Publications by authors named "Philippe Meyer"

206 Publications

Acute surgical management of children with ruptured brain arteriovenous malformation.

J Neurosurg Pediatr 2021 Jan 22:1-9. Epub 2021 Jan 22.

1APHP, Necker Hospital.

Objective: Rupture of brain arteriovenous malformation (AVM) is the main etiology of intracerebral hemorrhage (ICH) in children. Ensuing intracranial hypertension is among the modifiable prognosis factors and sometimes requires emergency hemorrhage evacuation (HE). The authors aimed to analyze variables associated with HE in children with ruptured AVM.

Methods: This study was a single-center retrospective analysis of children treated for ruptured AVM. The authors evaluated the occurrence of HE, its association with other acute surgical procedures (e.g., nidal excision, decompressive hemicraniectomy), and clinical outcome. Variables associated with each intervention were analyzed using univariable and multivariable models. Clinical outcome was assessed at 18 months using the ordinal King's Outcome Scale for Childhood Head Injury.

Results: A total of 104 patients were treated for 112 episodes of ruptured AVM between 2002 and 2018. In the 51 children (45.5% of cases) who underwent HE, 37 procedures were performed early (i.e., within 24 hours after initial cerebral imaging) and 14 late. Determinants of HE were a lower initial Glasgow Coma Scale score (adjusted odds ratio [aOR] 0.83, 95% CI 0.71-0.97 per point increase); higher ICH/brain volume ratio (aOR 18.6, 95% CI 13-26.5 per percent increase); superficial AVM location; and the presence of a brain herniation (aOR 3.7, 95% CI 1.3-10.4). Concurrent nidal surgery was acutely performed in 69% of Spetzler-Martin grade I-II ruptured AVMs and in 25% of Spetzler-Martin grade III lesions. Factors associated with nidal surgery were superficial AVMs, late HE, and absent alteration of consciousness at presentation. Only 8 cases required additional surgery due to intracranial hypertension. At 18 months, overall mortality was less than 4%, 58% of patients had a favorable outcome regardless of surgical intervention, and 87% were functioning independently.

Conclusions: HE is a lifesaving procedure performed in approximately half of the children who suffer AVM rupture. The good overall outcome justifies intensive initial management.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3171/2020.8.PEDS20479DOI Listing
January 2021

Hemorrhage Expansion After Pediatric Intracerebral Hemorrhage.

Stroke 2021 Jan 11;52(2):588-594. Epub 2021 Jan 11.

GHU Paris Psychiatrie et Neurosciences, Hospitalier Sainte Anne, Service d'imagerie Morphologique et Fonctionnelle, Institut de Psychiatrie et Neurosciences de Paris, Unité mixte de recherche S1266, Institut National de la Santé Et de la Recherche Médicale, Université de Paris, Paris, France (G.B., J.-F.H., B.K., F.G., L.G., O.N.).

Background And Purpose: Significant hemorrhage expansion (sHE) is a known predictor of poor outcome after an intracerebral hemorrhage (ICH) in adults but remains poorly reported in children. In a large inception cohort, we aimed to explore the prevalence of sHE, its associations with clinical outcomes, and its clinical-imaging predictors in children.

Methods: Children admitted between January 2000 and March 2020 at a quaternary care pediatric hospital were screened for inclusion. Sample was restricted to children with 2 computed tomography scans within 72 hours of ICH onset, and a minimal clinical follow-up of months. sHE was defined as an increase from baseline ICH volume by 6 cc or 33% on follow-up computed tomography. Clinical outcome was assessed at 12 months with the King's Outcome Scale for Childhood Head Injury score and defined as favorable for scores ≥5.

Results: Fifty-two children met inclusion criteria, among which 8 (15%) demonstrated sHE, and 18 (34.6%) any degree of expansion. Children with sHE had more frequent coagulation disorders (25.0% versus 2.3%; =0.022). After multivariable adjustment, only the presence of coagulation disorders at baseline remained independently associated with sHE (adjusted odds ratio, 14.4 [95% CI, 1.04-217]; =0.048). sHE was independently associated with poor outcome (King's Outcome Scale for Childhood Head Injury <5A, odds ratio, 5.77 [95% CI, 1.01-38.95]; =0.043).

Conclusions: sHE is a frequent phenomenon after admission for a pediatric ICH and more so in children with coagulation defects. As sHE was strongly associated with poorer clinical outcomes, these data mandate a baseline coagulation work up and questions the need for protocolized repeat head computed tomography in children admitted for pediatric ICH.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1161/STROKEAHA.120.030592DOI Listing
January 2021

COVID-19 and cardiovascular disease: what have we learned?

Swiss Med Wkly 2020 12 31;150:w20452. Epub 2020 Dec 31.

Cardiology Service, Geneva University Hospitals, Geneva, Switzerland.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4414/smw.2020.20452DOI Listing
December 2020

Patiromer and medication optimisation in heart failure with reduced ejection fraction: a Swiss perspective.

Swiss Med Wkly 2020 Sep 6;150:w20362. Epub 2020 Oct 6.

Cardiology, Cardiovascular Department, Lausanne University Hospital and University of Lausanne, Switzerland.

