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Roger G, Denormandie P, Gobe T, Azzolina D, Pham T, Chantalat C, Cuveillier D, Bouchachi A, Jourdain P, Lai C, Pavot A, Fage N, Domnariu P, Teboul JL, Monnet X. Left ventricular global longitudinal strain and acute myocardial injury in patients with sickle cell disease admitted to the intensive care unit for vaso-occlusive crisis. Br J Haematol 2024; 204:2007-2015. [PMID: 38471666 DOI: 10.1111/bjh.19394] [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: 10/22/2023] [Revised: 02/27/2024] [Accepted: 02/29/2024] [Indexed: 03/14/2024]
Abstract
In patients with sickle cell disease (SCD), SCD-related cardiomyopathy may be partly due to repeated ischaemic events related to sickling during vaso-occlusive crises, but few clinical studies support this hypothesis. We evaluated the incidence of acute myocardial ischaemia during vaso-occlusive crises as assessed by the left ventricular global longitudinal strain (LVGLS) and high-sensitive cardiac troponin T (hs-cTnT). We included adult patients with SCD admitted to the intensive care unit (ICU) for vaso-occlusive crisis. We collected hs-cTnT and measured LVGLS with echocardiography at admission (day 1), day 2, day 3 and ICU discharge. Among 55 patients included, considering only the first hospitalization of patients admitted several times, 3 (5%) had elevated hs-cTnT at ≥1 time point of the ICU stay. It was ≤2 times the upper limit of normal in two of these patients. LVGLS was altered at ≥1 time point of the ICU stay in 13 (24%) patients. Both hs-cTnT and LVGLS were abnormal at ≥1 time point of the hospital stay in 2 (4%) patients. Acute myocardial injury as assessed by troponin elevation and LVGLS impairment was a rare event during vaso-occlusive crises.
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Affiliation(s)
- Guillaume Roger
- Service de Médecine Intensive-Réanimation, AP-HP, Hôpital de Bicêtre, Université Paris-Saclay, DMU 4 CORREVE Maladies du Cœur et des Vaisseaux, Inserm UMR_S999, FHU SEPSIS, Groupe de Recherche CARMAS, Le Kremlin-Bicêtre, France
- Sorbonne Université, Paris, France
| | - Pierre Denormandie
- Service de Médecine Intensive-Réanimation, AP-HP, Hôpital de Bicêtre, Université Paris-Saclay, DMU 4 CORREVE Maladies du Cœur et des Vaisseaux, Inserm UMR_S999, FHU SEPSIS, Groupe de Recherche CARMAS, Le Kremlin-Bicêtre, France
| | - Thibaut Gobe
- Service de Médecine Intensive-Réanimation, AP-HP, Hôpital de Bicêtre, Université Paris-Saclay, DMU 4 CORREVE Maladies du Cœur et des Vaisseaux, Inserm UMR_S999, FHU SEPSIS, Groupe de Recherche CARMAS, Le Kremlin-Bicêtre, France
| | - Danila Azzolina
- Department of Environmental and Preventive Science, University of Ferrara, Ferrara, Italy
| | - Tài Pham
- Service de Médecine Intensive-Réanimation, AP-HP, Hôpital de Bicêtre, Université Paris-Saclay, DMU 4 CORREVE Maladies du Cœur et des Vaisseaux, Inserm UMR_S999, FHU SEPSIS, Groupe de Recherche CARMAS, Le Kremlin-Bicêtre, France
| | - Christelle Chantalat
- Service de Médecine Interne et Immunologie Clinique, AP-HP, Hôpital de Bicêtre, Université Paris-Saclay, DMU 7 Endocrinologie-Immunités-Inflammations-Cancer-Urgences, Le Kremlin-Bicêtre, France
| | - Daphnée Cuveillier
- Service de Médecine Interne et Immunologie Clinique, AP-HP, Hôpital de Bicêtre, Université Paris-Saclay, DMU 7 Endocrinologie-Immunités-Inflammations-Cancer-Urgences, Le Kremlin-Bicêtre, France
| | - Amir Bouchachi
- Service de Cardiologie, AP-HP, Hôpital de Bicêtre, Université Paris-Saclay, DMU 4 CORREVE Maladies du Cœur et des Vaisseaux, Inserm UMR_S999, Le Kremlin-Bicêtre, France
| | - Patrick Jourdain
- Service de Cardiologie, AP-HP, Hôpital de Bicêtre, Université Paris-Saclay, DMU 4 CORREVE Maladies du Cœur et des Vaisseaux, Inserm UMR_S999, Le Kremlin-Bicêtre, France
| | - Christopher Lai
- Service de Médecine Intensive-Réanimation, AP-HP, Hôpital de Bicêtre, Université Paris-Saclay, DMU 4 CORREVE Maladies du Cœur et des Vaisseaux, Inserm UMR_S999, FHU SEPSIS, Groupe de Recherche CARMAS, Le Kremlin-Bicêtre, France
| | - Arthur Pavot
- Service de Médecine Intensive-Réanimation, AP-HP, Hôpital de Bicêtre, Université Paris-Saclay, DMU 4 CORREVE Maladies du Cœur et des Vaisseaux, Inserm UMR_S999, FHU SEPSIS, Groupe de Recherche CARMAS, Le Kremlin-Bicêtre, France
| | - Nicolas Fage
- Service de Médecine Intensive-Réanimation, AP-HP, Hôpital de Bicêtre, Université Paris-Saclay, DMU 4 CORREVE Maladies du Cœur et des Vaisseaux, Inserm UMR_S999, FHU SEPSIS, Groupe de Recherche CARMAS, Le Kremlin-Bicêtre, France
| | - Paul Domnariu
- Service de Médecine Interne et Immunologie Clinique, AP-HP, Hôpital de Bicêtre, Université Paris-Saclay, DMU 7 Endocrinologie-Immunités-Inflammations-Cancer-Urgences, Le Kremlin-Bicêtre, France
| | - Jean-Louis Teboul
- Service de Médecine Intensive-Réanimation, AP-HP, Hôpital de Bicêtre, Université Paris-Saclay, DMU 4 CORREVE Maladies du Cœur et des Vaisseaux, Inserm UMR_S999, FHU SEPSIS, Groupe de Recherche CARMAS, Le Kremlin-Bicêtre, France
| | - Xavier Monnet
- Service de Médecine Intensive-Réanimation, AP-HP, Hôpital de Bicêtre, Université Paris-Saclay, DMU 4 CORREVE Maladies du Cœur et des Vaisseaux, Inserm UMR_S999, FHU SEPSIS, Groupe de Recherche CARMAS, Le Kremlin-Bicêtre, France
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Jozwiak M, Dupuis C, Denormandie P, Aurenche Mateu D, Louchet J, Heme N, Mira JP, Doyen D, Dellamonica J. Right ventricular injury in critically ill patients with COVID-19: a descriptive study with standardized echocardiographic follow-up. Ann Intensive Care 2024; 14:14. [PMID: 38261092 PMCID: PMC10805901 DOI: 10.1186/s13613-024-01248-8] [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: 09/23/2023] [Accepted: 01/10/2024] [Indexed: 01/24/2024] Open
Abstract
PURPOSE Patients with COVID-19 admitted to intensive care unit (ICU) may have right ventricular (RV) injury. The main goal of this study was to investigate the incidence of RV injury and to describe the patient trajectories in terms of RV injury during ICU stay. METHODS Prospective and bicentric study with standardized transthoracic echocardiographic (TTE) follow-up during ICU stay with a maximum follow-up of 28 days. The different patterns of RV injury were isolated RV dilation, RV dysfunction (tricuspid annular plane systolic excursion < 17 mm and/or systolic tricuspid annular velocity < 9.5 cm/s and/or RV fractional area change < 35%) without RV dilation, RV dysfunction with RV dilation and acute cor pulmonale (ACP, RV dilatation with paradoxical septal motion). The different RV injury patterns were described and their association with Day-28 mortality was investigated. RESULTS Of 118 patients with complete echocardiographic follow-up who underwent 393 TTE examinations during ICU stay, 73(62%) had at least one RV injury pattern during one or several TTE examinations: 29(40%) had isolated RV dilation, 39(53%) had RV dysfunction without RV dilation, 10(14%) had RV dysfunction with RV dilation and 2(3%) had ACP. Patients with RV injury were more likely to have cardiovascular risk factors, to be intubated and to receive norepinephrine and had a higher Day-28 mortality rate (27 vs. 7%, p < 0.01). RV injury was isolated in 82% of cases, combined with left ventricular systolic dysfunction in 18% of cases and 10% of patients with RV injury experienced several patterns of RV injury during ICU stay. The number of patients with de novo RV injury decreased over time, no patient developed de novo RV injury after Day-14 regardless of the RV injury pattern and 20(31%) patients without RV injury on ICU admission developed RV injury during ICU stay. Only the combination of RV dysfunction with RV dilation or ACP (aHR = 3.18 95% CI(1.16-8.74), p = 0.03) was associated with Day-28 mortality. CONCLUSION RV injury was frequent in COVID-19 patients, occurred within the first two weeks after ICU admission and was most often isolated. Only the combination of RV dysfunction with RV dilation or ACP could potentially be associated with Day-28 mortality. Clinical trial registration NCT04335162.
