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Evaluation of a prophylactic transfusion program on obstetric outcomes in pregnant women with sickle cell disease: A single centre retrospective cohort study. Eur J Obstet Gynecol Reprod Biol 2023; 290:103-108. [PMID: 37776703 DOI: 10.1016/j.ejogrb.2023.08.390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 08/04/2023] [Accepted: 08/30/2023] [Indexed: 10/02/2023]
Abstract
OBJECTIVE To evaluate the effects of a prophylactic transfusion program (TP) on obstetric and perinatal outcomes in pregnant women with sickle cell disease (SCD). METHODS This retrospective cohort study included all singleton pregnancies among women with SCD in a French university tertiary care center between 1 January 2004 and 31 December 2017. The TP group included patients selected according to the French guidelines who received regular red blood cell transfusions during pregnancy until delivery. The factors associated with TP indication [year of birth, SCD genotype, history of acute chest syndrome and delayed hemolysis transfusion reaction (DHTR) risk score] were taken into account in a propensity score. A composite obstetric adverse outcome was defined associating birth before 34 gestational weeks and/or pre-eclampsia and/or small for gestational age and/or abruption and/or stillbirth and/or maternal death and/or neonatal death. RESULTS In total, 246 pregnancies in 173 patients were analyzed. Twenty-two pregnancies with a history of DHTR were excluded. A higher frequency of TP was found before 2013 [119/148 (80.4%) vs 38/76 (50%); p < 0.001]. Rates of preterm birth before 34 gestational weeks (5.6% vs 19.7%; p = 0.001), vaso-occlusive crisis (36.5% vs. 61.8%; p < 0.001), and acute chest syndrome (6.1% vs. 14.5%; p = 0.04) during pregnancy were decreased significantly in the TP group. Among the groups with and without composite obstetric adverse outcomes, the frequency of TP was 52.6% and 74.7%, respectively [odds ratio (OR) 0.30, 95% confidence interval (CI) 0.09-1.02]. The multivariate analysis shows that the TP was associated with a significant reduction in the risk of composite obstetric adverse outcomes (OR 0.28, 95% CI 0.08-0.97; p = 0.04). CONCLUSION A red blood cell TP may have an independent protective effect on maternal and perinatal adverse outcomes during pregnancy in women with SCD.
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Exploration de l’hémolyse associée à la drépanocytose et perspectives thérapeutiques spécifiques. Rev Med Interne 2023; 44:4S7-4S11. [PMID: 38049244 DOI: 10.1016/s0248-8663(23)01303-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
Sickle Cell Anemia is a disease with a strong vascular tropism. Beyond anemia, the pathophysiological mechanisms responsible for hemolysis, directly affect both acute and chronic vascular damages, thus resulting in a systemic disease. Understanding the different types of hemolysis underline the need for novel specific biomarkers. Targeted therapeutic approaches for these pathophysiological pathways are necessary to improve Sickle Cell patients' prognosis. Finally, given its complexity, Sickle Cell Disease is often used as a "proof of concept" for other pathologies. It seems likely that the rapidly evolving knowledge in this field will also benefit other diseases. © 2023 Société nationale française de médecine interne (SNFMI). Published by Elsevier Masson SAS. All rights reserved.
