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Gampenrieder SP, Dezentjé V, Lambertini M, de Nonneville A, Marhold M, Le Du F, Cortés Salgado A, Alpuim Costa D, Vaz Batista M, Chic Ruché N, Tinchon C, Petzer A, Blondeaux E, Del Mastro L, Targato G, Bertucci F, Gonçalves A, Viret F, Bartsch R, Mannsbart C, Deleuze A, Robert L, Saavedra Serrano C, Gion Cortés M, Sampaio-Alves M, Vitorino M, Pecen L, Singer C, Harbeck N, Rinnerthaler G, Greil R. Influence of HER2 expression on prognosis in metastatic triple-negative breast cancer-results from an international, multicenter analysis coordinated by the AGMT Study Group. ESMO Open 2023; 8:100747. [PMID: 36563519 PMCID: PMC10024122 DOI: 10.1016/j.esmoop.2022.100747] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 11/16/2022] [Accepted: 11/22/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Triple-negative breast cancer (TNBC) is associated with poor prognosis, and new treatment options are urgently needed. About 34%-39% of primary TNBCs show a low expression of human epidermal growth factor receptor 2 (HER2-low), which is a target for new anti-HER2 drugs. However, little is known about the frequency and the prognostic value of HER2-low in metastatic TNBC. PATIENTS AND METHODS We retrospectively included patients with TNBC from five European countries for this international, multicenter analysis. Triple-negativity had to be shown in a metastatic site or in the primary breast tumor diagnosed simultaneously or within 3 years before metastatic disease. HER2-low was defined as immunohistochemically (IHC) 1+ or 2+ without ERBB2 gene amplification. Survival probabilities were calculated by the Kaplan-Meier method, and multivariable hazard ratios (HRs) were estimated by Cox regression models. RESULTS In total, 691 patients, diagnosed between January 2006 and February 2021, were assessable. The incidence of HER2-low was 32.0% [95% confidence interval (CI) 28.5% to 35.5%], with similar proportions in metastases (n = 265; 29.8%) and primary tumors (n = 425; 33.4%; P = 0.324). The median overall survival (OS) in HER2-low and HER2-0 TNBC was 18.6 and 16.1 months, respectively (HR 1.00; 95% CI 0.83-1.19; P = 0.969). Similarly, in multivariable analysis, HER2-low had no significant impact on OS (HR 0.95; 95% CI 0.79-1.13; P = 0.545). No difference in prognosis was observed between HER2 IHC 0/1+ and IHC 2+ tumors (HR 0.89; 95% CI 0.69-1.17; P = 0.414). CONCLUSIONS In this large international dataset of metastatic TNBC, the frequency of HER2-low was 32.0%. Neither in univariable nor in multivariable analysis HER2-low showed any influence on OS.
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Affiliation(s)
- S P Gampenrieder
- Salzburg Cancer Research Institute- Center for Clinical Cancer and Immunology Trials, Salzburg, Austria; Cancer Cluster Salzburg, Salzburg, Austria; IIIrd Medical Department with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - V Dezentjé
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - M Lambertini
- Medical Oncology Department, U.O.C. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino Genova, Genova, Italy; Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, Università di Genova, Genova, Italy
| | - A de Nonneville
- Department of Medical Oncology, Institut Paoli-Calmettes, Aix-Marseille Univ, CNRS, INSERM, Marseille, France
| | - M Marhold
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - F Le Du
- Département d'oncologie médicale, Centre Eugène-Marquis, Rennes, France
| | - A Cortés Salgado
- Medical Oncology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - D Alpuim Costa
- Haematology and Oncology Department, CUF Oncologia, Lisbon, Portugal; NOVA Medical School, (NMS), Faculdade de Ciências Médicas (FCM), Lisbon, Portugal; Centro de Medicina Subaquática e Hiperbárica (CMSH), Marinha Portuguesa, Lisbon, Portugal
| | - M Vaz Batista
- Oncology Department, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - N Chic Ruché
- Department of Medical Oncology, Hospital Clínic Barcelona, Barcelona, Spain
| | - C Tinchon
- Department for Haemato-Oncology, LKH Hochsteiermark-Leoben, Leoben, Austria
| | - A Petzer
- Internal Medicine I for Hematology with Stem Cell Transplantation, Hemostaseology and Medical Oncology, Ordensklinikum Linz Barmherzige Schwestern-Elisabethinen, Linz, Austria
| | - E Blondeaux
- U.O. Epidemiology Unit, IRCCS Ospedale Policlinico San Martino Genova, Genova, Italy
| | - L Del Mastro
- Medical Oncology Department, U.O.C. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino Genova, Genova, Italy; Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, Università di Genova, Genova, Italy
| | - G Targato
- Dipartimento di Oncologia, Ospedale Santa Maria della Misericordia di Udine, Udine, Italy