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Affiliation(s)
- Mathieu Jozwiak
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 27 Rue du Faubourg Saint Jacques, 75014, Paris, France.
- Université Paris Cité, Paris, France.
- UR2CA-Unité de Recherche Clinique Côte d'Azur, Université Côte d'Azur, Nice, France.
| | - Claire Dupuis
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Clermont-Ferrand, Hôpital Gabriel Montpied, 58 Rue Montalembert, 63000, Clermont-Ferrand, France
- IAME Université Paris Cité, U 1137, 75018, Paris, France
| | - Pierre Denormandie
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 27 Rue du Faubourg Saint Jacques, 75014, Paris, France
| | - Didac Aurenche Mateu
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nice, Hôpital L'Archet 1, 151 Rue Saint Antoine de Ginestière, 06200, Nice, France
| | - Jean Louchet
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nice, Hôpital L'Archet 1, 151 Rue Saint Antoine de Ginestière, 06200, Nice, France
| | - Nathan Heme
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nice, Hôpital L'Archet 1, 151 Rue Saint Antoine de Ginestière, 06200, Nice, France
| | - Jean-Paul Mira
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 27 Rue du Faubourg Saint Jacques, 75014, Paris, France
- Université Paris Cité, Paris, France
| | - Denis Doyen
- UR2CA-Unité de Recherche Clinique Côte d'Azur, Université Côte d'Azur, Nice, France
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nice, Hôpital L'Archet 1, 151 Rue Saint Antoine de Ginestière, 06200, Nice, France
| | - Jean Dellamonica
- UR2CA-Unité de Recherche Clinique Côte d'Azur, Université Côte d'Azur, Nice, France
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nice, Hôpital L'Archet 1, 151 Rue Saint Antoine de Ginestière, 06200, Nice, France
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Jozwiak M, Doyen D, Denormandie P, Goury A, Marey J, Pène F, Cariou A, Mira JP, Dellamonica J, Nguyen LS. Impact of sex differences on cardiac injury in critically ill patients with COVID-19. Respir Res 2023; 24:292. [PMID: 37986157 PMCID: PMC10662091 DOI: 10.1186/s12931-023-02581-5] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 10/26/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND COVID-19 infections are associated with accrued inflammatory responses which may result in cardiac injury. Immune response to infection appears different between men and women, suggesting that COVID-19 patients' outcomes may differ according to biological sex. However, the impact of biological sex on the occurrence of cardiac injury during intensive care unit (ICU) stay in COVID-19 patients remain unclear. METHODS In this multicenter and prospective study, we included consecutive patients admitted to ICU for severe COVID-19 pneumonia, during the first two pandemic waves. Biological, electrocardiogram (ECG) and echocardiographic variables were collected on ICU admission. Cardiac injury was defined by increased troponin above 99th percentile of upper norm value and newly diagnosed ECG and/or echocardiographic abnormalities. The primary endpoint was the proportion of patients with cardiac injury during ICU stay according to biological sex. The impact of biological sex on other subsequent clinical outcomes was also evaluated. RESULTS We included 198 patients with a median age of 66 (56-73) years, 147 (74%) patients were men and 51 (26%) were women. Overall, 119 (60%) patients had cardiac injury during ICU stay and the proportion of patients with cardiac injury during ICU stay was not different between men and women (60% vs. 61%, p = 1.00). Patients with cardiac injury during ICU stay showed more cardiovascular risk factors and chronic cardiac disease and had a higher ICU mortality rate. On ICU admission, they had a more marked lymphopenia (0.70 (0.40-0.80) vs. 0.80 (0.50-1.10) × 109/L, p < 0.01) and inflammation (C-Reactive Protein (155 (88-246) vs. 111 (62-192) mg/L, p = 0.03); D-Dimers (1293 (709-2523) vs. 900 (560-1813) µg/L, p = 0.03)). Plasmatic levels of inflammatory biomarkers on ICU admission correlated with SAPS-2 and SOFA scores but not with the different echocardiographic variables. Multivariate analysis confirmed cardiovascular risk factors (OR = 2.31; 95%CI (1.06-5.02), p = 0.03) and chronic cardiac disease (OR = 8.58; 95%CI (1.01-73.17), p = 0.04) were independently associated with the occurrence of cardiac injury during ICU stay, whereas biological sex (OR = 0.88; 95%CI (0.42-1.84), p = 0.73) was not. Biological sex had no impact on the occurrence during ICU stay of other clinical outcomes. CONCLUSIONS Most critically ill patients with COVID-19 were men and experienced cardiac injury during ICU stay. Nevertheless, biological sex had no impact on the occurrence of cardiac injury during ICU stay or on other clinical outcomes. Clinical trial registration NCT04335162.
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Affiliation(s)
- Mathieu Jozwiak
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, Assistance Publique, Hôpitaux de Paris, 27 Rue du Faubourg Saint Jacques, 75014, Paris, France.
- Université Paris Cité, Paris, France.
- UR2CA, Unité de Recherche Clinique Côte d'Azur, Université Côte d'Azur, Nice, France.