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Risque d’insuffisance rénale aiguë après injection de produit de contraste iodé chez les adultes atteints de drépanocytose : une série de cas autocontrôlés issue d’un entrepôt de données de santé multicentrique. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.10.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Implication de l’activation du complément dans les lésions d’organes notamment rénales de la drépanocytose chez des patients et dans un modèle murin. Nephrol Ther 2022. [DOI: 10.1016/j.nephro.2022.07.263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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S299: ROLE OF RED BLOOD CELL MEMBRANE-DERIVED PARTICLES ON ENDOTHELIAL DAMAGES DURING ONSET STAGE OF DELAYED HEMOLYTIC TRANSFUSION REACTION. Hemasphere 2022. [DOI: 10.1097/01.hs9.0000844088.18349.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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P1500: 2,3-DIPHOSPHOGLYCERATE DETECTION VIA DIRECT INFUSION HIGH RESOLUTION MASS SPECTROMETRY CORRELATES WITH QUANTITATIVE DETECTION IN BLOOD OF PATIENTS WITH SICKLE CELL DISEASE. Hemasphere 2022. [PMCID: PMC9429661 DOI: 10.1097/01.hs9.0000848856.08012.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Comprehensive Evaluation and Determinant of Second Lactate Threshold in Homozygous Sickle Cell Disease. ARCHIVES OF CARDIOVASCULAR DISEASES SUPPLEMENTS 2022. [DOI: 10.1016/j.acvdsp.2021.09.242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Echocardiographic determinants of ventricular arrhythmia in sickle cell disease. ARCHIVES OF CARDIOVASCULAR DISEASES SUPPLEMENTS 2022. [DOI: 10.1016/j.acvdsp.2021.09.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Association entre les crises vaso-occlusives hospitalisées et la mortalité chez les patients drépanocytaires de plus de 16 ans : une étude nationale Française. Rev Med Interne 2021. [DOI: 10.1016/j.revmed.2021.10.278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Echocardiographic determinants of ventricular arrhythmia in sickle cell disease adults. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Unexplained sudden death remains one of the leading causes of death in sickle cell disease (SCD) adults. Ventricular arrhythmia is a well-known risk factor for sudden death but its prevalence and determinants in the context of SCD remain understudied.
Purpose
The aim of this study was to identify echocardiographic predictors of ventricular arrhythmia in SCD.
Methods
From January 2019 to March 2021, consecutive adult patients with SCD referred to ambulatory cardiology department for possible cardiac involvement were prospectively included (Drepacoeur cohort). All patients that had 24-hour ECG monitoring (24h-holter) and thransthoracic echocardiography (TTE) on the same day were analysed in this study. The primary end point was the occurrence of ventricular arrhythmia, defined as sustained or non-sustained ventricular tachycardia (VT), more than 500 premature ventricular contractions (PVC) on 24h-holter, or history of VT ablation.
Results
Overall, 90 patients were included and 54 (60%) were analysed. Mean age was 47.6±11.6 years (range 21–69), 53% were male. Heart function was mainly preserved with a mean left ventricular ejection fraction (LVEF) of 57.9±4.9% and a mean global longitudinal strain (GLS) of −18±2.8%. Mean tricuspid regurgitation velocity was 2.6±0.4m/s.
Ventricular arrhythmia was observed in 13 (24.1%) patients (4 non-sustained VT [range 4–121 consecutive PVC], 9 with more than 500 PVC [range 500–13000 PVC/24h] and 1 history of VT ablation). Regarding echocardiographic parameters, ventricular arrhythmia was associated with lower GLS (−15.8±1.8% vs. −19±2.7%, P<0,001), lower tricuspid annular plane systolic excursion (TAPSE, 23±5.7mm vs. 26.9±4.6mm, P=0,02) and more dilated right ventricle assessed by tricuspid annulus diameter (38.2±6.1mm vs. 34.2±4.5mm, P=0,02). In multivariate analysis, GLS was independently associated with ventricular arrhythmia (OR=2,1 CI95% [1,3; 3,3], P=0,004) with a moderate exponential correlation with PVC load on 24h-holter (R=0,5, P<0,001). Interestingly, ventricular arrhythmia was not associated with corrected QT interval nor with age or hemoglobin serum level.
Conclusion
In SCD adults with preserved LVEF, GLS was the only independent echocardiographic predictor of ventricular arrhythmia.
Funding Acknowledgement
Type of funding sources: None.
