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Chakabva MS, Polina S, Brauner M, McGuire M, Brown Z, Akthar T, Todt M, Polina A, Nova FF. Comparison of Standard Versus Intermediate Prophylaxis Dose for Venous Thromboembolism Prophylaxis in Patients Hospitalized With COVID-19 Infection. Hosp Pharm 2024; 59:94-101. [PMID: 38223865 PMCID: PMC10786052 DOI: 10.1177/00185787231194997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
Background: COVID-19 infection is associated with a high risk of venous thromboembolism (VTE) events. VTE prophylaxis reduces the risk of these events. The optimal dose of VTE prophylaxis however remains uncertain. Objectives: To compare the incidence of VTE in patients treated with either standard dose VTE versus intermediate dose VTE prophylaxis. Methods: In this retrospective cohort study, we analyzed data from 1786 adult patients admitted into the hospital with polymerase chain reaction confirmed COVID-19 infection between April 2020 to September 2021. For analysis, patients were divided into 2 cohorts: either standard dose prophylaxis treatment group (patients who received either unfractionated heparin 5000units 3 times a day or enoxaparin 30-40 mg daily subcutaneously) or intermediate dose VTE prophylaxis group (patients received either unfractionated heparin 7500 units 3 times daily or enoxaparin 30-40 mg twice a day subcutaneously). The primary outcome was incidence of VTE events described as either deep vein thrombosis (DVT) or pulmonary embolism (PE). Secondary outcome was bleeding events. Results: During the study period, 398 (22%) patients were primarily treated with standard dose VTE prophylaxis, whereas 1388 (78%) patients were treated with intermediate dose VTE prophylaxis. There was a significantly higher incidence of venous thromboembolism events noted in the standard dose prophylaxis treatment group when compared with the intermediate dose prophylaxis group (25/398 (6.3%) vs 35/1388 (2.5%) P < .001, [Odds Ratio 2.6197, 95% confidence interval = 1.5482-4.4327]). Multivariable-adjusted logistic regression, adjusting for age, obesity, and smoking, with the intermediate dose prophylaxis treatment group as the referent category revealed higher odds for incident venous thromboembolism events in the standard dose prophylaxis group. There was no statistically significant difference in bleeding events between the 2 treatment groups (9 (2.3%) for standard dose prophylaxis group vs 46 (3.3%) for intermediate dose prophylaxis group P = .26). Conclusions: Among patients hospitalized with COVID-19 infection, patients receiving intermediate dose VTE prophylaxis experienced lower incident rates of venous thromboembolism events compared to those receiving standard dose VTE prophylaxis without a statistically significant increase in the risk of bleeding events.
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Affiliation(s)
| | | | | | | | | | | | | | - Aws Polina
- Wayne State/Detroit Medical Center Internal Medicine Residency, Detroit, MI, USA
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Rousset L, Bohelay G, Gille T, Le Roux-Villet C, Kambouchner M, Levy A, Brauner M, Tandjaoui H, Aucouturier F, Mignot S, Caux F, Prost-Squarcioni C, Alexandre M. Bronchial involvement in mucous membrane pemphigoid: 2 cases and a literature review. Ann Dermatol Venereol 2023; 150:64-70. [PMID: 36435654 DOI: 10.1016/j.annder.2022.08.009] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 05/05/2022] [Accepted: 08/30/2022] [Indexed: 11/25/2022]
Affiliation(s)
- L Rousset
- Department of Dermatology, Avicenne Hospital, Assistance Publique Hôpitaux De Paris (AP-HP), Paris 13 University, Bobigny, France; Referral Centre for Autoimmune Blistering Diseases (MALIBUL), France
| | - G Bohelay
- Department of Dermatology, Avicenne Hospital, Assistance Publique Hôpitaux De Paris (AP-HP), Paris 13 University, Bobigny, France; Referral Centre for Autoimmune Blistering Diseases (MALIBUL), France
| | - T Gille
- Department of Physiology and Functional Explorations, Avicenne Hospital, Assistance Publique Hôpitaux De Paris (AP-HP), Paris 13 University, Bobigny, France; Inserm U1272 "Hypoxia and the Lung", UFR SMBH Léonard de Vinci, Paris 13 University, France
| | - C Le Roux-Villet
- Department of Dermatology, Avicenne Hospital, Assistance Publique Hôpitaux De Paris (AP-HP), Paris 13 University, Bobigny, France; Referral Centre for Autoimmune Blistering Diseases (MALIBUL), France
| | - M Kambouchner
- Department of Pathology, Avicenne Hospital, Assistance Publique Hôpitaux De Paris (AP-HP), Paris 13 University, Bobigny, France
| | - A Levy
- Department of Pathology, Avicenne Hospital, Assistance Publique Hôpitaux De Paris (AP-HP), Paris 13 University, Bobigny, France
| | - M Brauner
- Department of Radiology, Avicenne Hospital, Assistance Publique Hôpitaux De Paris (AP-HP), Paris 13 University, Bobigny, France
| | - H Tandjaoui
- Department of Pulmonology, Avicenne Hospital, Assistance Publique Hôpitaux De Paris (AP-HP), Paris 13 University, Bobigny, France
| | - F Aucouturier
- Department of Immunology, Saint-Louis Hospital, Assistance Publique Hôpitaux De Paris (AP-HP), Paris 7 University, 75010 Paris, France
| | - S Mignot
- Department of Immunology, Bichat Hospital, Assistance Publique Hôpitaux De Paris (AP-HP), Paris 7 University, 75018 Paris, France
| | - F Caux
- Department of Dermatology, Avicenne Hospital, Assistance Publique Hôpitaux De Paris (AP-HP), Paris 13 University, Bobigny, France; Referral Centre for Autoimmune Blistering Diseases (MALIBUL), France
| | - C Prost-Squarcioni
- Department of Dermatology, Avicenne Hospital, Assistance Publique Hôpitaux De Paris (AP-HP), Paris 13 University, Bobigny, France; Referral Centre for Autoimmune Blistering Diseases (MALIBUL), France; Histology Laboratory, UFR SMBH Léonard de Vinci, Paris 13 University, Bobigny, France
| | - M Alexandre
- Department of Dermatology, Avicenne Hospital, Assistance Publique Hôpitaux De Paris (AP-HP), Paris 13 University, Bobigny, France; Referral Centre for Autoimmune Blistering Diseases (MALIBUL), France.
