Three-dimensional computed tomography scan and maximum intensity projection reconstruction in the pretransplant evaluation of patients at risk of vascular disease.
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Female↗
Biomedical subjects
F Guillemin
Publications and source records attributed to F Guillemin.
[Comparison of 3 quality of life instruments in the longitudinal study of rheumatoid arthritis].
Quality of life measures take into account the patient's perception of health. Many generic or specific instruments are available. The psychometric properties of such measures should allow for adequately testing the hypothesis of an investigation. We studied the properties of three quality of life measures: the Health Assessment Questionnaire (HAQ) specific for rheumatic diseases, the Nottingham Health Profile (NHP)--a generic measure--and the General Health Questionnaire (GHQ) which measures psychological dimensions. They were applied in a one year cohort study of 111 French rheumatoid arthritis patients set up for determining prognosis factors of quality of life. Criterion validity was established on high correlation between Ritchie index and physical dimensions (r = 0.29 to 0.58, p < 0.01). Internal consistency was good with Cronbach's alpha coefficients over 0.8 for all dimensions. Reproducibility was studied for physical dimensions with Intra-class Correlation Coefficient (ICC) for patients clinically unchanged. It was excellent for the HAQ (ICC = 0.89), good for the NHP (ICC = 0.57 to 0.73) but weak for the GHQ (ICC = 0.13 for somatic dimension). After one year follow-up, a significant change in quality of life could only be evidenced by the HAQ (Standardized Response Mean = 0.4, p < 0.05) in patients with clinical significant change. So among the three instruments, the HAQ should be preferred for longitudinal studies, possibly supplemented with a generic instrument that investigates more dimensions of quality of life.
Adult↗
[Standards, options and recommendations for the practice of oncologic surgery. National Federation of Centers for the Fight against Cancer].
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Decision Trees↗
[Evaluation of the importance of systematic neck dissection in carcinoma of the oral cavity treated by brachytherapy alone for the primary lesion (apropos of a series of 346 patients)].
UNLABELLED: The study includes 346 carcinomas of the oral cavity (244 mobile tongues and 102 floors of mouth) treated by brachytherapy alone at primary tumor. We noted 199 T1, 131 T2, 14 T3 and 2 TxNx. Among T1, 36 patients had a neck dissection as well as 73 T2. Brachytherapy was performed according to the Paris system. In 59 cases, the curage on the lesion side was a radical neck dissection, in 14 cases a functional neck dissection and in 45 cases a submaxillary and submental dissection. A combined controlateral neck dissection was performed in 20 cases. A complementary irradiation of the node areas was given in 28 cases. RESULTS: for T1, the local control (LC) is 96%, the locoregional control (LRC) 83%, the specific survival (SS) 88%, and the overall survival (OS) 73%. For T2, LC 85%, LRC 70%, SS 75%, OS 52%. For T3, LC 64%, LRC 44%, SS 25%, OS 18%. The difference is very significant between T1 T2 T3 (p < 0.006) for results concerning N0, it is not significant between the N1 in each category, but their number is too low to reach a degree of significancy. In the 36 neck dissection specimens of T1, we found only in 7 cases positive nodes and in the 73 specimens of T2, 24 cases of positive nodes. A detailed study is reported. Tumoral, node or both recurrences are summarized (see table IV). Node recurrences are more frequent in patients without neck dissection than in those with neck dissection for T1, T2, N0, but this is significant only for LRC, SS and OS between patients with negative nodes on neck dissection and those with positive nodes (p < 0.0001). No significant difference was found between OS and SS for patients T1, T2, N0 with positive systematic neck dissection and those with a neck dissection differed until the node recurrence. Among T1, T2, T3, we noted more metastases in patients who presented a recurrence than in others. In conclusion, for patients treated by brachytherapy alone to the primary lesion, it seems desirable to perform a systematic neck dissection if there are adenopathies on initial examination. The dissection can be delayed for small tumors T1 N0 and low T2 N0 if the patients are followed-up regularly. However, a systematic dissection must be advised for high T2 N0 and T3 N0 given the frequency of the node involvement and the risk of metastases.
Brachytherapy↗
Determination of amplification level of the c-erbB-2 proto-oncogene in human breast carcinomas: a comparative study between non-radioactive and radioactive labelling.