| | - Denis Doyen
- UR2CA, Unité de Recherche Clinique Côte d'Azur, Université Côte d'Azur, Nice, France
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nice, Hôpital L'Archet 1, 151 Rue Saint Antoine de Ginestière, 06200, Nice, France
| | - Pierre Denormandie
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, Assistance Publique, Hôpitaux de Paris, 27 Rue du Faubourg Saint Jacques, 75014, Paris, France
| | - Antoine Goury
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Reims, Rue du Général Koenig, 51092, Reims, France
| | - Jonathan Marey
- Unité de Soins Intensifs Pneumologiques, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, Assistance Publique, Hôpitaux de Paris, 27 Rue du Faubourg Saint Jacques, 75014, Paris, France
| | - Frédéric Pène
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, Assistance Publique, Hôpitaux de Paris, 27 Rue du Faubourg Saint Jacques, 75014, Paris, France
- Université Paris Cité, Paris, France
| | - Alain Cariou
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, Assistance Publique, Hôpitaux de Paris, 27 Rue du Faubourg Saint Jacques, 75014, Paris, France
- Université Paris Cité, Paris, France
| | - Jean-Paul Mira
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, Assistance Publique, Hôpitaux de Paris, 27 Rue du Faubourg Saint Jacques, 75014, Paris, France
- Université Paris Cité, Paris, France
| | - Jean Dellamonica
- UR2CA, Unité de Recherche Clinique Côte d'Azur, Université Côte d'Azur, Nice, France
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nice, Hôpital L'Archet 1, 151 Rue Saint Antoine de Ginestière, 06200, Nice, France
| | - Lee S Nguyen
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, Assistance Publique, Hôpitaux de Paris, 27 Rue du Faubourg Saint Jacques, 75014, Paris, France
- Recherche et Innovation, Groupe hospitalier privé Ambroise Paré, Hartmann, 48Ter Bd Victor Hugo, 92200, Neuilly-Sur-Seine, France
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Gallet R, Su JB, Corboz D, Chiaroni PM, Bizé A, Dai J, Panel M, Boucher P, Pallot G, Brehat J, Sambin L, Thery G, Mouri N, de Pommereau A, Denormandie P, Germain S, Lacampagne A, Teiger E, Marbán E, Ghaleh B. Three-vessel coronary infusion of cardiosphere-derived cells for the treatment of heart failure with preserved ejection fraction in a pre-clinical pig model. Basic Res Cardiol 2023; 118:26. [PMID: 37400630 DOI: 10.1007/s00395-023-00995-2] [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: 09/30/2022] [Revised: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 07/05/2023]
Abstract
Heart failure with preserved ejection fraction (HFpEF) is a major public health concern. Its outcome is poor and, as of today, barely any treatments have been able to decrease its morbidity or mortality. Cardiosphere-derived cells (CDCs) are heart cell products with anti-fibrotic, anti-inflammatory and angiogenic properties. Here, we tested the efficacy of CDCs in improving left ventricular (LV) structure and function in pigs with HFpEF. Fourteen chronically instrumented pigs received continuous angiotensin II infusion for 5 weeks. LV function was investigated through hemodynamic measurements and echocardiography at baseline, after 3 weeks of angiotensin II infusion before three-vessel intra-coronary CDC (n = 6) or placebo (n = 8) administration and 2 weeks after treatment (i.e., at completion of the protocol). As expected, arterial pressure was significantly and similarly increased in both groups. This was accompanied by LV hypertrophy that was not affected by CDCs. LV systolic function remained similarly preserved during the whole protocol in both groups. In contrast, LV diastolic function was impaired (increases in Tau, LV end-diastolic pressure as well as E/A, E/E'septal and E/E'lateral ratios) but CDC treatment significantly improved all of these parameters. The beneficial effect of CDCs on LV diastolic function was not explained by reduced LV hypertrophy or increased arteriolar density; however, interstitial fibrosis was markedly reduced. Three-vessel intra-coronary administration of CDCs improves LV diastolic function and reduces LV fibrosis in this hypertensive model of HFpEF.
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Affiliation(s)
- Romain Gallet
- Inserm U955-IMRB, UPEC, Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, France
- Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, Service de Cardiologie, Créteil, France
| | - Jin-Bo Su
- Inserm U955-IMRB, UPEC, Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, France
| | - Daphné Corboz
- Inserm U955-IMRB, UPEC, Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, France
| | - Paul-Matthieu Chiaroni
- Inserm U955-IMRB, UPEC, Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, France
- Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, Service de Cardiologie, Créteil, France
| | - Alain Bizé
- Inserm U955-IMRB, UPEC, Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, France
| | - Jianping Dai
- Inserm U955-IMRB, UPEC, Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, France
| | - Mathieu Panel
- PhyMedExp, Université de Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, France
| | - Pierre Boucher
- Center for Interdisciplinary Research in Biology (CIRB), College de France, CNRS, INSERM, PSL Research University, Paris, France
| | - Gaëtan Pallot
- Center for Interdisciplinary Research in Biology (CIRB), College de France, CNRS, INSERM, PSL Research University, Paris, France
| | - Juliette Brehat
- Inserm U955-IMRB, UPEC, Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, France
| | - Lucien Sambin
- Inserm U955-IMRB, UPEC, Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, France
| | - Guillaume Thery
- Inserm U955-IMRB, UPEC, Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, France
| | - Nadir Mouri
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, Département de biochimie-pharmacologie-biologie moléculaire-génétique médicale, Créteil, France
| | - Aurélien de Pommereau
- Inserm U955-IMRB, UPEC, Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, France
| | - Pierre Denormandie
- Inserm U955-IMRB, UPEC, Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, France
| | - Stéphane Germain
- Center for Interdisciplinary Research in Biology (CIRB), College de France, CNRS, INSERM, PSL Research University, Paris, France
| | - Alain Lacampagne
- PhyMedExp, Université de Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, France
| | - Emmanuel Teiger
- Inserm U955-IMRB, UPEC, Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, France
- Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, Service de Cardiologie, Créteil, France
| | - Eduardo Marbán
- Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Bijan Ghaleh
- Inserm U955-IMRB, UPEC, Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, France.
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Mailhan L, Schnitzler A, Genêt F, Gatin L, Calé F, Geffrier A, Denormandie P. Clinical assessment of upper limb hypertonia in central neurological diseases. Hand Surg Rehabil 2021; 41S:S132-S136. [PMID: 34438111 DOI: 10.1016/j.hansur.2019.03.008] [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] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 03/01/2019] [Accepted: 03/04/2019] [Indexed: 11/20/2022]
Abstract
The clinical assessment of a hypertonic upper limb in central neurological diseases should be analytical, systematic (shoulder, elbow, extrinsic and intrinsic hand) and focused on the patient or caregiver's wishes and on the expected objectives (esthetic, hygienic, functional). Nerve blocks can help to separate mixed contractures, show the existence of antagonist muscles or find a starter muscle in dystonia patterns. The etiology (especially the evolving nature of the disease), general health condition (especially in older adults), associated deficits (cerebellar, sensory and cognitive; hemineglect) are considered together to arrive at a contract with patients and/or caregivers.
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Affiliation(s)
- L Mailhan
- Service de Médecine Physique et de Réadaptation, Institution Nationale des Invalides, 6 Boulevard des Invalides, 75007 Paris, France; Service de Chirurgie Orthopédique, Hôpital Raymond Poincaré, 104, Boulevard Raymond Poincaré, 92380 Garches, France.
| | - A Schnitzler
- Service de Médecine Physique et de Réadaptation, Hôpital Raymond Poincaré, 104, Boulevard Raymond Poincaré, 92380 Garches, France
| | - F Genêt
- Service de Médecine Physique et de Réadaptation, Hôpital Raymond Poincaré, 104, Boulevard Raymond Poincaré, 92380 Garches, France
| | - L Gatin
- Service de Chirurgie Orthopédique, Hôpital Raymond Poincaré, 104, Boulevard Raymond Poincaré, 92380 Garches, France
| | - F Calé
- Service de Chirurgie Orthopédique, Hôpital Raymond Poincaré, 104, Boulevard Raymond Poincaré, 92380 Garches, France
| | - A Geffrier
- Service de Chirurgie Orthopédique, Hôpital Raymond Poincaré, 104, Boulevard Raymond Poincaré, 92380 Garches, France
| | - P Denormandie
- Service de Chirurgie Orthopédique, Hôpital Raymond Poincaré, 104, Boulevard Raymond Poincaré, 92380 Garches, France
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Denormandie P, Simon T, Cayla G, Steg PG, Montalescot G, Durand-Zaleski I, Le Bras A, Le Breton H, Valy Y, Schiele F, Cuisset T, Vanzetto G, Levesque S, Goube P, Nallet O, Angoulvant D, Roubille F, Charles-Nelson A, Chatellier G, Danchin N, Puymirat E. Compared Outcomes of ST-Elevation Myocardial Infarction Patients with Multivessel Disease Treated with Primary Percutaneous Coronary Intervention and Preserved Fractional Flow Reserve of Non-Culprit Lesions Treated Conservatively and of Those with Low Fractional Flow Reserve Managed Invasively: Insights from the FLOWER MI trial. Circ Cardiovasc Interv 2021; 14:e011314. [PMID: 34420366 DOI: 10.1161/circinterventions.121.011314] [Citation(s) in RCA: 16] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: In patients with ST-elevation myocardial infarction (STEMI) and multivessel disease, percutaneous coronary intervention (PCI) for non-culprit lesions guided by FFR is superior to treatment of the culprit lesion alone. Whether deferring non-culprit PCI is safe in this specific context is questionable. We aimed to assess clinical outcomes at one-year in STEMI patients with multivessel coronary artery disease and an FFR-guided strategy for non-culprit lesions, according to whether or not ≥1 PCI was performed. Methods: Outcomes were analyzed in patients of the randomized FLOWER MI (Flow Evaluation to Guide Revascularization in Multivessel ST-Elevation Myocardial Infarction) trial in whom, after successful primary PCI, non-culprit lesions were assessed using FFR. The primary outcome was a composite of all-cause death, non-fatal MI, and unplanned hospitalization with urgent revascularization at one year. Results: Among 1,171 patients enrolled in this study, 586 were assigned to the FFR-guided group: 388 (66%) of them had ≥1 PCI and 198 (34%) had no PCI. Mean FFR before decision (i.e., PCI or not) of non-culprit lesions were 0.75±0.10 and 0.88±0.06, respectively. During follow-up, a primary outcome event occurred in 16 of 388 patients (4.1%) in patients with PCI and in 16 of 198 patients (8.1%) in patients without PCI (adjusted hazard ratio, 0.42; 95% confidence interval, 0.20 to 0.88; P = 0.02). Conclusions: In patients with STEMI undergoing complete revascularization guided by FFR measurement, those with ≥1 PCI had lower event rates at 1 year, compared with patients with deferred PCI, suggesting that deferring lesions judged relevant by visual estimation but with FFR >0.80 may not be optimal in this context. Future randomized studies are needed to confirm this data.