| | - F Bertucci
- Department of Medical Oncology, Institut Paoli-Calmettes, Aix-Marseille Univ, CNRS, INSERM, Marseille, France
| | - A Gonçalves
- Department of Medical Oncology, Institut Paoli-Calmettes, Aix-Marseille Univ, CNRS, INSERM, Marseille, France
| | - F Viret
- Department of Medical Oncology, Institut Paoli-Calmettes, Aix-Marseille Univ, CNRS, INSERM, Marseille, France
| | - R Bartsch
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - C Mannsbart
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - A Deleuze
- Département d'oncologie médicale, Centre Eugène-Marquis, Rennes, France
| | - L Robert
- Département d'oncologie médicale, Centre Eugène-Marquis, Rennes, France
| | - C Saavedra Serrano
- Medical Oncology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - M Gion Cortés
- Medical Oncology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - M Sampaio-Alves
- Faculdade de Medicina, Universidade do Porto (FMUP), Oporto, Portugal
| | - M Vitorino
- Oncology Department, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - L Pecen
- Institute of Computer Science, Czech Academy of Sciences, Praha, Czech Republic; Faculty of Medicine in Pilsen - Charles University, Pilsen, Czech Republic
| | - C Singer
- Department of Obstetrics and Gynecology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - N Harbeck
- Breast Center, Department of Gynecology and Obstetrics, Comprehensive Cancer Center of the Ludwig-Maximilians-University, Munich, Germany
| | - G Rinnerthaler
- Salzburg Cancer Research Institute- Center for Clinical Cancer and Immunology Trials, Salzburg, Austria; Cancer Cluster Salzburg, Salzburg, Austria; IIIrd Medical Department with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - R Greil
- Salzburg Cancer Research Institute- Center for Clinical Cancer and Immunology Trials, Salzburg, Austria; Cancer Cluster Salzburg, Salzburg, Austria; IIIrd Medical Department with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria.
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Guerin M, Miran C, Colomba E, Cabart M, Herrmann T, Pericart S, Maillet D, Neuzillet Y, Deleuze A, Coquan E, Laramas M, Thibault C, Abbar B, Mesnard B, Borchiellini D, Dumont C, Boughalem E, Deville JL, Cancel M, Saldana C, Khalil A, Baciarello G, Flechon A, Walz J, Gravis G. Urachal carcinoma: a large retrospective multicentric study from the French Genito-Urinary Tumor Group. Front Oncol 2023; 13:1110003. [PMID: 36741023 PMCID: PMC9892758 DOI: 10.3389/fonc.2023.1110003] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 01/06/2023] [Indexed: 01/20/2023] Open
Abstract
Introduction Urachal cancer (UrC) is a rare, non-urothelial malignancy. Its natural history and management are poorly understood. Although localized to the bladder dome, the most common histological subtype of UrC is adenocarcinoma. UrC develops from an embryonic remnant, and is frequently diagnosed in advanced stage with poor prognosis. The treatment is not standardized, and based only on case reports and small series. This large retrospective multicentric study was conducted by the French Genito-Urinary Tumor Group to gain a better understanding of UrC. Material and Methods data has been collected retrospectively on 97 patients treated at 22 French Cancer Centers between 1996 and 2020. Results The median follow-up was 59 months (range 44-96). The median age at diagnosis was 53 years (range 20-86), 45% were females and 23% had tobacco exposure. For patients with localized disease (Mayo I-II, n=46) and with lymph-node invasion (Mayo III, n=13) median progression-free-survival (mPFS) was 31 months (95% CI: 20-67) and 7 months (95% CI: 6-not reached (NR)), and median overall survival (mOS) was 73 months (95% CI: 57-NR) and 22 months (95% CI: 21-NR) respectively. For 45 patients with Mayo I-III had secondary metastatic progression, and 20 patients were metastatic at diagnosis. Metastatic localization was peritoneal for 54% of patients. Most patients with localized tumor were treated with partial cystectomy, with mPFS of 20 months (95% CI: 14-49), and only 12 patients received adjuvant therapy. Metastatic patients (Mayo IV) had a mOS of 23 months (95% CI: 19-33) and 69% received a platin-fluorouracil combination treatment. Conclusion UrC is a rare tumor of the bladder where patients are younger with a higher number of females, and a lower tobacco exposure than in standard urothelial carcinoma. For localized tumor, partial cystectomy is recommended. The mOS and mPFS were low, notably for patients with lymph node invasion. For metastatic patients the prognosis is poor and standard therapy is not well-defined. Further clinical and biological knowledge are needed.
