Bernard Tardy - Academia.edu (original) (raw)
Papers by Bernard Tardy
Research and Practice in Thrombosis and Haemostasis, 2018
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-... more This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
Clinical Infectious Diseases, 1999
It was shown in children that serum procalcitonin was the best marker to use to differentiate bac... more It was shown in children that serum procalcitonin was the best marker to use to differentiate bacterial from viral meningitis. To evaluate procalcitonin in the diagnosis of acute bacterial and viral meningitis, we conducted a prospective study including adult patients who were suspected of having meningitis and who were admitted to an emergency department. Cerebrospinal fluid (CSF) and serum levels of procalcitonin were measured in 105 consecutive patients. The diagnosis of meningitis was based on clinical findings, gram staining, culture, and chemical analysis of CSF. Twenty-three patients had bacterial meningitis, 57 had viral meningitis, and 25 did not have meningitis. Bacteriologic and chemical analysis of CSF did not allow correct differentiation of viral from bacterial meningitis. On the other hand, a serum procalcitonin level ú0.2 ng/mL had a sensitivity and specificity of up to 100% in the diagnosis of bacterial meningitis. Serum procalcitonin levels seem to be the best marker in differentiating between bacterial and viral meningitis in adults.
Nous avons étudié de façon prospective la fréquence, les facteurs déclenchants et les modalités d... more Nous avons étudié de façon prospective la fréquence, les facteurs déclenchants et les modalités de prise en charge des patients asthmatiques en détention aux Prisons de Lyon. Les personnes inclues dans l’étude sont les détenus masculins majeurs écroués d’avril à août 2007, dont le séjour durait plus de 7 jours. Ils ont été interrogés par les équipes médicale et soignante à l’aide de questionnaires. Au cours de cette période, 1 082 détenus ont été écroués. 727 (86,4 %) questionnaires ont été exploités. 78 patients soit 10,8 % des arrivants, présentaient un asthme. Cette prévalence est supérieure à celle de l’asthme dans la population générale (5 à 7 %). La proportion de patients asthmatiques est plus importante dans la population consommant un ou plusieurs toxique(s) pour toutes fréquences de consommation confondues. La consommation de cocaïne ou de méthadone est significativement plus fréquemment associée à la pathologie asthmatique. Pour la cocaïne, 19 % de la population consommatr...
Presse médicale (Paris, France : 1983), Jan 5, 1991
Vox Sanguinis, 2007
Background/Objectives A multicentre retrospective study was performed to assess the efficacy/safe... more Background/Objectives A multicentre retrospective study was performed to assess the efficacy/safety of a French purified plasma-derived protein C (PC) concentrate in inherited PC deficiency. Materials and Methods Nine patients were enrolled, five children aged < 5 weeks, among whom four with a severe deficiency were homozygous, and four patients < 37 years with PC levels ranging 14-25%, including one compound heterozygous. Results Thirty replacement therapy courses were recorded with mean PC dosages ranging between 24-90 IU/kg/day for prophylactic courses and 51-209 IU/kg/day for treatment courses. Recoveries varied between 0•8 and 1•12% IU/kg in preventive situations and between 1•09 and 1•91% IU/kg for treatment courses; 23 treatment courses were performed in patients aged 1 day to 18 years, 19 out of 23 treatments resulted in complete recovery with no sequelae. Treatment efficacy was difficult to assess in four out of 23 cases because the thrombotic event was not confirmed in one case and due to late treatment initiation in the three other cases. Seven prophylactic treatments were used either in association of vitamin K antagonists or to prevent thrombotic events due to vitamin K antagonist introduction or withdrawal. The safety assessed during 914 infusions was excellent. No abnormal bleeding was reported, including with high doses, during surgery, with heparin therapy. Conclusions Replacement therapy with this French PC concentrate is safe and effective in patients with inherited PC deficiency.
