Brest University Hospital Research Articles

Astreinte odontologique au sein d’un CHU : mise en place et résultats préliminaires d’activité

Background In France, few hospitals are able to provide uninterrupted care for dental emergencies. To meet the legal and deontological requirements, since October 2007, the Brest University Hospital has set up a dental emergency unit with on call consultants. Prior to this set-up, the needs had been evaluated through surveys conducted in Brest hospital. This study deals with the results of these surveys, and reports the experience of this call emergency service after 1 year of operation. Methods The needs of the general population concerning emergency dental care were quantified in three units of Brest hospital (general, pediatric and ENT emergencies) for 6 months and the mobile emergency unit (Samu 29) for 1 year. The findings led to setting up an emergency dental unit during week-ends. The activities of this unit after 1 year of operation were evaluated retrospectively. Variables concerning attendance and activity level, patient parameters and out-of-hours emergency activity were studied. For this purpose, data from the medical record and from complementary “information sheets” completed by the clinicians were analyzed. Results The preliminary step of needs-quantification recorded an important demand for dental service in both emergencies units of Brest hospital and Samu 29. During the first year of operation, attendance level was on average 6.3 (± 4.3) consultations per week-end. Peak activity levels were reached on saturday and sunday afternoons and also during the summer months. Male patients were more numerous than females and the mean age of the population was 32.6 years (±17.6). By decreasing order of frequency, the diseases encountered were mainly infectious, then trauma-related, inflammatory and others. Clinical interventions were mainly in endodontics, conservative dentistry and surgery. Conclusion This on call emergency service meets the needs of the general population concerning emergency dental care when hospital dental departments and regular dental offices are closed. This is a public health issue.

Detection of occult wrist fractures by quantitative radioscintigraphy: a prospective study on selected patients

To determine the value of quantitative radioscintigraphy (QRS) in the diagnosis of wrist trauma occult fractures. Because of the risk of non-union, the diagnosis of wrist fractures, including scaphoid fractures, is essential but remains difficult despite many imaging modalities. The aim of the study was to assess the benefits of QRS in the diagnosis of occult post-trauma wrist fractures. This prospective study included all patients presenting at the orthopaedic department at Brest University Hospital for wrist pain after trauma with initial normal plain radiographs. Patients with normal radiographs but strongly suspected of fracture underwent QRS consisting of three-phase bone scintigraphy with quantitative analysis. When a fracture was suspected the radiograph and scintigraphy were fused to precisely locate the fracture if the index was higher than 2. If the index was lower than 1.9, fracture was excluded. Between these two indices, other investigations, such as magnetic resonance imaging, were performed. All patients were followed for at least 3 months and reviewed by the same surgeon. Patients underwent a physical examination and possibly other investigations. From April 2006 to July 2008, 87 patients were enrolled (34 women, 53 men; median age 29 years; range, 15-87 years). Among the 46 pathologic bone scintigrams, 55 occult fractures were highlighted. At follow-up, none presented non-union. One had an undetermined QRS. Among the 40 negative results for QRS at follow-up, only one had a non-union. Sensitivity and negative predictive value were 97 and 98%, respectively for carpal fractures. This study highlights the benefit of QRS, which allows the detection of most occult carpal fractures and reduces the risks of complications such as pseudoarthritis.

Use of anticoagulants in elderly patients: practical recommendations

Elderly people represent a patient population at high thromboembolic risk, but also at high hemorrhagic risk. There is a general tendency among physicians to underuse anticoagulants in the elderly, probably both because of underestimation of thromboembolic risk and overestimation of bleeding risk. The main indications for anticoagulation are venous thromboembolism (VTE) prophylaxis in medical and surgical settings, VTE treatment, atrial fibrillation (AF) and valvular heart disease. Available anticoagulants for VTE prophylaxis and initial treatment of VTE are low molecular weight heparins (LMWH), unfractionated heparin (UFH) or synthetic anti-factor Xa pentasaccharide fondaparinux. For long-term anticoagulation vitamin K antagonists (VKA) are the first choice and only available oral anticoagulants nowadays. Assessing the benefit-risk ratio of anticoagulation is one of the most challenging issues in the individual elderly patient, patients at highest hemorrhagic risk often being those who would have the greatest benefit from anticoagulants. Some specific considerations are of utmost importance when using anticoagulants in the elderly to maximize safety of these treatments, including decreased renal function, co-morbidities and risk of falls, altered pharmacodynamics of anticoagulants especially VKAs, association with antiplatelet agents, patient education. Newer anticoagulants that are currently under study could simplify the management and increase the safety of anticoagulation in the future.

