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Bonnin A, Terriou L, Beuvon C, Tudesq JJ, Puyade M, Pugnet G, Maria A, Llorente CC, Lansiaux P, Cacciatore C, Badoglio M, Yakoub-Agha I, Farge-Bancel D, Marjanovic Z. [Mobilization and conditioning protocols actualization for autologous stem cell transplantation for autoimmune diseases: Guidelines from MATHEC-SFGM-TC]. Bull Cancer 2024; 111:S84-S95. [PMID: 37845095 DOI: 10.1016/j.bulcan.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/25/2023] [Accepted: 09/01/2023] [Indexed: 10/18/2023]
Abstract
The Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC) organized the 13th workshop on hematopoietic stem cell transplantation clinical practices harmonization procedures in September 2022 in Lille, France. The aim of this workshop is to update the mobilization and conditioning protocols for autologous hematopoietic stem cell transplantation for autoimmune diseases, and to specify contraindications for transplant, conditioning regimen selection, immunosuppressive treatment discontinuation before mobilization and disease-specific surveillance.
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Affiliation(s)
- Agnès Bonnin
- AP-HP, hôpital Saint-Antoine, service d'hématologie clinique et thérapie cellulaire, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France
| | - Louis Terriou
- CHU de Lille, département de médecine interne et immunologie clinique, 59000 Lille, France; Centre de référence des maladies auto-immunes et auto-inflammatoires rares (CERAINO), 59000 Lille, France
| | - Clément Beuvon
- CHU de Poitiers, service de médecine interne, 2, rue de La Miletrie, 86021 Poitiers, France
| | - Jean-Jacques Tudesq
- Université de Montpellier, CHU de Montpellier, service d'hématologie clinique, 80, avenue Augustin-Fliche, 34295 Montpellier, France
| | - Mathieu Puyade
- CHU de Poitiers, service de médecine interne, 2, rue de La Miletrie, 86021 Poitiers, France
| | - Grégory Pugnet
- CHU de Toulouse Rangueil, service de médecine interne et immunologie clinique, 2, rue Viguerie, 31059 Toulouse, France
| | - Alexandre Maria
- CHU de Montpellier, hôpital Saint-Eloi, Université de Montpellier, Institute for Regenerative Medicine and Biotherapy (IRMB), médecine interne et immuno-oncologie (MedI20), 80, avenue Augustin-Fliche, 34295 Montpellier, France
| | - Cristina Castilla Llorente
- Gustave-Roussy Cancer Campus, département d'hématologie, 114, rue Edouard-Vaillant, 94805 Villejuif, France
| | - Pauline Lansiaux
- AP-HP, hôpital St-Louis, centre de référence des maladies auto-immunes systémiques rares d'Île-de-France MATHEC (FAI2R), unité de médecine interne : maladies auto-immunes et pathologie vasculaire (UF 04), 1, avenue Claude-Vellefaux, 75010 Paris, France; Université de Paris Cité, institut de recherche Saint-Louis, recherche clinique appliquée à l'hématologie, EA3518, 75010 Paris, France
| | - Carlotta Cacciatore
- AP-HP, hôpital St-Louis, centre de référence des maladies auto-immunes systémiques rares d'Île-de-France MATHEC (FAI2R), unité de médecine interne : maladies auto-immunes et pathologie vasculaire (UF 04), 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - Manuela Badoglio
- Hôpital Saint-Antoine, EBMT Office, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | | | - Dominique Farge-Bancel
- AP-HP, hôpital St-Louis, centre de référence des maladies auto-immunes systémiques rares d'Île-de-France MATHEC (FAI2R), unité de médecine interne : maladies auto-immunes et pathologie vasculaire (UF 04), 1, avenue Claude-Vellefaux, 75010 Paris, France; Université de Paris Cité, institut de recherche Saint-Louis, recherche clinique appliquée à l'hématologie, EA3518, 75010 Paris, France; McGill University, H3A 1A1, Department of Medicine, Montreal, Canada
| | - Zora Marjanovic
- AP-HP, hôpital Saint-Antoine, service d'hématologie clinique et thérapie cellulaire, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France.
