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1. Post-viral idiopathic purpura fulminans is associated with inherited thrombophilia and anti-cardiolipin antibodies

Author

A. Theron, S. Ayadi, E. Boissier, O. Dautremay, J.-F. Schved, N. Sirvent, I. Diaz, G. Captier, C. Biron-Andreani, and E. Jeziorski

Subjects
purpura fulminans, thrombophilia, anti-cardiolipin antibodies, child, chickenpox, Pediatrics, RJ1-570
Abstract

IntroductionIdiopathic purpura fulminans (IPF) is a rare and severe coagulation disorder, associated with transient anti-protein S (anti-PS) antibodies in the context of post-viral infection such as varicella. Anti-protein S antibodies are frequently found in the context of varicella, in contrast with the rarity of IPF. Other factors such as anti-phospholipid antibodies (APL) and inherited thrombophilia may be associated with severe vascular complication.MethodThis is an ancillary study of a French multicenter retrospective series and systematic review of literature. We analyzed patients who were tested for inherited thrombophilia, namely antithrombin, protein C, protein S deficiency; prothrombin gene G20210A polymorphism (FII:G20210A),Factor V R506Q polymorphism (FV:R506Q); and/or for APL (lupus anticoagulant (LA), anti-cardiolipin antibodies (ACL), or anti-beta 2-GPI antibodies (Aβ2GP1).ResultsAmong the 25 patients tested for inherited thrombophilia, 7 (28%) had positive results. Three had FV R506Q, two FII:G20210A, one compound heterozygote FV:R506Q associated to FII:G20210A, and one protein C deficiency. APL testing was performed in 32 patients. It was positive in 19 patients (59%): 17 ACL (53%), 5 LA (16%), 4 Aβ2GP1 (13%). The risk of severe complications was not associated with presence of inherited thrombophilia or APL presence, with RR: 0.8 [95% CI: 0.37–1.71], p = 1 and RR: 0.7 [95% CI: 0.33–1.51], p = 0.39, respectively. We found a high prevalence of inherited thrombophilia or APL in a population of patients with IPF. However, we do not find an association with the occurrence of severe vascular complications or venous thromboembolism.

Published
2023
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2. Terrain Deformation Measurements from Optical Satellite Imagery: On-Line Processing Services for Geohazards Monitoring

Author

Pascal G. Lacroix, Floriane Provost, E. Pointal, E. Boissier, Philippe Bally, Jean-Philippe Malet, Marie-Pierre Doin, and D. Michea

Subjects
geography, Digital image correlation, Tectonics, geography.geographical_feature_category, Glacier, Terrain, Satellite imagery, Landslide, Deformation (meteorology), Displacement (vector), Geology, Remote sensing
Abstract

Measuring ground deformation is crucial in many fields of Earth sciences (eg. glaciers, landslides or tectonics) to understand the environmental forcing at work. In this work, we present the processing chain Multi-Pairwise Image Correlation for OPTical images (MPIC-OPT) to compute the ground displacement [1]. The chain is accessible on-line through different platforms (Geohazards Exploitation Platform -GEP- and For M@Ter webservice) allowing an easy access High-Performance Computing (HPC) infrastructures and currently ingest Sentinel-2 L1C data. The application of the method is presented for three use cases: a) to measure the co-seismic displacement of the Palu, Sulawesi (Indonesia) 2018 earthquake, b) to monitor ice velocity of the Khumbu glacier (Nepal), c) to monitor the ground displacement of the Slumgullion landslide (USA).

Published
2021
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3. Prevention of venous thromboembolism and haemostasis monitoring in patients with COVID-19: Updated proposals (April 2021)

Author

Alexandre Godon, Charles Ambroise Tacquard, Alexandre Mansour, Delphine Garrigue, Philippe Nguyen, Dominique Lasne, Sophie Testa, Jerrold H. Levy, Pierre Albaladejo, Yves Gruel, Sophie Susen, Anne Godier, P. Albaladejo, N. Blais, F. Bonhomme, A. Borel-Derlon, A. Cohen, J.-P. Collet, E. de Maistre, P. Fontana, D. Garrigue Huet, A. Godier, Y. Gruel, A. Godon, B. Ickx, S. Laporte, D. Lasne, J. Llau, G. Le Gal, T. Lecompte, S. Lessire, J.H. Levy, D. Longrois, S. Madi-Jebara, A. Mansour, M. Mazighi, P. Mismetti, P.E. Morange, S. Motte, F. Mullier, N. Nathan, P. Nguyen, G. Pernod, N. Rosencher, S. Roullet, P.M. Roy, S. Schlumberger, P. Sié, A. Steib, S. Susen, C.A. Tacquard, S. Testa, A. Vincentelli, P. Zufferey, E Boissier, B Dumont, C James, V. Siguret, BrainTech Laboratory [CHU Grenoble Alpes - Inserm U1205] (Brain Tech Lab ), CHU Grenoble-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Grenoble Alpes (UGA), Service d'Anesthésie-Réanimation [Strasbourg], Nouvel Hôpital Civil [Strasbourg], CHU Strasbourg-CHU Strasbourg, Centre d'Investigation Clinique [Rennes] (CIC), Université de Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Pontchaillou [Rennes], Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Centre Hospitalier Universitaire de Reims (CHU Reims), Hémostase, Inflammation, Thrombose (HITH - U1176 Inserm - CHU Bicêtre), Institut National de la Santé et de la Recherche Médicale (INSERM)-AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre)-Université Paris-Saclay, Istituti Ospitalieri di Cremona, Duke University [Durham], CHU Grenoble, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble, CHU Trousseau [Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), CHU Lille, Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Centre Hospitalier Universitaire (CHU), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Institut de Cardiométabolisme et Nutrition = Institute of Cardiometabolism and Nutrition [CHU Pitié Salpêtrière] (IHU ICAN), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), CHU Saint-Antoine [AP-HP], Institut de cardiologie [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), CHU Dijon, Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E), Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO)-Université de Brest (UBO), Hôpitaux Universitaires de Genève (HUG), Université de Genève = University of Geneva (UNIGE), CHU UCL Namur, AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université Paris Cité (UPCité), Fondation Ophtalmologique Adolphe de Rothschild [Paris], Laboratoire de Recherche Vasculaire Translationnelle (LVTS (UMR_S_1148 / U1148)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Université Sorbonne Paris Nord, Hôpital Lariboisière-Fernand-Widal [APHP], FHU NeuroVasc [Site Sainte-Anne, Paris] (GHU-PPN), Centre Hospitalier Sainte Anne [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Cité (UPCité), Biologie Intégrative du Tissu Osseux (LBTO), Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Investigation Clinique - Epidémiologie Clinique Saint-Etienne (CIC-EC), Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM), F-Crin Innovte [CHU Saint-Etienne], Service d’Hématologie Biologique [CHU Lariboisière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal [APHP], Innovations thérapeutiques en hémostase = Innovative Therapies in Haemostasis (IThEM - U1140), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), Roche, and Sanofi

Subjects
medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), business.industry, [SDV]Life Sciences [q-bio], COVID-19, Retrospective cohort study, General Medicine, Perioperative, Critical Care and Intensive Care Medicine, medicine.disease, Thrombosis, Article, Anticoagulation, Thrombotic risk, Anesthesiology and Pain Medicine, Intensive care, Bleeding risk, Epidemiology, Medicine, In patient, business, Intensive care medicine, Thromboprophylaxis, Venous thromboembolism
Abstract

In April 2020, in response to the high thrombotic risk associated with COVID-19, the GIHP and GFHT published proposals for the prevention of venous thromboembolism (VTE) and haemostasis monitoring in patients with COVID-19 [1]. In February 2021, six authors from the proposals (CT, AM, AlG, AnG, SS, YG, PA) decided to update them. This update was justified by several points: - The epidemiology of thrombotic complications has been described. - Different anticoagulation regimens have been reported, and retrospective studies have suggested that higher-than-standard prophylactic anticoagulation may be beneficial. - Initially underestimated, bleeding complications have emerged as a limitation of increased-dose anticoagulation and occur later than thrombotic events. - The first results of large-scale randomised controlled studies on increased doses of anticoagulation have been published. - Immunomodulatory therapies (corticosteroids, interleukin-6 receptor antagonists) are now widely used, but their effect on the thrombotic risk is unknown. - Despite improved survival, thrombotic complications remain a concern [2].

