Biomedical subjects

A J Scheen

Publications and source records attributed to A J Scheen.

At least 199 records · Page 11Linked to original sources

PubMed1999

[Clinical study of the month. The CAPPP study: "The Captopril Prevention Project"].

The Captopril Prevention Project (CAPPP) was a prospective, randomized, open trial which aimed at comparing the prevention by captopril (n = 5492) or by a conventional treatment (n = 5493; diuretics or beta-blockers) of cardiovascular morbidity and mortality in patients with hypertension (diastolic blood pressure > 100 mmHg). After a mean follow-up of 6.1 years, the results regarding the primary endpoint and most secondary endpoints were not significantly different between the two therapeutic modalities. The only differences (perhaps due to a randomisation bias) were a slightly higher incidence of stroke, but a lower risk of diabetes mellitus, in the captopril group than in the group receiving conventional treatment. In conclusion, the CAPPP study demonstrates, for the first time, that captopril, an angiotensin-converting-enzyme inhibitor, is as effective as conventional treatment with diuretics or beta-blockers, two drugs whose efficacy has already been demonstrated when compared to placebo, in the prevention of cardiovascular morbidity and mortality in hypertensive patients.

Adrenergic beta-Antagonists↗

PubMed1999

[Anorexia nervosa, a serious disease of young women].

Anorexia nervosa is characterized by a triad comprising anorexia, weight loss, and amenorrhoea. It is typically present in adolescent or young adult women and its prevalence appears to increase in our society. Eating disorders may lead to cachexia and various severe complications. This disease, which appears to be associated to a particular psychological background, is triggered by conflictual relationships, usually within the family. The anorectic patient should be carefully evaluated, as soon as possible, from a somatic, dietetic and psychological point of view. A specific therapeutic approach should be rapidly proposed in a specialized centre, if possible by a multidisciplinary team. The treatment is most often difficult and of long duration. Prognosis remains uncertain in most cases, especially when appropriate care is delayed.

Adolescent↗

PubMed1999

[Obesity and women: esthetic preoccupation or medical problem?].

Women more and more frequently refer to medical doctors for treating weight excess. Even if the primum movens is usually a pure esthetic concern, medical aspects should not be neglected. Indeed, if obesity with gynoid adipose tissue distribution is less deleterious than android obesity from a metabolic point of view, severe obesity is frequently associated with cardiovascular risk factors which may hinder the prognosis of these female patients. Other complications are common in obese women, such as oestrogen-related cancers, osteoarticular problems and psychological disturbances. Various therapeutic approaches are available which permit an encouraging weight loss and a rapid improvement of risk factors. Unfortunately, long-term results are often disappointing, essentially because of the difficulty to follow on the long term a strict diet regimen and practice physical exercise and because of the usual unrealistic expectations of the obese women who consult medical doctors.

Adult↗

PubMed1999

[Drugs in pregnancy].

Since the dramatic observations of fetal abnormalities associated to thalidomide use during pregnancy, the risk of malformations when prescribing drugs in pregnant women is a well-known problem, among the public as well as among medical doctors. However, the complexity of the problem, the lack of robust scientific data and the emotional context characterizing this period make the prescription of medications to a pregnant woman a difficult task for every people involved in health care, the pharmacist, the general practitioner and even the gynaecologist.

Abnormalities, Drug-Induced↗

PubMed1999

[Gestational diabetes: definition, screening and management].

Defined as glucose intolerance with onset or first recognition during pregnancy, gestational diabetes mellitus represents in fact an heterogeneous clinical entity which may concern 1 to 4% of all pregnant women in our country. Its adverse effects on the mother and her child, the need for a universal screening and the mode of screening are still controversial. Screening may be made either by a first test with a 50 g oral glucose load (the so-called O'Sullivan test), confirmed if positive by a 100 g oral glucose tolerance test (OGTT), or at first glance by a 75 g OGTT performed between the 24th and 28th weeks of gestation. The treatment of gestational diabetes is based on diet. In case of diet failure to obtain good glucose control, insulin therapy should be proposed.

Diabetes, Gestational↗

PubMed1999

[Gestational diabetes: physiopathology and prognostic significance for the mother].

Pregnancy is associated with important changes in mother metabolism, especially in late gestation, among which a decreased glucose tolerance caused by insulin resistance. In some of these women, glucose intolerance is increased by a defect in B-cell function and diabetes mellitus occurs. These women who develop a gestational diabetes need a close follow-up because they are at high risk for further development of diabetes, especially type 2 diabetes.

Diabetes Mellitus, Type 2↗

PubMed1999

Minimal influence of the time interval between injection of regular insulin and food intake on blood glucose control of type 1 diabetic patients on a basal-bolus insulin scheme.