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Foré R, Liozon E, Dumonteil S, Sené T, Héron E, Lacombe V, Leclercq M, Magnant J, Beuvon C, Régent A, de Mornac D, Samson M, Smets P, Alexandra JF, Granel B, Robert PY, Curumthaullee MF, Parreau S, Palat S, Bezanahary H, Ly KH, Fauchais AL, Gondran G. BOB-ACG study: Pulse methylprednisolone to prevent bilateral ophthalmologic damage in giant cell arteritis. A multicentre retrospective study with propensity score analysis. Joint Bone Spine 2024; 91:105641. [PMID: 37734440 DOI: 10.1016/j.jbspin.2023.105641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 08/25/2023] [Accepted: 09/05/2023] [Indexed: 09/23/2023]
Abstract
INTRODUCTION Giant cell arteritis (GCA) is complicated in 10 to 20% of cases by permanent visual ischemia (PVI). International guidelines advocate the use of intravenous pulse of methylprednisolone from 250 to 1000mg per day, for three days, followed by oral prednisone at 1mg/kg per day. The aim of this study is to assess whether this strategy significantly reduces the risk of early PVI of the second eye, compared with direct prednisone at 1mg/kg per day. METHODS We conducted a multicentre retrospective observational study over the past 15 years in 13 French hospital centres. Inclusion criteria included: new case of GCA; strictly unilateral PVI, prednisone at dose greater than or equal to 0.9mg/kg per day; for the intravenous methylprednisolone (IV-MP) group, total dose between 900 and 5000mg, close follow-up and knowledge of visual status at 1 month of treatment, or earlier, in case of contralateral PVI. The groups were compared on demographic, clinical, biological, iconographic, and therapeutic parameters. Statistical analysis was optimised using propensity scores. RESULTS One hundred and sixteen patients were included, 86 in the IV-MP group and 30 in the direct prednisone group. One patient in the direct prednisone group and 13 in the IV-MP group bilateralised, without significant difference between the two strategies (3.3% vs 15.1%). Investigation of the association between IV-MP patients and contralateral PVI through classical logistic regression, matching or stratification on propensity score did not show a significant association. Weighting on propensity score shows a significant association between IV-MP patients and contralateral PVI (OR=12.9 [3.4; 94.3]; P<0.001). Improvement in visual acuity of the initially affected eye was not significantly associated with IV-MP (visual acuity difference 0.02 vs -0.28 LogMar), even in the case of early management, i.e., within the first 48hours after the onset of PVI (n=61; visual acuity difference -0.11 vs 0.25 LogMar). Complications attributable to corticosteroid therapy in the first month were significantly more frequent in the IV-MP group (31.8 vs 10.7%; P<0.05). DISCUSSION Our data do not support the routine use of pulse IV-MP for GCA complicated by unilateral PVI to avoid bilateral ophthalmologic damage. It might be safer to not give pulse IV-MP to selected patients with high risks of glucocorticoids pulse side effects. A prospective randomised multicentre study comparing pulse IV-MP and prednisone at 1mg/kg per day is desirable.
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Affiliation(s)
- Romain Foré
- Department of Internal Medicine, CHU Dupuytren 2, Limoges, France.
| | - Eric Liozon
- Department of Internal Medicine, CHU Dupuytren 2, Limoges, France
| | | | - Thomas Sené
- Department of Internal Medicine, Rothschild Foundation Hospital, Paris, France
| | - Emmanuel Héron
- Department of Internal Medicine, CH National d'Ophtalmologie des Quinze-Vingt, Paris, France
| | - Valentin Lacombe
- Department of Internal Medicine and Clinical Immunology, CHU d'Angers, Angers, France
| | | | - Julie Magnant
- Department of Internal Medicine, CHU de Tours, Tours, France
| | - Clément Beuvon
- Department of Internal Medicine, CHU La Milétrie, Poitiers, France
| | - Alexis Régent
- Department of Internal Medicine, Hôpital Cochin, Paris, France
| | | | - Maxime Samson
- Department of Internal Medicine and Clinical Immunology, CHU de Dijon, Dijon, France
| | - Perrine Smets
- Department of Internal Medicine, CHU de Clermont-Ferrand, site Gabriel-Montpied, Clermont-Ferrand, France
| | | | - Brigitte Granel
- Department of Internal Medicine, Hôpital Nord, Marseille, France
| | | | | | - Simon Parreau
- Department of Internal Medicine, CHU Dupuytren 2, Limoges, France
| | - Sylvain Palat
- Department of Internal Medicine, CHU Dupuytren 2, Limoges, France
| | - Holy Bezanahary
- Department of Internal Medicine, CHU Dupuytren 2, Limoges, France
| | - Kim Heang Ly
- Department of Internal Medicine, CHU Dupuytren 2, Limoges, France
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Thille AW, Marie D, Reynaud F, Barrau S, Beuvon C, Bironneau V, Jutant EM, Coudroy R, Frat JP, Rault C, Drouot X. Sleep Assessment in Critically Ill Patients With Acute Hypoxemic Respiratory Failure. Respir Care 2023; 68:1417-1425. [PMID: 37253613 PMCID: PMC10506642 DOI: 10.4187/respcare.10844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Sleep deprivation alters respiratory muscle performance and may precipitate respiratory failure. This study aimed to assess sleep in subjects admitted to ICU for acute hypoxemic respiratory failure and its role in the risk of intubation. METHODS This was a prospective observational single-center cohort study including subjects admitted to ICU for de novo acute hypoxemic respiratory failure defined as breathing frequency ≥ 25 breaths/min or clinical signs of respiratory distress and PaO2 /FIO2 < 300 mm Hg while receiving high-flow nasal oxygen. Subjects with altered consciousness, central nervous or psychiatric disorders, continuous sedation or neuroleptic medication, or were uncooperative were excluded. Sleep was assessed by complete polysomnography (PSG) the night following ICU admission. The main outcome was to assess sleep among subjects with acute hypoxemic respiratory failure and to compare sleep between subjects who eventually required intubation to those who did not. RESULTS Over a 24-month inclusion period, 34 subjects had complete PSG, among whom 5 (15%) required intubation in the ICU. Total sleep time was 4.2 h in median (interquartile range 2.9-6.8); deep-sleep duration was 70 min (34-127), and rapid eye movement (REM) sleep duration was 9 min (0-28). Among them, 13 subjects (38%) had no REM sleep. Total sleep time and duration of deep and REM sleep stages did not differ between subjects who required intubation and those successfully treated with high-flow nasal oxygen. CONCLUSIONS Whereas total sleep time remained relatively preserved in critically ill subjects with acute hypoxemic respiratory failure, REM sleep time was uncommon or completely absent in a large number of subjects. Sleep did not differ between subjects who required intubation and those who did not. However, given a trend toward an increased risk of intubation in subjects with a complete absence of REM sleep, further studies are needed to better explore the impact of REM sleep on the risk of intubation.