Despite medical advances, heart failure remains a major public health issue and is associated with considerable morbidity and mortality. Suboptimal use of evidence-based therapies and lack of medication up-titration play important roles in this regard. Hyperkalaemia is a frequent and potentially harmful finding which hinders treatment optimisation in patients with heart failure. In this review, heart failure experts from two Swiss academic hospitals discuss the principles of general pharmacological therapy in heart failure with reduced ejection fraction and the different treatment options for chronic hyperkalaemia, focusing on patiromer, a recently available potassium binder. Patiromer has been accepted for reimbursement since 1 August 2020 in Switzerland, and has been shown in several clinical trials to safely reduce potassium levels over the long term, thereby allowing up-titration or maintenance of renin-angiotensin-aldosterone inhibitors in patients with chronic kidney disease, including those with heart failure. Whether this promising approach improves outcomes in patients with heart failure and reduced ejection fraction is currently under investigation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4414/smw.2020.20362DOI Listing
September 2020

Use of SGLT2 inhibitors in cardiovascular diseases: why, when and how?

Swiss Med Wkly 2020 Aug 1;150:w20341. Epub 2020 Sep 1.

Department of Cardiology, Lausanne University Hospital and University of Lausanne, Switzerland.

Sodium-glucose cotransporter 2 (SGLT2) inhibitors are a new class of drugs that reduce blood glucose levels by increasing urinary glucose excretion. On top of the glucose-lowering effect, they offer cardiovascular and renal benefits, the mechanisms of which are probably pleiotropic and include blood pressure reduction, volume depletion, weight loss and several metabolic effects (such as lipolysis and synthesis of ketone bodies). SGLT2 inhibitors are currently indicated in Europe and the USA, as first- or second-line treatments of type 2 diabetes mellitus (T2DM) in patients with established cardiovascular disease, high/very high cardiovascular risk, renal disease or heart failure. The use of dapagliflozin has recently been extended to patients with heart failure without T2DM, as new emerging data show benefits in this population. Despite an overall favourable safety profile, attention has to be paid to the increased risk of euglycaemic diabetic ketoacidosis and genital mycotic infections, as well as lower limb amputations and fractures, which have been inconsistently associated with SGLT2 inhibition. For the moment, cost related data for the Swiss setting is lacking but corresponding analyses from abroad suggest cost-effectiveness. Despite their numerous favourable cardiorenal implications, many physicians remain hesitant to use SGLT2 inhibitors. In this article, we present an up-to-date narrative literature review of the physiological mechanisms of action, current indications, therapeutic utility and side effects of SGLT2 inhibitors.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4414/smw.2020.20341DOI Listing
August 2020

Forehead Widening in Nonsyndromic Scaphocephaly Operated After 12 Months of Age.

J Craniofac Surg 2021 Jan-Feb 01;32(1):42-45

Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Service de neurochirurgie pédiatrique, Unité fonctionnelle de chirurgie crânio-faciale; Filière TeteCou, Centre de Références Maladies Rares CRANIOST, Université Paris Descartes, Paris, France.

Aim And Scope: Our standard management is to operate isolated sagittal synostosis around 4 months of age because of morphological and cognitive outcomes. However, some patients present late and the likelihood of spontaneous remodeling is low in isolated sagittal craniosynostosis operated on after 12 months of age with a limited technique. The preliminary result of a modified technique for forehead remodeling and subtotal calvarial remodeling in nonsyndromic scaphocephalic children with late presentation is presented.

Patients And Methods: All patients older than 1 with isolated sagittal synostosis assessed between 2011 and 2015, over 1 year of age at the time of surgery, with available pre and postoperative computed tomography-scans, were retrospectively included into the study. The following parameters were collected: (1) age at surgery, (2) duration of the procedure, (3) surgical technique, (4) fronto-nasal angle before and after surgery and (5) forehead width before and after surgery.

Results: Ten patients aged between 15 months and 6 years were retrospectively included. Delayed surgery was due to late presentation or initial parental reluctance. All patients presented with a transversal narrowing of the forehead and an anterior bulge. Mean age at surgery was 28 months and mean follow up was 23 months (1-4 years). Measurements showed significant improvement of both the fronto-nasal angle and the width of the forehead.

Conclusions: Late-presenting scaphocephalic patients operated on after 12 months of age require forehead remodeling to achieve satisfactory aesthetic results. Modified forehead remodeling by splitting the forehead sagittally into 2 symmetrical halves and adding a midline bone strip is a safe and feasible way to widen the forehead. Long term follow-up is needed to assess this modified technique.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/SCS.0000000000006860DOI Listing
August 2020

Coronavirus Disease 2019 (COVID-19) and Cardiac Injury.

JAMA Cardiol 2020 Jul 8. Epub 2020 Jul 8.

Departement of Cardiology, University Hospital of Zurich, Zurich, Switzerland.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1001/jamacardio.2020.2453DOI Listing
July 2020

[Myocarditis in 2020].

Rev Med Suisse 2020 Jun;16(696):1133-1139

Service de Cardiologie, HUG, 1211 Genève 14.

Myocarditis is an inflammatory disease of the myocardium caused by various etiologies with a dominance of viral infections and potential post-infectious autoimmunity. The clinical presentation ranges from chest pain to severe complications including cardiogenic shock, ventricular arrhythmias, and progression to dilated cardiomyopathy. The diagnostic approach is challenging and includes several investigations, such as an ECG, an echocardiography, troponin testing and the exclusion of coronary artery disease. Although endomyocardial biopsy remains the gold standard, cardiovascular magnetic resonance is now the most valuable tool to accurately characterize myocardial tissue inflammation. The management is mainly symptomatic and consists in early detection and treatment of complications including heart failure and arrhythmias.
View Article and Find Full Text PDF

Download full-text PDF

Source
June 2020

Coexistence and outcome of coronary artery disease in Takotsubo syndrome.

