Biomedical subjects
B Lepage
Publications and source records attributed to B Lepage.
Effects on sound localization of configuration and type of hearing impairment.
Localization ability of 87 bilaterally hearing-impaired listeners was tested in the horizontal and vertical planes, frontally and laterally. In those with sensorineural hearing loss, it was found that deficits in localization accuracy in different regions of auditory space could be related to different configurations of hearing loss. For example, there were associations between vertical plane discrimination and high-frequency sensitivity; and front-rear discrimination and mid-to-high-frequency sensitivity. These results agree with theoretical expectations, while the outcome overall contrasts with previous reports that localization performance is unrelated to audiometric configuration. A comparison of 13 listeners with conductive/mixed types of impairment with a sensorineural-loss group, matched for degree of loss, showed that a conductive component adds significantly to localization disturbance, particularly in the horizontal plane. The probable reason is a disturbance of low-frequency interaural time cues, and this occurs because a higher proportion of low-frequency sound is likely to be transmitted via bone conduction relative to air conduction. Correlations between hearing loss and localization are only moderate, suggesting that aspects of hearing impairment, in addition to simple attenuation, may also reduce auditory localization performance.
[Celioscopic cholecystectomy in simple and complicated cholelithiasis. Apropos of 392 cases].
In a study including 392 patients we compared two groups of patients according to the indication for laparoscopic cholecystectomy: group I: 293 patients treated for simple cholelithiasis (n = 291) or gallbladder polyps (n = 2). Group II: 99 patients operated for complicated cholelithiasis. For each patient, 14 pre, intra and postoperative parameters were analysed and compared. Mean operative time was 80 minutes. Primary and secondary laparotomies were necessary in 5.8% and 1.3% of cases respectively. Biliary injury was the most frequent complication (1.3%). Mean hospital stay was 4.5 days. In terms of mean age, operative time, intraoperative incidents and complications, and primary laparotomy. There was a significant difference between the two groups (p less than 0.001). There were 4 secondary laparotomies in group II and one in group I. These results suggests that laparoscopic cholecystectomy is a safe technique with a low mortality rate (0.25%). The comparative study proves that this technique, first indicated for simple cholelithiasis, is also applicable to the majority of complicated cholelithiasis.
[A prospective and comparative study of 262 laparoscopic cholecystectomies].
A prospective, comparative study is made of 262 patients (195 males, 67 females) subjected to laparoscopic cholecystectomy. Two groups were considered: simple cholelithiasis (SC) (187 cases), and complicated cholelithiasis (CC) (75 cases: 63 acute cholecystitis, 8 hydrocholecystitis, 4 pancreatitis). Mean age was 51 among the SC cases, and 57 in the CC patients. Mean operating time was 67 and 96 minutes for the SC and groups, respectively. Preoperative complications were more frequent in the CC group (51.4%) than in the SC patients (24%)--immediate laparotomies being performed in 2 and 25% of the SC and CC patients, respectively. Mortality was zero, with similar morbidity in both groups. Mean hospitalization time was 4.9 and 3.4 days for the CC and SC groups, respectively.
Personality dimensions through the schizophrenia borderline.
While the schizoid dimension of personality has often been thought to be unitary, it has recently been suggested that several dimensions may be involved. In this study two separately derived normal population personality scales from within the psychoticism domain, the Rust Inventory of Schizotypal Cognitions (RISC), a scale designed to measure the positive cognitive schizotypal dimension, and the Eysencks' P scale from within the Eysenck Personality Questionnaire, were administered to a group of 608 Venezuelan university students. It was found that the RISC and the EPQ had only a small correlation of 0.12. It was concluded that at least two dimensions were involved in the schizophrenic/normal spectrum, and that the EPQ Psychoticism scale was in fact measuring a dimension of personality disorder rather than a general factor of psychoticism.
[Diagnostic traps and procedure to follow in radio-invisible biliary calculi].
Instead of the term biliary microlithiasis, the authors prefer the general concept of radio-invisible biliary lithiasis. The size, the homogeneity, the site and chemical composition of the gall stones, which are the usual criteria of biliary microlithiasis, also are valid for radio-invisibility; thus the diagnostic traps are the only original characteristics of a pathology with hazy outlines, defined as one which escapes well conducted a radiological exploration. Biliary micro-lithiasis therefore raises a triple problem. The indications for biliary surgical exploration, in spite of normal cholangiography, seem to us undoubted in acute relapsing pancreatitis, once the usual medical causes have been eliminated. It should be more relative in pure biliary pain which first requires, not only repeated cholangiography, but also constant clinical and laboratory signs which suggest that the symptoms are organic and that gall stones are in formation. After laparotomy, cholecystectomy is required, not only in perceptible lithiasis, but also when the gall bladder bile contains mud, débris, sand or cholesterol spheroids. In the other cases, the choice between abstention or cholecystectomy depends on the clinical and laboratory context. The surgical attitude with regard to the common bile duct is discussed in three possibilities depending on the case, e.g. routine exploration, abstention or exploration in certain cases.
[Postoperative febrile jaundice after non-biliary abdominal surgery. Diagnositc and therapeutic problems apropos of 8 cases].
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Evaluation of the laparoscopic cholecystectomy on patients with simple and complicated cholecystolithiasis.
Laparoscopic cholecystectomy is now a well described method for the treatment of cholelithiasis. The purpose of this paper is to define its implementation, limits, risks and indications. Following a prospective method, the results of this treatment were compared in 187 patients with simple cholelithiasis and 75 patients with complicated cholelithiasis. Cholecystectomy was performed with a straight optic introduced through the paraumbilical region, and coupled with video camera. Two, 3, or 4 other trocars were inserted and placed as required by anatomic conditions. In the group with simple cholelithiasis, laparoscopic cholecystectomy was performed in 99% of the patients while in the group with complicated cholelithiasis the procedure was achieved in 75% of the patients. Immediate laparotomy was done in 1% and 25% of cases respectively in both groups. No interventional mortality occurred. Postoperative complications have been acceptable (1.6% and 2.7%), with no late complications reported. Our study shows that laparoscopic cholecystectomy is feasible in the majority of cases of complicated cholelithiasis and that the main advantages of this method were retained.