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A Taytard

Publications and source records attributed to A Taytard.

At least 37 records · Page 2Linked to original sources
PubMed2001

[Epidemiology and management of suspected pneumonia in nursing home residents].

OBJECTIVE: We conducted a descriptive epidemiology study to examine the conditions of management of infectious lung disease in institutionalized elderly populations (population profile, diagnostic and therapeutic modalities) and to analyze the general and mental consequences in terms of independence (impact of the infectious event on the subject's life style). PATIENTS AND METHODS: A pragmatic survey was conducted by a multicentric observatory composed of 573 general practitioners, practicing in nursing homes. The series included 1790 patients aged over 70 years and residing in nursing homes who developed infectious lung disease over a 10-month period. The MMSE score was used to assess mental status and the Barthel index to assess functional handicap. Each patient was evaluated at the time of the final diagnosis (prescription of an antibiotic or decision for hospitalization) and at most 3 days after the end of this treatment or at discharge from hospital. RESULTS: The elderly population (84 +/- 7 years) was predominantly composed of women. The patients were treated for an acute respiratory infection considered in 30% of the cases to be acute lobar pneumonia. Subgroups of patients were identified for analysis: death (3.7%), x-ray confirmation of the diagnosis (11.5%), hospitalized patients (10.2%). In addition to major deterioration of the general health status, a consequence of the infection more than of the severity of the respiratory symptoms, the development of an acute episode coincided with reduced intellectual functions and onset of a state of confusion. In 70% of the cases, this resulted in a loss of independence of variable importance--simple difficulty for moving around to major functional handicap. The infectious episode was cured or improved (persistence of minor signs not requiring specific treatment) in 94.3% of the cases with appropriate antibiotics: single-drug regimen in 93.7% give per os (75%) or intravenously (25%) using aminopenicillin (with or without a beta lactamase inhibitor) in 80% of the cases. Antibiotic treatment was associated with physical therapy in more than half the cases, and with general conticosteroids in 40%. The treatment scheme was modified in 9.4% of the cases (change of antibiotic in 6%). CONCLUSION: This survey confirms the high risk related to general conditions in elderly institutionalized patients who develop respiratory infection. More than the infection itself, the rapid degradation of the general health status, or decompensation of comorbid states can create life-threatening situations or favor the development of irreversible handicaps.

Aged↗
PubMed2001

[From diagnosis of asthma to chronic disease].

Asthma patients, in their daily life, may experience 3 different situations needing 3 types of management: attack (which is an emergency issue); post-attack period (very often under-diagnosed and under-treated, what is one of the major relapse factors); stable state (which should be the "natural" state of any chronic patient). Despite the availability of very active treatments, asthma still represents an handicap for many patients, and mortality rates go unchanged. All this has lead to issue asthma severity scales and consensus therapeutic management guidelines. Promoting and implementing these guidelines is the only way for improving asthma management.

Asthma↗
PubMed2001

Spontaneous pneumothorax: pragmatic management and long-term outcome.

We prospectively considered 65 patients admitted for a spontaneous pneumothorax (SP) to describe the pragmatic management of SP, the first recurrence-free interval after medical therapeutic procedure and to specify the first recurrence risk factors over a 7-year period in these patients treated medically. The treatment options were observation alone (9%), needle aspiration (6%), small calibre chest tube (Pleurocatheter) drainage (28%) or thoracic tube drainage (49%), and pleurodesis with video-assisted thoracic surgery procedure (8%). Duration of the drainage and length of hospital stay were shorter in the Pleurocatheter group than in the thoracic tube group (P < 0.01). Among the 47 patients (72%) with a first SP and treated medically, nine patients (19%) had a first homolateral recurrence (FHR) during a mean follow-up of 84+/-13 months. Recurrence-free intervals ranged from 1 to 24 months (mean +/- SD: 9.3+/-8.4 months). FHR cases were more frequent in the Pleurocatheter group (P < 0 04). Analysis of potential risk factors showed that the patient's height and a previous homolateral SP episode are independent recurrence risk factors.

Adolescent↗
PubMed2001

[Management of lower respiratory tract infections by general practitioners in France].