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Affiliation(s)
- Arnaud W Thille
- INSERM CIC 1402, ALIVE Research Group, University of Poitiers, Poitiers, France; and CHU de Poitiers, Médecine Intensive Réanimation, Poitiers, France.
| | - Damien Marie
- INSERM CIC 1402, ALIVE Research Group, University of Poitiers, Poitiers, France; and CHU de Poitiers, Médecine Intensive Réanimation, Poitiers, France
| | - Faustine Reynaud
- INSERM CIC 1402, ALIVE Research Group, University of Poitiers, Poitiers, France; and CHU de Poitiers, Médecine Intensive Réanimation, Poitiers, France
| | - Stéphanie Barrau
- INSERM CIC 1402, ALIVE Research Group, University of Poitiers, Poitiers, France; and CHU de Poitiers, Médecine Intensive Réanimation, Poitiers, France
| | - Clément Beuvon
- INSERM CIC 1402, ALIVE Research Group, University of Poitiers, Poitiers, France; and CHU de Poitiers, Médecine Intensive Réanimation, Poitiers, France
| | - Vanessa Bironneau
- INSERM CIC 1402, ALIVE Research group, University of Poitiers, Poitiers, France; and CHU de Poitiers, Pneumologie, Poitiers, France
| | - Etienne-Marie Jutant
- INSERM CIC 1402, ALIVE Research group, University of Poitiers, Poitiers, France; and CHU de Poitiers, Pneumologie, Poitiers, France
| | - Rémi Coudroy
- INSERM CIC 1402, ALIVE Research Group, University of Poitiers, Poitiers, France; and CHU de Poitiers, Médecine Intensive Réanimation, Poitiers, France
| | - Jean-Pierre Frat
- INSERM CIC 1402, ALIVE Research Group, University of Poitiers, Poitiers, France; and CHU de Poitiers, Médecine Intensive Réanimation, Poitiers, France
| | - Christophe Rault
- INSERM CIC 1402, ALIVE Research Group, University of Poitiers, Poitiers, France; and CHU de Poitiers, Neurophysiologie clinique et Explorations fonctionnelles, Poitiers, France
| | - Xavier Drouot
- INSERM CIC 1402, ALIVE Research Group, University of Poitiers, Poitiers, France; and CHU de Poitiers, Neurophysiologie clinique et Explorations fonctionnelles, Poitiers, France
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Martin M, Nguyen H, Beuvon C, Benne J, Palassin P, Atzenhoffer M, Rouby F, Sassier M, Perault-Pochat M, Roblot P, Allouchery M, Puyade M. Cytopénies auto-immunes induites par les inhibiteurs de points de contrôle immunitaire : à propos de 68 cas issus de la base nationale de pharmacovigilance. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.10.040] [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: 12/12/2022]
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Breillat P, Jachiet M, Ditchi Y, Lenormand C, Costedoat-Chalumeau N, Mathian A, Moguelet P, Duriez P, Trendelenburg M, Huynh-Do U, Chizzolini C, Beuvon C, Roy-Peaud F, Bouaziz JD, Barbaud A, Francès C, Mékinian A, Fain O, Amoura Z, Chasset F. Cutaneous vasculitis occurring in the setting of systemic lupus erythematosus: a multicenter cohort study. Rheumatology (Oxford) 2022:6747185. [PMID: 36190335 DOI: 10.1093/rheumatology/keac566] [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: 04/14/2022] [Revised: 08/23/2022] [Accepted: 09/20/2022] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To describe the clinical and pathological features of biopsy-proven cutaneous vasculitis (CV) associated with systemic lupus erythematosus (SLE), focusing on diagnosis classification and impact on overall SLE activity. METHODS Retrospective multicentric cohort study including SLE patients with biopsy-proven CV identified by 1) data from pathology departments of three university hospitals and 2) a national call for cases. SLE was defined according to 1997 revised ACR and/or 2019 ACR/EULAR criteria. CV diagnosis was confirmed histologically and classified by using the dermatological addendum of the Chapel Hill classification. SLE activity and flare severity at the time of CV diagnosis were assessed independently of vasculitis items with the SELENA-SLEDAI and SELENA-SLEDAI Flare Index. RESULTS Overall, 39 patients were included; 35 (90%) were female. Cutaneous manifestations included mostly palpable purpura (n = 21; 54%) and urticarial lesions (n = 18; 46%); lower limbs were the most common location (n = 33; 85%). Eleven (28%) patients exhibited extracutaneous vasculitis. A higher prevalence of Sjögren's syndrome (51%) was found compared with SLE patients without CV from the French referral center group (12%, p < 0.0001) and the Swiss SLE Cohort (11%, p < 0.0001). CV were mostly classified as urticarial vasculitis (n = 14, 36%) and cryoglobulinemia (n = 13, 33%). Only 2 (5%) patients had no other cause than SLE to explain the CV. Sixty-one percent of patients had inactive SLE. CONCLUSION SLE-related vasculitis seems very rare and other causes of vasculitis should be ruled out before considering this diagnosis. Moreover, in more than half of patients, CV was not associated with another sign of active SLE.