New England Journal of Medicine, 1998
Background The efficacy and safety of vena caval filters in the prevention of pulmonary embolism ... more Background The efficacy and safety of vena caval filters in the prevention of pulmonary embolism in patients with proximal deep-vein thrombosis are still a matter of debate. Methods Using a two-by-two factorial design, we randomly assigned 400 patients with proximal deepvein thrombosis who were at risk for pulmonary embolism to receive a vena caval filter (200 patients) or no filter (200 patients), and to receive low-molecularweight heparin (enoxaparin, 195 patients) or unfractionated heparin (205 patients). The rates of recurrent venous thromboembolism, death, and major bleeding were analyzed at day 12 and at two years.
American Journal of Respiratory and Critical Care Medicine, 2001
To determine the specificity of pulmonary embolism (PE) symptoms and lung scan perfusion defects ... more To determine the specificity of pulmonary embolism (PE) symptoms and lung scan perfusion defects in patients with deep vein thrombosis (DVT), we analyzed data on 400 patients with phlebography-proven proximal DVT included in a prospective trial. As the incidence of PE during anticoagulant therapy was the main outcome measure of the trial, all patients underwent lung scanning and/or pulmonary angiography within 48 h of inclusion, and then whenever PE was suspected. Angiography was recommended in patients with nondiagnostic lung scan. At baseline, the presence or absence of PE could be ascertained in 350 patients (87.5%), and 197 (56%) had PE. Sensitivity and specificity of symptoms for PE were 74 and 67%, respectively. Among 37 patients with symptoms and nondiagnostic lung scan, only 8 (22%) had PE at angiography. During anticoagulant therapy (3 mo), there were 29 events suspicious for PE, mostly (53%) within 2 wk of inclusion. Repeated perfusion studies with comparison to baseline tests excluded PE in 21 cases. Cumulated 3-mo risks of suspected and confirmed on-treatment PE were 6.8% (95% CI, 5.4- 8.2%) and 2.0% (95% CI, 0.6-3.4%) respectively. Even in patients with known proximal DVT, PE symptoms are unspecific and careful imaging studies are needed for diagnosis, both at baseline and during anticoagulant therapy.
Http Www Theses Fr, 2004
Utilite des D-dimeres ELISA a titre diagnostique : Le but de la premiere etude etait d’evaluer l’... more Utilite des D-dimeres ELISA a titre diagnostique : Le but de la premiere etude etait d’evaluer l’interet des D-dimeres chez 96 patients âges de plus de 70 ans admis pour suspicion d’EP. Dans cette etude, le dosage ELISA des D-dimeres a, pour une valeur seuil inferieur a 500ng/ml , une excellente sensibilite et valeur predictive negative pour le diagnostic d’exclusion d’une EP. Par contre, sa specificite est mediocre de l’ordre de 15%. Le but de la deuxieme etude etait d’evaluer l’interet des D-dimeres des patients admis pour cephalee aigue suspecte de thrombose veineuse cerebrale (TVC). La population a consiste en 18 patients avec une TVC et 34 temoins avec cephalee aigue d’origine migraineuse. Dans cette etude, les D-dimeres ELISA ont une excellente valeur predictive negative (100%) pour le diagnostic d’exclusion de TVC chez les patients presentant des cephalees aigues. D-dimeres ELISA a titre therapeutique : Le but de la premiere etude etait de comparer l'evolution des Fragments Prothrombiniques 1+2 et des D-dimeres apres arret brutal ou progressif d'un traitement AVK chez des malades traites pour une maladie thromboembolique veineuse. Dans cette etude randomisee et en double aveugle portant sur 20 patients, aucun argument biologique ne supporte l’existence d’un effet rebond lie a l'arret brutal du traitement AVK. Le but de la deuxieme etude etait d’evaluer la cinetique des D-dimeres au cours du traitement heparinique des TVC. Les resultats preliminaires sur 17 patients montrent que le taux de D-dimeres se normalisent rapidement au cours des traitements adaptes par heparine mais qu’ils stagnent ou augmentent en cas d’extension de la thrombose ou d’insuffisance du traitement anticoagulant.