Published
2021
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4. Influence of surgical bleeding on the relationship between admission coagulopathy and risk of massive transfusion: lesson from 704 severe trauma patients

Author

Pauline Deras, A. Dehon, Pascal Latry, Jean-François Schved, E. Boissier, Jonathan Charbit, Karim Lakhal, Xavier Capdevila, Hôpital Lapeyronie [Montpellier] (CHU), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Département d'hématologie biologique[Montpellier], Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-CHU Saint-Eloi, Institut des Neurosciences de Montpellier - Déficits sensoriels et moteurs (INM), and Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)

Subjects
Adult, Male, Risk, medicine.medical_specialty, Adolescent, education, Acute trauma coagulopathy, Blood Loss, Surgical, 030204 cardiovascular system & hematology, Logistic regression, standard coagulation tests, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Odds Ratio, Coagulopathy, Humans, Medicine, Blood Transfusion, Retrospective Studies, Prothrombin time, Receiver operating characteristic, medicine.diagnostic_test, business.industry, [SDV.MHEP.HEM]Life Sciences [q-bio]/Human health and pathology/Hematology, 030208 emergency & critical care medicine, Retrospective cohort study, prediction, Hematology, General Medicine, Blood Coagulation Disorders, Middle Aged, medicine.disease, prothrombin time, Surgery, ROC Curve, Severe trauma, Area Under Curve, trauma management, haemorrhagic shock, Wounds and Injuries, Population study, Female, Partial Thromboplastin Time, business, Packed red blood cells
Abstract

Background This study hypothesized that the relationship between early coagulopathy and massive transfusion (MT) in trauma was highly dependent on the presence of surgical bleeding. Methods Consecutive severe trauma patients admitted to our institution over a 4-year period were included in this retrospective study. Surgical bleeding was defined as an injury requiring an invasive endovascular or surgical haemostatic procedure. The ability of prothrombin time ratio (PTr) and activated partial thromboplastin time ratio (aPTTr) to predict MT (≥10 units of packed red blood cells during the first 24 h) was determined by ROC curves. The strength of association and interaction between PTr, surgical bleeding and MT was assessed using a logistic regression analysis. Results Among the 704 patients included (ISS 21·0 ± 16·2), MT rate was higher in patients with surgical bleeding than in those with no surgical bleeding (47% vs. 5%; P

Published
2016
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5. L’argatroban, nouvel antithrombotique pour la thrombopénie induite par l’héparine en chirurgie cardiaque de l’adulte : utilisation en chirurgie cardiaque et en réanimation

Author

Yvonnick Blanloeil, F Stephan, E Boissier, Bertrand Rozec, Anne Godier, and Raphaël Cinotti

Subjects
Anesthesiology and Pain Medicine, General Medicine
Abstract

Resume Objectifs La thrombopenie induite par l’heparine (TIH), bien que rare, se caracterise par des manifestations thromboemboliques associees a une morbimortalite elevee. Moins frequente avec les heparines de bas poids moleculaire (HBPM) qu’avec l’heparine non fractionnee (HNF), cette pathologie est observee plus frequemment dans les circonstances ou l’HNF reste indiquee, comme en chirurgie cardiaque. L’argatroban, inhibiteur selectif de la thrombine recemment disponible, a ete propose comme traitement de la TIH. Cette mise au point presente les principales caracteristiques de ce produit, ses indications et ses modalites d’utilisation en chirurgie cardiaque de l’adulte et en reanimation. Methodologie Recherche bibliographique des 15 dernieres annees sur base de donnees Medline, avec les mots cles suivants : argatroban, chirurgie cardiaque, assistance circulatoire, circulation extracorporelle. Resultats Malgre une cinetique d’action rapide, l’argatroban est inadapte a la prise en charge de la circulation extracorporelle (CEC) peroperatoire. En revanche, il est utilisable pour la periode postoperatoire des differents types de chirurgie cardiaque (standard, cœur battant, assistance circulatoire). Neanmoins, une surveillance biologique etroite (tests specifiques) est recommandee en raison de l’existence frequente chez ces operes de defaillances viscerales (renale, cardiaque ou hepatique). Les principaux freins a l’utilisation de ce medicament novateur sont l’absence d’antidote, sa contre-indication chez l’insuffisant hepatique severe, et son utilisation exclusive par voie intraveineuse. Conclusion L’argatroban est un nouvel inhibiteur direct de la thrombine bien evaluee en chirurgie cardiaque comme anticoagulant en cas de TIH. Son interet est encore renforce avec la disparition de la lepirudine et les difficultes d’approvisionnement du danaparoide.

Published
2014
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6. Les chordomes

Author

B. George, D. Bresson, S. Bouazza, S. Froelich, E. Mandonnet, S. Hamdi, M. Orabi, M. Polivka, A. Cazorla, H. Adle-Biassette, J.-P. Guichard, M. Duet, E. Gayat, F. Vallée, C.-H. Canova, F. Riet, S. Bolle, V. Calugaru, R. Dendale, J.-J. Mazeron, L. Feuvret, E. Boissier, S. Vignot, S. Puget, C. Sainte-Rose, and K. Beccaria

Subjects
Surgery, Neurology (clinical)
Published
2014
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7. Syndrome de Willebrand acquis : étude d’une série de neuf patients et revue de la littérature

Author

Jacques Pouchot, Brigitte Ranque, Luc Darnige, J. Tapon-Bretaudière, Jean-Benoit Arlet, Sophie Georgin-Lavialle, E. Boissier, S. Dupeux, Julie Dougados, and C. Caron

Subjects
Gastroenterology, Internal Medicine
Abstract

Resume Propos Alors que la maladie de Willebrand est la plus frequente des pathologies hemorragiques constitutionnelles, le syndrome de Willebrand acquis est rare. Methodes Etude retrospective monocentrique descriptive des observations de syndrome de Willebrand acquis diagnostiques entre 2000 et 2012. Les criteres diagnostiques retenus etaient l’absence d’antecedents hemorragiques cutaneomuqueux, et la diminution des taux de facteur VIII (FVIII) et de facteur Willebrand (VWF), activite cofacteur de la ristocetine (RCo) et antigene (Ag). Resultats Neuf hommes presentant un syndrome de Willebrand acquis ont ete etudies, dont six ayant un syndrome hemorragique recent. Chez tous sauf un, la caracterisation phenotypique evoquait une maladie de Willebrand qualitative, avec diminution du rapport VWF:RCo/VWF:Ag. Tous avaient une maladie lymphoproliferative avec immunoglobuline monoclonale circulante (une leucemie lymphoide chronique, trois maladies de Waldenstrom, un lymphome de la zone marginale, quatre gammapathies monoclonales de signification indeterminee). La recherche d’anticorps anti-VWF etait negative. Un traitement symptomatique par concentres de VWF etait instaure en cas d’hemorragie severe. Cinq patients ont recu des immunoglobulines intraveineuses, avec une bonne reponse uniquement chez les porteurs d’immunoglobuline monoclonale d’isotype G. Chez trois patients, la remission du lymphome sous chimiotherapie a ete suivie d’une normalisation partielle ou totale du taux de VWF, les autres patients ayant conserve un deficit. Conclusion Le syndrome de Willebrand acquis est rare mais potentiellement grave. Il doit etre evoque chez l’adulte devant un syndrome hemorragique cutaneomuqueux inhabituel avec ou sans allongement du temps de cephaline activee (TCA) et confirme par dosage du VWF (Ag et RCo). Une maladie associee hematologique, neoplasique ou valvulaire cardiaque doit etre recherchee.

