Is the volume-outcome relation still an issue in the era of PCI with systematic stenting? Results of the greater Paris area PCI registry.
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AIMS: In acute myocardial infarction (AMI), primary percutaneous transluminal angioplasty (PTCA) is the preferred option when it can be performed rapidly. Because of the limited access to high PTCA volume centres in some areas, it has been suggested that PTCA could be performed in low-volume centres on AMI patients. Little data exist on the validity of this strategy in modern era PTCA. METHODS AND RESULTS: The Greater Paris area comprises 11 million inhabitants and accounts for 18% of the French population. In 2001, the hospital agency of the Greater Paris area set up a registry of all PTCAs performed in this region. Data from 2001 and 2002 was analysed. Hospitals performing <400 PTCAs per year were classified as low-volume. A case-control analysis (propensity score) compared in-hospital mortality in low- and high-volume centres. A total of 37 848 angioplasty procedures were performed in 44 centres during the study period; 24.7% were performed in low-volume centres. A non-statistically significant trend towards reduced in-hospital mortality was noted in high-volume centres as opposed to low-volume centres: 2.01 vs. 2.42%, P = 0.057. In-hospital mortality rates were significantly different in the sub-group of emergency procedures: 6.75% in high- vs. 8.54% in low-volume centres, P = 0.028. No difference was noted between low- and high-volume centres in non-emergency procedures (0.62 vs. 0.62%, P = 0.99). CONCLUSION: In the era of modern stenting, a clear inverse relationship exists between hospital PTCA volume and in-hospital mortality after emergency procedures. Tolerance of low-volume thresholds for angioplasty centres with the purpose of providing primary PTCA in AMI should not be recommended, even in underserved areas. (+info)
Microbiological diagnosis of empyema in children: comparative evaluations by culture, polymerase chain reaction, and pneumococcal antigen detection in pleural fluids.
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BACKGROUND: Pleural empyema is an increasingly reported complication of pneumonia in children. Microbiological diagnostic tests for empyema by culture frequently have false-negative results due to previous administration of antibiotics. Molecular diagnosis by broad-range 16S ribosomal DNA (rDNA) polymerase chain reaction (PCR) and rapid pneumococcal antigen detection are reliable tools, but their diagnostic value has not been clearly established for pleural fluid samples. Pneumococcal antigen detection has only been validated for urine and cerebrospinal fluid samples. METHODS: Over 4 years, pleural fluid specimens were collected from 78 children with pleural empyema. Standard culture, pneumococcal antigen detection by latex agglutination (Pastorex; Bio-Rad) and immunochromatographic testing (Binax NOW Streptococcus pneumoniae), and 16S rDNA PCR were performed on these specimens. Pneumococcal identification by 16S rDNA PCR and sequencing was confirmed by pneumolysin PCR. RESULTS: Of the 78 cases of pleural empyema, 60 (77%) were microbiologically documented by culture or 16S rDNA PCR. Of the 40 pneumococcal empyema cases, 17 (43%) were only diagnosed by PCR and 23 with PCR and culture. The sensitivity and specificity of the latex antigen detection (with the use of culture and/or PCR as the test standard) were 90% and 95%, respectively. The immunochromatographic test detected pneumococcal antigens in 3 additional specimens for which latex agglutination results were negative, thereby increasing the sensitivity of antigen detection. CONCLUSIONS: Pneumococcal antigen detection in pleural fluid specimens from children provides a rapid and sensitive method of diagnosis of pneumococcal empyema, which can be confirmed by specific pneumolysin PCR when culture results are negative. Broad-range 16S rDNA PCR has value in detecting bacterial agents responsible for culture-negative pleural empyema. (+info)
Adolphe Pinard (1844-1934) of Paris and intrauterine paediatric care.
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Pinard was a pioneer of modern perinatal care. His provision of social care to deprived pregnant women progressed to a recognition of the value of medical care of mother and baby before as well as after birth. The creation of antenatal departments and wards in maternity hospitals followed. He also established abdominal obstetric palpation on sound principles. (+info)
Guillain-Barre syndrome, greater Paris area.
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We studied 263 cases of Guillain-Barre syndrome from 1996 to 2001, 40% of which were associated with a known causative agent, mainly Campylobacter jejuni (22%) or cytomegalovirus (15%). The cases with no known agent (60%) peaked in winter, and half were preceded by respiratory infection, influenza-like syndrome, or gastrointestinal illness. (+info)
Colorectal polyps and cancers diagnosed by pathologists in Ile de France Region. Crisapif-Petri Study.
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OBJECTIVES: The aim of this study was to evaluate the histological characteristics of adenomatous polyps (AP), non adenomatous polyps (NAP), and colorectal cancers (CRC) diagnosed in the greater Paris area. MATERIAL AND METHODS: Pathologists filled out an identification and histological questionnaire for each biopsy or surgical specimen received between 20/09/02 and 20/12/02, which had at least one colorectal polyp or CRC, taken from a patient of the greater Paris area. RESULTS: The participation rate of pathologists was 73.3% and 10,396 patients with 16,681 lesions were included. Lesions consisted in 1,223 CRC among 1,107 patients, 9,280 AP and 6,178 NAP. Mean age of patients with CRC was 68 years, with at least one AP without CRC 62 years, and with at least one NAP without CRC or AP 58 years. The mean number of polyps per patient was 1.4, and increased with age. Average size of AP was larger than that of NAP and the size increased with age for AP but not NAP. pTNM staging of CRC was: pT0, 1% pT1, 4% pT2, 13% pT3, 63% pT4, 19% N0, 55% N1, 24% N2, 19% Nx, 2%. CONCLUSION: This study provides detailed data on colorectal polyps and colorectal cancers in the greater Paris region, which does not have a cancer registry. Repeated surveys could be helpful for evaluating the efficacy of screening programs in the general population. (+info)
Risk factors for heat related death during the August 2003 heat wave in Paris, France, in patients evaluated at the emergency department of the Hopital Europeen Georges Pompidou.
