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Biomedical subjects

C Leroyer

Publications and source records attributed to C Leroyer.

51 records · Page 3Linked to original sources
PubMed1995

[Chronic hyperventilation syndrome].

Hyperventilation syndrome is a frequent, but poorly understood clinical entity. The clinical expression is a rich combination of respiratory, cardiac and neurological signs which can simulate various organic diseases. Hypocapnia remains the primum movens for most authors although the relationship with psychiatric situations, in particular in anxious patients, is increasingly emphasized. The diagnosis is currently based on the elimination of diseases associated with hyperventilation, then on Nijmegen's questionnaire and is confirmed by the reproduction of the same clinical picture in a voluntary hyperventilation test. Respiratory function tests offer little information. Treatment is based on combining rehabilitation therapy focused on the diaphragm and on relaxation. Specialized care may be needed in psychiatric patients.

Chronic Disease↗
PubMed1995

Frequency of obstructive sleep apnoea syndrome detected by means of a questionnaire in patients with coronary heart disease.

As previous studies have suggested an association between obstructive sleep apnea syndrome (OSA) and ischaemic heart disease, the aim of the present study was to evaluate the frequency of clinically relevant OSA in this selected population. From September 1992 to April 1993, 136 patients referred to the Cardiology Unit for suspected angina pectoris were asked to participate in the study. The main inclusion criterion was a stable coronary heart disease, diagnosed by angiography. A sleep questionnaire was administered by a trained physician. Patients who experienced one of the following symptoms: association of body mass index (-weight/height2) above 27.5 and heavy snoring, breathing stops, or daytime hypersomnolence, were selected for a nocturnal oxygen saturation recording. The occurrence of at least one desaturation, defined as a 4% fall from baseline, led to a full night-time polysomnography. One hundred and eight patients (78 males), satisfied the entry criteria. A pulse oximetry was performed in 15, and three patients experienced a significant desaturation. Finally, one patient satisfied the criteria of OSA. The estimated proportion of OSA amounted to 0.92%, in accordance with the prevalence of OSA described in the general population. Clinically relevant OSA does not appear to be more frequent in patients suffering from stable coronary heart disease. Systematic sleep investigations in such patients do not appear to be useful in daily clinical practice.

Aged↗
PubMed1995

[Pulmonary embolism and the level of thrombosis. A prospective study of 155 patients].

This study was designed to assess the risk of associated pulmonary embolism according to the level of deep venous thrombosis. From March 1992 to March 1994, 328 patients were referred to medical units for suspected deep venous thrombosis, with recent clinical signs, less than a week. Each patient underwent contrast venography and/or duplex ultrasounds of lower extremities, ventilation and perfusion lung scan within 48 hours and angiography in case of low or intermediate pulmonary embolism probability. Diagnosis of deep venous thrombosis was confirmed in 155 patients; location was distal in 41, proximal in 114; an associated pulmonary embolism was found in 66 patients (10 with distal, 56 with proximal deep venous thrombosis); odds ratio was 2.99 (95% Cl: 1.2-3.13). Significantly higher risk of associated pulmonary embolism when deep venous thrombosis involves proximal veins is confirmed, but as many as 10 out of 41 patients with distal thrombosis also had an associated embolism. Management of both distal and proximal deep venous thromboses appears identical.

Aged↗
PubMed1995

[Plastic bronchitis].

We report a case of plastic bronchitis occurring in a 58 year-old man free from underlying pulmonary disease. Relief of symptoms was observed under steroid therapy (1 mg/kg), but relapse occurred as treatment being tapered. Such evolution is in accordance with recent published data.

Bronchitis↗
PubMed1995

[Value and role of clinical findings in the diagnosis of pulmonary embolism].

The value and role of clinical findings in the diagnosis of pulmonary embolism were analysed in the three steps of clinical reasoning: firstly, they lead the physician to suspect the diagnosis; however, no sign or association of clinical signs allow confirmation or infirmation of the diagnosis; they are simply a guide to diagnosis; secondly, they contribute to the exclusion of a number of differential diagnoses, with the help of simple complementary investigations such as blood gases, electrocardiograms and chest X-ray; finally, when grouped together and expressed in terms of probability, clinical data are essential for the interpretation of pulmonary scintigraphy and for assessing the indications of further investigations.

Blood Gas Analysis↗
PubMed1994

[Small-cell carcinoma of the trachea in a 27-year-old patient].

A rare small-cell carcinoma of the trachea was observed in a 27 year-old man. Treatment included chemotherapy and radiotherapy as for bronchogenic small cell carcinomas. This treatment regimen led to complete but temporary remission. The patient died 4 months after the end of the treatment due to multiple cerebral metastases.