Published
2014
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8. Insuffisance rénale aiguë et inhibiteurs de PARP

Author

Marie Courbebaisse, Alexandre Karras, R. Cohen, H. Ayari, Nicolas Pallet, E. Boissier, Nicolas Delanoy, Eric Thervet, and Hélène Lazareth

Subjects
Nephrology
Abstract

Introduction Les inhibiteurs de la poly-ADP-ribose-polymerase-1(PARP) sont prescrits pour le traitement des cancers du sein et de l’ovaire metastatiques. Ils reduisent l’activite du systeme de reparation de l’ADN. En synergie avec les mutations perte de fonction de BRCA dans les cellules tumorales, ils induisent l’apoptose de la cellule. L’Olaparib est frequemment associe a une elevation moderee de la creatininemie par inhibition d’OCT2. Aucune donnee n’existe sur la fonction renale des patientes sous Niraparib. Methodes Etude retrospective monocentrique sur toutes les patientes ayant recu du Niraparib en traitement d’entretien d’un cancer de l’ovaire metastatique. Resultats obtenus ou attendus Vingt patientes ont ete incluses. Le Niraparib a ete introduit en moyenne 4,6 ans apres le diagnostic, principalement apres la troisieme ligne de chimiotherapie (75 %). L’âge moyen etait de 71,1 ans, 70 % des malades presentaient une hypertension arterielle, 25 % une dyslipidemie,15 % etaient diabetiques, 30 % avaient un IMC > 25 kg/m2. Toutes les malades ont recu des sels de platines, 90 % des anti-VEGF. Avant traitement, le debit de filtration glomerulaire moyen estime (DFGe, CKD-EPI) etait de 66,35 ± 3,5 ml/min/1,73m2. Apres introduction du Niraparib, toutes les malades ont developpe une insuffisance renale aigue. La diminution moyenne du DFGe etait de 19,5 ± 2,6 ml/min/1,73m2 (p Conclusion L’utilisation du Niraparib est associee a la survenue systematique d’une insuffisance renale aigue, regressant a l’arret. L’hypothese physiopathologique principale serait une inhibition des recepteurs dopaminergiques entrainant une diminution de la vasodilatation de l’arteriole afferente et du DFG.

Published
2019
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9. Paralysie périodique thyréotoxique hypokaliémique : quatre observations et revue de la littérature

Author

Brigitte Ranque, D. Cochereau, Elisabeth Aslangul, E. Boissier, R. Ducloux, Jacques Pouchot, and Sophie Georgin-Lavialle

Subjects
Gynecology, medicine.medical_specialty, business.industry, Gastroenterology, Internal Medicine, Medicine, Thyrotoxic periodic paralysis, business, medicine.disease
Abstract

Resume Propos La paralysie periodique thyreotoxique hypokaliemique (PPT) est une complication neuromusculaire de l’hyperthyroidie. Plus frequente chez les hommes jeunes, asiatiques, cette manifestation meconnue reste rare, surtout chez les Caucasiens. Nous rapportons quatre nouvelles observations et effectuons une revue des principales manifestations cliniques, des etiologies, de la physiopathologie et du traitement. Observations Deux patients originaires des Philippines, un d’origine malienne et un Caucasien, avec un âge median de 34,5 ans etaient hospitalises pour une paresie ou une paralysie flasque, sans atteinte respiratoire. La recherche d’episodes anterieurs, la presence d’une hypokaliemie majeure (kaliemie moyenne chiffree a 2 mmol/L) et la presence de signes cliniques et biologiques d’hyperthyroidie permettaient de poser le diagnostic. Une maladie de Basedow etait retrouvee chez ces quatre patients. Le traitement adapte, symptomatique et etiologique, permettait la disparition des manifestations neuromusculaires et aucune recidive n’etait notee dans l’evolution. Conclusion La PPT est une pathologie grave, secondaire a une anomalie de la pompe Na + -K + ATPasique, dont la prise en charge initiale repose sur un traitement symptomatique par β-bloquants et une recharge potassique prudente. Le traitement etiologique, medical ou chirurgical, de la thyreotoxicose est primordial pour prevenir la recidive. Cette maladie est sans doute sous-diagnostiquee : une correction tres rapide d’une hypokaliemie profonde (en moins de 12 heures) doit faire evoquer le diagnostic ; devant une paresie avec hypokaliemie, il faut penser a rechercher systematiquement des signes et des symptomes d’hyperthyroidie.

Published
2013
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10. Need for a stratified analysis in stage I malignant ovarian germ cell tumors (MOGCT): Prospective survival analysis of cases collection from the French rare malignant ovarian tumors (TMRO) network & GINECO group

Author

G. Ferron, V. Lavoué, Elsa Kalbacher, Julien Edeline, Anne Floquet, T. de La Motte Rouge, Patricia Pautier, A.-C. Hardy Bessard, I.L. Ray-Coquard, Dominique Berton-Rigaud, Jérôme Alexandre, J.-P. Lotz, Hélène Vegas, F. Derquin, Anne Patsouris, E. Boissier, and C. Lefeuvre-Plesse

Subjects
Stratified analysis, Oncology, medicine.medical_specialty, business.industry, Internal medicine, Medicine, Hematology, Germ cell tumors, business, medicine.disease, Survival analysis
Published
2018
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11. [Argatroban, a new antithrombotic treatment for heparin-induced thrombocytopenia application in cardiac surgery and in intensive care]

Author

B, Rozec, E, Boissier, A, Godier, R, Cinotti, F, Stephan, and Y, Blanloeil

Subjects
Sulfonamides, Critical Care, Fibrinolytic Agents, Heparin, Pipecolic Acids, Anticoagulants, Humans, Cardiac Surgical Procedures, Arginine, Thrombocytopenia
Abstract

Although heparin-induced thrombocytopemia (HIT) is uncommon, its thromboembolic complications are potentially life-threatening. The low-molecular weight heparins are less responsible of HIT than unfractionated heparin (UFH) but this latter is still indicated in some circumstances such as cardiac surgery. Argatroban, a selective thrombin inhibitor, recently available, has been indicated in HIT treatment. This review presents the main pharmacological characteristics, its indications and uses in the context of cardiac surgery and in intensive care medicine.Review of the literature in Medline database over the past 15 years using the following keywords: argatroban, cardiac surgery, circulatory assistance, cardiopulmonary bypass.Despite its short-acting pharmacokinetic, argatroban cannot be recommended during cardiopulmonary bypass. On the contrary, argatroban is indicated in many circumstances in postoperative period of various cardiac surgeries (on-pump, off-pump, circulatory assistance). Nevertheless, after cardiac surgery, doses have to be adapted according to coagulation laboratory testing (ACT), particularly in patients presenting acute organ failure (kidney injury, heart failure, liver failure). This compound has no antagonist and is excluded during severe hepatic failure. The continuous intravenous administration is a drawback.Argatroban is a new direct competitive thrombin inhibitor well evaluated as treatment of HIT after cardiac surgery. In HIT management, argatroban is an interesting alternative to lepirudin that is not anymore available and danaparoid because of supply disturbances.

