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Dumas G, Danjou A, Richaud C, Spear R, Joly M, Blaise S. Feasibility of performing treadmill walking test for patients with peripheral arterial occlusive disease by the advanced practice nurses. J Med Vasc 2024; 49:90-97. [PMID: 38697715 DOI: 10.1016/j.jdmv.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 03/22/2024] [Indexed: 05/05/2024]
Abstract
AIM The treadmill walking test with post-exercise pressure measurement can be used as a diagnostic test and could classify peripheral arterial disease of the lower limbs. It can also exclude the diagnosis allowing to raise the possibility of differential diagnoses. In this study, we assessed the feasibility of performing treadmill test by advanced practice nurse to assess suspected lower extremity peripheral artery disease patients. DESIGN AND METHOD This is a longitudinal monocentric study to assess the feasibility of a treadmill walking test performed by an advanced practice nurse. The primary endpoint was the number of tests performed during this period. The secondary objectives were to evaluate the reasons for requesting the test, the main results obtained in terms of the test's contribution and diagnoses, and patients' clinical characteristics. RESULTS From February to May 2023, amongst 31 patients who underwent the treadmill walking test, 4 tests were able to rule out peripheral arterial disease and to detect differential diagnoses. For the remaining 27 patients, 4 had stage IIa of the Leriche classification, 23 had stage IIb, 2 of which were associated with a narrow lumbar spine. In contrast to the usual report, the APN's report on the walking test included an identification of cardiovascular risk factors, as well as a possible medical reorientation linked to the correction of a detected cardiovascular risk factor. CONCLUSION The treadmill walking test can be performed by an advanced practice nurse. He/She added a comprehensive/global patient management, with the detection of cardiovascular risk factors. This new profession led to an increase in the number of tests performed of more than 50% over the period and reduced the time to access the test.
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Affiliation(s)
- G Dumas
- Service de Médecine Vasculaire, department of Vascular Medicine, Grenoble University Hospital, BP 217, 38043 Grenoble cedex 09, France
| | - A Danjou
- Grenoble Alpes Data Institute, TIMC, UMR 5525 CNRS, University Grenoble Alpes, Grenoble, France; IFSI, CHU de Grenoble Alpes, CS10217, 38043 Grenoble cedex 9, France
| | - C Richaud
- Service de Médecine Vasculaire, department of Vascular Medicine, Grenoble University Hospital, BP 217, 38043 Grenoble cedex 09, France
| | - R Spear
- Service de Chirurgie Vasculaire, department of Vascular Surgery, Grenoble University Hospital, BP 217, 38043 Grenoble cedex 09, France
| | - M Joly
- Service de Médecine Vasculaire, department of Vascular Medicine, Grenoble University Hospital, BP 217, 38043 Grenoble cedex 09, France
| | - S Blaise
- Service de Médecine Vasculaire, department of Vascular Medicine, Grenoble University Hospital, BP 217, 38043 Grenoble cedex 09, France; Inserm U1300, HP2, University Grenoble Alpes, Grenoble, France.
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Blaise S, Malloizel-Delaunay J, Nou M. Diagnosis of a chronic wound in the special case of a vascular malformation: A proposal of the Wound and Healing Group of the French Society of Vascular Medicine. J Med Vasc 2024; 49:103-111. [PMID: 38697706 DOI: 10.1016/j.jdmv.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 03/17/2024] [Indexed: 05/05/2024]
Abstract
Vascular malformations can present with a variety of symptoms and an unpredictable course with the occurrence of wounds. Ulcerations in patients with vascular malformations are fortunately rare. Although few data exist, complications may involve a variety of mechanistic or hemodynamic factors. A rigorous etiological and vascular assessment is therefore essential. In view of the paucity of recommendations, the Wound and Healing Group of the French Society of Vascular Medicine, based on the literature on the subject, presents a number of suggestions for the diagnosis and management of wounds associated with vascular malformations.
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Affiliation(s)
- Sophie Blaise
- Department of Vascular Medicine, Grenoble University Hospital, BP 217, 38043 Grenoble Cedex 09, France.
| | | | - Monira Nou
- Department of Vascular Medicine, Montpellier University Hospital, 34090 Montpellier, France
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Blaise S, Soya E, Nou M, Malloizel-Delaunay J, Thiel H, Bisdorff-Bresson A, Seinturier C. Localised intravascular coagulation complicating venous malformations: Clinical characterisation. Phlebology 2024; 39:169-173. [PMID: 37978831 DOI: 10.1177/02683555231216349] [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] [Indexed: 11/19/2023]
Abstract
OBJECTIVE The International Union of Phlebology recommends measuring at least D-dimer and fibrinogen levels in the diagnosis of extensive extra-truncular venous malformations, with a surface area of 10 cm2 or those which are deep, as well as prior to any interventional procedure. The aim of the study was to characterise venous malformations associated with a possible vascular complication. METHOD This study was an observational and multicentre study. The objective was to explore the presence of a possible coagulation disorder among patients with venous malformation. The primary endpoint was to characterise venous malformations with increased D-dimer levels. RESULTS The majority of the 72 venous malformations were located in the trunk region, mostly in intramuscular or subcutaneous locations. There were 72 venous malformations with increased D-dimer levels including 3 with biological disseminated intravascular coagulation (elevated D-dimer and fibrinogen <1 g/L). The anticoagulant treatments administered were very heterogeneous in class and dosage, and at the end of the treatment, 17 elevated D-dimers were persistent, 9 venous malformations remained painful and 27 showed thrombotic regression. CONCLUSION Venous vascular malformations are probably underestimated and should probably be explored more systematically in terms of coagulation disorder regardless of size or symptomatology. The therapeutic recommendations to treat localised intravascular coagulation with low-molecular weight are not widely applied. Studies are needed, in particular to assess the role of oral anticoagulants in the management of coagulation disorder among patients with venous malformation.
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Affiliation(s)
- Sophie Blaise
- Department of Vascular Medicine, Grenoble University Hospital, Grenoble, France
| | - Esaie Soya
- Department of Vascular Medicine, Grenoble University Hospital, Grenoble, France
- Service de soins intensifs médicaux, Institut de Cardiologie d'Abidjan, Abidjan, Cote d'Ivoire
| | - Monira Nou
- Department of Vascular Medicine, Montpellier University Hospital, Montpellier, France
| | | | - Hélène Thiel
- Department of Radiology, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
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Achiti A, Zenati N, Seinturier C, Cracowski JL, Blaise S. Negative pressure wound therapy with instillation and dwell time in debridement of fibrinous leg ulcers. J Wound Care 2024; 33:166-170. [PMID: 38451785 DOI: 10.12968/jowc.2024.33.3.166] [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] [Indexed: 03/09/2024]
Abstract
OBJECTIVE In conjunction with appropriate wound care, negative pressure wound therapy with instillation and dwell time (NPWTi-d) may be used as an adjunct therapy for acute or hard-to-heal (chronic) wounds, especially when infected. However, there are very few data on the use of NPWTi-d in the treatment of fibrinous wounds that are difficult to debride mechanically. The main objective of this study was to describe changes in the fibrin area of such wounds, before and after treatment with NPWTi-d. METHOD This was a monocentric, observational, prospective pilot study evaluating the NPWTi-d medical device. Eligible patients included in the study were those with hard-to-heal lower limb ulcers who had previously undergone unsuccessful specific debridement treatment for their wound, with failure of manual mechanic debridement for at least six weeks' duration, and whose wounds had a fibrinous surface area of >70% of the total wound surface area. The primary endpoint was the difference in the percentage of fibrinous surface area before and after treatment. RESULTS A total of 14 patients who received treatment for lower limb ulcers between October 2017 and August 2019 were included in the study. There was a significant shrinkage rate of the fibrinous wound surface between the start and end of treatment (83.6±14.5% and 32.2±19.7%, respectively; p<0.001). CONCLUSION This study showed a significant decrease in fibrin area in wounds treated with NPWTi-d, with good tolerance. We believe that NPWTi-d has its place in the multidisciplinary management of patients with hard-to-heal ulcers. Additional randomised studies are required to confirm these findings. DECLARATION OF INTEREST The authors have no conflicts of interest.
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Affiliation(s)
- Alexandru Achiti
- Service de Médecine Vasculaire, Centre Hospitalier et Universitaire de Grenoble Alpes, F-38000 Grenoble, France
| | - Nora Zenati
- Service de Médecine Vasculaire, Centre Hospitalier et Universitaire de Grenoble Alpes, F-38000 Grenoble, France
| | - Christophe Seinturier
- Service de Médecine Vasculaire, Centre Hospitalier et Universitaire de Grenoble Alpes, F-38000 Grenoble, France
| | | | - Sophie Blaise
- Service de Médecine Vasculaire, Centre Hospitalier et Universitaire de Grenoble Alpes, F-38000 Grenoble, France
- Université Grenoble Alpes, Inserm, HP2, F-38000, Grenoble, France
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Monfort JB, Klejtman T, Lazareth I, Kottler D, Blaise S, Imbert B, Chaby G, Lok C, Maillard H, Beneton N, Journet-Tollhupp J, Goujon E, Jacquin A, Tella E, Mboup B, Vicaut E, Senet P. Nailfold dermoscopy predicts the absence of a capillaroscopy sclerodermic pattern: The multicentre, prospective VASCUL-R trial. J Eur Acad Dermatol Venereol 2024. [PMID: 38251814 DOI: 10.1111/jdv.19803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 11/28/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND Nailfold capillaroscopy is recommended to diagnose primary or secondary Raynaud's phenomenon (RP). Capillaroscopy is normal in primary RP, which is the most frequent. Screening for RP capillary anomalies with nailfold dermoscopy has been promising. OBJECTIVE To determine whether normal nailfold dermoscopy-based on the absence of five criteria that define a sclerodermic pattern-is able to predict normal capillaroscopy with good positive-predictive value (PPV). METHODS Prospective, 2-phase (monocentre and multicentre) study on patients at first consultation for RP undergoing nailfold video capillaroscopy (NVC) and nailfold dermoscopy by two different 'blinded' trained observers, respectively, a vascular specialist and a dermatologist, not familiar with capillaroscopy. The five criteria noted were as follows: disorganization, megacapillaries, low capillary density, avascular areas and haemorrhages. RESULTS Based on 105 patients, the dermoscopy PPV for a normal NVC was 100% (p = 0.015), with 37.9% sensitivity, when no criterion was observed. Excluding haemorrhages, the PPV remained 100% (p < 0.0001), with sensitivity rising to 73.7% and 100% specificity. CONCLUSION Normal nailfold dermoscopy with the absence of four easy-to-observe criteria predicts normal NVC with an excellent PPV.
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Affiliation(s)
- Jean-Benoît Monfort
- Service de Dermatologie et Médecine Vasculaire, Faculté de Médecine, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, Paris, France
| | - Tiffany Klejtman
- Service de Médecine Vasculaire, Institut de la Cicatrisation Jean-Paul-Belmondo, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - Isabelle Lazareth
- Service de Médecine Vasculaire, Institut de la Cicatrisation Jean-Paul-Belmondo, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - Diane Kottler
- Service de Dermatologie, Centre Hospitalier Universitaire de Caen, Caen, France
| | - Sophie Blaise
- Department of Vascular Medicine, Grenoble Alpes University Hospital, Grenoble, France
| | - Bernard Imbert
- Department of Vascular Medicine, Grenoble Alpes University Hospital, Grenoble, France
| | - Guillaume Chaby
- Service de Dermatologie, Centre Hospitalier Amiens, Amiens, France
| | - Catherine Lok
- Service de Dermatologie, Centre Hospitalier Amiens, Amiens, France
| | - Hervé Maillard
- Service de Dermatologie, Centre Hospitalier Le Mans, Le Mans, France
| | - Nathalie Beneton
- Service de Dermatologie, Centre Hospitalier Le Mans, Le Mans, France
| | | | - Elisa Goujon
- Service de Dermatologie, Centre Hospitalier Chalon-sur-Saône, Chalon-sur-Saône, France
| | - Aurélien Jacquin
- Service de Dermatologie et Médecine Vasculaire, Centre Hospitalier Victor-Dupouy, Argenteuil, France
| | - Emilie Tella
- Service de Dermatologie et Médecine Vasculaire, Centre Hospitalier Victor-Dupouy, Argenteuil, France
| | - Bassirou Mboup
- Unité de Recherche Clinique, Hôpital Fernand-Widal, Paris, France
| | - Eric Vicaut
- Unité de Recherche Clinique, Hôpital Fernand-Widal, Paris, France
| | - Patricia Senet
- Service de Dermatologie et Médecine Vasculaire, Faculté de Médecine, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, Paris, France
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Blaise S, Sinniger V, Seinturier C. Literature review of transcutaneous electrical nerve stimulation in peripheral arterial occlusive disease of the lower limbs. J Med Vasc 2023; 48:116-123. [PMID: 37914456 DOI: 10.1016/j.jdmv.2023.10.001] [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: 06/30/2023] [Accepted: 09/20/2023] [Indexed: 11/03/2023]
Abstract
The therapeutic challenge in peripheral arterial occlusive disease (PAD) is often to increase walking distance, improve pain or heal a wound when PAD is symptomatic. Walking rehabilitation or surgical revascularization techniques are limited. Others strategies as alternatives and/or complementary treatments are needed. Among alternative options, Transcutaneous Electrical Nerve Stimulations (TENS) could be of interest, both for improved walking distance or pain reduction. The Transcutaneous Electrical Nerve Stimulation (TENS) is a non-pharmacological, mini-invasive technique involving transcutaneous electrical stimulation. However, there are other transcutaneous electrical nerve stimulation techniques based on the principle of vagus nerve stimulation with different mechanistics. Trans-auricular Vagus nerve stimulation (Ta-VNS) is another TENS technique (electrode on the external ear) which relies on the anti-inflammatory pathways of efferent and afferent vagal fibers. We propose here to review the literature of mini-invasive electrical stimulations, whatever the anatomical zone concerned, in PAD. METHOD The aim was to evaluate the use of non-invasive transcutaneous electrical stimulation therapies (regardless of location) in PAD of the lower limbs, whatever the disease grade. A review of the literature was carried out via a search of the MEDLINE/PubMed database from 1975 to 2023. The articles were selected via abstracts by checking (1) medical indications: PAD patients with claudication were retained, excluding neurological or venous claudication, PAD whatever the disease grade (intermittent claudication or critical limb ischemia [CLI]) and (2) non invasive electrical stimulations were considered (neuromuscular electrical stimulation and spinal cord stimulation were excluded) whatever the anatomical site. Non-electrical stimuli such as acupuncture and reflexotherapy were excluded. RESULTS Only 9 items were selected, including 7 studies with TENS treatment on the calf, one with trans-auricular vagus nerve stimulation and one with electro-acupuncture points of stimulation. CONCLUSION Even if the mechanisms involved are different, TENS on the calves or in the external ears show an improvement of walking distance in PAD patients with intermittent claudication. The results of the studies show few positive effects in arteriopathy but we should keep vigilant in the technics used since mechanisms are different and not fully understood. Electro-stimulation of the calf and external ear appears to be an easy-to-use and accessible therapeutic option, especially since some PAD patients are still failing to be released from pain, despite the rise of endovascular interventional techniques.