A quantitative method of polymerase chain reaction (PCR) using both digoxigenin and radioactive labelled probes has been used for the detection of the c-erbB-2 proto-oncogene amplification in breast carcinomas with formalin-fixed paraffin-embedded tissue sections. c-erbB-2 proto-oncogene amplification has been demonstrated in 14 infiltrating ductal carcinomas. The technique consisted of the co-amplification of c-erbB-2 and IFN-gamma (interferon-gamma) genes. The latter was considered as a single copy gene per genome-equivalent. The aim of this study was to compare two quantitative PCR techniques based on the incorporation of either digoxigenin-11-dUTP or 32P-dCTP, during amplification. For the colorigenic method, using the Dig system, after electrophoresis and transfer, the specific bands were revealed with a chromogenic substrate of phosphatase. Their intensity estimated by scanning photometry following blot transparisation. After electrophoresis, the radioactive gel was submitted to radioautography and the band intensities evaluated by scanning spectrophotometry. For the 14 samples, a good agreement between both methods was noted. The colorigenic method is a valuable alternative to radiolabelling due to: i) time saving, ii) reagent conservation, iii) safe manipulation and iv) sensitivity of the same order for both methods.
Base Sequence↗
[Evaluation of the quality of life in chronic respiratory diseases].
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Chronic Disease↗
The assessment of functional status in rheumatoid arthritis: a cross cultural, longitudinal comparison of the Health Assessment Questionnaire and the Groningen Activity Restriction Scale.
OBJECTIVE: To compare a disease specific measure of functional status, the Health Assessment Questionnaire (HAQ) with a generic measure of functional status, the Groningen Activity Restriction Scale (GARS) in a cross cultural and longitudinal setting. Besides the comparison of psychometric properties, sex differences were also studied. METHODS: In a sample of 634 patients with rheumatoid arthritis (RA) (290 from The Netherlands, 116 from France, 228 from Norway), the psychometric properties (Cronbach's alpha and rho) of the GARS and the HAQ were compared among countries. The sensitivity for change between T1 and T2 was tested by means of the standardized response mean for a one year followup; furthermore, the relative efficiency of both instruments was computed. A t test was used to trace sex differences. RESULTS: The psychometric properties of both the HAQ and the GARS were very good. Both form unidimensional scales of hierarchically ordered items; alpha and rho are > 0.91 for both instruments. For patients who improved between T1 and T2, measured by the Ritchie Articular Index, the standardized response mean of the HAQ and the GARS were moderate, whereas for patients who worsened, the standardized response means were small. The results based on the relative efficiency were ambiguous. Furthermore, the mean score for women on the HAQ was 0.25 higher in contrast to scores for men. The GARS did not yield different scores for women and men. CONCLUSION: The internal consistency of the GARS and the HAQ are comparable. The HAQ has yielded different results for women and men. Therefore, when the HAQ is used, sex differences should be taken into account. With respect to sensitivity to change, the GARS and the HAQ obtained much better results for patients who improved in contrast to patients who worsened. The GARS was found to be more sensitive to change for patients who improved.
Arthritis, Rheumatoid↗
[Diagnosis and staging of colorectal cancers].
Early colorectal cancer produces no symptom, thus justifying efforts at detection in screening programs. Symptoms are usually secondary to obstruction, local invasion, perforation or bleeding. Any fecal bleeding must be investigated to rule out a colorectal cancer. The initial imaging study to identify a colorectal cancer is often colonoscopy, which is frequently supplemented with a double contrast barium enema. Once the presence of cancer is histologically proven, the preoperative evaluation includes detection of hepatic and extrahepatic spread, especially with ultrasound and CT scan. Endorectal ultrasonography has been shown to be a significant advance for staging rectal cancer. It provides the best staging in selecting patients for preservation of sphincter function and for adjuvant therapies. The most useful prognostic factors in tumors without distant metastases are the depth of tumor extension, the number of positive lymph nodes and the histologic grade. Preoperative CEA level, vascular invasion and ploidy are also important prognostic factors.
Colorectal Neoplasms↗
[Measurement of quality of life in rheumatic practice].