The Lancet, 1991
... Ann NY Acad Sci 1989; 556: 333-353. PubMed. 5 Chong Bh, Bemdt MC.. Heparin-induced thrombocyt... more ... Ann NY Acad Sci 1989; 556: 333-353. PubMed. 5 Chong Bh, Bemdt MC.. Heparin-induced thrombocytopenia. Blut 1989; 58: 53-57. CrossRef | PubMed. 6 Sheridan D., Carter C., Kelton JG.. A diagnostic test for heparin-induced thrombocytopenia. Blood 1986; 67: 27-30. ...
Journal of Pain and Symptom Management, 2011
1. J Pain Symptom Manage. 2011 Oct 28. [Epub ahead of print] Venous Thromboembolism Prophylaxis i... more 1. J Pain Symptom Manage. 2011 Oct 28. [Epub ahead of print] Venous Thromboembolism Prophylaxis in Palliative Care Patients. Tardy B, Vassal P, Richard A. Inserm CIE3, Université Jean Monnet, Palliative Care Federation, CHU Saint Etienne, Saint Etienne, France. ...
Archives of Internal Medicine, 2008
La procalcitonine, un precurseur de la calcitonine, fut initialement presentee comme un nouveau m... more La procalcitonine, un precurseur de la calcitonine, fut initialement presentee comme un nouveau marqueur de la reponse inflammatoire specifique de l'infection bacterienne. Bien que des incertitudes persistent sur cette molecule (lieu de synthese, role physiologique), de nombreuses etudes ont evalue l'interet de ce marqueur chez les patients hospitalises en reanimation dans diverses situations ou il est difficile de differencier l'origine infectieuse ou non de la reponse inflammatoire systemique: infection, etats de choc, pancreatite, brulures etendues, periode postoperatoire, polytraumatisme. L'analyse de la litterature semble confirmer l'interet clinique de la procalcitonine par rapport aux autres marqueurs de l'inflammation (CRP, cytokines) en fournissant une aide diagnostique et pronostique. Les dosages repetes de procalcitonine semblent plus interessants que les dosages isoles. Cependant, la procalcitonine ne peut etre consideree actuellement comme le mar...
Biomedicines
Reliable laboratory diagnosis of heparin-induced thrombocytopenia (HIT) remains a major clinical ... more Reliable laboratory diagnosis of heparin-induced thrombocytopenia (HIT) remains a major clinical concern. Immunoassays are highly sensitive, while confirmatory functional tests (based on heparin-dependent platelet activation) lack standardization. We evaluated the diagnostic performance of a functional flow cytometric assay (FCA) based on the detection of heparin-dependent platelet activation with an anti-p-selectin. A total of 288 patients were included (131 HIT-positive and 157 HIT-negative) with a HIT diagnosis established by expert opinion adjudication (EOA) considering clinical data and local laboratory results. The FCA was centrally performed in a single laboratory on platelet-rich plasma, using a very simple four-color fluorometer. The results were standardized according to the Heparin Platelet Activation (HEPLA) index. The serotonin release assay (SRA) was performed in the four French reference laboratories. Based on the final HIT diagnosis established by EOA, the sensitivit...
Objective:Assessment of fluid responsiveness is problematic in intensive care unit patients. Lung... more Objective:Assessment of fluid responsiveness is problematic in intensive care unit patients. Lung recruitment maneuvers (LRM) can be used as a functional test to predict fluid responsiveness. We propose a new test to predict fluid responsiveness in mechanically ventilated patients by analyzing the variations in central venous pressure (CVP) and systemic arterial parameters during a prolonged sigh breath LRM without the use of a cardiac output measuring device. Design:Prospective observational cohort study.Setting:Intensive Care Unit, Saint-Etienne University Central Hospital.Patients:Patients under mechanical ventilation, equipped with invasive arterial blood pressure, CVP, pulse contour analysis (PICCOTM), requiring volume expansion, with no right ventricular dysfunction.Interventions:None.Measurements and Main Results:CVP, systemic arterial parameters and stroke volume (SV) were recorded during prolonged LRM followed by a 500mL fluid expansion to asses fluid responsiveness. 25 pat...
