damien jolly - Profile on Academia.edu (original) (raw)
Papers by damien jolly
La Presse Médicale, 2010
médecine interne, réseau d'épidémiologie clinique international francophone (RECIF),
Assessment of Bullous Pemphigoid Disease Area Index during Treatment: A Prospective Study of 30 Patients
Dermatology, 2014
Background: Recently, a consensus Bullous Pemphigoid Disease Area Index (BPDAI) was proposed to m... more Background: Recently, a consensus Bullous Pemphigoid Disease Area Index (BPDAI) was proposed to measure therapeutic outcomes in bullous pemphigoid (BP). Objective: To compare BPDAI with other clinical parameters of disease activity at baseline and to describe the variations of BPDAI during the initial phase of treatment. Methods: Thirty BP patients were included and followed for 1 year. BPDAI was assessed at baseline and on days 30, 90 and 360 by the same investigator. Concomitantly, the number of daily new blisters, the skin surface area of erythematous/eczematous/urticarial plaques and blisters/erosions, total lesion area (TLA), pruritus score and mucosal involvement were recorded. Results: At baseline, BPDAI was 46.7 ± 25 (mean ± SD); it was well correlated with erythematous/eczematous/urticarial skin surface (r = 0.63), TLA (r = 0.83), number of daily new blisters (r = 0.7; p ≤ 0.0002) and anti-BP180 autoantibodies (r = 0.49; p = 0.006), but not with anti-BP230 autoantibodies. F...
[Comparative study of antitoxoplasmic IgG isotypes titrated by high sensitivity direct agglutination and indirect immunofluorescence: consequence of the choice of methods on the expression of results in international units]
Annales de biologie clinique
The use of International Units per ml (IU/ml) to express antitoxoplasmic IgG antibody titers in t... more The use of International Units per ml (IU/ml) to express antitoxoplasmic IgG antibody titers in the various diagnostic systems presently proposed, is misleading owing to discrepancies in the values found from one test to the other for a given serum. The authors compared the results of high sensitivity direct agglutination (HSDA) to those of indirect immunofluorescence (IIF) in two studies, systematic and longitudinal, dealing with 158 sera stratified for values ranging from 102,400 to 5 IU/ml. Discordances between the methods, which are greater for high values, prompt the use of low-titer sera for standardization. From the systematic study, a correlation table was established and proposed to convert the HSDA results into the theoretical corrected values close to those that would be obtained by IIF. Although this may be of interest in maintaining a coherent language, this table has its limits, particularly in acute episodes where the various antibody kinetics vary and amplify further...
Colonic Flat Neoplasia: Frequency and Concordance Between Endoscopic Appearance and Histological Diagnosis in a French Prospective Series
The American Journal of Gastroenterology, 2004
INTRODUCTION In 1985, Muto et al. (1) described colorectal flat adenomas characterized by a high ... more INTRODUCTION In 1985, Muto et al. (1) described colorectal flat adenomas characterized by a high rate of high-grade dysplasia and, a few years later, the first large series of 45 superficial nonpolypoid colorectal adenocarcinomas was reported (2). Endoscopists describe these ...
Bleeding reflux esophagitis: a prospective 1-year study in a university hospital
The American Journal of Gastroenterology, 2001
The prevalence of bleeding from reflux esophagitis has not been studied. The aim of the study was... more The prevalence of bleeding from reflux esophagitis has not been studied. The aim of the study was to evaluate the 1-yr prevalence of bleeding from reflux esophagitis, as well as the independent factors associated with bleeding. All patients with reflux esophagitis diagnosed with upper digestive tract endoscopy in Reims Hospital in 1996 were included. Studied parameters were prospectively recorded and compared between patients with bleeding and nonbleeding reflux esophagitis. Endoscopy was performed in 1983 patients of whom 219 (11.0%) had overt upper digestive tract hemorrhage. Reflux esophagitis was the cause of bleeding in 32 patients (14.6%). Reflux esophagitis was diagnosed in 391 patients during the same period of time. Bleeding reflux esophagitis accounted for 8.2% of them. Independent factors associated with bleeding were grade 3 or 4 (Savary-Miller) esophagitis (odds ratio [OR]: 25.5, 95% confidence interval [CI]: 9.6-67.9), cirrhosis (OR: 5.7, 95% CI: 1.7-18.9), Eastern Cooperative Oncology Group performance status > or = 3 (OR: 4.6, 95% CI: 1.5-14.2), and anticoagulant therapy (OR: 3.9, 95% CI: 1.2-12.5). A history of reflux esophagitis or heartburn was noted in only 28.1% or 37.5% of the patients with bleeding reflux esophagitis, respectively. In this population of patients with reflux esophagitis, the prevalence of bleeding esophagitis was high (8.2%). Bleeding esophagitis occurred primarily in patients with severe esophagitis and was the revealing clinical form of gastroesophageal reflux disease in the majority of cases, suggesting that bleeding prevention would hardly be effective.
