG-TEP-TDM au cours de la sarcoïdose. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.03.281] [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: 10/18/2022]
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Bouchut A, Lhote R, Maksud P, Ben Salem T, Fustier A, Moyon Q, Haroche J, Soussan M, Mathian A, Hié M, Amoura Z, Cohen F. POS1379 HYPERMETABOLIC BONE SARCOIDOSIS ON 18F-FDG PET-CT: IMPACT ON TREATMENT AND DISEASE RELAPSE IN A COHORT OF 165 PATIENTS FROM A SINGLE UNIVERSITY HOSPITAL. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.5419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundSarcoidosis is a multisystemic granulomatosis of unknown cause. Prevalence of bone sarcoidosis is estimated between 3 and 30%. Bone sarcoidosis is symptomatic in about half of the cases. 18F-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET-CT) is a useful imaging modality in sarcoidosis, to search for a biopsiable site, evaluate organ involvement or assess disease activity. It is a sensitive imaging modality to detect bone involvement. However, clinical and prognostic significance of hypermetabolic bone involvement of sarcoidosis is not well known.ObjectivesThe aim of this study was to compare the characteristics of patients with and without hypermetabolic bone involvement of sarcoidosis and to evaluate the impact of metabolic bone involvement on treatments and outcomes.MethodsThis was an observational, comparative, retrospective monocentric study of prospectively collected data. Inclusion criteria were a diagnosis of sarcoidosis according to the World Association of Sarcoidosis and Other Granulomatous diseases (WASOG) criteria and at least one 18F-FDG PET-CT during follow-up. Metabolic bone involvement of sarcoidosis was defined as bone hypermetabolism for which alternative causes had been reasonably excluded, following the WASOG criteria of « at least probable » bone sarcoidosis. Characteristics of patients with and without bone involvement were compared using bilateral Fisher or Mann-Whitney tests. Relapse-free survival curves were constructed following the Kaplan-Meier method and compared using a log-rank test. A p-value < 0.05 was considered significant.ResultsAmong 503 patients with sarcoidosis, 165 with definite sarcoidosis who had undergone at least one 18F-FDG PET-CT were included. Fourteen patients had positive bone PET-CT findings which were attributed to other cause than sarcoidosis. Metabolic bone involvement of sarcoidosis was found in 29 patients (18%), among which 9 (31%) had structural bone lesions on CT. Metabolic bone involvement of sarcoidosis was associated with more frequent intrathoracic lymph node involvement (28 [96%] and 107 [79%], p < 0.001), extrathoracic lymph node involvement (15 [52%] and 40 [30%], p = 0.03) and a higher number of organ involvements (median [interquartile range], 6 [4-7] and 4 [2-5], p < 0.001). Patients with metabolic bone involvement received more frequently corticosteroids (29 [100%] and 99 [73%], p < 0.001), methotrexate (26 [90%] and 66 [48%], p < 0.001), tumor necrosis factor (TNF) alpha inhibitors (22 [76%] and 41 [30%], p < 0.001), and a higher number of treatments (3 [3-4] and 2 [1-3], p < 0.001). Despite more intensive treatments, disease relapse occurred significantly sooner in patients with metabolic bone involvement of sarcoidosis (median time to the first relapse, 63 [44-84] months and 96 [72-156] months respectively, p = 0.01).ConclusionMetabolic bone involvement on PET-CT was present in 18% of patients with sarcoidosis. It was predominantly axial and without structural lesions. In this comparative study, patients with metabolic bone involvement received significantly more treatments and had a shorter time to relapse. It could therefore reflect a more severe multisystemic involvement and chronic evolution of the disease. This could help adjust individual therapeutic strategy for patients with sarcoidosis.References[1]Challenges of Sarcoidosis and Its Management. Drent M, Crouser ED, Grunewald J. N Engl J Med. 2021 Sep 9;385(11):1018-1032.[2]Clinical Presentation and Treatment of High-Risk Sarcoidosis. Perlman DM, Sudheendra MT, Furuya Y, Shenoy C, Kalra R, Roukoz H, Markowitz J, Maier LA, Bhargava M. Ann Am Thorac Soc. 2021 Sep 15. doi: 10.1513/AnnalsATS.202102- 212CMEFigure 1.Disclosure of InterestsNone declared
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Razanamahery J, Humbert S, Emile JF, Cohen-Aubart F, Fontan J, Maksud P, Audia S, Haroche J. Immune Thrombocytopenia Revealing Enriched IgG-4 Peri-Renal Rosai-Dorfman Disease Successfully Treated with Rituximab: A Case Report and Literature Review. Front Med (Lausanne) 2021; 8:678456. [PMID: 34222286 PMCID: PMC8244783 DOI: 10.3389/fmed.2021.678456] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 03/09/2021] [Accepted: 05/13/2021] [Indexed: 12/03/2022] Open
Abstract
Immune thrombocytopenia (ITP) is a rare autoimmune-mediated condition characterized by isolated thrombocytopenia (<100 G/L) after exclusion of other causes. Mostly primary, it is associated with hematological malignancy, autoimmune disorders, or infection in 20% of patients. It is exceptionally described in patients with histiocytosis, mostly in children (seven patients in literature). We report a case of a 69-year-old man with ITP leading to the diagnosis of histiocytosis. At ITP's diagnosis, the patient had elevated gamma-globulins leading to computed tomography showing bilateral peri-renal infiltration. The biopsy showed enriched IgG-4 peri-renal Rosai Dorfman disease with MAP2K1 mutation, although peri-renal infiltration is highly suggestive of Erdheim-Chester disease. This overlapping association was described in men with mutation in MAP2K1 gene. Macrophages are implicated in the pathophysiology of ITP in multiple ways, notably by the phagocytosis of opsonized platelets and their function of antigen-presenting cells able to stimulate autoreactive T cells. Histiocytic cells derivate from monocyte-macrophage lineage. Activation of macrophages in active histiocytosis is responsible for consequential platelet destruction in ITP associated histiocytosis. Finally, this case highlights a rare presentation of ITP revealing histiocytosis, both being efficiently treated with rituximab.
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Affiliation(s)
- Jerome Razanamahery
- Internal Medicine Department and Clinical Immunology, Dijon University Hospital, Dijon, France
| | - Sebastien Humbert
- Internal Medicine Department, Besancon University Hospital, Besançon, France
| | - Jean-Francois Emile
- Department of Pathology, Ambroise-Paré Hospital, Assistance-Publique Hopitaux de Paris, Paris, France
| | - Fleur Cohen-Aubart
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Internal Medicine Department 2, National Reference Center for Histiocytosis, Paris, France
| | - Jean Fontan
- Department of Haematology, Besancon University Hospital, Besançon, France
| | - Philippe Maksud
- Department of Nuclear Medicine, Pitié-Salpêtrière Hospital, Paris, France
| | - Sylvain Audia
- Internal Medicine Department and Clinical Immunology, Dijon University Hospital, Dijon, France
| | - Julien Haroche
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Internal Medicine Department 2, National Reference Center for Histiocytosis, Paris, France
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Cohen Aubart F, Idbaih A, Galanaud D, Law-Ye B, Emile JF, Charlotte F, Donadieu J, Maksud P, Seilhean D, Amoura Z, Hoang-Xuan K, Haroche J. Central nervous system involvement in Erdheim-Chester disease: An observational cohort study. Neurology 2020; 95:e2746-e2754. [PMID: 32887776 DOI: 10.1212/wnl.0000000000010748] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 06/12/2020] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE CNS involvement in Erdheim-Chester disease (ECD) leads to substantial morbidity and mortality. To assess CNS manifestations in a French cohort of 253 patients with ECD, we determined clinical characteristics and outcomes, including those under targeted therapies. METHODS This was a retrospective longitudinal study. CNS manifestations were determined by clinical examination and brain or spine MRI. Targeted therapy efficacy was assessed using global assessment from a physician and a radiologist. The study was approved by the ethics committee Comité de Protection des Personnes Ile de France III. RESULTS Ninety-seven of 253 patients (38%) with ECD had CNS involvement. CNS involvement was significantly associated with a younger age at diagnosis (mean 55.5 years) and at symptom onset (mean 50.5 years), as well as with the presence of the BRAF V600E mutation (in 77% of cases), xanthelasma (34%), and diabetes insipidus (36%). Median survival among patients with CNS involvement was significantly lower than that of patients with ECD without CNS involvement (124 months vs 146 months, p = 0.03). Seventy-four CNS MRIs were centrally reviewed, which showed 3 patterns: tumoral in 66%, pseudo-degenerative in 50%, and vascular in 18%. Targeted therapy (BRAF or MEK inhibitors) was associated with improved symptoms in 43% of patients and MRI improvement in 45%. CONCLUSIONS CNS manifestations are typically associated with poor prognosis in patients with ECD. Three distinct patterns can be recognized: tumoral, pseudodegenerative, and vascular. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that targeted therapy leads to clinical or imaging improvement in almost 50% of patients.
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Affiliation(s)
- Fleur Cohen Aubart
- From Service de Médecine Interne 2, Centre National de Référence Maladies Systémiques Rares et Histiocytoses (F.C.A., Z.A., J.H.), Service de Neuroradiologie (D.G., B.L.-Y.), Service d'Anatomopathologie (F.C.), Service de Médecine Nucléaire (P.M.), Service de Neuropathologie (D.S.), Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Université; Service de Neurologie 2-Mazarin (A.I., K.H.-Z.), Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle Épinière, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Sorbonne Université, Paris; Département de Pathologie (J.-F.E.), EA4340, Université Versailles-Saint Quentin, Assistance Publique Hôpitaux de Paris, Hôpital Ambroise Paré, Boulogne; and Service d'Hématologie Pédiatrique, Centre de Référence National Histiocytoses (J.D.), Hôpital Trousseau, Sorbonne Université, Paris, France
| | - Ahmed Idbaih
- From Service de Médecine Interne 2, Centre National de Référence Maladies Systémiques Rares et Histiocytoses (F.C.A., Z.A., J.H.), Service de Neuroradiologie (D.G., B.L.-Y.), Service d'Anatomopathologie (F.C.), Service de Médecine Nucléaire (P.M.), Service de Neuropathologie (D.S.), Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Université; Service de Neurologie 2-Mazarin (A.I., K.H.-Z.), Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle Épinière, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Sorbonne Université, Paris; Département de Pathologie (J.-F.E.), EA4340, Université Versailles-Saint Quentin, Assistance Publique Hôpitaux de Paris, Hôpital Ambroise Paré, Boulogne; and Service d'Hématologie Pédiatrique, Centre de Référence National Histiocytoses (J.D.), Hôpital Trousseau, Sorbonne Université, Paris, France
| | - Damien Galanaud
- From Service de Médecine Interne 2, Centre National de Référence Maladies Systémiques Rares et Histiocytoses (F.C.A., Z.A., J.H.), Service de Neuroradiologie (D.G., B.L.-Y.), Service d'Anatomopathologie (F.C.), Service de Médecine Nucléaire (P.M.), Service de Neuropathologie (D.S.), Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Université; Service de Neurologie 2-Mazarin (A.I., K.H.-Z.), Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle Épinière, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Sorbonne Université, Paris; Département de Pathologie (J.-F.E.), EA4340, Université Versailles-Saint Quentin, Assistance Publique Hôpitaux de Paris, Hôpital Ambroise Paré, Boulogne; and Service d'Hématologie Pédiatrique, Centre de Référence National Histiocytoses (J.D.), Hôpital Trousseau, Sorbonne Université, Paris, France
| | - Bruno Law-Ye
- From Service de Médecine Interne 2, Centre National de Référence Maladies Systémiques Rares et Histiocytoses (F.C.A., Z.A., J.H.), Service de Neuroradiologie (D.G., B.L.-Y.), Service d'Anatomopathologie (F.C.), Service de Médecine Nucléaire (P.M.), Service de Neuropathologie (D.S.), Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Université; Service de Neurologie 2-Mazarin (A.I., K.H.-Z.), Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle Épinière, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Sorbonne Université, Paris; Département de Pathologie (J.-F.E.), EA4340, Université Versailles-Saint Quentin, Assistance Publique Hôpitaux de Paris, Hôpital Ambroise Paré, Boulogne; and Service d'Hématologie Pédiatrique, Centre de Référence National Histiocytoses (J.D.), Hôpital Trousseau, Sorbonne Université, Paris, France
| | - Jean-François Emile
- From Service de Médecine Interne 2, Centre National de Référence Maladies Systémiques Rares et Histiocytoses (F.C.A., Z.A., J.H.), Service de Neuroradiologie (D.G., B.L.-Y.), Service d'Anatomopathologie (F.C.), Service de Médecine Nucléaire (P.M.), Service de Neuropathologie (D.S.), Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Université; Service de Neurologie 2-Mazarin (A.I., K.H.-Z.), Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle Épinière, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Sorbonne Université, Paris; Département de Pathologie (J.-F.E.), EA4340, Université Versailles-Saint Quentin, Assistance Publique Hôpitaux de Paris, Hôpital Ambroise Paré, Boulogne; and Service d'Hématologie Pédiatrique, Centre de Référence National Histiocytoses (J.D.), Hôpital Trousseau, Sorbonne Université, Paris, France
| | - Frédéric Charlotte
- From Service de Médecine Interne 2, Centre National de Référence Maladies Systémiques Rares et Histiocytoses (F.C.A., Z.A., J.H.), Service de Neuroradiologie (D.G., B.L.-Y.), Service d'Anatomopathologie (F.C.), Service de Médecine Nucléaire (P.M.), Service de Neuropathologie (D.S.), Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Université; Service de Neurologie 2-Mazarin (A.I., K.H.-Z.), Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle Épinière, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Sorbonne Université, Paris; Département de Pathologie (J.-F.E.), EA4340, Université Versailles-Saint Quentin, Assistance Publique Hôpitaux de Paris, Hôpital Ambroise Paré, Boulogne; and Service d'Hématologie Pédiatrique, Centre de Référence National Histiocytoses (J.D.), Hôpital Trousseau, Sorbonne Université, Paris, France