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Affiliation(s)
- Pierre Denormandie
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Department of Cardiology, Université de Paris, Paris, France
| | - Tabassome Simon
- AP-HP, Hôpital Saint Antoine, Department of Clinical Pharmacology and Unité de Recherche Clinique (URCEST), Université Pierre et Marie Curie (UPMC-Paris 06), INSERM U-698, Paris, France; French Alliance for Cardiovascular Trials (FACT)
| | - Guillaume Cayla
- Cardiology Department, Nîmes University Hospital, Montpellier University, Nîmes, France
| | - Philippe Gabriel Steg
- French Alliance for Cardiovascular Trials (FACT); Université de Paris, INSERM Unité-1148, and Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, France
| | - Gilles Montalescot
- Sorbonne Université, ACTION Study group, Institut de Cardiologie (APHP), INSERM UMRS 1166, Hôpital Pitié-Salpêtrière, Paris, France
| | | | - Alicia Le Bras
- Clinical Research Unit Eco Ile de France, Hôpital Hôtel Dieu, AP-HP, Paris, France
| | - Hervé Le Breton
- Univ Rennes, CHU Rennes, Inserm, LTSI - UMR1099, F 35000 Rennes, France
| | - Yann Valy
- Department of Cardiology, CH Saint-Louis, La Rochelle, France
| | - François Schiele
- French Alliance for Cardiovascular Trials (FACT); Department of Cardiology, University Hospital Besançon, Besançon, France, EA 3920 University of Burgundy Franche-Comté, Besançon, France
| | - Thomas Cuisset
- ACTION Study Group, Cardiology Department, INSERM UMR1062, INRA UMR1260, Centre Hospitalier Universitaire La Timone, Aix-Marseille University, Marseille, France
| | - Gérald Vanzetto
- French Alliance for Cardiovascular Trials (FACT); Department of Cardiology, University Hospital, 38000 Grenoble Alpes, France, INSERM, U1039, Radiopharmaceutiques Biocliniques, Grenoble Alpes University, 38000 Grenoble Alpes, France
| | - Sébastien Levesque
- Cardiovascular Interventional Unit, Division of Cardiology, Department of Medicine, Centre Cardio-Vasculaire, CHU de Poitiers, Poitiers, France
| | - Pascal Goube
- Department of Cardiology, Centre Hospitalier Sud Francilien, Corbeil Essonne, France
| | - Olivier Nallet
- Cardiology Department, Groupe Hospitalier Intercommunal Le Raincy-Montfermeil, Montfermeil, France
| | - Denis Angoulvant
- Cardiology Department and EA4245 T2i, University Hospital of Tours and Tours University, 37000 Tours, France
| | - François Roubille
- Department of Cardiology, Regional University Hospital of Montpellier, Montpellier, France, PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, France
| | - Anaïs Charles-Nelson
- Clinical Research Unit and CIC 1418 INSERM, George-Pompidou European Hospital, AP-HP, 75015 Paris, France
| | - Gilles Chatellier
- Clinical Research Unit and CIC 1418 INSERM, George-Pompidou European Hospital, AP-HP, 75015 Paris, France
| | - Nicolas Danchin
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Department of Cardiology, Université de Paris, Paris, France; AP-HP, Hôpital Saint Antoine, Department of Clinical Pharmacology and Unité de Recherche Clinique (URCEST), Université Pierre et Marie Curie (UPMC-Paris 06), INSERM U-698, Paris, France
| | - Etienne Puymirat
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Department of Cardiology, Université de Paris, Paris, France; AP-HP, Hôpital Saint Antoine, Department of Clinical Pharmacology and Unité de Recherche Clinique (URCEST), Université Pierre et Marie Curie (UPMC-Paris 06), INSERM U-698, Paris, France
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Perrier A, Gatin L, Bucki M, Geffrier A, Denormandie P, Payan Y. Biomechanical modeling of the diabetic foot ulcer risk to guide surgery. Comput Methods Biomech Biomed Engin 2019. [DOI: 10.1080/10255842.2020.1714256] [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: 10/24/2022]
Affiliation(s)
- A. Perrier
- Univ. Grenoble Alpes, CNRS, TIMC-IMAG, Grenoble, France
- Orthopaedic Unit, Croix Saint-Simon hospital, Paris
- TexiSense, Torcy, France
| | - L. Gatin
- Orthopaedic Unit, Raymond Poincaré Hospital, Garches, France
| | | | - A. Geffrier
- Orthopaedic Unit, Raymond Poincaré Hospital, Garches, France
| | - P. Denormandie
- Orthopaedic Unit, Raymond Poincaré Hospital, Garches, France
| | - Y. Payan
- Univ. Grenoble Alpes, CNRS, TIMC-IMAG, Grenoble, France
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Genêt F, Denormandie P, Keenan MA. Orthopaedic surgery for patients with central nervous system lesions: Concepts and techniques. Ann Phys Rehabil Med 2018; 62:225-233. [PMID: 30290282 DOI: 10.1016/j.rehab.2018.09.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [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: 03/10/2018] [Revised: 09/09/2018] [Accepted: 09/09/2018] [Indexed: 12/26/2022]
Abstract
Since ancient times, the aim of orthopedic surgery has been to correct limb and joint deformities, including those resulting from central nervous system lesions. Recent developments in the treatment of spasticity have led to changes in concepts and management strategies. The increase in life expectancy has increased the functional needs of patients. Orthopedic surgery, along with treatments for spasticity, improves the functional capacity of patients with neuro-orthopaedic disorders, improving their autonomy. In this paper, we describe key moments in the history of orthopedic surgery regarding the treatment of patients with central nervous system lesions, from poliomyelitis to stroke-related hemiplegia, from the limbs to the spine, and from contractures to heterotopic ossification. A synthesis of the current surgical techniques is then provided, and the importance of multidisciplinary evaluation and management is highlighted, along with indications for medical, rehabilitation and surgical treatments and their combinations. We explain why it is essential to consider patients' expectations and to set achievable goals, particularly before surgery, which is by nature irreversible. More recently, specialized surgical teams have begun to favor the use of soft-tissue techniques over bony and joint procedures, except for spinal disorders. We highlight that orthopedic surgery is no longer the end-point of treatment. For example, lengthening a contractured muscle improves the balance around a joint, improving mobility and stability but may be only part of the problem. Further medical treatment and rehabilitation, or additional surgery, are often necessary to continue to improve the function of the limb. Despite the recognized effectiveness of orthopedic surgery for neuro-orthopedic disorders, few studies have formally evaluated them. Hence, there is a need for research to provide evidence to support orthopedic surgery for treating neuro-orthopedic disorders.
