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Biomedical subjects

A Duhamel

Publications and source records attributed to A Duhamel.

At least 73 records · Page 4Linked to original sources
PubMed1995

Early predictors of death and disability after acute cerebral ischemic event.

BACKGROUND AND PURPOSE: Many clinical trials are currently being conducted to evaluate the ability of neuroprotectors and thrombolytic agents to improve survival and functional outcome after ischemic stroke. Such trials require early predictors of survival and disability for ethical and methodological reasons. The aim of the study was to determine which variables, of those easily assessable during the first 24 hours after stroke onset, would be predictors of 8-day mortality rate and 3-month clinical outcome. METHODS: One hundred fifty-two consecutive patients with an acute ischemic event were evaluated within 24 hours after symptom onset. We determined (1) the 8-day mortality rate and (2) the 3-month functional outcome (Glasgow Outcome Scale). The following potential predictors of outcome were tested by means of a stepwise logistic regression analysis: age, sex, body mass index, atrial fibrillation, previous stroke, existence of headache, Orgogozo score, level of consciousness, swallowing disturbances, hemianopia, pulse rate, mean blood pressure, hematocrit, glycemia, and computed tomographic scan data (cerebral atrophy score, hyperdense middle cerebral artery sign, number of silent infarcts, leukoaraiosis score). RESULTS: The multivariate analysis revealed that the 8-day mortality rate depended only on the level of consciousness at admission (P = .0001); death or dependence at month 3 (scores 3 to 5 on the Glasgow Outcome Scale) depended on the severity of the clinical deficits (P = .0001), previous stroke (P = .0018), and age (P = .0237). CONCLUSIONS: In future drug trials, the distribution of patients between "active treatment" and "placebo" groups should be balanced regarding the severity of clinical deficits, history of stroke, and age.

Acute Disease↗
PubMed1994

Comparative study of split thickness skin grafts taken from the scalp and thigh in children.

We compared 29 split thickness skin grafts taken from the thigh (group I) and 37 taken from the scalp (group II). The study was prospective with a follow-up period of 1 year. The average age was 29 months. Included in group I were those children whose parents refused permission for their hair to be shaved and those with burns to the head. We compared ease of technique, percentage of graft accepted, quality of the graft and after-effects of the donor site. Acceptance of the graft was close to 100 per cent in both groups. Harvesting was more difficult from the scalp (P < 0.0001). The quality of the grafts was identical in both groups. After-effects at the donor site were absent in group II and evident in group I (P < 0.0001). There was no alopecia. The scalp represented a better donor site for split-thickness skin grafting than the thigh in the child.

Burns↗
PubMed1994

Pulmonary sarcoidosis: role of CT in the evaluation of disease activity and functional impairment and in prognosis assessment.

PURPOSE: To investigate the role of computed tomography (CT) in determining disease activity and functional impairment and in predicting the prognosis of lung involvement in patients with sarcoidosis. MATERIALS AND METHODS: Two groups of patients underwent CT, pulmonary function tests, and bronchoalveolar lavage. Disease activity was based on serum angiotensin converting enzyme activity and/or lymphocytosis at bronchoalveolar lavage. CT findings in group 1 were correlated with indexes of disease activity and functional parameters at diagnosis. In group 2, evaluation initially and at follow-up led to investigation of correlations between initial CT findings and evolution of disease activity and functional impairment. RESULTS: CT abnormalities in group 1 were nodules, air-space consolidation, lung distortion, septal and nonseptal linear areas of high attenuation, ground-glass attenuation, and honeycombing. Profusion of septal lines was the only CT finding that correlated with disease activity. Statistically significant (P < .05) but low correlation (r < .48) was observed between the extent of abnormalities at CT and impairment of lung function, except for nodules. CONCLUSION: Profusion of lung changes reflects functional impairment but not disease activity. CT findings cannot help predict the evolution of lung changes over time.

Adult↗
PubMed1993

Interrelationship between ultrasonography and biology in the diagnosis of polycystic ovarian syndrome.

