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Biomedical subjects

F Hemery

Publications and source records attributed to F Hemery.

5 recordsLinked to original sources
PubMed2001

Effects of hydroxyethylstarch and gelatin on renal function in severe sepsis: a multicentre randomised study.

BACKGROUND: Hydroxyethylstarch used for volume restoration in brain-dead kidney donors has been associated with impaired kidney function in the transplant recipients. We undertook a multicentre randomised study to assess the frequency of acute renal failure (ARF) in patients with severe sepsis or septic shock treated with hydroxyethylstarch or gelatin. METHODS: Adults with severe sepsis or septic shock were enrolled prospectively in three intensive-care units in France. They were randomly assigned 6% hydroxyethylstarch (200 kDa, 0.60-0.66 substitution) or 3% fluid-modified gelatin. The primary endpoint was ARF (a two-fold increase in serum creatinine from baseline or need for renal replacement therapy). Analyses were by intention to treat. FINDINGS: 129 patients were enrolled over 18 months. Severity of illness and serum creatinine (median 143 [IQR 88-203] vs 114 [91-175] micromol/L) were similar at baseline in the hydroxyethylstarch and gelatin groups. The frequencies of ARF (27/65 [42%] vs 15/64 [23%], p=0.028) and oliguria (35/62 [56%] vs 23/63 [37%], p=0.025) and the peak serum creatinine concentration (225 [130-339] vs 169 [106-273] micromol/L, p=0.04) were significantly higher in the hydroxyethylstarch group than in the gelatin group. In a multivariate analysis, risk factors for acute renal failure included mechanical ventilation (odds ratio 4.02 [95% CI 1.37-11.8], p=0.013) and use of hydroxyethylstarch (2.57 [1.13-5.83], p=0.026). INTERPRETATIONS: The use of this preparation of hydroxyethylstarch as a plasma-volume expander is an independent risk factor for ARF in patients with severe sepsis or septic shock.

Acute Kidney Injury↗
PubMed2000

Cost evaluation of the medical management of neurofibromatosis 1: a prospective study on 201 patients.

Neurofibromatosis 1 (NF1) is associated with many internal complications as well as skin manifestations, and patients may require a variety of medical and surgical interventions. We aimed to assess the medical needs of NF1 patients, and to evaluate the financial cost of the resources used for them in relation to the severity of the disease. We conducted a prospective analysis on a cohort of 201 patients in our referral centre for adults. Severity of the disease was assessed. Therapeutic management was considered as multidisciplinary if it required more than three different specialists. Plastic and dermatological surgery procedures performed were recorded. Hospital costs were computed over a 3-year period and included all hospitalization days, clinic visits and procedures performed in all departments where the patients were admitted. One hundred and thirty-seven patients had at least one out-patient procedure or one hospitalization during the follow-up period. The mean cost per patient per year was pound810 (median 240; range 0-13, 860). Multidisciplinary procedures were more frequent in moderately and severely affected NF1 patients than in milder cases (P < 0. 0001); hence, the costs for moderate and severe cases were higher than for less severe groups (P = 0.005). Plastic and/or dermatological surgery was performed with the same frequency in the different severity groups (71%). Regardless of the presence of serious intractable complications, the patients' priority is for treatment of the disfigurement due to the disease. The management of these patients can be considered relatively inexpensive from the viewpoint of the healthcare system.

Adolescent↗
PubMed2000

DbMap: improving database interoperability issues in medical software using a simple, Java-Xml based solution.

In medical software development, the use of databases plays a central role. However, most of the databases have heterogeneous encoding and data models. To deal with these variations in the application code directly is error-prone and reduces the potential reuse of the produced software. Several approaches to overcome these limitations have been proposed in the medical database literature, which will be presented. We present a simple solution, based on a Java library, and a central Metadata description file in XML. This development approach presents several benefits in software design and development cycles, the main one being the simplicity in maintenance.

Databases as Topic↗
PubMed2000

[Results of 25 years of kidney transplantation].

Between 1975 and 2000, 1008 renal transplantations were performed in 935 recipients at Henri Mondor hospital. The mean objective of this study is to analyse patient and graft survivals at long term. For kidney transplantations performed respectively before and after 1985, ten years patient survival was 74.3% +/- 0.03 and 85.7% +/- 0.01, p = 0.03 and ten years graft survival was 39.5% +/- 0.04 and 71.9% +/- 0.02 after 1985, p = 0.001. Since 1985, an enhancement in graft actuarial survival still improved (one year survival 86.1% +/- 0.01 versus 90.8% +/- 0.02, three years survival 78.5% +/- 0.02 versus 85.5% +/- 0.02, five years survival 71.7% +/- 0.02 versus 78.8% +/- 0.04, for the years 1985-1994 versus 1995-2000, p < or = 0.05). Immunosuppressive drugs may contribute to results enhancement in kidney transplantation while other non immunologic factors are becoming more predominant.

Adolescent↗