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Affiliation(s)
- F Genêt
- Service de médecine physique et de réadaptation, hôpital Raymond Poincaré, Assistance publique-Hôpitaux de Paris, CIC-IT 1429, 92380 Garches, France; End:icap" U1179 Inserm, service de université Versailles Saint Quentin en Yvelines, UFR des Sciences de la Santé-Simone Veil, 2, avenue de la source de bièvres, 78170 Montigny le Bretonneux, France.
| | - P Denormandie
- End:icap" U1179 Inserm, service de université Versailles Saint Quentin en Yvelines, UFR des Sciences de la Santé-Simone Veil, 2, avenue de la source de bièvres, 78170 Montigny le Bretonneux, France; Chirurgie orthopédique et traumatologique, hôpital Raymond Poincaré, Assistance publique-Hôpitaux de Paris, CIC-IT 1429, 92380 Garches, France
| | - M A Keenan
- Penn Neuro-Orthopaedics Service, University of Pennsylvania, Philadelphia, PA, USA
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Salga M, Gatin L, Geffrier A, Calé F, Schnitzler A, Genêt F, Denormandie P. Interdisciplinary collaboration: 30 years of experience in a neuro-orthopedic consultation at Raymond-Poincaré hospital. Ann Phys Rehabil Med 2018. [DOI: 10.1016/j.rehab.2018.05.266] [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: 10/28/2022]
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10
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de l’Escalopier N, Denormandie P, Gatin L, Grelier A, Genet F. Resection of neurogenic heterotopic ossification (NHO) of the hip, lessons learned after 377 procedures. Ann Phys Rehabil Med 2018. [DOI: 10.1016/j.rehab.2018.05.385] [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: 10/28/2022]
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11
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Grelier A, Salga M, Gatin L, Debaud C, Genet G, De L’Escalopier N, Denormandie P, Genet F. Troublesome heterotopic ossification. Does the etiology have an impact on joint location and surgical complications? Ann Phys Rehabil Med 2018. [DOI: 10.1016/j.rehab.2018.05.306] [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: 11/28/2022]
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Denormandie P, de l'Escalopier N, Gatin L, Grelier A, Genêt F. Resection of neurogenic heterotopic ossification (NHO) of the hip. Orthop Traumatol Surg Res 2018; 104:S121-S127. [PMID: 29174871 DOI: 10.1016/j.otsr.2017.04.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 02/21/2017] [Accepted: 04/13/2017] [Indexed: 02/02/2023]
Abstract
Neurogenic heterotopic ossification of the hip is secondary to neurologic lesions such as cranial trauma, stroke, medullary injury or cerebral anoxia. We shall not deal here with the other etiologies of heterotopic ossification. There are numerous locations within the hip, depending on etiology and relations with adjacent neurovascular structures are sometimes close. Preoperative work-up should include contrast-enhanced CT; scintigraphy is non-contributive. Indications for surgery are decided in a multidisciplinary team meeting, with a contract laying out expected functional gain. It is this contract that determines the extent of resection, without seeking complete resection, which would incur an increased risk of complications. The surgical approach and resection strategy depend on lesion location and any resulting neurovascular compression. The most common complications are infection and postoperative hematoma. No adjuvant treatments have demonstrated efficacy against recurrence.
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Affiliation(s)
- P Denormandie
- Service de chirurgie orthopédique, hôpital Raymond-Poincaré, 92380 Garches, France
| | - N de l'Escalopier
- Service de chirurgie orthopédique, traumatologie et chirurgie réparatrice des membres, hôpital d'instruction des Armées-Percy, 101, avenue Henri-Barbusse, 92140 Clamart, France.
| | - L Gatin
- Service de chirurgie orthopédique, hôpital Raymond-Poincaré, 92380 Garches, France
| | - A Grelier
- Service de médecine physique et réadaptation, hôpital Raymond-Poincaré, 92380 Garches, France
| | - F Genêt
- Service de médecine physique et réadaptation, hôpital Raymond-Poincaré, 92380 Garches, France
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Delespierre T, Denormandie P, Bar-Hen A, Josseran L. Empirical advances with text mining of electronic health records. BMC Med Inform Decis Mak 2017; 17:127. [PMID: 28830417 PMCID: PMC5568397 DOI: 10.1186/s12911-017-0519-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 12/07/2016] [Accepted: 08/04/2017] [Indexed: 11/20/2022] Open
Abstract
Background Korian is a private group specializing in medical accommodations for elderly and dependent people. A professional data warehouse (DWH) established in 2010 hosts all of the residents’ data. Inside this information system (IS), clinical narratives (CNs) were used only by medical staff as a residents’ care linking tool. The objective of this study was to show that, through qualitative and quantitative textual analysis of a relatively small physiotherapy and well-defined CN sample, it was possible to build a physiotherapy corpus and, through this process, generate a new body of knowledge by adding relevant information to describe the residents’ care and lives. Methods Meaningful words were extracted through Standard Query Language (SQL) with the LIKE function and wildcards to perform pattern matching, followed by text mining and a word cloud using R® packages. Another step involved principal components and multiple correspondence analyses, plus clustering on the same residents’ sample as well as on other health data using a health model measuring the residents’ care level needs. Results By combining these techniques, physiotherapy treatments could be characterized by a list of constructed keywords, and the residents’ health characteristics were built. Feeding defects or health outlier groups could be detected, physiotherapy residents’ data and their health data were matched, and differences in health situations showed qualitative and quantitative differences in physiotherapy narratives. Conclusions This textual experiment using a textual process in two stages showed that text mining and data mining techniques provide convenient tools to improve residents’ health and quality of care by adding new, simple, useable data to the electronic health record (EHR). When used with a normalized physiotherapy problem list, text mining through information extraction (IE), named entity recognition (NER) and data mining (DM) can provide a real advantage to describe health care, adding new medical material and helping to integrate the EHR system into the health staff work environment. Electronic supplementary material The online version of this article (doi:10.1186/s12911-017-0519-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- T Delespierre
- Institut du Bien Vieillir Korian, 21-25 rue Balzac, 75008, Paris, France. .,Research lab: EA 4047, UFR des Sciences de la Santé Simone Veil, UVSQ Université Paris-Saclay, 2 Avenue de la Source de la Bièvre, Montigny le Bretonneux, 78180, France.