Presse Medicale, 2007
The aim of this study was to identify early indicators of prolonged hospital stays by elderly pat... more The aim of this study was to identify early indicators of prolonged hospital stays by elderly patients. ■ Résumé Objectif > Identifier les indicateurs précoces de durée de séjour prolongée chez des patients âgés hospitalisés en service de court séjour de médecine. Méthodes > Une étude pilote prospective a été réalisée au CHRU de Strasbourg incluant des sujets âgés de 75 ans ou plus hospitalisés en
Presse Medicale, 2010
What do we learn from the SAFEs cohort to fit hospital care models for aged inpatient? Que nous a... more What do we learn from the SAFEs cohort to fit hospital care models for aged inpatient? Que nous apprend la cohorte SAFEs sur l'adaptation des filières de soins intra-hospitalières à la prise en charge des patients âgés ? Gé riatrie tome 39 > n811 > novembre 2010
![Research paper thumbnail of [Frailty: learnings from the SAFEs cohort study and future perspectives for the research]](https://attachments.academia-assets.com/107462210/thumbnails/1.jpg)
](Geriatrie et Psychologie Neuropsychiatrie du Vieillissement, 2011
Si les efforts de recherche ont conduit à mieux préciser la physiopathologie et la dynamique du p... more Si les efforts de recherche ont conduit à mieux préciser la physiopathologie et la dynamique du processus de fragilisation, l'actuelle définition opérationnelle de la fragilité est encore loin d'être univoque. Les études réalisées à partir des données la cohorte hospitalière SAFEs ont permis une approche pragmatique de l'identification des sous-populations à risque de survenue d'incapacité durant l'hospitalisation et les facteurs influenç ant leur devenir à court, moyen et long termes. À partir des enseignements existants, nous proposons une réflexion sur la pertinence des indicateurs opérationnels actuels de l'état de fragilité afin de montrer que les marqueurs ou indicateurs cliniques sont insuffisants pour permettre de différencier le processus de fragilisation du vieillissement normal. Finalement, nous mettons en exergue l'impérative nécessité d'identifier la fragilité à un stade pré-clinique au travers de marqueurs biologiques et plus particulièrement les marqueurs de l'inflammation.
Adverse Drug Reactions in Elderly Subjects Hospitalized in a Specialized Dementia Management Unit
Drugs & Aging, 2014
Factors Predicting the Long-Term Success of Maintenance Cyclosporine Monotherapy After Kidney TRANSPLANTATION1
Transplantation, 2000
The theoretical aim of maintenance cyclosporine monotherapy (mCsA) after kidney transplantation i... more The theoretical aim of maintenance cyclosporine monotherapy (mCsA) after kidney transplantation is to reduce the incidence of the metabolic complications of corticosteroids and to minimize the adverse effects of excessive long-term immunosuppression. This study was performed in low-immunological-risk cadaveric kidney transplant recipients to evaluate the risks and benefits of mCsA and the long-term graft survival, and to determine the factors predicting success of this policy. The multicenter retrospective study was conducted in 329 Caucasian patients receiving mCsA out of 728 first cadaveric kidney transplant recipients. The inclusion criteria were: HLA antibodies < or =25%, serum creatinine <200 micromol/L, and no rejection or only one rejection episode. At the end of the study, we compared the group of patients successfully treated with mCsA (successful group) with those requiring additional immunosuppressive agents (unsuccessful mCsA group). Overall patient and graft survival rates for the 728 first cadaveric graft were 92% and 64%, respectively, at 8 years. Out of 329 patients enrolled in mCsA, 240 were maintained on this treatment and 89 were withdrawn (3 deaths, 18 graft losses, 68 functional grafts). The 8-year graft survival in the 329 enrolled mCsA patients was 84%, 95% in the successful mCsA group, and 70% in the unsuccessful mCsA group. Multivariate analysis showed that the factors predicting success of mCsA were: donor age <40 years (P = 0.001), serum creatinine at mCsA initiation <125 micromol/L (P = 0.02), no rejection episode before mCsA initiation (P = 0.005), and glomerulopathy as the primary renal disease (P = 0.001). Numerous kidney transplant recipients with a low immunological risk and good and stable renal function may benefit from discontinuation of prednisone and azathioprine in order to reduce the complications related to these drugs. This therapeutic approach had no adverse impact on the overall long-term graft survival for "low risk" and successful patients.
PLoS ONE, 2014
Background: This prospective multicenter study aimed to study the impact of the recalibration com... more Background: This prospective multicenter study aimed to study the impact of the recalibration component of responseshift (RS) on time to deterioration (TTD) in health related quality of life (QoL) scores in breast cancer (BC) patients and the influence of baseline QoL expectations on TTD. Methods: The EORTC-QLQ-C30 and BR-23 questionnaires were used to assess the QoL in a prospective multicenter study at inclusion (T0), at the end of the first hospitalization (T1) and, three (T2) and 6 months after the first hospitalization (T3). Recalibration was investigated by the then-test method. QoL expectancy was assessed at diagnosis. Deterioration was defined as a 5-point decrease in QoL scores, considered a minimal clinically important difference (MCID). TTD was estimated using the Kaplan-Meier method. Cox regression analyses were used to identify factors influencing TTD. Results: From February 2006 to February 2008, 381 women were included. Recalibration of breast cancer patients' internal standards in the assessment of their QoL had an impact on TTD. Median TTD were significantly shorter when recalibration was not taken into account than when recalibration was taken into account for global health, role-functioning, socialfunctioning, body-image and side effects of systemic therapy. Cox multivariate analyses showed that for body image, when recalibration was taken into account, radiotherapy was associated with a shorter TTD (HR: 0.60[0.38-0.94], whereas, no significant impact of surgery type on TTD was observed. For global health, cognitive and social functioning dimensions, patients expecting a deterioration in their QoL at baseline had a significantly shorter TTD. Conclusions: Our results showed that RS and baseline QoL expectations were associated with time to deterioration in breast cancer patients.