Published
2013

12. [Chordoma]

Author

B, George, D, Bresson, S, Bouazza, S, Froelich, E, Mandonnet, S, Hamdi, M, Orabi, M, Polivka, A, Cazorla, H, Adle-Biassette, J-P, Guichard, M, Duet, E, Gayat, F, Vallée, C-H, Canova, F, Riet, S, Bolle, V, Calugaru, R, Dendale, J-J, Mazeron, L, Feuvret, E, Boissier, S, Vignot, S, Puget, C, Sainte-Rose, and K, Beccaria

Subjects
Treatment Outcome, Chordoma, Humans, Neoplasm Recurrence, Local, Combined Modality Therapy, Skull Base Neoplasms, Follow-Up Studies
Abstract

To review in the literature, all the epidemiological, clinical, radiological, histological and therapeutic data regarding chordomas as well as various notochordal entities: ecchordosis physaliphora, intradural and intraparenchymatous chordomas, benign notochordal cell tumors, parachordomas and extra-axial chordomas. To identify different types of chordomas, including familial forms, associations with tuberous sclerosis, Ollier's disease and Maffucci's syndrome, forms with metastasis and seeding. To assess the recent data regarding molecular biology and progress in targeted therapy. To compare the different types of radiotherapy, especially protontherapy and their therapeutic effects. To review the largest series of chordomas in their different localizations (skull base, sacrum and mobile spine) from the literature.The series of 136 chordomas treated and followed up over 20 years (1972-2012) in the department of neurosurgery at Lariboisière hospital is reviewed. It includes: 58 chordomas of the skull base, 47 of the craniocervical junction, 23 of the cervical spine and 8 from the lombosacral region. Similarly, 31 chordomas in children (less than 18 years of age), observed in the departments of neurosurgery of les Enfants-Malades and Lariboisière hospitals, are presented. They were observed between 1976 and 2010 and were located intracranially (n=22 including 13 with cervical extension), 4 at the craniocervical junction level and 5 in the cervical spine.In the entire Lariboisière series and in the different groups of localization, different parameters were analyzed: the delay of diagnosis, of follow-up, of occurrence of metastasis, recurrence and death, the number of primary patients and patients referred to us after progression or recurrence and the number of deaths, recurrences and metastases. The influence of the quality of resection (total, subtotal and partial) on the prognosis is also presented. Kaplan-Meier actuarial curves of overall survival and disease free survival were performed in the entire series, including the different groups of localization based on the following 4 parameters: age, primary and secondary patients, quality of resection and protontherapy. In the pediatric series, a similar analysis was carried-out but was limited by the small number of patients in the subgroups.In the Lariboisière series, the mean delay of diagnosis is 10 months and the mean follow-up is 80 months in each group. The delay before recurrence, metastasis and death is always better for the skull base chordomas and worse for those of the craniocervical junction, which have similar results to those of the cervical spine. Similar figures were observed as regards the number of deaths, metastases and recurrences. Quality of resection is the major factor of prognosis with 20.5 % of deaths and 28 % of recurrences after total resection as compared to 52.5 % and 47.5 % after subtotal resection. This is still more obvious in the group of skull base chordomas. Adding protontherapy to a total resection can still improve the results but there is no change after subtotal resection. The actuarial curve of overall survival shows a clear cut in the slope with some chordomas having a fast evolution towards recurrence and death in less than 4 years and others having a long survival of sometimes more than 20 years. Also, age has no influence on the prognosis. In primary patients, disease free survival is better than in secondary patients but not in overall survival. Protontherapy only improves the overall survival in the entire series and in the skull base group. Total resection improves both the overall and disease free survival in each group. Finally, the adjunct of protontherapy after total resection is clearly demonstrated. In the pediatric series, the median follow-up is 5.7 years. Overall survival and disease free survival are respectively 63 % and 54.3 %. Factors of prognosis are the histological type (atypical forms), localization (worse for the cervical spine and better for the clivus) and again it will depend on the quality of resection.Many different pathologies derived from the notochord can be observed: some are remnants, some may be precursors of chordomas and some have similar features but are probably not genuine chordomas. To-day, immuno-histological studies should permit to differentiate them from real chordomas. Improving knowledge of molecular biology raises hopes for complementary treatments but to date the quality of surgical resection is still the main factor of prognosis. Complementary protontherapy seems useful, especially in skull base chordomas, which have better overall results than those of the craniocervical junction and of the cervical spine. However, we are still lacking an intrinsic marker of evolution to differentiate the slow growing chordomas with an indolent evolution from aggressive types leading rapidly to recurrence and death on which more aggressive treatments should be applied.

Published
2013

13. [Acquired von Willebrand syndrome: a case series of nine patients and literature review]

Author

E, Boissier, L, Darnige, J, Dougados, J-B, Arlet, S, Dupeux, S, Georgin-Lavialle, C, Caron, J, Tapon-Bretaudière, J, Pouchot, and B, Ranque

Subjects
Adult, Aged, 80 and over, Male, Hemostasis, von Willebrand Diseases, Humans, Syndrome, Middle Aged, Monoclonal Gammopathy of Undetermined Significance, Aged, Retrospective Studies
Abstract

Whereas von Willebrand disease is the most common constitutional bleeding disorder, acquired von Willebrand syndrome is rare.Retrospective, monocentric descriptive study of consecutive cases of acquired von Willebrand syndrome diagnosed between 2000 and 2012. Diagnostic criteria included: absence of a past history of mucocutaneous bleeding, with low plasma levels of factor VIII (FVIII) and von Willebrand factor (VWF), ristocetine cofactor activity (RCo) and antigen (Ag).Nine men were diagnosed with von Willebrand syndrome. Six of them presented with recent mucocutaneous bleeding. In eight cases, the biological phenotype was a type 2 von Willebrand disease, with decreased VWF:RCo/VWF:Ag ratio. A lymphoproliferative disease with circulating paraprotein was identified in all patients, including one chronic lymphoid leukemia, three Waldenström and one marginal zone lymphomas, four monoclonal gammapathies of unknown significance. Screening for an anti-VWF inhibitor was negative. Symptomatic treatment using infusion of VWF concentrates was administrated in the presence of severe mucocutaneaous bleeding. Five patients received intravenous immunoglobulins with a good response only in patients with G isotype paraprotein. A chemotherapy was initiated if indicated for the underlying disorder. Three of the four patients who achieved remission of the associated lymphoma had a subsequent improvement of plasma VWF levels, while all other patients remained deficient.Acquired von Willebrand syndrome is a rare but potentially serious disease. The diagnostic should be suspected in adults with unusual mucocutaneous bleeding, with or without prolonged partial thromboplastin time (PTT), and confirmed with a decreased plasma level of VWF (Ag and RCo). An associated haematological, neoplastic or cardiac valvular disease must be searched.

Published
2012

14. [Thyrotoxic periodic paralysis: a case series of four patients and literature review]

Author

E, Boissier, S, Georgin-Lavialle, D, Cochereau, R, Ducloux, B, Ranque, E, Aslangul, and J, Pouchot

Subjects
Adult, Male, Thyrotoxicosis, Adolescent, Hypokalemic Periodic Paralysis, Potassium, Humans, Middle Aged
Abstract

Periodic thyrotoxic hypokalemic paralysis (TPP) is a neuromuscular complication of hyperthyroidism. It is more common in young Asian males than in Caucasian and African patients. We report four new cases and review the literature.Four consecutive patients were diagnosed with TPP. They were all men with a median age of 34.5 years at presentation. Two patients originated from the Philippines, one was African and one was Caucasian ethnic background. They all presented with a paresis or flaccid paralysis, without respiratory failure. Previous similar episodes in their past medical history, the presence of profound hypokalemia (mean serum potassium level of 2 mmol/L) and the presence of clinical and biological signs of hyperthyroidism led to the diagnosis of TPP. All four patients were diagnosed with Graves' disease. Outcome was favourable in all four patients with the symptomatic treatment of TPP and treatment of Graves' disease.TPP is a severe condition, due to a dysfunction of the Na(+)-K(+) ATPase pump. Initial management relies on β-blocker treatment and careful potassium supplementation. Then, medical or surgical etiological treatment of the thyrotoxicosis is essential to prevent a recurrence. The disease is probably underdiagnosed: it must be suspected when a profound hypokaliema resolves very quickly (12hours); hyperthyroidism should always be included in the differential diagnosis of a paresis associated with hypokalemia.

