Biomedical subjects

A Prost

Publications and source records attributed to A Prost.

166 records · Page 10Linked to original sources

PubMedDate not supplied

[The role of epidemiology in the process of decision-making].

Epidemiology is the method of choice for quantifying and interpreting health phenomena, placing them into perspective to allow trend analysis and projections. It is a tool for analysis, evaluation and forecasting and is thus indispensable in the decision-making process. However, this comprehensive technique has its limitations since health is the result of complex interactions: individual requirements do not always correspond to the overall needs of the community; consideration has to be given to solidarity and the necessity for cost-sharing; and the decision process is strongly influenced by social, cultural, religious and political factors which defy quantification and, on occasion, any rational course of action. Each indicator only takes into account one aspect of the situation and the pertinent indicator should therefore be carefully selected. At the same time, any choice implicitly signifies value judgements-often unnoticed-which need to be balanced and validated in relation to the ethical values of the community in order to be of any assistance to decision-making. Decision-making is a qualitative political process which, although based on the quantitative analysis supplied by epidemiology, cannot be limited to it. Each approach enhance the other, but they should not be confused if freedom to act is to be preserved from being locked into some kind of mechanical process that is unacceptable both to man and to society.

Cost Sharing↗

PubMedDate not supplied

[Treatment with low dose methotrexate in rheumatoid arthritis: risk factors for severe complications].

Treatment with low dose methotrexate in rheumatoid arthritis is associated with serious side effects in about 5 per cent of cases (respiratory, haematological or infectious). The goal of a null risk seems unrealistic because of the idiosyncrasy of some of the risks and our poor understanding of others (enzymatic polymorphisms might be operational, and infectious agents could act as co-factors). However, risk can be greatly reduced by a careful selection of patients. Some contraindications are strict: poor compliance and the possibility of mistake in the timing of the administration; pregnancy or desire for pregnancy; treatment with trimetoprim; haemodialysis; renal insufficiency (clearance < or = 50 ml/min) (and therefore old age), alcoholism. Others remain relative although well established; hypoalbuminaemia, diabetes mellitus, obesity, past infection with hepatitis virus. Others are dubious: starvation, macrocytosis, surgical stress, NSAIDs. An extensive large study of side effects is warranted.

Antirheumatic Agents↗

PubMedDate not supplied

Algodystrophy (reflex sympathetic dystrophy syndrome) and causalgia: novel concepts regarding the nosology, pathophysiology, and pathogenesis of complex regional pain syndromes. Is the sympathetic hyperactivity hypothesis wrong?

Concepts regarding the nosology, pathophysiology and pathogenesis of reflex sympathetic dystrophy syndrome are currently in a state of flux. Causalgia and reflex sympathetic dystrophy syndrome are now generally felt to be on the same continuum and as a result interest for defining criteria for the latter condition has waned. The pathogenic role of adrenergic sympathetic activity has been so successfully challenged that the last international consensus conference judged inappropriate any reference to the sympathetic system in the terms used to designate these conditions, thus confirming the position long defended by most French authors. The vasomotor abnormalities may be due to antidromic release of neuromediators by the endings of polymodal C fibers. These fibers do not belong to the sympathetic system but often travel with sympathetic nerves, a characteristic that may explain the efficacy of sympathetic nerve blocks, although other possibilities exist including a placebo effect. Also, efferent sympathetic fibers may undergo activation by nonadrenergic mediators. The mechanisms capable of initiating and perseverating activation of polymodal C afferents are being actively investigated and have been found to exhibit similarities with the mechanisms underlying peripheral and central sensitization of pain-producing afferents. Growth factors, such as nerve growth factor, may play an important role in causalgia. In "reflex sympathetic dystrophy syndrome", microcirculatory stasis may contribute to the initiation or perpetuatation of the disorders. Further work on the nerve supply to the venular network and on the venoarterial reflex is needed.

Causalgia↗

PubMedDate not supplied

[Extensive bone marrow necrosis and thrombotic microangiopathic anemia revealing disseminated adenocarcinoma].

BACKGROUND: Bone marrow necrosis and thrombotic microangiopathy are uncommonly associated. We report an observation. CASE REPORT: A 52-year-old man with extensive bone marrow necrosis, associated with hemolytic microangiopathic anemia, was treated unsuccessfully with corticosteroids and plasmapheresis. Outcome was fatal. Autopsy showed disseminated bone marrow necrosis and medullary invasion by adenocarcinoma cells in this patient operated 13 years earlier for gastric cancer. DISCUSSION: Extensive bone marrow necrosis or thrombotic microangiopathy can complicate usually advanced cancer. Prognosis is poor without response to chemotherapy. Corticosteroids and plasma exchange are sometimes successful. A relative efficacy of treatment with staphylococcal protein A immunopheresis is reported by several authors in thrombotic microangiopathy.

Adenocarcinoma↗