Genetic risk factor in primary open-angle glaucoma: a case-control study
Ophthalmic Epidemiology, 1994
To evaluate the link between primary open-angle glaucoma (POAG) and potential genetic and environ... more To evaluate the link between primary open-angle glaucoma (POAG) and potential genetic and environmental risk factors. A case/control study was carried out using 175 POAG patients and 175 controls, all Caucasians of at least 40 years of age. The diagnosis of POAG was established based on the presence of characteristic defects in the visual field and on glaucomatous cupping. The presence of risk factors was established by means of a questionnaire. Using a conditional logistic regression, we found that a family history of POAG in first-degree relatives was a major risk factor (OR = 7.67; 95% CI: [3.25-18.1]; p < 10(-5)). We found no link between diabetes and POAG, high blood pressure and POAG, heart disease and POAG, myopia and POAG, or the use of alcohol or tobacco and POAG. Our results indicate a strong genetic influence in the development of POAG and suggest the hypothesis of a polygenic or multifactorial mechanism.
Nursing Home Admission in Elderly Subjects With Dementia: Predictive Factors and Future Challenges
Journal of the American Medical Directors Association, 2012
The aim of this study was to identify factors predictive of nursing home admission (NHA) over a p... more The aim of this study was to identify factors predictive of nursing home admission (NHA) over a period of 1 year among elderly subjects with dementia. The study population was drawn from the SAFES cohort that was formed within a national research program into the recruitment of emergency departments in 9 teaching hospitals. Subjects were to have been hospitalized in a medical ward in the same hospital as the emergency department to which they were initially admitted. Subjects who experienced NHA before emergency department admission were excluded. Those with a confirmed diagnosis of dementia were considered in the present analysis. NHA has been defined as the incident admission into either a nursing home or other long term care facility within the follow-up period. Data obtained from a Comprehensive Geriatric Assessment were used in a Cox model to predict 1-year NHA. The 425 subjects of the study were 86 ± 6 years old, and were mainly women (63%). NHA rate was 40% (n = 172). Four factors were identified to increase NHA risk: age 85 or older (hazard ratio [HR] = 1.5; 95% confidence interval [CI] = 1.1-2.1), inability to use the toilet (HR = 2.5; 95% CI = 1.5-4.2), balance disorders (HR = 1.5; 95% CI = 1.1-2.1), and living alone (HR = 1.5; 95% CI = 1.1-2.1). Three factors decreased this risk significantly: inability to transfer (HR = 0.5; 95% CI = 0.3-0.8), increased number of children (HR = 0.88; 95% CI = 0.96-0.99), and increased initial Mini-Mental State Examination score (HR = 0.97; 95% CI = 0.8-0.9). NHA determinants in dementia are strongly linked to the patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s own characteristics but also to his or her physical or social environment. Interventions should target both members of the dyad &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;patient-caregiver&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; because both are affected by the disease.
Prevalence, characteristics and prognosis of MEN 1-associated glucagonomas, VIPomas, and somatostatinomas
Gastroentérologie Clinique et Biologique, 2004
Few studies have concerned the rare functioning endocrine pancreatic tumors associated with multi... more Few studies have concerned the rare functioning endocrine pancreatic tumors associated with multiple endocrine neoplasia type 1 (MEN 1). When sporadic, these tumors have a poor prognosis. To analyze the frequency, characteristics and prognosis of MEN 1-associated glucagonomas, VIPomas and somatostatinomas recorded in the GTE (Groupe des Tumeurs Endocrines) registry. Records of the patients whose GTE registry codes included glucagonoma, VIPoma or somatostatinoma were reviewed. The diagnosis was confirmed when there were clinical signs of a functioning tumor and/or when blood levels of the peptide were higher than twice the upper limit of normal. Among 580 patients with MEN 1, duodeno-pancreatic involvement was present in 307 (52.9%). Five (1.6%) had a glucagonoma, 3 (0.98%) a VIPoma and 2 (0.65%) a somatostatinoma. A clinical syndrome was present in 1 patient with glucagonoma, in the 3 with VIPomas and in 1 with somatostatinoma. Tumor size was greater than 3 cm more often for these rare tumours (67%) than in patients with other type of duodeno-pancreatic involvement (28%) (P=0.02) and visceral metastases were more frequent (40% vs 15%; P=0.056). Ten-year survival of patients with glucagonomas, VIPomas or somatostatinomas (53.8%; CI95%: 15.5-92.1) was poorer than that of patients with insulinomas (91.4%; CI95%: 83.399.5; P=0.01) or gastrinomas (81.7%; CI95%: 74.9-88.5; P=0.20) and close to that of patients with non-functioning tumors (62.2%, CI95%: 41.0-83.9; NS). Glucagonomas, VIPomas and somatostatinomas, especially the functioning type, are very rare in patients with MEN 1. Prognosis is poor, probably because of large tumor size and high rate of metastasis. Survival is similar to that in patients with non-functioning tumors.