| | - Jean Donadieu
- From Service de Médecine Interne 2, Centre National de Référence Maladies Systémiques Rares et Histiocytoses (F.C.A., Z.A., J.H.), Service de Neuroradiologie (D.G., B.L.-Y.), Service d'Anatomopathologie (F.C.), Service de Médecine Nucléaire (P.M.), Service de Neuropathologie (D.S.), Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Université; Service de Neurologie 2-Mazarin (A.I., K.H.-Z.), Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle Épinière, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Sorbonne Université, Paris; Département de Pathologie (J.-F.E.), EA4340, Université Versailles-Saint Quentin, Assistance Publique Hôpitaux de Paris, Hôpital Ambroise Paré, Boulogne; and Service d'Hématologie Pédiatrique, Centre de Référence National Histiocytoses (J.D.), Hôpital Trousseau, Sorbonne Université, Paris, France
| | - Philippe Maksud
- From Service de Médecine Interne 2, Centre National de Référence Maladies Systémiques Rares et Histiocytoses (F.C.A., Z.A., J.H.), Service de Neuroradiologie (D.G., B.L.-Y.), Service d'Anatomopathologie (F.C.), Service de Médecine Nucléaire (P.M.), Service de Neuropathologie (D.S.), Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Université; Service de Neurologie 2-Mazarin (A.I., K.H.-Z.), Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle Épinière, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Sorbonne Université, Paris; Département de Pathologie (J.-F.E.), EA4340, Université Versailles-Saint Quentin, Assistance Publique Hôpitaux de Paris, Hôpital Ambroise Paré, Boulogne; and Service d'Hématologie Pédiatrique, Centre de Référence National Histiocytoses (J.D.), Hôpital Trousseau, Sorbonne Université, Paris, France
| | - Danielle Seilhean
- From Service de Médecine Interne 2, Centre National de Référence Maladies Systémiques Rares et Histiocytoses (F.C.A., Z.A., J.H.), Service de Neuroradiologie (D.G., B.L.-Y.), Service d'Anatomopathologie (F.C.), Service de Médecine Nucléaire (P.M.), Service de Neuropathologie (D.S.), Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Université; Service de Neurologie 2-Mazarin (A.I., K.H.-Z.), Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle Épinière, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Sorbonne Université, Paris; Département de Pathologie (J.-F.E.), EA4340, Université Versailles-Saint Quentin, Assistance Publique Hôpitaux de Paris, Hôpital Ambroise Paré, Boulogne; and Service d'Hématologie Pédiatrique, Centre de Référence National Histiocytoses (J.D.), Hôpital Trousseau, Sorbonne Université, Paris, France
| | - Zahir Amoura
- From Service de Médecine Interne 2, Centre National de Référence Maladies Systémiques Rares et Histiocytoses (F.C.A., Z.A., J.H.), Service de Neuroradiologie (D.G., B.L.-Y.), Service d'Anatomopathologie (F.C.), Service de Médecine Nucléaire (P.M.), Service de Neuropathologie (D.S.), Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Université; Service de Neurologie 2-Mazarin (A.I., K.H.-Z.), Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle Épinière, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Sorbonne Université, Paris; Département de Pathologie (J.-F.E.), EA4340, Université Versailles-Saint Quentin, Assistance Publique Hôpitaux de Paris, Hôpital Ambroise Paré, Boulogne; and Service d'Hématologie Pédiatrique, Centre de Référence National Histiocytoses (J.D.), Hôpital Trousseau, Sorbonne Université, Paris, France
| | - Khê Hoang-Xuan
- From Service de Médecine Interne 2, Centre National de Référence Maladies Systémiques Rares et Histiocytoses (F.C.A., Z.A., J.H.), Service de Neuroradiologie (D.G., B.L.-Y.), Service d'Anatomopathologie (F.C.), Service de Médecine Nucléaire (P.M.), Service de Neuropathologie (D.S.), Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Université; Service de Neurologie 2-Mazarin (A.I., K.H.-Z.), Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle Épinière, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Sorbonne Université, Paris; Département de Pathologie (J.-F.E.), EA4340, Université Versailles-Saint Quentin, Assistance Publique Hôpitaux de Paris, Hôpital Ambroise Paré, Boulogne; and Service d'Hématologie Pédiatrique, Centre de Référence National Histiocytoses (J.D.), Hôpital Trousseau, Sorbonne Université, Paris, France
| | - Julien Haroche
- From Service de Médecine Interne 2, Centre National de Référence Maladies Systémiques Rares et Histiocytoses (F.C.A., Z.A., J.H.), Service de Neuroradiologie (D.G., B.L.-Y.), Service d'Anatomopathologie (F.C.), Service de Médecine Nucléaire (P.M.), Service de Neuropathologie (D.S.), Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Université; Service de Neurologie 2-Mazarin (A.I., K.H.-Z.), Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle Épinière, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, Sorbonne Université, Paris; Département de Pathologie (J.-F.E.), EA4340, Université Versailles-Saint Quentin, Assistance Publique Hôpitaux de Paris, Hôpital Ambroise Paré, Boulogne; and Service d'Hématologie Pédiatrique, Centre de Référence National Histiocytoses (J.D.), Hôpital Trousseau, Sorbonne Université, Paris, France.
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9
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Chazal T, Varnous S, Guihaire J, Goeminne C, Launay D, Boignard A, Vermes E, Dorent R, Camilleri L, Lelong B, Epailly E, Lebreton G, Waintraub X, Cluzel P, Maksud P, Fouret P, Leprince P, Grenier P, Amoura Z, Cohen Aubart F. Sarcoidosis diagnosed on granulomas in the explanted heart after transplantation: Results of a French nationwide study. Int J Cardiol 2020; 307:94-100. [DOI: 10.1016/j.ijcard.2019.12.066] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 12/01/2019] [Accepted: 12/30/2019] [Indexed: 01/13/2023]
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10
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Moyon Q, Boussouar S, Maksud P, Emile JF, Charlotte F, Aladjidi N, Prévot G, Donadieu J, Amoura Z, Grenier P, Haroche J, Cohen Aubart F. Lung Involvement in Destombes-Rosai-Dorfman Disease: Clinical and Radiological Features and Response to the MEK Inhibitor Cobimetinib. Chest 2019; 157:323-333. [PMID: 31669429 DOI: 10.1016/j.chest.2019.09.036] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 09/08/2019] [Accepted: 09/12/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Destombes-Rosai-Dorfman disease (RDD) is a rare multisystemic histiocytosis. Pulmonary involvement during RDD has been poorly described. The goal of this study was to examine the clinical presentations, radiological features, and outcomes of 15 patients with RDD and lung involvement. METHODS The cases of RDD with lung involvement were extracted from the French National Histiocytosis registry. Efficacy of the MEK inhibitor cobimetinib in treating lung disease was evaluated with an 18fluorodeoxyglucose PET scanner and chest CT scans. RESULTS Fifteen patients (six women; median age, 40 years at RDD diagnosis) were included. All patients had evidence of systemic disease with extrapulmonary localizations of the disease (lymphadenopathy [n = 12], skin [n = 9], bones [n = 6], retroperitoneal involvement [n = 3], sinuses [n = 3], parotid gland [n = 2], submandibular gland [n = 1], and breast [n = 1]). Presenting symptoms were dominated by dyspnea and dry cough in seven patients. Restrictive physiology was observed in two of five patients. BAL showed lymphocytosis in one of five cases. Eight patients received corticosteroids, all but one with variable immunosuppressive or immunomodulatory therapies. Two patients received cobimetinib for severe lung disease, with dramatic pulmonary metabolic and tumoral responses. Two patients died during follow-up: one of hemoptysis, and the other of an unrelated cerebral tumor. CONCLUSIONS Pulmonary involvement in RDD is rare, proteiform, and sometimes severe. The MEK inhibitor cobimetinib can lead to dramatic responses.
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Affiliation(s)
- Quentin Moyon
- Service de Médecine Interne 2, Centre National de Référence Maladies Systémiques Rares et Histiocytoses, Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Samia Boussouar
- Service de Radiologie, Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Philippe Maksud
- Service de Médecine Nucléaire, Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Jean-François Emile
- EA4340, Université Versailles-Saint Quentin, Assistance Publique Hôpitaux de Paris, Hôpital Ambroise Paré, Département de Pathologie, Boulogne, France
| | - Frédéric Charlotte
- Service d'Anatomopathologie, Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Nathalie Aladjidi
- Service d'hématologie pédiatrique, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Grégoire Prévot
- Service de pneumologie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Jean Donadieu
- Service d'Hématologie Pédiatrique, Assistance Publique Hôpitaux de Paris, Hôpital Trousseau, Paris, France
| | - Zahir Amoura
- Service de Médecine Interne 2, Centre National de Référence Maladies Systémiques Rares et Histiocytoses, Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Philippe Grenier
- Service de Radiologie, Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Julien Haroche
- Service de Médecine Interne 2, Centre National de Référence Maladies Systémiques Rares et Histiocytoses, Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Fleur Cohen Aubart
- Service de Médecine Interne 2, Centre National de Référence Maladies Systémiques Rares et Histiocytoses, Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital de la Pitié-Salpêtrière, Paris, France.
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11
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Trosini-Désert V, Jeny F, Maksud P, Giron A, Degos V, Similowski T. Contribution of endobronchial ultrasound elastography to the characterization of mediastinal lymphadenopathy: A single-center, prospective, observational study. Respir Med Res 2019; 76:28-33. [PMID: 31505324 DOI: 10.1016/j.resmer.2019.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 08/02/2019] [Accepted: 08/07/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND Endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) is a reliable technique providing high diagnostic yield in mediastinal lymphadenopathy. However, mediastinoscopy is sometimes necessary to eliminate false-negative results. Elastography is a recent technique that can be combined with EBUS to evaluate the elasticity and consequently the nature of a tissue. The primary objective was to evaluate the diagnostic performance of EBUS-TBNA combined with elastography for the assessment of mediastinal lymph nodes. METHODS Single-center, prospective study in patients with mediastinal lymphadenopathy. EBUS-TBNA combined with elastography was performed in each patient. Several elastographic parameters were studied: colorimetric score, average elasticity, elasticity ratio, percentage of hard areas. The final diagnosis was that obtained by TBNA cytology, histology of a surgical biopsy, when performed, or follow-up CT and PET-CT at 6 months. RESULTS Overall, 110 lymph nodes were examined in 87 patients: 44 were malignant according to TBNA. These nodes had significantly higher elasticity ratio, percentage of hard areas and colorimetric score and significantly lower average elasticity compared to benign nodes (P<0.001). With a negative predictive value of 100%, the cut-offs defined by receiver operating characteristic curves were 1.4 for elasticity ratio, 84.8 for average elasticity, 32.6 for percentage of hard areas and 3 for colorimetric score. No adverse events were observed. CONCLUSION Endobronchial ultrasound elastography is a non-invasive technique that can contribute to prediction of the nature of lymph nodes by distinguishing malignant from benign nodes. Although EBUS cannot replace histological examination, elastography can provide reliable complementary information when combined with EBUS.
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Affiliation(s)
- V Trosini-Désert
- AP-HP, groupe hospitalier Pitié-Salpêtrière Charles-Foix, service de pneumologie, médecine intensive et réanimation, département R3S, 75013 Paris, France; Groupe d'endoscopie de langue française (GELF), Société de pneumologie de langue française, 75011 Paris, France.
| | - F Jeny
- AP-HP - hôpitaux de Paris, hôpital Avicenne, groupe hospitalier hôpitaux universitaires Paris Seine-Saint-Denis, service de pneumologie, 75013 Bobigny France
| | - P Maksud
- AP-HP, groupe hospitalier Pitié-Salpêtrière Charles-Foix, service de médecine nucléaire, 75013 Paris, France
| | - A Giron
- Laboratoire d'imagerie biomédicale, inserm-CNRS-UPMC UMR-S 1146, 75013 Paris, France
| | - V Degos
- Department of anesthesia, critical care and perioperative medicine, Pitié Salpêtrière Hospital, 75013 Paris France; Sorbonne université, inserm, UMRS1158 neurophysiologie respiratoire expérimentale et clinique, 75005 Paris, France
| | - T Similowski
- AP-HP, groupe hospitalier Pitié-Salpêtrière Charles-Foix, service de pneumologie, médecine intensive et réanimation, département R3S, 75013 Paris, France; Sorbonne université, inserm, UMRS1158 neurophysiologie respiratoire expérimentale et clinique, 75005 Paris, France
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12
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Michon A, Cohen Aubart F, Haroche J, Charlotte F, Maksud P, Amoura Z. Long-bones involvement in generalized crystal-storing histiocytosis. Joint Bone Spine 2019; 86:652-653. [PMID: 30685538 DOI: 10.1016/j.jbspin.2019.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 10/21/2018] [Accepted: 01/10/2019] [Indexed: 12/31/2022]
Affiliation(s)
- Arthur Michon
- Sorbonne université, assistance publique Hôpitaux de Paris, service de médecine interne 2, institut e3m, hôpital de la Pitié-Salpêtrière, centre national de référence maladies rares histiocytoses, Paris 75013, France
| | - Fleur Cohen Aubart
- Sorbonne université, assistance publique Hôpitaux de Paris, service de médecine interne 2, institut e3m, hôpital de la Pitié-Salpêtrière, centre national de référence maladies rares histiocytoses, Paris 75013, France.