In order to compare the diagnostic significance of hormonal and ultrasonic criteria of polycystic ovarian syndrome (PCOS), the presence or the absence of ultrasonographic and hormonal features of PCOS were recorded in a heterogeneous population of 90 women presenting with hyperandrogenism and/or menstrual disorders. On clinical and hormonal grounds exclusively, these patients could be separated into five diagnostic subgroups: presumed cases of PCOS (n = 21), idiopathic hirsutism (IH) (n = 26), hypothalamic anovulation (HA) (n = 11), hyperprolactinemia (HPRL) (n = 9), and miscellaneous or undetermined diagnosis (n = 23). By the means of a computed automatic classification of patients (cluster analysis) using five hormonal and ultrasonic criteria of PCOS, four homogeneous clusters of patients were obtained. Cluster #1 (25 patients) had the most characteristic profile of PCOS. It included 15 cases of PCOS and 7 cases of IH. Cluster #4 (47 patients) had the less characteristic profile of PCOS. It included the majority of patients with HA and HPRL and the half of the patients with IH. Cluster #2 included only two hyperandrogenic patients, who were massively obese and in whom ultrasonography may have failed to detect PCOS. Cluster #3 (16 patients) included patients from each diagnostic group, who were gathered together because ultrasonographic and hormonal features were, respectively, present and absent in nearly all of them. With the same analysis, the criteria of PCOS could be graded according to their grouping potential. The presence of an abnormal ovarian stroma by ultrasonography appeared as the most potent criterion. Elevated serum testosterone and androstenedione levels and the polyfollicular pattern of ovaries gave intermediate results, while elevated basal LH level was a much weaker grouping parameter. In conclusion, the automatic classification of patients by cluster analysis using both hormonal and ultrasonographic criteria revealed that the classical diagnostic classification, relying upon hormonal data exclusively, may arbitrarily separate patients having the same disease; and that ultrasonography affords pertinent information that should help provide a better diagnostic definition of PCOS.

Adolescent↗
PubMed1993

Early and delayed distribution of N-isopropyl-[123I]-p-iodoamphetamine in haemorrhagic and ischaemic brain.

Single photon emission computed tomography (SPECT) was used to study redistribution of N-isopropyl-[123I]-p-iodoamphetamine (IAMP) in 10 patients with intracerebral haemorrhage and 7 with ischaemic stroke. Delayed/early IAMP uptake ratios (D/E) were calculated for four different cerebral zones: haematoma or infarct, perilesional, normal and crossed cerebellar diaschisis areas. Delayed uptake was observed in all areas, but there were no significant differences between the haematoma and infarct results nor between the lesional and perilesional results. Delayed redistribution of IAMP therefore did not seem to be associated with neuronal metabolic activity.

Adult↗
PubMed1993

Importance of ground-glass attenuation in chronic diffuse infiltrative lung disease: pathologic-CT correlation.

PURPOSE: To correlate areas of ground-glass attenuation at computed tomography (CT) with findings at open lung biopsy in chronic diffuse lung disease. MATERIALS AND METHODS: The cases of 26 patients were included on the basis of (a) extensive areas of ground-glass attenuation as the predominant (n = 17) or exclusive (n = 9) abnormality at CT in the absence of honeycombing and (b) histologic evaluation at open lung biopsy. Severity of ground-glass attenuation was scored in the lobe sampled at biopsy, with separate analysis of associated lung changes. RESULTS: Correlation of CT with histologic findings at the 37 biopsy sites demonstrated that ground-glass attenuation corresponded to inflammation in 24 (65%) cases and to fibrosis in 13 (54%) cases. Eleven of the 13 patients (85%) with fibrosis had traction bronchiectasis or bronchiolectasis. These findings were not present in any of the patients with inflammation. CONCLUSION: In patients with chronic diffuse infiltrative lung disease, areas of ground-glass attenuation not associated with traction bronchiectasis or bronchiolectasis are a reliable indicator of inflammation.

Biopsy↗
PubMed1993

Prognostic factors in Waldenström's macroglobulinemia: a report of 167 cases.