The present study aimed at investigating the influence of the time interval between injection of regular insulin and meal ingestion on postprandial glucose changes and overall blood glucose control in patients with type 1 diabetes on intensive insulin therapy. Fifteen C-peptide negative subjects were submitted, in a randomized order, to two 6-week treatment periods in which regular insulin was injected either 5 minutes or 30 minutes before each of the three main meals, in combination with a bedtime NPH insulin injection. The changes in plasma glucose excursions following a breakfast test (Cmax, Tmax, Cmin, Tmin, AUC0-240 min) were similar in the two experimental protocols. Furthermore, no significant changes were observed in daily insulin dosages nor in glucose profiles obtained using home blood glucose monitoring. Only a tendency to a greater 90-minutes postprandial increase in blood glucose levels was observed when regular insulin was injected 5 minutes rather than 30 minutes before meal. Glycated haemoglobin levels were similar after each treatment period (7.6 +/- 0.2% versus 7.5 +/- 0.2%; NS) and no differences in the incidence or severity of hypoglycaemic episodes were noticed between the two insulin schemes. In conclusion, in type 1 diabetic patients who are rather well controlled with a basal-bolus insulin scheme, the injection of regular insulin 30 minutes before each main meal provides no significant advantage as compared to the injection of regular insulin 5 minutes before meal.

Adult↗

PubMed1999

[Gestational diabetes: prognostic significance for the infant].

Gestational diabetes, even if it seems to induce far less foetal complications than classical type 1 or type 2 diabetes mellitus, may be deleterious for the child. We will successively consider the complications that could affect the child during gestation, during the neonatal period and during adult life. These consequences for the offspring require optimal screening and management of gestational diabetes mellitus.

Abortion, Spontaneous↗

PubMed1999

[Glucotoxicity and lipotoxicity, two implicated accomplices in the vicious circle of type 2 diabetes].

Type 2 diabetes mellitus is a dynamic disease whose natural history is characterized by a progressive aggravation leading to a progressively severe hyperglycaemia, which generally requires a more complex therapy as time progresses. Such an evolution results from a vicious circle where both glucotoxicity and lipotoxicity contribute to reduce insulin secretion and the action of insulin on cell glucose metabolism. These new concepts are able to modify the strategies of prevention and treatment of type 2 diabetes.

Diabetes Mellitus, Type 2↗

PubMed1999

[How I evaluate ... a overweight or obese patient].

The evaluation of an obese subject aims at better understanding the disease, its causes and consequences, in order to optimize its management. Schematically, this task can be done in three successive steps. First, it is necessary to analyse data from the past, by asking about family and personal history. Then, the present data should be carefully analysed, especially the severity of overweight, its type of distribution and the importance of associated complications. Finally, it is mandatory to project these data into the future, in order to assess the final prognosis of the obese patient allowing a better definition of the goals and the therapeutical strategies.

Humans↗

PubMed1999

[Clinical study of the month. Prevention of cerebral vascular accidents in patients with atrial fibrillation].

A recent analysis of the literature, published in the 19 May issue of the JAMA, once again demonstrates the efficacy of warfarin, and its superiority on aspirin, in preventing stroke in patients with atrial fibrillation, at least in subjects at highest risk. However, a feasibility study, published in the 15 May issue of the British Medical Journal, points to the difficulties of implementing guidelines from evidence-based medicine in general practice, essentially because of the reluctance of the physician and/or the patient when the constraints, risks and even advantages of antithrombotic treatment are taken into account.

Anticoagulants↗

PubMed1999

[Treatment of combined hyperlipidemia: fibrate and/or statin?].

Combined hyperlipidaemia, associating hypercholesterolaemia and hypertriglyceridaemia, is a common metabolic disorder with a prevalence of about 1/500. It has a genetic background, but its phenotype is triggered by various predisposing factors such as obesity, type 2 diabetes and alcohol consumption. Combined hyperlipidaemia is undoubtedly associated with an increased cardiovascular risk and thus deserves specific management. After diet failure, the first drug choice remains controversial. Indeed, fibrates are more active on hypertriglyceridaemia while statins are more active on hypercholesterolaemia (LDL subfraction). Both pharmacological classes have their advantages and disadvantages, and there is no prospective study comparing the cardiovascular protective efficacy of these two treatments in patients with such dyslipidemia. Furthermore, monotherapy is generally incapable of normalizing the lipid profile in the presence of severe combined hyperlipidaemia. Ideally, a statin-fibrate combination would be most appropriate in order to act on the two components of such hyperlipidaemia and to benefit of the complementary and additive action of the two pharmacological classes. Such association is still contra-indicated because of the description of some cases of rhabdomyolysis is high risk patients; however, it now deserves much interest and is currently being tested in large prospective studies, especially in the population with type 2 diabetes.

Anticholesteremic Agents↗

PubMed1999

[How to assess insulin action in man in research and clinical practice].