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Affiliation(s)
- S Blaise
- Service de médecine vasculaire, Grenoble University Hospital, BP 217, 38043 Grenoble Cedex 09, France; Université de Grenoble Alpes, Inserm U1300, HP2, Grenoble, France.
| | - V Sinniger
- Université de Grenoble Alpes, U1216, Grenoble Institut des Neurosciences, CHU deGrenoble Alpes, 38000 Grenoble, France
| | - C Seinturier
- Service de médecine vasculaire, Grenoble University Hospital, BP 217, 38043 Grenoble Cedex 09, France
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Jambon-Barbara C, Bernardeau C, Bezin J, Roustit M, Blaise S, Cracowski JL, Khouri C. Use of Bisphosphonates and the Risk of Skin Ulcer: A National Cohort Study Using Data from the French Health Care Claims Database. Drug Saf 2023; 46:905-916. [PMID: 37531074 DOI: 10.1007/s40264-023-01336-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2023] [Indexed: 08/03/2023]
Abstract
INTRODUCTION Previous pre-clinical and pharmacovigilance disproportionality analyses highlighted a safety signal of cutaneous ulcer with bisphosphonate use. Therefore, our objective is to evaluate this risk and assess whether unmeasured confounding factors could explain this association. METHODS This study is a population-based cohort study from a representative sample (1/97th) of the French health insurance claims database: Echantillon Généraliste des Bénéficiaires (EGB) from 2006 to 2019. To limit the impact of our study design and methodological choices on any association between skin ulceration and exposure to bisphosphonates, we used several methods: a Cox proportional hazards analysis and a prior event rate ratio (PERR) analysis, using two propensity matched control groups, and either the first episode of incident ulceration or multiple event-time outcomes. RESULTS There were 7402 individuals newly exposed to bisphosphonates matched to 29,605 unexposed individuals on propensity score. The primary outcome was skin ulcer occurrence assessed by at least 2 deliveries of wound dressing during the period of one month. Among 6911 individuals newly exposed to bisphosphonates and 28,072 unexposed individuals with no previous skin ulcer, the Cox regression yielded a hazard ratio (HR) of 1.40 (95% CI 1.26-1.56) for newly exposed individuals. Among 7402 exposed and 29,605 unexposed individuals, the PERR analysis found a non-significant HR of 1.03 (95% CI 0.87-1.24). Results were similar on the different sensitivity analyses. CONCLUSION No association between bisphosphonate and skin ulcers was found in the French population. The association observed in previous pharmacovigilance studies and in the Cox regression analysis is likely due to unmeasured confounding factors.
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Affiliation(s)
- Clément Jambon-Barbara
- Pharmacovigilance Department, Grenoble Alpes University Hospital, 38043, Grenoble, France
| | - Claire Bernardeau
- Pharmacovigilance Department, Grenoble Alpes University Hospital, 38043, Grenoble, France
| | - Julien Bezin
- University Bordeaux, INSERM, BPH, Team AHeaD, U1219, 33000, Bordeaux, France
- Clinical Pharmacology Unit, CHU de Bordeaux, 33000, Bordeaux, France
| | - Matthieu Roustit
- University Grenoble Alpes, Inserm U1300, HP2, 38000, Grenoble, France
- University Grenoble Alpes, Inserm CIC1406, Grenoble Alpes University Hospital, 38000, Grenoble, France
| | - Sophie Blaise
- University Grenoble Alpes, Inserm U1300, HP2, 38000, Grenoble, France
- Department of Vascular Medicine, Grenoble Alpes University Hospital, University Grenoble Alpes, 38000, Grenoble, France
| | - Jean-Luc Cracowski
- Pharmacovigilance Department, Grenoble Alpes University Hospital, 38043, Grenoble, France
- University Grenoble Alpes, Inserm U1300, HP2, 38000, Grenoble, France
| | - Charles Khouri
- Pharmacovigilance Department, Grenoble Alpes University Hospital, 38043, Grenoble, France.
- University Grenoble Alpes, Inserm U1300, HP2, 38000, Grenoble, France.
- University Grenoble Alpes, Inserm CIC1406, Grenoble Alpes University Hospital, 38000, Grenoble, France.
- Centre Regional de Pharmacovigilance, CHU Grenoble Alpes, CS 10217, 38043, Grenoble Cedex 9, France.
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Guigui A, Liaigre L, Manceau M, Gaget O, Cracowski JL, Blaise S, Khouri C, Roustit M. Assessment of digital perfusion as a surrogate outcome in Raynaud's phenomenon clinical trials. Rheumatology (Oxford) 2023:kead337. [PMID: 37421381 DOI: 10.1093/rheumatology/kead337] [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: 04/17/2023] [Revised: 06/07/2023] [Accepted: 06/27/2023] [Indexed: 07/10/2023] Open
Abstract
OBJECTIVES Measurement of digital perfusion, sometimes coupled with a cold challenge, has been widely used as an objective outcome in trials evaluating drug therapies in Raynaud's Phenomenon (RP), in addition to patient-reported outcomes or to establish the proof-of-concept in preliminary studies. However, whether digital perfusion is a valid surrogate for clinical outcomes in RP trials has never been explored. The principal aim of this study was to evaluate the potential surrogacy of digital perfusion, by combining individual-level and trial-level data. METHODS We used individual data from a series of n-of-1 trials, and trial data from a network meta-analysis. We estimated individual-level surrogacy through coefficients of determination between digital perfusion and clinical outcomes (R2ind). We further calculated the coefficients of determination between treatment effect on the clinical outcomes and on digital perfusion, at the individual level (R2TEInd) and at the trial level (R2trial), using non-weighted linear regression, with their 95% CI calculated through bootstrapping. RESULTS Results from 33 patients and 24 trials were included in the final analysis. At the individual level, there was no correlation between digital perfusion and clinical outcomes at rest and in response to various cooling tests (the highest R2ind was 0.03 [-0.07; 0.09]), and R2TEinf was also very low 0.07 [0; 0.29]. At the trial level, the highest value of R2trial was 0.1 [0; 0.477]. CONCLUSIONS Digital perfusion, at rest or in response to a cold challenge, and whatever the method used, does not fulfill the criteria of a valid surrogate for existing patient-reported outcomes in RP trials.
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Affiliation(s)
- Alicia Guigui
- Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, Grenoble, HP2, France
- Univ. Grenoble Alpes, Inserm CIC1406, CHU Grenoble Alpes, Grenoble, France
| | - Léa Liaigre
- Univ. Grenoble Alpes, Inserm CIC1406, CHU Grenoble Alpes, Grenoble, France
| | - Marc Manceau
- Univ. Grenoble Alpes, Inserm CIC1406, CHU Grenoble Alpes, Grenoble, France
| | - Olivier Gaget
- Univ. Grenoble Alpes, Inserm CIC1406, CHU Grenoble Alpes, Grenoble, France
| | - Jean-Luc Cracowski
- Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, Grenoble, HP2, France
- Univ. Grenoble Alpes, Pharmacovigilance unit, CHU Grenoble Alpes, Grenoble, France
| | - Sophie Blaise
- Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, Grenoble, HP2, France
- Univ. Grenoble Alpes, Department of Vascular Medicine, CHU Grenoble Alpes, Grenoble, France
| | - Charles Khouri
- Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, Grenoble, HP2, France
- Univ. Grenoble Alpes, Inserm CIC1406, CHU Grenoble Alpes, Grenoble, France
- Univ. Grenoble Alpes, Pharmacovigilance unit, CHU Grenoble Alpes, Grenoble, France
| | - Matthieu Roustit
- Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, Grenoble, HP2, France
- Univ. Grenoble Alpes, Inserm CIC1406, CHU Grenoble Alpes, Grenoble, France
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Zenati N, Seinturier C, Blaise S. [Can retained products of conception be considered as an unclassified acquired vascular malformation?]. Gynecol Obstet Fertil Senol 2023; 51:387-389. [PMID: 36924926 DOI: 10.1016/j.gofs.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 03/09/2023] [Accepted: 03/11/2023] [Indexed: 03/15/2023]
Affiliation(s)
- Nora Zenati
- Department of Vascular Medicine, Grenoble-Alpes University Hospital, 38000 Grenoble, France
| | - Christophe Seinturier
- Department of Vascular Medicine, Grenoble-Alpes University Hospital, 38000 Grenoble, France
| | - Sophie Blaise
- Department of Vascular Medicine, Grenoble-Alpes University Hospital, 38000 Grenoble, France; HP2 Laboratory, University Grenoble-Alpes, 38000 Grenoble, France.
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10
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Blaise S. A 2023 update of choosing wisely "Chemical or thermal occlusion treatments in saphenous vein insufficiency and recurrence": What objectives for what impact? J Med Vasc 2023; 48:53-54. [PMID: 37422327 DOI: 10.1016/j.jdmv.2023.06.003] [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] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Indexed: 07/10/2023]
Affiliation(s)
- Sophie Blaise
- Service de médecine vasculaire, Grenoble University Hospital BP 217, 38043 Grenoble Cedex 09, France.
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Senet P, Maillard H, Diot E, Lazareth I, Blaise S, Arnault JP, Pistorius MA, Boulon C, Cogrel O, Warzocha U, Rivière S, Malloizel-Delaunay J, Servettaz A, Sassolas B, Viguier M, Monfort JB, Janique S, Vicaut E. Efficacy and Safety of Botulinum Toxin in Adults with Raynaud's Phenomenon Secondary to Systemic Sclerosis: A Multicenter, Randomized, Double-Blind, Placebo-Controlled Study. Arthritis Rheumatol 2023; 75:459-467. [PMID: 36066501 DOI: 10.1002/art.42342] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 08/10/2022] [Accepted: 08/31/2022] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To determine whether a single session of botulinum toxin type A (BTA) injections into both hands more effectively decreases the frequency of systemic sclerosis-associated Raynaud's phenomenon (SSc-RP) episodes than placebo. METHODS This multicenter, randomized, double-blind, placebo-controlled, parallel-group phase III trial in patients with SSc-RP assessed the effect of 50-unit BTA or placebo injections into the palms of both hands around each neurovascular bundle during 1 session in winter. The primary end point was the between-group difference in the median change in the number of RP episodes from baseline (day 0) to 4 weeks postinjection. Values between the groups were compared with the Wilcoxon rank-sum test. RESULTS The intent-to-treat analysis included 46 BTA-treated patients and 44 placebo recipients. At 4 weeks after assigned treatment injections, the median number of daily RP episodes decreased comparably in the BTA and placebo groups (median change -1 episode/day [interquartile range (IQR) -1.5, 0 episodes/day] and -1 episode/day [IQR -2.5, 0 episodes/day], respectively) (P = 0.77 versus placebo). Moreover, change in Raynaud's Condition Score, quality of life assessed by Health Assessment Questionnaire disability index, and hand function assessed by shortened Disabilities of the Arm, Shoulder, and Hand (QuickDASH) and Cochin Hand Function Scale from baseline to follow-up weeks 4, 12, and 24 did not differ significantly between groups. The BTA group experienced transient hand muscle weakness significantly more frequently (P = 0.003). CONCLUSION Neither the primary nor secondary end points were reached, and our results do not support any beneficial effect of palmar BTA injections to treat SSc-RP.