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Echocardiographic phenotypes of patients with sickle cell disease. An unsupervised analysis based on etendard cohort. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): PHRC
Backgroung
Echocardiography is the cornerstone in the diagnosis of cardiopulmonary involvement in sickle cell disease (SCD). However, given the unique pathophysiology of SCD associating high cardiac output, and various degrees of peripheral vasculopathy, differentiate the pathological from the physiological using echocardiography can be particularly challenging.
Purpose
This study sought to link cardiac phenotypes in homozygous SCD patients with clinical profiles and outcomes using cluster analysis.
Methods
We analyzed data of 379 patients with a sufficient echographic dataset included in the French Etendard Cohort, a prospective cohort initially designed to assess the prevalence of pulmonary hypertension. A cluster analysis was performed on echocardiographic variables, and the association between clusters and clinical profiles and outcomes was assessed.
Results
Three clusters were identified. Cluster 1 (N = 122) patients had the lowest cardiac output, only mild left cavities remodeling, diastolic dysfunction, and high tricuspid regurgitation velocity (TRV). They were predominantly female, as old as cluster 2, and displayed the most severe functional limitation. Cluster 2 (N = 103) patients had the highest cardiac output, left ventricular mass and a severely dilated left atrium. Diastolic function and TRV were similar to cluster 1. These patients had a higher blood pressure and a severe hemolytic anemia. Cluster 3 (N = 154) patients had mild left cavities remodeling, the best diastolic function and the lowest TRV. They were younger patients with the highest hemoglobin and lowest hemolytic markers. Right heart catheterization was performed in 94 patients. Cluster 1 gathered the majority of precapillary PH while cluster 2 gathered postcapillary PH and no PH was found in cluster 3. After a follow-up of 9.9 years (IQR: 9.3 to 10.5 years) death occurred in 38 patients (10%). Clusters 2 had the worst prognosis with 18% mortality rate vs. 12% in cluster 2 and 5% in cluster 1 (P log-rank = 0,02). Results are summarized in the central illustration.
Conclusions
Cluster analysis of echocardiographic variables identified 3 phenotypes among SCD patients, each associated with different clinical features and outcome. These findings underlines the necessity to rethink echocardiographic evaluation of SCD patients, with an integrative approach based on simultaneous evaluation of TRV along with left cavities remodeling and diastolic parameters.
Abstract Figure.
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Echocardiographic evaluation of patients with sickle cell disease. A study based on Etendard cohort. ARCHIVES OF CARDIOVASCULAR DISEASES SUPPLEMENTS 2021. [DOI: 10.1016/j.acvdsp.2020.10.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Echocardiographic evaluation of patients with sickle cell disease. A study based on Etendar Cohort. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Echocardiography is the main non-invasive screening tool for pulmonary hypertension (PH) in Sickle Cell Disease (SCD), but relies mostly on the tricuspid regurgitation velocity (TRV) assessment, without distinction between pre and postcapillary patterns.
Purpose
Using Etendard Cohort data, the aim of this study was to refine echocardiographic assessment of PH in SCD patients.
Methods
The French Etendard Study is a prospective cohort initially designed to assess the prevalence of PH among 398 SCD participants. We analyzed echocardiography data of the 96 Etendard patients who underwent Right Heart Catheterization (RCH), because of a TRV≥2.5m/s, and compared them to invasive haemodynamic measurements. Based on RHC results, patients were classified as follows: Absence of pulmonary hypertension if mean pulmonary arterial pressure (mPAP) was <25mmHg. Precapillary PH if mPAP≥25mmHg and pulmonary-capillary wedge pressure (PCWP) ≤15mmHg. Postcapillary PH if mPAP≥25mmHg and PCWP >15mmHg.
