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Biomedical subjects

A Taytard

Publications and source records attributed to A Taytard.

At least 55 records · Page 3Linked to original sources
PubMed1996

[Morbidity and mortality induced by asthma in 1996].

Because asthma is an episodic disease with intermittent and unpredictable manifestations, the patient must be constantly on the alert to his condition, causing permanent stress for the entire family. The time and effort spent for treatment can be a great burden for the patient and his family and friends, sometimes causing a handicap in school or profession life. Consequently, the way relatives, friends, and society in general perceive asthma can have an effect on their reaction to the disease. Dominant attitudes in a given social setting create a standard, socially accepted definition of the disease which can play an essential role in asthma-induced morbidity. The link between morbidity, mortality, poverty and quality of health care is a constant feature in epidemiological data on asthma. In areas where pollution is low or access to health care unimpaired, survival curves for asthma patients are similar to those for the non-asthmatic population, demonstrating the role of the social context in asthma-induced mortality. One must however be very prudent in analyzing epidemiological data on asthma since most published work has been conducted in a specific cultural and medical context, often with a health care structure which is quite different from the situation in France. In order to improve the situation of the asthma population in France, two essential questions, "which patients suffer from their asthma?" and "which patients die from their asthma?" must be answered. Then in order to reach those patients which do not consult, the general population should then be informed. Important targets include better informing general practitioners, facilitating access to health care, training asthma patients, and improving social aid to compensate for the patient's economic incapacity. No matter what improvements in treatment are acquired, in these factors are not taken into consideration, there can be little hope of improving asthma-induced morbidity and mortality.

Asthma↗
PubMed1996

[Moderate asthma in adults: diagnosis and management in general medical practice].

Moderate asthma is a frequent disorder in general medicine. In 1990, the British Thoracic Society published their first guidelines on the management of asthma. Three years later, we have studied, using a questionnaire, the diagnosis and therapeutic criteria of moderate asthma used by general physicians, and comparing these to the guideline recommendations. Out of 46 physicians questioned in Bordeaux, 40 (87 per cent) agreed to participate in the study. Thirty two physicians (80 per cent) described as moderate an asthma which was mild according to the guidelines; eight physicians (20 per cent) described a moderate asthma according to the guidelines; twenty five (63 per cent) considered as severe a moderate asthma according to the recommendations, although eleven (28 per cent) considered it as moderate and four (10 per cent) did not give an opinion. In total, four (10 per cent) judged asthma severity according to the guidelines (Group R), twenty one (52 per cent) over-estimated the severity of moderate asthma (Group S), and fifteen (37 per cent) gave an inconsistent assessment (Group 1). Twenty six (65 per cent) prescribed an association of beta-2-agonists and inhaled corticosteroids for moderate asthma. Although most of the questioned physicians gave an appropriate treatment for moderate asthma treatment adapted to the severity of the situation, their therapeutic approach did not seem to be based upon the same criteria than that recommended in the guidelines.

Administration, Inhalation↗
PubMed1996

[Symptoms and life of patients with chronic bronchitis. Preliminary results].

Improvement in the bronchial obstruction is the aim of treatment for patients with chronic bronchitis. In this work, we attempted to identify subjective psychosocial and neurophysiological factors which are essential for understanding the quality of life in these patients. The study included 77 male patients under 80 years of age who were diagnosed as having chronic bronchitis by their family physician. In all cases, the disease state was stable without any other complication or co-morbidity. Each patient responded to a questionnaire and underwent volume-flow tests. The population was divided into 2 groups by VEMS: VEMS > or = 50% (n = 48) and VEMS < 50 (n = 19). Main component analysis followed by varimax rotation was used to analyse data. A Cronbach coefficient was calculated to measure data skewness. The Pearson correlations were calculated for the different factors. Mean intergroup means were compared with the unpaired t test. Data analysis demonstrated two physical factors: dyspnea and bronchial obstruction; 4 psychological factors: anxiety, impotency/hopeless feeling, depression, fatigue: and one psychological trait. Key symptoms of chronic bronchitis developed in patients with affective states contributing to the patient's subjective description of his disease and influencing therapeutic management. A better understanding of these patients is needed to improve treatment of chronic bronchitis.

