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Biomedical subjects

B Yersin

Publications and source records attributed to B Yersin.

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

[Value of Doppler ultrasonic studies in the diagnosis of deep venous thrombosis of the lower limbs].

To compare the operating characteristics of the venous echo-doppler and that of venous phlebography in our setting, 90 consecutive patients admitted on suspicion of deep vein thrombosis of one leg underwent both examinations. Phlebography confirmed the diagnosis in 46 patients (51%). The sensitivity, specificity, and positive and negative predictive values of the echo-doppler were 91, 92, 94 and 90% respectively. For the subgroup of patients with proximal deep vein thrombosis, these values were 97, 97, 97 and 97%, respectively; for the subgroup with distal deep vein thrombosis, these values were 60, 95, 75 and 90%, respectively. This study confirms the excellent performance of the venous echo-doppler for the diagnosis of deep vein thrombosis of the leg in our hospital. However, in the subgroup of patients with distal deep vein thrombosis, only the sensitivity of the venous echo-doppler is relatively low and the diagnosis may still require color echo-doppler or phlebography.

Diagnosis, Differential↗
PubMed1996

New alterations of serum glycoproteins in alcoholic and cirrhotic patients revealed by high resolution two-dimensional gel electrophoresis.

Plasma protein are synthesized and secreted by the liver. Several reports have shown that excessive consumption of ethanol interferes with the hepatic protein synthesis and/or secretion. This study was undertaken to identify the plasma/serum proteins altered in two groups of patients with different alcohol-related diseases: actively drinking alcoholic patients group without liver disease and alcohol cirrhotic patients group. Two-dimensional gel electrophoresis was used to separate proteins with high resolution. Proteins were detected by silver staining and glycoproteins were specifically visualized and analyzed after lectin blotting followed by chemiluminescence detection. Different protein alterations were identified in each group of patients. In the alcoholic group, two new glycosylation modifications of serum proteins were identified. An abnormal microheterogeneity of haptoglobin and alpha1-antitrypsin was detected in the serum of all alcoholic patients. We also characterized by two-dimensional gel electrophoresis the carbohydrate deficient transferrin. The modifications of haptoglobin, alpha1-antitrypsin and transferrin present a similar change of charge and molecular weight in the two-dimensional gel electrophoresis pattern. These qualitative estimations support the hypothesis of a general mechanism of liver glycosylation alteration of serum proteins induced by excessive alcohol consumption. The immunoglobulin alterations were easily visualized and identified for the cirrhotic and the alcoholic patients. And finally, the decrease of haptoglobin and albumin spots for cirrhotic patients was confirmed.

Alcoholism↗
PubMed1996

Validation of the Addiction Severity Index in French-speaking alcoholic patients.

OBJECTIVE: Evaluation of a French translation of the Addiction Severity Index (ASI) in 100 (78 male) alcoholic patients. METHOD: Validity of the instrument was assessed by measuring test-retest and interrater reliability, internal consistency and convergence and discrimination between items and scales. Concurrent validity was assessed by comparing the scores from the ASI with those obtained from three other clinimetric instruments. RESULTS: Test-retest reliability of ASI scores (after a 10-day interval) was good (r = 0.63 to r = 0.95). Interrater reliability was evaluated using six video recordings of patient interviews. Severity ratings assigned by six rates were significantly different (p < .05), but 72% of the ratings assigned by those who viewed the videos were within two points of the interviewer's severity ratings. Cronbach alpha coefficient of internal consistency varied from 0.58 to 0.81 across scales. The average item-to-scale convergent validity (r value) was 0.49 (range 0.0 to 0.84) for composite scores and 0.35 (range 0.00 to 0.68) for severity ratings, whereas discriminant validity was 0.11 on average (range-0.19 to 0.46) for composite scores and 0.12 (range-0.20 to 0.52) for severity ratings. Finally, concurrent validity with the following instruments was assessed: Severity of Alcoholism Dependence Questionnaire (40% shared variance with ASI alcohol scale), Michigan Alcoholism Screening Test (2% shared variance with ASI alcohol scale) and Hamilton Depression Rating Scale (31% shared variance with ASI psychiatric scale). CONCLUSIONS: The Addiction Severity Index covers a large scope of problems encountered among alcoholics and quantifies need for treatment. This French version presents acceptable criteria of reliability and validity.

Adult↗
PubMed1996

[Opinion and attitude of physicians regarding organization and participation on a multidisciplinary alcoholism unit].

