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Biomedical subjects

A Grand

Publications and source records attributed to A Grand.

At least 37 records · Page 2Linked to original sources
PubMed1999

A group motivational treatment for chemical dependency.

Patient "motivation" has been implicated as a critical component in addiction treatment outcomes. To date, treatments utilizing motivational elements have been conducted as individual interventions. We describe the development of a Group Motivational Intervention (GMI), a four-session, manual-driven group approach that employs key hypothesized motivational elements. These include the six motivational elements derived by Miller and Sanchez (1994) from successful alcoholism treatments, described with the acronym, FRAMES (feedback, responsibility, advice, menu of options, empathy, and self-efficacy). GMI is additionally informed by concepts derived from "self-determination theory" (Deci & Ryan, 1985), concerned with understanding motivation as either internal/autonomous or external/controlled. Evidence indicates that people will value and persist longer in behaviors that they perceive as autonomously motivated. GMI techniques utilize the interpersonal factors found to be autonomy-supportive in self-determination theory. Preliminary results from a randomized clinical trial suggest that key motivational processes are affected by GMI: patients perceive the GMI environment and group leader as significantly more "autonomy supportive" than treatment "as usual."

Alcoholism↗
PubMed1999

Caregiver stress: a failed negotiation? A qualitative study in South West France.

The purpose of this work is to analyze the various negotiations involved in setting up and developing a caregiving relationship with a disabled elderly person, to understand the processes inducing caregiver stress. Within the conceptual framework defined by the paradigm of negotiation, this study uses the theoretical contributions of the parallelist theory and the theory of the gift. It is based on a qualitative inquiry including fifty-four caregivers conducted in Toulouse (South West France). The analysis focuses on two undersystems of the caregiver's relationships: 1) the caregiver/cared-for's relationship, which is characterized by the establishment and maintenance of a "tacit contract" and 2) the relationships with other eligible caregivers, which are marked by the "designation" of the principal caregiver. This analysis shows that a failure in the negotiation process can induce a designation and/or a weak tacit contract-the result of which is the caregiver's expression of stress. This expression is closely linked to the caregiver's perception of a negative balance in his/her exchanges with the partners. This study should help break away from the one-way arrow model currently dominating the field of caregiver stress research.

Aged↗
PubMed1999

[Treatment of coronary insufficiency in diabetics: Part 2: acute coronary insufficiency].

Treatment of acute coronary insufficiency in diabetics--recent myocardial infarction (MI--unstable angina--uses the same modalities as in the absence of diabetes. Thrombolytics improve the prognosis of MI, although the hospital mortality remains about two fold in the presence of diabetes. Primary angioplasty has an identical success rate, but restenoses are significantly more frequent in diabetics. Systematic use of stents allows a reduction of the restenosis rate to the level observed in the absence of diabetes. In unstable angina, low molecular weight heparins have an efficacy and a safety identical to those observed in non-diabetic patients. There is therefore no limitation to their use. Diabetics present permanent activation of blood platelets which promotes their adhesion and aggregation. Aspirin must therefore be systematically prescribed to diabetic patients, except in the presence of a contraindication, especially gastrointestinal, in which case, ticlopidine can be used. Platelet glycoprotein IIB-IIIA receptor inhibitors have the same indications and provide the same results as in the absence of diabetes. Contrary to a widely held belief, beta-blockers, especially cardioselective, can be widely used in diabetics. The same applies to angiotensin converting enzyme inhibitors. Finally, during the acute phase of coronary insufficiency, continuous insulin infusion via a pump ensures better control of diabetes and also decreases the mortality of MI. Permanent collaboration between cardiologists and diabetologists is therefore essential to increase the efficacy of treatment and to improve the prognosis of acute coronary insufficiency in diabetic patients.

Acute Disease↗
PubMed1999

[Treatment of coronary insufficiency in diabetics. Part 1: objectives and targets].