PURPOSE: A single-center retrospective analysis was conducted in 167 patients with Waldenström's macroglobulinemia (WM) to delineate prognostic factors. PATIENTS AND METHODS: One hundred sixty-seven patients diagnosed between January 1969 and December 1988, fulfilling diagnostic criteria of WM, were entered onto this study. One hundred twenty-eight patients were treated with chlorambucil (0.1 mg/kg/d): 117 at diagnosis and 11 during the disease course. Seventeen variables were analyzed in all patients and in treated patients for their prognostic value on survival using the Kaplan-Meier method and a Cox multivariate regression analysis. RESULTS: Median survival duration for all patients was 60 months. Pretreatment factors associated with shorter survival in the entire population were age > or = 60 years (P = .006), male sex (P = .0001), general symptoms (P = .01), hemoglobin less than 10 g/dL (P = .008), leukocytes less than 4 X 10(9)/L (P = .02), neutrophils less than 1.7 X 10(9)/L (P = .02), and platelets less than 150 X 10(9)/L (P = .0006). Organomegaly, signs of hyperviscosity, renal failure, monoclonal immunoglobulin M (M IgM) level, blood lymphocytosis, and percentage of marrow lymphoid cells were not significantly correlated with survival. In a Cox multivariate regression analysis, the combination of factors that gave the best prognostic value was the association of sex (P = .0002), neutrophils (P = .002), age (P = .008), and hemoglobin (P = .02). CONCLUSION: Our findings suggest that some pretreatment parameters, including older age, male sex, general symptoms, and cytopenias, carry a poor prognosis in WM. By contrast, high initial tumor burden (indicated by organomegaly, high IgM level, and high percentage of marrow lymphoid cells) does not seem to be significantly associated with short survival. Our results help define a high-risk population that could perhaps benefit from newer therapeutic approaches.

Aged↗
PubMed1993

Cytogenetic analysis has strong independent prognostic value in de novo myelodysplastic syndromes and can be incorporated in a new scoring system: a report on 408 cases.

Although the prognostic value of cytogenetic analysis has previously been demonstrated in myelodysplastic syndromes (MDS), karyotype had not been included in previously published scoring systems, such as Bournemouth and Sanz's scores. We studied karyotype at diagnosis in 408 cases of de novo MDS (after excluding therapy-related MDS). Karyotypes were classified in 10 groups: normal; isolated del 5q; del 5q and other rearrangements; isolated +8; isolated -7 or del 7q; del 20q; isolated -Y; miscellaneous single rearrangements; -7 or del 7q and other rearrangements; miscellaneous complex rearrangements. Karyotypes were considered complex when at least three chromosomes were rearranged. Complex karyotypes included all patients with del 5q and other rearrangements, -7 or del 7q and other rearrangements, and miscellaneous complex rearrangements (i.e. three of the 10 groups). Median actuarial survival of the 408 patients was 28 months, and 90 patients (22%) progressed to acute myeloid leukemia (AML). For survival, bone marrow (BM) blasts, circulating blasts, white blood cell (WBC), neutrophil count, platelet count, hemoglobin, age, sex, FAB classification, and Bournemouth and Sanz's scores had strong prognostic value. Cytogenetics also had strong prognostic value. An unfavorable cytogenetic group (patients with complex karyotypes) was identified. On the other hand, although patients with isolated del 20q and del 5q had a somewhat better prognosis than other patients with non-complex cytogenetic findings, they could not be statistically individualized as a favorable group, possibly owing to their relatively limited number. By multivariate regression analysis, a three-variable new scoring system could be designed based on karyotype (1 point for complex karyotype; 0 for other groups), platelets (0 for > 75 x 10(9)/l; 1 for < 75 x 10(9)/l), and BM blasts (0 for < 5%, 1 for 5-10%, 2 for > 10%). The total score (addition of points for the three variables) was able to separate patients in three groups with low (score 0) intermediate (score 1 or 2), and high risk (score 3 or 4) which included 34%, 47%, and 19% of the patients, and had a median survival of 55, 24, and 6 months, respectively (chi 2 = 110, p < 10(-4)). This new score (Lille score) was able to subdivide risk groups according to Bournemouth and Sanz's scores into further subgroups of different prognoses. For progression to AML, BM blasts, circulating blasts, WBC count, hemoglobin, FAB type, and karyotype had prognostic value by univariate analysis.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1993

[Nutrition of children and adolescents engaged in high-level sports activities].

Young high-level athletes are frequently exposed to deficiencies, the most frequent origin of which is dietary. Supervision must be clinical, biological and dietary. Recommendations should be made individually, based on the nature and intensity of the exercise, and are calculated from the recommended supplements for the paediatric population. Protein, glucid and lipid supplements must represent approximately 12, 60 and 28% of the daily energetic intake respectively, the glucid ratio reaching 70% under certain conditions of prolonged exercise. Liquids must be controlled when exercise takes place in a warm atmosphere because young athletes are rapidly exposed to dehydration, the osmolarity of the selected drink being below 250 mosm/l. Mineral and vitamin supplementations are recommended. For minerals, perspiration losses may be associated with dietary deficiency. Possible vitamin deficiencies concern B1, B2, B6, B9, B12, C and D vitamins. The daily mineral supplements are estimated at 10 mg for iron, 5 mg for zinc and 1 mg for copper, and have to be prescribed in regular treatment after biological control.