Authors:
L Christian Napp Victoria L Cammann Milosz Jaguszewski Konrad A Szawan Manfred Wischnewsky Sebastiano Gili Maike Knorr Susanne Heiner Rodolfo Citro Eduardo Bossone Fabrizio D'Ascenzo Michael Neuhaus Jennifer Franke Ioana Sorici-Barb Michel Noutsias Christof Burgdorf Wolfgang Koenig Behrouz Kherad Annahita Sarcon Lawrence Rajan Guido Michels Roman Pfister Alessandro Cuneo Claudius Jacobshagen Mahir Karakas Alexander Pott Philippe Meyer Jose D Arroja Adrian Banning Florim Cuculi Richard Kobza Thomas A Fischer Tuija Vasankari K E Juhani Airaksinen Christian Hauck Carla Paolini Claudio Bilato Yoichi Imori Ken Kato Yoshio Kobayashi Grzegorz Opolski Monika Budnik Rafal Dworakowski Philip MacCarthy Christoph Kaiser Stefan Osswald Leonarda Galiuto Wolfgang Dichtl Christina Chan Paul Bridgman Daniel Beug Clément Delmas Olivier Lairez Ibrahim El-Battrawy Ibrahim Akin Ekaterina Gilyarova Alexandra Shilova Mikhail Gilyarov John D Horowitz Karolina Polednikova Petr Tousek Petr Widimský David E Winchester Jan Galuszka Christian Ukena Gregor Poglajen Pedro Carrilho-Ferreira Carlo Di Mario Abhiram Prasad Charanjit S Rihal P Christian Schulze Matteo Bianco Filippo Crea Martin Borggrefe Lars S Maier Fausto J Pinto Ruediger C Braun-Dullaeus Wolfgang Rottbauer Hugo A Katus Gerd Hasenfuß Carsten Tschöpe Burkert M Pieske Holger Thiele Heribert Schunkert Michael Böhm Stephan B Felix Thomas Münzel Jeroen J Bax Johann Bauersachs Eugene Braunwald Thomas F Lüscher Frank Ruschitzka Jelena R Ghadri Christian Templin

Eur Heart J 2020 Sep;41(34):3255-3268

University Heart Center, Department of Cardiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland.

Aims: Takotsubo syndrome (TTS) is an acute heart failure syndrome, which shares many features with acute coronary syndrome (ACS). Although TTS was initially described with angiographically normal coronary arteries, smaller studies recently indicated a potential coexistence of coronary artery disease (CAD) in TTS patients. This study aimed to determine the coexistence, features, and prognostic role of CAD in a large cohort of patients with TTS.

Methods And Results: Coronary anatomy and CAD were studied in patients diagnosed with TTS. Inclusion criteria were compliance with the International Takotsubo Diagnostic Criteria for TTS, and availability of original coronary angiographies with ventriculography performed during the acute phase. Exclusion criteria were missing views, poor quality of angiography loops, and angiography without ventriculography. A total of 1016 TTS patients were studied. Of those, 23.0% had obstructive CAD, 41.2% had non-obstructive CAD, and 35.7% had angiographically normal coronary arteries. A total of 47 patients (4.6%) underwent percutaneous coronary intervention, and 3 patients had acute and 8 had chronic coronary artery occlusion concomitant with TTS, respectively. The presence of CAD was associated with increased incidence of shock, ventilation, and death from any cause. After adjusting for confounders, the presence of obstructive CAD was associated with mortality at 30 days. Takotsubo syndrome patients with obstructive CAD were at comparable risk for shock and death and nearly at twice the risk for ventilation compared to an age- and sex-matched ACS cohort.

Conclusions: Coronary artery disease frequently coexists in TTS patients, presents with the whole spectrum of coronary pathology including acute coronary occlusion, and is associated with adverse outcome.

Trial Registration: ClinicalTrials.gov number: NCT01947621.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/eurheartj/ehaa210DOI Listing
September 2020

Hydrocephalus in children with ruptured cerebral arteriovenous malformation.

J Neurosurg Pediatr 2020 May 22:1-5. Epub 2020 May 22.

1APHP, Necker Hospital, Université de Paris.

Objective: Hydrocephalus is a strong determinant of poor neurological outcome after intracerebral hemorrhage (ICH). In children, ruptured brain arteriovenous malformations (bAVMs) are the dominant cause of ICH. In a large prospective cohort of pediatric patients with ruptured bAVMs, the authors analyzed the rates and predictive factors of hydrocephalus requiring acute external ventricular drainage (EVD) or ventriculoperitoneal shunt (VPS).

Methods: The authors performed a single-center retrospective analysis of the data from a prospectively maintained database of children admitted for a ruptured bAVM since 2002. Admission clinical and imaging predictors of EVD and VPS placement were analyzed using univariate and multivariate statistical models.

Results: Among 114 patients (mean age 9.8 years) with 125 distinct ICHs due to ruptured bAVM, EVD and VPS were placed for 55/125 (44%) hemorrhagic events and 5/114 patients (4.4%), respectively. A multivariate nominal logistic regression model identified low initial Glasgow Coma Scale (iGCS) score, hydrocephalus on initial CT scan, the presence of intraventicular hemorrhage (IVH), and higher modified Graeb Scale (mGS) score as strongly associated with subsequent need for EVD (all p < 0.001). All children who needed a VPS had initial hydrocephalus requiring EVD and tended to have higher mGS scores.

Conclusions: In a large cohort of pediatric patients with ruptured bAVM, almost half of the patients required EVD and 4.4% required permanent VPS. Use of a low iGCS score and a semiquantitative mGS score as indicators of the IVH burden may be helpful for decision making in the emergency setting and thus improve treatment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3171/2020.3.PEDS19680DOI Listing
May 2020

Age-Related Variations in Takotsubo Syndrome.