Coronary insufficiency affects 55% of insulin-dependant diabetics and is responsible for 60% of deaths in this population. Its particular severity is essentially due to the severity of coronary atherosclerosis, which is usually multi-vessel, involves both large trunks and microcirculation, is made of frequently lipid-rich and therefore fragile plaques, and is accompanied by abnormal but specific reactions of the arterial wall (tendency to vasoconstriction and increased neointimal proliferation after trauma). Coronary atherosclerosis is also often associated with HT, lower limb arteriopathy or cerebral atherosclerosis. Quality of blood glucose control, other organic lesions of diabetes (nephropathy, retinopathy), disturbances of platelet function and dyslipidaemias (hypercholesterolaemia, hypertriglyceridaemia, increased levels of highly atherogenic small LDL particles) are also involved in the development of coronary insufficiency. A precise knowledge of the diseases to be treated and their particularly rigorous prevention and treatment can improve the prognosis of coronary insufficiency in diabetics.

Cause of Death↗
PubMed1999

[Treatment of coronary insufficiency in diabetics. Part 3: chronic coronary insufficiency].

The drug treatment of chronic coronary insufficiency in diabetic patients is now well defined. Platelet antiaggregants, especially aspirin, must be prescribed in the long-term or even indefinitely. Other drugs (beta-blockers, calcium channel blockers, nitrates, etc.) can be used in the same way as in the absence of diabetes. Angioplasty gives immediate favourable results in diabetics, very similar to those obtained in the absence of diabetes. In contrast, the longer term prognosis is less favourable, as the mortability, myocardial infarction, restenosis and bypass graft rates are significantly higher. First-line stenting lowers the restenosis rate to a level comparable to that observed in non-diabetics. However, instrumental revascularization is less complete than surgical revascularization and the number of redilatations and/or secondary bypass grafts remains high. The indications, mortality and early complications of coronary surgery are now identical to those observed in the absence of diabetes. Its long-term results are significantly more favourable than those of medical treatment or even angioplasty, although this issue is still controversial. The improved prognosis observed in operated diabetic coronary patients is due to the more frequent use of arterial bypass grafts. The maintenance of blood glucose control and correction of the frequently associated cardiovascular risk factors (obesity, sedentary lifestyle, smoking, HT, dyslipidaemia) increase the efficacy of treatment of coronary insufficiency in diabetic patients. This goal can only be achieved by permanent, unfailing collaboration between cardiologists and diabetologists.

Actuarial Analysis↗
PubMed1998

[The importance of lipoprotein(a) as a predictive factor of coronary atherosclerosis].

OBJECTIVE: The predictive value of lipoprotein(a), Lp(a), for coronary artery disease, is strongly suspected, though unproven. The normal serum level is 0.3 g/l. We searched for correlations between serum Lp(a) levels and coronary artery disease in a population of patients hospitalized in a general cardiology unit. METHOD: Serum Lp(a) was assayed in all patients consecutively hospitalized during 1994 in the Valence hospital cardiology unit. Two groups were distinguished: patients with coronary artery disease (n = 444) and those presumed free of coronary artery disease (n = 555). Coronography were performed when required. Serum Lp(a) levels were compared for the following variables: age, sex, smoking habits, blood pressure, total cholesterol, HDL and LDL-cholesterol, triglycerides and apolipoproteins A1 and A2. Univariate, then multivariate analysis were performed first patients of all ages, then for those aged more and less than 60 years. RESULTS: Univariate analysis demonstrated that Lp(a) > 0.3 g/l was associated with coronary heart disease (OR = 1.33; p = 0.03), although this correlation was no longer significant after adjustment for other known risk factors (OR = 1.28; p = 0.07), except in the subgroup of patients over 60 years of age (OR = 1.37; p = 0.04). CONCLUSION: There was a non-significant trend favoring an association between serum Lp(a) level > 0.3 g/l and the development of coronary artery disease.

Adult↗
PubMed1998

[Communication between the left ventricle and the right atrium in infectious endocarditis. Diagnosis using Doppler-echocardiography].

The diagnosis of a communication between the left ventricle and right atrium was made by transthoracic and transoesophageal echocardiography in a 67 year old man with a recurrence of a methicillin-resistant staphylococcus aureus infectious endocarditis complicating aortic valve replacement with a bioprosthesis seven weeks previously. This diagnosis was confirmed at surgery; the left ventricular-right atrial communication was closed by suturing its edges and a new aortic valve prosthesis was implanted. Unfortunately, the patient died 4 months later of myocardial dysfunction although the infectious endocarditis seemed to have been sterilised by antibiotic therapy. Doppler echocardiography, especially using the transoesophageal approach is the best diagnostic method for rare complications of infectious endocarditis, usually of the aortic valve, the prognosis of which is improved by early surgery and appropriate antibiotic therapy for the causal organisms.