Caractéristiques d’une cohorte d’enfants et d’adolescents de la liste d’attente de consultation d’un service universitaire sectorisé de psychiatrie de l’enfant et de l’adolescent du CHU de Brest

Objective Give the sociodemographic features of the requests made in 2004 for consultations at the Child and Adolescent Psychiatry Department of Brest University Hospital and assess the immediate help given to those young outpatients. Methods It is based on the phone calls for consultations received by the medical secretaries who filled in a 49-item data-grid. The collected data are thus: date of phone call, date of birth, sex, address, school level, size of the subject's-family and his position within it, twins, type of family, person or institution responsible for the request (hospital, maternal child départment, other child psychiatry départment, GP, social services, justice, family, school), reason at the origin of the request (psychofunctional disorder(s), agressiveness, behaviour, kind of parenthood, level in school, events in the family life, ill-treatment, subject behind at school, depression/anxiety, psychosis), history of medical follow-up, type of action (in-hospital or out-hospital intervention, waiting list), waiting time prior to the first consultation, attendance to this consultation. The data are passed on to the coordinator doctor who, in turn, directs the request either to a child psychiatrist for consultation, or to a medical intern for a quick appointment and advice or to the waiting list. Results The total number of requests in 2004 was 140; 71.2% of them were about subjects with no past history of follow-up and 63.3% were about boys. Half of the intervention cases were about children below eight years with a peak at the age of four. It is worth noting that other peaks were found at eight and 11 years; two out of three children go to a nursery school or a primary school where he is usually in the early years. Moreover, in two out of three families, the subject has, at least, a brother or a sister, and most of the time he is the elder. In 41% of cases, the request emanated from the child's parents, in 25.9% from a doctor (a GP for nine out of 10 cases) and in 9.4% from the child's school. A third of the requests was made because of behaviour disorders; among the other cases 15% were induced by problems at school. A consultation intervention by a child psychiatrist and or resident was possible for 41% out of the 140 requests, 6% of cases were followed as out-patients, and the last 53% were put on a waiting list. In 75% of cases, an appointment was given by the following month and 3,5% of children did not come to the consultation. Conclusion The close examination of waiting lists should be a valuable help to find more satisfying solutions to the constant increase of calls for appointment with a Child and Adolescent psychiatrist observed over the last five years.

Metabolic syndrome: A major risk factor for atherosclerosis in HIV-infected patients (SHIVA study)

Metabolic syndrome (MetS) is directly related to a high incidence of cardiovascular disease in the general population. The association is more doubtful among HIV-infected patients, although MetS has an elevated prevalence in this population. We explored the impact of MetS on early atherosclerosis markers. All HIV-infected outpatients followed at the Brest University Hospital were included in this cross-sectional hospital-based study (SHIVA study, France) (n=154). The MetS status (NCEP ATPIII definition, at least three of these five criteria: fasting glucose, triglycerides, HDL-C, waist circumference and hypertension.) of each patient was analyzed (Mann-Whitney test) according to carotid intima-media thickness, number of plaques, and a combined cardiovascular score. After exclusion of 6 patients treated with statins or insulin or both, MetS status was available for 140 (90.9%) patients and positive for 10 (7.1%). MetS status was due predominantly to blood glucose and triglyceride levels and was strongly correlated with all atherosclerosis markers (p < or = 0.01). The MetS prevalence in this population is low for a group with HIV infection, even after inclusion of the statin-treated patients (11.4%), but remains higher than among the general population. MetS in this population is probably a heterogeneous cluster of side effects of antiretroviral therapy (high triglycerides, lower HDL-C, and hypertension) and direct effects of HIV (glucose disturbances). Because it is strongly linked to the presence of plaque and intimal thickness, it is a pertinent criterion for deciding about cardiovascular prevention.