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Affiliation(s)
- M. Guerin
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France,*Correspondence: M. Guerin,
| | - C. Miran
- Department of Medical Oncology, Centre Leon-Berard, Lyon, France
| | - E. Colomba
- Department of Cancer Medicine, Institut Gustave-Roussy, University of Paris Saclay, Villejuif, France
| | - M. Cabart
- Department of Medical Oncology, Institut Bergonie, Bordeaux, France
| | - T. Herrmann
- Department of Medical Oncology, Centre Jean-Perrin, Clermont-Ferrand, France
| | - S. Pericart
- Department of Anatomo-pathology, Institut Universitaire du Cancer, Centre Hospital-Universitaire de Toulouse, Toulouse, France
| | - D. Maillet
- Department of Medical Oncology, Centre hospitalo-Universitaire Hospices civils, Lyon, France
| | - Y. Neuzillet
- Department of Urology, Hopital Foch, Paris, France
| | - A. Deleuze
- Department of Medical Oncology, Centre Eugene Marquis, Rennes, France
| | - E. Coquan
- Department of Medical Oncology, Centre François Baclesse, Caen, France
| | - M. Laramas
- Department of Medical Oncology, Centre Hospitalo-Universitaire, Grenoble, France
| | - C. Thibault
- Department of Medical Oncology, Hopital Europeen Georges Pompidou, Paris, France
| | - B. Abbar
- Department of Medical Oncology, Hopital Pitié-Salpetriere, Paris, France
| | - B. Mesnard
- Department of Urology, Centre Hospitalo-Universitaire, Nantes, France
| | - D. Borchiellini
- Department of Medical Oncology, Centre Lacassagne, Nice, France
| | - C. Dumont
- Department of Medical Oncology, Hopital Saint-Louis, Paris, France
| | - E. Boughalem
- Department of Medical Oncology, Centre Paul Papin, Angers, France
| | - JL. Deville
- Department of Medical Oncology, Centre Hospitalo-Universitaire Timone, Marseille, France
| | - M. Cancel
- Department of Medical Oncology, Centre Hospitalo-Universitaire Bretonneau, Tours, France
| | - C. Saldana
- Department of Medical Oncology, Hopital Henri Mondor, Paris, France
| | - A. Khalil
- Department of Medical Oncology, Hopital tenon, Paris, France
| | - G. Baciarello
- Department of Cancer Medicine, Institut Gustave-Roussy, University of Paris Saclay, Villejuif, France
| | - A. Flechon
- Department of Medical Oncology, Centre Leon-Berard, Lyon, France
| | - J. Walz
- Department of Urology, Institut Paoli-Calmettes, Marseille, France
| | - G. Gravis
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
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Gampenrieder S, Dezentjé V, Lambertini M, de Nonneville A, Marhold M, Le Du F, Saavedra Serrano C, Alpuim Costa D, Blondeaux E, Del Mastro L, Bertucci F, Gonçalves A, Bartsch R, Deleuze A, Cortés Salgado A, Vitorino M, Tinchon C, Pecen L, Rinnerthaler G, Greil R. 177P Low HER2 expression does not influence prognosis in metastatic triple-negative breast cancer: Results from an international, multicenter analysis coordinated by the Austrian Group Medical Tumor Therapy (AGMT). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.03.196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Guerin M, Colomba-Blameble E, Miran C, Herrmann T, Pericart S, Maillet D, Neuzillet Y, Deleuze A, Thibault C, Coquan E, Dumont C, Boughalem E, Borchiellini D, Mesnard B, Khalil A, Baciarello G, Fléchon A, Walz J, Gravis G. 788P Urachal carcinoma: Large retrospective multicentric GETUG-AFU study. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.860] [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] Open
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Baty M, Créhange G, Pasquier D, Palard X, Deleuze A, Gnep K, Key S, Beuzit L, Castelli J, de Crevoisier R. Salvage reirradiation for local prostate cancer recurrence after radiation therapy. For who? When? How? Cancer Radiother 2019; 23:541-558. [PMID: 31421999 DOI: 10.1016/j.canrad.2019.07.125] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 07/03/2019] [Indexed: 12/22/2022]