Published
2012

15. Povidone iodine: features of critical systemic absorption

Author

R. Choukhi, Karim Lakhal, E. Boissier, Xavier Capdevila, and J. Faidherbe

Subjects
Adult, medicine.medical_specialty, medicine.drug_class, medicine.medical_treatment, chemistry.chemical_element, Absorption (skin), Iodine, Absorption, Route of administration, Antiseptic, Coagulopathy, medicine, Humans, Renal replacement therapy, Coloring Agents, Povidone-Iodine, business.industry, General Medicine, medicine.disease, Surgery, Anesthesiology and Pain Medicine, medicine.anatomical_structure, chemistry, Anesthesia, Toxicity, Female, business, Fallopian tube
Abstract

Povidone iodine (PI), a skin antiseptic, is sometimes used internally but this procedure exposes to potentially lethal iodine absorption. Indeed, a 41-year-old woman, with no relevant medical history, developed a transient hypotension, anuric renal failure, hemolysis, coagulopathy and uterine infarction after intra-uterine injection of PI as a dye to check the fallopian tube patency (hydrotubation). Iodemia peaked at 6929 μg/dL (normal range 3.4-8.0 μg/dL), and decreased over the 9 days of renal replacement therapy. Extreme caution should be exercised when PI is in contact with a mucosa, the early recognition of iodine toxicity being of utmost importance to rapidly prompt renal replacement therapy. The main purpose of this report is to highlight the clinical features of PI absorption, whatever the route of administration.

Published
2011

16. Alafosfalin as a selective agent for isolation of salmonella from clinical samples

Author

E. Boissier, J. M. Perez, F.K. Gould, A. M. Freydière, John D. Perry, G. Riley, and R. T. Ouedraogo

Subjects
Microbiology (medical), Alafosfalin, Salmonella, medicine.disease_cause, Salmonella typhi, Sensitivity and Specificity, Microbiology, chemistry.chemical_compound, Feces, Drug Resistance, Bacterial, Gram-Negative Bacteria, medicine, Humans, Escherichia coli, Bacteriological Techniques, Alanine, biology, Hektoen enteric agar, Bacteriology, biology.organism_classification, Isolation (microbiology), Enterobacteriaceae, Culture Media, chemistry, Chromogenic Compounds, Bacteria
Abstract

The selectivity of a range of culture media for the detection of Salmonella was assessed using 435 strains of gram-negative bacteria. These media showed limited ability to inhibit non- Salmonella strains found in stool samples. We report the evaluation of alafosfalin as a selective agent for isolation of Salmonella from stool samples. Susceptibility studies with this agent showed that non- typhi Salmonella strains were relatively resistant (mean MIC, 10.2 mg/liter) compared to many coliforms including Escherichia coli (mean MIC, 0.7 mg/liter). A chromogenic medium, ABC medium, was modified to incorporate alafosfalin and was compared with standard ABC medium and Hektoen enteric agar for the isolation of Salmonella from 1,000 stool samples. On direct culture, modified ABC medium showed higher recovery of Salmonella (53.6%) compared with either ABC medium (35.7%) or Hektoen enteric agar (48.2%). We conclude that alafosfalin is a useful selective agent for the isolation of Salmonella from stool samples.

Published
2002

18. Erodium romanum var. rupestre

Author

E. Boissier, E. Boissier, E. Boissier, and E. Boissier

Abstract

Angiosperms, http://name.umdl.umich.edu/IC-HERB00IC-X-1192293%5DMICH-V-1192293, https://quod.lib.umich.edu/cgi/i/image/api/thumb/herb00ic/1192293/MICH-V-1192293/!250,250, The University of Michigan Library provides access to these materials for educational and research purposes. Some materials may be protected by copyright. If you decide to use any of these materials, you are responsible for making your own legal assessment and securing any necessary permission. If you have questions about the collection, please contact the Herbarium professional staff: herb-dlps-help@umich.edu. If you have concerns about the inclusion of an item in this collection, please contact Library Information Technology: libraryit-info@umich.edu., https://www.lib.umich.edu/about-us/policies/copyright-policy

19. Frankenia reuteri

Author

E. Boissier, E. Boissier, E. Boissier, and E. Boissier

Abstract

Angiosperms, http://name.umdl.umich.edu/IC-HERB00IC-X-1192290%5DMICH-V-1192290, https://quod.lib.umich.edu/cgi/i/image/api/thumb/herb00ic/1192290/MICH-V-1192290/!250,250, The University of Michigan Library provides access to these materials for educational and research purposes. Some materials may be protected by copyright. If you decide to use any of these materials, you are responsible for making your own legal assessment and securing any necessary permission. If you have questions about the collection, please contact the Herbarium professional staff: herb-dlps-help@umich.edu. If you have concerns about the inclusion of an item in this collection, please contact Library Information Technology: libraryit-info@umich.edu., https://www.lib.umich.edu/about-us/policies/copyright-policy

20. Arenaria triquetra var. granatensis

Author

E. Boissier, E. Boissier, E. Boissier, and E. Boissier

Abstract

Angiosperms, http://name.umdl.umich.edu/IC-HERB00IC-X-1115013%5DMICH-V-1115013, https://quod.lib.umich.edu/cgi/i/image/api/thumb/herb00ic/1115013/MICH-V-1115013/!250,250, The University of Michigan Library provides access to these materials for educational and research purposes. Some materials may be protected by copyright. If you decide to use any of these materials, you are responsible for making your own legal assessment and securing any necessary permission. If you have questions about the collection, please contact the Herbarium professional staff: herb-dlps-help@umich.edu. If you have concerns about the inclusion of an item in this collection, please contact Library Information Technology: libraryit-info@umich.edu., https://www.lib.umich.edu/about-us/policies/copyright-policy

21. Arenaria armeriastrum

Author

E. Boissier, E. Boissier, E. Boissier, and E. Boissier

Abstract

Angiosperms, http://name.umdl.umich.edu/IC-HERB00IC-X-1115025%5DMICH-V-1115025, https://quod.lib.umich.edu/cgi/i/image/api/thumb/herb00ic/1115025/MICH-V-1115025/!250,250, The University of Michigan Library provides access to these materials for educational and research purposes. Some materials may be protected by copyright. If you decide to use any of these materials, you are responsible for making your own legal assessment and securing any necessary permission. If you have questions about the collection, please contact the Herbarium professional staff: herb-dlps-help@umich.edu. If you have concerns about the inclusion of an item in this collection, please contact Library Information Technology: libraryit-info@umich.edu., https://www.lib.umich.edu/about-us/policies/copyright-policy

22. Cerastium ramosissimum

Author

E. Boissier, E. Boissier, E. Boissier, and E. Boissier

Abstract

Angiosperms, http://name.umdl.umich.edu/IC-HERB00IC-X-1115011%5DMICH-V-1115011, https://quod.lib.umich.edu/cgi/i/image/api/thumb/herb00ic/1115011/MICH-V-1115011/!250,250, The University of Michigan Library provides access to these materials for educational and research purposes. Some materials may be protected by copyright. If you decide to use any of these materials, you are responsible for making your own legal assessment and securing any necessary permission. If you have questions about the collection, please contact the Herbarium professional staff: herb-dlps-help@umich.edu. If you have concerns about the inclusion of an item in this collection, please contact Library Information Technology: libraryit-info@umich.edu., https://www.lib.umich.edu/about-us/policies/copyright-policy