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Lehot JJ, Clec’h C, Bonhomme F, Brauner M, Chemouni F, de Mesmay M, Gayat E, Guidet B, Hejblum G, Hernu R, Jauréguy F, Martin C, Rousson R, Samama M, Schwebel C, Van de Putte H, Lemiale V, Ausset S. Pertinence de la prescription des examens biologiques et de la radiographie thoracique en réanimation RFE commune SFAR-SRLF. Méd Intensive Réa 2019. [DOI: 10.3166/rea-2018-0004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Méchaï F, Fock-Yee C, Bouvry D, Raffetin A, Bouchaud O, Brauner M, Brillet PY. [Pulmonary tuberculosis: Radiological evolution of broncho-pulmonary lesions at the end of treatment]. Rev Mal Respir 2018; 36:22-30. [PMID: 30236440 DOI: 10.1016/j.rmr.2018.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 01/28/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To describe the residual broncho-pulmonary lesions and evaluate the role of CT scanning at the end of treatment of pulmonary tuberculosis. MATERIALS AND METHODS Analysis of the initial and end of treatment CT scans of 56 patients with pulmonary tuberculosis according to a reading grid including parenchymatous and airways lesions. The CT data at the end of treatment were analysed in relation to the clinical and microbiological data, and the original CT scan. RESULTS Active lesions (thick walled cavities and/or centrilobular micronodules) persisted in 24 patients (43%) after a mean treatment period of 7 months. The persistence of these signs of activity was correlated with the initial presence of a cavitary syndrome (p=0.027), with predominant sub-segmentary bronchial involvement, with extensive micronodular spread (p=0.024) and with bronchiectasis (p=0.04). These residual lesions were not associated with an increased risk of relapse. CONCLUSION The persistence of signs of activity on the CT scan at the end of treatment of tuberculosis do not necessarily correspond to an absence of cure but to a radiological delay. This imaging is nevertheless useful to make an assessment of any subsequent changes in the bronchial tree and to estimate the risk of later complications.
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Affiliation(s)
- F Méchaï
- Service des maladies infectieuses et tropicales, hôpital Avicenne, 125, route de Stalingrad, 93000 Bobigny, France; Inserm, IAME, UMR 1137, 75018 Paris, France.
| | - C Fock-Yee
- Service de radiologie, hôpital Avicenne, Bobigny, France
| | - D Bouvry
- Service de pneumologie, hôpital Avicenne, Bobigny, France
| | - A Raffetin
- Service des maladies infectieuses et tropicales, hôpital Avicenne, 125, route de Stalingrad, 93000 Bobigny, France
| | - O Bouchaud
- Service des maladies infectieuses et tropicales, hôpital Avicenne, 125, route de Stalingrad, 93000 Bobigny, France; Laboratoire éducations et pratiques de santé EA 3412, université Paris 13, Bobigny, France
| | - M Brauner
- Service de radiologie, hôpital Avicenne, Bobigny, France
| | - P Y Brillet
- Service de radiologie, hôpital Avicenne, Bobigny, France
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Rousset L, Bohelay G, Caux F, Levy A, Le Roux Villet C, Brauner M, Tandjaoui H, Gille T, Laroche L, Prost C, Alexandre M. Pemphigoïde des muqueuses avec atteinte bronchique spécifique développée sur métaplasie malpighienne : 2 cas. Ann Dermatol Venereol 2015. [DOI: 10.1016/j.annder.2015.10.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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AzimiHashemi N, Erbguth K, Vogt A, Riemensperger T, Rauch E, Woodmansee D, Nagpal J, Brauner M, Sheves M, Fiala A, Kattner L, Trauner D, Hegemann P, Gottschalk A, Liewald JF. Synthetic retinal analogues modify the spectral and kinetic characteristics of microbial rhodopsin optogenetic tools. Nat Commun 2014; 5:5810. [PMID: 25503804 DOI: 10.1038/ncomms6810] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 11/10/2014] [Indexed: 11/09/2022] Open
Abstract
Optogenetic tools have become indispensable in neuroscience to stimulate or inhibit excitable cells by light. Channelrhodopsin-2 (ChR2) variants have been established by mutating the opsin backbone or by mining related algal genomes. As an alternative strategy, we surveyed synthetic retinal analogues combined with microbial rhodopsins for functional and spectral properties, capitalizing on assays in C. elegans, HEK cells and larval Drosophila. Compared with all-trans retinal (ATR), Dimethylamino-retinal (DMAR) shifts the action spectra maxima of ChR2 variants H134R and H134R/T159C from 480 to 520 nm. Moreover, DMAR decelerates the photocycle of ChR2(H134R) and (H134R/T159C), thereby reducing the light intensity required for persistent channel activation. In hyperpolarizing archaerhodopsin-3 and Mac, naphthyl-retinal and thiophene-retinal support activity alike ATR, yet at altered peak wavelengths. Our experiments enable applications of retinal analogues in colour tuning and altering photocycle characteristics of optogenetic tools, thereby increasing the operational light sensitivity of existing cell lines or transgenic animals.