Impact de l’infection à Helicobacter pylori sur le risque de complications gastro-duodénales des traitements anti-inflammatoires non stéroïdiens
Gastroentérologie Clinique et Biologique, 2004
ABSTRACT
Gastroentérologie Clinique et Biologique, 2006
Introduction-Previous studies have suggested that iron deficiency could be due to atrophic gastri... more Introduction-Previous studies have suggested that iron deficiency could be due to atrophic gastritis of the body/fundus. The aim of this study was to determine the prevalence of iron deficiency among patients with pernicious anemia and associated factors. Patients and methods-All patients with pernicious anemia diagnosed at our institution between January 1990 and February 2005 were included. Inclusion criteria were: 1-histological diagnosis of atrophic fundic gastritis and 2-criteria of gastric autoimmune involvement. Histology of gastric biopsies was performed in a blinded manner. Iron deficiency was defined as serum ferritin level < 15 µg/L in women and < 40 µg/L in men. Results-Ninety-five patients (69 women), mean age 60 years (range: 23-90) were included. Twenty patients (21.1 %) had normal blood cell counts; 12 patients (12.6 %) had microcytosis with or without anemia and 53 patients (55.8 %) macrocytosis with or without anemia. Serum ferritin levels were measured in 58 patients, 16 (27.6 %) of whom, all women, had iron deficiency. They were significantly younger (39.2 years) than patients without iron deficiency (61.6 years, P < 0.0001). Serum gastrin levels did not differ between the groups with and without iron deficiency. A significantly more severe inflammatory infiltrate of the fundus and endocrine cell hyperplasia was observed in iron deficiency patients. Multivariate analysis showed that iron deficiency was linked to female gender and age < 50 years. Conclusion-Iron deficiency and microcytic anemia are not rare in patients with pernicious anemia and should not rule out the diagnosis. Iron deficiency does not appear to be related to the degree of atrophic fundic gastritis but is linked to female gender and young age, suggesting menstrual blood loss could play a role. Whether decreased iron absorption due to reduced acid secretion favors the expression of gynecological iron loss cannot be ascertained.
Digestive calcitonin-secreting tumors of the foregut: comparison with non-calcitonin-secreting tumors
European Journal of Gastroenterology & Hepatology, 2006
Digestive calcitonin-secreting endocrine tumors are very rare lesions of the foregut. This study ... more Digestive calcitonin-secreting endocrine tumors are very rare lesions of the foregut. This study was undertaken to compare the characteristics and the prognosis of these tumors and those of non-calcitonin-secreting endocrine tumors. All patients with a digestive endocrine tumor of the foregut followed up in Reims University Hospital and whose serum calcitonin levels were determined between 1988 and 2004 were included. Clinical and tumor characteristics of calcitonin-positive and calcitonin-negative patients were compared. Thirty-two patients were included. Among the five (15.6%) with high calcitonin levels (median: 340 pg/ml, range: 42-7460 pg/ml), only one tumor was functioning (diarrhea). Significant differences between patients with positive and negative calcitonin levels were, respectively: liver metastases [5 (100%) versus 11 (40.7%); P=0.04], type according to the World Health Organization 2000 histological classification [notably 4 (80%) versus 3 (12.5%) poorly differentiated endocrine carcinomas; P=0.02] and Ki67 proliferation index [median: 25% (range: 20-30%) versus 7% (0-80%); P=0.03]. The only calcitonin-positive well-differentiated endocrine carcinoma had a high proliferation index (30%). Survival also differed significantly (P=0.001), as all calcitonin-positive patients died, with a median survival of 22.6 months (range: 1.2-27.2 months), versus five (18.5%) calcitonin-negative patients. Median follow-up period for the latter was 42.3 months (range: 3.4-208 months). The secretion of calcitonin appears predictive of a poor prognosis. Digestive endocrine calcitonin-secreting tumors correspond histopathologically to poorly differentiated or well-differentiated carcinomas with high proliferation indexes.