| | - Julien Haroche
- Sorbonne université, assistance publique Hôpitaux de Paris, service de médecine interne 2, institut e3m, hôpital de la Pitié-Salpêtrière, centre national de référence maladies rares histiocytoses, Paris 75013, France
| | - Frédéric Charlotte
- Assistance publique Hôpitaux de Paris, service d'anatomopathologie, hôpital de la Pitié-Salpêtrière, 75013 Paris, France
| | - Philippe Maksud
- Assistance publique Hôpitaux de Paris, département de médecine nucléaire, hôpital de la Pitié-Salpêtrière, Paris 75013, France
| | - Zahir Amoura
- Sorbonne université, assistance publique Hôpitaux de Paris, service de médecine interne 2, institut e3m, hôpital de la Pitié-Salpêtrière, centre national de référence maladies rares histiocytoses, Paris 75013, France
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Renard Penna R, Maksud P. SP-0553: What’s new in the management of high risk prostate cancer patients in 2018: the role of Imaging. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)30863-6] [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: 11/27/2022]
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Cohen-Aubart F, Maksud P, Emile JF, Benameur N, Charlotte F, Cluzel P, Amoura Z, Haroche J. Efficacy of infliximab in the treatment of Erdheim-Chester disease. Ann Rheum Dis 2018; 77:1387-1390. [PMID: 29363511 DOI: 10.1136/annrheumdis-2017-212678] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Revised: 01/04/2018] [Accepted: 01/05/2018] [Indexed: 11/04/2022]
Affiliation(s)
- Fleur Cohen-Aubart
- Internal Medicine Department 2, AP-HP, French National Reference Centre for Rare Systemic Diseases, Pitié-Salpêtrière Hospital, Paris, France.,Paris VI University, UPMC, Sorbonne Universités, Paris, France
| | - Philippe Maksud
- Paris VI University, UPMC, Sorbonne Universités, Paris, France.,Nuclear Medicine Department, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Jean-François Emile
- Pathology Department, AP-HP, Ambroise Paré Hospital, Versailles University, Boulogne, France
| | - Neila Benameur
- Pharmacy Department, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Frédéric Charlotte
- Paris VI University, UPMC, Sorbonne Universités, Paris, France.,Pathology Department, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Philippe Cluzel
- Paris VI University, UPMC, Sorbonne Universités, Paris, France.,Cardiovascular Imaging Department, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Zahir Amoura
- Internal Medicine Department 2, AP-HP, French National Reference Centre for Rare Systemic Diseases, Pitié-Salpêtrière Hospital, Paris, France.,Paris VI University, UPMC, Sorbonne Universités, Paris, France
| | - Julien Haroche
- Internal Medicine Department 2, AP-HP, French National Reference Centre for Rare Systemic Diseases, Pitié-Salpêtrière Hospital, Paris, France.,Paris VI University, UPMC, Sorbonne Universités, Paris, France
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Isnard Bagnis C, Pieroni L, Inaoui R, Maksud P, Lallauret S, Valantin MA, Tubiana R, Katlama C, Deray G, Courbebaisse M, Tourret J, Tezenas du Montcel S. Impact of lean mass and bone density on glomerular filtration rate estimation in people living with HIV/AIDS. PLoS One 2017; 12:e0186410. [PMID: 29096403 PMCID: PMC5668131 DOI: 10.1371/journal.pone.0186410] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 09/29/2017] [Indexed: 11/18/2022] Open
Abstract
Context Chronic kidney disease is a frequent complication in persons living with HIV/AIDS. Although previous studies have suggested that the CKD-EPI formula is appropriate to estimate glomerular filtration rate (GFR) in HIV-positive adults with normal kidney function, the optimal way to estimate GFR in those with Stage 3 chronic kidney disease is not known. Moreover, the impact of muscle mass on creatinine level and GFR estimation is unknown. Aim and methods Our study aimed to evaluate the accuracy of different diagnostic tests available compared to the gold standard measurement of GFR. A group of 44 HIV-1 patients with an estimated GFR between 60 and 30 ml/min/1.73 m2 were included in a single-center cross-sectional study. Serum creatinine and cystatin C were measured. GFR was estimated using Cockcroft-Gault, MDRD, sMDRD, CKD-EPI, CKD-EPIcyst, and CKD-EPIcyst/creat formulae and was measured using isotopic Chrome51 EDTA clearance. Bone density and muscle mass were measured by DXA scan. Results Mean age was 62±10 years. Mean BMI was 23±4 kg/m2. Prevalence of diabetes was 30% and of hypertension was 47%. Viral load was <40 copies/ml for 90% of the patients, and mean CD4 count was 446±191 cells/mm3. Mean measured GFR was 63.4±16.5 ml/min/1.73 m2. All formulae under-estimated GFR. The best relative precision and accuracy were provided by the CKP-EPI formula. sMDRD, CKD-EPIcyst, and CKD-EPIcyst/creat performed worse than the CKD-EPI formula. Body composition did not significantly influence accuracy or precision of GFR estimation. Conclusion In HIV-infected patients in stable immunovirologic conditions with CKD stage 3 and high prevalence of metabolic associated conditions, the CKD-EPI formula performed best, although all formulae under estimate GFR.
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Affiliation(s)
- Corinne Isnard Bagnis
- Nephrology, AP-HP, Groupe Hospitalier Pitié Salpetrière, Paris, France et Université Pierre et Marie Curie, Paris, France
- * E-mail:
| | - Laurence Pieroni
- Biochemistry Department, AP-HP, Groupe Hospitalier Pitié Salpetrière, Paris, France et Université Pierre et Marie Curie, Paris, France
| | - Rachida Inaoui
- Rhumatology, AP-HP, Groupe Hospitalier Pitié Salpetrière, Paris, France et Université Pierre et Marie Curie, Paris, France
| | - Philippe Maksud
- Nuclear Medicine, AP-HP, Groupe Hospitalier Pitié Salpetrière, Paris, France et Université Pierre et Marie Curie, Paris, France
| | - Stéphanie Lallauret
- Biostatistics Unit and Clinical Research Unit, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Marc-Antoine Valantin
- Infectious Diseases, AP-HP, Groupe Hospitalier Pitié Salpetrière, Paris, France et Université Pierre et Marie Curie, Paris, France
| | - Roland Tubiana
- Infectious Diseases, AP-HP, Groupe Hospitalier Pitié Salpetrière, Paris, France et Université Pierre et Marie Curie, Paris, France
| | - Christine Katlama
- Infectious Diseases, AP-HP, Groupe Hospitalier Pitié Salpetrière, Paris, France et Université Pierre et Marie Curie, Paris, France
| | - Gilbert Deray
- Nephrology, AP-HP, Groupe Hospitalier Pitié Salpetrière, Paris, France et Université Pierre et Marie Curie, Paris, France
| | - Marie Courbebaisse
- Physiology Department, Hôpital Européen Georges Pompidou, Paris, France et INSERM, Paris, France
| | - Jérôme Tourret
- Nephrology, AP-HP, Groupe Hospitalier Pitié Salpetrière, Paris, France et Université Pierre et Marie Curie, Paris, France
| | - Sophie Tezenas du Montcel
- Biostatistics Unit and Clinical Research Unit, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
- Sorbonne Université, UPMC Univ Paris 06 UMR_S1136, Paris, France
- Institut Pierre Louis d’EPIdémiologie et de Santé Publique, Paris, France
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Sbei A, ElBedoui K, Barhoumi W, Maksud P, Maktouf C. Hybrid PET/MRI co-segmentation based on joint fuzzy connectedness and graph cut. Comput Methods Programs Biomed 2017; 149:29-41. [PMID: 28802328 DOI: 10.1016/j.cmpb.2017.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 06/03/2017] [Accepted: 07/18/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND AND OBJECTIVE Tumor segmentation from hybrid PET/MRI scans may be highly beneficial in radiotherapy treatment planning. Indeed, it gives for both modalities the suitable information that could make the delineation of tumors more accurate than using each one apart. We aim in this work to propose a co-segmentation method that deals with several challenges, notably the lack of one-to-one correspondence between tumors of the two modalities and the boundaries' smoothing. METHODS The proposed method is designed to surpass these limits, we propose a segmentation method based on the GCsummax technique. The method takes the advantage of Iterative Relative Fuzzy Connectedness (IRFC) on seeds initialization, and the standard min-cut/max-flow technique for the boundary smoothing. Seed initialization was accurately performed thanks to high uptake regions on PET. Besides, a visibility weighting scheme was adapted to achieve the task of co-segmentation using the IRFC algorithm. Then, given the co-segmented regions, we introduce a morphological-based technique that provides object seeds to standard Graph Cut (GC) allowing it to avoid the shrinking problem. Finally, for each modality, the segmentation task is formulated as an energy minimization problem which is resolved by a min-cut/max-flow technique. RESULTS The overlap ratio (denoted DSC) between our segmentation results and the ground-truth for PET images is 92.63 ± 1.03, while the DSC for MRI images is 90.61 ± 3.70. CONCLUSIONS The proposed method was tested on different types of diseases and it outperformed the state-of-the-art methods. We show its superiority in terms of assymetric relation between PET and MRI and tumors heterogeneity.
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Affiliation(s)
- Arafet Sbei
- Université de Tunis El Manar, Institut Supérieur d'Informatique, Research Team on Intelligent Systems in Imaging and Articial Vision (SIIVA), LR16ES06 Laboratoire de recherche en Informatique, Modélisation et Traitement de l'Information et de la Connaissance (LIMTIC), Tunisia; Nuclear Medicine Department, Pasteur Institute of Tunis, Tunis, Tunisia
| | - Khaoula ElBedoui
- Université de Tunis El Manar, Institut Supérieur d'Informatique, Research Team on Intelligent Systems in Imaging and Articial Vision (SIIVA), LR16ES06 Laboratoire de recherche en Informatique, Modélisation et Traitement de l'Information et de la Connaissance (LIMTIC), Tunisia; Université de Carthage, Ecole Nationale d'Ingénieurs de Carthage, Tunisia
| | - Walid Barhoumi
- Université de Tunis El Manar, Institut Supérieur d'Informatique, Research Team on Intelligent Systems in Imaging and Articial Vision (SIIVA), LR16ES06 Laboratoire de recherche en Informatique, Modélisation et Traitement de l'Information et de la Connaissance (LIMTIC), Tunisia; Université de Carthage, Ecole Nationale d'Ingénieurs de Carthage, Tunisia.
| | - Philippe Maksud
- Nuclear Medicine Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - Chokri Maktouf
- Nuclear Medicine Department, Pasteur Institute of Tunis, Tunis, Tunisia
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Marchal A, Charlotte F, Maksud P, Haroche J, Lifferman F, Miyara M, Choquet S, Amoura Z, Cohen Aubart F. [Sarcoidosis flare after autologous stem cell transplantation: An immune paradox?]. Rev Med Interne 2017; 38:619-622. [PMID: 28196699 DOI: 10.1016/j.revmed.2017.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 05/07/2016] [Revised: 11/06/2016] [Accepted: 01/05/2017] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Sarcoidosis is a systemic granulomatous disorder of unknown cause. Apparition or flare of previously diagnosed sarcoidosis following hematopoietic stem cell transplantation (HSCT) has rarely been reported. OBSERVATION We report a 62-year-old woman who presented a radiological flare of sarcoidosis post-autologous stem cell transplantation for a POEMS syndrome. Imaging findings and lymph node histology, which revealed non-caseating granuloma, were consistent with the sarcoidosis diagnosis. The patient was asymptomatic and was kept free of treatment. CONCLUSION Sarcoidosis must be considered ahead of compatible clinicoradiological presentation occurring after HSCT. Sarcoidosis can mimic metastatic cancer or lymphatic relapse. Tissue biopsies and exclusion of differential diagnosis of granuloma diseases are warranted to confirm sarcoidosis diagnosis.
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Affiliation(s)
- A Marchal
- Service de médecine interne, institut E3M, centre national de référence maladies auto-immunes systémiques rares, hôpital Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France
| | - F Charlotte
- Université Pierre-et-Marie-Curie, université Paris VI, Sorbonne Université, Paris 75013, France; Service d'anatomopathologie, hôpital Pitié-Salpêtrière, AP-HP, Paris 75013, France
| | - P Maksud
- Université Pierre-et-Marie-Curie, université Paris VI, Sorbonne Université, Paris 75013, France; Service de médecine nucléaire, hôpital Pitié-Salpêtrière, AP-HP, Paris 75013, France
| | - J Haroche
- Service de médecine interne, institut E3M, centre national de référence maladies auto-immunes systémiques rares, hôpital Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France; Université Pierre-et-Marie-Curie, université Paris VI, Sorbonne Université, Paris 75013, France
| | - F Lifferman
- Service de médecine interne, hôpital de Dax, Dax 40180, France
| | - M Miyara
- Service de médecine interne, institut E3M, centre national de référence maladies auto-immunes systémiques rares, hôpital Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France; Université Pierre-et-Marie-Curie, université Paris VI, Sorbonne Université, Paris 75013, France; Département d'immunochimie, hôpital Pitié-Salpêtrière, AP-HP, Paris 75013, France
| | - S Choquet
- Service d'hématologie, hôpital Pitié-Salpêtrière, AP-HP, Paris 75013, France
| | - Z Amoura
- Service de médecine interne, institut E3M, centre national de référence maladies auto-immunes systémiques rares, hôpital Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France; Université Pierre-et-Marie-Curie, université Paris VI, Sorbonne Université, Paris 75013, France
| | - F Cohen Aubart
- Service de médecine interne, institut E3M, centre national de référence maladies auto-immunes systémiques rares, hôpital Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France; Université Pierre-et-Marie-Curie, université Paris VI, Sorbonne Université, Paris 75013, France.