Hard, objective data to evaluate outcome in patients with rheumatology diseases is not only difficult to obtain, but often poorly correlated with the degree of the functional incapacity caused by these non-fatal but disabilitating diseases. Soft, subjective data does not meet the traditional criteria for scientific research. However, due to important advances in the field of psychometry and its medical applications, we now have adequate instruments to evaluate quality of life, the major outcome parameter in patients with chronic rheumatic diseases. The Arthritis Impact Measurement Scales is the most widely used and is particularly adapted to patients with rheumatoid arthritis. Other scales include the Health Assessment Questionnaire, the Nottingham Health Profile, and the Sickness Impact Profile. Most of the studies conducted in the field of rheumatology concern patients with rheumatoid arthritis or osteoarthritis of the lower limbs. Quality of life measures can however be applied to most all the different clinical situations including low back pain, ankylosing spondylitis and systemic diseases. Quality of life measures will play an important role in treatment evaluation procedures. They correspond to real progress in responding to the legitimate demand of patient with chronic diseases for effective validated health care.
Health Status Indicators↗
Group education interventions for people with low back pain. An overview of the literature.
STUDY DESIGN: This study systematically reviewed the literature on group education for people with low back pain. Findings are considered in relation to parameters such as the characteristics of the study participants, the intervention, and the setting. OBJECTIVE: To make a recommendation regarding the effectiveness of group education as an intervention for people with low back pain. RESULTS: Based on a systematic search of the literature, 13 primary studies are cited; 6 of these were sufficiently well designed and executed for their findings to be considered. Of the four quality studies with chronic back pain subjects, only one found a positive short-term effect on one of the outcome measures considered (pain intensity). In the two studies with acute cases, group education was found by one of the studies to reduce pain duration and initial sick leave duration in the short term, but the intervention also included work-site visits. At 1 year of follow-up, there was no evidence in the six studies of clinically important benefits on any of the outcome measures. CONCLUSIONS: There is insufficient evidence to recommend group education for people with low back pain.
Adult↗
Gastrointestinal manifestations of systemic sclerosis.
Gastrointestinal (GI) manifestations of systemic sclerosis (SSc) were found in 82% of 262 patients followed up prospectively. Esophageal dysmotility, lower esophageal sphincter laxity, bacterial overgrowth, and wide mouth diverticuli were the most common findings. The disease is usually diffuse with multiple levels of involvement. Gastrointestinal involvement was not significantly correlated with gender, age at SSc diagnosis or disease type (limited or diffuse scleroderma). Upper GI symptoms develop early in the course of SSc and may not correlate with objective findings. Various investigations, treatment regimens, and less frequent disease manifestations are reviewed and discussed.
Adult↗
Design of a non-docking intraoperative electron beam applicator system.
A development of a non-docking system is described which enables collimation of an electron beam for intraoperative radiation therapy. This system, adapted to a linear accelerator (SATURNE 43-CGR MeV), has been designed to minimize the mechanical, electrical and tumor visualization problems associated with a docking system. A number of dosimetric considerations and technical innovations have been used in the design of this system. Among them are the central axis of the beam alignment with the axis of the cone via a laser system and the clamping method of the intraoperative cone to the treatment couch by a rigid system. This collimation system can be adapted for different makes of linear accelerator. The dose distribution in this new design system shows a better homogeneity in the patient's target volume and small (thus accessable) leakage radiation dose to tissues outside the intraoperative cone. The design concept and dosimetric characteristics of this novel applicator system are presented in this paper.
Acrylic Resins↗
Short and long-term effect of spa therapy in chronic low back pain.
The effect of spa therapy on chronic low back pain (LBP) was assessed in a randomized trial comparing patients undergoing a 3-week therapy programme in a spa resort in France (n = 50) with patients receiving ambulatory care (n = 52). After 3 weeks, patients in the spa group had significant improvement in their spine mobility and functional score (Waddell index) and a reduction in their daily duration of pain, pain intensity and drug consumption. The long-term effect was assessed after 9 months and showed continued reduction in pain and drug consumption, and improvement in spine mobility but no longer in functional score which returned to baseline level. It is concluded that spa therapy has a positive short-term and a moderate long-term effectiveness on chronic LBP.