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OBJECTIVES: This study sought to determine the risk factors for short term mortality in the victims of the heat wave of August 2003 in France from among patients evaluated in our emergency department (ED). It was hypothesised that age, temperature, and some long term therapies and pre-existing pathologies were factors associated with short term mortality. METHODS: A retrospective analysis of a seven day period. Four experts decided blindly, in pairs, whether a patient had presented with a heat related problem. Inclusion criteria were: core temperature > or =38 degrees C and/or clinical signs of dehydration. Comparisons were made between the survivors and one month non-survivors for 57 different items. Short term mortality was defined as death in the ED or within the first month of the ED visit. RESULTS: Of 841 patients attending the ED in the study period, 165 were included in the study, of which most were elderly women. Thirty one (18.8%) died within one month. Factors associated with short term mortality were: a greater degree of dependent living; more severe clinical condition on admission (higher temperature and heart rate, lower blood pressure, hypoxia, and altered mental status); higher values of blood glucose, troponin, and white blood cell count; lower values of serum protein and prothrombin levels; pre-existing ischaemic cardiomyopathy; pneumonia as associated infection; and previous psychotropic treatment. The total number of survivors at one year was 91. CONCLUSIONS: Although this study is limited because of the small sample size, the results have helped determine factors useful for future identification of patients at greatest risk of death in order to implement a more efficient patient care protocol. (+info)
Clonal dissemination of a CTX-M-15 beta-lactamase-producing Escherichia coli strain in the Paris area, Tunis, and Bangui.
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One hundred twenty CTX-M-15-producing Escherichia coli strains isolated in 10 different hospitals from Paris (France), in the Hospital Charles Nicolle in Tunis (Tunisia), and in the Pasteur Institute in Bangui, Central African Republic (CAR), between 2000 and 2004 were studied. Eighty isolates, recovered from the three countries, were clonally related by repetitive extragenic palindromic PCR and pulsed-field gel electrophoresis. Various resistance profiles were identified among these clonal strains. After conjugation or electroporation of plasmids from E. coli strains representative of each profile and each geographic region, we observed seven resistance profiles in the recipient strains. Incompatibility typing showed that all the plasmids transferred from the clonal strains studied, except one, belonged to the incompatibility group FII. They all shared a multidrug resistance region (MDR) resembling the MDR region located in pC15-1a, a plasmid associated with an outbreak of a CTX-M-15-producing E. coli strain in Canada. They also shared the common backbone of an apparent mosaic plasmid, including several features present in pC15-1a and in pRSB107, a plasmid isolated from a sewage treatment plant. This study suggests that although the plasmid-borne blaCTX-M-15 gene could be transferred horizontally, its dissemination between France, Tunisia, and CAR was due primarily to its residence in an E. coli clone with a strong propensity for dissemination. (+info)
Odontogenic cysts: a clinical study of 695 cases.
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The aim of this study was to analyze the files of 695 consecutive patients operated on under general anesthesia for odontogenic cysts in an adult French teaching hospital for comparison with findings in world surveys. A retrospective survey of cysts of the jaws was undertaken at the Maxillofacial department, Pitie-Salpetriere University Hospital, Paris, France. Data were retrieved from case notes, imaging, histopathology records and follow-up reports from January 1995 to January 2005. The mean age of patients was 41.8 +/- 15.8 years. There was an overall male to female ratio of 1.86:1. Mandible to maxilla ratio was 3:1. Regarding the mandible, the angle was involved in 36% of the cases, horizontal branch in 32%, parasymphysis in 18%, ramus in 11.6%, coronoid process in 1.5% and condyle in 0.9% (total = 100%). Regarding the maxilla, the canine to canine region was involved in 40% of the cases, premolar and molar region in 45%, and wisdom tooth region in 15% (total = 100%). The three most frequently diagnosed odontogenic cysts were radicular cysts (53.5%), dentigerous cysts (22.3%) and odontogenic keratocysts (19.1%). Together, these three entities represented 94.9% of all odontogenic cysts. The mean number of operation per patient was 1.16 (SD: 0.6, range: 1-10). The mean cumulated duration of hospitalization for one patient was 2.46 days (SD: 1.9, range: 1-28). The mean length of follow-up was 8.4 months (SD: 15.2, range: 0-120). Sixty five percent had a follow-up inferior to 6 months and 18% had no follow-up at all. The two most important findings of this case series are 1) the important number of radicular cysts that could be avoided because most of these cysts develop as a consequence of advanced carious lesions and 2) regarding other types of cysts, the dramatic rate of patients lost to follow-up. (+info)