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Affiliation(s)
- Patricia Senet
- Assistance Publique-Hôpitaux de Paris, and Service de Dermatologie, Centre Hospitalier Universitaire Tenon, Groupe Hospitalier Sorbonne Université, Paris, France
| | - Hervé Maillard
- Service de Dermatologie, Centre Hospitalier Le Mans, Le Mans, France
| | - Elisabeth Diot
- Service de Médecine Interne et Immunologie Clinique, Centre Hospitalier Universitaire Bretonneau-Tours, Tours, France
| | | | - Sophie Blaise
- Université Grenoble Alpes, Inserm, HP2, Grenoble, France
| | - Jean-Philippe Arnault
- Service de Dermatologie, Centre Hospitalier Universitaire Amiens-Picardie, Amiens, France
| | | | - Carine Boulon
- Service de Médecine Vasculaire, Centre Hospitalier Universitaire St-André, Bordeaux, France
| | - Olivier Cogrel
- Unité de Dermatologie Interventionnelle, Service de Dermatologie, Centre Hospitalier Universitaire, Bordeaux, France
| | - Ursula Warzocha
- Assistance Publique-Hôpitaux de Paris, and Service de Médecine Interne, Centre Hospitalier Universitaire Avicenne, Bobigny, France
| | - Sébastien Rivière
- Assistance Publique-Hôpitaux de Paris, and Service de Médecine Interne, Centre Hospitalier Universitaire Saint-Antoine, Groupe Hospitalier Sorbonne Université, Paris, France
| | | | - Amélie Servettaz
- Service de Médecine Interne, Maladies Infectieuses, Immunologie Clinique, Hôpital Robert-Debré, Centre Hospitalier Universitaire, Reims, France
| | - Bruno Sassolas
- Département de Médecine Interne et Pneumologie, Hôpital de la Cavale Blanche, Centre Hospitalier Régional Universitaire, Brest, France
| | - Manuelle Viguier
- Service de Dermatologie-Vénéréologie, Hôpital Robert-Debré, Université Reims Champagne Ardenne, IRMAIC, EA7509, Reims, France
| | - Jean-Benoit Monfort
- Assistance Publique-Hôpitaux de Paris, and Service de Dermatologie, Centre Hospitalier Universitaire Tenon, Groupe Hospitalier Sorbonne Université, Paris, France
| | - Solène Janique
- Assistance Publique-Hôpitaux de Paris, Unité de Recherche Clinique, Centre Hospitalier Universitaire Fernand-Widal, Paris, France
| | - Eric Vicaut
- Assistance Publique-Hôpitaux de Paris, Unité de Recherche Clinique, Centre Hospitalier Universitaire Fernand-Widal, Paris, France
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Galanaud JP, Genty-Vermorel C, Barrellier MT, Becker F, Jabbour V, Blaise S, Bura-Rivière A, Comte A, Grange C, Guenneguez H, Maufus M, Ouvry P, Richaud C, Rolland C, Schmidt J, Sevestre MA, Verrière F, Bosson JL, Bosson JL, Pichot O, Maufus M, Guenneguez H, Ouvry P, Di Maio A, Schmidt J, Galanaud JP, Bura-Rivière A, Couturaud F, Danguy Des Déserts M, Grange C, Mismetti P, Barrellier MT, Laneelle D, Terriat B, Stansal A, Martin M, Quashie C, Bonaldi M, Lanoye P, Ponchaux-Crépin F, Berremili T, Sevestre-Pietri MA, Samy-Modeliar S, Addala A, Toffin L, Rouquet B, Michot-Casbas M, Lacaze G, Roy PM, Durant C, Baldassini-Esquis AL, Cazanave A, Rouvière D, Skolka H, Salem T, Monsallier JM, Roger B, Tra TQ, Kalolwa M, Diard A, Lambert M, Taiar M, Gaudout C, Ancey S, Jurus C. 25 mm Hg versus 35 mm Hg elastic compression stockings to prevent post-thrombotic syndrome after deep vein thrombosis (CELEST): a randomised, double-blind, non-inferiority trial. Lancet Haematol 2022; 9:e886-e896. [DOI: 10.1016/s2352-3026(22)00247-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/15/2022] [Accepted: 07/18/2022] [Indexed: 11/30/2022]
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Joly M, Gillois P, Satger B, Blaise S, Pernod G. Comparative evaluation of socioeconomic insecurity in peripheral and coronary artery disease patients. J Med Vasc 2022; 47:220-227. [PMID: 36464416 DOI: 10.1016/j.jdmv.2022.10.001] [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: 08/24/2022] [Accepted: 09/30/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Cardiovascular disease represents the leading cause of death worldwide. Socioeconomic deprivation is a risk factor for cardiovascular disease. We have previously shown that precariousness was more frequent in symptomatic peripheral artery disease (PAD) patients than in the general population. According to a previous study, coronary artery disease (CAD) patients have a higher level of education than CAD with PAD, but no study directly compared the level of precariousness in PAD and CAD patients. AIM To measure and compare the level of socioeconomic insecurity in patients suffering from symptomatic PAD with those suffering from isolated CAD, i.e without symptomatic PAD. METHODS We conducted an observational, cohort, prospective, multicenter study. Patients suffering from symptomatic PAD or CAD were recruited through the medical or surgical vascular or cardiology departments, or the vascular rehabilitation center. The EPICES score and the INSEE parameters were used for analysis. The individual is considered precarious when his or her score is greater than or equal to 30. Cardiovascular risk factors and peripheral arterial disease stages were also collected. RESULTS In total, 230 patients were included. According to the EPICES score, 47.8% [95%CI, 38.7-56.7] of patients with symptomatic PAD were in a precarious situation compared to 17.4% [95%CI, 10.5-24.3] of patients suffering from isolated CAD (P<0.001). The mean EPICES score was 33.3 (SD 22.5) in the PAD and 16.9 (SD 17.02) in the CAD population, respectively (P<0.001). In the PAD population, the level of education was low, with an under-representation of patients with a baccalaureate or higher education degree: 21.7% [95%CI, 14.2-29.3] vs. 41.7% [95%CI, 32.7-50.7] in the PAD and CAD populations, respectively. There was also an under-representation of executives and intellectual and intermediate professions in the PAD population, 18.3% [95%CI, 11.2-25.3], compared to the CAD population, 31.3% [95%CI, 22.8-39.8]. CONCLUSION PAD patients are more precarious than patients suffering from CAD. A better detection of socioeconomic deprivation in patients suffering from peripheral arterial disease could allow comprehensive care and thus hope for an improvement in terms of morbidity and mortality.
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Affiliation(s)
- Marion Joly
- Department of Vascular Medicine, University Hospital Grenoble-Alpes, Grenoble, France
| | - Pierre Gillois
- Department of Public Health, University Hospital Grenoble-Alpes, Grenoble, France; Université Grenoble-Alpes, CNRS/TIMC-IMAG UMR 5525/Themas, Grenoble, France
| | - Bernadette Satger
- Department of Vascular Medicine, University Hospital Grenoble-Alpes, Grenoble, France
| | - Sophie Blaise
- Department of Vascular Medicine, University Hospital Grenoble-Alpes, Grenoble, France
| | - Gilles Pernod
- Department of Vascular Medicine, University Hospital Grenoble-Alpes, Grenoble, France; Université Grenoble-Alpes, CNRS/TIMC-IMAG UMR 5525/Themas, Grenoble, France.
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14
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Senet P, Addala A, Léger P, Chahim M, Malloizel J, Blaise S, Sauvadet A, Tacca O, Stücker M, Dissemond J. A new compression system for treatment of venous leg ulcers: a prospective, single-arm, clinical trial (FREEDOM). J Wound Care 2022; 31:734-747. [PMID: 36113543 DOI: 10.12968/jowc.2022.31.9.734] [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] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate the efficacy, tolerability and acceptability of a new multicomponent compression system in one bandage for the local treatment of patients with venous leg ulcers (VLUs). METHOD This was an international, prospective, non-comparative, clinical trial, conducted in France and Germany. Eligible participants had a VLU with a wound area of 2-20cm2, lasting for a maximum of 24 months. For a period of 6 weeks, patients were treated with a new multicomponent compression system in one bandage which was worn day and night, providing high working pressure and moderate resting pressure (UrgoK1). Clinical assessments, wound measurement and photographs were planned at weeks 1, 2, 4 and 6. The primary endpoint was the relative wound area reduction (RWAR) after 6 weeks of treatment. Secondary endpoints included wound closure rate, oedema resolution, change in patient's health-related quality of life (HRQoL), acceptability, adherence to the compression therapy, local tolerance, and physician's overall satisfaction with the evaluated compression system. RESULTS A cohort of 52 patients (52% female, mean age 75.4±13.0 years) with VLUs, including oedema in 58% of cases, were recruited from 22 centres. At baseline, 42 patients had already been treated with a different compression system. VLUs had been present for 5.6±4.9 months and had a mean area of 5.7±4.3cm2. After 6 weeks of treatment, a median RWAR of 91% (interquartile range: 39.4; 100.0) was achieved. Wound closure was reported in 35% of patients. A RWAR ≥40% at week 4, predictive of wound healing at 12 weeks, was achieved in 62% of patients. At the final visit, oedema present at baseline was resolved in 57% of patients. Substantial improvements in the HRQoL of the patients were reported with a decrease of the pain/discomfort and anxiety/depression dimensions. Comfort in wearing the evaluated system was reported as 'very good' or 'good' by 79% of patients, resulting in a high patient adherence to compression therapy. Compared to previous compression systems, half of the patients reported more ease in wearing shoes, and greater satisfaction and comfort with this new system. Nine non-serious adverse events related to the device or its procedure occurred in seven patients. At the final visit, the majority of the physicians were 'very satisfied' or 'satisfied' with the new compression system overall. CONCLUSION The new multicomponent compression system in one bandage has been shown to promote rapid healing of VLUs, reduce oedema, improve HRQoL and to be well tolerated and accepted. It appears to be a viable alternative to existing compression systems.
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Affiliation(s)
- Patricia Senet
- Department of Dermatology, Paris Est University Hospitals (AP-HP) - Tenon Hospital, Paris, France
| | - Azeddine Addala
- Department of Vascular Medicine, Edouard Herriot Hospital, Lyon, France
| | - Philippe Léger
- Wound and Wound Healing Centre, Pasteur Clinic, Toulouse, France
| | - Maxime Chahim
- Department of Vascular Medicine, Corentin Celton Hospital, Issy Les Moulineaux, France
| | - Julie Malloizel
- Department of Vascular Medicine, Rangueil University Hospital, Toulouse, France
| | - Sophie Blaise
- Department of Vascular Medicine, Albert Michalon University Hospital, Grenoble, France
| | - Anne Sauvadet
- Clinical Development Department, URGO Research Innovation and Development, Chenove, France
| | - Olivier Tacca
- Clinical Development Department, URGO Research Innovation and Development, Chenove, France
| | - Markus Stücker
- Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - Joachim Dissemond
- Department of Dermatology, Venerology and Allergology, University Hospital Essen, Essen, Germany
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Joergensen B, Blaise S, Svensson AS. A randomised, open-label, parallel-group, multicentre, comparative study to compare the efficacy and safety of Exufiber® with Aquacel® Extra™ dressings in exuding venous and mixed aetiology leg ulcers. Int Wound J 2022; 19 Suppl 1:22-38. [PMID: 36111589 PMCID: PMC9478964 DOI: 10.1111/iwj.13913] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Indexed: 12/02/2022] Open
Abstract
The performance and safety of Exufiber® gelling fibre and Aquacel® Extra™ Hydrofiber® wound dressings were compared for the management of chronic, exuding leg ulcers. The 6‐week study (≤ 24 weeks in a subgroup of subjects) was a randomised, open‐label, parallel‐group, multicentre, non‐inferiority design. Adults (n = 248, 30–97 years of age) were randomised to either Exufiber® or Aquacel® Extra™ dressing. The dressings were applied at baseline and evaluations of wound condition and performance of the dressing were recorded at 1, 2, 3, 4, and 6 weeks. The primary efficacy endpoint was the percentage reduction in wound area at 6 weeks relative to baseline, in the per protocol (PP) population. A median relative reduction of 50% for Exufiber® (n = 100) vs 42% for Aquacel® Extra™ (n = 107) was demonstrated in the PP population (P = 0.093) and confirmed in the intention‐to‐treat population. As the mean and 95% confidence interval for the difference in relative wound area reduction between groups at 6 weeks was −29.4% (−63.5; 3.2), and the lower limit did not exceed 12%, non‐inferiority of Exufiber® was concluded. Both dressings were well tolerated and no safety concerns were identified in both groups. Clinicians' satisfaction with the dressings was higher for Exufiber® than for Aquacel® Extra™ in terms of ease of use and management of exudate, slough, and blood.