European Journal of Epidemiology, 2007
Background The preservation of autonomy and the ability of elderly to carry out the basic activit... more Background The preservation of autonomy and the ability of elderly to carry out the basic activities of daily living, beyond the therapeutic care of any pathologies, appears as one of the main objectives of care during hospitalization. Objectives To identify early clinical markers associated with the loss of independence in elderly people in short stay hospitals. Methods Among the 1,306 subjects making up the prospective and multicenter SAFEs cohort study (Sujet Agé Fragile: É volution et suivi-Frail elderly subjects, evaluation and follow-up), 619 medical inpatients, not disabled at baseline and hospitalized through an emergency department were considered. Data used in a multinomial logistic regression were obtained through a comprehensive geriatric assessment (CGA) conducted in the first week of
Potentially Inappropriate Use of Psychotropic Medications in Hospitalized Elderly Patients in France
Drugs & Aging, 2008
La Presse Médicale, 2010
médecine interne, réseau d'épidémiologie clinique international francophone (RECIF),
Assessment of Bullous Pemphigoid Disease Area Index during Treatment: A Prospective Study of 30 Patients
Dermatology, 2014
Background: Recently, a consensus Bullous Pemphigoid Disease Area Index (BPDAI) was proposed to m... more Background: Recently, a consensus Bullous Pemphigoid Disease Area Index (BPDAI) was proposed to measure therapeutic outcomes in bullous pemphigoid (BP). Objective: To compare BPDAI with other clinical parameters of disease activity at baseline and to describe the variations of BPDAI during the initial phase of treatment. Methods: Thirty BP patients were included and followed for 1 year. BPDAI was assessed at baseline and on days 30, 90 and 360 by the same investigator. Concomitantly, the number of daily new blisters, the skin surface area of erythematous/eczematous/urticarial plaques and blisters/erosions, total lesion area (TLA), pruritus score and mucosal involvement were recorded. Results: At baseline, BPDAI was 46.7 ± 25 (mean ± SD); it was well correlated with erythematous/eczematous/urticarial skin surface (r = 0.63), TLA (r = 0.83), number of daily new blisters (r = 0.7; p ≤ 0.0002) and anti-BP180 autoantibodies (r = 0.49; p = 0.006), but not with anti-BP230 autoantibodies. F...
[Comparative study of antitoxoplasmic IgG isotypes titrated by high sensitivity direct agglutination and indirect immunofluorescence: consequence of the choice of methods on the expression of results in international units]
Annales de biologie clinique
The use of International Units per ml (IU/ml) to express antitoxoplasmic IgG antibody titers in t... more The use of International Units per ml (IU/ml) to express antitoxoplasmic IgG antibody titers in the various diagnostic systems presently proposed, is misleading owing to discrepancies in the values found from one test to the other for a given serum. The authors compared the results of high sensitivity direct agglutination (HSDA) to those of indirect immunofluorescence (IIF) in two studies, systematic and longitudinal, dealing with 158 sera stratified for values ranging from 102,400 to 5 IU/ml. Discordances between the methods, which are greater for high values, prompt the use of low-titer sera for standardization. From the systematic study, a correlation table was established and proposed to convert the HSDA results into the theoretical corrected values close to those that would be obtained by IIF. Although this may be of interest in maintaining a coherent language, this table has its limits, particularly in acute episodes where the various antibody kinetics vary and amplify further...
Colonic Flat Neoplasia: Frequency and Concordance Between Endoscopic Appearance and Histological Diagnosis in a French Prospective Series
The American Journal of Gastroenterology, 2004
INTRODUCTION In 1985, Muto et al. (1) described colorectal flat adenomas characterized by a high ... more INTRODUCTION In 1985, Muto et al. (1) described colorectal flat adenomas characterized by a high rate of high-grade dysplasia and, a few years later, the first large series of 45 superficial nonpolypoid colorectal adenocarcinomas was reported (2). Endoscopists describe these ...
Bleeding reflux esophagitis: a prospective 1-year study in a university hospital
The American Journal of Gastroenterology, 2001
The prevalence of bleeding from reflux esophagitis has not been studied. The aim of the study was... more The prevalence of bleeding from reflux esophagitis has not been studied. The aim of the study was to evaluate the 1-yr prevalence of bleeding from reflux esophagitis, as well as the independent factors associated with bleeding. All patients with reflux esophagitis diagnosed with upper digestive tract endoscopy in Reims Hospital in 1996 were included. Studied parameters were prospectively recorded and compared between patients with bleeding and nonbleeding reflux esophagitis. Endoscopy was performed in 1983 patients of whom 219 (11.0%) had overt upper digestive tract hemorrhage. Reflux esophagitis was the cause of bleeding in 32 patients (14.6%). Reflux esophagitis was diagnosed in 391 patients during the same period of time. Bleeding reflux esophagitis accounted for 8.2% of them. Independent factors associated with bleeding were grade 3 or 4 (Savary-Miller) esophagitis (odds ratio [OR]: 25.5, 95% confidence interval [CI]: 9.6-67.9), cirrhosis (OR: 5.7, 95% CI: 1.7-18.9), Eastern Cooperative Oncology Group performance status > or = 3 (OR: 4.6, 95% CI: 1.5-14.2), and anticoagulant therapy (OR: 3.9, 95% CI: 1.2-12.5). A history of reflux esophagitis or heartburn was noted in only 28.1% or 37.5% of the patients with bleeding reflux esophagitis, respectively. In this population of patients with reflux esophagitis, the prevalence of bleeding esophagitis was high (8.2%). Bleeding esophagitis occurred primarily in patients with severe esophagitis and was the revealing clinical form of gastroesophageal reflux disease in the majority of cases, suggesting that bleeding prevention would hardly be effective.