Adult↗
PubMed1995

[Diagnostic and therapeutic strategies in exacerbations of chronic bronchitis in city practice].

The consensus conference convened by the French Language Society for Infectious Disease at Lille in 1991 stressed the fact that two germs were most often the cause of exacerbation in chronic bronchitis (Streptococcus pneumoniae and Haemophilus influenzae) and that antibiotic therapy was the "safe solution" and that the first intention treatment should be either penicillin A, a first generation cephalosporin or a macrolide for the first 8-10 days. A chest x-ray was recommended if there was the slightest doubt about co-existing parenchymal disease with a reevaluation around the 7th day and a prescription of penicillin A plus a beta-lactamase inhibitor or a second or third generation cephalosporin in case of failure. The aim of this study was to assess the diagnostic and therapeutic attitudes of general practitioners when faced with exacerbation in chronic bronchitis in an adult of 60 without severe signs and to find out the antibiotic of first choice and also the antibiotic to be used if the first treatment failed. One hundred doctors were drawn at random from a list of general practitioners in Bordeaux. They were requested to reply to a questionnaire on the strategy of first choice antibiotic and the means of reassessment of the treatment after it had been instituted and the strategy used when faced with a patient who did not improve after the initial treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Anti-Bacterial Agents↗
PubMed1995

[Presumed transudative pleural effusion?].

We report a case of recurrent transudative pleural effusion. The initial cardiovascular investigations failed to determine its cause. The catheterization showed a "dip-plateau" suggesting a restrictive cardiomyopathy. Endomyocardial biopsy finally proved a cardiac amyloidosis.

Aged↗
PubMed1995

[Necrotic purpura of the head disclosing Churg-Strauss syndrome].

INTRODUCTION: Among the cutaneous manifestations of the Churg-Strauss syndrome, palpable purpura of the extremities is the most common. Although they are not specific, sub-cutaneous nodules of the scalp are the most distinctive lesions. CASE REPORT: A 58 year-old man, with a 7-years history of asthma, developed profuse cutaneous lesions involving the face and the scalp, initially erythematosus and vesiculous, then purpuric and necrotic which led to the diagnostic of Churg-Strauss syndrome. COMMENTARY: Cutaneous lesions occur frequently during the Churg-Strauss syndrome and may reveal the disease as in our patient. However, the initial clinical presentation was uncommon with erythematosus and vesiculous lesions mimicking primary herpes infection. Cutaneous biopsy was useful leading to an early diagnosis.

Churg-Strauss Syndrome↗
PubMed1995

[Carboplatin-VP16 combination in non small cell lung cancers in the aged patient. A study of the French group in pneumology (GFPC)].

UNLABELLED: Between February 1992 and May 1993, 22 patients older than 75 years, with non small cell lung cancer, were treated with carboplatin and oral etoposide. There were 18 men and four women with a median age of 79 years. Fourteen patients had an epidermoid carcinoma: four had an adenocarcinoma and four had an undifferentiated carcinoma. Carboplatin was administered intravenously on day 1 at a dose of 300 mg/m2; oral etoposide was administered at a dose of 600 mg/m2 (two capsules daily) for 9, 10, 11, or 12 days according to body surface. Courses were repeated every 28 days for a total of three courses. TOXICITY: 15 patients (68%) had received previous chemotherapy. Myelosuppression was the main problem with one grade IV and five grade III hematologic toxicities. We observed one mild neurologic toxicity. RESULTS: 19 patients were evaluable for response. We observed one complete response (5%), five disease stabilizations (26%) and 13 disease progressions. Median survival was 5 months. These results led to discontinue this study.

Aged↗
PubMed1995

Evaluation of efficacy and safety of erdosteine in patients affected by chronic bronchitis during an infective exacerbation phase and receiving amoxycillin as basic treatment (ECOBES, European Chronic Obstructive Bronchitis Erdosteine Study).