OBJECTIVE: The purpose of this study was to describe the diagnostic and therapeutic strategies used by general practitioners (GPs) in patients with lower respiratory tract infections (LRTI). METHODS: Four hundred fifty GPs practicing in France participated in the study; they included 804 patients. The GP recorded social and demographic data and their prescription on a data sheet and responded to a phone questionnaire about their strategy. RESULTS: Most of the LRTI were acute bronchitis (72%); pneumonia and acute exacerbations of chronic bronchitis were observed respectively in 11% of the patients recruited. Diagnostic criteria used by the GPs were generally auscultation signs in patients with fever, cough and expectoration. Specialized advice (always a chest physician) and hospitalization were exceptional. Prescription of complementary exams was strongly related to the diagnosis of pneumonia (OR = 33.3; CI0.95: 15.48-70.4). Sick leaves were related to general symptoms (fever, asthenia). Antibiotics were prescribed in 95.7% of the patients, mainly aminopenicillin (40.4%) and macrolides (33.2%). Nonsteroidal or steroidal antiinflammatory drugs were prescribed in 72.5% of the patients irrespective of the LRTI diagnosis. DISCUSSION: The fact that GPs do not often refer patients to specialists or order hospitalization confirms their important role in setting up recommendations. It would also be necessary to develop an education program on better use of antibiotics targeted to GPs and patients.

Adolescent↗
PubMed2001

[Mediastinal sarcoidosis and vascular thrombosis: a fortuitous association?].

A 43-year-old woman presented with a recent history of intermittent dyspnea with wheezing. The chest x-ray evidenced mediastinal nodes. A CT scan showed vascular embolism. Mediastinoscopy was performed and pathology examination of the node confirmed the diagnosis of sarcoidosis. The patient responded to corticosteroid and anticoagulation therapy. Is this a fortuitous association? A vascular localization of sarcoidosis? Thrombosis by compression?

Adrenal Cortex Hormones↗
PubMed2000

Practical evaluation of asthma exacerbation self-management in children and adolescents.

The objective of this study was to describe asthma exacerbation self-management in children and adolescents. We used a cross-sectional study population enrolled in the International Study of Asthma and Allergies in Childhood (ISAAC) in Bordeaux. Subjects answered an additional questionnaire on utilization of health services, self-evaluation of usual asthma exacerbation severity and home management of asthma exacerbation. Criteria used for selecting patients were both having asthma confirmed by a physician and having had suffered from symptoms during the past year. Children and adolescents attended similar health services for managing their asthma but compliance to anti-asthmatic treatment was better in children than in adolescents. Among the children 4.8% had asthma and 6.2% of adolescents had asthma, as diagnosed by a doctor. Of the children, 72.3% and of the adolescents 54.7% had less than one asthma attack per month. In cases of mild asthma exacerbation, 38.7% of adolescents and 9.3% of children waited until the end of exacerbation without taking any medication. The proportion of children not receiving any treatment was lower when symptoms were more severe but this was not the case in adolescents. Although most of the patients used were taking beta2-agonist, we found that 21-43% of children or adolescents did not receive appropriate medication in the event of asthma exacerbation. These results demonstrate that (i) asthma exacerbation self-management is related to self-assessed severity of symptoms and that (ii) a large proportion of asthmatic children in the community, and particularly adolescents, do not therefore receive appropriate treatment in the event of asthma exacerbation.

Acute Disease↗
PubMed2000

[Efficacy of docetaxel in non-small cell lung cancer patients previously treated with platinum-containing chemotherapy. French Group of Pneumo-Cancerology].

PURPOSE: Determine the response to, and toxicity of docetaxel (Taxotere) in patients (pts) with inoperable non-small-cell lung cancer (NSCLC) previously treated with platinum-containing chemotherapy. PATIENTS AND METHODS: Twenty-seven patients with stage IIIB or IV NSCLC, having received one platinum-containing regimen were treated with 100 mg/m2/3 weeks of docetaxel until tumor progression or severe toxicity. Premedication with prednisolone and diosmin was given in all patients. Antitumoral activity was assessable in 21/27 pts. Median age: 52 years; WHO performance status 0-1: 77% pts, stage IV disease: 63% pts. RESULTS: 6/21 eligible pts (24%) achieved a partial response to treatment [C.I 95%: 5.6-42]. Median time to progression: 2.9 months, median survival: 8.5 months with a median follow-up of 23.7 months (range: 13.5-27). Hematologic toxicity: grade 3-4 neutropenia: 75% pts, febrile neutropenia: 11% cycles. Non hematologic toxicities: fluid retention, rash, alopecia, sensory neuropathy, asthenia, and nail changes. CONCLUSION: Docetaxel (Taxotere) administered at 100 mg/m2/3 weeks has relevant clinical activity against platinum treated NSCLC pts. Neutropenia is the main toxicity.

