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Roeser A, Vanjak A, Mettler C, Gramont B, Azoyan L, Oziol E, Le Moigne E, Bouillet L, Durieu I, Bourgarit A. [Place of internal medicine specialists in inpatient unprogrammed care of adult patients in France: A survey of in training and senior internal medicine specialists]. Rev Med Interne 2022; 43:524-527. [PMID: 35989195 DOI: 10.1016/j.revmed.2022.07.006] [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: 04/17/2022] [Revised: 06/27/2022] [Accepted: 07/10/2022] [Indexed: 10/15/2022]
Abstract
INTRODUCTION French internal medicine specialists are trained in clinical immunology and rare diseases as well as frequent ones. The latest activity is rarely highlighted by practitioners themselves and their representative authorities. Frequent diseases care in French hospitals are also the tasks of physicians without internal medicine specialty, mostly trained in general medicine, who practice in departments carrying various names. METHODS We conducted a survey to estimate the part of frequent diseases' care and unplanned hospital medicine in the practice of specialists and residents in internal medicine in France, and its designation, through two surveys released by the "Collège National Professionnel de Médecine Interne" (for the internal medicine specialists), and the "Amicale des Jeunes Internists" (for the internal medicine residents). RESULTS A total of 180 and 247 responses were obtained among the residents and the specialists, respectively, representing 31.3% and 24.8% of the internal medicine specialist's workforce. The most suitable qualifier for frequent diseases' care and unplanned hospital medicine, primarily post-emergency, was "general hospital medicine" for 48.9% of the residents and "general internal medicine" for 35.6% of the specialists. Unplanned hospital medicine was considered to represent a large part of the internal medicine activity by 66.7% and 64.7% of residents and specialists, respectively. A 50% and more hourly part of the activity devoted to it was reported by 71.4% of the residents and 76.1% of the specialists. General hospital medicine was reported to be distinct from internal medicine-clinical immunology by 46.1% of the residents and 47.4% of the specialists. CONCLUSION French internists devote a large part of their activities to frequent diseases' care and unscheduled medicine, the name of which was not consensual. However, their work could not be summarized to it, often involving a specific activity named internal medicine - clinical immunology.
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Affiliation(s)
- A Roeser
- Amicale des jeunes internistes, 15, rue de l'École-de-Médecine, 75005 Paris, France.
| | - A Vanjak
- Amicale des jeunes internistes, 15, rue de l'École-de-Médecine, 75005 Paris, France
| | - C Mettler
- Amicale des jeunes internistes, 15, rue de l'École-de-Médecine, 75005 Paris, France
| | - B Gramont
- Service de médecine interne, CHU de Saint-Étienne, Saint-Étienne, France
| | - L Azoyan
- Amicale des jeunes internistes, 15, rue de l'École-de-Médecine, 75005 Paris, France
| | - E Oziol
- Service de médecine interne, centre hospitalier de Béziers, Béziers, France
| | - E Le Moigne
- Département de médecine interne, médecine vasculaire et pneumologie, centre hospitalier universitaire de Brest, Brest, France
| | - L Bouillet
- Service de médecine interne et immunologie clinique, centre hospitalier universitaire de Grenoble, Grenoble, France
| | - I Durieu
- Service de médecine interne et pathologie vasculaire, groupement hospitalier Sud, hospices civils de Lyon, université Claude-Bernard Lyon 1, Lyon, France
| | - A Bourgarit
- Service de médecine interne, hôpital Jean-Verdier, Assistance-Publique Hôpitaux-de-Paris, Bondy, France
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Lessard P, Hoffmann C, De Moreuil C, Rouviere B, Guellec D, Bruguet M, Jousse Joulin S, Didier R, Beuzit S, Le Moigne E. Étude du pronostic vasculaire de l’artérite à cellules géantes en fonction du résultat du doppler des artères temporales : cohorte VASC’HORTON. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.03.270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Delplanque M, Pogossian A, Molina B, Rouviere B, Sassolas B, Le Moigne E, De Moreuil C. Lupus discoïde paranéoplasique : à propos d’un cas. Rev Med Interne 2021. [DOI: 10.1016/j.revmed.2021.03.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Salomon C, de Moreuil C, Hannigsberg J, Trémouilhac C, Drugmanne G, Gatineau F, Nowak E, Anouilh F, Briend D, Moigne EL, Merviel P, Abgrall JF, Lacut K, Petesch BP. Haematological parameters associated with postpartum haemorrhage after vaginal delivery: Results from a French cohort study. J Gynecol Obstet Hum Reprod 2021; 50:102168. [PMID: 34033967 DOI: 10.1016/j.jogoh.2021.102168] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 05/11/2021] [Accepted: 05/19/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND Immediate postpartum haemorrhage (PPH) is a major, feared and often unpredictable issue. Besides many clinical risk factors, some biological parameters could also be predictive of PPH. OBJECTIVE To study simple and easily accessible haematological parameters as potential risk factors for PPH after vaginal delivery. METHODS All women who had a vaginal delivery between April 1, 2013 and May 29, 2015 in the maternity ward of Brest University Hospital (France) were included, after oral informed consent obtained. Clinical data were collected by obstetricians or midwives during antenatal care visits, labour and delivery, and recorded by trained research assistants. Haematological variables, including immature platelet fraction, were measured from a blood sample systematically collected at the entrance in the delivery room. PPH, measured with a graduated collector bag, was defined as blood loss of at least 500 ml. RESULTS 2742 women were included. PPH occurred in 141 (5%) women. Seven clinical factors were independently associated with PPH: pre-eclampsia (OR 5.85, 95%CI 2.02, 16.90), multiple pregnancy (OR 3.28, 95%CI 1.21, 8.91), assisted reproduction (OR 2.75, 95%CI 1.45, 5.20), antepartum bleeding (OR 2.15, 95%CI 1.24,3.73), post-term delivery (OR 1.93, 95%CI 1.17, 3.17), obesity (OR 2.95, 95%CI 1.76, 4.93) and episiotomy (OR 2.51, 95%CI 1.63, 3.74). Three haematological factors were additionally identified as independent risk factors for PPH: platelets < 150 Giga/L (OR 2.98, 95%CI 1.63, 5.46), fibrinogen < 4.5 g/l (OR 1.86, 95%CI 1.21, 2.87) and APTT ratio ≥ 1.1 (OR 2.16, 95%CI 1.31, 3.57). Immature platelet fraction was not associated with PPH. CONCLUSION Besides classical clinical risk factors, this study identifies simple haematological parameters as risk factors for PPH.