An international multicentric study was conducted with the aim of demonstrating that erdosteine improves the efficacy of amoxycillin in the treatment of infective exacerbation of chronic bronchitis mainly on the clinical symptomatology (primary objective), on spirometric tests and body temperature, without negatively influencing the tolerance (secondary objectives). The study was conducted as a prospective evaluation, with 2 comparative groups treated with erdosteine (300 mg x 2/day) or placebo in association with amoxycillin (1500 mg/day) for a maximum of 10 days. The design of the trial was double-blind and parallel group with 2 subgroups. The treatments have been assigned randomly to a population of chronic bronchitic patients in exacerbation phase of n = 237 subjects. The study was conducted according to the principles of the Declaration of Helsinki and its amendments (Hong Kong, September 1989). The primary end-point used to determine effectiveness in this study was the global clinical assessment (GCA) which was choosen as a general indication of activity with objective/subjective evaluation of the clinical picture. Secondary endpoints of efficacy are sputum parameters, functional signs of chronic obstructive bronchitis, spirometric tests and overall judgement of efficacy. Safety was evaluated with adverse drug reactions reporting, arterial blood pressure, heart rate and laboratory tests monitoring. The obtained values have been analyzed with two-way and factorial ANOVA, Least Squares Catmod-SAS, Wilcoxon and Chi-square tests. The number of patients included in the effectiveness analysis is of n = 226 subjects, due to the fact that 11 patients were lost due to different reasons. In term of results as far as the primary objective of the study was concerned, erdosteine resulted more active than placebo. The analysis evidenced a very significant difference for treatment, time and interaction time x treatment. No difference on the contrary was observed for center and the interaction center x treatment. Sputum volume, body temperature and spirometric parameters were not significantly influenced by both treatments. Viscosity, appearance as well as functional signs evidenced a modification over time in favour of erdosteine. As safety is concerned the majority of adverse events, both in the erdosteine and in the placebo group, were related to the gastrointestinal area. For erdosteine, of 9/17 side-effects, 3 were epigastralgias, 3 nauseas, 1 diarrhoea, 1 taste loss, 1 hemorrhoids. For placebo of 13/17 related events 3 were epigastralgias, 4 nauseas, 4 diarrhoeas, 1 pyrosis, 1 dry mouth. In terms of severity they have been all defined as mild or moderate degree. Also from a qualitative perspective it is clear that there are no relevant differences between the 2 treatments under evaluation, concerning safety. In conclusion of particular interest is the datum arising from the efficacy/safety evaluation, which indicates that the clinical picture is modified earlier and at deeper degree by the synergistic activity of erdosteine and of the antibiotic without the risk of an augmentation of side-effects incidence.

Aged↗
PubMed1995

[Comparative trial of the clinical efficacy and tolerance of cefatrizine (Cefaperos) and cefpodoxime proxetil (Orelox) in superinfections of chronic obstructive bronchopneumopathies in adults in urban practice].

In order to compare the clinical efficacy and safety of cefatrizine (Cefaperos) and cefpodoxime proxetil (Orelox) in the treatment of secondarily infected chronic obstructive pulmonary disease (COPD) in adults, a multicentre, randomized, open study was conducted by 60 general practitioners in two parallel groups of patient suffering from COPD complicated by an acute episode of superinfection (Anthoniesen stages 2 and 3). After verification of the eligibility criteria, written consent and randomization, the patients received, for 10 days, either cefatrizine at the dose of 1 g/day or cefpodoxime proxetil at the dose of 400 mg/day. A self-assessment form was given to the patient. A telephone visit was planned for D3. The final visit on D11 +/- 1 evaluated clinical efficacy (success or failure) and safety. The study population was composed of 250 patients with a mean age of 59.9 +/- 15.9 years (sex ratio M/F = 1.5). The principal etiology of COPD was chronic bronchitis in 67.5% of patients, longstanding asthma in 24.5% and emphysema in 6.8%. The mean history of the disease was 13.0 +/- 10.8 years. The Anthoniesen score was equal to 2 in 73.6% of patients, 3 in 8.8% of patients and 1 in 17.6% of patients. No significant difference concerning these criteria was observed between the two study groups. The clinical success rate was equivalent in the two groups. The time to regression of clinical signs tended to be shorter, up until the sixth day (mainly between D4 and D6) for patients treated with cefatrizine (p = 0.09; NS). The clinical safety was considered to be good and was comparable in the two study groups. This study concluded on the equivalent clinical efficacy of cefatrizine and cefpodoxime proxetil in the treatment of superinfections of COPD in general practice (97.5% and 99%, respectively), with a satisfactory and comparable safety, but with a much lower cost of treatment for cefatrizine. This conclusion is particularly important in the context of opposable medical references, as, although the treatment of superinfections of COPD by second and third generation cephalosporins is frequently proposed, the prescription of a less expensive cephalosporin appears to be more relevant.