Results
PH was found in 24/96 patients with 11 precapillary and 13 postcapillary. In addition to TRV, multivariate analysis identified indexed left atrial volume (LAVind) and lateral E' wave velocity (E'lat) as independent echocardiographic predictors of PH (OR=1.06 and 0.6 respectively, p<0.01). LAVind and E'lat showed good correlation with mPAP (R=0.51 and R=0.40 respectively and p<10–3 for both) and had good accuracy to predict PH with an optimal cut-off of 48ml/m2 for LAVind (AUC=0.78, Se=81% and Sp=75%) and 12cm/s for E'lat (AUC=0.8, Se=72% and Sp=79). Using the association of a TRV≥3m/s or a TRV [2.5; 2.9] m/s with LAVind>48ml/m2 and E'lat<12cm/s, we could predict PH with a PPV of 68% and NPV of 90%.
Moreover, comparing echocardiography data of pre and post-capillary PH patients, we observed that Pulmonary acceleration time (PAcT) was different in the two groups (104±22ms vs. 160±21ms, p<0.001) with an excellent accuracy for the differentiation of both phenotypes (AUC=0.95, optimal cut-off=115ms, Se=100% and Sp=78%). PAcT correlated with pulmonary vascular resistance (PVR) assessed by RHC (R=0.34, p=0.001) but not with mPAP (R=0.1, p=0.2) and a PAcT>115ms ruled out pre-capillary PH with a NPV of 97%.
Conclusion
Echocardiography can accurately estimates the probability of PH in SCD patients with an integrated approach using TRV, LAVind and E'lat. In addition, among patients with suspected PH, measuring PAcT as a PVR surrogate allows a good differentiation between pre and post-capillary phenotypes. We propose a new echocardiographic algorithm for the diagnosis of PH in SCD that could be a true assistance in referring patients for RHC.
TTE Algorithm for PH in SCD
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Funded by the French Ministry of Health and Assistance Publique–Hôpitaux de Paris
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Odontogenic-Related Head and Neck Infections: From Abscess to Mediastinitis – Our Experience Limits and Perspectives. J Oral Maxillofac Surg 2020. [DOI: 10.1016/j.joms.2020.07.144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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ASL avec délais post-marquage multiples : un meilleur biomarqueur de perfusion cérébrale dans la vasculopathie drépanocytaire ? J Neuroradiol 2020. [DOI: 10.1016/j.neurad.2019.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Systemo-pulmonary shunting and acute chest syndrome in a patient with SC sickle-cell disease. Respir Med Res 2020; 77:21-23. [PMID: 32036282 DOI: 10.1016/j.resmer.2019.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 11/10/2019] [Accepted: 11/15/2019] [Indexed: 10/25/2022]
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S906 PRECLINICAL EVALUATION OF THE PRESERVATION OF RED BLOOD CELL CONCENTRATES IN HYPOXIA BY HYPOXIC STORAGE TECHNOLOGY FOR TRANSFUSION IN SICKLE CELL DISEASE. Hemasphere 2019. [DOI: 10.1097/01.hs9.0000561904.90219.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Molecular testing for respiratory pathogens in sickle cell disease adult patients presenting with febrile acute chest syndrome. Med Mal Infect 2019; 50:49-56. [PMID: 31088757 PMCID: PMC7127005 DOI: 10.1016/j.medmal.2019.04.391] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 10/17/2018] [Accepted: 04/15/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Differentiating acute chest syndrome (ACS) from community-acquired pneumonia (CAP) is challenging in adults presenting with major sickle cell disease (SCD) (semiological similarity, rare microbiological documentation). We aimed to assess the usefulness of nucleic acid amplification test (NAAT) for respiratory pathogens, in combination with standard bacteriological investigations, in febrile ACS adult patients presenting with major SCD. METHODS We performed a prospective, monocentric, observational study of 61 SCD adults presenting with febrile ACS from February 2015 to April 2016. Systematic blood, urine, and respiratory specimens were collected, before antibiotic initiation, for culture, urinary antigen tests, serology, and NAAT for respiratory pathogens. RESULTS A pathogen was detected in 12 febrile ACS (19.7%): four viruses (6.6%) (Rhinovirus; Influenza A/B), seven bacteria (11.4%) (S. aureus, S. pneumoniae, K. pneumoniae, L. pneumophila, M. pneumoniae), one mixed infection (1.6%) (S. aureus and Influenza B). NAAT only detected L. pneumophila in one case (serogroup 2). Apart from a significantly shorter antibiotic therapy duration (6.1 vs. 7.8 days, P=0.045), no difference was observed between undocumented and microbiologically-documented febrile ACS. CONCLUSION Using NAAT for the detection of respiratory pathogens in adults presenting with SCD slightly improved the microbiological diagnostic of febrile ACS, although respiratory infections are not the main etiological factor.