The inaccuracy of physicians in the diagnosis, evaluation and treatment referral of alcoholic patients has prompted us to set a Multidisciplinary Alcohol Unit (Unit). Its aims are to set coordinated and individualized treatment proposals and to train medical staff in dealing with alcohol problems. After six months of activity we performed an investigation by all physicians who delt with the Unit including residents and practitioners. We sent 78 questionnaires investigating training in alcohol problems, addictive diseases and psycho-social medicine, subjective usefulness of the Unit for the patient as well as for the medical staff, subjective effectiveness of treatments for alcoholics and reasons for patients' referral. 87% of the physicians completed the questionnaire. According to groups, 12 to 20% of the physicians reported that their training in addictive problems was sufficient. Half of practitioners and 20% of hospital residents reported that their training in psychosocial medicine was satisfactory. All the physicians who answered the questionnaire considered the Unit to be usefull for themselves, mainly because of the Unit's teaching abilities and 89% considered the Unit useful for the patients. In term of effectiveness, alcoholism treatment is percieved by residents to be more efficient when mediated by a specialized unit rather than by practitioners or by themselves. Practitioners percieved that the treatment is more efficient when handled by themselves or by a specialized social unit. Principal reasons to seek help from the Unit were a main diagnosis of alcohol-related disease, the need to complete the psycho-social evaluation and subjective insufficient skills in the field. In conclusion the Unit seems to meet the need of medical doctors despite the limited number of referred cases and is said to be usefull for their patients as well as for themselves.

Adult↗
PubMed1996

[Peripheral nerve and spinal cord complication in intravenous heroin addiction].

The neurological complications observed in 6 HIV negative intravenous drug users are reported. Four developed acute neuromuscular involvement in a lumbosacral or brachial distribution with rhabdomyolysis, myoglobinuria, hypovolemia, renal and hepatic failure in the 3 most severely affected patients. Despite evidence of immunologic abnormalities and especially presence of anti-heroin antibodies, we feel that causative mechanisms include mixed compression and ischemia with an underlying toxic myopathy, resulting in segmental myopathy with secondary compression of peripheral nerves. Two patients developed myelopathy with acute or chronic onset. The mechanisms were vascular with spinal cord infarction in the acute form and probably infectious with secondary compressive arachnoiditis in the chronic form. In these 2 patients with myelopathy, outcome was poor.

Acute Disease↗
PubMed1995

Screening for excessive alcohol drinking. Comparative value of carbohydrate-deficient transferrin, gamma-glutamyltransferase, and mean corpuscular volume.

BACKGROUND: Screening medical patients for excessive alcohol drinking is important because minimal intervention by physicians is effective in reducing excessive consumption. Screening tests, such as biologic markers of alcohol consumption, should therefore be investigated to assess their validity to detect alcohol drinking. METHOD: Levels of carbohydrate-deficient transferrin (CDT), gamma-glutamyltransferase (GGT), and mean corpuscular volume (MCV) were determined in 1202 consecutive patients (20 to 75 years old) seen at the medical emergency ward (n = 552) and the primary care center (n = 650) of a city and teaching hospital. Each eligible patient was administered a CAGE questionnaire (an acronym for questions regarding cutting down on drinking, annoyance at others' concern about drinking, feeling guilty about drinking, and using alcohol as an eye-opener in the morning), and for each CAGE-positive patient (score > or = 2) as well as for a random sex-matched sample of CAGE-negative patients, standardized data about the recent level of alcohol drinking, morbidities, drug therapy, and smoking were recorded. The operating characteristics of CDT, GGT, and MCV were determined according to alcohol consumption and the CAGE test. Sensitivities, specificities, and receiver operating characteristic curves were computed to compare the tests at different cutoff values. RESULTS: Levels of CDT were elevated in 21% of men and 7% of women. According to recent alcohol consumption in men (> 60 g/d), the respective sensitivity and specificity of the tests were 0.58 and 0.82 for CDT, 0.69 and 0.65 for GGT, and 0.27 and 0.91 for MCV. Overall, receiver operating characteristic curves demonstrated similar performance of the three tests for screening of excessive alcohol drinking or alcohol abuse. However, in young men (< 40 years of age) and in smokers, CDT was superior to GGT or MCV. CONCLUSIONS: The study suggests that CDT determination may be a useful test for screening programs of excessive alcohol drinking in young male medical patients.

Adult↗
PubMed1995

[Detection of alcoholism in the medical office: applicability of the CAGE questionnaire by the practicing physician. Group of Medical Practitioners PMU].