Adolescent↗
PubMed1994

Salivary IgE in allergic patients and normal donors.

A prospective study was conducted on 73 allergic patients and 14 normal volunteers in order to measure the IgE concentration in both serum and saliva, and analyze salivary IgE according to the characteristics of the allergic disease. IgE was more frequently detected in saliva from allergic patients than from normal subjects, but its concentration was not significantly higher in the allergic group. The IgE concentration in saliva was not related to serum IgE or to the type of syndromes of the allergic disease, but increased with the symptoms during the pollen season in patients suffering from pollen-induced rhinitis and conjunctivitis.

Adolescent↗
PubMed1994

[Diagnostic and therapeutic strategies in acute pneumopathies in urban practice].

The consensus conference of the French Language Society of Infectious Disease convened at Lille in 1991 stressed the fact that "in the management of pneumonia, neither the clinical features nor the bacteriological information would enable a prediction of the responsible and effective agent with sufficient accuracy" and that antibiotic therapy should be empirical, based on the probabilities linked to the epidemiology and locality. The object of this study was to ascertain the diagnosis and therapeutic attitude of the general practitioner (GP) dealing with an acute infectious pneumonia in a 40 year old adult, previously well without any critical signs, which was the model taken for the consensus conference. One hundred GPs were selected at random from the general medical list in the city of Bordeaux and registered with the local medical council in Gironde. They were invited to answer a questionnaire containing 69 questions. The results were analysed for the two phases of the enquiry. The strategy of first intention and the method of re-evaluating for treatment instituted. Secondly the strategy used when faced with a patient who did not improve with the initial treatment. Eighty eight GPs answered the questionnaire and thus we are able to give the following information: the differential diagnosis was not clearly made between bronchial and pulmonary pathology when faced with a lower respiratory tract infection; two thirds of the GPs had a diagnostic and therapeutic approach which was in agreement with the recommendations of the consensus.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1994

[Treatment of severe asthmatic crisis. Evaluation of international guidelines].

Acute asthma can sometimes be severe and potentially life threatening. International guidelines have defined both characteristics of these severe attacks and the associated therapeutic instructions. The efficacy and feasibility of these recommendations were evaluated in 15 asthmatic patients who were admitted to hospital because a severe asthma attack. These patients fulfilled the criteria of severity defined by a British experts conference in the international guidelines published in 1990 in the British Medical Journal. A first line treatment was given to all the patients and included both systemic corticosteroids and inhaled beta 2-agonists. In case of failure, beta 2-agonists were given intravenously and oxygen was administered as required. Monitoring was carried out between the admission and the 8th hour using the following criteria: peak expiratory flow (DP), respiratory frequency (FR), and heart rate (FC). Both DP and FR significantly improved from 196 +/- 79 to 292 +/- 104 l/min (p < 0.01) and from 27.5 +/- 5.5 to 23.7 +/- 5.6 (p < 0.02), respectively. FR remained unchanged (97 +/- 13 vs 98 +/- 13; ns). There was a favourable outcome in all cases. beta 2-agonists administered intravenously were only necessary in two patients for whom no predictive factor could be determined. It is concluded that international guidelines are applicable to severe acute asthma. Inhaled route for beta 2-agonist is sufficient for the majority of patients presenting with the criteria defining severe acute asthma unless life threatening symptoms are present.