Aged↗
PubMed1997

[Value of mass dosage of the MB isoenzyme of creatinine phosphokinase in the diagnosis of recent myocardial infarction].

In 391 patients admitted 3.7 hours (h) (median) after experiencing infarct-like pain, kinetic monitoring of CK-MB "mass" (threshold: 7 micrograms/l), myoglobin (threshold: 90 micrograms/l) and total CK (threshold: 290 micrograms/l) was carried out at the time of admission and after 1.5, 3, 6, 9, 12, 24 and 48 h. When myocardial infarction (MI) was treated conventionally (102 patients). CK-MB peaked 11 h (median) after the onset of pain, later than myoglobin (9 h), but before total CK (12 h). The peak of the markers was higher in Q+ than in Q-MI (p < 0.05). When MI was treated by thrombolytic medications (44 patients), the increases in CK-MB, myoglobin and total CK were larger, and occurred sooner (peaks 9, 6 and 6 h, after the onset of pain respectively), but did not last as long. In 245 patients who had not had MI (including 123 with spontaneous angina), the levels of the three markers remained stable and well below the decision thresholds. The sensitivities of CK-MB, myoglobin and total CK were respectively 47.1, 51.8 and 34.8% at the time of admission, 67.3, 82.7 and 57.1% after 3 h and 83.1, 76.9 and 88.9% after 6 h. The combined determination of CK-MB and of myoglobin had a higher sensitivity (67.7% at the time of admission, 84.9% after 1.5% and 88.2% after 3 h: but most of this gain was due to myoglobin. The specificity of the three markers and their diagnostic accuracy are comparable. In the course of recent MI, the kinetics of CK-MB mass are thus slower than those of myoglobin, but a little faster than those of total CK. The choice of the most effective biochemical marker depends upon the interval between onset of chest pain and hospitalization of the patient. Repetition of the determinations improves the diagnostic situation.

Adult↗
PubMed1997

[Myocardial infarction in the elderly. Comparison between 2 groups of patients over 75 and under 65 years of age].

To define the clinical characteristics, prognosis and treatment of myocardial infarction (MI) in the elderly, we retrospectively compared the files of 101 patients aged > or = 75 years (mean: 82 +/- 4 years) and of 120 others aged < or = 65 years (mean: 55 +/- 4.7 years). The figures corresponding to younger patients are presented in brackets. The elderly group included 60.4% women (5%: p < 0.001), 58.9% hypertensive subjects (38.3%: p = 0.005); 30.4% diabetics (11.7%: p = 0.0013) and 12.6% smokers (66.1%: p < 0.001); 20.8% of the elderly had a history of MI (10%: p = 0.002), 15.8% of arteriopathy of the lower limbs (8.3%: p = 0.001) and 6.9% of cerebrovascular accident (1.7%: p = 0.02). Elderly patients were admitted after an average of 26.6 hours (10.4 hours: p < 0.001). Only 56.4% (79.2%) reported typical MI pain, 22.8% (7.5%) had a painless form, 31.8% (4.2%) an initial left ventricular failure, 21.8% (7.5%) a global cardiac dysfunction and 20.8% (4.2%) a cardiogenic shock (p < 0.001 for all comparisons). 63.4% had an anterior MI (40.8%: p < 0.001), 40.6% a Q-form (29.6%: p = NS) and 22.2% an atrial fibrillation (0.8%: p < 0.001). Serum myoglobin and total CK concentrations were significantly lower in elderly subjects. 20.8% of them received beta-blockers (86.7%), 43.6% aspirin (80%), 14.6% oral anticoagulant (56.7%), but 63.4% were given diuretics (25.2%) and 31.7% digitalis alkaloids and positive inotropic drugs (6.7%) (p < 0.001 for all these comparisons). Heparin, nitrates, calcium channel blockers, ACE inhibitors and antiarrhythmics were prescribed as often regardless of age. Only 10 elderly patients (9.9%) were treated with thrombolytics (77: 65%: p < 0.001); 6 (5.9%) underwent coronary angiography (43: 35.8%: p < 0.001), 2 (2%) angioplasty (11: 9.2%) and one (1%) coronary bypass surgery (12: 10%). 35 elderly patients (34.7%) died while in hospital (5: 4.2%), 22 suddenly, 10 in cardiogenic shock and 3 due to arrhythmias. 38 cases (37.8%) of heart failure (21: 17.5%), 21 (20.8%) recurrences of coronary insufficiency (8: 6.7%) and 11 (10.9%) mechanical complications of MI (4: 3.3%) were also observed (p < 0.001 for all these comparisons). Due to lack of sufficient data, we could not define the status of the surviving patients discharged from hospital. The wider use of thrombolytics, angiography and angioplasty (coronary bypass surgery still having a heavy mortality and morbidity) is probably the best way to improve the prognosis of MI in the elderly.