INTRODUCTION: The general practitioner (GP) plays a very important role in early detection of alcoholism. Clinical evaluation is often the only method used, although it has been suggested that any systematic patient history should include the CAGE test. We compare the effectiveness of these two approaches and attempt to determine the applicability of the CAGE test in a general practitioner's usual practice. METHOD: 12 GPs took part in this study during 6 months. They looked for possible alcohol abuse in each new patient by a standard patient history and clinical examination. Patients were randomized into 2 groups, one of which was given the CAGE test and the other not. For each patient in the CAGE group the applicability of the test was quantified by the GP. RESULTS: 416 patients were included; 214 were randomized into the "CAGE group" and 202 into the control group. On a clinical basis, 15 patients in the control group and 16 in the "CAGE group" (14 men, 2 women) were suspected of alcohol abuse. The CAGE test was positive in 15 patients (7%); among these, 6 were not suspect on a clinical basis. In patients aged 18-34, the detection rate of alcohol-related problems more than doubled when the CAGE test was used. The age of the patients influenced performance of the CAGE test and clinical evaluation. Only 2% of women had a positive CAGE test. Administration of the CAGE test was considered easy in 112 patients and average to difficult in 50, while the test was inapplicable with 52 patients. The latter proportion was higher than that observed in institutions (hospitals, outpatient departments) of the same region. Applicability was influenced neither by the sex nor the age of the patients, but varied greatly according to the physician (from 38% to 100%). CONCLUSION: The CAGE test increases the number of patients detected with alcohol problems by 37% and seems to be especially useful when administered to young people. The number of women with alcohol problems is probably underestimated by both clinical evaluation and the CAGE test. Furthermore, physicians in private practice are more reluctant to use the CAGE test systematically than those in a public institution.

Adolescent↗
PubMed1995

Improvement of renal failure with repeated head-out water immersions in patients with hepatorenal syndrome associated with alcoholic hepatitis.

Two patients with severe hepatorenal syndrome associated with alcoholic hepatitis are reported, in whom repeated daily courses of head-out water immersion were dramatically effective in producing an improvement of the renal function. Using repeated 2-hour courses of head-out water immersion for 7 days in the 1st patient, an immediate increase in urine output was observed. A slight increase in renal sodium excretion was also noted. The patient lost 7 kg over 1 week. Serum creatinine decreased from 520 to 370 mumol/l, and the renal function continued to improve thereafter. In the 2nd patient, repeated head-out water immersion was associated with a progressive improvement of the renal function, an effect that was absent during an initial therapy of volume load. The acute effects of immersion in in this 2nd patient were characterized by a dramatic increase in urine output and renal sodium excretion as well as in p-aminohippurate and creatinine clearances. These effects were associated with a decrease in the activity of the renin-angiotensin system and a modest increase in plasma atrial natriuretic peptide levels. Thus, these 2 cases emphasize the potential benefits of repeated head-out water immersions in improving the renal function of patients with hepatorenal syndrome.

Adult↗
PubMed1993

[Screening for alcoholism among patients of a medical polyclinic in French-speaking Switzerland].

In order to test an alcoholism screening strategy in a primary care population of a polyclinic, we administered two standardized questionnaires, the Michigan Alcoholism Screening Test (MAST) and the Cut-down, Annoyed, Guilty, Eye-opener Test (CAGE), to all consecutive patients seen during a week. The applicability rate was 77% (269/350). Reasons for being inapplicable were inability to understand the test questions or restricted time allowed for each visit. Tests were positive in 19 and 22%, for the MAST and CAGE, respectively. Kappa coefficient of agreement between tests was 0.69. Based on a positive MAST (cutoff > or = 5), alcoholism was more frequent in males than in females (27 vs 10%), in patients aged 40-49 years (males 45%, females 29%), in unemployed than in employed people (32 vs 22%), in native citizens than in foreigners (21 vs 17%). 23% of MAST positive patients had one or more alcohol-related somatic diseases. Only 60% of MAST positive patients were known to physicians as alcoholics or alcohol-abusers. In conclusion, we showed that (1) prevalence of alcoholism is high in this primary care population, (2) agreement between MAST and CAGE is good, and (3) alcoholism screening is better performed by standardized questionnaires than the usual clinical investigations.

Adolescent↗
PubMed1993

Dental disease among alcoholic individuals: a comparative study of hospitalized patients.