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Cohen Aubart F, Emile JF, Maksud P, Galanaud D, Cluzel P, Benameur N, Aumaitre O, Amoura Z, Haroche J. Efficacy of the MEK inhibitor cobimetinib for wild-type BRAF Erdheim-Chester disease. Br J Haematol 2016; 180:150-153. [PMID: 27711968 DOI: 10.1111/bjh.14284] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Fleur Cohen Aubart
- Internal Medicine Department, French National Center for Rare Systemic Diseases, Pitié-Salpêtrière Hospital, AP-HP, Paris, France.,Paris VI University, UPMC, Sorbonne Universités, Paris, France
| | - Jean-François Emile
- EA4340, Pathology Department, Ambroise Paré Hospital, Versailles University, AP-HP, Boulogne, France
| | - Philippe Maksud
- Nuclear Medicine Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - Damien Galanaud
- Neuroradiology Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - Philippe Cluzel
- Vascular Imaging Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - Neila Benameur
- Pharmacy Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - Olivier Aumaitre
- Internal Medicine Department, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Zahir Amoura
- Internal Medicine Department, French National Center for Rare Systemic Diseases, Pitié-Salpêtrière Hospital, AP-HP, Paris, France.,Paris VI University, UPMC, Sorbonne Universités, Paris, France
| | - Julien Haroche
- Internal Medicine Department, French National Center for Rare Systemic Diseases, Pitié-Salpêtrière Hospital, AP-HP, Paris, France.,Paris VI University, UPMC, Sorbonne Universités, Paris, France
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Haroche J, Papo M, Cohen-Aubart F, Charlotte F, Maksud P, Grenier PA, Cluzel P, Mathian A, Emile JF, Amoura Z. [Erdheim-Chester disease (ECD), an inflammatory myeloid neoplasia]. Presse Med 2016; 46:96-106. [PMID: 27234902 DOI: 10.1016/j.lpm.2016.02.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 02/11/2016] [Indexed: 01/21/2023] Open
Abstract
In a compatible clinico-radiological setting, the diagnosis of Erdheim-Chester disease (ECD) involves the analysis of histiocytes in tissue biopsies: they are typically foamy and CD68+ CD1a, whereas in Langerhans cell histiocytosis (LCH) they are CD68+ CD1a+. Overlap forms of histiocytoses are frequent. Technetium bone scintigraphy showing nearly constant tracer uptake by the long bones is highly suggestive of ECD and a 'hairy kidney' appearance on abdominal CT scan is observed in more than half ECD cases. CNS involvement is a strong prognostic factor and an independent predictor of death in cases of ECD. Optimal initial therapy for ECD appears to be administration of IFN-α (and/or pegylated IFN-α) and prolonged treatment significantly improves survival; however, tolerance may be poor. Best alternative therapies are anakinra, mainly effective for mild forms of the disease, infliximab, and sirolimus. Cases of ECD present with strong systemic immune activation, involving IFN-α, IL-1/IL1-RA, IL-6, IL-12, and MCP-1, consistent with the systemic immune Th-1-oriented disturbance associated with the disease. Between 57 and 75 % of ECD patients carry the BRAFV600E mutation, an activating mutation of the proto-oncogene BRAF. More than 50 cases harboring BRAF mutation and with severe multisystemic and refractory ECD (sometimes associated with LCH) have been treated worldwide with vemurafenib, a BRAF inhibitor that proved to be very beneficial. Other recurrent mutations of the MAPK (NRAS, MAP2K1) and PIK3 pathways (PIK3CA) have been found among ECD patients. As recurrent mutations in the MAPK pathway are found in ECD and LCH on a background of chronic inflammation, we believe that both conditions should be redefined as an inflammatory myeloid neoplasia.
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Affiliation(s)
- Julien Haroche
- Assistance publique-Hôpitaux de Paris, hôpital Pitié-Salpêtrière, université Pierre-et-Marie-Curie Paris 6, institut E3M, centre de référence des maladies rares auto-immunes et systémiques, service de médecine interne 2, Paris, France.
| | - Matthias Papo
- Assistance publique-Hôpitaux de Paris, hôpital Pitié-Salpêtrière, université Pierre-et-Marie-Curie Paris 6, institut E3M, centre de référence des maladies rares auto-immunes et systémiques, service de médecine interne 2, Paris, France
| | - Fleur Cohen-Aubart
- Assistance publique-Hôpitaux de Paris, hôpital Pitié-Salpêtrière, université Pierre-et-Marie-Curie Paris 6, institut E3M, centre de référence des maladies rares auto-immunes et systémiques, service de médecine interne 2, Paris, France
| | - Frédéric Charlotte
- Assistance publique-Hôpitaux de Paris, hôpital Pitié-Salpêtrière, université Pierre-et-Marie-Curie Paris 6, service d'anatomopathologie, Paris, France
| | - Philippe Maksud
- Assistance publique-Hôpitaux de Paris, hôpital Pitié-Salpêtrière, université Pierre-et-Marie-Curie Paris 6, service de médecine nucléaire, Paris, France
| | - Philippe A Grenier
- Assistance publique-Hôpitaux de Paris, hôpital Pitié-Salpêtrière, université Pierre-et-Marie-Curie Paris 6, département de radiologie, Paris, France
| | - Philippe Cluzel
- Assistance publique-Hôpitaux de Paris, hôpital Pitié-Salpêtrière, université Pierre-et-Marie-Curie Paris 6, département de radiologie, Paris, France
| | - Alexis Mathian
- Assistance publique-Hôpitaux de Paris, hôpital Pitié-Salpêtrière, université Pierre-et-Marie-Curie Paris 6, institut E3M, centre de référence des maladies rares auto-immunes et systémiques, service de médecine interne 2, Paris, France
| | - Jean-François Emile
- Assistance publique-Hôpitaux de Paris, hôpital Ambroise-Paré, université Saint-Quentin-en-Yvelines, service d'anatomopathologie, Boulogne, France
| | - Zahir Amoura
- Assistance publique-Hôpitaux de Paris, hôpital Pitié-Salpêtrière, université Pierre-et-Marie-Curie Paris 6, institut E3M, centre de référence des maladies rares auto-immunes et systémiques, service de médecine interne 2, Paris, France
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Cohen-Aubart F, Emile JF, Maksud P, Charlotte F, Cluzel P, Benameur N, Aumaitre O, Amoura Z, Haroche J. Treatment of Erdheim-Chester disease patients with the MEK inhibitor cobimetinib. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e19074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Fleur Cohen-Aubart
- Department of Internal Medicine and French reference Center for Rare Auto-immune and Systemic Diseases, Institut E3M, Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière Hospital, & Université Pierre et Marie Curie, UPMC, Paris, France
| | | | - Philippe Maksud
- Department of Nuclear Medicine, Assistance Publique–Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière, Paris VI University Pierre et Marie Curie, Paris, France
| | - Frédéric Charlotte
- Department of Pathology, Assistance Publique–Hôpitaux de Paris (AP-HP), Pitié-Salpétriêre Hospital, Paris VI University Pierre et Marie Curie, Paris, France
| | - Philippe Cluzel
- Department of Radiology, Assistance Publique–Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière, Paris VI University Pierre et Marie Curie, Paris, France
| | - Neïla Benameur
- Pharmacy, Assistance Publique–Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière, Paris VI University Pierre et Marie Curie, Paris, France
| | - Olivier Aumaitre
- Service de médecine interne, CHU Gabriel-Montpied, Clermont-Ferrand, France
| | - Zahir Amoura
- Department of Internal Medicine and French reference Center for Rare Auto-immune and Systemic Diseases, Institut E3M, Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière Hospital, & Université Pierre et Marie Curie, UPMC, Paris, France
| | - Julien Haroche
- Department of Internal Medicine and French reference Center for Rare Auto-immune and Systemic Diseases, Institut E3M, Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière Hospital, & Université Pierre et Marie Curie, UPMC, Paris, France
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Haroche J, Cohen-Aubart F, Charlotte F, Maksud P, Grenier PA, Cluzel P, Mathian A, Emile JF, Amoura Z. The histiocytosis Erdheim–Chester disease is an inflammatory myeloid neoplasm. Expert Rev Clin Immunol 2015. [DOI: 10.1586/1744666x.2015.1060857] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Haroche J, Cohen-Aubart F, Emile JF, Maksud P, Drier A, Tolédano D, Barete S, Charlotte F, Cluzel P, Donadieu J, Benameur N, Grenier PA, Besnard S, Ory JP, Lifermann F, Idbaih A, Granel B, Graffin B, Hervier B, Arnaud L, Amoura Z. Reproducible and sustained efficacy of targeted therapy with vemurafenib in patients with BRAF(V600E)-mutated Erdheim-Chester disease. J Clin Oncol 2014; 33:411-8. [PMID: 25422482 DOI: 10.1200/jco.2014.57.1950] [Citation(s) in RCA: 204] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Histiocytoses are rare disorders with heterogeneous prognosis. BRAF(V600E) mutations have been observed in half of patients with Langerhans cell histiocytosis (LCH) and in 50% to 100% of patients with Erdheim-Chester disease (ECD) patients. We recently reported short-term efficacy of a BRAF inhibitor (vemurafenib) in three patients with multisystemic ECD. PATIENTS AND METHODS Vemurafenib was given to eight patients with multisystemic ECD with CNS and/or cardiac involvement. All patients were refractory to first-line treatment and harbored a BRAF(V600E) mutation. Four patients also had LCH lesions. Positron emission tomography (PET) scan response at month 6 was used as the main evaluation criterion. Secondary evaluation criteria were comparison at baseline and at last visit of PET and of cardiovascular and cerebral infiltrations (computed tomography scan and magnetic resonance imaging [MRI]). RESULTS All patients were partial metabolic responders at 6 months of vemurafenib, and the median reduction in maximum standardized uptake value was 63.5% (range, 41.3% to 86.9%). Evaluation of cardiac and aortic infiltrations showed that seven patients had a partial response and one patient had stable disease according to surface measurements derived from RECIST criteria. The four patients with infratentorial CNS infiltration had an objective decrease of the lesions on MRI. All patients had an improvement of general symptoms and a persistent response to vemurafenib, with a median follow-up time of 10.5 months (range, 6 to 16 months). Skin adverse effects were frequent and severe. CONCLUSION Vemurafenib has an objective and sustained efficacy in BRAF(V600E)-mutated ECD as second-line therapy. In contrast to melanoma, no resistance has emerged to date after 6 to 16 months.
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Affiliation(s)
- Julien Haroche
- Julien Haroche, Fleur Cohen-Aubart, Philippe Maksud, Aurélie Drier, Dan Tolédano, Stéphane Barete, Frédéric Charlotte, Philippe Cluzel, Neïla Benameur, Philippe A. Grenier, Ahmed Idbaih, Baptiste Hervier, Laurent Arnaud, and Zahir Amoura, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière; Philippe Maksud, Stéphane Barete, Frédéric Charlotte, Philippe Cluzel, Philippe A. Grenier, Ahmed Idbaih, Julien Haroche, Fleur Cohen-Aubart, Baptiste Hervier, Laurent Arnaud, and Zahir Amoura, Paris VI University Pierre et Marie Curie; Jean Donadieu, AP-HP, Hôpital Trousseau, French National Center for Histiocytosis, Paris; Jean-François Emile, EA4340-BCOH, Versailles University, and AP-HP, Hôpital Ambroise Paré, Boulogne; Sophie Besnard, Centre Hospitalier Universitaire de Rennes, Pontchaillou University Hospital, Rennes Cedex; Jean-Paul Ory, Centre Hospitalier Régional de Vesoul, Vesoul; François Lifermann, Hôpital de Dax-Côte d'Argent, Dax; Brigitte Granel, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille; and Bruno Graffin, Hôpital d'Instruction des Armées Legouest, Metz, France.