Aged↗
PubMed1996

[Measuring the burden for carers of dependent elderly with the Zarit inventory].

The aim of this study was to measure the subjective burden felt by persons who care for dependent elderly people living in their home. A questionnaire was administered to 291 persons. The burden is measured by the Zarit "Burden Inventory" in the French version; it is a 22 question scale exploring the consequences of caring activities in the physical, psychological and social area. The burden score is related to the physical dependency and mostly to the behavioural troubles of the elderly. It is not different according to the carer's family relationship but it is related to his family situation, his self-rated health and the desire to institutionalize the elderly person. This synthetic tool seems to measure the quality of life of carers, but longitudinal studies are necessary to measure its predictive value concerning behaviours in this population.

Activities of Daily Living↗
PubMed1996

[Ilio-femoral vein thrombosis treated with tissue plasminogen activator in a pregnant woman].

A 27-year-old woman, after 31 weeks of amenorrhoea during her second pregnancy, developed a left external iliac and femoral deep vein thrombosis, confirmed by venous ultrasonography and magnetic resonance imaging. The infusion of tissue plasminogen activator (rt-PA: 1.2 mg/kg, i.e. 80 mg over 3 hours), on the 2nd day, allowed revascularization of the femoral junction, while the external iliac vein remained occluded. The patient did not develop pulmonary embolism or haemorrhage, particularly obstetric haemorrhage. The subsequent pregnancy was uneventful until delivery, six weeks later, of a normal child. Three years later, the patient has no sequelae of her deep vein thrombosis. When required by the patient's condition, it seems that rt-PA can be used to treat severe deep vein thrombosis during pregnancy, either isolated or complicated by pulmonary embolism. Very rigorous cardiological, obstetric and laboratory surveillance is essential. A sufficient dosage, identical to that used in clinical settings other than pregnancy and a brief treatment duration (2 to 3 hours) are probably more effective and more reliable than lower doses continued for several days. However, the risk of haemorrhage remains difficult to predict and its prognosis, especially foetal, is often very poor. A larger series of cases is therefore necessary before this drug can unreservedly recommended in pregnant women.

Adult↗
PubMed1994

[Aneurysm of the gastroduodenal artery ruptured into the peritoneum. Treatment by embolization].

Aneurysms rarely occur in the gastroduodenal artery. We encountered such an aneurysm which bled into the peritoneum leading to a difficult diagnostic situation. A 58-year-old man was hospitalized for acute abdominal pain. Past history included alcohol intake (wine, 3/4 litre per day) and moderate increase in serum gamma-glutamyl transferase levels (100 IU/L). At admission there was abdominal contracture, vomiting and shock (blood pressure 70 mmHg). Based on the clinical picture and laboratory tests the diagnosis of acute pancreatitis was entertained, but after the haemodynamic situation was reestablished by intravenous fluids, echography and computed tomography of the abdomen failed to give confirmation. An effusion however was seen in the peritoneum together with a large mass in the head of the pancreas compatible with a haematoma. Arteriography rapidly demonstrated an aneurysm of the gastroduodenal artery. Embolization was preferred over surgery due to the precarious haemodynamic situation. Outcome was quite favourable and no complications have been observed with a follow-up of 6 months. Reports of true aneurysms of the gastroduodenal artery are rare but clinical manifestations are usually latent or absent. Reported complications include massive digestive haemorrhage and rarely jaundice, haemobilia or wirsungorrhagia due to compression. Excepting recognized trauma, few aetiological factors have been determined. Fragile arterial walls due to atheroma, isolated dysplasia or connective tissue disease appear to be damaged by successive systolic distension leading to rupture of certain elements of the arterial wall and finally aneurysm. Embolization carries less risk than surgical repair but must be indicated only after precise characterization including localization, size and local involvement.