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Évaluation de l’oxygénation tissulaire cérébrale au moyen de la NIRS au cours des échanges transfusionnels chez des patients drépanocytaires atteints d’une vasculopathie cérébrale. Rev Med Interne 2018. [DOI: 10.1016/j.revmed.2018.03.290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Traitement des ulcères de jambe drépanocytaires par la trinitrine. Rev Med Interne 2018. [DOI: 10.1016/j.revmed.2018.03.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Left ventricular dysfunction in patients with sickle cell disease. ARCHIVES OF CARDIOVASCULAR DISEASES SUPPLEMENTS 2018. [DOI: 10.1016/j.acvdsp.2017.11.294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Management of delayed hemolytic transfusion reaction in sickle cell disease: Prevention, diagnosis, treatment. Transfus Clin Biol 2017; 24:227-231. [DOI: 10.1016/j.tracli.2017.05.016] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Improved Fetal Hemoglobin With mTOR Inhibitor-Based Immunosuppression in a Kidney Transplant Recipient With Sickle Cell Disease. Am J Transplant 2017; 17:2212-2214. [PMID: 28276629 DOI: 10.1111/ajt.14263] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Revised: 02/17/2017] [Accepted: 02/22/2017] [Indexed: 01/25/2023]
Abstract
Fetal hemoglobin induction is a key point in the management of sickle cell disease (SCD). We report the case of a kidney transplant recipient with SCD who was treated with everolimus, a mammalian target of rapamycin inhibitor. At 10 months after initiating therapy, the patient's fetal hemoglobin level was dramatically increased (from 4.8% to 15%) and there was excellent tolerance to treatment.
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Des anomalies de l’oxygénation et de la perfusion tissulaire peuvent être détectées par IRM pendant les crises vaso-occlusives drépanocytaires. Nephrol Ther 2016. [DOI: 10.1016/j.nephro.2016.07.346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
Neuropsychiatric manifestations of systemic lupus erythematosus (NPSLE) are among the main causes of morbidity and mortality attributed to lupus activity. Conventional NPSLE treatment combines CS and immunosuppressants, but some symptoms do not respond. We retrospectively evaluated the adjunction of plasma exchanges (PE) to treat 13 NPSLE flares occurring in 10 patients (mean age, 30 years) between 1989 and 2002. NP manifestations were the first SLE symptoms for seven patients, with a mean of 3.2 NP manifestations/flare. All patients received CS and cyclophosphamide pulses. A mean of 15 PE/flare were performed. All patients improved within a mean of 3 (median: 2.5; range: 1.5—8) weeks thereafter. Complete remissions of 7/13 flares were obtained within a mean of 7 (median: 4; range: 2—22) weeks. Partial remissions were achieved for the remaining six flares, characterized by new NP manifestations during three and insufficient control of the others. Other SLE manifestations regressed for all patients with the mean European consensus lupus activity measurement score declining from pretreatment 6.9 to 1.2. A regimen combining CS, cyclophosphamide and PE is effective against severe NPSLE, with acceptable toxicity. Lupus (2007) 16, 817—822.