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Affiliation(s)
- N AzimiHashemi
- 1] Buchmann Institute for Molecular Life Sciences (BMLS), Goethe-University, Max-von-Laue-Straße 15, 60438 Frankfurt, Germany [2] Institute of Biochemistry, Goethe-University, Max-von-Laue-Straße 9, 60438 Frankfurt, Germany
| | - K Erbguth
- 1] Buchmann Institute for Molecular Life Sciences (BMLS), Goethe-University, Max-von-Laue-Straße 15, 60438 Frankfurt, Germany [2] Institute of Biochemistry, Goethe-University, Max-von-Laue-Straße 9, 60438 Frankfurt, Germany
| | - A Vogt
- Institute for Biology-Experimental Biophysics, Humboldt-Universität zu Berlin, Invalidenstraße 42, 10115 Berlin, Germany
| | - T Riemensperger
- Department of Molecular Neurobiology of Behavior, Georg-August-Universität Göttingen, Julia-Lermontowa-Weg 3, 37077 Göttingen, Germany
| | - E Rauch
- Endotherm, Science-Park II, 66123 Saarbrücken, Germany
| | - D Woodmansee
- Department of Chemistry, Ludwig-Maximilians-Universität München, Butenandtstraße 5-13, 81377 München, Germany
| | - J Nagpal
- 1] Buchmann Institute for Molecular Life Sciences (BMLS), Goethe-University, Max-von-Laue-Straße 15, 60438 Frankfurt, Germany [2] Institute of Biochemistry, Goethe-University, Max-von-Laue-Straße 9, 60438 Frankfurt, Germany
| | - M Brauner
- Institute of Biochemistry, Goethe-University, Max-von-Laue-Straße 9, 60438 Frankfurt, Germany
| | - M Sheves
- Department of Organic Chemistry, The Weizmann Institute of Science, Rehovot 76100, Israel
| | - A Fiala
- Department of Molecular Neurobiology of Behavior, Georg-August-Universität Göttingen, Julia-Lermontowa-Weg 3, 37077 Göttingen, Germany
| | - L Kattner
- Endotherm, Science-Park II, 66123 Saarbrücken, Germany
| | - D Trauner
- Department of Chemistry, Ludwig-Maximilians-Universität München, Butenandtstraße 5-13, 81377 München, Germany
| | - P Hegemann
- Institute for Biology-Experimental Biophysics, Humboldt-Universität zu Berlin, Invalidenstraße 42, 10115 Berlin, Germany
| | - A Gottschalk
- 1] Buchmann Institute for Molecular Life Sciences (BMLS), Goethe-University, Max-von-Laue-Straße 15, 60438 Frankfurt, Germany [2] Institute of Biochemistry, Goethe-University, Max-von-Laue-Straße 9, 60438 Frankfurt, Germany [3] Cluster of Excellence Frankfurt Macromolecular Complexes (CEF-MC), Goethe University, Max-von-Laue Straße 15 60438, Frankfurt, Germany
| | - J F Liewald
- 1] Buchmann Institute for Molecular Life Sciences (BMLS), Goethe-University, Max-von-Laue-Straße 15, 60438 Frankfurt, Germany [2] Institute of Biochemistry, Goethe-University, Max-von-Laue-Straße 9, 60438 Frankfurt, Germany
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Fock-Yee C, Méchaï F, Bouvry D, Bouchaud O, Brauner M, Brillet PY. K-01: Tuberculose pulmonaire : intérêt du scanner de fin de traitement. Med Mal Infect 2014. [DOI: 10.1016/s0399-077x(14)70206-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Crockett F, Ben Romdhane H, Hervé A, Gille T, Valeyre D, Brauner M, Nunes H. Présentations TDM rares de la sarcoïdose : étude cas-témoins. Rev Mal Respir 2013. [DOI: 10.1016/j.rmr.2012.10.087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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Verin A, Uzunhan Y, Brillet P, Larroche C, Warzocha U, Abad S, Valeyre D, Brauner M, Dhote R. Atteinte respiratoire au cours du syndrome de Gougerot-Sjogren : analyse systématique des données TDM. Rev Med Interne 2012. [DOI: 10.1016/j.revmed.2012.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Saidenberg-Kermanac'h N, Semerano L, Naccache JM, Brauner M, Falgarone G, Dumont-Fischer D, Guillot X, Valeyre D, Boissier MC. Screening for latent tuberculosis in anti-TNF-α candidate patients in a high tuberculosis incidence setting. Int J Tuberc Lung Dis 2012; 16:1307-14. [DOI: 10.5588/ijtld.12.0111] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Crestani B, Chapron J, Wallaert B, Bergot E, Delaval P, Israel-Biet D, Lacronique J, Monnet I, Reynaud-Gaubert M, Tazi A, Lebtahi R, Debray MP, Brauner M, Dehoux M, Dornic Q, Aubier M, Mentre F, Duval X. Octreotide treatment of idiopathic pulmonary fibrosis: a proof-of-concept study. Eur Respir J 2012; 39:772-5. [DOI: 10.1183/09031936.00113011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Soussan M, Mekinian A, Brillet PY, Khafagy A, Nicolas P, Vessieres A, Fain O, Brauner M, Weinmann P. Les différents profils de la tuberculose en TEP/scanner au FDG. Rev Med Interne 2011. [DOI: 10.1016/j.revmed.2011.10.276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Nardi A, Brillet PY, Letoumelin P, Girard F, Brauner M, Uzunhan Y, Naccache JM, Valeyre D, Nunes H. Stage IV sarcoidosis: comparison of survival with the general population and causes of death. Eur Respir J 2011; 38:1368-73. [PMID: 22075486 DOI: 10.1183/09031936.00187410] [Citation(s) in RCA: 139] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The objectives of this study were to compare the survival of sarcoid patients with pulmonary fibrosis with that of the general population and to determine the causes of death and the incidence of evolutive complications. This retrospective cohort included 142 sarcoid patients in radiographic stage IV (74 males; mean ± SD age 48.1 ± 12 yrs). Their survival was compared with that of the general French population, matched for the year and age at diagnosis of stage IV disease, sex and length of follow-up. Expected survival probabilities were calculated year-by-year on the basis of probabilities provided by official demographic data for France. Survival curves were based on the Kaplan-Meier method and compared using the log-rank test. During the follow-up period (7.1 ± 4.8 yrs), pulmonary hypertension (PH) was observed in 29.7% of cases and aspergilloma in 11.3%. Long-term oxygen therapy was required in 12%. Survival was 84.1% at 10 yrs, which was worse than for the general population (p = 0.013). 16 (11.3%) patients died from the following causes: refractory PH (n = 5), chronic respiratory insufficiency (n = 4), acute respiratory insufficiency (n = 2), haemoptysis due to aspergilloma (n = 1), heart sarcoidosis (n = 1), nocardiosis (n = 1) and unknown causes (n = 2). Survival is significantly decreased in stage IV patients. 75% of fatalities are directly attributable to respiratory causes.
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Affiliation(s)
- A Nardi
- Dept of Pneumology, Avicenne Hospital, University Paris 13, UPRES EA 2363, Assistance Publique Hôpitaux de Paris, Bobigny, France
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Augier A, Ould Hmeidi Y, Neves F, Salama J, Brauner M, Dumas JL. [Isolated cerebellar syndrome due to ventrolateral thalamic nucleus infarction]. J Radiol 2010; 91:732-734. [PMID: 20808279 DOI: 10.1016/s0221-0363(10)70108-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Johnson SR, Cordier JF, Lazor R, Cottin V, Costabel U, Harari S, Reynaud-Gaubert M, Boehler A, Brauner M, Popper H, Bonetti F, Kingswood C. European Respiratory Society guidelines for the diagnosis and management of lymphangioleiomyomatosis. Eur Respir J 2010; 35:14-26. [PMID: 20044458 DOI: 10.1183/09031936.00076209] [Citation(s) in RCA: 316] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- S R Johnson
- Division of Therapeutics and Molecular Medicine and Respiratory Biomedical Research Unit, University of Nottingham, Nottingham, UK.