Aneurysm, Ruptured↗
PubMed1994

[Value of the early determination of plasma myoglobin level in the diagnosis of acute myocardial infarction].

Serum myoglobin (Mb) was assayed by immuno-nephelemetry or immuno-turbidimetry together with creatinine kinase activity (CK) by spectrophotometry in 290 consecutive patients admitted to hospital between January 1st and September 30th 1992 in three cardiology departments for chest pain suggesting myocardial infarction (MI). The measurements were made at admission (T0) and 90 minutes later (T90). On admission, patients were classified as certain MI (N = 62), possible MI (N = 107) or definitely not MI (N = 121) and, on discharge, as certain MI (N = 144) or definitely not MI (N = 146). At T0, for a threshold value of 90 mcg/l, Mb assay had a sensitivity of 49.3% and a specificity of 95.2%, a positive predictive value of 91.8% and a negative predictive value of 65.6%. Increasing the threshold of positivity to 130 mcg/l was accompanied by a significant loss of sensitivity (38.2%) without any change in the other parameters. At T90, for a threshold value of 90 mcg/l, Mb assay had a sensitivity of 81.7%, a specificity of 92%, a positive predictive value of 89.5% and a negative predictive value of 85.8%. The increase in sensitivity between T0 and T90 made Mb assay very useful for correctly classifying the initial false negative results (20/28: 71.4%) and for diagnosing the possible MI (27/32: 84.4%). Decreasing the threshold of positivity to 80 or even to 70 mcg/l did not improve the diagnostic value of this test. The sensitivity of Mb assay was significantly higher than that of CK at T0 (49.3% vs 26.4%: p < 0.0001) and at T90 (81.7% vs 48.9%: p < 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)

Creatine Kinase↗
PubMed1994

[Infectious endocarditis induced by Actinobacillus actinomycetemcomitans. 8 new cases].

A commensal organism of the buccal cavity, Actinobacillus actinomycetemcomitans (AAC) has been responsible for at least four new cases of infectious endocarditis by year in France. This retrospective study was based on 90 new cases of infectious endocarditis by AAC, including 8 personal observations. One third of patients had no known cardiac disease before their infectious endocarditis, the portal of entry of which was usually dental. In cases of suspected infectious endocarditis, rapid and severe weight loss (43% of cases) and, less commonly, anicteric cholestasis (8%) should alert the physician for the possible pathological role of AAC. The echocardiographic appearances are non-specific. The diagnosis is confirmed on blood cultures but the organism grows slowly in CO2 enriched atmosphere. Initially, the course of the disease was favourable in one third of patients but, in two thirds of cases, complications were observed almost renal (26%), cardiac (24%) and neurological (18%). Two thirds of patients were cured by the time they were discharged whereas the remainder had sequellae, mainly valvular and neurological. The hospital mortality was 9%; late mortality was 6%. Therefore, the prognosis of AAC endocarditis, seems to be better than that of other bacteriological forms. A combination of cephalosporin and aminoside, or even a simple third generation cephalosporin antibiotic therapy for at least 4 weeks are usually effective. The complementary surgical indications are the same as for other forms of infectious endocarditis. Prophylaxis depends on strict prophylactic amoxicillin therapy for all cardiac patients at risk of infectious endocarditis before dental treatment and on good bucco-dental hygiene.

Actinobacillus Infections↗
PubMed1993

Aging couples and disability management.

The purpose of this work is to identify, in an elderly population, couple patterns and to relate this typology to the management of disabilities. Resulting from questions arising from research in gerontology, it utilizes the theoretical contribution of the sociology of the family so as to understand the relationships between the functioning of the couple and the management of disability. Four types of couples have been identified according to the presence or absence of a tacit contract between husband and wife and according to the character of their relationships. In each type, we have studied the conduct of daily life and its negotiation as well as the management of disabilities. The analysis shows that this management is very different according to the type of couple and thus confirms the importance of taking the functioning of the couple into account so as to fully understand the situation of disabled married elderly persons.

Adaptation, Psychological↗