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Affiliation(s)
- C Salomon
- EA3878, Université de Bretagne Occidentale - Brest,France
| | - C de Moreuil
- EA3878, Université de Bretagne Occidentale - Brest,France; Département de médecine interne, médecine vasculaire et pneumologie, CHU Brest - Brest, France.
| | - J Hannigsberg
- EA3878, Université de Bretagne Occidentale - Brest,France; Service de Gynécologie Obstétrique, CHU Brest - Brest, France
| | - C Trémouilhac
- EA3878, Université de Bretagne Occidentale - Brest,France; Service de Gynécologie Obstétrique, CHU Brest - Brest, France
| | | | | | - E Nowak
- CIC1412, INSERM - Brest, France
| | - F Anouilh
- Ecole de Sage-femmes, UFR Santé - Brest, France
| | - D Briend
- Service de Gynécologie Obstétrique, CHU Brest - Brest, France
| | - E Le Moigne
- EA3878, Université de Bretagne Occidentale - Brest,France; Département de médecine interne, médecine vasculaire et pneumologie, CHU Brest - Brest, France
| | - P Merviel
- EA3878, Université de Bretagne Occidentale - Brest,France; Service de Gynécologie Obstétrique, CHU Brest - Brest, France
| | - J F Abgrall
- Centre de traitement de l'hémophilie, Hématologie, CHU Brest - Brest,France
| | - K Lacut
- EA3878, Université de Bretagne Occidentale - Brest,France; Département de médecine interne, médecine vasculaire et pneumologie, CHU Brest - Brest, France
| | - B Pan Petesch
- EA3878, Université de Bretagne Occidentale - Brest,France; Centre de traitement de l'hémophilie, Hématologie, CHU Brest - Brest,France
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Lacut K, Le Moigne E, Couturaud F, Font C, Vázquez FJ, Cañas I, Díaz-Peromingo JA, Gil-Díaz A, Bucherini E, Monreal M. Outcomes in patients with acute pulmonary embolism and patent foramen ovale: Findings from the RIETE registry. Thromb Res 2021; 202:59-66. [PMID: 33740536 DOI: 10.1016/j.thromres.2021.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 02/08/2021] [Accepted: 03/01/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION An increased risk of ischemic stroke in patients with acute pulmonary embolism (PE) and patent foramen ovale (PFO) was reported but few data exist regarding prognostic outcomes of those patients. MATERIAL AND METHODS Using data in the RIETE registry, we compared the characteristics, therapeutic approaches and outcomes of patients with PE according to the presence or absence of PFO. RESULTS From August 2016 to January 2020, 4148 patients with acute PE were enrolled. Of these, 2775 (67%) had no transthoracic echocardiogram (TTE), 993 (24%) underwent TTE but had no reported results on PFO. Among the remaining 380 patients, 287 (74%) did not have PFO and 93 (26%) had PFO. Patients with PFO were more likely to have chronic heart failure, prior myocardial infarction or ischemic stroke than those without PFO. Patients with PFO had a higher rate of subsequent ischemic stroke than those without PFO (hazard ratio (HR): 9.28; 95% CI: 1.83-69.1), than those with TTE but no data on PFO (HR: 10.1; 95% CI: 2.56-42.4) or without TTE (HR: 9.78; 95% CI: 3.02-28.4). On multivariable analysis, patients with PFO were at increased risk for subsequent ischemic stroke than those without PFO (HR: 8.96; 95% CI: 1.68-47.7). CONCLUSIONS PFO was searched in a minority of patients with an acute PE in real life setting. Subject to possible selection and measurement biases, our results confirmed a higher risk of ischemic stroke in PE patients with PFO compared to those without PFO. This association warrants further investigation before determining the best therapeutic option in patients with acute PE and concomitant PFO.
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Affiliation(s)
- K Lacut
- Département de Médecine interne, Médecine vasculaire et Pneumologie, CHU Brest, Brest, France; EA3878, Université de Bretagne Occidentale, Brest, France
| | - E Le Moigne
- Département de Médecine interne, Médecine vasculaire et Pneumologie, CHU Brest, Brest, France; EA3878, Université de Bretagne Occidentale, Brest, France
| | - F Couturaud
- Département de Médecine interne, Médecine vasculaire et Pneumologie, CHU Brest, Brest, France; EA3878, Université de Bretagne Occidentale, Brest, France.
| | - C Font
- Department of Medical Oncology, Hospital Clínic, Barcelona, Spain
| | - F J Vázquez
- Department of Internal Medicine, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - I Cañas
- Department of Internal Medicine, Hospital General de Granollers, Barcelona, Spain
| | - J A Díaz-Peromingo
- Department of Internal Medicine, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
| | - A Gil-Díaz
- Department of Internal Medicine, Hospital Universitario de Gran Canaria Dr, Negrín, Las Palmas, Spain
| | - E Bucherini
- Department of Vascular Medicine, Azienda U.S.L, Di Ravenna - O.C. Di Faenza, Ravenna, Italy
| | - M Monreal
- Department of Internal Medicine, Hospital Germans Trias i Pujol, Badalona, Barcelona, Universidad Católica de Murcia, Spain
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Feliachi S, Le Moigne E, Le Ven F, Hoffmann C, Bressolette L, Didier R, Jobic Y, Gilard M, Mansourati J, Leroyer C, Couturaud F. Comparison between transthoracic echocardiography and transcranial Doppler for detection of PFO in patients in the acute phase of a pulmonary embolism. A Post-hoc analysis of EPIC-FOP. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Patent foramen ovale is a fairly common defect found in a quarter of the population. PFO has always been associated with an increased risk of stroke, the mechanism of which has been attributed to the paradoxical embolism of venous thrombi passing through the PFO directly into the left atrium, however this mechanism remains debated to date.