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Affiliation(s)
| | - Sophie Blaise
- Department of Vascular Medicine, Grenoble Alpes University Hospital, Grenoble, France
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Roustit M, Jullien A, Jambon-Barbara C, Goudon H, Blaise S, Cracowski JL, Khouri C. Placebo response in Raynaud's Phenomenon clinical trials: the prominent role of regression towards the mean. Semin Arthritis Rheum 2022; 57:152087. [DOI: 10.1016/j.semarthrit.2022.152087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 08/11/2022] [Accepted: 08/19/2022] [Indexed: 11/24/2022]
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17
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Faisant MC, Legros L, Préaubert L, Forey PL, Blaise S, Equy V, Riethmuller D. [Management of pregnant woman with Klippel-Trenaunay syndrome: A rare and complex situation, about a case report]. Gynecol Obstet Fertil Senol 2022; 50:563-565. [PMID: 35472443 DOI: 10.1016/j.gofs.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 02/27/2022] [Accepted: 04/02/2022] [Indexed: 06/14/2023]
Affiliation(s)
- M-C Faisant
- Département de gynécologie-obstétrique et médecine de la reproduction, CHU Grenoble-Alpes, Grenoble, France
| | - L Legros
- Département de gynécologie-obstétrique et médecine de la reproduction, CHU Grenoble-Alpes, Grenoble, France
| | - L Préaubert
- Département de gynécologie-obstétrique et médecine de la reproduction, CHU Grenoble-Alpes, Grenoble, France
| | - P-L Forey
- Département de gynécologie-obstétrique et médecine de la reproduction, CHU Grenoble-Alpes, Grenoble, France
| | - S Blaise
- Médecine vasculaire, CHU Grenoble-Alpes, Grenoble, France
| | - V Equy
- Département de gynécologie-obstétrique et médecine de la reproduction, CHU Grenoble-Alpes, Grenoble, France
| | - D Riethmuller
- Département de gynécologie-obstétrique et médecine de la reproduction, CHU Grenoble-Alpes, Grenoble, France.
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Loseto N, Zenati N, Seinturier C, Blaise S. Evaluation of patients' and practitionners' satisfaction with the use of hypnosis during a thermal endovenous procedure. J Med Vasc 2022; 47:82-86. [PMID: 35691667 DOI: 10.1016/j.jdmv.2022.04.001] [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: 03/15/2022] [Accepted: 04/01/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION In the field of vascular surgery, hypnosis has been used in the creation of venous approaches but also as a complement to local anesthesia during more extensive vascular surgery, including the insertion of abdominal aortic aneurysm stents. The practice of thermal endovenous procedures seems to us to be conducive to hypnotic support in particular to reinforce hypnoanalgesia. METHOD We present a prospective and monocentric observational study at the University Hospital of Grenoble with consecutive inclusions whose objective was to evaluate the interest and the satisfaction of the patients and practionners about the practice of hypnosis during procedures of thermal endovenous treatments. RESULTS Among the 31 patients treated with endovenous laser, 27 accepted the hypnosis proposal, 16 had hypnosis considered as formal and 13 conversational hypnosis and 10 conversation only. Among them, 29% of patients considered that the hypnoanalgesia technique had enormously relaxed them and 19% "very relaxed"; 42% of patients considered themselves "good", 32% "very good" and 19% "extremely good" at the end of the procedure. Concerning the practitioners performing the endovenous procedure, more than half (51, 51%) considered that hypnoanalgesia relaxed the patient "moderately and/or a lot". The results were as a whole point to a high level of satisfaction on the part of patients and practitioners with the practice of procedures with various levels of hypnosis induction. Despite many biases, this study has the merit of concluding that the patients were very satisfied with the apprehension of these gestures as well as the practitioners, and this without any additional time during the procedure.
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Affiliation(s)
- N Loseto
- Department of Vascular Medicine, Grenoble Alpes University Hospital CS 10217 38043, 38000 Grenoble cedex 09, France
| | - N Zenati
- Department of Vascular Medicine, Grenoble Alpes University Hospital CS 10217 38043, 38000 Grenoble cedex 09, France
| | - C Seinturier
- Department of Vascular Medicine, Grenoble Alpes University Hospital CS 10217 38043, 38000 Grenoble cedex 09, France
| | - S Blaise
- Department of Vascular Medicine, Grenoble Alpes University Hospital CS 10217 38043, 38000 Grenoble cedex 09, France; Université de Grenoble Alpes. Inserm, HP2, 38000 Grenoble, France.
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Boulon C, Velardo F, Blaise S, Mangin M, Chevoir JDL, Senet P, Lazareth I, Baudot N, Tribout L, Imbert B, Lapebie FX, Dari L, Lacroix P, Truchetet ME, Seneschal J, Solanilla A, Lazaro E, Quéré I, Pistorius MA, Asselineau J, Lhomme E, Carpentier P, Constans J. Correlation of nailfold capillaroscopy findings with history of digital ulcer on same finger: Results of SCLEROCAP study. Microvasc Res 2022; 142:104365. [DOI: 10.1016/j.mvr.2022.104365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/16/2022] [Accepted: 03/21/2022] [Indexed: 11/28/2022]
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Kotzki S, Savina Y, Bouvet R, Gil H, Blaise S, Cracowski JL, Roustit M. Iontophoresis of treprostinil promotes wound healing in a murine model of scleroderma-related ulcers. Rheumatology (Oxford) 2021; 61:2704-2708. [PMID: 34888615 DOI: 10.1093/rheumatology/keab852] [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: 07/14/2021] [Revised: 11/06/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Systemic Sclerosis (SSc) is a rare, chronic disease characterized by fibrosis, vascular alterations and digital ulcerations. Few drugs have shown efficacy to enhance wound healing of existing SSc-related ulcers. Local delivery of treprostinil, a prostacyclin analogue, may improve wound healing. The present work aimed first at developing a mouse model of SSc-related ulcerations and second at assessing the effect of iontophoresis of treprostinil on wound healing. METHODS We used two murine models of SSc: chemically-induced with HOCl, and Urokinase-type plasminogen activator receptor (uPAR)-deficient. Excisional wounding was performed on the dorsal midline with a biopsy punch. Animals were randomized into three groups: treated with electrostimulation alone, with treprostinil iontophoresis, or untreated. We assessed wound healing over time, as well as skin microvascular reactivity, inflammation, microvessel density, and collagen distribution, before wounding and after re-epithelialization. RESULTS uPAR-/- mice, but not HOCl-treated mice, showed impaired wound healing and decreased microvascular reactivity compared with their controls. Treprostinil iontophoresis improved wound healing and microvascular density and decreased inflammation in uPAR-/- mice, while electro-stimulation did not. However, treprostinil had no effect on microvascular reactivity and collagen distribution. CONCLUSION This study suggests that excisional wounds in uPAR-/- mice are a relevant model of SSc-related ulcers. In addition, treprostinil iontophoresis enhances wound healing in this model. Further work in now needed to show whether this effect translates in humans.
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Affiliation(s)
- Sylvain Kotzki
- Univ. Grenoble Alpes, Inserm, UMR1300, HP2, 38000, France .Grenoble.,Grenoble-Alpes University Hospital, Grenoble, 38043, France
| | - Yann Savina
- Univ. Grenoble Alpes, Inserm, UMR1300, HP2, 38000, France .Grenoble
| | - Raphael Bouvet
- Univ. Grenoble Alpes, Inserm, UMR1300, HP2, 38000, France .Grenoble
| | - Hugo Gil
- Grenoble-Alpes University Hospital, Grenoble, 38043, France
| | - Sophie Blaise
- Univ. Grenoble Alpes, Inserm, UMR1300, HP2, 38000, France .Grenoble.,Grenoble-Alpes University Hospital, Grenoble, 38043, France
| | - Jean-Luc Cracowski
- Univ. Grenoble Alpes, Inserm, UMR1300, HP2, 38000, France .Grenoble.,Grenoble-Alpes University Hospital, Grenoble, 38043, France
| | - Matthieu Roustit
- Univ. Grenoble Alpes, Inserm, UMR1300, HP2, 38000, France .Grenoble.,Grenoble-Alpes University Hospital, Grenoble, 38043, France
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Briche N, Seinturier C, Cracowski JL, Zaoui P, Blaise S. Digital pressure with laser Doppler flowmetry is better than photoplethysmography to characterize peripheral arterial disease of the upper limbs in end-stage renal disease patients. Microvasc Res 2021; 139:104264. [PMID: 34653520 DOI: 10.1016/j.mvr.2021.104264] [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: 07/16/2021] [Revised: 10/01/2021] [Accepted: 10/07/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE There is no consensual definition of significant peripheral arterial disease of the upper limbs. Patients with end-stage renal disease are usually explored with Doppler ultrasound, which seems insufficient to characterize and quantify the arterial disease in this anatomic site. Candidates for haemodialysis access tend to be increasingly older and have polyvascular disease, and a better assessment of the vascular status of their upper limbs with finger systolic blood pressure is necessary. Photoplethysmography is simple and currently used in practice, but laser Doppler flowmetry may be more sensitive for low values. Our objective is to investigate additional information in the digit assessment over the ultrasound assessment of the upper limbs of patients awaiting haemodialysis and compare digital pressure values taken by photoplethysmography and laser Doppler. METHODS All included patients with end-stage renal disease scheduled for haemodialysis access received a prospective evaluation of their upper limbs with a clinical examination of the hands, an arterial upper limb Doppler ultrasound, and finger systolic blood pressure using photoplethysmography and laser Doppler flowmetry. Significant upper limb arterial disease was defined by a finger systolic blood pressure below 60 mm Hg or a finger brachial pressure index below 0.7. RESULTS Twenty-four patients were included in the study. In all, 41.7% of patients (n = 10) had parietal calcifications to the antebrachial arteries on Doppler ultrasound, 8.3% of patients (n = 2) had bilateral finger systolic blood pressure values below 60 mm Hg with laser Doppler flowmetry (but not confirmed with photoplethysmography), and 16.6% of patients (n = 4) had a finger brachial pressure index below 0.7 on both laser Doppler flowmetry and photoplethysmography. While there was an agreement between these two methods, higher values were recorded with photoplethysmography. The Pearson coefficient was 0.493 for the median of basal digital pressures in absolute values and 0.489 for finger brachial pressure index (p < 0.001). CONCLUSION Our study confirms the need to evaluate significant upper limb arterial disease in patients with end-stage renal disease not only with Doppler ultrasound but also with an evaluation of the finger systolic blood pressure. The correlation of the finger systolic blood pressure values using laser Doppler flowmetry and photoplethysmography was poor, which was probably due to an overestimation of the pressures with photoplethysmography. Despite the absence of a gold standard, we suggest that Laser Doppler flowmetry should be used rather than photoplethysmography to better characterize significant peripheral arterial disease of the upper limbs in patients with end-stage renal disease, particularly before creation of a new haemodialysis access. Protocol Record on clinical trial 38RC19.285.
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Affiliation(s)
- Nicolas Briche
- Department of Vascular Medicine, Dijon University Hospital, 21000 Dijon, France
| | - Christophe Seinturier
- Department of Vascular Medicine, Grenoble Alpes University Hospital, F-38000 Grenoble, France
| | - Jean Luc Cracowski
- INSERM CIC1406, Grenoble Alpes University Hospital, F-38000 Grenoble, France; Univ. Grenoble Alpes, INSERM, HP2, F-38000 Grenoble, France
| | - Philippe Zaoui
- Department of Nephrology, Grenoble Alpes University Hospital, F-38000 Grenoble, France
| | - Sophie Blaise
- Department of Vascular Medicine, Grenoble Alpes University Hospital, F-38000 Grenoble, France; Univ. Grenoble Alpes, INSERM, HP2, F-38000 Grenoble, France.
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22
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Boscaro G, Danjou A, Seinturier C, Blaise S. Training of advanced practice nurses in vascular medicine in France. Position in the care system. J Med Vasc 2021; 46:258-261. [PMID: 34862022 DOI: 10.1016/j.jdmv.2021.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 10/15/2021] [Indexed: 06/13/2023]
Affiliation(s)
- G Boscaro
- Department of Cardiology, Grenoble Alpes University Hospital, 38000 Grenoble, France
| | - A Danjou
- Institut de formation des professionnels de santé, Grenoble Alpes University Hospital, 38000 Grenoble, France
| | - C Seinturier
- Department of Vascular Medicine, Grenoble Alpes University Hospital, 38000 Grenoble, France
| | - S Blaise
- Department of Vascular Medicine, Grenoble Alpes University Hospital, 38000 Grenoble, France.
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23
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Tembely D, Bocquet O, Kawecki C, Terryn C, Schmelzer C, Heinz A, Romier-Crouzet B, Bennasroune A, Blaise S, Sartelet H, Martiny L, Duca L, Maurice P. Characterization of novel interactions with plasma membrane NEU1 reveals new biological functions for the elastin receptor complex in vascular diseases. Atherosclerosis 2021. [DOI: 10.1016/j.atherosclerosis.2021.06.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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24
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Henry A, Berquand A, Terryn C, Maurice P, Bennasroune A, Blaise S, Romier-Crouzet B, Sartelet H, Gillery P, Jaisson S, Duca L. Effect of elastin-derived peptides (EDPS) and carbamylated-EDPS on vascular smooth muscle cells phenotype in relation to atherosclerosis development. Atherosclerosis 2021. [DOI: 10.1016/j.atherosclerosis.2021.06.192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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25
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Abstract
Vancomycin is a tricyclic glycopeptide antibiotic produced from Streptococcus orientalis. There is much variation in the literature with regard to the recommended dose, dilution rate and type of infusion. Given the vesicant properties of vancomycin at supratherapeutic doses (>10mg/ml), tissue damage including blistering and necrosis have been reported. We report a rare case of bilateral cutaneous necrosis induced by accidental extravasation of vancomycin when being intravenously administered. The skin surrounding the injection site was marked by the appearance of subcutaneous calcifications. The development of iatrogenic skin calcinosis has not yet been described for the extravasation of vancomycin. The mechanism underlying the calcinosis observed in our case remains unclear, but we hypothesised a form of localised calciphylaxis induced by a local triggering factor. The ulcers progressed to re-epithelialisation following necrosis debridement and local conservative treatments. Given the increased prevalence of meticillin-resistant Staphylococcus aureus, which has prompted clinicians to gradually increase vancomycin dosage, clinicians should be aware of the high risk of skin toxicity in cases of vancomycin high-dose extravasation.