23. Festuca granatensis

Author

E. Boissier, E. Boissier, E. Boissier, and E. Boissier

Abstract

Angiosperms, http://name.umdl.umich.edu/IC-HERB00IC-X-1108669%5DMICH-V-1108669, https://quod.lib.umich.edu/cgi/i/image/api/thumb/herb00ic/1108669/MICH-V-1108669/!250,250, The University of Michigan Library provides access to these materials for educational and research purposes. Some materials may be protected by copyright. If you decide to use any of these materials, you are responsible for making your own legal assessment and securing any necessary permission. If you have questions about the collection, please contact the Herbarium professional staff: herb-dlps-help@umich.edu. If you have concerns about the inclusion of an item in this collection, please contact Library Information Technology: libraryit-info@umich.edu., https://www.lib.umich.edu/about-us/policies/copyright-policy

24. Cytisus affinis

Author

E. Boissier, E. Boissier, E. Boissier, and E. Boissier

Abstract

Angiosperms, http://name.umdl.umich.edu/IC-HERB00IC-X-1107217%5DMICH-V-1107217, https://quod.lib.umich.edu/cgi/i/image/api/thumb/herb00ic/1107217/MICH-V-1107217/!250,250, The University of Michigan Library provides access to these materials for educational and research purposes. Some materials may be protected by copyright. If you decide to use any of these materials, you are responsible for making your own legal assessment and securing any necessary permission. If you have questions about the collection, please contact the Herbarium professional staff: herb-dlps-help@umich.edu. If you have concerns about the inclusion of an item in this collection, please contact Library Information Technology: libraryit-info@umich.edu., https://www.lib.umich.edu/about-us/policies/copyright-policy

25. Genista haensseleri

Author

E. Boissier, E. Boissier, E. Boissier, and E. Boissier

Abstract

Angiosperms, http://name.umdl.umich.edu/IC-HERB00IC-X-1107289%5DMICH-V-1107289, https://quod.lib.umich.edu/cgi/i/image/api/thumb/herb00ic/1107289/MICH-V-1107289/!250,250, The University of Michigan Library provides access to these materials for educational and research purposes. Some materials may be protected by copyright. If you decide to use any of these materials, you are responsible for making your own legal assessment and securing any necessary permission. If you have questions about the collection, please contact the Herbarium professional staff: herb-dlps-help@umich.edu. If you have concerns about the inclusion of an item in this collection, please contact Library Information Technology: libraryit-info@umich.edu., https://www.lib.umich.edu/about-us/policies/copyright-policy

26. Genista biflora var. plumosa

Author

E. Boissier, E. Boissier, E. Boissier, and E. Boissier

Abstract

Angiosperms, http://name.umdl.umich.edu/IC-HERB00IC-X-1107288%5DMICH-V-1107288, https://quod.lib.umich.edu/cgi/i/image/api/thumb/herb00ic/1107288/MICH-V-1107288/!250,250, The University of Michigan Library provides access to these materials for educational and research purposes. Some materials may be protected by copyright. If you decide to use any of these materials, you are responsible for making your own legal assessment and securing any necessary permission. If you have questions about the collection, please contact the Herbarium professional staff: herb-dlps-help@umich.edu. If you have concerns about the inclusion of an item in this collection, please contact Library Information Technology: libraryit-info@umich.edu., https://www.lib.umich.edu/about-us/policies/copyright-policy

27. Leobordea lupinifolia

Author

E. Boissier, E. Boissier, E. Boissier, and E. Boissier

Abstract

Angiosperms, http://name.umdl.umich.edu/IC-HERB00IC-X-1104126%5DMICH-V-1104126, https://quod.lib.umich.edu/cgi/i/image/api/thumb/herb00ic/1104126/MICH-V-1104126/!250,250, The University of Michigan Library provides access to these materials for educational and research purposes. Some materials may be protected by copyright. If you decide to use any of these materials, you are responsible for making your own legal assessment and securing any necessary permission. If you have questions about the collection, please contact the Herbarium professional staff: herb-dlps-help@umich.edu. If you have concerns about the inclusion of an item in this collection, please contact Library Information Technology: libraryit-info@umich.edu., https://www.lib.umich.edu/about-us/policies/copyright-policy

28. Erodium romanum var. rupestre

Author

E. Boissier, E. Boissier, E. Boissier, and E. Boissier

Abstract

Angiosperms, http://name.umdl.umich.edu/IC-HERB00IC-X-1192293%5DMICH-V-1192293, https://quod.lib.umich.edu/cgi/i/image/api/thumb/herb00ic/1192293/MICH-V-1192293/!250,250, The University of Michigan Library provides access to these materials for educational and research purposes. Some materials may be protected by copyright. If you decide to use any of these materials, you are responsible for making your own legal assessment and securing any necessary permission. If you have questions about the collection, please contact the Herbarium professional staff: herb-dlps-help@umich.edu. If you have concerns about the inclusion of an item in this collection, please contact Library Information Technology: libraryit-info@umich.edu., https://www.lib.umich.edu/about-us/policies/copyright-policy

29. Frankenia reuteri

Author

E. Boissier, E. Boissier, E. Boissier, and E. Boissier

Abstract

Angiosperms, http://name.umdl.umich.edu/IC-HERB00IC-X-1192290%5DMICH-V-1192290, https://quod.lib.umich.edu/cgi/i/image/api/thumb/herb00ic/1192290/MICH-V-1192290/!250,250, The University of Michigan Library provides access to these materials for educational and research purposes. Some materials may be protected by copyright. If you decide to use any of these materials, you are responsible for making your own legal assessment and securing any necessary permission. If you have questions about the collection, please contact the Herbarium professional staff: herb-dlps-help@umich.edu. If you have concerns about the inclusion of an item in this collection, please contact Library Information Technology: libraryit-info@umich.edu., https://www.lib.umich.edu/about-us/policies/copyright-policy

30. Cerastium ramosissimum

Author

E. Boissier, E. Boissier, E. Boissier, and E. Boissier

Abstract

Angiosperms, http://name.umdl.umich.edu/IC-HERB00IC-X-1115011%5DMICH-V-1115011, https://quod.lib.umich.edu/cgi/i/image/api/thumb/herb00ic/1115011/MICH-V-1115011/!250,250, The University of Michigan Library provides access to these materials for educational and research purposes. Some materials may be protected by copyright. If you decide to use any of these materials, you are responsible for making your own legal assessment and securing any necessary permission. If you have questions about the collection, please contact the Herbarium professional staff: herb-dlps-help@umich.edu. If you have concerns about the inclusion of an item in this collection, please contact Library Information Technology: libraryit-info@umich.edu., https://www.lib.umich.edu/about-us/policies/copyright-policy

31. Arenaria triquetra var. granatensis

Author

E. Boissier, E. Boissier, E. Boissier, and E. Boissier

Abstract

Angiosperms, http://name.umdl.umich.edu/IC-HERB00IC-X-1115013%5DMICH-V-1115013, https://quod.lib.umich.edu/cgi/i/image/api/thumb/herb00ic/1115013/MICH-V-1115013/!250,250, The University of Michigan Library provides access to these materials for educational and research purposes. Some materials may be protected by copyright. If you decide to use any of these materials, you are responsible for making your own legal assessment and securing any necessary permission. If you have questions about the collection, please contact the Herbarium professional staff: herb-dlps-help@umich.edu. If you have concerns about the inclusion of an item in this collection, please contact Library Information Technology: libraryit-info@umich.edu., https://www.lib.umich.edu/about-us/policies/copyright-policy