| | - Fleur Cohen-Aubart
- Julien Haroche, Fleur Cohen-Aubart, Philippe Maksud, Aurélie Drier, Dan Tolédano, Stéphane Barete, Frédéric Charlotte, Philippe Cluzel, Neïla Benameur, Philippe A. Grenier, Ahmed Idbaih, Baptiste Hervier, Laurent Arnaud, and Zahir Amoura, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière; Philippe Maksud, Stéphane Barete, Frédéric Charlotte, Philippe Cluzel, Philippe A. Grenier, Ahmed Idbaih, Julien Haroche, Fleur Cohen-Aubart, Baptiste Hervier, Laurent Arnaud, and Zahir Amoura, Paris VI University Pierre et Marie Curie; Jean Donadieu, AP-HP, Hôpital Trousseau, French National Center for Histiocytosis, Paris; Jean-François Emile, EA4340-BCOH, Versailles University, and AP-HP, Hôpital Ambroise Paré, Boulogne; Sophie Besnard, Centre Hospitalier Universitaire de Rennes, Pontchaillou University Hospital, Rennes Cedex; Jean-Paul Ory, Centre Hospitalier Régional de Vesoul, Vesoul; François Lifermann, Hôpital de Dax-Côte d'Argent, Dax; Brigitte Granel, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille; and Bruno Graffin, Hôpital d'Instruction des Armées Legouest, Metz, France
| | - Jean-François Emile
- Julien Haroche, Fleur Cohen-Aubart, Philippe Maksud, Aurélie Drier, Dan Tolédano, Stéphane Barete, Frédéric Charlotte, Philippe Cluzel, Neïla Benameur, Philippe A. Grenier, Ahmed Idbaih, Baptiste Hervier, Laurent Arnaud, and Zahir Amoura, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière; Philippe Maksud, Stéphane Barete, Frédéric Charlotte, Philippe Cluzel, Philippe A. Grenier, Ahmed Idbaih, Julien Haroche, Fleur Cohen-Aubart, Baptiste Hervier, Laurent Arnaud, and Zahir Amoura, Paris VI University Pierre et Marie Curie; Jean Donadieu, AP-HP, Hôpital Trousseau, French National Center for Histiocytosis, Paris; Jean-François Emile, EA4340-BCOH, Versailles University, and AP-HP, Hôpital Ambroise Paré, Boulogne; Sophie Besnard, Centre Hospitalier Universitaire de Rennes, Pontchaillou University Hospital, Rennes Cedex; Jean-Paul Ory, Centre Hospitalier Régional de Vesoul, Vesoul; François Lifermann, Hôpital de Dax-Côte d'Argent, Dax; Brigitte Granel, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille; and Bruno Graffin, Hôpital d'Instruction des Armées Legouest, Metz, France
| | - Philippe Maksud
- Julien Haroche, Fleur Cohen-Aubart, Philippe Maksud, Aurélie Drier, Dan Tolédano, Stéphane Barete, Frédéric Charlotte, Philippe Cluzel, Neïla Benameur, Philippe A. Grenier, Ahmed Idbaih, Baptiste Hervier, Laurent Arnaud, and Zahir Amoura, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière; Philippe Maksud, Stéphane Barete, Frédéric Charlotte, Philippe Cluzel, Philippe A. Grenier, Ahmed Idbaih, Julien Haroche, Fleur Cohen-Aubart, Baptiste Hervier, Laurent Arnaud, and Zahir Amoura, Paris VI University Pierre et Marie Curie; Jean Donadieu, AP-HP, Hôpital Trousseau, French National Center for Histiocytosis, Paris; Jean-François Emile, EA4340-BCOH, Versailles University, and AP-HP, Hôpital Ambroise Paré, Boulogne; Sophie Besnard, Centre Hospitalier Universitaire de Rennes, Pontchaillou University Hospital, Rennes Cedex; Jean-Paul Ory, Centre Hospitalier Régional de Vesoul, Vesoul; François Lifermann, Hôpital de Dax-Côte d'Argent, Dax; Brigitte Granel, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille; and Bruno Graffin, Hôpital d'Instruction des Armées Legouest, Metz, France
| | - Aurélie Drier
- Julien Haroche, Fleur Cohen-Aubart, Philippe Maksud, Aurélie Drier, Dan Tolédano, Stéphane Barete, Frédéric Charlotte, Philippe Cluzel, Neïla Benameur, Philippe A. Grenier, Ahmed Idbaih, Baptiste Hervier, Laurent Arnaud, and Zahir Amoura, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière; Philippe Maksud, Stéphane Barete, Frédéric Charlotte, Philippe Cluzel, Philippe A. Grenier, Ahmed Idbaih, Julien Haroche, Fleur Cohen-Aubart, Baptiste Hervier, Laurent Arnaud, and Zahir Amoura, Paris VI University Pierre et Marie Curie; Jean Donadieu, AP-HP, Hôpital Trousseau, French National Center for Histiocytosis, Paris; Jean-François Emile, EA4340-BCOH, Versailles University, and AP-HP, Hôpital Ambroise Paré, Boulogne; Sophie Besnard, Centre Hospitalier Universitaire de Rennes, Pontchaillou University Hospital, Rennes Cedex; Jean-Paul Ory, Centre Hospitalier Régional de Vesoul, Vesoul; François Lifermann, Hôpital de Dax-Côte d'Argent, Dax; Brigitte Granel, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille; and Bruno Graffin, Hôpital d'Instruction des Armées Legouest, Metz, France
| | - Dan Tolédano
- Julien Haroche, Fleur Cohen-Aubart, Philippe Maksud, Aurélie Drier, Dan Tolédano, Stéphane Barete, Frédéric Charlotte, Philippe Cluzel, Neïla Benameur, Philippe A. Grenier, Ahmed Idbaih, Baptiste Hervier, Laurent Arnaud, and Zahir Amoura, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière; Philippe Maksud, Stéphane Barete, Frédéric Charlotte, Philippe Cluzel, Philippe A. Grenier, Ahmed Idbaih, Julien Haroche, Fleur Cohen-Aubart, Baptiste Hervier, Laurent Arnaud, and Zahir Amoura, Paris VI University Pierre et Marie Curie; Jean Donadieu, AP-HP, Hôpital Trousseau, French National Center for Histiocytosis, Paris; Jean-François Emile, EA4340-BCOH, Versailles University, and AP-HP, Hôpital Ambroise Paré, Boulogne; Sophie Besnard, Centre Hospitalier Universitaire de Rennes, Pontchaillou University Hospital, Rennes Cedex; Jean-Paul Ory, Centre Hospitalier Régional de Vesoul, Vesoul; François Lifermann, Hôpital de Dax-Côte d'Argent, Dax; Brigitte Granel, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille; and Bruno Graffin, Hôpital d'Instruction des Armées Legouest, Metz, France
| | - Stéphane Barete
- Julien Haroche, Fleur Cohen-Aubart, Philippe Maksud, Aurélie Drier, Dan Tolédano, Stéphane Barete, Frédéric Charlotte, Philippe Cluzel, Neïla Benameur, Philippe A. Grenier, Ahmed Idbaih, Baptiste Hervier, Laurent Arnaud, and Zahir Amoura, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière; Philippe Maksud, Stéphane Barete, Frédéric Charlotte, Philippe Cluzel, Philippe A. Grenier, Ahmed Idbaih, Julien Haroche, Fleur Cohen-Aubart, Baptiste Hervier, Laurent Arnaud, and Zahir Amoura, Paris VI University Pierre et Marie Curie; Jean Donadieu, AP-HP, Hôpital Trousseau, French National Center for Histiocytosis, Paris; Jean-François Emile, EA4340-BCOH, Versailles University, and AP-HP, Hôpital Ambroise Paré, Boulogne; Sophie Besnard, Centre Hospitalier Universitaire de Rennes, Pontchaillou University Hospital, Rennes Cedex; Jean-Paul Ory, Centre Hospitalier Régional de Vesoul, Vesoul; François Lifermann, Hôpital de Dax-Côte d'Argent, Dax; Brigitte Granel, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille; and Bruno Graffin, Hôpital d'Instruction des Armées Legouest, Metz, France
| | - Frédéric Charlotte
- Julien Haroche, Fleur Cohen-Aubart, Philippe Maksud, Aurélie Drier, Dan Tolédano, Stéphane Barete, Frédéric Charlotte, Philippe Cluzel, Neïla Benameur, Philippe A. Grenier, Ahmed Idbaih, Baptiste Hervier, Laurent Arnaud, and Zahir Amoura, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière; Philippe Maksud, Stéphane Barete, Frédéric Charlotte, Philippe Cluzel, Philippe A. Grenier, Ahmed Idbaih, Julien Haroche, Fleur Cohen-Aubart, Baptiste Hervier, Laurent Arnaud, and Zahir Amoura, Paris VI University Pierre et Marie Curie; Jean Donadieu, AP-HP, Hôpital Trousseau, French National Center for Histiocytosis, Paris; Jean-François Emile, EA4340-BCOH, Versailles University, and AP-HP, Hôpital Ambroise Paré, Boulogne; Sophie Besnard, Centre Hospitalier Universitaire de Rennes, Pontchaillou University Hospital, Rennes Cedex; Jean-Paul Ory, Centre Hospitalier Régional de Vesoul, Vesoul; François Lifermann, Hôpital de Dax-Côte d'Argent, Dax; Brigitte Granel, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille; and Bruno Graffin, Hôpital d'Instruction des Armées Legouest, Metz, France
| | - Philippe Cluzel
- Julien Haroche, Fleur Cohen-Aubart, Philippe Maksud, Aurélie Drier, Dan Tolédano, Stéphane Barete, Frédéric Charlotte, Philippe Cluzel, Neïla Benameur, Philippe A. Grenier, Ahmed Idbaih, Baptiste Hervier, Laurent Arnaud, and Zahir Amoura, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière; Philippe Maksud, Stéphane Barete, Frédéric Charlotte, Philippe Cluzel, Philippe A. Grenier, Ahmed Idbaih, Julien Haroche, Fleur Cohen-Aubart, Baptiste Hervier, Laurent Arnaud, and Zahir Amoura, Paris VI University Pierre et Marie Curie; Jean Donadieu, AP-HP, Hôpital Trousseau, French National Center for Histiocytosis, Paris; Jean-François Emile, EA4340-BCOH, Versailles University, and AP-HP, Hôpital Ambroise Paré, Boulogne; Sophie Besnard, Centre Hospitalier Universitaire de Rennes, Pontchaillou University Hospital, Rennes Cedex; Jean-Paul Ory, Centre Hospitalier Régional de Vesoul, Vesoul; François Lifermann, Hôpital de Dax-Côte d'Argent, Dax; Brigitte Granel, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille; and Bruno Graffin, Hôpital d'Instruction des Armées Legouest, Metz, France
| | - Jean Donadieu
- Julien Haroche, Fleur Cohen-Aubart, Philippe Maksud, Aurélie Drier, Dan Tolédano, Stéphane Barete, Frédéric Charlotte, Philippe Cluzel, Neïla Benameur, Philippe A. Grenier, Ahmed Idbaih, Baptiste Hervier, Laurent Arnaud, and Zahir Amoura, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière; Philippe Maksud, Stéphane Barete, Frédéric Charlotte, Philippe Cluzel, Philippe A. Grenier, Ahmed Idbaih, Julien Haroche, Fleur Cohen-Aubart, Baptiste Hervier, Laurent Arnaud, and Zahir Amoura, Paris VI University Pierre et Marie Curie; Jean Donadieu, AP-HP, Hôpital Trousseau, French National Center for Histiocytosis, Paris; Jean-François Emile, EA4340-BCOH, Versailles University, and AP-HP, Hôpital Ambroise Paré, Boulogne; Sophie Besnard, Centre Hospitalier Universitaire de Rennes, Pontchaillou University Hospital, Rennes Cedex; Jean-Paul Ory, Centre Hospitalier Régional de Vesoul, Vesoul; François Lifermann, Hôpital de Dax-Côte d'Argent, Dax; Brigitte Granel, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille; and Bruno Graffin, Hôpital d'Instruction des Armées Legouest, Metz, France
| | - Neïla Benameur
- Julien Haroche, Fleur Cohen-Aubart, Philippe Maksud, Aurélie Drier, Dan Tolédano, Stéphane Barete, Frédéric Charlotte, Philippe Cluzel, Neïla Benameur, Philippe A. Grenier, Ahmed Idbaih, Baptiste Hervier, Laurent Arnaud, and Zahir Amoura, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière; Philippe Maksud, Stéphane Barete, Frédéric Charlotte, Philippe Cluzel, Philippe A. Grenier, Ahmed Idbaih, Julien Haroche, Fleur Cohen-Aubart, Baptiste Hervier, Laurent Arnaud, and Zahir Amoura, Paris VI University Pierre et Marie Curie; Jean Donadieu, AP-HP, Hôpital Trousseau, French National Center for Histiocytosis, Paris; Jean-François Emile, EA4340-BCOH, Versailles University, and AP-HP, Hôpital Ambroise Paré, Boulogne; Sophie Besnard, Centre Hospitalier Universitaire de Rennes, Pontchaillou University Hospital, Rennes Cedex; Jean-Paul Ory, Centre Hospitalier Régional de Vesoul, Vesoul; François Lifermann, Hôpital de Dax-Côte d'Argent, Dax; Brigitte Granel, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille; and Bruno Graffin, Hôpital d'Instruction des Armées Legouest, Metz, France
| | - Philippe A Grenier
- Julien Haroche, Fleur Cohen-Aubart, Philippe Maksud, Aurélie Drier, Dan Tolédano, Stéphane Barete, Frédéric Charlotte, Philippe Cluzel, Neïla Benameur, Philippe A. Grenier, Ahmed Idbaih, Baptiste Hervier, Laurent Arnaud, and Zahir Amoura, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière; Philippe Maksud, Stéphane Barete, Frédéric Charlotte, Philippe Cluzel, Philippe A. Grenier, Ahmed Idbaih, Julien Haroche, Fleur Cohen-Aubart, Baptiste Hervier, Laurent Arnaud, and Zahir Amoura, Paris VI University Pierre et Marie Curie; Jean Donadieu, AP-HP, Hôpital Trousseau, French National Center for Histiocytosis, Paris; Jean-François Emile, EA4340-BCOH, Versailles University, and AP-HP, Hôpital Ambroise Paré, Boulogne; Sophie Besnard, Centre Hospitalier Universitaire de Rennes, Pontchaillou University Hospital, Rennes Cedex; Jean-Paul Ory, Centre Hospitalier Régional de Vesoul, Vesoul; François Lifermann, Hôpital de Dax-Côte d'Argent, Dax; Brigitte Granel, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille; and Bruno Graffin, Hôpital d'Instruction des Armées Legouest, Metz, France
| | - Sophie Besnard