Abstract
PURPOSE Literature review reporting results of salvage brachytherapy and stereotactic body radiotherapy for prostate recurrence only after radiotherapy for prostate cancer. MATERIALS AND METHODS A total of 38 studies (including at least 15 patients per study) were analysed: 19 using low-dose-rate brachytherapy, nine high-dose-rate brachytherapy and ten stereotactic body radiotherapy. Only five studies were prospective. The median numbers of patients were 30 for low-dose-rate brachytherapy, 34 for high-dose-rate brachytherapy, and 30 for stereotactic body radiotherapy. The median follow-up were 47months for low-dose-rate brachytherapy, 36months for high-dose-rate brachytherapy and 21months for stereotactic body radiotherapy. RESULTS Late genitourinary toxicity rates ranged, for grade 2: from 4 to 42% for low-dose-rate brachytherapy, from 7 to 54% for high-dose-rate brachytherapy and from 3 to 20% for stereotactic body radiotherapy, and for grade 3 or above: from 0 to 24% for low-dose-rate brachytherapy, from 0 to 13% for high-dose-rate brachytherapy and from 0 to 3% for grade 3 or above (except 12% in one study) for stereotactic body radiotherapy. Late gastrointestinal toxicity rates ranged, for grade 2: from 0 to 6% for low-dose-rate brachytherapy, from 0 to 14% for high-dose-rate brachytherapy and from 0 to 11% for stereotactic body radiotherapy, and for grade 3 or above: from 0 to 6% for low-dose-rate brachytherapy, and from 0 to 1% for high-dose-rate brachytherapy and stereotactic body radiotherapy. The 5-year biochemical disease-free survival rates ranged from 20 to 77% for low-dose-rate brachytherapy and from 51 to 68% for high-dose-rate brachytherapy. The 2- and 3-year disease-free survival rates ranged from 40 to 82% for stereotactic body radiotherapy. Prognostic factors of biochemical recurrence have been identified. CONCLUSION Despite a lack of prospective data, salvage reirradiation for prostate cancer recurrence can be proposed to highly selected patients and tumours. Prospective comparative studies are needed.
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Affiliation(s)
- M Baty
- Department of radiotherapy, centre Eugène-Marquis, 3, avenue de la Bataille-Flandres-Dunkerque, 35000 Rennes, France
| | - G Créhange
- Department of radiotherapy, centre Georges-François-Leclerc, 1, rue du Professeur-Marion, 21000 Dijon, France
| | - D Pasquier
- Department of radiation oncology, centre Oscar-Lambret, 3, avenue Frédéric-Combemale, 59020 Lille, France
| | - X Palard
- Department of nuclear medicine, centre Eugène-Marquis, 3, avenue de la Bataille-Flandres-Dunkerque, 35000 Rennes, France
| | - A Deleuze
- Department of oncology, centre Eugène-Marquis, 3, avenue de la Bataille-Flandres-Dunkerque, 35000 Rennes, France
| | - K Gnep
- Department of radiotherapy, centre Eugène-Marquis, 3, avenue de la Bataille-Flandres-Dunkerque, 35000 Rennes, France
| | - S Key
- Department of radiotherapy, centre Eugène-Marquis, 3, avenue de la Bataille-Flandres-Dunkerque, 35000 Rennes, France
| | - L Beuzit
- Department of radiology, CHU de Rennes, 35000 Rennes, France
| | - J Castelli
- Department of radiotherapy, centre Eugène-Marquis, 3, avenue de la Bataille-Flandres-Dunkerque, 35000 Rennes, France; LTSI, Inserm U1099, 35042 Rennes, France; Université Rennes 1, 35042 Rennes, France
| | - R de Crevoisier
- Department of radiotherapy, centre Eugène-Marquis, 3, avenue de la Bataille-Flandres-Dunkerque, 35000 Rennes, France; LTSI, Inserm U1099, 35042 Rennes, France; Université Rennes 1, 35042 Rennes, France.