Thrombosis and Haemostasis
Background Heparin-induced thrombocytopenia (HIT) is a rare complication of heparin treatments, a... more Background Heparin-induced thrombocytopenia (HIT) is a rare complication of heparin treatments, and only a few large patient cohorts have been reported. In this study, biological and clinical data from 144 French patients with HIT were analyzed in comparison with the literature. Methods The diagnosis of HIT was confirmed in all patients by an immunoassay combined with serotonin release assay. In the literature, only cohorts of at least 20 HIT patients published from 1992 were selected for a comparative analysis. Results Two-thirds of patients were hospitalized in surgery and most were treated with unfractionated heparin (83.2% vs. 16.8% with low molecular weight heparin only). Thrombotic events in 54 patients (39.7%) were mainly venous (41/54). However, arterial thrombosis was more frequent after cardiac surgery (13.2% vs. 2.4% in other surgeries, p = 0.042) with a shorter recovery time (median = 3 vs. 5 days, p
BMJ Open
IntroductionTwo meta-analyses showed lower bone mineral density (BMD) in patients with haemophili... more IntroductionTwo meta-analyses showed lower bone mineral density (BMD) in patients with haemophilia (haemophilia type and severity were often not specified) compared with healthy controls. This finding could be related to reduced mobility and sedentary lifestyle, and/or hepatitis C or HIV infection. The aim of this study is to determine osteoporosis prevalence in patients with haemophilia classified in function of the disease type (A or B) and severity, and to evaluate the potential role of regular prophylactic factor replacement (early vs delayed initiation) in preserving or restoring BMD.Methods and analysisThe haemoPHILia and ostEoporOSis Study is a prospective, controlled, multicentre study that will include patients in France (13 haemophilia treatment centres), Belgium (1 centre) and Romania (1 centre). In total, 240 patients with haemophilia and 240 matched healthy controls will be recruited (1:1). The primary objective is to determine osteoporosis prevalence in patients with s...
Research and Practice in Thrombosis and Haemostasis, 2018
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-... more This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
Clinical Infectious Diseases, 1999
It was shown in children that serum procalcitonin was the best marker to use to differentiate bac... more It was shown in children that serum procalcitonin was the best marker to use to differentiate bacterial from viral meningitis. To evaluate procalcitonin in the diagnosis of acute bacterial and viral meningitis, we conducted a prospective study including adult patients who were suspected of having meningitis and who were admitted to an emergency department. Cerebrospinal fluid (CSF) and serum levels of procalcitonin were measured in 105 consecutive patients. The diagnosis of meningitis was based on clinical findings, gram staining, culture, and chemical analysis of CSF. Twenty-three patients had bacterial meningitis, 57 had viral meningitis, and 25 did not have meningitis. Bacteriologic and chemical analysis of CSF did not allow correct differentiation of viral from bacterial meningitis. On the other hand, a serum procalcitonin level ú0.2 ng/mL had a sensitivity and specificity of up to 100% in the diagnosis of bacterial meningitis. Serum procalcitonin levels seem to be the best marker in differentiating between bacterial and viral meningitis in adults.
Nous avons étudié de façon prospective la fréquence, les facteurs déclenchants et les modalités d... more Nous avons étudié de façon prospective la fréquence, les facteurs déclenchants et les modalités de prise en charge des patients asthmatiques en détention aux Prisons de Lyon. Les personnes inclues dans l’étude sont les détenus masculins majeurs écroués d’avril à août 2007, dont le séjour durait plus de 7 jours. Ils ont été interrogés par les équipes médicale et soignante à l’aide de questionnaires. Au cours de cette période, 1 082 détenus ont été écroués. 727 (86,4 %) questionnaires ont été exploités. 78 patients soit 10,8 % des arrivants, présentaient un asthme. Cette prévalence est supérieure à celle de l’asthme dans la population générale (5 à 7 %). La proportion de patients asthmatiques est plus importante dans la population consommant un ou plusieurs toxique(s) pour toutes fréquences de consommation confondues. La consommation de cocaïne ou de méthadone est significativement plus fréquemment associée à la pathologie asthmatique. Pour la cocaïne, 19 % de la population consommatr...