For the detection of PFO, several modalities exist including transcranial doppler (TCD), transthoracic echocardiography (TTE) and transoesophageal echocardiography. This raises the question of the examination with the best diagnostic performance for its detection.
Purpose
The majority of studies comparing the different modalities of patient PFO diagnosis have been conducted in the context of stroke assessment. Very few studies have focused on the acute PE patient population. The interest of our study is therefore to evaluate the diagnostic performance of two modalities (TTE versus TCD) for the detection of shunts, especially since this population is at risk of stroke by paradoxical embolism due to the phenomenon of hyperpressure in the right heart chambers increasing the chances of having a paradoxical embolism.
Methods
We performed a post HOC analysis of the EPIC-FOP study which is a multicenter, prospective, French cohort study. Patients were recruited within 3 days of diagnosis of PE. Patients included were given a transthoracic echocardiography (TTE) with PFO screening by injection of saline contrast and magnetic resonance imaging (MRI) within 7 days of inclusion to look for signs of recent stroke. A proportion of the patients included in this study also received a transcranial doppler in search of PFO, the results of which were used in our study.
Results
The mean age of the patients was 62±14.66 years with a slight male predominance (55.6%). TCD was able to detect 97 right-left shunts while the TTE detected only 25 shunts. Concordance analysis by Cohen's Kappa Coefficient: 0.1767 [0.0427; 0.3107–p<0.001] is considered poor.
Using TTE as the reference examination, transcranial Doppler has a very good sensitivity 96.00% (79.65% to 99.90%) and a poor specificity 42.06% (33.33% to 51.18%). A good negative likelihood ratio 0.10 (0.01 to 0.66).
Using TCD, incidence of stroke in the acute phase of PE was significantly higher in the PFO population. In the ten strokes detected 9 had occurred in patients with PFO, RR=1.43 IC95% (1.1169 to 1.8228) p=0. 0044. The difference in proportion is calculated to be 26.92%.
Conclusion
It is the first study that compared TCD vs TEE in the setting of acute phase of PE for detection of PFO. TCD showed a good sensitivity and negative likelihood ratio that can be used as a first means to rule out PFO or associated with TTE. Also, our analysis confirms the increased risk of stroke following a PE episode when a PFO is present.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- S Feliachi
- University Hospital of Brest, Brest, France
| | | | - F Le Ven
- University Hospital of Brest, Brest, France
| | - C Hoffmann
- University Hospital of Brest, Brest, France
| | | | - R Didier
- University Hospital of Brest, Brest, France
| | - Y Jobic
- University Hospital of Brest, Brest, France
| | - M Gilard
- University Hospital of Brest, Brest, France
| | | | - C Leroyer
- University Hospital of Brest, Brest, France
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de Moreuil C, Fauchais AL, Merviel P, Tremouilhac C, Le Moigne E, Pasquier E, Pan-Petesch B, Lacut K. [Pre-eclampsia prevention in 2018 in general population and in lupic women: At the dawn of a personalized medicine?]. Rev Med Interne 2018; 39:935-941. [PMID: 29933972 DOI: 10.1016/j.revmed.2018.06.001] [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: 03/31/2018] [Revised: 05/27/2018] [Accepted: 06/03/2018] [Indexed: 11/17/2022]
Abstract
Pre-eclampsia prevention represents a major public health issue, as this vasculo-placental disorder generates a great burden of foeto-maternal morbi-mortality. Aspirin has proved its efficacy in primary and secondary pre-eclampsia prevention, especially when it is given at 150mg per day bedtime before 15 weeks of gestation to high-risk women. In the English trial ASPRE, high-risk women were identified by an algorithm taking into account angiogenic biomarkers ascertained at the end of first trimester of pregnancy. This article focuses on physiopathological mechanisms and risk factors of pre-eclampsia and on the interest of early angiogenic biomarkers dosing during pregnancy, for the assessment of pre-eclampsia risk. Unlike Great Britain or Israel, cost-effectiveness of this algorithm in general population has not been assessed in France. Finally, systemic lupus erythematous is at high risk of vasculo-placental disorders. Although few studies of angiogenic biomarkers dosing during lupus pregnancies identified a correlation between high sFlt1 levels at the end of first trimester and subsequent onset of severe vasculo-placental disorders, with a very good negative predictive value of sFtl1. Angiogenic biomarkers ascertainment for screening of vasculo-placental disorders in pregnant women with systemic lupus erythematous could allow targeting at best women needing an aspirin treatment and a closer monitoring.
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Affiliation(s)
- C de Moreuil
- Département de médecine interne et pneumologie, hôpital La Cavale Blanche, CHU de Brest, boulevard Tanguy-Prigent, 29609 Brest cedex, France; EA 3878, GETBO, université Bretagne-Loire, 29200 Brest cedex, France.