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Borie F, Mathonnet M, Deleuze A, Millat B, Gravié JF, Johanet H, Lesage JP, Gugenheim J. Risk management for surgical energy-driven devices used in the operating room. J Visc Surg 2018; 155:259-264. [PMID: 29289460 DOI: 10.1016/j.jviscsurg.2017.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Complications related to energy sources in the operating room are not well-recognized or published, despite occasionally dramatic consequences for the patient and the responsible surgeon. The goal of this study was to evaluate the risks and consequences related to use of energy sources in the operating room. PATIENTS AND METHODS Between 2009 and 2015, 876 adverse events related to health care (AERHC) linked to energy sources in the operating room were declared in the French experience feedback data base "REX". We performed a descriptive analysis of these AERHC and analyzed the root causes of these events and of the indications for non-elective repeat operations, for each energy source. RESULTS Five different energy sources were used, producing 876 declared AERHC: monopolar electrocoagulation: 614 (70%) AERHC, advanced bipolar coagulation (thermofusion): 137 (16%) AERHC, ultrasonic devices: 69 (8%) AERHC, traditional bipolar electrocoagulation: 32 AERHC, and cold light: 24 AERHC. The adverse events reported were skin burns (27.5% of AERHC), insulation defects (16% of AERHC), visceral burns or perforation (30% of AERHC), fires (11% of AERHC), bleeding (7.5% of AERHC) and misuse or miscellaneous causes (8% of AERHC). For the five energy sources, the root causes were essentially misuse, imperfect training and/or cost-related reasons regarding equipment purchase or maintenance. One hundred and forty-six non-elective procedures (17% of AERHC) were performed for complications related to the use of energy sources in the operating room. CONCLUSION This study illustrates the risks related to the use of energy sources on the OR and their consequences. Most cases were related to persistent misunderstanding of appropriate usage within the medical and paramedical teams, but complications are also related to administrative decisions concerning the purchase and maintenance of these devices.
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Affiliation(s)
- F Borie
- Fédération de chirurgie viscérale et digestive (FCVD), 6, rue Pétrarque, 31000 Toulouse, France.
| | - M Mathonnet
- Fédération de chirurgie viscérale et digestive (FCVD), 6, rue Pétrarque, 31000 Toulouse, France
| | - A Deleuze
- Fédération de chirurgie viscérale et digestive (FCVD), 6, rue Pétrarque, 31000 Toulouse, France
| | - B Millat
- Fédération de chirurgie viscérale et digestive (FCVD), 6, rue Pétrarque, 31000 Toulouse, France
| | - J-F Gravié
- Fédération de chirurgie viscérale et digestive (FCVD), 6, rue Pétrarque, 31000 Toulouse, France
| | - H Johanet
- Fédération de chirurgie viscérale et digestive (FCVD), 6, rue Pétrarque, 31000 Toulouse, France
| | - J-P Lesage
- Fédération de chirurgie viscérale et digestive (FCVD), 6, rue Pétrarque, 31000 Toulouse, France
| | - J Gugenheim
- Fédération de chirurgie viscérale et digestive (FCVD), 6, rue Pétrarque, 31000 Toulouse, France
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Affiliation(s)
- A Deleuze
- Département d'Anesthésie-Réanimation, Clinique de l'Espérance, Groupe A.-Tzanck, 122, avenue du Docteur-M.-Donat, 06250 Mougins, France.
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Gentili ME, Deleuze A, Paqueron X. [Infraclavicular block]. Ann Fr Anesth Reanim 2006; 25:229-32. [PMID: 16356679 DOI: 10.1016/j.annfar.2005.11.003] [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] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Affiliation(s)
- M E Gentili
- Département d'Anesthésie-Réanimation, ACHP Saint-Grégoire, 35760 Saint-Grégoire, France.
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Affiliation(s)
- A Deleuze
- Département d'anesthésie-réanimation, clinique de l'Espérance, Groupe A Tzanck, 122, avenue du Dr-M.-Donat, 06250 Mougins, France.
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Gentili M, Deleuze A. [Spinal anesthesia and ambulatory surgery]. Ann Fr Anesth Reanim 2004; 23:443-5. [PMID: 15120799 DOI: 10.1016/j.annfar.2004.02.043] [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] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Affiliation(s)
- M Gentili
- Polyclinique Saint-Vincent, Saint Grégoire, France.