Modification in expression of EGFr, p53, and pTEN in non small cell lung cancer (NSCLC)

13151 Background: Treatment inhibiting tyrosine kinase domain of EGFr have proved dramatically efficient in NSCLC. Even if several studies have revealed predictors of treatment response, - such as gender, adenocarcinoma histology, gene mutations, or Asian origin-, response to treatment remains random and is not correlated with an initial overexpression of EGFr by the tumor. The efficiency of those EGFr inhibitors was only shown in second- or third-line treatments, and studies using them in first-line treatments, particularly when combined, had no positive outcome. We have therefore assessed the expression of EGFr in NSCLC before and after cisplatin-based chemotherapy to see if it modified the level of expression of either EGFr, or of molecules including its chain of activation, such as P53 or pTEN. Methods: Tumor samples were obtained from patients treated for NSCLC. We retrospectively studied the bronchial samples of all the patients treated for NSCLC in Brest University Hospital for 6 months. Patients with treatment response whose control samples were negative were not included. We extracted paraffin embedded samples from NSCLC before and after cisplatin-based chemotherapy. For all cases EGFr expression has been assessed with the Ventana CONFIRM TM EGFr 3C6 antibody, P53 expression with the DAKO P53 D07 kit, and pTEN expression with Novocastra antibody. Intensity was scored 0, 1+, 2+, 3+. Results: Data on 30 patients are available, 27 males and 3 females. 70% of tumors show overexpression of EGFr before chemotherapy, and 63.3% after, which has no stastistical significance. The same was observed for pTEN and P53, whose level of expression is similar before and after treatment. The level of expression of P53, pTEN, and EGFr is not correlated with gender or histological type. However, EGFr expression tends to increase after chemotherapy for the subsets of adenocarcinoma and women, but this remains statistically non-significant. Conclusions: Cisplatin-based chemotherapy does not seem to modify the expression of EGFr nor its chain of activation. However, the level of expression, particularly for EGFr, seems to be higher after chemotherapy for the subsets of adenocarcinoma and women. No significant financial relationships to disclose.

Estrogen receptor alpha polymorphism and venous thromboembolism in male and female: Data from the EDITH study

Background Association between estrogen receptor (ER) alpha polymorphism c.454–397 T > C and venous thromboembolism (VTE) has been reported in postmenopausal women. Comprehensive data are lacking. We herein evaluated the risk for VTE related to c.454–397 T > C ER alpha gene polymorphism in both men and women. Patients/methods The EDITH Study enrolled consecutive patients, aged over 18 years, hospitalized between May 2000 and December 2004 in Brest University Hospital with an objectively proven symptomatic VTE. For each case, one control who matched the case for age within a five-year age band, gender and major acquired risk factors, was selected. The present analysis was restricted to 677 cases with a VTE event not related to major acquired risk factors and their matched controls. Results and conclusions The relationship between VTE and c.454–397 T > C ER alpha polymorphism was consistent with a dominant model in women and a recessive model in men. Adjusted conditional odds ratios (95% CI) were 1.37 (1.05–1.78) and 1.29 (0.85–1.94) for CT/CC genotypes in women and CC genotype in men respectively compared to TT genotype. Among women hormone use did not substantially modify effect-measure estimate. Our results further extend results from previous studies. Other investigations are required to precise underlying mechanisms.

Pacing to Prevent Atrial Fibrillation: Utility or Futility?