OBJECTIVE: To measure the presence and severity of dental disease, as assessed by physicians, among consecutively hospitalized alcoholic and nonalcoholic medical patients. DESIGN: Descriptive cross-sectional study. Patients who had Michigan Alcoholism Screening Test (MAST) scores > or = 8 were identified as being alcoholic. Nonalcoholic patients were defined as individuals with MAST scores < or = 4. These patients were matched with alcoholic patients for gender and age (+/- 5 years). The decayed, missing, and filled teeth (DMF) score and its components were used as a measure of dental disease. SETTING: General wards of internal medicine of a 1,000-bed urban teaching hospital in Lausanne, Switzerland. RESULTS: Among patients aged 20-75 years, the mean DMF score was higher among alcoholic patients than among nonalcoholic patients (26 vs 23, respectively; p < 0.001). This difference was greater among patients aged 20-39 years (20 vs 14, respectively) than among those aged 60-75 years (29 vs 27, respectively). The positive association between alcoholism and dental disease (crude odds ratio, 2.24; 95% CI, 1.15-4.31) remained after sequential stratification for several confounding factors. CONCLUSION: The study suggests that dental disease is frequent and severe in hospitalized medical patients and that alcoholism is an independent predictor of its severity. Routine assessment of dental disease by the physician is important for medical inpatients, especially among those who are alcoholic.

Adult↗
PubMed1992

[Anatomo-clinical discordance: analysis of a series of consecutive autopsies].

In order to assess the level of agreement between clinical and autopsy diagnoses in the medical wards of a city and teaching hospital, we studied 94 consecutive patients autopsied during a 12 months' period. The rate of autopsy in this study was 59%. The main diagnosis was confirmed at autopsy in 80% of the cases, more precisely defined in 11% and discovered in 9%. Among 124 secondary diagnoses, 34% were diagnosed by the pathologist. The retrospective analysis of the cases in which there was disagreement between clinical and autopsy diagnosis showed that in 8 of them (8.5% of all patients), a clinical impact on survival was possible. However, all of these patients were over 80 and had multiple and/or terminal diseases. Thus, the real impact of these diagnostic errors is debatable.

Adult↗
PubMed1992

[Screening for alcoholism].

This paper reviews current knowledge of screening for alcoholism. It emphasizes the validity of some screening instruments, e.g. standardized questionnaires, the accuracy of which appears to be superior to that of other commonly used tests such as biological markers of alcohol intake. Regarding effectiveness of screening for alcoholism, recent studies have proposed new therapies, particularly for use in multidisciplinary medical settings. The leading role of physicians in building these models should be emphasized, since it is well-known that alcoholics are frequently medical patients. Another factor in favour of screening for alcohol problems is the significant reduction of medical costs antialcoholic for alcoholics under treatment. To allow development of screening programmes for alcoholism by physicians it is indispensable that their medical education provides adequate information regarding this important health matter.

Alcoholism↗
PubMed1992

[Identification of alcoholism and therapeutic proposals: a study in a general hospital].

Alcoholism is a frequent condition in patients admitted to general hospitals. The rate of identification of patients suspected to be alcoholic, the therapeutic measures proposed to such patients and their destination at hospital discharge were among the issues studied in the general wards of a department of internal medicine of an hospital in the French-speaking region of Switzerland. The Michigan Alcoholism Screening Test (MAST) was utilized systematically among all patients aged 20-75 years who where admitted consecutively to the department. Two cohorts matched for age and sex were thus formed: 102 alcoholics (MAST greater than or equal to 8) and 102 non-alcoholics (MAST less than or equal to 4). A diagnosis of alcoholism or of a syndrome of alcohol dependence was found in only 50% of all exit reports of the alcoholic cohort, whereas alcohol-related problems were identified on a verbal basis by the attending physician in 89% of cases. Therapeutic measures were proposed to 69% of female alcoholics and to 43% of male alcoholics, more frequently among patients with the highest MAST scores. In addition, at hospital discharge, alcoholic patients were more likely to be sent to a destination other than their place of residence than were the non-alcoholic patients. This study illustrates the low rate of identification and subsequent treatment of alcoholism among hospitalized patients. It also suggests that hospital stays should be used more frequently to increase the systematic identification of alcohol problems, increase awareness of alcoholism and provide information to both patients and those caring for them.

Adult↗
PubMed1992

Detrimental effect of alcohol intoxication on severity of injuries in male traffic accident victims: a cross-sectional study.

A cross-sectional emergency room study was performed among traffic accident victims aged 16 to 75 years in order to investigate the prevalence of alcohol intoxication (blood alcohol concentration (BAC greater than or equal to 0.8 g/kg) and its potential detrimental effect on injury severity. A BAC greater than or equal to 0.8 g/kg was present in 29% of the male patients. Intoxicated patients had a similar propensity to require inpatient hospital care (65 versus 60%) but had significantly longer hospital stays than the non-intoxicated patients (36 versus 20 days; p less than 0.05), observations which may be explained by the higher prevalence of serious injuries (head and internal injuries) among the intoxicated cohort. This study supports and emphasizes the detrimental effect of alcohol intoxication on the severity of injuries in traffic accident victims, and reinforces the need for further legal and public health measures in preventing alcohol-related traffic accidents.

Accidents, Traffic↗