Presse médicale (Paris, France : 1983), Jan 5, 1991
Vox Sanguinis, 2007
Background/Objectives A multicentre retrospective study was performed to assess the efficacy/safe... more Background/Objectives A multicentre retrospective study was performed to assess the efficacy/safety of a French purified plasma-derived protein C (PC) concentrate in inherited PC deficiency. Materials and Methods Nine patients were enrolled, five children aged < 5 weeks, among whom four with a severe deficiency were homozygous, and four patients < 37 years with PC levels ranging 14-25%, including one compound heterozygous. Results Thirty replacement therapy courses were recorded with mean PC dosages ranging between 24-90 IU/kg/day for prophylactic courses and 51-209 IU/kg/day for treatment courses. Recoveries varied between 0•8 and 1•12% IU/kg in preventive situations and between 1•09 and 1•91% IU/kg for treatment courses; 23 treatment courses were performed in patients aged 1 day to 18 years, 19 out of 23 treatments resulted in complete recovery with no sequelae. Treatment efficacy was difficult to assess in four out of 23 cases because the thrombotic event was not confirmed in one case and due to late treatment initiation in the three other cases. Seven prophylactic treatments were used either in association of vitamin K antagonists or to prevent thrombotic events due to vitamin K antagonist introduction or withdrawal. The safety assessed during 914 infusions was excellent. No abnormal bleeding was reported, including with high doses, during surgery, with heparin therapy. Conclusions Replacement therapy with this French PC concentrate is safe and effective in patients with inherited PC deficiency.
New England Journal of Medicine, 1998
Background The efficacy and safety of vena caval filters in the prevention of pulmonary embolism ... more Background The efficacy and safety of vena caval filters in the prevention of pulmonary embolism in patients with proximal deep-vein thrombosis are still a matter of debate. Methods Using a two-by-two factorial design, we randomly assigned 400 patients with proximal deepvein thrombosis who were at risk for pulmonary embolism to receive a vena caval filter (200 patients) or no filter (200 patients), and to receive low-molecularweight heparin (enoxaparin, 195 patients) or unfractionated heparin (205 patients). The rates of recurrent venous thromboembolism, death, and major bleeding were analyzed at day 12 and at two years.
American Journal of Respiratory and Critical Care Medicine, 2001
To determine the specificity of pulmonary embolism (PE) symptoms and lung scan perfusion defects ... more To determine the specificity of pulmonary embolism (PE) symptoms and lung scan perfusion defects in patients with deep vein thrombosis (DVT), we analyzed data on 400 patients with phlebography-proven proximal DVT included in a prospective trial. As the incidence of PE during anticoagulant therapy was the main outcome measure of the trial, all patients underwent lung scanning and/or pulmonary angiography within 48 h of inclusion, and then whenever PE was suspected. Angiography was recommended in patients with nondiagnostic lung scan. At baseline, the presence or absence of PE could be ascertained in 350 patients (87.5%), and 197 (56%) had PE. Sensitivity and specificity of symptoms for PE were 74 and 67%, respectively. Among 37 patients with symptoms and nondiagnostic lung scan, only 8 (22%) had PE at angiography. During anticoagulant therapy (3 mo), there were 29 events suspicious for PE, mostly (53%) within 2 wk of inclusion. Repeated perfusion studies with comparison to baseline tests excluded PE in 21 cases. Cumulated 3-mo risks of suspected and confirmed on-treatment PE were 6.8% (95% CI, 5.4- 8.2%) and 2.0% (95% CI, 0.6-3.4%) respectively. Even in patients with known proximal DVT, PE symptoms are unspecific and careful imaging studies are needed for diagnosis, both at baseline and during anticoagulant therapy.