Adolescent↗
PubMed1993

[Combination of cisplatin-mitomycin-vindesine for inoperable, non-small-cell bronchial cancers. French study group in pneumo-cancerology].

The efficacy of the association of cisplatinum-mitomycine and vindesine on inoperable non-small cell bronchial cancer has been assessed in a prospective study. Cisplatinum 120 mg/m2 and mitomycine 8 mg/m2 on day 1, day 28 and day 70, and vindesine 3 mg/m2 once per week for the first cycle, once every 15 days for the second and third cycles. 98 patients were included in the study between February 1989 and June 1990: there were 89 men and 9 women with a mean age of 60. There were 57 epidermoid cancers, 22 adenocarcinomas, 1 neuroendocrine carcinoma and 18 large cell cancers. There was an objective response (RO) in 25% (of whom 5% had a complete response) without any significant difference between the 56 cancers at stage III (32% RO) and 42 cancers in stage IV (17% RO). The median survival of the responders was 14 months again 5 months for the non-responders. The initial loss of weight seemed to be a prognostic factor because the number of objective responders was significantly greater in the patients with only a small weight loss: 37% of RO if the weight loss was less than 5%, against 11% for a weight loss of greater than 5%. The myelotoxicity of this association was important because 85% of those patients presented with a leucopenia at least grade II OMS. Peripheral neuropathies occurred in 27% of cases: 4 cases of cardiotoxicity were reported.

Actuarial Analysis↗
PubMed1992

[Epidemiology of asthma].

Asthma epidemiology aims to provide answers to the following questions: what is the prevalence? what are the consequences? what are the risk factors of asthma? Questionnaires indicate that asthma prevalence averages 6 to 8% whereas assessment of bronchial reactivity reveals that approximately 15% of the population exhibit bronchial hyperesponsiveness; these figures have been increasing in many western countries. Asthma is an important cause of impairment in children physical development, school-related problems along with increased number and duration of hospitalizations. Asthma mortality averages 3/100,000 in France and is mainly focused on people more than 50 years old; its increase is very likely in some countries, but is still controversial in France. Environmental and socio-economic factors play a major role in the development of asthma and genetic factors are now under investigation. Although both understanding and drug treatment of asthma have dramatically improved in the recent past, no positive change has been observed so far in terms of morbidity and mortality. Nevertheless, knowledge of factors specific to France requires further investigations.

Adult↗
PubMed1992

The effect of sodium cromoglycate on platelets: an in vivo and in vitro approach.

Platelet functions are altered in patients suffering from atopic diseases, including asthma. Such alterations might be related to IgE since platelets bear a specific IgE receptor termed Fc epsilon receptor II, and there is some evidence that IgE alone, that is, in the absence of antigen, could modify platelet functions, such as monoamine uptake. Although disodium cromoglycate (DSCG) has been demonstrated to interfere with IgE-mediated activation of human platelets, its effect in the absence of antigen remains unknown. We examined the DSCG effect on IgE-induced alterations both in vivo and in vitro. The effect, in vivo, of a daily intake of 40 mg of DSCG for 4 weeks was assessed on platelet kinetics, studied by a labeling technique on four patients with stable asthma. The effect, in vitro, of DSCG was assessed on IgE-induced alteration in monoamine uptake in platelets from 12 healthy subjects. DSCG significantly increased, in vivo, the mean time constant of platelet-survival curves from 234 +/- 40 to 463 +/- 150 hours (p less than 0.01). The amplitude of this effect increased with the patient's serum IgE concentration. DSCG, in vitro, reduced the inhibitory effect of IgE on monoamine uptake by 82%. This effect was concentration dependent and not related to IgE binding. It is concluded that DSCG alters both the survival time of platelets from allergic patients in vivo and the IgE-dependent monoamine uptake in platelets from normal subjects in vitro. These effects are likely to be related to the direct action of DSCG on cells bearing the Fc epsilon receptor II and might be independent of the specific trigger.

Adult↗