- Julien Haroche, Fleur Cohen-Aubart, Philippe Maksud, Aurélie Drier, Dan Tolédano, Stéphane Barete, Frédéric Charlotte, Philippe Cluzel, Neïla Benameur, Philippe A. Grenier, Ahmed Idbaih, Baptiste Hervier, Laurent Arnaud, and Zahir Amoura, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière; Philippe Maksud, Stéphane Barete, Frédéric Charlotte, Philippe Cluzel, Philippe A. Grenier, Ahmed Idbaih, Julien Haroche, Fleur Cohen-Aubart, Baptiste Hervier, Laurent Arnaud, and Zahir Amoura, Paris VI University Pierre et Marie Curie; Jean Donadieu, AP-HP, Hôpital Trousseau, French National Center for Histiocytosis, Paris; Jean-François Emile, EA4340-BCOH, Versailles University, and AP-HP, Hôpital Ambroise Paré, Boulogne; Sophie Besnard, Centre Hospitalier Universitaire de Rennes, Pontchaillou University Hospital, Rennes Cedex; Jean-Paul Ory, Centre Hospitalier Régional de Vesoul, Vesoul; François Lifermann, Hôpital de Dax-Côte d'Argent, Dax; Brigitte Granel, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille; and Bruno Graffin, Hôpital d'Instruction des Armées Legouest, Metz, France
| | - Jean-Paul Ory
- Julien Haroche, Fleur Cohen-Aubart, Philippe Maksud, Aurélie Drier, Dan Tolédano, Stéphane Barete, Frédéric Charlotte, Philippe Cluzel, Neïla Benameur, Philippe A. Grenier, Ahmed Idbaih, Baptiste Hervier, Laurent Arnaud, and Zahir Amoura, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière; Philippe Maksud, Stéphane Barete, Frédéric Charlotte, Philippe Cluzel, Philippe A. Grenier, Ahmed Idbaih, Julien Haroche, Fleur Cohen-Aubart, Baptiste Hervier, Laurent Arnaud, and Zahir Amoura, Paris VI University Pierre et Marie Curie; Jean Donadieu, AP-HP, Hôpital Trousseau, French National Center for Histiocytosis, Paris; Jean-François Emile, EA4340-BCOH, Versailles University, and AP-HP, Hôpital Ambroise Paré, Boulogne; Sophie Besnard, Centre Hospitalier Universitaire de Rennes, Pontchaillou University Hospital, Rennes Cedex; Jean-Paul Ory, Centre Hospitalier Régional de Vesoul, Vesoul; François Lifermann, Hôpital de Dax-Côte d'Argent, Dax; Brigitte Granel, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille; and Bruno Graffin, Hôpital d'Instruction des Armées Legouest, Metz, France
| | - François Lifermann
- Julien Haroche, Fleur Cohen-Aubart, Philippe Maksud, Aurélie Drier, Dan Tolédano, Stéphane Barete, Frédéric Charlotte, Philippe Cluzel, Neïla Benameur, Philippe A. Grenier, Ahmed Idbaih, Baptiste Hervier, Laurent Arnaud, and Zahir Amoura, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière; Philippe Maksud, Stéphane Barete, Frédéric Charlotte, Philippe Cluzel, Philippe A. Grenier, Ahmed Idbaih, Julien Haroche, Fleur Cohen-Aubart, Baptiste Hervier, Laurent Arnaud, and Zahir Amoura, Paris VI University Pierre et Marie Curie; Jean Donadieu, AP-HP, Hôpital Trousseau, French National Center for Histiocytosis, Paris; Jean-François Emile, EA4340-BCOH, Versailles University, and AP-HP, Hôpital Ambroise Paré, Boulogne; Sophie Besnard, Centre Hospitalier Universitaire de Rennes, Pontchaillou University Hospital, Rennes Cedex; Jean-Paul Ory, Centre Hospitalier Régional de Vesoul, Vesoul; François Lifermann, Hôpital de Dax-Côte d'Argent, Dax; Brigitte Granel, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille; and Bruno Graffin, Hôpital d'Instruction des Armées Legouest, Metz, France
| | - Ahmed Idbaih
- Julien Haroche, Fleur Cohen-Aubart, Philippe Maksud, Aurélie Drier, Dan Tolédano, Stéphane Barete, Frédéric Charlotte, Philippe Cluzel, Neïla Benameur, Philippe A. Grenier, Ahmed Idbaih, Baptiste Hervier, Laurent Arnaud, and Zahir Amoura, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière; Philippe Maksud, Stéphane Barete, Frédéric Charlotte, Philippe Cluzel, Philippe A. Grenier, Ahmed Idbaih, Julien Haroche, Fleur Cohen-Aubart, Baptiste Hervier, Laurent Arnaud, and Zahir Amoura, Paris VI University Pierre et Marie Curie; Jean Donadieu, AP-HP, Hôpital Trousseau, French National Center for Histiocytosis, Paris; Jean-François Emile, EA4340-BCOH, Versailles University, and AP-HP, Hôpital Ambroise Paré, Boulogne; Sophie Besnard, Centre Hospitalier Universitaire de Rennes, Pontchaillou University Hospital, Rennes Cedex; Jean-Paul Ory, Centre Hospitalier Régional de Vesoul, Vesoul; François Lifermann, Hôpital de Dax-Côte d'Argent, Dax; Brigitte Granel, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille; and Bruno Graffin, Hôpital d'Instruction des Armées Legouest, Metz, France
| | - Brigitte Granel
- Julien Haroche, Fleur Cohen-Aubart, Philippe Maksud, Aurélie Drier, Dan Tolédano, Stéphane Barete, Frédéric Charlotte, Philippe Cluzel, Neïla Benameur, Philippe A. Grenier, Ahmed Idbaih, Baptiste Hervier, Laurent Arnaud, and Zahir Amoura, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière; Philippe Maksud, Stéphane Barete, Frédéric Charlotte, Philippe Cluzel, Philippe A. Grenier, Ahmed Idbaih, Julien Haroche, Fleur Cohen-Aubart, Baptiste Hervier, Laurent Arnaud, and Zahir Amoura, Paris VI University Pierre et Marie Curie; Jean Donadieu, AP-HP, Hôpital Trousseau, French National Center for Histiocytosis, Paris; Jean-François Emile, EA4340-BCOH, Versailles University, and AP-HP, Hôpital Ambroise Paré, Boulogne; Sophie Besnard, Centre Hospitalier Universitaire de Rennes, Pontchaillou University Hospital, Rennes Cedex; Jean-Paul Ory, Centre Hospitalier Régional de Vesoul, Vesoul; François Lifermann, Hôpital de Dax-Côte d'Argent, Dax; Brigitte Granel, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille; and Bruno Graffin, Hôpital d'Instruction des Armées Legouest, Metz, France
| | - Bruno Graffin
- Julien Haroche, Fleur Cohen-Aubart, Philippe Maksud, Aurélie Drier, Dan Tolédano, Stéphane Barete, Frédéric Charlotte, Philippe Cluzel, Neïla Benameur, Philippe A. Grenier, Ahmed Idbaih, Baptiste Hervier, Laurent Arnaud, and Zahir Amoura, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière; Philippe Maksud, Stéphane Barete, Frédéric Charlotte, Philippe Cluzel, Philippe A. Grenier, Ahmed Idbaih, Julien Haroche, Fleur Cohen-Aubart, Baptiste Hervier, Laurent Arnaud, and Zahir Amoura, Paris VI University Pierre et Marie Curie; Jean Donadieu, AP-HP, Hôpital Trousseau, French National Center for Histiocytosis, Paris; Jean-François Emile, EA4340-BCOH, Versailles University, and AP-HP, Hôpital Ambroise Paré, Boulogne; Sophie Besnard, Centre Hospitalier Universitaire de Rennes, Pontchaillou University Hospital, Rennes Cedex; Jean-Paul Ory, Centre Hospitalier Régional de Vesoul, Vesoul; François Lifermann, Hôpital de Dax-Côte d'Argent, Dax; Brigitte Granel, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille; and Bruno Graffin, Hôpital d'Instruction des Armées Legouest, Metz, France
| | - Baptiste Hervier
- Julien Haroche, Fleur Cohen-Aubart, Philippe Maksud, Aurélie Drier, Dan Tolédano, Stéphane Barete, Frédéric Charlotte, Philippe Cluzel, Neïla Benameur, Philippe A. Grenier, Ahmed Idbaih, Baptiste Hervier, Laurent Arnaud, and Zahir Amoura, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière; Philippe Maksud, Stéphane Barete, Frédéric Charlotte, Philippe Cluzel, Philippe A. Grenier, Ahmed Idbaih, Julien Haroche, Fleur Cohen-Aubart, Baptiste Hervier, Laurent Arnaud, and Zahir Amoura, Paris VI University Pierre et Marie Curie; Jean Donadieu, AP-HP, Hôpital Trousseau, French National Center for Histiocytosis, Paris; Jean-François Emile, EA4340-BCOH, Versailles University, and AP-HP, Hôpital Ambroise Paré, Boulogne; Sophie Besnard, Centre Hospitalier Universitaire de Rennes, Pontchaillou University Hospital, Rennes Cedex; Jean-Paul Ory, Centre Hospitalier Régional de Vesoul, Vesoul; François Lifermann, Hôpital de Dax-Côte d'Argent, Dax; Brigitte Granel, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille; and Bruno Graffin, Hôpital d'Instruction des Armées Legouest, Metz, France
| | - Laurent Arnaud
- Julien Haroche, Fleur Cohen-Aubart, Philippe Maksud, Aurélie Drier, Dan Tolédano, Stéphane Barete, Frédéric Charlotte, Philippe Cluzel, Neïla Benameur, Philippe A. Grenier, Ahmed Idbaih, Baptiste Hervier, Laurent Arnaud, and Zahir Amoura, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière; Philippe Maksud, Stéphane Barete, Frédéric Charlotte, Philippe Cluzel, Philippe A. Grenier, Ahmed Idbaih, Julien Haroche, Fleur Cohen-Aubart, Baptiste Hervier, Laurent Arnaud, and Zahir Amoura, Paris VI University Pierre et Marie Curie; Jean Donadieu, AP-HP, Hôpital Trousseau, French National Center for Histiocytosis, Paris; Jean-François Emile, EA4340-BCOH, Versailles University, and AP-HP, Hôpital Ambroise Paré, Boulogne; Sophie Besnard, Centre Hospitalier Universitaire de Rennes, Pontchaillou University Hospital, Rennes Cedex; Jean-Paul Ory, Centre Hospitalier Régional de Vesoul, Vesoul; François Lifermann, Hôpital de Dax-Côte d'Argent, Dax; Brigitte Granel, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille; and Bruno Graffin, Hôpital d'Instruction des Armées Legouest, Metz, France
| | - Zahir Amoura
- Julien Haroche, Fleur Cohen-Aubart, Philippe Maksud, Aurélie Drier, Dan Tolédano, Stéphane Barete, Frédéric Charlotte, Philippe Cluzel, Neïla Benameur, Philippe A. Grenier, Ahmed Idbaih, Baptiste Hervier, Laurent Arnaud, and Zahir Amoura, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière; Philippe Maksud, Stéphane Barete, Frédéric Charlotte, Philippe Cluzel, Philippe A. Grenier, Ahmed Idbaih, Julien Haroche, Fleur Cohen-Aubart, Baptiste Hervier, Laurent Arnaud, and Zahir Amoura, Paris VI University Pierre et Marie Curie; Jean Donadieu, AP-HP, Hôpital Trousseau, French National Center for Histiocytosis, Paris; Jean-François Emile, EA4340-BCOH, Versailles University, and AP-HP, Hôpital Ambroise Paré, Boulogne; Sophie Besnard, Centre Hospitalier Universitaire de Rennes, Pontchaillou University Hospital, Rennes Cedex; Jean-Paul Ory, Centre Hospitalier Régional de Vesoul, Vesoul; François Lifermann, Hôpital de Dax-Côte d'Argent, Dax; Brigitte Granel, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille; and Bruno Graffin, Hôpital d'Instruction des Armées Legouest, Metz, France
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Haroche J, Cohen-Aubart F, Arnaud L, Hervier B, Charlotte F, Drier A, Gorochov G, Grenier P, Cluzel P, Maksud P, Emile JF, Amoura Z. Maladie d’Erdheim-Chester. Rev Med Interne 2014; 35:715-22. [DOI: 10.1016/j.revmed.2014.04.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Revised: 01/14/2014] [Accepted: 04/14/2014] [Indexed: 10/25/2022]
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Cohen-Aubart F, Emile JF, Maksud P, Galanaud D, Idbaih A, Chauvet D, Amar Y, Benameur N, Amoura Z, Haroche J. Marked efficacy of vemurafenib in suprasellar Erdheim-Chester disease. Neurology 2014; 83:1294-6. [DOI: 10.1212/wnl.0000000000000832] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Haroche J, Cohen-Aubart F, Emile JF, Arnaud L, Maksud P, Charlotte F, Cluzel P, Drier A, Hervier B, Benameur N, Besnard S, Donadieu J, Amoura Z. Dramatic efficacy of vemurafenib in both multisystemic and refractory Erdheim-Chester disease and Langerhans cell histiocytosis harboring the BRAF V600E mutation. Blood 2013; 121:1495-500. [PMID: 23258922 DOI: 10.1182/blood-2012-07-446286] [Citation(s) in RCA: 372] [Impact Index Per Article: 33.8] [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: 02/06/2023] Open
Abstract
Histiocytoses are rare disorders of unknown origin with highly heterogeneous prognosis. BRAFV600E gain-of-function mutations have been observed in 57% of cases of Langerhans cell histiocytosis (LCH) and 54% of cases of Erdheim-Chester disease (ECD), but not in other types of histiocytoses. Targeted therapy with an inhibitor of mutated BRAF (vemurafenib) improves survival of patients with melanoma. Here, we report vemurafenib treatment of 3 patients with multisystemic and refractory ECD carrying the BRAFV600E mutation; 2 also had skin or lymph node LCH involvement. The patients were assessed clinically, biologically (CRP values), histologically (skin biopsy), and morphologically (positron emission tomography [PET], computed tomography and magnetic resonance imaging). For all patients, vemurafenib treatment led to substantial and rapid clinical and biologic improvement, and the tumor response was confirmed by PET, computed tomography, and/or magnetic resonance imaging 1 month after treatment initiation. For the first patient treated, the PET response increased between months 1 and 4 of treatment. The treatment remained effective after 4 months of follow-up although persistent disease activity was still observed. Treatment with vemurafenib, a newly approved BRAF inhibitor, should be considered for patients with severe and refractory BRAFV600E histiocytoses, particularly when the disease is life-threatening.