Adenocarcinoma↗
PubMed2000

[Phase II study of docetaxel in inoperable advanced non small cell lung cancer].

The purpose is to determine the response to, and toxicity of docetaxel (Taxotère) in patients with inoperable non small cell lung cancer (NSCLC), previously untreated. Seventy patients with stage IIIB or IV NSCLC were treated by 100 mg/m2/ 3 weeks of docetaxel until tumor progression or severe toxicity. Premedication with diosmine and prednisolone was given in all patients: 66/70 were eligible and 55/70 were assessable for antitumoral activity. Median age: 63 years, WHO performans status 0-1: 83%, stage IV: 96%. For eligible patients, 17/66 (26%) achieved an objective response: 1 complete response and 16 partial response (IC 95% = 15-36). With a median follow-up of 23.4 months (range 14.9-28.7), for evaluable patients, the median response duration was 8 months, the median time to progression 4 months, and the median survival time 10 months. The median number of administered cycles is 5 (range 1-12). The estimate one year survival rate was 47%. Seventy-six patients presented neutropenia (grade 3-4); febrile neutropenia was observed in 7% of cycles. Non haematological toxicities are: fluid retention related to docetaxel (2.9%), diarrhea (6%), nausea-vomiting (4%), asthenia (3%), nail changes (6%). Docetaxel (Taxotère) administered at 100 mg/m2/3 weeks has relevant clinical activity in previously untreated NSCLC with a acceptable toxicity.

Adult↗
PubMed2000

[Epidemiology of respiratory allergies: current data].

Respiratory allergic diseases include seasonal allergic rhinitis or hay fever, perennial allergic rhinitis and allergic asthma. Prevalence of asthma is difficult to assess through epidemiological questionnaires. In France hay fever roughly affects 6% of children and 18% of teenagers and nasal allergies, more than one fourth of young adults. Prevalence of asthma is equal to 10 to 15% in teenagers and 7 to 9% in young adults. Risk factors include genetic as well as environmental factors. The role of the former have been exemplified in family studies, especially twin studies, and surveys of inbred populations. Environmental factors can be allergic or non-allergic. The influence of allergenic exposure on sensitization, occurrence and severity of respiratory allergic disease is well documented. The triggering influence of non-allergenic factors on established allergic diseases is also clear. In contrast, their implication in allergic sensitization and occurrence of allergic diseases need to be clarified.

Adult↗
PubMed1999

The effect of zafirlukast on repetitive exercise-induced bronchoconstriction: the possible role of leukotrienes in exercise-induced refractoriness.

BACKGROUND: Single doses of zafirlukast attenuate exercise-induced bronchoconstriction (EIB), but previous studies have not measured zafirlukast's effects after regular dosing or its duration of effect beyond 4 hours. OBJECTIVE: The purpose of this study was to assess the effects of zafirlukast 20 mg and 80 mg twice daily compared with placebo on exercise challenges performed at 2 and 8 hours after the last dose of regular administration. METHODS: Twenty-four adult patients with stable asthma taking beta(2)-agonists, inhaled corticosteroids, or both received treatment with zafirlukast (20 mg and 80 mg) and placebo. The patients were treated twice daily for 14 days in a randomized, double-blind, 3-way cross-over fashion, with a 7-day washout period between each treatment. Exercise challenges were performed at 2 and 8 hours after the morning dose on day 14. FEV(1) was measured before exercise and at set intervals after exercise until it returned to within 7% of its baseline value. RESULTS: Both zafirlukast treatments significantly reduced EIB, as measured by the area under the FEV(1) time curve after the 2-hour (P <.001) and 8-hour (P <.001) exercise challenges and maximum fall in FEV(1) at the 2-hour challenge (P <.001). The comparison at 8 hours between treatments was affected by the unexpected finding that EIB was less in the placebo group after the 8-hour challenge than after the 2-hour challenge, as measured by the within-group change in the maximum fall in FEV(1) (P <.001) and the area under the FEV(1) time curve (P =.0023). CONCLUSION: Regular zafirlukast treatment protects against EIB for at least 8 hours after regular dosing. A refractory period, which may be caused by exercise-induced leukotriene release, may last for up to 6 hours after the initial response to exercise.

Adolescent↗
PubMed1999

[Evolution of the management of lung diseases in general medicine in Bordeaux (1992-1995)].