Http Www Theses Fr, 2004
Utilite des D-dimeres ELISA a titre diagnostique : Le but de la premiere etude etait d’evaluer l’... more Utilite des D-dimeres ELISA a titre diagnostique : Le but de la premiere etude etait d’evaluer l’interet des D-dimeres chez 96 patients âges de plus de 70 ans admis pour suspicion d’EP. Dans cette etude, le dosage ELISA des D-dimeres a, pour une valeur seuil inferieur a 500ng/ml , une excellente sensibilite et valeur predictive negative pour le diagnostic d’exclusion d’une EP. Par contre, sa specificite est mediocre de l’ordre de 15%. Le but de la deuxieme etude etait d’evaluer l’interet des D-dimeres des patients admis pour cephalee aigue suspecte de thrombose veineuse cerebrale (TVC). La population a consiste en 18 patients avec une TVC et 34 temoins avec cephalee aigue d’origine migraineuse. Dans cette etude, les D-dimeres ELISA ont une excellente valeur predictive negative (100%) pour le diagnostic d’exclusion de TVC chez les patients presentant des cephalees aigues. D-dimeres ELISA a titre therapeutique : Le but de la premiere etude etait de comparer l'evolution des Fragments Prothrombiniques 1+2 et des D-dimeres apres arret brutal ou progressif d'un traitement AVK chez des malades traites pour une maladie thromboembolique veineuse. Dans cette etude randomisee et en double aveugle portant sur 20 patients, aucun argument biologique ne supporte l’existence d’un effet rebond lie a l'arret brutal du traitement AVK. Le but de la deuxieme etude etait d’evaluer la cinetique des D-dimeres au cours du traitement heparinique des TVC. Les resultats preliminaires sur 17 patients montrent que le taux de D-dimeres se normalisent rapidement au cours des traitements adaptes par heparine mais qu’ils stagnent ou augmentent en cas d’extension de la thrombose ou d’insuffisance du traitement anticoagulant.
The Lancet, 1991
... Ann NY Acad Sci 1989; 556: 333-353. PubMed. 5 Chong Bh, Bemdt MC.. Heparin-induced thrombocyt... more ... Ann NY Acad Sci 1989; 556: 333-353. PubMed. 5 Chong Bh, Bemdt MC.. Heparin-induced thrombocytopenia. Blut 1989; 58: 53-57. CrossRef | PubMed. 6 Sheridan D., Carter C., Kelton JG.. A diagnostic test for heparin-induced thrombocytopenia. Blood 1986; 67: 27-30. ...
Journal of Pain and Symptom Management, 2011
1. J Pain Symptom Manage. 2011 Oct 28. [Epub ahead of print] Venous Thromboembolism Prophylaxis i... more 1. J Pain Symptom Manage. 2011 Oct 28. [Epub ahead of print] Venous Thromboembolism Prophylaxis in Palliative Care Patients. Tardy B, Vassal P, Richard A. Inserm CIE3, Université Jean Monnet, Palliative Care Federation, CHU Saint Etienne, Saint Etienne, France. ...
Archives of Internal Medicine, 2008
La procalcitonine, un precurseur de la calcitonine, fut initialement presentee comme un nouveau m... more La procalcitonine, un precurseur de la calcitonine, fut initialement presentee comme un nouveau marqueur de la reponse inflammatoire specifique de l'infection bacterienne. Bien que des incertitudes persistent sur cette molecule (lieu de synthese, role physiologique), de nombreuses etudes ont evalue l'interet de ce marqueur chez les patients hospitalises en reanimation dans diverses situations ou il est difficile de differencier l'origine infectieuse ou non de la reponse inflammatoire systemique: infection, etats de choc, pancreatite, brulures etendues, periode postoperatoire, polytraumatisme. L'analyse de la litterature semble confirmer l'interet clinique de la procalcitonine par rapport aux autres marqueurs de l'inflammation (CRP, cytokines) en fournissant une aide diagnostique et pronostique. Les dosages repetes de procalcitonine semblent plus interessants que les dosages isoles. Cependant, la procalcitonine ne peut etre consideree actuellement comme le mar...