| | | | - A Bar-Hen
- UFR de Mathématiques et Informatique, Université de Paris Descartes, 45 rue des Saints-Pères, Paris, 75006, France
| | - L Josseran
- Research lab: EA 4047, UFR des Sciences de la Santé Simone Veil, UVSQ Université Paris-Saclay, 2 Avenue de la Source de la Bièvre, Montigny le Bretonneux, 78180, France
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Gatin L, Genêt F, Dinh A, Denormandie P. Postoperative infections after excision of neurogenic heterotopic ossifications at the hip: Risk factors and causative organisms. Orthop Traumatol Surg Res 2017; 103:357-361. [PMID: 28215612 DOI: 10.1016/j.otsr.2017.02.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 07/28/2016] [Revised: 01/30/2017] [Accepted: 02/01/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Neurogenic heterotopic ossification (NHO) is usually treated by surgical excision. Postoperative infection (POI) is a possible complication, whose epidemiology, causative organisms, and risk factors are poorly known. We therefore conducted a case-control study to (1) identify the risk factors for POI after surgical excision of NHO at the hip, (2) determine the frequency of POI, (3) and identify the causative organisms. HYPOTHESIS Risk factors for POI after NHO excision at the hip can be identified. MATERIAL AND METHODS In this retrospective case-control study, the BANKHO database for patients with NHO at our centre was used to identify risk factors by comparing patients with and without POI after NHO excision at the hip. To this end, odds ratios (ORs) with their 95% confidence intervals (95%CIs) were computed for each main criterion. Postoperative follow-up was at least 6 months. RESULTS Between 1993 and 2013, 411 hip NHO excisions were performed. Among them, 42 (10%) were followed by POI. The American Society of Anesthesiologists (ASA) score was I in 2/42 (5%) patients with vs. 74/369 (20%) patients without POI, II in 30/42 (71%) patients with vs. 258/369 (70%) patients without POI, and III in 10/42 (24%) patients with vs. 37/369 (10%) patients without POI (P<0.01). Mean age was 31±11 years (range, 17-79years) in the group with POI and 39±14 years (range, 15-77years) in the group without POI (P<0.01). The NHO was related to spinal cord injury in 26/42 (62%) patients with POI compared to 92/369 (25%) patients without POI (P<0.01). ORs indicated a significant risk increase in patients with an ASA score of III (2.84; 95%CI, 1.28-6.31), age younger than 30 years (1.85; 95%CI, 1.03-3.32), and spinal cord injury as the cause of NHO (4.89; 95%CI, 2.67-8.98). The predominant organisms were staphylococci (skin flora) in the patients with spinal cord injury and bacteria commonly found in intensive care units in the other patients. DISCUSSION A higher ASA score, younger age, and spinal cord injury as the cause of NHO at the hip are risk factors for POI. The proportion of patients with POI after hip NHO excision was 10%, in accordance with previous reports. POI was more common among patients with spinal cord injury (22% vs. 5% in the other patients). Neither changes in prophylactic antibiotic therapy regimens nor the institution of a detailed skin preparation protocol affected the frequency of POI. Skin pH alterations may deserve to be investigated with the goal of diminishing the risk of POI, most notably in spinal cord injury patients. LEVEL OF EVIDENCE III, case-control study.
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Affiliation(s)
- L Gatin
- Service de chirurgie orthopédique et traumatologique, hôpital Raymond-Poincaré, 104, boulevard Raymond-Poincaré, 92380 Garches, France.
| | - F Genêt
- Service de médecine physique et réadaptation, hôpital Raymond-Poincaré, 104, boulevard Raymond-Poincaré, 92380 Garches, France
| | - A Dinh
- Unité de maladies infectieuses et tropicales, hôpital Raymond-Poincaré, 104, boulevard Raymond-Poincaré, 92380 Garches, France
| | - P Denormandie
- Service de chirurgie orthopédique et traumatologique, hôpital Raymond-Poincaré, 104, boulevard Raymond-Poincaré, 92380 Garches, France
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Herr M, Grondin H, Sanchez S, Vial A, Denormandie P, Ankri J. Évaluation de la qualité de la prescription médicamenteuse chez 30 702 sujets âgés institutionnalisés à partir des données enregistrées lors de la préparation des piluliers. Rev Epidemiol Sante Publique 2016. [DOI: 10.1016/j.respe.2016.10.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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16
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Genet F, Schnitzler A, Droz-Bartholet F, Salga M, Tatu L, Debaud C, Denormandie P, Parratte B. Successive motor nerve blocks to identify the muscles causing a spasticity pattern: example of the arm flexion pattern. J Anat 2016; 230:106-116. [PMID: 27595994 DOI: 10.1111/joa.12538] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2016] [Indexed: 11/30/2022] Open
Abstract
Botulinum Toxin A has been the main treatment for spasticity since the beginning of the 1990s. Surprisingly, there is still no consensus regarding injection parameters or, importantly, how to determine which muscles to target to improve specific functions. The aim of this study was to develop a systematic approach to determine this, using the example of the arm flexion pattern. We first determined anatomical landmarks for selective motor block of the brachialis nerve, using 20 forearms from 10 fresh cadavers in Ecole Européenne de Chirurgie and a university-based dissection centre, Paris, France. We then carried out selective blocks of the motor nerves to the brachialis, brachioradialis and biceps brachii in patients with stroke with an arm flexion pattern, in a University Rehabilitation Hospital, Garches, France. We measured: the resting angle of the elbow angle in standing (manual goniometer), active and passive range of extension, and spasticity using the Held and Tardieu and the Modified Ashworth scales. Range of passive elbow extension was also measured with the shoulder in 90° of flexion. The resting angle of the elbow in standing decreased by 35.0° (from 87.6 ± 23.7 to 52.6 ± 24.2°) with inhibition of brachialis, by a further 3.9° (from 52.6 ± 24.2 to 48.7 ± 23.7°) with inhibition of brachioradialis and a further 14.5° (from 48.7 ± 23.7to 34.2 ± 20.7°) with inhibition of biceps brachii. These results were consistent with the clinical evaluation of passive elbow range of motion with the shoulder at 90°. Sequential blocking of the nerves to the three main elbow flexors revealed that the muscle that limited elbow extension the most, was brachialis. This muscle should be the main target to improve the arm flexion pattern. These results show that it is important not simply to inject the most superficial or powerful muscles to treat a spastic deformity. A comprehensive assessment is required. The strategy proposed in this paper should increase the effectiveness of botulinum toxin injections by ensuring that the relevant muscles are targeted.
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Affiliation(s)
- F Genet
- Service de Médecine Physique et de Réadaptation, Hôpital Raymond Poincaré, Garches, France.,'End:icap' U1179 INSERM, UFR des Sciences de la Santé - Simone Veil, Université Versailles Saint Quentin en Yvelines, Montigny le Bretonneux, France.,Ecole Européenne de Chirurgie (EEC), Paris, France
| | - A Schnitzler
- Service de Médecine Physique et de Réadaptation, Hôpital Raymond Poincaré, Garches, France.,Ecole Européenne de Chirurgie (EEC), Paris, France
| | - F Droz-Bartholet
- Service de Médecine Physique et de Réadaptation, CHRU Besançon, Besançon Cedex, France
| | - M Salga
- Service de Médecine Physique et de Réadaptation, Hôpital Raymond Poincaré, Garches, France.,'End:icap' U1179 INSERM, UFR des Sciences de la Santé - Simone Veil, Université Versailles Saint Quentin en Yvelines, Montigny le Bretonneux, France
| | - L Tatu
- Laboratoire d'anatomie UFR SMP, Université Bourgogne/Franche-Comté, Besançon Cedex, France.,Service d'Explorations et Pathologies Neuro-musculaires, CHRU Besançon, Besançon Cedex, France
| | - C Debaud
- 'End:icap' U1179 INSERM, UFR des Sciences de la Santé - Simone Veil, Université Versailles Saint Quentin en Yvelines, Montigny le Bretonneux, France.,Service de Chirurgie Orthopédique, Hôpital Européen Georges Pompidou, Paris, France
| | - P Denormandie
- 'End:icap' U1179 INSERM, UFR des Sciences de la Santé - Simone Veil, Université Versailles Saint Quentin en Yvelines, Montigny le Bretonneux, France.,Ecole Européenne de Chirurgie (EEC), Paris, France.,Service de Chirurgie Orthopédique, Hôpital Raymond Poincaré, Garches, France
| | - B Parratte
- Ecole Européenne de Chirurgie (EEC), Paris, France.,Service de Médecine Physique et de Réadaptation, CHRU Besançon, Besançon Cedex, France.,Laboratoire d'anatomie UFR SMP, Université Bourgogne/Franche-Comté, Besançon Cedex, France
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Schnitzler A, Diebold A, Genêt F, Denormandie P. Percutaneous needle tenotomy: Technique and first results. Ann Phys Rehabil Med 2015. [DOI: 10.1016/j.rehab.2015.07.197] [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: 10/23/2022]
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18
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Motavasseli D, Diebold A, Schnitzler A, Denormandie P, Popoff M, Genêt F. Bone graft of a femoral head by fragments of neurogenic heterotopic ossification. Ann Phys Rehabil Med 2015. [DOI: 10.1016/j.rehab.2015.07.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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19
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Chesnel C, Genet F, Almangour W, Denormandie P, Parratte B, Schnitzler A. Effectiveness and complications of percutaneous needle tenotomy with a large gauge needle for muscle contractures: A cadaver study. Ann Phys Rehabil Med 2015. [DOI: 10.1016/j.rehab.2015.07.195] [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: 11/30/2022]
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20
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Delespierre T, Denormandie P, Durand A, Josseran L. Comment passer d’un usage individuel du dossier résident à un bénéfice collectif avec le « Data Warehouse » Korian et bâtir une base de données de santé publique ? Rev Epidemiol Sante Publique 2015. [DOI: 10.1016/j.respe.2015.03.035] [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: 11/30/2022] Open
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21
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Jourdan C, Bévalot J, Denormandie P, Dionnet A, Parratte B. Training evaluation for a practice in spasticity-related techniques. Ann Phys Rehabil Med 2015; 58:114-5. [PMID: 25770006 DOI: 10.1016/j.rehab.2014.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 10/16/2014] [Indexed: 11/27/2022]
Affiliation(s)
- C Jourdan
- AP-HP, hôpital Raymond-Poincaré, service de médecine physique et de réadaptation, 104, boulevard Raymond-Poincaré, 92380 Garches, France; EA 4047 ECIPSY, université de Versailles Saint-Quentin UFR des sciences de la santé Simone Veil, 2 avenue de la Source-de-la-Bièvre, 78180 Montigny-Le-Bretonneux, France.