Adolescent↗
PubMed1992

Pulsatility of growth hormone secretion and its relation to growth.

84 short children were submitted to nocturnal spontaneous growth hormone (GH) secretion tests and to provocative insulin-arginine tests. Discrepancies between the GH peak under the provocative test (I-AP) and nocturnal GH maximal peak (PA) and mean concentration (MC) were frequently observed, despite significant statistical correlation between I-AP and PA (r = 0.47; p < 0.02) and between I-AP and MC (r = 0.42; p < 0.02). Night profiles were evaluated by time analysis: 31 fitted a theoretical model, consisting of a cosine function of time (modelizable profiles). Spectral analysis, from Fourier transformation, indicated predominant periods after cluster analysis. The major predominant period in modelizable (n = 9) and in nonmodelizable (n = 28) profiles was close to 180 min and a secondary period was on average 122 min in modelizable (n = 20) and 105 min in nonmodelizable (n = 23) profiles. Two modelizable and two nonmodelizable profiles escaped this classification. The general, auxological and GH secretory status did not differ significantly between patients with modelizable and nonmodelizable profils. Growth velocity correlated with GH mean concentration (r = 0.36; p < 0.001), but not with plasma insulin-like growth factor-I levels nor with any of the pulsatility indices: number of peaks, main period, and pulse height index = mean GH peak/mean GH concentration. The relevance of GH pulsatility to growth is, therefore, unclear in humans.

Adolescent↗
PubMed1991

Assessment of diffuse infiltrative lung disease: comparison of conventional CT and high-resolution CT.

The diagnostic accuracies of conventional computed tomography (CT) and high-resolution CT (HRCT) in examination of the entire lungs were compared prospectively, and the diagnostic utility of a limited number of HRCT sections in the evaluation of diffuse infiltrative lung disease (DILD) was determined in 150 consecutive patients. Conventional 10-mm CT sections were equivalent to 1.2-mm HRCT sections in the recognition of nodules, masses, nodular irregularities of the interfaces, large cystic air spaces, and architectural distortion. Conventional CT was superior to HRCT in the diagnosis of micronodules and infiltrates. However, 15% of micronodules were recognized only on HRCT images because of their small size and low density. Fine bronchial and parenchymal lesions were best seen on HRCT scans. HRCT was the only technique that allowed assessment of the presence of areas of ground-glass attenuation. HRCT improves visualization of small parenchymal structures and allows a confident evaluation of DILD, providing that the entire lungs are studied. Nevertheless, an optimal CT evaluation of micronodular patterns requires additional thick-section CT scans.

Algorithms↗
PubMed1990

Assessment of the reproducibility of nocturnal growth hormone secretion.

The reproducibility of measurements of nocturnal spontaneous secretion of growth hormone (GH) was assessed. The study population consisted of 15 short children with a variety of pathological conditions. Blood samples were taken every 20 min from each subject during sleep on two consecutive nights. The analysis of variance of matched series indicated a global reproducibility, but also demonstrated significant individual variabilities (with-in-subject effect) of both peak amplitude (p = 0.05) and mean concentration (p = 0.02). We did not find any link between the variation of the GH parameters and the variations of the clinical sleep score in 11 patients.

Analysis of Variance↗
PubMed1987

[Gallium-67 scintigraphic evaluation of primary dilated myocardiopathies in adults].