Authors:
Victoria L Cammann Konrad A Szawan Barbara E Stähli Ken Kato Monika Budnik Manfred Wischnewsky Sara Dreiding Rena A Levinson Davide Di Vece Sebastiano Gili Rodolfo Citro Eduardo Bossone Michael Neuhaus Jennifer Franke Benjamin Meder Miłosz Jaguszewski Michel Noutsias Maike Knorr Susanne Heiner Fabrizio D'Ascenzo Wolfgang Dichtl Christof Burgdorf Behrouz Kherad Carsten Tschöpe Annahita Sarcon Jerold Shinbane Lawrence Rajan Guido Michels Roman Pfister Alessandro Cuneo Claudius Jacobshagen Mahir Karakas Wolfgang Koenig Alexander Pott Philippe Meyer Marco Roffi Adrian Banning Mathias Wolfrum Florim Cuculi Richard Kobza Thomas A Fischer Tuija Vasankari K E Juhani Airaksinen L Christian Napp Rafal Dworakowski Philip MacCarthy Christoph Kaiser Stefan Osswald Leonarda Galiuto Christina Chan Paul Bridgman Daniel Beug Clément Delmas Olivier Lairez Ekaterina Gilyarova Alexandra Shilova Mikhail Gilyarov Ibrahim El-Battrawy Ibrahim Akin Karolina Poledniková Petr Toušek David E Winchester Jan Galuszka Christian Ukena Gregor Poglajen Pedro Carrilho-Ferreira Christian Hauck Carla Paolini Claudio Bilato Yoshio Kobayashi Toshihiro Shoji Iwao Ishibashi Masayuki Takahara Toshiharu Himi Jehangir Din Ali Al-Shammari Abhiram Prasad Charanjit S Rihal Kan Liu P Christian Schulze Matteo Bianco Lucas Jörg Hans Rickli Gonçalo Pestana Thanh H Nguyen Michael Böhm Lars S Maier Fausto J Pinto Petr Widimský Stephan B Felix Ruediger C Braun-Dullaeus Wolfgang Rottbauer Gerd Hasenfuß Burkert M Pieske Heribert Schunkert Martin Borggrefe Holger Thiele Johann Bauersachs Hugo A Katus John D Horowitz Carlo Di Mario Thomas Münzel Filippo Crea Jeroen J Bax Thomas F Lüscher Frank Ruschitzka Jelena R Ghadri Grzegorz Opolski Christian Templin

J Am Coll Cardiol 2020 04;75(16):1869-1877

University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland. Electronic address:

Background: Takotsubo syndrome (TTS) occurs predominantly in post-menopausal women but is also found in younger patients.

Objectives: This study aimed to investigate age-related differences in TTS.

Methods: Patients diagnosed with TTS and enrolled in the International Takotsubo Registry between January 2011 and February 2017 were included in this analysis and were stratified by age (younger: ≤50 years, middle-age: 51 to 74 years, elderly: ≥75 years). Baseline characteristics, hospital course, as well as short- and long-term mortality were compared among groups.

Results: Of 2,098 TTS patients, 242 (11.5%) patients were ≤50 years of age, 1,194 (56.9%) were 51 to 74 years of age, and 662 (31.6%) were ≥75 years of age. Younger patients were more often men (12.4% vs. 10.9% vs. 6.3%; p = 0.002) and had an increased prevalence of acute neurological (16.3% vs. 8.4% vs. 8.8%; p = 0.001) or psychiatric disorders (14.1% vs. 10.3% vs. 5.6%; p < 0.001) compared with middle-aged and elderly TTS patients. Furthermore, younger patients had more often cardiogenic shock (15.3% vs. 9.1% vs. 8.1%; p = 0.004) and had a numerically higher in-hospital mortality (6.6% vs. 3.6% vs. 5.1%; p = 0.07). At multivariable analysis, younger (odds ratio: 1.60; 95% confidence interval: 0.86 to 3.01; p = 0.14) and older age (odds ratio: 1.09; 95% confidence interval: 0.66 to 1.80; p = 0.75) were not independently associated with in-hospital mortality using the middle-aged group as a reference. There were no differences in 60-day mortality rates among groups.

Conclusions: A substantial proportion of TTS patients are younger than 50 years of age. TTS is associated with severe complications requiring intensive care, particularly in younger patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jacc.2020.02.057DOI Listing
April 2020

Typical takotsubo syndrome triggered by SARS-CoV-2 infection.

Eur Heart J 2020 05;41(19):1860

Department of Cardiology, University Hospital of Zurich, Zurich, Switzerland.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/eurheartj/ehaa306DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7184501PMC
May 2020

Right diaphragmatic palsy as a cause of QRS alternans.

Eur Heart J 2020 Jun;41(21):2039

Cardiology Service, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/eurheartj/ehaa244DOI Listing
June 2020

Functional outcome after severe childhood traumatic brain injury: Results of the TGE prospective longitudinal study.

Ann Phys Rehabil Med 2021 Jan 7;64(1):101375. Epub 2020 Apr 7.

Rehabilitation Department for Children with Acquired Brain Injury, Hôpitaux de Saint Maurice, Saint Maurice, France; Sorbonne Université, Laboratoire d'Imagerie Biomédicale, Paris, France; GRC 24 Handicap Moteur et Cognitif et Réadaptation (HaMCRe), Sorbonne Université, Paris, France.

Background: Childhood severe traumatic brain injury (TBI) is a leading cause of long-lasting acquired disability, but little is known about functional outcome.

Objective: We aimed to 1) study clinical recovery and functional outcome over 24 months after severe childhood TBI, 2) identify early sociodemographic and severity factors influencing outcome, and 3) examine the clinical utility of the Pediatric Injury Functional Outcome Scale (PIFOS) to assess functional outcome.