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Affiliation(s)
- Julien Haroche
- Department of Internal Medicine and French Reference Center for Rare Auto-immune and Systemic Diseases, Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière Hospital, Paris, France.
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Clarençon F, Jean B, Pham HP, Cormier E, Bensimon G, Rose M, Maksud P, Chiras J. Value of percutaneous radiofrequency ablation with or without percutaneous vertebroplasty for pain relief and functional recovery in painful bone metastases. Skeletal Radiol 2013; 42:25-36. [PMID: 22080377 DOI: 10.1007/s00256-011-1294-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [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: 05/01/2011] [Revised: 08/19/2011] [Accepted: 09/23/2011] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of percutaneous radiofrequency (RF) ablation with or without percutaneous vertebroplasty (PV) on pain relief, functional recovery and local recurrence at 6 months' follow-up (FU), in patients with painful osseous metastases. MATERIALS AND METHODS Thirty RF ablations were performed in 24 patients (mean age: 61 years) with bone metastases. Half of the patients had an additional PV. The primary end point was pain relief evaluated by a visual analogue scale (VAS) before treatment, and at 1 and 6 months' FU. Functional outcome was assessed according to the evolution of their ability to walk at 6 months' FU. Imaging FU was available in 20 out of 24 patients with a mean delay of 4.7 months. RESULTS Reduction of pain was obtained at 6 months FU in 81% of cases (15 out of 18). Mean pretreatment VAS was 6.4 (±2.7). Mean VAS was 1.9 (±2.4) at 1 month FU, and 2.3 (±2.9) at 6 months' FU. Pain was significantly reduced at 6 months FU (mean VAS reduction = 4.1; P < 0.00001). Functional improvement was obtained in 74% of the cases. Major complications rate was 12.5 % (3 out of 24) with 2 skin burns, and 1 case of myelopathy. Local tumour recurrence or progression was recorded in 5 cases. CONCLUSION Radiofrequency ablation is an effective technique in terms of pain relief and functional recovery for the treatment of bone metastases, which provides a relatively low rate of local recurrence.
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Affiliation(s)
- Frédéric Clarençon
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, 47, Boulevard de l'Hôpital, 75013, Paris, France.
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Consoli A, Ronen K, An-Gourfinkel I, Barbeau M, Marra D, Costedoat-Chalumeau N, Montefiore D, Maksud P, Bonnot O, Didelot A, Amoura Z, Vidailhet M, Cohen D. Malignant catatonia due to anti-NMDA-receptor encephalitis in a 17-year-old girl: case report. Child Adolesc Psychiatry Ment Health 2011; 5:15. [PMID: 21569502 PMCID: PMC3121673 DOI: 10.1186/1753-2000-5-15] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Accepted: 05/13/2011] [Indexed: 01/17/2023] Open
Abstract
Anti-NMDA-Receptor encephalitis is a severe form of encephalitis that was recently identified in the context of acute neuropsychiatric presentation. Here, we describe the case of a 17-year-old girl referred for an acute mania with psychotic features and a clinical picture deteriorated to a catatonic state. Positive diagnosis of anti-NMDA-receptor encephalitis suggested specific treatment. She improved after plasma exchange and immunosuppressive therapy. Post-cognitive sequelae (memory impairment) disappeared within 2-year follow-up and intensive cognitive rehabilitation.
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Affiliation(s)
- Angèle Consoli
- Department of Child and Adolescent Psychiatry, Université Pierre et Marie Curie, Hôpital Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013, Paris, France.
| | - Karine Ronen
- Department of Child and Adolescent Psychiatry, Université Pierre et Marie Curie, Hôpital Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013, Paris, France
| | - Isabelle An-Gourfinkel
- Department of Neurology, Université Pierre et Marie Curie, Hôpital Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013, Paris, France
| | - Martine Barbeau
- Department of Child and Adolescent Psychiatry, Université Pierre et Marie Curie, Hôpital Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013, Paris, France
| | - Donata Marra
- Department of Internal Medicine, Université Pierre et Marie Curie, Hôpital Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013, Paris, France
| | - Nathalie Costedoat-Chalumeau
- Department of Internal Medicine, Université Pierre et Marie Curie, Hôpital Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013, Paris, France
| | - Delphine Montefiore
- Department of Adult Psychiatry, Université Pierre et Marie Curie, Hôpital Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013, Paris, France
| | - Philippe Maksud
- Department of Nuclear Medicine, Université Pierre et Marie Curie, Hôpital Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013, Paris, France
| | - Olivier Bonnot
- Department of Child and Adolescent Psychiatry, Université Pierre et Marie Curie, Hôpital Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013, Paris, France
| | - Adrien Didelot
- Reference center of paraneoplastic neurological syndrome diagnosis and treatment, Hôpital Pierre Wertheimer, 59, bld Pinel, 69 003 Lyon
| | - Zahir Amoura
- Department of Internal Medicine, Université Pierre et Marie Curie, Hôpital Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013, Paris, France
| | - Marie Vidailhet
- Department of Neurology, Université Pierre et Marie Curie, Hôpital Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013, Paris, France
| | - David Cohen
- Department of Child and Adolescent Psychiatry, Université Pierre et Marie Curie, Hôpital Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013, Paris, France
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Horn JF, Habert MO, Kas A, Malek Z, Maksud P, Lacomblez L, Giron A, Fertil B. Differential automatic diagnosis between Alzheimer's disease and frontotemporal dementia based on perfusion SPECT images. Artif Intell Med 2009; 47:147-58. [PMID: 19481429 DOI: 10.1016/j.artmed.2009.05.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2008] [Revised: 02/08/2009] [Accepted: 05/03/2009] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Alzheimer's disease (AD) and frontotemporal dementia (FTD) are among the most frequent neurodegenerative cognitive disorders, but their differential diagnosis is difficult. The aim of this study was to evaluate an automatic method returning the probability that a patient suffers from AD or FTD from the analysis of brain perfusion single photon emission computed tomography images. METHODS AND MATERIALS A set of 116 descriptors corresponding to the average activity in regions of interest was calculated from the images of 82 AD and 91 FTD patients. A set of linear (logistic regression and linear discriminant analysis) and non-linear (support vector machines, k-nearest neighbours, multilayer perceptron and kernel logistic PLS) classification methods was subsequently used to ascertain diagnoses. Validation was carried out by means of the leave-one-out protocol. Diagnoses by the classifier and by four physicians (visual assessment) were compared. Since images were acquired in different hospitals, the impact of the medical centre on the diagnosis of both the classifier and the physicians was investigated. RESULTS Best results were obtained with support vector machine and partial least squares regression coupled with k-nearest neighbours methods (PLS+K-NN), with an overall accuracy of 88%. PLS+K-NN was however considered as the best method since performances obtained with leave-one-out cross-validation were closer to whole-database learning. The performances of the classifier were higher than those of experts (accuracy ranged from 65 to 72%). Physicians found it more difficult to diagnose the images from centres other than their own, and it affected their performances. CONCLUSIONS The performances obtained by the classifier for the differential diagnosis of AD and FTD were found convincing. It could help physicians in daily practice, particularly when visual assessment is inconclusive, or when dealing with multicentre data.
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Affiliation(s)
- Jean-François Horn
- INSERM, U678, CHU Pitié-Salpêtrière, 91 boulevard de l'Hôpital, 75634 Paris Cedex 13, France.
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Habert MO, Lacomblez L, Maksud P, El Fakhri G, Pradat JF, Meininger V. Brain perfusion imaging in amyotrophic lateral sclerosis: extent of cortical changes according to the severity and topography of motor impairment. ACTA ACUST UNITED AC 2007; 8:9-15. [PMID: 17364429 DOI: 10.1080/14660820601048815] [Citation(s) in RCA: 17] [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: 10/23/2022]
Abstract
In amyotrophic lateral sclerosis (ALS), attempts have been made to correlate the extent of cortical lesions with the intensity of motor dysfunction in ALS patients. Our aim was to compare the cerebral perfusion as measured by SPECT with the topography and severity of motor impairment as measured by ALSFRS. Fifty-five patients with sporadic ALS were included. 99mTc-ECD brain perfusion tomographic studies were performed and reconstructed slices analysed with a voxel-based statistical method (Statistical Parametric Mapping). Correlations between ALSFRS total score and sub-scores were calculated. We observed a positive correlation between the degree of involvement of the motor functions as measured by the ALSFRS score and the perfusion decrease of the cerebral cortex. Analysis of the ALSFRS sub-scores revealed that the cortical involvement was important for lower limbs score, moderate for bulbar score and below the level of statistical significance for the respiratory and upper limb scores. The decrease of perfusion was asymmetrical (right hemisphere) and observed mainly in the lateral premotor cortex, the insula and the cingulate cortex. Our study confirms that in ALS the cortical involvement is asymmetrical and predominant in the premotor region and the insula.
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Affiliation(s)
- Marie-Odile Habert
- Département de Médecine Nucléaire, Hôpital Pitié-Salpêtrière, Pares, France.
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Abstract
STUDY OBJECTIVE To identify the neural structures and pathways underlying cataplexy during status cataplecticus in a narcoleptic patient, using brain perfusion single photon emission computed tomography (SPECT). METHODS A 68-year-old woman with hypocretin-deficient narcolepsy-cataplexy suffered status cataplecticus after having stopped clomipramine. She underwent a 99mTc-ethylcysteinate dimer brain SPECT during an episode of cataplexy; this image was compared with her brain SPECT during an intervening asymptomatic period. Subtraction SPECT coregistered to magnetic resonance imaging (MRI)(SISCOM)-determined anatomic areas differentially perfused during cataplexy and basal wakefulness state. RESULTS The areas hyperactivated during cataplexy corresponded on brain MRI with the cingular area, the left and right orbitofrontal cortex, the right temporal cortex, and the right putamen. No significant hypoperfused region was observed during the cataplectic episode. DISCUSSION Cataplexy during status cataplecticus partially resembles normal rapid eye movement sleep (with high cingular, orbitofrontal, and putamen activity) but without the other imaging characteristics of this state (no hyperactivation of the pons, amygdale, or occipital cortex).
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Abstract
PURPOSE Ictal single-photon emission computed tomography (SPECT) may help localize the seizure-onset zone (SOZ) by detecting changes in regional cerebral blood flow induced by epileptic discharges. This imaging method also reveals hyperperfusions in areas of seizure propagation, including the hemisphere contralateral to the SOZ. We have studied the occurrence, the topography, and the clinical value of such contralateral ictal hyperperfusion areas (HPAs). METHODS We examined data from presurgical evaluations of 36 consecutive patients with pharmacoresistant partial epilepsy of various localizations. Ictal and interictal SPECT examinations were made with 99mTc-ECD, and the scans were processed for coregistration, normalization, subtraction, and merging with MRI images. RESULTS Contralateral HPAs were observed in 72% of the patients: 50% of mesiotemporal epilepsy cases with hippocampal sclerosis, 85.7% of the other mesiotemporal epilepsies, 85.7% of neocortical lateral temporal epilepsies, and 87.5% of extratemporal epilepsies. Contralateral HPAs were usually symmetrical to the SOZ, forming a mirror image, observed in 57.1% of the patients. They could be slightly asymmetrical in mesiotemporal epilepsies, perhaps because of the particular anatomic pathways linking temporal lobes. In neocortical epilepsies, they were located in the cortex homotopic to the SOZ. CONCLUSIONS We show that the symmetrical nature of the mirror image usually does not disturb SPECT interpretation. It can confirm the location of the SOZ (11 patients) and even occasionally improve the precision of its definition (nine patients) by restraining several potential SOZ-related HPAs to a single one or by permitting a restricted localization of the SOZ in a large HPA.
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Affiliation(s)
- Gilles Huberfeld
- Epileptology Unit, INSERM U739, Cortec & Epilepsie, Faculté de Médecine, Hopital Pitié Salpêtrière, Paris, France.
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Abstract
PURPOSE Ictal single-photon emission computed tomography (SPECT) may help localize the seizure-onset zone (SOZ) by detecting changes in regional cerebral blood flow induced by epileptic discharges. This imaging method also reveals hyperperfusions in areas of seizure propagation, including the hemisphere contralateral to the SOZ. We have studied the occurrence, the topography, and the clinical value of such contralateral ictal hyperperfusion areas (HPAs). METHODS We examined data from presurgical evaluations of 36 consecutive patients with pharmacoresistant partial epilepsy of various localizations. Ictal and interictal SPECT examinations were made with 99mTc-ECD, and the scans were processed for coregistration, normalization, subtraction, and merging with MRI images. RESULTS Contralateral HPAs were observed in 72% of the patients: 50% of mesiotemporal epilepsy cases with hippocampal sclerosis, 85.7% of the other mesiotemporal epilepsies, 85.7% of neocortical lateral temporal epilepsies, and 87.5% of extratemporal epilepsies. Contralateral HPAs were usually symmetrical to the SOZ, forming a mirror image, observed in 57.1% of the patients. They could be slightly asymmetrical in mesiotemporal epilepsies, perhaps because of the particular anatomic pathways linking temporal lobes. In neocortical epilepsies, they were located in the cortex homotopic to the SOZ. CONCLUSIONS We show that the symmetrical nature of the mirror image usually does not disturb SPECT interpretation. It can confirm the location of the SOZ (11 patients) and even occasionally improve the precision of its definition (nine patients) by restraining several potential SOZ-related HPAs to a single one or by permitting a restricted localization of the SOZ in a large HPA.