Lower respiratory tract infections (LRTI) are very often managed by General Practitioners (GPs). In France, the 1991 Lille Consensus Conference set out guidelines for the management of respiratory tract infections; in 1994, the Ministry of Health published Official Medical Recommendations (OMR) to be applied to seasonal respiratory infections. The aim of the study is to evaluate the impact of these OMR in 1995 on GPs' attitude when confronted with a community-acquired pneumonia in a previously healthy 40-year-old adult, with no sign of complications. Sixty seven GPs took, part in the same study by questionnaire in 1992 and 1995; we observed an increase in the prescription of aminopenicillin without a beta-lactamase inhibitor (41% in 1992 vs 66% in 1995; p = 0.009), and a reduction in both the use of aminopenicillin with a beta-lactamase inhibitor (35% in 1992 vs 11% in 1995; p = 0.002) and the concomitant prescription of cortico-steroids (43% in 1992 vs 14% vs 14% in 1995; p = 0.0009). Between 1992 and 1995, general practitioners in the Bordeaux region have changed their therapeutic choices in community-acquired pneumonia. In 1995, antibiotic prescriptions followed consensus guidelines more closely.

Adult↗
PubMed1999

[Coping strategies utilized by asthma patients].

In the Lazarus' transactional model of stress, each individual when facing a stressful situation, set up specific adjustement strategies called coping, including a meaningful pattern of cognitive, behavioral, emotional and somatic responses. Coping strategies used by asthmatic patient are relatively unknown. The objective of this study was to assess the usual coping strategies. We administered the WCC (a shortened version of Lazarus and Folkman's questionnaire) to 116 asthmatic patients and 880 healthy adults French subjects (males and females). A principal component analysis, followed by varimax rotations yielded three factors accounting for about 68.2% of the total variance. They were interpreted as Problem-focused, Emotion-focused and Social-support seeking types of coping. These two first dimensions of coping were closed to those generally described in the literature. Asthmatic patients used more emotion-focused strategy than the control group. These results and their theoretical and practical implications are discussed.

Adaptation, Psychological↗
PubMed1998

Characteristics and survival of patients prescribed long-term oxygen therapy outside prescription guidelines.

Criteria for the prescription of long-term oxygen therapy (LTOT) have been published by academic societies and regulatory bodies, but many prescriptions for LTOT do not fulfil these criteria. Demographic, functional data and survival were compared in chronic obstructive pulmonary disease (COPD) patients with different levels of oxygenation, i.e. arterial oxygen tension (Pa,O2) < 8 kPa or > or = 8 kPa (60 mmHg), at the time of initial registration in the ANTADIR Observatory. Data were collected between 1984-1995. Selection criteria were a diagnosis of COPD or emphysema with forced expiratory volume in one second (FEV1) < 80% pred, FEV1/vital capacity (VC) < 70% and age between 18-75 yrs. Of 7,700 patients prescribed LTOT 18.5% had stable Pa,O2 > or = 8 kPa. While the FEV1 was the same they differed from the patients with more severe hypoxaemia in having a higher rate of diagnosis of primary emphysema and a lower arterial carbon dioxide tension (Pa,CO2). In this group of patients LTOT was more frequently administered as liquid oxygen than in other patients on LTOT. The survival of these patients was reduced compared to the general population of the same age and sex but comparable to that of patients with a Pa,O2 between 6.7-8 kPa (50-60 mmHg). Patients prescribed long-term oxygen therapy with an arterial oxygen tension > or = 8 kPa (60 mmHg) in the ANTADIR network were shown to have severe chronic obstructive pulmonary disease on the basis of spirometry and their survival was similar to that of more hypoxaemic patients. Randomized controlled trials of the effect of long-term oxygen therapy in patients with arterial oxygen tension > or = 8 kPa are needed.

Aged↗
PubMed1998

[Osmolarity of solutions used in nebulization].

Inhaled medications are widely used in patients suffering from bronchial diseases. Beside their pharmacological properties, nebulised solutions have physico-chemical characteristics that can alter bronchial reactivity. Non-isotonic solutions can induce a bronchial hyperresponsiveness and/or a severe bronchonconstriction. Nevertheless, multiple drugs are used for nebulisation despite their unknown osmolarity. The aim of this study was to measure the tonicity of drug solutions commonly used for nebulisation in patients suffering from bronchial disease. Drug solutions were prepared either according to manufacturer recommendations or by diluting the stock in 5 ml of NaCl (0.9%) or H2CO3 (0.14%). Although bronchodilatator solutions (i.e. salbutamol, terbulatine, ipratropium bromide) were nearly isotonic, some drugs prepared for nebulisation had either a very high (e.g. mesna, netilmicine) or a very low (e.g. gomenol, sodium cromoglycate) tonicity. These values may be responsible for bronchoconstriction. Some hypertonic solutions, prepared with drugs such as acetylcytein or netilmycin, are not commercialised for nebulisation but are commonly used for aerosol therapy. In addition, solutions initially isotonic could become significantly hypertonic towards the end of nebulisation. Taken together, these results suggest that non-isotonic solutions should be used with caution specially in patients with bronchial hyperresponsiveness, even when aerosol therapy is prescribed for upper airways.