32. Arenaria armeriastrum

Author

E. Boissier, E. Boissier, E. Boissier, and E. Boissier

Abstract

Angiosperms, http://name.umdl.umich.edu/IC-HERB00IC-X-1115025%5DMICH-V-1115025, https://quod.lib.umich.edu/cgi/i/image/api/thumb/herb00ic/1115025/MICH-V-1115025/!250,250, The University of Michigan Library provides access to these materials for educational and research purposes. Some materials may be protected by copyright. If you decide to use any of these materials, you are responsible for making your own legal assessment and securing any necessary permission. If you have questions about the collection, please contact the Herbarium professional staff: herb-dlps-help@umich.edu. If you have concerns about the inclusion of an item in this collection, please contact Library Information Technology: libraryit-info@umich.edu., https://www.lib.umich.edu/about-us/policies/copyright-policy

33. Festuca granatensis

Author

E. Boissier, E. Boissier, E. Boissier, and E. Boissier

Abstract

Angiosperms, http://name.umdl.umich.edu/IC-HERB00IC-X-1108669%5DMICH-V-1108669, https://quod.lib.umich.edu/cgi/i/image/api/thumb/herb00ic/1108669/MICH-V-1108669/!250,250, The University of Michigan Library provides access to these materials for educational and research purposes. Some materials may be protected by copyright. If you decide to use any of these materials, you are responsible for making your own legal assessment and securing any necessary permission. If you have questions about the collection, please contact the Herbarium professional staff: herb-dlps-help@umich.edu. If you have concerns about the inclusion of an item in this collection, please contact Library Information Technology: libraryit-info@umich.edu., https://www.lib.umich.edu/about-us/policies/copyright-policy

34. Genista haensseleri

Author

E. Boissier, E. Boissier, E. Boissier, and E. Boissier

Abstract

Angiosperms, http://name.umdl.umich.edu/IC-HERB00IC-X-1107289%5DMICH-V-1107289, https://quod.lib.umich.edu/cgi/i/image/api/thumb/herb00ic/1107289/MICH-V-1107289/!250,250, The University of Michigan Library provides access to these materials for educational and research purposes. Some materials may be protected by copyright. If you decide to use any of these materials, you are responsible for making your own legal assessment and securing any necessary permission. If you have questions about the collection, please contact the Herbarium professional staff: herb-dlps-help@umich.edu. If you have concerns about the inclusion of an item in this collection, please contact Library Information Technology: libraryit-info@umich.edu., https://www.lib.umich.edu/about-us/policies/copyright-policy

35. Cytisus affinis

Author

E. Boissier, E. Boissier, E. Boissier, and E. Boissier

Abstract

Angiosperms, http://name.umdl.umich.edu/IC-HERB00IC-X-1107217%5DMICH-V-1107217, https://quod.lib.umich.edu/cgi/i/image/api/thumb/herb00ic/1107217/MICH-V-1107217/!250,250, The University of Michigan Library provides access to these materials for educational and research purposes. Some materials may be protected by copyright. If you decide to use any of these materials, you are responsible for making your own legal assessment and securing any necessary permission. If you have questions about the collection, please contact the Herbarium professional staff: herb-dlps-help@umich.edu. If you have concerns about the inclusion of an item in this collection, please contact Library Information Technology: libraryit-info@umich.edu., https://www.lib.umich.edu/about-us/policies/copyright-policy

36. Genista biflora var. plumosa

Author

E. Boissier, E. Boissier, E. Boissier, and E. Boissier

Abstract

Angiosperms, http://name.umdl.umich.edu/IC-HERB00IC-X-1107288%5DMICH-V-1107288, https://quod.lib.umich.edu/cgi/i/image/api/thumb/herb00ic/1107288/MICH-V-1107288/!250,250, The University of Michigan Library provides access to these materials for educational and research purposes. Some materials may be protected by copyright. If you decide to use any of these materials, you are responsible for making your own legal assessment and securing any necessary permission. If you have questions about the collection, please contact the Herbarium professional staff: herb-dlps-help@umich.edu. If you have concerns about the inclusion of an item in this collection, please contact Library Information Technology: libraryit-info@umich.edu., https://www.lib.umich.edu/about-us/policies/copyright-policy

37. Leobordea lupinifolia

Author

E. Boissier, E. Boissier, E. Boissier, and E. Boissier

Abstract

Angiosperms, http://name.umdl.umich.edu/IC-HERB00IC-X-1104126%5DMICH-V-1104126, https://quod.lib.umich.edu/cgi/i/image/api/thumb/herb00ic/1104126/MICH-V-1104126/!250,250, The University of Michigan Library provides access to these materials for educational and research purposes. Some materials may be protected by copyright. If you decide to use any of these materials, you are responsible for making your own legal assessment and securing any necessary permission. If you have questions about the collection, please contact the Herbarium professional staff: herb-dlps-help@umich.edu. If you have concerns about the inclusion of an item in this collection, please contact Library Information Technology: libraryit-info@umich.edu., https://www.lib.umich.edu/about-us/policies/copyright-policy

38. Cotoneaster granatensis

Author

E. Boissier, E. Boissier, E. Boissier, and E. Boissier

Abstract

Angiosperms, http://name.umdl.umich.edu/IC-HERB00IC-X-1229083%5DMICH-V-1229083, https://quod.lib.umich.edu/cgi/i/image/api/thumb/herb00ic/1229083/MICH-V-1229083/!250,250, The University of Michigan Library provides access to these materials for educational and research purposes. Some materials may be protected by copyright. If you decide to use any of these materials, you are responsible for making your own legal assessment and securing any necessary permission. If you have questions about the collection, please contact the Herbarium professional staff: herb-dlps-help@umich.edu. If you have concerns about the inclusion of an item in this collection, please contact Library Information Technology: libraryit-info@umich.edu., https://www.lib.umich.edu/about-us/policies/copyright-policy

39. Deschampsia minor

Author

E. Boissier, E. Boissier, E. Boissier, and E. Boissier

Abstract

Angiosperms, http://name.umdl.umich.edu/IC-HERB00IC-X-1210172%5DMICH-V-1210172, https://quod.lib.umich.edu/cgi/i/image/api/thumb/herb00ic/1210172/MICH-V-1210172/!250,250, The University of Michigan Library provides access to these materials for educational and research purposes. Some materials may be protected by copyright. If you decide to use any of these materials, you are responsible for making your own legal assessment and securing any necessary permission. If you have questions about the collection, please contact the Herbarium professional staff: herb-dlps-help@umich.edu. If you have concerns about the inclusion of an item in this collection, please contact Library Information Technology: libraryit-info@umich.edu., https://www.lib.umich.edu/about-us/policies/copyright-policy

40. Festuca duriuscula subsp. indigesta

Author

E. Boissier, E. Boissier, E. Boissier, and E. Boissier

Abstract

Angiosperms, http://name.umdl.umich.edu/IC-HERB00IC-X-1210650%5DMICH-V-1210650, https://quod.lib.umich.edu/cgi/i/image/api/thumb/herb00ic/1210650/MICH-V-1210650/!250,250, The University of Michigan Library provides access to these materials for educational and research purposes. Some materials may be protected by copyright. If you decide to use any of these materials, you are responsible for making your own legal assessment and securing any necessary permission. If you have questions about the collection, please contact the Herbarium professional staff: herb-dlps-help@umich.edu. If you have concerns about the inclusion of an item in this collection, please contact Library Information Technology: libraryit-info@umich.edu., https://www.lib.umich.edu/about-us/policies/copyright-policy

41. Saxifraga camposii

Author

E. Boissier, E. Boissier, E. Boissier, and E. Boissier

Abstract

Angiosperms, http://name.umdl.umich.edu/IC-HERB00IC-X-1192720%5DMICH-V-1192720, https://quod.lib.umich.edu/cgi/i/image/api/thumb/herb00ic/1192720/MICH-V-1192720/!250,250, The University of Michigan Library provides access to these materials for educational and research purposes. Some materials may be protected by copyright. If you decide to use any of these materials, you are responsible for making your own legal assessment and securing any necessary permission. If you have questions about the collection, please contact the Herbarium professional staff: herb-dlps-help@umich.edu. If you have concerns about the inclusion of an item in this collection, please contact Library Information Technology: libraryit-info@umich.edu., https://www.lib.umich.edu/about-us/policies/copyright-policy