Journal of Cardiovascular ElectrophysiologyVolume 16, Issue 7 p. 724-726 Pacing to Prevent Atrial Fibrillation: Utility or Futility? JEAN-JACQUES BLANC M.D., JEAN-JACQUES BLANC M.D. Department of Cardiology – Hôpital de la Cavale Blanche, Brest University Hospital, FranceSearch for more papers by this author JEAN-JACQUES BLANC M.D., JEAN-JACQUES BLANC M.D. Department of Cardiology – Hôpital de la Cavale Blanche, Brest University Hospital, FranceSearch for more papers by this author First published: 28 April 2005 https://doi.org/10.1111/j.1540-8167.2005.50114.xCitations: 2 Address for correspondence: Jean-Jacques Blanc, Department of Cardiology, Brest University Hospital, Boulevard Tanguy Prigent, 29609 Brest Cedex, France. Fax: (33) 2 98 34 78 03; E-mail: jean-jacques.blanc@univ-brest.fr J Cardiovasc Electrophysiol, Vol. 16, pp. 1-3, July 2005. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume16, Issue7July 2005Pages 724-726 RelatedInformation

Statins but not fibrates are associated with a reduced risk of venous thromboembolism: a hospital-based case-control study.

Previous studies of selected patients have suggested a reduction in the risk of venous thromboembolism with the use of statins. The objective of this study is to evaluate the influence of statin use on the risk of venous thromboembolic (VTE) events. The study is a case-control study (EDITH: Etude des Déterminants et Interactions de la Thrombose Veineuse), designed to investigate the genetic and environmental risk factors of VTE. A total of 377 patients consecutively hospitalized in the Brest University Hospital for a documented VTE event, between May 2000 and May 2002, and 377 age- and sex-matched controls were studied. Statin use was associated with a 58% decreased risk of VTE [odds ratio (OR) 0.42; 95% confidence interval (CI) 0.23-0.76; P = 0.002]. Adjustment for age, gender, coronary heart disease, atherosclerothrombotic disease or current use of aspirin did not alter the result. Neither fibrates (OR 1.38; 95% CI 0.76-2.52; P = 0.26), nor thienopyridines (OR 1.07; 95% CI 0.48-2.41; P = 0.85) were associated with a reduced risk of VTE. Aspirin use tended to decrease the risk of VTE, but this result was not significant (OR, 0.66; 95% CI, 0.42-1.05). The use of statins is associated with a significant reduction in the risk of VTE, irrespective of age, gender, and past history of atherosclerothrombotic disease, as well as the use of aspirin. This possible protective effect of statins warrants further investigations.

Évaluation du système de notification des incidents transfusionnels immédiats au CHU de Brest

The Haemovigilance Unit of Brest University Hospital has had a reporting system of transfusion reactions since october 1994. Reporting “any unexpected or undesirable effect due or likely to be due to the administering of blood cell components” must be done on an answering machine immediately or in the next eigth hours. The main goal of the evaluation of this epidemiological surveillance system was to assess its sensitivity, its positive predictive value, its acceptability, its timeliness and its simplicity, according to the Centers for Disease Control criteria. An exhaustive monitoring of the immediate transfusion reactions (ITR) occurring within the 24 hours following the procedure was conducted from April 1, to June 30, 1998. Two sources of information were used, the spontaneous notification to the Haemovigilance Unit using the answering machine, and a telephone survey of the nurse responsable for the transfusion or post-transfusion follow-up. During the survey, 19 ITR, among which 12 were reported to the Haemovigilance Unit on the answering machine, were recorded.The incidence rate of the I.T.R. was estimated at 5‰ transfused blood cell components. The sensitivity of the notification system was estimated at 63% (95% confidence interval: 41–85) and the positive predictive value at 70% (95% confidence interval: 48–92). This notification system is operational. The function of sanitary alert is ensured at the primary level of the system surveillance. The undernotification of the ITR (37% of false negative) must be corrected by specific recommendations.

Correcting keratoconus with intracorneal rings

Purpose To evaluate the potential of intrastromal corneal ring technology (Intacs™, KeraVision) to correct keratoconus without central corneal scarring. Setting Department of Ophthalmology, Brest University Hospital, Brest, France. Methods In this prospective, noncomparative, interventional case series, Intacs segments were implanted in 10 keratoconic eyes with clear central corneas and contact lens intolerance after corneal pachymetry was checked. Segment thicknesses varied based on corneal topography analysis. Results No intraoperative complications occurred. The mean follow-up was 10.6 months. Postoperative results revealed a reduction in astigmatism and spherical correction and an increase in topographical regularity and increased uncorrected visual acuity. Conclusion Intacs technology can reduce the corneal steepening and astigmatism associated with keratoconus.