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Lamonerie L, Marret E, Deleuze A, Lembert N, Dupont M, Bonnet F. Prevalence of postoperative bladder distension and urinary retention detected by ultrasound measurement. Br J Anaesth 2004; 92:544-6. [PMID: 14977795 DOI: 10.1093/bja/aeh099] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Postoperative bladder distension and urinary retention are commonly underestimated. Ultrasound enables accurate measurement of bladder volume and thus makes it possible to determine the prevalence of postoperative bladder distension. METHODS Using ultrasound, we measured the volume of the bladder contents at the time of discharge from the recovery room in 177 adult patients who had undergone thoracic, vascular, abdominal, orthopaedic or ENT surgery. RESULTS Forty-four per cent of the patients had a bladder volume >500 ml and 54% of the 44%, who had no symptoms of bladder distension, were unable to void spontaneously within 30 min. The risk factors for urinary retention were age >60 yr (odds ratio (OR) 2.11, 95% confidence interval (CI) 1.01-4.38), spinal anaesthesia (OR 3.97, 95% CI 1.32-11.89) and duration of surgery >120 min (OR 3.03, 95% CI 1.39-6.61). CONCLUSION Before discharge from the recovery room it seems worthwhile to systematically check the bladder volume with a portable ultrasound device in patients with risk factors.
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Affiliation(s)
- L Lamonerie
- Service d'Anesthésie-Réanimation, Hôpital Tenon, Assistance Publique Hôpitaux de Paris, 4 rue de la Chine, 75970 Paris cedex 20, France
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Deleuze A, Gentili M. [Postoperative pain in ORL surgery]. Ann Fr Anesth Reanim 2004; 23:78-81. [PMID: 14980332 DOI: 10.1016/j.annfar.2003.11.005] [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] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Affiliation(s)
- A Deleuze
- Clinique de l'Espérance, groupe A.-Tzank, Mougins, France.
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Affiliation(s)
- A Deleuze
- Département d'anesthésie-réanimation, clinique de l'Espérance, groupe A.-Tzanck, Mougins, France.
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Decker G, Borie F, Millat B, Berthou JC, Deleuze A, Drouard F, Guillon F, Rodier JG, Fingerhut A. One hundred laparoscopic choledochotomies with primary closure of the common bile duct. Surg Endosc 2003; 17:12-8. [PMID: 12364990 DOI: 10.1007/s00464-002-9012-6] [Citation(s) in RCA: 101] [Impact Index Per Article: 4.8] [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: 01/15/2002] [Accepted: 05/23/2002] [Indexed: 12/22/2022]
Abstract
BACKGROUND Several technical approaches for laparoscopic CBD exploration (LCBDE) exist. Laparoscopic choledochotomy is required in some situations and whenever a transcystic approach fails. Biliary drainage after choledochotomy has a 5% morbidity rate and avoidance of biliary drains might therefore further improve the results of LCBDE. The authors report a prospective multicentric evaluation of laparoscopic choledochotomy with completion choledochoscopy and primary duct closure without any biliary drainage. METHODS Between October 1991 and December 1997, 100 patients from four surgical centers underwent this approach for CBD stones. Choledocholithiasis had been demonstrated preoperatively in 35 patients (35%), suspected in 52 and was incidentally found during routine intraoperative cholangiography in 13 patients. External ultrasound was the only preoperative imaging investigation in 87 patients. LCBDE was attempted irrespective of age, ASA score, or the circumstances leading to the preoperative diagnosis or suspicion of CBD stones (acute cholecystitis in 33% of patients, cholangitis in 10%, or mild acute pancreatitis in 6% of all patients). RESULTS The technique was equally feasible in all participating centers (University hospital, general hospital, or private practices). Vacuity of the CBD was achieved in all patients without mortality. Eleven patients had complications and 3 patients required a laparoscopic reintervention. Median postoperative hospital stay was 6 days (range: 1-26). No patient required additional CBD procedures during follow-up. CONCLUSIONS In case of LCBDE, choledochotomy with primary closure without external drainage of the CBD is a safe and efficient alternative, even in patients with acute cholecystitis, cholangitis, or pancreatitis, provided that choledochoscopy visualizes a patent CBD. This technique is applicable in all types of medical institutions if required laparoscopic skills and equipment are available.