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Affiliation(s)
- Nora Zenati
- Grenoble University Hospital, Department of Vascular Medicine, F-38000 Grenoble, France
| | - Charles Khouri
- Grenoble Alpes University Hospital, Pharmacovigilance Unit, F-38000 Grenoble, France.,Grenoble Alpes University Hospital, Clinical Pharmacology Department, INSERM CIC1406, F-38000 Grenoble, France.,Univ. Grenoble Alpes, UMR 1042-HP2, INSERM, F-38000 Grenoble, France
| | - Carole Schwebel
- Medical Intensive Care Unit, Grenoble University Hospital, F-38000 Grenoble, France
| | - Sophie Blaise
- Grenoble University Hospital, Department of Vascular Medicine, F-38000 Grenoble, France.,Univ. Grenoble Alpes, UMR 1042-HP2, INSERM, F-38000 Grenoble, France
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26
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Zenati N, Seinturier C, Blaise S. [Overt disseminated intravascular coagulation complicating a venous malformation]. Rev Med Interne 2020; 42:131-133. [PMID: 33168353 DOI: 10.1016/j.revmed.2020.08.012] [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: 12/31/2019] [Revised: 07/31/2020] [Accepted: 08/04/2020] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Coagulopathy related to venous malformations can be life threatening. This complication is little known and underestimated. CASE REPORT We report the case of a 52-year-old female patient who presented with a left femoral fracture. She had a pre-existing muscular infiltrating venous malformation of the left hip. During surgery, she developed acute disseminated intravascular coagulation. The latter was probably a consequence of both surgery and localized intravascular coagulation that was unknown before the trauma. CONCLUSION It is important to diagnose localized intravascular coagulation in venous malformations, since the risk of disseminated intravascular coagulation can be prevented by anticoagulant therapy.
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Affiliation(s)
- N Zenati
- Department of Vascular Medicine, Grenoble-Alpes University Hospital, 38000 Grenoble, France.
| | - C Seinturier
- Department of Vascular Medicine, Grenoble-Alpes University Hospital, 38000 Grenoble, France
| | - S Blaise
- Department of Vascular Medicine, Grenoble-Alpes University Hospital, 38000 Grenoble, France; HP2 laboratory, University Grenoble-Alpes, 38000 Grenoble, France
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27
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Guigui A, Mazet R, Blaise S, Cracowski C, Beau Guillaumot M, Kotzki S, Roustit M, Cracowski J. Treprostinil iontophoresis in systemic sclerosis-related digital skin ulcers: A single ascending dose safety study. Archives of Cardiovascular Diseases Supplements 2020. [DOI: 10.1016/j.acvdsp.2020.03.026] [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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28
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Blaise S, Constans J, Pellegrini L, Senet P, Lazareth I, Cracowski JL, Carpentier P. Optimizing finger systolic blood pressure measurements with laser Doppler: Validation of the second phalanx site. Microvasc Res 2020; 131:104029. [DOI: 10.1016/j.mvr.2020.104029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 06/06/2020] [Indexed: 10/24/2022]
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29
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Duron D, Blaise S, Cracowski JL, Roustit M, Khouri C. Drug-induced skin ulcers: A disproportionality analysis from the WHO pharmacovigilance database. J Am Acad Dermatol 2020; 85:229-232. [PMID: 32781179 DOI: 10.1016/j.jaad.2020.08.013] [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: 04/26/2020] [Revised: 07/08/2020] [Accepted: 08/02/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Dorothée Duron
- Clinical Pharmacology Department, INSERM CIC1406, Grenoble Alpes University Hospital, France
| | - Sophie Blaise
- Vascular Medicine Department, Thorax and Vessels Division, Grenoble Alpes University Hospital, France
| | - Jean-Luc Cracowski
- Clinical Pharmacology Department, INSERM CIC1406, Grenoble Alpes University Hospital, France; INSERM UMR 1042-HP2, University Grenoble Alpes, France
| | - Matthieu Roustit
- Clinical Pharmacology Department, INSERM CIC1406, Grenoble Alpes University Hospital, France; INSERM UMR 1042-HP2, University Grenoble Alpes, France
| | - Charles Khouri
- Clinical Pharmacology Department, INSERM CIC1406, Grenoble Alpes University Hospital, France; INSERM UMR 1042-HP2, University Grenoble Alpes, France; Pharmacovigilance Department, Grenoble Alpes University Hospital, France.
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30
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Pistorius MA, Blaise S, Le Hello C, Barbarot S, Dréno B. Chilblains and COVID19 infection: Causality or coincidence? How to proceed? JMV-Journal de Médecine Vasculaire 2020; 45:221-223. [PMID: 32571563 PMCID: PMC7211700 DOI: 10.1016/j.jdmv.2020.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 04/30/2020] [Indexed: 11/30/2022]
Affiliation(s)
- M A Pistorius
- Department of Vascular Medicine, Nantes University Hospital, 44000 Nantes, France.
| | - S Blaise
- Department of Vascular Medicine, Grenoble University Hospital, University Grenoble Alpes, 38000 Grenoble, France
| | - C Le Hello
- Department of Therapeutic and Vascular Medicine, Saint-Etienne University Hospital, inserm, U1059 Sainbiose, University de Lyon, Saint-Etienne, 42000 Saint-Etienne, France
| | - S Barbarot
- Department of Dermatology, Nantes University Hospital, 44000 Nantes, France
| | - B Dréno
- Department of Dermatology, Nantes University Hospital, 44000 Nantes, France
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31
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Perger E, Blaise S, Vermorel C, Boge G, Pepin JL, Redolfi S, Bosson JL. Subjects with venous insufficiency have high risk of obstructive sleep apnea in relationship to fluid shift. Sleep Med 2020; 72:135-137. [PMID: 32619847 DOI: 10.1016/j.sleep.2020.03.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 03/24/2020] [Accepted: 03/30/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is highly prevalent in conditions characterized by fluid overload. Chronic venous insufficiency (CVI) is associated to fluid overload that might interfere with OSA occurrence and severity. METHODS A total of 180 patients with symptomatic CVI completed the Berlin questionnaire and were assessed for the presence of symptoms and signs of OSA and fluid shift. RESULTS According to the Berlin questionnaire, 59 patients (33%) had high risk of OSA. The predictors of having a positive Berlin questionnaire were male sex, body mass index and symptoms possibly related to fluid shift. CONCLUSIONS Patients with CVI, a disease characterized by fluid overload, present high risk of OSA, which might be related to fluid shift.
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Affiliation(s)
- Elisa Perger
- AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Service de Pathologies du Sommeil (Département R3S), Paris, France.
| | - Sophie Blaise
- Univ. Grenoble Alpes, CNRS, Service de Médecine vasculaire, CHU Grenoble Alpes, 38000 Grenoble, France
| | - Céline Vermorel
- Univ. Grenoble Alpes, CNRS, Public Health department, CHU Grenoble Alpes, Grenoble INP, TIMC-IMAG, 38000 Grenoble, France
| | - Gudrun Boge
- Association des Médecins Vasculaires Hospitaliers, Service de Médecine Vasculaire CHU Montpellier, France
| | - Jean Louis Pepin
- Univ. Grenoble Alpes, CHU de Grenoble, Laboratoire EFCR, Clinique Universitaire de Physiologie, 38000 Grenoble, France
| | - Stefania Redolfi
- AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Service de Pathologies du Sommeil (Département R3S), Paris, France; Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Jean Luc Bosson
- Association des Médecins Vasculaires Hospitaliers, Service de Médecine Vasculaire CHU Montpellier, France
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32
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Guigui A, Mazet R, Blaise S, Cracowski C, Beau-Guillaumot M, Kotzki S, Roustit M, Cracowski JL. Treprostinil Hydrogel Iontophoresis in Systemic Sclerosis-Related Digital Skin Ulcers: A Safety Study. J Clin Pharmacol 2020; 60:758-767. [PMID: 32080862 DOI: 10.1002/jcph.1574] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 12/02/2019] [Indexed: 12/19/2022]
Abstract
Digital skin ulcers are a severe complication of systemic sclerosis. The first-line treatment is intravenous iloprost, but it induces dose-limiting adverse effects. Local administration of treprostinil through skin iontophoresis may be a safe alternative. We conducted a 2-stage, randomized, placebo-controlled single-ascending-dose study in healthy volunteers and patients with systemic sclerosis-related digital ulcer. We further explored the effect of the procedure on skin blood flux. In a first group of healthy subjects, treprostinil and placebo iontophoresis were performed at 3 locations (ie, 6 skin sites): the sole of the foot, the leg, and the fingers. We used a 1-mg/mL hydrogel of treprostinil. We then randomly treated systemic sclerosis-related digital ulcers in a 3:1 ratio of treprostinil or placebo. We used concentrations from 0.1 to 1 mg/mL. All adverse events were recorded and rated according to the Common Terminology Criteria for Adverse Events (CTCAE), whereas skin microvascular blood flux was recorded with laser speckle contrast imaging. Among the 12 healthy volunteers, we observed 60 local adverse effects: burns, skin pain, erythema, and pruritus, graded 1 or 2 on the 5-point CTCAE scale. Treprostinil iontophoresis significantly increased skin blood flux on the leg (AUC0-4 h at 88 460% ± 6436% versus 12 730% ± 3397% baseline flux.min respectively; P < .001) and on the sole of the foot (AUC0-3 h at 20 124% ± 6119% versus 3142% ± 3036% baseline flux.min, respectively; P = .018) with a trend on the finger. Among 5 patients with systemic sclerosis-related digital ulcer, 2 resolutive local adverse effects were reported. Iontophoresis of treprostinil hydrogel was safe in systemic sclerosis patients with digital ulcer.
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Affiliation(s)
- Alicia Guigui
- Grenoble Alpes University Hospital, Clinical Pharmacology, Grenoble, France.,Univ. Grenoble Alpes, Grenoble, France
| | - Roseline Mazet
- Grenoble Alpes University Hospital, Pharmacy, Grenoble, France.,Univ. Grenoble Alpes, DPM, UMR CNRS 5063, ICMG FR 2607, Saint Martin d'Hères, France
| | - Sophie Blaise
- Univ. Grenoble Alpes, Grenoble, France.,Grenoble Alpes University Hospital, Department of Vascular Medicine, Grenoble, France
| | - Claire Cracowski
- Grenoble Alpes University Hospital, Clinical Pharmacology, Grenoble, France.,Univ. Grenoble Alpes, Grenoble, France
| | | | | | - Matthieu Roustit
- Grenoble Alpes University Hospital, Clinical Pharmacology, Grenoble, France.,Univ. Grenoble Alpes, Grenoble, France
| | - Jean-Luc Cracowski
- Grenoble Alpes University Hospital, Clinical Pharmacology, Grenoble, France.,Univ. Grenoble Alpes, Grenoble, France
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33
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Seinturier C, Blaise S, Tiffet T, Provencher CB, Cracowski JL, Pernod G, Carpentier P. Fluorescence angiography compared to toe blood pressure in the evaluation of severe limb ischemia. VASA 2020; 49:230-234. [PMID: 32026753 DOI: 10.1024/0301-1526/a000853] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background: Severity of limb ischemia in peripheral arterial disease (PAD) patients is usually evaluated by clinical assessment and toe blood pressure (TBP) or transcutaneous oxygen pressures (TcPO 2). Indocyanin green angiography (IGA) is a promising tool generating a foot cartography of skin microvascular perfusion. However, there is no consensus about the fluorescence parameters that should be used to evaluate ischemia. The purpose of this cross-sectional evaluation and 3-month clinical follow-up was to determine the best fluorescence parameter for the evaluation of severe PAD, using TBP as reference. Patients and methods: IGA was realized in patients with clinical suspicion of CLI in addition to TBP and TcPO 2. Parameters from the time intensity fluorescence curve measured on the foot were compared with TBP (primary reference), and with TcPO2. Clinical outcomes (amputation, revascularization, death) were recorded at 3 months follow-up. Results: Thirty-four patients were included and IGA could be analysed in 29 of them. When all limbs were studied, no significant correlation was found between any of the measured fluorescence parameters (saturation time, ingress slope, amplitude, delay) and TBP pressure neither TCPO2. In the limbs with CLI, a significant correlation between the TBP and amplitude on the forefoot was found. According to the outcome, none of the fluorescence parameters showed a significant prognostic value in contrast to the significant results for TBP and TcPO2. Conclusions: In this study, quantitative analysis of IGA parameters did not show any prognostic value, nor was there any significant statistical association with well-established prognostic parameters such as TBP and TcPO 2 in patients with suspected CLI. A correlation was found between amplitude and TBP in patients with CLI. Topographical information such as perfusion heterogeneity was not evaluated and remains a valuable target to be investigated.