Chronic Disease↗
The Groningen Activity Restriction Scale for measuring disability: its utility in international comparisons.
OBJECTIVES: The Groningen Activity Restriction Scale (GARS) is a non-disease-specific instrument to measure disability in activities of daily living (ADL) and instrumental activities of daily living (IADL). It was developed in studies of Dutch samples consisting of elderly or chronically ill people. The psychometric properties of the GARS demonstrated in these studies were highly satisfactory. This paper addresses the psychometric properties of the GARS across countries. METHODS: Data of 623 patients with recently diagnosed rheumatoid arthritis from four European countries were analyzed by means of a principal components analysis and a Mokken scale analysis for polychotomous items. RESULTS: The results of the analyses were highly satisfactory: there was one strong and reliable general factor representing one underlying dimension of disability in ADL and IADL, and there was a clear hierarchical ordering of the items included in the GARS. The validity of the GARS was strongly suggested by the pattern of associations of the GARS with age, sex, and other existing health status measures. CONCLUSIONS: The psychometric characteristics of the GARS, which measures disability in ADL and IADL simultaneously, make this instrument very useful for comparative research across countries.
Activities of Daily Living↗
Low incidence of rheumatoid arthritis in France.
The incidence of rheumatoid arthritis (RA) was estimated in the Lorraine district, eastern France, over the period 1986-1989. Cases were identified from in- and outpatients at the district Rheumatology Hospital Centre, private rheumatologists, general practitioners and by regional media announcements. Supplementary cases resident in the area were sought by extending the procedure to adjacent districts. The population count was obtained from the national Census. An overall age-adjusted incidence rate of 8.8/100,000 was found using the 1987 ACR criteria (12.7/100,000 in females, 4.7/100,000 in males; sex ratio = 2.65) and 9.5/100,000 using the 1958 ARA criteria (definite and classic RA). These rates were compared, using the same standard population, with the age-adjusted incidence rates in other incidence studies mainly conducted in Caucasian populations. The RA incidence rates appeared lower in France than in any other country in Europe, USA and Japan.
Adult↗
[Indications for palliative surgery in digestive cancerology].
The data of the literature demonstrate the poor global results of surgical treatment of the principal gastrointestinal cancers: oesophagus, stomach, bile ducts, liver, exocrine pancreas, colon and rectum. Surgery which was thought to be curative all too frequently proves to be simply a palliative procedure. The risk of failure is so high that a strategy should now be systematically adopted, combining surgery, radiotherapy, chemotherapy and symptomatic treatments. The rigor of this multidisciplinary approach is based on comparative studies confirming the prospective series and measuring the quality and duration of survival. Some protocols provide considerable improvement, for example preoperative radiotherapy of cancers of the rectum, or propose an interesting alternative such as the combination of radiotherapy and chemotherapy in cancer of the oesophagus. The participation of surgeons in multicentre prospective studies should validate and improve current oncological practice while also evaluating the contribution of a new method such as laparoscopic surgery. This commitment includes a definition of therapeutic objectives, definition of the reference treatment, selection of the criteria of the quality of the procedures involved in this treatment and objective assessment of the results.
Biliary Tract Neoplasms↗
[Usefulness of measurements of health-related quality of life].
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Humans↗
Functional disability in early rheumatoid arthritis: description and risk factors.
OBJECTIVE: To provide a description and identify risk factors for functional disability in early rheumatoid arthritis (RA). METHODS: A cohort of 337 patients with early RA with disease duration under 5 years was constituted in 2 areas in France and The Netherlands. Examination included the Ritchie index, the presence of nodes and other extraarticular manifestations, and the erythrocyte sedimentation rate (ESR). The Health Assessment Questionnaire, adapted and validated in the French and Dutch languages, was used to assess functional disability. RESULTS: The results allowed for the cross sectional description of a marked early functional disability, with a score of 1 (adjusted for disease activity variables) from the first year of the disease. Functional disability was increasing nonlinearly with the disease duration in a quadratic model. Disease activity variables, namely ESR and Ritchie index, were identified as other important components of functional disability. CONCLUSION: Consequences for the early management of RA are underlined.
Arthritis, Rheumatoid↗