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Steiner J, Walter M, Guest P, Myint AM, Schiltz K, Panteli B, Brauner M, Bernstein HG, Gos T, Herberth M, Schroeter ML, Schwarz MJ, Westphal S, Bahn S, Bogerts B. Elevated S100B levels in schizophrenia are associated with insulin resistance. Mol Psychiatry 2010; 15:3-4. [PMID: 20029405 DOI: 10.1038/mp.2009.87] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Augier A, Ould Hmeidi Y, Neves F, Bonnet D, Brauner M, Dumas JL. [MRI features of spinal neurosarcoidosis associed with cervical spondylosis]. Rev Neurol (Paris) 2009; 166:257-61. [PMID: 19386338 DOI: 10.1016/j.neurol.2009.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2008] [Revised: 03/06/2009] [Accepted: 03/24/2009] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Spinal neurosarcoidosis is rare and exceptionally inaugural. OBSERVATION A 49-year-old African woman developed a progressive left Brown-Sequard syndrome. Magnetic resonance imaging (MRI) scans of the cervical spinal cord revealed an intramedullary lesion from C2 to T1 with intense pial enhancement after administration of contrast material associated with cervical spondylosis. The diagnostic of sarcoidosis was confirmed by liver biopsy which demonstrated noncaseating granulomas. CONCLUSIONS MRI features of spinal neurosarcoidosis were reviewed by the authors with focus on differential diagnosis.
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Affiliation(s)
- A Augier
- Service de radiologie, hôpital Avicenne, 125, route de Stalingrad, 93000 Bobigny, France.
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Brauner M, Brillet PY. [Non-small cell lung cancer: evaluation of node and metastatic staging]. Rev Pneumol Clin 2008; 64:245-249. [PMID: 18995154 DOI: 10.1016/j.pneumo.2008.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2008] [Accepted: 07/14/2008] [Indexed: 05/27/2023]
Affiliation(s)
- M Brauner
- Service de radiologie, UFR santé-médecine-biologie humaine, hôpital Avicenne, université Paris-13, AP-HP, 125, route de Stalingrad, 93009 Bobigny cedex, France.
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Woltjer M, Rammer W, Brauner M, Seidl R, Mohren GMJ, Lexer MJ. Coupling a 3D patch model and a rockfall module to assess rockfall protection in mountain forests. J Environ Manage 2008; 87:373-88. [PMID: 17412480 DOI: 10.1016/j.jenvman.2007.01.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2005] [Revised: 12/01/2006] [Accepted: 01/17/2007] [Indexed: 05/14/2023]
Abstract
Many forests in the Alps are acknowledged for protecting objects, such as (rail) roads, against rockfall. However, there is a lack of knowledge on efficient silvicultural strategies and interventions to maintain these forests at optimal protection level. Therefore, assessment tools are required that quantify the rockfall protection effect of forest stands over time, and thereby provide the ability to evaluate the necessity and effect of management interventions. This paper introduces such a tool that consists of a 3D rockfall module embedded in the patch based forest simulator PICUS. The latter is extended for this study with a new regeneration module. In a series of experiments the new combined simulation tool is evaluated with regard to parameter sensitivity, model intercomparison experiments with recently proposed algorithms from the literature, and the ability to respond realistically to different management regimes in rockfall protection forests. Results confirm the potential of the new tool for realistic simulation of rockfall activity in heterogeneous mountain forests, but point at the urgent need to improve the knowledge base on the interaction of understory and rockfall activity. Further work will focus on model validation against empirical rockfall data, and include reduced tree vitality due to damage from boulder collisions as well as the explicit consideration of downed dead wood.
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Affiliation(s)
- M Woltjer
- Institute of Silviculture, Department of Forest and Soil Sciences, University of Natural Resources and Applied Life Sciences, Peter Jordanstrasse 82, 1190 Vienna, Austria
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Augier A, Zrig H, Roqueplan F, Brauner M, Dumas J. Caractéristiques IRM et TDM de la tuberculose de la jonction crânio-vertébrale : à propos de 5 cas. ACTA ACUST UNITED AC 2008; 89:585-9. [DOI: 10.1016/s0221-0363(08)71485-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [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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Abstract
INTRODUCTION Interstitial lung diseases (ILD) in systemic sclerosis (SSc) are mainly encountered in patients with diffuse disease although they may occur less frequently in patients with limited cutaneous disease. BACKGROUND In SSc early detection of ILD should be achieved by high resolution computed tomography and pulmonary function tests, including measurement of DLCO. In total up to 75% of patients with SSc develop ILD but it is progressive in only a minority of patients. Unlike idiopathic ILD, SSc associated ILD corresponds to non-specific interstitial pneumonia rather than usual interstitial pneumonia in the majority of cases. This explains the better prognosis of SSc associated ILD compared with idiopathic ILD. Nevertheless ILD represents one of the two main causes of death in SSc. VIEWPOINT The treatment of SSc associated ILD is not well established. Anti-fibrosing treatments have failed to demonstrate benefit and cyclophosphamide, which has been used for about 15 years in the treatment of this condition, has recently been evaluated in two prospective randomised studies which showed a significant but modest effect on respiratory function. CONCLUSION A subgroup of patients with rapidly progressive ILD might benefit from pulsed intravenous cyclophosphamide combined with prednisone 15 mg daily, but this remains to be confirmed.
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Affiliation(s)
- L Mouthon
- Service de Médecine Interne, Hôpital Cochin, Centre de Référence pour la sclérodermie systémique, Assistance Publique-Hôpitaux de Paris et Université Paris-Descartes, Faculté de Médecine Paris-Descartes, Paris, France.
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Bréchot JM, Kamboucher M, Brauner M, Destable MD, Duperron F, Morère JF. [Pulmonary metastases from endometrial stromal sarcoma may benefit from hormone therapy]. Rev Mal Respir 2007; 24:69-72. [PMID: 17268368 DOI: 10.1016/s0761-8425(07)91014-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Low grade endometrial stromal sarcoma (ESS) often expresses oestrogen (ER) and progesterone (PR) receptors, even in metastatic disease. These receptors may also be hormone dependent. CASE REPORT Two years after the institution of oestrogen replacement therapy (HRT) a woman of 56 presented with haemoptysis which led to the discovery of multiple pulmonary nodules. Twelve years previously the patient had had a hysterectomy for a low grade endometrial stromal sarcoma, ER and PR positive. Surgical resection of the nodules on the right side confirmed the diagnosis of metastatic endometrial stromal sarcoma. The metastases expressed oestrogen and progesterone receptors. Three months after the withdrawal of HRT and treatment with an aromatase inhibitor (letrozole) the contralateral metastases had disappeared and this complete response was maintained for more than 2 years of follow-up. CONCLUSION Care should be taken in the institution of HRT in a woman with a history of low grade ESS. Hormonal treatment with aromatase inhibitors may be considered in cases where ER and PR are expressed by the primary tumour and metastases, with possible benefits even in metastatic disease.