Methods: Children (0-15 years) consecutively admitted in a trauma centre after accidental severe TBI over 3 years were included in a prospective longitudinal study (Traumatisme Grave de l'Enfant cohort). We measured clinical/neurological recovery, functional status (Pediatric Injury Functional Outcome Scale, [PIFOS]), overall disability (pediatric Glasgow Outcome Scale [GOS-Peds]) as well as intellectual ability (Wechsler scales) and educational outcome (mainstream school vs special education) of survivors at 1, 3, 12 and 24 months post-injury.

Results: For 45 children (aged 3 to 15 years at injury), functional impairments were severe within the first 3 months. Despite the initial rapid clinical recovery and significant improvement over the first year, substantial alterations persisted for most children at 12 months post-TBI, with no significant improvement up to 2 years. Up to 80% of children still had moderate or severe overall disability (GOS-Peds) at 24 months. The severity of functional impairments (PIFOS) at 12 and 24 months was mostly related to socio-emotional, cognitive and physical impairments, and was significantly correlated with clinical/neurological deficits and cognitive (intellectual, executive) and behavioural disorders. Initial TBI severity was the main prognostic factor associated with functional status over the first 2 years post-injury.

Conclusions: Our results confirm the significant impact of severe childhood TBI on short- and medium-term functional outcomes and overall disability. All patients should benefit from systematic follow-up. The PIFOS appeared to be an accurate and reliable tool to assess functional impairment evolution and clinically meaningful outcomes over the first 2 years post-injury.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.rehab.2020.01.008DOI Listing
January 2021

Impact of using immersive virtual reality over time and steps in the Timed Up and Go test in elderly people.

PLoS One 2020 13;15(3):e0229594. Epub 2020 Mar 13.

UFR STAPS, Faculty of Sport Science, Université de Lorraine, Villers-lès- Nancy, France.

Today, falls constitute a substantial health problem, especially in the elderly, and the diagnostic tests used by clinicians present often a low sensitivity and specificity. This is the case for the Timed Up and Go test which lacks contextualization with regard to everyday life limiting the relevance of its diagnosis. Virtual reality enables the creation of immersive, reproducible and secure environments, close to situations encountered in daily life, and as such could improve falling risk assessment. This study aims to evaluate the effect of immersive virtual reality by wearing a virtual reality headset with a non-disturbing virtual environment compared to real world on the Timed Up and Go test completion. Thirty-one elders (73.7 ± 9 years old) volunteered to participate in the study and the mean times and number of steps to complete a Timed Up and Go were compared in two conditions: actual-world clinical and virtual reality conditions. The results showed that the mean completion times and most of the mean number of steps of the Timed Up and Go in virtual reality condition were significantly different to those in clinical condition. These results suggest that there is a virtual reality effect and this effect is significantly correlated to the time taken to complete the Timed Up and Go. This information will be of interest to quantify the potential part of virtual reality effect on the motor control, measured in a virtual task using virtual controlled disturbances.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0229594PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7069621PMC
June 2020

Comparison of interlaminar CT-guided epidural platelet-rich plasma versus steroid injection in patients with lumbar radicular pain.

Eur Radiol 2020 Jun 24;30(6):3152-3160. Epub 2020 Feb 24.

Centre d'imagerie ostéo-articulaire, Clinique du sport, 2 rue Georges-Negrevergne, 33700, Mérignac, France.

Introduction: The treatment of persistent lumbar radicular pain (LRP) by CT-guided epidural steroid injection (ESI) is extensively used and associated with rare but serious complications. Platelet-rich plasma (PRP), which has recently been shown to favor healing and the anti-inflammatory process by delivering growth factors and cytokines, might be an alternative and potentially safer option. We compared the efficacy of interlaminar CT-guided epidural PRP injections (EPRPI) and ESI in the treatment of persistent LRP (> 6 weeks).

Methods: In this non-randomized comparative study, patients were prospectively assessed for pain using the numerical rating scale (NRS) and for function with the Oswestry Disability Index (ODI) before and 6 weeks after treatment. Related paired and independent t tests were used for intra- and inter-group comparisons.

Results: A total of 60 patients were included in 2 groups (n = 30 EPRPI, n = 30 ESI). A statistically significant improvement was found in both groups at 6 weeks (mean NRS values 5.7 (± 2.36) at D0 and 3.7 (± 2.3) at 6 weeks (p < 0.01); mean ODI values 30 (± 11) at D0 and 21 (± 13) at 6 weeks (p < 0.01)). No significant difference was observed in the decrease in NRS and ODI scores between the 2 groups at 6 weeks (p = 0.848 and p = 0.314 for the NRS and ODI, respectively). No major complications were noted.

Conclusion: The results of CT-guided interlaminar EPRPI are similar to ESI for the treatment of persistent LRP and could be a safer option.

Key Points: • Treatment of persistent lumbar radicular pain by CT-guided epidural steroid injections is associated with rare but serious complications. • By promoting an anti-inflammatory process, epidural platelet-rich plasma injections might be an alternative treatment of persistent radicular pain. • Platelet-rich plasma CT-guided epidural injections are similar to steroid for the treatment of lumbar radicular pain at 6 weeks post-procedure and could be a safer option.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00330-020-06733-9DOI Listing
June 2020

Central-line-associated bloodstream infections in a surgical paediatric intensive care unit: Risk factors and prevention with chlorhexidine bathing.

J Paediatr Child Health 2020 Jun 15;56(6):936-942. Epub 2020 Jan 15.

Surgical Pediatric Intensive Care Unit, Universitary Hospital Necker Enfants Malades, Paris, France.