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Affiliation(s)
- Paul Breillat
- Sorbonne Université, Faculté de médecine, AP-HP, Service de Médecine interne 2, Hôpital Pitié Salpetrière, Paris, France
| | - Marie Jachiet
- Université de Paris, Faculté de médecine, AP-HP, Service de Dermatologie, Hôpital Saint-Louis, Paris, France
| | - Yoan Ditchi
- Sorbonne Université, Faculté de médecine, AP-HP, Service d'anatomo-pathologie, Hôpital Saint Antoine, Paris, France
| | - Cédric Lenormand
- Service de Dermatologie, Hôpital Civil - Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Nathalie Costedoat-Chalumeau
- Université de Paris cité, Faculté de médecine, AP-HP, Service de Médecine interne, Hôpital Cochin, Paris, France
| | - Alexis Mathian
- Sorbonne Université, Faculté de médecine, AP-HP, Service de Médecine interne 2, Hôpital Pitié Salpetrière, Paris, France
| | - Philippe Moguelet
- Sorbonne Université, Faculté de médecine, AP-HP, Service d'anatomo-pathologie, Hôpital Saint Antoine, Paris, France
| | - Paul Duriez
- Sorbonne Université, Faculté de médecine, AP-HP, Service d'anatomo-pathologie, Hôpital Saint Antoine, Paris, France
| | - Marten Trendelenburg
- Laboratory for Clinical Immunology, Department of Biomedicine and Division of Internal Medicine, University Hospital of Basel, Switzerland
| | - Uyen Huynh-Do
- Division of Nephrology and Hypertension, Inselspital, Bern University Hospital, Switzerland
| | - Carlo Chizzolini
- Pathology and Immunology, Centre Médical Universitaire, School of Medicine, Geneva, Switzerland.,Department of Pathology and Immunology, School of Medicine, Geneva, Switzerland
| | - Clément Beuvon
- Service de Médecine interne, Hôpitaux Universitaires de Poitiers, Poitiers, France
| | - Frederique Roy-Peaud
- Service de Médecine interne, Hôpitaux Universitaires de Poitiers, Poitiers, France
| | - Jean-David Bouaziz
- Université de Paris, Faculté de médecine, AP-HP, Service de Dermatologie, Hôpital Saint-Louis, Paris, France
| | - Annick Barbaud
- Sorbonne Université, Faculté de médecine, AP-HP, Service de Dermatologie et Allergologie, Hôpital Tenon, Paris, France
| | - Camille Francès
- Sorbonne Université, Faculté de médecine, AP-HP, Service de Dermatologie et Allergologie, Hôpital Tenon, Paris, France
| | - Arsène Mékinian
- Sorbonne Université, Faculté de médecine, AP-HP, Service de Médecine interne, Hôpital Saint-Antoine, Paris, France
| | - Olivier Fain
- Sorbonne Université, Faculté de médecine, AP-HP, Service de Médecine interne, Hôpital Saint-Antoine, Paris, France
| | - Zahir Amoura
- Sorbonne Université, Faculté de médecine, AP-HP, Service de Médecine interne 2, Hôpital Pitié Salpetrière, Paris, France
| | - François Chasset
- Sorbonne Université, Faculté de médecine, AP-HP, Service de Dermatologie et Allergologie, Hôpital Tenon, Paris, France
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Allouchery M, Beuvon C, Pérault-Pochat MC, Roblot P, Puyade M, Martin M. Immune Checkpoint Inhibitors and Venous Thromboembolism: An Analysis of the WHO Pharmacovigilance Database. Clin Pharmacol Ther 2022; 112:164-170. [PMID: 35426120 DOI: 10.1002/cpt.2615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 04/06/2022] [Indexed: 11/07/2022]
Abstract
Data on venous thromboembolic events (VTEs) in patients receiving immune checkpoint inhibitors (ICIs) are scarce and conflicting. This study investigated the risk of reporting VTEs associated with ICIs in comparison with all other anticancer drugs. The World Health Organization pharmacovigilance database (VigiBase), comprising >30 million individual case safety reports, was queried. All reports on patients with cancer, involving at least one anticancer drug as a suspect or interacting drug and registered from January 1, 2008, to May 31, 2021, were included. The association between ICIs and the risk of reporting VTEs was estimated using the reporting odds ratio (ROR) as a measure of disproportionality with all other anticancer drugs as comparators. RORs were estimated as crude and adjusted RORs for age, sex, and other medications (excluding anticancer drugs) associated with risk of VTEs. Among 1,196 patients experiencing VTEs after ICI treatment, the median age was 65 years and 57.6% were men. Anti-PD-1 agents (62.5%) were the most frequently reported. ICIs were not associated with higher reporting of VTEs when compared with other anticancer drugs (crude ROR 0.63, 95% confidence interval (CI) 0.60 to 0.67 and adjusted ROR 0.70, 95% CI 0.65-0.74). No signal of disproportionate reporting was found when considering each class of ICIs. In conclusion, ICIs were not associated with higher reporting of VTEs, in comparison with all other anticancer drugs in a large-scale pharmacovigilance database. Owing to the limitations inherent to pharmacovigilance studies, prospective studies, including an adequate comparison group, are needed to assess the risk of VTEs in ICI-treated patients.