| | - A-L Fauchais
- Département de médecine interne, CHU de Limoges, 29200 Limoges, France
| | - P Merviel
- EA 3878, GETBO, université Bretagne-Loire, 29200 Brest cedex, France; Service de gynécologie et d'obstétrique, hôpital Morvan, CHU de Brest, 29200 Brest, France
| | - C Tremouilhac
- EA 3878, GETBO, université Bretagne-Loire, 29200 Brest cedex, France; Service de gynécologie et d'obstétrique, hôpital Morvan, CHU de Brest, 29200 Brest, France
| | - E Le Moigne
- Département de médecine interne et pneumologie, hôpital La Cavale Blanche, CHU de Brest, boulevard Tanguy-Prigent, 29609 Brest cedex, France; EA 3878, GETBO, université Bretagne-Loire, 29200 Brest cedex, France
| | - E Pasquier
- Département de médecine interne et pneumologie, hôpital La Cavale Blanche, CHU de Brest, boulevard Tanguy-Prigent, 29609 Brest cedex, France; EA 3878, GETBO, université Bretagne-Loire, 29200 Brest cedex, France
| | - B Pan-Petesch
- EA 3878, GETBO, université Bretagne-Loire, 29200 Brest cedex, France; Fédération de cancérologie et d'hématologie, hôpital Morvan, CHU de Brest, 29200 Brest, France
| | - K Lacut
- Département de médecine interne et pneumologie, hôpital La Cavale Blanche, CHU de Brest, boulevard Tanguy-Prigent, 29609 Brest cedex, France; EA 3878, GETBO, université Bretagne-Loire, 29200 Brest cedex, France
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Mollard LM, Le Mao R, Tromeur C, Le Moigne E, Gouillou M, Pan-Petesch B, Delluc A, Couturaud F, Lacut K. Antipsychotic drugs and the risk of recurrent venous thromboembolism: A prospective cohort study. Eur J Intern Med 2018; 52:22-27. [PMID: 29548526 DOI: 10.1016/j.ejim.2018.02.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 02/21/2018] [Accepted: 02/25/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Numerous studies have suggested that antipsychotic drugs are associated with an increased risk for a first episode of venous thromboembolism (VTE). However, after anticoagulation discontinuation, the impact of antipsychotic drugs on the risk of recurrent VTE (rVTE) remains unknown. OBJECTIVE To estimate the risk of rVTE in association with antipsychotic drugs. METHODS Between May 2000 and December 2012, we included all consecutive patients with a first unprovoked symptomatic VTE and who discontinued anticoagulation. During follow-up, exposure to antipsychotic drugs was systematically assessed. RESULTS A total of 736 patients with a first unprovoked symptomatic VTE were followed-up during a median period of 27.0 months (interquartile range (IQR) 6.2-60.0). Patients' median age was 66.0 years (IQR 49.0-76.0), 404 (54.9%) were men, and 61 (8.3%) were exposed to antipsychotics during follow-up. The incidence rate of r VTE was 12.1% person-year (95% CI 7.2-20.5) in antipsychotics users compared with 8.3% person-year (95% CI 7.1-9.8) in non-users (p = 0.20). Multivariate analysis showed a significant increased risk of recurrence associated with antipsychotic exposure (adjusted hazard ratio 1.9, 95% CI 1.1-3.3). CONCLUSIONS In this cohort study, exposure to antipsychotic drugs was found to be associated with an increased risk of rVTE among patients with a previous first unprovoked symptomatic VTE and who discontinued anticoagulation. Larger studies are needed to confirm and further explore this association.
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Affiliation(s)
- L M Mollard
- Département de médecine interne et pneumologie, CHU Brest - Brest, France
| | - R Le Mao
- Département de médecine interne et pneumologie, CHU Brest - Brest, France; EA3878, Université de Bretagne Occidentale - Brest, France
| | - C Tromeur
- Département de médecine interne et pneumologie, CHU Brest - Brest, France; EA3878, Université de Bretagne Occidentale - Brest, France
| | - E Le Moigne
- Département de médecine interne et pneumologie, CHU Brest - Brest, France; EA3878, Université de Bretagne Occidentale - Brest, France
| | | | - B Pan-Petesch
- EA3878, Université de Bretagne Occidentale - Brest, France; Centre de traitement de l'hémophilie, Hématologie, CHU Brest - Brest, France
| | - A Delluc
- Département de médecine interne et pneumologie, CHU Brest - Brest, France; EA3878, Université de Bretagne Occidentale - Brest, France
| | - F Couturaud
- Département de médecine interne et pneumologie, CHU Brest - Brest, France; EA3878, Université de Bretagne Occidentale - Brest, France; CIC1412, INSERM - Brest, France
| | - K Lacut
- EA3878, Université de Bretagne Occidentale - Brest, France; CIC1412, INSERM - Brest, France.
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Gourier G, Théréné C, Abasq-Thomas C, Brenaut E, Sonbol H, Pasquier E, Saraux A, Devauchelle-Pensec V, Le Moigne E, Misery L, Renaudineau Y. Étude du profil immunologique des patients atteints de sclérodermie souffrant de prurit. Ann Dermatol Venereol 2017. [DOI: 10.1016/j.annder.2017.09.492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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10
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Jobic Y, Le Moigne E, Timsit S, Ben Salem D, Didier R, Le Ven F, Hoffmann C, Dion A, Tromeur C, Pouliquen M, Le Gal G, Gilard M, Couturaud F, Mottier D. P4310Impact of patent foramen ovale on the prevalence of recent ischemic stroke in patients with acute pulmonary embolism: the EPIC FOP prospective multicenter study. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4310] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Y. Jobic
- Hospital Cavale Blanche, department of cardiology, Brest, France
| | - E. Le Moigne
- University Hospital of Brest, internal medecine, Brest, France
| | - S. Timsit
- University Hospital of Brest, of Neurology, Brest, France
| | - D. Ben Salem
- University Hospital of Brest, Radiology, Brest, France
| | - R. Didier
- Hospital Cavale Blanche, department of cardiology, Brest, France
| | - F. Le Ven
- Hospital Cavale Blanche, department of cardiology, Brest, France
| | | | - A. Dion
- University Hospital of Brest, Brest, France
| | - C. Tromeur
- University Hospital of Brest, Pneumology, Brest, France
| | - M.C. Pouliquen
- Hospital Cavale Blanche, department of cardiology, Brest, France
| | - G. Le Gal
- University Hospital of Brest, internal medecine, Brest, France
| | - M. Gilard
- Hospital Cavale Blanche, department of cardiology, Brest, France
| | - F. Couturaud
- University Hospital of Brest, Pneumology, Brest, France
| | - D. Mottier
- University Hospital of Brest, internal medecine, Brest, France