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Affiliation(s)
- J M Bréchot
- Service d'Oncologie Médicale, Hôpital Avicenne, AP-HP, Bobigny, France.
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23
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Abstract
Malignant tumors of the pleura are most often diffuse, nethertheless they are sometimes localized. There is an overlap of the radiologic features of the benign and malignant pleural lesions. The differential diagnosis may be difficult, even on histological sample. Imaging allows the diagnosis of pleural involvement, suggests the malignity, guides percutaneous or thoracoscopic biopsies of the pleura, defines extent of the tumor and follows the course of the disease. We will describe the malignant pleural tumors: pleural metastases, pleural involvement of broncho-pulmonary cancer, of lymphoma and leukaemia. Then the rare pleural tumors will be described: malignant pleural fibroma, sarcoma, histiocytoma and hemangiopericytoma.
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Affiliation(s)
- M Brauner
- Service de Radiologie, Hôpital Avicenne, AP-HP, 125, route de Stalingrad, 93009 Bobigny Cedex, Université de Paris-13, UFR SMBH.
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Beigelman-Aubry C, Brauner M. [Computed tomographic anatomy of the intercostal space and the pleura. Pleural plaques: positive and differential diagnosis]. Rev Pneumol Clin 2006; 62:93-6. [PMID: 16670662 DOI: 10.1016/s0761-8417(06)75422-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Diagnosis of pleural plaques depends on adequate knowledge of the normal anatomy of the pleura and intercostals spaces which is indispensable for understanding the normal computed tomographic images of the thorax and anatomic variants.
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Affiliation(s)
- C Beigelman-Aubry
- Service de Radiologie, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75651 Paris Cedex 13.
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Colombat M, Monnet I, Groussard O, Stern M, Taillé C, Fournier M, Valeyre D, Brauner M, Herson S, Danel C. Une nouvelle cause de maladie kystique du poumon : la maladie des dépôts de chaines légères. Rev Mal Respir 2006. [DOI: 10.1016/s0761-8425(06)72373-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Nunes H, Humbert M, Capron F, Brauner M, Sitbon O, Battesti JP, Simonneau G, Valeyre D. Pulmonary hypertension associated with sarcoidosis: mechanisms, haemodynamics and prognosis. Thorax 2005; 61:68-74. [PMID: 16227329 PMCID: PMC2080703 DOI: 10.1136/thx.2005.042838] [Citation(s) in RCA: 211] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Pulmonary hypertension (PH) is a rare complication of sarcoidosis, although it is not uncommon in advanced disease. METHODS A retrospective series of 22 sarcoidosis patients (16 men) of mean (SD) age 46 (13) years with PH was divided into two groups depending on the absence (stage 0: n = 2, stage II: n = 4, stage III: n = 1) or presence (n = 15) of radiographic pulmonary fibrosis at the time of PH diagnosis. RESULTS In both groups PH was moderate to severe and there was no response to acute vasodilator challenge. In non-fibrotic cases no other cause of PH was found, suggesting a specific sarcoidosis vasculopathy, although no histological specimens were available. In cases with fibrosis there was no correlation between haemodynamics and lung volumes or arterial oxygen tensions, suggesting other mechanisms for PH in addition to pulmonary destruction and hypoxaemia. These included extrinsic arterial compression by lymphadenopathies in three cases and histologically proven pulmonary veno-occlusive disease in the five patients who underwent lung transplantation. Ten patients received high doses of oral prednisone for PH (stage 0: n = 1, stage II: n = 4 and stage IV: n = 5); three patients without pulmonary fibrosis experienced a sustained haemodynamic response. Survival of the overall population was poor (59% at 5 years). Mortality was associated with NYHA functional class IV but not with haemodynamic parameters or with lung function. CONCLUSION Two very different phenotypes of sarcoidosis combined with PH are observed depending on the presence or absence of pulmonary fibrosis. PH is a severe complication of sarcoidosis.
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Affiliation(s)
- H Nunes
- UPRES EA 2363, Service de Pneumologie, Hôpital Avicenne, Assistance Publique-Hôpitaux de Paris, Université Paris 13, 125 rue de Stalingrad, 93009 Bobigny, France.
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27
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Abstract
INTRODUCTION Chronic beryllium disease (CBD) is an occupational lung disease caused by the inhalation of beryllium dust, fumes or metallic salts. CURRENT DATA Beryllium affects the lungs via particles deposited in the pulmonary alveoli. These are ingested by alveolar macrophages which act as antigen presenting cells to CD4+ T lymphocytes. T lymphocytes proliferate in response to beryllium antigens and combined with macrophages produce numerous epithelioid granulomas with the release of inflammatory cytokines (IFNgamma, IL-2, TNFalpha and IL6) and growth factors. Beryllium induces macrophage apoptosis which reduces its clearance from the lung which in turn contributes to the host's continual re-exposure and thus a chronic granulomatous disorder. Pulmonary granulomatous inflammation is the primary manifestation of CBD, but the disease occasionally involves other organs such as the liver, spleen, lymph nodes and bone marrow. The clinical, radiological, and histopathological features of CBD can be difficult to distinguish from sarcoidosis. The Beryllium lymphocyte proliferation test (BeLPT) demonstrates a beryllium specific immune response, confirms the diagnosis of CBD, and excludes sarcoidosis. CONCLUSIONS AND PERSPECTIVES CBD provides a human model of pulmonary granulomatous disease produced by an occupational exposure, occurring more frequently in those with a genetic pre-disposition. It can be differentiated from sarcoidosis by specific immunological testing.