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Affiliation(s)
- Marion Allouchery
- Pharmacologie Clinique et Vigilances, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
- Faculté de Médecine et de Pharmacie, Université de Poitiers, Poitiers, France
| | - Clément Beuvon
- Faculté de Médecine et de Pharmacie, Université de Poitiers, Poitiers, France
- Médecine Interne et Maladies Infectieuses, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Marie-Christine Pérault-Pochat
- Pharmacologie Clinique et Vigilances, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
- Faculté de Médecine et de Pharmacie, Université de Poitiers, Poitiers, France
- Laboratoire de Neurosciences Expérimentales et Cliniques, INSERM U1084, Université de Poitiers, Poitiers, France
- CIC-1402, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Pascal Roblot
- Faculté de Médecine et de Pharmacie, Université de Poitiers, Poitiers, France
- Médecine Interne et Maladies Infectieuses, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Mathieu Puyade
- Médecine Interne et Maladies Infectieuses, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
- CIC-1402, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Mickaël Martin
- Faculté de Médecine et de Pharmacie, Université de Poitiers, Poitiers, France
- Médecine Interne et Maladies Infectieuses, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
- INSERM U1313, Université de Poitiers, Poitiers, France
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7
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Allouchery M, Beuvon C, Pérault-Pochat MC, Roblot P, Puyade M, Martin M. Safety of Immune Checkpoint Inhibitor Resumption after Interruption for Immune-Related Adverse Events, a Narrative Review. Cancers (Basel) 2022; 14:cancers14040955. [PMID: 35205703 PMCID: PMC8870725 DOI: 10.3390/cancers14040955] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/07/2022] [Accepted: 02/09/2022] [Indexed: 12/19/2022] Open
Abstract
Immune checkpoint inhibitors (ICIs) have become the standard of care for several types of cancer due to their superiority in terms of survival benefits in first- and second-line treatments compared to conventional therapies, and they present a better safety profile (lower absolute number of grade 1-5 adverse events), especially if used in monotherapy. However, the pattern of ICI-related adverse events is totally different, as they are characterized by the development of specific immune-related adverse events (irAEs) that are unique in terms of the organs involved, onset patterns, and severity. The decision to resume ICI treatment after its interruption due to irAEs is challenged by the need for tumor control versus the risk of occurrence of the same or different irAEs. Studies that specifically assess this point remain scarce, heterogenous and mostly based on small samples of patients or focused only on the recurrence rate of the same irAE after ICI resumption. Moreover, patients with grade ≥3 irAEs were excluded from many of these studies. Herein, we provide a narrative review on the field of safety of ICI resumption after interruption due to irAE(s).
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Affiliation(s)
- Marion Allouchery
- Pharmacologie Clinique et Vigilances, Centre Hospitalier Universitaire de Poitiers, 2 Rue de la Milétrie, 86000 Poitiers, France; (M.A.); (M.-C.P.-P.)
- Université de Poitiers, 15 Rue de l’Hôtel-Dieu, TSA 71117, 86000 Poitiers, France; (C.B.); (P.R.)
| | - Clément Beuvon
- Université de Poitiers, 15 Rue de l’Hôtel-Dieu, TSA 71117, 86000 Poitiers, France; (C.B.); (P.R.)
- Médecine Interne et Maladies Infectieuses, Centre Hospitalier Universitaire de Poitiers, 2 Rue de la Milétrie, 86000 Poitiers, France;
| | - Marie-Christine Pérault-Pochat
- Pharmacologie Clinique et Vigilances, Centre Hospitalier Universitaire de Poitiers, 2 Rue de la Milétrie, 86000 Poitiers, France; (M.A.); (M.-C.P.-P.)
- Université de Poitiers, 15 Rue de l’Hôtel-Dieu, TSA 71117, 86000 Poitiers, France; (C.B.); (P.R.)
- CIC-1402, Centre Hospitalier Universitaire de Poitiers, 2 Rue de la Milétrie, 86000 Poitiers, France
- Laboratoire de Neurosciences Expérimentales et Cliniques, INSERM U1084, Université de Poitiers, 1 Rue Georges Bonnet, 86073 Poitiers, France
| | - Pascal Roblot
- Université de Poitiers, 15 Rue de l’Hôtel-Dieu, TSA 71117, 86000 Poitiers, France; (C.B.); (P.R.)
- Médecine Interne et Maladies Infectieuses, Centre Hospitalier Universitaire de Poitiers, 2 Rue de la Milétrie, 86000 Poitiers, France;
| | - Mathieu Puyade
- Médecine Interne et Maladies Infectieuses, Centre Hospitalier Universitaire de Poitiers, 2 Rue de la Milétrie, 86000 Poitiers, France;
- CIC-1402, Centre Hospitalier Universitaire de Poitiers, 2 Rue de la Milétrie, 86000 Poitiers, France
| | - Mickaël Martin
- Université de Poitiers, 15 Rue de l’Hôtel-Dieu, TSA 71117, 86000 Poitiers, France; (C.B.); (P.R.)
- Médecine Interne et Maladies Infectieuses, Centre Hospitalier Universitaire de Poitiers, 2 Rue de la Milétrie, 86000 Poitiers, France;
- INSERM U1313, Centre Hospitalier Universitaire de Poitiers, 2 Rue de la Milétrie, 86000 Poitiers, France
- Correspondence: ; Tel.: +33-549-444-004
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Baillou C, Jacomet F, Dejoie T, Lureau P, Beuvon C, Grados A, Martins P, Roblot P, Puyade M, Martin M. Polyclonal hypergammaglobulinaemia: towards definition of a threshold. Postgrad Med J 2022:7127883. [PMID: 37073601 DOI: 10.1136/postmj/postgradmedj-2021-140591] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 01/18/2022] [Indexed: 04/20/2023]
Abstract
BACKGROUND Polyclonal hypergammaglobulinaemia (PH) represents a classic diagnosis problem in internal medicine. However, there is no consensus threshold for PH. The aim of this study was to define a threshold for PH. METHODS We conducted a retrospective multicentric study using laboratory biological databases between 1 January 2016 and 31 December 2016 in two university hospitals and one non-university hospital. All patients 18 years old or over and with at least one serum protein electrophoresis (SPE) available in 2016 were included. Exclusion criteria were monoclonal, biclonal, or oligoclonal spikes or, in case of hypogammaglobulinaemia, proven free light chain gammopathy. The main endpoint was to define the threshold values for PH in this population. Another objective was to define the 95th percentile of the distribution. RESULTS 20 766 SPEs were included in this cohort. The PH threshold on 95th percentile was 18.9 g/L. The threshold varied according to geographical areas. CONCLUSIONS This is the first study to scientifically define a PH threshold. The main limitation is that our threshold is only biological. The study was not designed to associate this threshold with a clinically active disease. In conclusion, while the 19 g/L cut-off seems the most relevant threshold, but it will need to be validated by prospective studies.