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Nau A, Pan-Petesch B, Sassolas B, Le Moigne E, Delluc A, Paret R, De Moreuil C. Éruption cutanée fébrile et pancytopénie : infection, hémopathie ou iatrogénie ? Rev Med Interne 2017. [DOI: 10.1016/j.revmed.2017.03.320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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12
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Le Moigne E, Pan-Petesch B, Tromeur C, Tremouilhac C, Jacquot M, Drugmanne G, Jolas S, Delluc A, Lacut K, Mottier D. Prophylaxie de la maladie veineuse thromboembolique par HBPM en post-partum en pratique : effets indésirables et problèmes rapportés par les patientes. Étude prospective dans deux maternités. Rev Med Interne 2017. [DOI: 10.1016/j.revmed.2017.03.019] [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: 10/19/2022]
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Gourier G, Théréné C, Abasq-Thomas C, Brenaut E, Sonbol H, Saraux A, Devauchelle V, Pasquier E, Le Moigne E, Misery L, Renaudineau Y. Étude du profil immunologique des patients atteints de sclérodermie souffrant de prurit. Rev Med Interne 2017. [DOI: 10.1016/j.revmed.2017.03.236] [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: 10/19/2022]
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Le Moigne E, Pan-Petesch B, Tromeur C, Tremouilhac C, Jacquot M, Drugmanne G, Jolas S, Alavi Z, Lacut K, Mottier D. P-038: Women’s self-reported experience on LMWH injections for venous thromboembolism prophylaxis during post-partum. Thromb Res 2017. [DOI: 10.1016/s0049-3848(17)30136-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Le Moigne E, Charneau B, Delluc A, Nowak E, Couturaud F, Mottier D. Facteurs prédictifs de maladie veineuse thromboembolique sous contraception œstroprogestative : étude cas-témoins. Rev Med Interne 2014. [DOI: 10.1016/j.revmed.2014.03.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Delluc A, De Moreuil C, Kerspern H, Le Moigne E, Mottier D, Tromeur C, Carre JL, Le Gal G, Lacut K. Body mass index, a major confounder to insulin resistance association with unprovoked venous thromboembolism. Results from the EDITH case-control study. Thromb Haemost 2013; 110:593-7. [PMID: 23803721 DOI: 10.1160/th13-01-0048] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Accepted: 06/07/2013] [Indexed: 02/06/2023]
Abstract
Shared risk factors help explain the association between venous thromboembolism (VTE) and atherothrombosis. The potential association between insulin resistance and VTE has been poorly evaluated. Thus, we aimed to assess the association between insulin resistance and VTE in the EDITH hospital-based case-control study. Between May 2000 and December 2004, 677 patients with unprovoked VTE and their age- and sex-matched controls were included. Fasting glycaemia and insulinaemia were measured and insulin resistance was estimated with the homeostasis model assessment of insulin resistance (HOMA-IR) equation. The association between HOMA-IR and VTE was determined in non-diabetic patients in a quintile-based analysis. A total of 590 non-diabetic cases (median age 73.0 years, 255 men) and 581 non-diabetic controls (median age 72.0 years, 247 men) were analysed. There was a trend for a higher median level of HOMA-IR index in cases than in controls (1.21 [interquartile range 0.84-2.10] vs1.19 [interquartile range 0.72-2.02], p=0.08). The unadjusted analysis showed an increased risk of unprovoked VTE associated with increasing HOMA-IR (odds ratio [OR] 1.53; 95% confidence interval [CI] 1.00-2.34 for the highest quintile of HOMA-IR compared with the first quintile). Adjustment for lipid lowering drugs and antiplatelet agents use slightly modified the association (OR 1.51; 95% CI 0.97-2.34). When body mass index was added in the adjusted model, HOMA-IR was no longer associated with VTE (OR 1.08; 95% CI 0.67-1.73). Our results highlight the role of body mass index in the association between cardiovascular risk factors and VTE.
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Affiliation(s)
- A Delluc
- Dr. Aurelien Delluc, EA3878 (GETBO), IFR 148, Université Européenne de Bretagne, Department of Internal Medicine and Chest Diseases, bd Tanguy Prigent, Brest, France 29609, Tel.: +33 298347336, Fax: +33 298347944, E-mail:
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Le Moigne E, Delluc A, Daoudal A, Nowak E, Mottier D, Le Gal G. P-022 Risk of recurrence during pregnancy after a first VTE: A French cohort. Thromb Res 2013. [DOI: 10.1016/s0049-3848(13)70068-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Le Moigne E, Delluc A, Le Bihan D, Nowak E, Mottier D, Le Gal G. P-023 Risk of recurrent venous thromboembolism among young women after a first event while exposed to oestrogen contraception versus not exposed to: A cohort study. Thromb Res 2013. [DOI: 10.1016/s0049-3848(13)70069-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Le Moigne E, Delluc A, Nowak E, Mottier D, Le Gal G. Risque de récidive de la maladie veineuse thrombo-embolique chez la femme jeune après un premier épisode sous contraception orale ou sans contexte hormonal. Rev Med Interne 2012. [DOI: 10.1016/j.revmed.2012.10.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rezig S, Daoudal A, Delluc A, Nowak E, Mottier D, Le Gal G, Le Moigne E. Prise en charge de l’accouchement après un premier épisode de maladie veineuse thromboembolique : étude de cohorte. Rev Med Interne 2012. [DOI: 10.1016/j.revmed.2012.10.345] [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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Delluc A, Le Moigne E, Le Gal G, Mottier D, Lacut K. Risque de récidive de maladie veineuse thromboembolique associé à l’exposition aux antiagrégants plaquettaires. Rev Med Interne 2012. [DOI: 10.1016/j.revmed.2012.10.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hemon F, Le Moigne E, Lacut K, Mottier D, Le Gal G, Delluc A. Peut-on éviter la survenue de la maladie veineuse thromboembolique dans les trois mois qui suivent une hospitalisation pour une affection médicale aiguë ? Résultats de la cohorte Edith. Rev Med Interne 2012. [DOI: 10.1016/j.revmed.2012.03.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Le Moigne E, Roudaut-Le Gall ML, Delluc A, Nowak E, Mottier D, Le Gal G. Contraception progestative après une maladie veineuse thromboembolique : étude de cohorte. Rev Med Interne 2011. [DOI: 10.1016/j.revmed.2011.10.391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Delluc A, Savary X, Le Moigne E, Le Hénaff M, Lacut K, Mottier D, Le Gal G. Validation externe du score modifié d’Ottawa pour la stratification du risque de récidive de maladie veineuse thromboembolique chez les patients atteints de cancer. Rev Med Interne 2011. [DOI: 10.1016/j.revmed.2011.03.