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Affiliation(s)
- S Marchand-Adam
- Service de Pneumologie, Hôpital Avicenne et EA 2363, UFR SMBH, Bobigny, France
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Naccache JM, Kambouchner M, Girard F, Antoine M, Parrot A, Piquet J, Brauner M, Valeyre D. Relapse of respiratory insufficiency one year after organising pneumonia. Eur Respir J 2004; 24:1062-5. [PMID: 15572553 DOI: 10.1183/09031936.04.00000204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- J-M Naccache
- Department of Pulmonary Medicine, Service de Pneumologie, Hôpital Avicenne, 125 route de Stalingrad, 93009, Bobigny, France
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Beigelman C, Brauner M. [What attitude to adopt before the sequellae of tuberculosis are evident on chest x-ray? Before a chest x-ray image, how do you confirm that a disturbance is a tuberculosis sequellae?]. Rev Mal Respir 2004; 21:S60-4. [PMID: 15344269 DOI: 10.1016/s0761-8425(04)71388-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- C Beigelman
- Service de radiologie, GH Pitié Salpêtrière, Paris, France
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Larroche C, Wind P, Brauner M, Zidi S. Les opales portent malheur, c'est bien connu…. Rev Med Interne 2004; 25 Suppl 2:S255-6. [PMID: 15460468 DOI: 10.1016/s0248-8663(04)80021-3] [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] [Indexed: 11/29/2022]
Affiliation(s)
- C Larroche
- Service de médecine interne, hôpital Avicenne, 125, rue de Stalingrad, 93009 Bobigny, France
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31
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Maulat I, Nunes H, Pigné E, Valeyre D, Brauner M. 194 Présentations thoraciques tomodensitométriques rares de la sarcoïdose. Rev Mal Respir 2004. [DOI: 10.1016/s0761-8425(04)71820-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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32
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Mouthon L, Pagnoux C, Mah A, Valeyre D, Brauner M, Guillevin L. Traitement des sclérodermies systémiques gravespar une stratégie associant cyclophosphamide et azathioprine. Rev Med Interne 2003. [DOI: 10.1016/s0248-8663(03)80343-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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33
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Mouthon L, Pagnoux C, Mahr A, Le-Guern V, André M, Garcia de la Pena-Lefebvre P, Valeyre D, Brauner M, Fain O, Guillevin L. Étude des marqueurs pronostiques de la sclérodermiesystémique au sein d'une cohorte de 203 malades. Rev Med Interne 2003. [DOI: 10.1016/s0248-8663(03)80342-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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34
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Charlier C, Hamel B, Kambouchner M, Nunes H, Brauner M, Valeyre D. [Multiple pulmonary nodules with halo sign]. Rev Mal Respir 2003; 20:459-61. [PMID: 12910124] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Affiliation(s)
- C Charlier
- Service de Pneumologie, Hôpital Avicenne, 125 route de Stalingrad, 93009 Bobigny Cedex
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35
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Mouthon L, Valeyre D, Brauner M, André M, Mahr A, Guillevin L. Traitement par mycophénolate mofétil des pneumopathies infiltrantes diffuses de la sclérodermieréfractaires au traitement par cyclophosphamide : Étude pilote sur cinq malades. Rev Med Interne 2002. [DOI: 10.1016/s0248-8663(02)80483-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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36
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Brauner M, Rety F. [Thoracic pseudo-lesions induced by incorrect techniques, optical illusions, and anatomic variations]. JOURNAL DE RADIOLOGIE 2001; 82:1065-6. [PMID: 11686151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
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37
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Brauner M, Rety F. [Thoracic pseudo-lesions induced by inadequate methodology, optical illusions, and anatomical variations]. J Radiol 2001; 82:1056-64. [PMID: 11567194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
False-positive or over-calling of findings at chest radiography may have important consequences by generating numerous and unnecessary examinations. The advances made in thoracic imaging have currently decreased the number of technical errors. However, we are frequently confronted with visual illusions or with failure to recognize anatomical variants, either congenital, age-related or physiological in nature. Other difficulties are due to functional variations. Over-calling depends on the clinical context, which may inadequately suggest an interstitial lung process, abnormalities of the vascularization or of the hila. In this article, several examples of false positives will be illustrated. An explanation for these appearances, based on the underlying etiology, will be provided.
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Affiliation(s)
- M Brauner
- Hôpital Avicenne, 125, route de Stalingrad, 93009 Bobigny Cedex.
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38
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Nunes H, Maurer C, Naccache JM, Girard F, Brauner M, Valeyre D. [Severe pulmonary sarcoidosis]. Ann Med Interne (Paris) 2001; 152:96-102. [PMID: 11357045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
Mediastinal and pulmonary localizations are found in 90% of al patients with sarcoidosis. In half the cases, the disease is not severe and is reversible without treatment. In the other half of cases, early or late respiratory complications can be seen. Early complications include subacute respiratory insufficiency by interstitial lung disease or by bronchial airway obstruction. Among late complications, the most frequent is pulmonary fibrosis. Four computed tomography patterns are found with variable functional impairments and course. Chronic obstructive respiratory insufficiency can be the consequence of specific bronchial lesions or pulmonary fibrosis surrounding proximal bronchi. Cor pulmonale is seen in 5% of cases. Aspergilloma seen in fibroemphysematous lesions can be the cause of major hempoptysis. Respiratory complications account for half of the 5% of deaths due to sarcoidosis. Respiratory complications are most often seen in radiographic stage III and IV disease. Treatments, mainly corticosteroids, only exert a suspensive effect but reduce the incidence and severity of respiratory manifestations. The gain obtained by treatment depends on the choice of the best time of institution and on the quality of monitoring. Lung transplantation is useful in most severe cases unresponsive to medical treatment.
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Affiliation(s)
- H Nunes
- Fédération des Maladies Respiratoires et Thoraciques de l'Adulte, Hôpital Avicenne, 125, rue de Stalingrad, 93009 Bobigny
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39
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Brauner M, Attali P, Dumas JL, Valeyre D. [Value of imaging in sarcoidosis]. Ann Med Interne (Paris) 2001; 152:39-44. [PMID: 11240425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Imaging plays an important role in identifying thoracic, abdominal and neurological localizations of sarcoidosis as well as ENT and bone localizations. It contributes to disease detection and is helpful for diagnostic, prognostic and therapeutic decision making and useful for therapeutic monitoring. The chest x-ray is particularly important in the initial work-up and to follow well-tolerated disease. Other investigations, depending on the localization, are helpful to follow the course of severe or chronic sarcoidosis.
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Affiliation(s)
- M Brauner
- Service de Radiologie, Fédération MARTHA, UFR Bobigny, Université Paris, Assistance Publique-Hôpitaux de Paris, Bobigny
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40
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Valeyre D, Brauner M, Cadranel J. [Diagnostic approach in diffuse infiltrative lung diseases]. Rev Prat 2000; 50:1879-87. [PMID: 11151328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Infiltrative lung diseases (ILD) include more than 130 diseases. Chronic and acute forms of ILD must be differentiated. In each group, cases with a known cause or with an unknown cause have to be individualized. For the physician, the distinctive sign of ILD is the evidence of diffuse pulmonary opacities on chest X rays or a suggestive pattern on pulmonary function tests. The diagnosis of chronic ILD depends on epidemiologic data ("a priori" probabilities), anamnestic informations, clinical and radiological (radiography and tomodensitometry) findings which make possible to consider a diagnosis of high probability in at least 60% of cases and reduce the gamut of hypothesis in the others. Other investigations (blood, endoscopy, broncho-alveolar lavage and sometimes surgical lung biopsy) lead to the final diagnosis. Most frequent chronic ILD are sarcoidosis, idiopathic pulmonary fibrosis and connective disease associated ILD. In case of acute ILD, diagnostic procedures depend on the severity of the disease and symptomatic treatment is urgent. The main lung lesion is either oedema or alveolitis. Main acute ILD are respectively cardiogenic oedema, lesional oedema, intra-alveolar hemorrhage, infectious ILD and acute eosinophilic pneumonia. The diagnostic approach depends on the presence of an initial orientation. Sometimes, several causes are associated.