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Affiliation(s)
- Chloé Baillou
- Service de médecine interne, maladies infectieuses et tropicales, CHU Poitiers, Poitiers, France
- Université de Poitiers, Poitiers, France
| | - Florence Jacomet
- Service d'immunologie et inflammation, CHU Poitiers, Poitiers, France
| | - Thomas Dejoie
- Laboratoire de biochimie, CHU Nantes, Nantes, France
| | - Pierre Lureau
- Laboratoire de biologie médicale, CH Niort, Niort, France
| | - Clément Beuvon
- Service de médecine interne, maladies infectieuses et tropicales, CHU Poitiers, Poitiers, France
- Université de Poitiers, Poitiers, France
| | | | - Pauline Martins
- Service de médecine interne-rhumatologie, CH La Rochelle, La Rochelle, France
| | - Pascal Roblot
- Service de médecine interne, maladies infectieuses et tropicales, CHU Poitiers, Poitiers, France
- Université de Poitiers, Poitiers, France
| | - Mathieu Puyade
- Service de médecine interne, maladies infectieuses et tropicales, CHU Poitiers, Poitiers, France
| | - Mickael Martin
- Service de médecine interne, maladies infectieuses et tropicales, CHU Poitiers, Poitiers, France
- Université de Poitiers, Poitiers, France
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Baillou C, Jacomet F, Dejoie T, Lureau P, Beuvon C, Grados A, Martins P, Roblot P, Puyade M, Martin M. Polyclonal hypergammaglobulinaemia: towards definition of a threshold. Postgrad Med J 2022; 99:postgradmedj-2021-140591. [DOI: 10.1136/postgradmedj-2021-140591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 01/18/2022] [Indexed: 11/03/2022]
Abstract
BackgroundPolyclonal hypergammaglobulinaemia (PH) represents a classic diagnosis problem in internal medicine. However, there is no consensus threshold for PH. The aim of this study was to define a threshold for PH.MethodsWe conducted a retrospective multicentric study using laboratory biological databases between 1 January 2016 and 31 December 2016 in two university hospitals and one non-university hospital. All patients 18 years old or over and with at least one serum protein electrophoresis (SPE) available in 2016 were included. Exclusion criteria were monoclonal, biclonal, or oligoclonal spikes or, in case of hypogammaglobulinaemia, proven free light chain gammopathy. The main endpoint was to define the threshold values for PH in this population. Another objective was to define the 95th percentile of the distribution.Results20 766 SPEs were included in this cohort. The PH threshold on 95th percentile was 18.9 g/L. The threshold varied according to geographical areas.ConclusionsThis is the first study to scientifically define a PH threshold. The main limitation is that our threshold is only biological. The study was not designed to associate this threshold with a clinically active disease. In conclusion, while the 19 g/L cut-off seems the most relevant threshold, but it will need to be validated by prospective studies.
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Breillat P, Jachiet M, Ditchi Y, Lenormand C, Costedoat-Chalumeau N, Mathian A, Beuvon C, Roy-Peaud F, Fain O, Bouaziz J, Amoura Z, Chasset F. Étiologies des vascularites cutanées au cours du lupus systémique et association avec la sévérité de la maladie, une étude rétrospective multicentrique de 35 patients (étude VasCuLup). Rev Med Interne 2021. [DOI: 10.1016/j.revmed.2021.10.219] [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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Beuvon C, Coudroy R, Bardin J, Marjanovic N, Rault C, Bironneau V, Drouot X, Robert R, Thille AW, Frat JP. β Agonist Delivery by High-Flow Nasal Cannula During COPD Exacerbation: A Prospective Physiological Study. Respir Care 2021; 67:9-15. [PMID: 34702767 DOI: 10.4187/respcare.09242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Whereas high-flow nasal cannula (HFNC) oxygen therapy is increasingly used in patients with exacerbation of COPD, the effectiveness of β 2 agonist nebulization through HFNC has been poorly assessed. We hypothesized that salbutamol vibrating-mesh nebulization through HFNC improves pulmonary function tests in subjects with COPD. METHODS We conducted a physiological crossover study including subjects admitted to the ICU for severe exacerbation of COPD. After subject improvement allowing a 3-h washout period without bronchodilator, pulmonary function tests were performed while breathing through HFNC alone and after salbutamol vibrating-mesh nebulization through HFNC. The primary end point consisted in the changes in FEV1 before and after salbutamol nebulization. Secondary end points included the changes in FVC, peak expiratory flow (PEF), airway resistance, and clinical parameters. RESULTS Among the 15 subjects included, mean (SD) FEV1 significantly increased after salbutamol nebulization from 931 mL (383) to 1,019 (432), mean difference +87 mL (95% CI 30-145) (P = .006). Similarly, FVC and PEF significantly increased, +174 mL (95% CI 66-282) (P = .004) and +0.3 L/min (95% CI 0-0.6) (P = .037), respectively. Airway resistances and breathing frequency did not significantly differ, whereas heart rate significantly increased after nebulization. CONCLUSIONS In subjects with severe exacerbation of COPD, salbutamol vibrating-mesh nebulization through HFNC induced a significant bronchodilator effect with volume and flow improvement.