Biomedicines
Reliable laboratory diagnosis of heparin-induced thrombocytopenia (HIT) remains a major clinical ... more Reliable laboratory diagnosis of heparin-induced thrombocytopenia (HIT) remains a major clinical concern. Immunoassays are highly sensitive, while confirmatory functional tests (based on heparin-dependent platelet activation) lack standardization. We evaluated the diagnostic performance of a functional flow cytometric assay (FCA) based on the detection of heparin-dependent platelet activation with an anti-p-selectin. A total of 288 patients were included (131 HIT-positive and 157 HIT-negative) with a HIT diagnosis established by expert opinion adjudication (EOA) considering clinical data and local laboratory results. The FCA was centrally performed in a single laboratory on platelet-rich plasma, using a very simple four-color fluorometer. The results were standardized according to the Heparin Platelet Activation (HEPLA) index. The serotonin release assay (SRA) was performed in the four French reference laboratories. Based on the final HIT diagnosis established by EOA, the sensitivit...
Objective:Assessment of fluid responsiveness is problematic in intensive care unit patients. Lung... more Objective:Assessment of fluid responsiveness is problematic in intensive care unit patients. Lung recruitment maneuvers (LRM) can be used as a functional test to predict fluid responsiveness. We propose a new test to predict fluid responsiveness in mechanically ventilated patients by analyzing the variations in central venous pressure (CVP) and systemic arterial parameters during a prolonged sigh breath LRM without the use of a cardiac output measuring device. Design:Prospective observational cohort study.Setting:Intensive Care Unit, Saint-Etienne University Central Hospital.Patients:Patients under mechanical ventilation, equipped with invasive arterial blood pressure, CVP, pulse contour analysis (PICCOTM), requiring volume expansion, with no right ventricular dysfunction.Interventions:None.Measurements and Main Results:CVP, systemic arterial parameters and stroke volume (SV) were recorded during prolonged LRM followed by a 500mL fluid expansion to asses fluid responsiveness. 25 pat...
Thrombosis and Haemostasis
Background Heparin-induced thrombocytopenia (HIT) is a rare complication of heparin treatments, a... more Background Heparin-induced thrombocytopenia (HIT) is a rare complication of heparin treatments, and only a few large patient cohorts have been reported. In this study, biological and clinical data from 144 French patients with HIT were analyzed in comparison with the literature. Methods The diagnosis of HIT was confirmed in all patients by an immunoassay combined with serotonin release assay. In the literature, only cohorts of at least 20 HIT patients published from 1992 were selected for a comparative analysis. Results Two-thirds of patients were hospitalized in surgery and most were treated with unfractionated heparin (83.2% vs. 16.8% with low molecular weight heparin only). Thrombotic events in 54 patients (39.7%) were mainly venous (41/54). However, arterial thrombosis was more frequent after cardiac surgery (13.2% vs. 2.4% in other surgeries, p = 0.042) with a shorter recovery time (median = 3 vs. 5 days, p
BMJ Open
IntroductionTwo meta-analyses showed lower bone mineral density (BMD) in patients with haemophili... more IntroductionTwo meta-analyses showed lower bone mineral density (BMD) in patients with haemophilia (haemophilia type and severity were often not specified) compared with healthy controls. This finding could be related to reduced mobility and sedentary lifestyle, and/or hepatitis C or HIV infection. The aim of this study is to determine osteoporosis prevalence in patients with haemophilia classified in function of the disease type (A or B) and severity, and to evaluate the potential role of regular prophylactic factor replacement (early vs delayed initiation) in preserving or restoring BMD.Methods and analysisThe haemoPHILia and ostEoporOSis Study is a prospective, controlled, multicentre study that will include patients in France (13 haemophilia treatment centres), Belgium (1 centre) and Romania (1 centre). In total, 240 patients with haemophilia and 240 matched healthy controls will be recruited (1:1). The primary objective is to determine osteoporosis prevalence in patients with s...