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Mise en évidence, par l’imagerie par résonance magnétique, d’une altération tissulaire du parenchyme rénal pendant la crise vaso-occlusive drépanocytaire. Rev Med Interne 2016. [DOI: 10.1016/j.revmed.2016.04.312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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RESPIR-02 - Apport de la biologie moléculaire dans l’exploration microbiologique des syndromes thoraciques aigus fébriles chez les patients drépanocytaires adultes : évaluation prospective monocentrique. Med Mal Infect 2016. [DOI: 10.1016/s0399-077x(16)30493-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Vers la fin d’un mythe : le Doppler transcrânien est réalisable et utile pour le dépistage de la vasculopathie cérébrale de l’adulte drépanocytaire. Rev Med Interne 2016. [DOI: 10.1016/j.revmed.2016.04.311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
Sickle cell disease is a systemic genetic disorder, causing many functional and tissular modifications. As the prevalence of patients with sickle cell disease increases gradually in France, every physician can be potentially involved in the care of these patients. Complications of sickle cell disease can be acute and chronic. Pain is the main symptom and should be treated quickly and aggressively. In order to reduce the fatality rate associated with acute chest syndrome, it must be detected and treated early. Chronic complications are one of the main concerns in adults and should be identified as early as possible in order to prevent end organ damage. Many organs can be involved, including bones, kidneys, eyes, lungs, etc. The indications for a specific treatment (blood transfusion or hydroxyurea) should be regularly discussed. Coordinated health care should be carefully organized to allow a regular follow-up near the living place and access to specialized departments. We present in this article the French guidelines for the sickle cell disease management in adulthood.
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[Symptomatic extramedullary haematopoiesis in β-thalassemia: A retrospective single centre study]. Rev Med Interne 2015; 37:5-12. [PMID: 26410419 DOI: 10.1016/j.revmed.2015.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Revised: 06/03/2015] [Accepted: 07/25/2015] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Symptomatic extramedullary hematopoiesis (EH) is a rare but potentially severe phenomenon which occurs in β-thalassemia. There are no treatment guidelines. METHODS Retrospective single centre study including the cases of symptomatic EH encountered between 1997 and 2014 in a unit specialised in red blood cell genetic disorders. Description of clinical, biological and radiological characteristics of the patients, treatments received, and outcomes. RESULTS Among 182 β-thalassemia patients followed during the study period, 7 cases of symptomatic EH were diagnosed. They were 5 men and 2 women, and their mean age was 37 years. Four patients were splenectomised, two patients were regularly transfused, and four patients had already received erythropoietin. EH was localised in intravertebral areas and responsible for dorsal spinal cord compression in 5 patients, in paravertebral dorsal area in 1 patient, and in presacral area in 1 patient. The mean hemoglobin level at diagnosis was 7.9 g/dL. Treatment administered included: red cell transfusion in 6 cases, associated with hydroxyurea in 5 cases and/or radiotherapy in 3 patients. One patient was treated with surgery and HU. After a median follow-up of 41 months, clinical recovery was complete in 2 patients and partial in 5 patients. CONCLUSION EH must be suspected in β-thalassemia in patients presenting clinical signs of organ compression, and a typical radiological aspect. The functional prognosis depends on the rapidity of treatment, which includes red blood cell transfusion, hydroxyurea, radiotherapy, and rarely surgery. Long-term outcome is uncertain.
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Un traitement de 6mois par Hydréa réduit la protéinurie et le DFG des patients drépanocytaires. Nephrol Ther 2015. [DOI: 10.1016/j.nephro.2015.07.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Évolution des causes de mortalité chez les drépanocytaires adultes. Rev Med Interne 2015. [DOI: 10.1016/j.revmed.2015.03.269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Appendicitis and abscess in an adult patient with intestinal nonrotation: Case report. LA CLINICA TERAPEUTICA 2015; 166:e105-7. [PMID: 25945440 DOI: 10.7417/ct.2015.1829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The aim of the article is showing a particular case of midgut nonrotation. It is a congenital defect of the bowel development, during which fails the rotation of 270° around the vascular pedicle. This anomaly causes a different intestinal arrangement: the small bowel is located in the right side of abdominal cavity while the large bowel is situated in the left side. We present a case of acute appendicitis and abscess treated successfully with urgent surgical intervention in a patient completely asymptomatic for nonrotation. Nonrotation may lead to acute symptoms, vague abdominal pain or may remain asymptomatic throughout all life and be discovered only accidentally. Radiological exams and laparoscopy can help to make a correct diagnosis. A conservative treatment could be preferred in asymptomatic patients and Ladd's surgical procedure should be performed in selected cases.