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Affiliation(s)
- D Valeyre
- Service de pneumologie, Fédération des maladies respiratoires et thoraciques de l'adulte CHU Avicenne et UPRES EA 2363 UFR SMBH 93009 Bobigny.
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Soler P, Bergeron A, Kambouchner M, Groussard O, Brauner M, Grenier P, Crestani B, Mal H, Tazi A, Battesti JP, Loiseau P, Valeyre D. Is high-resolution computed tomography a reliable tool to predict the histopathological activity of pulmonary Langerhans cell histiocytosis? Am J Respir Crit Care Med 2000; 162:264-70. [PMID: 10903252 DOI: 10.1164/ajrccm.162.1.9906010] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
High-resolution computed tomography (HRCT) has proved to be very useful in the diagnosis and follow-up of pulmonary Langerhans cell histiocytosis (PLCH), but the precise relationships between nodules and thin-wall cysts observed by HRCT, and granulomatous or cystic lesions present in lung tissue, remain to be established. The aim of this study was to compare quantitative data obtained by HRCT and those obtained by histopathological examination of corresponding lung tissue specimens in patients with biopsy-proven PLCH. The results demonstrated that the extent of nodular abnormalities was strongly correlated with the density of florid granulomatous lesions in lung tissue. A strong correlation was also found between the extent of cystic abnormalities and the density of cavitary lesions, but the latter included both still inflammatory cavitary granulomas and cicatricial fibrous cysts. Interestingly, small isolated florid granulomas were found in lung tissue from most patients with a predominant cystic CT scan pattern. Taken together, these results demonstrate that HRCT has to be considered with caution to evaluate the histopathological activity of PLCH. Patients presenting with predominant HRCT cystic abnormalities should benefit from a long-term follow-up. Because these patients are susceptible to developing severe respiratory insufficiency, they should also be considered for treatment as soon as an effective therapy for LCH is available.
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Affiliation(s)
- P Soler
- INSERM U 408, UFR Xavier Bichat, Paris, France; Fédération des Maladies Respiratoires et Thoraciques, Hôpital Avicenne, AP-HP, Bobigny, France
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Dumas JL, Valeyre D, Chapelon-Abric C, Belin C, Piette JC, Tandjaoui-Lambiotte H, Brauner M, Goldlust D. Central nervous system sarcoidosis: follow-up at MR imaging during steroid therapy. Radiology 2000; 214:411-20. [PMID: 10671588 DOI: 10.1148/radiology.214.2.r00fe05411] [Citation(s) in RCA: 89] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To document the changes observed at sequential magnetic resonance (MR) imaging of sarcoidosis lesions of the central nervous system (CNS) during treatment with corticosteroids. MATERIALS AND METHODS The abnormalities detected in 24 patients (mean follow-up, 36 months) were compared before and after therapeutic periods (n = 75) that were divided into attack (high-dose), upkeep (decreased-dose), and minimal (low-dose) periods. Parenchymal lesions were classified as type 1 (enhanced with gadolinium), type 2 (demyelinating), or type 3 (lacunar) and were assessed as regressing, stable, or progressing. RESULTS Seven of the 24 patients had several types of lesions. Isolated type 3 lesions (six patients) were the only lesions not associated with neurologic deficit. Type 1 lesions (13 patients) regressed in 22 of 22 attack periods and progressed in nine of 27 upkeep and minimal periods. MR imaging depicted relapses in patients with multifocal CNS involvement or long-standing CNS impairment or in those who had previously received steroid therapy. Type 2 (seven patients) and type 3 (13 patients) lesions remained stable in 68 of 68 therapeutic periods. Type 1 lesions appeared in three patients with type 2 and type 3 lesions during two upkeep and three minimal periods. Findings at follow-up MR imaging contributed to the reintroduction of high-dose corticosteroid therapy in eight patients. CONCLUSION MR imaging can be used to differentiate between reversible and irreversible lesions in CNS sarcoidosis. MR imaging can be a useful tool for adjusting treatment to prevent irreversible CNS damage.
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Affiliation(s)
- J L Dumas
- Department of Radiology, Hôpital Avicenne, 125 route de Stalingrad, 93009 Bobigny, France
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Abstract
Tuberculosis (TB) remains a common disease in the World. Its incidence has risen steadily since 1985, despite a preexisting continuous decreasing of its frequency due to an effective chemotherapy. Nonwhite people, socioeconomically disadvantaged, chronically debilitated groups and AIDS patients are the most concerned. Chest radiography remains the first imaging modality to evaluate TB. Widely radiographic appearances can be encountered, including normal chest X-ray. CT can be useful in all stages of the disease, particularly when clinical and radiological findings are in disagreement and/or when imaging findings are equivocal. CT should be proposed at the end of an effective antituberculous treatment to better subsequently detect fine lesions suggestive of reactivation TB.