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Le Moigne E, Tromeur C, Guinard S, Leroyer C, Mottier D, Couturaud F. Risque de maladie veineuse thrombo-embolique (MVTE) au cours de la grossesse chez les femmes apparentées à des sujets porteurs du facteur V Leiden (FVL). Rev Med Interne 2011. [DOI: 10.1016/j.revmed.2011.03.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Delluc A, Le Moigne E, Rolland F, Le Gal G, Mottier D, Lacut K. Risque de récidive de maladie veineuse thromboembolique associé à l’exposition aux hypolipémiants. Rev Med Interne 2010. [DOI: 10.1016/j.revmed.2010.10.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Le Moigne E, Gueguen C, Delluc A, Novak E, Mottier D, Le Gal G. Récidive après une MVTE survenue sous contraception oestroprogestative : quel risque ? quels facteurs de risque ? Rev Med Interne 2010. [DOI: 10.1016/j.revmed.2010.10.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Delluc A, Malécot JM, Le Moigne E, Kerspern H, Oger E, Nowak E, Mottier D, Le Gal G, Lacut K. Taux sériques des paramètres lipidiques et thrombose veineuse. Résultats de l’étude cas–témoin EDITH. Rev Med Interne 2010. [DOI: 10.1016/j.revmed.2010.03.372] [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: 10/19/2022]
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Delluc A, Le Gal G, Le Moigne E, Lacut K, Oger E, Mottier D. Poids et présentation clinique des thromboses veineuses profondes symptomatiques des membres inférieurs. Rev Med Interne 2009. [DOI: 10.1016/j.revmed.2009.03.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Delluc A, Rousseau A, Delluc C, Le Moigne E, Lacut K, Oger E, Van Dreden P, Mottier D. Cancer du pancréas et maladie veineuse thromboembolique : implication du facteur tissulaire ? Rev Med Interne 2008. [DOI: 10.1016/j.revmed.2008.10.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Le Henaff AK, Le Moigne E, Tanguy K, Delluc C. Dénutrition des personnes âgées hospitalisées : enquête épidémiologique et évaluation des pratiques professionnelles. Rev Med Interne 2008. [DOI: 10.1016/j.revmed.2008.03.120] [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: 10/22/2022]
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Le Moigne E, Bressollette L, Delluc C, Delluc A. Une complication méconnue des chambres implantables : la sténose sous-clavière. Rev Med Interne 2008. [DOI: 10.1016/j.revmed.2008.03.149] [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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Oger E, Leroyer C, Bressollette L, Nonent M, Le Moigne E, Bizais Y, Amiral J, Grimaux M, Clavier J, Ill P, Abgrall JF, Mottier D. Evaluation of a new, rapid, and quantitative D-Dimer test in patients with suspected pulmonary embolism. Am J Respir Crit Care Med 1998; 158:65-70. [PMID: 9655708 DOI: 10.1164/ajrccm.158.1.9710058] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Previous studies have suggested the utility of D-Dimer ELISA assays in eliminating a diagnosis of pulmonary embolism (PE). Our objectives were to evaluate the performance of a new, rapid, quantitative, and automated Liatest D-Dimer Assay in patients with suspected PE. Three hundred eighty-six consecutive patients referred to our institution between March 1992 and December 1996 for clinically suspected PE, with recent clinical signs not exceeding 1 wk, were included in this study. Diagnosis of PE was based on clinical evaluation, radionuclide lung imaging, lower limb examination, and, when required, pulmonary angiography. D-Dimer performances, for both Liatest D-Dimer and standard D-Dimer ELISA (Asserachrom DDi), assays, were assessed at the end of the study. Among the 386 patients tested, 146 (37.8%) were classified as PE-positive. Liatest D-Dimer assay had a 100% sensitivity (95% confidence interval, 97 to 100%) and a negative predictive value of 100% (95% confidence interval, 94 to 100%). A normal result, below the cutoff of 500 ng/ml, occurred in 83 of the 386 (21%) patients. There was a strong agreement between Liatest D-Dimer and Asserachrom DDi analyses. These findings suggest that this rapid, quantitative, and automated D-Dimer assay provides a useful diagnostic tool for the clinician with regard to exclusion of PE.
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Affiliation(s)
- E Oger
- Department of Internal Medicine and Chest Diseases, Department of Radiology, Department of Biophysics, and Department of Haematology, CHRU de la Cavale Blanche, Brest Cedex, France
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Escoffre-Barbe M, Oger E, Leroyer C, Grimaux M, Le Moigne E, Nonent M, Bressollette L, Abgrall JF, Soria C, Amiral J, Ill P, Clavier J, Mottier D. Evaluation of a new rapid D-dimer assay for clinically suspected deep venous thrombosis (Liatest D-dimer). Am J Clin Pathol 1998; 109:748-53. [PMID: 9620034 DOI: 10.1093/ajcp/109.6.748] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
In previous studies, enzyme-linked immunosorbent assays (ELISA) for plasma D-dimer analysis have demonstrated high sensitivity, suggesting their potential usefulness in excluding deep venous thrombosis (DVT). We evaluated the usefulness of a new D-dimer test (Liatest D-dimer) for suspected DVT in a prospective study of patients admitted to the hospital because of recent (not exceeding 1 week before admission) clinical signs. Contrast venography or compression ultrasonography or both were performed within 24 hours of admission. A new quantitative determination of D-dimer concentration using a suspension of microlatex particles coated with specific antibodies was tested. A standard plasma D-dimer ELISA measurement was also performed. Of 464 patients, 276 had a proven DVT (distal, 74; proximal, 202). For a cutoff level of 400 ng/mL, sensitivity of the Liatest method in the diagnosis of overall DVT was 94.6% (95% confidence interval, 92.0%-97.0%), and the specificity was 35% (95% confidence interval, 28%-42%). The sensitivity and negative predictive value were 98.5% and 95.6%, respectively, in the diagnosis of proximal DVT, but only 83.8% and 84.6%, respectively, in the diagnosis of distal DVT. This new rapid Liatest D-dimer assay seems to be highly sensitive and could replace the ELISA method in excluding patients with proximal DVT. Both methods provide lower sensitivity for distal DVT.