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The use of rituximab to prevent severe delayed haemolytic transfusion reaction in immunized patients with sickle cell disease. Vox Sang 2014; 108:262-7. [DOI: 10.1111/vox.12217] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 10/06/2014] [Accepted: 10/06/2014] [Indexed: 11/28/2022]
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Déterminants biologiques de l’atteinte cardiaque et facteurs prédictifs de survie chez le patient drépanocytaire homozygote. Rev Med Interne 2014. [DOI: 10.1016/j.revmed.2014.10.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Score prédictif de survenue d’un syndrome thoracique durant une crise vaso-occlusive drépanocytaire dès l’arrivée aux urgences. Rev Med Interne 2014. [DOI: 10.1016/j.revmed.2014.10.058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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L’hydroxyurée diminue l’albuminurie et améliore le débit de filtration glomérulaire en 6 mois chez l’adulte drépanocytaire. Rev Med Interne 2014. [DOI: 10.1016/j.revmed.2014.10.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Exploration de l’acidose tubulaire chez le patient drépanocytaire. Nephrol Ther 2014. [DOI: 10.1016/j.nephro.2014.07.243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Hematologic determinants of cardiac remodelling and cardiac index in sickle cell disease patients. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.p5065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Nouvelles approches thérapeutiques de la drépanocytose. Transfus Clin Biol 2013. [DOI: 10.1016/j.tracli.2013.04.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Anémie et myélopathie : une colle inhabituelle. Rev Med Interne 2011; 32:191-4. [DOI: 10.1016/j.revmed.2010.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Accepted: 12/22/2010] [Indexed: 11/28/2022]
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Ascaris Lumbricoides infestation and intestinal MZBCL: a surgical and radiological perspective. LA CLINICA TERAPEUTICA 2011; 162:e169-e171. [PMID: 22262337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Ascaris Lumbricoides is the most common worm found in human beings and it is the largest of the intestinal nematodes parasitizing humanity. The most common complication of Ascariasis is mechanical bowel obstruction caused by a large number of worms. Bowel obstruction can also be caused by various toxins released by the worms. A large worm bolus can also cause volvulus or intussusception. We report a case of Intestinal Obstruction due to an Ileal MZBCL in an Ascaris. Lumbricoides infestation setting.
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Abdominal emergency in young women: gynecological or bowel disease? Two case reports. G Chir 2011; 32:48-51. [PMID: 21352709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Abdominal pain is a frequent symptom in Emergency Departments. Often is not so easy make a diagnosis of cause. Particular importance in young women has differential diagnosis with gynecological diseases. Often laboratory exams have not good specificity. US and TC are the imaging techniques most used to make a diagnosis, but both have ours limits. Definitely surgeon's experience is the most important resource for a correct approach to abdominal pain. We present two cases of low abdominal pain in young women due to ovarian teratoma erroneously diagnosed as appendicitis.