Presse Medicale, 2007
The aim of this study was to identify early indicators of prolonged hospital stays by elderly pat... more The aim of this study was to identify early indicators of prolonged hospital stays by elderly patients. ■ Résumé Objectif > Identifier les indicateurs précoces de durée de séjour prolongée chez des patients âgés hospitalisés en service de court séjour de médecine. Méthodes > Une étude pilote prospective a été réalisée au CHRU de Strasbourg incluant des sujets âgés de 75 ans ou plus hospitalisés en
Presse Medicale, 2010
What do we learn from the SAFEs cohort to fit hospital care models for aged inpatient? Que nous a... more What do we learn from the SAFEs cohort to fit hospital care models for aged inpatient? Que nous apprend la cohorte SAFEs sur l'adaptation des filières de soins intra-hospitalières à la prise en charge des patients âgés ? Gé riatrie tome 39 > n811 > novembre 2010
Geriatrie et Psychologie Neuropsychiatrie du Vieillissement, 2011
Si les efforts de recherche ont conduit à mieux préciser la physiopathologie et la dynamique du p... more Si les efforts de recherche ont conduit à mieux préciser la physiopathologie et la dynamique du processus de fragilisation, l'actuelle définition opérationnelle de la fragilité est encore loin d'être univoque. Les études réalisées à partir des données la cohorte hospitalière SAFEs ont permis une approche pragmatique de l'identification des sous-populations à risque de survenue d'incapacité durant l'hospitalisation et les facteurs influenç ant leur devenir à court, moyen et long termes. À partir des enseignements existants, nous proposons une réflexion sur la pertinence des indicateurs opérationnels actuels de l'état de fragilité afin de montrer que les marqueurs ou indicateurs cliniques sont insuffisants pour permettre de différencier le processus de fragilisation du vieillissement normal. Finalement, nous mettons en exergue l'impérative nécessité d'identifier la fragilité à un stade pré-clinique au travers de marqueurs biologiques et plus particulièrement les marqueurs de l'inflammation.
Adverse Drug Reactions in Elderly Subjects Hospitalized in a Specialized Dementia Management Unit
Drugs & Aging, 2014
Factors Predicting the Long-Term Success of Maintenance Cyclosporine Monotherapy After Kidney TRANSPLANTATION1
Transplantation, 2000
The theoretical aim of maintenance cyclosporine monotherapy (mCsA) after kidney transplantation i... more The theoretical aim of maintenance cyclosporine monotherapy (mCsA) after kidney transplantation is to reduce the incidence of the metabolic complications of corticosteroids and to minimize the adverse effects of excessive long-term immunosuppression. This study was performed in low-immunological-risk cadaveric kidney transplant recipients to evaluate the risks and benefits of mCsA and the long-term graft survival, and to determine the factors predicting success of this policy. The multicenter retrospective study was conducted in 329 Caucasian patients receiving mCsA out of 728 first cadaveric kidney transplant recipients. The inclusion criteria were: HLA antibodies < or =25%, serum creatinine <200 micromol/L, and no rejection or only one rejection episode. At the end of the study, we compared the group of patients successfully treated with mCsA (successful group) with those requiring additional immunosuppressive agents (unsuccessful mCsA group). Overall patient and graft survival rates for the 728 first cadaveric graft were 92% and 64%, respectively, at 8 years. Out of 329 patients enrolled in mCsA, 240 were maintained on this treatment and 89 were withdrawn (3 deaths, 18 graft losses, 68 functional grafts). The 8-year graft survival in the 329 enrolled mCsA patients was 84%, 95% in the successful mCsA group, and 70% in the unsuccessful mCsA group. Multivariate analysis showed that the factors predicting success of mCsA were: donor age <40 years (P = 0.001), serum creatinine at mCsA initiation <125 micromol/L (P = 0.02), no rejection episode before mCsA initiation (P = 0.005), and glomerulopathy as the primary renal disease (P = 0.001). Numerous kidney transplant recipients with a low immunological risk and good and stable renal function may benefit from discontinuation of prednisone and azathioprine in order to reduce the complications related to these drugs. This therapeutic approach had no adverse impact on the overall long-term graft survival for "low risk" and successful patients.
PLoS ONE, 2014
Background: This prospective multicenter study aimed to study the impact of the recalibration com... more Background: This prospective multicenter study aimed to study the impact of the recalibration component of responseshift (RS) on time to deterioration (TTD) in health related quality of life (QoL) scores in breast cancer (BC) patients and the influence of baseline QoL expectations on TTD. Methods: The EORTC-QLQ-C30 and BR-23 questionnaires were used to assess the QoL in a prospective multicenter study at inclusion (T0), at the end of the first hospitalization (T1) and, three (T2) and 6 months after the first hospitalization (T3). Recalibration was investigated by the then-test method. QoL expectancy was assessed at diagnosis. Deterioration was defined as a 5-point decrease in QoL scores, considered a minimal clinically important difference (MCID). TTD was estimated using the Kaplan-Meier method. Cox regression analyses were used to identify factors influencing TTD. Results: From February 2006 to February 2008, 381 women were included. Recalibration of breast cancer patients' internal standards in the assessment of their QoL had an impact on TTD. Median TTD were significantly shorter when recalibration was not taken into account than when recalibration was taken into account for global health, role-functioning, socialfunctioning, body-image and side effects of systemic therapy. Cox multivariate analyses showed that for body image, when recalibration was taken into account, radiotherapy was associated with a shorter TTD (HR: 0.60[0.38-0.94], whereas, no significant impact of surgery type on TTD was observed. For global health, cognitive and social functioning dimensions, patients expecting a deterioration in their QoL at baseline had a significantly shorter TTD. Conclusions: Our results showed that RS and baseline QoL expectations were associated with time to deterioration in breast cancer patients.