| | - J Bévalot
- Centre de rééducation et de réadaptation fonctionnelle des Salins de Brégille, 7, chemin Monts-de-Bregille-Haut, 25000 Besançon, France
| | - P Denormandie
- AP-HP, hôpital Raymond-Poincaré, service de chirurgie orthopédique, 104, boulevard Raymond-Poincaré, 92380 Garches, France
| | - A Dionnet
- École européenne de chirurgie, 45, rue des Saint-Pères, 75006 Paris, France
| | - B Parratte
- CHU de Besançon, service de médecine physique et de réadaptation, 2, place Saint-Jacques, 25000 Besançon, France; Université Franche Comté, laboratoire d'anatomie, UFR sciences médicales et pharmaceutiques, 19, rue Ambroise-Paré, 25030 Besançon cedex, France
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Genêt F, Ruet A, Almangour W, Gatin L, Denormandie P, Schnitzler A. Beliefs relating to recurrence of heterotopic ossification following excision in patients with spinal cord injury: a review. Spinal Cord 2015; 53:340-4. [DOI: 10.1038/sc.2015.20] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 12/15/2014] [Accepted: 01/12/2015] [Indexed: 11/09/2022]
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Lansaman T, Genet F, Schwald Adam N, Dehail P, Denormandie P, Schnitzler A. Prospective multicenter study evaluating the interests of Seat-Braces in gerontology. Ann Phys Rehabil Med 2014. [DOI: 10.1016/j.rehab.2014.03.432] [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: 11/29/2022]
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Denormandie P, Gatin L, Schnitzler A, Mailhan L, Allieu Y, Genet F. Comment renforcer chirurgicalement la puissance, réanimer ou stabiliser l’extension du carpe et des doigts ? Ann Phys Rehabil Med 2014. [DOI: 10.1016/j.rehab.2014.03.1423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Ruet A, Desroches A, Pansard E, Schnitzler A, Denormandie P. Traitement des pieds varus équins sévères de l’adulte par talectomie. Ann Phys Rehabil Med 2014. [DOI: 10.1016/j.rehab.2014.03.763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Denormandie P, Gatin L, Schnitzler A, Mailhan L, Allieu Y, Genet F. Surgical treatment of the extrinsic extensor carpi and finger's retraction. Ann Phys Rehabil Med 2014. [DOI: 10.1016/j.rehab.2014.03.1404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Denormandie P, Gatin L, Schnitzler A, Mailhan L, Allieu Y, Genet F. Comment traiter chirurgicalement l’hypertonie et la rétraction des extenseurs extrinsèques du carpe et des doigts. Ann Phys Rehabil Med 2014. [DOI: 10.1016/j.rehab.2014.03.1422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Denormandie P, Simon AL, Combourieu B, Pennecot GF, Judet T. Long-term evaluation of the triple arthrodesis associate to muscular rebalancing procedures in neurological foot. Ann Phys Rehabil Med 2014. [DOI: 10.1016/j.rehab.2014.03.1409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Dehail P, Simon O, Godard A, Faucher N, Coulomb Y, Schnitzler A, Denormandie P, Jeandel C. Acquired deforming hypertonia and contractures in elderly subjects: Definition and prevalence in geriatric institutions (ADH survey). Ann Phys Rehabil Med 2014; 57:11-23. [DOI: 10.1016/j.rehab.2013.11.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 11/12/2013] [Accepted: 11/14/2013] [Indexed: 11/24/2022]
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Denormandie P, Payet E, Pansard E, Schnitzler A, Mailhan L, Genet F. Causes of flat foot valgus original proposal central and neurological therapy. Ann Phys Rehabil Med 2013. [DOI: 10.1016/j.rehab.2013.07.1005] [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: 10/26/2022]
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31
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Schnitzler A, Denormandie P, Mailhan L, Jourdan C, Genet F. Percutaneous hamstring lengthening with a Large-Gauge Needle a retrospective study. First results and technic. Ann Phys Rehabil Med 2013. [DOI: 10.1016/j.rehab.2013.07.989] [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: 10/26/2022]
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Bevalot J, Jourdan C, Denormandie P, Parratte B. Training evaluation for a practice in spasticity associated techniques. Ann Phys Rehabil Med 2013. [DOI: 10.1016/j.rehab.2013.07.1039] [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: 10/26/2022]
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Bevalot J, Jourdan C, Denormandie P, Parratte B. Évaluation de la formation pour une pratique des techniques associées à la spasticité. Ann Phys Rehabil Med 2013. [DOI: 10.1016/j.rehab.2013.07.1029] [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: 10/26/2022]
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Denormandie P, Payet E, Pansard E, Schnitzler A, Mailhan L, Genet F. Causes du pied plat valgus d’origine neurologique centrale et propositions therapeutiques. Ann Phys Rehabil Med 2013. [DOI: 10.1016/j.rehab.2013.07.999] [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: 10/26/2022]
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Schnitzler A, Denormandie P, Mailhan L, Jourdan C, Genet F. Ténotomie percutanée à l’aiguille des muscles ischio-jambiers : technique et premiers résultats. Ann Phys Rehabil Med 2013. [DOI: 10.1016/j.rehab.2013.07.982] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Levy J, Rech C, Denormandie P, Mandon L, Hugeron C, Ben Smail D. Para-ostéoarthropathies (POA) multiples chez l’adulte dans les suites d’une polyneuropathie de réanimation et syndrome de détresse respiratoire aiguë (SDRA), stratégie rééducative et chirurgicale : à propos d’un cas. Ann Phys Rehabil Med 2012. [DOI: 10.1016/j.rehab.2012.07.465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Salga M, Durand M, Jourdan C, Schnitzler A, Denormandie P, Genet F. Neurogenic heterotopic ossification (NHO) and nerve compression: Example of the hip posterior HO and sciatic compression. Ann Phys Rehabil Med 2012. [DOI: 10.1016/j.rehab.2012.07.448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Genet F, Schnitzler A, Jourdan C, Denormandie P. Neurological heterotopic ossification (NHO): Impact of the time for surgery. Ann Phys Rehabil Med 2012. [DOI: 10.1016/j.rehab.2012.07.460] [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: 12/01/2022]
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Genet F, Thevenin-Lemoine C, Schnitzler A, Lautridou C, Allieu Y, Denormandie P. Traitement chirurgical de l’hypoextensibilité des fléchisseurs extrinsèques des doigts par désinsertion proximale au coude chez le patient cérébrolésé. Une étude rétrospective. Ann Phys Rehabil Med 2012. [DOI: 10.1016/j.rehab.2012.07.457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Levy J, Rech C, Denormandie P, Mandon L, Hugeron C, Ben Smail D. Multiple heterotopic ossifications in adults with critical illness polyneuropathy secondary to acute respiratory distress syndrome (ARDS): A case-report on rehabilitation and surgical strategy. Ann Phys Rehabil Med 2012. [DOI: 10.1016/j.rehab.2012.07.468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Salga M, Durand M, Jourdan C, Schnitzler A, Denormandie P, Genet F. Para-ostéoarthropathie neurogène (POAN) et compressions nerveuses : exemple de la POAN postérieure de hanche et compression sciatique. Ann Phys Rehabil Med 2012. [DOI: 10.1016/j.rehab.2012.07.442] [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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42
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Genet F, Thevenin-Lemoine C, Schnitzler A, Lautridou C, Allieu Y, Denormandie P. Flexor origin slide for contracture of spastic finger flexor muscles. A retrospective study. Ann Phys Rehabil Med 2012. [DOI: 10.1016/j.rehab.2012.07.462] [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: 11/30/2022]
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43
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Denormandie P, Combourieu B, Schnitzler A, Pansard E, Genet F. Surgical treatment for neurological heterotopic ossification (NHO): Surgical principles and specific aspects of certain locations. Ann Phys Rehabil Med 2012. [DOI: 10.1016/j.rehab.2012.07.459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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44