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Affiliation(s)
- Gilles Huberfeld
- Epileptology Unit, INSERM U739, Cortec & Epilepsie, Faculté de Médecine, Hopital Pitié Salpêtrière, Paris, France.
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El Fakhri G, Habert MO, Maksud P, Kas A, Malek Z, Kijewski MF, Lacomblez L. Quantitative simultaneous (99m)Tc-ECD/123I-FP-CIT SPECT in Parkinson's disease and multiple system atrophy. Eur J Nucl Med Mol Imaging 2005; 33:87-92. [PMID: 16180033 DOI: 10.1007/s00259-005-1920-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2005] [Accepted: 07/21/2005] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to investigate the feasibility and utility of dual-isotope SPECT for differential diagnosis of idiopathic Parkinson's disease (IPD) and multiple system atrophy (MSA). METHODS Simultaneous (99m)Tc-ECD/123I-FP-CIT studies were performed in nine normal controls, five IPD patients, and five MSA patients. Projections were corrected for scatter, cross-talk, and high-energy penetration, and iteratively reconstructed while correcting for patient-specific attenuation and variable collimator response. Perfusion and dopamine transporter (DAT) function were assessed using voxel-based statistical parametric mapping (SPM2) and volume of interest quantitation. DAT binding potential (BP) and asymmetry index (AI) were estimated in the putamen and caudate nucleus. RESULTS Striatal BP was lower in IPD (55%) and MSA (23%) compared to normal controls (p<0.01) , and in IPD compared to MSA (p<0.05). AI was greater for IPD than for MSA and controls in both the caudate nucleus and the putamen (p<0.05). There was significantly decreased perfusion in the left and right nucleus lentiformis in MSA compared to IPD and controls (p<0.05). CONCLUSION Dual-isotope studies are both feasible in and promising for the diagnosis of parkinsonian syndromes.
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Affiliation(s)
- Georges El Fakhri
- Division of Nuclear Medicine, Department of Radiology, Harvard Medical School and Brigham and Women's Hospital, Boston, MA, USA.
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Isnard Bagnis C, Tezenas du Montcel S, Beaufils H, Jouanneau C, Jaudon MC, Maksud P, Mallet A, LeHoang P, Deray G. Long-term renal effects of low-dose cyclosporine in uveitis-treated patients: follow-up study. J Am Soc Nephrol 2002; 13:2962-8. [PMID: 12444215 DOI: 10.1097/01.asn.0000034945.61533.26] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.5] [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] Open
Abstract
Cyclosporine (CsA), a widely used immunosuppressive drug, is an effective treatment of sight-threatening posterior idiopathic uveitis. CsA's main side effect is nephrotoxicity. The aim of this single-center prospective cohort study (conducted in a tertiary care teaching hospital in Paris, France) was to assess the long-term renal tolerance of a low-dose CsA treatment in patients with previously healthy kidneys on clinical, biologic, and pathologic criteria. Forty-one patients treated with 4.3 +/- 1.6 mg/kg body wt per day CsA for 44.9 +/- 3.6 mo were included. Mean follow-up was 55.4 +/- 0.2 mo. BP, CsA trough level, and renal function were prospectively monitored together with blood urea, creatinine clearance, GFR, and effective renal plasma flow. Eleven patients underwent serial kidney biopsies before and after 2 yr of a 4 +/- 0.9 mg/kg daily CsA treatment. Sustained low-dose CsA treatment induced a significant increase in plasma creatinine (P < 0.0001), a significant decrease in creatinine clearance (P < 0.0001), and isotopic GFR (P < 0.0001) over time. The highest dose induced more severe alterations in any of the renal parameters than the lowest dose. Prevalence of hypertension was particularly high. Histopathologic data showed significant interstitial fibrosis (P < 0.003) and tubular atrophy (P < 0.003) after 2 yr. Low-dose long-term CsA treatment induces significant renal impairment and a high incidence of hypertension. Our study suggests that lowering daily dosage may prevent CsA-induced nephrotoxicity if a daily dose of < or =3 mg/kg is used. Whether once established it is reversible is still prospective, although the occurrence of interstitial fibrosis in the kidney would argue against reversibility.
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Affiliation(s)
- Corinne Isnard Bagnis
- Department of Nephrology, Pitié-Salpétrière Hospital, 83 Boulevard de l'Hôpital, 75013 Paris, France.
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Izzedine H, Koskas F, Cluzel P, Mallet A, Maksud P, Deray G. Renal function after aortic stent-grafting including coverage of renal arterial ostia. Am J Kidney Dis 2002; 39:730-6. [PMID: 11920338 DOI: 10.1053/ajkd.2002.31992] [Citation(s) in RCA: 21] [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: 11/11/2022]
Abstract
Considerable experience has been gained with endoluminal stent-graft techniques for the treatment of infrarenal aortic aneurysms. The inclusion of uncovered suprarenal stents eases the treatment of cases with a short, angulated, or bottlenecked proximal neck. However, few data have been published on the effect of a stent-graft crossing renal artery ostia on long-term renal function. We therefore retrospectively analyzed the influence of intra-aortic stent-grafts, including suprarenal fixation on long-term renal function. Thirty-nine patients who received a Gianturco Z stent across renal artery ostia as part of a made-to-measure stent-graft treating an infrarenal aortic aneurysm were evaluated at 6 (all patients) and 30 months (15 patients) after surgery. Renal function evaluation included serum creatinine level, creatinine clearance using the Cockcroft-Gault formula, and renal tomography. Initial technical success was achieved in all patients. There were no minor or major complications. Mean serum creatinine levels were 1.16 +/- 0.25, 1.12 +/- 0.28, and 1.24 +/- 0.25 mg/dL before and 6 and 30 months after endoluminal stent-graft performance, respectively (P = not significant [NS]). Mean creatinine clearances were 60.3 +/- 19.7, 63 +/- 23, and 60.6 +/- 17.5 mL/min before and 6 and 30 months after endoluminal stent-graft performance, respectively (P = NS). Only two patients (5%) had a decrease in glomerular filtration rate greater than 20% at 6 months. Both patients had renal insufficiency before endovascular grafting. Renal function was stable in all patients at 30 months' follow-up. We suggest that renal function is unaffected by coverage of renal arterial ostia with Gianturco Z stents.
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Affiliation(s)
- Hassane Izzedine
- Department of Nephrology, Pitié Salpétrière Hospital, Paris, France.
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El Fakhri G, Moore SC, Maksud P, Aurengo A, Kijewski MF. Absolute activity quantitation in simultaneous 123I/99mTc brain SPECT. J Nucl Med 2001; 42:300-8. [PMID: 11216530] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
UNLABELLED Dual-isotope imaging can allow simultaneous assessment of brain perfusion using a 99mTc-labeled tracer and neurotransmission using an 123I-labeled tracer. However, the images are affected by scatter, cross talk, attenuation, distance-dependent collimator response (DCR), and partial-volume effect. We determined the accuracy and precision of activity quantitation in simulated normal and pathologic studies of simultaneous 123I/99mTc brain SPECT when compensating for all degrading phenomena. METHODS Monte Carlo simulations were performed using the Zubal brain phantom. Contamination caused by high-energy 123I decay photons was incorporated. Twenty-four 99mTc and 123I activity distributions were simulated on the basis of normal and pathologic patient activity distributions. Cross talk and scatter were corrected using a new method based on a multilayer perceptron artificial neural network (ANN), as well as by the asymmetric window (AW) approach; for comparison, unscattered (U) photons of 99mTc and 123I were recorded. Nonuniform attenuation and DCR were modeled in an iterative ordered-subset expectation maximization (OSEM) algorithm. Mean percentage biases and SDs over the 12 normal and 12 pathologic simulated studies were computed for each structure with respect to the known activity distributions. RESULTS For 123I, AW + OSEM yielded a bias of 7% in the cerebellum, 21% in the frontal cortex, and 36% in the corpus callosum in the simulated normal population. The bias was increased significantly in the striata of simulated pathologic studies (P < 0.05). The bias associated with ANN was significantly lower (<9% in these brain structures, P < 0.05). For 99mTc with AW + OSEM, the bias was 60% in the corpus callosum, 36% in the striata, and 18%-22% in the cortical lobes in the simulated normal population. This bias was <11% in all brain structures with ANN. In the simulated pathologic population, the bias associated with AW increased significantly in the cortical lobes to 55% (P < 0.05), although it did not change significantly with ANN. CONCLUSION The accuracy and variability over simulated normal and pathologic studies of both 99mTc and 123I activity estimates were very close with ANN to those obtained with U + OSEM. ANN + OSEM is a promising approach for absolute activity quantitation in simultaneous 99mTc/123I SPECT.
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Affiliation(s)
- G El Fakhri
- Department of Radiology, Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts 02115, USA
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Maksud P, Fertil B, Rica C, El Fakhri G, Aurengo A. Artificial neural network as a tool to compensate for scatter and attenuation in radionuclide imaging. J Nucl Med 1998; 39:735-45. [PMID: 9544691] [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: 02/07/2023] Open
Abstract
UNLABELLED This study investigates the ability of artificial neural networks (ANN) to simultaneously correct for attenuation and Compton scattering in scintigraphic imaging. METHODS Three sets of experiments are conducted using images of radioactive sources with various shapes and distributions in a homogeneous medium. Numerical Monte Carlo simulations and physical phantom acquisitions of radioactive geometric sources provide the basic material for correction. Our method is based on the following assumptions: information needed to correct for scattering can be extracted from the energy spectrum at each pixel without any assumption concerning the source distribution, and two diametrically opposed energy spectrum acquisitions yield enough information on the source location in the diffusing medium for simultaneous correction for attenuation and scattering. RESULTS Qualitative and quantitative evaluations of scatter correction by ANN demonstrate its ability to perform scatter correction from the energy spectra observed in each pixel. By using the energy spectra of incident photons detected in two diametrically opposed images, multilayer neural networks are able to perform a proper restitution of projection images without any assumption on geometry or position of radioactive sources in simple geometric cases. ANN corrections compare favorably to those provided by five of the most popular methods. A satisfying correction of both scatter and attenuation is observed for a human pelvis scan obtained during routine clinical practice. CONCLUSION An ANN is an efficient tool for attenuation and Compton scattering in simple model cases. The results obtained for routine scintigrams in a much more complex situation are strong incentives for performing further studies.
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Affiliation(s)
- P Maksud
- Institut National de la Santé et de la Recherche Médicale Unité 66, Paris, France
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Abstract
We describe a primitive hyperparathyroid in a old woman due to a parathyroid adenoma localized by Technetium 99m, Thallium 201 scintigraphy within the thyroid gland. During surgery, this adenoma was found inside a thyroid adenoma. It is the second case reported on the literature in a such localization. We underline the interest of the scintigraphy Technetium 99m, Thallium 201, for the detection of ectopic parathyroid adenoma.
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Affiliation(s)
- K Chemlal
- Service de médecine interne, CHU Pitié-Salpêtrière, Paris, France
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Deray G, Benhmida M, Le Hoang P, Maksud P, Aupetit B, Baumelou A, Jacobs C. Renal function and blood pressure in patients receiving long-term, low-dose cyclosporine therapy for idiopathic autoimmune uveitis. Ann Intern Med 1992; 117:578-83. [PMID: 1524331 DOI: 10.7326/0003-4819-117-7-578] [Citation(s) in RCA: 53] [Impact Index Per Article: 1.7] [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] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To determine the renal side effects of long-term, low-dose cyclosporine therapy (initial dose, 5 mg/kg body weight per day) in patients with autoimmune idiopathic uvetis. DESIGN Cohort study with at least 2 years of follow-up. SETTING A teaching hospital in Paris, France (Hôpital Pitié-Salpétrière). PATIENTS Sixteen patients with idiopathic autoimmune uveitis who were normotensive and had normal renal function before treatment. Cyclosporine was administered orally for at least 2 years at an initial dosage of 5 mg/kg body weight per day. RESULTS After 2 years of treatment, the serum creatinine level increased by 35 +/- 5 mumol/L (0.40 +/- 0.06 mg/dL) (95% CI, 25 to 46 mumol/L, [73 +/- 4 to 108 +/- 4 mumol/L]). Creatinine clearance decreased significantly from 120 +/- 5 mL/min to 75 +/- 4 mL/min. Glomerular filtration rate decreased from 116 +/- 8 mL/min to 75 +/- 3 mL/min, and effective renal plasma flow decreased from 455 +/- 24 mL/min to 338 +/- 30 mL/min (P less than 0.05). Cyclosporine induced a significant increase in serum uric acid, total cholesterol, and serum potassium levels. Blood pressure was normal in all patients before treatment; 81% (95% CI, 64% to 98%) of these patients developed hypertension after 24 months of treatment. Blood pressure was controlled with a single drug in all but two patients. CONCLUSIONS In patients with healthy native kidneys, long-term cyclosporine therapy, even at a low dose (5 mg/kg per day), is nephrotoxic and is associated with a high incidence of hypertension.
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Affiliation(s)
- G Deray
- Hôpital Pitié-Salpétrière, Paris, France
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