Showing papers by "CHU Ambroise Paré published in 2007"

Effects of Tezosentan on Symptoms and Clinical Outcomes in Patients With Acute Heart Failure: The VERITAS Randomized Controlled Trials

Abstract: ContextPlasma concentrations of the vasoconstrictor peptide endothelin-1 are increased in patients with heart failure, and higher concentrations are associated with worse outcomes. Tezosentan is an intravenous short-acting endothelin receptor antagonist that has favorable hemodynamic actions in heart failure.ObjectiveTo determine if tezosentan improves outcomes in patients with acute heart failure.Design, Setting, and ParticipantsThe Value of Endothelin Receptor Inhibition With Tezosentan in Acute Heart Failure Studies, 2 independent, identical, and concurrent randomized, double-blind, placebo-controlled, parallel-group trials conducted from April 2003 through January 2005 at sites in Australia, Europe, Israel, and North America. Patients admitted within the previous 24 hours with persisting dyspnea and a respiratory rate of 24/min or greater were eligible provided they fulfilled 2 of 4 criteria: (1) elevated plasma concentrations of B-type or N-terminal pro–B-type natriuretic peptide, (2) clinical pulmonary edema, (3) radiologic pulmonary congestion or edema, or (4) left ventricular systolic dysfunction.InterventionInfusion of tezosentan (5 mg/h for 30 minutes, followed by 1 mg/h for 24 to 72 hours [n = 730]) or placebo (n = 718).Main Outcome MeasuresThe coprimary end points were change in dyspnea (measured at 3, 6, and 24 hours using a visual analog scale from 0-100) over 24 hours (as area under the curve) in the individual trials and incidence of death or worsening heart failure at 7 days in both trials combined.ResultsOf the 1435 patients who received treatment as assigned, 855 (60%) were men; mean age was 70 years. Mean left ventricular ejection fraction (measured in 779 patients [54%]) was 29% (SD, 11%). Baseline dyspnea scores were similar in the 2 treatment groups. Tezosentan did not improve dyspnea more than placebo in either trial, with a mean treatment difference of −12 (95% confidence interval [CI], −105 to 81) mm · h (P = .80) in the first trial and −25 (95% CI, −119 to 69) mm · h (P = .60) in the second. The incidence of death or worsening heart failure at 7 days in the combined trials was 26% in each treatment group (odds ratio, 0.99; 95% confidence interval, 0.82-1.21; P = .95).ConclusionThe endothelin receptor antagonist tezosentan did not improve symptoms or clinical outcomes in patients with acute heart failure.Trial Registrationclinicaltrials.gov Identifiers: NCT00525707 (VERITAS-1) and NCT00524433 (VERITAS-2).

The HIV/AIDS epidemic in Cuba: description and tentative explanation of its low HIV prevalence

Abstract: Background The Cuban HIV/AIDS epidemic has the lowest prevalence rate of the Caribbean region. The objective of this paper is to give an overview of the HIV/AIDS epidemic in Cuba and to explore the reasons for this low prevalence.

La consultation d’annonce en cancérologie digestive

Abstract: La mise en place du dispositif d’annonce est une des mesures essentielles du plan cancer. Les objectifs de la consultation d’annonce ainsi que les modalites de sa mise en place et les resultats des premieres evaluations realisees seront presentes dans cet article.

“Bedside echocardiography evaluation of hemodynamics in sepsis: is qualitative evaluation sufficient?”: reply to Russell