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Affiliation(s)
- Clément Beuvon
- INSERM CIC-1402, ALIVE Research Group, University of Poitiers, Poitiers, France and Médecine Intensive Réanimation, CHU de Poitiers, Poitiers, France
| | - Rémi Coudroy
- INSERM CIC-1402, ALIVE Research Group, University of Poitiers, Poitiers, France and Médecine Intensive Réanimation, CHU de Poitiers, Poitiers, France
| | - Justine Bardin
- INSERM CIC-1402, ALIVE Research Group, University of Poitiers, Poitiers, France and Médecine Intensive Réanimation, CHU de Poitiers, Poitiers, France
| | - Nicolas Marjanovic
- INSERM CIC-1402, ALIVE Research Group, University of Poitiers, Poitiers, France and Service d'accueil des Urgences, CHU de Poitiers, Poitiers, France
| | - Christophe Rault
- INSERM CIC-1402, ALIVE Research Group, University of Poitiers, Poitiers, France and Service de Neurophysiologie, CHU de Poitiers, Poitiers, France
| | - Vanessa Bironneau
- INSERM CIC-1402, ALIVE Research Group, University of Poitiers, Poitiers, France; and Service de Pneumologie, CHU de Poitiers, Poitiers, France
| | - Xavier Drouot
- INSERM CIC-1402, ALIVE Research Group, University of Poitiers, Poitiers, France and Service de Neurophysiologie, CHU de Poitiers, Poitiers, France
| | - René Robert
- INSERM CIC-1402, ALIVE Research Group, University of Poitiers, Poitiers, France and Médecine Intensive Réanimation, CHU de Poitiers, Poitiers, France
| | - Arnaud W Thille
- INSERM CIC-1402, ALIVE Research Group, University of Poitiers, Poitiers, France and Médecine Intensive Réanimation, CHU de Poitiers, Poitiers, France
| | - Jean-Pierre Frat
- INSERM CIC-1402, ALIVE Research Group, University of Poitiers, Poitiers, France and Médecine Intensive Réanimation, CHU de Poitiers, Poitiers, France
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Luca L, Beuvon C, Puyade M, Roblot P, Martin M. [Selective IgA deficiency]. Rev Med Interne 2021; 42:764-771. [PMID: 34364731 DOI: 10.1016/j.revmed.2021.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 06/14/2021] [Accepted: 07/17/2021] [Indexed: 10/20/2022]
Abstract
Selective IgA deficiency (SIgAD) is defined by the European Society for Immunodeficiencies (ESID) as a serum IgA of less than 0.07g/L in patients greater than 4 years old with normal levels of IgG and IgM, normal vaccine responses, and with the exclusion of secondary causes of hypogammaglobulinemia. When serum IgA level is higher than 0.07g/L but two standard deviations below normal for age, the condition may be referred to as partial IgA deficiency, which is quite common. SIgAD is the most common primary immunodeficiency in Europe (1/600 in France) and most patients with SIgAD are asymptomatic (75-90%). The clinical complications associated with SIgAD include recurrent respiratory infections (in particular involving Haemophilus influenza and Streptococcus pneumoniae) and gastrointestinal (mainly due to Giardialamblia), autoimmune and allergic manifestations (anaphylaxis if blood products with IgA are administrated), inflammatory gastrointestinal disease. There is no specific treatment for SIgAD and each patient must be managed individually. While asymptomatic subjects do not need any treatment, it is still necessary for them to be up-to-date with vaccinations. If the patient experiences recurrent infections, prophylactic antibiotics may be beneficial. Immunoglobulin replacement therapy should be considered in patients with SIgAD and concomitant IgG subclass deficiency. Treatment for autoimmune and allergic manifestations is based on current standards of care for specific disease entities. To improve quality of life and reduce morbidity, an interdisciplinary team approach is essential.
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Affiliation(s)
- L Luca
- Service de médecine interne, maladies infectieuses et tropicales, centre hospitalier universitaire de Poitiers, 2, rue de la Milétrie, 86021 Poitiers cedex, France.
| | - C Beuvon
- Service de médecine interne, maladies infectieuses et tropicales, centre hospitalier universitaire de Poitiers, 2, rue de la Milétrie, 86021 Poitiers cedex, France; Université de Poitiers, 6, rue de la Milétrie, TSA 51115, 86073 Poitiers cedex 9, France
| | - M Puyade
- Service de médecine interne, maladies infectieuses et tropicales, centre hospitalier universitaire de Poitiers, 2, rue de la Milétrie, 86021 Poitiers cedex, France
| | - P Roblot
- Service de médecine interne, maladies infectieuses et tropicales, centre hospitalier universitaire de Poitiers, 2, rue de la Milétrie, 86021 Poitiers cedex, France; Université de Poitiers, 6, rue de la Milétrie, TSA 51115, 86073 Poitiers cedex 9, France
| | - M Martin
- Service de médecine interne, maladies infectieuses et tropicales, centre hospitalier universitaire de Poitiers, 2, rue de la Milétrie, 86021 Poitiers cedex, France; Université de Poitiers, 6, rue de la Milétrie, TSA 51115, 86073 Poitiers cedex 9, France
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Beuvon C, Martin M, Baillou C, Roblot P, Puyade M. Etiologies of Polyclonal Hypergammaglobulinemia: A scoping review. Eur J Intern Med 2021; 90:119-121. [PMID: 34127335 DOI: 10.1016/j.ejim.2021.05.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/14/2021] [Accepted: 05/16/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Clément Beuvon
- Service de Médecine Interne, Maladies infectieuses et Tropicales, Centre Hospitalier Universitaire (CHU) de Poitiers, 2, rue de la Milétrie, 86021 Poitiers cedex, France; Université de Poitiers, 6, rue de la Milétrie, TSA 51115, 86073 Poitiers cedex 9, France.