Adult↗
PubMed1993

Mesenchymal cystic hamartoma of the lung.

We report the case of an asymptomatic 51-year-old man, presenting with chest X-ray abnormalities consisting in multiple pulmonary nodules; the diagnosis of mesenchymal cystic hamartoma of the lung was made by an open lung biopsy, revealing both nodules of mesenchymal cells and cysts with a lining of normal or metaplastic epithelium. Clinical and pathological characteristics of this rare entity are reviewed.

Cysts↗
PubMed1989

[Value of ipratropium (Atrovent) in the treatment of chronic obstructive lung diseases in myasthenic patients treated with anticholinesterase agents. Apropos of a case].

We report a case of myasthenia gravis occurring in a 70-year old patient with old chronic bronchitis. Anticholinesterase therapy led to an increase in respiratory symptoms, but relief was obtained with inhaled ipratropium. The activity of this drug was confirmed by spirography. This clinical finding is compared with similar data found in the literature.

Aged↗
PubMed1988

[Malignant endobronchial melanoma, apparently primary. Apropos of a case].

This case concerns a 48 year-old patient whose endobronchial malignant melanoma was discovered on the occasion of a haemoptysis. A search for primary localization remained negative, suggesting a primary endobronchial lesion. Only a few cases of endobronchial malignant melanoma have been published, and several assumptions can be raised to explain the possibility of their primary origin.

Bronchial Neoplasms↗
PubMedDate not supplied

Early versus delayed introduction of oral vitamin K antagonists in combination with low-molecular-weight heparin in the treatment of deep vein thrombosis. a randomized clinical trial. The ANTENOX Study Group.

OBJECTIVE: To compare oral anticoagulant treatment (fluindione) started on either the 1st or the 10th day of a low-molecular-weight heparin (enoxaparin) treatment for deep vein thrombosis confirmed by venography. DESIGN: An open, multicenter, randomized study in two parallel treatment groups. INTERVENTIONS: All patients received enoxaparin, 1 mg/kg s.c. twice daily, and oral fluindione, 20 mg once daily, either beginning on day 1 or on day 10 of the enoxaparin treatment. Enoxaparin was discontinued once the international normalized ratio under fluindione was stable between 2.0 and 3.0 over 2 days. Fluindione treatment was maintained during a 3-month follow-up period. OUTCOME MEASUREMENTS: Specific examinations (venography and/or V/Q lung scanning and/or angiography) were performed only in the event of a clinically suspected recurrence of venous thromboembolism during the 3-month follow-up period. All cases were blindly assessed by an independent Reading Committee. RESULTS: A clinically suspected venous thromboembolism was confirmed by objective tests in 1 of 223 patients (group of delayed introduction of fluindione; n = 111). Equivalence was demonstrated between the two treatment schedules (p < 0.0001) for a maximal difference of 10% (90% confidence interval: -2.42 to 0.58). The mean duration of hospitalization was significantly reduced (p = 0.0001) in the group with early introduction of fluindione. The incidence of hemorrhage was comparable between the two treatment groups. CONCLUSION: Early and delayed introduction of oral anticoagulant treatment in association with subcutaneous enoxaparin in patients with deep vein thrombosis was shown to be equivalent in preventing the recurrence of venous thromboembolism. In patients with early introduction of oral anticoagulant, hospitalization was significantly reduced.

Administration, Oral↗
PubMedDate not supplied

Assessment of the risk and prophylactic treatment of venous thromboembolism in the elderly.

Numerous large randomized controlled trials have assessed the benefit of prophylactic anticoagulation for venous thromboembolism in selected patients. However, few trials were conducted in elderly patients, as this issue was not addressed in this specific population,or as elderly patients were excluded of these studies. Therefore, as the risk of a first episode of venous thromboembolism (in surgical and in medical setting) and the risk of a major anticoagulant-related bleeding are both increased in elderly subjects, the results of the main available studies can not be extrapolated to this population. Consequently, in practice, the balance between expected benefit and risk of prophylactic anticoagulation should be carefully assessed for each individual elderly patient taking in account the specific risk of venous thromboembolism in elderly in the absence of anticoagulation, the risk of anticoagulant related bleeding according to the type of anticoagulant treatment and the intrinsic risk of bleeding of elderly subjects and, lastly, the available guideline recommendations. In order to improve such evaluation, it is anticipated that further prophylactic studies are needed in elderly patients. In addition, the development of anticoagulation clinics and new oral anticoagulants should help to reduce anticoagulant related bleeding for an equivalent, or an increased, benefit.

Aged↗