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Denormandie P, Combourieu B, Schnitzler A, Pansard E, Genet F. Prise en charge chirurgicale des para-ostéoarthropathies neurogènes (POAN) : principes, particularités et risques en fonction des localisations. Ann Phys Rehabil Med 2012. [DOI: 10.1016/j.rehab.2012.07.454] [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: 10/27/2022]
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Denormandie P. The spastic hip in cerebral palsy patients. Ann Phys Rehabil Med 2011. [DOI: 10.1016/j.rehab.2011.07.908] [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: 10/17/2022]
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46
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Chéhensse C, Jourdan C, Schnitzler A, Lautridou C, Denormandie P, Genêt F. Influence des séquelles cognitives et fonctionnelles sur la survenue d’une récidive post résection de para ostéoarthropathies chez le traumatisé crânien : une étude cas-témoins. Ann Phys Rehabil Med 2011. [DOI: 10.1016/j.rehab.2011.07.904] [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: 10/17/2022]
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Denormandie P. La hanche spastique du paralysé cérébral. Ann Phys Rehabil Med 2011. [DOI: 10.1016/j.rehab.2011.07.898] [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: 10/17/2022]
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Genet F, Marmorat JL, Lautridou C, Schnitzler A, Mailhan L, Denormandie P. Impact of late surgical intervention on heterotopic ossification of the hip after traumatic neurological injury. ACTA ACUST UNITED AC 2009; 91:1493-8. [PMID: 19880896 DOI: 10.1302/0301-620x.91b11.22305] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Heterotopic ossification (HO) of the hip after injury to the central nervous system can lead to joint ankylosis. Surgery is usually delayed to avoid recurrence, even if the functional status is affected. We report a consecutive series of patients with HO of the hip after injury to the central nervous system who required surgery in a single, specialised tertiary referral unit. As was usual practice, they all underwent CT to determine the location of the HO and to evaluate the density of the femoral head and articular surface. The outcome of surgery was correlated with the pre-, peri- and post-operative findings. In all, 183 hips (143 patients) were included of which 70 were ankylosed. A total of 25 peri-operative fractures of the femoral neck occurred, all of which arose in patients with ankylosed hips and were associated with intra-articular lesions in 18 and severe osteopenia of the femoral head in seven. All the intra-articular lesions were predicted by CT and strongly associated with post-operative complications. The loss of the range of movement before ankylosis is a more important factor than the maturity of the HO in deciding the timing of surgery. Early surgical intervention minimises the development of intra-articular pathology, osteoporosis and the resultant complications without increasing the risk of recurrence of HO.
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Affiliation(s)
- F Genet
- Service de Médecine, Physioque et de Réadaptation, L'Hôpital Raymond Poincaré, Garches, France.
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Massin P, Chabouis A, Erginay A, Viens-Bitker C, Lecleire-Collet A, Meas T, Guillausseau PJ, Choupot G, André B, Denormandie P. OPHDIAT: a telemedical network screening system for diabetic retinopathy in the Ile-de-France. Diabetes Metab 2008; 34:227-34. [PMID: 18468470 DOI: 10.1016/j.diabet.2007.12.006] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2007] [Revised: 12/02/2007] [Accepted: 12/23/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE International and national guidelines recommend an annual funduscopic examination for all diabetic patients, but such annual fundus examinations are not sufficiently performed in France. Non-mydriatic fundus photography is a valid method of evaluation for diabetic retinopathy (DR) and a viable alternative to ophthalmoscopy. After two pilot studies demonstrated the feasibility of telemedical screening for diabetic retinopathy in both hospital and primary-care settings, we developed a regional telemedical network, OPHDIAT, designed to facilitate access to regular annual evaluations of patients with diabetes while saving medical time. MATERIALS AND METHODS OPHDIAT comprises peripheral screening centres equipped with non-mydriatic cameras, where fundus photographs are taken by technicians linked by telemedicine to a reference centre, where ophthalmologists grade the images. Currently in the Ile-de-France region, 16 screening centres are linked through a central server to an ophthalmologic reading centre and includes 11 centres located in the diabetes departments of 11 hospitals, one diabetic retinopathy screening centre located in northern Paris, three in healthcare centres and one in a prison. RESULTS During the 28-month evaluation period, 15,307 DR screening examinations were performed. Retinal photographs of at least one eye could not be graded in 1332 patients (9.7%) and diabetic retinopathy was detected in 3350 patients (23.4%). After the screening examination, 3478 patients (25.2%) were referred to an ophthalmologist for either DR, cataract and/or non-gradable photographs. CONCLUSION Fundus photography combined with telemedicine has the potential to improve the regular annual evaluation for diabetic retinopathy. The organization of the network around a central reading centre serves to guarantee quality control.
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Affiliation(s)
- P Massin
- Ophthalmology department, hôpital Lariboisière, université Paris-VII, Assistance publique-Hôpitaux de Paris, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France.
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Abstract
PURPOSE OF THE STUDY Neurogenic paraosteoarthropathy of the elbow is a frequent complication in head injury patients. The functional impairment may be severe. The purpose of this work was to evaluate the efficacy of our medico-surgical approach and to determine indications for surgery. MATERIAL AND METHODS We analyzed retrospectively a continuous series of 44 patients (51 elbows) with neurogenic heterotopic new bone of the elbow joint managed from 1993 to 2000. The heterotopic bone had developed on a central deficit limb in 70% of the patients. Flexion-extension was limited in all patients, and pronation-supination in nine. The ulnar nerve was compressed by the heterotopic bone in half of the patients. A 3D reconstruction CT-scan with contrast injection was obtained in all patients. We consider did not the classical criteria for bone maturation to assess operability. Using an adapted approach, we removed the heterotopic new bone to enable complete elbow motion. Associated procedures were performed in fifteen patients due to persistent intraoperative joint stiffness related to muscle-tendon retraction. We did not prescribe diphosphonates or radiotherapy postoperatively. RESULTS At 45 months follow-up, one patient had been lost. Relative gain was considered very good in 34 elbows, good in 13 and fair in 3. There were no cases of lost motion. There were no recurrences causing joint limitation, but two of nine cases of radioulnar synostosis recurred. DISCUSSION Neurogenic paraosteopathy of the elbow impairs joint function and may lead to ulnar nerve compression. The goal of surgery is to improve function. The analysis of our results show that early surgery yields good results without complementary treatment, irrespective of the patient's overall functional deficit or cognitive status and irrespective of the localization of the hetertopic bone. The essential prognostic factor for the quality results is the neurological status of the limb, particularly the degree of spasticity and muscle-tendon retraction.
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Affiliation(s)
- G Sorriaux
- Service de Chirurgie Orthopédique et Traumatologique, Hôpital Raymond-Poincaré, 104, boulevard Raymond-Poincaré, 92380 Garches
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