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Affiliation(s)
- M Escoffre-Barbe
- Department of Haematology, Hôpital de la Cavale Blanche, Brest, France
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Oger E, Leroyer C, Mercier B, Van Dreden P, Bressollette L, De Saint-Martin L, Le Moigne E, Blouch MT, Thuillier N, Amiral J, Ferec C, Abgrall JF, Mottier D. Assessment of activated protein C resistance using a new and rapid venom-based test: STA Staclot APC-R. Blood Coagul Fibrinolysis 1998; 9:355-9. [PMID: 9690807 DOI: 10.1097/00001721-199806000-00008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Activated protein C (APC) resistance is related to a single point mutation in the factor V gene (FV:Q506) and appears to be the most common inherited risk factor for venous thromboembolism. A reliable screening test is therefore useful. We aimed to evaluate a new APC resistance test, on the basis of the procoagulant activity present in one snake venom of a crotalidae family: STA Staclot APC-R. We studied 36 consecutive patients with an acute deep venous thrombosis (DVT) confirmed by compression ultrasonography and carrying the FV:Q506 allele, assessed by DNA analysis, 103 of their family members and 35 consecutive patients with a proven DVT but who did not carry the FV:Q506 allele. Blood samples were collected within 24 h of admission for the DVT cases and on the day of medical registration for the family members. Tests were performed blind. The STA Staclot APC-R test, using a cut-off value of 0.80, had an overall sensitivity of 100% (95% CI, 95-100) and a specificity of 98.8% (95% CI, 92.0-99.6). An acute thrombosis process did not influence the performance of the test. We conclude that this test is easy and rapid to perform in every day practice and fulfills the criteria for a screening test.
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Affiliation(s)
- E Oger
- Department of Internal Medicine and Chest Diseases, Hôpital de la Cavale Blanche, Brest, France
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Oger E, Leroyer C, Le Moigne E, Pomey MP, Bressollette L, Clavier J, Mottier D. The value of a risk factor analysis in clinically suspected deep venous thrombosis. Respiration 1997; 64:326-30. [PMID: 9311047 DOI: 10.1159/000196699] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [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: 02/05/2023] Open
Abstract
BACKGROUND The value of a risk factor analysis in the presence of a clinically suspected deep venous thrombosis (DVT) has been assessed mainly in inpatient populations. The aim of this prospective study was to evaluate the potential association between DVT and acquired circumstances suspected as risk factors, in a cohort of outpatients with a clinically suspected DVT. METHODS Consecutive outpatients referred for a clinically suspected DVT, with recent clinical signs, not exceeding 1 week, were included. Before venography, all patients were interviewed by a trained physician to detect the presence of risk factors. RESULTS From March 1992 to February 1994, 277 patients were included; venography was positive in 162 (58.4%). Five independent variables were significantly associated with the occurrence of DVT; in a multivariate analysis, 64.7% of patients were correctly classified; odds ratios for having DVT in the presence of these underlying conditions were respectively: 1.75 for age over 65 years, 1.68 for prior history of venous thromboembolism, 1.69 for high risk circumstances (any type of surgery or leg trauma within the past 3 months), 5.59 for malignancy, and 2.56 for varicose veins. CONCLUSIONS In outpatients referred for a clinically suspected DVT, recognition of associated conditions might increase the certainty of the diagnosis.
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Affiliation(s)
- E Oger
- Department of Internal Medicine and Chest Diseases, CHRU de la Cavale Blanche, Brest, France
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Bressollette L, Guias B, Lemire A, Nonent M, Garcia JF, Oger E, Le Moigne E, Mottier D. [Pulmonary embolism and unusual deep venous thrombosis. Report of two cases]. J Mal Vasc 1997; 22:265-7. [PMID: 9411012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Contrast venography is the gold standard for the diagnosis of deep vein thrombosis in the lower limb extremities, but it fails to visualize deep veins like deep femoral vein and internal iliac vein. The internal iliac can be examined with duplex scanning if the technique and the examination conditions are correct. As reported in these two cases, thrombosis of these deep veins may lead to pulmonary embolism. The first case is a young female with venous thromboembolic disease in whom internal iliac vein thrombosis was documented only at the second examination. In the second case, deep femoral vein thrombosis appeared early in a comatose young male. This thrombosis may be classified as proximal muscular vein thrombosis. These two cases emphasize the importance of a duplex scanning examination performed with rigorous technique, whose the main limitation being examination conditions.
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Leroyer C, Escoffre M, Le Moigne E, Grimaux M, Cagnioncle O, Oger E, Bressollette L, Abgrall JF, Amiral J, Mottier D. Diagnostic value of a new sensitive membrane based technique for instantaneous D-dimer evaluation in patients with clinically suspected deep venous thrombosis. Thromb Haemost 1997; 77:637-40. [PMID: 9134634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Plasma D-Dimer analysis, using ELISA assays, has demonstrated in previous studies a high sensitivity, suggesting its utility in excluding deep venous thrombosis (DVT). AIM To assess the performance of a new rapid plasma D-Dimer ELISA measurement in suspected DVT patients with recent clinical signs, not exceeding one week. METHODS A prospective study of patients admitted for a suspected recent DVT. Contrast venography or compression ultrasonography were performed within 24 h of admission. A new membrane based ELISA technique, which uses an immunofiltration and two complementary monoclonal antibodies was tested. Results were expressed as positive or negative. A standard plasma D-Dimer ELISA measurement was also performed. D-Dimer performances were assessed at the end of the study. RESULTS 265/448 patients had a proven DVT (72 distal, 193 proximal). The sensitivity of the instantaneous method in the diagnosis of overall DVT is 92 +/- 3.4% (95% CI), and specificity is 36.6 +/- 6.9%. Positive predictive value is 67.7 +/- 4.8% and negative predictive value is 76.1 +/- 8.9%. Sensitivity and negative predictive values reach 97.9 and 94.3% in the diagnosis of proximal DVT, but only 76.3 and 79.7% in the diagnosis of distal DVT. Similar results are observed with the standard ELISA method. CONCLUSION This new rapid plasma D-Dimer measurement appears highly sensitive, and could substitute the older ELISA methods. Both methods provide lower sensitivity in the case of a distal DVT location.