Aim: The aims of the study are to evaluate the impact of a 4% chlorhexidine (CHG4%) bathing on the occurrence of central-line-associated bloodstream infection (CLABSI) and to identify risk factors (RFs) for CLABSI in our population. This is a retrospective monocentric cohort study in the paediatric surgical intensive care unit at the Necker Enfants Malades Hospital, Paris, France.

Methods: All hospitalised patients with central venous catheters (CVCs) in 2015 were included. CHG4% bathing was prescribed in CLABSI high-risk patients, defined by the presence of exposition factors (EFs): constitutive or acquired immunosuppression, presence of an invasive medical device (IMD) and the carriage of Staphylococcus aureus. The overall 2015 CLABSI incidence rate was compared with 2014 CLABSI incidence rate (before CHG4% bathing).

Results: In all, 775 patients were analysed. Some 182 had at least one EF, and 49 received CHG4%. The incidence rates of CLABSI in 2014 and 2015 were, respectively, 6.1 and 2.3/1000 days CVC (P < 0.01). The presence of at least one EF was associated with the CLABSI's occurrence: odds ratio = 15.13 (95% confidence interval: 4.26-53.71; P < 0.0001), particularly acquired immunosuppression, IMD and S. aureus colonisation. Other RFs were age <1 year and carrying duration >16 days.

Conclusions: This study showed a significant reduction in incidence of CLABSI after introduction of a targeted CHG4% bathing protocol. Presence of IMD, S. aureus colonisation, immunosuppression, age <1 year and carrying duration >16 days were CLABSI RFs. Regarding the literature, the presence of IMD seems to be underestimated in CLABSI prevention.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/jpc.14780DOI Listing
June 2020

An unusual thrombus location in a Heartmate 3 device with fatal outcome.

Perfusion 2020 07 9;35(5):442-446. Epub 2019 Dec 9.

Geneva Hemodynamic Research Group, Geneva, Switzerland.

Even if the HeartMate 3 left ventricular assist device is associated with excellent outcomes, complications, such as pump thrombosis continue to affect patients on hemodynamic support. We report the history of a 68-year-old man who underwent implantation of an HeartMate 3 as a bridge to transplantation. Nineteen months later, he developed signs of heart failure leading to cardiogenic shock. Neither clinical examination nor parameters from the device allowed a clear-cut diagnosis. Only surgical exploration revealed the presence of clots between the polyethylene terephthalate (Dacron®) and polytetrafluoroethylene tubes. This constitutes a weakness of this device for which we propose to the manufacturer for minimal modifications to overcome the problem.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/0267659119890218DOI Listing
July 2020

First Line Onyx Embolization in Ruptured Pediatric Arteriovenous Malformations : Safety and Efficacy.

Clin Neuroradiol 2019 Dec 4. Epub 2019 Dec 4.

Pediatric Radiology, Necker Children Hospital, Paris, France.

Purpose: Brain arteriovenous malformations (bAVM) are the main cause of pediatric intracerebral hemorrhage (pICH). Embolization with Onyx (ev3, Irvine, CA, USA) in children with ruptured bAVM has been infrequently reported. The aim of this study was to assess the safety and efficacy profile of Onyx embolization as first line endovascular treatment of ruptured pediatric bAVMs.

Methods: Children with non-traumatic pICH due to bAVM rupture at a pediatric quaternary care center were prospectively enrolled in a registry and retrospectively analyzed between 2013 and 2018. Clinical and demographic data, treatment modalities and clinical imaging follow-up were retrieved, and detailed procedural data were retrospectively assessed by two investigators. The safety (procedural morbidity and mortality) and efficacy (obliteration and interval rebleeding) were evaluated.

Results: In this study 29 children treated for a bAVM by Onyx embolization were included (14 girls, 48%; median age 11.1 years, interquartile range, IQR 8.1-12.7 years) with a total of 72 endovascular sessions (median of 2 sessions per patient IQR 1-3). The AVMs were deeply located in 23 patients (79%). No systemic complications occurred, and no child experienced embolization-related persistent neurological deficits. Non-clinically relevant complications were observed during five procedures, unrelated to Onyx. After a mean follow-up of 31 months from rupture complete obliteration rates were 100%, 89%, 29%, 14% in bAVM Spetzler Martin grades I, II, III and IV-V, respectively.

Conclusion: It was found that Onyx embolization is safe and represents a good option for an initial treatment approach, in a sequential treatment strategy for pediatric ruptured brain AVMs. Younger age may not be an argument to deny Onyx embolization.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00062-019-00861-6DOI Listing
December 2019

Intraventricular Thrombus Formation and Embolism in Takotsubo Syndrome: Insights From the International Takotsubo Registry.

Arterioscler Thromb Vasc Biol 2020 01 26;40(1):279-287. Epub 2019 Nov 26.

From the Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland (K.J.D., V.L.C., K.A.S., B.E.S., D.D.V., F.R., J.R.G., C. Templin).

Objective: Takotsubo syndrome (TTS) is characterized by acute left ventricular dysfunction, which can contribute to intraventricular thrombus and embolism. Still, prevalence and clinical impact of thrombus formation and embolic events on outcome of TTS patients remain unclear. This study aimed to investigate clinical features and outcomes of patients with and without intraventricular thrombus or embolism. Additionally, factors associated with thrombus formation or embolism, as well as predictors for mortality, were identified. Approach and Results: TTS patients enrolled in the International Takotsubo Registry at 28 centers in Australia, Europe, and the United States were dichotomized according to the occurrence/absence of intraventricular thrombus or embolism. Patients with intraventricular thrombus or embolism were defined as the ThrombEmb group. Of 1676 TTS patients, 56 (3.3%) patients developed intraventricular thrombus and/or embolism following TTS diagnosis (median time interval, 2.0 days [range, 0-38 days]). Patients in the ThrombEmb group had a different clinical profile including lower left ventricular ejection fraction, higher prevalence of the apical type, elevated levels of troponin and inflammatory markers, and higher prevalence of vascular disease. In a Firth bias-reduced penalized-likelihood logistic regression model apical type, left ventricular ejection fraction ≤30%, previous vascular disease, and a white blood cell count on admission >10×10 cells/μL emerged as independent predictors for thrombus formation or embolism.