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Affiliation(s)
- C Beigelman
- Department of Radiology, Groupe Hospitalier Pitié Salpêtrière, Paris, France
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44
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Abstract
STUDY OBJECTIVE Airway obstruction (AO) in sarcoidosis is reported to be associated with respiratory symptoms, increased morbidity, and an increased mortality risk. Because AO in sarcoidosis may result from several causes, the therapeutic benefit of corticosteroids is difficult to determine. The aim of this study was to evaluate the therapeutic response of AO attributable to sarcoid granulomas in the bronchial wall. PATIENTS We selected 11 patients who had sarcoidosis with AO (defined as FEV(1)/vital capacity [VC] < 70%) associated with sarcoid granulomas on an endobronchial biopsy. Exclusion criteria were history of asthma, smoker or ex-smoker, stage 4 disease, evidence of extrinsic compression by enlarged lymph nodes, and localized endobronchial stenosis seen during fiberoptic bronchoscopy. INTERVENTIONS We compared the results of pulmonary function tests and clinical, radiologic, and biological findings at baseline with those obtained at the time of the last pulmonary function tests available, between the sixth and 12th months of treatment. Eight patients took oral corticosteroids (20 to 60 mg/d initially), one received IV methylprednisolone pulses, another took oral hydroxychloroquine, and the last one received IM methotrexate. MEASUREMENTS AND RESULTS With treatment, FEV(1) and FEV(1)/VC significantly improved in eight patients (72%), normalized in four patients, and was unchanged in the remaining three patients. The mean FEV(1) increased from 60.8 +/- 10.8% to 76 +/- 13.7% of the predicted value (p < 0.02). VC did not change significantly. FEV(1)/VC increased from 76.1 +/- 6.4% to 87.6 +/- 10.7% of the predicted value (p < 0.01). Dyspnea on exertion and other clinical findings were attenuated in 10 patients; the chest radiograph improved in 9 patients, and normalized in 5 patients. The mean serum angiotensin-converting enzyme level decreased from 112 +/- 48 to 58 +/- 40 IU/mL (p < 0.05), and normalized in four patients. CONCLUSION The present study indicates that AO caused by sarcoid granulomas in the bronchial wall can be either partially or completely reversed by treatment with a concomitant attenuation of pulmonary symptoms.
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Affiliation(s)
- F Lavergne
- Service de Pneumologie, Hôpital Avicenne (Assistance Publique-Hôpitaux de Paris), UFR Bobigny, Bobigny, France
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45
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Affiliation(s)
- V Bousson
- Hôpital Saint-Antoine, Paris, France
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46
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Grenier P, Brauner M, Valeyre D. Computed tomography in the assessment of diffuse lung disease. Sarcoidosis Vasc Diffuse Lung Dis 1999; 16:47-56. [PMID: 10207941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Computed tomography (CT) has a significant impact on the evaluation of patients suspected of having diffuse lung disease. The technique is based on thin-section scans and high-resolution reconstruction. CT interpretation is based on a recognition of the main pattern, associated findings, and distribution of the lesions assessed at the regional level as well as the level of the secondary pulmonary lobule. CT may demonstrate clinically suspected abnormalities undetected on the radiographs. It may have characteristic pictures in patients with non specific findings on the radiograph. It can be used to limit the differential diagnosis to a few possibilities. In selected cases, in the presence of the appropriate clinical setting, CT appearances can be diagnostic or so strongly suggestive that lung biopsy can be avoided. When a lung biopsy is indicated, CT has a considerable value in determining the most appropriate site for the biopsy. To a certain extent, CT may also provide information on disease activity and prognosis, particularly in the differentiation between inflammatory changes, potentially treatable or reversible, and irreversible lung fibrosis.
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Affiliation(s)
- P Grenier
- Service de Radiologie Polyvalente Diagnostique et Interventionnelle Groupe Hospitalier Pitié-Salpêtrière, Paris, France
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Pommer W, Brauner M, Westphale HJ, Brunkhorst R, Krämer R, Bundschu D, Höffken B, Steinhauer HB, Schümann E, Lüttgen FM, Schillinger-Pokorny E, Schaefer F, Wende R, Offner G, Näther S, Osten B, Zimmering M, Ehrich JH, Kehn M, Mansmann U, Grosse-Siestrup C. Effect of a silver device in preventing catheter-related infections in peritoneal dialysis patients: silver ring prophylaxis at the catheter exit study. Am J Kidney Dis 1998; 32:752-60. [PMID: 9820444 DOI: 10.1016/s0272-6386(98)70130-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Catheter-related infections remain a significant cause of method failure in chronic peritoneal dialysis (PD) therapy. Given the increasing antibiotic resistance, such nonpharmacological strategies as local silver devices attract more interest. To establish whether a silver ring device (designed by Grosse-Siestrup in 1992) mounted onto the PD catheter and placed at the exit site at skin level is effective in preventing exit-site and other catheter-related infections, a prospective 12-month, multicenter, controlled study stratified by diabetes status was conducted. The study subjects were assessed by an extensive structured inventory, including a broad spectrum of control variables, such as age, body mass index (BMI), Staphylococcus aureus carrier status, catheter features, mode and quality of PD therapy, comorbidity, and psychosocial rehabilitation. Ten experienced German outpatient dialysis centers (seven adult, three pediatric) participated in the trial. All eligible patients (n=195) from the study area without catheter-related infections during the ascertainment period were included (incidental subjects undergoing PD therapy for at least 3 months). The main outcome measures were the occurrence of first exit-site infections (primary study end point), sinus tract/tunnel infection, and peritonitis. Ninety-seven patients were assigned to the silver ring and 98 patients to the control group. Baseline characteristics of age, sex, proportion of pediatric and incidental patients, S aureus carrier status, and other variables were similar in both groups. The incidence of infections in the silver ring group versus the control group was as follows: 23 of 97 versus 16 of 98 patients had exit-site infections, 12 of 97 versus 12 of 98 patients had sinus tract/tunnel infections, 16 of 97 versus 18 of 98 patients had peritonitis, respectively. Kaplan-Meier analysis for the probability of an infection-free interval showed no statistical difference (log-rank test) between the two groups. Displacement of the silver ring contributed to study termination in 6% of the study group patients, including two patients with catheter loss. Univariate analysis and multiple logistic regression identified younger age (<50 years), low serum albumin level (<35 g/L), number of previously placed PD catheters, short cuff-exit distance (<2 cm), and S aureus nasal carriage as risk factors for the development of exit-site infections. In conclusion, our study does not show any benefit of the silver ring in preventing catheter-related infections in PD patients. Thus, prevention of infection-related method failure in PD still has to rely on conventional antibiotic treatment strategies and less so on alternative methods.
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Affiliation(s)
- W Pommer
- Department of Nephrology/Hypertension, Humboldt Hospital, Berlin, Germany.
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Guillevin L, Brauner M. Magnetic resonance imaging of ureter stenosis in Wegener's granulomatosis. Ann Med Interne (Paris) 1998; 149:287. [PMID: 9791562] [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] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Affiliation(s)
- L Guillevin
- Service de Médecine Interne, Hôpital Avicenne, Université Paris-Nord, Bobigny
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Valeyre D, Cadranel J, Brauner M. [Diffuse interstitial pneumopathy. Etiology and diagnosis]. Rev Prat 1998; 48:1003-9. [PMID: 11767342] [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] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Affiliation(s)
- D Valeyre
- Service de pneumologie, hôpital Avicenne, route de Stalingrad, 93009 Bobigny
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