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Affiliation(s)
- G Decker
- Department of Visceral Surgery A, University Hospital Center Montpellier Hôpital Saint-Eloi, F-34295 Montpellier, France
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15
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Deleuze A, Marret E, Lamonerie L, Bonnet F. [Spinal clonidine: potential consequences for fetal monitoring]. Ann Fr Anesth Reanim 2002; 21:341-2. [PMID: 12033108 DOI: 10.1016/s0750-7658(02)00595-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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16
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Kurdi O, Deleuze A, Marret E, Bonnet F. Asystole during anaesthetic induction with remifentanil and sevoflurane. Br J Anaesth 2001; 87:943. [PMID: 11878707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
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17
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Fierobe L, Lucet JC, Decré D, Muller-Serieys C, Deleuze A, Joly-Guillou ML, Mantz J, Desmonts JM. An outbreak of imipenem-resistant Acinetobacter baumannii in critically ill surgical patients. Infect Control Hosp Epidemiol 2001; 22:35-40. [PMID: 11198020 DOI: 10.1086/501822] [Citation(s) in RCA: 84] [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: 11/03/2022]
Abstract
OBJECTIVE To describe an outbreak of imipenem-resistant Acinetobacter baumannii (IR-Ab) and the measures for its control, and to investigate risk factors for IR-Ab acquisition. DESIGN An observational and a case-control study. SETTING A surgical intensive care unit (ICU) in a university tertiary care hospital. METHODS After admission to the ICU of an IR-Ab-positive patient, patients were prospectively screened for IR-Ab carriage upon admission and then once a week. Environmental cleaning and barrier safety measures were used for IR-Ab carriers. A case-control study was performed to identify factors associated with IR-Ab acquisition. Cases were patients who acquired IR-Ab. Controls were patients who were hospitalized in the ICU at the same time as cases and were exposed to IR-Ab for a similar duration as cases. The following variables were investigated as potential risk factors: baseline characteristics, scores for severity of illness and therapeutic intervention, presence and duration of invasive procedures, and antimicrobial administration. RESULTS Beginning in May 1996, the outbreak involved 17 patients over 9 months, of whom 12 acquired IR-Ab (cases), 4 had IR-Ab isolates on admission to the ICU, and 1 could not be classified. Genotypic analysis identified two different IR-Ab isolates, responsible for three clusters. Ten of the 12 nosocomial cases developed infection. Control measures included reinforcement of barrier safety measures, limitation of the number of admissions, and thorough environmental cleaning. No new case was identified after January 1997. Eleven of the 12 cases could be compared to 19 controls. After adjustment for severity of illness, a high individual therapeutic intervention score appeared to be a risk factor for IR-Ab acquisition. CONCLUSION The outbreak ended after strict application of control measures. Our results suggest that high work load contributes to IR-Ab acquisition.
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Affiliation(s)
- L Fierobe
- Department of Anesthesiology and Intensive Care, Bichat-Claude Bernard University Hospital, Paris, France
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18
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Billard V, Deleuze A, Pénot C, Lohberger C, Kolb F, Elias D. [Sufentanil in balanced anesthesia: need to predict concentrations for dose optimization]. Ann Fr Anesth Reanim 1999; 18:237-42. [PMID: 10207598] [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
During balanced anaesthesia sufentanil may be difficult to use, as the required doses change over time depending on the patient and the noxious stimuli. Patient adjustment may be improved by using pharmacokinetic simulations that predict the concentration achieved in the body. In the first case report, sufentanil was given manually as repeated boluses, then by infusion. As haemodynamic status remained unstable, a simulation of the sufentanil concentration time course was started during the case. It showed that instability had pharmacokinetic explanation and allowed to determine the adequate sufentanil concentrations (0.30-0.40 ng.mL-1 + N2O + isoflurane 0.8-1 vol% for abdominal surgery). However, adjusting the doses manually required numerous human actions. In the second case, sufentanil was given as a computer-controlled infusion. The adequate concentrations were determined (0.15-0.20 ng.mL-1 + N2O + isoflurane 0.4 vol% for peripheral surgery in an aged cardiac patient). They were maintained with a limited number of human actions and resulted in satisfactory haemodynamic stability.