Conclusions: Intraventricular thrombus or embolism occur in 3.3% of patients in the acute phase of TTS. A simple risk score including clinical parameters associated with intraventricular thrombus formation or embolism identifies patients at increased risk.

Clinical Trial Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01947621.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1161/ATVBAHA.119.313491DOI Listing
January 2020

Critical shoulder angle: what do radiologists need to know?

Skeletal Radiol 2020 Apr 19;49(4):515-520. Epub 2019 Nov 19.

MSK Imaging Department, Clinique du sport, Bordeaux-Mérignac, 2 rue George Negrevergne, 33700, Merignac, France.

The critical shoulder angle (CSA) constitutes a straightforward and highly reproducible tool. Degenerative rotator cuff tears (RCT) are associated with a significantly larger CSA. In this review, the most relevant features of the CSA are summarized: (1) the relationship between the CSA and RCT pathophysiology, (2) accurate measurement of the CSA according to various imaging modalities, (3) the contribution of the CSA in predicting the occurrence of RCT, and (4) RCT recurrence after surgical repair.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00256-019-03337-3DOI Listing
April 2020

Clinical Predictors and Prognostic Impact of Recovery of Wall Motion Abnormalities in Takotsubo Syndrome: Results From the International Takotsubo Registry.

J Am Heart Assoc 2019 11 1;8(21):e011194. Epub 2019 Nov 1.

University Heart Center Department of Cardiology University Hospital Zurich Zurich Switzerland.

Background Left ventricular (LV) recovery in takotsubo syndrome (TTS) occurs over a wide-ranging interval, varying from hours to weeks. We sought to investigate the clinical predictors and prognostic impact of recovery time for TTS patients. Methods and Results TTS patients from the International Takotsubo Registry were included in this study. Cut-off for early LV recovery was determined to be 10 days after the acute event. Multivariable logistic regression was used to assess factors associated with the absence of early recovery. In-hospital outcomes and 1-year mortality were compared for patients with versus without early recovery. We analyzed 406 patients with comprehensive and serial imaging data regarding time to recovery. Of these, 191 (47.0%) had early LV recovery and 215 (53.0%) demonstrated late LV improvement. Patients without early recovery were more often male (12.6% versus 5.2%; =0.011) and presented more frequently with typical TTS (76.3% versus 67.0%, =0.040). Cardiac and inflammatory markers were higher in patients without early recovery than in those with early recovery. Patients without early recovery showed unfavorable 1-year outcome compared with patients with early recovery (=0.003). On multiple logistic regression, male sex, LV ejection fraction <45%, and acute neurologic disorders were associated with the absence of early recovery. Conclusions TTS patients without early LV recovery have different clinical characteristics and less favorable 1-year outcome compared with patients with early recovery. The factors associated with the absence of early recovery included male sex, reduced LV ejection fraction, and acute neurologic events. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT01947621.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1161/JAHA.118.011194DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6898832PMC
November 2019

Nontraumatic Pediatric Intracerebral Hemorrhage.

Stroke 2019 12 22;50(12):3654-3661. Epub 2019 Oct 22.

From the Pediatric Radiology Department, Necker Enfants Malades (NEM), INSERM UMR1266, Sainte-Anne (G.B., J.F.H., O.N.).

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1161/STROKEAHA.119.025783DOI Listing
December 2019

[« ARNI » (Angiotensin Receptor-Neprilysin Inhibitor): when, for whom and how?]

Rev Med Suisse 2019 Oct;15(667):1882-1886

Service de médecine interne générale, Département de médecine, HUG, 1211 Genève 14.

The association of an angiotensin II receptor antagonist and a neprilysin inhibitor (ARNI or Angiotensin Receptor-Neprilysin Inhibitor) is a new actor in the management of heart failure with reduced left ventricular ejection fraction (LVEF). The PARADIGM-HF trial performed in outpatients with a LVEF ≤ 35-40 % demonstrated that sacubitril-valsartan was superior to enalapril in reducing cardiovascular mortality and heart failure hospitalizations. Precautions in the initiation of sacubitril-valsartan, its use as well as its place in the drug management strategy for chronic heart failure are described in the present review. Additional data in patients hospitalized with reduced LVEF, in patients with LVEF > 45 % as well as the effects on blood pressure, renal or cognitive functions are presented.
View Article and Find Full Text PDF

Download full-text PDF

Source
October 2019

Executive functions and attention 7years after severe childhood traumatic brain injury: Results of the Traumatisme Grave de l'Enfant (TGE) cohort.

Ann Phys Rehabil Med 2020 Jul 9;63(4):270-279. Epub 2019 Oct 9.

Rehabilitation Department for Children with Acquired Neurological Injury and Outreach team for Children and Adolescents with Acquired Brain Injury, Hôpitaux de Saint Maurice, Saint-Maurice, France; Sorbonne Université, Laboratoire d'Imagerie Biomédicale (LIB), Paris, France; GRC 24 Handicap Moteur et Cognitif et Réadaptation (HaMCRe), Sorbonne Université, Paris, France.

Objectives: Severe childhood traumatic brain injury (TBI) leads to long-standing executive function and attention deficits, with negative consequences for participation, academic outcome and independence. This study aimed to assess executive function and attention 7 years after severe childhood TBI in comparison with a matched control group and to investigate associated factors.