Abstract: We thank Dr Conn Russell for his interesting comment. We totally agree with him when he calls for wide use of echocardiography in the everyday hemodynamic management of the acutely ill patient. This has actually been our practice for the past 20 years! [1]. However, we disagree with him when he suggests that using transthoracic echocardiography (TTE), rather than transesophageal echocardiography (TEE), may even further simplify such management. A qualitative approach, as described in our paper [2], is only possible when the quality of the examination is optimal. Such a condition is infrequent in mechanically ventilated patients when using TTE. An optimal examination does not only mean “good” visualization of cardiac chambers, it also means the right visualization, using the optimal views, which can be identically reproduced over time, whoever the physician. Moreover, we believe that the best parameter to detect hypovolemia is the superior vena cava collapsibility index [3]. This requires a transesophageal route and must be used in mechanically ventilated patients. However, the most severely ill patients in intensive care units (ICUs), needing optimal hemodynamic management, are actually mechanically ventilated. Dr Russell suggests that TEE could be an invasive procedure. In the medical dictionary, an invasive procedure is “a technique in which the body is entered by puncture or incision”. This is, of course, not the case for TEE. Moreover, a recent paper reported a low incidence of complications of TEE in 21 previous studies and 2,508 procedures [4]. In our practice, we have performed TEE more than 3,000 times since 1993 in mechanically ventilated patients, and we have never observed serious side effects. Lessons can probably be learned from emergency medicine, as Dr Conn says. However, this then regards a diagnostic approach only, as previously proposed in injured patients in the form of the FAST (Focused Assessment with Sonography for Trauma) concept [5]. For echocardiography, this amounts to quick detection of pericardial effusion or recognition of marked dilation of the right or left ventricle. In these situations, it’s true that TTE is of great interest. In ICUs, however, TEE is more than a diagnostic approach; it is a true monitoring procedure permitting complete assessment of hemodynamics before and after treatment.

The Meaning of Hemodynamic Monitoring in Patients with Shock: Role of Echocardiography

Abstract: The development of noninvasive devices to manage hemodynamics in patients with shock is directly prompted by the results of recent studies in the intensive care unit (ICU), and during the perioperative period, which demonstrated the inability of an invasive approach, based on right heart catheterization, to improve prognosis [1]. Some authors have suggested that these results were largely due to inaccurate use of right heart catheterization, without clear goals or protocol [2], However, previous studies have demonstrated that optimization of cardiac output and mixed venous oxygen saturation (SvO2) with clear endpoints also fails to improve prognosis [3]. So, the lack of efficacy is inherent in the device. In 1985, Eugene Robin suggested that using right heart catheterization in patients with shock led physicians to give fluids plus diuretics whatever the wedge pressure [4]. In 2003, Francois Jardin claimed that we were going to move from the “age of oil lamps” to the “age of elec-tricity” [5]. In fact, we are going to change our practices in the management of shock, from an invasive and quantitative approach of hemodynamics to a non-invasive one, more functional and especially qualitative, mainly thanks to the use of echocardiography. This leads us to think about the meaning of hemodynamic monitoring.

Forces et contraintes des tests diagnostiques de l’infection à papillomavirus en biologie médicale

Abstract: Le depistage des lesions precancereuses du col uterin, initialement base sur une evaluation morphologique, evolue progressivement vers une evaluation double : morphologique et virologique. L’arrivee conjointe des vaccins d’une part, et des nouveaux tests de diagnotic de l’infection a HPV d’autre part, ouvrent des perspectives importantes dans la prise en charge de cette pathologie. Le choix des tests, ainsi que leurs interpretations constitueront un enjeu essentiel pour les biologistes. Ce chapitre positionne les etapes preanalytiques, analytiques et postanalytiques essentielles a prendre en compte dans ce contexte. Le futur sera certainement constitue d’un seul test incluant a la fois la detection, le typage et la quantification virale de ces HPVs.

Traitement des cancers digestifs du sujet âgé

Abstract: Les cancers digestifs surviennent dans la grande majorite des cas chez les patients âges de plus de 65 ans. Compte tenu du vieillissement de la population, l’incidence des cancers digestifs chez les sujets âges va augmenter de facon importante au cours des prochaines annees et la prise en charge de ces patients represente un veritable enjeu de sante publique.

Douleurs et syndrome de l'intestin irritable : prise en charge thérapeutique à la lumière des nouvelles pistes physiopathologiques

Abstract: Le syndrome de l’intestin irritable (SII) est un motif frequent de consultation pour lequel le praticien est souvent en situation d’echec ou d’insuffisance therapeutique. Une des explications serait que le SII ne repose pas sur un mecanisme unique, mais sur differents mecanismes physiopathologiques s’exprimant par un meme phenotype, la douleur abdominale. Ces dernieres annees ont ete marquees par un demembrement progressif de ce syndrome justifiant une demarche therapeutique progressive des antispasmodiques aux antidepresseurs ou l’hypnose, assez proche de celles utilisees au cours des douleurs neuropathiques.