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VAC (Vacuum Assisted Closure) treatment in Fournier's gangrene: personal experience and literature review. LA CLINICA TERAPEUTICA 2011; 162:e1-e5. [PMID: 21448535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
INTRODUCTION Fournier's gangrene (FG) is a rapidly developing necrotizing fasciitis that originates in genital and perineal region. The mortality rate is high and requires prompt diagnosis, antibiotic treatment and extensive necrosectomy with derivative colostomy. Vacuum Assisted Closure (VAC) is a wound care system of paramount importance in the treatment of complex wounds, including the perineum. MATERIALS AND METHODS We evaluated 6 cases of FG (males, mean age: 54.6 yrs) of the last 3 years (February 2008-August 2010). All patients were diabetics. We used intravenous antibiotic treatment and early surgical debridement with colostomy, followed by immediate positioning of a VAC device (NP 125-200 mmHg). The dressing changes were done every 3-4 days. Hyperbaric oxygen therapy (HBOT) was given only to one patient. Microbiological etiology was assessed by multiple cultures to tailor the antimicrobial treatment. RESULTS The VAC therapy reduces the number of dressings and the hospital length of stay (LOS), in agreement with the literature; in one of the cases a secondary reconstructive surgical intervention was possible. The colostomy was reversed in all patients within 3 months. CONCLUSIONS Negative pressure is a time saving device, reducing days of hospitalization, patient's discomfort and number of medications. The possibility of a early reconstructive surgery improves significantly quality of life.
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Étude prospective du syndrome thoracique aigu au cours de la crise vaso-occlusive drépanocytaire de l’adulte initialement non compliquée. Analyse intermédiaire de l’étude PRESEV. Rev Med Interne 2010. [DOI: 10.1016/j.revmed.2010.10.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Sickle cell disease is a systemic disease that can potentially involve all organs. As the prevalence of patients with sickle cell disease increases gradually in France, every physician can be potentially involved in the care of these patients. Complications of sickle cell disease can be acute or chronic. Pain is the main symptom and should be treated quickly and aggressively. Acute chest syndrome is the leading cause of acute death and must be prevented, detected, and treated without delay. Chronic complications are one of the main concerns in adults and should be identified as early as possible in order to prevent sequels. Many organs can be involved, including the bones, kidneys, eyes, lungs... The indications for a specific treatment (blood transfusion or hydroxyurea) should be discussed. Health care should be carefully organized to allow both a regular follow-up near the living place and access to specialized departments. We present in this article the French guidelines for the sickle cell disease management in adulthood.
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Primary psoas abscess in a patient affected by acquired immunodeficiency syndrome: a rare case according to the reviewed literature. LA CLINICA TERAPEUTICA 2008; 159:261-263. [PMID: 18776984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Abscesses of the psoas muscle can be divided into primary and secondary. In the primary ones, it is not possible to identify any further infected site. The localization to this muscle is due to its rich vascularization and Staphylococcus aureus is the most frequent aetiological agent of the infection. Treatment requires the use of appropriate antibiotics, as well as surgical or percutaneous drainage of the abscess. The percutaneous drainage is much less invasive and a low risk in the patients with acquired immunodeficiency syndrome, and is effective for draining even multiloculated abscess. The authors present a rare case of primary psoas abscess in patient affected by acquired human immunodeficiency syndrome, showing a mass in the inferior lumbar region through the lumbar triangle of Petit and fever. Treatment consisting in percutaneous drainage combined with systemic antibiotic administration was successful.
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Maladie de Still et leucopénie : à propos de deux observations. Rev Med Interne 2005; 26:670-2. [PMID: 15921827 DOI: 10.1016/j.revmed.2005.04.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2005] [Accepted: 04/04/2005] [Indexed: 10/25/2022]
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Mechanical small bowel obstruction due to an inflamed appendix wrapping around the last loop of ileum. G Chir 2005; 26:261-6. [PMID: 16329768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Acute apendicitis rarely presents with a clinical picture of mechanical small-bowel obstruction. The Authors report a case of this inusual clinical occurrence, arised like a complication of a common disease, characterized by a chronically inflamed appendix (mucocele) wrapping around the last loop of ileum that produced volvolus and strangulation. The few similar cases reported in the literature are moreover reviewed.
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