Genetic risk factor in primary open-angle glaucoma: a case-control study
Ophthalmic Epidemiology, 1994
To evaluate the link between primary open-angle glaucoma (POAG) and potential genetic and environ... more To evaluate the link between primary open-angle glaucoma (POAG) and potential genetic and environmental risk factors. A case/control study was carried out using 175 POAG patients and 175 controls, all Caucasians of at least 40 years of age. The diagnosis of POAG was established based on the presence of characteristic defects in the visual field and on glaucomatous cupping. The presence of risk factors was established by means of a questionnaire. Using a conditional logistic regression, we found that a family history of POAG in first-degree relatives was a major risk factor (OR = 7.67; 95% CI: [3.25-18.1]; p < 10(-5)). We found no link between diabetes and POAG, high blood pressure and POAG, heart disease and POAG, myopia and POAG, or the use of alcohol or tobacco and POAG. Our results indicate a strong genetic influence in the development of POAG and suggest the hypothesis of a polygenic or multifactorial mechanism.
Nursing Home Admission in Elderly Subjects With Dementia: Predictive Factors and Future Challenges
Journal of the American Medical Directors Association, 2012
The aim of this study was to identify factors predictive of nursing home admission (NHA) over a p... more The aim of this study was to identify factors predictive of nursing home admission (NHA) over a period of 1 year among elderly subjects with dementia. The study population was drawn from the SAFES cohort that was formed within a national research program into the recruitment of emergency departments in 9 teaching hospitals. Subjects were to have been hospitalized in a medical ward in the same hospital as the emergency department to which they were initially admitted. Subjects who experienced NHA before emergency department admission were excluded. Those with a confirmed diagnosis of dementia were considered in the present analysis. NHA has been defined as the incident admission into either a nursing home or other long term care facility within the follow-up period. Data obtained from a Comprehensive Geriatric Assessment were used in a Cox model to predict 1-year NHA. The 425 subjects of the study were 86 ± 6 years old, and were mainly women (63%). NHA rate was 40% (n = 172). Four factors were identified to increase NHA risk: age 85 or older (hazard ratio [HR] = 1.5; 95% confidence interval [CI] = 1.1-2.1), inability to use the toilet (HR = 2.5; 95% CI = 1.5-4.2), balance disorders (HR = 1.5; 95% CI = 1.1-2.1), and living alone (HR = 1.5; 95% CI = 1.1-2.1). Three factors decreased this risk significantly: inability to transfer (HR = 0.5; 95% CI = 0.3-0.8), increased number of children (HR = 0.88; 95% CI = 0.96-0.99), and increased initial Mini-Mental State Examination score (HR = 0.97; 95% CI = 0.8-0.9). NHA determinants in dementia are strongly linked to the patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s own characteristics but also to his or her physical or social environment. Interventions should target both members of the dyad &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;patient-caregiver&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; because both are affected by the disease.
Prevalence, characteristics and prognosis of MEN 1-associated glucagonomas, VIPomas, and somatostatinomas
Gastroentérologie Clinique et Biologique, 2004
Few studies have concerned the rare functioning endocrine pancreatic tumors associated with multi... more Few studies have concerned the rare functioning endocrine pancreatic tumors associated with multiple endocrine neoplasia type 1 (MEN 1). When sporadic, these tumors have a poor prognosis. To analyze the frequency, characteristics and prognosis of MEN 1-associated glucagonomas, VIPomas and somatostatinomas recorded in the GTE (Groupe des Tumeurs Endocrines) registry. Records of the patients whose GTE registry codes included glucagonoma, VIPoma or somatostatinoma were reviewed. The diagnosis was confirmed when there were clinical signs of a functioning tumor and/or when blood levels of the peptide were higher than twice the upper limit of normal. Among 580 patients with MEN 1, duodeno-pancreatic involvement was present in 307 (52.9%). Five (1.6%) had a glucagonoma, 3 (0.98%) a VIPoma and 2 (0.65%) a somatostatinoma. A clinical syndrome was present in 1 patient with glucagonoma, in the 3 with VIPomas and in 1 with somatostatinoma. Tumor size was greater than 3 cm more often for these rare tumours (67%) than in patients with other type of duodeno-pancreatic involvement (28%) (P=0.02) and visceral metastases were more frequent (40% vs 15%; P=0.056). Ten-year survival of patients with glucagonomas, VIPomas or somatostatinomas (53.8%; CI95%: 15.5-92.1) was poorer than that of patients with insulinomas (91.4%; CI95%: 83.399.5; P=0.01) or gastrinomas (81.7%; CI95%: 74.9-88.5; P=0.20) and close to that of patients with non-functioning tumors (62.2%, CI95%: 41.0-83.9; NS). Glucagonomas, VIPomas and somatostatinomas, especially the functioning type, are very rare in patients with MEN 1. Prognosis is poor, probably because of large tumor size and high rate of metastasis. Survival is similar to that in patients with non-functioning tumors.