Methods: Children (<15years) with severe accidental TBI consecutively admitted in a single trauma center over 3years were included in the Traumatisme Grave de l'Enfant (TGE) prospective longitudinal study. Of the 81children initially included, 65survived. At 7years post-TBI, executive functions and attention were assessed in 27participants (42 % of the 65 survivors) by using a combination of computerized tasks from the Test of Attentional Performance (TAP) and the Behavioral Rating of Executive Functions (BRIEF) questionnaire. Patients were compared to a group of 27typically developing controls who were matched for sex, age and parental education level.

Results: Among the 27participants, mean (SD) age at injury was 7.7 (4.6)years, and mean length of coma 5.6 (4.6) days. Regarding the TAP, the number of errors was significantly higher (P=0.003) and reaction time marginally slower (P=0.08) in the TBI than control group. The BRIEF questionnaire completed by parents indicated significantly more executive difficulties in the TBI than control group (Behavior Regulation Index, P=0.005; Metacognitive index, P=0.02; Global Executive Composite, P=0.012). Correlations between BRIEF and TAP scores did not reach statistical significance. BRIEF total score was correlated moderately with length of coma (r=0.40, P=0.037), and TAP scores were correlated with the Full-Scale Intellectual Quotient (total number of errors: r=-0.48; P=0.01; mean reaction time: r=-0.51; P=0.009).

Conclusions: Executive and attention deficits were evident 7 years after severe childhood TBI. Computerized tasks and questionnaires provide complementary and non-redundant information. Systematic long-term follow-up should be provided until the transition to adulthood, to assess ongoing development and to implement timely tailored interventions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.rehab.2019.09.003DOI Listing
July 2020

Insuffisance cardiaque : approche médicamenteuse.

Authors:
Philippe Meyer

Rev Med Suisse 2019 Oct;15(666):1832

Médecin adjoint agrégé, Unité d'insuffisance cardiaque et de réadaptation cardiaque, HUG, 1211 Genève 14.

View Article and Find Full Text PDF

Download full-text PDF

Source
October 2019

Iron Deficiency in Acute Decompensated Heart Failure.

J Clin Med 2019 Oct 1;8(10). Epub 2019 Oct 1.

Service of General Internal Medicine, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland.

The aim of this study was to characterize iron deficiency (ID) in acutely decompensated heart failure (ADHF) and identify whether ID is associated with dyspnea class, length of stay (LOS), biomarker levels, and echocardiographic indices of diastolic function in patients with reduced ejection fraction (HFrEF) and with preserved ejection fraction (HFpEF). Consecutive patients admitted with ADHF at a single tertiary center were included. Demographic information, pathology investigations, and metrics regarding hospital stay and readmission were recorded. Patients were classified as having 'absolute' ID if they had a ferritin level <100 ng/mL; or 'functional' ID if they had a ferritin 100-200 ng/mL and a transferrin saturation <20%. Of 503 patients that were recruited, 270 (55%) had HFpEF, 160 (33%) had HFREF, and 57 (12%) had heart failure with mid-range ejection fraction. ID was present in 54% of patients with HFrEF and 56% of patients with HFpEF. In the HFpEF group, ID was associated with a LOS of 11 ± 7.7 vs. 9 ± 6 days in iron replete patients, = 0.036, and remained an independent predictor of increased LOS in a multivariate linear regression incorporating comorbidities, age, and ID status. This study corroborates a high prevalence of ID in both HFrEF and HFpEF, and further shows that in patients with HFpEF there is a prolongation of LOS not seen in HFrEF which may indicate a more prominent role for ID in HFpEF.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/jcm8101569DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6832529PMC
October 2019

Self- and parent-reported Quality of Life 7 years after severe childhood traumatic brain injury in the Traumatisme Grave de l'Enfant cohort: associations with objective and subjective factors and outcomes.

Qual Life Res 2020 Feb 23;29(2):515-528. Epub 2019 Sep 23.

Laboratoire d'Imagerie Biomédicale, LIB, Sorbonne Université, Paris, France.

Purpose: To investigate self- and parent-reported Health-Related Quality-of-Life (HRQoL) and their associations after severe childhood traumatic brain injury (TBI) in the Traumatisme Grave de l'Enfant (TGE) cohort.

Methods: Self- (n = 34) and/or parent-reports (n = 25) of HRQoL were collected for 38 participants (age 7-22 years) 7 years after severe childhood TBI. The collected data included sociodemographic characteristics, injury severity indices, and overall disability and functional outcome at 3-months, 1- and 2-years post-injury. At 7-years post-injury, data were collected in the TBI group and in a control group (n = 33): overall disability (Glasgow Outcome Scale Extended), intellectual ability (IQ), and questionnaires assessing HRQoL (Pediatric Quality of Life Inventory), executive functions (Behavior Rating Inventory of Executive Functions), behavior (Child Behavior Checklist), fatigue (Multidimensional Fatigue Scale) and participation (Child and Adolescent Scale of Participation).

Results: Parent- and self-reports of HRQoL were significantly lower in the TBI group than in the control group. Parent-rated HRQoL was not associated with objectively assessed factors, whereas self-reported HRQoL was associated with gender (worse in females) and initial functional outcome. All questionnaire scores completed by the same informant (self or parent) were strongly inter-correlated.

Conclusions: Reported HRQoL 7-years after severe childhood TBI is low compared to controls, weakly or not-related to objective factors, such as injury severity indices, clinically assessed functional outcomes, or IQ, but strongly related to reports by the same informant of executive deficits, behavior problems, fatigue, and participation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11136-019-02305-7DOI Listing
February 2020