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Affiliation(s)
- Christophe Seinturier
- Department of Vascular Medicine, Grenoble-Alpes University Hospital, Grenoble, France
| | - Sophie Blaise
- Department of Vascular Medicine, Grenoble-Alpes University Hospital, Grenoble, France
| | - Théophile Tiffet
- Clinical Pharmacology Department, Grenoble-Alpes University Hospital, Grenoble, France
| | | | - Jean Luc Cracowski
- Clinical Pharmacology Department, Grenoble-Alpes University Hospital, Grenoble, France
| | - Gilles Pernod
- Department of Vascular Medicine, Grenoble-Alpes University Hospital, Grenoble, France
| | - Patrick Carpentier
- Department of Vascular Medicine, Grenoble-Alpes University Hospital, Grenoble, France
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34
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Zenati N, Charles J, Templier I, Blaise S. [Digital ischaemia with fingertip ulcers during ipilimumab therapy]. Ann Dermatol Venereol 2019; 147:212-216. [PMID: 31864764 DOI: 10.1016/j.annder.2019.09.606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 01/29/2019] [Revised: 04/17/2019] [Accepted: 09/05/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Anti-cancer drugs have many adverse effects including vascular side effects. Herein we present the case of a patient presenting digital ischaemia with high imputability of ipilimumab. OBSERVATION A 47-year-old male patient was treated for popliteal melanoma, initially stage IIIA but which subsequently became metastatic (stage IV), and for which ipilimumab was given after the failure of two lines of chemotherapy. During the 4th course of ipilimumab, the patient developed autoimmune hepatitis. Ipilimumab was suspended. Three months later, he developed a drug-like neuropathy followed one month later by ulceration of the right index finger. Causes of embolic, autoimmune and occupational origin (thrombotic microangiopathy, thrombosed aneurysm) were rapidly ruled out. Although a paraneoplastic origin could not be formally excluded, drug-induced immune disorder remained the most plausible origin. DISCUSSION This is the first reported case of digital ulceration under ipilimumab.
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Affiliation(s)
- N Zenati
- Department of Vascular Medicine, Grenoble University Hospital, 38000 Grenoble, France
| | - J Charles
- Department of dermatology, Grenoble University Hospital, 38000 Grenoble, France
| | - I Templier
- Department of dermatology, Grenoble University Hospital, 38000 Grenoble, France
| | - S Blaise
- Department of Vascular Medicine, Grenoble University Hospital, 38000 Grenoble, France; UMR 1042-HP2, Inserm, University of Grenoble-Alpes, 38000 Grenoble, France.
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35
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Martin H, Bursztejn A, Albuisson E, Leguern A, Mahe E, Villemur B, Blaise S, Perceau G, Goujon E, Lok C, Modiano P, Debure C, Guillot B, Maillard H, Say M, Carvalho-Lallement P, Dompmartin A, Journet-Tollhupp J, Schmutz JL, Senet P, Schoeffler A. Caractéristiques des plaies chroniques chez les toxicomanes : étude rétrospective de 58 patients. Ann Dermatol Venereol 2019; 146:793-800. [DOI: 10.1016/j.annder.2019.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 07/07/2019] [Accepted: 09/03/2019] [Indexed: 12/21/2022]
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36
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Khouri C, Lepelley M, Bailly S, Blaise S, Herrick AL, Matucci-Cerinic M, Allanore Y, Trinquart L, Cracowski JL, Roustit M. Comparative efficacy and safety of treatments for secondary Raynaud's phenomenon: a systematic review and network meta-analysis of randomised trials. Lancet Rheumatol 2019; 1:e237-e246. [PMID: 38229380 DOI: 10.1016/s2665-9913(19)30079-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 10/04/2019] [Accepted: 10/07/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Several pharmacological treatments are available for secondary Raynaud's phenomenon, but there is uncertainty regarding the best options. We aimed to assess and compare the benefits and harms of treatments available for secondary Raynaud's phenomenon. METHOD We did a systematic review and network meta-analysis of randomised controlled trials (RCTs) of pharmacological treatments. We searched for systematic reviews published in MEDLINE and the Cochrane Database of Systematic Reviews up to Jan 31, 2017, and for RCTs published from inception to Sept 24, 2019 in MEDLINE, Embase, and ClinicalTrials.gov. We included double-blind RCTs (parallel or crossover) that compared two or more pharmacological treatments or placebo in patients with secondary Raynaud's phenomenon. Individual patient data were obtained for one unpublished RCT. Three researchers independently screened the texts and extracted the data. Efficacy outcomes included severity (on a ten-point scale), daily frequency, and mean duration of Raynaud's phenomenon attacks. We also examined tolerability and acceptability. Pairwise meta-analyses and Bayesian random-effects network meta-analyses were used to synthesise data. This study is registered with PROSPERO (CRD42017057518). FINDINGS We included 58 RCTs in the analysis, comprising 3867 patients (3540 [91·5%] with secondary Raynaud's phenomenon) and 15 classes of drugs. Phosphodiesterase 5 (PDE5) inhibitors were more effective than placebo for frequency (mean difference -0·36 [95% credibility interval -0·69 to -0·04]), severity (-0·34 [-0·66 to -0·03]), and duration (-3·42 [-6·62 to -0·29]) of attacks (low to moderate level of evidence). Calcium channel blockers (CCBs) were superior to placebo for frequency (-0·35 [-0·67 to -0·02]) and severity (-0·84 [-1·25 to -0·45]) of attacks (low level of evidence). For severity of attacks, selective serotonin-reuptake inhibitors (-1·54 [-2·68 to -0·41]; very low level of evidence) and oral prostacyclin receptor agonists (-0·48 [-0·80 to -0·16]; low level of evidence) were superior to placebo. No other drug classes were significantly superior to placebo with regard to efficacy outcomes. Compared with placebo, tolerability was lower for PDE5 inhibitors (incidence rate ratio for serious adverse events or early study exit due to adverse events 3·30 [95% CrI 1·49 to 7·55]) and CCBs (3·13 [1·33 to 7·04]). For all outcomes, global heterogeneity and between-study variance ranged from low (I2=0% and τ2=0·0 for attack severity and duration) to moderate (I2=41% and τ2=0·2 for tolerability). The overall risk of bias was judged to be low in 22 (38%), high in ten (17%), and unclear in 26 (45%) RCTs. INTERPRETATION PDE5 inhibitors and CCBs are the most effective pharmacological options, albeit with moderate efficacy and a low level of evidence. Current evidence does not support the use of any other drug in secondary Raynaud's phenomenon. FUNDING None.
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Affiliation(s)
- Charles Khouri
- Pharmacovigilance Unit, Grenoble Alpes University Hospital, Grenoble, France; Clinical Pharmacology Department, INSERM CIC1406, Grenoble Alpes University Hospital, Grenoble, France; HP2 Laboratory, U1042 INSERM, Grenoble Alpes University, Grenoble, France
| | - Marion Lepelley
- Pharmacovigilance Unit, Grenoble Alpes University Hospital, Grenoble, France
| | - Sebastien Bailly
- EFCR Laboratory, Grenoble Alpes University Hospital, Grenoble, France; HP2 Laboratory, U1042 INSERM, Grenoble Alpes University, Grenoble, France
| | - Sophie Blaise
- Department of Vascular Medicine, Grenoble Alpes University Hospital, Grenoble, France; HP2 Laboratory, U1042 INSERM, Grenoble Alpes University, Grenoble, France
| | - Ariane L Herrick
- Centre for Musculoskeletal Research, University of Manchester, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Department of Geriatric Medicine, Division of Rheumatology and Scleroderma Unit, Careggi University Hospital, Florence, Italy
| | - Yannick Allanore
- INSERM U1016 UMR8104 Cochin Institute, Paris Descartes University, Paris, France; Rheumatology A Department, Cochin Hospital, Paris Descartes University, Paris, France
| | - Ludovic Trinquart
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Jean-Luc Cracowski
- Clinical Pharmacology Department, INSERM CIC1406, Grenoble Alpes University Hospital, Grenoble, France; HP2 Laboratory, U1042 INSERM, Grenoble Alpes University, Grenoble, France
| | - Matthieu Roustit
- Clinical Pharmacology Department, INSERM CIC1406, Grenoble Alpes University Hospital, Grenoble, France; HP2 Laboratory, U1042 INSERM, Grenoble Alpes University, Grenoble, France.
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37
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Soya E, Makowski C, Blaise S. Leg ulcer induced by hydroxycarbamide in sickle cell disease: What is the therapeutic impact? Int Wound J 2019; 16:897-902. [PMID: 30916480 PMCID: PMC7949276 DOI: 10.1111/iwj.13115] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 01/24/2019] [Accepted: 02/28/2019] [Indexed: 11/27/2022] Open
Abstract
Major sickle cell disease syndrome (SCD) is a set of potentially serious and disabling constitutional haemoglobin pathologies characterised by chronic haemolysis and vaso-occlusion phenomena. If expression takes the form of acute vaso-occlusive crisis, SCD is currently considered to be a chronic systemic pathology, primarily associated with vasculopathy and ischaemia-reperfusion phenomena. The haemolytic aspect of the disease may be associated with endothelial dysfunctional complications, including leg ulcers, which are a classic spontaneous complication of major SCD. Their frequency, all aetiologies combined, varies considerably according to the series under consideration. Hydroxycarbamide has become the standard treatment for some SCD phenotypes, but has classically been described as one of the causes of leg ulcer. This causality is widely debated and is still difficult to establish because it is a specific complication of the disease. Comorbidity factors (eg, iron deficiency) are also often implicated as causal or aggravating factors so research into all the potential aetiologies of leg ulcers in a sickle cell patient must be exhaustive. We discuss the aetiologies of a leg ulcer in a patient treated by hydrocarbamide for major SCD. The imputation of the drug was established, followed by a marrow allograft in this patient.
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Affiliation(s)
- Esaie Soya
- Department of Vascular MedicineGrenoble University HospitalGrenobleFrance
| | | | - Sophie Blaise
- Department of Vascular MedicineGrenoble University HospitalGrenobleFrance
- UMR 1042–HP2INSERM and University Grenoble‐AlpesGrenobleFrance
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Boulon C, Aiouaz S, Blaise S, Mangin M, Decamps-Le Chevoir J, Senet P, Lazareth I, Baudot N, Tribout L, Imbert B, Lapebie FX, Lacroix P, Truchetet ME, Seneschal J, Solanilla A, Skopinski S, Lazaro E, Quéré I, Pistorius MA, Le Hello C, Perez P, Carpentier P, Constans J. Correlation between capillaroscopic classifications and severity in systemic sclerosis: results from SCLEROCAP study at inclusion. Clin Exp Rheumatol 2019; 37 Suppl 119:63-68. [PMID: 31172926] [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] [Received: 01/18/2019] [Accepted: 04/01/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES We assessed the correlation between severity of systemic sclerosis (SSc) and current staging systems based on nailfold capillaroscopy. METHODS SCLEROCAP is a multicenter prospective study including consecutive scleroderma patients who have a yearly routine follow-up with capillaroscopy and digital blood pressure measurement. Capillaroscopy images were read by two observers blinded from each other, then by a third one in the case of discordance. A follow-up of 3 years is planned. The present study assessed the correlation between severity of systemic sclerosis (SSc) and current staging systems based on nail fold capillaroscopy at enrollment in the SCLEROCAP study. Univariate and multivariate logistic regression analysis was performed for both the Maricq and Cutolo classifications. RESULTS SCLEROCAP included 387 patients in one year. Maricq's active and Cutolo's late classifications were very similar. In multivariate analysis, the number of digital ulcers (OR for 2 ulcers or more, respectively 2.023 [1.074-3.81] and 2.596 [1.434-4.699]) and Rodnan's skin score >15 (OR respectively 32.007 [6.457-158.658] and 18.390 [5.380-62.865]) correlated with Maricq's active and Cutolo's late stages. Haemoglobin rate correlated with Cutolo's late stage (hemoglobin<100 vs. >120 g/dl: OR 0.223 [0.051-0.980]), and total lung capacity with Maricq's active one: increase in 10%: OR0.833 [0.717-0.969]. CONCLUSIONS The correlations found between capillaroscopy and severity of SSc are promising before the ongoing prospective study definitively assesses whether capillaroscopy staging predicts complications of SSc. Only two capillaroscopic patterns seem useful: one involving many giant capillaries and haemorrhages and the other with severe capillary loss.