Myocardiopathy (MCP) is diagnosed by exclusion in patients with congestive heart failure in the absence of lesions of the coronary vessels or cardiac valves. Endo-myocardial biopsies and several cases of clinical improvement under immunosuppressive therapy suggest that it may be due due to an immune mechanism. Gallium-67 is taken up by the myocardium and may be regarded as a scintigraphic marker of myocardial inflammation. It may therefore be used to determine which patients would benefit from immunosuppressants. Our study involved 47 patients (mean age 40.1 +/- 10.2 years) with MCP evidenced by angiography and coronary arteriography. Isotopic ejection fraction (EF) and Ga-67 uptake by the myocardium were evaluated in all cases. A significant Ga-67 uptake was observed in 22 patients, 20 of whom could be divided into two groups: group I received an immunosuppressive treatment (azathioprine plus prednisone); group II did not receive such treatment. A new radionuclide cardiac examination was carried out 5 months after the beginning of treatment. No significant Ga-67 uptake could be detected in either group. Significant improvement of EF was observed in 6 patients of group I and in 2 patients of group II. Four patients had died: 1 in group I and 3 in group II. Thus, a decrease in Ga-67 uptake was noted in all patients 5 months after the initial examination, irrespective of the treatment received, which suggests that this decrease belongs to the natural history of the disease. The effect of immunosuppressive therapy on MCP, therefore, ought to be re-evaluated.

Adult↗
PubMedDate not supplied

Pronostic factors of synchronous brain metastases from lung cancer.

BACKGROUND: The prognosis of brain metastases (BM) from lung cancer is poor. The management of lung cancer with BM is not clear. This retrospective study attempts to determine their prognostic factors, and to better define the role of different treatments. METHODS: We reviewed the clinical characteristics of 271 consecutive patients with synchronous brain metastases (SBM) from lung cancer (small-cell lung cancers and non-small-cell lung cancers), collected between January 1985 and May 1993. Data were available for all patients as well as follow-up information on all patients through to death. Patients had all undergone heterogeneous treatments. Each physician had chosen the appropriate treatment after collegiate discussion. Survival curves were compared using the log-rank test in univariate analysis, and Cox's Regression model in multivariate analysis. Statistical significance was defined as P<0.05. RESULTS: 249 patients were assessable. Treatments included: neurosurgical resection in 56 cases, brain irradiation in 87 cases, and chemotherapy in 126 cases. Median overall survival time from the date of histological diagnosis of SBM was 103 days (range, 1-1699). In multivariate analysis, prognostic factors for longer overall survival times were: absence of adrenal metastases (P=0.007), neurosurgical resection (P=0.028), chemotherapy (P=0.032) and brain irradiation (P=0.008). Moreover, risk factors of intracranial hypertension as cause of death were number of SBM and absence of neurosurgical resection. CONCLUSIONS: These results and others suggest that patients with SBM from lung cancer be considered for carcinologic treatment, and not only for best supportive care. However, further studies are necessary to evaluate quality of life with or without carcinologic treatment.

Adult↗
PubMedDate not supplied

CT angiography of thoracic outlet syndrome: evaluation of imaging protocols for the detection of arterial stenosis.

PURPOSE: The purpose of this work was to evaluate the results of cross-sectional imaging and multiplanar and 3D reconstructions for the detection of thoracic outlet arterial stenosis on CT angiograms. METHOD: Eighty-two patients were prospectively evaluated with CT angiography: in the neutral position and after postural maneuver (164 acquisitions); with contralateral injection of a 24% (Group 1; n = 68) or 30% (Group 2; n = 96) contrast agent; and reconstruction of four sets of images from each acquisition, that is, transverse CT scans, sagittal reformations, and 3D [shaded surface displays (SSD) and volume-rendered (VR)] images. A total of 656 sets of images were blindly and independently interpreted by three readers of variable experience. A consensus interpretation of the four sets of images of each acquisition was used as a standard of reference. RESULTS: The number of examinations coded with an excellent degree of arterial enhancement was significantly higher in Group 2 than in Group 1 [68 (71%) vs. 35 (51%); p < 0.001]. The sensitivity and specificity for detection of arterial stenosis were 67 and 96% for transverse CT scans, 69 and 94% for sagittal reformations, 71 and 99% for 3D-SSDs, and 95 and 100% for VR images. Compared with the standard of reference, a concordant scoring of arterial stenosis severity was found in 54% of transverse CT scans, 84% of sagittal reformations, 78% of 3D-SSDs, and 91% of VR images. Underestimation of stenosis was found in 43% of transverse CT scans and 10% of sagittal reformations; overestimation of stenosis was more frequent on 3D-SSDs (16%) than on VR images (7%). The reader's experience was marked for the interpretation of cross-sectional images but did not influence the interpretation of 3D images. CONCLUSION: Thoracic outlet arterial compression is best depicted with the injection of a 30% contrast agent and reconstruction of VR images.

Adolescent↗