Acetylcysteine↗
PubMed1998

[The patient's representation of asthma. Preliminary results of a survey].

There is often a discrepancy between doctors' and patients' points of view on asthma. However, few studies have been devoted to the patients' representation of asthma. In this study 27 subjects, with moderate asthma, had to choose from a list of 35 groups of words and expressions, those which look to them to best evoke asthma. The results of this descriptive study show that "allergy" is the most frequently chosen term associated by patients with "suffocate", "attack", "heredity", and "psychic". Asthmatic patients minimise disease severity and refuse to be categorised as ill; they reject terms stigmatising asthmatic subject and the dangerousness of their disease. However, they recognise that asthma has psychological repercussions and prefer self-care. They consider drugs as dangerous and are afraid of their addiction and toxicity. These results have implications on information and education of asthmatic patients. To identify, for each patient, what is his/her representation of his/her disease would be very useful to provide patients with an adapted and personalized help for the management of his/her disease.

Adult↗
PubMed1997

Carboplatin as radiosensitizer in non-small cell lung cancer after cisplatin containing chemotherapy. A phase I study of a groupe francais de pneumo-cancerologie (G.F.P.C.).

A Phase I trial of carboplatin therapy was performed on patients with locally advanced non-small cell lung cancer who had been previously treated with cisplatin, mitomycin and a vinca aklaloïd. This was administered as a daily bolus infusion or as a continuous infusion for 6 weeks with concurrent daily thoracic radiation. All patients had to be objective responders or to show no change after chemotherapy. The carboplatin was started at 10 mg/m2 per day, and increased to 15 mg/m2 per day and 20 mg/m2 per day, if treatment was feasible in successive cohorts of at least six patients. The radiation therapy consisted of 62-66 Gray on the tumor and the ipsilateral mediastinal nodes, 50 Gray on the mediastinum and 40-45 Gray on the supraclavicular lymph nodes. Twenty-nine patients took part in this study. Thrombocytopenia was the principal dose-limiting toxicity, with 15 mg/m2 per day of bolus or continuous infusion. Other toxicities included a fall in haemoglobin level, a fall in white-blood cell count, nausea and vomiting. The median survival time was 12 months, but the response rate cannot be determined among patients selected on the basis of response to chemotherapy. The recommended Phase II dose for patients previously treated with cisplatin containing chemotherapy, is 10 mg/m2 per day of either a bolus or continuous infusion.

Adult↗
PubMed1997

[Bacterial infectious agents implicated in lower respiratory tract infections in general practice].

The consensus of the French Society of Infectious Diseases established in 1991 states that Streptococcus pneumoniae and Haemophilus influenzae are the main causal agents of community-acquired lower airway infections and that antibiotics constitute the "prudent" solution in case of acute bronchitis which persists more than one week or in case of pneumonia in "fragile" at-risk adults. The efficacy of these "probabilistic" recommendations depends on the epidemiology of the infectious agents. The objective of this study was to identify the causal germs in lower airway infections and determine their sensitivity to the antibiotics recommended in the consensus statement. The study was conducted from December to March, in 1992 and 1993. Expectoration samples were obtained from 111 cases including 29 patients with chronic bronchitis. Seventy different strains were isolated including 24 strains of H. influenzae (3 betalactamase producers), 15 strains of S. pneumoniae (1 with reduced sensitivity to peni G: MIC = 1 mu/ml), 9 strains of S. aureus (2 methicillin resistant), and 8 strains of Branhamella catarrhalis (6 betalactamase producers). The number of positive serologies was very low: 5 Chlamydiae pneumoniae, 2 Chlamydiae trachomatis and 1 Mycoplasma pneumoniae. In conclusion H. influenzae is the most frequent germ; S. pneumoniae infections with reduced peni-G sensitivity and atypical germs are uncommon. The consensus recommendations appear to be adapted to the bacterial flore causing community-acquired lower airway infection in healthy and at-risk subjects.

Adult↗