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Affiliation(s)
- Carine Boulon
- Service de Médecine Vasculaire, Hôpital Saint-André, Bordeaux, France
| | - Soraya Aiouaz
- Unité de Soutien Méthodologique à la Recherche Clinique, Pôle de Santé Publique, CHU de Bordeaux, France
| | - Sophie Blaise
- Hôpital Universitaire de Grenoble, Département de Médecine Vasculaire, Grenoble, France
| | - Marion Mangin
- Service de Médecine Vasculaire, Hôpital Saint-André, Bordeaux, France
| | | | - Patricia Senet
- Service de Dérmatologie, Médecine Vasculaire et Allergologie, Hôpital Tenon, Paris, France
| | | | - Nathalie Baudot
- Service de Dérmatologie, Médecine Vasculaire et Allergologie, Hôpital Tenon, Paris, France
| | - Laurent Tribout
- Service de Dérmatologie, Médecine Vasculaire et Allergologie, Hôpital Tenon, Paris, France
| | - Bernard Imbert
- Hôpital Universitaire de Grenoble, Département de Médecine Vasculaire, Grenoble, France
| | | | | | | | | | - Anna Solanilla
- Service de Médecine Interne, Clinique Mutualiste de Lesparre, France
| | - Sophie Skopinski
- Service de Médecine Vasculaire, Hôpital Saint-André, Bordeaux, France
| | - Estibaliz Lazaro
- Service de Médecine Interne et Maladies Infectieuses, Hôpital Haut-Lévêque, Pessac, France
| | - Isabelle Quéré
- Service de Médecine Vasculaire, Hôpital Saint Eloi, Montpellier, France
| | | | - Claire Le Hello
- Service de Médecine Vasculaire, CHU Nord Saint-Etienne, Université Jean Monnet, Campus Santé et Innovations, Saint-Etienne, France
| | - Paul Perez
- Unité de Soutien Méthodologique à la Recherche Clinique, Pôle de Santé Publique, CHU de Bordeaux, France
| | | | - Joel Constans
- Service de Médecine Vasculaire, Hôpital Saint-André, Bordeaux, France.
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Lavaud J, Coll JL, Cracowski JL, Blaise S, Josserand V. Photoacoustic imaging as an innovative technique for the exploration of blue rubber bleb naevus. Br J Dermatol 2019; 181:596-597. [PMID: 30742706 DOI: 10.1111/bjd.17765] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- J Lavaud
- Institute for Advanced Biosciences, University of Grenoble Alpes, INSERM U1209 and CNRS UMR5309, F-38000, Grenoble, France
| | - J-L Coll
- Institute for Advanced Biosciences, University of Grenoble Alpes, INSERM U1209 and CNRS UMR5309, F-38000, Grenoble, France
| | - J-L Cracowski
- HP2, INSERM U1042, University Grenoble Alpes, F-38000, Grenoble, France.,Centre d'Investigations Cliniques, Grenoble University Hospital, F-38000, Grenoble, France
| | - S Blaise
- Department of Vascular Medicine, Grenoble University Hospital, F-38000, Grenoble, France
| | - V Josserand
- Institute for Advanced Biosciences, University of Grenoble Alpes, INSERM U1209 and CNRS UMR5309, F-38000, Grenoble, France
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Khouri C, Blaise S, Guigui A, Cracowski C, Allanore Y, Hachulla E, Senet P, Roustit M, Cracowski JL. French translation and linguistic validation of the Raynaud's condition score. Therapie 2019; 74:627-631. [PMID: 31023622 DOI: 10.1016/j.therap.2019.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 01/21/2019] [Accepted: 03/15/2019] [Indexed: 11/18/2022]
Abstract
The Raynaud's condition score is a 11-point scale severity score used in Raynaud's phenomenon clinical trials since 1998. The Raynaud's condition score diary has been recommended for use in clinical trials assessing efficacy of interventions on scleroderma related Raynaud's phenomenon. However, this score has never been formally validated in French. We thus performed a translation and a linguistic validation of the Raynaud's condition score through a forward/backward translations process followed by an expert review and cognitive patient interviews. The translations led to a French version of the Raynaud's condition score that was linguistically valid, and conceptually equivalent to the original English version. This "Score de Raynaud" will be usable to perform and harmonize clinical trials in French-speaking patients with secondary Raynaud's phenomenon.
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Affiliation(s)
- Charles Khouri
- Pharmacovigilance unit, Grenoble Alpes university hospital, 38000 Grenoble, France; Inserm CIC1406, clinical pharmacology department, Grenoble Alpes university hospital, 38000 Grenoble, France; Inserm, UMR 1042-HP2, university Grenoble Alpes, 38000 Grenoble, France.
| | - Sophie Blaise
- Inserm, UMR 1042-HP2, university Grenoble Alpes, 38000 Grenoble, France; Department of vascular medicine, Grenoble university hospital, 38000 Grenoble, France
| | - Alicia Guigui
- Inserm CIC1406, clinical pharmacology department, Grenoble Alpes university hospital, 38000 Grenoble, France
| | - Claire Cracowski
- Inserm CIC1406, clinical pharmacology department, Grenoble Alpes university hospital, 38000 Grenoble, France
| | - Yannick Allanore
- Service de rhumatologie A, hôpital Cochin, université Paris Descartes, 75014 Paris, France
| | - Eric Hachulla
- Service de médecine interne, Centre de référence des maladies auto-immunes systémiques rares du Nord et Nord-Ouest de France (CeRAINO), hôpital Claude Huriez, CHU de Lille, 59045 Lille, France
| | - Patricia Senet
- Service de dermatologie et allergologie, hôpital Tenon, groupe hospitalier universitaire Paris Est, Assistance publique-Hôpitaux de Paris, 75020 Paris, France
| | - Mathieu Roustit
- Inserm CIC1406, clinical pharmacology department, Grenoble Alpes university hospital, 38000 Grenoble, France; Inserm, UMR 1042-HP2, university Grenoble Alpes, 38000 Grenoble, France
| | - Jean-Luc Cracowski
- Inserm CIC1406, clinical pharmacology department, Grenoble Alpes university hospital, 38000 Grenoble, France; Inserm, UMR 1042-HP2, university Grenoble Alpes, 38000 Grenoble, France
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Gillet JL, Guex JJ, Allaert FA, Avouac B, Leger P, Blaise S, Marchand A, Maillard H, Simon M, Amor CB, Pasqualini M. Clinical superiority of an innovative two-component compression system versus four-component compression system in treatment of active venous leg ulcers: A randomized trial. Phlebology 2019; 34:611-620. [PMID: 30836836 DOI: 10.1177/0268355519833523] [Citation(s) in RCA: 3] [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] [Indexed: 11/15/2022]
Abstract
Objective To evaluate the efficacy, safety and acceptability of an innovative two-component versus a well-established four-component compression systems in the management of venous leg ulcer. Method Multicentre randomized controlled trial in patients with active venous leg ulcer. Patients were followed-up monthly for a maximum of 16 weeks. The primary endpoint was the complete healing rate at 16 weeks. Results Ninety-two patients were randomized to either the two-component BIFLEX® Kit group ( n = 49) or the four-component PROFORE® group ( n = 43). In the full analysis set ( n = 88), a complete healing rate of 48.9% and 24.4% was reported in BIFLEX® Kit versus PROFORE® groups, respectively (i.e. a superiority of 24.5%, p = 0.02). Acceptability of BIFLEX® Kit was higher from both the patients’ and physicians’ perspectives. Conclusion The BIFLEX® Kit represents a valid alternative therapy in the management of venous leg ulcer according to its clinical efficacy, safety and acceptability with potential positive impacts on healthcare costs.
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Affiliation(s)
| | | | | | | | - Philippe Leger
- Centre de Plaies et Cicatrisation, Clinique Pasteur, Toulouse, France
| | - Sophie Blaise
- Vascular Medicine Department, Grenoble University Hospital, Grenoble, France.,Université Grenoble Alpes, Grenoble, France
| | - Angélique Marchand
- Department of Dermatology, University Hospital Center of Angers, Angers, France
| | - Hervé Maillard
- Dermatology Department, Centre Hospitalier Général, Le Mans, France
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Sigal ML, Addala A, Maillard H, Chahim M, Sala F, Blaise S, Dalac S, Meaume S, Bohbot S, Tumba C, Tacca O. Evaluation of TLC-NOSF dressing with poly-absorbent fibres in exuding leg ulcers: two multicentric, single-arm, prospective, open-label clinical trials. J Wound Care 2019; 28:164-175. [DOI: 10.12968/jowc.2019.28.3.164] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Azeddine Addala
- Vascular Medicine Department, Edouard Herriot Hospital, Lyon, France
| | - Hervé Maillard
- Dermatology Department, Le Mans Hospital, Le Mans, France
| | - Maxime Chahim
- Department of Vascular Medicine, Corentin Celton Hospital, Issy Les Moulineaux, France
| | - Florent Sala
- Vascular Surgery Department, Montréal Polyclinic, Carcassonne, France
| | - Sophie Blaise
- Department of Vascular Medicine, Albert Michalon University Hospital, Grenoble, France
| | - Sophie Dalac
- Dermatology Department, Dijon University Hospital, Dijon, France
| | - Sylvie Meaume
- Geriatric Department, Rotschild University Hospital, Paris, France
| | - Serge Bohbot
- Medical Affair Department, Laboratoires Urgo, Paris, France
| | - Clémence Tumba
- Clinical Research Department, Laboratoires Urgo, Chenôve, France
| | - Olivier Tacca
- Clinical Research Department, Laboratoires Urgo, Chenôve, France
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Blaise S, Imbert B, Boulon C, Senet P, Carpentier P, Constans J. Prévalence et corrélations des artériopathies digitales dans la sclérodermie systémique. Données à l’inclusion de l’étude Sclérocap. Rev Med Interne 2018. [DOI: 10.1016/j.revmed.2018.10.283] [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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Vinceneux-Talvande B, Carvallho P, Safa G, Journet Tollhupp J, Lembelembe J, Blaise S, Maillard H. Intérêt du Cellutome® pour la cicatrisation des ulcères veineux ou mixte. Ann Dermatol Venereol 2018. [DOI: 10.1016/j.annder.2018.09.545] [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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45
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Boulon C, Blaise S, Imbert B, Constans J. Classifications capillaroscopiques et atteintes sévères dans la sclérodermie systémique. Résultats à l’inclusion de l’étude Sclérocap. Rev Med Interne 2018. [DOI: 10.1016/j.revmed.2018.10.284] [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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Roustit M, Giai J, Gaget O, Khouri C, Mouhib M, Lotito A, Blaise S, Seinturier C, Subtil F, Paris A, Cracowski C, Imbert B, Carpentier P, Vohra S, Cracowski JL. On-Demand Sildenafil as a Treatment for Raynaud Phenomenon: A Series of n-of-1 Trials. Ann Intern Med 2018; 169:694-703. [PMID: 30383134 DOI: 10.7326/m18-0517] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Treatment of Raynaud phenomenon (RP) with phosphodiesterase-5 inhibitors has shown moderate efficacy. Adverse effects decrease the risk-benefit profile of these drugs, and patients may not be willing to receive long-term treatment. On-demand single doses before or during exposure to cold may be a good alternative. OBJECTIVE To assess the efficacy and safety of on-demand sildenafil in RP. DESIGN Series of randomized, double-blind, n-of-1 trials. (ClinicalTrials.gov: NCT02050360). SETTING Outpatients at a French university hospital. PARTICIPANTS Patients with primary or secondary RP. INTERVENTION Each trial consisted of a multiple crossover study in a single patient. Repeated blocks of 3 periods of on-demand treatment were evaluated: 1 week of placebo, 1 week of sildenafil at 40 mg per dose, and 1 week of sildenafil at 80 mg per dose, with a maximum of 2 doses daily. MEASUREMENTS Raynaud Condition Score (RCS) and frequency and daily duration of attacks. Skin blood flow in response to cooling also was assessed with laser speckle contrast imaging. Mixed-effects models were used and parameters were estimated in a Bayesian framework to determine individual and aggregated efficacy. RESULTS 38 patients completed 2 to 5 treatment blocks. On the basis of aggregated data, the probability that sildenafil at 40 mg or 80 mg was more effective than placebo was greater than 90% for all outcomes (except for RCS with sildenafil, 80 mg). However, the aggregated effect size was not clinically relevant. Yet, substantial heterogeneity in sildenafil's efficacy was observed among participants, with clinically relevant efficacy in some patients. LIMITATION The response to sildenafil was substantially heterogeneous among patients. CONCLUSION Despite a high probability that sildenafil is superior to placebo, substantial heterogeneity was observed in patient response and aggregated results did not show that on-demand sildenafil has clinically relevant efficacy. In this context, the use of n-of-1 trials may be an original and relevant approach in RP. PRIMARY FUNDING SOURCE GIRCI (Groupement Interrégional de Recherche Clinique et d'Innovation) Auvergne Rhône-Alpes (academic funding) and Pfizer.