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Affiliation(s)
- C Leroyer
- Department of Chest Diseases and Internal Medicine, Hôpital de la Cavale Blanche, Brest, France
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Oger E, Lernyer C, Dueymes M, Le Moigne E, Bressolette L, Escoffre M, Youinou P, Mottier D. Association between IgM anticardiolipin antibodies and deep venous thrombosis in patients without systemic lupus erythematosus. Lupus 1997; 6:455-61. [PMID: 9229365 DOI: 10.1177/096120339700600508] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Patients with systemic lupus erythematosus (SLE) are at risk of developing deep venous thrombosis (DVT). Should anticardiolipin antibodies (aCL) be detectable, this risk is significantly raised, particularly when these autoanti-bodies are cofactor-dependent. We conducted a cross-sectional study of consecutive unselected outpatients referred for clinical suspicion of DVT, as an attempt to address the following questions: firstly, were aCL antibodies associated with DVT in non-SLE patients? Secondly, was this association related to the cofactor dependence? From March 1992 to February 1994, 208 patients were enrolled in the study. Venography was positive in 110 patients (DVT patients), while the diagnosis of DVT could not be confirmed in the remaining 98 (referred to as disease controls). ACL was measured by ELISA, for IgG and IgM isotypes in two ways: fetal calf serum or bovine serum albumin were used as blocking agents to distinguish between cofactor-dependent and cofactor-independent antibodies. Positive aCL was defined as optical density (OD) values greater than the 95th percentile of OD distribution of 60 healthy controls. We found a high frequency of positive IgG aCL antibodies in both DVT patients and in disease controls (25.5 vs 23.5%). We suggest an association between IgM aCL and DVT. This association was, however, not dependent on the cofactor requirement.
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Affiliation(s)
- E Oger
- Department of Internal Medicine and Chest Diseases, Hôpital de la Cavale Blanche, Brest, France
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Couturaud F, Leroyer C, Le Moigne E, Oger E, Mottier D. [Prevention of deep venous thrombosis in medical care]. Presse Med 1996; 25:1935-40. [PMID: 9033615] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Venous thromboembolism is a frequent and potentially severe ailment in medical patients; the clinical signs are unreliable and as early detection of the thrombosis process by non-invasive techniques is not available, prevention appears to be an alternative. Careful definition of the medical situations at risk from venous thromboembolism is necessary. Age, prior history of venous thromboembolism, and immobilization constitute high risk circumstances. Analysis of the published studies advocates prevention in three circumstances: myocardial infarction, stroke and intensive care. In other cases, further controlled studies, randomized versus placebo, are needed.
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Affiliation(s)
- F Couturaud
- Fédération de Médecine interne et de Pneumologie, Hôpital de la Cavale Blanche, Brest
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Cartier H, Le Moigne E, de Saint Martin L, Bourdier J, Leroy J, Sassolas S, Guillet G, Mottier D. BCGite généralisée après instillations intravésicales de bacille de Calmette et Guérin. Rev Med Interne 1996. [DOI: 10.1016/s0248-8663(97)81046-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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42
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Delmas A, Le Moigne E, Cartier H, Leroy J, Guillet G, Mottier D. Fasciite de Shulman d'évolution sclérodermiforme et syndrome des antiphospholipides. Rev Med Interne 1996. [DOI: 10.1016/s0248-8663(97)80975-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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43
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Le Moigne E, Oger E, Leroyer C, Bressollette L, Yvelin N, Neuhart E, Blanc J, Clavier J, Simonneau G, Decousus H, Mottier D. Étude ouverte comparative de l'efficacité et de la tolérance de l'introduction des AVK au 1er ou au 10e jour du traitement par énoxaparine des thromboses veineuses profondes. Rev Med Interne 1996. [DOI: 10.1016/s0248-8663(97)80953-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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44
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Oger E, Leroyer C, Dueymes M, Le Moigne E, Bressolette L, Escoffre M, Youinou P, Mottier D. Association entre les anticorps anticardiolipine de type IgM et l'existence d'une thrombose veineuse profonde des membres inférieurs chez des patients non lupiques. Rev Med Interne 1996. [DOI: 10.1016/s0248-8663(97)80917-4] [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: 10/16/2022]
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45
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Le Moigne E, Leroyer C, Oger E, Bressollette L, Escoffre M, Abgrall J, Amiral J, Mottier D. Valeur diagnostique d'un nouveau test D-dimères rapide chez les patients présentant une suspicion clinique de thrombose veineuse profonde. Rev Med Interne 1996. [DOI: 10.1016/s0248-8663(97)80951-4] [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: 10/16/2022]
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46
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Le Moigne E, Leroyer C, Mercier B, Bressollette L, Le Ber C, Garcia JF, Escoffre M, Raguénès A, Mansourati J, Férec C, Mottier D. Prévalence et caractéristiques cliniques des thromboses veineuses profondes associées au facteur V Leiden. Rev Med Interne 1995. [DOI: 10.1016/0248-8663(96)86532-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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47
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Dupon M, Le Moigne E, Ryman A, Paty M, Winnock S, Janvier G, Saric J, Lacut J. Les complications infectieuses chez les transplantés hépatiques. Expérience bordelaise sur 51 patients. Med Mal Infect 1991. [DOI: 10.1016/s0399-077x(05)80143-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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