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Affiliation(s)
- V Billard
- Départements d'anesthésie-réanimation-analgésie, institut Gustave-Roussy, Villejuif, France
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Millat B, Atger J, Deleuze A, Briandet H, Fingerhut A, Guillon F, Marrel E, De Seguin C, Soulier P. Laparoscopic treatment for choledocholithiasis: a prospective evaluation in 247 consecutive unselected patients. Hepatogastroenterology 1997; 44:28-34. [PMID: 9058114] [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: 05/22/2023]
Abstract
BACKGROUND/AIMS Evaluation of the feasibility and results of the one-stage treatment combining routine intraoperative cholangiography and laparoscopic common bile duct exploration for choledocholithiasis. PATIENTS AND METHODS Multicentric (5 centers-9 surgeons) prospective study in 247 consecutive patients (mean age 68 years; range 21-92) during a 50-month period (November 1991-December 1995). Laparoscopic treatment of choledocholithiasis was attempted irrespective of the circumstances leading to the diagnosis of biliary lithiasis or the preoperative suspicion of choledocholithiasis. RESULTS One out of four patients (n = 61) had unsuspected choledocholithiasis disclosed by routine intraoperative cholangiography. A laparoscopic complete clearance of choledocholithiasis was achieved in 208 of 236 attempted cases (88%), with either transcystic duct extraction (n = 116) or choledochotomy (n = 92). Open surgery was required in 20 patients for failure of laparoscopic treatment and in 3 patients despite successful extraction. Twenty-one of 25 patients (84%) referred for failure of retrograde endoscopic stone extraction had successful laparoscopic choledocholithiasis clearance. The mean duration for the laparoscopic transcystic approach and choledochotomy were 108 min (range 50-300) and 173 min (range 70-480), respectively. Eleven patients had retained stones (4.4%). Minor and major complications were recorded in 9 and 22 patients respectively. The operative mortality was 0.4% (95% confidence interval: 0-1.2%). CONCLUSION Intraoperative cholangiography during laparoscopic cholecystectomy and laparoscopic common bile duct exploration when required should be considered as the simplest and most efficient treatment for choledocholithiasis. The multicenter character of this study including consecutive patients from public and private practices, strengthens our conclusions and is consistent with a wide diffusion of this diagnostic and therapeutic strategy.
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Affiliation(s)
- B Millat
- Chirurgie Digestive, Hopital Saint-Eloi, Montpellier
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Millat B, Deleuze A, de Saxce B, de Seguin C, Fingerhut A. Routine intraoperative cholangiography is feasible and efficient during laparoscopic cholecystectomy. Hepatogastroenterology 1997; 44:22-7. [PMID: 9058113] [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: 02/03/2023]
Abstract
BACKGROUND/AIMS This is the evaluation of the feasibility and results of routine laparoscopic intraoperative cholangiography. PATIENTS AND METHODS A multicentric prospective study in 315 consecutive patients undergoing elective or urgent laparoscopic cholecystectomy. RESULTS The success rate was 94%. Mean duration of intraoperative cholangiography was 12 min. Sixteen of 18 failures were related to a narrow cystic duct. One cystic duct avulsion (ligated under laparoscopy) and 2 false positive cholangiograms (1 transcystic exploration, 1 conversion) were noted. Intraoperative cholangiography revealed aberrant bile ducts possibly at risk to injury from dissection in four patients (1.3 per cent). Intraoperative cholangiography disclosed unsuspected stones in 10 patients (4%). Forty-five patients had a preoperative suspicion of choledocholithiasis: choledocholithiasis were found at intraoperative cholangiography in 3 of 13 patients who had preoperative endoscopic sphincterotomy for stone extraction, in 1 of 11 patients with normal preoperative endoscopic cholangiography, and in 11 of 21 patients undergoing surgery alone (57%). CONCLUSION If complete clearance of choledocholithiasis is to remain the objective of surgical treatment of biliary lithiasis including laparoscopic cholecystectomy, then routine intraoperative cholangiography is feasible and efficient.
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Affiliation(s)
- B Millat
- Département de Chirurgie Digestive A, Hôpital Saint-Eloi, Montpellier
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Millat B, Fingerhut A, Deleuze A, Briandet H, Marrel E, de Seguin C, Soulier P. Prospective evaluation in 121 consecutive unselected patients undergoing laparoscopic treatment of choledocholithiasis. Br J Surg 1995; 82:1266-9. [PMID: 7552015 DOI: 10.1002/bjs.1800820936] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Laparoscopic common bile duct (CBD) exploration was attempted in 115 of 121 consecutive unselected patients with choledocholithiasis (mean age 69 (range 21-92) years) found during routine intraoperative cholangiography. The CBD was successfully cleared of all stones in 100 patients (87 per cent). Ten of 11 patients referred for surgery after failure of endoscopic sphincterotomy had complete laparoscopic choledocholithiasis. Eleven patients (10 per cent) required conversion to open CBD exploration, and laparoscopic exploration was not attempted in six (5 per cent) because of inflammation or fibrosis. Postoperative endoscopic sphincterotomy was required in four patients (4 per cent) for retained stones after laparoscopic exploration. There were no postoperative deaths (39 per cent of patients were aged 75 years or more). Routine intraoperative cholangiography, and when required laparoscopic CBD exploration, should be compared in randomized trials with preoperative endoscopic retrograde cholangiography in patients with suspected choledocholithiasis.
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Affiliation(s)
- B Millat
- Department of Digestive Surgery A, Hospital Saint-Eloi, Montpellier, France
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