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Affiliation(s)
- Matthieu Roustit
- Université Grenoble Alpes and Grenoble Alpes University Hospital, Grenoble, France (M.R., O.G., C.K., M.M., A.L., S.B., C.S., A.P., C.C., B.I., P.C., J.C.)
| | - Joris Giai
- Université de Lyon and Hospices Civils de Lyon, Lyon, France (J.G., F.S.)
| | - Olivier Gaget
- Université Grenoble Alpes and Grenoble Alpes University Hospital, Grenoble, France (M.R., O.G., C.K., M.M., A.L., S.B., C.S., A.P., C.C., B.I., P.C., J.C.)
| | - Charles Khouri
- Université Grenoble Alpes and Grenoble Alpes University Hospital, Grenoble, France (M.R., O.G., C.K., M.M., A.L., S.B., C.S., A.P., C.C., B.I., P.C., J.C.)
| | - Myriam Mouhib
- Université Grenoble Alpes and Grenoble Alpes University Hospital, Grenoble, France (M.R., O.G., C.K., M.M., A.L., S.B., C.S., A.P., C.C., B.I., P.C., J.C.)
| | - Adrien Lotito
- Université Grenoble Alpes and Grenoble Alpes University Hospital, Grenoble, France (M.R., O.G., C.K., M.M., A.L., S.B., C.S., A.P., C.C., B.I., P.C., J.C.)
| | - Sophie Blaise
- Université Grenoble Alpes and Grenoble Alpes University Hospital, Grenoble, France (M.R., O.G., C.K., M.M., A.L., S.B., C.S., A.P., C.C., B.I., P.C., J.C.)
| | - Christophe Seinturier
- Université Grenoble Alpes and Grenoble Alpes University Hospital, Grenoble, France (M.R., O.G., C.K., M.M., A.L., S.B., C.S., A.P., C.C., B.I., P.C., J.C.)
| | - Fabien Subtil
- Université de Lyon and Hospices Civils de Lyon, Lyon, France (J.G., F.S.)
| | - Adeline Paris
- Université Grenoble Alpes and Grenoble Alpes University Hospital, Grenoble, France (M.R., O.G., C.K., M.M., A.L., S.B., C.S., A.P., C.C., B.I., P.C., J.C.)
| | - Claire Cracowski
- Université Grenoble Alpes and Grenoble Alpes University Hospital, Grenoble, France (M.R., O.G., C.K., M.M., A.L., S.B., C.S., A.P., C.C., B.I., P.C., J.C.)
| | - Bernard Imbert
- Université Grenoble Alpes and Grenoble Alpes University Hospital, Grenoble, France (M.R., O.G., C.K., M.M., A.L., S.B., C.S., A.P., C.C., B.I., P.C., J.C.)
| | - Patrick Carpentier
- Université Grenoble Alpes and Grenoble Alpes University Hospital, Grenoble, France (M.R., O.G., C.K., M.M., A.L., S.B., C.S., A.P., C.C., B.I., P.C., J.C.)
| | - Sunita Vohra
- University of Alberta, Edmonton, Alberta, Canada (S.V.)
| | - Jean-Luc Cracowski
- Université Grenoble Alpes and Grenoble Alpes University Hospital, Grenoble, France (M.R., O.G., C.K., M.M., A.L., S.B., C.S., A.P., C.C., B.I., P.C., J.C.)
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Galanaud JP, Blaise S, Sevestre MA, Terrisse H, Pernod G, Gaillard C, Genty C, Monreal M, Rabah Y, Kahn SR, Quéré I, Bosson JL. Long-term outcomes of isolated superficial vein thrombosis in patients with active cancer. Thromb Res 2018; 171:179-186. [DOI: 10.1016/j.thromres.2018.04.013] [Citation(s) in RCA: 9] [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: 01/24/2018] [Revised: 04/11/2018] [Accepted: 04/13/2018] [Indexed: 02/01/2023]
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Vinceneux Talvande B, Carvalho Lallement P, Safa G, Journet Tollhupp J, Lembelembe JP, Blaise S, Maillard H. Use of Cellutome for the healing of venous or mixed ulcers. Int Wound J 2018; 15:993-999. [PMID: 30091520 DOI: 10.1111/iwj.12966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 06/05/2018] [Accepted: 06/15/2018] [Indexed: 11/29/2022] Open
Abstract
Venous or mixed ulcers are common and invalidating. Cutaneous transplants may be necessary if conventional treatment is ineffective. We evaluated the performance of Cellutome in promoting the healing of venous or mixed ulcers 2 months after grafting. This was a retrospective, multi-centric, descriptive study of patients who had a venous or mixed ulcer for at least several months and who received an autologous skin graft using the Cellutome system at least 2 months before. The principle evaluation criterion was the state of the wound after 2 months (completely healed vs not healed). The secondary evaluation criterion was the percentage of wound healing after 2 months. A total of 47 patients were included in the study. The ulcers had evolved over an average of 18 months. The average surface area was 13.37 cm2 . After 2 months, the grafts of 26 of 47 patients (55.3%) were completely healed. The grafts of 21 patients (44.6%) were not completely healed but showed an average rate of healing of 51%. Use of the Cellutome system for epidermal transplants promoted complete or improved healing after 2 months for 55.3% of patients with chronic venous or mixed ulcers. The limited data on the rate of healing of conventional transplants in the literature report rates of approximately 50%. The Cellutome system may therefore be of interest as the healing rate is similar to that of conventional techniques, but using a much simpler, painless procedure on an outpatient basis.
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Affiliation(s)
| | | | - Gilles Safa
- Service de Dermatologie du CH de St Brieuc, Saint Brieuc, France
| | | | | | - Sophie Blaise
- Service de Médecine vasculaire La Tronche, La Tronche, France
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Bohelay G, Blaise S, Levy P, Claeys A, Baudot N, Cuny JF, Maillard H, Granel-Brocard F, Boyé T, Lok C, Bénéton N, Francès C, Senet P. Lower-limb Ulcers in Systemic Sclerosis: A Multicentre Retrospective Case-control Study. Acta Derm Venereol 2018; 98:677-682. [PMID: 29648670 DOI: 10.2340/00015555-2939] [Citation(s) in RCA: 10] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Lower-limb ulcers in systemic sclerosis patients are rarely reported. The aim of this study was to describe the main causes and outcomes of lower-limb ulcers in systemic sclerosis patients and to assess factors associated with ischaemic causes (arterial disease and/or microvascular impairment). A retrospective, multicentre, case-control study was conducted in 2013 and 2014, including 45 systemic sclerosis patients presenting lower-limb ulcers between 2008 and 2013. The estimated prevalence of lower-limb ulcers among systemic sclerosis patients was 12.8%. Ulcers were related to venous insufficiency in 22 cases (49%), ischaemic causes in 21 (47%) and other causes in 2 (4%). Complete healing was observed in 60% of cases in a mean time of 10.3 months; 59% relapsed during a mean follow-up of 22 months. Ischaemic lower-limb ulcer outcomes were poor, with a 28.6% amputation rate. Logistic-regression multivariate analyses between ischaemic lower-limb ulcer cases and matched systemic sclerosis-controls identified past or concomitant digital ulcer and cutaneous sclerosis of the feet as independent risk factors associated with ischaemic lower-limb ulcers.
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Affiliation(s)
- Gérôme Bohelay
- Department of Dermatology, Tenon Hospital, Public Assistance - Paris Hospitals (AP-HP), Paris, France
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Maruani A, Boccara O, Bessis D, Guibaud L, Vabres P, Mazereeuw-Hautier J, Barbarot S, Chiaverini C, Blaise S, Droitcourt C, Mallet S, Martin L, Lorette G, Woillard JB, Jonville-Bera AP, Rollin J, Gruel Y, Herbreteau D, Goga D, le Touze A, Leducq S, Gissot V, Morel B, Tavernier E, Giraudeau B. Treatment of voluminous and complicated superficial slow-flow vascular malformations with sirolimus (PERFORMUS): protocol for a multicenter phase 2 trial with a randomized observational-phase design. Trials 2018; 19:340. [PMID: 29945674 PMCID: PMC6020321 DOI: 10.1186/s13063-018-2725-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 06/06/2018] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Slow-flow superficial vascular malformations (VMs) are rare congenital anomalies that can be responsible for pain and functional impairment. Currently, we have no guidelines for their management, which can involve physical bandages, sclerotherapy, surgery, anti-inflammatory or anti-coagulation drugs or no treatment. The natural history is progressive and worsening. Mammalian target of rapamycin (mTOR) is a serine/threonine kinase that acts as a master switch in cell proliferation, apoptosis, metabolism and angio/lymphangiogenesis. Sirolimus directly inhibits the mTOR pathway, thereby inhibiting cell proliferation and angio/lymphangiogenesis. Case reports and series have reported successful use of sirolimus in children with different types of vascular anomalies, with heterogeneous outcomes. OBJECTIVE The objective of this trial is to evaluate the efficacy and safety of sirolimus in children with complicated superficial slow-flow VMs. METHODS/DESIGN This French multicenter randomized observational-phase, phase 2 trial aims to include 50 pediatric patients 6 to 18 years old who have slow-flow (lymphatic, venous or lymphatico-venous) voluminous complicated superficial VM. Patients will be followed up for 12 months. All patients will start with an observational period (no treatment). Then at a time randomly selected between month 4 and month 8, they will switch to the experimental period (switch time), when they will receive sirolimus until month 12. Each child will undergo MRI 3 times: at baseline, at the switch time, and at month 12. For both periods (observational and treatment), we will calculate the relative change in volume of the VM divided by the study period duration. This relative change weighted by the study period duration will constitute the primary endpoint. VM will be measured by MRI images, which will be centralized and interpreted by the same radiologist who will be blinded to the study period. Hence, each patient will be his/her own control. Secondary outcomes will include assessment of safety and efficacy by viewing standardized digital photographs and according to the physician, the patient or proxy; impact on quality of life; and evolution of biological makers (coagulation factors, vascular endothelial growth factor, tissue factor). DISCUSSION The main benefit of the study will be to resolve uncertainty concerning the efficacy of sirolimus in reducing the volume of VMs and limiting related complications and the safety of the drug in children with slow-flow VMs. This trial design is interesting in these rare conditions because all included patients will have the opportunity to receive the drug and the physician can maintain it after the end of the protocol if is found efficient (which would not be the case in a classical cross-over study). TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02509468 , first received: 28 July 2015. EU Clinical Trials Register EudraCT Number: 2015-001096-43.
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Affiliation(s)
- Annabel Maruani
- University of Tours, University of Nantes, INSERM, SPHERE U1246, Tours, France. .,Department of Dermatology, Unit of Pédiatric Dermatology, CHRU Tours, 37044, Tours Cedex 9, France. .,CHRU Tours, Clinical Investigation Center, INSERM 1415, 37000, Tours, France.
| | - Olivia Boccara
- Department of Dermatology and Reference center for genodermatoses and rare skin diseases (MAGEC), University Hospital Necker-Enfants Malades, 75015, Paris, France
| | - Didier Bessis
- Department of Dermatology, University Hospital Center of Montpellier, 34000, Montpellier, France
| | - Laurent Guibaud
- University Hospital Center of Lyon, Consultation Multidisciplinaire Lyonnaise des Angiomes, 69229, Lyon Cedex 2, France
| | - Pierre Vabres
- Department of Dermatology, University Hospital Center of Dijon, 21000, Dijon, France
| | | | - Sébastien Barbarot
- Department of Dermatology, University Hospital Center of Nantes, 44000, Nantes, France
| | - Christine Chiaverini
- Department of Dermatology, University Hospital Center of Nice, 06000, Nice, France
| | - Sophie Blaise
- Department of Vascular Medicine, University Hospital Center of Grenoble, 38043, Grenoble Cedex 9, France
| | - Catherine Droitcourt
- Department of Dermatology, University Hospital Center of Rennes, 35000, Rennes, France
| | - Stéphanie Mallet
- Department of Dermatology, University Hospital Center of Marseille, 13885, Marseille Cedex 5, France
| | - Ludovic Martin
- Department of Dermatology, University Hospital Center of Angers, 49000, Angers, France
| | - Gérard Lorette
- Department of Dermatology, Unit of Pédiatric Dermatology, CHRU Tours, 37044, Tours Cedex 9, France
| | - Jean-Baptiste Woillard
- Department of Pharmacology and Toxicology, University of Limoges, INSERM UMR 850, CHU Limoges, 87000, Limoges, France
| | - Annie-Pierre Jonville-Bera
- University of Tours, University of Nantes, INSERM, SPHERE U1246, Tours, France.,Department of Clinical Pharmacology, Regional Pharmacovigilance Center, CHRU Tours, 37044, Tours Cedex 9, France
| | - Jérome Rollin
- Department of Hematology-Hemostasis, University of Tours, UMR-CNRS 7292, CHRU Tours, 37044, Tours Cedex 9, France
| | - Yves Gruel
- Department of Hematology-Hemostasis, University of Tours, UMR-CNRS 7292, CHRU Tours, 37044, Tours Cedex 9, France
| | - Denis Herbreteau
- Department of Neuroradiology, University of Tours, CHRU Tours, 37000, Tours, France
| | - Dominique Goga
- Department of Maxillo-Facial surgery, University of Tours, CHRU Tours, 37044, Tours Cedex 9, France
| | - Anne le Touze
- Department of Pediatric Surgery, CHRU Tours, 37000, Tours, France
| | - Sophie Leducq
- Department of Dermatology, Unit of Pédiatric Dermatology, CHRU Tours, 37044, Tours Cedex 9, France
| | - Valérie Gissot
- CHRU Tours, Clinical Investigation Center, INSERM 1415, 37000, Tours, France
| | - Baptiste Morel
- Department of Pediatric Radiology, University of Tours, CHRU Tours, 37000, Tours, France
| | - Elsa Tavernier
- University of Tours, University of Nantes, INSERM, SPHERE U1246, Tours, France.,CHRU Tours, Clinical Investigation Center, INSERM 1415, 37000, Tours, France
| | - Bruno Giraudeau
- University of Tours, University of Nantes, INSERM, SPHERE U1246, Tours, France.,CHRU Tours, Clinical Investigation Center, INSERM 1415, 37000, Tours, France
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