Impact de l’infection à Helicobacter pylori sur le risque de complications gastro-duodénales des traitements anti-inflammatoires non stéroïdiens
Gastroentérologie Clinique et Biologique, 2004
ABSTRACT
Gastroentérologie Clinique et Biologique, 2006
Introduction-Previous studies have suggested that iron deficiency could be due to atrophic gastri... more Introduction-Previous studies have suggested that iron deficiency could be due to atrophic gastritis of the body/fundus. The aim of this study was to determine the prevalence of iron deficiency among patients with pernicious anemia and associated factors. Patients and methods-All patients with pernicious anemia diagnosed at our institution between January 1990 and February 2005 were included. Inclusion criteria were: 1-histological diagnosis of atrophic fundic gastritis and 2-criteria of gastric autoimmune involvement. Histology of gastric biopsies was performed in a blinded manner. Iron deficiency was defined as serum ferritin level < 15 µg/L in women and < 40 µg/L in men. Results-Ninety-five patients (69 women), mean age 60 years (range: 23-90) were included. Twenty patients (21.1 %) had normal blood cell counts; 12 patients (12.6 %) had microcytosis with or without anemia and 53 patients (55.8 %) macrocytosis with or without anemia. Serum ferritin levels were measured in 58 patients, 16 (27.6 %) of whom, all women, had iron deficiency. They were significantly younger (39.2 years) than patients without iron deficiency (61.6 years, P < 0.0001). Serum gastrin levels did not differ between the groups with and without iron deficiency. A significantly more severe inflammatory infiltrate of the fundus and endocrine cell hyperplasia was observed in iron deficiency patients. Multivariate analysis showed that iron deficiency was linked to female gender and age < 50 years. Conclusion-Iron deficiency and microcytic anemia are not rare in patients with pernicious anemia and should not rule out the diagnosis. Iron deficiency does not appear to be related to the degree of atrophic fundic gastritis but is linked to female gender and young age, suggesting menstrual blood loss could play a role. Whether decreased iron absorption due to reduced acid secretion favors the expression of gynecological iron loss cannot be ascertained.
Digestive calcitonin-secreting tumors of the foregut: comparison with non-calcitonin-secreting tumors
European Journal of Gastroenterology & Hepatology, 2006
Digestive calcitonin-secreting endocrine tumors are very rare lesions of the foregut. This study ... more Digestive calcitonin-secreting endocrine tumors are very rare lesions of the foregut. This study was undertaken to compare the characteristics and the prognosis of these tumors and those of non-calcitonin-secreting endocrine tumors. All patients with a digestive endocrine tumor of the foregut followed up in Reims University Hospital and whose serum calcitonin levels were determined between 1988 and 2004 were included. Clinical and tumor characteristics of calcitonin-positive and calcitonin-negative patients were compared. Thirty-two patients were included. Among the five (15.6%) with high calcitonin levels (median: 340 pg/ml, range: 42-7460 pg/ml), only one tumor was functioning (diarrhea). Significant differences between patients with positive and negative calcitonin levels were, respectively: liver metastases [5 (100%) versus 11 (40.7%); P=0.04], type according to the World Health Organization 2000 histological classification [notably 4 (80%) versus 3 (12.5%) poorly differentiated endocrine carcinomas; P=0.02] and Ki67 proliferation index [median: 25% (range: 20-30%) versus 7% (0-80%); P=0.03]. The only calcitonin-positive well-differentiated endocrine carcinoma had a high proliferation index (30%). Survival also differed significantly (P=0.001), as all calcitonin-positive patients died, with a median survival of 22.6 months (range: 1.2-27.2 months), versus five (18.5%) calcitonin-negative patients. Median follow-up period for the latter was 42.3 months (range: 3.4-208 months). The secretion of calcitonin appears predictive of a poor prognosis. Digestive endocrine calcitonin-secreting tumors correspond histopathologically to poorly differentiated or well-differentiated carcinomas with high proliferation indexes.
European Journal of Epidemiology, 2007
Background The preservation of autonomy and the ability of elderly to carry out the basic activit... more Background The preservation of autonomy and the ability of elderly to carry out the basic activities of daily living, beyond the therapeutic care of any pathologies, appears as one of the main objectives of care during hospitalization. Objectives To identify early clinical markers associated with the loss of independence in elderly people in short stay hospitals. Methods Among the 1,306 subjects making up the prospective and multicenter SAFEs cohort study (Sujet Agé Fragile: É volution et suivi-Frail elderly subjects, evaluation and follow-up), 619 medical inpatients, not disabled at baseline and hospitalized through an emergency department were considered. Data used in a multinomial logistic regression were obtained through a comprehensive geriatric assessment (CGA) conducted in the first week of
Potentially Inappropriate Use of Psychotropic Medications in Hospitalized Elderly Patients in France
Drugs & Aging, 2008