| | - Mickaël Martin
- Service de Médecine Interne, Maladies infectieuses et Tropicales, Centre Hospitalier Universitaire (CHU) de Poitiers, 2, rue de la Milétrie, 86021 Poitiers cedex, France; Université de Poitiers, 6, rue de la Milétrie, TSA 51115, 86073 Poitiers cedex 9, France
| | - Chloé Baillou
- Service de Médecine Interne, Maladies infectieuses et Tropicales, Centre Hospitalier Universitaire (CHU) de Poitiers, 2, rue de la Milétrie, 86021 Poitiers cedex, France
| | - Pascal Roblot
- Service de Médecine Interne, Maladies infectieuses et Tropicales, Centre Hospitalier Universitaire (CHU) de Poitiers, 2, rue de la Milétrie, 86021 Poitiers cedex, France; Université de Poitiers, 6, rue de la Milétrie, TSA 51115, 86073 Poitiers cedex 9, France
| | - Mathieu Puyade
- Service de Médecine Interne, Maladies infectieuses et Tropicales, Centre Hospitalier Universitaire (CHU) de Poitiers, 2, rue de la Milétrie, 86021 Poitiers cedex, France
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Beuvon C, Rammaert B, Torregrossa J, Gallego Hernanz M, Roblot F, Roblot P, Puyade M. Impact du seuil de fièvre dans l’initiation de l’antibiothérapie empirique chez les patients atteints de neutropénie fébrile : étude FLAM. Med Mal Infect 2020. [DOI: 10.1016/j.medmal.2020.06.249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Martellosio JP, Landron C, Milin S, Sarfati R, Arrivé F, Beuvon C, Roblot P. [Surgical treatment of an auto-immune hemolytic anemia]. Rev Med Interne 2018; 39:435-438. [PMID: 29650300 DOI: 10.1016/j.revmed.2018.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 02/11/2018] [Accepted: 03/10/2018] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Auto-immune hemolytic anemia (AIHA) is a rare cause of anemia, characterized by autoantibodies directed against self red blood cells. It can be primary or secondary, in particular due to lymphoproliferative diseases. CASE REPORT We report the case of a 24-year-old woman who presented with a severe macrocytic anemia associated with an ovarian teratoma. CONCLUSION Ovarian teratoma is a rare cause of secondary AIHA, with only few cases reported. Its treatment differs from primary AIHA as steroids may be ineffective. Indeed, complete response can only be achieved with surgical excision of the tumor.
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Affiliation(s)
- J-P Martellosio
- Service de médecine interne, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers cedex, France.
| | - C Landron
- Service de médecine interne, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers cedex, France
| | - S Milin
- Service d'anatomie et cytologie pathologique, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers cedex, France
| | - R Sarfati
- Service de gynécologie-obstétrique, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers cedex, France
| | - F Arrivé
- Service de médecine interne, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers cedex, France
| | - C Beuvon
- Service de médecine interne, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers cedex, France
| | - P Roblot
- Service de médecine interne, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers cedex, France
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Arrivé F, Roncato-Saberan M, Beuvon C, Martellosio JP, Meriglier E. [Tracheotomy for laryngeal tuberculosis]. Med Mal Infect 2017; 47:174-175. [PMID: 28215824 DOI: 10.1016/j.medmal.2017.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 01/18/2017] [Indexed: 10/20/2022]
Affiliation(s)
- F Arrivé
- Service de médecine interne, CHU de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France.
| | - M Roncato-Saberan
- Service de médecine interne/maladies infectieuses, CH La Rochelle, rue du Dr-Albert-Schweitzer, 17000 La Rochelle, France.
| | - C Beuvon
- Service de médecine interne, CHU de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France.
| | - J-P Martellosio
- Service de médecine interne, CHU de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France.
| | - E Meriglier
- Service de médecine interne, CHU de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France.
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Beuvon C, Meriglier E, Bachelet-Rousseau C, Roblot P, Roy-Peaud F, Martellosio J, Landron C. Glomérulonéphrite à lésions glomérulaires minimes : un cas rare qui a du Still. Rev Med Interne 2016. [DOI: 10.1016/j.revmed.2016.04.148] [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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Beuvon C, Meriglier E, Arrivé F, Pourreau F, Croquette M, Leroy F. Une vascularite à ANCA révélant deux néoplasies pulmonaires : à propos d’un cas. Rev Med Interne 2016. [DOI: 10.1016/j.revmed.2016.04.064] [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: 10/21/2022]
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Meriglier E, Debouverie O, Walter-Lepage A, Brigaud A, Beuvon C, Luca L. [Primary Sjögren's syndrome revealing cerebellar syndrome]. Rev Neurol (Paris) 2015; 171:674-6. [PMID: 25912281 DOI: 10.1016/j.neurol.2015.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 02/23/2015] [Accepted: 03/02/2015] [Indexed: 11/30/2022]
Affiliation(s)
- E Meriglier
- Service de médecine interne, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France.
| | - O Debouverie
- Service de médecine interne, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France
| | - A Walter-Lepage
- Service de médecine interne, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France
| | - A Brigaud
- Service de médecine interne, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France
| | - C Beuvon
- Service de médecine interne, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France
| | - L Luca
- Service de médecine interne, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France
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