Various methods have been proposed to assess insulin action in vivo, from the most complex to the simplest. All methods are based on the comparison of plasma concentrations of glucose and insulin, but can be differentiated by some important characteristics: evaluation in the basal state, after administration of exogenous insulin or after stimulation of insulin secretion; measurement in conditions of normo, hyper- or hypoglycaemia; and assessment using or not a modeling approach. For research purpose, the most informative techniques, such as the "euglycaemic hyperinsulinaemic clamp" or the intravenous glucose tolerance test combined with the minimal model approach, should be preferred. Easier tests may be used as alternative approaches, such as the fixed insulin-glucose infusion or the continuous infusion of glucose with model assessment (CIGMA). In daily practice, the clinician can often use simpler indices, such as fasting insulin concentrations, eventually analysed in comparison with corresponding glucose levels using the HOMA method. The only easy to perform dynamic maneuver is the short insulin tolerance test, but it is subject to several criticisms. As every approach for measuring insulin action has its own advantages and disadvantages, the selection essentially depends on studied populations (diabetic or not), primary objectives and, most importantly, available means.

Clinical Trials as Topic↗

PubMed1999

[Type II diabetes: diagnostic approaches, glycemia objectives and therapeutic strategies].

Type 2 diabetes is a prevalent disease, with high morbidity and mortality rates, which is usually managed by general practitioners. We will discuss the new diagnostic approaches, the glycaemic goals and the therapeutic strategies which may contribute to improve both adequate management and prognosis of diabetic patients with type 2 diabetes. As far as possible, the management should be both individualized and integrated, not only focused on blood glucose control but also on the correction of other vascular risk factors frequently associated with diabetes (mainly arterial hypertension and dyslipidaemias). Obviously, the reduction of the incidence and severity of microangiopathy and macroangiopathy diabetic complications would require a tight collaboration between general practitioners and specialized physicians.

Blood Glucose↗

PubMed1999

[Study of the month. Long-term (1-2 years) clinical trials with orlistat, a new drug for the treatment of obesity].

Orlistat (Xenical), whose original mechanism of action consists of the selective inhibition of gastrointestinal lipases, has been recently commercialized for the treatment of obesity. Despite its recent launch and when compared to common anorectic agents, it has been much better evaluated in long-term trials carried out according to the rules of Good Clinical Practice. We will summarize the four recently published randomized, placebo-controlled, double-blind clinical trials lasting up to 1 to 2 years and evaluating the effects of orlistat 3 x 120 mg/day in obese patients (BMI > or = 28 kg/m2).

Clinical Trials as Topic↗

PubMed1999

[New approaches in drug therapy 1999].

The most important drugs registered and/or launched in Belgium during the last year in the various disciplines of internal medicine will be briefly described. The originality of each molecule as well as its modalities of appropriate use in clinical practice will be stressed.

Belgium↗

PubMed1999

[Thyroid disorders and dyslipidemias].

While overt thyroid disturbances, characterized by symptoms and/or clinical signs with abnormal serum levels of thyroid hormones, are generally associated with perturbations in the lipid profile, the situation is less clear as far as subclinical thyroid disturbances, defined by isolated abnormalities of thyroid stimulating hormone (TSH) levels, are concerned. In severe hyperthyroidism, a decrease of total cholesterol, LDL cholesterol and apoprotein B concentrations is generally observed. These biological parameters are normalized when appropriate antithyroid treatment is given. In profound hypothyroidism, on the contrary, elevated levels of total and LDL cholesterol levels are observed, which decrease after hormonal replacement. In both cases, the changes in serum levels of HDL cholesterol, triglycerides and lipoprotein (a) are less systematic, both before and after treatment. Lipid abnormalities associated with subclinical thyroid disturbances remain controversial. However, two recent meta-analyses have shown higher LDL cholesterol levels in presence of subclinical hypothyroidism and a significant reduction of such lipid abnormality after administration of thyroxine. Furthermore, they demonstrated a higher prevalence of subclinical hypothyroidism in a population with hypercholesterolaemia when compared to a population with normal cholesterol levels. Finally, a significant reduction in both total and LDL cholesterol concentrations has been reported after administration of thyroxine in a small group of hypercholesterolaemic patients with basal TSH levels in the upper range of normal values. In view of the results of the literature, strategies are proposed to help the clinician in the management of patients with overt or subclinical thyroid disturbances, associated with dyslipidaemia.

Cholesterol, LDL↗

PubMed1999

[Clinical study of the month. Usefulness of increasing HDL cholesterol in secondary prevention of coronary heart disease: results of the VA-HIT study].

The "Veterans Affairs Cooperative Studies Program High-Density Lipoprotein Cholesterol Intervention Trial" (VA-HIT) is a large randomised, double-blind, placebo-controlled clinical trial for the secondary prevention of coronary heart disease. It demonstrates that a fibrate treatment (gemfibrozil) significantly reduces the relative risk of major coronary (-22%, p = 0.006) and cardiovascular (-24%, p < 0.001) events in men with coronary heart disease whose primary lipid abnormality is a low HDL cholesterol level. These findings suggest that, in such a population, the rate of coronary events is reduced under gemfibrozil therapy by raising HDL cholesterol levels (+6%) and lowering levels of triglycerides (-31%) without lowering LDL cholesterol concentrations.

Adult↗