42. Festuca clementei

Author

E. Boissier, E. Boissier, E. Boissier, and E. Boissier

Abstract

Angiosperms, http://name.umdl.umich.edu/IC-HERB00IC-X-1210486%5DMICH-V-1210486, https://quod.lib.umich.edu/cgi/i/image/api/thumb/herb00ic/1210486/MICH-V-1210486/!250,250, The University of Michigan Library provides access to these materials for educational and research purposes. Some materials may be protected by copyright. If you decide to use any of these materials, you are responsible for making your own legal assessment and securing any necessary permission. If you have questions about the collection, please contact the Herbarium professional staff: herb-dlps-help@umich.edu. If you have concerns about the inclusion of an item in this collection, please contact Library Information Technology: libraryit-info@umich.edu., https://www.lib.umich.edu/about-us/policies/copyright-policy

43. Euphorbia chamaesyce var. canescens

Author

E. Boissier, E. Boissier, E. Boissier, and E. Boissier

Abstract

Angiosperms, http://name.umdl.umich.edu/IC-HERB00IC-X-1304285%5DMICH-V-1304285, https://quod.lib.umich.edu/cgi/i/image/api/thumb/herb00ic/1304285/MICH-V-1304285/!250,250, The University of Michigan Library provides access to these materials for educational and research purposes. Some materials may be protected by copyright. If you decide to use any of these materials, you are responsible for making your own legal assessment and securing any necessary permission. If you have questions about the collection, please contact the Herbarium professional staff: herb-dlps-help@umich.edu. If you have concerns about the inclusion of an item in this collection, please contact Library Information Technology: libraryit-info@umich.edu., https://www.lib.umich.edu/about-us/policies/copyright-policy

44. Cotoneaster granatensis

Author

E. Boissier, E. Boissier, E. Boissier, and E. Boissier

Abstract

Angiosperms, http://name.umdl.umich.edu/IC-HERB00IC-X-1229083%5DMICH-V-1229083, https://quod.lib.umich.edu/cgi/i/image/api/thumb/herb00ic/1229083/MICH-V-1229083/!250,250, The University of Michigan Library provides access to these materials for educational and research purposes. Some materials may be protected by copyright. If you decide to use any of these materials, you are responsible for making your own legal assessment and securing any necessary permission. If you have questions about the collection, please contact the Herbarium professional staff: herb-dlps-help@umich.edu. If you have concerns about the inclusion of an item in this collection, please contact Library Information Technology: libraryit-info@umich.edu., https://www.lib.umich.edu/about-us/policies/copyright-policy

45. Festuca clementei

Author

E. Boissier, E. Boissier, E. Boissier, and E. Boissier

Abstract

Angiosperms, http://name.umdl.umich.edu/IC-HERB00IC-X-1210486%5DMICH-V-1210486, https://quod.lib.umich.edu/cgi/i/image/api/thumb/herb00ic/1210486/MICH-V-1210486/!250,250, The University of Michigan Library provides access to these materials for educational and research purposes. Some materials may be protected by copyright. If you decide to use any of these materials, you are responsible for making your own legal assessment and securing any necessary permission. If you have questions about the collection, please contact the Herbarium professional staff: herb-dlps-help@umich.edu. If you have concerns about the inclusion of an item in this collection, please contact Library Information Technology: libraryit-info@umich.edu., https://www.lib.umich.edu/about-us/policies/copyright-policy

46. Festuca duriuscula subsp. indigesta

Author

E. Boissier, E. Boissier, E. Boissier, and E. Boissier

Abstract

Angiosperms, http://name.umdl.umich.edu/IC-HERB00IC-X-1210650%5DMICH-V-1210650, https://quod.lib.umich.edu/cgi/i/image/api/thumb/herb00ic/1210650/MICH-V-1210650/!250,250, The University of Michigan Library provides access to these materials for educational and research purposes. Some materials may be protected by copyright. If you decide to use any of these materials, you are responsible for making your own legal assessment and securing any necessary permission. If you have questions about the collection, please contact the Herbarium professional staff: herb-dlps-help@umich.edu. If you have concerns about the inclusion of an item in this collection, please contact Library Information Technology: libraryit-info@umich.edu., https://www.lib.umich.edu/about-us/policies/copyright-policy

47. Saxifraga camposii

Author

E. Boissier, E. Boissier, E. Boissier, and E. Boissier

Abstract

Angiosperms, http://name.umdl.umich.edu/IC-HERB00IC-X-1192720%5DMICH-V-1192720, https://quod.lib.umich.edu/cgi/i/image/api/thumb/herb00ic/1192720/MICH-V-1192720/!250,250, The University of Michigan Library provides access to these materials for educational and research purposes. Some materials may be protected by copyright. If you decide to use any of these materials, you are responsible for making your own legal assessment and securing any necessary permission. If you have questions about the collection, please contact the Herbarium professional staff: herb-dlps-help@umich.edu. If you have concerns about the inclusion of an item in this collection, please contact Library Information Technology: libraryit-info@umich.edu., https://www.lib.umich.edu/about-us/policies/copyright-policy

48. Deschampsia minor

Author

E. Boissier, E. Boissier, E. Boissier, and E. Boissier

Abstract

Angiosperms, http://name.umdl.umich.edu/IC-HERB00IC-X-1210172%5DMICH-V-1210172, https://quod.lib.umich.edu/cgi/i/image/api/thumb/herb00ic/1210172/MICH-V-1210172/!250,250, The University of Michigan Library provides access to these materials for educational and research purposes. Some materials may be protected by copyright. If you decide to use any of these materials, you are responsible for making your own legal assessment and securing any necessary permission. If you have questions about the collection, please contact the Herbarium professional staff: herb-dlps-help@umich.edu. If you have concerns about the inclusion of an item in this collection, please contact Library Information Technology: libraryit-info@umich.edu., https://www.lib.umich.edu/about-us/policies/copyright-policy

49. Frankenia reuteri

Author

E. Boissier, E. Boissier, E. Boissier, and E. Boissier

Abstract

Angiosperms, http://name.umdl.umich.edu/IC-HERB00IC-X-1192290%5DMICH-V-1192290, https://quod.lib.umich.edu/cgi/i/image/api/thumb/herb00ic/1192290/MICH-V-1192290/!250,250, The University of Michigan Library provides access to these materials for educational and research purposes. Some materials may be protected by copyright. If you decide to use any of these materials, you are responsible for making your own legal assessment and securing any necessary permission. If you have questions about the collection, please contact the Herbarium professional staff: herb-dlps-help@umich.edu. If you have concerns about the inclusion of an item in this collection, please contact Library Information Technology: libraryit-info@umich.edu., https://www.lib.umich.edu/about-us/policies/copyright-policy

50. Erodium romanum var. rupestre

Author

E. Boissier, E. Boissier, E. Boissier, and E. Boissier

Abstract

Angiosperms, http://name.umdl.umich.edu/IC-HERB00IC-X-1192293%5DMICH-V-1192293, https://quod.lib.umich.edu/cgi/i/image/api/thumb/herb00ic/1192293/MICH-V-1192293/!250,250, The University of Michigan Library provides access to these materials for educational and research purposes. Some materials may be protected by copyright. If you decide to use any of these materials, you are responsible for making your own legal assessment and securing any necessary permission. If you have questions about the collection, please contact the Herbarium professional staff: herb-dlps-help@umich.edu. If you have concerns about the inclusion of an item in this collection, please contact Library Information Technology: libraryit-info@umich.edu., https://www.lib.umich.edu/about-us/policies/copyright-policy

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